ABSTRACT
The diagnosis of onychomycosis, using direct microscopy and fungal cultures, is often negative despite the presence of disease. Periodic acid-Schiff (PAS) staining of nail clippings, using histopathological processing, may be positive in these cases. It is not always clear, however, whether the fungal elements detected by PAS staining are pathogenic fungi or some are saprophytes. We aimed to study the efficacy of histopathological PAS staining of nail clippings as a second-line diagnostic tool in onychomycosis. The study included 100 consecutive cases in which direct microscopy and fungal cultures from suspected onychomycosis were negative on one occasion or more. The obtained nail clippings were processed for routine histology, stained with hematoxylin and eosin and PAS, and examined microscopically. Of the 100 cases, 38 (38%) showed positive fungal elements. As a result, 9 patients had sought and received oral antifungal therapy and all achieved complete clinical cure. The histological examination also revealed parakeratosis and globules of plasma, which were statistically significantly more common in the fungal infected nail samples. This may indicate an ongoing inflammatory process associated with onychomycosis. Neutrophils and bacteria were not statistically and significantly more common in the fungal infected nails. We conclude that as a second-line diagnostic tool, PAS stain of nail clippings increases markedly the diagnostic yield of onychomycosis and, consequently, the outcome of therapy.
Subject(s)
Nails/pathology , Onychomycosis/diagnosis , Periodic Acid-Schiff Reaction , Administration, Oral , Adolescent , Adult , Aged , Antifungal Agents/therapeutic use , Female , Fungi/drug effects , Fungi/isolation & purification , Fungi/metabolism , Glycogen/metabolism , Humans , Itraconazole/therapeutic use , Male , Middle Aged , Mycology/methods , Nails/microbiology , Naphthalenes/therapeutic use , Onychomycosis/drug therapy , Onychomycosis/microbiology , Terbinafine , Treatment Outcome , Young AdultABSTRACT
Cutaneous involvement is a rare presentation of ovarian cancer. There are only a few such case reports in the literature, most of them in surgical scars or subcutaneous nodules. This is a rare case of a patient presenting with skin metastases originating from primary ovarian carcinoma, which appeared 8 months following a disease-free interval. Based on this case report and a review of the literature, it is concluded that cutaneous involvement in ovarian cancer is a poor prognostic sign. Life expectancy of these patients is only a few months from the time of diagnosis of skin metastases. Thus, one should consider merely a palliative approach in these cases.
