Mycosis fungoides and Kaposi's sarcoma association in an HIV-negative patient

Abstract The association of mycosis fungoides and kaposi’s sarcoma in HIV-negative patients is a rare phenomenon. The presence of human herpesvirus 8 (HHV-8) – associated with all forms of Kaposi’s sarcoma – has also been recently identified in mycosis fungoides lesions. However, a causal association between HHV-8 and the onset of mycosis fungoides has not been established yet. The present case reports a patient who developed Kaposi’s sarcoma lesions after a two-year UVB phototherapy to treat a mycosis fungoides. Negative immunohistochemistry staining for Kaposi’s sarcoma-associated herpesvirus in the initial mycosis fungoides lesions strengthens the absence of a link between Kaposi’s sarcoma-associated herpesvirus and mycosis fungoides. Immunosuppression caused by the lymphoma and prolonged phototherapy were probably the contribut ing factors for the onset of Kaposi’s sarcoma.

Mycosis fungoides and Kaposi's sarcoma association in an HIV-negative patient.

The association of mycosis fungoides and kaposi's sarcoma in HIV-negative patients is a rare phenomenon. The presence of human herpesvirus 8 (HHV-8) - associated with all forms of Kaposi's sarcoma - has also been recently identified in mycosis fungoides lesions. However, a causal association between HHV-8 and the onset of mycosis fungoides has not been established yet. The present case reports a patient who developed Kaposi's sarcoma lesions after a two-year UVB phototherapy to treat a mycosis fungoides. Negative immunohistochemistry staining for Kaposi's sarcoma-associated herpesvirus in the initial mycosis fungoides lesions strengthens the absence of a link between Kaposi's sarcoma-associated herpesvirus and mycosis fungoides. Immunosuppression caused by the lymphoma and prolonged phototherapy were probably the contribut ing factors for the onset of Kaposi's sarcoma.

Multiple skin neoplasms in subjects under 40 years of age in Goiania, Brazil.

OBJECTIVE To describe the trend for malignant skin neoplasms in subjects under 40 years of age in a region with high ultraviolet radiation indices.METHODS A descriptive epidemiological study on melanoma and nonmelanoma skin cancers that was conducted in Goiania, Midwest Brazil, with 1,688 people under 40 years of age, between 1988 and 2009. Cases were obtained fromRegistro de Câncer de Base Populacional de Goiânia(Goiania's Population-Based Cancer File). Frequency, trends, and incidence of cases with single and multiple lesions were analyzed; transplants and genetic skin diseases were found in cases with multiple lesions.RESULTS Over the period, 1,995 skin cancer cases were observed to found, of which 1,524 (90.3%) cases had single lesions and 164 (9.7%) had multiple lesions. Regarding single lesions, incidence on men was observed to have risen from 2.4 to 3.1/100,000 inhabitants; it differed significantly for women, shifting from 2.3 to 5.3/100,000 (Annual percentage change - [APC] 3.0%, p = 0.006). Regarding multiple lesions, incidence on men was observed to have risen from 0.30 to 0.98/100,000 inhabitants; for women, it rose from 0.43 to 1.16/100,000 (APC 8.6%, p = 0.003). Genetic skin diseases or transplants were found to have been correlated with 10.0% of cases with multiple lesions - an average of 5.1 lesions per patient. The average was 2.5 in cases without that correlation.CONCLUSIONS Skin cancer on women under 40 years of age has been observed to be increasing for both cases with single and multiple lesions. It is not unusual to find multiple tumors in young people - in most cases, they are not associated with genetic skin diseases or transplants. It is necessary to avoid excessive exposure to ultraviolet radiation from childhood.

Multiple skin neoplasms in subjects under 40 years of age in Goiania, Brazil / Neoplasias múltiplas de pele em indivíduos com menos de 40 anos em Goiânia, Brasil

OBJECTIVE To describe the trend for malignant skin neoplasms in subjects under 40 years of age in a region with high ultraviolet radiation indices.METHODS A descriptive epidemiological study on melanoma and nonmelanoma skin cancers that was conducted in Goiania, Midwest Brazil, with 1,688 people under 40 years of age, between 1988 and 2009. Cases were obtained fromRegistro de Câncer de Base Populacional de Goiânia(Goiania's Population-Based Cancer File). Frequency, trends, and incidence of cases with single and multiple lesions were analyzed; transplants and genetic skin diseases were found in cases with multiple lesions.RESULTS Over the period, 1,995 skin cancer cases were observed to found, of which 1,524 (90.3%) cases had single lesions and 164 (9.7%) had multiple lesions. Regarding single lesions, incidence on men was observed to have risen from 2.4 to 3.1/100,000 inhabitants; it differed significantly for women, shifting from 2.3 to 5.3/100,000 (Annual percentage change - [APC] 3.0%, p = 0.006). Regarding multiple lesions, incidence on men was observed to have risen from 0.30 to 0.98/100,000 inhabitants; for women, it rose from 0.43 to 1.16/100,000 (APC 8.6%, p = 0.003). Genetic skin diseases or transplants were found to have been correlated with 10.0% of cases with multiple lesions - an average of 5.1 lesions per patient. The average was 2.5 in cases without that correlation.CONCLUSIONS Skin cancer on women under 40 years of age has been observed to be increasing for both cases with single and multiple lesions. It is not unusual to find multiple tumors in young people - in most cases, they are not associated with genetic skin diseases or transplants. It is necessary to avoid excessive exposure to ultraviolet radiation from childhood.

OBJETIVO Descrever a tendência da incidência de neoplasias malignas de pele em indivíduos com menos de 40 anos de idade em região de altos índices de raios ultravioleta.MÉTODOS Estudo epidemiológico descritivo de câncer de pele melanoma e não melanoma realizado em Goiânia, Brasil, com 1.688 pessoas com menos de 40 anos de idade, no período de 1988 a 2009. Os casos incidentes foram obtidos do Registro de Câncer de Base Populacional de Goiânia. Foram analisadas: frequência, tendência e incidência de casos com lesões únicas e múltiplas e, nos casos de lesões múltiplas, a presença de transplante e de doenças genéticas cutâneas.RESULTADOS No período, ocorreram 1.995 casos de câncer de pele, dos quais 1.524 (90,3%) foram de lesão única e 164 (9,7%), lesões múltiplas. Das lesões únicas, a incidência em homens aumentou de 2,4 para 3,1/100.000 habitantes; em mulheres, diferiu significativamente, passando de 2,3 para 5,3/100.000 (Annual percentage change - [APC] 3,0%, p = 0,006). A incidência de lesões múltiplas em homens aumentou de 0,30 para 0,98/100.000 habitantes; nas mulheres, o aumento foi de 0,43 para 1,16/100.000 (APC 8,6%, p = 0,003). Encontrou-se associação com doença genética cutânea ou transplante em 10,0% dos casos com lesões múltiplas, com média de 5,1 lesões por paciente. Nos casos sem associação essa média foi de 2,5.CONCLUSÕES A incidência de câncer de pele em mulheres com menos de 40 anos está aumentando tanto com lesões únicas, quanto com múltiplas. A ocorrência de tumores múltiplos em jovens não é raro e na maioria dos casos não está associado à doença genética cutânea ou transplante. É necessário prevenir a exposição excessiva à radiação ultravioleta desde a infância.

Cutaneous squamous cell carcinoma of the lower limbs in Goiânia, Goiás, Brazil.

BACKGROUND: Cutaneous squamous cell carcinoma is a common malignant neoplasm that affects areas that are exposed to the sun in fair-skinned people. It occurs less frequently on the lower limbs where other etiological factors are involved. OBJECTIVE: To determine the epidemiological aspects of cutaneous squamous cell carcinoma of the lower limbs in Goiânia. METHODOLOGY: Forty-three cases of cutaneous squamous cell carcinoma of the lower limbs from the Cancer Registry of the Population Base of Goiás, for the period between 1995 and 1999, were included in the study. RESULTS: Among the cases of cutaneous squamous cell carcinoma registered in this 5-year interval, 43 (4.6%) represented cases affecting the lower limbs. Of these individuals, seven (16.3%) were male and 36 (83.7%) female (P < 0.001). Those in the age group of 60 years and above represented 90.7% of the cases (P < 0.001). None of the patients had metastasis. CONCLUSION: Cutaneous squamous cell carcinomas on the lower limbs are more frequently seen in women older than 60 years of age, and they rarely metastasize.

The profile of fogo selvagem (endemic pemphigus foliaceus) at the University Hospital of Brasilia-Brazil. Epidemiological and clinical considerations.

BACKGROUND: Endemic pemphigus foliaceus (EPF) or fogo selvagem (FS) is an endemic autoimmune disease, characterized by flaccid bullae induced by IgG(4) subclass antibodies. The authors demonstrate the epidemiological and clinical status of patients who have been followed at the University Hospital of Brasilia (HUB) for more than 15 years. METHODS: One hundred and ninety-six patients with FS took part in the project. In setting up this study a historical descriptive cohort of patients was put together. In order to collect data, the authors used a questionnaire where the patient indicated the sex, age at the onset, occupation, origin, clinical status, including scalp compromise, evolution, cofactors influencing clinical worsening and the treatment compliance. In order to minimize loss to follow up, the authors used the statistical method of incidence density (patients/years). RESULTS: The disease occurred in 58.4% of the young patients in the 11-30-year age bracket, and 52% came from urban areas. These patients included students and teachers. Localized disease predominated as compared with the generalized presentation of this condition. Fifty-nine percent of the patients evolved to the recurrent form. Those patients with the evolutional form, in remission for more than 1 year (94%), had been followed for more than 5 years. Even patients with the less active forms of the disease had scalp lesions. Thus scalp lesions are not an indicator of bad prognosis. CONCLUSIONS: In the present study, the disease affected patients from a higher sociocultural class than previously described. Furthermore, in contrast to other reports, a substantial number of the patients lived in urban areas, although often spending some time in a rural setting for leisure or professional activities. This study suggests that the longer the follow up, the higher the likelihood that the disease would progress to a more controlled clinical presentation. Scalp lesions were not related to adverse prognosis. Sun, heat and infections act as triggering factors for the immunological imbalance, worsening the disease.

Fogo selvagem (pênfigo foliáceo endêmico) no Hospital Universitário de Brasília: aspectos imunológicos / Fogo Selvagem (Endemic Pemphigus Foliaceus) at the University Hospital of Brasilia: Immunological aspects

O fogo selvagem (FS) apresenta características clinicoepidemiológicas peculiares. O histopatológico, a imunofluorescência direta e a indireta são os exames mais utilizados para diagnóstico da doença. O objetivo era analisar os achados da imunofluorescência direta (IFD) e indireta (IFI) dos pacientes de fogo selvagem (FS) do Hospital Universitário de Brasília (HUB). De 176 pacientes portadores de FS diagnosticados no HUB foram coletados os resultados da histopatologia, IFD e IFI no período de março de 1985 a março de 1999. Os títutlos de IFI foram correlacionados com o número de lesões cutâneas. A histopatologia mostrou acantólise subcórnea em 88 por cento. As IFDs foram positivas para IgG em 88 por cento e para C3 em 54 por cento. Percentual que variou de 90 a 95 por cento dos pacientes sem lesões ou com até seis lesões apresentavam títulos de IFI até 1/160. A IFI contribuiu para a valiar a atividade da doença, bem como para seu diagnóstico, o complementeo parece colaborar para o desencadeamento das lesões

Onicomicose e tinea pedis causados por microsporum nanum em paciente portador de hanseníase virchowiana / Onychomycosis and tinea pedis caused by microsporum nanum in patient affected by lepromatous leprosy

O microsporum nanum é dermatófito que raramente causa infecçäo no humana. No entanto, é com freqüência isolado da pele de suínos com ou sem lesöes. Este é um relato de infecçäo humana por M. nanum em paciente procedente de área rural e criador de porcos, com hanseníase virchowiana, que apresentava hiperceratose plantar e onicólise das unhas dos pés e algumas da mäo direita. A cultura para fungos revelou o crescimento do Microsporum nanum a partir de material colhido da regiäo plantar e unhas. Houve regressäo das lesöes da pele e melhora das lesöes ungueais 15 meses após pulsoterapia com itraconazol; entretanto, o exame micológico do raspado das plantas dos pés persistia com presença de hifas de dermatófitos. O Microsporum nanum é referido acometendo várias regiöes da pele glabra e também o couro cabeludo; aos autores entretanto parece ser a primeira citaçäo de acontecimento ungueal