Cell Blocks from Ultrasound Guided Fine Needle Aspirates: Diagnostic Yield in a Series of 51 Dermatologic Lesions. / [Artículo traducido] Bloques celulares obtenidos de la punción-aspiración con aguja fina ecoguiada: rendimiento diagnóstico en una serie de 51 lesiones dermatológicas.

The generation of cell blocks (CBs) obtained from ultrasound-guided fine needle aspiration biopsies (USFNAB) is a well-established technique in breast and thyroid pathology, but is rarely used in dermatology. We reviewed CBs obtained from USFNAB of skin lesions, which were categorized as malignant skin tumors, benign skin tumors, inflammatory skin tumors or deposit skin diseases. The diagnostic yield of each category was compared to histopathology. The USFNAB of 51 skin lesions was processed into CBs. There was overall agreement between histopathology and CBs in 84.31% of cases. Diagnostic group concordance for benign, malignant as well as inflammatory and deposit skin lesions were 69.2%, 93.7% and 86.3% respectively. Cell block generation from USFNAB aspirates of skin lesions should be considered as part of the dermatologic diagnostic armamentarium. Further experience is needed to better understand for which types of dermatologic lesions it would be clearly indicated.

Cell Blocks from Ultrasound Guided Fine Needle Aspirates: Diagnostic Yield in a Series of 51 Dermatologic Lesions.

The generation of cell blocks (CB) obtained from ultrasound-guided fine needle aspiration biopsies (USFNAB) is a well-established technique in breast and thyroid pathology, but is rarely used in dermatology. We reviewed CBs obtained from USFNAB of skin lesions, which were categorized as malignant skin tumors, benign skin tumors, inflammatory skin tumors or deposit skin diseases. The diagnostic yield of each category was compared to histopathology. The USFNAB of 51 skin lesions was processed into CBs. There was overall agreement between histopathology and CBs in 84.31% of cases. Diagnostic group concordance for benign, malignant as well as inflammatory and deposit skin lesions were 69.2%, 93.7% and 86.3% respectively. Cell block generation from USFNAB aspirates of skin lesions should be considered as part of the dermatologic diagnostic armamentarium. Further experience is needed to better understand for which types of dermatologic lesions it would be clearly indicated.

Subungual Melanocytic Lesions in Pediatric Patients. / Lesiones melanocíticas subungueales en la edad pediátrica.

The study of subungual melanocytic lesions can present challenges because of the clinical and histologic characteristics of the nail unit and the difficulty of performing nail biopsies and processing specimens. These lesions can be even more challenging in children due to differences in clinical and epidemiological profiles between the adult and pediatric populations. Many of the clinical features of subungual melanocytic lesions that would raise alarm in an adult do not have the same implications in children. Consensus is also lacking on when a nail biopsy is needed to rule out malignancy in the pediatric setting. In view of these considerations and the rarity of subungual melanoma in childhood, the recommended approach in most cases is a watch-and-wait strategy. Subungual melanocytic lesions in children may also show atypical histopathologic features that are not necessarily associated with aggressive behavior. Subungual melanoma is very rare in childhood, with just 21 cases described to date. None of the patients developed visceral metastasis or died as a result and the diagnosis was controversial in many of the cases. Considering the above and the significantly higher frequency and particular characteristics of longitudinal melanonychia with a benign etiology in children, subungual melanocytic lesions should be managed differently in this setting than in adults. In most cases, a watch-and-wait approach is the most appropriate strategy.

Subungual Melanocytic Lesions: Key Clinical and Pathologic Concepts and Biopsy Techniques.

Both dermatologists and pathologists sometimes find daunting the evaluation of melanonychia (especially subungual melanocytic lesions) because of the fear of performing nail surgery due to the risk of dystrophy, difficulties processing and interpreting nail biopsy specimens, and a general lack of experience in the field. Nevertheless, mastery of nail biopsy techniques, correct processing and orientation of specimens, and familiarity with the histologic particularities of the nail apparatus can attenuate the undoubted complexity and facilitate the tasks involved. Longitudinal excision is the biopsy technique that ensures the simplest histologic interpretation, and it is associated with a low risk of nail dystrophy when performed correctly. Clinical and epidemiological data are crucial. Subungual melanoma in childhood, for instance, is very rare and even lesions with atypical clinical and/or histologic features are probably benign. The presence of suprabasal melanocytes and other findings that would suggest malignancy at other sites are considered normal in the nail apparatus. Subungual melanoma shows a lentiginous pattern in the early stages of disease, and detection of an inflammatory infiltrate accompanying atypical lentiginous subungual lesions would appear to be one of the first diagnostic findings.

Subungual Melanocytic Lesions: Key Clinical and Pathologic Concepts and Biopsy Techniques. / Lesiones melanocíticas subungueales: claves clínico-patológicas y técnicas de biopsia.

Both dermatologists and pathologists sometimes find daunting the evaluation of melanonychia (especially subungual melanocytic lesions) because of the fear of performing nail surgery due to the risk of dystrophy, difficulties processing and interpreting nail biopsy specimens, and a general lack of experience in the field. Nevertheless, mastery of nail biopsy techniques, correct processing and orientation of specimens, and familiarity with the histologic particularities of the nail apparatus can attenuate the undoubted complexity and facilitate the tasks involved. Longitudinal excision is the biopsy technique that ensures the simplest histologic interpretation, and it is associated with a low risk of nail dystrophy when performed correctly. Clinical and epidemiological data are crucial. Subungual melanoma in childhood, for instance, is very rare and even lesions with atypical clinical and/or histologic features are probably benign. The presence of suprabasal melanocytes and other findings that would suggest malignancy at other sites are considered normal in the nail apparatus. Subungual melanoma shows a lentiginous pattern in the early stages of disease, and detection of an inflammatory infiltrate accompanying atypical lentiginous subungual lesions would appear to be one of the first diagnostic findings.

Clinical and Histologic Features of Multiple Primary Melanoma in a Series of 31 Patients. / Características clínicas e histológicas del melanoma primario múltiple en una serie de 31 pacientes.

BACKGROUND: We reviewed all cases of multiple primary melanoma diagnosed at our department over a 32-year period (1987-2019) to better characterize this subgroup of patients and develop a tailored protocol to offer them closer follow-up. METHODS: Retrospective, observational, descriptive study of patients diagnosed with multiple primary melanoma at a tertiary care hospital between January 1987 and March 2019. We collected clinical, epidemiologic, and histologic characteristics of primary and subsequent melanomas and performed a descriptive analysis. RESULTS: Thirty-one patients (15 men and 16 women) with a median age of 67years (range, 36-85years) were included. Second primary melanomas were diagnosed after a median of 2years (range, 0-4years). The median number of melanomas per patient was 2 (range, 2-6). Twenty-three of the 31 patients, 25 had 2 primary melanomas (80%), 4 had 3 melanomas (13%), and 2 patients each had 5 and 6 primary melanomas. Subsequent melanomas were less invasive than the initial primary melanomas. Median Breslow thickness was 1mm (range, 0.67-4mm) for the first primary melanoma and 0.5mm (range, 0.32-2.42mm) for subsequent melanomas. CONCLUSIONS: Subsequent melanomas are thinner than primary melanomas. We observed an increase in the number of cases of multiple primary melanoma diagnosed in the last 2years of our study. Our findings highlight the importance of close, long-term follow-up of patients.

Retrospective study of pilomatricoma: 261 tumors in 239 patients.

INTRODUCTION AND OBJECTIVES: Pilomatricoma is the second most common skin tumor in childhood and youth and it has a broad differential diagnosis. The main objective of the present study was to determine the incidence of pilomatricomas in our hospital and to analyze the following variables: patient age and sex, tumor site, symptoms, previous trauma, clinical diagnosis, associated diseases, number of cases of multiple tumors, ultrasound findings, anesthetic and surgical techniques, and postoperative complications. MATERIAL AND METHOD: This was a retrospective study of the pilomatricomas surgically excised between January 2004 and December 2012 and registered in the database of the pathology department of our hospital. RESULTS: We found 261 pilomatricomas in 239 patients (120 female and 119 male) between 1 and 83 years of age (mean age, 26.4 years). The most common presentation was as a firm subcutaneous nodule, which was asymptomatic in 82% of cases. Tumors most commonly affected the head and neck (49.81%). Preoperative diagnosis was correct in 54.4% of cases, concomitant diseases were present in 59 cases, and 7 patients reported a history of trauma in the area of the tumor. There were 17 cases of multiple tumors, 1 case in a patient with familial disease and 2 in patients with Steinert disease. Soft-tissue ultrasound was performed on 57 lesions; images were compatible with pilomatricoma in 48 cases. Tumor excision was performed under local anesthesia in 185 cases and under local and general anesthesia in 76. The postoperative complications were hypertrophic scarring and wound dehiscence (1 case each). CONCLUSIONS: This was a retrospective study with the largest series recorded in Spain and with one of the highest incidences. In addition, we report on variables not described in other studies.

[Lipoid pneumonia related to workplace exposure to paint]. / Neumonía lipoidea en relación con exposición laboral a pinturas.

A 49-year-old man with no known history of pulmonary disease was treated at our hospital after observation of an interstitial pattern on a chest film. The patient was a smoker and professional painter. Computed tomography of the chest showed a diffuse bilateral ground-glass pattern. The lung biopsy showed intra-alveolar lipid accumulation in the form of vacuoles of varying sizes surrounded by numerous focally multinucleated macrophages, establishing a definitive diagnosis of exogenous lipoid pneumonia. Given the patient's profession, he was recommended to avoid workplace exposure to paraffins and oily sprays. The clinical course was favorable after exposure was stopped, with improved lung function and symptoms.