The finding of thyroid nodules is a very common occurrence in routine clinical practice. Approximately 5% to 7% of the entire population have thyroid nodules. Vascular lesions are one of the most controversial issues in thyroid pathology. These include benign lesions such as hemangiomas and, rarely, malignant tumors such as angiosarcomas or undifferentiated angiosarcomatoid carcinomas. In particular, angiosarcoma of the thyroid gland is a rare, highly aggressive malignant vascular tumor and in Italy the greatest geographical incidence of this lesion is witnessed near the Alps. Here, a case of thyroid angiosarcoma in a 71-year-old man with a history of goiter for about 20 years is described. The unusual localization of this lesion, the difficulties in reaching a definitive diagnosis for this particular histological type of primary tumor and a history of long-standing multinodular goiter in thyroid of an older man from outside the Alpine region prompted us to report this case of thyroid angiosarcoma mainly to discuss surgical, histopathological and immunohistochemical features.
Verrucous carcinoma of the foot often affects deep structures such as tendons, muscles, or bones. A 74-year-old man presented with a foot lesion that had been diagnosed as a skin infection 7 years earlier. He was treated with multiple excisions and superficial biopsies associated with antibiotic therapy without success. In our department he underwent an aggressive and accurate debridement with marginal excision harvesting multiple biopsies. Pathological evaluation of tissue at the time of operation confirmed the diagnosis of verrucous carcinoma of the foot. Therefore, the patient underwent an amputation below knee, and there were no postoperative complications; the patient was able to walk with the aid of a prosthesis with no signs of recurrence. The lesion follows a chronic course evolving from a discrete focal lesion to a large fungating deeply penetrating mass often compromised by local infection. The slow growth and confusing early-stage appearances can lead to delays in diagnosis of 8 to 15 years causing the extracutaneous involvement that requires a leg amputation. Many patients are initially treated with many topical medications without success, and most tumors have been treated as recalcitrant warts or corns for some time, whereas the basic approach is surgical.
BackgroundSchwannoma and angiosarcoma are infrequent pathologies that have been rarely reported in the kidney. Angiosarcoma is an uncommon malignant tumor presenting a recognizable vascular differentiation. It can develop in any site but the most common locations include the skin, soft tissues, breast, bone, liver, and spleen while renal localization has been very rarely reported in the literature. Schwannoma is a benign peripheral nerve sheath tumor composed of cells with the immunophenotype and ultrastructural features of differentiated Schwann cells. It has a wide anatomical distribution but the most frequent locations include subcutaneous tissues of the extremities and the head and neck region and the retroperitoneal and mediastinal soft tissues. The occurrence of an angiosarcoma in a pre-existing schwannoma is an extremely rare event with <20 cases reported in worldwide literature. In the present study, a renal case of angiosarcoma arising in schwannoma is presented with a detailed review of the pertinent literature.Case PresentationA 56-year-old man was admitted with a few days history of lower back pain and hematuria. Abdominal ultrasound showed a mass inside the left renal medulla. Subsequent imaging investigations with computed tomography and magnetic resonance confirmed the presence of the lesion and showed a pulmonary metastasis.ConclusionsThe final histopathological examination led to the diagnosis of epithelioid angiosarcoma arising in a schwannoma. The patient came to death a few months later due to a massive hemothorax. To the best of our knowledge, the present is the first case of an angiosarcoma arising in a schwannoma of the kidney.
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