Trichilemmoma arising in the nasal vestibule: report of three cases with special emphasis on the differential diagnosis.

Trichilemmoma is a benign cutaneous epithelial tumor with differentiation towards cells of the outer hair root sheath and usually presents as a small papule on the face of middle-aged or older adults. We herein report three cases of trichilemmoma located in the nasal vestibule, including two of the conventional type and one of the desmoplastic variant. To our knowledge, only one case of trichilemmoma arising in the nasal vestibule has been previously reported. Trichilemmoma must be included in the differential diagnosis of epithelial lesions arising in this location. This is particularly important in the case of the desmoplastic trichilemmoma, a tumor that resembles invasive carcinoma such as desmoplastic squamous cell carcinoma, sclerosing basal cell carcinoma, and trichilemmal carcinoma. The circumscription of the lesion, the architectural pattern of epithelial cell cords and small nests merging with a desmoplastic stroma in the central area of the tumor, the expression of CD34, and the lack of an obvious squamous differentiation or basaloid foci favor the diagnosis of desmoplastic trichilemmoma. All these features help to rule out the diagnosis of carcinoma with significant clinical implications.

Dermatomyofibromas presenting in pediatric patients: clinicopathologic characteristics and differential diagnosis.

Dermatomyofibroma represents a rare benign fibroblastic/ myofibroblastic cutaneous tumor that mostly occurs in young adult women. It has been seldom reported in pediatric patients. In this analysis, the clinical, histopathological and immunohistochemical findings of 12 dermatomyofibromas occurring in patients up to 16 years of age are compared with those reported in adults. Six patients were male and six were female. Nine lesions were located on the neck, two on the back and one involved the chest. The usual presentation was as an asymptomatic plaque composed of bland spindled cells arranged in dermal fascicles that were oriented parallel to the epidermis. Immunohistochemically, the lesional cells expressed calponin in 11 cases, smooth muscle actin in six and muscle-specific actin in three. In contrast to prior reports from adults, dermatomyofibromas in pediatric patients do not show a female predilection. In addition, they are mostly located on the neck (56%), while in adults the most frequent location is the shoulder (35%). Dermatomyofibromas seem to stabilize after an initial period of enlargement. Punch biopsy and clinical follow up could be an alternative approach to the surgical excision in some cases of dermatomyofibroma, particularly in instances in which surgery might inflict cosmetic defects.

Risperidone in the treatment of mania: efficacy and safety results from a large, multicentre, open study in Spain.

BACKGROUND: A number of open studies and preliminary results of unpublished double-blind trials have suggested that the novel antipsychotic risperidone may be effective and well tolerated in the treatment of acute mania in bipolar disorder. METHODS: A total of 174 patients entered this large, open, multicentre trial. Inclusion criteria were: current manic, hypomanic or mixed episode (DSM-IV), and a Young Mania Rating Scale (YMRS) score of >7. Assessments included the YMRS, Positive and Negative Syndrome Scale (PANSS), Hamilton Rating Scale for Depression (HAM-D), Clinical Global Impression (CGI), and Udvalg for Kliniske Undersøgelser (UKU) subscale for neurological side effects. RESULTS: There were significant reductions (P<0.0001) on the YMRS, PANSS and HAM-D scores and a significant improvement (P<0.0001) in CGI ratings at the endpoint. There were no statistically significant increments in the severity of extrapyramidal symptoms according to the UKU. Risperidone was generally well tolerated. The mean dose of risperidone at the endpoint was 4.9+/-2.9 mg/day. CONCLUSIONS AND CLINICAL IMPLICATIONS: This open study provides further evidence that risperidone is safe and effective in combination with mood stabilisers in the manic phase of bipolar disorder. LIMITATIONS: The open design and the use of concomitant medications make unclear to what extent the positive results were entirely related to risperidone.