RESUMEN
ABSTRACT: Post-transplant lymphoproliferative disorder (PTLD) is a term used to describe a range of lymphoproliferative disorders that occur after solid organ transplant. Although the clinical presentation is variable, primary cutaneous PTLD typically presents as isolated nodules that appear as dermal-based proliferations. We present a case of a 70-year-old woman with a history of a kidney transplant who presented with a 2-month history of an asymptomatic, erythematous plaque on the right shin, clinically suspected to be squamous cell carcinoma in situ. Histomorphology demonstrated a dermal proliferation of atypical plasma cells with dense chromatin, variable nucleoli, and irregular nuclear borders. The atypical plasma cells were positive for Epstein-Barr virus by in situ hybridization and markedly kappa-restricted by RNAscope in situ hybridization. A diagnosis of cutaneous monomorphic PTLD, plasma cell neoplasm variant, was rendered, a rare diagnosis in the skin. Treatment for PTLD typically involves reduction of immunosuppression, although our patient progressed and developed new lesions despite this intervention. In this study, we present an atypical presentation of cutaneous PTLD, plasma cell neoplasm variant, presenting as squamous cell carcinoma in situ.
Asunto(s)
Huésped Inmunocomprometido , Trasplante de Riñón/efectos adversos , Trastornos Linfoproliferativos/diagnóstico , Complicaciones Posoperatorias/inmunología , Enfermedades de la Piel/diagnóstico , Anciano , Carcinoma de Células Escamosas/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Trastornos Linfoproliferativos/inmunología , Trastornos Linfoproliferativos/patología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/patología , Enfermedades de la Piel/inmunología , Enfermedades de la Piel/patología , Neoplasias Cutáneas/diagnósticoAsunto(s)
Hiperpigmentación , Anomalías Cutáneas , Humanos , Hiperpigmentación/diagnóstico , Hiperpigmentación/etiología , Cuello , PielAsunto(s)
Dermatosis Facial/diagnóstico , Dermatosis Facial/patología , Esclerosis Tuberosa/diagnóstico , Esclerosis Tuberosa/patología , Adolescente , Biopsia , Mejilla , Diagnóstico Diferencial , Dermatosis Facial/genética , Femenino , Humanos , Mosaicismo , Piel/patología , Esclerosis Tuberosa/genéticaAsunto(s)
Trióxido de Arsénico/efectos adversos , Erupciones por Medicamentos/etiología , Erupciones por Medicamentos/patología , Leucemia Promielocítica Aguda/tratamiento farmacológico , Tretinoina/uso terapéutico , Anciano , Trióxido de Arsénico/uso terapéutico , Biopsia con Aguja , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Leucemia Promielocítica Aguda/diagnóstico , Masculino , Remisión Espontánea , Medición de Riesgo , Resultado del Tratamiento , Tretinoina/efectos adversosRESUMEN
BACKGROUND/OBJECTIVES: Lichen planus-like keratoses (LPLK) are benign skin lesions that can mimic malignancy; the clinical and dermoscopic features distinguishing lichen planus-like keratoses from skin tumors have not been extensively studied. The objective of this study was to identify dermoscopic features that may prevent unnecessary biopsies of lichen planus-like keratoses. METHODS: Retrospective, single-center, observational study of biopsied skin lesions at a tertiary center. We compared 355 lichen planus-like keratoses to 118 non-lichen planus-like keratoses lesions with lichen planus-like keratosis in the differential diagnosis biopsied from August 1, 2015, to December 31, 2016. The investigators were blinded to the diagnosis of the lesions. RESULTS: Lichen planus-like keratoses were most frequently non-pigmented (61.7%), truncal (52.1%), and on sun-damaged skin (69.6%); the majority occurred in Whites (95.5%) and females (62.8%). Dermoscopically, lichen planus-like keratoses were more likely than non-lichen planus-like keratoses to have scale (42.5% vs 31.4%, P = 0.03) and orange colour (8.2% vs 0.9%, P = 0.01). Among lesions with peppering (n = 76; 63 lichen planus-like keratoses and 13 non-lichen planus-like keratoses), coarse ± fine peppering (73% vs 38.5%, P = 0.02) and peppering as the only feature (34.9% vs 0%, P = 0.01) were associated with lichen planus-like keratoses. CONCLUSIONS: Lichen planus-like keratoses can be challenging to distinguish from benign and malignant skin tumors. The presence of dermoscopic scale and orange colour may aid in the recognition of lichen planus-like keratosis. Coarse peppering and the presence of peppering as the only dermoscopic feature may further aid the identification of pigmented lichen planus-like keratoses.
Asunto(s)
Dermoscopía , Queratosis/patología , Liquen Plano/patología , Anciano , Biopsia , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Estudios Retrospectivos , Piel/patología , Neoplasias Cutáneas/diagnósticoAsunto(s)
Erupciones Acneiformes/tratamiento farmacológico , Cetuximab/efectos adversos , Factor de Crecimiento Epidérmico/antagonistas & inhibidores , Ivermectina/uso terapéutico , Ácaros , Erupciones Acneiformes/diagnóstico , Erupciones Acneiformes/parasitología , Animales , Antineoplásicos Inmunológicos/efectos adversos , Antineoplásicos Inmunológicos/uso terapéutico , Antiparasitarios/uso terapéutico , Biopsia , Cetuximab/uso terapéutico , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/tratamiento farmacológicoRESUMEN
A 27-year old male with Hodgkin's lymphoma was treated with combined chemotherapy that included bleomycin. He presented with pruritic erythematous, edematous linear lesions and was diagnosed to have flagellate hyperpigmentation, a rare side effect of bleomycin chemotherapy.
RESUMEN
A 67-year-old woman presented with a firm plaque in the perineal region, 16 months after diagnosis of a high-grade basaloid squamous cell carcinoma of the vagina and treatment by external beam radiation therapy and vaginal cuff brachytherapy. The differential diagnosis included radiation-induced morphea, radiation dermatitis, or, possibly, radiation-induced lichen sclerosus. Biopsy findings, including special staining, confirmed the diagnosis of radiation-induced lichen sclerosus. To our knowledge, this is the first report of radiation-induced lichen sclerosus of the vulvar region.
Asunto(s)
Braquiterapia , Carcinoma Basoescamoso/radioterapia , Radiodermatitis/diagnóstico , Neoplasias Vaginales/radioterapia , Liquen Escleroso Vulvar/diagnóstico , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Radiodermatitis/patología , Neoplasias Vaginales/patología , Vulva/patología , Liquen Escleroso Vulvar/patologíaRESUMEN
Basal cell carcinomas represent one of the most common skin cancers and often present initially in the primary care setting. Subtle basal cell carcinomas may be difficult to detect, and early detection of these carcinomas remains important in limiting patient morbidity. In this article, we present a simple diagnostic maneuver, "basal cell blanche," to increase early detection of basal cell carcinomas.