Seborrhoeic keratoses (SK) are benign tumors that mainly occur in the head and in the trunk. Their size generally varies from a few millimeters up to a few centimeters. Giant lesions are very rare but pose a problem in terms both of treatment and transformation. Their occurrence in the genital area is even more rare, posing a problem in differential diagnosis of genital warts. Differentiation is only based on histopathology. We report the case of a 80-year old man, with no particular past medical history, who presented with asymptomatic abdominal and genital lesions evolving over the last twenty years. Clinical examination showed four hyperpigmented, humped, well-defined tumors, with warty surface measuring 2-10 cm along its longer axis (A). Dermoscopic examination showed cerebriform convolutions appearance suggesting seborrhoeic keratoses (B). Histology confirmed the diagnosis, without signs of viral infection or malignant transformation. The patient underwent surgical resection resulting in permanent scar.
Proliferating trichilemmal tumor (PTT), still referred to as proliferative trichilemmal cyst (TC), is an uncommon malignant adnexal tumor originating from the cells of the outer root sheath of the hair follicle or, more often, from a trichilemmal cyst, following multiple trauma and/or recurrent inflammation. We report the case of a 64-year old female patient, with no particular previous history, presenting with tumor of the scalp gradually evolving over 18 months. Clinical examination showed a painless, firm, adhering ulcero-budding tumor mass measuring 12 cm along its longer axis at the level of the vertex. The patient had clinically negative lymph nodes. Histological examination showed malpighian cell proliferation arranged in clumps and coalescing lobules with focal areas of abrupt trichilemmal keratinization, with very marked atypies cyto-nuclear and an infiltrated fibrous stroma, suggesting proliferating trichilemmal tumor. Staging evaluation showed no metastase. The patient underwent wide surgical resection followed by in depth removal of extra tissue, without recurrence at 3-months’ follow-up
Parry-Romberg Syndrome (PRS) is an uncommon disorder characterized by a slowly and acquired progressive atrophy involving skin, soft tissue, cartilage, and bony structures. Accompanying atrophies of the other parts of the body are rarely reported. We report an extremely unusual case with PRS associated with contralateral lower extremity atrophy. KeywordsParry romberg syndrome, Facial haematrophy, Extra-cephalic involvement, Lower limb, Scleroderma IMAGE ARTICLEfacial mass demonstrated a discreet atrophy of the soft straight jaw parts without osseous involvement. The spinal teleradiography was in favor of dorso-lumbar scoliosis by inequality of the 2 lower limbs, with a 14 mm shortening of the left lower limb without apparent bone lesions.Electroencephalogram, ultrasound of supra-aortic trunks, and cerebral MRI were normal. A systemic treatment with corticosteroids of 0.5 mg/kg/day and Methotrexate at 12.5 mg/week was initiated. The progression was satisfactory, with the end of the progression of atrophy, within a follow-up of 18 months. A facial lipostructure for morphological restoration is expected after stopping growth.
Scleroatrophic lichen (SL) and vitiligo are two depigmenting disorders which may occur separately or, rarely, in combination. Their association may seem logical because both these disorders are characterized by the suspicion of an autoimmune pathogenesis. We here report the case of a 8-year old girl, with no notable medical history, presenting with achromic macules and papular nonpruritic lesions evolving over 6 months. Clinical examination showed two types of lesions (A): ovalaire achromic macules measuring 1-3 cm along their longer axis, located at the level of the front, of the neck, of the shoulders, as well as of the peri-mamelonar and of the genital region. These lesions exhibited slightly raised peripheral inflammatory border as well as a poliosis. The patient also had pearly white atrophic papular plaques at the level of the interscapular and abdominal regions as well as of the anterior face of the knees. Two biopsies were performed. Histological examination of an achromic macula showed vitiligo with inflammatory reaction while histological examination of an infiltrated lesion allowed the diagnosis of scleroatrophic lichen. Significant clinical improvement was obtained by local treatment with dermocorticoids. Therefore, this pathological association between scleroatrophic lichen and vitiligo in our patient, highlights the key role of epidermal lichenoid inflammatory process in the disappearance of melanocytes and, possibly, in the induction of a auto-immune process.
Chondrosarcoma is a malignant tumor of bone of mesenchymal origin which usually occurs in people after age 40 at the level of the pelvis and the shoulder. We report the case of a 65-year old female patient, with no particular past medical history, with impaired general condition, hospitalized for exploration of a large tumor of the right shoulder, evolving over 3 years. Clinical examination showed giant, humpbacked, hard, adherent tumor measuring 44 × 32 cm along its longer axis, with inflammatory signs associated with signs of vasculo-nervous compression. Radiological evaluation showed expansive, epiphyseal, metaphyseal, diaphyseal, heterogeneou, multilobulated, poorly differentiated, calcified tumoral process with complete destruction of the glenohumeral joint that extensively invaded the soft tissues with loco-regional extension. Histological examination of a deep biopsy specimen was in favor of poorly differentiated chondrosarcoma. Staging evaluation objectified bilateral axillary lymphadenopathies and multiple metastatic subpleural and hepatic nodules. The patient died after 2 months. This study highlights the role of awareness campaigns for early diagnosis and management.
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