ABSTRACT
BACKGROUND: Leprosy and HIV are diseases that have a major impact on public health in Brazil. Patients coinfected with both diseases, appear to be at higher risk to develop leprosy reactions. OBJECTIVE: The aim of this study is to describe the histopathological aspects of cutaneous lesions during reactional states in a group of patients with HIV-leprosy coinfection, compared to patients with leprosy, without coinfection. METHODS: Two groups were established: group 1 comprised of 40 patients coinfected with HIV-leprosy; group 2, comprised of 107 patients with leprosy only. Patients presenting reactional states of leprosy had their lesions biopsied and comparatively evaluated. RESULTS: Reversal reaction was the most frequent feature in both groups, with dermis edema as the most common histopathological finding. Giant cells were seen in all group 1 histopathological examinations. Dermis edema was the most common finding in patients with erythema nodosum leprosum. CONCLUSION: Few histopathological differences were found in both groups, with reversal reaction as the most significant one, although this fact should be analyzed considering the predominant BT clinical form in the coinfected group and BB form in the group without HIV. Larger prospective studies in patients with HIV-leprosy coinfection are needed to confirm and broaden these results. .
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , HIV Infections/pathology , Leprosy/pathology , Age Distribution , Biopsy , Chi-Square Distribution , Coinfection/pathology , Granuloma/pathology , Risk Factors , Sex Distribution , Skin/pathologyABSTRACT
Psoriasiform Keratosis is a rare clinic entity. The etiopathogenesis remains unknown and the disease is characterized by a solitary, scaly or keratotic papule, or plaque mainly located on the extremities. Histopathological features closely resemble those of psoriasis. We report the case of a 70-year-old woman presenting a solitary and asymptomatic keratotic plaque, located on the back of the left leg, unresponsive to topical corticosteroids. We performed an excisional biopsy and histopathology was consistent with psoriasiform keratosis.
Subject(s)
Humans , Female , Aged , Psoriasis/pathology , Keratosis/pathology , Skin/pathology , Biopsy , Leg Dermatoses/pathologyABSTRACT
Tufted angioma is an acquired vascular proliferation with specific histological characteristics. The most common clinical features are erythematous macules. It occurs predominantly in children and young adults, especially in the chest and neck. We report the case of a male patient, 12 years old, with an increased right ear auricle associated with erythematous macules and increased local temperature, referred with a diagnosis of lepromatous leprosy; however, this diagnosis was questioned. Histopathology was consistent with tufted angioma.
O Hemangioma em penacho é uma proliferação vascular adquirida de características histológicas peculiares. Sua característica clínica mais comum são máculas eritematosas. Ocorre predominantemente em crianças e adultos jovens, principalmente no tórax e pescoço. Relata-se o caso de paciente do sexo masculino, 12 anos, com aumento do pavilhão auricular direito associado a máculas eritematosas e aumento da temperatura local, encaminhado com diagnóstico de Hanseníase Virchowiana, entretanto, tal diagnóstico foi questionado. Histopatologia compatível com Hemangioma em penacho.
Subject(s)
Child , Humans , Male , Ear Auricle/pathology , Ear Neoplasms/pathology , Hemangioma/pathology , Skin Neoplasms/pathology , Biopsy , Diagnosis, Differential , Leprosy, Lepromatous/pathologyABSTRACT
Paracoccidioidomycosis presenting as a sarcoid-like plaque may be misdiagnosed as leprosy, especially when shared endemic areas are concerned. We report the case of a Brazilian male patient presenting with an ulcerated plaque on his left ear and neighboring areas. The plaque simulated tuberculoid leprosy type 1 reaction, both clinically and histopathologically. A perineural granuloma with no organisms detected by routine and Fite-Faraco staining reinforced that diagnosis. Paracoccidioidomycosis was confirmed only after a second biopsy, taken from the ulcerated area.
Paracoccidioidomicose expressando-se como placa sarcoídica pode ser confundida com hanseníase, especialmente em zonas endêmicas comuns às duas condições. Apresentamos um paciente brasileiro, com placa ulcerada na orelha direita e em áreas vizinhas que simulava, clinica e histopatologicamente, hanseníase tuberculoide em reação tipo 1. O encontro de granuloma perineural, sem parasitas detectáveis às colorações de rotina e Fite-Faraco, reforçou a hipótese de hanseníase. Apenas com uma nova biópsia, desta vez da área ulcerada, a paracoccidioidomicose pôde ser confirmada.
Subject(s)
Humans , Male , Middle Aged , Ear Diseases/pathology , Granuloma/pathology , Paracoccidioidomycosis/pathology , Biopsy , Diagnosis, Differential , Ear, External/pathology , Leprosy, Tuberculoid/pathologyABSTRACT
Granular cell tumor is a rare benign neoplasm of neural origin. We report the case of a female patient, 27 years old presenting a brown-red nodule in the right arm, which pathological examination showed to be formed by polygonal cells with eosinophilic granular cytoplasm and immunohistochemistry positive for S100 protein and CD68. Granular cell tumor is usually solitary and in half the cases located in the head and neck areas, 30% of these in the tongue. It is most frequent between the third and fifth decades of life in women and people of African-American ethnicity. Its origination is controversial, including the possible origins in muscle, fibroblasts, neural crest, neural sheath or histiocytes. The positivity for S-100 and CD68 suggest the neural origin.
O tumor de células granulares é uma neoplasia benigna rara, de origem neural. Relatamos caso de paciente feminina, 27 anos, com nódulo de superfície acastanhada no braço direito, cujo exame anatomopatológico evidenciou densa proliferação de células, com amplo citoplasma contendo grânulos eosinofílicos, e imuno-histoquímica positiva para proteínas S100 e CD68. O tumor de células granulares é geralmente solitário e, em metade dos casos, localiza-se em cabeça e pescoço, dos quais 23% na língua. É mais frequente entre a terceira e a quinta décadas de vida, em mulheres e pessoas de etnia negra. A positividade para S-100 e CD68 favorece origem neural.
Subject(s)
Humans , Female , Adult , Skin Neoplasms/pathology , Granular Cell Tumor/pathology , Immunohistochemistry , Antigens, Differentiation, Myelomonocytic/metabolism , S100 Proteins/metabolism , Biomarkers, Tumor/metabolism , Antigens, CD/metabolismABSTRACT
Tattooing has been associated with a variety of complications including inflammatory and granulomatous reactions, transmission of infections, and neoplasms. We report a case of a 24-year-old male who presented with a 2-month history of an erythematous nodule involving a newly made tattoo on the right leg. An excisional biopsy was performed and the histopathological evaluation was consistent with dermatofibroma. Only three cases of dermatofibroma associated with tatooing were reported in litetature. We report an additional case and review the literature regarding cutaneous reactions to tattoos.
Tatuagens têm sido associadas com uma variedade de complicações incluindo reações inflamatórias e granulomatosas, transmissão de infecções e neoplasias. Relatamos um caso de homem com 24 anos de idade que apresentava há dois meses nódulo eritematoso sob pigmento preto de uma tatuagem na coxa direita. A biópsia excisional foi realizada e a avaliação histológica foi consistente com dermatofibroma. Apenas três casos da associação dermatofibroma e tatuagem foram relatados na literatura. Nós reportamos um caso adicional e revisamos a literatura sobre reações cutâneas em tatuagens.
Subject(s)
Humans , Male , Young Adult , Histiocytoma, Benign Fibrous/etiology , Skin Neoplasms/etiology , Tattooing/adverse effects , Biopsy , Histiocytoma, Benign Fibrous/pathology , Skin Neoplasms/pathologyABSTRACT
Clear cell acanthoma or Degos' acanthoma is a distinct disease concerning its clinical, histopathological, and immunohistochemical features. Its pathologic nature - whether neoplastic or reactive - is still under dispute among researchers. The disease shows a chronic course and often presents with a single papulonodular lesion on the lower limbs of adults. However, cases with multiple lesions, sometimes occurring in an eruptive fashion, and with clear variation in the size and shape of the cutaneous lesions have been reported. So far, five cases in which the lesions were exclusively located in the nipple area have been reported, all in Korean women. Four of these cases mimicked eczema and one, a polypoid nodule. The aim of this article is to present clinical, histopathological, and immunohistochemical features of two additional cases in Brazilian women with similar nipple topography.
O acantoma de células claras ou acantoma de Degos é uma doença bem individualizada quanto aos seus aspectos clínicos, histopatológicos e imuno-histoquímicos. Sua natureza patológica - se neoplásica ou reativa - ainda é debatida por pesquisadores. De evolução crônica, ocorre predominantemente nos membros inferiores de adultos, em geral como lesão papulonodular única. Entretanto, foram observados casos com lesões múltiplas, por vezes de caráter eruptivo, e com notável variação de tamanho e forma das eflorescências cutâneas. Há relatos de cinco casos com localização exclusiva na aréola e no mamilo, quatro simulando eczema e um como nódulo polipoide; todos ocorridos em mulheres coreanas. O objetivo deste trabalho é apresentar os aspectos clínicos, histopatológicos e imuno-histoquímicos de dois novos casos da doença, com idêntica topografia areolomamilar, observados em mulheres brasileiras.
Subject(s)
Adolescent , Adult , Female , Humans , Acanthoma/pathology , Nipples/pathology , Skin Neoplasms/pathology , Brazil , Diagnosis, Differential , ImmunohistochemistryABSTRACT
O granuloma anular elastolítico gigantocelular é dermatose granulomatosa rara, caracterizada, histologicamente, por fagocitose das fibras elásticas por células gigantes multinucleadas e, clinicamente, por placas anulares com bordas elevadas e centro atrófico, com preferência por áreas expostas. A patogênese é controversa. Descreve-se um caso de mulher de 44 anos, com achados clínicos e histológicos clássicos, que apresentou boa resposta à hidroxicloroquina, após o período de 1 mês.
Annular elastolytic giant cell granuloma is a rare granulomatous skin disease characterized histologically by phagocytosis of elastic fibers by multinucleated giant cells and clinically by annular patches with elevated borders and atrophic centers found mainly on sun-exposed skin. The pathogenesis of the disease is controversial. We report the case of a 44-year-old woman with classical clinical and histological findings of the disease whose condition improved when hydroxychloroquine was administered over a four-week period.
Subject(s)
Adult , Female , Humans , Granuloma, Giant Cell/pathology , Skin Diseases/pathology , Antirheumatic Agents/therapeutic use , Elastic Tissue/pathology , Forearm , Granuloma, Giant Cell/drug therapy , Hydroxychloroquine/therapeutic use , Skin Diseases/drug therapyABSTRACT
O líquen escleroso e atrófico é uma doença crônica da pele e mucosas, que, usualmente, afeta a área genital de mulheres. Poucos casos de líquen escleroso e atrófico, confinados nos pés e/ou mãos, têm sido relatados. Relatamos um caso de líquen escleroso e atrófico envolvendo as extremidades e,posteriormente, a área perigenital.
Lichen sclerosus et atrophicus is a chronic disorder of the skin and mucosal surfaces, most commonly affecting the female genitalia. Few cases of lichen sclerosus et atrophicus confined to the feet and/or hands have been reported. We report a case of lichen sclerosus et atrophicus involving first the extremities and then the perigenital area.
Subject(s)
Female , Humans , Middle Aged , Foot Dermatoses/diagnosis , Foot Dermatoses/pathology , Lichen Sclerosus et Atrophicus/pathology , Anti-Inflammatory Agents/therapeutic use , Chronic Disease , Clobetasol/therapeutic use , Foot Dermatoses/drug therapy , Immunosuppressive Agents/therapeutic use , Lichen Sclerosus et Atrophicus/drug therapy , Tacrolimus/therapeutic use , Vulvar Diseases/drug therapy , Vulvar Diseases/pathologyABSTRACT
Tumor triquilemal proliferante é uma neoplasia incomum que surge do istmo folicular, cuja característica histológica é a presença de ceratinização triquilemal. Apresenta-se usualmente como nódulo solitário no couro cabeludo de mulheres idosas. Descreve-se um caso de tumor triquilemal proliferante que se apresenta como lesão tumoral nodular na região glútea de uma jovem de 16 anos de idade.
Proliferating trichilemmal tumor (PTT) is an uncommon neoplasm arising from the follicular isthmus. Its histological characteristic is the presence of trichilemmal keratinization. PTT usually presents as a solitary nodule on the scalp of elderly women. We describe a case of a PTT on the gluteal region (buttocks) of a 16-year-old female, presenting as a solitary nodule.
Subject(s)
Adolescent , Female , Humans , Epidermal Cyst/pathology , Skin Neoplasms/pathology , Buttocks/pathology , Epidermal Cyst/surgery , Skin Neoplasms/surgeryABSTRACT
Doença de Jorge Lobo (DJL) é infecção granulomatosa cutânea crônica produzida pelo fungo Lacazia loboi, cujas lesões mais típicas têm aspecto queloidiano, com localizações preferenciais em membros e orelhas. As lesões restringem-se à pele, havendo apenas uma referência, do conhecimento dos autores, à localização em semimucosa labial. Apresenta-se caso de doença de Jorge Lobo em paciente masculino, com lesão papulonodular no vermelhão do lábio superior, à esquerda, de dez anos de evolução, exitosamente submetida a tratamento cirúrgico, sem recidiva após oito anos.
Jorge Lobo's Disease (JLD) is a chronic granulomatous cutaneous mycosis caused by Lacazia loboi. The most typical lesions are keloid-like growths preferentially located on limbs and ears. To the best of the authors' knowledge, only one labial case has previously been reported. We describe the case of a man who presented with a left-sided papulonodular lesion of 10 years' duration on the vermillion border of the upper lip. A successful surgical resection of the lesion was performed and there was no recurrence in eight years of follow-up.
Subject(s)
Humans , Male , Middle Aged , Lip Diseases/microbiology , Lobomycosis/pathology , Follow-Up Studies , Lip Diseases/pathology , Lip Diseases/surgery , Lobomycosis/surgeryABSTRACT
Relatar dificuldades diagnósticas face à ocorrência simultânea, num mesmo paciente,de duas enfermidades infecciosas com aspectos clínicos semelhantes. Relato de caso: homemde 21 anos, há nove meses apresentando placas eritematovioláceas infiltradas na face, dorso e pédireito. A histopatologia de uma lesão do dorso evidenciou quadro de dermatite granulomatosa,com pesquisa de bacilos álcool-ácido resistentes negativa à coloração de Fite-Faraco. Umdiagnóstico de hanseníase dimorfo-tuberculoide foi realizado e o paciente submetido àpoliquimioterapia multibacilar. As lesões do pé direito evoluíram com ulceração e pesquisadireta positiva para formas amastigotas de Leishmania spp; entretanto, um exame imunohistoquímicodo material emblocado da biópsia anterior, do dorso, mostrou resultado negativocom anticorpo antileishmania, Considerações finais: A conclusão diagnóstica de coinfecçãohanseníase-leishmaniose tegumentar para o caso apresentado, somente foi possível graças àcorrelação clínico-patológica e realização de provas histoquímicas e imuno-histoquímicas.
To report diagnostic difficulties that may arise when a simultaneous occurrence oftwo infectious diseases presenting similar clinical features takes place in a single patient. Casereport: a 21-year-old male presented with violaceous, infiltrated plaques on his face, dorsumand right foot. A granulomatous dermatitis was diagnosed histologically in a biopsy taken fromthe dorsum, with no demonstrable acid-fast organisms on Fite-Faraco stain. A diagnosis ofbordeline-tuberculoid leprosy was concluded, and the patient was given multibacillarypolychemotherapy. The lesions on the right foot became ulcerated, and positive smears forLeishmania spp amastigotes were obtained. However, immunohistochemistry failed todemonstrate leishmania antigens in recuts of the paraffin-embedded material from the originaldorsal biopsy. Final considerations: the diagnosis of leprosy-leishmaniasis coinfection to thiscase has been possible only after clinical-pathological correlation as well as histochemical andimmunohistochemical procedures were carried out
ABSTRACT
Biópsias são ocasionalmente necessárias para confirmação diagnóstica de sífilis secundária, normalmente obtida por correlação clínico-sorológica. Entretanto, o exame histopatológico pode oferecer pistas que conduzam a um diagnóstico em casos antes insuspeitos ou de apresentação clínica incomum. Apresentamos um paciente de 35 anos, há dois com lesões acrômicas vitiligoides, para o qual sífilis foi sugerida somente após o exame histopatológico. Alguns aspectos microscópicos observados são discutidos e comparados com dados disponíveis na literatura.
Biopsies are occasionally necessary to confirm the diagnosis of secondary-stage syphilis, currently achieved by clinico-serological correlation. However, histopathologic examination may offer clues that can lead to the diagnosis of the disease in previously unsuspected or unusual cases. We report the case of a 35-year-old male patient with vitiligo-like lesions for two years, whose diagnosis of syphilis was suggested only after histopathologic examination. Some microscopic aspects observed are discussed and compared to data from the literature.
Subject(s)
Adult , Humans , Male , Hypopigmentation/pathology , Syphilis, Cutaneous/pathology , Vitiligo/pathology , Biopsy , Diagnosis, Differential , Hypopigmentation/etiology , Syphilis, Cutaneous/complicationsSubject(s)
Amphotericin B/administration & dosage , Amphotericin B/adverse effects , Paracoccidioides/immunology , Paracoccidioides/isolation & purification , Paracoccidioidomycosis/diagnosis , Paracoccidioidomycosis/epidemiology , Sulfadiazine/administration & dosage , Sulfadoxine/administration & dosage , Sulfadoxine/adverse effects , Sulfamethoxazole/administration & dosage , Diagnosis, Differential , Fluconazole/administration & dosage , Fluconazole/adverse effects , Fluconazole/therapeutic use , Itraconazole/administration & dosage , Itraconazole/adverse effects , Paracoccidioidomycosis/etiology , Paracoccidioidomycosis/prevention & control , Paracoccidioidomycosis/transmission , Signs in HomeopathyABSTRACT
Neste artigo säo registrados os tópicos que merecem a atençäo dos componentes do Grupo de Trabalho - GT10 do 50§ Congresso Brasileiro de Dermatologia, realizado em Belém do Pará, em 1995 - sobre novas estratégias para futuros congressos. Säo apresentados os aspectos relativos à Programaçäo Científica, Programaçäo Social e Cultural, a fonte de recursos e aspectos financeiros, além de um conjunto de críticas sobre as formas que têm sido utilizadas pelos últimos congressos brasileiros. Säo oferecidas sugestöes para o aperfeiçoamento dos eventos.