RESUMO
This case report describes a man in his 50s with HIV/AIDS who presented with widely scattered recalcitrant mpox lesions.
Assuntos
Síndrome da Imunodeficiência Adquirida , Mpox , Infecções por Papillomavirus , Humanos , Cidofovir , Antivirais/uso terapêutico , Citosina/uso terapêutico , Injeções IntralesionaisAssuntos
Líquen Plano , Alopecia , Humanos , Líquen Plano/radioterapia , Projetos Piloto , Estudos Prospectivos , Couro CabeludoRESUMO
BACKGROUND: Amphiregulin (AREG) is increased in circulation in acute graft-versus-host disease (aGVHD) and is associated with poor steroid response and lower survival. The expression of AREG in aGVHD target organs and its association with clinical outcomes are unknown. METHODS: We performed AREG immunohistochemical staining on skin specimens from 67 patients with aGVHD between the years 2010 and 2015. Two blinded reviewers assessed AREG expression and scored specimens with a semiquantitative scale ranging from 0 (absent) to 4 (most intense). RESULTS: Median AREG score of aGVHD cases was 3. Sixteen of 67 (23.9%) aGVHD cases had an AREG >3. High skin AREG expression (>3 vs. ≤3) was associated with increased overall clinical grade of aGVHD (52.9% vs. 33.4% clinical grade III-IV, p = 0.02), reduced 3-year overall survival (OS; 13% vs. 61%, p < 0.01), and increased 3-year non-relapse mortality (NRM; 56% vs. 20%, p = 0.05). CONCLUSION: High skin AREG immunohistochemical expression is associated with high clinical grade aGVHD, poor OS, and increased NRM.
Assuntos
Anfirregulina , Doença Enxerto-Hospedeiro , Transplante de Células-Tronco Hematopoéticas , Pele , Doença Aguda , Anfirregulina/análise , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/mortalidade , Humanos , Recidiva Local de Neoplasia , Pele/metabolismo , EsteroidesRESUMO
Pseudolymphomatous infiltrates associated with angiosarcoma are a rarely reported phenomenon. Recognition of this reactive process is critical to making an accurate diagnosis, both in diagnosing the angiosarcoma and in avoiding an incorrect diagnosis of lymphoma. Here, we present a novel histopathologic pattern, angiosarcoma with a prominently intravascular atypical lymphoid component, mimicking intravascular T-cell lymphoma. Interestingly, serial biopsies in this case revealed a progressive increase in lymphocyte density and intravascular component over time. Despite prior reports of improved progression-free survival and overall survival of patients with pseudolymphomatous angiosarcoma, this patient showed rapid disease progression.
Assuntos
Hemangioendotelioma/patologia , Hemangiossarcoma/patologia , Linfoma de Células T/patologia , Pseudolinfoma/patologia , Neoplasias Cutâneas/patologia , Idoso , Biópsia , Diagnóstico Diferencial , Progressão da Doença , Hemangioendotelioma/diagnóstico , Hemangiossarcoma/diagnóstico , Hemangiossarcoma/cirurgia , Humanos , Linfócitos/patologia , Linfoma de Células T/diagnóstico , Masculino , Margens de Excisão , Cirurgia de Mohs/efeitos adversos , Pseudolinfoma/diagnóstico , Neoplasias Vasculares/patologiaRESUMO
BACKGROUND: Voriconazole and genus beta human papillomavirus (HPV) are independently associated with the development of photo-exposed cutaneous squamous cell carcinoma (SCC) but have not been evaluated concurrently. The objective of this study is to determine the prevalence and type of detectable HPV DNA in voriconazole-associated SCC. METHODS: SCCs from immunosuppressed patients, in those with and without voriconazole exposure, were evaluated by PCR analysis for HPV DNA and compared to SCC from non-immunosuppressed patients. An additional expanded PCR analysis of all SCC that developed in the voriconazole group was also performed. RESULTS: HPV DNA was detected by PCR in all groups regardless of the immunosuppression status (80.5%) with beta HPV most prevalent (64.3-78.6%). However, immunosuppressed patients were significantly more likely to be infected by beta HPV types 5, 8, 14, 20, and 21 (P-value 0.014), and represented the majority of beta HPV types found in the voriconazole group. CONCLUSIONS: In this retrospective study, beta HPV 5, 8, 14, 20, and 21 were commonly detected in voriconazole-associated SCC. The results indicate a possible role of beta HPV in the pathogenesis of cutaneous SCC in photo-exposed areas. Further studies are needed to establish the role of HPV and voriconazole in the pathogenesis of the lesion.
Assuntos
Betapapillomavirus/isolamento & purificação , Carcinoma de Células Escamosas/etiologia , Infecções por Papillomavirus/epidemiologia , Neoplasias Cutâneas/etiologia , Voriconazol/efeitos adversos , Idoso , Betapapillomavirus/genética , DNA Viral/isolamento & purificação , Feminino , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Infecções Fúngicas Invasivas/imunologia , Infecções Fúngicas Invasivas/prevenção & controle , Masculino , Pessoa de Meia-Idade , Transplante de Órgãos/efeitos adversos , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/virologia , Reação em Cadeia da Polimerase , Estudos RetrospectivosRESUMO
Mycosis fungoides (MF) is an indolent, uncommon, non-Hodgkin T-cell lymphoma of the skin. It classically presents with patches, plaques, and tumors and may rarely show spread to internal organs or bone marrow. Up to 7.5% of MF patients may be diagnosed with a second malignancy. Intravascular large B-cell lymphoma (IVLBCL) is an exceedingly rare non-Hodgkin B-cell lymphoma characterized by predominant growth of large neoplastic cells in the lumina of blood vessels. This case presents with an unusual confluence of two rare diagnoses, MF and IVLBCL, made more remarkable by the presence of both diagnoses on a single skin biopsy sample.
Assuntos
Linfoma Difuso de Grandes Células B/patologia , Micose Fungoide/patologia , Neoplasias Primárias Múltiplas/patologia , Neoplasias Cutâneas/patologia , Neoplasias Vasculares/patologia , Idoso , Feminino , HumanosRESUMO
Importance: Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a spectrum of severe mucocutaneous drug reaction associated with significant morbidity and mortality. A previously developed SJS/TEN-specific severity-of-illness model (Score of Toxic Epidermal Necrolysis [SCORTEN]) has been reported to overestimate and underestimate SJS/TEN-related in-hospital mortality in various populations. Objective: To derive a risk prediction model for in-hospital mortality among patients with SJS/TEN and to compare prognostic accuracy with the SCORTEN model in a multi-institutional cohort of patients in the United States. Design, Setting, and Participants: Data from a multicenter cohort of patients 18 years and older treated for SJS/TEN between January 1, 2000, and June 1, 2015, were obtained from inpatient consult databases and electronic medical record systems at 18 medical centers in the United States as part of the Society for Dermatology Hospitalists. A risk model was derived based on data from 370 of these patients. Model discrimination (calculated as area under the receiver operating characteristic curve [AUC]) and calibration (calculated as predicted vs observed mortality, and examined using the Hosmer-Lemeshow goodness-of-fit statistic) were assessed, and the predictive accuracy was compared with that of SCORTEN. All analysis took place between December 2016 and April 2018. Main Outcomes and Measures: In-hospital mortality. Results: Among 370 patients (mean [SD] age 49.0 [19.1] years; 195 [52.7%] women), 54 (15.14%) did not survive to hospital discharge. Five covariates, measured at the time of admission, were independent predictors of in-hospital mortality: age in years (odds ratio [OR], 1.05; 95% CI, 1.02-1.07), body surface area (BSA) in percentage of epidermal detachment (OR, 1.02; 95% CI, 1.01-1.04), serum bicarbonate level below 20 mmol/L (OR, 2.90; 95% CI, 1.43-5.88), active cancer (OR, 4.40; 95% CI, 1.82-10.61), and dialysis prior to admission (OR, 15.94; 95% CI, 3.38-66.30). A severity-of-illness score was calculated by taking the sum of 1 point each for age 50 years or older, epidermal detachment greater than 10% of BSA, and serum bicarbonate level below 20 mmol/L; 2 points for the presence of active cancer; and 3 points for dialysis prior to admission. The score was named ABCD-10 (age, bicarbonate, cancer, dialysis, 10% BSA). The ABCD-10 model showed good discrimination (AUC, 0.816; 95% CI, 0.759-0.872) and calibration (Hosmer-Lemeshow goodness of fit test, P = .30). For SCORTEN, on admission, the AUC was 0.827 (95% CI, 0.774-0.879) and was not significantly different from that of the ABCD-10 model (P = .72). Conclusions and Relevance: In this cohort of patients with SJS/TEN, ABCD-10 accurately predicted in-hospital mortality, with discrimination that was not significantly different from SCORTEN. Additional research is needed to validate ABCD-10 in other populations. Future use of a new mortality prediction model may provide improved prognostic information for contemporary patients, including those enrolled in observational studies and therapeutic trials.
Assuntos
Mortalidade Hospitalar , Modelos Teóricos , Síndrome de Stevens-Johnson/mortalidade , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Índice de Gravidade de Doença , Síndrome de Stevens-Johnson/fisiopatologia , Estados UnidosAssuntos
Linfoma Folicular , Radioterapia/métodos , Neoplasias Cutâneas , Adulto , Doenças Assintomáticas , Biópsia/métodos , Humanos , Linfoma Folicular/diagnóstico , Linfoma Folicular/patologia , Linfoma Folicular/radioterapia , Masculino , Escápula , Pele/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/radioterapia , Resultado do TratamentoRESUMO
Skin biopsy remains one of the most important tools in the evaluation of dermatologic disease in hospitalized patients and is diagnostic for many common inpatient dermatoses, including various drug eruptions and cutaneous infections. The dermatopathology team thus plays a crucial role in the care of many of these patients and can add significant value through timely and precise diagnoses. Here, we review the unique challenges of dermatopathology in hospital-based medicine, discuss approaches to timely care, and examine effective clinicopathologic correlation in this setting.
Assuntos
Biópsia , Dermatologia , Medicina Hospitalar , Dermatopatias/diagnóstico , Dermatopatias/patologia , Pele/patologia , Biópsia/métodos , Humanos , Dermatopatias Infecciosas/microbiologia , Dermatopatias Infecciosas/patologia , Manejo de EspécimesAssuntos
Antígenos CD8/imunologia , Orelha Externa/patologia , Papulose Linfomatoide/patologia , Papulose Linfomatoide/cirurgia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Idoso , Biópsia por Agulha , Progressão da Doença , Orelha Externa/cirurgia , Seguimentos , Humanos , Imuno-Histoquímica , Papulose Linfomatoide/diagnóstico , Papulose Linfomatoide/imunologia , Masculino , Cirurgia de Mohs/métodos , Doenças Raras , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/imunologia , Resultado do TratamentoRESUMO
The diagnosis of serum sickness-like reaction (SSLR) is typically based on clinical findings. Histopathologic examination is often deferred, as these eruptions commonly present in young children, and often to primary care providers. A PubMed literature search revealed only five existing cases of SSLR which describe cutaneous histopathologic features. We report two cases of SSLR, one each to bupropion and cefazolin. Skin biopsy findings in both cases showed a neutrophil-predominant urticarial pattern resembling neutrophilic urticaria or neutrophilic urticarial dermatosis. We also provide a summary of the histopathologic findings that can help support a diagnosis of SSLR.
Assuntos
Toxidermias/patologia , Neutrófilos/patologia , Doença do Soro/patologia , Urticária/induzido quimicamente , Urticária/patologia , Idoso , Antibacterianos/efeitos adversos , Antidepressivos de Segunda Geração/efeitos adversos , Bupropiona/efeitos adversos , Cefazolina/efeitos adversos , Humanos , Masculino , Adulto JovemAssuntos
Dermatofibrossarcoma/epidemiologia , Neoplasias Cutâneas/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Células Dendríticas/química , Células Dendríticas/patologia , Dermatofibrossarcoma/patologia , Feminino , Humanos , Incidência , Lactente , Masculino , Melaninas/análise , Pessoa de Meia-Idade , Especificidade de Órgãos , Grupos Raciais , Programa de SEER , Neoplasias Cutâneas/patologia , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Precise diagnosis of childhood vascular anomalies is challenging, and requires careful correlation of clinical findings, diagnostic imaging, histopathology and genetic analysis. Skin and soft tissue biopsies remain an important element in the complete evaluation of many vascular anomalies included in the revised 2014 International Society for the Study of Vascular Anomalies (ISSVA) classification. Here we present an overview of the light microscopic and immunohistochemical features of the entities in this updated classification scheme, with emphasis on newly-included diagnoses such as PTEN hamartoma of soft tissue.
Assuntos
Neoplasias de Tecido Vascular/classificação , Neoplasias de Tecido Vascular/patologia , Malformações Vasculares/classificação , Malformações Vasculares/patologia , HumanosRESUMO
We report the case of a 2-week-old boy who presented with a vesiculopustular, bullous eruption in the setting of autoimmune enteropathy, hypothyroidism, membranous nephropathy, Coombs-positive hemolytic anemia, and persistent eosinophilia. Immunologic testing revealed a deficiency of FOXP3-expressing regulatory T cells, and a diagnosis of immune dysregulation, polyendocrinopathy, enteropathy, X-linked syndrome was made. Histologic analysis, immunofluorescence, and enzyme-linked immunosorbent assay confirmed the bullous eruption as epidermolysis bullosa acquisita with associated collagen VII autoantibody production. The skin lesions responded to systemic immunosuppressant therapy and have regressed after allogeneic bone marrow transplantation.
Assuntos
Diarreia/diagnóstico , Epidermólise Bolhosa Adquirida/diagnóstico , Doenças do Sistema Imunitário/congênito , Transplante de Medula Óssea , Diabetes Mellitus Tipo 1/congênito , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/terapia , Diagnóstico Diferencial , Diarreia/terapia , Ensaio de Imunoadsorção Enzimática , Epidermólise Bolhosa Adquirida/terapia , Imunofluorescência , Doenças Genéticas Ligadas ao Cromossomo X/diagnóstico , Doenças Genéticas Ligadas ao Cromossomo X/terapia , Humanos , Doenças do Sistema Imunitário/diagnóstico , Doenças do Sistema Imunitário/terapia , Imunossupressores/uso terapêutico , Recém-Nascido , MasculinoAssuntos
Calcinose/patologia , Tecido Elástico/patologia , Sobrepeso/diagnóstico , Dermatopatias/patologia , Biópsia por Agulha , Calcinose/complicações , Calcinose/diagnóstico , Seguimentos , Doença de Graves/diagnóstico , Doença de Graves/cirurgia , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Sobrepeso/complicações , Doenças Raras , Dermatopatias/diagnóstico , Tireoidectomia/métodos , Aumento de PesoRESUMO
The incidence of cutaneous malignant melanoma has rapidly increased in recent years in all parts of the world, and melanoma is a leading cause of cancer death. As even relatively small melanomas may have metastatic potential, accurate assessment of progression is critical. Although diagnosis of cutaneous malignant melanoma is usually based on histopathologic criteria, these criteria may at times be inadequate in differentiating melanoma from certain types of benign nevi. As for prognosis, tumor (Breslow) thickness, mitotic rate, and ulceration have been considered the most important prognostic indicators among histopathologic criteria. However, there are cases of thin primary melanomas that have ultimately developed metastases despite complete excision. Given this, an accurate assessment of melanoma progression is critical, and development of molecular biomarkers that identify high-risk melanoma in its early phase is urgently needed. Large-scale genomic profiling has identified considerable heterogeneity in melanoma and suggests subgrouping of tumors by patterns of gene expression and mutation will ultimately be essential to accurate staging. This subgrouping in turn may allow for more targeted therapy. In this review, we aim to provide an update on the most promising new biomarkers that may help in the identification and prognostication of melanoma.