International Journal of Cadaveric Studies and Anatomical Variations

Cadaveric Study: Sign of Leser-Trélat Associated with Breast Cancer

Brigitte Cochran, Savita Arya, Shiv Dhiman — Wed, 28 Feb 2024 00:00:00 -0600

INTRODUCTION: Seborrheic keratoses (SK) is considered the most common benign skin lesions found in individuals that are middle aged and older. In dermatology practice, these lesions pose no threat to the individual but can be concerning for cosmetic and underlying malignancy reasons when they cover most of the skin surface. Of specific concern is the sign of Leser-Trélat, which has been documented as a cutaneous harbinger of underlying malignancy associated with proliferation of the size and/or number seborrheic keratoses. The rare sign is usually caused by malignancies such as gastrointestinal adenocarcinoma, but also lung, kidney, liver, or pancreatic cancer. This case report will describe the histology of the skin lesions in Lesar Trélat and analyze the current literature regarding its association with breast cancer, which is quite rare.

RESOURCES: For this case study, a cadaver from the body donor program in Philadelphia College of Osteopathic Medicine (PCOM), South Georgia was used. Skin samples were sent to Colquitt Regional Center for processing, where sections were embedded in paraffin and were stained with H&E stain. A pathologist reported histopathological findings of the skin lesions and the breast tissue samples.

DESCRIPTION: Multiple SK lesions covering the face, abdomen, back, as well as both upper and lower extremities were observed in one of the cadavers in the gross anatomy laboratory. Due to the significant number of pigmented, verrucous lesions, the sign of Leser-Trélat was clinically postulated, later confirmed during routine laboratory dissection of the breast tissue. Histology sections confirmed not only multiple SK lesions in the skin, but also revealed an associated breast cancer in the form of an infiltrative ductal carcinoma.

SIGNIFICANCE: The sign of Leser-Trélat is rare by itself and its association with breast cancer is even more uncommon. Once a clinician recognizes the multiple SK eruptions, the patient should be meticulously investigated for not only for an underlying GI malignancy, but also for other cancers like breast cancer. Additionally, a case report confirmed malignant melanoma that mimicked sign of Leser-Trélat, warranting the importance of further analyzing the pathology diagnosis when there is a proliferation of multiple seborrheic keratoses.Therefore, biopsy and histology diagnosis is crucial for ruling out both cutaneous as well as underlying malignancies and should be encouraged when patients present in clinic rather than assuming the typical benign characteristics of seborrheic keratosis.

A Case Report of a Rare Subset of Meningiomas: Intraosseous Meningioma

Fri, 01 Mar 2024 00:00:00 -0600

Meningiomas are the most common central nervous system neoplasms and occur most frequently along the dural folds and cerebral convexities. While meningiomas are slow growing and typically do not invade brain parenchyma they are of clinical importance as they can impinge surrounding structure causing a variety of signs and symptoms depending on size and location. We report here a rare subgroup of extradural meningiomas that emerge from the calvaria, a primary intraosseous meningioma, found during cadaveric dissection in a graduate anatomy course in the Department of Physician Assistant Studies at Samford University.

Dermatopathological Analysis of Common Skin Lesions Encountered in Cadavers

Brigitte Cochran Cochran, Tamryn Van Der Horn, Savita Arya, Shiv Dhiman — Wed, 06 Mar 2024 00:00:00 -0600

This study served as a purpose for medical students to gain experience in both dermatology and pathology, which is a common barrier that prevents first and second year medical students from refining skills that are not later taught until residency. This prompted a study to develop gross differential diagnostic skills and how to analyze histopathology slides to diagnose common skin lesions to refine skills in both clinical and histology presentation.

A cadaveric case series was designed to examine multiple shave biopsies on all abnormal skin lesions observed from nine cadavers used for the first year medical students gross anatomy lab during the year 2022-2023. Biopsies were stained using hematoxylin and eosin. Histopathology slides, though initially viewed by medical students, were confirmed by a pathologist at a later time.

25 samples were taken from the 9 cadavers. The most commonly encountered lesion was macular seborrheic keratosis, with nine of the 25 (32%). Seven of the sample lesions (26.9%) were melanocytic nevus. Two sample lesions (8.0%) from the same cadaver were a superficial cutaneous cyst and one sample lesion (3.8%) from a separate cadaver indicated verruca vulgaris.

Common dermatological lesions were identified among the nine cadavers used for analysis. This provided opportunities to develop and refine skills in dermatopathology. A further increase in sample size is needed to gain exposure to a larger variety of lesions and to identify common dermatological lesions grossly based on differing race, age, and gender.

Inferior Trapezius Muscle Agenesis and Scapular Dyskinesis in a 58 Year-Old Black Male Donor: A Cadaveric Case Report

Sat, 09 Mar 2024 00:00:00 -0600

A functionally significant abnormality was observed in a 58 year-old Black male donor with a cause of death of thyroid cancer. He exhibited left inferior trapezius muscle agenesis as well as scapular dyskinesis. The left scapula is shown pressing into the adjacent vertebral bodies of C7 and T1, which resulted in deviations in the location of the left semispinalis capitis, semispinalis cervicis, and splenius cervicis muscles. This resulted in compromise of the left levator scapulae muscle. It is suspected that these abnormalities would have resulted in functional limitations in arm movement, particularly in adduction. A literature review was completed to understand the significance of these abnormalities.

Beyond The Ordinary: A Case of a Unilateral Persistent Sciatic Vein

Khulud Nurani, Khalid Ayub, Wambua Brian — Fri, 15 Mar 2024 00:00:00 -0500

Uncommon anatomical variations in venous structures continue to intrigue anatomists and clinicians alike. Here, we present a rare case of a unilateral persistent sciatic vein observed in the right thigh of an adult male cadaver. Unlike the commonly associated Klippel-Trenaunay-Weber syndrome, this finding emerged as an isolated phenomenon. During routine dissection, a conspicuous enlarged sciatic vein of lower type morphology was discovered in the right lower limb. This prominent vein, comparable in size to the sciatic nerve, originated from the confluence of posterior tibial, central soleal and peroneal veins at the distal end of the popliteal fossa. It ran a short course along the posterior thigh medial to the sciatic nerve, before terminating into the profunda femoris vein. This case underscores the importance of recognizing rare venous anatomical occurrences such as a persistent sciatic vein which predisposes one to deep vein thrombosis.

Case Study: Co-existing Isolated Internal Iliac Artery Aneurysm and Solitary Kidney

Mon, 25 Mar 2024 00:00:00 -0500

Purpose: The purpose of this case study is to report on an isolated internal iliac artery aneurysm (IIIAA) with solitary kidney found during cadaveric dissection and to discuss potential clinical implications of such a variation.

Methods: IIIAA and solitary kidney were discovered during cadaveric dissection performed by six nursing graduate students at Samford University in Birmingham, Alabama. Upon discovery, a literature review was performed to consider clinical implications, patient presentation, and management strategies associated with IIIAA and solitary kidney. This is the first time the pairing of these variations has been reported and thus it is difficult to speculate whether or not this person had symptoms associated with either of these conditions.

Results: IIIAA is independently associated with bladder, ureter, rectal, iliac vein, and sciatic nerve symptoms. Solitary kidney is associated with hypertension and end-stage renal disease.

Conclusion: As this variation was discovered post-mortem, it is unknown whether this condition was symptomatic.

Superior Thyroid Artery Originating from the Ascending Pharyngeal Artery

Wed, 10 Apr 2024 00:00:00 -0500

Background: The superior thyroid artery generally originates from the anterior surface of the external carotid artery. The superior thyroid artery originating from the ascending pharyngeal artery is an extremely rare anatomic variation. Nevertheless, some variations in the origin of the superior thyroid artery have been reported in the literature. Such knowledge is important during neck surgeries such as thyroidectomy and radical neck dissection. Here we report the first case of a superior thyroid artery arising from the ascending pharyngeal artery.

Case report: During a routine dissection on the neck, a superior thyroid artery originating from the ascending pharyngeal artery was observed on the right side, in a 37-year-old male cadaver. The superior thyroid artery had two segments, a superior (or horizontal) segment and an inferior (or vertical) segment. The superior segment passed posterior to the linguofacial trunk. The inferior segment passed posterior to the superior laryngeal artery and an artery that went to the infrahyoid muscles. These last two arteries came directly from the external carotid artery. The superior thyroid artery terminated in two branches (one lateral and one medial) 6 mm above the superior pole of the right thyroid lobe.

Conclusion: The origin of the superior thyroid artery from the ascending pharyngeal artery is an extremely rare anatomical variation. A thorough knowledge of the variations in origin of the superior thyroid artery is decisive for head and neck surgeries.

Bilateral Medially Duplicated Internal Jugular Veins in an 85-Year-Old Female Donor

Wed, 17 Apr 2024 00:00:00 -0500

An 85-year-old female donor prosected during an advanced anatomy graduate nursing course in 2023 was found to have bilateral anomalous internal jugular veins. These were classified as duplications as opposed to fenestrations, as each vein entered the subclavian vein separately. These variations have been classified into types A, B, and C. Type A is classified as a high fenestration joining to make a single entry into the subclavian vein. Type B is a duplication from just below the jugular foramen to the subclavian vein. Type C is a duplication starting commensurate to the hyoid bone with a laterally duplicated segment crossing the posterior triangle and making separate entry into the subclavian vein. This donor possesses a Type C bilateral medial variation with the duplicated limb descending medial to the carotid sheath and entering the subclavian vein lateral to the limb in standard position. Clinical ramifications and current literature are discussed.

Incomplete Transverse Pulmonary Fissures: Embryological Basis, Clinical, and Surgical Implications: A Cadaveric Case Report

Andrew Tito, Joseph Mwabaleke, Atuganile Mwasunga, Flora Fabian — Tue, 25 Jun 2024 00:00:00 -0500

Incomplete pulmonary fissures (IPF) represent a common anatomical variation in the human lung. While often considered silent, incomplete pulmonary fissures can have notable clinical and surgical implications, necessitating a comprehensive understanding of their anatomical characteristics. IPF may have significant implications in both clinical practice and surgical interventions. We report a case of an incomplete transverse fissure of the right lung from an adult male cadaver, exploring the embryological basis, clinical significance, and surgical implications. The findings underscore the importance of understanding the lung embryology and resulting normal anatomy, and associated anatomical variations to ensure accurate diagnosis, appropriate management, and optimal surgical outcomes.

Accessory Right and Left Hepatic Arteries in a 69 year-old White Female Donor with a Duplicated Inferior Vena Cava: Anatomical and Surgical Significance

Wed, 26 Jun 2024 00:00:00 -0500

Hepatic artery variations are relatively common findings in patients with an array of findings that were categorized and quantified in the Michels classification system. Findings of an accessory right and left hepatic artery were found in a 69 year-old white female donor with a duplicated inferior vena cava during routine anatomical dissection (Michels type 7 variation). Research supports that the hepatic artery variations can be due to either failure of regression of ventral anastomosis between the dual aortas or failed regression of fetal hepatic blood flow. Given the concurrent development of the IVC and aortic branches during the fourth to seventh week of gestation, this patient’s duplicated IVC and abnormal CT and SMA anatomy are likely related, both a result of failure of regression of fetal vasculature. There are no known associated comorbidities with this vascular variation however it is clinically significant when undergoing any hepatobiliary surgical procedures and suggests an increased risk for hepatic ischemic events.