Eumycetoma is a chronic subcutaneous infection caused by filamentous fungi and is clinically characterized by swelling, nodules, sinus tracts, and grain discharge. Acremonium species are rare opportunistic fungal pathogens implicated in eumycetoma, with few reports in the dermatologic literature. This report describes a 64-year-old male farmer from rural western Guatemala with a 14-year history of chronic dermatosis localized to the right foot. Clinical examination identified nodular lesions, crusting, and edema, consistent with mycetoma. Diagnosis was confirmed through mycological studies and morphological identification of Acremonium species.

Osteosarcoma (OSA) is a malignant neoplasm of mesenchymal origin characterized by osteoid or immature bone production and is rarely reported in reptiles. A 3-month-old Argentine black and white tegu presented with a subcutaneous mass on the left flank, approximately 2 months after a dog bite. Physical and radiographic examination revealed no initial internal abnormalities, but follow-up examination revealed a rapidly enlarging soft tissue mass. Ultrasonography confirmed a well-encapsulated mass, while contrast-enhanced computed tomography demonstrated mineralization, rib osteolysis, and multiple bilateral nodules, indicating a malignant process. Histopathological examination of the excised mass demonstrated features consistent with giant cell-rich osteosarcoma, including irregular bony trabeculae, numerous multinucleated giant cells, and peripheral osteoid matrix. This case highlights the diagnostic challenges of OSA in reptiles, the value of integrating diagnostic imaging and histopathology, and the need for species-specific imaging protocols in ectothermic species, thereby expanding the literature on reptilian neoplasia.

Salivary adenoid cystic carcinoma (SACC) is a malignant salivary gland neoplasm characterized by aggressive local invasion and a marked propensity for metastasis. However, the role of MEOX1 in SACC progression remains poorly defined. In this study, we examined the effects of MEOX1 overexpression on the malignant behavior of SACC cells in vitro and in vivo. Human SACC-83 and SACC-LM cells were transduced with lentiviral vectors encoding MEOX1 or an empty vector control, and cell proliferation, migration, invasion, and cell cycle distribution were assessed using CCK-8, wound healing, Transwell, and flow cytometric assays, respectively. RNA sequencing was performed to characterize transcriptional changes associated with MEOX1 overexpression. In vivo, tumor growth was evaluated in BALB/c nude mice bearing subcutaneous xenografts, and pulmonary metastatic colonization was assessed using a tail vein injection model. MEOX1 overexpression reduced the proliferation, migration, and invasion of SACC cells in vitro and increased the G2/M phase fraction. In xenograft models, MEOX1-overexpressing cells formed smaller tumors and showed lower Ki67 staining than control cells. In the experimental lung metastasis model, mice injected with MEOX1-overexpressing cells developed fewer pulmonary metastatic nodules. RNA-seq identified 588 differentially expressed genes associated with MEOX1 overexpression, with enrichment in pathways including cytokine-cytokine receptor interaction, Toll-like receptor signaling, and G protein-coupled receptor signaling. Together, these findings indicate that enforced MEOX1 expression is associated with reduced malignant phenotypes in SACC models and with transcriptomic alterations in pathways related to immune response, G protein-coupled receptor signaling, and DNA damage response.

Urinary incontinence is a common condition in adult women, significantly affecting quality of life, daily activities, and psychosocial well-being. Stress urinary incontinence (SUI) is the most frequent subtype, and it often coexists with pelvic organ prolapse (POP), as both conditions result from pelvic floor dysfunction and share risk factors such as childbirth and menopause. The Altis® mid-urethral sling (Coloplast Corp., Minneapolis, MN, USA) is a minimally invasive mesh implant designed to treat stress urinary incontinence in women by providing urethral support. Although it demonstrates high success rates, potential complications, such as early-onset groin pain, urinary tract infection, voiding difficulties, subepithelial erosion or mesh extrusion, labial nodule, or paraurethral granuloma, may arise, sometimes requiring medical or surgical intervention. Our patient, a 43-year-old woman (P2002), developed severe early-onset groin pain, subepithelial vaginal erosion, a left paraurethral granuloma, and a labial subcutaneous nodule following the placement of an Altis® single incision sling system for stress urinary incontinence confirmed by urodynamic studies. Her symptoms began within days of the procedure. On examination, there was ulceration of the left vaginal wall with granulation tissue, though no mesh fibers were visible. MRI showed inflammation along the left sling's anchoring arm. The patient underwent surgical excision of the granuloma, removal of the left sling arm, and resection of the labial nodule, resulting in complete resolution of her symptoms. This case highlights an uncommon early complication of single-incision mid-urethral sling placement related to anchor-associated granulomatous inflammation. Early-onset groin pain and subepithelial vaginal erosion may occur without visible mesh exposure. Prompt recognition and targeted surgical management can result in symptom resolution and favorable clinical outcomes.

Between 2015 and 2024, outbreaks of muscular and visceral granulomatous disease, resulting in moderate-to-severe mortality in farmed groupers, occurred in southern Taiwan. Initially, affected groupers were screened for granuloma-associated pathogens, including Mycobacterium spp., Nocardia spp., Photobacterium damselae and Edwardsiella spp., using PCR methods at local animal disease prevention and control centres. Twenty-five hybrid groupers (Epinephelus fuscoguttatus × E. lanceolatus) that tested negative for these pathogens were submitted to our laboratory for further examination. Infected fish exhibited multiple grey-white nodules on the body surface and visceral organs, particularly the kidneys. Large numbers of Gram-negative bacilli, measuring 2-3 μm in length, were observed in organ smears. Microscopic examination revealed multifocal granulomatous lesions in the subcutaneous muscle, kidneys, spleen and liver. Sequencing of the 16S rRNA gene and the Vibrio harveyi hemolysin (vhh) gene from all isolates confirmed their identity as V. harveyi. The pathogen was definitively localised within the lesions via in situ hybridisation using a digoxigenin (DIG)-labelled probe. This is the first report of natural V. harveyi infection causing muscular and visceral granulomatous disease in Taiwanese grouper farms. These findings underscore the emerging pathological relevance of V. harveyi and provide a practical diagnostic framework for granulomatous diseases in aquaculture.

Darier-Roussy sarcoidosis is a rare cutaneous sarcoidosis presenting with painless subcutaneous nodules and minimal systemic involvement. A 58-year-old Ethiopian man developed symmetrical nodules mimicking rheumatoid nodules. Histology confirmed non-caseating granulomas. Corticosteroid therapy achieved complete resolution, underscoring the importance of histopathological diagnosis and early treatment with excellent clinical outcomes and prognosis.

A 67-year-old woman had undergone radiofrequency ablation (RFA) for right breast cancer at a university hospital 21 years before and visited our hospital for annual breast surveillance after finishing the 10-year follow-up. During the annual breast surveillance, unexplained and unintentional weight loss made the subcutaneous fat just above the RFA nodule thin. It caused cellulitis due to the RFA nodule-related stimuli to the overlying skin. Image evaluation clarified the strong adhesion between the RFA nodule and the overlying skin. After recovery from cellulitis, the patient requested resection of the RFA nodule to prevent recurrence. The patient, however, already had marked asymmetry of the breasts due to the radiation-induced shrinkage of the right breast. The patient, therefore, underwent breast surgeries as follows to get better cosmetic outcomes. The patient underwent RFA nodule resection via a retromammary space approach through a lateral vertical skin incision, achieving a difficult but successful complete removal of the RFA nodule. After that, the shrunken and hard right mammary gland was partially incised in several linear fashions from the retromammary space, followed by immediate breast augmentation using the latissimus dorsi musculocutaneous flap. Additionally, the left breast was treated with inverted T reduction mammoplasty, successfully leading to the favorable cosmesis of the breasts. The patient recovered uneventfully, is fully satisfied with the cosmetic outcomes of her breasts after the operation, and is scheduled to further receive annual breast surveillance on an outpatient basis. Breast surgeons should note that the RFA indication for breast cancer should not only include breast cancer characteristics but also late and aging-related complications.

Subcutaneous granuloma annulare (SGA) is a rare skin condition that has overlapping features with rheumatoid nodules due to similar clinical and histological features. A 42-year-old female with a history of celiac disease and a family history of rheumatoid arthritis developed progressively painful nodules on her right hand. She was initially thought to have rheumatoid arthritis, but her serological markers were negative, and an incisional biopsy revealed palisaded granulomas with central mucin and necrobiotic collagen that led to a diagnosis of SGA. Differentiating between these two conditions is important because rheumatoid nodules require immunosuppressive therapy due to systemic inflammation, while SGA is a self-limiting benign condition. This case highlights the need for a biopsy of atypical subcutaneous nodules and the importance of combining clinical, pathological, and interdisciplinary expertise to ensure accurate diagnosis and the best patient care.

Contrast-enhanced CT is commonly used in the evaluation of hepatic metastatic lesions. This prospective study aimed to assess the capability of artificial intelligence iterative reconstruction (AIIR) in low-dose CT for detection of hepatic metastases. Thirty-two patients with hepatic metastases were enrolled and underwent dual-phase CT scans in the venous phase. Each patient received a standard-dose (SD) scan (120 kVp, 180 mAs) followed by a reduced-dose (RD) scan (120 kVp, 30 mAs). All data were analyzed. Compared with the SD CT scan, the volume CT dose index (CTDIvol), dose length product (DLP), and effective dose (ED) were significantly lower in the RD CT, with an average radiation reduction of approximately 80%. Radiation dose reduction significantly increased the image noise and degraded the overall image quality. However, higher reconstruction levels resulted in an increasingly prominent "waxy" texture on CT images. There were significant (P < 0.05) differences in liver noise, subcutaneous fat noise, liver parenchymal SNR, portal vein SNR, liver parenchymal contrast-to-noise ratio (CNR), and portal vein CNR among the groups, with the ranking of noise, SNR and CNR: RD AIIR Group 1 < RD AIIR Group 3 < RD AIIR Group 5 < SD Karl group < RD Karl group. In the SD Karl group, 218 metastatic nodules were identified in 32 patients, whereas in the RD Karl group, 176 (80.7%) nodules were detected. However, the RD AIIR 3 group identified 204 (93.6%) nodules. As the metastatic nodules size decreased, the detection rate in the RD Karl significantly declined, with the detection rate 14.29% in the RD Karl for nodules < 5 mm. In RD AIIR 3, the detection rate reached 100% for lesions ≥ 10 mm and 57.14% for lesions < 5 mm, which was significantly higher than in the RD Karl group (P < 0.05). The CNR of intrahepatic nodules in the SD Karl, RD Karl, and RD AIIR 3 was 2.68 (2.17, 3.80), 2.18 (1.64, 2.79), and 6.34 (4.34, 8.36), respectively, with significant differences among them. The signal-to-noise ratio of the lesions in the RD AIIR 3 group was the highest. AIIR-assisted low-dose CT reconstruction yields image quality comparable to standard-dose CT, while preserving diagnostic performance for the detection of small hepatic metastases.

SUMMARYJorge Lobo's disease (JLD) is a chronic cutaneous and subcutaneous mycosis endemic to the Amazon Basin and tropical rainforests of Latin America. Despite more than a century of study, the disease remains underrecognized, poses significant diagnostic challenges, and is often therapeutically refractory. Here, we synthesize historical, clinical, and ecoepidemiological evidence; provide a practical diagnostic approach; and highlight unresolved questions. Clinically, JLD presents as slowly progressive keloid-like nodules and plaques on exposed areas. Diagnosis relies on direct microscopy and histopathology showing chains of thick-walled yeast-like cells connected by narrow-neck budding; culture is not feasible, and molecular assays are rarely available outside reference centers. We contrast JLD with key mimickers (cutaneous leishmaniasis, chromoblastomycosis, leprosy, atypical mycobacterioses, and non-infectious lesions such as keloid scars) and summarize current management options, emphasizing when surgery alone suffices and when prolonged azole therapy should be considered. From an ecoepidemiological perspective, historical settlement patterns, occupational exposures, and environmental disturbance in humid forest biomes appear to have amplified human contact with putative environmental reservoirs. New phylogenomic data position Paracoccidioides lobogeorgii as an early-diverging lineage within Paracoccidioides, refining prior MLST-based inferences. We outline practical surveillance steps to address under-ascertainment, standardized case definitions, sentinel reporting, and laboratory quality assurance and propose research priorities spanning environmental detection, host-pathogen interactions, and therapeutic evaluation. We contextualize the disease within broader frameworks of fungal emergence, structural neglect, and environmental disruption, arguing that revisiting JLD is not merely retrospective but a necessary scientific and ethical priority.