Sea-urchin granuloma: histologic profile. A pathologic study of 50 biopsies

Cutaneous eccrine inflammation and necrosis: review of inflammatory disorders affecting the eccrine apparatus including new associations

Despite being frequently overlooked during the examination of histopathological sections, eccrine sweat glands can offer clues for diagnosing various skin conditions. They provide important functions and can lead to several diseases when inflamed or injured. This review article provides information regarding eccrine physiology as well as well-established and novel entities that occur in association with eccrine gland pathology.

It's elemental! Siliceous diatom frustules producing sarcoid-like granulomas in the subcutis

Silica granulomas have been described on the skin and are rare; however, this is the first report of a sarcoid-like granulomatous reaction because of siliceous diatom frustules in the subcutis, making this an unprecedented case. A 41-year-old female presented with a subcutaneous nodule on the right forearm clinically suggestive of cyst, foreign body, or lipoma. Excisional biopsy revealed subcutis with a sarcoid-like granulomatous reaction in a background of fibrosis, containing abundant semitransparent, exquisitely geometric particles, mildly refringent under polarized light, highlighted by phase contrast microscopy; special stains were negative for microorganisms. Definitive characterization of the peculiar fragments was accomplished by confocal laser microscopy, scanning electron microscopy, and energy dispersive X-ray spectroscopy, revealing them as diatom frustules made of silicon dioxide (SiO₂ ) or silica. Diatoms are unicellular algae, their skeletons (frustules) made of silica have collected on the bottom of rivers, lakes, and oceans for thousands or millions of years and form what we know as diatomite or diatomaceous earth, which is widely used in different industries and easily available in the market. The mechanism whereby diatom frustules gained access to the patient's subcutis is enigmatic.

A cross-sectional study on dermatoses among underwater workers: a new clinical sign of peculiar distribution pattern of lesions in sea urchin prick reaction revealed

BACKGROUND

The pattern of dermatoses among underwater workers is undocumented and, hence, worth studying. The objective of the study was to document the pattern of dermatoses among underwater workers in a tropical seaside area.

METHODS

A population-based cross-sectional study of 1 year from April 2015 among people regularly involved in underwater occupation, especially the collection of mollusks.

RESULTS

Among 62 participants analyzed, the commonly noted dermatoses were scars of previous injuries, sea urchin prick reaction, onychomycosis, tinea versicolor, dermatophytosis, warts, and intertrigo. These workers stabilize their position under water by fixing elbows and knees to rocks, where they get accidentally pricked by sea urchins attached to the rocks. Hands also get pricked by sea urchins while trying to pluck mollusks from rocks, thus leading to the predominance of lesions in elbows, knees, and hands.

CONCLUSION

Documenting the pattern of dermatological diseases in any group of underwater workers has not been done previously. Along with doing that, the study also brought to light the existence of a rare disease, sea urchin prick reaction, in notable proportions among an underprivileged group. This study also detected a previously unrecorded clinical finding of a peculiar distribution pattern of lesions over the body in patients with sea urchin prick reaction. The evidence toward possible commensalism between the two species of organisms noted in this study extends its scope beyond the realms of dermatology and opens new areas for research in other branches of science also.

Sea Urchin Granuloma of the Hands: A Case Report

Penetrating wounds from sea urchin spines are marine injuries that may cause morbidity in humans. Seasonal fishing for abalone in Dhofar is associated with an increase in the number of these injuries, as divers may strike their extremities, especially the dorsum of hands and fingers, on the rocks where Echinoderms and juvenile abalone (Haliotis mariae) are anchored. The immediate effect of injuries includes pain, edema, bleeding, erythema, and rarely systemic complications. There can be a delayed effect in the form of chronic granulomatous skin disease, which is a slow developing reaction to retained spine fragments in the wound that may take several months to develop. We report a case of sea urchin granulomas in a 45-year-old male who injured his hands by the spines of sea urchin while harvesting Haliotis mariae. Clinical manifestations, histological patterns, and treatment modalities are discussed here, to enhance the knowledge about these injuries and the available therapies.

The Use of Sonography in the Identification, Localization, and Removal of Soft Tissue Foreign Bodies

A retrospective review was conducted to determine the effect sonography has in localizing these foreign bodies. Patients selected for this study included all cases in which sonography was performed and demonstrated the presence or assisted in the removal of FB. After review of the records, 20 patients fit this selection criterion. Seventeen of the 20 patients had radiographs performed, in which only 8 of the 17 were positive for FB. Sonography demonstrated all FB in 19 of 20. In 11 of 20 patients, sonographic imaging directly guided their removal. Sonography can be an invaluable tool in finding and localizing for removal soft tissue foreign bodies.

Foreign Body Granulomas

A large list of foreign substances may penetrate the skin and induce a foreign body granulomatous reaction. These particles can enter the skin by voluntary reasons or be caused by accidental inclusion of external substances secondary to cutaneous trauma. In these cases, foreign body granulomas are formed around such disparate substances as starch, cactus bristles, wood splinters, suture material, pencil lead, artificial hair, or insect mouthparts. The purpose of this article is to update dermatologists, pathologists, and other physicians on the most recent etiopathogenesis, clinical presentations, systemic associations, evaluation, and evidence-based management concerning foreign body granulomatous reactions of skin.

Syringometaplasia: variants and underlying mechanisms

Syringometaplasia is an adaptive, benign, metaplastic cellular process that affects the eccrine ducts and glands in response to a variety of physiological or pathological stimuli. Different subtypes of syringometaplasia have been described, including the squamous, mucinous, and adenomatous types. These metaplastic changes have been reported in association with chemotherapeutic agents, as well as with a variety of skin disorders including multiple infectious, neoplastic, and inflammatory skin diseases. In this review, we attempt to shed light on the different patterns of syringometaplasia, its pathogenesis, the plethora of skin conditions in which it may be observed, and the differential diagnoses that should be considered.

SEA URCHIN SPINE ARTHRITIS OF THE PROXIMAL INTERPHALANGEAL JOINT OF THE HAND: RADIOLOGICAL, INTRAOPERATIVE AND HISTOPATHOLOGICAL FINDINGS

Penetrating sea urchin spine injuries, can lead to devastating, irreversible consequences. Persistent inflammation, cutaneous granuloma, neuroma, tenosynovitis, arthritis and destructive arthritis, leading to permanent loss of function and digit amputation, can occur. We present a case of a patient who developed sea urchin spine arthritis of the proximal interphalangeal joint. Only 17 cases of sea urchin spine arthritis of the hand have been documented in the medical literature. However, in this case, the article also includes sequential radiographs, histopathological slides, and intra-operative photographs.

Histopathologic patterns associated with external agents

A large number of foreign substances may penetrate the skin for both voluntary and involuntary reasons. The voluntary group includes the particulate materials used in tattoos and cosmetic fillers, whereas the involuntary group is almost always caused by accidental inclusion of external substances secondary to cutaneous trauma. This article focuses on the histopathologic findings seen in cutaneous reactions to exogenous agents, with special emphasis on the microscopic morphology of the external particles in recognizing specifically the involved substance (something that is becoming increasingly important in the event of litigation).

Exploiting the nephrotoxic effects of venom from the sea anemone, Phyllodiscus semoni, to create a hemolytic uremic syndrome model in the rat

In the natural world, there are many creatures with venoms that have interesting and varied activities. Although the sea anemone, a member of the phylum Coelenterata, has venom that it uses to capture and immobilise small fishes and shrimp and for protection from predators, most sea anemones are harmless to man. However, a few species are highly toxic; some have venoms containing neurotoxins, recently suggested as potential immune-modulators for therapeutic application in immune diseases. Phyllodiscus semoni is a highly toxic sea anemone; the venom has multiple effects, including lethality, hemolysis and renal injuries. We previously reported that venom extracted from Phyllodiscus semoni induced acute glomerular endothelial injuries in rats resembling hemolytic uremic syndrome (HUS), accompanied with complement dysregulation in glomeruli and suggested that the model might be useful for analyses of pathology and development of therapeutic approaches in HUS. In this mini-review, we describe in detail the venom-induced acute renal injuries in rat and summarize how the venom of Phyllodiscus semoni could have potential as a tool for analyses of complement activation and therapeutic interventions in HUS.

Aquatic dermatoses

Despite the fascination of the aquatic world, it can be associated with some medical risks. Natural bodies of water, swimming pools and aquariums contain many living organisms. Some of these aquatic species may cause traumatic or toxic skin reactions after contact as well as life-threatening systemic reactions. Most frequently, the injuries include poisonous bites and stings by coelenter-ates, worms,stinging fish,mollusks and echinoderms or skin infections. A basic knowledge regarding the flora and fauna that populate the aquatic world can help to avoid contact with such organisms,or if it happens,to promptly initiate appropriate therapy.

Sea urchin spine arthritis of the hand

PURPOSE

Although rare, hand injury caused by puncture with the sea urchin spine can result in serious complications. To emphasize its clinical significance, this article describes a group of patients who sustained chronic granulomatous arthritis induced by puncture with sea urchin spine (designated sea urchin spine arthritis).

METHODS

Five patients who developed sea urchin spine arthritis of the hand after puncture with sea urchin spine were treated at our hospitals. All lesions involved the proximal interphalangeal (PIP) joint (4 index fingers and 1 middle finger). Patients experienced pain, swelling, and discomfort around the site of puncture immediately after the injury. These initial symptoms subsided within a few days, and secondary symptoms including fusiform swelling, limited motion, and mild pain of the PIP joint appeared from 1 to 2 months later. Laboratory tests of inflammation and blood cell counts were negative. Plain radiographs showed soft tissue swelling and osteolysis but no visible spine. Thorough synovectomy of the PIP joint was performed, and the granulation tissue around the joint was also removed.

RESULTS

No microorganism was identified from tissue culture or polymerase chain reaction in any of the 5 patients. At a mean follow-up of 21 months, 2 patients exhibited essentially normal active motion of the affected PIP joint, whereas the remaining 3 patients had diminished range of motion.

CONCLUSIONS

Diagnosis of sea urchin spine arthritis can be made by history of sea urchin spine injury, a symptom-free period before the development of synovitis, and the absence of laboratory test abnormalities. Neither antibiotics nor nonsteroidal anti-inflammatory agents are effective. Undertaken early enough, thorough synovectomy might avoid complications and obtain favorable results.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Sea urchin granuloma

Injuries caused by venomous and poisonous aquatic animals may provoke important morbidity in humans. The phylum Echinoderma include more than 6000 species of starfish, sea urchins, sand dollars, and sea cucumbers some of which have been found responsible for injuries to humans. Initial injuries by sea urchins are associated with trauma and envenomation, but later effects can be observed. Sea urchin granuloma is a chronic granulomatous skin disease caused by frequent and successive penetration of sea urchin spines which have not been removed from wounds. The authors report a typical case of sea urchin granuloma in a fisherman and its therapeutic implications.

A case of implantation dermatosis that formed a tumor

A 51-year-old man visited our hospital complaining of a tumor located above his lip. He had been hit on his upper left lip by a chopstick holder 2 months previously. The lesion turned into a tumor and gradually enlarged. The tumor was well circumscribed, smooth and covered with reddish, partially milk-white skin. During surgery to remove the tumor, a piece of a chopstick was found in the subcutaneous tissue, and a diagnosis of implantation dermatosis (ID) was made. On histology, the tumor appeared as an abscess that had increased fibroblasts, small vessels and a large number of neutrophils. In the Japanese published work, we found 86 cases of ID; three were similar to our case and had been clinically diagnosed as adnexal tumors. There were also six cases that showed abscess formation similar to our case on histology. In a survey of the published work from other countries, there were 44 ID cases. There were no common features found among the cases reported in the published work.

Clinically unsuspected foreign bodies: the importance of sonography

OBJECTIVE

To show the value of sonography in the detection of clinically unsuspected foreign bodies appearing as soft tissue masses.

METHODS

High-resolution B-mode and color Doppler sonography was performed in 288 patients referred with superficial soft tissue masses over a period of 2 years.

RESULTS

In 8 lesions in 6 patients, sonography showed small curved or linear echogenic structures surrounded by hypoechoic masses characteristic of foreign bodies with granulation tissue. One lesion had increased vascularity on color Doppler sonography. Patients were referred for other imaging studies, including magnetic resonance imaging, computed tomography, and bone and labeled red blood cell scintigraphy, which did not add relevant information. Three patients underwent surgery; foreign bodies were found in 2, and infected granulation tissue was found in 1. Spontaneous resolutions and no growth of the lesions were seen in the other 2 patients.

CONCLUSIONS

The possibility of a foreign body should be considered when scanning soft tissue masses even in the absence of a relevant clinical history. Once a foreign body is diagnosed, no further workup is indicated.