Cutaneous tuberculosis and squamous-cell carcinoma / Tuberculose cutânea e carcinoma de células escamosas

The incidence of all forms of cutaneous tuberculosis, including lupus vulgaris (the most common form) decreased progressively in developed countries during the twentieth century, this change being attributed to improved living standards and specific therapy. Despite the decrease in cutaneous tuberculosis, some cases are still found and correct diagnosis and management are fundamental, both for the patients and for public health. Long lasting, misdiagnosed or untreated cutaneous tuberculosis may lead to different forms of cancer. This case report involves a 74-year old male farmer with lupus vulgaris on his face. During anti-tuberculosis treatment he developed a tumor on his forehead, which was histologically confirmed as a squamous cell carcinoma.

A incidência de todas as formas de tuberculose cutânea, incluindo o lúpus vulgar (a forma mais comum) diminuiu progressivamente nos países desenvolvidos durante o século XX e esta mudança foi atribuída a melhores condições de vida e uso de terapia específica. Apesar da diminuição da TBC cutânea, alguns casos ainda são detectados hoje em dia e o diagnóstico acurado e o tratamento apropriado são fundamentais para os doentes e a saúde pública. A TBC cutânea quando prolongada, diagnosticada erroneamente ou não tratada pode levar a diferentes neoplasias. Este é o relato de um caso de lúpus vulgar na pele do rosto de uma paciente do sexo masculino, agricultor, de 74 anos de idade. Durante a terapia antituberculosa ele desenvolveu um tumor na pele da testa, histologicamente confirmado como carcinoma de células escamosas.

Tuberous sclerosis with portal vein thrombosis, protein C and S deficiency.

A 29-year-old lady with a bad obstetric history and portal vein thrombosis, presented to the Skin OPD for facial lesions. On examination, angiofibromas on face, shagreen patch and periungual fibromas were observed. She also had dental pits and a retinal hamartoma. Investigations revealed hamartomas in the brain and kidney. Hematological work-up showed protein C and S deficiency with Factor V Leiden positivity. Except for the cutaneous symptoms, the patient did not have any clinical manifestations in other organs affected by tuberous sclerosis. A similar association of tuberous sclerosis with protein C deficiency has been reported in only one case in literature.

PHACES syndrome with congenital hypothyroidism.

The acronym PHACE syndrome stands for Posterior fossa malformations, Hemangiomas, Arterial anomalies, Coarctation of the aorta and other cardiac defects, Eye abnormalities, Sternal clefting and/or a supraumbilical raphe. We report a 20 day old neonate who presented with a large facial hemangioma and Dandy-Walker cyst. This case is unusual because the cyst was detected antenatally and there was associated congenital hypothyroidism, which has been described very rarely with this condition.

Coexistence of two neurocutaneous syndromes: tuberous sclerosis and hypomelanosis of Ito.

Tuberous sclerosis complex (TSC) and hypomelanosis of Ito (HI) are two uncommon neurocutaneous syndromes and their coexistence is extremely rare. An epileptic child presented with progressively increasing multiple hypopigmented macules arranged in a linear and whorled pattern along the lines of Blaschko over the trunk and limbs, characteristic of HI. He also had facial angiofibromas, ash-leaf and confetti macules and shagreen patches. Magnetic resonance imaging of the brain showed cortical tubers and subependymal nodules; which are diagnostic of TSC. The TSC defining loci have been mapped to Chromosome 9q34 (TSC1) and 16 pl3.3 (TSC2). There is no common genetic background for HI, but mosaicism of 9q33 locus has been documented. As per our knowledge, this is the second case of association of TSC with HI in a four-year-old child.

Bilateral facial squamous cell carcinoma in an 18-month-old girl with xeroderma pigmentosum.

Squamous cell carcinoma (SCC) of the skin usually occurs in older patients and commonly develops from actinic keratosis. Patients with xeroderma pigmentosum (XP) are highly sensitive to ultraviolet radiation and prone to develop multiple skin malignancies and can acquire SCC at an early age. We report an 18-month-old girl with XP who presented clinically because of a bilateral facial skin mass that was biopsied and found to be SCC. To our knowledge, the case we describe represents the youngest XP patient to have developed facial SCC.

The rebound effect in the treatment of complex hemangioma with interferon alpha 2A

The authors report the case of an infant with an extensive face hemangiona with subglottic airway obstruction which had been successfully treated with interferon alpha 2A but then reoccurred with the same dimensions and airway blockage after treatment was abruptly interrupted. The authors suggest the implementation of a standard procedure for the interruption of interferon alpha 2A treatment in order to avoid this rebound effect and advise on the need for further studies to properly evaluate dosage and administration parameters for interferon alpha 2A in the treatment of difficult hemangioma.

Multiple basal cell carcinoma associated with keratoacanthoma

We report a case of multiple basal cell carcinoma associated with keratoacanthoma. A 65-year-old Korean female had suffered from multiple, variable-sized papules and nodules on the face for 20 years previous to treatment. She had no history of arsenic intake, irradiation, herb medication, or hereditable or preexisting dermatoses. Histopathologically, the tumors revealed typical findings of solid and adenoid types of basal cell carcinoma and keratoacanthoma.

Paralisia unilateral do abducente como manifestaçäo de neoplasia de seios da face / Unilateral abducent palsy as a manifestation of sinuses neoplasia

Os autores relatam dois casos de carcinomas indiferenciados de seios da face de início provavelmente etmoidal e maxilar associados à paralisia isoloda e unilateral do abducente, motivando os pacientes para a busca de atendimento médico. Um dos casos tinha realizado exérese de gânglio cervical e radioterapia por carcinoma indiferenciado sem sítio primário identificado 14 meses antes do aparecimento da paralisia do abducente. A massa etmoidal só foi identificada na segunda tomografia computadorizada do encéfalo, realizada cinco meses após a paralisia, pelo aprecimento de dor ocular. O outro tinha uma massa ganglionar cervical de aparecimento três meses antes da paralisia do abducente. Apenas este caso apresentava história de "sinusite" submetida a múltiplos tratamento e o diagnóstico foi evidence já ao exame radiológico simples do crânio. Alerta-se para a necessidade de investigaçäo exaustiva e repetida destes casos e revisa-se a literatura sobre os passos desta investigaçäo