RESUMEN
Injection of soft tissue fillers for esthetic purposes is considered a relatively simple, minimally invasive procedure. Although rare, significant complications exist and may occur in the setting of both non-medical grade and medical-grade silicone fillers, administered by untrained or trained providers. We report a case of a 61 y/o male with an unusual case of foreign body granulomas arising on his forehead and periorbital region for the past 3 years. He had no drug allergies or history of trauma. He only recalled administration of "Botox" near the affected area 20 years ago, although he acknowledged being unsure of the nature of the substance. Examination showed bilateral, periorbital, edematous plaques, with subcutaneous nodules on the forehead. Punch biopsy showed multiple vacuoles surrounded by collagen bundles in the dermis, a histiocytic infiltrate, and multinucleated giant cells. Based on clinicopathological correlation, a diagnosis of foreign body granuloma related to silicone filler injections was made. He was treated with intralesional steroids and doxycycline 100 mg twice daily with complete resolution. Physicians should acknowledge this potential complication of silicone fillers and should inquire about their use with close-ended questions. We also review the diagnostic and therapeutic challenges faced by physicians when encountering this diagnosis.
Asunto(s)
Técnicas Cosméticas , Rellenos Dérmicos , Granuloma de Cuerpo Extraño , Colágeno , Técnicas Cosméticas/efectos adversos , Rellenos Dérmicos/efectos adversos , Edema/etiología , Cara/patología , Frente/patología , Granuloma de Cuerpo Extraño/diagnóstico , Granuloma de Cuerpo Extraño/etiología , Granuloma de Cuerpo Extraño/terapia , Humanos , Ácido Hialurónico , MasculinoRESUMEN
This is a report of a 15-year-old female who presented with a skin eruption and clinical features consistent with severe sepsis and septic shock. A diagnosis of acquired hemophagocytic lymphohistiocytosis (HLH) was made and confirmed by bone marrow analysis. Skin biopsy showed hemophagocytosis and CD163-positive staining of macrophages. We briefly review the clinical, histologic, and laboratory findings of hemophagocytic lymphohistiocytosis in addition to the potential role of skin biopsies in this condition.
Asunto(s)
Linfohistiocitosis Hemofagocítica/diagnóstico , Adolescente , Biopsia , Femenino , Humanos , Piel/patologíaAsunto(s)
Angiomatosis/patología , Enfermedades de la Mama/patología , Enfermedades de la Piel/patología , Úlcera Cutánea/patología , Adulto , Angiomatosis/fisiopatología , Biopsia con Aguja , Enfermedades de la Mama/fisiopatología , Fármacos Dermatológicos/uso terapéutico , Diagnóstico Diferencial , Femenino , Humanos , Inmunohistoquímica , Pronóstico , Recurrencia , Cuidados de la Piel/métodos , Enfermedades de la Piel/fisiopatología , Úlcera Cutánea/fisiopatología , Cicatrización de Heridas/fisiologíaAsunto(s)
Angiomatosis/patología , Enfermedades de la Mama/patología , Enfermedades de la Piel/patología , Úlcera Cutánea/patología , Adulto , Angiomatosis/fisiopatología , Angiomatosis/terapia , Biopsia con Aguja , Enfermedades de la Mama/fisiopatología , Fármacos Dermatológicos/uso terapéutico , Diagnóstico Diferencial , Femenino , Humanos , Inmunohistoquímica , Pronóstico , Recurrencia , Cuidados de la Piel/métodos , Enfermedades de la Piel/fisiopatología , Enfermedades de la Piel/terapia , Úlcera Cutánea/fisiopatología , Cicatrización de Heridas/fisiologíaRESUMEN
It has been proposed by many authors that follicular mucinosis is directly associated with mycosis fungoides (MF). Follicular mucinosis may be classified into 3 main clinical variants: a benign idiopathic form in children and young adults, which includes an acneiform presentation; an idiopathic form in older patients with a benign course; and a third variant that occurs in adults and is associated with MF. Our goal was to study the relationship between the acneiform variant of follicular mucinosis and MF. Eight patients previously diagnosed with the acneiform variant of follicular mucinosis were identified. Biopsy specimens were reviewed to evaluate the histopathologic attributes that characterize the disease and the infiltrate's immunohistochemistry. Also, patient follow-up was assessed to evaluate the clinical course of the disease. Median age of onset of disease was 29.5 years; 95% of lesions were located in the head and neck region. Biopsy specimens showed a moderate to dense perivascular, perifollicular, and interstitial infiltrate of lymphocytes with mucinous deposits within the follicular epithelium. On immunohistochemistry, the infiltrate showed prominent leukocyte common antigen (LCA) positivity and a CD3-positive and CD4-positive infiltrate with rare CD20-positive cells. None of the study patients showed evidence of MF after a mean follow-up of 3 years. The benign course of disease demonstrated in the study patients suggests that the acneiform variant of follicular mucinosis probably represents a subpopulation of the benign idiopathic form of the disease. However, given that histopathologically this variant cannot be distinguished from the lymphoma-associated variant of follicular mucinosis, longitudinal evaluation is still warranted in these patients.
Asunto(s)
Erupciones Acneiformes/etiología , Erupciones Acneiformes/patología , Mucinosis Folicular/complicaciones , Mucinosis Folicular/patología , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Adulto JovenAsunto(s)
Lepra Lepromatosa/patología , Molusco Contagioso/patología , Niño , Diagnóstico Diferencial , Humanos , MasculinoRESUMEN
OBJECTIVE: To describe the behavior of non-melanoma skin cancer (NMSC) based on tumor's characteristics. METHODS: A total of 219 of NMSC were analyzed via a retrospective medical chart review. The data obtained from each record included but was not limited to: number of Mohs micrographic surgery (MMS) stages required for tumor clearance, defect size, repair type and size according to the neoplasm's histopathologic subtype. RESULTS: The mean number of stages required to clear morpheaphorm/infiltrative and micronodular basal cell carcinomas (BCCs) (n= 34) was 2.03, while the nodular and superficial BCCs (n= 125) needed a mean of 1.56 stages (p value= .034). Of the tumors located on a high-risk zone, 59.6% required two or more stages to be cleared while 67.7% of the lesions on a non-high risk zone were cleared with one stage (p value = 0.001). Recurrent tumors required a mean 2.22 MMS stages to be cleared, whereas primary tumors required a mean 1.61 stages (p value= .006). CONCLUSION: Subclinical spread was seen in morpheaform/infiltrative and micronodular BCC histologic subtypes, recurrent tumors, and tumors in high-risk locations. These could help predict aggressive tumor behavior and optimize surgical planning.