Cutaneous Intravascular CD-30-Positive Anaplastic Large Cell Lymphoma: A Case Report and Literature Review.

Intravascular cutaneous anaplastic large cell lymphoma (ALCL) is an extremely rare non-Hodgkin lymphoma that proliferates in the lumen of small blood vessels and has a propensity to manifest in the skin. Most reported cases of intravascular lymphoma described in the literature are of large B-cell lymphomas, making T-cell lymphomas incredibly rare. As such, we present the case of an 87-year-old male with primary cutaneous intravascular anaplastic large T-cell lymphoma that initially presented with an erythematous, subcutaneous nodule on the right mid-abdomen. We report the immunohistochemical results showing lymphoma cells staining positively for CD3 and CD30 and lacking expression of anaplastic lymphoma kinase, pan-cytokeratin, CD10, CD20, and SOX10. We also review and compare previously reported cases of intravascular ALCL with primary cutaneous involvement.

Rumpel-Leede Phenomenon Following Radial Artery Catheterisation.

Rumpel-Leede phenomenon is a rarely diagnosed entity that can be seen in patients following the application of tourniquet-like forces to the extremities. This phenomenon describes petechiae and purpura secondary to venous compression and congestion, with its underlying aetiology involving the fragility of capillary vessels within the dermis. This condition is associated with chronic medical conditions such as diabetes mellitus, hypertension, dyslipidemia, peripheral vascular disease and systemic inflammatory diseases, including infections. In addition, patients with coagulopathy including thrombocytopenia or platelet dysfunction from antiplatelet use, or those with thrombotic thrombocytopenic purpura and idiopathic thrombocytopenic purpura, are predisposed to capillary haemorrhage and petechiae formation. In this report, we present a case of a patient who developed Rumpel-Leede phenomenon following catheterisation of the right radial artery with spontaneous resolution - where only five cases have been reported to date - with the aim to make clinicians aware of this condition and to avoid unnecessary interventions. LEARNING POINTS: Rumpel-Leede phenomenon is a benign condition that can be seen after tourniquet-like compression of a limb in those with capillary fragility.Dermatologists and other practitioners should remain aware of the phenomenon, helping to avoid unnecessary investigation.Rumpel-Leede phenomenon self-resolves, with only supportive treatment required with no reported lingering effects to date.

​​Longitudinal Erythronychia Secondary to a Wooden Splinter.

Longitudinal erythronychia (LE) is a term for red streaks in the nail which can be caused by a range of diseases. The specific type of longitudinal erythronychia can correlate with certain associated conditions making it important to properly categorize when discovered. A 71-year-old Hispanic male presented to the clinic with a type 1A LE associated with subungual keratosis that had been asymptomatic for approximately 12 months. The patient denied injury, pain, cold sensitivity, or cosmetic distress. The working diagnosis was squamous cell carcinoma in situ (SCCIS) vs. onychopapilloma or glomus tumor. A 4mm punch biopsy from the distal nail matrix was performed, and dermatopathology revealed that the LE was secondary to a wooden splinter. After a literature review, it was discovered that this is the first confirmed case of LE secondary to a splinter. Future providers should keep splinters as a potential differential diagnosis, especially as they evaluate LE, but ultimately all suspicious type IA lesions should be biopsied to rule out potential insidious pathologies, such as SCCIS and malignant melanoma.

Neurofibroma Within a Nevus Sebaceus: A Case Report.

Nevus sebaceus most commonly presents as a yellow, alopecic plaque on the head or neck in childhood and evolves into a verrucous plaque at puberty. Numerous secondary tumors may arise within nevus sebaceus lesions. Tumors of mesenchymal origin have been rarely documented. We present a unique case of a patient who presented with a nevus sebaceus on the scalp. Excision of the tumor and subsequent histopathology of the lesion revealed a nevus sebaceus with a desmoplastic trichilemmoma, a tumor of follicular infundibulum, and a neurofibroma. This case highlights a rare finding of a mesenchymal tumor, and the first reported neurofibroma, arising in association with a nevus sebaceus.

Adnexal iceberg: pruritic papule on top of a nodule on the back.

Basal cell carcinoma (BCC), one of the most common malignancies, is rarely associated with follicular and apocrine differentiation patterns. This case presents a case of BCC with atypical gross presentation and features of aberrant differentiation. Clinicians should maintain a high level of clinical suspicion for BCC in atypical lesions. Click here for the corresponding questions to this CME article.

Multiple secondary neoplasms in nevus sebaceus excision.

Nevus sebaceus is a congenital hamartoma associated with several secondary tumors. We report the case of a 19-year-old woman who presented with changes in a nevus sebaceus lesion on her parietal scalp, which was subsequently excised. Upon pathological examination, both basaloid hamartoma and syringocystadenoma papilliferum were noted within the specimen, which is rare. The primary treatment modalities for nevus sebaceus are either close clinical observation or surgical excision, but no definitive consensus exists on the excision timeline of nevus sebaceus.

Basal cell carcinoma arising within a longstanding hemangioma.

Basal cell carcinomas have been reported to arise within several different tumors. Without careful attention to detail, basal cell carcinomas may go unnoticed when presenting within or directly adjacent to another distinct tumor. The increased use and accessibility of dermoscopy has allowed dermatologists to detect skin cancers that might otherwise be undetected by the naked eye. This case report details a collision, detected by dermoscopy, of a basal cell carcinoma developing within a long-standing hemangioma (cherry angioma) on the left lower eyelid of a 75-year-old man.

Developing and Validating a Step Test of Aerobic Fitness among Elementary School Children.

Purpose: The tests to estimate aerobic fitness among children require substantial space and maximum effort, which is often difficult for children. We developed a simple submaximal step test (Step Test of Endurance for Pediatrics, or STEP) and assessed its reliability, validity, and ability to estimate aerobic fitness among elementary school children. Method: Children aged 5-10 years completed the STEP with a protocol consisting of 0.1-, 0.2-, and 0.3-metre (4, 8, and 12 in.) step heights. Participants underwent treadmill testing with open circuit spirometry to determine actual maximal oxygen consumption (V̇o2max). Intra-class correlation coefficients (ICCs) assessed test-retest reliability of the STEP and its component tests. Multivariate linear regression assessed the associations between the STEP and V̇o2max, adjusting for potential covariates such as age, sex, BMI, and comorbidity count. Results: The STEP showed excellent reliability (ICC ≥ 0.92; N = 170), irrespective of effort level during testing. Significant effort issues and collinearity among the independent variables led us to exclude children aged 5-6 years (n = 45) from the regression analysis. The final regression model for children aged 7-10 years with adequate effort (n = 111), as defined by a respiratory exchange ratio of 1.0 or more, showed that the STEP, sex, and BMI were significantly predictive of V̇o2max (R 2 = 0.51). Conclusions: This new, effort-independent step test can estimate the aerobic fitness of children aged 7-10 years. Regression equations to estimate V̇o2max from the STEP were provided.

Objectif : les tests d'évaluation de la capacité aérobique chez les enfants exigent beaucoup d'espace et un effort maximal, et les enfants éprouvent souvent de la difficulté à les exécuter. La présente étude visait à mettre à l'essai un simple test sous-maximal de la marche d'escalier (test de la marche d'escalier pour établir l'endurance en pédiatrie, ou STEP, selon l'acronyme anglais) et à en déterminer la fiabilité, la validité et la capacité à évaluer la capacité aérobique des enfants du primaire. Méthodologie : des enfants de cinq à dix ans ont effectué le STEP selon un protocole qui incluait des marches de 0,1, 0,2 et 0,3 mètre (4, 8 et 12 pouces). Les participants ont effectué une épreuve d'effort sur tapis roulant avec spirométrie en circuit ouvert pour déterminer leur consommation maximale réelle d'oxygène (V̇o2max). Les chercheurs ont utilisé les coefficients de corrélation intraclasse (CCI) pour évaluer la fiabilité test-retest du STEP et des tests qui le composaient. Ils ont utilisé la régression linéaire multivariée pour évaluer les associations entre le STEP et le V̇o2max, rajustée pour tenir compte de covariances potentielles comme l'âge, le sexe, l'indice de masse corporelle (IMC) et le nombre de comorbidités. Résultats : le STEP était d'une excellente fiabilité (CCI ≥ 0,92; n = 170), quel que soit le niveau d'effort utilisé. Des problèmes relatifs à l'importance de l'effort et la colinéarité entre les variables indépendantes ont incité les chercheurs à exclure de l'analyse de régression les enfants de cinq et six ans (n = 45). Le modèle de régression final des enfants de sept à dix ans qui faisaient un effort approprié (n = 111), défini par un ratio d'échanges gazeux minimal de 1,0, a révélé que le STEP, le genre et l'IMC étaient très prédictifs du V̇o2max (R 2 = 0,51). Conclusion : ce nouveau test de la marche d'escalier qui n'est pas lié à l'effort peut évaluer la capacité aérobique des enfants de sept à dix ans. Les chercheurs ont fourni les équations de régression pour évaluer le V̇o2max à partir du STEP.

Vancomycin-induced DRESS syndrome treated with systemic steroids in a 16-year-old male.

This is a case report of a 16-year-old patient with DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) associated with vancomycin who improved with systemic steroid treatment. DRESS syndrome is a life-threatening disease process typically secondary to medications, such as anticonvulsants, sulfonamides, and allopurinol. Vancomycin has also been associated with this condition. Apart from discontinuation of the offending agent, there are no clear treatment guidelines, but reports of improvement with systemic corticosteroids are described. We present a case of a 16-year-old male who had been on vancomycin for greater than 4 weeks before developing symptoms consistent with the diagnosis of DRESS syndrome. Our patient demonstrated marked improvement with systemic corticosteroids.