Challenges in the Diagnosis and Management of Giant Porokeratosis: A Case Report.

Porokeratosis encompasses a diverse group of dermatoses, both acquired and genetic, marked by a keratinization disorder. Porokeratosis of Mibelli (PKM) presents as solitary plaques or multiple papules/macules with central atrophy and raised hyperkeratotic borders. Here, we present a case of giant porokeratosis (GPK), a rare form often considered a morphological variant of PKM, with unique clinical and histopathological aspects. Our case involves a 29-year-old patient with a 15 × 10 cm irregular plaque on the dorsal aspect of the right hand. The patient was previously prescribed various topical treatments (retinoids, calcineurin inhibitors, and combinations of corticosteroids with vitamin D3 analogs) and systemic retinoids without improvement before presenting to our department. Due to the high risk of neoplastic transformation and the unavailability of imiquimod, the patient was recommended topical 5-fluorouracil treatment. The trajectory of the lesion under treatment revealed a favorable evolution, and the patient was subjected to regular monitoring every three months to assess the ongoing progress. Recognizing GPK as a high-risk variant is crucial for dermatologists, and it requires a personalized approach. Regular monitoring is advised to detect potential malignant transformations promptly. Future research holds promise for diagnostic advancements, refined treatment modalities, and a deeper understanding of the molecular mechanisms underlying malignancy in porokeratosis.

A Rare Association of Disseminated Granuloma Annulare With Recurrent Uveitis.

Granuloma annulare is a benign chronic inflammatory granulomatous dermatosis with a variable clinical presentation. The disseminated form of the disease is characterized by a widespread papular eruption, primarily affecting the trunk, neck, and extremities. The development of granuloma annulare in patients with systemic diseases, such as diabetes mellitus, malignancy, or dyslipidemia, has been extensively documented. Still, only a few cases of granuloma annulare associated with recurrent uveitis have been reported. Herein, we present a rare case of generalized granuloma annulare that was associated with concomitant recurrent uveitis in a 60-year-old male patient with a history of type II diabetes mellitus. A general physical exam revealed widespread erythematous papules in an annular pattern on the trunk, characteristic of granuloma annulare. A series of tests were conducted, including autoimmune workup, all within normal limits. Histopathologic findings revealed features consistent with granuloma annulare. The patient was successfully treated with systemic corticosteroids for the uveitis and isotretinoin for the skin lesions. A close follow-up is recommended given the rare association of granuloma annulare and uveitis.

[Barriers to entry into Ehpad since the Covid-19 crisis: a qualitative study of people over 65 in Marseille]. / Freins à l'entrée en Ehpad depuis la crise Covid-19 : étude qualitative auprès de personnes âgées de plus de 65 ans à Marseille.

From the outset of the Covid-19 health crisis, residential care facilities for the dependent elderly (Ehpad) were faced with health and safety challenges. Strict infection prevention measures, such as visiting restrictions and the implementation of sanitary protocols, have been essential to protect residents. While Ehpad occupancy rates were stable before the health crisis, they fell sharply in the aftermath of Covid-19.

Workplace humour, compassion, and professional quality of life among medical staff.

Background: Professional quality of life pertains to the balance between compassion fatigue and compassion satisfaction. In recent years, there was an increase in compassion fatigue among medical staff due to the pandemic, all over the world, while compassion satisfaction was reported at a moderate level.Objectives: The aim of this study was to identify the relationship between workplace humour and professional quality of life among medical staff, as well as the moderating role of compassion in this relationship.Method: The sample consisted of 189 participants (Mage = 41.01; SD = 9.58). Of the total sample, 57.1% are physicians, 32.3% are nurses and 6.9% are clinical psychologists. The participants completed scales measuring compassion, workplace humour, and professional quality of life.Results: The results showed that self-enhancing and affiliative humour were positively related, while self-defeating humour was negatively related to compassion satisfaction. Burnout and secondary traumatic stress were negatively related to self-enhancing humour and positively related to self-defeating humour. Compassion moderated the relationship between affiliative humour and secondary traumatic stress.Conclusions: Encouraging coping strategies based on adaptive humour (i.e. affiliative humour, self-enhancing) and raising awareness about negative humour strategies (i.e. self-defeating) could contribute to an increase of quality of life among healthcare providers. Another conclusion derived from the present study sustains that compassion is a valuable personal resource positively related to compassion satisfaction. Compassion also facilitates the relationship between affiliative humour and low secondary traumatic stress. Thus, encouraging compassionate skills could be beneficial for the optimal professional quality of life.

Self-enhancing and affiliative humour were positively related, while self-defeating humour was negatively related to compassion satisfaction.Burnout and secondary traumatic stress were negatively related to self-enhancing humour and positively related to self-defeating humour.Compassion moderated the relationship between affiliative humour and secondary traumatic stress.

Cutaneous Melanoma and Glioblastoma Multiforme Association-Case Presentation and Literature Review.

The occurrence of both melanoma and glioma was first suggested by the observation of a familial association between these conditions, which was later confirmed by the description of the melanoma-astrocytoma syndrome, an extremely rare, inherited affliction in which people have an increased risk of developing melanoma and nervous system tumors. Taking into consideration the common embryologic precursor, the neuroectoderm, it was hypothesized that this syndrome is associated with a genetic disorder. While some families with germline CDKN2A mutations are prone to develop just melanomas, others develop both melanomas and astrocytomas or even other nervous-system neoplasms. Herein, we report the case of a 63-year-old male patient with no personal or family history of malignancy who had primary melanoma followed by glioblastoma. Our case report suggests that the occurrence of both melanoma and glioblastoma is most likely not coincidental but instead linked to genetic mutations of common embryologic precursors or signaling pathways.

Challenging Patterns of Atypical Dermatofibromas and Promising Diagnostic Tools for Differential Diagnosis of Malignant Lesions.

Dermatofibroma (DF) or fibrous histiocytoma is one of the most frequent benign cutaneous soft-tissue lesions, characterized by a post-inflammatory tissue reaction associated with fibrosis of the dermis. Clinically DFs have a polymorphous clinical aspect from the solitary, firm, single nodules to multiple papules with a relatively smooth surface. However, multiple atypical clinicopathological variants of DFs have been reported and, therefore, clinical recognition may become challenging, leading to a more burdensome identification and sometimes to misdiagnosis. Dermoscopy is considered an important tool in DFs diagnosis, as it improves diagnostic accuracy for clinically amelanotic nodules. Although typical dermoscopic patterns are most frequently seen in clinical practice, there have also been some atypical variants described, mimicking some underlying recurrent and sometimes harmful skin afflictions. Usually, no treatment is required, although an appropriate work-up may be necessary in specific cases, such as in the presence of atypical variants or a history of recent changes. This narrative review's aim is to summarize current evidence regarding clinical presentation, positive and differential diagnosis of atypical dermatofibromas and also to raise awareness about the importance of specific characteristics of atypical variants to better differentiate them from malignant conditions.

Unusual median nerve schwannoma: a case presentation.

Peripheral nerve sheath tumors are common soft tissue neoplasms and their characterization is often challenging. Although the surgical pathology defines some typical entities, some degree of controversy regarding the classification of these tumors still exists. Newer imagistic and histopathological techniques are crucial for their accurate diagnosis and grading. We present an unusual case of median nerve schwannoma in a young patient, discussing the clinical, surgical and pathological elements, including immunohistochemistry.

Axillary basal cell carcinoma--a rare form of a frequent kind of carcinoma.

Basal cell carcinoma (BCC) is the most common cutaneous cancer. It seems that the most important prognostic factor is exposure to ultraviolet radiation (solar and artificial), correlated with other factors as well. In this article, we aimed to review basal cell carcinoma located in the axilla, referring to cases from our hospital. Axillary location of BCC is rare, with a very low number of cases quoted in the literature, compared to the high prevalence of basal cell carcinoma in the general population. During a period of two years, we detected only four cases of axillary basal cell carcinoma out of a total number of 921 cases diagnosed as BCC. We were interested in identifying certain factors involved in causing BCC, post-excision clinical evolution, histological type and aggressiveness of axillary basal cell carcinoma. Therefore, we quantified objectively the tumor and stromal expression of some immunological markers like: metalloproteinases MMP1, 3, 11, Ber-EP4 and Ki67. Histological types of tumors investigated here belong to the category of non-aggressive BCC, namely as nodular and superficial, although Ki67 index is greater than the average reported in the literature for this type of tumor. MMPs exhibited increased expression in tumors and stromal compartments, especially at the tumor invasion front, and was not associated with tumor ulceration or surrounding tissue remodeling-related changes. Our results confirm the literature data concerning the involvement of MMPs in BCC progression, whatever the tumor location is.

Human Dirofilaria repens Infection in Romania: A Case Report.

Human dirofilariasis is a zoonotic infectious disease caused by the filarial nematodes of dogs Dirofilaria repens and Dirofilaria immitis. Depending on the species involved, human infections usually manifest as one cutaneous or visceral larva migrans that forms a painless nodule in the later course of disease. Dirofilariae are endemic in the Mediterranean, particularly in Italy. They are considered as emerging pathogens currently increasing their geographical range. We present one of the few known cases of human dirofilariasis caused by D. repens in Romania. The patient developed unusual and severe clinical manifestations that mimicked pathological conditions like cellulitis or deep venous thrombosis.

Giant inflammatory fibroid polyp.

Inflammatory fibroid polyps are uncommon but well documented polypoid lesions occurring in gastrointestinal tract, most commonly in the stomach followed by ileum and rarely in the colon, duodenum or esophagus, especially in the sixth decade of life. The lesions are characterized by variable proliferation of fibroblasts and small vessels which may involve the whole thickness of the digestive wall, in an edematous connective tissue accompanying a marked inflammatory cell infiltrate which contains numerous eosinophils. We present the case of a 33 years old male patient with a solid, cylindrical-shaped 11/6.5/5 cm tumor arising from the inferior 1/3rd of the esophagus and eso-gastric region, projecting into the lumen of the stomach. The morphological features and the immunohistochemical profile were consistent with the diagnosis of IFP. This case has peculiar clinical and pathological particularities (sex and age of the patient, location and large dimensions of the lesion) that should be kept in mind when evaluating a mesenchymal tumor of the eso-gastric junction.

Regression of precancerous epithelial alteration in patients with Helicobacter pylori chronic gastritis.

As a Group 1 carcinogen for gastric cancer, Helicobacter pylori (H. pylori) was involved in many studies and researches focused on physiopathology and morphopathologic changes induced by this bacterium. The study included 3069 gastric endoscopies performed between January 2005 and December 2009 in "Colentina" Clinical Hospital. During upper endoscopy biopsies from antro-pyloric and corporeo-fundic region were collected. Histopathologic diagnosis of these biopsies was made using Sydney criteria. The patients were divided in two groups, based on the presence or absence of H. pylori: group A included 1414 H. pylori positive patients and group B included 1653 H. pylori negative patients. We evaluated several histopathological parameters, correlating the degree of inflammation, atrophy, metaplasia, regenerative hyperplasia and dysplasia with the presence of H. pylori infection. Our study identifies an overall tendency towards regression of premalignant lesions of gastric epithelium (regenerative epithelial hyperplasia, atrophy and intestinal metaplasia) after H. pylori eradication, as well an increasing number of patients diagnosed with early gastric cancer, thus consolidating the results of studies who foretell the significant decrease of gastric cancer mortality. These lesions are present years before becoming clinically manifest, and consequently treatable. In respect of carcinogenic mechanisms, some of our results confirm the carcinogenic cascade triggered by the H. pylori infection, as it was proposed by Correa et al. in 1975. However, we obtained data leading to the idea that the "precursor lesions" could appear (and subsequently histopathologically evaluated) independent one to the other, through other steps then Correa's model.

Rectal leiomyoma--report of two cases originating in muscularis mucosae.

We present two rare cases of rectal leiomyoma originating in muscularis mucosae. The lesions were incidentally discovered in a 58-years-old woman and 53-years-old man during colonoscopy performed for unrelated symptoms. Both presented as small polyps and were removed by conventional colonoscopic snare polypectomy without clinical recurrence. Gross examination revealed pedunculated polyps covered by non-ulcerated mucosa. Histologically the lesions represent smooth muscle cells proliferation originating in muscularis mucosae. Both lesions were uniformly positive for SMA and DESM and negative for CD34, CD117 and S100. These tumors have a different clinical course than gastrointestinal stromal tumors; since morphologic appearance is sometimes confusing, CD117 staining is mandatory for an accurate diagnostic. We decided to present these cases because of the rarity of this condition concerning both the location and the origins of tumors. We stress the importance of the proper classification of this rare lesion, considering its outmost importance.

Helicobacter pylori: pathological mechanism involved in gastric colonization.

Since 1982, when Marshall and Warren highlighted the presence of H. pylori at the apical pole of the epithelial gastric cells, the medical literature has registered a cascade of subsequent researches concerning this amazing bacterium, its action on the human body and the body response. The apogee of these studies and conclusions about the pathogenic role of HP was touched with its certain recognition as class one carcinogenic agent (Peura 1997, WHO), becoming the first bacteria with such an action. The data gathered in the last period identify different virulence factors of HP, but fail to fully explain the relatively low incidence of gastric cancer in HP carriers; therefore, it is now considered that the carcinogenic potential related to HP infection in humans is due to the synergic and complementary association of the bacterial genetic equipment with diet and host response.