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Lim B, Seth I, Cuomo R, Cameron A, Rozen WM. Cutaneous amyloidosis mimicking basal cell carcinoma: a case series and literature review. J Plast Reconstr Aesthet Surg 2024; 95:340-348. [PMID: 38959620 DOI: 10.1016/j.bjps.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Amyloidosis is characterized by extracellular amyloid protein deposition. When amyloidosis intersects with basal cell carcinoma (BCC), it introduces complex diagnostic challenges. This study explored the overlap between primary localized cutaneous amyloidosis (PLCA) and BCC, examining amyloid deposits in BCC, systemic amyloidosis risk in PLCA, and various treatment methods. METHODS Two case studies were discussed, followed by a literature review, in which PubMed, Web of Science, EMBASE, and the Cochrane Library databases were utilized. The search, covering studies from infinity up to January 2024, focused on "cutaneous amyloidosis," "basal cell carcinoma," and related terms. Articles in English detailing the clinical presentation, diagnostic methods, treatment, and outcomes of cutaneous amyloidosis mimicking BCC were included. Data extraction and synthesis were performed by two independent reviewers. CASE SERIES This study highlighted two cases exemplifying the complexity of diagnosing BCC and PLCA. The first case (a 64-year-old with a nodule on the cheek) and the second (a 67-year-old with a nodular lesion on the upper lip cheek) were initially suspected as BCC and were later identified as PLCA upon histopathological examination. DISCUSSION The diagnosis of amyloidosis within BCC nodules remains a diagnostic challenge. Although their coexistence is relatively prevalent, their local recurrence rates remain debatable. Various diagnostic and therapeutic approaches have been suggested, such as topical creams and phototherapy. However, none have garnered conclusive and consistent evidence to establish reliable clinical application. CONCLUSION The findings emphasized the importance of considering alternative pathologies in differential diagnoses. Future research should focus on understanding systemic amyloidosis risks and optimizing care for both conditions.
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Affiliation(s)
- Bryan Lim
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria 3199, Australia.
| | - Ishith Seth
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria 3199, Australia; Department of Plastic Surgery, Bendigo Hospital, Bendigo, Victoria 3500, Australia
| | - Roberto Cuomo
- Department of Medicine, Plastic Surgery and Neuroscience, University of Siena, Siena 53100, Italy
| | - Alex Cameron
- Department of Plastic Surgery, Bendigo Hospital, Bendigo, Victoria 3500, Australia
| | - Warren M Rozen
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria 3199, Australia
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2
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Pálla S, Kuroli E, Tóth EA, Hidvégi B, Holló P, Medvecz M. Primary Localized Cutaneous Amyloidosis in Central Europe: A Retrospective Monocentric Study on Epidemiology and Therapy. J Clin Med 2023; 12:7672. [PMID: 38137741 PMCID: PMC10743860 DOI: 10.3390/jcm12247672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Amyloid deposits can be the cause of many chronic diseases. Primary localized cutaneous amyloidosis (PLCA) is a chronic dermatologic condition with amyloid deposits in the papillary dermis. The most common types of the keratinocyte-derived form of PLCA include macular (MA), lichen (LA), and biphasic (BA) amyloidosis. The estimated prevalence of PLCA in the Asian population is 0.98/10,000, which is higher than in the European population; thus, epidemiologic data on PLCA in the Caucasian population are limited. We performed a retrospective single-center study analyzing epidemiologic characteristics of a Central European PLCA population. Epidemiologic data regarding age, sex, skin phototype (Fitzpatrick scale I-VI), disease duration, comorbidities, history of atopy, and family history of PLCA were collected. Clinical characteristics, localization of PLCA lesions, applied therapies and treatment outcomes were also analyzed. Dermoscopic characteristics were also evaluated. A total of 41 patients diagnosed with PLCA were included, with 22 presenting with macular, 18 with lichen, and 1 with biphasic amyloidosis. The male/female ratio was 16/25, and mean age at diagnosis was 54.6 ± 15.2 years (range 27-87 years). The mean age at the onset of PLCA was 53 ± 16.1 years (range 19-79 years) in MA, 46.7 ± 18.2 years (range 14-73 years) in LA, and 26 years in BA. The interscapular region in MA and the extensor surface of the lower extremities in LA proved to be localization-related areas. In our center, a wide range of therapeutic options was applied, with the most prescribed being topical corticosteroids in all types of PLCA. We presented a retrospective, monocentric study on the epidemiology of PLCA in the Central European region. By examining the medical data of a significant number of PLCA patients, we compared our epidemiologic data with that of the Asian PLCA population. Due to the rarity of the condition, further randomized controlled trials and guidelines are needed to improve therapeutic outcomes.
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Affiliation(s)
- Sára Pálla
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary
| | - Enikő Kuroli
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary
- Department of Pathology and Experimental Cancer Research, Semmelweis University, 1085 Budapest, Hungary
| | - Eszter Alexa Tóth
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary
| | - Bernadett Hidvégi
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary
| | - Péter Holló
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary
| | - Márta Medvecz
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary
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3
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Ramachandran V. Mucocutaneous manifestations of systemic amyloidosis in a Black patient. QJM 2022; 115:237-238. [PMID: 35179575 DOI: 10.1093/qjmed/hcac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- V Ramachandran
- Department of Internal Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USADepartment of Dermatology, New York University, New York City, NY, USA
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4
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Katagiri F, Ueo D, Okubo-Gunge Y, Usui A, Kuwatsuka S, Mine Y, Hamada K, Fujiwara S, Sasaki T, Nomizu M, Utani A. Fibulin-4 accelerates amyloid formation through binding with a keratin 5 peptide fragment. JID INNOVATIONS 2022; 2:100114. [PMID: 35480396 PMCID: PMC9035805 DOI: 10.1016/j.xjidi.2022.100114] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/05/2022] [Accepted: 02/08/2022] [Indexed: 11/06/2022] Open
Abstract
Keratins are the major amyloid fibril component in localized cutaneous amyloidosis. We analyzed the amyloid components in the skin of patients with localized cutaneous amyloidosis by immunohistochemical staining using antisera against extracellular matrix proteins and keratin 5 (K5). Fibulin-4 and K5 colocalized in the amyloid deposits. Using 14 synthetic peptides, we screened for amyloidogenic sequences in the C-terminal region of K5, including the α-helical rod domain and the tail domain. Two peptides stained with thioflavin T possessed a β-sheet structure and formed amyloid-like fibrils. Among the amyloidogenic peptides, a peptide KT5-6 (YQELMNTKLALDVEIATYRKLLEGE) derived from the α-helical rod domain of K5 specifically bound to fibulin-4. In addition, amyloid formation of KT5-6 was accelerated by fibulin-4. These results suggest that degraded fragments of K5 containing the KT5-6 sequence form amyloid fibrils with fibulin-4. The data further suggest that degraded fragments of K5 and fibulin-4 have the potential to initiate cutaneous amyloidosis.
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5
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Amyloidosis cutis dyschromica cases caused by GPNMB mutations with different inheritance patterns. J Dermatol Sci 2021; 104:48-54. [PMID: 34551863 DOI: 10.1016/j.jdermsci.2021.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 06/04/2021] [Accepted: 08/08/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Amyloidosis cutis dyschromica (ACD) is a rare form of primary cutaneous amyloidosis featured by reticulate dotted hypo- and hyperpigmentation. Recently, loss-of-function mutations in GPNMB, encoding glycoprotein (transmembrane) nonmetastatic melanoma protein B, were found in autosomal-recessive or semi-dominant ACD. OBJECTIVE This study aims to detect the genetic defect underlying ACD in nine separate cases and to investigate the functional consequences of the mutants. METHODS Nine ACD cases were collected including eight with autosomal-recessive pattern and one with autosomal-dominant pattern. Whole-exome sequencing or Sanger sequencing of the GPNMB gene was performed to detect the pathogenic mutations. Haplotype analysis was employed to determine the origin of mutation c.565C > T using adjacent highly polymorphic SNPs. Immunoblotting and subcellular localization assessments were performed to evaluate the expression of the mutants using HEK293 cells transfected with the GPNMB constructs. RESULTS We detected four recurrent mutations (c.393 T > G, p.Y131*; c.565C > T, p.R189*; c.1056delT, p.P353Lfs*20; c.1238 G > C, p.C413S) and two novel mutations (c.935delA, p.N312Tfs*4; c.969 T > A, p.C323*) in GPNMB. Mutation c.565C > T found in six separate ACD cases shared a common haplotype. The two novel mutations caused a decreased abundance of truncated proteins. The c.1238 G > C mutation, which was detected in the autosomal-dominant case, caused abnormal reticular subcellular localization of the protein. A major percentage of wildtype changed its expression pattern when co-expressed with this mutant. CONCLUSIONS Our findings proved that the recurrent mutation c.565C > T originated from a founder effect. The autosomal-dominant ACD associated mutation p.C413S played its pathogenic role through a dominant-negative effect on wild-type GPNMB. This study expands the genotype and inherited modes of ACD and improves our understanding of the pathogenesis of this disorder.
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6
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Guillet C, Steinmann S, Maul JT, Kolm I. Primary Localized Cutaneous Amyloidosis: A Retrospective Study of an Uncommon Skin Disease in the Largest Tertiary Care Center in Switzerland. Dermatology 2021; 238:579-586. [PMID: 34525472 DOI: 10.1159/000518948] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/04/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Primary localized cutaneous amyloidosis (PLCA) is defined by the deposition of amyloid protein in the skin without systemic involvement. There are four subtypes of PLCA: lichen amyloidosis (LA), macular amyloidosis (MA), biphasic amyloidosis (BA), and nodular amyloidosis (NA). PLCA occurs most frequently in Latin Americans and Asians. Treatment is not standardized. OBJECTIVES To identify subtypes, demographic and clinical features and treatment efficacy in patients with histopathologically confirmed PLCA. MATERIALS AND METHODS Data of PLCA patients were extracted from the electronic hospital database and included if diagnosis of PLCA was histopathologically confirmed and if sufficient information regarding treatment and follow-up was available. The evaluation of the treatment efficacy was based on a novel score to assess the reduction of itch and skin lesions. RESULTS In this retrospective, monocentric study, 37 cases of PLCA diagnosed between 2000 and 2020 were included (21 females) with a mean age of 52 years. LA was the most frequent subtype found in 21 patients (56.8%), followed by MA in 10 patients (28%) and BA in 6 patients (16.2%). No cases of NA were included. 22 patients (59.4%) had skin phototype II or III. Regarding treatment, a combination of UVA1 phototherapy with high-potency topical corticosteroids seemed to show the highest efficacy with complete clearance of symptoms in 4 patients (10.8%). A substantial improvement of symptoms was found in 5 patients (12.7%) treated with high-potency topical corticosteroids alone or in combination either with UVA1 or bath PUVA or monotherapy with UVA1 phototherapy or capsaicin (0.075%) cream. Low-/medium-potency topical corticosteroids alone or in combination with UVBnb (311 nm) phototherapy showed a lower efficacy. CONCLUSION Our data show that PCLA is a rare disease in central Europe but can also be expected in a predominantly Caucasian population. The best treatment response was achieved with a combination of UVA1 phototherapy and high-potency topical corticosteroids.
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Affiliation(s)
- Carole Guillet
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Dermatological Allergology, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Simona Steinmann
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Isabel Kolm
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
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7
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Primary Localized Cutaneous Amyloidosis of Keratinocyte Origin: An Update with Emphasis on Atypical Clinical Variants. Am J Clin Dermatol 2021; 22:667-680. [PMID: 34286474 DOI: 10.1007/s40257-021-00620-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 01/19/2023]
Abstract
Amyloid is a protein derived from at least 20 different substances. Once misfolded, it results in a group of cutaneous and systemic conditions. Primary localized cutaneous amyloidosis of keratinocyte origin is a very common subtype that can manifest either as lichen or macular amyloidosis, lacking systemic involvement. Lichen amyloidosis often presents as multiple hyperpigmented papules on the lower extremities whereas macular amyloidosis is classically characterized by dark brown rippled macules on the interscapular area. Review of the literature reveals that in addition to the classical presentation of primary localized cutaneous amyloidosis there exists a plethora of various manifestations that can be grouped into either geographic or morphologic categories. This review provides clinicians with the intimate knowledge of these presentations and summarizes the available treatment modalities.
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8
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Chen J, Yang H, Xu Z, Lu P, Yuan L, Xue Y, Xue R, Yang B. Diagnosis of Primary Cutaneous Amyloidosis by Rapid 4,6-Diamidino-2-Phenylindole Staining. Dermatology 2021; 238:368-376. [PMID: 34515096 PMCID: PMC8985017 DOI: 10.1159/000518082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/18/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Quick and accurate diagnosis of primary cutaneous amyloidosis (PCA) may be difficult because its symptoms are often subtle and nonspecific. OBJECTIVE We sought to review the literature on the roles of various staining methods in the diagnosis of amyloidosis and demonstrate added benefits of using rapid 4,6-diamidino-2-phenylindole (DAPI) staining in the diagnosis of PCA. METHODS Three groups of cases, namely, PCA, neurodermatitis, and prurigo nodularis, were retrieved from a computerized pathology database for study, and their paraffin-embedded tissue blocks were cut following standard procedures. The tissue sections were stained with three stains: hematoxylin-eosin (HE), Congo red, and DAPI stains, and examined under the microscope to compare the staining patterns of these three methods. We also performed amyloid keratin and apolipoprotein E (APOE) staining on the sections of PCA in order to further support our conclusion. The PCA sections were read by junior and senior dermatopathologists for comparison. RESULTS The sensitivity of DAPI staining for PCA was significantly higher than that of Congo red staining and HE staining (p < 0.001). This statement holds true whether the experiment was grouped in one sample or was divided into groups of junior and senior dermatopathologists (p < 0.001). The DAPI-positive staining areas, except for the nuclei, were consistent with the amyloid deposition areas. In this study, DAPI staining had a sensitivity of 98.6% and a specificity of 100%. CONCLUSION DAPI staining could serve as a useful technique to establish the diagnosis of PCA, and its high efficacy in diagnosing PCA makes it less dependent on the experience levels of the evaluators. Additionally, the binding of DAPI to the A-T-rich sequence of double-stranded DNA suggests that amyloid may contain DNA or a similarly structured nucleic acid.
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Affiliation(s)
- Junchen Chen
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Huan Yang
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Zhijun Xu
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, China,
| | - Ping Lu
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Liyan Yuan
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Yaohua Xue
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Ruzeng Xue
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Bin Yang
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, China
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9
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Fawzy MM, Kamel MM, El Maadawi Z, Abdel Hady R, Osman MA. Fractional Erbium-Doped Yttrium Aluminum Garnet Laser in the Treatment of Primary Cutaneous Amyloidosis. Dermatol Surg 2021; 47:e205-e211. [PMID: 33731571 DOI: 10.1097/dss.0000000000002994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although various treatments are currently available for primary cutaneous amyloidosis (PCA), there is no entirely satisfactory treatment. Recently, fractional ablative lasers are claimed to have therapeutic effects for PCA. OBJECTIVE To evaluate the efficacy and safety of fractional Er:YAG laser for the treatment of PCA. METHODS AND MATERIALS Ten patients with macular and lichen amyloidosis received 4 treatment sessions with 4-week intervals. The outcome was assessed clinically (degree of pigmentation, rippling, lichenification, and itching) through photographs and histologically (amount of amyloid, melanin, epidermal thickness, and depth of rete ridges) through biopsy specimens stained with hematoxylin-eosin, Congo red, and Fontana-Masson stain. Patients were followed up for 3 months after the final treatment. RESULTS At 3-month follow-up, fractional Er:YAG laser exhibited a significant clinical and histological improvement. Patient satisfaction concurred with physicians' evaluations. Recurrence was detected in 1 patient. CONCLUSION In light of the authors' findings, fractional Er:YAG laser offered a great clinical and histological efficacy with excellent safety profile. Careful laser selection based on making a compromise between efficacies and safeties may improve outcome.
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Affiliation(s)
- Marwa M Fawzy
- Dermatology Department, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, ICDP-UEMS, Giza, Egypt
| | - Marwa M Kamel
- Dermatology Department, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, ICDP-UEMS, Giza, Egypt
| | - Zeinab El Maadawi
- Histology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | | | - Mai Abdelraouf Osman
- Dermatology and Laser at Dermatology Unit, Medical Laser Applications-National Institute of Laser Enhanced Sciences (NIlES), Cairo University, Giza, Egypt
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10
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SnapshotDx Quiz: June 2021. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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11
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Light chain amyloidosis presenting as retiform purpura. JAAD Case Rep 2021; 12:34-36. [PMID: 34026991 PMCID: PMC8121765 DOI: 10.1016/j.jdcr.2021.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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12
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Jung JH, Kwon DI, Seong SH, Lee KH, Suh KS, Jang MS, Park JB. Usefulness of dermoscopy in identifying amyloid purpura. J Dermatol 2021; 48:e260-e262. [PMID: 33878225 DOI: 10.1111/1346-8138.15854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/23/2021] [Accepted: 03/03/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Jang Hwan Jung
- Department of Dermatology, Kosin University College of Medicine, Busan, South Korea
| | - Do Ik Kwon
- Department of Dermatology, Kosin University College of Medicine, Busan, South Korea
| | - Seol Hwa Seong
- Department of Dermatology, Kosin University College of Medicine, Busan, South Korea
| | - Kang Hoon Lee
- Department of Dermatology, Kosin University College of Medicine, Busan, South Korea
| | - Kee Suck Suh
- Department of Dermatology, Kosin University College of Medicine, Busan, South Korea
| | - Min Soo Jang
- Department of Dermatology, Kosin University College of Medicine, Busan, South Korea
| | - Jong Bin Park
- Department of Dermatology, Kosin University College of Medicine, Busan, South Korea
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13
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Beatty PE, Killion L, Mc Hugh J, Tobin AM. Spontaneous bilateral peri-orbital purpura: an important clinical sign of primary systemic amyloidosis. BMJ Case Rep 2021; 14:14/4/e239478. [PMID: 33795269 DOI: 10.1136/bcr-2020-239478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 69-year-old woman presented with an 18-month history of recurrent bruising of the eyelids. She was otherwise asymptomatic and systems review was unremarkable. On examination, she had peri-orbital purpura and waxy papules at the inner canthus of both eyes. Macroglossia was also noted. Subcutaneous abdominal biopsy identified amorphous material in the dermis that stained positive for Congo red, with apple-green birefringence seen under polarised microscopy. Immunohistochemistry demonstrated antibodies against lambda light chains. Bone marrow biopsy identified further deposits of immunoglobulin light chain amyloid and a clonal infiltrate with 10%-20% plasma cells, confirming amyloidosis secondary to multiple myeloma. Iodine-123-labelled serum amyloid protein scintigraphy showed no abnormal uptake, thereby excluding significant amyloid deposits in the liver, spleen or kidneys. Cardiac MRI was consistent with early amyloid infiltration. We highlight the importance of dermatological manifestations in amyloidosis, to allow for early diagnosis, potentially limiting end organ involvement.
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Affiliation(s)
| | - Lisa Killion
- Department of Dermatology, Tallaght University Hospital, Dublin, Ireland
| | - Johnny Mc Hugh
- Department of Haematology, Tallaght University Hospital, Dublin, Ireland
| | - Ann-Marie Tobin
- Department of Dermatology, Tallaght University Hospital, Dublin, Ireland
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14
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Chapman JR, Liu A, Yi SS, Hernandez E, Ritorto MS, Jungbluth AA, Pulitzer M, Dogan A. Proteomic analysis shows that the main constituent of subepidermal localised cutaneous amyloidosis is not galectin-7. Amyloid 2021; 28:35-41. [PMID: 32867548 PMCID: PMC7962860 DOI: 10.1080/13506129.2020.1811962] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Lichen or macular localised cutaneous amyloidoses have long been described as keratinic amyloidoses and believed to be due to the deposition of cytokeratin peptides originating from epidermis in the dermal papillae. However, recently it was suggested that galectin-7 is the causative protein for this type of amyloidosis. This was based on the detection of galectin-7 in a biopsy from a patient diagnosed with Bowen's disease and localised cutaneous amyloidosis. In this study we report mass spectrometry-based proteomic analysis of the protein composition of localised cutaneous amyloid deposits from seven patients using laser microdissection and show that basal keratins are the main constituents of the amyloid deposits. Galectin-7 was not present in the dermal amyloid deposits and was only present in the overlying Congo red negative epidermis.
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Affiliation(s)
- Jessica R Chapman
- Hematopathology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anna Liu
- Hematopathology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - San S Yi
- Hematopathology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Enmily Hernandez
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria Stella Ritorto
- Hematopathology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Achim A Jungbluth
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Melissa Pulitzer
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ahmet Dogan
- Hematopathology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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15
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Panse G, Subtil A, McNiff JM, Glusac EJ, Ko CJ, Galan A, Myung P, Xu ML. Cutaneous Involvement in Plasma Cell Myeloma. Am J Clin Pathol 2021; 155:106-116. [PMID: 32885235 DOI: 10.1093/ajcp/aqaa122] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Plasma cell myeloma (PCM) involving skin is rare and occurs in 1% to 4% of patients with PCM. We evaluated the clinicopathologic features, cytogenetic findings and clinical follow-up in a series of PCM cases with cutaneous involvement. METHODS Cases of PCM with cutaneous involvement were retrospectively reviewed with clinical data. RESULTS Skin involvement in PCM occurred in older individuals (mean, 75 years) and was more frequent in men (7/10 patients). All cases showed bone marrow involvement preceding the cutaneous lesions. Histopathologically, the infiltrate was plasmacytic (n = 5) or primitive or plasmablastic (n = 4), and 1 case showed predominantly lymphoplasmacytic features with cyclin D1 immunoreactivity and CCND1 gene rearrangement. Concurrent amyloid deposition was seen in one biopsy, and another case demonstrated coexisting squamous cell carcinoma. The most common immunophenotype was CD138+, CD20-, and CD56+ with light chain restriction. Cytogenetic analysis (available for 7 cases) showed multiple hyperdiploid abnormalities. Follow-up was available for 8 cases (mean, 42 months; range, 11-156 months) and showed short-term disease-related death in 7 of 8 patients. CONCLUSIONS Cutaneous involvement in PCM demonstrates a diverse cytomorphologic spectrum with plasmacytic, plasmablastic, or lymphoplasmacytic features and may show concurrent amyloid deposition or neoplasms such as squamous cell carcinoma. Cutaneous involvement typically occurs late in the course of the disease and likely portends poor outcome.
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Affiliation(s)
- Gauri Panse
- Department of Dermatology, Yale School of Medicine, New Haven, CT
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Antonio Subtil
- Department of Dermatology, Yale School of Medicine, New Haven, CT
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Jennifer M McNiff
- Department of Dermatology, Yale School of Medicine, New Haven, CT
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Earl J Glusac
- Department of Dermatology, Yale School of Medicine, New Haven, CT
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Christine J Ko
- Department of Dermatology, Yale School of Medicine, New Haven, CT
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Anjela Galan
- Department of Dermatology, Yale School of Medicine, New Haven, CT
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Peggy Myung
- Department of Dermatology, Yale School of Medicine, New Haven, CT
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Mina L Xu
- Department of Pathology, Yale School of Medicine, New Haven, CT
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16
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Nijhawan S, Bhargava P, Singdia H, Garg R, Chepa N, Mathur D. The amyloid–melanin connection: a cross sectional study on primary cutaneous Macular Amyloidosis. PIGMENT INTERNATIONAL 2021. [DOI: 10.4103/pigmentinternational.pigmentinternational_36_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Hoffman JE, Dempsey NG, Sanchorawala V. Systemic Amyloidosis Caused by Monoclonal Immunoglobulins: Soft Tissue and Vascular Involvement. Hematol Oncol Clin North Am 2020; 34:1099-1113. [PMID: 33099427 DOI: 10.1016/j.hoc.2020.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Clinical features of soft tissue amyloid light-chain (AL) amyloidosis include macroglossia, arthropathy, muscle pseudohypertrophy, skin plaques, and carpal tunnel syndrome. Vascular manifestations of AL amyloid include periorbital ecchymosis, jaw or limb claudication, and even myocardial infarction caused by occlusion of small vessel coronary arteries. Some of these features, such as macroglossia, periorbital ecchymosis, and the so-called shoulder-pad sign, are pathognomonic for AL amyloidosis. These findings may be the initial presenting features of the disease, and the recognition of these red flag symptoms is very important for the diagnosis and early intervention on the underlying plasma cell disease.
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Affiliation(s)
- James E Hoffman
- Department of Medicine, Division of Hematology, University of Miami/Sylvester Comprehensive Cancer Center, 1475 Northwest 12th Avenue, Miami, FL 33136, USA
| | - Naomi G Dempsey
- Department of Medicine, Division of Hematology, University of Miami/Sylvester Comprehensive Cancer Center, 1475 Northwest 12th Avenue, Miami, FL 33136, USA
| | - Vaishali Sanchorawala
- Boston University School of Medicine and Boston Medical Center, 72 East Concord Street, K-503, Boston, MA 02118, USA.
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18
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Sidey K, Kobic A, Vidal NY. Identifying squamous cell carcinoma and cytokeratin-derived amyloid with pan-cytokeratin AE1/AE3 during Mohs micrographic surgery. JAAD Case Rep 2020; 6:776-779. [PMID: 32760776 PMCID: PMC7390831 DOI: 10.1016/j.jdcr.2020.06.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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19
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Jowkar F, Kahnooj MH, Aslani FS, Parvizi MM. Clinicopathological evaluation of patients with rippled pattern pigmentation of the skin: A single-center study. Dermatol Ther 2020; 33:e13278. [PMID: 32077214 DOI: 10.1111/dth.13278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Abstract
The aim of the present study was to investigate the clinical association between rippled pattern pigmentation and the positivity of histopathological analysis for amyloid. A total of 50 patients (90% women) with rippled pattern pigmentation referring to Dermatology Clinic of Shahid Faghihi Hospital, Shiraz, Iran, in 2015 participated in this study. Two biopsies were performed for all the cases from the most frequently affected sites. The specimens were evaluated for amyloid deposits with hematoxylin-eosin (H&E), Congo red (CR), and crystal violet (CV) stains. The upper back was the most frequently affected area in the patients. Family history (28%), atopy (14%), pruritus as a common finding (86%), and history of friction (54%) were positive. The prevalence of disease was higher in patients with skin photo Type 3. Amyloid deposit was not detected in most patients by these stains. No statistically significant difference was found between the amyloid positive cases stained with H&E, CR, and CV (p-value > 0.05). Only the difference in positive results between biopsy number 2 and the total biopsy (1 and 2) was significant (p-value < .05). In conclusion, it seems that it is useful to increase the number of biopsies and other more sensitive staining methods to detect small focal amyloid deposits.
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Affiliation(s)
- Farideh Jowkar
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Dermatology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Fatemeh Sari Aslani
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Pathology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Mahdi Parvizi
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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20
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Alexanian C, Chen YC, Le S, Fung MA, Konia T, Tartar D. Nodular amyloidosis of the lips as a presenting feature of systemic amyloidosis associated with multiple myeloma. JAAD Case Rep 2019; 5:963-965. [PMID: 31687465 PMCID: PMC6820285 DOI: 10.1016/j.jdcr.2019.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Claire Alexanian
- University of California, Davis Medical Center, Department of Dermatology, Sacramento, California
- Georgetown University School of Medicine, Washington, DC
| | - Yi-Chun Chen
- University of California, Davis Medical Center, Department of Dermatology, Sacramento, California
| | - Stephanie Le
- University of California, Davis Medical Center, Department of Dermatology, Sacramento, California
| | - Maxwell A. Fung
- University of California, Davis Medical Center, Department of Dermatology, Sacramento, California
| | - Thomas Konia
- University of California, Davis Medical Center, Department of Dermatology, Sacramento, California
| | - Danielle Tartar
- University of California, Davis Medical Center, Department of Dermatology, Sacramento, California
- Correspondence to: Danielle Tartar, MD, PhD, Department of Dermatology, University of California, Davis, 3301 C St, Ste 1300, Sacramento, CA, 95816.
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21
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Abstract
Primary localized cutaneous amyloidosis (PLCA) occurs when amyloid is deposited only within the skin and there is no evidence of systemic involvement. Nodular amyloidosis is the rarest subtype of PLCA. It typically involves the acral regions but can sometimes present on the head and neck. The condition usually presents clinically as a single tan or yellow nodule or plaque that may appear waxy. Herein, we present a rare case of a 66-year-old man with nodular amyloidosis on the lower back.
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Affiliation(s)
- Yelena Dokic
- Dermatology, Baylor College of Medicine, Houston, USA
| | - Paul Subrt
- Dermatology, Katy Westside Dermatology, Houston, USA
| | - Jaime Tschen
- Dermatology, St. Joseph Dermatopathology, Houston, USA
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22
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Cutaneous light chain amyloidosis with multiple myeloma: A concise review. Hematol Oncol Stem Cell Ther 2019; 12:71-81. [DOI: 10.1016/j.hemonc.2018.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 07/09/2018] [Accepted: 09/03/2018] [Indexed: 11/17/2022] Open
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23
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Hoffmann S, Schreml S. [Large waxy, yellowish-reddish tumor on the temple of a 79-year-old man : Preparation for the specialist examination: part 2]. Hautarzt 2018; 69:81-85. [PMID: 30374543 DOI: 10.1007/s00105-018-4232-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Hoffmann
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland
| | - S Schreml
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland.
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24
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Yoon SH, Cho JH, Jung HY, Hwang WM, Yun SR, Choi JY, Park SH, Kim CD, Kim MS, Kim YL. Exceptional mucocutaneous manifestations with amyloid nephropathy: a case report. J Med Case Rep 2018; 12:241. [PMID: 30126443 PMCID: PMC6102914 DOI: 10.1186/s13256-018-1760-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/03/2018] [Indexed: 11/30/2022] Open
Abstract
Background Amyloidosis is a very rare disease that is difficult to diagnose because of the unspecific early clinical manifestations of the disease. Accurate and early diagnosis is extremely important because the effect of treatment is dependent on the extent of disease progression. Sicca syndrome and nail dystrophy are very rare symptoms of amyloidosis. We report here a case of sicca syndrome and nail dystrophy with renal dysfunction in a 52-year-old Korean woman who was diagnosed as having systemic amyloidosis. Case presentation We present the case of a 52-year-old Korean woman complaining of dry mouth and nail dystrophy for 4 months as an initial symptom. A slit lamp examination revealed superficial keratoconjunctival erosion in both eyes. A laboratory test showed anemia, azotemia, and proteinuria. Urine protein electrophoresis showed increased gamma globulin excretion. Serum free light chain of kappa and lambda were increased. Histopathological studies of biopsy specimens of minor salivary glands and kidney revealed deposits of amyloid fibrils. A bone marrow aspiration biopsy showed hypercellular marrow with 5% plasma cells. She was diagnosed as having primary systemic amyloidosis then started on chemotherapy. Conclusion Such atypical mucocutaneous manifestations of amyloidosis can serve as important early diagnostic signs with less invasive biopsy confirmation in patients with systemic amyloidosis.
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Affiliation(s)
- Se-Hee Yoon
- Division of Nephrology, Department of Internal Medicine, Myunggok Medical Research Institute, College of Medicine, Konyang University, Daejeon, South Korea.
| | - Jang-Hee Cho
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Hee-Yeon Jung
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Won-Min Hwang
- Division of Nephrology, Department of Internal Medicine, Myunggok Medical Research Institute, College of Medicine, Konyang University, Daejeon, South Korea
| | - Sung-Ro Yun
- Division of Nephrology, Department of Internal Medicine, Myunggok Medical Research Institute, College of Medicine, Konyang University, Daejeon, South Korea
| | - Ji-Young Choi
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Sun-Hee Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Chan-Duck Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Mee-Seon Kim
- Department of Pathology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.
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25
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Trajber Horvat A, Trčko K, Jurčić V, Marko PB. A case of primary systemic amyloidosis. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2018. [DOI: 10.15570/actaapa.2018.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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26
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Bilal A, Der Mesropian P, Lam F, Shaikh G. Oligosecretory Myeloma With Amyloidosis and Alopecia. J Investig Med High Impact Case Rep 2018; 6:2324709617752737. [PMID: 29399587 PMCID: PMC5788141 DOI: 10.1177/2324709617752737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/26/2017] [Accepted: 12/01/2017] [Indexed: 11/15/2022] Open
Abstract
Amyloidosis is a systemic illness characterized by the extracellular deposition of abnormal proteins in body tissues and organs. In addition to renal involvement, amyloidosis can also present with a variety of skin manifestations, though rarely with alopecia. Sixteen cases of alopecia secondary to systemic amyloidosis are reported. There is one reported case that presented with alopecia universalis. We report a case of a 68-year-old woman presenting with alopecia universalis, rapid decline in kidney function, and nephrotic syndrome who was found to have multiple myeloma-associated AL amyloidosis (immunoglobulin light chain). Her serological workup including serum electrophoresis was negative and she underwent renal biopsy. Pathology revealed eosinophilic material within the mesangium that was Congo-red positive, had apple-green birefringence under polarized light, and ultramicroscopically appeared as fibrillary material. Subsequent bone marrow examination showed a diffuse increase in plasma cells with atypia indicating plasma cell neoplasm. This case underlines several interesting aspects of multiple myeloma and the way it may present with amyloidosis. The lack of monoclonal spike on electrophoresis yet positive light chain analysis deserves special attention by clinicians to avoid a missed diagnosis. The extensive skin involvement also raises several questions regarding the pathologic mechanisms of alopecia in a patient with amyloidosis.
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27
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Wilder EG, Frieder J, Sulhan S, Michel P, Cizenski JD, Wright JM, Menter MA. Spectrum of orocutaneous disease associations: Genodermatoses and inflammatory conditions. J Am Acad Dermatol 2017; 77:809-830. [PMID: 29029902 DOI: 10.1016/j.jaad.2017.02.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/01/2017] [Accepted: 02/08/2017] [Indexed: 12/18/2022]
Abstract
The oral cavity and cutaneous organ systems share a close embryologic origin. Therefore, there are numerous dermatologic conditions presenting with concomitant oral findings of which the dermatologist must be aware. The second article in this continuing medical education series reviews inflammatory orocutaneous conditions and a number of genodermatoses. It is essential for dermatologists to be familiar with oral cavity manifestations associated with dermatologic diseases for prompt diagnosis, management, and appropriate referral to stomatology and dentistry.
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Affiliation(s)
- Elizabeth G Wilder
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas
| | - Jillian Frieder
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas
| | - Suraj Sulhan
- Texas A&M Health Science Center College of Medicine, Bryan, Texas
| | - Pablo Michel
- Baylor Institute for Immunology Research, Dallas, Texas
| | - Jeffrey D Cizenski
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas
| | - John M Wright
- Texas A&M University College of Dentistry, Dallas, Texas
| | - M Alan Menter
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas.
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28
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Weidner T, Illing T, Elsner P. Primary Localized Cutaneous Amyloidosis: A Systematic Treatment Review. Am J Clin Dermatol 2017; 18:629-642. [PMID: 28342017 DOI: 10.1007/s40257-017-0278-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Primary localized cutaneous amyloidosis (PLCA) is characterized by extracellular deposition of heterogenic amyloid proteins in the skin without systemic involvement. Lichen amyloidosis, macular amyloidosis, and (primary localized cutaneous) nodular amyloidosis are different subtypes of PLCA. OBJECTIVE The aim of this study was to review the current reported treatment options for PLCA. METHODS This systematic review was based on a search in the PubMed database for English and German articles from 1985 to 2016. RESULTS Reports on the treatment of PLCA were limited predominantly to case reports or small case series. There were a few clinical trials but these lacked control groups. A variety of treatment options for PLCA were reported including retinoids, corticosteroids, cyclophosphamide, cyclosporine, amitriptyline, colchicine, cepharanthin, tacrolimus, dimethyl sulfoxide, vitamin D3 analogs, capsaicin, menthol, hydrocolloid dressings, surgical modalities, laser treatment, and phototherapy. CONCLUSION No definitive recommendation of preferable treatment procedures can be made based on the analyzed literature. Randomized controlled trials are needed to offer patients an evidence-based therapy with high-quality standardized treatment regimens for PLCA.
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29
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Shimoda Y, Sato Y, Hayashida Y, Yamazaki Y, Mizukawa Y, Nakajima K, Shiohara T, Aoyama Y. Lichen amyloidosus as a sweat gland/duct-related disorder: resolution associated with restoration of sweating disturbance. Br J Dermatol 2017; 176:1308-1315. [DOI: 10.1111/bjd.15060] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Y. Shimoda
- Department of Dermatology; Kyorin University School of Medicine; Mitaka Japan
| | - Y. Sato
- Department of Dermatology; Kyorin University School of Medicine; Mitaka Japan
| | - Y. Hayashida
- Dermatology; Kawasaki Medical School; General Medical Center; Okayama Japan
| | - Y. Yamazaki
- Department of Dermatology; Kyorin University School of Medicine; Mitaka Japan
| | - Y. Mizukawa
- Department of Dermatology; Kyorin University School of Medicine; Mitaka Japan
| | - K. Nakajima
- Department of Dermatology; Kochi University School of Medicine; Nankoku Japan
| | - T. Shiohara
- Department of Dermatology; Kyorin University School of Medicine; Mitaka Japan
| | - Y. Aoyama
- Dermatology; Kawasaki Medical School; General Medical Center; Okayama Japan
- Department of Dermatology; Kawasaki Medical School; Kurashiki Japan
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30
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Nam CH, Park MK, Choi MS, Hong SP, Park BC, Kim MH. Secondary Cutaneous Amyloidosis in a Patient with Mycosis Fungoides. Ann Dermatol 2017; 29:79-82. [PMID: 28223751 PMCID: PMC5318532 DOI: 10.5021/ad.2017.29.1.79] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/16/2016] [Accepted: 06/25/2016] [Indexed: 11/30/2022] Open
Abstract
Secondary cutaneous amyloidosis refers to clinically unapparent amyloid deposits within the skin in association with a pre-existing skin condition or skin tumors, such as basal cell carcinoma, porokeratosis, solar elastosis, Bowen's disease, and mycosis fungoides. A 70-year-old woman presented with a 6-month history of asymptomatic multiple yellowish plaques on both legs. She had been diagnosed with mycosis fungoides 7 years ago and was treated with psoralen and ultraviolet A radiation (PUVA) therapy, narrow-band ultraviolet B (UVB) therapy, and acitretin for 5 years. Finally, she reached complete remission of mycosis fungoides. However, new yellowish lesions started to appear 1 year after discontinuing the phototherapy. A physical examination revealed multiple yellowish plaques on both extremities. The plaques were well circumscribed and slightly elevated. All laboratory tests were normal. A biopsy specimen showed multiple nodular deposits of eosinophilic amorphous material in papillary dermis and upper reticular dermis. The deposits represented apple green birefringence on Congo red stain viewed under polarized light. Acellular small nodules in the upper dermis consisted of randomly oriented, non-branching, 6.67~12.7 nm thick amyloid fibrils on electron microscopy. We report an interesting and rare case of secondary cutaneous amyloidosis after narrow-band UVB therapy and PUVA therapy in a patient with mycosis fungoides.
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Affiliation(s)
- Chan Hee Nam
- Department of Dermatology, Dankook University Medical College, Cheonan, Korea
| | - Min Kee Park
- Department of Dermatology, Dankook University Medical College, Cheonan, Korea
| | - Mi Soo Choi
- Department of Dermatology, Dankook University Medical College, Cheonan, Korea
| | - Seung Phil Hong
- Department of Dermatology, Dankook University Medical College, Cheonan, Korea
| | - Byung Cheol Park
- Department of Dermatology, Dankook University Medical College, Cheonan, Korea
| | - Myung Hwa Kim
- Department of Dermatology, Dankook University Medical College, Cheonan, Korea
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31
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Systemic Light Chain Amyloidosis Mimicking Rheumatic Disorders. Case Rep Med 2017; 2016:7649510. [PMID: 28042297 PMCID: PMC5153512 DOI: 10.1155/2016/7649510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/26/2016] [Accepted: 09/28/2016] [Indexed: 12/17/2022] Open
Abstract
Secondary amyloidosis can complicate chronic inflammatory autoimmune diseases. However, the clinical findings of primary amyloidosis may mimic those of primary rheumatologic disorders. We present the case of a 53-year-old woman who presented with dystrophic nail changes, dry eyes, bilateral carpal tunnel syndrome, Raynaud's phenomenon, and high titer positive nucleolar pattern antinuclear antibody. She was initially misdiagnosed as having Undifferentiated Connective Tissue Disease (UCTD). On further workup, she was eventually diagnosed with lambda light chain systemic amyloidosis by abdominal fat pad biopsy. Her symptoms completely resolved after autologous stem cell transplantation. With this case, we would like to highlight the similarities in the clinical features between light chain amyloidosis and rheumatological disorders. We would also like to emphasize the importance of the prompt recognition of the clinical features of amyloidosis which are crucial to triggering appropriate diagnostic procedures, since early diagnosis is a key to improving outcomes in this disease with an otherwise poor prognosis.
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32
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Tchernev G, Chokoeva AA, Wollina U. Lichen amyloidosis associated with rheumatoid arthritis: unique presentation in a Bulgarian patient. SAO PAULO MED J 2017; 135:76-78. [PMID: 28076615 PMCID: PMC9969724 DOI: 10.1590/1516-3180.2016.024921102016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 10/21/2016] [Indexed: 11/21/2022] Open
Affiliation(s)
- Georgi Tchernev
- MD, PhD. Professor, Department of Dermatology, Venereology and Dermatological Surgery, Medical Institute of the Ministry of the Interior (MVR-Sofia), Sofia, Bulgaria; Associate Professor, "Onkoderma" Polyclinic for Dermatology and Dermatological Surgery, Sofia, Bulgaria.
| | - Anastasiya Atanasova Chokoeva
- MD. Surgeon, "Onkoderma" Polyclinic for Dermatology and Dermatological Surgery, Sofia, Bulgaria; Chair, Department of Dermatology and Venereology, School of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria.
| | - Uwe Wollina
- MD, PhD. Director, Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse, Dresden, Germany.
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33
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Dickison P, Howard V, Wylie B, Smith SD. Localized axillary milia en plaque: a rare cutaneous case presentation of systemic amyloidosis. Clin Exp Dermatol 2016; 41:764-7. [PMID: 27663153 DOI: 10.1111/ced.12914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 11/28/2022]
Abstract
Systemic AL amyloidosis is known to be associated with plasma cell dyscrasias, including multiple myeloma. The cutaneous manifestations of systemic AL amyloidosis are varied, but typically include waxy plaques or subcutaneous nodules. We report a woman who presented with bilateral eruptions of hyperpigmented plaques in her axillae, which were diagnosed as milia en plaque. She had a history of multiple myeloma, for which she was under the care of a haematologist. This is the first documented case, to our knowledge, of an eruption in the axillae being milia en plaque.
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Affiliation(s)
- P Dickison
- Department of Dermatology, Royal North Shore Hospital, St Leonards, NSW, Australia.
| | - V Howard
- Department of Histopathology, Douglas Hanly Moir Pathology, North Ryde, NSW, Australia
| | - B Wylie
- Department of Haematology, Gosford Hospital, Gosford, NSW, Australia
| | - S D Smith
- Department of Dermatology, Royal North Shore Hospital, St Leonards, NSW, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,The Dermatology and Skin Cancer Centre, Gosford, NSW, Australia
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34
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Levesque MH, Doré N, Marion A, Cadotte M. Primary Systemic Amyloidosis. J Cutan Med Surg 2016. [DOI: 10.1177/120347549700200114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Primary systemic amyloidosis is a rare disease with multiorgan involvement including the skin. Because of the nonspecific and variable presenting symptoms and signs, this condition usually follows a long course before the correct diagnosis is established. Fortunately, skin manifestations contribute greatly in revealing the disease and determining the amyloidosis type. Objective: This article reports a case of primary systemic amyloidosis mimicking nodular primary localized cutaneous amyloidosis of the legs. We describe our systemic findings and the investigation procedure to classify and characterize the amyloidosis type. Methods and Results: After histologic studies revealed amyloid substance in the skin nodules of our 82-year-old patient, she was hospitalized for an appropriate systemic evaluation of this condition and associated medical problems. The investigation included biochemical, immunologic, radiologic, pathologic, and histochemical methods. Conclusion: This case of primary systemic amyloidosis, simulating a localized cutaneous form with nodular lesions, demonstrates the importance of the distinction between both entities. In fact, the management and prognosis will vary significantly.
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Affiliation(s)
| | - Normand Doré
- Division of Dermatology, Department of Medicine, Hôtel-Dieu de Montréal, University of Montréal
| | - Alain Marion
- Department of Pathology, Hôtel-Dieu de Montréal, University of Montréal, Montréal, Quebec
| | - Marcel Cadotte
- Department of Pathology, Hôtel-Dieu de Montréal, University of Montréal, Montréal, Quebec
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35
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Sangen Y, Kawada A, Maeda A, Aragane Y, Tezuka T. Primary Localized Cutaneous Amyloidosis in Association with Papillary Thyroid Carcinoma. J Cutan Med Surg 2016. [DOI: 10.1177/120347540200600404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Lichen amyloidosis, a type of primary localized cutaneous amyloidosis, is characterized by pruritic brown or grayish pigmented papules. Objective: We report a case of lichen amyloidosis in which the skin lesion consisted of asymptomatic salmon-pink-colored papules on the back of the neck to the upper back. This was different from typical clinical pictures of lichen amyloidosis. Our patient proved to have thyroid papillary carcinoma. Conclusion: Our case may suggest that lichen amyloidosis could be a cutaneous manifestation of thyroid cancers.
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Affiliation(s)
- Yoshiko Sangen
- Department of Dermatology, Kinki University School of Medicine, Osaka, Japan
| | - Akira Kawada
- Department of Dermatology, Kinki University School of Medicine, Osaka, Japan
| | - Akira Maeda
- Department of Dermatology, Kinki University School of Medicine, Osaka, Japan
| | - Yoshinori Aragane
- Department of Dermatology, Kinki University School of Medicine, Osaka, Japan
| | - Tadashi Tezuka
- Department of Dermatology, Kinki University School of Medicine, Osaka, Japan
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Kakani RS, Goldstein AE, Meisher I, Hoffman C. Nodular Amyloidosis: Case Report and Literature Review. J Cutan Med Surg 2016. [DOI: 10.1177/120347540100500201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Amyloidosis refers to a group of depositional diseases that are classified into two main types: systemic and localized. Large nodules of localized cutaneous amyloidosis of the nasal ala and surrounding skin are rare and the treatment is often unsatisfactory. Objective: We report a case of rapidly enlarging, localized, nodular cutaneous amyloidosis of the nose and the surrounding skin with a brief review of the current literature regarding treatment of this rare disease. Conclusion: Nodular amyloidosis can be treated successfully with cold steel excision in combination with carbon dioxide laser. Close followup of these patients is warranted, as nodular amyloidosis may be the precursor to systemic amyloidosis.
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Affiliation(s)
- Rajesh S. Kakani
- Department of Otolaryngology, Albert Einstein College of Medicine, Bronx, New York 10461
| | - Amy E. Goldstein
- Department of Dermatology, St. Barnabas Hospital, Bronx, New York 10457
| | - Irina Meisher
- Department of Pathology, Coney Island Hospital, Brooklyn, New York 11235
| | - Cindy Hoffman
- Department of Dermatology, St. Barnabas Hospital, Bronx, New York 10457
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Schucht K, Schröder J, Siegmund H, Grafe C, Schreml S. Nodular Cutaneous Amyloidosis at the Temple. Case Rep Dermatol 2016; 8:193-6. [PMID: 27504090 PMCID: PMC4965534 DOI: 10.1159/000447234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 05/27/2016] [Indexed: 11/19/2022] Open
Abstract
A 52-year-old woman presented with a large partially yellow and erythematous tumor on her right temple. She reported that it had grown over the last 4 years. Regional lymph nodes were impalpable. A punch biopsy showed eosinophilic material in the dermis and subcutis. Immunohistochemistry showed positive staining for kappa and lambda light chains. Electron microscopy showed the typical amyloid fibrils (7–10 nm in diameter). There was no evidence of systemic amyloidosis, paraproteinemia or underlying plasmacytoma. The tumor was completely removed via curettage. At follow-up, the patient presented in good health with no signs of relapse.
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Affiliation(s)
- Kathrin Schucht
- Department of Dermatology, University Medical Center Regensburg, Regensburg, Germany
| | - Josef Schröder
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Heiko Siegmund
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Claudia Grafe
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Stephan Schreml
- Department of Dermatology, University Medical Center Regensburg, Regensburg, Germany
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Alhaddab M, Srolovitz H, Rosen N. Primary Systemic Amyloidosis Presenting as Extensive Cutaneous Ulceration. J Cutan Med Surg 2016; 10:253-6. [PMID: 17234110 DOI: 10.2310/7750.2006.00046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: We report a case of primary systemic amyloidosis in a 78-year-old Caucasian woman presented as a nonhealing ulcer on the right thigh for 3 months. Histopathology of the skin revealed widely thickened walls of middermal and subcutaneous vessels from deposition of amorphous eosinophilic material that stained positively with Congo red and crystal violet. Objective: This case represents a very unusual presentation of primary systemic amyloidosis, one in which the cutaneous manifestations provided the first signs of a devastatingly widespread multiorgan infiltration of amyloid protein. Conclusion: This presentation of the disease may signify an advanced stage with a grave prognosis as our patient passed away 3 months after development of the cutaneous ulceration.
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Affiliation(s)
- Mohammed Alhaddab
- Department of Dermatology, McGill University Health Centre, Montreal, QC, Canada.
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Haverkampf S, Evert K, Schröder J, Schreml S. Nodular Cutaneous Amyloidosis Resembling a Giant Tumor. Case Rep Dermatol 2016; 8:22-5. [PMID: 27293389 PMCID: PMC4899645 DOI: 10.1159/000443950] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A 79-year-old man presented with a large tumor on the left side of his head, which had grown over 5 years. Regional lymph nodes were impalpable and computed tomography revealed no signs of bone infiltration. Histology showed that the entire dermis was filled with amorphous eosinophilic material. Immunohistochemistry was negative for cytokeratin, but showed that the dermis and parts of the subcutis were filled with amyloid consisting of immunoglobulin light chains. There were no signs of paraproteinemia or underlying plasmocytoma. In electron microscopy, the typical amyloid fibrils were found. The tumor was completely removed via curettage. At 1-year follow-up, the patient was doing fine with no signs of relapse or systemic disease.
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Affiliation(s)
- Sonja Haverkampf
- Department of Dermatology, University Medical Center Regensburg, Germany
| | - Katja Evert
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Josef Schröder
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Stephan Schreml
- Department of Dermatology, University Medical Center Regensburg, Germany
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Bhutani M, Shahid Z, Schnebelen A, Alapat D, Usmani SZ. Cutaneous manifestations of multiple myeloma and other plasma cell proliferative disorders. Semin Oncol 2016; 43:395-400. [DOI: 10.1053/j.seminoncol.2016.02.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Scapineli JO, Ceolin L, Puñales MK, Dora JM, Maia AL. MEN 2A-related cutaneous lichen amyloidosis: report of three kindred and systematic literature review of clinical, biochemical and molecular characteristics. Fam Cancer 2016; 15:625-33. [DOI: 10.1007/s10689-016-9892-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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43
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Shim JH, Oh SH, Jun JY, Kim JH, Park JH, Lee DY. Trachyonychia as the presenting sign of myeloma-associated amyloidosis. Int J Dermatol 2016; 55:e410-2. [PMID: 26872688 DOI: 10.1111/ijd.13240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/23/2015] [Accepted: 11/08/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Joon Ho Shim
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Seung Hwan Oh
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Ji-Young Jun
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Jun-Hwan Kim
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Ji-Hye Park
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Dong-Youn Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea.
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Roh EK, Ali M, Lu MT, Bradshaw SH. Case 2-2016. An 84-Year-Old Woman with Chest Pain, Dyspnea, and a Rash. N Engl J Med 2016; 374:264-74. [PMID: 26789875 DOI: 10.1056/nejmcpc1502149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
An 84-year-old woman was admitted to the hospital because of chest pain, respiratory distress, and a purpuric rash. Initial chest imaging showed bilateral patchy and confluent opacities, a finding consistent with pulmonary edema. A diagnostic procedure was performed.
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Panchaprateep R, Tusgate S, Munavalli GS, Noppakun N. Fractional 1,550nm Ytterbium/Erbium fiber laser in the treatment of lichen amyloidosis: Clinical and histological study. Lasers Surg Med 2015; 47:222-30. [DOI: 10.1002/lsm.22338] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Ratchathorn Panchaprateep
- Department of Medicine; Division of Dermatology; King Chulalongkorn Memorial Hospital; Bangkok Thailand
| | - Sai Tusgate
- Department of Medicine; Division of Dermatology; King Chulalongkorn Memorial Hospital; Bangkok Thailand
| | - Girish S. Munavalli
- Division of Dermatology; Laser and Vein Specialists of Carolinas; Charlotte North Carolina
| | - Nopadon Noppakun
- Department of Medicine; Division of Dermatology; King Chulalongkorn Memorial Hospital; Bangkok Thailand
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Floyd MS, Glendinning J, Hiew K, Avram AM, Seneviratne R, Parr NJ. Localised amyloidosis of the glans penis presenting as a painless lump with progression after 10 years. Int Urol Nephrol 2014; 46:1737-9. [DOI: 10.1007/s11255-014-0756-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/25/2014] [Indexed: 10/25/2022]
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Incidence of Tuberculosis and Amyloidosis among Sudanese Patients Presented with Enlarged Nodes. J Trop Med 2014; 2014:832029. [PMID: 24799916 PMCID: PMC3985298 DOI: 10.1155/2014/832029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 02/24/2014] [Indexed: 11/23/2022] Open
Abstract
Objectives. To determine the incidence of tuberculous lymphadenitis and amyloidosis in enlarged lymph nodes (LN). Methodology. A retrospective study was carried out in the department of pathology at the Faculty of Medicine, University of Kordofan, during one-year period. The study included a group of 103 patients with lymphadenopathy. Results. Of the 103 cases with enlarged neck nodes, 35 (34%) had tuberculous lymphadenitis. Sixteen (46%) cases were males and 19 (54%) cases were females. Out of the 103 patients, amyloidosis was diagnosed in 9/103 (8.7%). Out of the 9 positive cases, 2/9 (22.2%) were males and 7/9 (77.8%) were females. Conclusion. There is high incidence of tuberculous lymphadenitis in patients with enlarged LN in developing countries like North Sudan. Amyloidosis should not be ignored when investigating enlarged LN.
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Jaeger T, Nowak J, Ring J, Brockow K, Andres C, Gutermuth J. Periorbital papules and erythematous-brownish plaques on the neck and axilla. J Eur Acad Dermatol Venereol 2014; 29:1651-3. [PMID: 24735195 DOI: 10.1111/jdv.12529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- T Jaeger
- Department of Dermatology and Allergy Biederstein, Technical University Munich, Munich, Germany
| | - J Nowak
- Department of Dermatology and Allergy Biederstein, Technical University Munich, Munich, Germany
| | - J Ring
- Department of Dermatology and Allergy Biederstein, Technical University Munich, Munich, Germany
| | - K Brockow
- Department of Dermatology and Allergy Biederstein, Technical University Munich, Munich, Germany
| | - C Andres
- Department of Dermatology and Allergy Biederstein, Technical University Munich, Munich, Germany
| | - J Gutermuth
- Department of Dermatology and Allergy Biederstein, Technical University Munich, Munich, Germany.,Department of Dermatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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49
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de Unamuno-Bustos B, Ballester-Sánchez R, Alegre de Miquel V. Placa en la nariz. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.ad.2013.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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50
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de Unamuno-Bustos B, Ballester-Sánchez R, Alegre de Miquel V. Plaque on the nose. ACTAS DERMO-SIFILIOGRAFICAS 2014; 105:305-6. [PMID: 24657021 DOI: 10.1016/j.adengl.2013.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 11/06/2013] [Indexed: 10/25/2022] Open
Affiliation(s)
- B de Unamuno-Bustos
- Servicio de Dermatología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
| | - R Ballester-Sánchez
- Servicio de Dermatología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - V Alegre de Miquel
- Servicio de Dermatología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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