Aggressive parotid gland and neck metastasis caused by cutaneous squamous cell carcinoma of the scalp: a case report / Metástasis agresiva de glándula parótida y cuello causada por carcinoma cutáneo de células escamosas decuero cabelludo: reporte de un caso

Introduction: The head and neck are frequent sites for the development of cutaneous cancer and squamous cell carcinoma of the skin (SCC), one of the more frequent malignant non-melanoma skin neoplasms in Chile (436 per 100,000 inhabitants). Between 5-10% skin SCC progresses aggressively generating metastasis to parotid and cervical lymph nodes. Case Report: A 82 years old male, presents painful increased volume lesion in the mandibular area. He has a history of chronic arterial hypertension, acute renal failure, SCC of the scalp, extra-pulmonary tuberculosis, chronic sun exposure and smoking. Extraoral examination showed a 4 cm lesion in the posterior third of the mandibular branch, with undefined edges, a firm consistency and painful on palpation. Intraorally, erythematous mucosa is observed, as well as lack of lubrication, tenderness and cortical bone expansion. Incisional biopsy is performed, imaging and histological exams are requested. The results indicate the presence of SCC, and therefore referral to secondary care. Many risk factors are associated with SCC development, with ultraviolet radiation the most relevant in this case, favoring its appearance on the scalp. The probability of metastasis is low, but when it happens, the majority of cases that started in the scalp, disseminate to the parotid and cervical region. Conclusion: The SCC has a good prognosis. However, there are antecedents, such as size and location, that must alert the professional to perform the monitoring, early screening, control of metastatic nodes in maxillofacial area.

Introducción: La cabeza y el cuello son sitios frecuentes de desarrollo de cáncer cutáneo y el carcinoma epidermoide de piel (CEC) es una de las neoplasias malignas sin melanoma más frecuentes en Chile (436 por 100.000 habitantes). Entre el 5% y el 10% del CCE cutáneo progresa de forma agresiva y genera metástasis en los ganglios linfáticos parótidos y cervicales. Reporte de Caso: Varón de 82 años, presenta lesión dolorosa de aumento de volumen en zona mandibular. Tiene antecedentes de hipertensión arterial crónica, insuficiencia renal aguda, CCE del cuero cabelludo, tuberculosis extrapulmonar, exposición crónica al sol y tabaquismo. El examen extraoral mostró una lesión de 4 cm en el tercio posterior de la rama mandibular, con bordes indefinidos, consistencia firme y dolorosa a la palpación. Intraoralmente se observa mucosa eritematosa, así como falta de lubricación, dolor a la palpación y expansión del hueso cortical. Se realiza biopsia incisional, se solicitan exámenes de imagen e histológicos. Los resultados indican la presencia de CCE y, por tanto, derivación a atención secundaria. Son muchos los factores de riesgo asociados al desarrollo de CEC, siendo la radiación ultravioleta la más relevante en este caso, favoreciendo su aparición en el cuero cabelludo. La probabilidad de metástasis es baja, pero cuando ocurre, la mayoría de los casos que comenzaron en el cuero cabelludo se diseminan a la región parotídea y cervical. Conclusión: El SCC tiene un buen pronóstico. Sin embargo, existen antecedentes, como tamaño y ubicación, que deben alertar al profesional para realizar el seguimiento, cribado precoz, control de ganglios metastásicos en zona maxilofacial.

Neumotórax espontáneo bilateral metastásico. Inusual manifestación de metástasis pulmonar / Spontaneous metastatic bilateral pneumothorax. Unusual manifestation of lung metastasis

Resumen Objetivo: Comunicar el caso de una paciente de 77 años tratada de un angiosarcoma de cuero cabelludo, que evoluciona con neumotórax bilateral, cuyo estudio histopatológico informa enfermedad metastásica. Materiales y Método: Revisión de ficha clínica electrónica, registro informático de imagenología e informes de biopsias. Seguimiento ambulatorio en policlínico de cirugía. Resultados: Se realiza manejo por videotoracoscopía bilateral, con bulectomía más pleurodesis. Discusión: El neumotórax secundario por enfermedad metastásica es poco frecuente, aproximadamente 1% a 2% de los casos. De los tumores que más frecuentemente metastizan al pulmón se encuentran los sarcomas. Conclusión: El neumotórax metastásico es poco frecuente y requiere un alto índice de sospecha. Su manejo va a depender del pronóstico y de las condiciones generales del paciente.

Aim: To report the case of a 77-year-old patient treated for angiosarcoma of the scalp, who evolves with bilateral pneumothorax, whose histopathological study reports metastatic disease. Materials and Method: Review of electronic clinical record, computerized imaging record and biopsy reports. Outpatient follow-up at the polyclinic of surgery. Results: Management was performed by bilateral videothoracoscopy, with bulectomy plus pleurodesis. Discussion: Secondary pneumothorax due to metastatic disease is rare, approximately 1 to 2% of cases. Sarcomas are among the tumors that most frequently metastasize to the lung. Conclusion: Metastatic pneumothorax is infrequent and requires a high index of suspicion. Its management will depend on the prognosis and the general conditions of the patient.

Fibroxantoma atípico: caso clínico / Scalp atypical fibroxanthoma: report of one case

Atypical Fibroxanthoma is an unusual dermal mesenchymal tumor. It especially affects older adults and occurs in areas of sun exposure. We report a 75 years old male with a history of sun exposure without using a hat presenting with a scalp nodule. An incisional biopsy showed an atypical fibroxantoma. In a new surgical procedure, the tumor was completely excised. The tumor relapsed in two occasions after subsequent excisions and the patient was treated with adjuvant radiotherapy avoiding new relapses.

Sebaceoma on the scalp simulating a malignant pigmented neoplasia

Abstract The correct identification of pigmented nodular lesions of the scalp is often challenging. Despite the importance of clinical patterns and dermoscopy, important adjuvant tools that are usually helpful, their interpretation sometimes is not clear-cut. Here, the authors discuss a case of sebaceoma mimicking a malignant pigmented neoplasia, with conclusive histopathology.

Carcinoma mucinoso primario de piel / Primary mucinous skin carcinoma

El adenocarcinoma mucinoso primario de piel es una neoplasia anexial, maligna e infrecuente, que afecta principalmente a hombres en una relación 2:1 con respecto a las mujeres. Presenta mayor incidencia entre la sexta y séptima década de la vida, y se manifiesta como un tumor único, asintomático, de tamaño variable. La localización más frecuente es la región periorbitaria y el cuero cabelludo. Se comunica el caso de una paciente de 92 años, con diagnóstico de carcinoma mucinoso primario de piel, sin evidencia de enfermedad sistémica ni recurrencia local al año de la resección por cirugía micrográfica de Mohs. Describimos sus principales características clínicas, dermatoscópicas y hallazgos histopatológicos. (AU)

Primary mucinous adenocarcinoma of the skin is an adnexal, malignant, and infrequent neoplasm that mainly affects men with a 2: 1 ratio, with respect to women. It presents higher incidence between the sixth and seventh decade of life, and manifests as a single tumor, asymptomatic, of variable size. The most frequent location is the periorbital region and scalp. We report the case of a 92-year-old patient with a diagnosis of primary mucinous skin carcinoma, without evidence of systemic disease or local recurrence one year after resection by Mohs micrographic surgery. We describe its main clinical features, dermatoscopic and histopathological findings. (AU)

Clinical-histopathological profile of the frontal fibrosing alopecia: a retrospective study of 16 cases of a university hospital

Abstract: Background: Frontal fibrosing alopecia is a condition of unknown origin, histologically similar to classic lichen planopilaris and generally observed in postmenopausal women with alopecia of the frontal-temporal hairline. Objectives: To describe the clinical, dermatoscopic, and histopathological characteristics and the treatment used in patients who have frontal fibrosing alopecia at the Alopecia Outpatient Clinic in a university hospital. Methods: Retrospective descriptive study performed by reviewing medical charts and biopsies of the scalp. Results: Sixteen patients were analyzed, all of them female, 93.75% of them postmenopausal, and 56.25% brown-skinned. All had frontal alopecia (100%), followed by temporal alopecia (87.5%) and madarosis (87.5%). On dermatoscopy, perifollicular erythema and tubular scales were found as a sign of disease activity. Of the patients, 68.75% had associated autoimmune diseases, including lupus, thyroid disease and vitiligo. Of the 13 biopsies from 8 patients, 10 showed microscopic aspects compatible with frontal fibrosing alopecia. Laboratory tests did not show major abnormalities and minoxidil was the most used treatment. Study limitation: Data collection limited by the study's retrospective design associated to flaws while filling in the medical charts and absence in standards to the collection and processing of the pathology and histopathological examination. Conclusions: A demographical, clinical, and histopathological description of 16 patients diagnosed with frontal fibrosing alopecia, which remains a challenging disease, of unknown origin, and frequently associated with autoimmune diseases. This study reinforces literary findings. However, more research is needed to establish the pathogenesis and effective treatments.

Proliferating trichilemmal cyst with clinical, radiological, macroscopic, and microscopic correlation

Abstract: Proliferating trichilemmal cyst is an uncommon neoplasm arising from the follicular isthmus, whose histopathological hallmark is the presence of trichilemmal keratinization. We describe a case of proliferating trichilemmal cyst in a 57-year-old woman with a broad clinical, radiological, macroscopic and microscopic correlation.

Hallazgos en gammagrafía con análogos de la somatostatina (Tc-99m HYNIC-TOC) en metástasis sobre cuero cabelludo como debut en un tumor neuroendocrino de origen incierto / Findings insomatostatin analogue scintigraphy (99mtc-HYNIC-TOC) in scalp metastasis as debut in a neuroendocrine tumor of uncertain origin / Achados em cintilografia com análogos de somatostatina (Tc-99m HYNIC-TOC) em metástases no couro cabeludo como estréia em um tumor neuroendócrino de origem incerta

Los estudios de medicina nuclear permiten en tumor neuroendocrino (TNE) de origen desconocido la búsqueda del tumor primario y estadificación de la enfermedad

Nuclear medicine studies allow neuroendocrine tumor (NET) of unknown origin to search for the primary tumor and staging the disease

Estudos de medicina nuclear permitem o tumor neuroendócrino (NET) de origem desconhecida para a pesquisa do tumor primário e o estadiamento da doença

Juvenile xantogranuloma with íris involvement / Xantogranuloma juvenil com acometimento iriano

Abstract Herein we report a case of juvenile xantogranuloma, an inflammatory disease more commonly diagnosed during childhood and is characterized by cutaneous and ocular manifestations. Iris is the main target, presenting as local or diffuse yellowish lesions. Iris involvement may precipitate not only glaucoma but also amblyopia. Treatment is based on corticosteroids therapy, either local or systemic aiming disease control.

Resumo É relatado um caso raro de xantogranuloma juvenil, doença de natureza inflamatória diagnosticada mais frequentemente na infância, com manifestações cutâneas e oculares. A íris é o principal sítio extracutâneo da doença, apresentando-se como lesão amarelada, difusa ou localizada. O acometimento iriano pode acarretar surgimento de glaucoma, além de ambliopia. O manejo clínico da lesão ocular no presente caso foi baseado no necessidade no uso contínuo de corticoide tópico e sistêmico para estabilização da doença.

Wound myiasis: the role of entodermoscopy

Abstract: Although wound or traumatic myiasis is common in tropical countries, only recently cases associated with underlying dermatoses, such as seborrheic dermatitis and psoriasis, have been reported. We describe a patient with seborrheic dermatitis and an ulcerated lesion on the scalp, in which the dermatological examination with the aid of dermoscopy allowed the identification of larvae (maggots) compatible with infestation by Cochliomyia hominivorax. Treatment was performed with oral and topical ivermectin, followed by manual extraction of the larvae.

Tumor triquilemal proliferante: reporte de un caso y revisión de la literatura / Trichilemmal proliferating tumor: case report and literature review

RESUMEN El tumor triquilemal proliferante es una neoplasia poco frecuente, usualmente sólida o parcialmente quística que se origina de la vaina externa de la raíz de un folículo piloso. Ocurre principalmente como una lesión solitaria en el cuero cabelludo de mujeres mayores. Presentamos el caso de una mujer de 56 años con un tumor cervical de nueve años de evolución. El estudio de la pieza de resección confirmó el diagnóstico.

ABSTRACT Trichilemmal proliferating tumor is an infrequent neoplasia, usually solid or partially cystic, originating in the external root sheath of hair follicle. It occurs mainly as a solitary lesion in the scalp in older women. We report the case of a 56 years old woman with a cervical tumor of nine years of growth. Histology of the resection specimen confirmed the diagnosis.

Coexistence of chronic cutaneous lupus erythematosus and frontal fibrosing alopecia

Abstract: Lupus erythemathosus is a chronic, relapsing disease with acute, subacute, and chronic lesions. Effluvium telogen occurs in the setting of systemic activity of the disease, and cicatricial alopecia results from discoid lesionsin on the scalp. Other types of alopecia, like alopecia areata, may rarely be found in lupus. Frontal fibrosing alopecia is characterized by frontotemporal hairline recession and eybrow loss. Histophatologically, it cannot be differentiated from lichen planopilaris.It is controversial whether frontal fibrosing alopecia is a subtype of lichen planopilaris.. A pacient with chronic lichenoid lupus erythematosus is described with clinical, histophatological and dermoscopic features of frontal fibrosing alopecia.We have not been able to find in the literature cases of frontal fibrosing alopecia as a clinical manifestation of lupus.

Lichen simplex chronicus on the scalp: exuberant clinical, dermoscopic, and histopathological findings

Abstract: Lichen simplex chronicus is a skin disease that mostly affects female patients, with a peak incidence between ages 35 and 50 years. On the scalp, it appears as a single or multiple oval lesions, showing scaling and hair shaft loss or breakage. An important dermoscopic feature of the disease are the "broom fibers." Histopathology reveals the "hamburger" and the "gear wheel" signs. The aim of this report is to demonstrate a case of lichen simplex chronicus on the scalp with typical and exuberant clinical, dermoscopic, and histopathological findings.

Piccardi-Lassueur-Graham-Little syndrome associated with frontal fibrosing alopecia

Abstract: Piccardi-Lassueur-Graham-Little syndrome is a rare entity characterized by progressive scarring alopecia of the scalp and keratotic papules on hairless skin, associated with non-scarring alopecia in the axilla and pubic area or lichen planus lesions. We describe the case of a 70-year-old woman who presented a Piccardi-Lasseur-Graham-Little syndrome, along with frontal fibrosing alopecia.

Lichen planopilaris developed during childhood

Abstract: Lichen planopilaris is a disease that appears with lymphocytic cicatricial alopecia. It is considered a follicular variant of lichen planus. The examination of affected areas shows alopecia with perifollicular erythema and scaling, revealing a predilection for hair follicles. The involvement of children is uncommon, with few reports in this population in the literature. This study presents a clinical case of a male patient of 15 years of age with characteristic lesions of lichen planopilaris.

Case for diagnosis. A bluish nodule on the scalp

Abstract: Acrospiroma, also known as hidradenoma, is a rare cutaneous tumor that has several histological characteristics. As a consequence, a high index of suspicion is necessary for its diagnosis. Here we report a case that illustrates the importance of a good clinical-pathologic correlation in order to recognize this disease.

Cutaneous angiosarcoma: report of three different and typical cases admitted in a unique dermatology clinic

Abstract: Angiosarcoma is a rare and aggressive tumor with high rates of metastasis and relapse. It shows a particular predilection for the skin and superficial soft tissues. We report three distinct and typical cases of angiosarcoma that were diagnosed in a single dermatology clinic over the course of less than a year: i) Angiosarcoma in lower limb affected by chronic lymphedema, featuring Stewart-Treves syndrome; ii) a case of the most common type of angiosarcoma loated in the scalp and face of elderly man and; iii) a skin Angiosarcoma in previously irradiated breast. All lesions presented characteristic histopathological findings: irregular vascular proliferation that dissects the collagen bundles with atypical endothelial nuclei projection toward the lumen.

Cutis verticis gyrata secundária à paquidermoperiostose. Relato de caso / Cutis verticis gyrata secondary to pachydermoperiostosis - case report

A cutis verticis gyrata é uma condição do couro cabeludo caracterizada por sulcos e dobras profundas, causando o espessamento da pele que lhe dá uma aparência semelhante aos giros do córtex cerebral. Pode ser congênita ou adquirida, e predomina no sexo masculino. É classificada de acordo com sua etiologia primária (essencial e não essencial) e secundária. Descrevemos aqui um caso de cutis verticis gyrata secundária à paquidermoperiostose em paciente do sexo masculino jovem, apresentando suas manifestações clínicas, laboratoriais e radiológicas. Estudo descritivo constando de relato de caso e revisão de literatura nas bases de dados da Biblioteca Virtual de Saúde. Foram obtidos artigos originais científicos nas bases LILACS, SciELO, Scopus e PubMed, buscando-se pelos descritores: "couro cabeludo", "doenças da pele e do tecido conjuntivo", "anormalidades da pele" e "dermatopatias". O limite temporal foi 2010 e as línguas escolhidas foram português, inglês, italiano, espanhol e francês. Paciente do sexo masculino, 25 anos, apresentando hipertrofias lineares em couro cabeludo, acompanhado de dor nas mãos, tornozelos e articulação coxofemoral. Presença de baqueteamento digital e hiperidrose palmoplantar. Trata-se de uma doença rara e progressiva, cuja avaliação clínica é essencial para definir a forma da cutis verticis gyrata e excluir outras síndromes associadas.

Cutis verticis gyrata (CVG) is a scalp condition characterized ridges and deep folds causing thickening of the skin, giving an appearance similar to the cerebral cortex gyri. It can be congenital or acquired, and predominates in males. It is classified according to its primary and secondary etiology (essential and non-essential). A case of Cutis verticis gyrata secondary to pachydermoperiostosis (PQP) is described in a young male patient, with its clinical, laboratory and radiological findings. This is a descriptive study consisting of a case report and review of literature on the Virtual Health Library databases (BVS). Scientific original articles were obtained in LILAC, SciELO, Scopus and PubMed databases, searching the keywords: "scalp", "skin and connective tissue diseases", "skin abnormalities" and "skin diseases" .The time limit was year 2010, and the languages chosen were Portuguese, English, Italian, Spanish and French. Male patient, 25 years old, with linear hypertrophy on the scalp, accompanied by pain in the hands, ankles and hip joint. Presence of digital clubbing, and palmoplantar hyperhidrosis. It is a rare, progressive disease whose clinical assessment is essential to define the type of cutis verticis gyrata, and to rule out other associated syndromes.