Vulvar lichen sclerosus (LS) is a common chronic mucocutaneous disease, which is usually underdiagnosed and tend to progress without adequate treatment.Morphological characteristics of vulvar LS with unusual histological features.Vulvar biopsy material (n = 83) with morphologically diagnosed LS was examined histologically and statistically.Often saw-toothed modification of the epithelium, fibrinoid necrosis, cytoid bodies, satellite cell necrosis, hemorrhages, papillomatosis, milia, predominantly plasma cell inflammatory infiltrate, lymphoid follicles, elastosis, angiokeratoma-like vasculare change were found on the background vulvar LS.Saw-tooth epidermal change, multiple cytoid bodies and satellite cell necrosis are histological features of LS described for the first time in this study, the former being a frequent presentation of vulvar LS. The mentioned above histological changes cannot appear as features in favor of lichen planus in the differential diagnosis of these diseases.
Синдром Свита является типичным представителем группы нейтрофильных дерматозов. Клинически процесс проявляется кожной сыпью, обычно сопровождающейся лихорадкой, анемией и лейкоцитозом, хорошим ответом на системную стероидную терапию. Морфологически для него характерны плотный сегментоядерный нейтрофильный инфильтрат с лейкоцитоклазией, без очевидных признаков васкулита. Редким гистологическим вариантом синдрома Свита считается гистиоцитоидный вариант, морфологически имитирующий миелопролиферативный процесс и требующий дополнительного исключения болезней крови. В данной статье приводится описание необычного клинического случая этого синдрома, развившегося у 68-летнего мужчины на фоне терапии варфарином по поводу тромбоза глубоких вен голеней, с хроническим рецидивирующим течением и наличием в составе воспалительного инфильтрата гистиоцитоидных миелоидных предшественников, а также массивных некрозов дермы. Поскольку гистиоцитоидный синдром Свита нередко ассоциируется со злокачественными новообразованиями, главным образом, миелодиспластическим синдромом, пациент продолжает получать кортикостероидную терапию и динамически наблюдается у врача-дерматолога и врача-гематолога с целью исключения субклинического течения миелодиспластического синдрома. Sweet’s syndrome is a typical representative of the group of neutrophilic dermatoses. Clinically, the process is manifested by a skin rash, usually accompanied by fever, anemia and leukocytosis, a good response to systemic steroid therapy. Morphologically, it is characterized by a dense segmented neutrophilic infiltrate with leukocytoclasia, without obvious signs of vasculitis. A rare histological variant of Sweet’s syndrome is considered to be a histiocytoid variant, which morphologically mimics the myeloproliferative process and requires additional exclusion of blood diseases. This article describes an unusual clinical case of this syndrome, which developed in a 68-year-old man during therapy with warfarin for deep vein thrombosis of the legs, with a chronic recurrent course and the presence of histiocytoid myeloid progenitors in the inflammatory infiltrate, as well as massive dermal necrosis. As histiocytoid Sweet’s syndrome is often associated with malignant neoplasms, mainly myelodysplastic syndrome, the patient continues to receive corticosteroid therapy and is dynamically monitored by a dermatologist and hematologist in order to exclude the subclinical course of myelodysplastic syndrome.
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