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HighlightsRenal cell carcinoma (RCC) with t(6:11) (p21;q12) are extremely rare, fewer than 30 cases have been reported in literature.This study reports a case of 11 year old boy diagnosed with this rare tumor, with the aim of highlighting distinctiveimmuno-histologic features of this tumor otherwise diagnosed by fluorescence in situ hybridization technique.Histologically tumor has a distinct biphasic pattern, with “pseudorosette” formation.Tumor cells show immunopositivity for melanocytic markers, HMB45 and Melan A and are negative for epithelial markers CK and EMA.Knowledge of unique immunohistology is helpful in not misdiagnosing this rare tumor for a non epithelial tumor like angiomyolipoma.

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with PHN. Patients with PHN were identified by a diagnosis of HZ and met PHN diagnosis criteria reported by Klompas (Mayo Clinic. Proc. 2011). Treatment patterns are reported descriptively for patients <65 (n=212 million) and $65 years old (n=20 million); of 0.4% of patients <65 and 1.3% $65 years were diagnosed with HZ, 14% and 34% of patients, respectively, subsequently diagnosed with PHN. In both age groups, patterns of initial analgesic use were observed. Approximately 36% of PHN patients received an opioid agonist, 21% received gabapentin, 4% lidocaine patch, 4% pregabalin, 4% a tricyclic antidepressant, 1% other topical lidocaine, and <1% capsaicin. Both lidocaine patch and gabapentin usage were significantly higher in patients $65 relative to patients <65 years. Gabapentin was used as initial treatment in 27% of patients $65 years versus 18% of patients <65 years (p<0.001), and lidocaine patches were used in 6% of patients $65 years versus 3% of patients <65 years (p<0.001). Results show higher opioid-based therapy across all ages, and substantial under-treatment with topical lidocaine and adjunctive neuropathic agents. With known risks of opioids in the elderly and the American Academy of Pain Medicine recommending that prescription of opioids for chronic, intractable pain is appropriate only when more conservative methods are ineffective, clinicians should reconsider their neuropathic treatment strategies to include other therapies. Lidocaine patches-recommended as first-line therapy for PHN-may be underutilized relative to other PHN therapies. Supported by SCILEX Pharmaceuticals.

A 62-year-old man presented with pain and gradually increasing swelling of the right scapular region for four months. On examination, there was a bony hard swelling on the scapula with no restriction of movement. Magnetic resonance imaging (MRI) showed a destructive lesion in the spine of the scapula (Figure 1). Whole body 18-Fluoro-deoxy-glucose positron emission tomography (FDG-PET) showed a non-FDG avid lesion in the spine of the scapula, with no other metabolically active lesion identified elsewhere (Figure 2). The spine of the scapula was surgically resected with adequate margins. Histopathology revealed a neuroendocrine tumor (NET). Lesional cells showed diffused string immunopositivity for pan cytokeratin (pan CK) an epithelial cell marker and markers of neuroendocrine differentiation, chromogranin and synaptophysin (Figure 3). Upper and lower endoscopies were negative for a primary gastrointestinal NET. Postoperatively, the patient did not receive any adjuvant therapy. The patient was followed up over four years and has remained disease free, clinically and radiologically.