Tattoos: risks and complications, clinical and histopathological approach

Abstract Background Skin modification through tattoos is as old as humanity itself. However, this trend is on the rise, and with the use of different types of pigments and application practices, both cutaneous and systemic complications can arise. Adverse reactions can be grouped into five classes: inflammatory, infectious, neoplastic, aesthetic, and miscellaneous. On histopathology, inflammatory reactions can exhibit a lichenoid pattern or present as spongiotic dermatitis, granulomatous reactions, pseudolymphoma, pseudoepitheliomatous hyperplasia, or scleroderma/morphea-like changes. This article reviews tattoo complications, including their clinical and histopathological characteristics. Methods An open search was conducted on PubMed using the terms "tattoo", "complications", and "skin". No limits were set for period, language, or publication type of the articles. Results Reactions to tattoos are reported in up to 67% of people who get tattooed, with papulonodular and granulomatous reactions being the most common. Some neoplastic complications have been described, but their causality is still debated. Any pigment can cause adverse reactions, although red ink is more frequently associated with them. Patients with pre-existing dermatoses may experience exacerbation or complications of their diseases when getting tattoos; therefore, this procedure is not recommended for this patient group. Conclusions Dermatological consultation is recommended before getting a tattoo, as well as a histopathological examination in case of complications. In patients who develop cutaneous inflammatory reactions following tattooing, additional studies are recommended to investigate systemic diseases such as sarcoidosis, pyoderma gangrenosum, atopic dermatitis, and neoplasms. It is important for physicians to be trained in providing appropriate care in case of complications.

Nefrectomía radical laparoscópica de tumor renal izquierdo con hallazgos de enfermedad de Rosai-Dorfman: reporte de caso / Laparoscopic radical nephrectomy of left renal tumor with demonstration of Rosai-Dorfman disease: case report

La enfermedad de Rosai-Dorfman se define como una histiocitosis de curso generalmente benigno, caracterizada por la acumulación ganglionar de histiocitos que presentan emperipolesis y positividad inmunohistoquímica para S-100 y CD68, y negatividad para CD1a y langerina. Su etiología exacta se desconoce, asociándose a factores autoinmunes, infecciosos y genéticos. El compromiso renal es infrecuente, identificándose en menos del 5% de los pacientes. Se presenta el caso de un hombre de 54 años, con descubrimiento incidental de lesión tumoral que comprometía el polo inferior de riñón izquierdo, quien fue sometido a nefrectomía radical y cuyos hallazgos histopatológicos confirmaron enfermedad de Rosai-Dorfman.

Rosai-Dorfman's disease is defined as a histiocytosis with a generally benign course, characterized by the accumulation of lymph nodes of histiocytes that present emperipolesis, and immunohistochemical positivity for S-100, and CD68, and negativity for CD1a and langerin. Its exact etiology is unknown, being associated with autoimmune, infectious, and genetic factors. Renal involvement is rare, being identified in less than 5% of patients. We present the case of a 54-year-old man, with incidental discovery of a tumor lesion that compromised the lower pole of the left kidney, who underwent radical nephrectomy and whose histopathological findings confirmed Rosai-Dorfman's disease

Sarcoma de la vena pulmonar / Sarcoma of the pulmonary vein

Resumen Los sarcomas son neoplasias primarias, cuya ubicación es rara en grandes vasos y excepcional en las venas pulmonares. Los dos tipos más frecuentes en las venas pulmonares son el leiomiosarcoma y el fibrosarcoma, con una distribución alrededor de la cuarta a la quinta décadas de vida, un pronóstico de 23 meses y 60% de metástasis al momento del diagnóstico. La presentación clínica es inespecífica ya que simula situaciones como embolia pulmonar, falla cardiaca descompensada y masa en la aurícula izquierda. Para su diagnóstico se cuenta con diferentes herramientas, como la ecocardiografía, la tomografía computarizada, la angiografía coronaria, la resonancia magnética y la tomografía por emisión de positrones (PET TC). El tratamiento incluye resección quirúrgica radical, manejo adyuvante con quimioterapia y radioterapia, e incluso, en casos seleccionados, trasplante de corazón. Se presenta el caso de una paciente con diagnóstico inicial de embolia pulmonar, con un episodio de edema pulmonar secundario a masa en la aurícula izquierda y extensión de un sarcoma de vena pulmonar derecha, con desenlace fatal. Se aporta a la literatura con el caso y la revisión de tema.

Abstract Sarcomas are primary neoplasms, whose location is rare in large vessels and in the pulmonary veins is exceptional. The two most frequent types in the pulmonary vein are leiomyosarcoma and fibrosarcoma, distribution around 4 and 5 decades of life, with a prognosis of 23 months and 60% metastasis at the time of diagnosis. The clinical presentation is nonspecific simulating situations such as pulmonary embolism, decompensated heart failure and mass in the left atrium. Different tools are available for its diagnosis, like echocardiography, computed tomography, coronary angiography, magnetic resonance imaging and PET CT. Treatment includes radical surgical resection, adjuvant therapy with chemotherapy, and radiation therapy, even heart transplantation in selected cases. It is presented the case of a patient with an initial diagnosis of pulmonary embolism, with an episode of pulmonary edema secondary to a mass in the left atrium, extension of a sarcoma of the right pulmonary vein, with a fatal outcome. We contributed to the literature with the case and review of theme.