Kaposi sarcoma in an HIV-negative Filipino man

INTRODUCTION: Kaposi sarcoma (KS) is a multicentric, vasoproliferative tumor. Human herpes virus 8 has been demonstrated to have a direct role in its development. Classic Kaposi sarcoma is seen in HIV-negative, elderly men, often of Jewish or Mediterranean lineage.CASE REPORT: A 78-year-old, HIV-negative man presented with a 4-year history of multiple nodules and plaques on both lower extremities. Histologic findings were consistent with nodular Kaposi sarcoma. Immunohistochemistry studies showed CD34+ cells. Tumor cells stained positive for HHV-8 latent nuclear antigen. As palliative treatment, the patient underwent external beam radiotherapy.CONCLUSION: Classic Kaposi sarcoma tends to run an indolent course. Progression of skin lesions however, can lead to immense discomfort and disfigurement. As there is no definitive treatment algorithm for KS, management decisions should be made judiciously to choose the most effective treatment that will cause the least morbidity.

The Philippine General Hospital experience with extramammary Paget's disease from 1997 to 2006

BACKGROUND: Extramammary Paget's disease (EMPD) is a rare intraepidermal adenocarcinoma seen in areas with high density of apocrine glands such as the vulva, perianal area, scrotal and penile regions. Clinically the lesions appear to be well-defined erythematous or white plaques accompanied by pruritus; often misdiagnosed as inflammatory or infectious conditions i.e. psoriasis, candidiasis or dermatitis. At present, there is no retrospective study on the prevalence of EMPD in the Philippines. OBJECTIVE: This study aimed to conduct a ten-year retrospective review of histologically diagnosed extramammary Paget's disease in the Philippine General Hospital from 1997 to 2006, and confirm the diagnoses by carcinoembryonic antigen immunostain (CEA). METHODS: Histopathology logbooks and organ files of the PGH Section of Dermatology and PGH Department of Pathology from January 1997 to December 2006 were searched. Records and specimen paraffin blocks of EMPD patients were retrieved for review and CEA immunostain, respectively. RESULTS: Nine EMPD patients were seen in a ten-year period, eight were positive for CEA, and one had no paraffin block available for review. The vulva was the most common site (89 percent) followed by the perianal area (11 percent), and all patients were females, aged 47 to 86 years old. The most common complaint was pruritus, often misdiagnosed as fungal infection, contact dermatitis, vulvar carcinoma or malignant melanoma; with one week to seven years before a final diagnosis of EMPD was made. Lesions were mostly erythematous, indurated plaques ranging from 0.48 cm to 299 cm with a mean of 120.67 cm . Malignancy was noted in one patient who had breast cancer prior to appearance of vulvar lesions. Surgical removal of the lesion was the main mode of-treatment. Vulvectomy, wide excision or local excision has been done with surgical flaps or grafts depending on the size of the lesion. CONCLUSION: From 1997 to 2006 the Philippine General Hospital had nine histopathologically diagnosed EMPD, eight of which in the vulvar area and eight had CEA positive staining. Recurrence of lesions and appearance of concomitant malignancy could not be assessed due to the poor follow up of patients and incomplete records.

An open label efficacy study of topical imiquimod 5% cream in the treatment of verruca vulgaris and verruca plana in Filipinos

BACKGROUND: Verrucae or warts, are benign epithelial growths caused by human papillomavirus (HPV) infection of the skin. They are unsightly and may affect a patient's quality of life, causing social embarrassment, discomfort, pain, and interference in certain activities. OBJECTIVE: To evaluate the efficacy and safety of imiquimod 5 percent cream for sixteen weeks in the treatment of verruca vulgaris and verruca plana in an open-label trial involving healthy immunocompetent Filipino patients of the Dermatology out-patient clinic of the Philippine General Hospital. METHODS: Imiquimod 5 percent cream was self-administered by patients with verruca vulgaris or verruca plana on their lesions, nightly for 16 weeks. Follow-up was done every two weeks to determine any change in size over time. Side effects were recorded. RESULTS: Complete clearance was seen in 31.8% of verruca vulgaris cases, with improvement seen in 59 percent of cases. Shorter duration of lesions was associated with clearance. Complete clearance was seen in only 1 out of 8 patients with verruca plana treated. Minor side effects were reported. CONCLUSION: Topical imiquimod 5 percent cream is a safe, well-tolerated, painless, convenient, patient-applied route which may be a preferred alternative treatment for verruca vulgaris.

The Philippine General Hospital experience with extramammary Paget's disease from 1997 to 2006

BACKGROUND: Extramammary Paget's disease (EMPD) is a rare intraepidermal adenocarcinoma seen in areas with high density of apocrine glands such as the vulva, perianal area, scrotal and penile regions. Clinically the lesions appear to be well-defined erythematous or white plaques accompanied by pruritus; often misdiagnosed as inflammatory or infectious conditions i.e. psoriasis, candidiasis or dermatitis. At present, there is no retrospective study on the prevalence of EMPD in the Philippines. OBJECTIVE: This study aimed to conduct a ten-year retrospective review of histologically diagnosed extramammary Paget's disease in the Philippine General Hospital from 1997 to 2006, and confirm the diagnoses by carcinoembryonic antigen immunostain (CEA). METHODS: Histopathology logbooks and organ files of the PGH Section of Dermatology and PGH Department of Pathology from January 1997 to December 2006 were searched. Records and specimen paraffin blocks of EMPD patients were retrieved for review and CEA immunostain, respectively. RESULTS: Nine EMPD patients were seen in a ten-year period, eight were positive for CEA, and one had no paraffin block available for review. The vulva was the most common site (89 percent) followed by the perianal area (11 percent), and all patients were females, aged 47 to 86 years old. The most common complaint was pruritus, often misdiagnosed as fungal infection, contact dermatitis, vulvar carcinoma or malignant melanoma; with one week to seven years before a final diagnosis of EMPD was made. Lesions were mostly erythematous, indurated plaques ranging from 0.48 cm to 299 cm with a mean of 120.67 cm . Malignancy was noted in one patient who had breast cancer prior to appearance of vulvar lesions. Surgical removal of the lesion was the main mode of-treatment. Vulvectomy, wide excision or local excision has been done with surgical flaps or grafts depending on the size of the lesion. CONCLUSION: From 1997 to 2006 the Philippine General Hospital had nine histopathologically diagnosed EMPD, eight of which in the vulvar area and eight had CEA positive staining. Recurrence of lesions and appearance of concomitant malignancy could not be assessed due to the poor follow up of patients and incomplete records.

An open label study of topical imiquimod 5% cream in the treatment of molluscum contagiosum in Filipino children

BACKGROUND: Molluscum contagiosum is a common viral skin infection seen mostly in children. A topical treatment modality for this condition is therefore desirable.OBJECTIVE: To determine the efficacy of Imiquimod 5% cream in the treatment of molluscum contagiosum in Filipino children.METHODS: Thirty Filipino children age 3 to 18 seen at the Philippine General Hospital outpatient dermatology clinic diagnosed with molluscum contagiosum were enrolled in this open label study. Imiquimod 5% cream was applied to each molluscum lesion and washed off after a contact time of 10 to 12 hours. Resolution of lesions and occurrence of systemic and local side effect were monitored.RESULTS: Out of the twenty-four (80%) patients who completed the study, 5 (21%) had a less than or equal to 50% decrease in the number of lesions, 14 (58%) a greater than 50% decrease in the number of lesions, and 5 (21%) had complete resolution of all their mollusca. The target lesion resolved in 14 (58%) of the patients. No systemic side effect was observed. While mild to moderate erythema, pruritus, or erosion and mild pain and crusting were the only local side effects noted.CONCLUSION: This study shows the possible effectiveness of Imiquimod 5% cream in the treatment of molluscum contagiosum in children. This topical medication has no systemic side effect and is well tolerated.