We report nine examples of a distinct cutaneous plaque-like proliferation of fibroblasts and myofibroblasts. Eight of nine lesions were located in or around the shoulder, including axilla and upper arm. There was a predominance of women to men of 8:1. The lesions measured from 1 to 2 cm in greatest diameter. All patients were young adults (mean age 29.8 yr). All lesions involved the reticular dermis in a plaque-like fashion and extended to the upper part of the subcutaneous septa in seven cases. The lesions consisted of a proliferation of very uniform slender spindle-shaped cells arranged as well-defined elongated and intersecting fascicles with a predominantly parallel arrangement to the skin surface. There was no evidence of cytologic atypia and mitotic figures were infrequent. The spindle-shaped cells were separated by thin collagen fibers. Elastic fibers were preserved and some of them appeared thicker than normal. All adnexal structures were spared. Immunohistochemistry revealed that the cells stained positively for vimentin and muscle actin, but lacked smooth-muscle specific actin, desmin, and S-100 protein. Some dermal dendrocytes stained positively for Factor XIIIa, but the spindle-shaped cells were negative. Electron microscopy studies revealed a mixture of fibroblasts, myofibroblasts, and undifferentiated mesenchymal cells. All lesions were treated by conservative excision; follow-up information revealed no evidence of recurrence. We name this distinct lesion dermatomyofibroma. To the best of our knowledge, this entity has not been previously described in the literature.

Our experience suggests that radiofrequency ablation can be used successfully in unresectable lung cancer as an alternative or complementary treatment to radio- or chemotherapy. Larger studies are necessary to fully evaluate its potential combination with other treatment techniques.

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Horseshoe kidney is a common urology anomaly, while its association with infrarenal abdominal aortic aneurysm represents a very rare condition. Surgical approach remains controversial however, we believe that the left retroperitoneal approach should be preferred in order to avoid isthmus resection with any subsequent renal infarction, urinary tract damage and to facilitate renal arteries reimplantation, when required.We present a case of voluminous infrarenal abdominal aortic aneurysm associated with horseshoe kidney, successfully treated through a left retroperitoneal approach on the retro-renal space. Keywords: horseshoe kidney, infrarenal abdominal aortic aneurysmIn 90% of cases computerized tomography (CT) gives the most detailed information about the morphology of HSK and the anatomic relationships between the kidney, its blood vessels, and the aneurysm. 2) Here we present our operative strategy to treat a patient affected by a voluminous symptomatic AAA associated with HSK, through a left retroperitoneal surgical approach. Case ReportA 67-year-old man with a history of hypertension, dyslipidemia and diabetes mellitus, reported to the emergency room complaining acute onset of abdominal pain, probably due to a rapid enlargement of the aneurysm diameters. Clinically, a pulsatile abdominal mass was observed. Computed tomography (CT) demonstrated an AAA measuring 6.68 cm × 5.74 cm in diameter, associated with a HSK, with the isthmus lying anterior to the aneurysm, containing functional parenchymal tissue (Fig. 1A). Three main left and one right renal arteries were detected through CT scan. One small accessory renal artery, arising from the aneurismal wall near to the inferior mesenteric artery origin was observed. Also, the presence of one small accessory renal artery arising from the right common iliac artery that presented a diameter of 31 mm and of a large renal accessory artery arising from the left common iliac artery were detected (Fig. 1B). Even if Ruppert and colleagues 3) reported that endovascular aneurysm repair with coiling of the renal accessory arteries can be performed safely in presence of HSK, we did not chose this option for our patient, in order to avoid possible complications, such as occlusion of accessory renal arteries with subsequent renal infarction and the development of type 2 endoleaks, that are reported in literature. 4) The rapid onset of abdominal pain leads us to opt an emergency operation. With the patient in the right semilateral position, we recurred to a left retroperitoneal approach on the retro-renal space, in order to avoid the kidney isthmus resection and urinary tract damage. The renal isthmus containing functional parenchymal tissue