Metástasis cutáneas de cáncer de mama: revisión de la literatura / Breast cancer cutaneous metastasis: literature review

Introducción: El cáncer de mama es uno de los tumores malignos más frecuentes en mujeres, y representa el principal carcinoma que genera metástasis cutáneas (MC), excluyendo al melanoma. Objetivos: Realizar una revisión de las MC del carcinoma mamario y mostrar las principales formas de presentación clínica. Discusión: Las MC pueden presentarse mediante diferentes manifestaciones dermatológicas, aunque lo más frecuente es un infiltrado eritematoso papulonodular único o múltiple, generalmente localizado en la piel subyacente o próxima al área del tumor primario. Las células tumorales alcanzan la piel por 3 vías de diseminación: hemática, linfática y por contigüidad. Los carcinomas mamarios, normalmente, se diseminan por la vía linfática y llegan a zonas de la piel cercanas; así, las MC de mama adoptan como sitio de implantación principal la piel del tórax. Conclusiones: Las MC pueden ser la manifestación inicial de un cáncer, o bien un signo de recurrencia de este. Es necesario tener un alto nivel de sospecha diagnóstica debido a su gran polimorfismo clínico.

Introduction: Breast cancer is one of the most frequent malignant tumors in women and is the main carcinoma leading cutaneous metastasis (CMs), excluding melanoma. Objectives: To present a literature review about CMs from breast cancer and to show the mainly clinical forms. Discussion: CMs can present different skin manifestations, but single or multiple papulonodular erythematosus infiltrate are the most common, generally located in the underlying skin or close to the primary tumor area. Tumor cells reach the skin through three dissemination forms -hematogeneus, lymphatic, and contiguity-. Breast carcinomas normally disseminate through lymphatic via and reach close skin zones; thus, breast CMs mainly allocate in the thorax skin. Conclusions: CMs can be the initial manifestation of a cancer or a sign of its recurrence. There must be a high level of suspicion because its clinical polymorphism.

Hidradenitis supurativa prepuberal: presentación de 2 casos clínicos / Prepubertal Hidradenitis suppurativa: Report of 2 clinical cases

La hidradenitis supurativa (HS) es una enfermedad inflamatoria de la piel, caracterizada por la aparición de nódulos profundos en zonas que poseen glándulas apocrinas. Aparece más frecuentemente en mujeres entre la segunda y la tercera década de la vida. Objetivo Reportar 2 pacientes portadoras de HS a edad prepuberal. Caso 1 Paciente de sexo femenino, 10 años de edad, Tanner I-II, con antecedentes de obesidad. Consultó por un cuadro de 4 meses de evolución caracterizado por lesiones recurrentes en región inguinal bilateral que ocasionalmente drenan material purulento. Se diagnosticó HS Hurley I, se trató con antibióticos tópicos y manejo nutricional, con buena respuesta. Caso 2 Paciente de sexo femenino, 10 años de edad, Tanner I-II, con antecedentes de obesidad. Consultó desde los 6 años por cuadros recurrentes de lesiones en cara interna de muslo izquierdo. Fue tratada con múltiples cursos de antibióticos con escasa respuesta. Se diagnosticó HS Hurley I y se decidió manejo con terapia fotodinámica y apoyo nutricional, con buena respuesta. Conclusiones La etiología de la HS no es clara. La presentación a edades tempranas se asocia a antecedentes familiares y compromiso más extenso a futuro. El tratamiento de la enfermedad depende de cada caso, no existiendo un protocolo establecido.

Hidradenitis suppurativa (HS) is an inflammatory follicular skin disease. It usually presents as recurrent, deep nodules in flexural apocrine gland bearing areas. It appears mainly in women, in the second and third decade of life. Objective To present 2 cases of patients with prepuberal HS. Case 1 A 10-year old female, Tanner stage I-II and obesity. History of 4 months of evolution with bilateral recurrent groin lesions that occasionally drain pus; HS Hurley stage I was diagnosed, and topical antibiotics and nutritional management were prescribed, with a good response. Case 2 A 10 years old female, Tanner stage I-II and obesity. Since the age of 6 years, recurrent episodes of lesions in the inner side of the left thigh were observed, and multiple antibiotics with poor response were prescribed. HS Hurley stage I was diagnosed, and photodynamic therapy and nutritional management were used, with good response. Conclusions The etiology of HS is unclear. Usually the presentation at early age is associated with a family history and more extensive compromise in the future. Treatment is difficult and depends on each case and severity.

[Prepubertal Hidradenitis suppurativa: Report of 2 clinical cases]. / Hidradenitis supurativa prepuberal: presentación de 2 casos clínicos.

UNLABELLED: Hidradenitis suppurativa (HS) is an inflammatory follicular skin disease. It usually presents as recurrent, deep nodules in flexural apocrine gland bearing areas. It appears mainly in women, in the second and third decade of life. OBJECTIVE: To present 2 cases of patients with prepuberal HS. CASE 1: A 10-year old female, Tanner stage I-II and obesity. History of 4 months of evolution with bilateral recurrent groin lesions that occasionally drain pus; HS Hurley stage i was diagnosed, and topical antibiotics and nutritional management were prescribed, with a good response. CASE 2: A 10 years old female, Tanner stage I-II and obesity. Since the age of 6 years, recurrent episodes of lesions in the inner side of the left thigh were observed, and multiple antibiotics with poor response were prescribed. HS Hurley stage i was diagnosed, and photodynamic therapy and nutritional management were used, with good response. CONCLUSIONS: The etiology of HS is unclear. Usually the presentation at early age is associated with a family history and more extensive compromise in the future. Treatment is difficult and depends on each case and severity.

Vasculitis periflexual como manifestación de primoinfección por parvovirus B19: a propósito de un caso / Periplexual vasculitis as a manifestation of primary infection by parvovirus B19: about a case

La infección por parvovirus B19 es común, siendo más recurrente en la edad escolar, invierno y primavera, y su seroprevalencia alcanza hasta el 85% en adultos mayores. La presentación típica de la infección por este virus se conoce como eritema infeccioso (o "quinta enfermedad", destacando la afectación facial característica y la erupción reticulada), sin embargo, se han reportado múltiples manifestaciones dermatológicas de la infección por el virus. Paciente de 17 años, con antecedente de migraña, que desarrolló máculas y pápulas eritematoso-violáceas confluentes con petequias, predominando en pliegues antecubital, poplíteo e inguinal y cara lateral del tórax, con menor compromiso abdominal, espalda y muslos. La biopsia de la piel y los exámenes de laboratorio fueron compatibles con vasculitis leucocitoclástica secundaria a infección por parvovirus B19. Se han descrito diferentes patrones de la manifestación cutánea de la infección por parvovirus B19. La paciente del caso clínico expuesto desarrolló un rash cutáneo que constituyó una superposición entre el patrón vasculítico y el periflexural, presentación poco descrita en la literatura.

Parvovirus B19 infection is common, being more typical among school-age children, with seasonal changes. Infectious erythema (or 'fifth disease') is the classic manifestation of this viral infection; however, multiple dermatological manifestations of the virus infection have been reported. An otherwise healthy 17-year-old female patient, developed confluent erythematous-violaceous macules and papules with petechiae. They mainly involved the antecubital, popliteal and inguinal crease and lateral thorax. The lower abdomen, back and thighs were less involved. The skin biopsy and laboratory workup showed leukocytoclastic vasculitis and positive reaction for parvovirus B19, respectively. A variety of patterns have been described related to the cutaneous manifestation of parvovirus B19 infection. In the present case, the patient developed a cutaneous rash that constituted an overlap between the vasculitic and the periflexural patterns. This variant of parvovirus B19 infection has not been frequently described in literature.

Ébola: caracterización, historia y manifestaciones cutáneas; lo que debemos saber / Ebola: characterization, history and cutaneous manifestations

Ebola virus (EV) is one of the most virulent human pathogens. Fruits bats are its natural reservoir, the transmission to humans is across wild animals (especially primates) and the propagation in human populations is through bodily fluid contact. The actual outbreak started in December 2013 and crossed continental borders. Up to now, there are 17,145 suspected and confirmed cases with 6,070 deaths, resulting a total case fatality rate of 35%. Clinical manifestations can be divided in 3 phases. In phase I, symptoms are similar to flu, which may appear in a range of 2 to 21 days. In phase II which occurs in over 50% of cases, visceral symptoms and mucocutaneous manifestations appear within 4 and 5 days of the onset of symptoms. The main symptoms are a macular or maculopapular non-pruritic rash, desquamation and mucosal involvement of eyes, mouth and pharynx. In phase III, recovery or death occurs. The diagnosis is made on clinical grounds, epidemiological suspicion and a positive polymerase chain reaction (PCR) test. The treatment is supportive. If there is a suspected case, it should be notified immediately and all relevant safety measures should be instituted.

[Mammary duct ectasia in children: A case report]. / Ectasia ductal mamaria en niños, a propósito de un caso clínico.

INTRODUCTION: Bloody nipple discharge is an infrequent symptom during childhood. The most common cause in this population is mammary duct ectasia (MDE), which is a benign and self-limiting condition, that is characterized by dilatation of the mammary ducts, fibrosis and periductal inflammation. OBJECTIVE: Report of a case of MDE in order to improve physicians' diagnosis accuracy and avoid aggressive studies and treatments. CASE REPORT: Six-months old male healthy infant, exclusively breastfeeded, that visited our clinic with a lump beneath his right nipple and bloody discharge from the same nipple. An ultrasound was performed which showed a multicystic lesion suggestive of MDE. Watchful waiting was decided as treatment, with good evolution after six months of follow up. CONCLUSIONS: The MDE is the leading cause of bloody discharge in pediatric population, being a benign condition that resolves spontaneously before nine months. The knowledge of this condition is essential so as to accurately diagnose and treat it.

Ectasia ductal mamaria en niños, a propósito de un caso clínico: A case report / Mammary duct ectasia in children

Introducción: La telorragia es un síntoma poco frecuente en pacientes pediátricos, la causa más frecuente en esta población es la ectasia ductal mamaria (EDM), que es una afección benigna y autolimitada, caracterizada por la dilatación del conducto mamario, fibrosis e inflamación periductal. Objetivo: Presentar un caso de EDM, para facilitar el rápido reconocimiento por parte de los médicos, y evitar estudios y tratamientos agresivos. Caso clínico: Lactante de sexo masculino de 6 meses de edad, sano, alimentado por lactancia materna exclusiva; consultó por un nódulo retroareolar derecho y telorragia unilateral. Se realizó una ecografía Doppler que mostró una lesión multiquística, sugerente de una EDM. Se planteó tratamiento expectante y acudió a control a los 6 meses con excelente evolución. Conclusiones: La EDM es la principal causa de telorragia en niños, corresponde a una afección benigna, y la resolución generalmente es espontánea, antes de los 9 meses. Por lo que su conocimiento es de gran relevancia para el adecuado diagnóstico y manejo de estos pacientes.

Introduction: Bloody nipple discharge is an infrequent symptom during childhood. The most common cause in this population is mammary duct ectasia (MDE), which is a benign and self-limiting condition, that is characterized by dilatation of the mammary ducts, fibrosis and periductal inflammation. Objective: Report of a case of MDE in order to improve physicians’ diagnosis accuracy and avoid aggressive studies and treatments. Case report: Six-months old male healthy infant, exclusively breastfeeded, that visited our clinic with a lump beneath his right nipple and bloody discharge from the same nipple. An ultrasound was performed which showed a multicystic lesion suggestive of MDE. Watchful waiting was decided as treatment, with good evolution after six months of follow up. Conclusions: The MDE is the leading cause of bloody discharge in pediatric population, being a benign condition that resolves spontaneously before nine months. The knowledge of this condition is essential so as to accurately diagnose and treat it.

[Ebola: characterization, history and cutaneous manifestations]. / Ébola: caracterización, historia y manifestaciones cutáneas; lo que debemos saber.

Ebola virus (EV) is one of the most virulent human pathogens. Fruits bats are its natural reservoir, the transmission to humans is across wild animals (especially primates) and the propagation in human populations is through bodily fluid contact. The actual outbreak started in December 2013 and crossed continental borders. Up to now, there are 17,145 suspected and confirmed cases with 6,070 deaths, resulting a total case fatality rate of 35%. Clinical manifestations can be divided in 3 phases. In phase I, symptoms are similar to flu, which may appear in a range of 2 to 21 days. In phase II which occurs in over 50% of cases, visceral symptoms and mucocutaneous manifestations appear within 4 and 5 days of the onset of symptoms. The main symptoms are a macular or maculopapular non-pruritic rash, desquamation and mucosal involvement of eyes, mouth and pharynx. In phase III, recovery or death occurs. The diagnosis is made on clinical grounds, epidemiological suspicion and a positive polymerase chain reaction (PCR) test. The treatment is supportive. If there is a suspected case, it should be notified immediately and all relevant safety measures should be instituted.