(BMJ)—An 81-yo woman presented w/ a large lesion on her R buttock. Exam: 10-cm, malodorous, friable, fungating, and pedunculated tumor. Bx confirmed the surprising dx. What is it?
Squamous cell carcinoma
Malignant melanoma
Giant pyogenic granuloma
Cutaneous blastomycosis
Inflamed seborrheic keratosis
You are correct. Histological findings were consistent w/ an inflamed and irritated seborrheic keratosis, a benign skin growth commonly seen in adults and often called a senile wart. Unusual presentations of seborrheic keratoses have been reported, including those that have been confused w/ malignancy.

BMJ 2017;356:i6440
(BMJ)—An infant born at 39 wk by normal spontaneous vaginal delivery had bilateral swollen feet. Maternal screening for aneuploidy during 1st trimester was abnormal, but amniocentesis showed a normal female karyotype. Exam: bilateral dorsal foot edema. Cerebral U/S: normal. Echocardiography: patent foramen ovale. What is the dx?
Yellow nail syndrome
Turner syndrome
Noonan syndrome
Trisomy 13
Milroy dz
You are correct. Milroy dz is a rare developmental disorder of the lymphatics that leads to disabling and disfiguring swelling of the extremities. Congenital primary lymphedema can be caused by several genetic diseases (trisomy 13, 18, and 21, Turner syndrome, Noonan syndrome, lymphedema-distichiasis, or yellow nail syndrome) but this pt had isolated lymphedema, no other malformations, and a normal karyotype. The dx was confirmed by identification of a mutation in the FTL4/VEGFR3 gene. Tx of Milroy dz is conservative and includes physical therapy, exercise, and simple elastic compression.

BMJ Case Reports 2016; doi:10.1136/bcr-2016-215872