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Background Neutrophilic dermatosis of the dorsal hands is an uncommon localised variant of Sweet syndrome first described in 1995. It is characterised by tender erythematous plaques, pustules and bullae on the dorsa of the hands. Literature Review A total of 123 cases of NDDH are included in this review. The mean patient age was 62.1 years and there was a slight female preponderance. 78.0% of cases had reported bilateral involvement and other sites were affected in almost a third of cases. Underlying disease was found in around 40% of patients, with the most common associations being haematological disorders (gammopathies, myelodysplasias or malignancies), recent infection, solid organ tumours and inflammatory bowel disease. Systemic and/or topical corticosteroids were employed in the treatment of 88.1% of cases while dapsone, colchicine and tetracyclines were the commonest steroid-sparing agents used. Improvement was often rapid and complete resolution the norm. Conclusions Whilst being uncommon, NDDH is frequently misdiagnosed and thus, its exact prevalence is probably underestimated. This may have significant implications including treatment delays or incorrect management. Moreover, recognition of NDDH is important since a correct diagnosis should trigger a search for underlying diseases and proper treatment with corticosteroids and/or steroid-sparing agents which is almost invariably curative.

A 30-year-old White man who was a renal transplant recipient presented with an eruption of folliculocentric papules with keratin spines.

We present the case of a middle-aged woman who presented with multiple indurated areas of hair loss on her scalp. Closer dermoscopic inspection of these patches revealed multiple arborizing vessels on an erythematous background. On further inspection nodules were also noted on the nape of the neck and right breast. Punch biopsies showed diffuse infiltration of the dermis by a neoplastic population of cells with moderate nuclear pleomorphism, abundant eosinophilic cytoplasm and brisk mitotic activity.

A 38-year-old healthy gentleman was referred for a dermatology review in view of a vesicobullous eruption. General examination revealed multiple, generally distributed targetoid lesions with central bullae as well as a superficial ulcer on the hard palate. The lesions were tender to touch but otherwise asymptomatic. Nikolsky sign was negative. Examination of other mucosae was normal.

A 68-year-old, otherwise healthy, man-presented-to-our-dermatology department in late April 2021 with a history-of-a-blistering-eruption-which commenced three days after his first dose of the Pfizer BioNTech COVID-19 vaccine (2nd March 2021) and worsened after the second dose given three weeks later. The blisters-first-appeared-over-the sternal area and were accompanied by intense, generalised-pruritus-which-started-a-day before the blisters appeared.

A 26-year-old, healthy, female nurse on no regular medication, developed a mildly pruritic, erythematous, annular patch with faint, central clearing on her left shoulder (Figure 1a). The patient had received the first dose of the Pfizer-BioNTech SARS-CoV-2 mRNA vaccine in the same arm 15 days prior to the development of the lesion. The injection site was 7cm distal to the evolving patch. Over the span of 2 days, the patch developed a shallow, central erosion surrounded by a halo of erythema (Figure 1b) and subsequently started to resolve spontaneously. The patient had also experienced facial flushing 15 minutes after the vaccine was administered.

Objective The aim of the study was to compare the relative predictive value of Marshall Classification System and Rotterdam scores on long-term rehabilitation outcomes. This study hypothesized that Rotterdam would outperform Marshall Classification System. Design The study used an observational cohort design with a consecutive sample of 88 participants (25 females, mean age = 42.0 [SD = 21.3]) with moderate to severe traumatic brain injury who were admitted to trauma service with subsequent transfer to the rehabilitation unit between February 2009 and July 2011 and who had clearly readable computed tomography scans. Twenty-three participants did not return for the 9-mo postdischarge follow-up. Day-of-injury computed tomography images were scored using both Marshall Classification System and Rotterdam criteria by two independent raters, blind to outcomes. Functional outcomes were measured by length of stay in rehabilitation and the cognitive and motor subscales of the Functional Independence Measure at rehabilitation discharge and 9-mo postdischarge follow-up. Results Neither Marshall Classification System nor Rotterdam scales as a whole significantly predicted Functional Independence Measure motor or cognitive outcomes at discharge or 9-mo follow-up. Both scales, however, predicted length of stay in rehabilitation. Specific Marshall scores (3 and 6) and Rotterdam scores (5 and 6) significantly predicted subacute outcomes such as Functional Independence Measure cognitive at discharge from rehabilitation and length of stay. Conclusions Marshall Classification System and Rotterdam scales may have limited utility in predicting long-term functional outcome, but specific Marshall and Rotterdam scores, primarily linked to increased severity and intracranial pressure, may predict subacute outcomes.

Diffuse large B-cell lymphoma (DLBCL) of the penis is a rare haematological malignancy, with less than 30 cases being reported in the literature. Our case mentions a 57-year-old man who presented with a penile lesion that was diagnosed as DLBCL on histological biopsy. Targeted investigation and proper diagnosis are essential to distinguish it from squamous cell carcinoma (SCC) of the glans, which presents similarly. Since guidelines are not available, the author compared different management mentioned in case reports and the outcome was noted. Chemotherapy, radiotherapy and surgery were the treatment modalities most used; out of which, chemotherapy had the most successful outcome. On the other hand, surgery is the preferred modality in SCC of the penis. This further consolidates the need for guidelines with regard to proper diagnosis and management of this malignancy.

We describe the case of a 77-year-old woman, presenting with non-specific epigastric pain. Physical examination and subsequent imaging revealed the presence of a large mass in the right liver lobe. This was shown to be a leiomyosarcoma on biopsy histology. Further investigation confirmed this to be a primary hepatic leiomyosarcoma with no evidence of metastases. The patient underwent successful surgical resection. She is currently under imaging follow-up, with no evidence of disease recurrence.

Systemic to pulmonary fistulas are an unusual entity, even more so in association with Hodgkin’s lymphoma. We herein report a case of a 33-year-old woman that presented with an incidental lung lesion on a chest radiograph with an associated high-frequency continuous murmur over the lesion. The diagnosis of primary pulmonary Hodgkin’s lymphoma, nodular sclerosis type, was obtained by a CT transthoracic biopsy. We achieved an excellent response after polychemotherapy with near-complete disappearance of the mass and a residual faint systolic murmur over the lesion.

Patients with C1 nerve root schwannomas usually present with signs relating to nerve root compression. However, asymptomatic presentations have never been reported. A healthy, 37-year-old female was referred in view of a slow-growing lump in the left posterosuperior aspect of the neck. The lump was asymptomatic and neurological examination was normal. Magnetic resonance imaging revealed a left C1 nerve root tumour, extending around the C1 vertebra and compressing the thecal sac. The tumour had invaded the basiocciput and was impinging on the left cerebellar hemispheric dura. Stereotactic biopsies of the lesion showed a spindle-cell tumour exhibiting an immunoprofile consistent with a schwannoma. The lesion was surgically excised by blunt dissection using a posterior midline approach. The case report adds to the diverse modes of presentation of C1 nerve root schwannomas, in that such lesions must be included in the differential diagnosis of asymptomatic posterior neck lumps., peer-reviewed

Obesity is a growing problem in the Western world and has been strongly linked to post-menopausal breast cancer. After menopause, adipose tissue assumes a major role in estrogen production, primarily because it expresses aromatase, which is critical in estrogen synthesis. Obese women have higher levels of circulating estrogen and lower levels of sex hormone-binding globulin. Free estrogen can promote fat deposition in the breast, which further increases local breast estrogen production. Estrogen promotes ductal proliferation by interacting with intracellular receptors, especially ER-a, but also through a host of membrane receptors like GPR30, which terminate on cyclin D1 activation, amongst other signals. Supplemental estrogen for this process can be provided by local macrophages and stromal cells. Excessive ductal proliferation is associated with accumulation of mutations in various genes, including HER2/neu, DIRAS3, TP53 and ESR1, which promote aberrant cell proliferation. This process is aided by genotoxic estrogen metabolites and by increased enterohepatic circulation of estrogen byproducts. In addition, hyperestrogenemia inhibits ubiquitin-mediated receptor degradation, hence promoting estrogen receptor expression in tumour cell lines. Other adipocytokines, like leptin, interleukin-6, adiponectin and insulin, have also been linked to breast cancer, with several molecular cross-interactions with estrogen receptor signaling pathways.

Background Day-of-injury (DOI) brain lesion volumes in traumatic brain injury (TBI) patients are rarely used to predict long-term outcomes in the acute setting. The purpose of this study was to investigate the relationship between acute brain injury lesion volume and rehabilitation outcomes in patients with TBI at a level one trauma center. Methods Patients with TBI who were admitted to our rehabilitation unit after the acute care trauma service from February 2009-July 2011 were eligible for the study. Demographic data and outcome variables including cognitive and motor Functional Independence Measure (FIM) scores, length of stay (LOS) in the rehabilitation unit, and ability to return to home were obtained. The DOI quantitative injury lesion volumes and degree of midline shift were obtained from DOI brain computed tomography scans. A multiple stepwise regression model including 13 independent variables was created. This model was used to predict postrehabilitation outcomes, including FIM scores and ability to return to home. A p value less than 0.05 was considered significant. Results Ninety-six patients were enrolled in the study. Mean age was 43 ± 21 years, admission Glasgow Coma Score was 8.4 ± 4.8, Injury Severity Score was 24.7 ± 9.9, and head Abbreviated Injury Scale score was 3.73 ± 0.97. Acute hospital LOS was 12.3 ± 8.9 days, and rehabilitation LOS was 15.9 ± 9.3 days. Day-of-injury TBI lesion volumes were inversely associated with cognitive FIM scores at rehabilitation admission (p = 0.004) and discharge (p = 0.004) and inversely associated with ability to be discharged to home after rehabilitation (p = 0.006). Conclusion In a cohort of patients with moderate to severe TBI requiring a rehabilitation unit stay after the acute care hospital stay, DOI brain injury lesion volumes are associated with worse cognitive FIM scores at the time of rehabilitation admission and discharge. Smaller-injury volumes were associated with eventual discharge to home. Volumetric neuroimaging in the acute injury phase may improve surgeons' ultimate outcome predictions in TBI patients. Level of evidence Prognostic/epidemiologic study, level V.