Patient: Male, 67Final Diagnosis: Recurrent metastatic eccrine porocarcinomaSymptoms: Skin lesionMedication: —Clinical Procedure: —Specialty: DermatologyObjective:Rare diseaseBackground:Eccrine porocarcinoma, or malignant eccrine poroma, is a rare primary skin tumor that develops in the sixth and seventh decades of life, and can present as a painless and solitary nodule. Histopathology is required to confirm the diagnosis. A rare case is presented of metastatic eccrine porocarcinoma, occurring four years after surgical excision of the primary scalp tumor, and includes a review of the literature.Case Report:A 67-year-old man initially presented with a scalp lesion that was non-painful, exophytic, and pigmented. Following complete excision, histopathology confirmed the diagnosis of eccrine porocarcinoma with clear resection margins. Four years later, he presented with discrete erythematous patches and plaques, in a zosteriform distribution, in the skin of the right neck, shoulder, and chest. A biopsy and histopathology of the skin rash confirmed metastatic eccrine porocarcinoma. A positron-emission tomography-computed tomography (PETCT) scan identified areas of hypermetabolic activity, with a standardized uptake value (SUV) of 12, and an infiltrating soft tissue tumor in the right suboccipital region. Surgical resection of the suboccipital mass, followed by histopathology, confirmed metastatic eccrine porocarcinoma. During a postoperative ear, nose, and throat (ENT) examination, he was found to have metastases in the right ear canal. The patient received five cycles of chemotherapy, but later developed renal failure and eventually chose palliative care.Conclusions:A rash-like presentation of skin metastasis to the trunk and metastasis to the ear from a primary eccrine porocarcinoma is rare. Early diagnosis and adequate surgical resection are recommended to reduce patient mortality.

Heart failure (HF) is one of the most important healthcare issues due to its prevalence, high morbidity and mortality, as well as its economic burden. A shift in the healthcare model towards reducing inpatient hospitalizations might have a significant impact on HF-related costs and quality of life. Recently, wireless monitoring has begun to be an essential part of the management in the patient with HF. The CardioMEMS HF system is one of the best examples pertaining to the success in this field. This article will discuss the CardioMEMS HF system and the rationale behind its development.

Cystic lymphangiomas are benign colonic neoplasms arising from the submucosa. Traditionally, endoscopic resection has been described for smaller lesions, while surgery is reserved for larger symptomatic lesions. We present a case of a 69-year-old asymptomatic individual noted to have a cystic lymphangioma of the colon measuring 5 cm, which was successfully removed with endoloop endoscopic resection without any complications.

BackgroundMultiple primary lung cancer may present in synchronous or metachronous form. Synchronous multiple primary lung cancer is defined as multiple lung lesions that develop at the same time, whereas metachronous multiple primary lung cancer describes multiple lung lesions that develop at different times, typically following treatment of the primary lung cancer. Patients with previously treated lung cancer are at risk for developing metachronous lung cancer, but with the success of computed tomography and positron emission tomography, the ability to detect both synchronous and metachronous lung cancer has increased.Case presentationWe present a case of a 63-year-old Hispanic man who came to our hospital for evaluation of chest pain, dry cough, and weight loss. He had recently been diagnosed with adenocarcinoma in the right upper lobe, with a poorly differentiated carcinoma favoring squamous cell cancer based on bronchoalveolar lavage of the right lower lobe for which treatment was started. Later, bronchoscopy incidentally revealed the patient to have an endobronchial lesion that turned out to be mixed small and large cell neuroendocrine lung cancer. Our patient had triple synchronous primary lung cancers that histologically were variant primary cancers.ConclusionsTriple synchronous primary lung cancer management continues to be a challenge. Our patient’s case suggests that multiple primary lung cancers may still occur at a greater rate than can be detected by high-resolution computed tomography.