[Melanoma within tattoos: Two cases and a systematic literature review]. / Mélanomes sur tatouage : deux observations et revue systématique de la littérature.

BACKGROUND: There have been reports of malignant melanoma arising within tattoos. However, there is no clear relationship between tattoos and the development of cutaneous malignancies. We report two new cases of melanoma and provide a review of cases of melanoma reported in the medical literature. PATIENTS AND METHODS: Case No. 1: a 61-year-old patient consulted following the appearance one year ago of a nodular lesion measuring 4.5×3cm on a blue and red tattoo on his back. Complete excision of the lesion with histological analysis revealed an ulcerated nodular melanoma with a Breslow depth of 7mm. No secondary sites were found. Case No. 2: a 39-year-old patient with a blue tattoo on his left arm consulted following the appearance of a pigmented lesion a few months earlier. Surgical excision was immediately performed, confirming the diagnosis of SSM, with a Breslow depth of 0.9mm. There was no sign of relapse 9 years later. DISCUSSION: In our systematic review we noted 34 cases of melanoma occurring in tattoos. There was a high male prevalence (90.3%) and a relatively young mean age (45.9 years). Most tattoos were monochrome (71.0%). The average time between tattooing and onset of melanoma was 13.2 years. The most common sites of melanoma were the upper limbs (53.1%) and trunk (34.4%). Mean tumor size was 11.6mm. Histologic examination revealed 2 cases of melanoma in situ, and in 13 cases, the Breslow depth was 1mm or less. In 5 cases, macroscopic or microscopic lymph node metastasis (sentinel lymph node) was found at diagnosis, and in one case, in transit skin metastases were also observed at the time of diagnosis. We discuss the hypothetical pathogenic role of tattoos in melanoma.

[Linear cystic lesion of the median raphe in an 11-year-old child]. / Lésion linéaire kystique du raphé médian chez un enfant de 11 ans.

BACKGROUND: Median raphe cysts are rare benign lesions of the male genitalia. They may be present along the entire raphe, from the urethral meatus to the anus, in the median position. We report herein a case of median raphe cyst with an atypical clinical and histological presentation. PATIENTS AND METHODS: An 11-year-old boy consulted in dermatology for an asymptomatic perineal lesion. The clinical examination revealed a linear cystic lesion with clear content extending from the base of the scrotum to the anus. The histological diagnosis was a superficial dermal glandular cyst suggestive of a possibly apocrine origin in this topography, or possibly due to malformation. DISCUSSION: Different clinical and histological features of median raphe cysts have been reported in the literature. Treatment is mainly surgical.

[Cutaneous tuberculosis and erythema induratum: a retrospective study of 13 cases in France]. / Tuberculose cutanée et érythème induré de Bazin: étude rétrospective de 13 cas.

BACKGROUND: Tuberculosis is the most common mycobacterial disease in the world. The cutaneous form is rare in low endemic countries. The occurrence of several cutaneous tuberculosis cases in our dermatology department during 2011-2012 led us to investigate whether there was a resurgence of cutaneous tuberculosis in France. The aim was to analyse changes in cutaneous tuberculosis and the related clinical, microbiological and therapeutic data. PATIENTS AND METHODS: We conducted a retrospective study in our hospital between 2005 and 2012 by querying the PMSI database (code: A 18.4). Epidemiological, clinical, paraclinical and therapeutic data were collected. Erythema induratum was regarded as a variety of cutaneous tuberculosis. RESULTS: Thirteen patients presented cutaneous tuberculosis between 2005 and 2012. The most frequent clinical forms were erythema induratum of Bazin (n=6) and scrofuloderma (n=3). Microbiological evidence was provided in only 4 cases. DISCUSSION: Diagnosis is difficult due to the varied clinical forms and to the relatively high frequency of paucibacillary forms. Further, the set of additional examinations is non-specific. In some cases, it is only therapeutic tests that allow diagnosis to be made. The place of new diagnostic tools must be clarified and a universally acceptable definition of erythema induratum devised.

Massive rectal bleeding distant from a blunt car trauma.

Mesenteric trauma is one of the possible injuries caused by the use of seat belts in case of motor vehicle crash. We report here a rare case of rectal bleeding by rupture of a mesosigmoid haematoma. An emergent laparotomy revealed a mesosigmoid haematoma with a centimetric rectal perforation. The wearing of safety belts added some specific blunt abdominal trauma, which directly depends on lap-and-sash belts. Mesenteric injuries are found out up to 5% of blunt abdominal traumas. "Seat belt mark" leads the surgical team to strongly suspect an intra-abdominal trauma. When "seat belt mark" sign is found, in patients with mild to severe blunt car injuries, CT-scan has to be realised to eliminate intra-abdominal complications, including mesenteric and mesosigmoid ones. In case of proved mesenteric haematoma associated to intestinal bleeding, a surgical treatment must be considered as first choice. Conservative approach remains possible in stable patients but surgical exploration remains necessary in unstable patients with active bleeding.

[Long-term efficacy of autologous stem cell transplantation for stage IV mycosis fungoides]. / Efficacité a long terme d'une autogreffe de cellules souches au cours d'un mycosis fongoïde de stade IV.

BACKGROUND: Mycosis fungoides during large cell transformation to lymphoma has a poor prognosis with mean survival of 36 months. Autologous stem cell transplantation is rarely proposed in this indication. We report the case of a young man still in complete remission for transformed mycosis fungoides 14 years after autologous stem cell transplantation. CASE REPORT: A 25-year-old man presenting eczema-like patches since childhood was treated by chemotherapy for multiple lymphadenopathies considered as Hodgkin's lymphoma. He was referred with diffuse skin tumours and infiltrated patches. Histology of tumour samples revealed atypical T-cell infiltrate with epidermotropism and presence of more than 25% of large CD30-positive cells. Non-infiltrated patches showed small T-cell lymphoma with epidermotropism. Histological verification of a previous lymphadenopathy confirmed the diagnosis of transformed mycosis fungoides. Despite multiple courses of chemotherapy, the disease progressed, with neurological involvement in particular. Because of tumour aggressiveness, autologous stem cell transplantation was performed and resulted in rapid regression of the tumours, lymphadenopathy and neurological symptoms. Non-transformed mycosis fungoides patches persisted but were controlled with topical mechlorethamine. This patient is still in complete remission for tumour and extracutaneous lesions 14 years after the autograft. DISCUSSION: This was probably a case of juvenile mycosis fungoides diagnosed and transformed in adult age. Neurological involvement by mycosis fungoides is rare and usually carries a drastic prognosis. To our knowledge, this is the longest remission of transformed mycosis fungoides seen after autograft. It highlights the value of this method in aggressive transformed mycosis fungoides, especially in patients ineligible for allograft.

[Pseudo-autoinflammatory attacks of temporal arteritis]. / Manifestations d'allure auto-inflammatoire d'une maladie de Horton.

INTRODUCTION: Usually, temporal arteritis progresses as a chronic disease. CASE REPORT: The authors report the observation of a 74-year-old woman who presented with two acute flares of temporal arteritis with headache, fever and inflammatory syndrome, which have spontaneously resolved. DISCUSSION: The observations of auto-inflammatory attacks of arteritis disease are rare, but maybe underestimated. The pathophysiology remains unclear.

Tuberculosis of the sacroiliac joint: clinical features, outcome, and evaluation of closed needle biopsy in 11 consecutive cases.

Sacroiliac joint (SIJ) involvement has been reported in up to 9.7 percent of patients with skeletal tuberculosis. Lack of awareness of this now uncommon form of infection often leads to diagnostic delay and increased morbidity. Eleven consecutive cases of SIJ tuberculosis are reported; clinical and radiologic features, diagnosis, treatment, and outcome are discussed. Buttock pain was the presenting complaint in all patients. However, radicular pain in the lower back (seven patients) or lower limb (10 patients) was common and in one patient precipitated an unnecessary surgical intervention. SIJ tuberculosis is frequently an isolated phenomenon. Therefore, direct sampling of the SIJ is necessary to establish the diagnosis. The recently described technique of closed needle biopsy of the SIJ was employed in all 11 patients and established the diagnosis in nine of the 11.

Association of human herpesvirus 6 infection with drug reaction with eosinophilia and systemic symptoms.

BACKGROUND: There is a current debate regarding the association of human herpesvirus 6 (HHV-6) infection and drug reaction with eosinophilia and systemic symptoms (DRESS). METHODS: Seven consecutive patients hospitalized with DRESS were enrolled in a prospective study to evaluate evidence of active HHV-6 infection. OBSERVATIONS: The imputable drugs were carbamazepine (5 patients), ibuprofen (1 patient), and sulfasalazine (1 patient). All patients were seropositive for anti-HHV-6 IgG antibodies. Anti-HHV-6 IgM antibodies were detected in 4 of the 7 patients with a seroconversion in 2 patients. Neither anti-cytomegalovirus nor anti-Epstein-Barr virus early antigen IgM antibody was detected. Human herpesvirus 6 genome was not detected by polymerase chain reaction in the first serum sample of all patients. It was weakly detected in skin lesions in the last patient tested by polymerase chain reaction but was not found in uninvolved skin. CONCLUSIONS: The results suggest an association between HHV-6 active infection (primo-infection or reactivation) and severe DRESS. Absence of anti-cytomegalovirus or anti-Epstein-Barr virus early antigen IgM antibodies argues against a nonspecific viral reactivation. Human herpesvirus 6 infection may play a role in the development of DRESS in susceptible patients. Some drugs with reactive metabolites could favor reactivation and propagation of HHV-6.

Bullous pemphigoid in a leg affected with hemiparesia: a possible relation of neurological diseases with bullous pemphigoid?

We report a typical case of bullous pemphigoid (BP) associated with a neurological disorder and study a possible link between neurological disorders and BP. An 84-year-old hemiplegic woman presented with unilateral BP on the hemiparetic side. BP was confirmed by histological and immunofluorescence data. The medical records of the previous 46 consecutive patients with BP were retrospectively analyzed (average age: 79; median age: 85). Thirty of the 46 patients with BP had neurological disorders. These disorders included dementia, epilepsy, multiple sclerosis, cerebral stroke, Parkinson's disease, gonadotropic adenoma, trembling, dyskinesia, lumbar spinal stenosis. In a control group of the 46 consecutive oldest patients (older than 71; average age: 82,5; median age: 80) with another skin disease referred during the previous two-year-period to our one-day-unit only, 13 patients had a neurological disorder. This study demonstrates that there is a high prevalence of neurological disorders in patients with BP (p = 0.0004). A prospective case control study with neurological examination and psychometrical evaluation is warranted to confirm these data. We speculate that neuroautoimmunity associated with the aging process or neurological disorders may be involved in pemphigoid development via an autoimmune response against dystonin which shares homology with bullous pemphigoid antigen 1. Bullous pemphigoid could be considered to be a marker of neurological disorder.

Spontaneous spinal epidural hematoma with spinal cord compression complicating plasma cell myeloma. A case report.

STUDY DESIGN: A case is reported in which a patient had acute paraplegia with sensory loss caused by a spontaneous epidural hematoma that was ascribed to bleeding of pre-existing myeloma lesions of the thoracic vertebrae. OBJECTIVES: To highlight the causes of secondary epidural hematomas with special attention to pre-existing vertebral or epidural lesions. SUMMARY OF BACKGROUND DATA: There are no apparent previous reports of epidural spinal hematomas ascribed to underlying malignant diseases. Benign dysplasia, such as hemangioma or Paget's disease, has been implicated in a few cases. METHODS: A case of spontaneous dorsal epidural hematoma is reported in a patient followed up for plasma cell myeloma with osteolytic lesions in the lower thoracic spine. There was no history of major trauma or coagulation disorders. Complete loss of motor and sensory function in both lower limbs was noted, with sphincter dysfunction. Magnetic resonance imaging of the thoracic spine showed a large posterolateral epidural hematoma responsible for spinal cord compression. RESULTS: The patient failed to improve despite surgical decompression within 6 hours of symptom onset. He died 13 days later of refractory bacterial pneumonia. A large epidural hematoma adjacent to myelomatous lesions of the thoracic vertebrae was found at autopsy. CONCLUSIONS: This is the first reported case of spontaneous epidural hematoma ascribed to underlying malignant disease, with confirmation of the diagnosis by postmortem examination. Possible mechanisms include tumor-related epidural inflammation and fragility of epidural venous plexuses.

[Wegener's granulomatosis and pregnancy. A case]. / Granulomatose de Wegener et grossesse. Une observation.

Pregnancy concomitant with Wegener's granulomatosis is extremely rare: so far, only four cases have been published. The authors report a fifth case where the disease appeared during the post-partum period, a situation which has already been noted in two of the published cases. Interruption of a subsequent pregnancy was followed by a flare-up of the disease resulting in the patient's death. This suggests that post-partum and post-abortum are probably instrumental in the onset and deterioration of Wegener's granulomatosis. The two patients previously reported who received immunosuppressants combined with corticosteroids had no flare-up after delivery. It seems permissible to prescribe such a therapeutic combination before and after delivery or abortion, especially since the fear of foetal toxicity from these drugs seems to be exaggerated.

[Muir-Torre syndrome. Multiple visceral cancers associated with an isolated sebaceous epithelioma]. / Syndrome de Muir-Torre. Cancers viscéraux multiples associés à un épithélioma sébacé isolé.

One case of Muir-Torre Syndrome (MTS) is reported. It is characterized by an unusual association of an unique cutaneous sebaceous epithelioma and multiple visceral adenocarcinomas. The patient was a 67 year-old white woman, from a family with inherited cancer syndrome, who developed previously four colic and one endometrial carcinomas. The morphologic spectrum of the cutaneous tumors observed in the MTS is represented by kerato-acanthoma and/or sebaceous tumors as in the original case described by Torre. The cutaneous tumors are usually multiple and follow after numerous visceral cancers such as colic, endometrial, urinary, or gastric carcinomas. The visceral cancers are remarkable because of the familial character, the multiplicity of tumors and the low-grade malignancy. Our case highlights the difficulty to make an accurate diagnosis for rare histological variants of cutaneous tumors in the MTS.

[Lympho-epithelial skin tumor. Case report with review of the literature and nosologic discussion]. / Tumeur lympho-épithéliale cutanée. A propos d'un cas avec revue de la littérature et discussion nosologique.

The clinical and histological findings of a lymphoepithelial tumor of the skin are presented and compared to the 11 cases already published in the literature. This review permits to point out the main characteristics of this recently described tumor. In 10 of the 11 cases the tumor is located on the face. The diagnosis of basal cell carcinoma is most often evoked. The mean age is 40 and 9 of the 11 cases are women. The tumor histologically presented as an epithelial proliferation of basaloid cells with peculiar features: cyst-like cavities infiltrated by mononuclear cells, histiocytic and lymphocytic cells; marks of pilosebaceous differentiation: curling of epithelial cells, areas of keratinisation, large clear cells of sebaceous aspect. The origin of this tumor is discussed and the hypothesis are oriented towards a rare histological form of basal cells carcinoma or a hair adnexial tumor. New cases would provide more informations to specify the nosological place of this tumor.

[Multicystic peritoneal mesothelioma. Ultrastructural and immunohistochemical study apropos of a case]. / Le mésothéliome multikystique péritonéal. Etude ultrastructurale et immunohistochimique à propos d'une observation.

Authors present the case of a 59 years old man in whom an intra abdominal mass was discovered fortuitly. A surgical intervention permitted to remove a retroperitoneal mass. The macroscopic features were similar to those of multicystic mesothelioma. A review of literature of the 31 cases published permits to present the characteristics of cystic mesothelioma. This entity was confound during a long time with cystic lymphangioma, from which it was distinguished in 1979 with the use of electron microscopy. Interest of studies in immunochemistry, already unpublished, is demonstrated here for Factor VIII and cytokeratin.

[Peripheral vascular leiomyosarcomas. Apropos of 2 cases]. / Léiomyosarcomes vasculaires périphériques. A propos de deux cas.

The authors report here two observations of leiomyosarcomas arising from peripheral blood vessels. The first case occurred in the pedious vein and infiltrated into tarsal bones. The second case was localized into leg muscles' tendons, near the knee. The topographical and histological characteristics of peripheral vascular leiomyosarcomas are noted, and compared, according to the review of literature, with those of the great central blood vessels, and of other classical leiomyosarcomas.

[Adenocarcinoma and primary osteosarcoma of the prostate. An unusual association]. / Adénocarcinome et ostéosarcome primitif de la prostate. Une association exceptionnelle.

The authors report an association of an adenocarcinoma and an osteosarcoma of the prostate in a 78-year-old man. He died within 18 months according to the bad prognosis encountered in the seven cases of prostatic primary osteosarcoma published in the literature.