Dermoscopy of inverted follicular keratosis: study of 12 cases.

BACKGROUND: Inverted follicular keratosis (IFK) is an uncommon benign tumour of the follicular infundibulum, which is often misdiagnosed clinically as other keratinizing tumours, and commonly diagnosed correctly by histopathology. There are few reports about the dermoscopic findings of this lesion. AIM: To evaluate the dermoscopic features of IFK. METHODS: The dermoscopic structures and patterns in digital dermoscopic images of 12 histopathologically confirmed cases of IFK collected from 5 hospitals in Spain were evaluated. RESULTS: A keratoacanthoma (KA)-like pattern composed of central keratin surrounded by hairpin vessels in a radial arrangement was the most common pattern in IFK (58.3%). The second most common pattern was composed of a yellowish-white amorphous central area surrounded by vascular structures in a radial arrangement (33.3%). The remaining case showed a pattern composed of a yellowish-white amorphous central area with milky red globules. Vascular structures were present in all cases, with a monomorphic pattern in seven cases and a polymorphic pattern in five, mainly with radial arrangement. Arborizing vessels, linear irregular vessels, corkscrew vessels and milky red globules were present in some cases. CONCLUSIONS: We describe the two main patterns of IFK. Lesions with a KA-like pattern are clinically and dermoscopically undistinguishable from KA and squamous cell carcinoma. Cases with a polymorphic vascular pattern could be confused with malignant tumours, including basal cell carcinoma and amelanotic melanoma.

Tuberculosis cutánea en una zona de Mallorca (2003-2011) / Cutaneous tuberculosis in an area of Mallorca (2003-2011)

Antecedentes y objetivo. La tuberculosis constituye un importante problema sanitario, también en nuestro medio. Este estudio sepropone describir las características clínicas y epidemiológicas de la tuberculosis cutánea en nuestro medio. Pacientes y métodos. Estudio retrospectivo de los casos de tuberculosis cutánea diagnosticados de enero de 2003 a julio de 2011 en un hospital de Mallorca. Se registraron las formas clínicas, la metodología diagnóstica empleada, el tratamiento utilizado y la evolución clínica. Resultados. Se diagnosticaron 28 casos de tuberculosis con afectación cutánea (5,9% del total de tuberculosis), tuberculosis verdadera en 15 casos (14 escrofulodermas, un empiema necessitatis) y tubercúlides en el resto (8 casos de eritema indurado de Bazin y 5 de eritema nodoso). El foco de origen de los escrofulodermas fue ganglionar (10), óseo (4) y pleural (1); 13/28 pacientes eran originarios de otros continentes. La mayoría de los pacientes fueron tratados con 3-4 fármacos tuberculostáticos, evolucionando favorablemente. Conclusión. La tuberculosis cutánea no es infrecuente en nuestro medio. En las tuberculosis cutáneas verdaderas el cultivo es el método diagnóstico más rentable, mientras que en las tubercúlides generalmente la histología es la que proporciona el diagnóstico(AU)

Background and objective. Tuberculosis is an important health care problem, even in our setting. The objective of this study is to describe clinic and epidemiological features of cutaneous tuberculosis in our area. Patients and methods. A retrospective study was performed of all patients diagnosed of cutaneous tuberculosis in a hospital in Mallorca (Spain) from January 2003 to July 2011. The clinical forms, diagnostic methods used, treatment used and clinical course were recorded. Results. Twenty-eight cases of cutaneous tuberculosis were diagnosed (5.9% of the tuberculosis cases diagnosed in this period), 15 with classic cutaneous tuberculosis (14 scrofuloderma, 1 empyema necessitatis) and 13 patients with tuberculids (8 erythema induratum of Bazin disease and 5 erythema nodosum). Scrofulodermas came from lymph nodes in 10 of the patients, infected bone in 4 and pleural in one case; 13/28 patients came from other continents. Most of the patients were treatment with 3-4 tuberculostatic drugs, with favorable course. Conclusions. Cutaneous tuberculosis is not uncommon in our setting. In classic cutaneous tuberculosis culture is the gold standard diagnostic method while tuberculids are most commonly diagnosed by histology(AU)

[Cutaneous tuberculosis in an area of Mallorca (2003-2011)]. / Tuberculosis cutánea en una zona de Mallorca (2003-2011).

BACKGROUND AND OBJECTIVE: Tuberculosis is an important health care problem, even in our setting. The objective of this study is to describe clinic and epidemiological features of cutaneous tuberculosis in our area. PATIENTS AND METHODS: A retrospective study was performed of all patients diagnosed of cutaneous tuberculosis in a hospital in Mallorca (Spain) from January 2003 to July 2011. The clinical forms, diagnostic methods used, treatment used and clinical course were recorded. RESULTS: Twenty-eight cases of cutaneous tuberculosis were diagnosed (5.9% of the tuberculosis cases diagnosed in this period), 15 with classic cutaneous tuberculosis (14 scrofuloderma, 1 empyema necessitatis) and 13 patients with tuberculids (8 erythema induratum of Bazin disease and 5 erythema nodosum). Scrofulodermas came from lymph nodes in 10 of the patients, infected bone in 4 and pleural in one case; 13/28 patients came from other continents. Most of the patients were treatment with 3-4 tuberculostatic drugs, with favorable course. CONCLUSIONS: Cutaneous tuberculosis is not uncommon in our setting. In classic cutaneous tuberculosis culture is the gold standard diagnostic method while tuberculids are most commonly diagnosed by histology.

El papel pronóstico de la invasión perineural en la biopsia prostática / Prognostic role of perineural invasion in prostate biopsy

Introducción: A pesar de que la diseminación celular tumoral a través del sistema nervioso intraprostático se considera un mecanismo de progresión del cáncer prostático, el significado de la invasión perineural en biopsias de próstata para predecir extensión extraprostática y su utilidad como potencial factor pronóstico es controvertido. Material y métodos: Estudio retrospectivo llevado a cabo en una institución sobre 208 pacientes tratados con prostatectomía radical (enero 2007-julio 2010) en los que se ha determinado la presencia de invasión perineural y el score de gleason en la biopsia preoperatoria, así como el estadio clínico y el PSA prequirúrgico. Clasificamos los pacientes en grupos de riesgo según la clasificación de D’Amico. Realizamos análisis estadístico bivariante y multivariante para establecerla correlación entre las distintas variables. Resultados: Se objetivó IPN en el 18,3% de las biopsias prostáticas. Presentaron extensión extraprostática el 71% de los espécimenes de prostatectomía con invasión perineural en la biopsia previa vs. 23,1% cuando no existía este hallazgo (p < 0,0001) y márgenes positivos el 47,4% de los casos con IPN, frente a 18,3% sin invasión perineural (p < 0,0001). De hecho, en el análisis multivariante la invasión perineural demostró ser un factor de riesgo independiente para presentar extensión extraprostática y márgenes positivos en la pieza de prostatectomía. Conclusiones: La presencia de Invasión perineural es un factor pronóstico útil para la predicción de extensión extraprostática y afectación de márgenes quirúrgicos en la pieza de prostatectomía radical. Consideramos que su determinación puede ser una herramienta útil en la mejora del diagnóstico preoperatorio y en la planificación del tratamiento (AU)

Introduction: Despite tumour cell dissemination through the intraprostatic nervous systembeing considered as a prostate cancer progression mechanism, the significance of perineural invasion in prostate biopsies to predict extraprostatic extension and its use as a potential prognosis factor is controversial. Materials and methods: Retrospective study carried out at an institution on 208 patients treated with radical prostatectomy (January 2007 - July 2010) in which the presence of perineural invasion and the Gleason score in the preoperative biopsy were determined, as well as the clinical stage and the pre-surgery PSA. We classified the patients in risk groups in accordance with the D’Amico classification. We performed bivariate and multivariate statistical analyses to establish the correlations between the different variables. Results: We objectified PNI in 18.3% of the prostate biopsies. 71% of the prostatectomy specimens with perineural invasion presented extraprostatic extension in the previous biopsy against 23.1% when this was not found (p < 0.0001) and 47% of the cases showed positive margins with PNI, against 18.3% without perineural invasion (p < 0.0001). In fact, in the multivariate analysis, perineural invasion proved to be an independent risk factor in the presentation of extraprostatic extension and positive margins in the prostatectomy specimen. Conclusions: The presence of perineural invasion is a useful prognostic factor for predicting extraprostatic extension and the involvement of surgical margin in the radical prostatectomy specimen. We believe that determining it may be a useful tool for improving preoperative diagnosis and planning treatment (AU)

Four imported cases of tungiasis in Mallorca.

Tungiasis is an endemic disease in many resource-poor communities some of which are in South America, which are visited frequently by Spanish travelers. Its diagnosis can be improved with the knowledge of the typical presentation and the correct management of its injuries. We report the first four cases identified of imported tungiasis in Mallorca. All four patients visited beaches in Brazil and presented the classical black lesions after their return. Two of the patients were diagnosed at primary care level and all were treated by dermatologists with surgical techniques. Dermoscopy was used for the initial approach to the injuries. Tungiasis can be suspected easily by examining carefully the black lesions and asking about previous travel. It can be treated readily by minor surgical techniques.

[Prognostic role of perineural invasion in prostate biopsy]. / El papel pronóstico de la invasión perineural en la biopsia prostática.

INTRODUCTION: Despite tumour cell dissemination through the intraprostatic nervous system being considered as a prostate cancer progression mechanism, the significance of perineural invasion in prostate biopsies to predict extraprostatic extension and its use as a potential prognosis factor is controversial. MATERIALS AND METHODS: Retrospective study carried out at an institution on 208 patients treated with radical prostatectomy (January 2007 - July 2010) in which the presence of perineural invasion and the Gleason score in the preoperative biopsy were determined, as well as the clinical stage and the pre-surgery PSA. We classified the patients in risk groups in accordance with the D'Amico classification. We performed bivariate and multivariate statistical analyses to establish the correlations between the different variables. RESULTS: We objectified PNI in 18.3% of the prostate biopsies. 71% of the prostatectomy specimens with perineural invasion presented extraprostatic extension in the previous biopsy against 23.1% when this was not found (p<0.0001) and 47% of the cases showed positive margins with PNI, against 18.3% without perineural invasion (p<0.0001). In fact, in the multivariate analysis, perineural invasion proved to be an independent risk factor in the presentation of extraprostatic extension and positive margins in the prostatectomy specimen. CONCLUSIONS: The presence of perineural invasion is a useful prognostic factor for predicting extraprostatic extension and the involvement of surgical margin in the radical prostatectomy specimen. We believe that determining it may be a useful tool for improving preoperative diagnosis and planning treatment.

Dermoscopy of cutaneous leishmaniasis.

BACKGROUND: Dermoscopy has been proposed as a diagnostic tool in the case of skin infections and parasitosis but no specific dermoscopic criteria have been described for cutaneous leishmaniasis (CL). OBJECTIVES: To describe the dermoscopic features of CL. METHODS: Dermoscopic examination (using the DermLite Foto; 3Gen, LLC, Dana Point, CA, U.S.A.) of 26 CL lesions was performed to evaluate specific dermoscopic criteria. RESULTS: We observed the following dermoscopic features: generalized erythema (100%), 'yellow tears' (53%), hyperkeratosis (50%), central erosion/ulceration (46%), erosion/ulceration associated with hyperkeratosis (38%) and 'white starburst-like pattern' (38%). Interestingly, at least one vascular structure described in skin neoplasms was observed in all cases: comma-shaped vessels (73%), linear irregular vessels (57%), dotted vessels (53%), polymorphous/atypical vessels (26%), hairpin vessels (19%), arborizing telangiectasia (11%), corkscrew vessels (7%) and glomerular-like vessels (7%). Combination of two or more different types of vascular structures was present in 23 of 26 CL lesions (88%), with a combination of two vascular structures in 13 cases (50%) and three or more in 10 cases (38%). CONCLUSIONS: Characteristic dermoscopic structures have been identified in CL. Important vascular patterns seen in melanocytic and nonmelanocytic tumours are frequently observed in this infection.