Granulomatous slack skin T-cell lymphoma: an important differential diagnosis with giant cell tumor of soft tissue

Abstract: Granulomatous slack skin is an indolent T-cell lymphoma, considered to be a variant of mycosis fungoides. Clinically it is characterized by areas of redundant skin, wrinkled, inelastic, with variable erythema and infiltration besides a poikilodermic surface. A differential diagnosis unknown to most dermatologists is the giant cell tumor of soft tissue, which is an extremely rare low-grade sarcoma. The authors report a patient who had undergone extensive surgery because of a primary diagnosis of giant cell tumor of soft tissue, but which proved to be granulomatous slack skin after a second interventional procedure with confirmatory histopathology.

Granulomatous slack skin T-cell lymphoma: an important differential diagnosis with giant cell tumor of soft tissue.

Granulomatous slack skin is an indolent T-cell lymphoma, considered to be a variant of mycosis fungoides. Clinically it is characterized by areas of redundant skin, wrinkled, inelastic, with variable erythema and infiltration besides a poikilodermic surface. A differential diagnosis unknown to most dermatologists is the giant cell tumor of soft tissue, which is an extremely rare low-grade sarcoma. The authors report a patient who had undergone extensive surgery because of a primary diagnosis of giant cell tumor of soft tissue, but which proved to be granulomatous slack skin after a second interventional procedure with confirmatory histopathology.

Investigação de efeitos lesivos de doses antiinflamatórias e imunossupressoras de dexametasona sobre a mucosa gástrica em camundongos / Investigation of damage effects by antiinflammatory and immunosuppressive doses of dexamethasone on mice´s gastric mucosal

A dexametasona, potente glicocorticóide, pode causar inúmeras complicações, porém com incerto papel ulcerogênico no trato gastrintestinal. O objetivo do presente estudo foi investigar o papel da dexametasona nas doses antiinflamatórias e imunossupressoras na geração de lesão gástrica em camundongos Swiss Webster. Quarenta camundongos fêmeas foram divididos em três grupos. No Grupo I (n=16), os animais receberam 5 mg/kg/dia via intraperitoneal (IP) de dexametasona (dose imunossupressora); no Grupo II (n=16), 1,25 mg/kg/dia IP (dose antiinflamatória); e no Grupo III (n=8), solução fisiológica estéril IP (grupo controle). Os animais foram sacrificados em câmara de CO2 a cada três dias a partir do 3° ao 12° dia. Foram realizadas gastrectomia total, adrenectomia bilateral e esternectomia. A leucometria global e específica foi feita em cinco animais de cada grupo a cada três dias. Não foram encontradas alterações macroscópicas e histológicas no trato gastrintestinal nos diferentes grupos. Em dois camundongos do grupo I e em dois do grupo II, observamos degeneração balonizante das células da supra-renal. Esteatose hepática foi observada apenas em um animal do grupo I. Os animais imunossuprimidos apresentaram leucopenia com linfopenia, neutrofilia e monocitopenia e naqueles submetidos a doses antiinflamatórias notaram-se apenas leucopenia com linfopenia. O grupo controle manteve a contagem dentro da normalidade. Não foi observado dano à mucosa gástrica com o uso de doses antiinflamatórias e imunossupressoras, utilizando-se a via intraperitoneal. Estudos complementares comparando diferentes vias de administração, doses, animais de experimentação e preparações de glicocorticóides deverão ser conduzidos antes de afastar um papel ulcerogênico deste grupo de medicamentos.

Dexamethasone is a powerful glucocorticoid and it may result in some adverse effects, but it is uncertain whether it is ulcerogenic to the gastrointestinal tract. The aim of the present study was to investigate the antiinflammatory and immunosuppressive dose's effect of dexamethasone on the production of gastric mucosal damage in Swiss Webster mice. Forty female mice were separated in 3 groups. In Group I (n=16), the animals received 5 mg/kg/day (intraperitoneal route (IP) of dexamethasone (immunosuppressive dose); Group II (n=16): 1.25 mg/kg/day IP (antiinflammatory dose); and in Group III (n=8), saline solution IP (control group). The animals were sacrificed and necropsied at 3, 6, 9 and 12 days postinnoculation. Stomach, adrenal and sternal samples were collected and processed for microscopy studies. Global and specific counts of white blood cell were made in five animals in each group, each three days. Macroscopic and histological alterations on the gastrointestinal tract were not found in the different groups. In two mice of group I and in two of group II, balloon degeneration in adrenal cells was observed. In one animal of group I hepatic steatosis was found. The immunosuppressed animals presented leukopenia with lymphopenia, neutrofilia and monocytopenia and in those submitted to antiinflammatory doses it was noticed only leukopenia with lymphopenia. The control group kept the count within normality. Gastric mucosal damage with the use of antiinflammatory and immunosuppressive doses was not observed by using the intraperitoneal route. Complementary studies comparing different administration routes, doses, experimental animals and preparations of glucocorticoid must be undertaken before discarding a ulcerogenic role of this medicine group.