[Lipomembranous panniculitis: clinicopathologic correlation of 8 cases]. / Paniculitis lipomembranosa: correlación clínico-patológica de 8 casos.

INTRODUCTION: The term lipomembranous panniculitis refers to a chronic inflammation of the subcutaneous cell tissue, probably representing a non-specific type of ischemic necrosis of the fatty tissue, common to several complaints. It is characterized by painful sclerotic subcutaneous deposits, located in the lower legs of obese, middle-aged woman, with a history of vascular insufficiency and stasis dermatitis. The condition may also appear in association with other inflammatory disorders. METHODS: This paper is a review of all cases of lipomembranous panniculitis diagnosed at the Skin Histopathology Laboratory at Santa Maria Hospital, Lisbon, from 1985-2005. In the histopathological study, the associated clinical processes were retrospectively analyzed and the risk factors/associated pathologies re-evaluated. RESULTS: Eight patients were identified, all women, and with an average age of 49. Over half the patients were overweight. In most cases the lesions had been evolving for over 6 months and were associated with chronic venous insufficiency of the legs, both from a clinical point of view (7 patients) and a histopathological point of view (6 patients). In two of the cases, the lesions occurred in patients with connective tissue disorders. CONCLUSION: Great variability was observed with regard to the clinical morphology of the lesions, the proposed diagnoses and prescribed treatments, all of which possibly highlight the non-specific nature of the process.

Paniculitis lipomembranosa: correlación clínico-patológica de 8 casos / Lipomembranous panniculitis: clinicopathologic correlation of 8 cases

Introducción. El término paniculitis lipomembranosa designa un proceso inflamatorio crónico del tejido celular subcutáneo que probablemente representa una forma inespecífica de necrosis isquémica del tejido adiposo, común a diversas entidades clínicas. Clínicamente se caracteriza por placas subcutáneas escleróticas, dolorosas, localizadas en las áreas distales de las piernas de mujeres obesas, de mediana edad, con una base de insuficiencia vascular y dermatitis de estasis. El proceso puede también desarrollarse en asociación con otras patologías inflamatorias. Métodos. El presente trabajo constituye una revisión de todos los casos de paniculitis lipomembranosa diagnosticados en el Laboratorio de Histopatología Cutánea del Hospital de Santa María de Lisboa entre 1985 y 2005. Se realizó un análisis retrospectivo de los procesos clínicos asociados y una reevaluación de los factores de riesgo/patologías asociadas en el estudio histopatológico. Resultados. Se identificaron 8 pacientes, todos del sexo femenino, con una media de edad de 49 años y más de la mitad con exceso de peso. En la mayoría de los casos las lesiones llevaban más de 6 meses de evolución y estaban asociadas a insuficiencia venosa crónica de las extremidades inferiores, tanto desde el punto de vista clínico (7 pacientes), como histopatológico (6 pacientes). En dos de los casos, las lesiones se presentaron en pacientes con conectivopatías. Conclusión. Se observó una gran variabilidad en cuanto a la morfología clínica de las lesiones, los diagnósticos propuestos y las terapéuticas administradas, lo que probablemente subraya también el carácter inespecífico de este proceso

Introduction. The term lipomembranous panniculitis refers to a chronic inflammation of the subcutaneous cell tissue, probably representing a non-specific type of ischemic necrosis of the fatty tissue, common to several complaints. It is characterized by painful sclerotic subcutaneous deposits, located in the lower legs of obese, middle-aged woman, with a history of vascular insufficiency and stasis dermatitis. The condition may also appear in association with other inflammatory disorders. Methods. This paper is a review of all cases of lipomembranous panniculitis diagnosed at the Skin Histopathology Laboratory at Santa Maria Hospital, Lisbon, from 1985-2005. In the histopathological study, the associated clinical processes were retrospectively analyzed and the risk factors/associated pathologies re-evaluated. Results. Eight patients were identified, all women, and with an average age of 49. Over half the patients were overweight. In most cases the lesions had been evolving for over 6 months and were associated with chronic venous insufficiency of the legs, both from a clinical point of view (7 patients) and a histopathological point of view (6 patients). In two of the cases, the lesions occurred in patients with connective tissue disorders. Conclusion. Great variability was observed with regard to the clinical morphology of the lesions, the proposed diagnoses and prescribed treatments, all of which possibly highlight the non-specific nature of the process

Dermatofibrosarcoma protuberans: a clinicopathological study of 20 cases.

AIM: To review the dinical and histological data of 20 cases of dermatofibrosarcoma protuberans presenting at two dermatology centres in Lisbon from 1978 to 1998. PATIENTS AND METHODS: The 20 subjects comprised nine males and 11 females ranging in age from 25 to 79 years, with highest frequency of subjects in the 30-50 year olds. We reviewed the clinical features, histopathological aspects, including morphologic variants and immunohistochemical studies. RESULTS: Median age at diagnosis was 51 years and the trunk was the most frequent location. The characteristic histologic storiform pattern was seen in all cases. Three subjects presented fibrosarcomatous areas, one with myoid differentiation and another with multinucleated giant cells. Immunohistochemical stains revealed CD34 expression in the 18 specimens tested, FXIIIa was negative, and these two antigens proved important for the differential diagnosis of this neoplasm. Local wide excision was performed in 13 cases and seven patients underwent Moh's micrographic surgery. Follow-up ranged from 2 months to 17 years and three recurrences were recorded, two following classical surgery and one after Moh's surgery; there was no difference in the rate of local recurrence (15%) for the two kinds of treatment in our series.