Diabetes mellitus and Degos disease.

We present the case of a 75-year-old man who was diagnosed with Degos disease (DD) in the context of type 2 diabetes mellitus. The cutaneous lesions of DD were located at the trunk as well as in the proximal parts of the arms. He presented with positive laboratory test for lupic anticoagulant, but other rheumatologic parameters of interest were within normal limits. The skin biopsy corroborated the diagnosis of DD, and also showed morphologic features traditionally associated to hyaline diabetic microangiopathy. Since the latter has recently been atributted to C5b-9 deposit in the vessel wall, we discuss if both conditions are pathogentically connected or just coincidental (Fig. 3, Ref. 32). Full Text (Free, PDF) www.bmj.sk.

Double immunostaining with CD1A and CD68 in the phenotypic characterization of indeterminate cell histiocytosis.

Indeterminate cell histiocytosis (ICH) is a rare disorder in which histiocytic cells proliferate, expressing markers of both X- and non-X histiocytosis. Nevertheless, it is not totally clear if both types of markers are co-expressed by the same cell in this disorder, or on the contrary, the histiocytosis is made of two phenotypically different types of cells. Some recent reports seem to indicate this latter option, since there is a non-homogeneous distribution of the cells in the dermis. The ones in the most superficial part of the biopsy would lose some of their markers when moving towards the bottom part of the dermis. In order to check if there is co-expression of CD1a and CD68 by the same cell, we performed an immunohistochemical study with double staining, in a case of ICH of a 74-year-old male, who presented multiple yellowish papules in chest, back and both arms. Their sizes varied between 1 and 3 mm. One of the biopsies from one lesion of the back showed a dermal histiocytic infiltrate, which expressed S-100, CD1a, Factor XIIIa and CD68 in the common immunohistochemical study. Birbeck granules were not found in the ultrastructural study. Our results with the double stain for CD1a and CD68 demonstrated that most of the histiocytes expressed either one marker or the other. Nevertheless, some of the histiocytes of the infiltrate co-expressed both markers. In all the cases, the cells with this combined phenotype were mononuclear. Although CD1a was mainly expressed by the cells at the top of the dermis, some cells of the deep dermis kept expressing this marker. The cells expressing both markers were mostly found in the top part of the dermis. The multinucleate cells expressed only CD68, but not CD1a.

[Encrusted alkaline cystitis and malacoplakia]. / Cistitis alcalina incrustante y malacoplaquia.

Urinary infection due to urea splitting bacteria leads to a rise in urinary pH, favouring the precipitation of calcium salts and struvita crystals. If deposited on the surface of a bladder with chronic inflammation or some other previous lesion, may produce an alkaline encrusted cystitis, now a rare condition. In the case here presented, occurred in a 69-year-old male. Corynebacterium urealyticum grown in the urine, and some foci of malakoplakia were found in the area of encrustation endoscopically excised. This case seems to be the third example of alkaline encrusted cystitis associated with malakoplakia reported in the bibliography. These two conditions share similar clinical signs and may probably have a common aetiopathogenesis.

Fine needle aspiration of sclerosing lymphocytic lobulitis of the breast. A report of two cases.

BACKGROUND: Sclerosing lymphocytic lobulitis (SLL) was described in 1948 by Soler and Khardori as fibrotic disease of the breast with histologic features similar to those of Hashimoto's thyroiditis. Associations of this process with thyroiditis, artropathy and diabetes mellitus have been seen. CASES: We report the fine needle aspiration biopsy (FNAB) findings of two cases of SLL seen in our service. Both patients showed a breast nodule suspicious for malignancy. The cytologic changes vary according to the stage of the disease, from abundant lymphocytes and scanty fibrosis (case 1) to the presence of a few lymphocytes, epithelioid fibroblasts and significant sclerosis (case 2). CONCLUSION: The cytologic changes seen in FNAB are sufficient to indicate the diagnosis of SLL. The differential diagnosis has to be made with primary breast lymphoma, periductal or perilobular inflammation and different types of sclerosing breast lesions, depending on the stage of the disease.