Sonographic Characteristics of Leiomyomatous Tumors of Skin and Nail: a Case Series.

Introduction: The clinical appearance of the uncommon cutaneous leiomyomatous tumors (LMT) is nonspecific, leading to an extensive differential diagnosis. A non-invasive tool such as high-frequency ultrasound (HFUS) is required for characterizing LMTs in the clinical setting. Although the sonographic features of their uterine counterpart had been well reported, there are only scant reports on the use of ultrasound for studying leiomyomatous neoplasms of the skin and nail. Objectives: To identify and well characterize common sonographic features of LMT. Methods: A retrospective analysis of HFUS images of LMT in three different patients, two of them with multiple cutaneous leiomyomas and another with a subungual leiomyosarcoma. Results: In all cases, several shared ultrasound characteristics were found. Moreover, we describe a new ultrasonographic sign in cutaneous leiomyomas called the "pine tree" sign, with other features not previously reported. Conclusions: These ultrasonographic characteristics would strengthen the clinical diagnosis, assist with treatment management, and may help avoid serial biopsies in cases with multiple cutaneous lesions.

Pseudoatrophoderma colli: distinct entity or just a variant of confluent and reticular papilomatosis of Gougerot-Carteaud.

Pseudoatrophoderma colli is a rare entity described in the same time period as confluent and reticular papillomatosis of Gougerot-Carteaud and the two conditions have certain similarities. Pseudoatrophoderma colli is clinically characterized by lesions with an atrophic and wrinkled appearance, which are mainly located on the trunk and neck (hence the name colli). Few references exist in the literature and most of them are very old. Histopathological findings are nonspecific, showing mild hyperkeratosis, thinning of the stratum granulosum, and acanthosis and papillomatosis in some areas. In the papillary dermis there is vascular dilatation with a sparse inflammatory lymphohistiocytic perivascular infiltrate. Fragmentation of elastic tissue has been described only in one case. There is no specific treatment, with variable responses to diverse therapies including ultraviolet light, vitamin A, lactic acid and minocycline. We describe in detail two patients with pseudoatrophoderma colli and show histology. The first patient was treated with minocycline 100mg per day for two months and the second patient was treated with lymecycline 600mg per day for three months and 300mg per day for another two months. Both patients demonstrated a good response within the first month of treatment.

Sonographic Characteristics of Apocrine Nodular Hidradenoma of the Skin.

Nodular hidradenomas are benign sweat gland-derived tumors that can produce clinical and dermatoscopic misdiagnoses. Histologically, these tumors can be classified into eccrine and apocrine subtypes. We present the sonographic characteristics of 6 cases of apocrine nodular hidradenomas, which, to our knowledge, is so far the largest series reported. A detailed sonographic analysis included layers, body location, shape, diameters, echostructure patterns, and vascularity. Two sonographic signs not previously reported in these or other common dermatologic lesions were detected: "snow falling" and "fluid-fluid level." The sonographic characteristics of apocrine nodular hidradenomas can support their earlier and more precise diagnosis.

Queratosis liquenoide / Lichenoid keratosis

La queratosis liquenoide se presenta como una lesión solitaria, en forma de una mácula o pápula de color rojo, violáceo o marrón, que aparece predominantemente en mujeres y se localiza en el tronco. Su histología es semejante a la del liquen plano. Su origen es desconocido, aunque se presume que corresponde al resultado final de un proceso inflamatorio de una lesión preexistente, principalmente léntigo solar, queratosis actínica yqueratosis seborreica.

Lichenoid keratosis occurs as a solitary lesion in form of a red, purple or brown, macule or papule which appears predominantly in women, and in the trunk. Its histology is similar to lichen plannus. Its origin is unknown, although it is presumed that it corresponds to the final result of an inflammatory process of a preexistinglesion, mainly solar lentigo, actinic keratosis and seborrheic keratosis.

Two episodes of axillary granular parakeratosis triggered by different causes: case report.

Granular parakeratosis is an acquired disorder of keratinization characterized by keratotic papules and plaques located in the intertriginous areas. Its etiology is unknown. Some cases have been related to the application of deodorants and antiperspirants, local irritation or increased sweating; in other cases no precipitant factors have been found. We report a case of axillary granular parakeratosis in an adult male in whom the lesions appeared twice under different circumstances: the first time the lesions appeared after local irritation produced by an antiperspirant and/or the use of a paste containing zinc oxide; two years later, an identical eruption reappeared in both axillae, while using his habitual deodorant and without a preceding irritation of the zone; only excessive sweating was mentioned this time after a weight gain of 20 kg. On both occasions, the lesions disappeared completely a few days after using topical calcipotriol. A constitutional factor may predispose the development of granular parakeratosis, which must be considered a reaction pattern that can be induced by multiple different causes.

DNA extraction from formalin-fixed laryngeal biopsies: Comparison of techniques.

CONCLUSION: PCR-quality DNA could be extracted from formalin-fixed paraffin-embedded (FFPE) samples with amplicons of at least 390 bp. Paraffin removal was not a necessary step. Proteinase K digestion was as efficient as the commercial kit for DNA extraction with a lower cost. OBJECTIVES: To compare different DNA extraction protocols for FFPE samples and to describe the suitability of the extracted DNA for PCR reactions. METHODS: For deparaffinization the following techniques were compared: alkaline heat, xylene, and no removal. For DNA extraction, proteinase K digestion and organic extraction were compared. A commercial extraction kit was included as standard. DNA quality was assessed by PCR amplification of the HFE gene, for amplicons of 208 and 390 bp. RESULTS: Extraction with the commercial kit and proteinase K digestion were more efficient than other techniques, with no statistical difference between them for both amplicons. The proteinase K digestion buffer had a cost of U$ 0.2 per sample and the commercial kit of U$7 per sample.

[Scedosporium apiospermum rhinosinusal infection in an immunocompetent host]. / Infección rinosinusal por Scedosporium apiospermum en un hospedero inmunocompetente.

Scedosporium species can cause colonization, superficial and deep localized infection or systemic disease, especially in immunocompromised hosts. We report a case of localized infection due to Scedosporium apiospermum in a 47 year old woman, with previous nasal surgery. She consulted for recurrent mucopurulent post-nasal discharge not responding to antibiotics. Computed tomography showed opacification of right maxillary sinus. Surgery was performed to removed abnormal tissue from sinus; biopsy revealed chronic sinusitis with aggregate of tightly packed hyphae suggestive of filamentous fungi. The microbiology fungal culture reported Scedosporium apiospermum.

[Recessive dystrophic epidermolysis bullosa. Report of one case]. / Epidermólisis bulosa distrófica recesiva. Caso clinico.

We report a female newborn with a dystrophic epidermolysis bullosa. The diagnosis was made by electron microscopy of a bullous skin lesion. The importance of reaching a specific diagnosis is underscored. Close relatives can therefore be informed and educated about prognosis, etiology and the possibility of having new affected offspring. An accurate diagnosis can be reached through electronic microscopy or modern immunohistochemical techniques. Further complementary information given by conventional histology is required. A complete study is recommended to minimize errors in the intepretation of morphology.

Circumscribed palmar or plantar hypokeratosis: a distinctive epidermal malformation of the palms or soles.

BACKGROUND: Epidermal malformations of the skin include a group of heterogeneous developmental defects that result from errors in morphogenesis of the epidermis during intrauterine life. OBJECTIVE: The purpose of this study was to report the clinical and histopathologic features of a distinctive epidermal malformation involving the skin of the palms or soles. METHODS: Ten patients were included in this study. All of them showed the same clinical features that consisted of a solitary circumscribed and circular area of erythematous depressed skin on the palm or on the sole. Diagnosis was confirmed by histopathologic study. RESULTS: All patients were middle aged or elderly. Nine patients were women and one was a man. The lesions showed predilection for the skin of the thenar and hypothenar regions of the palm or the medial side of the sole. Histopathologic study demonstrated a depression of the epidermis, with a sharp stair between normal and involved skin. The epidermis covering the depression showed markedly thinner horny layer and a slightly diminished granular cell layer when compared with adjacent noninvolved skin. Keratinocytes of the squamous cell layer, granular cells, and corneocytes showed, otherwise, a normal appearance. Serial sections failed to demonstrate cornoid lamellation. CONCLUSION: On the basis of the clinical and histopathologic findings in these 10 patients, we have named this malformation circumscribed palmar or plantar hypokeratosis. This lesion seems to be a distinctive entity that has not been previously described.

Tumor de células gigantes de las vainas tendinosas / Giant cell tumor of the tendon sheath

El tumor de células gigantes de las vainas tendinosas es una neoplasia benigna derivada de la vaina externa de los tendones. Aunque es una lesión relativamente frecuente, sus referencias en la literatura dermatológica son muy escasas. Se describen dos casos de esta patología en los dedos de las manos, su localización más frecuente

Liquen plano actínico / Actinic lichen planus

Presentamos cuatro pacientes de raza blanca, oriundos de Sudamérica, con liquen plano actínico. Tres de ellos correspondían a la variedad anular, con lesiones localizadas casi exclusivamente en la cara, caracterizadas por placas ovaladas con bordes sobreelevados y centro de aspecto atrófico. Otro caso mostraba una forma de liquen plano actínico tipo melasma