Recurrent nodule on the nasal columella: a good reason to re-biopsy
ABSTRACT A 15-year-old Caucasian male presented with 9-month history of a recurrent nodule on the nasal columella. The previous biopsy was reported as a neurofibroma.
Frozen sections revealed a spindle cell neoplasm. Permanent section immunohistochemistry sections stained positive for vimentin and smooth muscle actin and negative for S100 and CD34, confirming the diagnosis of leiomyosarcoma.
The tumor was removed using Mohs micrographic surgery. Radiological work-up revealed no distant metastasis. There has been no local recurrence to date.
Leiomyosarcoma is a difficult diagnosis to make clinically and requires histological confirmation. Re-biopsy of a "benign" growth may be necessary if clinicopathological correlation does not match with the clinical behavior of the tumor in question. Finally, Mohs micrographic surgery is a useful treatment modality for leiomyosarcomas, particularly those located in cosmetically-sensitive regions of the body such as the nose.
Article: Crusted pink papule in a 20-year-oldInternational journal of dermatology 10/2010; 49(10):1089-91. DOI:10.1111/j.1365-4632.2010.04525.x · 1.31 Impact Factor
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ABSTRACT: We report a rare case of fibro-hyaline anterior extensions of the bony nasal pyramid. The clinical, radiological, intra-operative and histological findings are presented. A 34-year-old man presented with bilateral nasal obstruction due to enlarged lateral walls of the nasal vestibule. Radiology showed normal bony structures. Surgery revealed three histologically identical, non-malignant, fibrous masses, one in the nasal septum and one in each of the vestibular walls. The latter were attached to the bony pyramid, protruding anteriorly and converging medially. The location and symmetry of the fibro-hyaline projections indicated that they constituted a malformation mimicking congenital bony nasal pyriform aperture stenosis. Histological analysis showed that the masses were not neoplastic.The Journal of Laryngology & Otology 08/2011; 125(10):1067-9. DOI:10.1017/S0022215111001897 · 0.67 Impact Factor
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ABSTRACT: Cutaneous spindle cell tumors share the common feature of appearing as spindle-shaped cells on light microscopy. Their pathogenesis, presentation, and prognosis are highly variable, and numerous techniques for workup and treatment have been reported. We performed an analysis of the available scientific literature in order to codify the clinical, immunohistochemical, and biologic features of these tumors and to provide insight into the most effective practices for their management, with a focus on Mohs micrographic surgery (MMS). In this article, the clinical and histopathological characteristics of dermatofibrosarcoma protuberans, atypical fibroxanthoma, malignant fibrous histiocytoma, spindle cell squamous cell carcinoma, superficial leiomyosarcoma, desmoplastic melanoma, cutaneous angiosarcoma, and myofibrosarcoma are described, and methods for diagnosis, workup, treatment, and surveillance are evaluated. Cutaneous spindle cell neoplasms are diverse in origin, presentation, and behavior. Immunostaining assists in differentiating among the various types. Further workup is sometimes indicated to characterize local invasion or assess for metastatic disease. Surgery is typically the first-line treatment, and MMS is associated with low recurrence rates and a tissue-sparing advantage for many tumors. Adjuvant treatments, including radiation therapy, molecular-targeted therapy, and conventional chemotherapy, are sometimes indicated, and close clinical surveillance is required after treatment.Dermatologic Surgery 01/2012; 38(6):825-50. DOI:10.1111/j.1524-4725.2012.02296.x · 2.11 Impact Factor