Lucio phenomenon is an atypical reaction of leprosy, characterized by vasculitic lesions that can mimic antiphospholipid syndrome (APS) clinically. Distinguishing the two can be difficult as antiphospholipid autoantibodies may be present in patients with leprosy. We report on a 32‐year‐old female patient presenting with a sudden onset of fever, hemorrhagic bullae, and skin necrosis on her lower legs. She was treated for APS due to the presence of antiphospholipid antibodies but had an inadequate response. A skin biopsy revealed thrombotic vasculopathy and necrotizing vasculitis associated with aggregation of foam cells in the perivascular area and subcutis, with acid‐fast bacilli in the histiocytes and blood vessel walls. Direct immunofluorescence showed IgM, C3, and fibrinogen deposition in the superficial and deep dermal blood vessels. The pathology confirmed the diagnosis of Lucio phenomenon, and appropriate therapy was given. It is essential to evaluate the patient comprehensively, including clinical, serological, and pathological aspects, to obtain the correct diagnosis.
Question: A woman in her 40s complained of itchy, thick plaque of 5 years duration on her left foot. She had had a history of chronic calcific pancreatitis for which she had undergone Roux-en-Y lateral pancreaticojejunostomy followed by the Frey procedure some years later. She recalled the presence of a rash on both feet during this period. Even though she was on pancreatic enzyme replacement, she complained of occasional claycolored stools. She was on topical steroids and oral antihistamines from multiple care providers for the cutaneous lesion with no significant improvement in her symptoms. On examination, we noticed hyperpigmented, thick keratotic plaque on her left hind foot near the sole margin (Figure A). Histopathology (Figure B; hematoxylin and eosin stain; original magnification Â10) revealed acanthosis, diffuse parakeratosis, and necrotic keratinocytes tracking the acrosyringium (Figure B, green arrows) in the epidermis with lymphocytic infiltrates in the dermis. Her serum zinc level was 34.68 mg/dL (reference range, 54-151 mg/dL). Viral markers including hepatitis C virus (HCV) were nonreactive. The rest of the routine blood investigations were within normal limits. What is the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.
Background Colorectal cancer (CRC) ranks as the third most commonly diagnosed cancer in males and the second in females. According to the TNM staging system, status of the draining lymph nodes is a key pathologic characteristic. Inadequate lymph node harvesting may result in under treatment of patients. The purpose of the present study was to evaluate the factors that influence the number of lymph nodes retrieved in colorectal cancer specimens. Methods Sixty five patients with histologically proven colorectal adenocarcinoma over a period of 18 months were included. All patients underwent surgical resection for their disease. All significant patient, tumour and treatment variables were assessed for their impact on the average total number of lymph node harvested. Further, the efficacy of the GEWF solution (glacial acetic acid, ethanol, distilled water, formaldehyde) in lymph node retrieval was also assessed. Results In this study, 43 men and 22 women with a median age of 61 years were included. The median total number of lymph nodes examined was 17. 87.6% had adequate (≥ 12) lymph nodes examined, and 12.4% had <12 nodes examined. The number of lymph nodes were found to be higher and statistically significant in under 60-year-old group (p=0.001), tumours of size > 5cm (p=0.002), tumours of the ascending colon (p=0.025) and cases operated on by super specialist surgeons (p=0.017).Factors such as gender (p=0.23),BMI (p=0.22),tumour differentiation (p=0.348) and T staging (p=0.026) had no statistically significant association with lymph node harvest. Mean LN count was significantly higher (p = 0.0001) regrossing by a senior pathologist. However a statistically significant increase in LN harvest was not seen (p=0.159) when specimens were further subjected to GEWF treatment. Conclusions This study indicates that several modifiable factors impact LN retrieval and hence gives scope for improvement. Refinement of surgical and pathological care is suggested especially in challenging cases like rectal cancer and elderly patients.
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