RESUMEN
Morel-Lavallée lesions (MLLs) result from high-energy trauma causing separation of subcutaneous tissue from the underlying tissue, most commonly in the gluteal region or thigh.We report the case of a woman in her 40s with a fluctuant collection of the cervico-thoracic region following trauma. Further imaging identified an MLL. An orthoplastic approach resulted in non-operative management with a spinal brace. Three months from initial injury, the lesion completely resolved. She was symptom free at final follow-up and discharged.We present the only recorded case of MLL developing in the cervico-thoracic region. Management posed difficultly as no literature currently exists. We demonstrated conservative management for cervico-thoracic MLL can be effective.We have described the first documented case of cervico-thoracic MLL. MLL is not exclusive to pelvic injuries and can develop in the cervico-thoracic region. We have shown conservative management is a viable treatment of atypical MLL.
Asunto(s)
Lesiones por Desenguantamiento , Traumatismos de los Tejidos Blandos , Femenino , Humanos , Traumatismos de los Tejidos Blandos/diagnóstico , Lesiones por Desenguantamiento/terapia , Lesiones por Desenguantamiento/patología , Muslo/patología , Dorso/patología , Torso/patologíaRESUMEN
Schwannoma is a benign tumour of Schwann cells originating from myelin sheath of axons of the nerves. It is usually seen in the vestibular region, very rarely found in extremity regions. Schwannomas are termed 'Giant' when they measure more than five centimetres in a minimum of one dimension. Giant schwannomas in the foot and ankle region are extremely uncommon. Only eight cases of such a condition are reported. This is a case report of a giant schwannoma found arising from the superficial peroneal nerve in the dorsolateral aspect of the foot. This swelling was excised completely and the diagnosis was confirmed by histopathology.
Asunto(s)
Neurilemoma , Nervio Peroneo , Humanos , Nervio Peroneo/cirugía , Neurilemoma/diagnóstico , Neurilemoma/cirugía , Neurilemoma/patología , Células de Schwann/patología , Torso/patología , Dorso/patologíaRESUMEN
ABSTRACT: Basal cell carcinomas and melanoma are common cutaneous malignancies. However, the development of a basomelanocytic tumor that simultaneously includes elements of melanoma and basal cell carcinoma is extremely rare. We present the case of an 84-year-old man who presented with a nonpigmented, nonulcerated pink nodule of his left upper back and discuss the current management recommendations for basomelanocytic tumors.
Asunto(s)
Carcinoma Basocelular , Melanoma , Neoplasias Cutáneas , Masculino , Humanos , Anciano de 80 o más Años , Neoplasias Cutáneas/patología , Carcinoma Basocelular/cirugía , Carcinoma Basocelular/patología , Melanoma/patología , Dorso/patologíaRESUMEN
ABSTRACT: Necrotizing infundibular crystalline folliculitis (NICF) is a rare distinct entity that was introduced in 1999. It typically presents with numerous eruptive waxy papules on the forehead and/or the upper back in adults in their fifth to seventh decade of life. The pathogenesis is unknown to date, but yeast and bacterial infection of the follicular ostia seems to contribute to the development. More recently, NICF has occasionally been observed as a side effect of targeted antitumoral therapy. Histopathologically, NICF is characterized by dilated follicular ostia filled with pale filamentous and birefringent material enclosed by parakeratotic columns of the epidermis and accompanied by a mild superficial inflammatory infiltrate of the dermis. This case report is about a 58-year-old male patient presenting with multiple eruptive keratotic papules on his forehead. Histopathology revealed all classic features of NICF. The case represents a classic example of NICF and is compared with previously published cases that are comprehensively summarized in this article.
Asunto(s)
Exantema , Foliculitis , Adulto , Dorso/patología , Foliculitis/tratamiento farmacológico , Foliculitis/patología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Lipomas are benign mesenchymal tumors that comprise almost one-half of all soft tissue tumors. Lipomas can occur at any site where fat cells are present but are rare in the oral cavity, especially the tongue, which is a very rare site. Lipoma has several variants. Fibrolipoma is a rare variant and accounts for 25-40% of lipomas of the tongue. In only 14 cases, the diagnosis of fibrolipoma has been made histologically. Most cases of lipomas occur above 40 years of age. Herein, we report a case of fibrolipoma of the tongue in a young female of 18 years. The patient presented with complaint of swelling on the dorsum of the tongue for 8 years. The swelling was surgically excised and microscopically a diagnosis of fibrolipoma was made. In conclusion, oral lipomas especially lingual lipomas are a rare entity. Although oral lipomas mostly occur above 40 years of age, they can occur at a younger age. Key Words: Fibrolipoma, Tongue, Histopathology.
Asunto(s)
Lipoma , Dorso/patología , Femenino , Humanos , Lipoma/diagnóstico , Lipoma/patología , Lipoma/cirugía , Lengua/patología , Lengua/cirugíaRESUMEN
Annular lichen planus is a rare clinical variant of the lichen planus presenting with round-oval, red to brown macules and plaques with no central atrophy and slightly raised, nonscaly borders. Histopathological features are indistinguishable from typical lichen planus. Given that the accurate diagnosis relies on both the clinical presentation and typical histological features, it is important to be aware of the clinical spectrum of lichen planus. Click https://wileyhealthlearning.com/#/online-courses/6be3b20c-e9c3-40e9-8f36-bfcda6718a73 for the corresponding questions to this CME article.
Asunto(s)
Dorso/patología , Liquen Plano/patología , Anciano de 80 o más Años , Fármacos Dermatológicos/uso terapéutico , Glucocorticoides/uso terapéutico , Humanos , Liquen Plano/diagnóstico , Liquen Plano/tratamiento farmacológico , Masculino , Prednisolona/análogos & derivados , Prednisolona/uso terapéuticoRESUMEN
Ligamentum flavum hypertrophy (HLF) is the most important component of lumbar spinal canal stenosis (LSCS). Analysis of hypertrophied ligamentum flavum (HLF) samples from patients with LSCS can be an important que. The current study analyzed the surgical samples of HLF samples in patients with LCSC using quantitative and qualitative high performance-liquid chromatography and mass spectrometry. We collected ligamentum flavum (LF) tissue from twelve patients with LSCS and from four patients with lumbar disk herniation (LDH). We defined LF from LSCS patients as HLF and that from LDH patients as non-hypertrophied ligamentum flavum (NHLF). Total lipids were extracted from the LF samples and evaluated for quantity and quality using liquid chromatography and mass spectrometry. The total lipid amount of the HLF group was 3.6 times higher than that of the NHLF group. Phosphatidylcholines (PCs), ceramides (Cers), O-acyl-ω-hydroxy fatty acids (OAHFAs), and triglycerides (TGs) in the HLF group were more than 32 times higher than those of the NHLF group. PC(26:0)+H+, PC(25:0)+H+, and PC(23:0)+H+ increased in all patients in the HLF group compared to the NHLF group. The thickness of the LF correlated significantly with PC(26:0)+H+ in HLF. We identified the enriched specific PCs, Cers, OAHFAs, and TGs in HLF.
Asunto(s)
Hipertrofia/patología , Ligamento Amarillo/patología , Metabolismo de los Lípidos/fisiología , Lípidos/fisiología , Vértebras Lumbares/patología , Canal Medular/patología , Estenosis Espinal/patología , Adulto , Anciano , Dorso/patología , Femenino , Fibrosis/patología , Humanos , Desplazamiento del Disco Intervertebral/patología , MasculinoRESUMEN
The keystone perforator island flap (KPIF) is popular in reconstructive surgery. However, despite its versatility, its biomechanical effectiveness is unclear. We present our experience of KPIF reconstruction in the human back and evaluate the tension-reducing effect of the KPIF. Between September 2019 and August 2020, 17 patients (51.82 ± 14.72 years) underwent KPIF reconstruction for back defects. In all cases, we measured wound tension at the defect and donor sites before and after KPIF reconstruction using a tensiometer. All defects occurred after complete excision of complicated epidermoid cysts and debridement of surrounding tissues. The defects were successfully covered with Type IIA KPIFs. All flaps survived, and there were no significant postoperative complications. The mean "tension change at the defect after Type I KPIF" and "tension change at the defect after Type II KPIF" were - 2.97 ± 0.22 N and - 5.59 ± 0.41 N, respectively, (P < 0.001). The mean "rate of tension change at the defect after Type I KPIF" and "rate of tension change at the defect after Type II KPIF" were - 36.54 ± 1.89% and - 67.98 ± 1.63%, respectively, (P < 0.001). Our findings confirm the stepwise tension-reducing effect of KPIF and clarify the biomechanics of this flap.
Asunto(s)
Dorso/cirugía , Colgajo Perforante , Procedimientos de Cirugía Plástica , Adulto , Anciano , Dorso/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
The outcomes of patients with metastatic melanoma (MM) have significantly improved after the introduction of BRAF-specific inhibitors. Herein is reported a patient with MM and non-V600-BRAF mutation who responded to iBRAF/iMEK therapy. In July 2014, a 63-year-old man presented with a 4.1mm-thick V600E-BRAF wild type melanoma on the back. Metastases were identified in one sentinel node and two of 11 subsequently excised lymph nodes, with no signs of distant metastatic disease. In September 2017, lung metastasis was observed and pembrolizumab was started. Progressive disease was apparent at cycle 10 and therapy was switched to ipilimumab. After four cycles, an asymmetric response was observed. In November 2017, next generation sequencing genomic profiling disclosed a rare L597K-BRAF mutation and vemurafenib plus cobimetinib therapy was initiated in January 2018. Seven days after treatment start, a remarkable clinical improvement was observed. In April 2018, the patient achieved partial response, which was sustained until October 2018. Cases of patients with non-V600-BRAF mutations responding to iBRAF/iMEK therapy have been reported over the last years. To the best of our knowledge, this is the first case reporting response to combined iBRAF/iMEK therapy in a patient with metastatic melanoma harboring L597K mutation.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Melanoma/tratamiento farmacológico , Melanoma/genética , Proteínas Proto-Oncogénicas B-raf/antagonistas & inhibidores , Proteínas Proto-Oncogénicas B-raf/genética , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/genética , Azetidinas/uso terapéutico , Dorso/patología , Dacarbazina/uso terapéutico , Humanos , Imidazoles/uso terapéutico , Masculino , Melanoma/patología , Persona de Mediana Edad , Mutación , Oximas/uso terapéutico , Piperidinas/uso terapéutico , Piridonas/uso terapéutico , Pirimidinonas/uso terapéutico , Neoplasias Cutáneas/patología , Vemurafenib/uso terapéuticoRESUMEN
Subcutaneous fat necrosis of the newborn is a rare lobular panniculitis. It is characteristic of term or post-term neonates with a history of perinatal compromise or maternal gestational pathology. The cutaneous manifestations consist of erythematous and indurated subcutaneous plaques and nodules located over the dorsal region and the shoulders. Diagnosis is clinical and pathological. Histopathological findings include lobular panniculitis with a lymphohistiocytic inflammatory infiltrate with few neutrophils, fatty necrosis, deposition of radial needle-shaped crystals in the adipocytes, and possible calcification and hemorrhage. The cutaneous ultrasound shows hyperechoic and avascular subcutaneous cellular tissue and acoustic shadows may appear corresponding to calcifications. The clinical differential diagnosis includes sclerema neonatorum and post-corticosteroid panniculitis. Histologically crystal-forming panniculitis conditions are in the differential diagnosis. The disease is usually self-limited but complications such as hypercalcemia, hypoglycemia, hypertriglyceridemia, thrombocytopenia, and anemia may occur. Complications should be ruled out and treated at diagnosis and during follow-up. The most important complication is hypercalcemia.La necrosis grasa subcutánea neonatal es una paniculitis lobulillar infrecuente. Es característica de neonatos a término o postérmino con antecedentes de sufrimiento perinatal o patología gestacional materna. Las manifestaciones cutáneas consisten en placas y nódulos subcutáneos eritematosos e indurados localizados preferentemente en la región dorsal y los hombros. El diagnóstico es clínicopatológico. Los hallazgos histopatológicos comprenden una paniculitis lobulillar con un infiltrado inflamatorio linfohistiocitario con escasos neutrófilos, necrosis grasa, depósito de cristales radiados en los adipocitos y posibles focos de calcificación y hemorragia. En la ecografía cutánea se observa hiperecogenicidad y avascularización del tejido celular subcutáneo y pueden aparecer sombras acústicas posteriores que se correspondencon calcificaciones. El diagnóstico diferencial clínico se debe realizar con el escleredema neonatorum y la paniculitis postesteroidea, e histológicamente con las paniculitis con formación de cristales. La enfermedad suele ser autolimitada pero pueden aparecer complicaciones como la hipercalcemia, la hipoglucemia, la hipertrigliceridemia, latrombocitopenia y la anemia. Las complicaciones deben ser descartadas y tratadas en el diagnóstico y durante el seguimiento. La complicación másimportante es la hipercalcemia.
Asunto(s)
Grasa Subcutánea/patología , Dorso/diagnóstico por imagen , Dorso/patología , Femenino , Humanos , Recién Nacido , Cuello/patología , Grasa Subcutánea/diagnóstico por imagen , UltrasonografíaRESUMEN
A widespread form of eruptive collagenomas in a 12-year-old man is presented for the impressive iconography, challenging differential diagnosis, and histopathological considerations associated with such rare connective tissue disorders. Syndromic forms should be carefully investigated for the different course and prognosis. Treatment is a major unsolved issue as aesthetic concerns are significant, especially in young adults.
Asunto(s)
Enfermedades del Tejido Conjuntivo/patología , Dermis/patología , Nevo/patología , Neoplasias Cutáneas/patología , Dorso/patología , Biopsia/métodos , Colorantes , Fibroblastos/patología , Humanos , Masculino , Adulto JovenAsunto(s)
Mioepitelioma , Factor 3 de Transcripción de Unión a Octámeros , Proteínas Proto-Oncogénicas , Proteínas Represoras , Sarcoma Sinovial , Neoplasias de los Tejidos Blandos/clasificación , Dorso/patología , Biomarcadores de Tumor/metabolismo , Niño , Femenino , Humanos , Hibridación Fluorescente in Situ/métodos , Ganglios Linfáticos/patología , Mioepitelioma/diagnóstico , Mioepitelioma/patología , Estadificación de Neoplasias , Factor 3 de Transcripción de Unión a Octámeros/metabolismo , Proteínas de Fusión Oncogénica/metabolismo , Patología Molecular/métodos , Proteínas Proto-Oncogénicas/metabolismo , Proteínas Represoras/metabolismo , Sarcoma Sinovial/diagnóstico , Sarcoma Sinovial/patología , Neoplasias de los Tejidos Blandos/diagnóstico , Neoplasias de los Tejidos Blandos/patologíaRESUMEN
Brachial plexus neuropathy is often seen in the military population, especially due to pressure (backpack palsy, BPP) or idiopathic (neuralgic amyotrophy, NA). We aimed to gain insight in the disease characteristics of soldiers with brachial plexus neuropathies in the Dutch military population and to compare disease characteristics between patients with BPP and NA. In this retrospective chart review study we aimed to include all patients with brachial plexus neuropathy, who presented in the Joint Military Hospital between 1 January, 2011 and 31 December, 2016. We calculated the incidence of NA and BPP and Chi-square tests or Student t tests were performed for differences in patient characteristics between NA and BPP. We included 127 patients, 63 with BPP, 45 with NA, 10 with traumatic brachial plexus neuropathy, and 9 with other plexopathy. The incidence of brachial plexus neuropathy was 50/100 000 person years overall, 25/100 000 person years for BPP, and 18/100 000 person years for NA. Patients in the BPP group differed from the NA with regard to pain (BPP 41% vs NA 93%, P = .000), atrophy (13% BPP vs 29% NA, P = .049), and sensory symptoms (83% BPP vs 44% NA, P = .000). In the BPP group 90% had incomplete recovery and in the NA group 78%. Our study showed a high incidence of BPP and NA in the military population and suggests recovery is not so benevolent as previously thought. Future research is necessary to improve insight and outcome of military patients with brachial plexus neuropathies.