Proliferación vascular atípica mamaria inducida por radioterapia / Atypical vascular proliferation of the breast induced by radiation

La proliferación vasculara típica mamaria inducida por radioterapia es una proliferación angiomatoide que aparece sobre la piel previamente irradiada por el tratamiento conservador de un carcinomademama. Se presenta el caso de una paciente de 58años que consultó por la aparición de múltiples pápulas purpúricas milimétricas en la mama derecha. Había recibido radioterapia y cuadrantectomía por un carcinoma intraductal 5años antes y estaba medicada con tamoxifeno. El análisis histópatológico e inmunohistoquímico informó: "Proliferación vascular atípica inducida por radiación, variedad atípica inducida por radiación, variedad linfática". Se adoptó una conducta expectante, con seguimiento estrecho.

Atypical vascular proliferation of the breast induced by radiation is an angiomatoid proliferation that appears on previously irradiated skin by the conservative treatament of a breast carcinoma. We present a 58-year-old female patient who consulted for multiple millimeter purpuric papules in the right breast. She received radiotherapy and quadrantectomy for an intraductal carcinoma 5 years before. She is currently on tomoxifen. The histopathology and immunohistochemistry reported atypical vascular proliferation induced by radiation, lymphatic variety. Watchuful waiting is adopted with close monitoring.

Complejo Esclerosis Tuberosa: diagnóstico en la edad adulta / Tuberous sclerosis complex diagnosed during adulthood

El complejo esclerosis tuberosa es una genodermatosis de herencia autosómico dominante, producido por mutaciones en dos genes supresores tumorales llamados TSC1 y TSC2. Se caracteriza por el desarrollo de múltiples hamartomas en distintos órganos de la economía, entre ellos la piel. El diagnóstico es clínico, pero puede verse demorado debido a la variedad fenotípica entre pacientes, incluso dentro de un mismo grupo familiar, ya que muchas veces las manifestaciones de la enfermedad son sutiles. Se presenta un caso clínico diagnosticado en la edad adulta, donde los angiofibromas faciales alertaron sobre esta condición. Posteriormente se sumaron otros signos dermatológicos y sistémicos que permitieron confirmarla...

Cutis marmorata telangiectásico congénito / Congenital telangiectatic cutis marmorata

El cutis marmorata telangiectásico congénito (CMTC) es una infrecuente malformación vascular de bajo flujo que compromete vasos capilares y venosos, caracterizada por la presencia de un patrón localizado o generalizado asimétrico de máculas reticuladas eritemato-violáceas presentes desde el nacimiento o poco después de éste. El diagnóstico es clínico y el pronóstico bueno, aunque depende de la presencia de anomalías congénitas asociadas. Se presenta un paciente de 7 días de edad, de sexo femenino, con lesión eritematosa violácea reticulada con telangiectasias periféricas, localizada en cara anterointerna de muslo derecho extendida a rodilla derecha, compatible con diagnóstico de CMTC localizado sin anomalías congénitas asociadas...

Cutaneous and subcutaneous phaeohyphomycosis.

UNLABELLED: Case 1: A 17-year-old male rural worker from Bolivia living in La Plata (Argentina) for the past year had a lesion on the flexor side of his right forearm (6 x 4 cm). The lesion was formed by several confluent nodular areas, wine-red in color, some fistulized, with hemopurulent drainage. The area was hot and painless (Figure 1). On physical examination, no regional adenomegalies were reported. The following analyses were requested and results reported. Soft tissue ultrasound: material of solid consistency with layered liquid areas, located in the subcutaneous cellular tissue, with fistulous tract, connecting through superficial planes. Evidence of peripheral edema. Bacteriologic analysis (puncture aspiration): methicillin-sensitive Staphylococcus aureus. Mycologic analysis (puncture aspiration): negative; laboratory results: eosinophilia; and human immunodeficiency virus: nonreactive. Histopathologic examination: lesions of necrosis with granulomatous inflammatory reaction. Fungi techniques (periodic acid-Schiff, Grocott stains): negative. Bacilos acid-alcohol resistentes (acid-alcohol resistant bacillus) (BAAR) techniques (Kinyoun, Ziehl-Neelsen): negative. Foreign body examination tested with polarized light: negative. Mycologic and bacteriologic examinations were repeated, including a search for mycobacterium species using material obtained from the biopsy performed on the cutaneous lesion. Macromorphology: the colony was initially black and of creamy consistency, to later become velvety. Micromorphology: dark blastoconidia, then cylindrical phialides with elliptical conidia (Figure 2). IDENTIFICATION: Exophiala dermatitidis infection. On the basis of these characteristics, the diagnosis is phaeohyphomycosis due to Edermatitidis. The patient is treated with antimycotic therapy, with oral itraconazole (400 mg/d), plus indication of surgical procedure to remove the lesion. The patient's condition evolves favorably with no recidivant episodes after the sixth month post-treatment (Figure 3). During the first year, controls were scheduled every 2 months. Case 2: A 72-year-old diabetic man had a painful chronic varicose ulcer on the side of his left foot, with black friable exudate, 2x3 cm in diameter after 1 year. Every time the black material was removed, it would quickly grow back again. No response was obtained with different therapies applied to seal the lesion (Figure 4). Routine laboratory results included the following. Glucemy: 1.82 g/dL. Histopathology: filamentous septate fungal elements with positive Grocott stain (Figure 5 and Figure 6). Mycologic examination and culture: direct: fungal elements in dematiaceous group. Culture: positive for Curvularia lunata (Figure 7). The treatment selected was oral itraconazole (400 mg/d) for 12 months, with periodic laboratory controls, plus application of wet pads on the ulcer containing sodium borate and ketoconazole cream. At the fourth month, the ulcer had completely closed (Figure 8).