Asunto(s)
Detección Precoz del Cáncer/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Melanoma/etiología , Neoplasias Cutáneas/etiología , Baño de Sol/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Melanoma/diagnóstico , Persona de Mediana Edad , Factores de Riesgo , Neoplasias Cutáneas/diagnóstico , Encuestas y CuestionariosRESUMEN
A 77-year-old white male presented to the clinic with two isolated cutaneous tumors on his forehead. A cutaneous biopsy showed a focally folliculotropic CD4 cutaneous lymphoma. The tumors were irradiated with a complete response, and he was started on oral bexarotene. He experienced localized cutaneous relapse 3 months into treatment. These new tumors now revealed a surprisingly CD8 cytotoxic phenotype, but with the same clone. A systemic workup was negative. His regimen was switched to romidepsin, and he was treated with local radiation again. Another 3.5 months passed in remission until he developed widespread cutaneous tumors. Positron emission tomography/computed tomography revealed multifocal systemic disease involving his diaphragm, liver, distal duodenum, proximal jejunum, anterior chest wall including pectoral muscles, and lungs without significant adenopathy. He died a few days later. Given his full clinical and pathological course, he was given the diagnosis of an aggressive primary cutaneous T-cell lymphoma, unspecified.
Asunto(s)
Antineoplásicos/administración & dosificación , Linfocitos T CD4-Positivos/efectos de los fármacos , Linfocitos T CD8-positivos/efectos de los fármacos , Depsipéptidos/administración & dosificación , Sustitución de Medicamentos , Linfoma Cutáneo de Células T/tratamiento farmacológico , Neoplasias Cutáneas/tratamiento farmacológico , Tetrahidronaftalenos/administración & dosificación , Anciano , Bexaroteno , Biomarcadores de Tumor/análisis , Biopsia , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD4-Positivos/patología , Linfocitos T CD8-positivos/inmunología , Linfocitos T CD8-positivos/patología , Quimioradioterapia , Progresión de la Enfermedad , Resultado Fatal , Humanos , Inmunohistoquímica , Inmunofenotipificación , Linfoma Cutáneo de Células T/inmunología , Linfoma Cutáneo de Células T/patología , Masculino , Metástasis de la Neoplasia , Fenotipo , Neoplasias Cutáneas/inmunología , Neoplasias Cutáneas/patología , Resultado del TratamientoRESUMEN
Langerhans cell histocytosis (LCH) and Erdheim-Chester disease are two rare histiocytic disorders. Their occurrence in the same patient is more infrequent, but has been described. We report a case of a 38-year-old woman who presented with a diagnosis of single system cutaneous LCH. Subsequently, she developed multiple papules on her extremities consistent with a non-LCH xanthogranuloma type lesion. BRAF(V600E) mutation immunostain, VE1 was positive in the skin lesion, which was confirmed by molecular polymerase chain reaction (PCR) studies, initiating a complete systemic workup for Erdheim-Chester disease. Systemic involvement was confirmed with bilateral sclerotic bone lesions and retroperitoneal and pelvic fibrosing disease. She was also found to have a BRAF(V600E) mutation positive papillary thyroid carcinoma. New suspicious cutaneous lesions presenting in patients with a history of LCH need to be biopsied. A BRAF(V600E) mutation in a non-LCH histiocytic lesion with a xanthogranuloma phenotype (CD163/CD68/CD14/fascin/Factor 13a) should prompt an Erdheim-Chester disease workup. This is a unique case of a woman with BRAF(V600E) mutation positive Erdheim-Chester disease and cutaneous LCH, while also being, to our knowledge, the first reported case in the English literature of it occurring in a patient with a BRAF(V600E) mutation positive papillary thyroid carcinoma.
Asunto(s)
Carcinoma , Enfermedad de Erdheim-Chester , Histiocitosis de Células de Langerhans , Mutación Missense , Proteínas Proto-Oncogénicas B-raf , Neoplasias de la Tiroides , Adulto , Sustitución de Aminoácidos , Carcinoma/genética , Carcinoma/metabolismo , Carcinoma/patología , Carcinoma Papilar , Enfermedad de Erdheim-Chester/genética , Enfermedad de Erdheim-Chester/metabolismo , Enfermedad de Erdheim-Chester/patología , Femenino , Histiocitosis de Células de Langerhans/genética , Histiocitosis de Células de Langerhans/metabolismo , Histiocitosis de Células de Langerhans/patología , Humanos , Proteínas Proto-Oncogénicas B-raf/genética , Proteínas Proto-Oncogénicas B-raf/metabolismo , Neoplasias Cutáneas/genética , Neoplasias Cutáneas/metabolismo , Neoplasias Cutáneas/patología , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides/genética , Neoplasias de la Tiroides/metabolismo , Neoplasias de la Tiroides/patologíaRESUMEN
Awareness of the extraintestinal manifestations of Crohn disease is increasing in dermatology and gastroenterology, with enhanced identification of entities that range from granulomatous diseases recapitulating the underlying inflammatory bowel disease to reactive conditions and associated dermatoses. In this review, the underlying etiopathology of Crohn disease is discussed, and how this mirrors certain skin manifestations that present in a subset of patients is explored. The array of extraintestinal manifestations that do not share a similar pathology, but which are often seen in association with inflammatory bowel disease, is also discussed. Treatment and pathogenetic mechanisms, where available, are discussed.
Asunto(s)
Enfermedad de Crohn/patología , Enfermedades de la Piel/patología , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/tratamiento farmacológico , Eritema Nudoso/tratamiento farmacológico , Eritema Nudoso/etiología , Eritema Nudoso/patología , Granulomatosis Orofacial/tratamiento farmacológico , Granulomatosis Orofacial/etiología , Granulomatosis Orofacial/patología , Humanos , Linfedema/tratamiento farmacológico , Linfedema/etiología , Linfedema/patología , Piodermia Gangrenosa/tratamiento farmacológico , Piodermia Gangrenosa/etiología , Piodermia Gangrenosa/patología , Enfermedades de la Piel/tratamiento farmacológico , Enfermedades de la Piel/etiología , Síndrome de Sweet/tratamiento farmacológico , Síndrome de Sweet/etiología , Síndrome de Sweet/patología , Vasculitis Leucocitoclástica Cutánea/tratamiento farmacológico , Vasculitis Leucocitoclástica Cutánea/etiología , Vasculitis Leucocitoclástica Cutánea/patologíaRESUMEN
Mycosis fungoides is uncommon in children and most often presents as stage IA/IB. We present a case of stage IIB mycosis fungoides in a 13-year-old boy and discuss diagnostic examination and treatment considerations.
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Micosis Fungoide/patología , Neoplasias Cutáneas/patología , Adolescente , Biomarcadores de Tumor/metabolismo , Humanos , Antígeno Ki-1/metabolismo , Masculino , Micosis Fungoide/metabolismo , Estadificación de Neoplasias , Neoplasias Cutáneas/metabolismoRESUMEN
Human polyomavirus 7 (HPyV7) is one of 11 HPyVs recently discovered through genomic sequencing technologies. Two lung transplant recipients receiving immunosuppressive therapy developed pruritic, brown plaques on the trunk and extremities showing a distinctive epidermal hyperplasia with virus-laden keratinocytes containing densely packed 36-45-nm icosahedral capsids. Rolling circle amplification and gradient centrifugation testing were positive for encapsidated HPyV7 DNA in skin and peripheral blood specimens from both patients, and HPyV7 early and capsid proteins were abundantly expressed in affected tissues. We describe for the first time that HPyV7 is associated with novel pathogenicity in some immunosuppressed individuals.
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Infecciones por Polyomavirus/patología , Infecciones por Polyomavirus/virología , Poliomavirus/aislamiento & purificación , Receptores de Trasplantes , Infecciones Tumorales por Virus/patología , Infecciones Tumorales por Virus/virología , Anciano , Sangre/virología , Exantema/patología , Exantema/virología , Histocitoquímica , Humanos , Huésped Inmunocomprometido , Inmunohistoquímica , Masculino , Microscopía Electrónica de Transmisión , Piel/patología , Piel/virología , ViremiaAsunto(s)
Penicilamina/efectos adversos , Esclerodermia Sistémica/tratamiento farmacológico , Enfermedades de la Piel , Piel/patología , Adulto , Antirreumáticos/administración & dosificación , Antirreumáticos/efectos adversos , Biopsia/métodos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/etiología , Femenino , Humanos , Cuello/patología , Penicilamina/administración & dosificación , Remisión Espontánea , Enfermedades de la Piel/inducido químicamente , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/fisiopatologíaAsunto(s)
Ileostomía/efectos adversos , Mucosa Intestinal/patología , Enfermedades de la Piel/patología , Anciano , Colon , Electrocoagulación , Femenino , Humanos , Mucosa Intestinal/cirugía , Metaplasia/etiología , Metaplasia/cirugía , Enfermedades de la Piel/etiología , Enfermedades de la Piel/cirugíaRESUMEN
BACKGROUND: Evolution in techniques and equipment has expanded the role, effectiveness, and safety of endovascular transarterial embolization for the treatment of severe epistaxis. Risks from this treatment approach include major ischemic complications. To date, there have been only a few reports of soft tissue necrosis following endovascular embolization for severe epistaxis; none involve the use of Onyx-18. CASE DESCRIPTION: We report the case of a 52-year-old woman who presented with epistaxis that was refractory to medical and surgical management, which lead to endovascular intervention and embolization with Onyx-18. The patient subsequently developed nasal ala and facial necrosis as a result of the procedure. CONCLUSION: We report the use of Onyx-18 for the endovascular embolization of a patient with severe epistaxis and subsequent complications. In cases of severe epistaxis that warrant intervention in the form of embolization, ischemic complications are rare; however, ischemic complications may be unavoidable and should factor into the discussion regarding procedural risks.
RESUMEN
BACKGROUND: Crohn's disease (CD) is a chronic inflammatory, relapsing, and progressive condition that leads to bowel damage and subsequent stricturing or penetrating complications. Tumor necrosis factor (TNF) α antagonists (e.g., infliximab) can achieve sustained remission in CD. However, a paradox exists as to whether use of these medications, which effectively treat psoriasis, also confer risk of developing psoriasiform lesions. METHODS: Data from the Food and Drug Administration Adverse Event Reporting System (2004-2011) were analyzed. Adverse event reports for the TNF-α antagonists infliximab, adalimumab, and certolizumab were reviewed. Primary "control" drugs examined included the non-CD drugs propranolol and lithium because of their recognized association with risk of psoriasis and the nonbiological CD drug mesalamine. Proportional reporting ratios for psoriasis adverse events were calculated for TNF-α antagonists versus control drugs. RESULTS: From more than 13 million reports in Adverse Event Reporting System, the biological group included 5432 reports with psoriasis listed (infliximab = 1789; adalimumab = 3475; and certolizumab = 168) compared with just 88 psoriasis reports for the control group (propranolol = 24; mesalamine = 24; and lithium = 40). Compared with control drugs, the psoriasis proportional reporting ratios for TNF-α antagonists were as follows: infliximab (6.61), adalimumab (12.13), and certolizumab (5.43) (P < 0.0001). The aggregate "class" proportional reporting ratio for all TNF-α antagonists versus control drugs was 9.24 (P < 0.0001). Similar results were observed when psoriasis reports were compared between TNF-α antagonists and other drugs used to treat CD, including azathioprine, 6-mercaptopurine, methotrexate, corticosteroids, ciprofloxacin, and the antimalarial drug, hydroxychloroquine. CONCLUSIONS: Data from the Food and Drug Administration Adverse Event Reporting System suggest that TNF-α antagonists used in the treatment of CD confer an increased risk of psoriasiform adverse events.
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Sistemas de Registro de Reacción Adversa a Medicamentos , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/tratamiento farmacológico , Psoriasis/inducido químicamente , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , United States Food and Drug Administration , Adalimumab , Antiinflamatorios/efectos adversos , Anticuerpos Monoclonales/efectos adversos , Anticuerpos Monoclonales Humanizados/efectos adversos , Estudios de Casos y Controles , Certolizumab Pegol , Femenino , Estudios de Seguimiento , Humanos , Fragmentos Fab de Inmunoglobulinas/efectos adversos , Inmunosupresores/efectos adversos , Infliximab , Masculino , Polietilenglicoles/efectos adversos , Pronóstico , Estados UnidosRESUMEN
The cutaneous manifestations of psoriasis can vary in morphology and severity, and therapy should be tailored accordingly. Biologic agents are important new options for treating patients with the most severe forms of the disease. All physicians should be aware that severe psoriasis may increase cardiovascular morbidity and the risk of death, and preventive strategies for patients with severe disease should be considered.
Asunto(s)
Psoriasis/tratamiento farmacológico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Humanos , Queratinocitos/fisiología , Psoriasis/complicaciones , Psoriasis/fisiopatología , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: In patients with a history of nodal anaplastic large-cell lymphoma (ALCL), differentiation of type C lymphomatoid papulosis from cutaneous involvement of systemic ALCL may be challenging because the 2 entities may exhibit identical histologic features. Although metastatic ALCL generally carries the same clone as the primary lymphoma, expression of a distinct clone likely represents a distinct process. OBSERVATIONS: A 54-year-old white man had a history of anaplastic lymphoma kinase 1-negative ALCL in the right inguinal lymph node 6 years ago. A complete response was achieved after 6 cycles of CHOP (cyclophosphamide, doxorubicin, vincristine [Oncovin], and prednisone administered in 21-day cycles) and radiation therapy. After 3½ years, the patient observed waxing and waning papules and nodules. Examination of the biopsy specimen revealed a dense CD30(+) lymphocytic infiltrate; no evidence of systemic malignancy was evident on positron emission tomography. Although clinically the presentation was consistent with lymphomatoid papulosis, metastatic ALCL had to be excluded. Polymerase chain reaction analysis with T-cell receptor γ-chain gene rearrangement (TCR-γR) was performed on the original lymph node and new skin lesions. Results of the TCR-γR analysis were positive for clonality in both lesions. However, separate clonal processes were identified. The identification of distinct clones supported the clinical impression of lymphomatoid papulosis. CONCLUSION: Polymerase chain reaction analysis of TCR-γR is a useful method for distinguishing different clonal processes and is recommended when differentiation of primary and secondary lymphoproliferative disorders is required.
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Reordenamiento Génico de la Cadena beta de los Receptores de Antígenos de los Linfocitos T , Linfoma Anaplásico de Células Grandes/genética , Linfoma Anaplásico de Células Grandes/patología , Papulosis Linfomatoide/genética , Papulosis Linfomatoide/patología , Neoplasias Cutáneas/genética , Neoplasias Cutáneas/patología , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Cutáneas/secundarioRESUMEN
Carcinoma of the prostate accounts for fewer than 1% of all skin metastases. Cutaneous metastases from prostate carcinoma most often involve the penis, the anterior aspect of the thighs, the suprapubic area, and the perineum, but they also have been reported in the scalp, the chest, the back, and even the face. We report an unusual case of metastatic prostate adenocarcinoma that presented as an umbilical nodule (Sister Mary Joseph nodule) and demonstrated significant epidermotropism histologically. A review of the literature has found only one documented case of prostatic carcinoma metastasizing to the umbilicus, and one other documented case of epidermotropic metastatic prostate carcinoma.