Paracoccidioidomycosis with sarcoid-like cutaneous lesion: A clinicopathological challenge.

We describe a case of sarcoid-like cutaneous paracoccidioidomycosis in a 26-year-old male, with a 10-year evolution, wrongly diagnosed as granulomatous rosacea. The correct diagnosis was only possible after the appearance of a new skin lesion with a more typical characteristic of the dermatosis, correlated with anatomopathological, laboratory and imaging exams. The clinical presentation of paracoccidioidomycosis is diverse, and the sarcoid-like form can mimic several chronic granulomatous diseases, such as sarcoidosis, tuberculoid leprosy, leishmaniasis, or tuberculosis. This presentation of cutaneous paracoccidioidomycosis is rare, and its diagnosis depends on the clinicopathological correlation, which can be a challenge for the dermatologist.

PD-1/PD-L1 and VEGF-A/VEGF-C expression in lymph node microenvironment and association with melanoma metastasis and survival.

Regional lymph nodes are affected frequently by melanoma metastasis. Its microenvironment may be associated with tumor progression. We investigated sentinel nodes with and without tumor and negative nodes surrounding positive nodes, looking for patterns related to tumor immune interaction and lymphovascular progression. We quantified programmed cell death protein 1 (PD-1)/programmed cell death-ligand 1, vascular endothelial growth factor (VEGF)-A/VEGF-C expressions in lymph nodes of 103 patients who underwent sentinel lymph node biopsy. Two groups were studied: negative sentinel lymph nodes and positive ones. Negative lymph nodes of sequential lymphadenectomy from positive cases were also studied. Markers were assessed by immunohistochemistry. Results were related to clinical/histological outcomes. VEGF-A/VEGF-C analysis showed higher positivity in metastatic nodes and higher positivity in the surrounding negative nodes from positive cases in comparison with nonmetastatic patients. Programmed cell death-ligand 1, studied only in metastasis, presented high positivity, not associated with prognosis. PD-1 expressions were similar in the groups with a 1% cutoff and higher in the metastasis with a 5% cutoff. Higher VEGF-A expression was related to higher pathological stages. PD-1 expression in the lymph node was associated with higher survival. Other clinical and histopatological variables were not associated with marker expression patterns. VEGF-A and VEGF-C expressions in lymph nodes were associated with the presence of lymph node metastasis. PD-1 expression in the lymph node was related to higher survival rates and this should be explored in the context of adjuvant immunotherapy.

Eventos adversos do ácido hialurônico injetável / Adverse events in injectable hyaluronic acid

Nos últimos anos, o uso de preenchedores para tratamento de rítides e aumento do volume facial cresceu consideravelmente. Há atualmente diferentes tipos de preenchedores, divididos em temporários, semipermanentes (permanência de no mínimo 18 meses no tecido) e permanentes, também classificados conforme a composição do material (colágeno, ácido hialurônico, ácido polilático, polimetilmetacrilato, hidroxiapatita); o ácido hialurônico pode ser sintético ou de origem animal. Dos diversos produtos, o ácido hialurônico (preenchedor reabsorvível, temporário) tem sido um dos mais utilizados. Ainda não há disponível no mercado substância ideal, pura e livre de efeitos colaterais. O objetivo do trabalho é auxiliar o reconhecimento dos efeitos colaterais com uso de preenchedor à base de ácido hialurônico. Isso permite diagnóstico e tratamento precoces, diminuindo a morbidade e sequelas dos pacientes.

The use of fillers for treatment of rhytids and facial volume enlargement has grown considerably in recent years. The various filler types used currently can be classified into temporary, semi-permanent (permanence of at least 18 months in the tissue) and permanent. Fillers can also be classified according to their composition (collagen, hyaluronic acid, polylactic acid, polymethylmethacrylate, hydroxyapatite). Moreover, the hyaluronic acid may be of synthetic or animal origin. Hyaluronic acid (temporary resorbable filler) has been one of the most frequently used substances. There is no ideal, pure and commercially available substance that is free of side effects. This study evaluates the side effects of using hyaluronic acid-based fillers in order to enable early diagnosis and treatment, and reduce morbidity and sequelae among patients.