Year 2023, Volume 7 - Issue 6

Background: Proliferating trichilemmal tumors (PTTs) are rare benign neoplasms that arise from the outer sheath of a hair follicle. Group III PTTs are high-grade malignant tumors reported to exhibit a high recurrence rate, lymph nodes, and a tendency to develop distant metastasis. Case Presentation: A 25 years old female patient was presented to us with a history of recurring soft tissue scalp lesions. The lesion recurred three times within 1 year. There was no history of trauma. Every time the lesion was excised but no histopathology of the specimen was done. Upon the third recurrence, it came out to be a malignant proliferating trichilemmal tumor (MPTT). Considering the young age of the patient and keeping in view the history of multiple recurrences with positive deep margin even after the third surgery, the patient was planned external beam radiotherapy (RT) 50 Gy/25 fx to scalp with 9 Mev electron using 0.5 cm bolus. The post-RT follow-up currently of 2 years is uneventful. Conclusion: The mainstay of treatment is surgery with wide surgical margins as local recurrence is most common in MPTT. Adjuvant RT was used in this case to prevent recurrence.

Background: Sarcomatoid carcinoma (SCA) of the jejunum is an extremely rare malignancy of the small intestine, with only about 20 cases reported to date. This type of cancer has features of both epithelial and mesenchymal tumors. Case Presentation: This case report describes a male patient in his 70s who presented with recurrent episodes of passage of melena. Conclusion: The diagnosis of SCA was confirmed by immunohistochemistry and this case emphasizes the course and metastatic nature of the tumor including constraints surrounding management.

Background: Differentiated thyroid cancer is the commonest endocrine malignancy. Mortality in the presence of distant metastasis can increase dramatically. Bony metastasis often leads to increased morbidity and mortality. We report a case of a 60-year-old male who had metastatic spread of follicular cancer of the thyroid, without any identifiable primary. Case Presentation: A 60-year-old male presented with backache and weakness of lower limbs due to the collapse of the 11th thoracic vertebra. He underwent laminectomy and internal fixation. The histopathology revealed that it was the metastatic spread of follicular cancer of the thyroid. The histopathology revealed no malignancy in the thyroidectomy specimen. Subsequent administration of radioactive iodine showed a fall in thyroglobulin from 6,000 to 203 ng/ml. Conclusion: In cases of metastasis from an unknown primary, follicular thyroid cancer should be included in the differential diagnosis. Treatment after thyroidectomy can lead to good results.

Background: Follicular thyroid carcinoma (FTC) is a type of thyroid cancer that arises from the follicular cells of the thyroid gland. It accounts for about 10%-15% of all thyroid cancers. CA 125 is a protein that is often used as a tumor marker for ovarian cancer, but it can also be elevated in other types of cancers, including thyroid cancer. The significance of raised CA 125 levels in FTC is not clear, but it indicates a more advanced or aggressive form of the disease [1,2]. Case Presentation: A 62-year-old male presented with a painless neck mass (Figure 1) for 8 years. Ultrasonography revealed a solid nodule in the left lobe of the thyroid gland. Fine-needle aspiration cytology of the nodule showed features of follicular neoplasm. Contrast-enhanced computed tomography (CECT) abdomen and blood routine ruled out other causes of raised CA 125. Chest X ray and CECT neck (Figure 2) and thorax showed lung (Figure 3) and thoracic vertebra metastasis (Figure 5). Total thyroidectomy with bilateral central compartment lymph node dissection was performed. Histopathology confirmed FTC (Figure 4) with capsular invasion, and lymphovascular and perineural invasion and lymph node-positive. The tumor was classified as T3bN1a according to the tumor, nodes, and metastasis staging system. I131 scan post-surgery showed uptake in lung metastasis sites which confirmed the diagnosis. Conclusion: The role of serum tumor markers, such as CA 125, in predicting the prognosis of FTC is not well established. However, elevated CA 125 levels have been reported in some cases of thyroid carcinoma with metastasis, and may reflect the presence of peritoneal or pleural involvement [3,4]. This case highlights the aggressive nature of FTC with metastasis and the limited treatment options available for patients with advanced disease. CA 125 as a prognostic marker in FTC warrants further investigation [5].

Background: Intravascular large B-cell lymphoma (IVLBCL) is infrequent and aggressive, clinically depicted by an almost exclusive growth of large cells within the lumen of blood vessels of all sizes. The clinical manifestations are diverse, encompassing many non-specific signs and symptoms such as fever of unknown origin, neurological symptoms, and skin lesions. Case Presentation: We report a case of a 49-year-old lady with unusual IVLBCL of the central nervous system. She presented with rapidly progressive dementia preceded by seizures and a short history of altered sensorium. There were no cutaneous lesions. Plain computed tomography brain showed no significant abnormalities. Cerebrospinal fluid analysis was normal except for mildly raised protein. Antinuclear antibody was positive 1:320 but the remaining autoimmune workups were negative. Electroencephalogram showed cortical dysfunction with occasional sharp wave at the right frontoparietal region. Other dementia workups were unremarkable. Magnetic resonance imaging brain revealed non-enhanced biparietal gyri hyperintensities which may represent encephalitis changes. She was empirically treated for viral encephalitis, however, there were still recurrent seizures despite adequate anti-seizure medications with minimal improvement of symptoms. Subsequent admissions noticed bicytopenia with elevated lactate dehydrogenase. Bone marrow aspirations and trephine biopsy disclosed High-Grade Mature B Cell Lymphoma germinal center B-cell Type. She was subsequently managed by the hematology team and started with conventional rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone therapy. Fortunately, she is currently on the road to recovery. Conclusion: High index of suspicion is warranted to diagnose early in order to have a better prognosis.