RESUMO
We report the case of an 85-year-old chronic lymphocytic leukemia patient with a local metastatic MCVPyV-negative Merkel cell carcinoma at initial diagnosis. Therapy comprised surgical excision and radiotherapy but without lymphadenectomy. Six months after the primary diagnosis, liver metastases were detected. They responded to the PD-L1 inhibitor avelumab for more than 15 months. Thus, we postulate a synergistic effect of combined therapy with chlorambucil and avelumab through a mutual improvement of immune function, from which both diseases benefit.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Carcinoma de Célula de Merkel/tratamento farmacológico , Clorambucila/uso terapêutico , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Humanizados , Carcinoma de Célula de Merkel/patologia , Carcinoma de Célula de Merkel/secundário , Humanos , Leucemia Linfocítica Crônica de Células B/patologia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/secundário , Resultado do TratamentoRESUMO
BACKGROUND: Skin lesions due to Fusarium spp. occur either secondarily following hematological spread in systemic infection or represent primary cutaneous infections following traumatic inoculation. CASE REPORT: A 34-year-old woman with insulin-dependent diabetes mellitus presented with a most likely posttraumatic leg ulcer present for 4 weeks. The ulcer showed superficial necrosis with cellular debris, neutrophils, and leukocytoclasia. Septate hyphae were detected both in the necrotic area and between the collagen fibers on initial H & E stained sections. Using PAS and Grocott-Gomori silver staining, the dichotomous branching hyphae were clearly visible. Unfortunately, cultural detection of the fungi was impossible. After extraction and purification of the fungal DNA from formalin-fixed and paraffin embedded (FFPE) tissue sections, the amplification of the ITS region of rDNA was done. Using sequencing and comparison with reference sequences of a gene bank, Fusarium oxysporum was identified. THERAPY: Therapy was performed by surgical excision of the entire ulcer followed by topical antiseptic treatment and wound conditioning. No systemic antifungal treatment was given. The lesion healed without any problems. DISCUSSION: Cutaneous fusarium infections are rare but emerging opportunistic infections. Histological examination represents the quickest diagnostic method for detection of the fungal infection. An alternative approach represents the species identification based on molecular techniques.
Assuntos
Dermatomicoses/diagnóstico , Dermatomicoses/microbiologia , Fusariose/diagnóstico , Fusariose/microbiologia , Fusarium/genética , Úlcera da Perna/diagnóstico , Úlcera da Perna/microbiologia , Adulto , DNA Ribossômico/genética , Dermatomicoses/cirurgia , Feminino , Formaldeído , Fusariose/cirurgia , Fusarium/classificação , Fusarium/isolamento & purificação , Marcadores Genéticos/genética , Humanos , Úlcera da Perna/cirurgia , Técnicas de Diagnóstico Molecular , Inclusão em Parafina , Análise de Sequência de DNA/métodos , Fixação de Tecidos , Resultado do TratamentoRESUMO
BACKGROUND: Phlebologic diseases have become extremely common and have major socio-economic impact. However, the percentage of dermatologists working in phlebology appears to be decreasing according to the data of the German Society of Phlebology (DGP). METHODS: To investigate the reasons for this development, we--on behalf of the DGP--sent a questionnaire to 120 German Departments of Dermatology in autumn 2012. RESULTS: In 76 returned questionnaires, the number of physicians with additional fellowship training in phlebology averaged 1.5; the average number of those who fulfill the criteria for training fellows in phlebology was 0.9. In 71.1 % of the departments there was a phlebologist. A special phlebologic outpatient clinic existed in 73.7 % of the departments. Sonography with Doppler (89.5 %) and duplex (86.8 %) was used as the most frequent diagnostic tool. For therapy, compression (94.7 %), sclerotherapy (liquid 78.9 %, foam 63.2 %, catheter 18.4 %), endoluminal thermic procedures (radio wave 28.9 %, laser 17.1 %) and surgery (especially crossectomy and stripping 67.1 %, phlebectomy of tributaries 75 %) were used. The average number of treatments was very heterogenous in the different departments. CONCLUSIONS: Phlebology definitely plays an important role in dermatology. Most departments fulfill the formal criteria for the license to conduct advanced training in phlebology. A wide spectrum of phlebological diagnostic and therapeutic procedures is available.
Assuntos
Dermatologia/estatística & dados numéricos , Departamentos Hospitalares/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Dermatopatias Vasculares/diagnóstico , Dermatopatias Vasculares/terapia , Insuficiência Venosa/diagnóstico , Insuficiência Venosa/terapia , Alemanha/epidemiologia , Humanos , Competência Profissional/estatística & dados numéricos , Dermatopatias Vasculares/epidemiologia , Inquéritos e Questionários , Insuficiência Venosa/epidemiologiaRESUMO
We report on two cases of adverse reactions to topical treatment with monoethyl fumarate. One patient suffering from atopic dermatitis reacted with contact dermatitis; the other, suffering from psoriasis, developed a generalized, partly pustulous exanthema as well as signs of systemic involvement, such as tachycardia and dyspnea. As the causative mechanism we suggest non-immunological contact urticaria syndrome.
Assuntos
Toxidermias/etiologia , Eczema/tratamento farmacológico , Fumaratos/efeitos adversos , Psoríase/tratamento farmacológico , Administração Tópica , Adulto , Anafilaxia/induzido quimicamente , Feminino , Fumaratos/administração & dosagem , Humanos , MasculinoRESUMO
A 17-year-old female patient developed a superficially spreading malignant melanoma (level III, thickness 0.91 mm) on a typical café-au-lait spot. There were no metastases, as yet. On the basis of this unusual case, we discuss the incidence of development of malignant melanoma on melanotic spots.
Assuntos
Transformação Celular Neoplásica/patologia , Melanoma/patologia , Nevo Pigmentado/patologia , Neoplasias Cutâneas/patologia , Adolescente , Divisão Celular/fisiologia , Feminino , Humanos , Melanócitos/patologiaRESUMO
In this study, two procedural aspects were investigated with regard to their effect on spontaneous use of manual signs with three Down's syndrome children. First, two modes of presenting reinforcement for spontaneous sign requesting were compared. Second, the effect of a least-to-most prompting procedure was evaluated. Within a randomization design, a statistically significant difference was observed between the two modes in favour of the one in which only a part of the sign-requested reinforcement was initially presented. Within a mixed design of reversal and multiple baseline, introduction of the least-to-most prompting procedure resulted in an increase of the spontaneous use of the target signs, while withdrawal of the procedure resulted in a decrease.