Granulomatous dermatitis in the context of chronic myelomonocytic leukemia: More than just reactive infiltrates. An illustrative case report with literature review.

Traditionally, skin involvement in chronic myelomonocytic leukemia (CMML) has been considered to be either specific (leukemia cutis) or non-specific, with granulomatous dermatitis included in the latter group. More recently, the true nature of the myeloid cells present in the cutaneous infiltrates of this theoretically reactive dermatitis is being clarified with the use of new molecular techniques such as next-generation sequencing. The same mutations in bone marrow (BM) myeloid neoplastic cells and in the cells of cutaneous infiltrates have been found. We present the case of a 77-year-old man who presented with spread and treatment-resistant skin granulomatous lesions previous to the diagnosis of CMML. The same clonal mutations in SRSF2, IDH1, and RUNX1 were found in both skin and BM with resolution of the lesions after the initiation of azacytidine. In conclusion, we report an exceptional case in which specific granulomatous cutaneous lesions have preceded and allowed the earlier diagnosis of an underlying CMML and a review of all previous similar cases in the literature, including molecular alterations.

Gorlin-Like Phenotype in a Young Girl With a De Novo PTCH2 Variant Mutation of Uncertain Significance.

ABSTRACT: Gorlin syndrome, also known as basal cell nevus syndrome, is an autosomal dominant genetic disorder that predisposes humans to tumors. In most cases, this syndrome results from inactivating mutations in the patched homologue 1 gene. Basal cell carcinomas are one of the main characteristics of this syndrome and serve as a major diagnostic criterion. Gorlin syndrome shows a variable phenotype, and recently, other less common mutations in the suppressor of fused homologue or patched homologue 2 genes have been documented in individuals with this syndrome. We present the case of a patient with early-onset basal cell carcinomas and a mild Gorlin syndrome phenotype, attributed to a de novo patched homologue 2 variant of uncertain significance, which has not been previously reported in the literature.

Hydroa Vacciniforme Lymphoproliferative Disorder in a Young Spanish Woman: An Infrequent Case With Fatal Outcome.

ABSTRACT: Hydroa vacciniforme (HV) lymphoproliferative disorder is a rare NK/T-cell lymphoma mainly affecting children and with a clinical resemblance to HV, which is mostly reported in Latin American and some Asian countries. Overall, the mature T cell and NK-cell neoplasms are now grouped into 9 families based on diverse concepts: cell of origin/differentiation state, clinical scenario, disease localization, and cytomorphology. HV lymphoproliferative disorder is listed within the group of Ebstein Barr Virus-positive T-cell and NK-cell lymphoid proliferations and lymphomas of childhood according to the fifth edition of the World Health Organization Classification of mature lymphoid neoplasms. We report the extraordinary case of a 22-year-old white woman, native of Spain, first presented in 2016 when she started suffering from recurrent facial edema. Four years later, the disease progressed with lymph node spreading and a fatal outcome. Here, we describe the clinical and histological presentation of the lymphoma throughout its evolution. Cases like this can be difficult to classify posing a real challenge to clinicians and pathologists. So, it is vital to be aware of the rare presentation of this disease to be able to identify the clinical and histological picture to make a correct diagnosis and establish an early treatment.

Localized pemphigus vulgaris on scalp: an atypical presentation.

We present two middle-aged patients with pruritic, crusted scalp erosions. Skin biopsy showed epidermal acantholysis with IgG and C3 intercellular deposits on direct immunofluorescence, leading to the diagnosis of localized pemphigus vulgaris. Resolution of the lesions without relapse occurred after low doses of oral prednisone and intralesional triamcinolone acetonide.

Essential thrombocythemia manifesting as livedoid and purpuric skin lesions: Report of two cases and literature review.

Essential thrombocythemia is a chronic myeloproliferative syndrome which usually runs its course as an asymptomatic elevated platelet count. Cutaneous manifestations secondary to microcirculation abnormalities are rare but can represent a helpful diagnostic clue in order to prevent major thromboembolic events. We report two cases of heterogeneous livedoid and "net-like" skin lesions in the context of essential thrombocythemia with identical histopathologic findings (medium-sized blood vessels with luminal obliteration by eosinophilic material, mostly positive for the platelet marker CD61, without vasculitis). In conclusion, we seek to raise awareness of the clinicopathological features of essential thrombocythemia to allow for prompt diagnosis and treatment.

SUFU-associated Gorlin syndrome: Expanding the spectrum between classic nevoid basal cell carcinoma syndrome and multiple hereditary infundibulocystic basal cell carcinoma.

Basal cell nevus syndrome (BCNS), also known as Gorlin syndrome, is characterized by an aberrant activation of the hedgehog (Hh) pathway, most cases being caused by PTCH1 mutations. However, certain features such as multiple hereditary infundibulocystic basal cell carcinomas (MHIBCC), sclerotic fibromas, childhood medulloblastoma or meningioma may be relatively specific to a SUFU mutation. We present two patients with MHIBCC, along with a more complex cutaneous and extracutaneous phenotype. MHIBCC syndrome and BCNS may share clinical features and, indeed, both syndromes probably represent different degrees of upregulation in the Hh pathway.

Granulomatous Dermatitis Heralding Myelodisplastic/Myeloproliferative Neoplasms. Neoplastic or Reactive Cells? A Study of 2 Cases.

ABSTRACT: Skin manifestations in the context of underlying hematological malignancies are well known and not an infrequent clinical finding. They can represent specific neoplastic infiltrates or be considered as reactive. In the latter group, where granulomatous dermatitis is included, controversy has emerged recently. According to newly reported data, the histiocytes comprising these granulomata can carry the same molecular alterations found in the primary process. Moreover, the skin manifestations in these patients are sometimes the initial clue for the diagnosis of the underlying malignancy. We present here 2 cases with granulomatous skin infiltrates preceding the diagnosis of myelodysplastic/myeloproliferative neoplasms. In one of them, the same IDH2 mutation was detected in granulomatous lesions on the skin and in the bone marrow. This was performed by pyrosequencing instead of next-generation sequencing, with improved cost-effectiveness.

Discoid Lupus Erythematosus Presenting With Disfiguring Acneiform Plaques: A Diagnostic Challenge.

ABSTRACT: Hypertrophic and acneiform forms are very rare variants of discoid lupus erythematosus (DLE), which can suppose a diagnostic and therapeutic challenge. We present a South American woman with facial disfiguring lesions of 7 years of evolution with clinical and histopathological characteristic of both hypertrophic and acneiform DLE. No criteria for systemic lupus erythematosus were present in the patient. To the best of our knowledge, no patients with concomitant hypertrophic and acneiform DLE have been previously reported in the literature.

Saturday night purpura: An uncommon presentation of exercise-induced vasculitis.

Exercise-induced vasculitis (EIV) is a benign cutaneous vasculitis that affects healthy individuals. We report a case of EIV in a 15-year-old male patient with a striking clinical appearance triggered by a combination of prolonged standing and disco dancing in a warm environment. Pediatric dermatologists should be aware of this activity as a possible trigger of EIV, especially in teenagers.

[ChatGPT is an above-average student at the Faculty of Medicine of the University of Zaragoza and an excellent collaborator in the development of teaching materials]. / ChatGPT es un estudiante por encima de la media en la Facultad de Medicina de la Universidad de Zaragoza y un colaborador excelente en la elaboración de material docente.

INTRODUCTION AND OBJECTIVE: Artificial intelligence is fully present in our lives. In education, the possibilities of its use are endless, both for students and teachers. MATERIAL AND METHODS: The capacity of ChatGPT has been explored when solving multiple choice questions based on the exam of the subject «Anatomopathological Diagnostic and Therapeutic Procedures¼ of the first call of the 2022-23 academic year. In addition, to comparing their results with those of the rest of the students presented the probable causes of incorrect answers have been evaluated. Finally, its ability to formulate new test questions based on specific instructions has been evaluated. RESULTS: ChatGPT correctly answered 47 out of 68 questions, achieving a grade higher than the course average and median. Most failed questions present negative statements, using the words «no¼, «false¼ or «incorrect¼ in their statement. After interacting with it, the program can realize its mistake and change its initial response to the correct answer. Finally, ChatGPT can develop new questions based on a theoretical assumption or a specific clinical simulation. CONCLUSIONS: As teachers we are obliged to explore the uses of artificial intelligence and try to use it to our benefit. Carrying out tasks that involve significant consumption, such as preparing multiple-choice questions for content evaluation, is a good example.

[Collision tumours in skin: usually an incidental finding. A retrospective study with literature revision]. / Tumores de colisión en la piel: un hallazgo incidental en la mayoría de los casos. Estudio retrospectivo y revisión de la literatura.

A collision tumour (CT) is a neoplastic lesion comprised of two or more distinct cell populations that maintain distinct borders. Mostly, these are incidental findings in skin biopsies, whose pathologic mechanism and prevalence remain unknown, with few references among literature. Here, we present a retrospective study of CT, diagnosed by a dermatopathologist in our hospital between 2019-2022. Lesions have been defined individually and organized into three categories: benign-benign (BB), benign-malignant (BM) and malignant-malignant (MM). A total of 108 CT were diagnosed (1,4% of the biopsies from the dermatopathologist during this period), from which BM was the most frequent collision (48,5%). Globally, basal cell carcinoma (BCC) was the main malignant lesion and melanocytic nevus (MN) the main benign lesion. We have used the software Stata 14.2 in order to analyse results, and we have detected a statistically significant difference between age and collision type.

Cutaneous Alternariosis in Immunosuppressed Patients Treated with Photodynamic Therapy and Oral Antifungals, a Synergistic Strategy.

Cutaneous alternariosis is a rare condition, more frequently presented in immunocompromised patients, which usually requires long courses of systemic antifungals that may interact with other medications. The presented series shows three cases of cutaneous alternariosis in immunocompromised patients and organ transplant recipients that were successfully treated with photodynamic therapy and oral antifungals, allowing a reduction in the systemic treatment duration and therefore decreasing the risk of side effects and drug interactions.