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Vulvar angiomyxomas are rare benign mesenchymal neoplasms. Superficial and Aggressive angiomyxomas are two distinct phenotypes that present similarly to other more common vulva-perineal pathologies. Albeit both angiomyxomas carry a risk of recurrence, especially in the setting of incomplete resection, simple excision is insufficient for Aggressive angiomyxoma. It requires wide local excision because of its unique potential for local invasion, infiltration of the paravaginal and pararectal tissue, and more distant metastasis. Here, we present a case of Superficial angiomyxoma and a case of Aggressive angiomyxoma to highlight the diagnostic challenges and management strategies of each tumor. In both cases, angiomyxomas were initially misdiagnosed because of their rarity and nonspecific presentation. Magnetic resonance imaging is the modality of choice for evaluation due to inherent higher spatial resolution of soft tissue anatomical details. Early diagnosis of Aggressive angiomyxoma can prevent incomplete excision and recurrence, spare additional surgery, and offer hormonal therapy options.
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Introduction Electrosurgery for dissection and hemostasis remains one of the foundational tools for the field of surgery as a whole. Monopolar cautery remains the most utilized modality for achieving the aforementioned goals. Given the prolonged history and pre-modern development of "Bovie" cautery, there remains a paucity of data regarding appropriate settings and intensity for various tissue types, procedures, or locales. As a result, utilized settings depend on precedent and personal preference. We aimed to determine the amount of secondary soft tissue injury by volume and depth beyond the electrocautery pen tip in the skin and subcutaneous tissue as well as skeletal muscle. Methods Porcine samples were used for experimental testing using two testing types: 1) skin and subcutaneous tissue and 2) Skeletal muscle. Sample sizes were standardized at 1 cm3 cubes. For skin samples, tissue injury was created with either a scalpel or electrocautery pen on cut setting, and tested at intensities from 10 to 150 in increments of 10. Skeletal muscle samples were similarly tested using the electrocautery pen only in either a cut or coagulation setting. Samples were tested at incremental intensities from 10 to 120 for both settings. Electrocautery was tested for a period of five seconds with a continuous current. All samples were placed in formalin and underwent histologic staining with hematoxylin and eosin staining to be assessed for the extent of tissue injury in terms of depth, radius, and volume. The measurements were recorded in millimeters. Results For skin incision, there was a positive and significant correlation with respect to the radius (R=.73, p=0.006). When considering intensity with an interval of 10-70 there was a positive and significant correlation with respect to the radius, depth, and volume. The cold knife incision had no notable soft tissue injury beyond the depth of the incision. Regarding skeletal muscle, again, a significant and positive correlation between increasing monopolar settings was noted for both the coagulation and cut functions (R=.84, p=.0005; R=0.84, p=0.0006). A positive correlation was found between increasing cut intensity and volume of soft tissue injury (R=0.73, p=.008); this was not reflected in the coagulation setting. When limited to an intensity range of 10-60, a significant relationship was noted for depth, radius and volume (R=.95, p= <0.001; R=0.98, p= <.001; R=.92, p=.001). Conclusion In all samples, apart from the cold knife skin incision, additional soft tissue injury beyond the tip of the electrocautery pen was noted. Given our findings, recommendations include using the lowest setting required for the purposes of the given surgical case as well as minimizing electrocautery use for skin incisions given its association with a larger volume of tissue injury in comparison with a scalpel. Additionally, electrocautery should be used with care in, and around neurovascular structures as soft tissue injury did occur several millimeters beyond the tip of the electrocautery pen. Further study is needed to see if these patterns are similar in living animals as well as human tissue and whether they bear any clinical impact on surgical wound healing or other surgical complications.
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Lipofibromatosis-like neural tumor (LPF-NT) is a rare variant of lipofibromatosis. Standard lipofibromatosis tumors show a predilection for the distal extremities of male children or young adults and are typically painless, slow-growing, subcutaneous or deep soft tissue masses. We present a case of a 50-year-old male with a slowly expanding, right foot mass. Physical examination revealed a painful, non-tender firm mass on the right medial foot. Magnetic imaging studies revealed a poorly defined soft tissue mass extending through subcutaneous tissue up to the dermis. Histologic examination revealed a spindle cell neoplasm. Immunohistochemistry showed co-expression of S100 protein, CD34 and TRK. In addition, the lesion was found to be positive for the LMNA-NTRK1 fusion by next-generation sequencing. These findings were supportive of a diagnosis of LPF-NT. At 3-month post-excision, the patient had no pain and repeat imaging indicated no evidence of tumor. The authors recommended including LPF-NT in the differential diagnosis of masses or lesions that are fibro-fatty tumors.
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Although neuroblastoma is one of the most common extra-cranial tumors in the pediatric population, it is rarely seen as a metastasis to the mandibular bone. The following is a case report of a 3-year-old male who initially presented with a submandibular mass that was proven to be a poorly differentiated metastatic neuroblastoma through excisional biopsy. This report is one of the few case reports that demonstrates metastatic submandibular neuroblastoma with mandibular bone involvement in the pediatric population.
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Neoplasias Primarias Secundarias , Neuroblastoma , Biopsia , Diferenciación Celular , Niño , Preescolar , Humanos , Masculino , Mandíbula/diagnóstico por imagen , Neuroblastoma/diagnóstico por imagenRESUMEN
Sera from patients with multiple myeloma usually display a single monoclonal immunoglobulin band on serum protein immunofixation electrophoresis. Multiple bands may be seen if the myeloma is bi- or triclonal or if the monoclonal immunoglobulin has rheumatoid factor activity. We describe a patient with light chain-predominant IgA lambda myeloma; the patient's serum displayed 2 spatially distinct bands reacting for alpha heavy and lambda light chains. The methods used to establish monoclonality are addressed.