ABSTRACT
Histoplasmosis is a fungal infection caused by the fungus Histoplasma capsulatum. It can manifest in various ways, ranging from pulmonary to disseminated presentations. Most of the disseminated cases are seen in immunocompromised patients; here, we present an unusual case of an 81-year-old Mexican male with a history of cave exposure in his childhood, with 75 years of incubation period of the disease, who developed disseminated cutaneous histoplasmosis with no evident immunocompromising conditions. We considered the hypotheses of transient immunosuppression, CD4+ T lymphocytopenia, and immune senescence as the cause of this manifestation. The present case is also notable for its recurrence following therapy. This report underscores the challenges in diagnosing histoplasmosis in immunocompetent individuals and highlights the importance of long-term treatment and follow-up.
ABSTRACT
A 63-year-old woman with light skin and a history of chronic sun damage presented with a painless, pale macule on her nasal tip. A punch biopsy was performed due to concerns about skin conditions like vitiligo or morpheaform basal cell carcinoma (BCC). The biopsy confirmed a micronodular BCC, an unusual presentation, as these typically manifest as an erythematous macule or thin papule/plaque. This report highlights the importance of considering various factors and differential diagnoses to ensure the best patient care and the need for vigilance in diagnosing rare presentations of BCC.
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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.
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.
Subject(s)
Ki-1 Antigen/metabolism , Lymphoma, Large-Cell, Anaplastic/pathology , Skin Neoplasms/pathology , Adult , Aged , Aged, 80 and over , Female , Humans , Lymphoma, Large-Cell, Anaplastic/diagnosis , Male , Middle Aged , Neoplasm Staging , Prognosis , Retrospective Studies , Skin Neoplasms/diagnosis , Young AdultABSTRACT
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.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Skin Neoplasms/pathology , Lymphoma, Large-Cell, Anaplastic/pathology , Ki-1 Antigen/metabolism , Prognosis , Skin Neoplasms/diagnosis , Retrospective Studies , Lymphoma, Large-Cell, Anaplastic/diagnosis , Neoplasm StagingABSTRACT
INTRODUCTION: T-cell lymphoid dyscrasia is a group of different, infrequent, epitheliotropic inflammatory dermatosis that precede cutaneous T-cell lymphomas. Treatment with ultraviolet radiation is safe and efficacious. OBJECTIVE: To describe responses to treatment, secondary effects and complications. METHOD: Eleven patients with different T-cell lymphoid dyscrasias were treated. Two received psoralens plus ultraviolet A radiation (PUVA) and nine narrow band ultraviolet B radiation (NB-UVB). RESULTS: Seven women and four men from 5 to 30 years-old and phototypes III and IV were included. They had hypopigmented epitheliotropic lymphoid dyscrasia, chronic pityriasis lichenoides, hypopigmented parapsoriasis and pigmented purpuric dermatoses. Two received PUVA and 9 NB-UVB. Eight achieved complete response and three partial response with 10 to 119 sessions. Any patient presented neither relapse nor progression to cutaneous T-cell lymphoma during treatment or in the follow up period after 34 to 247 sessions. Secondary effects were xerosis and mild pruritus. CONCLUSIONS: The majority of patients with T-cell lymphoid dyscrasias can be successfully and safely treated with minimal secondary effects after a variable number of sessions and periods of time with ultraviolet radiation.
INTRODUCCIÓN: Las discrasias linfoides epiteliotrópicas de células T son un grupo de dermatosis inflamatorias poco frecuentes que pueden progresar a linfomas cutáneos. El tratamiento con radiación ultravioleta ha sido descrito como seguro y eficaz. OBJETIVO: Describir la respuesta al tratamiento, sus efectos secundarios y complicaciones. MÉTODO: Se administró radiación ultravioleta A con psoralenos (PUVA) a dos pacientes y radiación ultravioleta B de banda estrecha (NB-UVB) a nueve pacientes, con diferentes discrasias. RESULTADOS: Conformaron la serie siete mujeres y cuatro hombres, con edades de 5 a 30 años y con fototipos III y IV, con diagnóstico de discrasia linfoide epiteliotrópica hipopigmentada, pitiriasis liquenoide crónica, parapsoriasis hipopigmentada y púrpura pigmentada. Dos recibieron PUVA y nueve recibieron NB-UVB. Ocho alcanzaron respuesta completa y tres respuesta parcial con 10 a 119 sesiones de tratamiento. Ningún paciente presentó reactivación de la enfermedad después de 34 a 247 sesiones, y ninguno en tratamiento o seguimiento evolucionó a linfoma cutáneo. Los efectos secundarios fueron xerosis y prurito. CONCLUSIÓN: El tratamiento de las discrasias linfoides con radiación ultravioleta es eficaz y seguro, con efectos secundarios leves y con respuestas exitosas en la mayoría de los pacientes, en tiempo y número de sesiones variables.
Subject(s)
Lymphoma, T-Cell, Cutaneous/prevention & control , Precancerous Conditions/therapy , T-Lymphocytes/immunology , Ultraviolet Therapy/methods , Adolescent , Adult , Child , Child, Preschool , Disease Progression , Female , Follow-Up Studies , Humans , Male , Middle Aged , PUVA Therapy/methods , Precancerous Conditions/complications , Precancerous Conditions/pathology , Skin Neoplasms/prevention & control , Treatment Outcome , Young AdultABSTRACT
INTRODUCTION: Perineurioma is an infrequent and benign cutaneous neoplasm characterized by proliferation of perineurial cells. It is classified into two main types: intraneural and the extraneural or soft tissue perineurioma, in which the sclerosing variant is included. Sclerosing perineurioma is more frequently found on acral skin. Clinically, they are well-circumscribed,skin colored, nodular tumors. OBJECTIVE: Describe and communicate clinicopathologic findings from a case series of sclerosing acral perineurioma. MATERIAL AND METHODS: This is a clinical, morphological and immunohistologic case study of eight patients with the diagnosis of sclerosing perineurioma. RESULTS: It included five men and five women, with ages ranging between nine and 66 years. All of them had lesion on acral skin. At microscopy study, the lesions showed a proliferation of epithelioid and spindle-shaped perineurial cells, arranged in small aggregates and short fascicles between thickened collagen bundles. Immunohistochemistry studies revealed that the proliferating cells expressed EMA, Claudin-1 and Glut-1, and were negative for S-100 protein. CONCLUSIONS: It is important to report these infrequent skin tumors, so they can be taken into account in the differential diagnoses of acral lesions.
Subject(s)
Nerve Sheath Neoplasms/pathology , Skin Neoplasms/pathology , Xanthomatosis/pathology , Adult , Aged , Child , Claudin-1/metabolism , Diagnosis, Differential , Female , Glucose Transporter Type 1/metabolism , Humans , Male , Middle Aged , Mucin-1/metabolism , Nerve Sheath Neoplasms/diagnosis , Sclerosis/pathology , Skin Neoplasms/diagnosis , Xanthomatosis/diagnosisABSTRACT
BACKGROUND: Psoriasis is a chronic inflammatory disease associated with increased cardiovascular risk. Metabolic syndrome (MS) is a significant predictor of cardiovascular events. OBJECTIVE: To assess the prevalence of MS in a Mexican population with psoriasis. METHODS: A descriptive, case control study was performed, involving a series of 209 patients. Relevant demographic, clinical, anthropometric, and analytic information was obtained from all participants. Metabolic syndrome was diagnosed according to the NCEP-ATPIII criteria. RESULTS: The study included 103 patients with psoriasis and 106 controls. The mean age of the case patients was 48.37 years; 55% were women and 46% were men. Metabolic syndrome was significantly more common in psoriatic patients than in controls (41.7 vs. 20%, odds ratio: 1.738; 95% CI: 1.194-2.531; p < 0.001). We also found a higher frequency of diabetes mellitus (17.3 vs. 6.6%; p = 0.001), alcoholic habits (8.7 vs. 0.9%; p = 0.009), and higher levels of blood pressure (p = 0.002), BMI (p = 0.016), waist circumference (p = 0.008), and triglycerides (p = 0.002). CONCLUSIONS: Psoriatic patients have a higher prevalence of metabolic syndrome, which can favor cardiovascular events.
Subject(s)
Metabolic Syndrome/complications , Metabolic Syndrome/epidemiology , Psoriasis/complications , Case-Control Studies , Female , Humans , Male , Middle Aged , PrevalenceABSTRACT
BACKGROUND: Onychomycosis is multifactorial in origin. Studies have suggested an autosomal dominant pattern of inheritance and human leukocyte antigen DR4 (HLA-DR4) has been shown to protect against onychomycosis in an Ashkenazi Jewish population. AIM: This study investigates HLA class II association in a Mexican Mestizo population with Trichophyton rubrum onychomycosis. METHODS: This was a prospective case-control study. Mexican Mestizos with a clinical diagnosis of onychomycosis and culture positive for T. rubrum were recruited, together with age- and sex-matched controls. First-degree relatives were also investigated for onychomycosis. Case-control samples were HLA typed by polymerase chain reaction sequence-specific primer based analysis. RESULTS: Twenty-one cases and 42 controls were recruited with a mean age of 40 years (range: 18-58 years). HLA-DR6 was found in seven (33%) cases and 19 (45%) controls [P < 0.023, odds ratio (OR) = 0.088, 95% confidence interval (CI): 0.01-0.71]. Six (29%) cases and three (7%) controls had an affected child (P < 0.043, OR = 9.15, 95% CI: 1.07-78.31), and 13 (62%) cases and 12 (29%) controls had an affected first-degree relative (P < 0.02, OR = 4.0, 95% CI: 1.1-14.3). CONCLUSIONS: These results suggest that HLA-DR6 confers protection against the development of onychomycosis in a Mexican Mestizo population. Having an affected first-degree relative significantly increases the risk of onychomycosis, suggesting genetic susceptibility.
Subject(s)
Genetic Predisposition to Disease , HLA-DR6 Antigen/genetics , Onychomycosis/ethnology , Onychomycosis/genetics , Adolescent , Adult , Alleles , Black People/genetics , Case-Control Studies , Female , Genotype , Humans , Indians, South American/genetics , Male , Mexico/epidemiology , Middle Aged , Onychomycosis/microbiology , Prospective Studies , Trichophyton/isolation & purification , White People/genetics , Young AdultABSTRACT
Introducción y objetivo: La frecuencia de infecciones bacterianas, virales y fúngicas es alta en los pacientes inmunosuprimidos. Las micosis superficiales pueden condicionar elevada morbi-mortalidad en los pacientes oncológicos, principalmente bajo inmunosupresión. El objetivo de este trabajo es de conocer la frecuencia y etiología de las infecciones micóticas superficiales en pacientes oncológicos hospitalizados con o sin inmunosupresión. Material y métodos: Estudio prospectivo, descriptivo y transversal de las micosis superficiales en 98 pacientes oncológicos hospitalizados en el Instituto Nacional de Cancerología. Resultados: Entre 98 pacientes, el 31,6% de los pacientes estudiados presentaron por lo menos alguna micosis superficial. Las más frecuentemente encontradas fueron las onicomicosis (58%), pie de atleta (38,7%) e intertrigos micóticos inguinales (9,6%). Fue mayor la frecuencia y extensión de las micosis superficiales en los pacientes inmunosuprimidos (41,1%) que en los no inmunosuprimidos (29,6%). Los agentes causales más frecuentes fueron T. rubrum (36,3%) y levaduras del género Candida (11,2%). Conclusiones: Las infecciones fúngicas superficiales son frecuentes en los pacientes oncológicos hospitalizados y son más graves en los inmunosuprimidos. La más frecuente fue la onicomicosis y el agente causal más comun fue T. rubrum. No hubo infecciones sistémicas secundarias a micosis superficiales
Background and objective: Bacterial, viral and mycotic infections are highly frequent in immunocompromised patients. Superficial mycosis can increase morbidity and mortality in oncologic patients, particularly in the immunosupressed. The objective of this work is to know the frequency and etiologic agents of superficial mycotic infections in a population of immunosupressed and not immunosupressed hospitalized oncologic patients. Material and methods: Superficial mycotic infections in ninety eight oncologic hospitalized patients in the Instituto Nacional de Cancerología were studied. Results: At least one type of superficial mycosis was present in 31.6% of 98 patients. Onychomycosis (58%), athlete´s foot (38.7%), candidiasis and tinea cruris (9.6%) were the most frequent types found. Frequency was higher in immunosupressed hosts (41.1%) than in the not immunosupressed (29.6%). The most common causal agents were T. rubrum (36.3%) and Candida sp (11.2%). Conclusions: Superficial mycosis are frequent in hospitalized oncologic patients, predominantly in immunosupressed hosts in which they tend to be more severe. Onychomycosis was the most common infection and, as usual, we also corroborate the higher incicdence of T. rubrum. No systemic infections due to superficial mycosis were found
Subject(s)
Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Humans , Dermatomycoses/etiology , Neoplasms/complications , Neoplasms/microbiology , Prospective Studies , SpainABSTRACT
An 80-year-old man presented with a localized tumor of the right occipital scalp. The tumor was a 1-cm, bright red-purple, ulcerated, and crusted exophytic nodule on a smooth base (Figure 1). The lesion had grown asymptomatically over 18 months except for profuse bleeding induced by minimal trauma. It was extirpated with the clinical diagnosis of pyogenic granuloma vs. renal metastasis to the scalp. The patient's medical history included a transurethral prostatic resection 3 years earlier and, 1 year later, a right nephrectomy for a 2-kg kidney tumor verbally reported as "benign." The patient also had a 2-year history of untreated high blood pressure. Histopathologically, the excised tissue was an exo-endophytic nodule of a solid form composed of pleomorphic neoplastic cells with abundant clear cytoplasm, surrounded by fibrous collagen septae, blood vessel proliferation, and areas of hemorrhage (Figures 2 and 3). The histopathologic diagnosis of metastatic renal cell carcinoma was supported by immunohistochemistry with positive epithelial membrane antigen staining (Figure 4). Cytokeratins 7 and 20 were nonreactive. Laboratory studies revealed hematuria and elevated creatinine and urea nitrogen levels, but no malignant cells were observed in five urinary cytologies. Renal ultrasound showed the presence of two simple cysts in the left kidney and data compatible with chronic inflammatory disease.
Subject(s)
Carcinoma, Renal Cell/diagnosis , Head and Neck Neoplasms/diagnosis , Kidney Neoplasms/diagnosis , Scalp/pathology , Skin Neoplasms/diagnosis , Aged, 80 and over , Carcinoma, Renal Cell/secondary , Diagnosis, Differential , Head and Neck Neoplasms/secondary , Humans , Kidney Neoplasms/pathology , Male , Neoplasm Metastasis , Skin Neoplasms/secondaryABSTRACT
Se comunica el caso de un paciente masculino de 24 años de edad con cambios clínicos e histopatológicos compatibles con lipodistrofia membranosa. Se hace también una breve revisión sobre aspectos clínicos, fisiopatológicos, histológicos y de tratamiento
Subject(s)
Humans , Male , Adult , Biopsy , Leg Dermatoses , Lipodystrophy/diagnosis , Lipodystrophy/pathologyABSTRACT
Caso de linfoma cutáneo de células T tipo inmunoblástico de células grandes en un paciente de 24 años de edad con lesiones en placa, mancha y tumorales
