ABSTRACT
Dirofilariasis is an emerging rare zoonotic disease in which man is a dead-end host and it is transmitted by mosquitoes. The cases of dirofilariasis are increasing over the past few years. Several species of the genera Culex spp., Aedes spp., and Anopheles spp. are involved in the transmission of this parasite. These species represent a constant risk of infection because they feed on both animal and human hosts. For this reason, dirofilariasis is considered an emerging public health problem because of its zoonotic potential. Most of the cases are ocular and subcutaneous presentations are rare. Here, we present a rare case of dirofilariasis presenting as a subcutaneous swelling near the knee joint. Dirofilariasis should be kept in mind as one of the differential diagnosis of subcutaneous nodule. In endemic areas, it can present in atypical forms like rash similar to this case; therefore, clinicians should be aware about this disease.
ABSTRACT
Backg round: Dermatofibroma sometimes clinically presents as a nodular lesion without gross skin surface change. Clinicopathologic features of this variant of dermatofi broma have not been evaluated. Aims: To assess clinicopathologic features of dermatofi broma presenting as a subcutaneous nodule. Methods: This study reviewed the clinical and histological features of 42 cases of subcutaneous dermatofibromas and compared them with 95 cases of conventional dermatofi broma. Results: Dermatofi broma without gross skin surface change was associated with a shorter pre-diagnosis duration than conventional dermatofi broma. Increase in size during the pre-diagnosis period was signifi cantly more frequent in the conventional type. In addition, these dermatofi bromas were more likely than the conventional type to occur in the head and neck region. Although tumor depth was deeper than in the conventional type, less than half of the dermatofi bromas without gross skin surface change were found histologically to be “subcutaneous” or “deep-penetrating dermatofi broma”. Subcutaneous extension was more frequent in these dermatofi bromas while focal stromal hyalinization and hemosiderin deposits were more common in the conventional type. Limitations: This study is a retrospective, single center design. Conclusion: The present study suggests that dermatofi broma without gross skin surface change is a variant type with distinct clinical and histological features that distinguish them from conventional dermatofi broma.
Subject(s)
Adult , Female , Histiocytoma, Benign Fibrous/anatomy & histology , Histiocytoma, Benign Fibrous/diagnosis , Histiocytoma, Benign Fibrous/epidemiology , Histiocytoma, Benign Fibrous/genetics , Histiocytoma, Benign Fibrous/pathology , Male , Skin/anatomy & histology , Surface PropertiesABSTRACT
The present study reports a human case of cutaneous gnathostomiasis with recurrent migratory nodule and persistent eosinophilia in China. A 52-year-old woman from Henan Province, central China, presented with recurrent migratory reddish swelling and subcutaneous nodule in the left upper arm and on the back for 3 months. Blood examination showed eosinophila (21.2%), and anti-sparganum antibodies were positive. Skin biopsy of the lesion and histopathological examinations revealed dermal infiltrates of eosinophils but did not show any parasites. Thus, the patient was first diagnosed as sparganosis; however, new migratory swellings occurred after treatment with praziquantel for 3 days. On further inquiring, she recalled having eaten undercooked eels and specific antibodies to the larvae of Gnathostoma spinigerum were detected. The patient was definitely diagnosed as cutaneous gnathostomiasis caused by Gnathostoma sp. and treated with albendazole (1,000 mg/day) for 15 days, and the subsequent papule and blister developed after the treatment. After 1 month, laboratory findings indicated a reduced eosinophil count (3.3%). At her final follow-up 18 months later, the patient had no further symptoms and anti-Gnathostoma antibodies became negative. Conclusively, the present study is the first report on a human case of cutaneous gnathostomiasis in Henan Province, China, based on the past history (eating undercooked eels), clinical manifestations (migratory subcutaneous nodule and persistent eosinophilia), and a serological finding (positive for specific anti-Gnathostoma antibodies).
Subject(s)
Animals , Female , Humans , Middle Aged , Anthelmintics/therapeutic use , Antibodies, Helminth/immunology , China , Eosinophilia/diagnosis , Gnathostoma/immunology , Gnathostomiasis/diagnosis , Skin Diseases, Parasitic/diagnosisABSTRACT
BACKGROUND: Ultrasonographic imaging is very useful tool to determine various neoplasms and inflammatory changes of the human body. In addition, thanks to the use of various frequencies in ultrasonography, subcutaneous and some dermal lesions can be evaluated without invasive procedures such as a biopsy. OBJECTIVE: This study was performed to evaluate the usefulness of ultrasonography in the diagnosis of subcutaneous nodules. METHODS: We reviewed the medical records of 29 patients with subcutaneous nodules and analyzed the correlation between ultrasonographic findings and final biopsy findings. The HDI-5000 ultrasonography system (Philips, Eindhoven, Netherlands) with variable probes (from 5 to 12 MHz) was used in this study. RESULTS: In 27 patients, ultrasonographic findings were matched with final biopsy findings. One pilomatricoma was misdiagnosed as a cyst and one hemangioma as lipoma. It was very interesting to find that two malignant tumors and one subcutaneous granuloma annulare were detected by ultrasonographic examination in the absence of any clinical clues. CONCLUSION: Ultrasonography is a very useful, noninvasive, easy to apply, and relatively predictive tool for the evaluation of subcutaneous nodules. Although a skin biopsy is necessary for final diagnosis, ultrasonography would be a good substitute in the diagnosis of subcutaneous nodules when the patient refuses a skin biopsy and the nodule is located in a highly cosmetic area.
Subject(s)
Humans , Biopsy , Diagnosis , Granuloma Annulare , Hemangioma , Human Body , Lipoma , Medical Records , Pilomatrixoma , Skin , UltrasonographyABSTRACT
Nodular cystic fat necrosis is a distinct benign subcutaneous nodule characterized by encapsulated necrosis of subcutaneous fat in which non-viable adipose cells are pathologically surrounded by fibrous tissue. We report a case of nodular cystic fat necrosis in a 47-year-old woman who presented with a 2-month history of had multiple highly- movable, subcutaneous nodules on both shins and posterior thigh. There was an absence of any noteworthy trauma history. Each lesion showed a highly-migratory property, and could easily be moved about 10 cm in any direction. Plain film revealed multiple radiopaque nodules on the right shin. Calcification and lipomembranous changes, in addition to typical features, were also found on histopathologic examination.
Subject(s)
Female , Humans , Middle Aged , Fat Necrosis , Necrosis , Subcutaneous Fat , ThighABSTRACT
Sparganosis is an infection caused by sparganum, the generic term for the migrating plerocercoid larva of tapeworm which belongs to the species Spirometra. We experienced two cases of sparganosis. The first patient was a 49-year-old woman. She visited our hospital because of a painful subcutaneous nodule on her left forearm, which had developed on her left shoulder at first and migrated to the medial aspect of the forearm. She had drunk fresh water 12 years ago at a mountain. The second patient was a 39-year-old man who showed a subcutaneous nodule on the right lower leg. He had eaten raw snake about 20 years ago. Sparganosis was confirmed after the larval worms were found in the excised tissues in both cases.
Subject(s)
Adult , Female , Humans , Middle Aged , Cestoda , Forearm , Fresh Water , Larva , Leg , Shoulder , Snakes , Sparganosis , Sparganum , SpirometraABSTRACT
BACKGROUND: The occurane of sarcoidosis seems to be increased recently. A proportion of patients initiallly visit the derrnatological department. However, there are few clinical reports about sarcoidosis for the dermatolagist. OBJECTIVE: This study wa performed to find the clinical and histopathological characteristis of sarcoidosis as a multisystemic disease. METHODS: We reviwed the chart of patients with sarcoidosis who were diagnosed at SNUH from 1984 to 1994 and analysed the characteristics of the clinical and histopathologic findings according to several factors. RESULTS: 1)Man to woman ratio was 1: 2 and 70% of patients were in theirs third to fifth decades. 2)The main complaints were respiratory symtoms and cutaneous lesion. 3)The most frequently invloved organ was intrathoracic, followed by skin, peripheral lymph node, eye and bone in that order. 4)The cutaneous lesion was found in 50% of patients(15 out of 30) and specitic lesions were present in 14 cases. A subcitaneous nodule was the most common lesion(67%). 5)In subcutaenous sarcoicosis, there was hilar lymphadenopathy in 70% of the patients, lung parenchymal infiltration in 10%, peripheral lymphadenopathy in 30%, bony lesion in 30%. 6)The laboratory and histopathological findings were similar to previously reported results. CONCLUSION: The general features of patients were similar to other reports except for the fre quency of cutaneous involviment. Cutaneous involvement was found in 50% of patients and this was higher than in foreigr reports. In cutaneous sarcoidosis, the subcutaneous nodule was the most frequent specific lesior.