Parotid Cystic Lesion in Amelanotic Malignant Melanoma.

A 60-year Brazilian woman, presented with an enlarged lymph node in the neck for one year, and a superficial nonulcerated lesion was observed in the scalp. Fine needle aspiration and biopsy of the lymph node revealed amelanocytic metastasis, and immunohistochemistry study showed Melan-A/ Mart-1 antigen (clone A103 and S-100 protein). The entire suspected area of the scalp was further resected and an amelanotic melanoma without angiolymphatic invasion was diagnosed. Ultrasonography and PET-computed tomography showed hypermetabolic cystic area in the right parotid. Furthermore, aspiration biopsy and surgical samples from parotid cyst confirmed the malignant amelanotic melanoma. Cystic metastases are scarcely reported in parotid gland, and can pose diagnostic challenges.

Mujer anciana con el síndrome de las uñas amarillas, artritis reumatoide e hipotiroidismo / Elderly woman with yellow nail syndrome, rheumatoid arthritis and hypothyroidism

The yellow nail syndrome is a scarcely reported condition, and its physiopathology is not well understood. The main characteristics of this syndrome are yellowish discoloration of the nail plates, pulmonary changes and pleural effusion, and lymphedema of the lower limbs. Case Report An 85-year-old Brazilian woman, with history of bronchial asthma, rheumatoid arthritis and arterial hypertension, was complaining of breathlessness, lower limb edema, and intense oliguria. Over the previous 40 years she had been treated with aurothioglucose, prednisone, and NSAIDs. Yellowish nail changes developed in her hand and toe fngers, and lung and pleural changes were detected by chest radiography and computerized tomography. With evidence of classical triad, the yellow nail syndrome was characterized. Laboratory tests showed elevated levels of TSH and normal levels of free-T4, establishing the additional diagnosis of subclinical hypothyroidism. Conclusion The purpose of this report is to discuss uncommon associated conditions with yellow nails syndrome, which is considered a rare clinical entity.

El síndrome de las uñas amarillas es una condición escasamente reportada, y su fsiopatología no es bien entendida. Las principales características de este síndrome son la decoloración amarillenta de las placas de las uñas, alteraciones pulmonares y efusión pleural, y linfedema de las extremidades inferiores. Presentación de caso Mujer brasileña, 85 años de edad, con antecedentes de asma bronquial, artritis reumatoide y hipertensión arterial se quejaba de falta de aire, edema de miembros inferiores y oliguria intensa. Durante los últimos 40 años había sido tratada con aurotioglucosa, prednisona, y AINEs. Uñas amarillas desarrollaron en los dedos de manos y pies, y cambios pulmonares y pleurales fueron detectados por radiografía de tórax y tomografía computarizada. Con evidencia de la tríada clásica, se caracterizó el síndrome de las uñas amarillas. Las pruebas de laboratorio mostraron niveles elevados de TSH, con niveles normales de T4 libre, y se estableció el diagnóstico adicional de hipotiroidismo subclínico. Conclusión El propósito de este informe es analizar condiciones poco comunes asociadas con el síndrome de las uñas amarillas, que se considera una entidad clínica rara. CASE REPORT Recibido: 06 ­ November ­ 2014 Aceptado: 01 ­ December ­ 2014 Key words: Rheumatoid arthritis; Subclinical hypothyroidism; Yellow nail syndrome; Case report. Revista Médica Vozandes Volumen 25, Número 1-2, 2014 This article is licensed under a Creative Commons Attribution ­ Non Commercial ­ No Derivatives 4.0 International Licence Resumen Mujer anciana con el síndrome de las uñas amarillas, artritis reumatoide e hipotiroidismo Palabras clave: Artritis reumatoide; Hipotiroidismo subclínico; Síndrome de las uñas amarillas; Rep