Unusual location of subungual melanoma surgically managed successfully: A rare case report from Syria

INTRODUCTION AND IMPORTANCE

Acral lentiginous melanoma (ALM), the least common subtype of cutaneous melanoma, poses challenges in early detection, resulting in low survival rates. Subungual melanoma (SUM), a rare form of ALM originating from the nail matrix, is less common on the hands than on the feet, accounting in the hands for only 0.3 % of all cutaneous melanomas. This makes the case of hand subungual melanoma that we are presenting very rare and significant.

CASE PRESENTATION

A 64-year-old woman presented with an asymptomatic subungual lesion on her left fifth finger. The lesion, ranging in color from brown to black, did not cause bleeding and exhibited a clear nail plate rupture. An incisional biopsy confirmed the diagnosis of subungual melanoma. The patient underwent a proximal interphalangeal (PIP) joint amputation and remains in good health. Regular CT scans and clinical examination have shown no recurrence.

CLINICAL DISCUSSION

Subungual melanoma, a rare subtype of acral lentiginous melanoma, comprises less than 1 % of all melanomas. While the Hallux and thumb are commonly affected, our case involved the little finger which is the rarest site of hand subungual melanoma. Occurrence ages are between 50 and 70. The Hutchinson sign, nail fold pigmentation, indicates poor prognosis in advanced stages, which was positive in our case. Recommended management is amputation at the level of the most distal unaffected joint.

CONCLUSION

Our aim is to raise healthcare professionals' awareness of early recognition and management of subungual melanoma. Early detection and treatment reduce metastasis risk and improve survival rates.

Adult omental alveolar rhabdomyosarcoma: An unusual site. A case report and literature review

Introduction and importance

Omental alveolar rhabdomyosarcoma (ARMS) in adults is a rare tumor and is not a common presentation of abdominal pain. We aim to report the eighth case of omental ARMS and perform a review of all publications that pertains to this topic.

Case presentation

we show a case of a Mediterranean 52 year old smoker male, complaining of unbearable dull pain in the right iliac fossa. He had no relevant medical history other than general abdominal pain in the past several months.

Clinical Discussion

the chief complaint was abdominal pain mimicking appendicitis. Physical examination showed a palpable mass in that region. Ultrasound and CT scan revealed a mass arising from the omentum. At this point we excluded the diagnosis of appendicitis and a laparotomy with biopsies sampling had been performed. The microscopical examination led to the diagnosis of alveolar rhabdomyosarcoma (ARMS). Treatment involved multidisciplinary care but the patient died during chemotherapy.

Conclusion

Adult rhabdomyosarcomas (RMS) are rare tumors that can arise from any soft tissue including omentum and should be taken into consideration when dealing with primary tumors that originate from the omental area. The studies and our understanding for this neoplasm are still very limited and should be expanded widely.

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Omental tumors are rare and have a wide range of DDx.

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Omental tumors can present as acute abdominal cases.

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Rhabdomyosarcoma can originate from any mesenchymal tissue and has genetic pathophysiology.

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Adult rhabdomyosarcomas are treated the same way as for its pediatrics' counterpart; although the prognosis is poorer.

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Adult Rhabdomyosarcoma's risk factors have not been studied at all.

Amelanotic nodular melanoma misdiagnosed as a benign skin lesion: A rare case report from Syria

Introduction

and importance: Amelanotic melanoma is a rare and aggressive type of melanoma. It is often diagnosed late because of the lack of melanin in its cells, and this causes treatment delay and, eventually, poor prognosis.

Case presentation

We report a case of a 79-year-old female patient that presented to the dermatology clinic with an asymptomatic lesion on the medial heel of the right foot, with no medical history of previous melanoma or related skin cancer. To get the right diagnosis, an incisional biopsy was performed, and the sample was sent to the pathology laboratory. The sample was stained with S100 and HMB-45 stains, and both were positive. Also, no melanin pigmented cells were seen, so the diagnosis was amelanotic nodular melanoma. The patient was then referred to surgery. The lesion was successfully excised with 5cm safety margins, and the whole lesion was sent to the pathology laboratory to ensure that the edges are malignancy-free. After 18 months of follow-up, the patient is in good health.

Conclusion

Accurate and early diagnosis with appropriate clinical intervention can improve the prognosis and reduce mortality and morbidity rates.

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Amelanotic melanoma is typically misdiagnosed with other skin lesions with similar characteristics, especially those on the foot.

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Accurate diagnosis is often delayed, resulting in a poor prognosis which makes AM a challenging case.

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Early and accurate diagnosis of the lesion using histological and immunohistochemical examinations can improve the prognosis and maintain the patient's quality of life.

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Surgical excision of the lesion with appropriate margins of safety is the current approved treatment while other treatments are still being researched.

Unicentric Castleman disease in the mesentery with ambiguous symptoms: a rare case report

Castleman disease (CD) is a rare clinical entity characterized by enlarged lymph nodes. It may affect a single lymph node (unicentric) or multiple lymph nodes in the body (multicentric). However, it is exceptionally uncommon for unicentric Castleman disease (UCD) to present in the mesentery. Herein, we report a case of 38-year-old female complaining of polymenorrhea and abdominal discomfort for 4 months. Her past medical history was unremarkable; however, she has started smoking recently. The physical examination and radiography indicated a large, well-defined mass in the right hypochondrium. Eventually, the patient underwent laparotomy and the mass was excised totally. The Pathologic study confirmed the diagnosis as mesenteric CD, hyaline-vascular type. After 5 months of follow-up, the patient showed no evidence of recurrence. In conclusion, this case underscores the importance of taking mesenteric CD into consideration in each patient who presents with solid abdominal mass or ambiguous abdominal discomfort.

Pelvic chodroma in the left obturator foramen: The first case report

INTRODUCTION AND IMPORTANCE

Chondroma is a benign and slow-growing tumour usually located in the hand and foot. Although many cases reported pelvic chondroma, to the best of our knowledge, this case is number one in the world because of the location of the sensitive tumour within the obturator foramen, and we did not review any case mentioned in the medical literature corresponding to our case.

CASE PRESENTATION

A 9-years-old male presented to our hospital, complaining of an inguinal mass, the patient had no history of pelvic discomfort. Computed tomography showed a hard mass in the left inguinal region. By open surgery, we extracted the mass. The patient was discharged after 4 days with no complaints.

CLINICAL DISCUSSION

Pelvic chondroma is one of the challenging cases that orthopedist's face. We presented a patient with a very hard, painless, not rubefacient and fixed on palpation mass. Computed tomography is considered an imaging study to evaluate such patients. Most cases of chondroma are treated by performing open surgery to extract the mass.

CONCLUSION

Pelvic chondroma should be extracted by open surgery in order not to extend to nearby tissue and hurt urinary and reproductive organs. The follow-up of these patients is essential, by imaging and pathological studies. Checking family history up is necessary, but in our case, there is no.

A child with Ewing's sarcoma in scapula: A rare case report

Introduction

Ewing's sarcoma is considered to be the second most frequent primary sarcoma in children. It affects children and young adults with a male predominance. Ewing's sarcoma is usually found in the femur, humerus, ilium and tibia; and in extremely rare cases Ewing's sarcoma might affect the scapula. There are only 15 papers in PubMed database regarding scapular Ewing's sarcoma.

Case presentation

A 14-year-old male, with no significant medical or surgical history, presented with a swelling in the right scapular area for two months. The patient also experienced mild pain and fever. On physical examination, there was a tender mass and restriction in the right shoulder joint movements. MRI showed a large scapular mass with the characteristics of a sarcoma. The final diagnosis was made based on pathologic findings. Eventually, the patient was subjected to neoadjuvant chemotherapy.

Discussion

The most common tumors affecting scapula are chondrosarcoma and osteosarcoma. In a cohort study about patients diagnosed with ES between 1988 and 2018, only 29 cases were involved in the scapula. There are 12 cases of congenital ES have been reported in the medical literature, 3 of them were in the shoulder girdle. Surgery with neoadjuvant chemotherapy is considered better for total survival in ES of scapula in comparison with chemotherapy and/or radiotherapy alone.

Conclusion

Ewing sarcoma is extremely rare in the scapula and should be considered as a differential diagnosis for any patient with scapular tumor.

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The most common tumors affecting scapula are chondrosarcoma and osteosarcoma.

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In extremely rare cases, Ewing’s sarcoma (ES) might affect the scapula.

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Surgery with neoadjuvant chemotherapy is considered better for total survival.

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ES should be considered in each child presents with a swelling over scapular region.

Benign multicystic peritoneal mesothelioma (BMPM) presenting with ambiguous symptoms: A rare case report

Introduction

Benign multicystic peritoneal mesothelioma (BMPM) represents a very rare clinical entity, with only 130 registered cases in the medical literature, therefore it is usually overlooked from the list of differential diagnoses. The treatment consists of surgery and other authors suggest complementing it with hyperthermic intraperitoneal chemotherapy.

Presentation of case

A 25-year-old multiparous female experienced periodic abdominal discomfort for two weeks. She developed constipation, urinary urgency, and irregular menstruation. Family history was remarkable for endometrial and breast cancer. Abdominal examination revealed a palpable mass. Abdominal ultrasound and computed tomography scan identified the multicystic appearance of the mass. The diagnosis was unclear, therefore exploratory laparotomy was performed, which revealed multiple grape-like clusters of cysts that were excised immediately. BMPM was diagnosed based on the pathology report. Eventually, the follow-up did not reveal any recurrence.

Discussion

Mesothelial tumors include three pathological entities, including Benign multicystic peritoneal mesothelioma (BMPM). BMPM is an uncommon neoplasm and has a high recurrence rate after surgery. BMPM consists of clear cysts that take the shape of a grape-like cluster. Clinically, BMPM resembles a tangible abdominal mass and it is challenging to be diagnosed, due to its numerous differential diagnoses.

Conclusion

The definitive diagnosis of intraperitoneal cystic masses is usually challenging. Therefore, BMPM -although very rare- should always be thought of when dealing with an intraperitoneal cystic mass, especially in women in the reproductive years. In our case cytoreductive surgery solely was sufficient to achieve a disease free follow up, however, further studies regarding treatment and follow-up are required.

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The incidence of Benign multicystic peritoneal mesothelioma (BMPM) is exceptionally rare.

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Pathological evaluation is considered the best technique to diagnose.

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BMPM is most common in women in reproductive age.

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BMPM should be considered as a differential diagnosis for abdominal masses.