Clinical and Pathological Features of Persistent Decorative Tattoo Reactions.

Persistent, non-infectious medical complications arising from decorative tattoos have increased considerably. They are difficult to characterize clinically, and histopathology shows a wide variety of overlapping patterns, with lichenoid and granulomatous dermatitis being the most common findings. Both clinical and pathological findings are difficult to ascribe to particular ink colour. The findings in 30 biopsies from 28 patients with persistent reactions in decorative tattoos are reported, including immunohistochemical findings.

Clear cell clusters in the kidney: a rare finding that should not be misdiagnosed as renal cell carcinoma.

Clear cytoplasm is a major characteristic feature of most malignant renal neoplasms. Benign clear cells in the renal parenchyma, usually histiocytes, can occasionally be found, but they are infrequently of an epithelial nature. We report histological, immunohistochemical, ultrastructural, and cytogenomic features of clear epithelial cell clusters incidentally found in four kidney specimens. Multiple microscopic clear cell clusters were present in the cortex, often in subcapsular location. They were composed of large epithelial cells with strikingly clear cytoplasm, without nuclear atypia, arranged in solid nests, and some tubules with narrow lumina. Immunohistochemically, they were positive for AE1AE3, PAX 8, EMA, kidney-specific cadherin, cytokeratin 7, E cadherin, and CD117, with focal immunoreactivity for CD10. Carbonic anhydrase IX, vimentin, and markers related to apoptosis and proliferation were negative. Ultrastructurally, the cytoplasms were enlarged and poor in organelles, showing ballooning degeneration. Array comparative genomic hybridization showed no chromosomal gains or losses. Clear cell clusters constitute a rare finding in the kidney and must be differentiated from benign lesions (ectopic adrenal tissue, osmotic tubulopathy, histiocytic clusters, renal adenomas) and renal cell carcinomas. Clear cell clusters appear to be generated from "endocrine-type" atrophic tubules whose cells are enlarged due to intracellular oedema. Immunohistochemistry shows a distal nephron phenotype with a limited expression of a proximal marker, CD10. Coexisting chronic renal disease or ischemic conditions seem to be related to the development of clear cell clusters. Pathological, ultrastructural, and cytogenomic features do not support a preneoplastic nature of this lesion, at least in the cases studied here.

Estado nutricional en mayores de 65 años atendidos en Atención Primaria en la zona norte de Galicia / Nutritional status in >65-year-old patients seen at Primary Care in Northern Galicia

Objetivo: conocer el estado nutricional de la población de 65 años o más no institucionalizada y autónoma, atendida en Atención Primaria en la zona norte de Galicia e identificar factores asociados al riesgo de malnutrición. Método: estudio descriptivo transversal de la población de 65 años o más, no institucionalizada y autónoma residente en las áreas sanitarias de A Coruña y Lugo. La muestra se seleccionó entre quienes acudieron a consulta (de febrero a diciembre de 2010). Enfermeras entrenadas administraron un cuestionario que incluyó variables sociodemográficas, antropométricas, de comorbilidad, la escala de comorbilidad de Charlson y la escala Mini Nutritional Assessment. Se realizaron índices de estadística descriptiva y modelos de regresión logística multivariante, cuya variable resultado fue la malnutrición y riesgo de malnutrición (MyRM). Resultados: la muestra final fue de 1.196 personas, con una media de edad de 75,2 años (DT 0,2) y un 61% de mujeres (n= 730). La prevalencia de malnutrición fue de 0,17 (IC95%: 0,02-0,60) y de malnutrición y riesgo de malnutrición (MyRM) fue del 15,5% (IC95%:13,4-17,5), similar en ambos sexos. Se encontró un aumento del riesgo (p< 0,05) de padecer MyRM en quienes no preparaban su comida (OR 1,49 (IC95%:1,01-2,21)), comían solos/as (OR 1,83 (IC95%:1,07-3,14)), tenían dos o más patologías (OR 1,58 (IC95%:1,04- 2,41)) o hubiesen estado ingresados en un hospital durante el último año (OR 2,16 (IC95%: 1,30-3,58)). Cada punto de mejoría en la valoración subjetiva del estado de salud realizada por la enfermera supuso disminución del riesgo (OR 0,68 (IC95%:0,60-0,76)). Conclusiones: la población de 65 años o más, no institucionalizada, autónoma y residente en la zona norte de Galicia, presenta un estado nutricional aceptable, aunque tres de cada 20 personas de este colectivo está en riesgo de malnutrición. Esta situación se asocia con factores sociales y clínicos

Objective: to understand the nutritional status of the ≥65-year-old population non-institutionalized and independent, seen at Primary Care in Northern Galicia, and to identify any factors associated with the risk of malnutrition. Method: a descriptive cross-sectional study in the ≥65-year-old population, non-institutionalized and independent, living in the health areas of A Coruña and Lugo. The sample was selected among those persons who came for a consultation (February to December, 2010). Trained nurses administered a questionnaire which included sociodemographical and anthropometric variables, as well as comorbidity, the Charlson comorbidity scale, and the Mini-Nutritional-Assessment scale. Descriptive statistical indexes were conducted, and multivariate logistical regression models, with the outcome variable Malnutrition and Risk of Malnutrition (MandRM). Results: the final sample was of 1.196 persons, with 75.2 years as mean age (TD 0.2); 61% were women (n= 730). The prevalence of malnutrition was 0.17 (CI 95%: 0.02-0.60), and 15.5% for MandRM (CI 95%:13.4-17.5), similar in both genders. It was found that there was an increase in the risk (p< 0.05) of suffering MandRM in those who did not prepare their meals (OR 1.49 (CI 95%:1.01-2.21)), those who ate alone (OR 1.83 (CI 95%:1.07-3.14)), suffered two or more health conditions (OR 1.58 (CI 95%:1.04- 2.41)) or had been hospitalized during the past year (OR 2.16 (CI 95%: 1.30-3.58)). Each point of improvement in the subjective evaluation by the nurse of their health status represented a reduction in risk (OR 0.68 (CI 95%:0.60-0.76)). Conclusions: the ≥65-year-old population, non-institutionalized, independent, and living in the Northern area of Galicia, presented an acceptable nutritional status, even though three of every 20 persons in this group are at risk of malnutrition. This situation is associated with social and clinical factors

Thyroid Pathology Findings in Cowden Syndrome: A Clue for the Diagnosis of the PTEN Hamartoma Tumor Syndrome.

OBJECTIVES: PTEN hamartoma tumor syndrome (PHTS) is a hereditary disorder caused by germline inactivating mutations of the PTEN gene. PHTS includes Cowden syndrome and Bannayan-Riley-Ruvalcaba syndrome. We describe how the peculiar pathologic and immunohistochemical thyroid features lead pathologists to suggest PHTS. METHODS: A 28-year-old white Spanish woman had a multinodular goiter. Total thyroidectomy was performed after fine-needle aspiration biopsy. Microscopic, immunohistochemical, and molecular analyses of the thyroid lesions were realized. RESULTS: The thyroid was multinodular, showing one papillary microcarcinoma, five follicular adenomas, three adenolipomas, 46 tiny adenomatous nodules (microadenomas), scattered foci of adipose tissue, and lymphocytic thyroiditis. Tumors were positive for thyroglobulin, thyroperoxidase, pendrin, cyclin D1, and p27 but negative for calcitonin and PTEN. A germline heterozygous deletion of one adenine at nucleotide 827 in exon 8 of the PTEN gene was confirmed. No BRAF, NRAS, or KRAS somatic mutations were detected in the papillary microcarcinoma, follicular adenoma, adenolipomas, or microadenomas. Negativity for PTEN was also found in the colonic tubulovillous adenoma and the storiform collagenoma. CONCLUSIONS: Pathologists play a crucial role in recognizing pathologic thyroid findings associated with PHTS for selecting patients for genetic testing.

Friction induced skin tags.

Skin tags are common benign neoplasm located predominantly in intertriginous skin. Generally of cosmetic concern, they can be easily treated with cryotherapy, electrodessication or snip-excision. Despite their high incidence data about their etiopathogenesis are scarce in the medical literature. We describe a patient who developed multiple skin tags arranged in a linear fashion suggesting an etiopathogenic role for friction.

Fabry disease: an ultrastructural comparative study of skin in hemizygous and heterozygous patients.

Fabry disease is a rare X-linked lysosomal storage disorder due to alpha galactosidase A deficiency, better known after the advent of a promising treatment, a periodical enzyme replacement. As other hereditary X-linked disorders, females have historically been considered non-affected carriers, although they are, actually, clinically and pathologically affected to a variable degree. Some women are asymptomatic, but the majority present milder forms of the disease and later onset. This wide range of disease expression is supposed to be related to the levels of enzymatic activity, probably in accordance with a skewing of X inactivation. Lysosomal deposits of ceramide trihexoside have been repeatedly documented in a wide range of tissues, including those found in angiokeratoma, the characteristic cutaneous lesion which allowed the definition of Fabry disease. The aim of this study was to investigate whether there was any difference in the amount of dermal lysosomal storage in males and females, thus accounting for the difference in clinical severity of both groups. For that purpose, with electron microscopy and quantitative methods, we studied the extent of lysosomal deposits in dermal fibroblasts of normal-appearing skin in six females and nine men, enzymatically and genetically proven as to have Fabry disease, and results were compared. Our results indicate a statistically significant difference between the two groups regarding both the percentage of dermal fibroblasts bearing stored material, and the storage surface occupied in 100 fibroblasts per case. We suggest that periodical ultrastructural examination of normal-appearing skin could be an indicator of the efficacy of enzyme replacement therapy and could help to evaluate results.