ABSTRACT
Background: Cutaneous vasculitis is common, yet the riskfactors for its chronicity have not been established.Objective: To describe the clinical spectrum and identify riskfactors for chronicity of cutaneous vasculitis.Methods: Retrospective data analysis of 275 patientsdiagnosed with cutaneous vasculitis from January 2008 toDecember 2013.Results: The mean age was 33.7 (±17.89) years, with femalepredominance. The majority of patients were Malays (67.3%).Skin biopsy was performed in 110 (40%) patients. Thecommonest sign was palpable purpura (30.6%). Theaetiology remained elusive in 51.3% of patients. Commonidentifiable causes include infection (19.7%) and connectivetissue disease (10.2%). Extracutaneous features were notedin 46.5% of patients. Erythrocyte sedimentation rate andantinuclear antibody were raised in 124 of 170 and 27 of 175patients with documented results respectively. Cutaneousvasculitis was the presenting symptom in seven patientswith newly diagnosed systemic lupus erythematosus. AntiStreptolysin O Titre was positive in 82 of 156 patients withdocumented results. Despite antibiotics, 31.7% of them hadchronic lesions. Prednisolone alone was used in 20% ofpatients while 16.4% needed steroid-sparing agents. Mostpatients who needed systemic therapy (62%) hadunidentifiable aetiology. Among the 155 patients whoremained under follow up, 36.4% had chronic disease, onepatient succumbed due to septicaemia, and the rest fullyrecovered within three months. The presence of ulcerativelesion was significantly associated with developing chronicvasculitis (p=0.003).Conclusion: The clinical spectrum of cutaneous vasculitis inour population was similar to other studies. Ulcerativelesion predicts a chronic outcome
ABSTRACT
Plasma cell granuloma is a rare benign tumor lesion that is classified and described under the pseudo inflammatory tumor category. Its occurrence in the oral cavity is rare, making diagnosis and treatment really difficult, as it bears some clinical similarity with malignant tumor diseases. Proper diagnosis and treatment of PCG requires performing biopsy and a histopathological/immunohistochemicalstudy to rule out possible plasma and neoplastic cell dyscrasias. Consequently, the use of these auxiliary diagnostic devices will enable us to provide the appropriate treatment for the patient. In this study, we present the case of a 63-year-old female patient with a tumor/ulcerative lesion of the left buccal mucosa of a month of evolution and a tumor/ulcerative lesion on the right buccal mucosa of 15 days of evolution after the onset of the first lesion. The patient was treated successfully for a period of one year with immunosuppressive drugs, and to date the disease is inactive. The purpose of this paper is to show one of the most unusual locations in the oral cavity affected by this pathological entity, its clinical and histological features, and establish the differential diagnosis correctly with other malignant or benign disease entities, suggesting the most suitable treatment for this type of condition...
El Granuloma de Células Plasmáticas es una rara lesión tumoral benigna descrita dentro de la clasificación de tumores pseudoinflamatorios, es rara su aparición dentro de la cavidad oral, haciendo realmente complicado su diagnóstico y tratamiento, ya que presenta similitud clínica con patologías tumorales malignas. Para el adecuado diagnóstico y tratamiento del GCP, se requiere de la realización de biopsia y estudio histopatológico/inmunohistoquímico, para descartar posibles discrasias de las células plasmáticas y neoplásicas, de tal forma que el uso de estos auxiliares de diagnóstico nos permitirá sustentar de manera adecuada el tratamiento otorgado al paciente. Se presenta el caso de paciente femenino de 63 años de edad, con una lesión tumoral/ulcerativa de la mucosa yugal izquierda de un mes de evolución y lesión tumoral/ulcerativa de la mucosa yugal derecha de 15 días de evolución posterior a la aparición de la primera lesión, tratada por un periodo de un año con inmunosupresores de forma exitosa ya que a la fecha la paciente presenta inactiva la enfermedad. El propósito de este manuscrito es mostrar una de las localizaciones más extrañas de esta entidad patológica en la cavidad oral, sus características clínicas e histológicas, establecer de forma correcta el diagnóstico diferencial con otras entidades patológicas malignas ó benignas y así emplear el tratamiento requerido para la forma en que se presente la misma...
Subject(s)
Humans , Female , Middle Aged , Mouth Diseases/pathology , Mouth Diseases/drug therapy , Granuloma, Plasma Cell/pathology , Granuloma, Plasma Cell/drug therapy , Biopsy , Diagnosis, Differential , Immunosuppressive Agents/therapeutic useABSTRACT
Necrotizing sialometaplasia (NSM) is a rare benign, inflammatory disease of both major and minor salivary glands, although more commonly reported in the minor glands of the palate. The characteristic clinical presentation can perplex the clinician and may be mistaken for a malignant neoplasm, such as mucoepidermoid carcinoma, as well as invasive squamous cell carcinoma. The clinical and histological similarity between this entity and a malignant lesion may result in unnecessary or mis-treatment. Though clinically mimics malignancy, NSM is considered to be a self-limiting disease, and takes about 3-12 weeks to resolve. Majority of the case resolves itself or by supportive and symptomatic treatment. Surgical intervention is rarely required in NSM except the diagnostic biopsy. Herein we report the clinical, histopathological feature and surgical management of a case of NSM of hard palate in a young adult male.
ABSTRACT
Traumatic ulceration of the ventral surface of the tongue is an uncommon condition in infants and toddlers, which is often associated with natal and neonatal teeth in newborns. The aim of this report is to present a case of bilateral ulcerative ulcers on the ventral surface of the tongue caused by the eruption of first primary mandibular molars in a 14-month-old male child. The child was able to point to the lesions and also refused to consume certain beverages and foods, which favored an early diagnosis. Clinical treatment consisted of manual smoothing of the sharp edges of both mandibular first molars and a home regimen of lidocaine hydrochloride solution (Xylocaine®, Astra) and a steroid solution of triamcinolone acetonide (Omcilon A, Brystol-Myers) for symptoms relief and lesion healing, respectively. Complete healing of both lesions and normal feeding were both observed at a one-week follow-up exam. Early detection of the lesions and parental compliance with recommended home regimens were key factors for a successful treatment outcome, since untreated cases of tongue ulcerative lesions may evoke feeding difficulties and failure to thrive. Although there are several reports of ulcerative lesions on the tongue caused by dental eruption, they are usually associated with the eruption of mandibular primary incisors (Riga-Fede disease). However, there are no reports of ulcerative lesions caused by other primary teeth.
La ulceración traumática de la superficie ventral de la lengua es una condición poco común en bebés y niños pequeños, la cual se asocia a menudo con los dientes natales y neonatales en los recién nacidos. El objetivo de este reporte es presentar un caso de úlceras bilaterales en la superficie ventral de la lengua causada por la erupción de los primeros molares mandibulares temporales en un infante de sexo masculino de 14 meses de edad. En niño fue capaz de señalar las lesiones y se negó a consumir ciertas bebidas y alimentos, lo que favoreció un diagnóstico precoz. El tratamiento clínico consistió en el suavizado manual de los bordes afilados de los primeros molares inferiores y un régimen casero de solución de clorhidrato de lidocaína (Xilocaína®, Astra) junto a la solución esteroidal de acetónido de triamcinolona (Omcilon - A, Brystol-Myers) para el alivio de los síntomas y curación de la lesión respectivamente. La curación completa de ambas lesiones y la alimentación normal se observó en una semana del control de seguimiento. La detección temprana de las lesiones y el cumplimiento de los padres con los regímenes caseros recomendados, son factores claves para un resultado exitoso del tratamiento, ya que los casos no tratados de estas lesiones ulcerosas pueden provocar dificultades en la alimentación y una evolución inadecuada. Aunque existen varios informes de lesiones ulcerosas en la lengua causada por la erupción dental, que se asocian generalmente con la erupción de los incisivos mandibulares temporales (enfermedad de Riga-Fede). Sin embargo, no existen informes de lesiones ulcerosas causadas por otros dientes temporales.
Subject(s)
Humans , Male , Infant , Natal Teeth/physiopathology , Tongue Diseases/etiology , Tongue/injuries , Oral Ulcer/etiology , Tongue Diseases/therapy , Tooth Eruption , Oral Ulcer/therapyABSTRACT
BACKGROUND/AIMS: Various etiologies and diseases may be related to erosions and/or small ulcers without gross inflammatory changes in the surrounding mucosa found in the colon and terminal ileum during colonoscopy. However, studies on follow-up of these lesions are rare. Thus, we investigated the clinical significance of these lesions and their characteristics helpful for differential diagnosis. METHODS: We reviewed the data of 183 patients with colonoscopically observed erosive or small ulcerative lesions (<2 cm), and analyzed them according to the location, number, and size of lesions, histopathologic findings, chief complaints, laboratory findings, changes of symptoms, and changes in lesions during 4-12 week follow-up period. RESULTS: Histopathologic findings of these lesions included acute nonspecific inflammation, chronic nonspecific inflammation, Crohn's disease, tuberculous colitis, ischemic colitis, Behcet's disease, cytomegalovirus infection, eosinophilic colitis, ulcerative colitis or pseudomembranous colitis, but most of them were nonspecific (84%). In patients with nonspecific inflammation, histopathologic findings, symptoms, location and multiplicity of the lesions were not prognostic factors for the persistency of symptoms and lesions during follow-up period. Two patients with acute inflammation, who showed no improvement in symptoms and lesions, were later diagnosed as Crohn's disease. CONCLUSIONS: Erosive or small ulcerative lesions without macroscopic inflammatory changes in the surrounding mucosa during colonoscopy, are mainly nonspecific. However, careful follow-up is required when the symptoms and/or lesions are not improved.