Blue nevus with satellitosis: case report and literature review.

Blue nevus is a benign melanocytic lesion, typically asymptomatic and of unknown etiology. Many histological subtypes are recognized, the most commons being: common blue nevus, cellular blue nevus, and combined blue nevus. New rare variants have been described in the literature, with emphasis on eruptive blue nevus, plaque, agminate, linear, with satellitosis, disseminated, familial and targetoid. The diagnosis of blue nevus usually presents no difficulties, however, the presence of structures such as irregular edges or satellitosis, are highly suggestive of malignancy, and the differential diagnosis with malignant blue nevus and melanoma with peripheral spread should be considered. We report a case of blue nevus with satellitosis in a 15-year-old female patient.

Carcinoma de células de Merkel com imunofenótipo atípico: desafio diagnóstico / Merkel cell carcinoma with atypical immunophenotype: diagnostic challenge

O carcinoma de células de Merkel (CCM) é um tumor raro de origem neuroendócrina e epidérmica, de mau prognóstico. Está classicamente associado à imunossupressão, exposição solar e, mais recentemente, ao poliomavírus (MCPyV). Caracteristicamente, o carcinoma de células de Merkel apresenta positividade para marcadores epiteliais e neuroendócrinos. A expressão combinada desses marcadores é o dado que corrobora o diagnóstico. Tumores MCPyV- possuem prognóstico desfavorável. Relata-se um caso de carcinoma de células de Merkel com imunofenótipo atípico (CK20 negativo) e comportamento agressivo. Este relato se justifica para reforçar a importância do conhecimento, pelos dermatologistas, de diferentes imunofenótipos que podem estar associados ao carcinoma de células de Merkel.

The Merkel cell carcinoma is a rare tumor of neuroendocrine and epidermal origin and with poor prognosis. It is classically associated with immunosuppression, exposure to the sunlight and, more recently, with the polyomavirus. It is positive for epithelial and neuroendocrine markers. The combined expression of these markers confirms the diagnosis. Polyomavirus tumors have an unfavorable prognosis. The authors report a case of Merkel cell carcinoma with atypical immunophenotype (CK20 negative) and aggressive behavior. The present report is aimed at highlighting the importance of dermatologists having knowledge of different immunophenotypes that may be associated with the Merkel cell carcinoma.

Blue nevus with satellitosis: case report and literature review

Abstract: Blue nevus is a benign melanocytic lesion, typically asymptomatic and of unknown etiology. Many histological subtypes are recognized, the most commons being: common blue nevus, cellular blue nevus, and combined blue nevus. New rare variants have been described in the literature, with emphasis on eruptive blue nevus, plaque, agminate, linear, with satellitosis, disseminated, familial and targetoid. The diagnosis of blue nevus usually presents no difficulties, however, the presence of structures such as irregular edges or satellitosis, are highly suggestive of malignancy, and the differential diagnosis with malignant blue nevus and melanoma with peripheral spread should be considered. We report a case of blue nevus with satellitosis in a 15-year-old female patient.

Melanoma após uso de ciclosporina em adolescente com dermatite atópica grave: relato de caso / Melanoma after cyclosporine use in teenager with dermatitis atopic disease: case report

Contexto: A ciclosporina é um potente imunossupressor que age primariamente nas células T por meio da inibição da calcineurina e consequente inibição da transdução do sinal mediada pela ativação do receptor das células T, sendo considerada por muitos como terapia de escolha nos casos de dermatite atópica grave. Descrição do caso: Relata-se o caso de paciente com dermatite atópica grave submetido a tratamento com ciclosporina que apresentou, em sua evolução, diagnóstico de melanoma in situ do tipo extensivo superficial. Discussão: Um dos efeitos colaterais mais graves do uso de ciclosporina é o aumento do risco de câncer, incluindo o desenvolvimento de lesões pré-malignas e tumores cutâneos malignos em áreas de pele expostas à luz solar, particularmente carcinomas de células escamosas. Conclusões: Há eficácia da ciclosporina na terapêutica de dermatite atópica grave, porém, pacientes que fazem uso desta droga devem ser submetidos rotineiramente a cuidadoso exame dermatológico à procura de qualquer sinal de neoplasia cutânea.

Cutaneous metastasis as the first manifestation of occult malignant breast neoplasia

Abstract Cutaneous metastases from primary internal malignancies represent 0.7-9% of patients with cancer. We report a 65-year-old female patient referred for evaluation of normochromic papules on the trunk and upper limbs that had been present for three months. A skin biopsy revealed diffuse cutaneous infiltration by small round cell tumors. Immunohistochemistry was positive for AE1/AE3, CK7, estrogen receptor and mammaglobin. The final diagnosis was cutaneous metastasis of occult breast cancer, since the solid primary tumor was not identified. The location of the primary tumor can not be determined in 5-10% of cases. In these cases, 27% are identified before the patient’s death, 57% at autopsy, and the remaining 16% can not be located.

O cuidado na doença de Alzheimer: as representações sociais dos cuidadores familiares / The care in Alzheimer's disease: social representations of family caregivers

Este estudo aborda as representações de cuidadores familiares de idosos com Alzheimer considerando o cuidado à luz da Teoria das Representações Sociais. Objetiva observar e identificar as representações dos cuidadores familiares sobre o cuidado e analisar como influenciam em suas práticas de cuidado. É do tipo empírico, exploratório, qualiquantitativo e utiliza como método o Discurso do Sujeito Coletivo. Participaram 21 cuidadores familiares de idosos com Alzheimer, sendo 24% homens e 76% mulheres, com faixa etária de 32 a 69 anos. Sobre o suporte familiar, 57% afirmaram possuir ajuda de parentes no cuidado com o idoso e 42 % declararam cuidar sozinhos deles. Quanto à renda, 24% afirmaram que era confortável, 63%, que era razoável. Quanto à ajuda de profissionais, 63% afirmaram não possuir qual quer tipo de ajuda em casa e 38% possuíam ajuda, mas frequentemente relacionada aos serviços domésticos. Emergiram as seguintes representações sociais: o cuidado como prisão; como missão; como desarmonia de identidades sociais e como gratidão. As representações atreladas às ideias de prisão e desarmonia de identidades acrescentam ansiedade, estresse e insegurança à vida dos cuidadores. Foram encontradas representações sobre o cuidado, sendo ao menos duas delas representações negativas, associando o cuidado às ideias de prisão e desarmonia de identidades sociais. Não foi possível alcançar de forma direta suas repercussões sobre a prática de cuidado pela ausência de observação da rotina de cuidado durante esta pesquisa.

This study deals with the representations of family caregivers of seniors with Alzheimer considering care under the light of the Social Representations Theory. It aims to observe and identify the represen tations of family caregivers about care and analyze how they influence their care practices. This study is exploratory, empirical, quantitative and qualita tive, using as a method of research the Discourse of the Collective Subject. Participants were 21 family caregivers of seniors with Alzheimer, 24% men and 76% women, aged 32-69 years. About the support of the family, 57% of them reported having help from relatives in caring for the elderly and 42% did not have any help. About the income, 24% said it was comfortable, 63% said it was reasonable. About the help of professionals, 63% said they did not have any help at home, 38% had help, but mostly related to domestic services. The following social repre sentations emerged: the care as prison; the care as mission; the care as disharmony of social identities and the care as gratitude. Representations linked to the ideas of prison and disharmony of social identity add anxiety, stress and insecurity of life of caregiv ers. This study found representations about the care of which at least two represented negative as sociations, comparing care with ideas of prison and disharmony of social identity. It was not possible to reach directly its repercussions on the care practice due to the absence of the care routine observation.

Cutaneous metastasis as the first manifestation of occult malignant breast neoplasia.

Cutaneous metastases from primary internal malignancies represent 0.7-9% of patients with cancer. We report a 65-year-old female patient referred for evaluation of normochromic papules on the trunk and upper limbs that had been present for three months. A skin biopsy revealed diffuse cutaneous infiltration by small round cell tumors. Immunohistochemistry was positive for AE1/AE3, CK7, estrogen receptor and mammaglobin. The final diagnosis was cutaneous metastasis of occult breast cancer, since the solid primary tumor was not identified. The location of the primary tumor can not be determined in 5-10% of cases. In these cases, 27% are identified before the patient's death, 57% at autopsy, and the remaining 16% can not be located.

Perfil epidemiológico das crianças internadas por queimaduras em hospital do sul do Brasil, de 1998 a 2008 / Epidemiological profile of children inmate by burns in a hospital in the south of Brazil from 1998 to 2008

Objetivo: Descrever o perfil epidemiológico de pacientes vítimas de queimaduras, verificar a prevalência desse trauma, os fatores associados e sua relação com diversas variáveis. Método: Estudo transversal, conduzidono Hospital Nossa Senhora da Conceição, em Tubarão, Santa Catarina,no período compreendido entre janeiro de 1998 a dezembro de 2008, cuja amostra final constituiu-se de 111 crianças e adolescentes. Os dados foram analisados por meio dos testes de qui-quadrado e t de Student, com nível de significância de 95%. Resultados: Observou-se maior prevalência de crianças com idade entre 0 e 3 anos, com predominância do gênero masculino (p< 0,001). O agente etiológico mais frequente foi a escaldadura (p< 0,001), seguido por fogo (chamas ou explosão) e contatocom superfícies quentes. Crianças mais novas tiveram maior relação com queimadura por escaldadura (p = 0,01), enquanto pacientes com maioridade queimaram-se com fogo. O tempo médio de internação foi de uma semana e as áreas corporais mais acometidas foram face, tórax e membros superiores. Não houve qualquer relação entre queimaduras e sazonalidade. Conclusões: As queimaduras foram mais comuns em menores de 3 anos do sexo masculino. O mecanismo mais prevalente foi a escaldadura.

Objective: To describe the epidemiological profile of burned patients, to verify the prevalence of this trauma, the associated factors and their relation to diverse variables. Methods: Cross-sectional study conducted at Nossa Senhora da Conceição Hospital in Tubarão, Santa Catarina, from January 1998 through December 1998, which final sample was constituted of 111 children and adolescents. The data was analyzed through tests of chi-square and t-student with a level of significance of 95%. Results: It was observed a greater prevalence of children between 0 and 3 years of age, with a predominance of the male gender (p< 0.001). The etiologic agent more frequent was the scald (p< 0.001), followed by fire (flames or explosion) and contact with hot surfaces. Younger children were more related to scald burns (p = 0.01), while the older ones were burned by fire. The approximate internment time was of a week and the body areas more affected were the face, chest and superior members. There was no relation between burns and seasons. Conclusions: The burns were more common in male children between 0 and 3 years of age. The predominant mechanism was the scald.

Primary pigmented nodular adrenocortical disease associated with Carney complex: case report and literature review

CONTEXT: Carney complex (CNC), a familial multiple neoplasm syndrome with dominant autosomal transmission, is characterized by tumors of the heart, skin, endocrine and peripheral nervous system, and also cutaneous lentiginosis. This is a rare syndrome and its main endocrine manifestation, primary pigmented nodular adrenal disease (PPNAD), is an uncommon cause of adrenocorticotropic hormone-independent Cushing's syndrome. CASE REPORT: We report the case of a 20-year-old patient with a history of weight gain, hirsutism, acne, secondary amenorrhea and facial lentiginosis. Following the diagnosing of CNC and PPNAD, the patient underwent laparoscopic bilateral adrenalectomy, and she evolved with decreasing hypercortisolism. Screening was also performed for other tumors related to this syndrome. The diagnostic criteria, screening and follow-up for patients and affected family members are discussed.

CONTEXTO: O complexo de Carney (CNC), uma síndrome de neoplasia múltipla familiar com transmissão autossômica dominante, caracteriza-se por tumores cardíacos, cutâneos, endócrinos e do sistema nervoso periférico, além de lentiginose cutânea. RELATO DE CASO: Devido à raridade da síndrome, bem como de sua principal manifestação endócrina, a doença adrenal nodular pigmentada primária (PPNAD), causa incomum de síndrome de Cushing ACTH-independente, relatamos o caso de uma paciente de 20 anos com história de ganho de peso, hirsutismo, acne, amenorréia secundária e lentiginose em face. Após estabelecido o diagnóstico de CNC e PPNAD, a paciente foi submetida a adrenalectomia bilateral via laparoscópica, evoluindo com melhora do hipercortisolismo. Também foi realizado rastreamento para os demais tumores relacionados à síndrome. Serão discutidos os critérios diagnósticos, o rastreamento e o acompanhamento dos pacientes e familiares afetados.

Primary pigmented nodular adrenocortical disease associated with Carney complex: case report and literature review.

CONTEXT: Carney complex (CNC), a familial multiple neoplasm syndrome with dominant autosomal transmission, is characterized by tumors of the heart, skin, endocrine and peripheral nervous system, and also cutaneous lentiginosis. This is a rare syndrome and its main endocrine manifestation, primary pigmented nodular adrenal disease (PPNAD), is an uncommon cause of adrenocorticotropic hormone-independent Cushing's syndrome. CASE REPORT: We report the case of a 20-year-old patient with a history of weight gain, hirsutism, acne, secondary amenorrhea and facial lentiginosis. Following the diagnosing of CNC and PPNAD, the patient underwent laparoscopic bilateral adrenalectomy, and she evolved with decreasing hypercortisolism. Screening was also performed for other tumors related to this syndrome. The diagnostic criteria, screening and follow-up for patients and affected family members are discussed.