Eccrine angiomatous hamartoma is an uncommon benign cutaneous hamartoma characterized by proliferation of eccrine and vascular components. It usually presents at birth or in childhood as a solitary extremity lesion and may be associated with pain, tenderness, hypertrichosis, or hyperhidrosis. We report a 6-year-old boy with a recurrent warm, hyperhidrotic subcutaneous tumor on the lateral aspect of the right ankle. The lesion had previously been excised under the clinical impression of hemangioma and was reported as angiolipoma, but later recurred and enlarged. Clinical examination showed a flesh-colored 5 × 4.5 cm tumor with clear surface secretion. Qualitative infrared thermography demonstrated focal surface warmth over the lesion. Histopathology showed well-circumscribed unencapsulated dermal and subcutaneous nodules composed of proliferating eccrine glands, vascular channels, mucinous stroma, mature fat, dilated sweat ducts, and large vessels with organizing thrombus, confirming eccrine angiomatous hamartoma. In this case, infrared thermography converted clinically perceived warmth into a visible, non-contact surface map that may help localize symptomatic surface involvement when planning conservative excision. Histopathology remains essential for diagnosis.

Nocardiosis is an uncommon infection that presents as a chronic, debilitating illness with radiographic manifestations simulating lung cancer or tuberculosis. Immunocompromised hosts may develop a fulminant disease resembling acute bacterial pneumonia or disseminated disease. We report a case of a juvenile lupus who developed disseminated Nocardia pseudobrasilienisis infection in form of necrotizing pneumonia, subcutaneous nodules and central nervous system (CNS) lesion in the right parietal lobe, following inadvertent hiking of steroids after a minor organ flare. This case was successfully treated with intravenous meropenem, amikacin, and oral cotrimoxazole therapy for 6 weeks which lead to resolution of pneumonia, and partial resolution of of the cutaneous and CNS lesion. As the patient was immunosuppressed, and had disseminated nocardiosis, we planned to put her on oral cotrimoxazole for the next 1 year.

Distal radial artery pseudoaneurysm is an uncommon vascular abnormality, usually occurring after trauma or iatrogenic arterial injury. Spontaneous cases are rare and have been reported primarily as isolated case reports in the general population. To our knowledge, no other published reports describe this presentation, especially within a dermatologic context among solid organ transplant recipients. We describe a 55-year-old immunocompromised male presenting with a 2-month history of a progressively enlarging, pulsatile nodule with overlying erythema and skin thinning on the surface of the right radial wrist. Physical examination revealed a subtle pulsatile subcutaneous mass. Biopsy was deferred, and the patient was referred for diagnostic imaging, which revealed a distal radial artery pseudoaneurysm. Vascular surgery was consulted, and the patient underwent urgent surgical resection with an unremarkable recovery. This case highlights that vascular lesions can mimic benign, inflammatory, or other soft tissue nodules in dermatologic practice. Carefulpalpation and imaging are essential when evaluating atypical wrist masses to avoid biopsy-related hemorrhage and ensure safe management.

Thyridium flavostromatum is a newly discovered species of plant fungus identified from the host plant Phyllostachys pubescens. It is a type of ascomycetes that has yellowish stromata and gets the name "flavostromatum." Immunocompromised patients are infected with rare and opportunistic fungal infections. We here present a case of multiple subcutaneous tender nodules caused by T. flavostromatum in a man with rheumatoid arthritis on immunosuppressants. Aspirate from the nodules revealed yeast-like cells with chlamydospores that were not identified in the matrix-assisted laser desorption ionization/time of flight mass spectrometry database. Additional DNA sequencing analysis identified the plant fungus T. flavostromatum. He was treated successfully with voriconazole. To our knowledge, this is the first reported case of the plant fungus Thyridium causing nodules on human skin.

Angiomatoid fibrous histiocytoma (AFH) is an uncommon fibrohistiocytic neoplasm of intermediate malignant potential that most often arises in the subcutaneous tissues of children and young adults. Involvement of the neck is unusual, and its clinical and radiological appearance may overlap with nodal or soft-tissue malignancy. Papillary thyroid carcinoma is the most common thyroid malignancy and commonly presents with suspicious thyroid nodules or cervical nodal disease. We report a 52-year-old man who presented with a gradually enlarging ulcerated left lateral neck mass and a small suspicious left thyroid nodule. Preoperative imaging showed a discrete thyroid lesion and a much larger necrotic lateral neck mass. Fine-needle aspiration of the thyroid nodule was suspicious for a follicular-patterned neoplasm, and the lateral mass was considered most likely to represent metastatic nodal disease. After multidisciplinary review, the patient underwent total thyroidectomy with excision of the lateral neck mass and neck dissection. Final histopathology demonstrated a 1.4-cm classic papillary thyroid carcinoma, staged pT1b pN0, with negative margins and no nodal metastasis. The lateral mass was a well-circumscribed fibrohistiocytic neoplasm with morphological and immunohistochemical features favoring AFH. The case represents the coincidence of having two different pathologies together when a patient presents with a lateral neck mass and thyroid malignancy. This emphasizes the need for an extensive workup for both pathologies separately, rather than taking a neck mass as a sequel of metastasis from thyroid malignancy. AFH has a high incidence of local recurrence, and a small proportion presents with distal metastases; thus, close follow-up is required. At one year, the patient remained clinically well, with no evidence of neck recurrence, undetectable thyroglobulin, and a stable incidental pulmonary nodule. This case illustrates the importance of tissue diagnosis from anatomically distinct lesions when the size or appearance of a presumed metastatic deposit is disproportionate to the primary tumor.

Carcinoid syndrome refers to the signs and symptoms a patient experiences secondary to a carcinoid tumor or another well-differentiated neuroendocrine tumor, which secretes serotonin and other peptides that enter the bloodstream; only 10% of patients with carcinoid tumors experience carcinoid syndrome. Common findings include facial flushing, tachycardia, and shortness of breath. Carcinoid tumors usually originate in the gastrointestinal (G.I.) tract. They are slow growing but can metastasize to the liver, lymph nodes, and elsewhere. Primary or metastatic cutaneous carcinoid tumors present as pink, fast-growing dermal or subcutaneous nodules. The diagnostic workup includes a thorough history and physical examination of the entire body, including a urinary 24-hour 5-hydroxyindoleacetic acid (5-HIAA) and serum chromogranin A. Management of carcinoid syndrome initially includes the use of somatostatin analogs, diet, medication regulation, and clinical monitoring. More aggressive treatment, such as peptide receptor radionuclide therapy or everolimus, an mTOR inhibitor, may be required.

Necrobiotic Xanthogranuloma (NXG) is a rare non-Langerhans histiocytosis often associated with paraproteinemia or hematologic disease. NXG is usually characterized by yellow-orange, reddish-brown, or violaceous papules and nodules which may progress to form infiltrative plaques, with lesions often occurring in a periorbital distribution. Histopathologic study typically demonstrates bands of inflammatory granulomatous tissue separated by zones of necrobiosis, with the dermis and subcutaneous tissue most commonly affected. Historically, the diagnosis has been made based on consistent clinical and histologic findings, although diagnostic criteria have recently been proposed. Research on NXG is limited due to the condition's rarity, making comparisons between therapeutic agents difficult. Numerous systemic and localized treatments have been documented with varying responses. Necrobiotic Xanthogranuloma (NXG) is a rare form of non-Langerhans histiocytosis first described by Steven Kossard and Richard Winkelmann (1924 -2012) in August 1980.[1] NXG is characterized by yellow-orange, reddish-brown, or violaceous papules and nodules, which progress to form infiltrative plaques.[2] While most commonly found on the periorbital skin, lesions may occur across multiple sites, including the trunk, extremities, and extracutaneous tissues.[2] The histopathology is characterized by zones of necrobiosis separating bands of granulomatous infiltrate extending from the dermis to the subcutaneous tissue, with the epidermis often unaffected.[1] Touton-type giant cells, foreign-body giant cells, and foam cells are also frequently appreciated, and cholesterol clefts may be present.[3] Systemic paraproteinemia is associated with over 80% of patients with NXG and may precede or follow the initial presentation of cutaneous lesions for several years.[4-8] Evaluation for potential underlying disease and effective treatment is necessary. As NXG is a rare condition, research is limited to case reports and retrospective studies, limiting assessment for efficacy of therapeutic agents. Numerous systemic and localized therapies have been used with varying response.[2,9,10] We review the epidemiology, pathogenesis, clinical presentation, histopathology, diagnosis, and treatment of necrobiotic xanthogranuloma.

Pulmonary neuroendocrine tumors are uncommon malignancies, and cutaneous metastasis as the initial presentation is exceedingly rare, often leading to diagnostic delays due to nonspecific clinical features. We reported a case of a 57-year-old male presenting with multiple progressively enlarging, painless cutaneous and subcutaneous nodules on the scalp and left chin without accompanying respiratory and constitutional symptoms. The lesions were initially treated as benign dermatological conditions without improvement. Excisional biopsy of a chin lesion demonstrated dermal infiltration by atypical polygonal cells with neuroendocrine morphology and dermal lymphatic invasion. Immunohistochemistry showed positivity for synaptophysin, cytokeratin 7 (CK7), and Cam5.2, consistent with neuroendocrine carcinoma. Contrast-enhanced computed tomography identified a heterogeneously enhancing mass in the left lower lobe of the lung with widespread metastatic disease. Further evaluation with Gallium-68 DOTATATE positron emission tomography/computed tomography, a somatostatin receptor-targeted imaging study, demonstrated avid lesions in the lung, lymph nodes, subcutaneous tissue, omentum, and skeleton. The patient was treated initially with octreotide hormone therapy. The patient had disease progression; therefore, therapy was changed to carboplatin and etoposide. This case highlights that unexplained skin lesions may present as the initial manifestation of an underlying visceral malignancy, signifying the role of early biopsy and comprehensive imaging to enable timely diagnosis and management of aggressive pulmonary neuroendocrine tumors.

Lipedema is a chronic disorder characterized by a disproportionate accumulation of subcutaneous adipose tissue in the extremities, typically sparing the hands and feet. It is commonly associated with pain, hypersensitivity, easy bruising, edema, and fibrotic nodules. Despite growing awareness, there is still no consensus on evidence-based therapeutic approaches. This integrative review aimed to identify physical therapy strategies described in the scientific literature for the assessment and conservative management of lipedema. Searches were conducted in the PubMed/MEDLINE, BVS, PEDro, Embase, and Cochrane databases, followed by critical appraisal and evidence synthesis, with applicable PRISMA-ScR checklist items used as a reporting guide for the study selection process. The findings indicate that physical therapy plays a key role in conservative treatment, particularly through complete decongestive therapy, compression therapy, exercise, manual therapy, and electrophysical agents. These interventions show potential benefits in reducing pain, improving functional capacity, controlling edema, and preventing disease progression. However, the available evidence remains limited, underscoring the need for more robust clinical trials to support evidence-based physical therapy practice in the treatment of lipedema.