Langerhans cell histiocytosis (LCH) is an infrequent clonal proliferative disorder of myeloid dendritic cells. It has a wide variety of cutaneous manifestations and retains the possibility of systemic implications. Because LCH is predominantly a disease of childhood, there are wellestablished clinical definitions, as well as guidelines regarding workup and treatment, in the context of pediatric disease. Here we present a case of isolated cutaneous LCH in an adult male, followed by a discussion of our diagnostic plan and treatment course. The patient exhibited a small, excoriated, yellow papule on his inferior forehead during a skin examination. The specimen underwent tangential shave biopsy; histopathologic evaluation with appropriate immunohistochemical staining confirmed a diagnosis of cutaneous LCH. After thorough investigation via serologic and imaging diagnostics, we confirmed isolated cutaneous disease. The patient underwent wide local excision (WLE) with no evidence of recurrence. It is crucial to appropriately screen all patients diagnosed with cutaneous LCH for internal organ involvement. The authors aim to highlight the need for further investigations to ultimately dictate standardized management and treatment for isolated cutaneous LCH in the adult population.
Objective
The purpose of this study was to investigate the anatomical patterns of superficial venous reflux in patients presenting with primary varicose veins.
Methods
Ultrasound scans, detailed vein maps, and histories of patients presenting to a single vein center were retrospectively reviewed. Patients included in the study were those presenting with primary varicose veins and classified as clinical, etiologic, anatomic, and pathophysiologic classes 2 through 4. Patients with histories of venous intervention, malformations, active ulcerations, or deep system abnormalities were excluded from this study.
Results
Overall, 1,027 limbs of 617 patients met the inclusion criterion. The male to female ratio was 1:6.0. Varicose veins were attributed to reflux in the great saphenous vein (GSV) 66% (n = 679) of the time. When GSV reflux was present, the saphenofemoral junction was incompetent 83% of the time. Six percent of varicose veins were attributed to the anterior accessory saphenous vein. Small saphenous vein (SSV) reflux was demonstrated in 34.8% (n = 357). The thigh extension of the SSV and vein of Giacomini demonstrated reflux in 7% (n = 69) and 1% (n = 15) of limbs, respectively. Reflux of nonsaphenous origin was present in 19% (n = 198) of limbs (isolated tributary reflux).
Conclusion
The variations of superficial venous reflux in patients presenting with primary varicose veins are diverse and complex. Therefore, thorough duplex ultrasound is necessary in all patients with primary varicose veins to evaluate the precise source of reflux to determine therapeutic options.
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