New inert materials such as polymerized silicones, Bioplastique, Artecoll, and Dermalive are now being used as injectable aesthetic microimplants. These substances are better than the old ones because they tend not to migrate and do not usually produce much of a host immune response. Adverse reactions after injection of these materials are rare, although there are a few reported cases as a result of bad technique or anomalous granulomatous reactions. We report on four patients with unsightly results after cosmetic microimplants, including one of Artecoll, one of Dermalive (to the best of our knowledge, the latter is the first such case reported), and two of silicone. This report describes the histopathologic features of cutaneous reactions to these injectable aesthetic materials.

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A 73-year-old male came to our institution with a history of right ptosis and intermittent double vision of 1 week's duration. He had been diagnosed with diabetes mellitus 5 years earlier and had chronic smoking and alcohol abuse history. Physical examination revealed right ptosis and outward ocular deviation with no evidence of pupillary asymmetry. There were no others abnormal findings on neurologic examination. With these finding, a third nerve palsy caused by an ischemic lesion of the nerve because of diabetes was suspected. Emergent computed tomography (CT) of the head revealed cortical-subcortical atrophy and no ischemic lesions. A cranial magnetic resonance showed a mass with a soft tissue component invading the right cavernous sinus. The mass displace the carotide and the intraselar structures (Figs. 1 and 2). With these results, a tumoral disease was suspected and for thus extensive systemic workup was initiated. Chest X-ray, routine blood values, and urinalysis results were normal. The serum PSA level was elevated (1000 ng/mL). Abdomen and chest CT detected hepatic and bone metastases. Findings on bone scintigraphy were compatible with extensive diffuse metastases throughout the skeleton, including the cranial lesion. Prostatic FNAB was indicated based on these findings, the result of which was prostatic adenocarcinoma (Fig. 3). Hormone therapy treatment was initiated with LH-RH agonist and Flutamide followed by Bifosfonates.Prostate carcinoma can metastasize to any organ especially bone but cranial nerve palsies secondary to metastatic prostate to the base of the skull are uncommon situations, most of them presented several years after the diagnosed is made. 1 The cause of the neuropathy is the direct compression of nerves by tumor in this strategic location. The involvement of the cavernous sinus area by malignant neoplasm may occur generally through local extension of a nearby locally advanced primary head and neck tumor or more rarely, through hematogenus spread of tumors located outside including breast and prostate cancer. 2 In most of the previous reports the cranial nerve palsy appears in the context of a widespread metastatic prostate disease diagnosed several years before. 3 The initial diagnosed is usually established by magnetic resonance images. 3 Treatment of skull metastases depends largely of patient symptoms as well as the radiologic findings. Two therapeutic approaches can be performed: systemic treatment with hormonal therapy; and a local therapy with surgery or radiotherapy. It has been reported that hormone therapy treatment can decrease the mass and improve the symptoms. 4 Radiation therapy often is performed in an attempt to palliate symptoms and surgery is occasionally necessary. 3 In conclusion, we describe an uncommon presentation of a metastatic prostate cancer. It should be mention that as more effective therapy for advanced prostate cancer becomes available and patients live longer, skull metastases can be expected to be encountered more frequently. Clinicians caring for pat...

Dermatofibrosarcoma protuberans is a tumour that grows locally, infiltrating the subcutaneous tissue; it is uncommon in children. We report the case of a 27-year-old man who had had such a lesion from the age of 3 years, and it had enlarged during his lifetime. A wide local excision with margins of 3.0 cm was performed, but the lesion was not entirely removed. This is a new report of infantile dermatofibrosarcoma protuberans, and this case reflects the need for Mohs micrographic surgery.

A 55-year-old woman with a one-year history of idiopathic myelofibrosis progressed to erythroleukemia. This is the first reported occurrence of erythroleukemia progression from idiopathic myelofibrosis. Certain patterns of leukemia transformation from myeloproliferative disorders are favored: Myeloblastic or myelomonocytic. The rare incidence of erythroblastic transformation is discussed.