ABSTRACT
PURPOSE: Typically, a diagnosis of erythema nodosum (EN) is based on clinical features. However, other diseases manifest with inflammatory nodules of the lower limbs in addition to EN, such as the EN-like lesions of Behcet's disease (BD). The purpose of this retrospective study was to investigate the frequency of histologically proven EN among diseases diagnosed clinically as EN, to determine underlying causes of EN, and to compare clinical and histologic features between EN and other diseases. PATIENTS AND METHODS: We selected 99 patients diagnosed clinically with EN and performed skin biopsies. All pathologic slides were evaluated and diagnosed; and after histologic diagnoses were made we reviewed the patients' medical records. RESULTS: Among the 99 patients diagnosed clinically with EN, 47 were biopsy-verified EN. The EN-like lesions of BD and nodular vasculitis were both in the primary differential diagnosis of EN. No definite difference in clinical features exists among these three diseases. Histologically, EN demonstrated septal panniculitis in the majority of patients. Lobular panniculitis was frequently observed in NV, and mixed or mostly lobular panniculitis was observed in the EN-like lesion. Vasculitis was rarely observed in EN; however lymphocytic vasculitis was observed frequently in EN-like lesions and neutrophilic vasculitis was observed in NV. The frequency of granulomatous inflammation was highest in NV. Some cases of patients with typical BD demonstrated classic EN lesions. CONSLUSION: It was extremely difficult to clinically differentiate EN from EN-like lesions or NV. We feel skin biopsy is mandatory for the diagnosis of lower extremity erythematous nodular lesions.
Subject(s)
Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Diagnosis, Differential , Erythema Nodosum/etiology , Retrospective StudiesABSTRACT
EL DIAGNOSTICO HISTOLÓGICO DE LA INFECCIÓN por Helicobacter pylori (Hp) puede ser difícil, principalmente en casos con pocos microorganismos. Nuestro objetivo fue determinar si hay diferencias significativas en la frecuencia del diagnóstico de la infección por Hp entre patólogos que laboran en Medellín. MATERIALES Y MÉTODOS: revisamos todos los informes de biopsias gástricas de ocho patólogos durante un año. Excluimos las biopsias con metaplasia, atrofia, displasia o carcinoma. Registramos la edad del paciente, la presencia o ausencia de Hp y el patólogo que estudió la biopsia. Calculamos el porcentaje de casos con la infección y el porcentaje por patólogo. Finalmente, comparamos estos porcentajes para determinar las diferencias. RESULTADOS: incluimos 2.023 casos en el presente estudio. El número de biopsias evaluadas por patólogo fue de 252,9 ± 154,9 (rango: 102-445). La edad promedio de los pacientes fue de 43,5 ± 15,1 años (rango 12-90). En 1.034 casos (51,1%) se diagnosticó la infección. La tasa de positividad para Hp por patólogo tuvo un rango de 38,8 a 71,1%, con una media de 51,1% ± 8,7% (p < 0,001). CONCLUSIÓN: hay una variabilidad significativa en la frecuencia de infección por Hp de acuerdo con el patólogo que interpreta la biopsia. Este resultado sugiere la necesidad de estudiar más a fondo la situación, buscando mayor homogeneidad de conceptos y criterios para el diagnóstico de esta infección y, posteriormente, mayor refinamiento en la graduación de su gravedad.
Histopathologic diagnosis of Helicobacter pylori (Hp) infection is not necessarily easy, and reproducibility is not perfect. Our aim was to determine differences in the frequency of Hp infection according to the pathologists interpreting gastric biopsies in Medellín ( Colombia ). MATERIAL AND METHODS: All gastric biopsy reports of eight pathologists during one year were reviewed. We excluded cases with intestinal metaplasia, atrophy, dysplasia or carcinoma. We registered patient age, positivity or negativity for H. pylori, and pathologist. We determined the percentage with H. pylori infection and the percentage of each pathologist in order to determine differences. RESULTS: 2.023 cases were included. Each pathologist evaluated a mean of 252.9 ± 154.9 cases (range: 102-445). Patients were 43.5 ± 15.1 years-old (range: 12-90). H. pylori was diagnosed in 1.034 cases (51.1%). The range of positivity according to the pathologist was 38.8-71.1%; mean 51.1% ± 8.7% (p < 0,001). CONCLUSION: Among pathologists, there is a significant variability in the frequency of diagnosis of H. pylori infection. This result suggests the need to achieve greater homogeneity of concepts and criteria for the diagnosis of this infection, and of its severity.