A poroid neoplasia arising close to a seborrheic keratosis and a trichoepithelioma.

A 69-year-old woman had a well-defined, slightly raised, brownish, keratotic plaque with an eccentric group of roughly circular, bluish, dome nodules on her right scapular area. Histological study revealed the presence of an eccrine poroma demonstrating features of eccrine poroma, hidroacanthoma simplex, and dermal duct tumor and arising in a lesion of seborrheic keratosis and a trichoepithelioma. In the eccrine poroma region, an area with malignant changes was evident. The findings in this case support the view of eccrine poroma as a spectrum of histological variants and the possibility of malignant transformation from a eccrine poroma towards porocarcinoma. The association with seborrheic keratosis is most probably coincidental, and the trichoepithelioma was probably due to induction of the tumoral stroma on adjacent follicular epithelia.

Leukocytoclastic vasculitis as a cutaneous manifestation of systemic infection caused by Brucella melitensis.

A 22-year-old man with leukocytoclastic vasculitis as a cutaneous manifestation of brucellosis is presented. Skin lesions resolved 48 hours after starting treatment with tetracycline and rifampicin. Although skin manifestations are rarely associated with infection due to Brucella and do not seem to worsen the prognosis, they may cause the patient to seek medical attention as well as contribute to the diagnosis.

Photosensitivity associated with treatment with triflusal.

BACKGROUND: Triflusal is a fluorinated aspirin derivative with antiplatelet properties, which is used in Spain for the management and prevention of thromboembolic disease. CASE REPORT: A 91-year-old female developed a systemic photosensitivity reaction 15 days after beginning triflusal preventive treatment (300 mg/12 h) for prior transient ischaemic attack. Photobiological study showed an abnormal response to light in areas exposed to ultraviolet B and A radiation, with a photopatch test positive to both triflusal and its main metabolite. These observations suggested a causal relation between triflusal and the clinical findings, as described in previous reports. CONCLUSIONS: The few cases reported to date and the clinicopathological features of this case suggested an immunological response as the most likely cause of the reaction.

Lipoatrophia semicircularis--a traumatic panniculitis: report of seven cases and review of the literature.

Lipoatrophia semicircularis is an apparently rare condition, which presents as semicircular band-like atrophy of the subcutaneous fatty tissue and involving half the circumference of the anterolateral aspects of the thighs. Repeated external microtraumatism seems to be the most plausible explanation in several cases in the literature, though in some patients the underlying traumatic mechanism is difficult to establish. No relation to underlying clinical or biologic abnormalities appears to be. Seven patients with lipoatrophia semicircularis are described. A detailed clinical history revealed precipitating trauma in all cases. A review is made of earlier reports in the literature.

Median raphe cysts of the penis: a report of five cases.

Cysts of the median raphe are embryologic developmental anomalies of the male genitalia. Although generally present since birth, these lesions tend to manifest in adult life. Histologically the cysts are characterized by a pseudostratified epithelium in the middle dermis. The early age at consultation is a common characteristic in four of the five patients reported herein and is probably due to the growing concern among the general population about skin problems.

Detection of Epstein-Barr virus DNA in a patient with Kimura's disease.

An 80-year-old man, with a past medical history of senile dementia, presented with a 6-month history of a solitary, gradually enlarging tumor, located on his chin. A squamous cell carcinoma had been surgically excised 30 years previously in the same location. Physical examination revealed an erythematous, well-defined plaque of 3 cm in diameter, located on the chin (Fig. 1). The submandibular lymph nodes were enlarged. Squamous cell carcinoma and primary cutaneous lymphoma were considered. Relevant laboratory findings were as follows: white blood cell count, 5.600/microL; eosinophils, 1000/microL; gammaglobulin, 2.4 g/dL; lactate dehydrogenase, 343 IU/L; and immunoglobulin G (IgG) antibodies to Epstein-Barr virus (EBV) positive (at 1 : 128 serum dilution), with negative IgM. Skin and lymph node biopsies were performed. Histopathologic study of the cutaneous specimen revealed a heavy lymphoid infiltrate with numerous lymphoid follicles, with prominent germinal centers involving the subcutaneous fat as well as the deep dermis and muscular fascia. Some germinal centers showed folliculolysis. The lymphoid follicles were surrounded by fibrous tissue. The interfollicular infiltrate was rich in plasma cells and eosinophils that formed scattered eosinophilic microabscesses. Thin-walled vessels were numerous and prominent, but with no epithelioid or vacuolated endothelial cells (Fig. 2). Histopathology of a lymph node biopsy specimen showed reactive lymphoid follicle hyperplasia, with prominent eosinophilic infiltrates in both follicular and interfollicular areas. Eosinophilic deposits and polykaryocytes of Warthin-Finkeldey type were seen in the germinal centers. The paracortical area showed vascular proliferation. Polymerase chain reaction (PCR) for the detection of specific sequences of EBV from routinely processed paraffin-embedded material was carried out under the conditions and with the same set of primers as described previously in detail (Tenorio A, Echevarría JE, Casas E et al. J Virol Methods 1993; 44: 261-269). DNA samples were confirmed to be amplifiable with PCR primers specific for a conserved region of the human beta-globin gene. Every sample was tested at least twice for EBV DNA and beta-globin gene. One sample from one skin lesion of the patient, with confirmed diagnosis of Kimura's disease, and 10 samples from normal skin biopsies retrospectively collected from other patients in archival files of our department were tested. Only the patient's specimen tested positive to EBV. The amplified product of EBV was analyzed using DNA sequencing and confirmed the results obtained. The patient received radiotherapy at doses of 35 Gy. Nevertheless, the tumor enlarged to reach twofold its original size 1 month later. Due to the physical status of the patient, no further treatments were considered, but the disease remained stable over the following 3 years.

Pseudovascular squamous cell carcinoma of the skin.

The presence of acantholysis in squamous cell carcinomas (SCC) may rarely be so extreme that, histologically, it mimics a vascular tumour. However, careful histological examination and immunohistochemical study usually lead to the correct diagnosis. We describe such a case to highlight the clinico-pathological features of this rare form of cutaneous malignancy and to emphasize the difficulties in establishing the correct diagnosis. We also review similar cases reported in the literature. Pseudovascular SCC shows a higher degree of recurrence and metastasis than other variants of SCC. Acantholytic foci in these tumours may demonstrate changes in keratinocyte differentiation markers, and this may explain the more aggresive biological behaviour in the pseudovascular variant of SCC.

Radius hypoplasia, radial palsy, and aplasia cutis due to amniotic band syndrome.

Amniotic band syndrome is one of the many causes of aplasia cutis congenita. It is usually seen as a constriction band surrounding a limb or as a membrane that adheres to some part of the body. This syndrome can be associated with various malformations. An infant with amniotic adhesions producing aplasia cutis, radial palsy, and hypoplasia of the radius is presented. Early treatment led to total functional recovery of the affected limb.

Congenital lower lip pits (Van der Woude syndrome): presentation of 10 cases.

Congenital lower lip pits are a rare developmental malformation of the lower lip. Clinically they present as bilateral depressions in the vermilion zone of the lower lip. It is important to be aware of this disorder because lower lip pits have also been reported in a variety of other congenital disorders and are associated with other malformations. Ten cases of this entity are presented. Nine of the 10 patients are members of two related families. The clinical and pathologic picture as well as some of the genetic and therapeutic aspects of this peculiar condition are discussed.

Enfermedad periodontal necrosante / Necrotizing periodontal disease

La enfermedad periodontal necrosante es una infección con necrosis de las papilas interdentarias, dolor y hemorragia gingival. Las espiroquetas sonlos patógenos implicados en la gingivitis necrosante aguda. Los factores predisponentes son el consumo de tabaco y alcohol, el déficit alimentario, lainmunosupresión, especialmente en pacientes infectados por VIH, el estrés emocional y la gingivitis preexistente. Presentamos el caso de un hombrede 38 años con lesiones en encías y labio superior, tratado con éxito con metronidazol y espiramicina (AU)

Necrotizing periodontal disease is an infection characterized by gingival necrosis, pain and gingival bleeding. Spirochetes are pathogens usually involvedin acute necrotizing gingivitis. Predisposing factors are tobacco smoking, alcohol abuse, poor diet, inmunosupression, specially in HIV infectedpatients, emotional stress and preexisting gingivitis. We present a 38-year-old man with gingival and upper lip lesiones, successfully treated withmetronidazole and spiramycin (AU)

Foliculitis de la barba candidomicética / Folliculitis barbae candidomycetica

La foliculitis de la barba candidomicética es una infección muy poco frecuente. Aunque se han citado diferentes factores predisponentes, la mayoríade los casos ocurren en personas sanas. Presentamos un caso de foliculitis de la barba candidomicética en un individuo sano de 41 años, tratado satisfactoriamentecon itraconazol durante 4 semanas. Sugerimos que en este paciente pudiera tratarse de una infección de transmisión sexual por contactoorogenital (AU)

Folliculitis barbae candidomycetica is a very rare infection. Although many predisposing factors have been cited, most cases occur in healthy individuals.We present a case of folliculitis barbae candidomycetica in a 41-year-old healthy man, successfully treated with itraconazole during 4 weeks. Wesuggest in this patient it could be a sexually transmitted infection due to orogenital contact (AU)