Chromoblastomycosis is a chronic, granulomatous, suppurative mycosis of the skin and subcutaneous tissue caused by traumatic inoculation of dematiaceous fungi of the family Herpotrichiellaceae. The species Fonsecaea pedrosoi and Cladophialophora carrionii are prevalent in regions where the disease is endemic. Chromoblastomycosis lesions are polymorphous: verrucous, nodular, tumoral, plaque-like, and atrophic. It is an occupational disease that predominates in tropical and subtropical regions, but there have been several reports of cases in temperate regions. The disease mainly affects current or former farm workers, mostly males, and often leaving disabling sequelae. This mycosis is still a therapeutic challenge due to frequent recurrence of lesions. Patients with extensive lesions require a combination of pharmacological and physical therapies. The article provides an update of epidemiological, clinical, diagnostic, and therapeutic features.
Metastasis is defined as a neoplastic lesion originating from another primary tumor, with which it is no longer in contact. Cutaneous metastases result from lymphatic embolization, hematogenous or contiguous dissemination or also direct implantation during surgical procedures. In women, the tumor most likely to metastasize to skin is breast cancer, which may manifest as papulonodular neoplastic lesions. We report the case of a 66 years old female patient, presenting papulonodular lesions13 years after the initial treatment with surgery and chemotherapy for a cancer of the left breast.
A 24-year-old male patient, who underwent kidney transplant six years ago due to Lupus nephritis, for the last two years presented asymptomatic erythematous scaly plaques on the abdomen and areas exposed to light. Post-transplantation immunosuppressive medications included prednisone, mycophenolate sodium and sirolimus. The histopathologic features were typical for epidermodysplasia verruciformis. Epidermodysplasia verruciformis is a rare autosomal recessive genodermatosis with increased susceptibility to specific strains of cutaneous human papilloma virus. The term ''acquired epidermodysplasia verruciformis'' was recently introduced to the literature and describes epidermodysplasia verruciformis occurring in patients with impaired cell-mediated immunity. We report an additional case associated to immunosuppression after kidney transplantation.
Resumo: FUNDAMENTOS: A eliminação transepidérmica de parasitas (ETEP) tem sido pouco estudada na doença de Jorge Lobo. OBJETIVOS: Identificar aspectos morfológicos da ETEP na doença de Jorge Lobo. MÉTODOS: Recortes de biópsias de doença de Jorge Lobo emblocados em parafina foram corados pela hematoxilina-eosina e examinados. Considerou-se como ETEP, exclusivamente, a presença de parasitas em estruturas epidérmicas. RESULTADOS: Foram incluídas no estudo 40 biópsias de 37 pacientes (31 homens e seis mulheres, média de idade 51,03 anos, variação 29-80 anos) realizadas em um período de 37 anos , das quais foram obtidos 511 cortes (média de 12,77 cortes por caso, variação 2-39 cortes por caso). Observou-se ETEP em 110/511 (21,52%) e não se observou em 401/511 cortes (78,48%) (p < 0,0001). Em relação aos pacientes (37), em 15 se verificaram aspectos consistentes com ETEP (40,5%), ao passo que, em 22 deles (59,5%), isso não foi observado (p > 0,05). Os parasitas dispunham-se em infundíbulos hiperplásicos, formando catênulas, ou como unidades isoladas, associados ou não a células inflamatórias. CONCLUSÕES: Aspectos consistentes com ETEP, embora observados em número estatisticamente não significante de pacientes da amostra (p > 0,05), sugerem que, na doença de Jorge Lobo, o fenômeno, invariavelmente, ocorra através do epitélio infundibular. Estudos futuros serão necessários para avaliar sua eventual importância na epidemiologia da micose. Palavras-chave: Doença granulomatosa crônica; Micoses; Micoses/patologia; Pele Abstract: BACKGROUND: Few studies have focussed on the transepidermal elimination of parasites in Jorge Lobo's disease (lobomycosis). OBJECTIVE: To identify the morphological features of the transepidermal elimination of parasites in lobomycosis. METHODS: Sections were obtained from paraffin-embedded biopsy specimens of patients with lobomycosis and stained with hematoxylin-eosin for microscopic examination. Only the presence of parasites in epidermal structures was considered to constitute transepidermal elimination. RESULTS: Forty biopsies from 37 patients were included in the study (31 males and 6 females). The mean age of patients was 51.03 years (range 29-80 years). Biopsies performed over a period of 37 years were used, from which 511 sections were obtained (a mean of 12.77 sections per case; range 2-39 sections per case). Transepidermal elimination of parasites was found in 110/511 (21.52%) and was absent in 401/511 sections (78.48%) (p<0.0001). Features consistent with the phenomenon were found in 15/37 patients (40.5%) and were absent in 22/37 (59.5%) (p>0.05). Parasites in the epidermis were detected within hyperplastic infundibula, either connected in chains or as isolated units, associated or not with inflammatory cells. CONCLUSION: Features consistent with transepidermal elimination of parasites were found in a statistically nonsignificant number of patients in the sample (p>0.05), suggesting that in Jorge Lobo's disease, this phenomenon invariably occurs through the infundibular epithelium. Fut...
Cutaneous metastases from internal malignant neoplasms are a rare event and a late clinical finding that is associated with disseminated disease and a poor prognosis. Skin metastases from colon tumors occur in only 4% of cases of metastatic colorectal cancer. They are most often located on the abdominal skin. We report a case of 54-year-old male patient with a cutaneous metastatic focus on the lower abdomen as the initial presenting symptom of an underlying colon cancer.
Clear cell acanthoma or Degos' acanthoma is a distinct disease concerning its clinical, histopathological, and immunohistochemical features. Its pathologic nature - whether neoplastic or reactive - is still under dispute among researchers. The disease shows a chronic course and often presents with a single papulonodular lesion on the lower limbs of adults. However, cases with multiple lesions, sometimes occurring in an eruptive fashion, and with clear variation in the size and shape of the cutaneous lesions have been reported. So far, five cases in which the lesions were exclusively located in the nipple area have been reported, all in Korean women. Four of these cases mimicked eczema and one, a polypoid nodule. The aim of this article is to present clinical, histopathological, and immunohistochemical features of two additional cases in Brazilian women with similar nipple topography.
Due to diverse clinical and histopathological presentations, diagnosis of secondary syphilis can occasionally prove challenging. Variable clinical presentations of secondary syphilis in HIV disease may result in an incorrect diagnosis and an inappropriate treatment regimen. Similarly, the histology of secondary syphilitic lesions may show considerable variation, depending on the clinical morphology of the eruption. We report a case of secondary syphilis in an HIV infected patient with cutaneous palmoplantar lesions simulating palmoplantar psoriasis.
Syringocystadenoma papilliferum is a rare benign hamartomatous adnexal tumor of the apocrine or eccrine sweat glands. Most patients present a solitary lesion in the head and neck region. Presentation outside the head and neck region is even more uncommon. We present a case of Syringocystadenoma papilliferum with papulonodular lesion located on the vulva of an infant girl. This case illustrates the atypical location of this rare disease and adds to the differential diagnosis of lesions on the vulva.
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