Rabdomiosarcoma alveolar con metástasis cardíaca en un paciente pediátrico / Alveolar rhabdomyosarcoma with cardiac metastasis in a pediatric patient

El rabdomiosarcoma es el tumor maligno de partes blandas más frecuente en la edad pediátrica. Puede afectar cualquier localización anatómica. El subtipo histológico alveolar suele causar lesiones en las extremidades en niños de mayor edad. Los sitios metástasicos más frecuentes son el pulmón, la médula ósea, el hueso y los ganglios linfáticos. Describimos el caso de un paciente con rabdomiosarcoma alveolar (RA) con metástasis cardíaca, una presentación poco frecuente de la patología.

Rhabdomyosarcoma is the most common malignant soft tissue tumor in pediatric age. It can affect any anatomical location. Alveolar histological subtype usually presents lesions on the extremities in older children. The most common metastatic sites are the lung, bone marrow, bone and lymph node. We describe a case of alveolar rhabdomyosarcoma with cardiac metastasis in a pediatric patient, a rare presentation of the pathology.

Papillary intralymphatic angioendothelioma: Dabska tumor

Abstract Papillary intralymphatic angioendothelioma (Dabska tumor) is a rarely metastasizing lymphatic vascular neoplasm that usually affects children and young adults. The majority of these cases occur in soft tissues of extremities, and to date less than 40 cases have been described. Despite the generally indolent evolution, can be locally invasive with the potential to metastasize. We describe a case of a young woman presenting with a plantar lesion, for 9 months and histological diagnosis of Dabska tumor. This neoplasm should be considered in the differential diagnosis of vascular dermatoses, allowing early diagnosis and treatment. Long-term follow-up should be performed.

Actinomicetoma plantar en un paciente sin factores de riesgo / Plantar actinomycetoma in a patient without risk factors

Resumen Se presenta un caso clínico de un actinomicetoma plantar en un paciente sin factores de riesgo, cuyo diagnóstico fue realizado mediante una biopsia de tejido plantar por sospecha de una neoplasia. Dado que el paciente no respondió satisfactoriamente a la terapia de primera línea, debió completar 24 semanas de tratamiento con doxiciclina, a lo cual evolucionó favorablemente. Finalmente, se desarrolla una breve discusión sobre los micetomas plantares.

A case of plantar actinomycetoma without risk factors is presented, which was diagnosed by hystopatological analysis of a foot biopsy because of the suspicion of neoplasia. Since the patient did not fully respond to the first-line therapy antibiotics, a 24-weeks doxycycline regime was started, achieving a satisfactory response. Finally, a brief discussion on plantar mycetomas is presented.

Prolonged survival after surgical resection of cerebral metastasis from melanoma with multisystemic metastasis already present: a case report and literature review

ABSTRACT CONTEXT: Malignant melanoma is the third most common cause of cerebral metastases after breast and lung cancer. Despite advances in therapeutic options, the prognosis for patients with cerebral metastases from melanoma remains poor, with a median survival time of six months after diagnosis. CASE REPORT: A 65-year-old woman was diagnosed with a malignant melanoma on the third toe of her left foot.The tumorous spot was excised surgically. However, the melanoma reappeared after one year and skin biopsy confirmed recurrence of malignant melanoma. Investigations showed metastasis to the left pelvic region, left lobe of the liver and right lobe of the lung.The patient then received chemotherapy. Subsequently, the patient was brought to the emergency department with an altered level of consciousness (Glasgow coma scale: 9) and hemiplegia on the right side of her body. Computed tomography scans of the brain revealed hemorrhagic lesions in the parieto-occipital lobes of the brain. Urgent surgical evacuation was done to remove the lesion, following which the patient showed improvement in her score on the Glasgow coma scale and a concomitant decrease in weakness. She was discharged from hospital with full consciousness.The patient died of acute renal failure 14 months after the brain surgery and approximately 4 years after the initial presentation of the case. CONCLUSION: This case outcome is rare and shows the effectiveness of surgery to treat cerebral metastasis from malignant melanoma in a situation with multisystem metastasis already present.

Unusual size, topography, and surgical resolution of an acquired fibrokeratoma

Abstract: Acquired fibrokeratoma is a rare benign skin tumor that usually manifests as a slow-growing solitary nodular lesion of the digits. We report a case of plantar acquired fibrokeratoma evidencing its atypical size and topography, in addition to the treatment with simple surgical excision followed by healing by second intention. Nondigital fibrokeratomas may occur in 18% of cases and rarely affect the palmoplantar region. These lesions are usually asymptomatic and show ≥ 3cm in size at the time of diagnosis due to delayed diagnosis. Complete surgical excision is the treatment of choice, which is usually curative. In general, primary closure is chosen; however healing by second intention becomes an option in regions of difficult approach.

Melanoma amelanótico acral en un paciente diabético / Acral amelanotic melanoma in a diabetic patient

Melanoma is one of the most aggressive and worse prognosis tumors. Early diagnosis is essential to offer therapeutic alternatives. Presentation may be variable. Within these the amelanotic melanoma form. We present the case of a patient treated at the ¨Hospital Regional de Talca¨, with an unclear diagnosis of melanoma at a first moment given the characteristics and location of the lesion, the history of trauma and the patient comorbidities, which after biopsy and immunohistochemical analysis, the diagnosis of amelanotic melanoma is possible.

Melanoma developed during pregnancy - A case report

We describe a case of plantar interdigital cutaneous melanoma in a 22-year-old woman who reported changes in a pigmented lesion during pregnancy. Diagnosis was late and evolution unfavourable. The purpose of this report is to draw the attention of dermatologists to the need for careful regular examination of melanocytic lesions in pregnant women, not ignoring possible changes as always physiological.

Tungiasis under dermoscopy: in vivo and ex vivo examination of the cutaneous infestation due to Tunga penetrans / Tungíase sob dermatoscopia: exame in vivo e ex vivo da infestação cutânea pela Tunga penetrans

The female flea Tunga penetrans is responsible for a cutaneous parasitosis known as Tungiasis. We report the clinical case of a 12 year-old Caucasian boy who sought treatment in a dermatological private office due to a painful lesion in the plantar area and whose dermoscopic examination, without skin contact, allowed the visualization of parasite's movement inside the skin. The diagnosis of tungiasis is clinical, but it can be aided by in vivo and ex vivo dermoscopic examination of the lesion.

A fêmea da pulga Tunga penetrans é responsável pela dermatose ectoparasitária denominada Tungíase. Relatamos o caso clínico de um adolescente branco de 12 anos de idade, o qual procurou atendimento em consultório dermatológico devido à lesão dolorosa na planta e cujo exame dermatoscópico sem contato com a pele permitiu visualizar o movimento do parasita dentro da pele. O diagnóstico da tungíase é clínico, porém pode ser auxiliado pelo exame dermatoscópico in vivo e ex vivo da lesão.

Signo de Leser-Trélat asociado a adenocarcinoma gástrico: Caso clínico / Leser-Trélat sign associated with gastric cancer: Report of one case

We report a 66-year-old male presenting with malaise, heartburn and pruritic seborrheic keratoses in both feet of sudden onset, suggesting a Leser-Trélat sign. An upper gastrointestinal endoscopy disclosed a gastric cancer. The patient was subjected to a total gastrectomy and duringfollow up, the skin lesions had disappeared.

Late diagnosis of nodular melanoma of the foot in a 74-year-old Brazilian man / Diagnóstico tardío de melanoma nodular del pie en un varón con 74 años

The incidence and mortality of malignant melanoma is increasing. Its early diagnosis can contribute to a favorable prognosis. We report a 74-year-old black man with a dark brown mole in the right plantar area, that grew slowly in the last decade. A biopsy of the lesion revealed a nodular malignant melanoma. A wide excision of the tumor was performed 18 months ago, followed by chemotherapy for nine months. At admission, the patient was debilitated, and presented with numerous nodules in the lower limb and suprapubic area. Imaging studies disclosed chest and abdominal nodules. The patient died 13 days after admission.

Melanoma maligno constituye una importante preocupación debido al incremento de la incidencia y mortalidad. El diagnóstico precoz de esta malignidad puede contribuir para prognósticos favorables. Se describe el diagnóstico tardío de melanoma nodular del pie en un varón afro-brasileño con 74 años de edad. El propósito es aumentar el índice de sospecha acerca de esta infrecuente localización del tumor de la piel, y estimular a los médicos de cuidado primario para realizar examen minucioso del cuerpo entero, contribuyendo a la detección temprana de los cánceres de piel.

Linfangioma microcístico acral: diagnóstico diferencial em lesões verrucosas de extremidades / Acral microcystic lymphangioma: differential diagnosis in verrucous lesions of the extremities

Linfangioma é uma má-formação originária da migração anormal de tecido linfático, levando a falhas na comunicação e na drenagem da linfa. Apresenta-se mais comumente como vésico-pápulas agrupadas de conteúdo translúcido na pele ou mucosas. A apresentação inicial na forma de placa verrucosa limitada a um único pododáctilo é atípica e reforça a relevância deste relato. Ainda que considerado lesão benigna, o linfangioma, a depender de sua localização e dimensão, pode apresentar dor local ou infecções recorrentes, com interferência substancial na qualidade de vida. Relatamos caso de linfangioma circunscrito a pododáctilo de surgimento tardio na idade adulta, na forma de placa verrucosa - apresentação atípica confirmada apenas após histopatológico. A excisão cirúrgica garantiu resposta estética e funcional satisfatória.

Lymphangiomas are a malformation caused by the abnormal migration of lymphatic tissue, leading to failures in the communication and drainage of the lymphatic system. They usually present as groups of translucent papules and vesicles in the skin or mucous membranes. Presentation as a verrucous plaque limited to a single toe is unusual and emphasizes the relevance of this case report. Although considered a benign lesion, depending on the site affected by the lymphangioma and its size, it may lead to localized pain or recurrent infections, substantially affecting the patient's quality of life. The present case report describes a patient with lymphangioma of late onset developing in adulthood in the form of a verrucous plaque confined to a single toe. Diagnosis of this unusual presentation could only be confirmed following histopathology. Surgical excision resulted in a satisfactory functional and cosmetic outcome.

Pé de Charcot: relato de caso antes e após participação em programa de educação em diabetes (doce desafio) / Charcot’s foot: reported case of a diagnosed diabetic person and result safter participation oriented program of physical activities to diabetic people(doce desafio/sweet-challenge)

Pé de Charcot é uma complicação rara que pode acometer diabéticos, em especial se mal controlados,sendo de alta morbidade. Estudo de caso de diabético, feminino, 44 anos de idade, ensino médio, 11anos de diagnóstico de DM, em insulinoterapia, com quadro de Pé de Charcot há 3 anos. Relacionou-sedados acerca de seu modo de vida e como ele se comporta em relação à patologia pré e pós Charcot.Informações foram coletadas através de entrevista e dados coletados nos prontuários do Doce DESAFIO.O sujeito relatou dificuldades, no princípio, para que o diagnóstico fosse estabelecido, referindo inclusiveter sido solicitado vários exames radiológicos após descrição de quadro álgico e edema, onde não foidetectado o desabamento do pé, característico do Pé de Charcot. Após aproximadamente 2 mesesdiagnosticou-se Charcot e foi prescrita palmilha e tala, que diminuíram os sintomas. Ao ingressar noDoce DESAFIO, 16 meses após, suas glicemias eram usualmente maiores que 500mg/dl. Apresentavamedo de episódios hipoglicêmicos, às vezes evitando aplicar insulina diária caso não tivesse certezaquanto às atividades e refeições ao longo do dia. Buscava corrigir hiperglicemias maiores que 250mg/dlcom valor fixo de 5u de insulina regular, independente da medida suposta ou aferida. A partir dasorientações de educação em diabetes, a monitorização foi iniciada, obteve mais informações sobre apatologia, especialmente sobre ação das insulinas e ajustes seguindo adaptações relacionando asmedidas da glicemia aferida com a insulina exógena a ser aplicada e, junto ao médico, a insulinização foimelhor distribuída e adequada, para a melhora da sua qualidade de vida. Também no Doce DESAFIO,além de orientação de atividade física para melhora da circulação periférica, houve fortalecimento damusculatura e tendões adjacentes para que fossem minimizadas as conseqüências do quadro. Atualmente,segundo a própria sua glicemia tem se mantido em torno de 96-125mg/dl...

Charcot’s Foot: a rare and high morbidity diabetic complication, especially in those with poor glycemiccontrol. Case study of a diabetic woman, age 44, high school; diabetes diagnosed 11 years ago, ininsulin therapy, 3 years since Charcot’s Foot diagnosis. Lifestyle and behavior information related tothe pathology pre and post-Charcot were collected through interview and from Sweet-Challenge (DoceDESAFIO) records. RESULTS: Diagnosis difficulties were refereed, even after various radiological examsfollowing pain and edema descriptions. Approximately 2 months after Charcot’s diagnosis, splint andfeet cast were prescript. Before joining Sweet-Challenge (16 months after), the glycemic values wereusually >500 mg/dl. There was apprehension of hypoglycemic episodes, sometimes avoiding insulinadministration when there wasn’t certainty about the activities and meals of the day. Hyperglycemiawas usually corrected with a fixed amount of 5U of regular insulin, not taking the measure onconsideration. With orientation from Sweet-Challenge, self-monitoring of blood glucose (SMBG) began.The information received was especially about insulin and its adjustments. With a physician, the insulintherapy improved. Oriented exercises for improvement of peripheral circulation and muscularstrengthening were initiated, thus, optimizing the prognostics; aiming the improvement of her quality oflife. She said that her glycemic values ranged 96-125 mg/dl after attending the Sweet-Challenge. Herattendance was about 1 time/month or a bit more. At the end of the classes her blood glucose was about168±65mg/dl. CONCLUSION: Self-confidence and consciousness of her diabetes control from theinstructions received was related, and also a better disposition and self-control was observed.

Neoplasia maligna en cicatriz de quemadura: úlcera de Marjolin: informe de dos casos y revisión de la literatura / Malignant neoplasm in burn scar: Marjolin's ulcer: report of two cases and review of the literature

BACKGROUND: Marjolin's ulcer forms part of a group of neoplasms that originate in a burn scar, a phenomenon associated with superficial tissue trauma. The frequency of Marjolin's ulcer is low and represents between 2 and 5% of all squamous cell carcinomas of the skin. This condition is found three times more frequently in men than in women and is thought to be more aggressive than conventional squamous cell carcinoma of the skin. CLINICAL CASES: We present two cases of squamous cell carcinoma that originated on a burn scar. 41 year old woman with gasoline burn on the left foot, 3 months old, in whom an exofitic ulcerated lesion on the right calcaneum region has evolved since she was 32 years old. Left transtibial amputation was decided. Another woman who started its suffering 9 years after a thorax burn with a progressive fungus lesion on the scar area. For its size and as it was a high degree neoplasia, surgical resection and radiotherapy to the zone of the primary with 50 Gy in 25 fractions was decided. CONCLUSIONS: Marjolin's ulcer usually occurs in old burn sites that were not skin grafted and were left to heal secondarily. Although it is believed that there is a latency period of 25-40 years after burn injury before the occurrence of malignancy, this may occur in a period as short as 3 months. Recurrence after radical surgery is 14.7%. Nonetheless, because of the aggressive behavior of this type of cancer, appropriate radical treatment allows an adequate control of the disease. Early grafting of the burn site can prevent the formation a malignant neoplasm. This condition should be suspected in a non-healing chronic ulcer on a burn scar.

Fisiopatología y clínica del pie diabético / Pathophysiology and clinical features that involve the foot in diabetic patients

Emergencies that involve the foot in diabetic patients are a very common cause of morbidity. Ischemia is of prime importance but, in addition, neuropathy (with hypoesthesia) and sepsis are factors. Infections may follow minor trauma, or may be secondary, either to a long-standing ulcer or to an area of gangrene. The major importance of chronic ulcers of the feet, is that they are a portal of entry for infection. All these considerations are described in the article, with special considerations to the shoes employed and the stay.

Synovial sarcoma of the foot: case report

Synovial sarcoma is a rare soft tissue sarcoma in the foot. It is commonly localized in the extremities, especially the lower thigh and knee areas. The histopathological immunohistochemical, and cytogenetic findings of a foot synovial sarcoma are described

[Postpartum foot drop a case report]

Postpartum foot drop is the clinical manifestation of lumbosacral plexus radiculopathy [LPR] which is a neurological maternal complication in obstetrics. It is mainly due to cephalopelvic disproportion. Occurring also in the third trimester of the pregnancy, this pathology includes motor and sensitive disorders interesting the lumbosacral plexus territory. Its diagnosis and physiopathology are based on electromyographic data. The prognosis is commonly favourable after a physical therapy program. The prevention is primarily based on the management of mechanic dystocia