Real-world study of pegylated interferon α-2a to treat mycosis fungoides/Sézary syndrome using time to next treatment as a measure of clinical benefit: an EORTC CLTG study.

BACKGROUND: Mycosis fungoides (MF) and Sézary syndrome (SS) are chronic malignant diseases that typically necessitate diverse strategies to achieve remission. Systemic interferon (IFN)-α (subtypes 2a and 2b) has been used to treat MF/SS since 1984; however, its production was recently stopped. The recombinant pegylated (PEG) form of IFN-α-2a remains the only alternative IFN treatment, although it has not been approved for use in MF/SS. OBJECTIVES: To assess the effectiveness and safety of PEG-IFN-α-2a in monotherapy and in combination with other treatments using time to next treatment (TTNT) as a measure of clinical therapeutic benefit in a real-world setting. METHODS: We conducted an international, multicentre retrospective study of patients with MF and SS (of any stage) treated with PEG-IFN-α-2a from July 2012 to February 2022. Patients were included across 11 centres in 10 countries. The primary endpoints were to determine the TTNT of PEG-IFN-α-2a and adverse events (AEs) in MF/SS. RESULTS: In total, 105 patients were included [mean (SD) age 61 (13.1) years]; 42 (40.0%) had stage IA-IIA and 63 (60.0%) had stage IIB-IVB disease. PEG-IFN-α-2a was combined with other therapies in 67 (63.8%) patients, most commonly with extracorporeal photopheresis (36%) and bexarotene (22%). Patients with stage I-IIA disease achieved an overall response rate (ORR) of 57%; the ORR in those with stage IIB-IVB disease was 51%. Combination treatment resulted in a median TTNT of 10.4 months (range 0.6-50.7) vs. 7.0 months (range 0.7-52.4) for those who received monotherapy (P < 0.01). Overall, the mean (SD) TTNT was 9.2 (10.6) months and the ORR was 53.3% (n = 56). A complete response was seen in 13% of patients and a partial response in 40%. AEs were described in 68.6% (n = 72) of patients. Flu-like symptoms (n = 28; 26.7%), lymphopenia (n = 24; 22.9%) and elevated liver function (n = 10; 9.5%) were the most frequently reported. Grade 3-4 AEs were reported in 23 (21.9%) patients, mostly related to myelosuppression. CONCLUSIONS: PEG-IFN-α-2a for MF/SS resulted in an ORR of 53.3% and a mean (SD) TTNT of 9.2 (10.6) months. Combination regimens were superior to monotherapy and doses of 180 µg PEG-IFN-α-2a weekly were related to a higher ORR.

Mycosis fungoides (MF) and Sézary syndrome (SS) are rare types of cancers of the lymphatic system (lymphomas). They result in patches, plaques and/or tumours on the skin that usually need a combination of treatments to be controlled. A drug called interferon alpha (IFN-α) has been used to treat cutaneous lymphomas since 1984, but its production was recently stopped, so another form of it called 'recombinant pegylated IFN α-2a' (PEG-IFN-α-2a) is the only alternative IFN treatment, even though it has not been formally approved for MF/SS. The lack of studies on PEG-IFN-α-2a for MF/SS treatment has meant that its use can vary between institutions. This study aimed to investigate the effectiveness, the safety and how well PEG-IFN-α-2a is tolerated as single treatment or in combination with other MF/SS treatments. We carried out a study of patients with MF/SS treated with PEG-IFN-α-2a between July 2012 and February 2022. In total, 105 patients were included from 10 countries. We found that 53% of the patients responded to PEG-IFN-α-2a treatment. We also found that doses of 180 µg weekly, as well as combining PEG-IFN-α-2a with other treatments, resulted in higher response rates and a longer time until a new treatment needed to be added. However, at least one adverse event occurred in 69% of patients. The most common were flu-like symptoms, a reduction in the number of white blood cells and increased liver function. Severe adverse events occurred in 21% of the patients, mostly related to a reduction in the number of blood cells. Overall, our study findings suggest that PEG-IFN-α-2a is an effective and generally well-tolerated option among the treatments for MF/SS, with patients experiencing a better response when it was used as part of a combination therapy and on doses of 180 µg weekly.

Comparison of two immunohistochemical staining protocols for ALK demonstrates non-inferiority of a 5A4 clone-based protocol versus an ALK01 clone-based protocol for the diagnosis of ALK + anaplastic large cell lymphoma.

Detection of ALK rearrangement and/or expression of the ALK protein is an essential component in the evaluation of many neoplasms. Variability has been reported in the ability of different antibody clones to detect ALK expression. The ALK01 clone is commonly used to detect ALK expression in ALK-positive anaplastic large cell lymphoma (ALK + ALCL). However, this clone has been shown to lack sensitivity when used for solid tumors. The aim of this study was to determine if our high-sensitivity 5A4-based immunohistochemistry protocol is non-inferior to our ALK01-based protocol for the detection of ALK expression in ALK + ALCL. To compare the two protocols, we stained tissue microarrays of 126 hematolymphoid neoplasms and an additional 21 primary cutaneous ALK-negative anaplastic large cell lymphomas with both protocols. All 28 ALK + ALCL samples that were positive for the ALK01 antibody were also positive for the 5A4 clone. Three cases on the tissue microarray that were negative with the ALK01 antibody were clearly positive with the 5A4 antibody. We subsequently stained whole tissue sections of these three cases with the ALK01 antibody and found that these three cases were indeed positive with the ALK01 protocol, suggesting that the absence of staining on the tissue microarray samples was due to a combination of sampling error as well as a dimmer signal with the ALK01 protocol. Our study demonstrates that our 5A4-based protocol is non-inferior to the ALK01 antibody for the diagnosis of ALK-positive anaplastic large cell lymphoma, thus allowing our laboratory to discontinue the use of the ALK01-based protocol.

Mastocitose sistêmica: visão do dermatologista e relato de um caso associado a líquen plano / Systemic mastocytosis: a dermatologist's view and report of a case associated with lichen planus

Contexto: A mastocitose ocorre devido a uma proliferação neoplásica e clonal de mastócitos que se acumulam em um ou mais sistemas de órgãos. A doença é heterogênea, com manifestações que vão desde lesões cutâneas que podem regredir espontaneamente até neoplasias altamente agressivas associadas à falência de múltiplos órgãos e baixa sobrevida. Não há relatos na literatura de sua associação com líquen plano. Descrição do caso: Relatamos o caso de uma paciente com diagnóstico de mastocitose sistêmica agressiva que apresentou durante o acompanhamento quadro compatível com líquen plano. Discussão: O diagnóstico da mastocitose sistêmica é baseado em critérios que foram refinados recentemente. O tratamento classicamente envolve bloqueio de mediadores de mastócitos e terapia citorredutora para variantes avançadas da doença. Novas drogas como a midostaurina e o avapritinibe são promissoras. Conclusões: Mesmo não fazendo parte da rotina do dermatologista, a mastocitose sistêmica deve ser uma doença lembrada pelo acometimento da pele e potencial gravidade do quadro.

Cutaneous metastases from solid neoplasms - Literature review

Abstract Cutaneous metastases from solid tumors are uncommon events in clinical practice. Most of the time, the patient already has the diagnosis of a malignant neoplasm when the cutaneous metastasis is detected. However, in up to one-third of cases, cutaneous metastasis is identified before the primary tumor. Therefore, its identification may be essential for starting treatment, although it is usually indicative of poor prognosis. The diagnosis will depend on clinical, histopathological, and immunohistochemical analysis. Sometimes the identification of the primary site is difficult; however, a thorough analysis using imaging tests and constant surveillance is important.

Amiloidose nodular - relato de rara apresentação da amiloidose localizada cutânea / Nodular amyloidosis - report of a rare presentation of cutaneous localized amyloidosis

Contexto: Amiloidose é um grupo de doenças caracterizadas pelo depósito de proteínas fibrilares, denominadas substância amiloide. Podem ser divididas em formas localizadas ou sistêmicas, sendo que dentre as localizadas, a forma nodular é a mais rara. Descrição do caso: Relatamos o caso de amiloidose primária localizada cutânea nodular que se apresentou com nódulos violáceos no dorso, e placas acastanhadas na região cervical há 8 anos sem evidências de envolvimento sistêmico. Discussão: Como cerca de 1% a 7% dos casos de amiloidose nodular localizada cutânea podem evoluir com envolvimento sistêmico, o seguimento dos pacientes faz-se necessário. O tratamento não é obrigatório, a retirada das lesões pode ser feita se o paciente o desejar, contudo as recidivas são frequentes. Conclusões: Mesmo possuindo baixa prevalência, a amiloidose nodular deve ser reconhecida pelo risco de progredir para acometimento sistêmico e associação com discrasias plasmocitárias, como mieloma múltiplo.

Queimaduras e COVID-19, qual o impacto da pandemia? Perfil epidemiológico de um centro de queimados entre 2018-2022 / Burns and COVID-19, what is the impact of the pandemic? Epidemiological profile of a burn center between 2018-2022

Introdução: Embora prevalente, a epidemiologia das queimaduras possui lacunas. Simultaneamente, a COVID-19 estabeleceu um cenário desafiador e com novos comportamentos humanos, que poderiam impactar nas características e na incidência de queimaduras. O objetivo geral do projeto foi descrever o perfil epidemiológico dos pacientes de uma Unidade de Tratamento de Queimados. Método: O estudo foi uma revisão prontuários de janeiro de 2018 até maio de 2022, incluindo uma amostra de 1164 admissões do Hospital Padre Albino (Catanduva-SP). A análise estatística foi realizada através do Google Sheets e JAMOVI, sendo aplicado o Teste U de Mann-Whitney para comparação de períodos de tempo antes e durante a pandemia. Antes da coleta de dados, o mesmo foi submetido e aprovado pelo Conselho de Ética em Pesquisa da instituição (parecer número 5.616.556, CAAE: 62621822.50000.5430). Resultados: As admissões apresentaram idade média de 31,38 anos e 17,88% de Superfície Corporal Queimada (SCQ), sendo 452 mulheres e 712 homens; a média de SCQ foi de 17 para mulheres e 18,6 para homens. O principal agente causador foi a escaldadura. No que tange à comparação por períodos, durante a pandemia a chama direta teve um aumento de 8% em relação ao período anterior (35%). A escaldadura ainda permaneceu com prevalência elevada, no entanto, apresentou queda de 2%, assim como as queimaduras por dermoabrasão, com queda de 10%. Conclusão: Os achados dos estudos possuem limites em termos de generalização e novos estudos precisam ser desenvolvidos. As mudanças observadas no período não foram significativas e sem relevância clínica.

Introduction: Although prevalent, the epidemiology of burns has gaps. At the same time, Covid-19 established a new scenario with new human behaviors, which could equally impact the characteristics and incidence of burns. The overall objective of the project was to describe the epidemiological profile of patients in a Burn Treatment Unit. Methods: The study was a chart review from January 2018 to May 2022, including a sample of 1164 admissions from Hospital Padre Albino (Catanduva, São Paulo, Brazil). Statistical analysis was performed using Google Sheets and JAMOVI, and Mann-Whitney U-test was applied for comparison of time periods before and during the pandemic. Before data collection, the study was submitted and approved by the Research Ethics Committee of the institution (document number 5.616.556, CAAE: 62621822.50000.5430). Results: The admissions presented a mean age of 31.38 years and 17.88% of body surface area burned, 452 women and 712 men, the mean age was 17 for women and 18.6 for men. The main agent was scalding. When it comes to period comparison, during the pandemic direct flaming had an 8% increase over the previous period (35%). The scalds still remained with high prevalence, however it presented a decrease of 2%, as well as the burns by dermabrasion, which had a decrease of 10%. Conclusion: The findings of the studies have limits in terms of generalization, and new studies need to be developed. The changes observed in the period were not significant and without clinical relevance.

Complicações cutâneas da hospitalização por COVID-19 relacionadas à pronação / skin complications of hospitalization for COVID-19 related to pronation

Contexto: A pandemia da doença do coronavírus (COVID-19) revelou uma miríade de manifestações sistêmicas e cutâneas possivelmente relacionadas à infecção por síndrome respiratória aguda grave ocasionada pelo coronavírus (SARS-CoV-2). O comprometimento pulmonar é a causa mais frequente de hospitalização e a progressão para síndrome respiratória aguda grave geralmente requer tratamento com ventilação mecânica na posição pronada. Períodos prolongados e repetidos de pronação aumentam o risco de complicações, incluindo úlcera de pressão, cegueira e neuropatia periférica. Descrição do caso: Relatamos três casos de complicações cutâneas relacionadas à ventilação em pronação avaliadas durante interconsultas no maior hospital terciário universitário da América Latina, e salientamos potenciais causas e medidas de prevenção. Discussão: Complicações da ventilação em pronação para tratamento da COVID-19 são provavelmente resultantes da interação entre múltiplos fatores, dentre os quais as condições clínicas do paciente, períodos prolongados na posição pronada e limitações para mudanças de decúbito. Conclusões: Medidas de prevenção para complicações da pronação e diagnóstico precoce são fundamentais para evitar aumento da morbidade e sequelas graves e irreversíveis associadas à COVID-19.

Cutaneous adverse events to systemic antineoplastic therapies: a retrospective study in a public oncologic hospital

Abstract Background: Mucocutaneous adverse events are common during anticancer treatment, with variable consequences for the patient and their therapeutic regimen. Objective: To evaluate the most common adverse events, as well as the drugs associated with their appearance and the consequences for cancer treatment. Methods: A retrospective study was carried out through the analysis of patients treated at the Clinical Dermatology Unit of a public oncologic hospital. Results: A total of 138 patients with 200 adverse events were evaluated. The most commonly identified adverse events were nail and periungual changes (20%), papulopustular eruptions (13%), acneiform eruptions (12%), hand-foot syndrome (6.5%), hand-foot skin reaction (6%), and xerosis (6%). The most frequently associated antineoplastic treatment groups were classical chemotherapy (46.2%), target therapy (32.3%), and other non-antineoplastic drugs used in neoplasia protocols (16.5%). Of the total number of patients, 17.4% had their treatment suspended or changed due to a dermatological adverse event. Study limitations: Retrospective study and analysis of patients who were referred for specialized dermatological examination only, not allowing the assessment of the actual incidence of adverse events. Conclusion: A wide variety of dermatological manifestations are secondary to antineoplastic treatment with several different drugs resulting, not rarely, in the interruption or modification of therapeutic regimens.

Manifestações cutâneas no lúpus eritematoso: o que o clínico precisa saber / Skin manifestations in the lupus erythematosus: what the clinician need to know

O lúpus eritematoso é uma doença autoimune complexa que afeta diversos órgãos. A pele é o segundo local mais acometido e as manifestações cutâneas são divididas em específicas e não específicas. As primeiras possuem em comum o achado histopatológico de dermatite de interface com degeneração vacuolar da camada basal e infiltrado linfocitário na junção dermoepidérmica e são subdivididas em agudas, subagudas e crônicas. As manifestações não específicas compõem um grupo heterogêneo de condições que frequentemente está associado ao lúpus eritematoso sistêmico. O conhecimento e a interpretação adequada de tais manifestações é importante, pois, além da relevância diagnóstica, as lesões cutâneas nos dão informações prognósticas. Portanto, é imprescindível que o clínico conheça as principais manifestações cutâneas do lúpus eritematoso para a melhor condução desses pacientes.

Taxane-induced scleroderma: report of two cases / Esclerodermia inducida por taxanos: informe de dos casos

ABSTRACT Taxanes are a class of chemotherapeutic agents with common associated dermatologic adverse events, such as skin hyperpigmentation, hand-foot skin syndrome, paronychia and onycholysis. Taxane-induced scleroderma is rare. Few cases with skin findings resembling systemic sclerosis, have been reported after the administration of these agents. We report two cases with stage IV breast cancer, aged 66 and 71 years, who developed sclerodermic skin lesions in their extremities after starting treatment with placlitaxel and nabplaclitaxel respectively.

Los taxanos son agentes quimioterapéuticos cuyo uso se asocia a problemas dermatológicos tales como hiperpigmentación, síndrome manos-pies, paroniquia y onicolisis. La esclerodermia inducida por taxanos es rara, con pocos casos informados en la literatura. Informamos los casos de dos pacientes con cáncer de mama en estado IV, de 66 y 71 años, que desarrollaron lesiones esclerodérmicas en las extremidades después de ser tratadas con placlitaxel y nabplaclitaxel, respectivamente.

Perfil epidemiológico dos pacientes idosos queimados internados em unidade de tratamento de queimados do Noroeste paulista / Epidemiological profile of burned elderly patients hospitalized in a reference hospital in the northwest of São Paulo / Perfil epidemiológico de los pacientes ancianos quemados y hospitalizados en un hospital de referencia del noroeste paulista

OBJETIVO: Analisar o perfil epidemiológico dos pacientes idosos internados na Unidade de Tratamento de Queimados (UTQ) do Hospital Padre Albino do município de Catanduva, SP. MÉTODO: Trata-se de um estudo transversal baseado na análise dos prontuários e do livro de registro da Unidade de Terapia de Queimados do Hospital Padre Albino. A coleta de dados ocorreu entre março de 2012 e março de 2013, sendo selecionados todos os idosos que passaram pela unidade. Foram coletados dados como: sexo, idade, local do acidente, período de internação, vícios apresentados pelos pacientes, comorbidades, agente agressor, profundidade da lesão, superfície da área queimada e evolução - que inclui enxertia, infecção e óbito. RESULTADOS: Houve predomínio de queimaduras em pacientes idosos do sexo masculino, tendo como local do acidente a própria casa. A maioria apresentava duas comorbidades associadas, sendo a principal a hipertensão arterial sistêmica. Chama direta foi o agente causal mais frequente, predominando queimaduras combinadas de 2o e 3o grau, sendo evidenciada elevada taxa de grandes queimados e necessidade de enxertia em alguns casos, seguida de alta possibilidade de infecção. CONCLUSÃO: O conhecimento do perfil epidemiológico é importante para medidas de prevenção, que devem ser tomadas por toda a comunidade. Além disso, com o conhecimento das principais comorbidades, características das queimaduras, condutas e evolução podem ser estabelecidas melhores estratégias de tratamento para o idoso.(AU)

OBJECTIVE: To analyze the epidemiological profile of the elderly patients hospitalized at the Burn Care Unit (BCU) of the Hospital Padre Albino in Catanduva-SP. METHOD: This is a retrospective study based on the analysis of the medical records from the Hospital Padre Albino's Burn Care Unit`s record book. For data collection it was used the period from March 2012 to March 2013, which were selected all elderly patients who passed through the unit. Data such as sex, age, the accident site, days of hospitalization comorbidities, agent, lesion depth, burn area and evolution, including grafting, infection and death were collected. RESULTS: There was a predominance of burns in elderly male patients, with the scene of the accident being the house itself. Most had two comorbidities, the main one was systemic hypertension; the direct flame is the most frequent causative agent, predominating combined burns of 2nd and 3rd degree, with evident high rate of major burns and the need for grafting in some cases, followed by high possibility of infection. CONCLUSION: The knowledge of the epidemiological profile is a matter of utmost importance to preventive measures that should be taken by the whole community. Also, with the knowledge of the main comorbidities, burn characteristics, behaviors and evolution, better treatment strategies can be established for the elderlies.

Objectivo: Analizar el perfil epidemiológico de los pacientes ancianos hospitalizados en la Unidad de Atención a Quemados del Hospital Padre Albino del municipio de Catanduva, Sao Paulo. Método: Se trata de un estudio retrospectivo basado en el análisis de la historia clínica y del libro de registros de la Unidad de Atención a Quemados del Hospital Padre Albino. La recolección de datos se hizo entre marzo de 2012 y marzo de 2013, periodo en que fueron seleccionadas todas las personas mayores que pasaron por la unidad. Los datos recolectados fueran: sexo, edad, lugar del accidente, días de internación adicciones que presentaban los pacientes, comorbilidades, agente agresor, profundidad de la lesión, superficie del área quemada y evolución, incluyéndose injerto, infección y muerte. Resultados: Se observó un predominio de quemaduras en los ancianos de sexo masculino, teniendo la propia casa como lugar del accidente. La mayoría tenía dos comorbilidades asociadas, principalmente hipertensión sistémica. La llama directa fue el causante más frecuente, ocasionando predominantemente quemaduras que combinan segundo y tercero grados, con evidente tasa de grandes quemados y necesidad de injerto en algunos casos, seguido de alta posibilidad de infección. Conclusión: El conocimiento del perfil epidemiológico es importante para las medidas preventivas que se deben tomar por toda la comunidad. Con el conocimiento de las principales comorbilidades, las características de las quemaduras, conductas y evolución, se pueden establecer mejores estrategias de tratamiento para las personas mayores.(AU)

Perfil epidemiológico de crianças atendidas em uma Unidade de Tratamento de Queimados no interior de São Paulo / Epidemiological profile of children admitted to a Burn Treatment Unit in the interior of São Paulo / Perfil epidemiológico de los niños atendidos en una Unidad de Tratamiento de Quemados en el interior de São Paulo

Introdução: A queimadura é uma lesão tecidual que pode ser que pode ter distintas causas, entre elas, temperatura, radiação, química e elétrica, apresentando grande incidência no nosso meio. Objetivo: Verificar a etiologia e a idade das crianças internadas na Unidade de Tratamento de Queimados de Catanduva,SP. Método: Foram avaliados 190 prontuários de crianças de 0 a 15 anos, internadas no período entre janeiro de 2012 e dezembro de 2015. Resultados: A maioria dos pacientes avaliados era do sexo masculino, de 0 a 5 anos, apresentando superfície corporal queimada de até 10%, sendo a etiologia principal escaldadura, acometendo os membros superiores e o tronco. Conclusão: O estudo demonstrou que as crianças de 0 a 5 anos foram as mais acometidas, a principal causa foi a escaldadura e o local de acometimento foi o ambiente domiciliar, demonstrando a importância das ações de prevenção de queimaduras e conscientização dos pais.

Introduction: Burn is a tissue injury that can be caused by multiple causes, including temperature, radiation, chemical and electrical, with a high incidence in our environment. Objective: To verify the etiology and age of the children hospitalized in the Burn Treatment Unit of Catanduva, SP. Method: 190 medical records of children from 0 to 15 years-old hospitalized in the period between January 2012 and December 2015 were evaluated. Results: The majority of the patients evaluated were males, 0 to 5 years-old, presenting a burned body surface of up to 10%, the main etiology being scalding and affecting the upper limbs and the trunk. Conclusion: The study showed that children from 0 to 5 years-old were more affected. The main cause was scald and the place of involvement was the home environment, demonstrating the importance of actions to prevent burns and awareness of parents.

Introdución: La quemadura es un daño tisular que puede tisular que puede tener distintas causas, incluyendo la temperatura, radiación, química y eléctrica, con una alta incidencia en nuestro medio. Objetivo: Investigar la etiología y la edad de los niños ingresados en la Unidad de Tratamiento de Quemados de Catanduva, SP. Método: Un total de 190 historias clínicas de niños de 0 a 15 años, ingresados entre enero de 2012 y diciembre de 2015 fueram analizados. Resultados: La mayoría de los pacientes eran varones, de 0 a 5 años de edad, con superficie corporal quemada de 10%, siendo quemaduras por escaldo las de mayor frecuencia, y los miembros superiore los más acometidos, seguidos del tronco. Conclusión: El estudio mostró que los niños de 0 a 5 años fueron los más afectados. La causa principal fue la escaldadura, ocurridas principalmente en el ambiente del hogar lo que demuestra la importancia de las acciones de prevención de quemaduras y el conocimiento de los padres.

Angiosarcoma in HIV-negative patients is not associated with HHV-8

Abstract: BACKGROUND: Angiosarcoma is an aggressive, malignant neoplasm of vascular or lymphatic origin. Herpes virus 8 (HHV-8) is a member of the herpes family with a tropism for endothelial cells and it has been proven to induce vascular neoplasms, such as Kaposi's sarcoma. The role of HHV-8 in the pathogenesis of angiosarcoma has not been well defined. OBJECTIVE: To investigate the relationship between the presence of HHV-8 and angiosarcoma. METHODS: In this study, the team investigated the relationship between the presence of HHV-8, as determined by polymerase chain reaction, and angiosarcoma, using samples from patients with epidemic Kaposi's sarcoma as controls. RESULTS: While all control cases with epidemic Kaposi's sarcoma were positive for HHV-8, none of the angiosarcoma cases was. CONCLUSION: These findings support most previous studies that found no association between HHV-8 and angiosarcoma.

Inversão da porção lateral do músculo orbicular para tratamento das rítides perioculares (pés-de-galinha) / Inversion of the lateral portion of the orbicularis oculi muscle for the treatment of periocular rhytides (crow's feet)

INTRODUÇÃO: A cirurgia plástica, sempre em busca de resultados cada vez mais expressivo, vem associando às técnicas já consagradas aos novos tempos intraoperatórios. Este trabalho descreve uma técnica cirúrgica para ser associada às ritidoplastias baseada na ressecção da porção lateral do músculo orbicular, seguida pela enxertia do próprio músculo, porém invertido, sobre a área ressecada. MÉTODO: Em um período de 5 anos, foram realizadas 54 ritidoplastias associadas a técnica descrita. RESULTADOS: O seguimento no pós-operatório tardio (5 anos) mostrou-se satisfatório com permanente desaparecimento das ritides perioculares por neutralizar as forças exercidas pelo músculo nesta área. Não houve insatisfação por parte dos pacientes. Logo, trata-se de um procedimento com excelentes resultados na resolução das ritides perioculares e na elevação da porção caudal da sobrancelha em relação a orbita. CONCLUSÃO: A técnica descrita gera resultados permanentes e satisfatórios.

INTRODUCTION:In the continued search for increasingly expressive results, plastic surgeons are combining established techniques with new intraoperative times. This article describes a surgical technique associated with rhytidoplasties based on the resection of the lateral portion of the orbicularis oculi muscle, followed by grafting the muscle itself, however inverted, on the resected area. METHOD: In a 5-year period, 54 rhytidoplasties associated with the described technique were performed. RESULTS: The follow-up in the late postoperative period (5 years) was satisfactory, with the permanent disappearance of periocular rhytides due to the neutralization of the forces exerted by the muscle in this area. There was no dissatisfaction on the part of the patients. Consequently, the procedure had excellent results in the resolution of periocular rhytides and in lifting the caudal part of the eyebrow in relation to the orbit. CONCLUSION: The technique described generates permanent and satisfactory results.

Hypopigmented mycosis fungoides: a review of its clinical features and pathophysiology / Micose fungoide hipocromiante: uma revisao de seus aspectos clinicos e fisiopatologicos

Several distinct clinical forms of mycosis fungoides have been described. Hypopigmented mycosis fungoides should be regarded as a subtype of mycosis fungoides, insofar as it presents some peculiar characteristics that contrast with the clinical features of the classical form. Most patients with hypopigmented mycosis fungoides are younger than patients typically diagnosed with classical mycosis fungoides. In addition to typical dark-skinned individuals impairment, hypopigmented mycosis fungoides has also been described in Asian patients. The prognosis for hypopigmented mycosis fungoides is much better than for classical mycosis fungoides: hypopigmented mycosis fungoides is diagnosed when there are only patches of affected skin, and lesions usually will not progress beyond terminal stages, although they can persist for many years. Diagnosis should involve clinicopathologic correlation: skin biopsy analysis often reveals intense epidermotropism, characterized by haloed, large, and atypical CD8+ lymphocytes with convoluted nuclei, in contrast to mild to moderate dermal lymphocytic infiltrate. These CD8+ cells, which participate in T helper 1-mediated immune responses, prevent evolution to mycosis fungoides plaques and tumors and could be considered the main cause of the inhibition of melanogenesis. Therefore, hypopigmentation could be considered a marker of good prognosis for mycosis fungoides.

Ultimamente diferentes formas clínicas da micose fungoide têm sido descritas. A micose fungoide hipocromiante pode ser considerada um subtipo da micose fungoide, apresentando algumas características peculiares que contrastam com os achados da forma clássica da micose fungoide. A maioria dos pacientes com micose fungoide hipocromiante são mais jovens que aqueles acometidos pela micose fungoide clássica. Esta variante é descrita principalmente em indivíduos melanodérmicos (afroamericanos e asiáticos). O prognóstico é melhor que o observado para a forma clássica: ao diagnóstico, os pacientes apresentam somente "patches", que tendem a perdurar por longos períodos, sem evolução para estágios mais avançados. O diagnóstico é feito através da correlação clinicopatológica: biópsia da lesão cutânea frequentemente revela intenso epidermotropismo, caracterizado por linfócitos CD8+ atípicos, grandes, com halo e núcleo convoluto, contrastando com o infiltrado dérmico leve a moderado. Estas células CD8+, que participam do perfil de resposta T helper-1, impediriam a evolução da doença para o desenvolvimento de placas infiltradas e tumores, além de determinar a inibição da melanogênese nas lesões hipocrômicas. Portanto, a hipocromia poderia ser considerada um marcador de bom prognóstico na micose fungoide.

Polymerase chain reaction-Based clonality analysis of cutaneous B-cell lymphoproliferative processes

Introduction: The differential diagnosis of B-cell lymphoproliferative processes remains a challenge for pathologists, dermatologists and oncologists, despite advances in histology, immunohistochemistry and molecular biology. Objective: Evaluate aid and limitations of clonality analysis in the diagnosis of primary cutaneous B-cell lymphomas and B-cell pseudolymphomas. Methods: This study included 29 cases of B-cell lymphoproliferative processes classified as primary cutaneous B-cell lymphomas (13), B-cell pseudolymphomas (6) and inconclusive cases (10) using histology and immunohistochemistry. The clonality analysis was performed by polymerase chain reaction analysis of immunoglobulin light chain and heavy chain rearrangements. Results: DNA quality was shown to be generally poor; eight samples were inadequate for polymerase chain reaction analysis. The results showed monoclonality in eight of the primary cutaneous B-cell lymphomas and polyclonality in four of the B-cell pseudolymphomas. In addition, monoclonality was shown in two of the inconclusive cases by histology and immunohistochemistry, demonstrating the utility of polymerase chain reaction as an ancillary diagnostic tool for primary cutaneous B-cell lymphomas. Discussion: The low quality DNA extracted from these cases demanded the use of an IgH protocol that yielded small fragments and IgK. Both methods used together improved detection. Conclusion: Use of the two protocols, immunoglobulin heavy chain FR3-trad and immunoglobulin light chain-Kappa Biomed protocols for clonality analysis improved diagnostic accuracy.