Distant Cutaneous Metastases of Prostate Cancer: A Report of 2 Cases. / Metástasis cutáneas a distancia de cáncer de próstata: 2 casos.

Cutaneous metastases of prostate cancer are extremely rare. We present 2 cases of distant cutaneous metastases at atypical locations of prostate adenocarcinoma, and highlight the value of 2 immunohistochemical stains-prostatic acid phosphatase and prostate-specific membrane antigen-that can aid diagnosis, particularly in cases with negative staining for prostate-specific antigen.

[Scurvy and acquired ichthyosis associated to Whipple's disease]. / Escorbuto e ictiosis adquirida asociadas a enfermedad de Whipple.

The skin manifestations, except for hyperpigmentation, are uncommon in Whipple's disease (WD). We present the case of a 48-year-old male with chronic diarrhea and long course general syndrome associated to neurological manifestations. Skin examination revealed lesions in the lower limbs and gums that were clinically consistent with scurvy and were confirmed by histological study and measurement of blood vitamin C levels. Furthermore, he had lesions that were clinically and histologically consistent with acquired ichthyosis. The digestive tract biopsy study showed non-necrotizing epithelioid granulomas without the presence of PAS positive macrophages. The patient was diagnosed of Whipple's disease through the identification of genomic fragments of Tropheryma Whippelii by PCR in duodenal samples. He was treated with antibiotics for two years with resolution of the cutaneous and digestive picture but with partial improvement of the neurological symptoms. In the literature reviewed, we did not find any case of acquired ichthyosis associated to WD and only one of scurvy secondary to this rare disease.

[Necrobiotic xanthogranuloma with scleroatrophic lichen associated with paraproteinemia]. / Xantogranuloma necrobiótico con paraproteinemia asociado a liquen escleroatrófico.

Necrobiotic xanthogranuloma (Xn) with paraproteinemia is a histiocytoxanthomatosis (non-X histiocytosis) that affects the dermis and subcutaneous tissue of the face and less frequently the trunk and limbs. We present the case of a 58-year-old woman with a previous background of IgG (lambda) paraproteinemia and multiple autoimmune diseases, that associate clinically and histologically typical lesions of Xn on face, neck and limbs and of lichen sclerosus et atrophius (LEA) on skin and mucosae. The treatments performed were ineffective, the Xn lesions followed a chronic and progressive course with increased number, size and ulceration of them. The paraproteinemia has remained stable since it was diagnosed eight years ago. We have not found the association of Xn with paraproteinemia and SAL described in the literature. We review the characteristics of this rare disease and its possible pathogenic mechanisms.

Escorbuto e ictiosis adquirida asociadas a enfermedad de Whipple / Scurvy and acquired ichthyosis associated to Whipple’s disease

Las manifestaciones cutáneas, a excepción de la hiperpigmentación, son poco frecuentes en la enfermedad de Whipple (EW). Presentamos el caso de un varón de 48 años de edad con diarrea crónica y síndrome general de larga evolución, asociado a manifestaciones neurológicas. En la exploración cutánea se observó en miembros inferiores y encías lesiones compatibles clínicamente con escorbuto, que se confirmó mediante estudio anatomopatológico y determinación de niveles de vitamina C en sangre. Así mismo, presentaba lesiones clínica e histológicamente compatibles con ictiosis adquirida. El estudio de la biopsia de aparato digestivo demostró granulomas epitelioides no necrotizantes sin la presencia de macrófagos PAS positivos. El paciente fue diagnosticado de enfermedad de Whipple mediante la determinación de fragmentos genómicos de Tropheryma Whippelii por reacción en cadena de la polimerasa (PCR) en muestras duodenales. Recibió tratamiento antibiótico durante dos años con resolución del cuadro cutáneo y digestivo, pero con mejoría parcial de la clínica neurológica. En la literatura revisada no hemos encontrado ningún caso de ictiosis adquirida asociada a EW, y sólo uno de escorbuto secundario a esta rara enfermedad

The skin manifestations, except for hyperpigmentation, are uncommon in Whipple's disease (WD). We present the case of a 48-year-old male with chronic diarrhea and long course general syndrome associated to neurological manifestations. Skin examination revealed lesions in the lower limbs and gums that were clinically consistent whit scurvy and were confirmed by histological study and measurement of blood vitamin C levels. Furthermore, he had lesions that were clinically and histologically consistent with acquired ichthyosis. The digestive tract biopsy study showed non-necrotizing epithelioid granulomas without the presence of PAS positive macrophages. The patient was diagnosed of Whipple's disease through the identification of genomic fragments of Tropheryma Whippelii by PCR in duodenal samples. He was treated with antibiotics for two years with resolution of the cutaneous and digestive picture but with partial improvement of the neurological symptoms. In the literature reviewed, we did not find any case of acquired ichthyosis associated to WD and only one of scurvy secondary to this rare disease

Xantogranuloma necrobiótico con paraproteinemia asociado a liquen escleroatrófico / Necrobiotic xanthogranuloma with scleroatrophic lichen associated with paraproteinemia

El xantogranuloma necrobiótico (Xn) con paraproteinemia es una histiocitoxantomatosis (histiocitosis no X) que afecta la dermis y el tejido subcutáneo de la cara y, con menor frecuencia, del tronco y las extremidades. Presentamos el caso de una mujer de 58 años con historia previa de paraproteinemia IgG lambda y múltiples patologías autoinmunes, que asocia lesiones clínica e histológicamente típicas de Xn en cara, cuello y extremidades, así como de liquen escleroatrófico (LEA) en piel y mucosas. Los tratamientos realizados fueron ineficaces, siguiendo las lesiones de Xn un curso crónico y progresivo, con aumento del número, tamaño y ulceración de las mismas. La paraproteinemia ha permanecido estable desde su diagnóstico hace 8 años. No hemos encontrado descrita en la literatura la asociación de Xn con paraproteinemia y LEA. Repasamos las características de esta rara enfermedad y sus posibles mecanismos patogénicos

Necrobiotic xanthogranuloma (Xn) with paraproteinemia is a histiocytoxanthomatosis (non-X histiocytosis) that affects the dermis and subcutaneous tissue of the face and less frequently the trunk and limbs. We present the case of a 58-year-old woman with a previous background of IgG (lambda) paraproteinemia and multiple autoimmune diseases, that associate clinically and histologically typical lesions of Xn on face, neck and limbs and of lichen sclerosus et atrophius (LEA) on skin and mucosae. The treatments performed were ineffective, the Xn lesions followed a chronic and progressive course with increased number, size and ulceration of them. The paraproteinemia has remained stable since it was diagnosed eight years ago. We have not found the association of Xn with paraproteinemia and SAL described in the literature. We review the characteristics of this rare disease and its possible pathogenic mechanisms