No abstract

We report seven cases of primary cutaneous phaeohyphomycosis. There were five males and two females, ranging in age from 42-65 years (mean 57.7 years). Two patients were otherwise healthy, but five were immunocompromised. One patient had rheumatoid arthritis and was on oral prednisone; two were renal transplant recipients, one was a heart transplant recipient, and the fifth had dermatomyositis. No history of trauma was elicited from any of the patients, but in two cases, foreign material was seen in the tissue sections. All lesions were on the extremities. In two cases, tissues were cultured, and these grew Exophiala jeanselmei. The others were not cultured because fungal infection was not clinically suspected. No systemic disease developed in any of the cases, and all were cured by the simple, complete excision of the lesions.

Tumors of the gut with composite features of both adenocarcinoma and carcinoid have been recognized mainly in the appendix. There also have been isolated reports of similar tumors arising from other parts of the gastrointestinal tract. It is generally concluded that these tumors have better prognosis than adenocarcinomas of the gastrointestinal tract. We reported six patients with composite tumors arising from the stomach in one, small intestine in two, cecum in two, and rectum in one patient. Clinical presentations in each was suggestive of malignancy with extension to either serosa and/or lymph nodes. Metastasis to liver was present in two patients. Histologically, the tumor showed glands with surface microvilli resembling adenocarcinoma and also organoid pattern with neurosecretory granules in cells resembling carcinoid. Two patients died three and nine months after surgery. The clinical presentation, findings at operation, and the postsurgical course of these six patients reveal that these tumors behave more like an adenocarcinoma than carcinoid and do not appear to have a better prognosis than ordinary adenocarcinoma.