Enfermedad de Paget pigmentada de la mama simuladora de melanoma cutáneo / Pigmented mammary Paget's disease mimicking cutaneous melanoma

Resumen ANTECEDENTES: La enfermedad de Paget pigmentada de la mama es una variante poco frecuente de este padecimiento cutáneo, una dermatosis que afecta al complejo areola-pezón de manera típicamente unilateral. La importancia del reconocimiento de esta dermatosis pigmentada inespecífica es que forma parte del diagnóstico diferencial del melanoma cutáneo, por manifestarse como una mácula pigmentada irregular, cuyo estudio histopatológico muestra una proliferación de melanocitos en los estratos suprabasales de la epidermis, fagocitosis de melanina y melanófagos en dermis, hallazgos muy similares al melanoma cutáneo, además de la coexistencia de células claras malignas, características de la enfermedad de Paget. La inmunohistoquímica es una técnica auxiliar en la dermatopatología, que forma parte del proceso diagnóstico de los pacientes para lograr el diagnóstico certero que, al correlacionar la clínica y el estudio histopatológico, le permite al dermatólogo tratar a los pacientes con enfermedad de Paget pigmentada de la mama junto con un equipo multidisciplinario para la búsqueda, diagnóstico y, en su caso, tratamiento quirúrgico de las neoplasias subyacentes que suelen relacionarse con esta variante pigmentada. CASO CLÍNICO: Paciente de 35 años con una lesión pigmentada que afectaba el complejo areola-pezón derecho. Con la correlación histopatológica e inmunohistoquímica se estableció el diagnóstico de enfermedad de Paget pigmentada de la mama y posterior al procedimiento ginecológico, se asoció esta dermatosis con un adenocarcinoma microinvasor triple negativo. CONCLUSIONES: La enfermedad de Paget pigmentada de la mama es un diagnóstico complejo que requiere correlación clínico-patológica y estudios de extensión para valorar su asociación con neoplasias subyacentes.

Abstract BACKGROUND: Pigmented Mammary Paget's Disease is a rare variant of this skin condition, an unilateral dermatosis that typically affects the areola-nipple complex. The importance of recognizing this nonspecific pigmented dermatosis resides in its differential diagnosis of cutaneous melanoma, as it presents as an irregular pigmented macula. The histopathological study shows proliferation of melanocytes in the suprabasal layers of epidermis, phagocytosis of melanin and melanophages in dermis. These findings are very similar to cutaneous melanoma, in addition to the presence of malignant clear epitelial cells that are characteristic of Paget's disease. Immunohistochemistry is part of the approach of patients with lesions that shows proliferating melanocytes to rule out other neoplasms. Making an accurate diagnosis by correlating the clinical, histopathological study and immunohistochemistry allows the dermatologist to approach patients with mammary pigmented mammary Paget's disease with a multidisciplinary team for the diagnosis and surgical treatment of the underlying neoplasms that are usually related to this pigmented variant. CASE REPORT: We report the case of a 35 years old woman with a pigmented lesion that affected the right areola-nipple complex. With the histopathological and immunohistochemical correlation, the diagnosis of pigmented mammary Paget's disease was made and after the gynecological approach, this dermatosis was associated with a triple negative microinvasive adenocarcinoma. CONCLUSION: Pigmented mammary Paget's disease is a complicated diagnosis that requires clinicopathological correlation and extension studies to assess its association to underlying neoplasms.

Neurofibromatosis segmentaria, a propósito de un caso / Segmental neurofibromatosis, case report

Resumen Introducción: la neurofibromatosis es un desorden genético, que afecta el crecimiento de tejidos neurales, con una incidencia de 1 en 4 000 personas, con impacto en la esperanza de vida por su asociación con neoplasias y enfermedad vascular. La neurofibromatosis segmentaria es una variante de la neurofibromatosis tipo 1, con una incidencia aproximada de 1 en 20 000 a 25,000 personas, se caracteriza por lesiones cutáneas que afectan un segmento corporal sin cruzar la línea media. Generalmente no tienen historia familiar ni compromiso sistémico. Caso clínico: paciente de sexo femenino de 63 años con dermatosis que afecta el tronco posterior de manera unilateral a nivel de los dermatomas T10-T11, caracterizada por múltiples neoformaciones exofíticas milimétricas en forma de domo, de consistencia blanda y depresibles a la palpación. El estudio histopatológico de una de ellas confirmó el diagnóstico de neurofibroma. La paciente no presentaba afectación neurológica ni ocular, además, sin afección en familiares, por lo que se establece diagnóstico de neurofibromatosis segmentaria. Conclusiones: la neurofibromatosis segmentaria es una patología poco frecuente, Aunque posiblemente sea subdiagnosticada por su carácter asintomático, lo que ocasiona una aparente baja incidencia. Los pacientes que la padecen pueden presentar penetrancia sistémica variable y un riesgo similar de neoplasias al descrito en pacientes con neurofibromatosis tipo 1. Pese al carácter benigno reportado en la literatura sugerimos un abordaje multidisciplinario de los pacientes.

Abstract Introduction: neurofibromatosis is a genetic disorder that affects the growth of neural tissues, with an incidence of 1 in 4 000, with impact on life expectancy due its association with neoplasms and vascular disease. segmental neurofibromatosis is a subtype of neurofibromatosis type 1, with an approximate incidence of 1 in 20 000 to 25 000 people, it is characterized by skin lesions that affects a body segment without crossing midline, they generally have no family history or systemic involvement. Clinical case: a 63-year-old female patient with dermatosis affecting the posterior trunk unilaterally at the level of dermatomes t10-t11, characterized by multiple exophytic, dome-shaped, millimeter sized neoformations, soft in consistency and depressible on palpation. the histopatologic study of one of them confirmed the diagnosis of neurofibroma. the patient did not present neurological or ocular involvement, without affection in relatives. diagnosis of segmental neurofibromatosis was made. Conclusions: segmental neurofibromatosis is a rare pathology, although it is possibly underdiagnosed due its asymptomatic nature, which causes an apparent low incidence. patients may present variable systemic penetrance and a similar risk of neoplasm compared to patients with neurofibromatosis type 1. despite the benign nature reported in the literature, we suggest a multidisciplinary approach to patients.

Dermatosis en la región mamaria: estudio retrospectivo de 171 pacientes atendidas en el Hospital General Dr. Manuel Gea González / Skin diseases of the breast: A retrospective study of 171 patients at "Dr. Manuel Gea González" General Hospital

Resumen OBJETIVO: Describir las dermatosis de la región mamaria que para su diagnóstico durante la consulta dermatológica ameritaron estudio histopatológico. MATERIALES Y MÉTODOS: Estudio retrospectivo llevado a cabo con base en los expedientes electrónicos de pacientes atendidas en el servicio de Dermatopatología entre 1992 y 2021. Los términos de búsqueda fueron: "mama", "seno", "areola" y "pezón". RESULTADOS: Se reunieron 171 reportes histopatológicos. El diagnóstico clínico de envío más común en mujeres fue la infiltración cutánea por cáncer de mama y en hombres el pezón supernumerario. Las dermatosis más frecuentes pertenecieron al grupo de tumoraciones benignas (78 de 171), seguidas de las dermatosis inflamatorias no infecciosas (48 de 171), en tercer lugar las neoplasias malignas (39 de 171) y 6 de 171 correspondieron a dermatosis inflamatorias infecciosas. CONCLUSIONES: Las enfermedades cutáneas de la mama tienen diversas manifestaciones clínicas que, en ocasiones, ameritan un estudio histopatológico, sobre todo para un diagnóstico oportuno de neoplasias malignas.

Abstract OBJECTIVE: Describe dermatoses of the mammary region that warranted histopathological diagnosis in dermatologic consults. MATERIALS AND METHODS: The Hospital "Dr. Manuel Gea Gonzalez" Dermatopathology Department record database was reviewed in the 1992 to 2021 period, using the search engine terms "breast," "mammary," "nipple," and "areola." Lesions were classified as benign, malignant, infectious and noninfectious inflammatory tumors. RESULTS: 171 histopathological reports were reviewed. There was a female predominance in histopathological studies (153/171). The most frequent clinical diagnosis for referral in female patients was breast cancer with cutaneous infiltration; supernumerary nipple was the most frequent clinical diagnosis for male patients. The most frequent dermatoses belonged to the benign tumor category (78/171), followed by noninfectious inflammatory dermatoses (48/171). Malignant neoplasms were in third place (39/171), and 3.5% of dermatoses were infectious inflammatory dermatoses. CONCLUSIONS: Cutaneous mammary disease has diverse clinical presentations that might occasionally warrant histopathological studies, mainly for the early diagnosis of malignant neoplasms.

Value of the toluidine blue test as an aid to determine the biopsy site in actinic prurigo cheilitis

Actinic prurigo (AP) is a type of photodermatosis that primarily affects the Latin American mestizo population. Histologically, AP cheilitis exhibits acanthosis with spongiosis and vacuolation of the basal cell layer overlying a dense lymphocytic inflammatory infiltrate that forms well-defined lymphoid follicles. Toluidine blue is a thiazide, acidophilic, and metachromatic dye used in vivo to selectively stain the acidic components of tissues such as sulfates, carboxylates, and phosphate radicals that are incorporated into DNA and RNA. It is necessary to develop a method that allows detecting, on clinical grounds the area of the lesion in which it is more feasible to find such structures. Thus to increase the sensitivity of the biopsy, in AP cheilitis to accurately identify where the lymphoid follicles reside, based on the higher concentration of DNA in such structures and thus confirm the diagnosis. In this study, staining was positive in 85% of patients with AP cheilitis, in 14 of whom 82% lymphoid follicles were observed by histopathology. One of the pathologist's problems in establishing the diagnosis of AP is that the main histopathological characteristics are not always identified in the submitted samples because it is not easy to clinically identify the most representative site of the lesion selected for performing a biopsy. Based on our results, we propose using toluidine blue as an auxiliary method to choose a tissue sample to facilitate the diagnosis and allow clinicians to make clinical correlations between the histopathological and therapeutic findings.

Linfoma anaplásico de células T grandes primario cutáneo CD30+. Serie de nueve casos / Primary cutaneous CD30+ anaplastic large T-cell lymphoma. Series of nine cases

Resumen Introducción: El linfoma anaplásico de células T grandes CD30+ es un linfoma primario cutáneo en el cual no hay evidencia de enfermedad sistémica; para su diagnóstico es necesario el estudio histopatológico. Objetivo: Presentar los casos diagnosticados en el Departamento de Dermatología del Hospital General "Dr. Manuel Gea González" con linfomas anaplásicos de células T grandes primarios cutáneos CD30+ durante un periodo de 24 años. Método: Estudio retrospectivo en el que realizó estadística descriptiva. Se recopiló información de sexo, edad, características clínicas, resultados de pruebas complementarias, tratamientos previos y actuales, reportes de los estudios histopatológicos y de inmunohistoquímica. Resultados: Entre 29 309 expedientes, se encontraron nueve casos (0.000034 %) con diagnóstico de linfoma anaplásico de células T CD30+. Se hizo la confirmación del diagnóstico histopatológico e inmunohistoquímico por dos dermatopatólogos certificados. La edad promedio fue de 61.2 años, hubo predominio del sexo femenino y de lesión papular o nodular y topografía variada como presentación clínica inicial. Conclusiones: El pronóstico del linfoma anaplásico de células T grandes CD30+ en la población estudiada fue dependiente del estadio clínico. El tratamiento en etapas tempranas tiene resultados favorables.

Abstract Introduction: CD30+ anaplastic large T cell lymphoma is a cutaneous primary lymphoma in which there is no evidence of systemic disease; histopathological study is required for its diagnosis. Objective: To present the cases diagnosed with primary cutaneous CD30+ anaplastic large T-cell lymphoma over a 24-year period in Hospital General "Dr. Manuel Gea González" Department of Dermatology. Method: Retrospective study. Descriptive statistics was carried out. Information was collected on gender, age, clinical characteristics, complementary test results, previous and current treatments, histopathological studies reports and immunohistochemistry test results. Results: Of 29 309 records, nine patients (0.000034%) with a diagnosis of CD30+ anaplastic T cell lymphoma were found. Histopathological and immunohistochemical diagnosis was confirmed by two certified dermatopathologists. Average age was 61.2 years, and there was a predominance of the female gender, with initial clinical presentation as a papular or nodular lesion and varied topography. Conclusions: The prognosis of CD30+ anaplastic large T cell lymphoma in the studied population was dependent on clinical stage. The treatment at early stages has favorable results.

Fox-Fordyce disease: report of two cases with perifollicular xanthomatosis on histological image

Abstract: Fox-Fordyce disease is a relatively infrequent pathology of the apocrine glands that affects almost exclusively young women. The disease is characterized by the presence of pruritic follicular papules mainly in the armpits that respond poorly to treatment and severely affect the patient's quality of life. We report two cases with clinical diagnosis and histopathological confirmation, presenting perifollicular xanthomatosis on histological examination, recently described as a distinctive, consistent, and specific feature of this disease.

Nevo comedónico mamario / Nevus Comedonicus in breast

Resumen ANTECEDENTES: El nevo comedónico es un tumor benigno del aparato pilosebáceo. Puede aparecer en topografía poco habitual, como la región mamaria. Es de manifes-tación aislada o puede formar parte del síndrome de nevo comedónico. No precisa tratamiento, salvo por motivos estéticos o complicaciones. CASO CLINICO: Paciente de 45 años que acudió a consulta por una dermatosis locali-zada en el tronco, unilateral, dispuesta linealmente, que afectaba la línea axilar media y la región mamaria derecha. Caracterizada por una placa de 4 x 1 cm, conformada por comedones abiertos. El padecimiento se inició durante la infancia, asintomático, sin aumento de la dermatosis. En la dermoscopia se observaron tapones de queratina color negro de 3 mm de diámetro. La biopsia incisional reportó que se trataba de un nevo comedónico. CONCLUSION: El nevo comedónico es un tumor poco frecuente que puede aparecer en la región mamaria y debe reconocerse como padecimiento benigno.

Abstract BACKGROUND: Comedonic nevus is a rare benign tumor of the pilo-sebaceous unit which can occur in unusual topography such as the mammary region. It can have an isolated presentation or as part of the nevus comedonic syndrome. There is no treat-ment except for aesthetic reasons or secondary complications. CLINICAL CASE: A 45- year-old patient presented with a unilateral, linearly arranged dermatosis located on the trunk, affecting the axillary midline and the right mam-mary region. Characterized by a plaque of 4 x 1 cm, formed by open comedons. Starts from childhood and referred as asymptomatic, it has not presented changes during life. By dermoscopy 3mm diameter black keratin plugs were observed. An incisional biopsy was performed and sent to a histopathological study, which reported as comedonic nevus. CONCLUSION: Comedonic nevus is a rare tumor that can occur in the mammary region and must be recognized as a benign entity.

Risk factors associated with actinic prurigo: a case control study

Abstract: Background: Actinic prurigo (AP) is an idiopathic photodermatosis. Although its initial manifestations can appear in 6 to 8-year-old children, cases are diagnosed later, between the second and fourth decades of life, when the injuries are exacerbated. Objective: To identify risk factors associated with clinical manifestations of AP such as skin and mucosal lesions. Methods: Thirty patients with AP and 60 controls were included in the study, the dependent variable was the presence of skin or labial mucosal lesions, the independent variables were age, sex, solar exposure, living with pets or farm animals, exposure to wood smoke, smoking habit, years smoking, and hours spent per day and per week in contact with people who smoke. Results: Of the 30 diagnosed AP patients, 66.7% were female. Patients age ranged from 7 to 71 years and the mean age was 35.77 ± 14.55 years. We found significant differences with the age and cohabitation with farm animals. Those who lived with farm animals presented 14.31 times higher probability of developing AP (95% CI 3-78.06). Study limitations: This is a case-control study; therefore, a causal relationship cannot be proven, and these results cannot be generalized to every population. Conclusions: The identification of factors related to the development of AP increases our knowledge of its physiopathology. Moreover, identifying antigens that possibly trigger the allergic reaction will have preventive and therapeutic applications in populations at risk of AP.

Chronic Suppurative Osteomyelitis of the Mandible Treated with Antibiotics Complemented with Surgical Treatment: A Case Report / Osteomielitis Crónica Supurativa en Mandíbula Tratada con Antibióticos y Cirugía: Reporte de Caso

ABSTRACT: Osteomyelitis is an infection that affects bone and bone marrow, it occurs due to inoculation of microorganisms either directly or by continuous accumulation through a hematogenous way. Female patient, 64 years old, presenting an increase of volume of the parotid masseteric region and right submandibular region, with approximately two weeks of evolution, which had a slightly fluctuating, hyperemic and hyperthermic indurated consistency; the patient complained of severe pain. CT scan and biopsy was indicated. It is imperative to identify the causative agent; the use of antibiotics must be complemented by surgical treatment to eliminate the possibility of a remaining infection.

RESUMEN: La osteomielitis es un proceso infeccioso que afecta al hueso y medula ósea y que se produce debido a la inoculación de microorganismos ya sea de manera directa, por continuidad o bien por medio de la vía hematógena. Paciente femenino de 64 años de edad que presentaba aumento de volumen en región submandibular derecha refiriendo dolor intenso con evolución de 2 semanas aproximadamente, el cual era de consistencia indurada ligeramente fluctuante, hiperémico e hipertérmico; la paciente se quejaba de dolor intenso, se indicó TC y biopsia. En estos casos para tener éxito en el tratamiento el uso de antibióticos debe complementarse con desbridamiento quirúrgico, aunado a un seguimiento estrecho para descartar la posibilidad de una infección remanente.

Tuberculosis pélvica y antecedente de embarazo. Reporte de caso / Pelvic tuberculosis and pregnancy antecedent. Case report

Resumen A lo largo del tiempo, la tuberculosis ha sido un problema de salud pública. La Organización Mundial de la Salud reporta anualmente alrededor de 8 millones de casos nuevos y 3 millones de muertes. En México se estima que anualmente prevalecen cerca de 64,000 casos de esta enfermedad gue puede afectar diferentes órganos con presentaciones clínicas gue simulan otras patologías. Se presenta el caso de una paciente de 22 años de edad con antecedente de embarazo normo evolutivo y parto vaginal 4 meses antes sin complicaciones, gue inició su cuadro clínico en el puerperio con presencia de tos en accesos gue remitió un mes posterior acompañado de síndrome de desgaste, pérdida de peso, dolor abdominal difuso, diarrea y fiebre. Recibió múltiples tratamientos sin mejoría, ingresó a nuestro hospita con cuadro de síndrome abdominal agudo y se le realizó laparotomía exploradora con hallazgos de abdomen congelado, engrosamiento de peritoneo parietal, adherencias fijas, colecciones en hueco pélvico, con material purulento caseoso, blanquecino, poco fétido, tejido friable, presencia de granulomas en asas de intestino; se realizó histerectomía subtotal abdominal con ooforectomía bilateral, la evolución posquirúrgica fue lenta hacia la mejoría tras corroborar por reporte histopatológico y cultivo el diagnóstico de tuberculosis pélvica e iniciar tratamiento específico.

Abstract Tuberculosis has been overtime public health problem. The World Health Organization reports annually about 8 million new cases and 3 million deaths. In Mexico, an estimation of around 64,000 prevalent cases of this disease are reported annually. Tuberculosis can affect different organs with clinica presentations that mimic other diseases. A patient presents a history of normal pregnancy and vaginal delivery without complications for 4 months. The clinical picture begins in the postpartum period with the presence of cough accesses registered a month later accompanied by fatigue, weight loss, diffuse abdominal pain, diarrhea and fever syndrome. She received multiple treatments without improvement. She was ad missioned to our hospital and an acute abdomen laparotomy was performed with findings of abdominal frozen thickened parietal peritoneum, fixed adhesions, collections of pelvic cavity with whitish, slightly fetid pus, friable tissue, presence of granulomas in bowel loop. A subtotal abdominal hysterectomy with bilateral oophorectomy was performed. The postoperative evolution showed a slow improvement after the reportand was corroborated bya histopathological diagnosis of pelvic tuberculosis culture and the initiation of a specific treatment.

Expresión de E-cadherina y células de Langerhans en verruga vulgar y papiloma bucal / Expression of E-cadherin and Langerhans cells in verruca vulgaris and oral papilloma

Introducción: la verruga vulgar y el papiloma bucal son lesiones provocadas por el virus papiloma humano se pueden encontrar presentes en la mayoría de las superfi cies cutáneas y mucosas, su comportamiento biológico es benigno. Las proteínas de adhesión como la E-cadherina, se encargan de mantener la organización y morfología celular, disminuyen su expresión epitelial en ciertas lesiones potencialmente cancerizables, y favorecen la migración e invasión celular ocasionando posiblesmetástasis. Las células de Langerhans, son células presentadoras deantígeno que activan el sistema inmunológico para proteger al organismocontra patógenos o sustancias extrañas. Objetivo: Determinar el grado de expresión de E-cadherina y de células de Langerhans en verruga vulgar y papiloma bucal. Material y métodos: Se realizó un estudio descriptivo y retrospectivo, en el cual se incluyeron 16 bloques con tejido incluido en parafi na con diagnóstico de verruga vulgar, ycuatro diagnosticados como papiloma bucal, todos los casos fueron corroborados con la tinción de hematoxilina y eosina. La determinacióndel grado de expresión de las células de Langerhans y E-cadherina se realizó por medio de la técnica de inmunohistoquímica, la valoraciónse llevó a cabo de manera semicuantitativa, y se realizó estadísticadescriptiva. Resultados: La expresión de E-cadherina en verruga vulgar fue intensa tanto en cantidad como intensidad, mientras que en papiloma bucal fue moderada también en ambos casos; las células de Langerhans mostraron una inmunotinción moderada en las lesiones de verruga vulgar en intensidad y cantidad; en el caso de papiloma bucal esta inmunotinción en intensidad y cantidad fue leve. . Conclusiones:Los resultados mostraron que las proteínas de adhesión E-cadherinano pierden su expresión en la verruga vulgar y papiloma bucal, lo cualconfi rma su benignidad...

Introduction: verruca vulgaris and oral papilloma are lesions causedby the human papillomavirus. They can be found on most skin and mucosalsurfaces, and their biological behavior is benign. Adhesion proteinssuch as E-cadherins are responsible for maintaining cell morphologyand organization; they decrease the expression in certain potentiallycancerous epithelial lesions and promote cell migration and invasion,causing possible metastasis. Langerhans cells are antigen-presentingcells that activate the immune system to protect the body againstpathogens or foreign substances. Objective: To determine the degreeof expression of E-cadherin and Langerhans cells in verruca vulgarisand oral papilloma. Material and methods: We performed a descriptiveand retrospective study involving 16 paraffi n-embedded tissue blocksof diagnosed cases of verruca vulgaris and 4 paraffi n-embedded tissueblocks identifi ed as oral papilloma. The diagnosis was previouslyconfi rmed by hematoxylin and eosin staining. The degree of expressionof Langerhans cells and E-Cadherin was determined by immunohistochemistry,while the evaluation was carried out semiquantitatively,with descriptive statistics being performed. Results: The expression ofE-cadherin in verruca vulgaris was strong in terms of both quantityand intensity, whereas in the case of oral papilloma it was moderatefor both. Langerhans cells showed moderate immunostaining for bothintensity and quantity in verruca vulgaris-type lesions, while for oralpapilloma, the immunostaining was also mild in both cases. Conclusions:The results suggest that the expression of E-cadherin adhesionproteins does not diminish in verruca vulgaris and oral papilloma,which confi rms their benignity...

Detection of apoptosis in pemphigus vulgaris by TUNEL technique

Abstract: Background: Pemphigus is part of a group of blistering diseases that affect the skin and mucous membranes. Based on its autoimmune origin, autoantibodies develop in pemphigus that are directed toward cell surface components of keratinocytes. However, some data cannot be explained, such as the lack of a relationship between autoantibody levels and the severity of clinical manifestations, treatment resistance, the presence of inflammatory infiltrates and the potential occurrence of apoptosis as determinants of vesicle formation. Objective: To examine the presence of apoptosis in pemphigus vulgaris by TUNEL technique. Methods: In this cross-sectional study, we selected 15 paraffin-embedded tissues from subjects who were diagnosed with pemphigus vulgaris by hematoxylin and eosin staining. The samples were subjected to TUNEL assay and examined under an Olympus BX61 fluorescence microscope. Positivity was categorized dichotomously, and the statistical analysis was performed using the X2 test. Results: Positivity was observed in basal layer cells in 14 (93.3%) cases. In 13 (86.7%) of the positive cases, we noted espinosum and granular layers that formed the blister roof, and in 12 cases (80%), positive acantholytic cells were observed. Conclusions: TUNEL positivity was observed in pemphigus vulgaris, implicating apoptosis in the pathophysiology of this condition, which can help guide the development of apoptotic blockers as therapeutics.

Correlation of serum IgE levels and clinical manifestations in patients with actinic prurigo

Abstract BACKGROUND: Actinic prurigo is an idiopathic photodermatosis, the pathophysiology of which has been hypothesized to involve subtype IV type b (Th2) hypersensitive response, whereby IL4, IL5, and IL13 are secreted and mediate the production of B cells, IgE, and IgG4. OBJECTIVES: To examine the association of serum IgE levels and the clinical severity of injuries. METHODS: This case-control study comprised patients with a clinical and histopathological diagnosis of actinic prurigo, as well as clinically healthy subjects, from whom 3cc of peripheral blood was taken for immunoassay. Cases were classified by lesion severity as mild, moderate, and severe. Descriptive statistics were analyzed, and chi-square test was performed. RESULTS: We included 21 actinic prurigo patients and 21 subjects without disease; 11 patients with actinic prurigo had elevated serum IgE levels, and 10 had low serum levels. Six actinic prurigo (AP) patients with elevated serum levels of IgE had moderate injuries, 4 had severe injuries, and 1 had minor injuries. Eight out of 10 patients with normal IgE levels presented with minor injuries in the clinical evaluation. The 21 controls did not have increased serum IgE levels. CONCLUSIONS: Elevated IgE levels are associated with moderate to severe clinical lesions, suggesting that actinic prurigo entails a type IV subtype b hypersensitivity response in which Th2 cells predominate.

Presencia del virus papiloma humano en la cavidad oral: revisión y actualización de la literatura / Presence of human papillomavirus in oral cavity: review and update of literature

El virus del papiloma humano (VPH) forma parte de un grupo de virus ADN heterogéneo llamados papillomaviridae; este virus es causante de múltiples lesiones hiperplásicas, verrucosas y papilomatosas de las células epiteliales de piel y mucosas, existen más de 120 tipos de VPH, de solo 100 se conoce su secuencia genómica completa. Los dos géneros más importantes son los papilomavirus alpha (ð) y los beta (ß), la mayoría de los virus que infectan el área genital pertenecen al género alpha; según sus características clínicas, se pueden subdividir en cutáneos y de mucosa. Si bien las infecciones por este virus son frecuentes en cavidad oral, este campo de la medicina se encuentra en estudio, debido a que la información sobre el tema no es concluyente, es prioritario para el estomatólogo conocer las generalidades acerca del VPH y tratar las lesiones de una manera informada, este virus se asocia a un 35% de los casos de cáncer de cavidad oral, de los cuales el 70% de ellos son de alto riesgo. En México, se tiene estimado que cerca del 43% de los hombres y del 17,5% de las mujeres, todos ellos sanos y sexualmente activos tienen alguna infección por VPH.

The human papillomavirus (HPV) is part of heterogeneous group of DNA viruses called papillomaviridae; this virus causes multiple hyperplastic, papillomatous and warty lesions of epithelial cells of skin and mucosa, there are more than 120 types of HPV, although, the complete genome sequence of only 100 of these is known. The most important types are the alpha papillomavirus (a) and beta (b), most viruses that infect the genital area belong to the alpha type; according to their clinical characteristics, they can be divided in cutaneous and mucosal. HPV infections are common in oral cavity, this field of medicine is currently being studied, considering that the information about this subject is not conclusive, it is a priority for the stomatologist to know the generalities about HPV and treat injuries in an informed manner; this virus is associated to a 35% of cases of oral cancer, of which 70% are considered high risk. In Mexico, it is estimated that about a 43% of men and a 17.5% of women, all of them healthy and sexually active have at least one HPV infection.

Intraosseous myofibroma of the mandible: a case report / Miofibroma intraoseo mandibular: reporte de caso

The myofibroma is defined as a benign neoplasm formed by myoid contractile cells localized around the wall of thin blood vessels, it is a tumor that presents itself mostly in infancy although it may occur at any age and it is most common in head and neck; it is uncommon to be localized in the oral cavity and even less common if it is intraosseous. It may also be associated to miofibromatosis or present itself as a solitary lesion. The differential diagnosis depends on the localization and the radiographic characteristics; it would be very difficult to include, at first hand, myofibroma as an intraosseous lesion. Histopathologically, a neoplasm with a biphasic pattern formed by spindle cells in fascicles and bundles, spindle nucleus with eosinophilic cytoplasm inside a hyalinized stroma was found. In lesions of neoplasms of spindle cells histological studies should be supported by an immunohistochemical panel and show positive results to antibodies Actin, smooth muscle Actin and Vimentin.

El miofibroma es una neoplasia benigna compuesta por células mioides contráctiles localizadas alrededor de la pared de vasos sanguíneos delgados, es un tumor que se presenta sobre todo en la infancia aunque puede ocurrir a cualquier edad, tiene predilección en cabeza y cuello, sin embargo en cavidad oral es raro y aún más si es intraóseo, puede estar asociado a miofibromatosis o bien presentarse de manera solitaria. Los diagnósticos diferenciales dependen de la localización y de las características radiográficas y de primera instancia es muy difícil incluir al miofibroma entre las lesiones intraóseas. Histológicamente presenta patrón bifásico conformado por células fusiformes dispuestas en fascículos y haces así como núcleos fusiformes con citoplasma eosinófilo dentro de un estroma hialinizado. Es necesario recurrir al panel de inmunohistoquímica en neoplasias de células fusiformes, positivo a Acs Actina, Actina músculo liso y Vimentina. Reportamos el caso de una mujer de 45 años con un miofibroma en la mandíbula.

Síndrome de hiperinmunoglobulinemia E: Reporte de dos casos / Hyperimmunoglobulin E syndrome: report of two cases

Introducción. El síndrome de hiperinmunoglobulinemia E es una inmunodeficiencia sistémica poco frecuente, caracterizada por dermatitis eccematosa, abscesos fríos recurrentes, infecciones pulmonares con formación de neumatoceles, facies tosca, niveles elevados de inmunoglobulina E (IgE) en suero y eosinofilia. Casos clínicos. Caso 1. Femenino de 11 años de edad con antecedentes de neumonía recurrente, gastroenteritis de repetición, dermatitis eccematosa de predominio en pliegues, y abscesos fríos; en estudios de laboratorio destacó el hallazgo de 16 070 eosinófilos e IgE de 4 864 Ul. Manejada con gammaglobulina se observó buena respuesta clínica. Caso 2. Femenino de 12 años de edad con historia de otitis recurrente y conjuntivitis supurativa, presentaba eccema crónico generalizado e impetiginizado. En estudios de laboratorio se reportó IgE de 3 000 UI; fue manejada con dapsona, trimetropim/sulfametoxazol y metotrexate. Conclusión. Los 2 casos aquí informados presentaron piel eccematosa, infecciones recurrentes e incremento de los niveles de IgE, compatibles con síndrome de hiperinmunoglobulinemia E en la forma autosómica recesiva.

Background. Hyperimmunoglobulin E syndrome is a rare systemic immunodeficiency characterized by eczematous dermatitis, recurrent cold abscesses, lung infections with pneumatoceles, coarse facial appearance, high IgE levels and eosinophilia. Case reports. Case 1: We report the case of an 11-year-old female with a history of recurrent lung infections, recurrent gastroenteritis, eczematous dermatitis affecting the skin folds and cold abscesses. Laboratory studies showed elevated eosinophils (16 070) and IgE 4864 IU. The patient received treatment with g-globulin, showing adequate clinic response to treatment. Case 2: We present the case of a 12-year-old female with a history of recurrent otitis and suppurative conjunctivitis, showing widespread and chronic infected eczema. Laboratory studies showed elevated IgE (3 000 IU). She was treated with dapsone, trimethoprim/sulfamethoxazole and methotrexate. Conclusions. We presented two patients with eczematous skin, recurrent infections and increased IgE levels, which are compatible with hyperimmunoglobulin E autosomal recessive syndrome.

Papilomatosis reticulada y confluente de Gougerot-Carteaud: un caso con excelente respuesta a minociclina / Confluent and reticulated Gougerot-Carteaud papillomatosis: a case report of an excellent response to minocycline

La papilomatosis reticulada y confluente de Gougerot-Carteaud es una dermatosis poco frecuente que por lo general afecta a individuos jóvenes, especialmente a mujeres de fototipos oscuros. Es asintomática y se presenta como placas pigmentadas con textura papilomatosa que confluyen formando placas reticuladas de mayor tamaño en el cuello y zonas intertriginosas. La causa es desconocida, aunque se ha implicado una queratinización anormal, y en ocasiones se puede asociar a Malassezia sp. Su evolución es crónica con remisiones y exacerbaciones. Por el momento no se dispone de un tratamiento específico. Se presenta un caso tratado de manera efectiva con minociclina que no presentó recidiva tras seis meses de seguimiento.

Confluent and reticulated Gougerot-Carteaud papillomatosis is an uncommon dermatological condition that affects adolescents, especially young women with dark skin types. It presents itself as asymptomatic pigmented patches with a papillomatous texture that coalesce to form reticular plaques localized in the neck and intertriginous areas. The cause of this disease is unknown, although an abnormal keratinization has been implicated and sometimes has been associated with Malassezia sp. It has a chronic course with remissions and exacerbations. Several therapies have been used unsuccessfully to eradicate it but nowadays there is no specific treatment. We report a case treated efficiently with minocycline without recurrence at 6 months follow-up.

Liquen plano e infección por virus de hepatitis C: ¿Existe una asociación? / Lichen planus and hepatitis C virus: Is there an association?

Antecedentes: la causa de liquen plano (LP) es desconocida. Se ha estudiado el posible papel del virus de hepatitis C (VHC) con resultados controvertidos. Material y métodos: el objetivo de este estudio fue determinar la prevalencia de infección por virus de hepatitis C en 36 pacientes con LP confirmado por histopatología, 12 en forma retrospectiva, y 24 en forma prospectiva. El grupo control constó de 60 donadores de sangre consecutivos del Banco de sangre del hospital. La prueba de inmunoensayo ligado a enzima de tercera generación fue utilizada para la determinación de anticuerpos contra VHC. Resultados:una prevalencia de infección por VHC de 2.77% en pacientes con LP, y 0% en el grupo control (Prueba exacta de Fisher - p=0.375). Conclusiones: en nuestro grupo de pacientes con LP se encontró prevalencia de serología positiva para VHC menor a la reportada en la literatura. Como en todos los estudios se han encontrado pacientes con LP sin infección por VHC, consideramos que existen otros factores en la patogénesis de esta dermatosis que deben ser estudiados.

Introduction: The etiology of lichen planus (LP) is unknown. The possible role of hepatitis C virus (HCV) has been studied with controversial results. Materials and Methods: The aim of this study was to determine the prevalence of HCV infection in 36 patients with lichen planus (LP) confirmed by histopathology, 12 in a retrospective way, and 24 in a prospective one. The controls were 60 consecutive blood donors from the Blood Bank of the hospital. Third generation enzyme immunoassay screening test was employed for determination of antibodies against HCV. Results: A prevalence of HCV infection of 2.77% in LP patients, and 0% in control group (Fisher's exact test -p=0.375). Conclusions: We found in our patients with LP a lower prevalence of positive serology for HCV than that reported in the literature. Since all studies have found patients with LP without infection by HC V, we think that other factors in the pathogenesis of this dermatosis need to be studied.

Miasis furunculoide por Dermatobia hominis: Un caso importado de Costa Rica al Distrito Federal / Furunculoid Myasis Due to Dermatobia hominis: A Case Imported to the Mexican Capital's Federal District from Costa Rica

La miasis furunculoide es una enfermedad parasitaria producida por la larva de la mosca Dermatobia hominis, endémica del sur de México, y de Centro y Sudamérica. Se presenta un caso de infestación por este agente en una persona residente del Distrito Federal que viajó a Costa Rica, así como una revisión de la literatura respecto a esta enfermedad poco frecuente en el Valle de México.

Furunculoid myiasis is malignant parasitation caused by larvae of the botfly Dermatobia hominis. It is endemic to Southern Mexico and Central and South America. We report here on the case of a patient living in Mexico's Federal District who was infested with Dermatobiahominis, and who had a history of travel to Costa Rica. A review of the literature regarding this uncommon ailment in the Valley of Mexico is also presented.