We report a case of cutaneous lymphadenoma on the posterior left ear of a 67-year-old woman. Although it is benign, recognition of cutaneous lymphadenoma is important as it presents a diagnostic pitfall to the unsuspecting dermatologist and general surgical pathologist, who may readily misdiagnose the lesion because it is not only very rare, but also clinically and histologically resembles the far more common and locally destructive basal cell carcinoma.
We report a 51-year-old woman who presented to the emergency department with left-sided pleuritic chest pain 2 weeks after subtotal hysterectomy and bilateral salpingo-oophorectomy for a leiomyomatous uterus. Computed tomography scan of the chest revealed bilateral pulmonary nodules. Biopsy showed cytologically bland spindle cells without overt malignant features. Immunohistochemistry confirmed smooth muscle phenotype, in keeping with a clinicopathologic diagnosis of benign metastasizing leiomyoma (BML). BML does not frequently come to the attention of the emergency physician because it is rare and usually asymptomatic. When symptomatic, its clinical presentation depends on the site(s) of metastasis, number, and size of the smooth muscle tumors. Emergent presentations of BML are reviewed.
Mucoepidermoid carcinoma (MEC) is a malignant glandular epithelial neoplasm that most commonly arises in the major salivary glands. Primary cutaneous MEC is very rare. There is a particular diagnostic challenge in determining the primary site of MEC when it is found in skin overlying the parotid gland. Attention to a combination of morphologic findings may be helpful. However, differentiation of primary cutaneous MEC from secondary cutaneous involvement by a parotid MEC may be unnecessary once the parotid gland is infiltrated. We report the case of a 54-year-old male with a 2-cm asymptomatic mass overlying the right parotid gland, which was managed by excision of the affected skin, right total parotidectomy, and right neck dissection. Histopathologic and immunohistochemical findings were consistent with a cutaneous intermediate-grade MEC. Postoperative radiotherapy was deferred. The patient showed no evidence of recurrence or metastasis at 2 months before self-discontinuing follow-up. To our knowledge, this is only the second reported case of MEC involving the parotid gland, but of overlying primary cutaneous origin.
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