A case report of a primary apocrine adenocarcinoma of the eyelid with literature review.

INTRODUCTION: Primary Apocrine adenocarcinomas (PAA) are very infrequent tumors that are often confused initially with benign lesions. Little is known about this disease and there is still much to be clarified. We present a case of PAA on the eyelid successfully treated with surgery alone and a literature review regarding what is currently described about this disease. METHODS: Noncomparative, retrospective case report of a patient with PAA on the eyelid succesfully treated with surgery alone and a literautre review. RESULTS: A 91-year-old man with a 2 months lesion on the upper left eyelid was treated with surgery alone with oncological margins of 5mm. The Hystopathology diagnosis was a PAA of the eyelid and free margins were obtained. After 12 months of follow-up, the patient does not show any signs of local recurrence or distant metastasis. A review of the literature suggests these tumors are located more frequently in the axilla (50%) and secondly in the head and neck (35%), with similar distribution in the upper (41%) and lower eyelid (45%). The most commonly used treatment is surgical excision, but radiotherapy and chemotherapy have also been used with variable results. CONCLUSIONS: PAA is a very rare and aggressive tumor. Because it is so infrequent, treatments are based on the sporadic cases encountered in the literature. As more cases are reported, more can be elucidated about the characteristics of this tumor, its behavior and best treatment choice and this may allow progress in the understanding and management of this disease.

Hidradenite supurativa (acne inversa): revisão da literatura e relato de caso sobre o tratamento cirúrgico de lesão pré-esternal / Hidradenitis suppurativa (acne inversa): review of the literature and case report on the surgical treatment of a presternal lesion

A Hidradenite Supurativa é uma doença crônica debilitante, estigmatizante e de difícil tratamento. A doença apresenta várias características clínicas, podendo ocorrer isolada ou simultaneamente em diversas localizações, geralmente simétricas, distribuídas na "linha do leite". Afeta a pele onde há maior quantidade de glândulas apócrinas intertriginosas, em ordem decrescente: axilas, região ano-genital, aréolas e sulco inframamário. Seu curso insidioso inicia com nódulos subcutâneos que se rompem e/ou coalescem, formando abscessos na derme profunda, extremamente doloridos. As lesões frequentemente drenam exudato purulento fétido, com importante prejuízo à qualidade de vida. Com a progressão da doença, ocorre formação de fistulas, comedões, fibrose, contraturas dérmicas e endurecimento da pele. Suas maiores chances de cura estão no diagnóstico precoce e tratamento individualizado, que abrange medidas farmacológicas, comportamentais e cirúrgicas. O tratamento cirúrgico tem sido considerado a medida curativa mais efetiva. A decisão entre as diversas modalidades vai depender do estágio, apresentação e comprometimento local e incluem incisão e drenagem dos abscessos, deroofing, marsupialização, eletrocirurgia, laser Nd:YAG, laser de CO2 e excisão cirúrgica extensa. As opções de reconstrução incluem cicatrização por segunda intenção, enxerto de pele total imediato ou tardio, fechamento primário e retalhos. O caso relatado de lesões préesternais apresentava características clínicas e histológicas compatíveis com HS, sendo esta uma localização incomum na Literatura. O resultado pós-operatório da ressecção de toda a lesão com fechamento primário mostrou-se resolutivo após longo tempo de seguimento. Mais ensaios clínicos randomizados são necessários para estipular o melhor manejo na HS.

Hidradenitis suppurativa is a chronic debilitating and stigmatizing disease that is difficult to treat. The disease presents several clinical characteristics, which may occur alone or simultaneously in various locations, generally symmetrical and distributed in the "milk line". It affects the following areas of the skin where intertriginous apocrine glands are numerous, in the descending order: axilla, anogenital region, areolas, and inframammary crease. Its insidious progression begins with formation of subcutaneous nodules that rupture and/or coalesce, forming extremely painful abscesses in the deep dermis. The lesions often drain foul purulent exudate, with significant damage to quality of life. As the disease progresses, formation of fistulas, comedones, fibrosis, dermal contractures, and hardening of the skin occur. The highest chances of cure are lie in early diagnosis and individualized treatment, which covers pharmacological, behavioral, and surgical measures. Surgical treatment has been considered a more effective curative measure. The decision between the different modalities will depend on the stage, presentation, and local commitment and include incision and drainage of abscesses, deroofing, marsupialization, electrosurgery, Nd:YAG laser, CO2 laser, and extensive surgical excision. The reconstruction options include healing by second intention, immediate or delayed full-thickness skin graft, primary closure, and flaps. The reported case of presternal injuries presented clinical and histological characteristics compatible with hidradenitis suppurativa; this location has been rarely reported in the literature. The postoperative results of complete resection of the lesion with primary closure indicated resolution over a long follow-up period. More randomized clinical trials are needed to determine the best management strategy for hidradenitis suppurativa.

Hidradenitis suppurativa: retrospective study of 20 cases.

In this study, twenty cases of severe hidradenitis suppurativa are reported, mainly in non-white people and in axillary areas. Wide surgical excision has offered good results, although relapses have occurred at variable intervals in the follow-up period.

Hidradenitis suppurativa: retrospective study of 20 cases / Hidradenite supurativa: estudo retrospectivo de 20 casos

In this study, twenty cases of severe hidradenitis suppurativa are reported, mainly in non-white people and in axillary areas. Wide surgical excision has offered good results, although relapses have occurred at variable intervals in the follow-up period.

São relatados 20 casos de hidradenite supurativa grave, com predomínio de não brancos e regiões axilares. A excisão cirúrgica ampla trouxe bons resultados, embora a recidiva ocorresse em intervalos variáveis no acompanhamento.

Tratamento da hiperidrose axilar com lipoaspiração / Liposuction for treatment of axillary hyperhidrosis

Introdução: A hiperidrose axilar primária e a bromohidrose são problemas comuns que levam vários pacientes a procurar atendimento médico. A remoção das glândulas sudoríparas écrinas e apócrinas da região axilar por meio de lipoaspiração superficial sob anestesia intumescente é um procedimento de pequeno porte, simples e com poucas complicações, oque pode ser observado em nosso estudo. O objetivo deste trabalho é a difusão desta técnica. Método: Vinte e cinco pacientes foram submetidos a lipoaspiração superficial da axila sobanestesia local e sedação. Resultados: Após um ano de acompanhamento pós-operatório, três pacientes apresentaram respostas regulares e dois apresentaram resultados insatisfatórios. Dentre os pacientes analisados, quatorze apresentavam bromohidrose associada e obtiveram respostas satisfatórias com redução significativa ou até mesmo desaparecimento do odor característico. Conclusão: Concluímos que o procedimento é eficaz e seguro para o tratamento de hiperidrose axilar primária e bromohidrose.

Introduction: Axillary hyperhidrosis and bromohidrosis are common problems for which many patients seek medical treatment. The removal of axillary sweat glands using liposuctionwith tumescent anesthesia in an out patient setting is a relatively short and simple procedure with few complications, as seen in this case series. The purpose of is study is to contribute for the spread of this technique. Methods: Twenty five patients were treated with axillaryliposuction under tumescent anesthesia. Results: One year after the procedure, three patients had regular results and two required additional liposuction to the same area. Those who had bromohidrosis associated presented good results with significant reduction of the odor. Conclusion: This procedure is efficient and safe when used to treat primary axillary hiperhidrosis and bromohidrosis.

Apocrine gland cyst with hemosiderotic dermatofibroma-like stroma: report of two cases.

Two cases of an unusual cutaneous lesion characterized by a dermal nodule with apocrine gland cysts surrounded by a hemosiderotic dermatofibroma-like proliferating stroma are reported. The first case was a 52-year-old female who presented with a nodule on the back of several years of evolution and with the clinical diagnosis of lipoma; the second case was a 41-year-old male who presented with a forehead nodule of several years of evolution with a clinical diagnosis of epidermal cyst. Histologically, an ill-delimited non-encapsulated nodule composed of cystic spaces and solid areas was found. The cystic spaces consisted of ductal structures and a bilayered epithelial covering with apocrine differentiation; the surrounding area showed a stroma composed of a mixture of both fibrocytes and macrophages and abundant hemosiderin granules; foci of recent hemorrhages and a more dense fibrous stroma at the periphery with typical storiform areas were also visible. Both cases have shown a benign course without local recurrence in follow up until this report date.