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Rodríguez-Cuadrado FJ, Reneses-Prieto E, Silvestre-Egea G, López-López A, Nájera-Botello L, Alfonso-Alberola R, Moragón-Gordón M, Roustan-Gullón G, Onrubia-Pintado J, López-Negrete-Arenal E. Self-Healing Juvenile Cutaneous Mucinosis: A Report of Two Cases With Differing Evolution. Am J Dermatopathol 2023; Publish Ahead of Print:00000372-990000000-00214. [PMID: 37378474 DOI: 10.1097/dad.0000000000002485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
ABSTRACT Self-healing juvenile cutaneous mucinosis is a rare entity, characterized by the presence of subcutaneous nodules together with frequent nonspecific systemic symptoms, which occurs in the pediatric age and characteristically resolves spontaneously. Although the diagnostic criteria do not require a biopsy to be performed, it is frequently performed, and an abundant dermal mucin deposition will be observed together with other features such as fibroblastic proliferation. Although the prognosis is benign, follow-up is required for the eventual development of a rheumatologic disease.We present 2 clinical cases, describing the clinical findings and their histopathologic correlation. Comparatively, the outcome in both cases was different: in one case, the mucinosis resolved without any related event in the follow-up, and in the other case, the resolution was accompanied by the subsequent development of idiopathic juvenile arthritis.
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Affiliation(s)
| | - Elvira Reneses-Prieto
- Department of Pediatrics, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| | - Gala Silvestre-Egea
- Department of Pathology, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| | - Agustín López-López
- Department of Pediatrics, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| | - Laura Nájera-Botello
- Department of Pathology, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| | | | | | - Gaston Roustan-Gullón
- Department of Dermatology, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| | - José Onrubia-Pintado
- Department of Pathology, Hospital Universitario San Juan de Alicante, Alicante, Spain
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2
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Barry KK, Reusch DB, Schmidt BAR, Hawryluk EB. Pediatric Lichen Myxedematosus: A Diagnostic and Management Challenge. CHILDREN 2022; 9:children9070949. [PMID: 35883934 PMCID: PMC9322068 DOI: 10.3390/children9070949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 11/16/2022]
Abstract
Localized lichen myxedematosus (LM) is a rare, idiopathic mucinosis characterized by dermal mucin deposition and variable fibroblast proliferation. Nodular lichen myxedematosus, a clinicopathologic subtype of localized LM, is exceedingly rare in pediatric patients with only three prior cases reported. Understanding of LM in pediatric patients is limited by the rarity of the disease, and diagnosis is complicated by overlapping clinical and histopathologic features. There is no standardized treatment for localized LM and treatment is largely dictated by a patient’s desire to minimize cosmetic disfigurement. This case series reports two additional patients with juvenile nodular lichen myxedematosus, highlights the limitations of existing diagnostic criteria, and describes successful treatment of one patient with intralesional triamcinolone.
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Affiliation(s)
- Kelly K. Barry
- Tufts University School of Medicine, Boston, MA 02111, USA;
- Dermatology Section, Division of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Diana B. Reusch
- Dermatology Section, Division of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Birgitta A. R. Schmidt
- Department of Pathology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Elena B. Hawryluk
- Dermatology Section, Division of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Correspondence: ; Tel.: +617-643-2622
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3
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Bishnoi A, Jindal AK, Anjani G, Patra PK, Chatterjee D, Vinay K, Kanwar AJ, Dogra S, Singh S. Self-healing juvenile cutaneous mucinosis, a sclerodermoid disorder simulating juvenile dermatomyositis: a case-based review. Rheumatol Int 2020; 40:1911-1920. [PMID: 32462254 DOI: 10.1007/s00296-020-04578-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/07/2020] [Indexed: 12/21/2022]
Abstract
Self-healing juvenile cutaneous mucinosis (SHJCM) is a rare childhood disease with characteristic cutaneous and rheumatic manifestations. Cutaneous manifestations include a combination of nodules affecting peri-articular (especially interphalangeal joints) and head and neck areas; and linearly arranged ivory white papules over an erythematous indurated skin. Despite a benign course, an abrupt onset of symptoms with extensive cutaneous involvement often leads to parental anxiety, overenthusiastic evaluation and sometimes aggressive treatment. A peculiar cutaneous distribution in SHJCM including nodular lesions and periorbital edema, arthritis and arthralgia in a few cases, may simulate juvenile dermatomyositis. It is, therefore, important for dermatologists and pediatricians to be aware of this entity. In this report, we describe two cases of SHJCM and briefly review similarly reported cases in children.
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Affiliation(s)
- Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ankur Kumar Jindal
- Department of Pediatric Clinical Immunology and Rheumatology, Allergy Immunology Unit, Postgraduate Institute of Medical Education and Research, Advanced Pediatric Center, Chandigarh, 160012, India
| | - Gummadi Anjani
- Department of Pediatric Clinical Immunology and Rheumatology, Allergy Immunology Unit, Postgraduate Institute of Medical Education and Research, Advanced Pediatric Center, Chandigarh, 160012, India
| | - Pratap Kumar Patra
- Department of Pediatric Clinical Immunology and Rheumatology, Allergy Immunology Unit, Postgraduate Institute of Medical Education and Research, Advanced Pediatric Center, Chandigarh, 160012, India
| | - Debajyoti Chatterjee
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | | | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Surjit Singh
- Department of Pediatric Clinical Immunology and Rheumatology, Allergy Immunology Unit, Postgraduate Institute of Medical Education and Research, Advanced Pediatric Center, Chandigarh, 160012, India
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4
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Rongioletti F. Primary paediatric cutaneous mucinoses. Br J Dermatol 2019; 182:29-38. [DOI: 10.1111/bjd.18004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2019] [Indexed: 12/11/2022]
Affiliation(s)
- F. Rongioletti
- Unit of Dermatology Department of Medical Sciences and Public Health University of Cagliari Cagliari Italy
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5
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Geagea C, Youssef N, Wakim G. Self-Healing Juvenile Cutaneous Mucinosis: A Case Report in the Middle East. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:65-69. [PMID: 30647403 PMCID: PMC6345112 DOI: 10.12659/ajcr.910047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patient: Male, 12 Final Diagnosis: Self-healing juvenile cutaneous mucinosis Symptoms: Facial edema • nodular skin lesion Medication: — Clinical Procedure: None Specialty: Pediatrics and Neonatology
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Affiliation(s)
- Caroline Geagea
- Department of Pediatrics and Adolescent Medicine, Lebanese American University Medical Center, Beirut, Lebanon
| | - Nour Youssef
- Department of Pediatrics and Adolescent Medicine, Lebanese American University Medical Center, Beirut, Lebanon
| | - Gerard Wakim
- Department of Pediatrics and Adolescent Medicine, Lebanese American University Medical Center, Beirut, Lebanon
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6
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Self-healing Cutaneous Mucinosis in Adulthood: The Adult Counterpart of the Juvenile Variant of the Disease? Am J Dermatopathol 2018; 41:60-64. [PMID: 29877895 DOI: 10.1097/dad.0000000000001201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Self-healing cutaneous mucinosis (SHCM) is an idiopathic localized cutaneous mucinosis mainly described in children and characterized clinically by an acute onset of papules and nodules that exhibit a spontaneous resolution in a period ranging from weeks to few months. Histologically, a diffuse mucin deposition in the dermis and/or hypodermis associated with a proliferation of spindle-shaped cells and some large epithelioid gangliocyte-like mononuclear cells is usually observed. An uncommon adult variant of SHCM has also been reported; however, the clinicopathological features described in these patients are extremely heterogeneous and differ significantly from the juvenile variant of the disease, often showing exclusively dermal involvement. We report a case of a 37-year-old female patient with multiple asymptomatic nodules located on the legs and arms that resolved spontaneously in a period of 2 years, showing the typical subcutaneous features of the juvenile variant of SHCM at the histological examination (ie, mucinous areas associated with dense bands of fibrosis containing arborizing thin-walled vessels, spindle-shaped fibroblasts, and some gangliocyte-like cells). To the best of our knowledge, this is the first report of SHCM showing the classic pattern of deep-seated subcutaneous involvement of the disease in an adult patient. We also review the cases of adult-onset SHCM reported in the literature.
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7
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Self-healing juvenile cutaneous mucinosis: Clinical and histopathologic findings of 9 patients. J Am Acad Dermatol 2018; 78:1164-1170. [DOI: 10.1016/j.jaad.2017.10.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 09/18/2017] [Accepted: 10/16/2017] [Indexed: 11/22/2022]
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8
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Abstract
Girl, aged 4 years old, began the disease with pain of the lower extremities, fever up to 38°C and signs of upper airway infection. Then the patient developed oedema and redness of the whole face, thickened skin, subcutaneous nodular foldings of the frontal, occipital, cervical and axillary regions, extensor areas of the joints; fine, hard whitish nodules in the frontal region and over interphalangeal joints of the hands, pruritus; oedemas of the ankles, knees and joints of the hands, cervical lymphadenopathy and hepatomegaly. Blood tests at the moment of the diagnosis revealed elevation of markers of inflammation as ESR and CRP, leukocytosis, thrombocytosis, hypoalbuminemia, and hyper-alfa-2-globulinemia. Histopathological examination of the skin biopsy specimen and subcutaneous tissue revealed myxoid subcutaneous tissue located under the dermis and a section consisting of myxoid mesenchymal tissue with inflammatory infiltration by histiocytic cells. The presence of acid mucopolysaccharides in fields of the myxoid tissue was also observed. The self-healing juvenile cutaneous mucinosis (SJCM) was diagnosed.
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9
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Abstract
A 14-year-old boy presented with a chronic history of atypical papular mucinosis consisting of multiple subcutaneous nodules and confluent papular skin lesions. He initially presented at age 2 years with the rapid onset of numerous subcutaneous nodular lesions that completely resolved over a period of years. Clinical and histologic evidence, together with his clinical course, were suggestive of self-healing juvenile cutaneous mucinosis (SHJCM), but a few years later, during childhood, he experienced a recurrence of the subcutaneous nodules involving the limbs, trunk, and face, in addition to new findings of multiple flesh-colored papules coalescing into plaques on his neck and back. Although his early childhood course and histologic picture were suggestive of SHJCM, the progressive nature of his disorder is not like that seen in SHJCM and appears different from other reported disorders involving cutaneous mucinosis.
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Affiliation(s)
- Charles A Williams
- Division of Genetics and Metabolism, Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida
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10
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Torcoletti M, Beltrami V, Petaccia A, Gelmetti C, Corona F. Multiple papules and nodules in a child with Bartonella infection. Pediatr Dermatol 2014; 31:515-6. [PMID: 25039707 DOI: 10.1111/pde.12149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Marta Torcoletti
- Clinica Pediatrica de Marchi, UOS Reumatologia Pediatrica, Fondazione IRCCS Ca' Granda, Milan, Italy
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11
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Abstract
Self-healing juvenile cutaneous mucinosis (SHJCM) is a rare disorder of unknown origin, which occurs in children in good health. It is characterized by the multiplication of transient cutaneous papules and nodules, mainly located on the head and periarticular areas that spontaneously resolve. Histological features of SHJCM have been well described; therefore, the diagnosis is usually made easily when papules are biopsied. We report a series of 3 new cases of SHJCM presenting mainly with nodular lesions. Histological examination of these nodules showed either lesions consistent with nodular or proliferative fasciitis or nonspecific panniculitis. Mucinous deposits were present but often inconspicuous, so could be disregarded. We wanted to emphasize this misleading presentation because a biopsy for histological examination is always mandatory in cases of proliferating nodules to rule out malignant tumors. Therefore, the diagnosis always requires discussion between pathologists and clinicians to rapidly reassure the parents and avoid inappropriate therapy.
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12
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Abstract
Fibroblastic and myofibroblastic tumors in children and adolescents are a relatively common group of soft tissue proliferations that range from reactive to hamartomatous to neoplastic, with a full spectrum of benign, intermediate, and malignant neoplasms. These lesions are diagnostically challenging because of morphologic and immunohistochemical overlap, despite significant clinical, genetic, and prognostic differences. The fibromatoses are a major subgroup, and all types of fibromatoses can occur in the 1st 2 decades of life. Intermediate and malignant fibroblastic-myofibroblastic tumors are an important group that includes variants of fibrosarcoma and other tumors with recurrent cytogenetic or molecular genetic abnormalities and low metastatic potential. Pathologic examination is enhanced by adjunct techniques, such as immunohistochemistry, cytogenetics, and molecular genetics, although morphology provides the ultimate criteria for a specific diagnosis. This article reviews the clinicopathologic features of fibroblastic and myofibroblastic tumors with an emphasis on the unique aspects of these neoplasms in children and adolescents, the use of diagnostic adjuncts, and differential diagnoses.
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Affiliation(s)
- Cheryl M Coffin
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN, USA.
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13
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Singh S, Kanwar AJ, Saikia UN. Scleromyxoedema with disseminated subcutaneous nodules: rare presentation of an uncommon dermatosis. Clin Exp Dermatol 2012; 38:36-9. [PMID: 22607617 DOI: 10.1111/j.1365-2230.2012.04387.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Scleromyxoedema, also known as generalized lichen myxoedematosus, is a cutaneous mucinosis characterized by a generalized papular and sclerodermoid eruption, mucin deposition, increased fibroblast proliferation and fibrosis. It is often associated with underlying monoclonal gammopathy, and it responds poorly to treatment. There are very few reports of nodular eruption in scleromyxoedema. We report a case of a prominent nodular eruption in an adolescent boy with scleromyxoedema without any underlying paraproteinaemia, and review the literature.
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Affiliation(s)
- S Singh
- Department of Dermatology and Venereology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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14
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Multiple metachronus proliferative fasciitis occurring in different anatomic regions: a case report and review of the literature. Pathol Res Pract 2012; 208:126-30. [PMID: 22265041 DOI: 10.1016/j.prp.2011.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 10/20/2011] [Accepted: 12/16/2011] [Indexed: 12/19/2022]
Abstract
Proliferative fasciitis is a benign lesion that usually has a self-limited course and rarely recurs after excision. In the literature, the multifocal occurrence of PF in different anatomic sites has not been reported so far. In this report, we describe the clinical case of a 30-year-old woman with two metachronous proliferative fasciitis occurring firstly in the orbit and, after 18 months, in the forearm; we also review the available literature on this topic, outlining guidelines for therapy and the follow-up of these patients.
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15
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Abbas O, Saleh Z, Kurban M, Al-Sadoon N, Ghosn S. Asymptomatic papules and nodules on forehead and limbs. Self-healing juvenile cutaneous mucinosis (SHJCM). Clin Exp Dermatol 2011; 35:e76-8. [PMID: 20500191 DOI: 10.1111/j.1365-2230.2009.03504.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- O Abbas
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
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16
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Bain Iii EE, Groben P, Morrell D. Painless hand nodules in a 15-year-old boy. Pediatr Dermatol 2009; 26:91-2. [PMID: 19250417 DOI: 10.1111/j.1525-1470.2008.00850.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- E Eugene Bain Iii
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27516, USA.
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