Assuntos
Melanoma , Nevo Pigmentado , Neoplasias Cutâneas , Dermoscopia , Humanos , Lactente , Masculino , Nevo Pigmentado/diagnósticoRESUMO
Chromoblastomycosis and phaeohyphomycosis are melanized fungal infections, which affect skin and subcutaneous tissues in immunocompetent and immunosuppressed patients, as solid-organ transplant recipients, respectively. In this present study, we report six cases of melanized fungal infection in kidney transplant recipients. In five cases, culture of tissue specimens identified two cases of Exophiala spp. and three cases of Fonsecaea spp. Molecular identification was performed in three cases based on sequencing of rDNA (ITS region) that revealed the following agents: Exophiala xenobiotica, Exophiala bergeri and Fonsecaea monophora. Clinically, they presented verrucous lesion, erythematous-squamous plaque, nodules and lymphangitic distribution. Histopathological aspect was tuberculous granuloma, with concomitant presence of muriform bodies and hyphae. Some patients presented fungal transepithelial elimination. One patient received only terbinafine. Three patients underwent surgery, and two of them received itraconazole. In these four cases, the infection did not relapse. The other two patients were treated only with itraconazole, one of them is still under treatment and the other one was lost to follow-up. These patients presented clinical and histopathological characteristics ranging from resistant to nonresistant forms.
Assuntos
Ascomicetos/isolamento & purificação , Transplante de Rim , Micoses/microbiologia , Micoses/patologia , Transplantados , Adulto , Idoso , Antifúngicos/uso terapêutico , Ascomicetos/classificação , Ascomicetos/genética , DNA Fúngico/química , DNA Fúngico/genética , DNA Espaçador Ribossômico/química , DNA Espaçador Ribossômico/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/tratamento farmacológico , Análise de Sequência de DNA , Resultado do TratamentoRESUMO
BACKGROUND: Adverse cutaneous drug reactions are frequent in hospital settings and are responsible for increased morbidity, mortality, and socioeconomic costs. The objective of this study was to identify high risk factors in hospitalized patients with adverse cutaneous drug reactions. METHODS: This descriptive and retrospective study was performed with data from 117 patients admitted to a quaternary hospital over 44 months. We reviewed their epidemiological data, suspected drugs, clinical presentation, histopathological diagnosis, and outcome. Statistical analysis was performed using the chi-squared test with a significance level of 5%. RESULTS: Anticonvulsants were responsible for 23.9% of cases followed by antibiotics (22.2%). In 29% of cases, patients were taking multiple medications that could have triggered their reactions. The most common clinical forms were exanthema (37.6%), drug reaction with eosinophilia and systemic symptoms (DRESS) (14.5%), and Stevens-Johnson syndrome/toxic epidermal necrolysis (12.8%). Anticonvulsants were associated with severe forms of adverse drug reactions. Most patients (89.7%) presented clinical improvement after treatment. There was a relationship between the use of anticonvulsants and atypical lymphocytes in the dermal infiltrate, as well as the clinical form DRESS and atypical lymphocytes in the dermal infiltrate. CONCLUSIONS: The use of anticonvulsants was a high risk factor for severe clinical forms of drug reactions. The presence of atypical lymphocyte infiltrates in the dermis could indicate the use of anticonvulsants.
Assuntos
Antibacterianos/efeitos adversos , Anticonvulsivantes/efeitos adversos , Toxidermias/etiologia , Exantema/induzido quimicamente , Pustulose Exantematosa Aguda Generalizada/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Dermatite Esfoliativa/induzido quimicamente , Toxidermias/patologia , Toxidermias/terapia , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Síndrome de Hipersensibilidade a Medicamentos/patologia , Eritema Multiforme/induzido quimicamente , Feminino , Síndrome Mão-Pé/etiologia , Hospitais , Humanos , Linfócitos/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Síndrome de Stevens-Johnson/etiologia , Urticária/induzido quimicamente , Vasculite/induzido quimicamente , Adulto JovemRESUMO
Paget's disease, described by Sir James Paget in 1874, is classified as mammary and extramammary. The mammary type is rare and often associated with intraductal cancer (93-100% of cases). It is more prevalent in postmenopausal women and it appears as an eczematoid, erythematous, moist or crusted lesion, with or without fine scaling, infiltration and inversion of the nipple. It must be distinguished from erosive adenomatosis of the nipple, cutaneous extension of breast carcinoma, psoriasis, atopic dermatitis, contact dermatitis, chronic eczema, lactiferous ducts ectasia, Bowen's disease, basal cell carcinoma, melanoma and intraductal papilloma. Diagnosis is histological and prognosis and treatment depend on the type of underlying breast cancer. Extramammary Paget's disease is considered an adenocarcinoma originating from the skin or skin appendages in areas with apocrine glands. The primary location is the vulvar area, followed by the perianal region, scrotum, penis and axillae. It starts as an erythematous plaque of indolent growth, with well-defined edges, fine scaling, excoriations, exulcerations and lichenification. In most cases it is not associated with cancer, although there are publications linking it to tumors of the vulva, vagina, cervix and corpus uteri, bladder, ovary, gallbladder, liver, breast, colon and rectum. Differential diagnoses are candidiasis, psoriasis and chronic lichen simplex. Histopathology confirms the diagnosis. Before treatment begins, associated malignancies should be investigated. Surgical excision and micrographic surgery are the best treatment options, although recurrences are frequent.
Assuntos
Neoplasias da Mama/patologia , Doença de Paget Extramamária/patologia , Doença de Paget Mamária/patologia , Neoplasias Cutâneas/patologia , Neoplasias da Mama/terapia , Carcinoma/patologia , Carcinoma/terapia , Diagnóstico Diferencial , Feminino , Neoplasias dos Genitais Masculinos/patologia , Neoplasias dos Genitais Masculinos/terapia , Humanos , Masculino , Mamilos/patologia , Doença de Paget Extramamária/terapia , Doença de Paget Mamária/terapia , Neoplasias Cutâneas/terapia , Neoplasias Vulvares/patologia , Neoplasias Vulvares/terapiaRESUMO
Paget's disease, described by Sir James Paget in 1874, is classified as mammary and extramammary. The mammary type is rare and often associated with intraductal cancer (93-100% of cases). It is more prevalent in postmenopausal women and it appears as an eczematoid, erythematous, moist or crusted lesion, with or without fine scaling, infiltration and inversion of the nipple. It must be distinguished from erosive adenomatosis of the nipple, cutaneous extension of breast carcinoma, psoriasis, atopic dermatitis, contact dermatitis, chronic eczema, lactiferous ducts ectasia, Bowen's disease, basal cell carcinoma, melanoma and intraductal papilloma. Diagnosis is histological and prognosis and treatment depend on the type of underlying breast cancer. Extramammary Paget's disease is considered an adenocarcinoma originating from the skin or skin appendages in areas with apocrine glands. The primary location is the vulvar area, followed by the perianal region, scrotum, penis and axillae. It starts as an erythematous plaque of indolent growth, with well-defined edges, fine scaling, excoriations, exulcerations and lichenification. In most cases it is not associated with cancer, although there are publications linking it to tumors of the vulva, vagina, cervix and corpus uteri, bladder, ovary, gallbladder, liver, breast, colon and rectum. Differential diagnoses are candidiasis, psoriasis and chronic lichen simplex. Histopathology confirms the diagnosis. Before treatment begins, associated malignancies should be investigated. Surgical excision and micrographic surgery are the best treatment options, although recurrences are frequent.
Assuntos
Feminino , Humanos , Masculino , Neoplasias da Mama/patologia , Doença de Paget Extramamária/patologia , Doença de Paget Mamária/patologia , Neoplasias Cutâneas/patologia , Neoplasias da Mama/terapia , Carcinoma/patologia , Carcinoma/terapia , Diagnóstico Diferencial , Neoplasias dos Genitais Masculinos/patologia , Neoplasias dos Genitais Masculinos/terapia , Mamilos/patologia , Doença de Paget Extramamária/terapia , Doença de Paget Mamária/terapia , Neoplasias Cutâneas/terapia , Neoplasias Vulvares/patologia , Neoplasias Vulvares/terapiaAssuntos
Carcinoma/patologia , Neoplasias Faciais/patologia , Transplante de Rim , Neoplasias Pulmonares/secundário , Neoplasias Parotídeas/secundário , Neoplasias das Glândulas Sudoríparas/patologia , Idoso , Carcinoma/secundário , Diferenciação Celular , Evolução Fatal , Humanos , Hospedeiro Imunocomprometido , MasculinoRESUMO
OBJECTIVES: The clinical significance of nevus-associated melanoma compared with de novo melanomas remains controversial. It has been suggested that nevus-associated melanomas have a higher Breslow thickness and therefore worse prognosis. Over a 10-year period, this study evaluated the incidence of nevus-associated melanoma and its prognostic significance related to clinicopathologic features. METHODS: Cross-sectional study from 1995 through 2004 in a dermatopathology referral center. With available data, we evaluated sex, primary location, histologic subtype, Breslow thickness, Clark level, presence of ulceration, associated lesion, and histologic subtype of the associated lesion. RESULTS: Of 135,653 pathologic records from skin biopsy specimens over a 10-year period, 1,190 melanoma records were selected. Nevus-associated melanomas corresponded to 390 (32.8%) melanomas, with thin melanomas having a nevus 1.52 times the association observed with thick melanomas (>1.01 mm; 95% confidence interval, 1.16-1.99; P < .001). Superficial spreading melanoma was the most frequent, while no lentigo maligna melanoma was associated with nevi. The median Breslow thickness of nevus-associated melanomas was lower than that of de novo melanomas. CONCLUSIONS: Nevus-associated melanomas, which represent one-third of the melanomas in southeast Brazil, are associated with intermittent sun exposure, superficial spreading melanomas, and lower Breslow thickness. This is one of the largest series describing nevus-associated melanomas in Latin America.
Assuntos
Melanoma/patologia , Nevo/patologia , Neoplasias Cutâneas/patologia , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Melanoma/epidemiologia , Nevo/epidemiologia , Nevo Pigmentado/epidemiologia , Nevo Pigmentado/patologia , Prognóstico , Neoplasias Cutâneas/epidemiologia , Luz Solar/efeitos adversos , Melanoma Maligno CutâneoRESUMO
BACKGROUND: Pigmented actinic keratosis (PAK) is a frequent simulator of lentigo maligna (LM) on the face upon clinical and dermoscopic examination, leading to misdiagnosis and unnecessary excisions. LM and PAK share dermoscopic features, making it difficult to have a confident diagnosis of PAK only with current dermoscopic knowledge. OBJECTIVE: We sought to evaluate sensitivity, specificity, and interobserver reproducibility of a novel dermoscopic feature, inner gray halo (IGH), and establish its histopathological and confocal correlations. METHODS: Dermoscopists blinded to histopathological diagnosis evaluated 58 PAK and 21 LM for the presence of IGH and dermoscopy parameters. Areas exhibiting IGH were marked and imaged with reflectance confocal microscopy before sampling for histopathologic correlation. Reflectance confocal microscopy and transverse histologic sectioning were performed in 14 of 79 cases. RESULTS: IGH was present in 53 of 58 (94.1%) PAK and in 5 of 21 (23.8%) LM in our series (sensitivity 91.4%; specificity 71.4%; positive predictive value 89.8%). Interobserver agreement was excellent (Kappa 0.846). Through transverse and perpendicular histologic sections, a dermoscopic-histologic-confocal correlation of IGH was established. LIMITATIONS: A larger test set is needed to further validate the use of IGH in the differential diagnosis of PAK and facial pigmented lesions. CONCLUSION: IGH is a novel dermoscopic parameter useful for the differentiation of PAK from LM on the face.
Assuntos
Sarda Melanótica de Hutchinson/diagnóstico , Hiperpigmentação/diagnóstico , Ceratose Actínica/diagnóstico , Lesões Pré-Cancerosas/patologia , Neoplasias Cutâneas/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Brasil , Estudos de Coortes , Intervalos de Confiança , Dermoscopia/métodos , Diagnóstico Diferencial , Face , Feminino , Humanos , Sarda Melanótica de Hutchinson/patologia , Sarda Melanótica de Hutchinson/ultraestrutura , Hiperpigmentação/patologia , Imuno-Histoquímica , Ceratose Actínica/patologia , Masculino , Microscopia Confocal , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/ultraestruturaRESUMO
BACKGROUND: Oral isotretinoin (ISO) is the only drug which promotes prolonged remission or cure of severe acne. It also has other properties, supporting its use for non-acne indications. Retinoic acid (RA) is gold standard treatment for photoaging. ISO for photoaging treatment was reported in non-controlled trials as alternative to RA, which causes skin irritation. OBJECTIVE: To compare clinical, histological, and immunohistochemical effects of low-dose ISO and 0.05% topical RA to treat photoaging. METHODS: Randomized, comparative, evaluator-blinded, single-center study. Twenty-four healthy, Caucasian, 50 to 75-year-old men and women (menopausal or sterilized) with advanced photoaging were included. Twelve subjects received ISO, 20 mg/day, and 12 subjects were treated with RA cream, for six months; both treatments were administered every other day, and moisturizer and sunscreen were also used. Outcome measures included patient assessments, blinded photographic evaluations, Life Quality Index, histological (HE, Verhoeff) and immunohistochemical (p53, collagen type I) evaluations, adverse events, liver function, lipid profile, and blood count. Statistical analysis with generalized estimating equations and repeated measures ANOVA tests was used. RESULTS: Eleven subjects in each group completed the study. Patient and photographic assessments showed overall improvement in skin appearance. Quality-of-life scores were reduced for all subjects. Histological analysis revealed corneal layer diminution, epidermal thickness increase, and elastosis reduction. Immunohistochemical findings revealed significant epidermal p53 reduction and dermal collagen 1 increase. No differences were found between groups; laboratory tests showed no significant alterations. CONCLUSION: Despite being safe and effective, low-dose ISO was not superior to 0.05% RA for advanced photoaging treatment.