Cutaneous metastases from primary internal malignancies represent 0.7-9% of
patients with cancer. We report a 65-year-old female patient referred for
evaluation of normochromic papules on the trunk and upper limbs that had been
present for three months. A skin biopsy revealed diffuse cutaneous infiltration
by small round cell tumors. Immunohistochemistry was positive for AE1/AE3, CK7,
estrogen receptor and mammaglobin. The final diagnosis was cutaneous metastasis
of occult breast cancer, since the solid primary tumor was not identified. The
location of the primary tumor can not be determined in 5-10% of cases. In these
cases, 27% are identified before the patient’s death, 57% at autopsy, and the
remaining 16% can not be located.
Stewart-Treves Syndrome is characterized by the presence of lymphangiosarcoma on limb
extremities. Rare, it occurs in 0.5% of patients who have undergone radical
mastectomy with axillary node dissection. The main cause is chronic lymphedema with
endothelial and lymphatic differentiation, with no direct relationship to breast
cancer. Seven years after a radical right-side mastectomy with lymph node dissection
and adjuvant therapy, the patient developed a lesion on her right arm. The
dermatological examination revealed an erythematous nodule with bleeding surface on
chronic right forearm lymphedema. After the biopsy, a lymphangiosarcoma on chronic
lymphedema was diagnosed. Infrequent, this syndrome is relevant because of its
associated mortality. Early diagnosis is important to improve survival and reduce
complications.
Brazil is a country with a high prevalence of infectious diseases such as leprosy
and leishmaniasis. However, coinfection of these diseases is still poorly
understood. We report a case of a patient who presented with lepromatous leprosy
and cutaneous-mucosal leishmaniasis at the same period. After clinical,
laboratory, and histopathological diagnosis, the treatment was introduced and
the patient showed important clinical improvement. He was followed in our
outpatient clinic. Both pathologies play an important role in the immune system.
Depending on the immune response profile of the host, diseases may present
themselves in different ways. In this case, the patient showed a divergent
immune response for each disease. We hypothesized that this response is specific
for each pathogen.
Leprosy patients can present reactions during the course of the disease. There
are no official data on these reactions in Brazil. We aimed to describe the
epidemiological characteristics of patients with such reactions, analyzing
information from patient records at a referral center in Campinas (SP), from
2010 to 2015.
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