Large prepatellar glomangioma: A case report.

INTRODUCTION: Glomangiomas are rare, benign tumors derived from the glomus body, typically presenting with the classic triad of pain, tenderness to palpation, and hypersensitivity to cold. Most commonly they present as a solitary lesion in the extremities, especially subungual, but they may present elsewhere. PRESENTATION OF CASE: We describe the case of a large (64mm×59mm×41mm) glomangioma on the anteroinferior aspect of a healthy 49 year old male's knee. Symptoms included constant throbbing pain with intermittent stabbing sensations localized to the mass. The mass was evaluated first by magnetic resonance (MR) imaging and then by histopathology following excision. DISCUSSION: Although rare, clinical diagnosis of glomangiomas may be sufficient in typical cases, however in atypical cases, like the one discussed here, further evaluation is often necessary. Here MR findings were suggestive of a glomangioma with low to intermediate signal strength on T1 and mixed signal strength on T2. Intravenous gadolinium infusion demonstrated marked heterogeneous enhancement of the lesion, as well as serpiginous vascular malformations surrounding the lesion. Histopathology following excision confirmed a benign glomangioma depicting monomorphic small, round eosinophilic cells with minimal atypia which stained positive for smooth muscle actin, and negative for cytokeratin, S-100 and CK-34 via immunohistochemistry. CONCLUSION: The following case report details an atypical presentation of a benign glomangioma anterior to the knee in a patient experiencing chronic minor trauma to the area. Diagnosis was suggested by clinical presentation and MR imaging, and was confirmed histologically.

Effect of long-term low-dose prednisone on height velocity and disease activity in pediatric and adolescent patients with Crohn disease.

OBJECTIVES: To determine whether long-term low-dose prednisone (LTLDP) therapy has a decelerating effect on growth velocity and whether this therapy is effective in the maintenance of remission in the subgroup of pediatric patients with Crohn disease (CD) who had previously experienced flares on more than 1 occasion when prednisone was discontinued. PATIENTS AND METHODS: A retrospective chart review of patients was done. Our sample consisted of patients 6 to 17 years of age with CD who had received uninterrupted prednisone at an average daily dose of 0.1 to 0.4 mg x kg(-1) x day(-1) for at least 8 weeks. Their heights were plotted on sex-appropriate growth charts at 4 time points: 1 year before LTLDP, at therapy onset, at therapy discontinuation, and 1 year after therapy was discontinued. The height velocities (HVs) were compared with the normal HV established by Tanner. The disease activities of 2 groups were compared: LTLDP plus azathioprine/6-mercaptopurine (AZA/6-MP) and LTLDP alone. RESULTS: One hundred two patients were included. The mean age of our sample was 13.7 +/- 2.7 years (standard deviation). The mean dose of prednisone dose was 0.18 +/- 0.07 mg x kg(-1) x day(-1)), for a mean duration of therapy of 14.4 +/- 7.2 months. Throughout the study, 78% of patients had normal HV. Growth deceleration was seen in 19% of patients with prior normal growth. Of this group, 31% had "catch-up" growth 1 year after prednisone was discontinued; the remaining 69% did not. Catch-up growth was more likely in patients who had reached the expected age peak HV, which is defined as 12.5 years for girls and 13.5 years for boys (P = 0.04). In addition, 6 patients reached the peak HV after LTLDP discontinuation; 13 did not. We found no difference in the maintenance of remission rate between the compared groups. CONCLUSIONS: A minority of our study population had growth deceleration. Age was an important factor for subsequent catch-up growth. LTLDP efficacy to maintain remission was not different from that of LTLDP plus AZA/6-MP; differences in concomitant therapies (eg, antibiotics, infliximab) between the 2 groups were not statistically significant.

Two-photon confocal microscopy: a nondestructive method for studying wound healing.

Two-photon confocal microscopy is a new technology useful in nondestructive analysis of tissue. The pattern generated from laser-excited autofluorescence and second harmonic signals can be analyzed to construct a three-dimensional, microanatomical, structural image. The healing of full-thickness guinea pig skin wounds was studied over a period of 28 days using two-photon confocal microscopy. Three-dimensional data were rendered from two-dimensional images and compared with conventional, en face, histologic sections. Two-photon confocal microscopy images show resolution of muscle, fascia fibers, collagen fibers, inflammatory cells, blood vessels, and hair. Although these images do not currently have the resolution of standard histology, the ability to noninvasively acquire three-dimensional images of skin promises to be an important tool in wound-healing studies.

Regeneration of neomucosa using cell-seeded collagen-GAG matrices in athymic mice.

Tissue engineering of oral mucosa could allow improved reconstructive options for intraoral tissue defects. Porous collagen-glycosaminoglycan (CG) matrices coated with a silicone elastomer were seeded by centrifugation with cultured human oral mucosal epithelial cells (strain OKG4 gingival keratinocytes) at a density of 250,000 cells per square centimeter. Full-thickness dorsal wounds (1.5 x 1.5 cm) were created surgically on each athymic mouse and were treated with either a seeded matrix or an unseeded matrix, or they were left open as a control. The CG matrices reduced the degree of wound contraction at day 14 compared with open wounds. The epithelial thickness of seeded matrices at day 14 was significantly greater (p = 0.0001) than that of unseeded matrices. Seeded matrices had more rapid degradation at 14 days compared with unseeded matrices. Human oral mucosal cells seeded into CG matrices contribute to form a stratified and differentiated epithelial layer during revascularization, cellular infiltration, and degradation of the CG matrix.