Mucinous Syringometaplasia: Case Report and Review of the Literature.

ABSTRACT: Mucinous syringometaplasia is a rare and poorly recognized entity that usually presents as a warty tumor in acral regions. It is more frequent in men, and the age of presentation is variable. Typically, it has been reported as a solitary lesion with a warty appearance that occasionally can drain serous material. The affected sites include head, neck, breast, acral regions, and buttocks. The evolution over time is variable. The pathogenesis has not been elucidated. Diagnosis is established through histopathology, the characteristic feature is an epidermal invagination, which creates a structure similar to a "pore" at the dermal level. The clinical differential diagnosis is mainly with a viral wart, but it can also resemble basal cell carcinomas and other adnexal tumors. The treatment is surgical, and no recurrences have been reported to date. We describe the case of a 25-year-old woman who presented with a lesion on one of her eyelids. A shave removal of the lesion was performed, and the diagnosis was established by histopathologic examination.

Lymphocytoma cutis (cutaneous B-cell pseudolymphoma): study of 102 cases with emphasis on the histological characteristics and immunohistochemistry of the miliarial type.

BACKGROUND: Lymphocytoma cutis (LC) is a benign reactive lymphoproliferative B-cell process. It has two variants: localized type with solitary lesions and miliarial type with numerous lesions. The objective was to investigate the characteristics of LC with emphasis on the miliarial type. METHODS: Retrospective study, patients with clinical and histopathological diagnosis of LC were included. Age, sex, evolution time, affected site, and type of treatment were investigated. In miliarial-type LC, the histological and immunohistochemical characteristics were also investigated. RESULTS: In an 18-year period, there were 102 patients found with LC: 72 (71%) corresponded to females, the median age was 45 years, the median evolution time was 4 months, and the face was the most predominant affected area in 81 (79%) cases. Localized-type LC corresponded to 88 (86%) cases, and miliarial type in 14 (14%). The most common treatment was surgery, which was used in 32 (31%) patients, all of whom had localized type (P < 0.01). The most frequent treatment for miliarial-type LC was corticosteroids in five (36%, P = 0.32), the predominant histopathological pattern was nodular in 10 (71%) specimens, and immunohistochemistry was performed in 11 (79%), where all were positive for CD20 with polyclonality to kappa and lambda light chains. CONCLUSIONS: The importance of LC lies in that it can be clinically and histopathologically confused with cutaneous lymphoma and that it is a rare entity, with its miliarial variant being rarer still. This study provides information on the clinical-histological characteristics of LC and its immunohistochemistry.

Blastomicosis: presentación de un caso importado en México, con lesiones exclusivamente cutáneas / Blastomycosis: report of an imported case in Mexico, with only cutaneous lesions

Antecedentes. La blastomicosis es una enfermedad infecciosa granulomatosa, causada por el hongo dimorfo Blastomyces dermatitidis. Predomina en Estados Unidos de América, y en México solo se han reportado 2 casos sistémicos importados. La forma primaria cutánea es la presentación clínica menos frecuente de la enfermedad y ocurre después de la inoculación del hongo por traumatismo. Objetivos. Se presenta el caso de un hombre de 54 años de edad, originario de Guadalajara, México, y residente en Chicago, Estados Unidos. Presentaba en la región frontal y surco nasogeniano derecho 2 nódulos verrugosos de 8mm de diámetro de 4 semanas de evolución. Métodos. Se realizó un estudio histopatológico (tinciones de hematoxilina-eosina, Gomori-Grocott y ácido peryódico de Schiff), además, estudio micológico (directo con KOH y cultivos en agar Sabouraud y micobiótico). Además, se realizaron otros estudios que descartaron afección sistémica. Resultados. La biopsia mostró una dermis con infiltrado inflamatorio compuesto por linfocitos, neutrófilos, histiocitos y células gigantes multinucleadas, y escasas levaduras monogemantes con base ancha y rodeadas por un halo. Al examen directo con KOH, se observaron levaduras monogemantes de 8 a 10mm de diámetro de B. dermatitidis. En el cultivo a 35°C creció una colonia blanca, plegada que, con el tiempo, se tornó amarillenta y cerebriforme. Resultados. Se indicó tratamiento con itraconazol a dosis de 200mg/d durante 2 meses con curación clínica y micológica. Conclusiones. El caso presentado podría ser el primero importado en México donde la blastomicosis se presenta solo con lesiones cutáneas y sin compromiso sistémico(AU)

Background. Blastomycosis is a granulomatous infectious disease. It is caused by the dimorphus fungus Blastomyces dermatitidis. It predominates in the United States of America, but in Mexico two systemic imported cases have been reported. Cutaneous primary blastomycosis is a rare clinical presentation, which occurs after traumatic inoculation of the fungus. Objectives. We present a case of a 54 year old male, born in Guadalajara, Mexico, and living in Chicago, USA, who had two verrucous nodules (8mm in diameter) on the forehead and right nasogenian fold, of 4 weeks progression. Methods. We made a histopathological study (hematoxylin and eosin, Gomori Groccot and periodic acid-Schiff stains) and mycology studies (direct microscopic examination, Sabouraud and mycobiotic agar cultures). Multiple studies were made with no evidence of systemic spread. Results. Biopsy showed a dermal inflammatory infiltrate made up of lymphocytes, neutrophils, histiocytes and multinucleated giant cells. A few large, haloed, broad-based budding yeasts were also observed. Direct examination with KOH revealed broad-based budding yeasts, 10ìm in diameter. Culture at 35°C yielded a white, pleated colony, which changed into a yellowish cerebriform. Multiple studies were made with no evidence of systemic spread. Results. Itraconazole 200mg qd PO was given over a 2 month period, with a complete clinical and mycological response. Conclusions. This is the first imported case in Mexico of blastomycosis with cutaneous lesions without systemic involvement(AU)

[Blastomycosis: report of an imported case in Mexico, with only cutaneous lesions]. / Blastomicosis: presentación de un caso importado en México, con lesiones exclusivamente cutáneas.

BACKGROUND: Blastomycosis is a granulomatous infectious disease. It is caused by the dimorphus fungus Blastomyces dermatitidis. It predominates in the United States of America, but in Mexico two systemic imported cases have been reported. Cutaneous primary blastomycosis is a rare clinical presentation, which occurs after traumatic inoculation of the fungus. OBJECTIVES: We present a case of a 54 year old male, born in Guadalajara, Mexico, and living in Chicago, USA, who had two verrucous nodules (8mm in diameter) on the forehead and right nasogenian fold, of 4 weeks progression. METHODS: We made a histopathological study (hematoxylin and eosin, Gomori Groccot and periodic acid-Schiff stains) and mycology studies (direct microscopic examination, Sabouraud and mycobiotic agar cultures). Multiple studies were made with no evidence of systemic spread. RESULTS: Biopsy showed a dermal inflammatory infiltrate made up of lymphocytes, neutrophils, histiocytes and multinucleated giant cells. A few large, haloed, broad-based budding yeasts were also observed. Direct examination with KOH revealed broad-based budding yeasts, 10µm in diameter. Culture at 35°C yielded a white, pleated colony, which changed into a yellowish cerebriform. Multiple studies were made with no evidence of systemic spread. Itraconazole 200mg qd PO was given over a 2 month period, with a complete clinical and mycological response. CONCLUSIONS: This is the first imported case in Mexico of blastomycosis with cutaneous lesions without systemic involvement.