Cutaneous metastases from internal cancers.

BACKGROUND: Cutaneous metastases (CMs) from carcinoma are relatively uncommon, being usually late events in the course of internal malignancies. CMs from internal tumors seen at a secondary dermatological centre in Tunis are reported. METHODS: A retrospective review of the available clinical records and histological material of all patients with CMs from internal malignancies was performed over a 14-year period. RESULTS: Fourteen cases of CMs were recorded: 8 males and 6 females. The age range was 53 to 96 years, with a mean of 63.5 years for males and 76.5 years for females. CMs represented the first indication of an internal malignancy in 64% of cases. Firm solitary or multiple nodules were the most relevant clinical presentation (93%). Preferred sites were the thorax (50%), the abdomen (29%), and the head and neck region (21%). The common sites of primary malignancy were the lungs (38%) in males and breast (33%) in females. Four out of 14 patients died within a short follow-up period (mean 9.5 months). DISCUSSION: CMs are relatively rare in patients with internal cancers, but they may be a presenting sign of such cancers.

[Childhood cutaneous leishmaniasis in Tunisia: retrospective study of 60 cases]. / La leishmaniose cutanée de l'enfant en Tunisie: étude rétrospective de 60 cas.

Cutaneous leishmaniasis (CL) is a widespread parasitic disease that represents a major public health problem in several countries including Tunisia. The aim of this study was to determine the characteristics of childhood CL in a university hospital center in Tunis. The files of all children treated for of CL in the Dermatology Department of Habib Thameur Hospital over a 23-year period were reviewed. A total of 60 children were included. The mean age was 9.2 years and the sex ratio was 0.93. All patients lived or had stayed in an endemic area. Infectious risk was highest in autumn (41.6%). The most frequent clinical finding consisted of crusty nodules (53.3%) that were most often the only manifestation (63.3%) and usually located on the face (65%). Clinical diagnosis was confirmed by either peripheral blood smear (56.6%) or histological examination (35%). The treatment of choice was Glucantime administered by the intralesional route in 70% of patients or by intramuscular route in 30%. The outcome was favorable in all cases within 2 weeks to 6 months. Sequels were noted in 9 cases (18%) in the form of pigmented (7 cases) or atrophic (2 cases) residual scars. The frequency of childhood CL is relatively high especially during the second decade of life. Childhood CL is characterized by a generally favorable outcome and lack of distinguishing clinical characteristics form adult CL. If possible, therapeutic abstention is more widely in the children due to the high risk of adverse reactions.

Trigeminal trophic syndrome: a report of two cases with review of literature.

Trigeminal trophic syndrome, a rare cause of facial ulceration, is the consequence of damage to the trigeminal nerve or its central sensory connections. We report two cases of trigeminal trophic syndrome, complications of cerebral vascular accidents. A 65-year-old woman complained of numerous and progressive ulcers of the right side of her face of 2 month's duration. A 67-year-old woman presented with an ulcer of the ala nasi of 10 week's duration. This syndrome most commonly occurs in women with an average age of 57 years. About 100 cases are reported in the literature. The diagnosis is made on clinical grounds, and is suggested when loss of sensation occurs in association with unilateral facial ulceration, especially involving the ala nasi. Once the ulcers appear, they are extremely persistent.

[Cutaneous tuberculosis: anatomoclinical features and clinical course (26 cases)]. / Tuberculose cutanée: aspects anatomocliniques et évolutifs (26 cas).

INTRODUCTION: Despite prevention programs, tuberculosis is still progressing endemically in developing countries. The prevalence of cutaneous tuberculosis is estimated as 2.1 p. 100 and represents a rare localization among the extra-pulmonary forms. In order to study the epidemiology, the most frequent anatomoclinical forms and the progressive features of cutaneous tuberculosis, we conducted a study in the area of Tunis over a 20-year period. PATIENTS AND METHODS: All cases of cutaneous tuberculosis observed between 1981 and 2000 in the dermatology department of the Habib Thameur hospital were included in a retrospective study. Diagnosis of cutaneous tuberculosis was challenging and required the correlation of clinical, biological and progressive features. RESULTS: Twenty-six patients were observed in the study. There were 12 men and 14 women with a mean age of 30.4 years (range: 6-74) and 20 p. 100 of infantile cases. Of the various patterns of cutaneous tuberculosis seen, 11 (42 p. 100) had lupus tuberculosis, 10 (38 p. 100) had scrofuloderma, 4 (15 p. 100) had tuberculosis verrucosa cutis and 1 child had a perianal tubercular ulcer. The Mantoux test was positive in 20/24 patients. Histological tuberculoid granuloma was seen in 25 cases (96 p. 100) associated with caseating necrosis in 10 cases (38 p. 100). All patients were treated successfully with triple or quadruple anti-tubercular drugs for 6 to 10 months. One patient exhibited a squamous cell carcinoma on a lupus tuberculosis scar four years later. DISCUSSION: The progression of cutaneous tuberculosis remains stable, ranging from 1.4 cases/year between 1981 and 1990 to 1.2 cases/year between 1991 and 2000. In our study, females were slightly more affected than men with a M/F sex ration of 0.86. Before 1984, scrofuloderma was the most frequent form among the cutaneous tuberculoses. Now the frequency of lupus tuberculosis has reached that of scrofuloderma, demonstrating the increase in the incidence of clinical pattern of cutaneous tuberculosis with strong immunity probably related to the improvement in health conditions and generalization of vaccination programs.

[Kaposi's sarcoma and hypereosinophilic syndrome]. / Sarcome de Kaposi et syndrome hyperéosinophilique.

The authors report the case of a 73-year-old patient with severe Kaposi's sarcoma associated with an idiopathic hypereosinophilic syndrome. This association has not been reported until today and incites us to report this case.

[Cutaneous epithelioid hemangioendothelioma]. / Hémangioendothéliome épithélioïde cutané.

INTRODUCTION: Epithelioid hemangioendothelioma is a tumor of soft tissues arising from the vascular endothelium. It is considered as a low-grade malignant tumor. Cutaneous involvement is rare and often associated with multi-systemic localizations. CASE REPORT: We report the case of a 34 year-old woman with a 6-month history of a 1.5 cm erythematous-violaceous, soft, painful cutaneous nodule involving the right forearm. An abdominal sonography had been performed 1 month before the onset of the nodule, because of epigastric pain and was normal. Histological and immunohistological examinations led to diagnosis of an epithelioid hemangioendothelioma. Assessment of the extension with radiology, sonography, tomodensitometry and magnetic resonance imaging, revealed nodules of the liver. Treatment consisted in the wide and complete excision of the tumor. There was no evidence of local recurrence after one year follow-up, and the hepatic lesions were stable. DISCUSSION: Epithelioid hemangioendotheliomas belong to the epithelioid vascular tumor spectrum. They have in common the morphologic epithelioid aspect of endothelial tumor cells. Cutaneous localization is rare, and to the best of our knowledge, only 20 cases of epithelioid hemangioendothelioma with skin involvement have been reported in the literature. Epithelioid hemangioendothelioma can be isolated or associated with internal visceral involvement. The detection of skin lesions should lead to a complete assessment of the extension of the disease to detect any internal localization. Because of low-grade malignancy of the tumor, and the integrity of the liver observed one month before the onset of the disease in our patient, epithelioid hemangioendothelioma appears to be a multicentric disease rather than metastatic hepatic localizations of a primitive skin cancer.

Acebutolol-induced subacute cutaneous lupus erythematosus.

Beta-blocking medications are rarely associated with drug-induced lupus erythematosus syndrome and have never been incriminated as a cause of subacute lupus erythematosus (SCLE). We present herein the first case of SCLE induced by acebutolol. A 57-year-old woman presented with a 1-month history of a cutaneous eruption of the photo-exposed areas. One month ago, the patient had started a treatment with oral acebutolol to cure a hypertension of 1-year evolution. Physical examination revealed erythematous scaly annular plaques, involving the face, arms and trunk. Immunologic serology findings revealed a positive titer of antinuclear antibodies up to 1/1,280 with positivity of antihistone and Ro/SSA antibodies. Acebutolol was stopped, and the lesions cleared completely 4 months later. Literature data, along with our case, suggest a link between acebutolol therapy and the onset of a lupus syndrome. Although this is the first report of acebutolol-induced SCLE, we should be aware of this occurrence, and avoidance of acebutolol is recommended in patients with stigmata of lupus erythematosus.

[Malignant fibrous histiocytoma with giant cells of the skin. Anatomoclinical and immunohistochemical study of a case]. / Histiocytome fibreux malin à cellules géantes de siège cutané. Etude anatomoclinique et immunohistochimique d'une observation.

The authors report a case of malignant giant cell soft tissue tumor which appeared as a skin tumor of the thigh in a Tunisian women aged 17 years. Immunohistochemical study showed that the giant cells recognized KP1 antibody, while spindle interstitial cells reacted with anti-factor XIIIa antibody. The patient is alive and well eighteen months after large surgical removal. Two similar cases have been reported in the literature. Differential diagnosis, histogenesis and prognosis of this rare tumor are discussed.