Metástasis digital acral: presentación de 2casos clínicos / Acral Metastasis of the Fingers: Report of 2 Cases

Las metástasis cutáneas aparecen en el 0,6-10,4% de los pacientes con tumores malignos y representan hasta el 2% de los tumores cutáneos. En algunos casos representan la primera manifestación de una neoplasia no conocida. Además pueden poner de manifiesto la progresión metastásica del tumor primario. Las metástasis de localización acral son particularmente raras. En la mayoría de los casos aparecen secundariamente a afectación ósea. Aunque la clínica es variable, generalmente se confunden con un proceso infeccioso o inflamatorio, retrasándose el diagnóstico. Cuando se localizan en los dedos de la mano la causa más frecuente es el carcinoma de pulmón, mientras que las localizadas en los dedos de los pies suelen deberse a tumores del tracto genitourinario. El estudio dermatopatológico en estos casos es fundamental para establecer el diagnóstico y orientar hacia el origen del tumor primario. Presentamos 2 casos clínicos de metástasis digital acral. El primero de ellos representa el primer caso de la literatura de metástasis acral de mioepitelioma maligno (carcinoma mioepitelial) de mama y el otro una metástasis acral como manifestación inicial de carcinoma de pulmón

Cutaneous metastases appear in 0.6% to 10.4% of malignant tumors and account for 2% of all cutaneous tumors. Metastasis to the skin may arise from progression of a known primary tumor or provide the first sign of an unsuspected one. Acral metastases are particularly unusual. Most derive from bone tumors. Clinical signs vary and the lesions generally resemble infection or inflammation, leading to diagnostic delays. When metástasis involves the fingers, the primary tumor is usually lung carcinoma. In contrast, toe involvement usually derives from a tumor in the genitourinary tract. A pathologic diagnosis in these cases is necessary and will suggest the location of the primary tumor. We report 2 cases of metástasis to the fingers. One is the first report of acral metástasis of a myoepithelial carcinoma of the breast. The other concerns acral metástasis as the first sign of lung carcinoma

Acral Metastasis of the Fingers: Report of 2 Cases. / Metástasis digital acral: presentación de 2casos clínicos.

Cutaneous metastases appear in 0.6% to 10.4% of malignant tumors and account for 2% of all cutaneous tumors. Metastasis to the skin may arise from progression of a known primary tumor or provide the first sign of an unsuspected one. Acral metastases are particularly unusual. Most derive from bone tumors. Clinical signs vary and the lesions generally resemble infection or inflammation, leading to diagnostic delays. When metástasis involves the fingers, the primary tumor is usually lung carcinoma. In contrast, toe involvement usually derives from a tumor in the genitourinary tract. A pathologic diagnosis in these cases is necessary and will suggest the location of the primary tumor. We report 2 cases of metástasis to the fingers. One is the first report of acral metástasis of a myoepithelial carcinoma of the breast. The other concerns acral metástasis as the first sign of lung carcinoma.

Cambio de inmunofenotipo asociado a angiocentricidad y características citotóxicas en un caso de micosis fungoide / Immunophenotypic shift associated with angiocentricity and cytoxic characteristics in a case of mycosis fungoides

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Interstitial granulomatous dermatitis and arthritis revealing oesophageal carcinoma.

Interstitial granulomatous dermatitis and arthritis (IGDA) is an uncommon clinicopathological condition that may occur in association with a number of systemic disorders. We present a novel case of IGDA in association with oesophageal squamous cell carcinoma (SCC). A 67-year-old man with a 3-month history of arthritis presented with several erythematous indurated plaques on his lateral trunk and arms. An oesophagogastroduodenoscopy showed an irregular mass 20 mm in size in the proximal third of the oesophagus, and on histopathological examination of a biopsy, the mass was identified as a poorly differentiated SCC. Histopathological examination of a skin biopsy found features consistent with interstitial granulomatous dermatitis. The combination of clinicopathological correlation and laboratory findings led to the diagnosis of IGDA. This association has not been previously described, to our knowledge.

Plasmocitoma primario cutáneo múltiple / Primary multiple cutaneous plasmacytoma

El plasmocitoma primario cutáneo es un linfoma cutáneo de células B originado primariamente en la piel. Deriva de la expansión monoclonal de células plasmáticas y no se evidencia afectación de médula ósea en el momento del diagnóstico. Presentamos un varón de 64 años que desarrolló un plasmocitoma primario cutáneo múltiple en su pierna derecha sin afectación sistémica hasta el momento actual. Fue tratado con cirugía y radioterapia local, presentando posteriormente dos recidivas locales que fueron tratadas de igual forma (AU)

Primary cutaneous plasmacytoma is a rare type of cutaneous B-cell lymphoma arising primarily in the skin and derived from clonally expanded plasmacells with a various degrees of maturation and atypia. The disease may be regarded as a subtype of extramedullary plasmacytoma arising primarily in the skin. We report the case of a primary multiple cutaneous plasmacytoma on the leg of a 64-year-old male. Combined radiation therapy and surgical excision resulted in the complete remission of the lesions (AU)

Pioderma gangrenoso: Presentación de 15 casos y revisión de la literatura / Pyoderma Gangrenosum: A Report of 15 Cases and Review of the Literature

Introducción: El pioderma gangrenoso (PG) es un proceso incluido en el grupo de las denominadas dermatosis neutrofílicas, del que existen pocos trabajos epidemiológicos y de abordaje terapéutico en la bibliografía dada su relativa escasa incidencia. Objetivo: Describir las características epidemiológicas y clínicas y exponer nuestra experiencia terapéutica en los pacientes con PG de un hospital de segundo nivel de Málaga (España). Material y métodos: El estudio observacional y retrospectivo incluyó todos los pacientes diagnosticados de PG en el Servicio de Dermatología del Hospital Clínico Universitario Virgen de la Victoria (Málaga) en un periodo de 10 años, comprendido entre enero de 2000 y diciembre de 2009. Resultados: La incidencia del PG en nuestra población de referencia es de 3,26 casos por millón de habitantes y año. La enfermedad sistémica asociada con mayor frecuencia a la aparición del PG fue la colitis ulcerosa (5 casos, 33%). En 4 pacientes con colitis ulcerosa el PG apareció durante un brote de la enfermedad. El 80% de los pacientes no fueron derivados a Dermatología en la fase inicial del PG, siendo los servicios con más derivaciones Digestivo y Cirugía general, con 4 pacientes cada uno (52%). Conclusiones: El PG a menudo llega al dermatólogo remitido por otros especialistas tras un tiempo variable sin diagnóstico correcto. Ante este proceso es básico descartar la existencia de alguna patología asociada, especialmente en pacientes entre 20 y 40 años. Adalimumab es una buena opción terapéutica en el tratamiento del PG (AU)

Background: Pyoderma gangrenosum is a condition that is included among the neutrophilic dermatoses. Given its low incidence, few studies have addressed its epidemiology or treatment. Objective: To describe the epidemiological and clinical characteristics of patients with pyoderma gangrenosum along with our experience of treating the condition in a referral hospital in Malaga, Spain. Material and methods: A retrospective, observational study was undertaken in the Department of Dermatology at Hospital Clínico Universitario Virgen de la Victoria in Malaga, Spain between January 2000 and December 2009 and included all patients diagnosed with pyoderma gangrenosum. Results: The incidence of pyoderma gangrenosum in our reference population is 3.26 cases per million inhabitants per year. The most frequent concomitant systemic disease was ulcerative colitis (5 cases, 33%). In 4 patients with that disease, pyoderma gangrenosum appeared during a flare-up. In 80% of cases, patients were not referred to a dermatologist during the initial phase of pyoderma gangrenosum, and most referrals were from gastroenterology or general surgery (4 patients each, 52%). Conclusions: Patients with pyoderma gangrenosum are often referred to dermatologists by other specialists after a varying period of time has elapsed without achieving an accurate diagnosis. In these patients, especially those between 20 and 40 years of age, it is essential to rule out concomitant disease. Adalimumab is a good treatment option for pyoderma gangrenosum (AU)

[Pyoderma gangrenosum: a report of 15 cases and review of the literature]. / Pioderma gangrenoso: Presentación de 15 casos y revisión de la literatura.

BACKGROUND: Pyoderma gangrenosum is a condition that is included among the neutrophilic dermatoses. Given its low incidence, few studies have addressed its epidemiology or treatment. OBJECTIVE: To describe the epidemiological and clinical characteristics of patients with pyoderma gangrenosum along with our experience of treating the condition in a referral hospital in Malaga, Spain. MATERIAL AND METHODS: A retrospective, observational study was undertaken in the Department of Dermatology at Hospital Clínico Universitario Virgen de la Victoria in Malaga, Spain between January 2000 and December 2009 and included all patients diagnosed with pyoderma gangrenosum. RESULTS: The incidence of pyoderma gangrenosum in our reference population is 3.26 cases per million inhabitants per year. The most frequent concomitant systemic disease was ulcerative colitis (5 cases, 33%). In 4 patients with that disease, pyoderma gangrenosum appeared during a flare-up. In 80% of cases, patients were not referred to a dermatologist during the initial phase of pyoderma gangrenosum, and most referrals were from gastroenterology or general surgery (4 patients each, 52%). CONCLUSIONS: Patients with pyoderma gangrenosum are often referred to dermatologists by other specialists after a varying period of time has elapsed without achieving an accurate diagnosis. In these patients, especially those between 20 and 40 years of age, it is essential to rule out concomitant disease. Adalimumab is a good treatment option for pyoderma gangrenosum.

Lepra importada y su dificultad en el medio actual: a propósito de 7 casos / The Current Challenge of Imported Leprosy in Spain: A Study of 7 Cases

Introducción: aunque los focos históricos de infección leprosa en nuestro país están controlados y son prácticamente inactivos, aún se siguen diagnosticando algunos casos autóctonos aislados. La elevada movilidad poblacional actual ha traído consigo un aumento en la incidencia de casos importados de países endémicos, lo que está motivando un cambio en las características epidemiológicas del paciente afecto de lepra. Objetivos: el propósito de este artículo es poner de manifiesto las características clínicas, epidemiológicas, dermatopatológicas, microbiológicas y terapéuticas de los pacientes diagnosticados de lepra en los últimos 5 años en nuestro Servicio. Material y método: presentamos los casos de lepra importada que hemos valorado en nuestro Servicio desde el año 2004 al 2009.Resultadosse trata de 7 casos de lepra, 3 varones y 4 mujeres, de edades comprendidas entre los 26 y los 80 años, 2 de tipo tuberculoide, 2 borderline tuberculoide y 3 de tipo indeterminada. Todos procedían de países sudamericanos o sudafricanos donde adquirieron la enfermedad, aunque residían en España en ese momento. Sólo uno de los pacientes era natural de Málaga, pero trabajó como misionero en Venezuela durante 25 años. En ningún caso se logró demostrar la existencia de bacilos mediante la técnica de Ziehl-Neelsen, siendo la baciloscopia igualmente negativa. Conclusiones: queremos destacar los cambios epidemiológicos que hemos observado en los casos de lepra diagnosticados en nuestro Servicio, la mayoría de los cuales son importados. Es importante seguir manteniendo la sospecha clínica de lepra ante dermatitis granulomatosas, especialmente en pacientes de países endémicos (AU)

Background: although the foci of leprosy once present in Spain are now under control and almost inactive, isolated cases are still occasionally diagnosed. Meanwhile, population migration has brought about an increase in the incidence of cases corresponding to individuals from countries where leprosy is endemic, leading to changes in the epidemiology of this disease. Objectives: the aim of this paper was to describe the clinical, epidemiologic, dermatologic, microbiologic, and therapeutic characteristics of cases of leprosy in our department in the last 5 years. Material and methods: we report the cases of imported leprosy seen in our department between 2004 and 2009. Results: seven patients with leprosy (3 men and 4 women; age range, 26-80 years) were diagnosed; 2 were cases of tuberculoid leprosy, 2 borderline tuberculoid leprosy, and 3 indeterminate. All patients acquired the disease in South American or South African countries, but were residing in Spain at the time of diagnosis. One patient was a Spaniard, from Malaga, who had worked as a missionary in Venezuela for 25 years. The presence of the bacterium by either Ziehl-Neelsen stain or bacilloscopy could not be demonstrated in any of the patients. Conclusions: we would like to draw attention to the changes we have observed in the characteristics of cases of leprosy seen in our department, the majority of which are imported. It is important to maintain a clinical suspicion of leprosy in cases of granulomatous dermatitis, particularly in patients from countries where the disease is endemic (AU)

[The current challenge of imported leprosy in Spain: a study of 7 cases]. / Lepra importada y su dificultad en el medio actual: a propósito de 7 casos.

BACKGROUND: although the foci of leprosy once present in Spain are now under control and almost inactive, isolated cases are still occasionally diagnosed. Meanwhile, population migration has brought about an increase in the incidence of cases corresponding to individuals from countries where leprosy is endemic, leading to changes in the epidemiology of this disease. OBJECTIVES: the aim of this paper was to describe the clinical, epidemiologic, dermatologic, microbiologic, and therapeutic characteristics of cases of leprosy in our department in the last 5 years. MATERIAL AND METHODS: we report the cases of imported leprosy seen in our department between 2004 and 2009. RESULTS: seven patients with leprosy (3 men and 4 women; age range, 26-80 years) were diagnosed; 2 were cases of tuberculoid leprosy, 2 borderline tuberculoid leprosy, and 3 indeterminate. All patients acquired the disease in South American or South African countries, but were residing in Spain at the time of diagnosis. One patient was a Spaniard, from Malaga, who had worked as a missionary in Venezuela for 25 years. The presence of the bacterium by either Ziehl-Neelsen stain or bacilloscopy could not be demonstrated in any of the patients. CONCLUSIONS: we would like to draw attention to the changes we have observed in the characteristics of cases of leprosy seen in our department, the majority of which are imported. It is important to maintain a clinical suspicion of leprosy in cases of granulomatous dermatitis, particularly in patients from countries where the disease is endemic.

Growth rate as a prognostic factor in localized invasive cutaneous melanoma.

BACKGROUND: Melanoma is a tumour with a very variable progression. Whilst some melanomas grow slowly over many years, others can reach several millimetres in thickness in just a few weeks. Since melanoma is a visible superficial tumour, the information obtained from the clinical interview may be of use to calculate the speed of growth of the melanoma. OBJECTIVE: This study aims to assess the growth rate (GR) of melanomas and the association of this GR with various clinical and pathological factors and their usefulness as prognostic markers for localized invasive cutaneous melanomas. METHODS: The GR of melanomas was calculated as the ratio of tumour thickness to time of development, as obtained from the clinical history (in millimetres per month). RESULTS: Applying the GR calculation to patients with a localized melanoma showed a significant association between melanomas with a GR greater than 0.4 mm per month and an age of 65 years or over, male sex, nodular melanoma, tumour thickness, level of invasion, the presence of ulceration and a high mitotic index. As an independent prognostic factor for overall survival, the GR proved to be significant (P = 0.024). CONCLUSION: The GR of localized cutaneous melanomas may be a possible prognostic factor for survival. Additionally, rapid GR is associated with male patients more advanced in age at diagnosis, which suggests the need to assess new strategies for the early detection of these melanomas.