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Pascual JC, Bañuls J, Albares MP, Vergara G, Belinchón I, Silvestre JF, Betlloch I. Presentation of Telangiectasia Macularis Eruptiva Perstans as a Long-Standing Solitary Plaque Associated with Renal Carcinoma. J Cutan Med Surg 2016. [DOI: 10.1177/120347540300700507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Mastocytosis is a rare disease characterized by a primary pathological increase in mast cells in different tissues. The skin is the most frequently affected organ. Cutaneous mastocytosis, including urticaria pigmentosa, solitary mastocytoma, diffuse cutaneous mastocytosis, and telangiectasia macularis eruptiva perstans (TMEP), is usually distinguished from systemic mastocytosis. TMEP is characterized mainly by telangiectatic macules. Objective and Methods: We report a case of TMEP with an unusual clinical presentation as a solitary plaque of telangiectatic macules. A renal clear cell carcinoma was detected in a workup for systemic mastocytosis. We discuss the clinical and histological findings and treatment of TMEP. Conclusions: TMEP is a rare form of mastocytosis, which occurs mainly in adults, generally has a good prognosis, and little tendency to urticate or show constitutional symptoms. Clinicians should consider this disorder when confronted with a progressive atypical telangiectatic lesion. However, the malignant neoplasm also found in this patient is of uncertain significance.
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Affiliation(s)
| | - José Bañuls
- Department of Dermatology, Hospital General de Alicante, Alicante, Spain
| | - Ma Pilar Albares
- Department of Dermatology, Hospital General de Alicante, Alicante, Spain
| | - Gloria Vergara
- Department of Dermatology, Hospital General de Alicante, Alicante, Spain
| | - Isabel Belinchón
- Department of Dermatology, Hospital General de Alicante, Alicante, Spain
| | | | - Isabel Betlloch
- Department of Dermatology, Hospital General de Alicante, Alicante, Spain
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Vannorsdall E, Collins J, Chen Q, Sarai G, Baer M. Symptomatic response to imatinib mesylate in cutaneous mastocytosis associated with chronic myelomonocytic leukemia. Curr Oncol 2013; 20:e349-53. [PMID: 23904774 PMCID: PMC3728064 DOI: 10.3747/co.20.1301] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Mastocytosis is an uncommon disorder defined by increased and abnormal mast cells in one or more tissues. Cutaneous mastocytosis (cm) is limited to the skin, with varying degrees of rash, pruritus, and disfigurement. Systemic mastocytosis (sm) typically involves the bone marrow, sometimes in association with other bone marrow disorders, including chronic myelomonocytic leukemia (cmml). Mastocytosis has been associated with somatic mutations in the gene encoding the tyrosine kinase Kit, leading to identification of Kit as a therapeutic target. The Kit inhibitor imatinib mesylate is approved for aggressive sm. We present an unusual patient with disabling pruritus from telangiectasia macularis eruptiva perstans, a subtype of cm, and cmml, but with no evidence of systemic mast cell disease. She was treated with imatinib and experienced marked improvement in her pruritus. Concomitant cm and cmml have not previously been reported, and the present report is the first of successful imatinib therapy in an adult patient with cm.
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Affiliation(s)
- E.J. Vannorsdall
- Department of Medicine, University of Maryland School of Medicine and University of Maryland Greenebaum Cancer Center, Baltimore, MD, U.S.A
| | - J.A. Collins
- Department of Pathology, University of Maryland School of Medicine and University of Maryland Greenebaum Cancer Center, Baltimore, MD, U.S.A
| | - Q.C. Chen
- Department of Pathology, University of Maryland School of Medicine and University of Maryland Greenebaum Cancer Center, Baltimore, MD, U.S.A
| | - G. Sarai
- Department of Medicine, University of Maryland School of Medicine and University of Maryland Greenebaum Cancer Center, Baltimore, MD, U.S.A
| | - M.R. Baer
- Department of Medicine, University of Maryland School of Medicine and University of Maryland Greenebaum Cancer Center, Baltimore, MD, U.S.A
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Watkins CE, Bokor WB, Leicht S, Youngberg G, Krishnaswamy G. Telangiectasia macularis eruptiva perstans: more than skin deep. Dermatol Reports 2011; 3:e12. [PMID: 25386256 PMCID: PMC4211494 DOI: 10.4081/dr.2011.e12] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 07/06/2011] [Accepted: 07/07/2011] [Indexed: 01/08/2023] Open
Abstract
Systemic mastocytosis is a rare disease involving the infiltration and accumulation of active mast cells within any organ system. By far, the most common organ affected is the skin. Cutaneous manifestations of mastocytosis, including Urticaria Pigmentosa (UP), cutaneous mastocytoma or telangiectasia macularis eruptive perstans (TMEP), may indicate a more serious and potentially life-threatening underlying disease. The presence of either UP or TMEP in a patient with anaphylactic symptoms should suggest the likelihood of systemic mastocytosis, with the caveat that systemic complications are more likely to occur in patients with UP. TMEP can usually be identified by the typical morphology, but a skin biopsy is confirmative. In patients with elevated tryptase levels or those with frequent systemic manifestations, a bone marrow biopsy is essential in order to demonstrate mast cell infiltration. Further genetic testing for mutations of c-kit gene or the FIP1L1 gene may help with disease classification and/or therapeutic approaches. Rarely, TMEP has been described with malignancy, radiation therapy, and myeloproliferative disorders. A few familial cases have also been described. In this review, we discuss the clinical features, diagnosis and management of patients with TMEP. We also discuss the possible molecular pathogenesis and the role of genetics in disease classification and treatment.
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Affiliation(s)
- Casey E Watkins
- East Tennessee State University, Quillen College of Medicine, Johnson City, TN
| | - Winston B Bokor
- East Tennessee State University, Quillen College of Medicine, Johnson City, TN
| | - Stuart Leicht
- East Tennessee State University, Quillen College of Medicine, Johnson City, TN; ; Department of Dermatology, Quillen College of Medicine, Johnson City, TN
| | - George Youngberg
- East Tennessee State University, Quillen College of Medicine, Johnson City, TN; ; Department of Pathology, Quillen College of Medicine, Johnson City, TN
| | - Guha Krishnaswamy
- East Tennessee State University, Quillen College of Medicine, Johnson City, TN; ; Department Allergy and Immunology, Quillen College of Medicine, Johnson City, TN; ; Veterans Affairs Medical Center, Mountain Home, TN, USA
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Kowalzic L, Eickenscheidt L, Seidel C, Kribus S, Ziegler H, Komar M. Telangiectasia macularis eruptiva perstans, a form of cutaneous mastocytosis, associated with malignant melanoma. J Dtsch Dermatol Ges 2009; 7:360-2. [DOI: 10.1111/j.1610-0387.2008.06941.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Cutaneous mastocytosis can be divided into 4 different clinical variants--urticaria pigmentosa, solitary mastocytoma, diffuse cutaneous mastocytosis, and telangiectasia macularis eruptiva perstans. Skin findings are often accompanied by symptoms secondary to mast cell release of mediators. These symptoms can be both localized to the skin lesion and systemic because of the release of mediators into the bloodstream. The majority of pediatric cases of cutaneous mastocytosis show a good prognosis with gradual resolution of both symptoms and skin lesions. This article will review each of the 4 clinical presentations focusing on pediatric-onset of disease while reviewing the literature.
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Affiliation(s)
- Laura D Briley
- PGY3- Department of Dermatology, Brody School of Medicine at East Carolina University, Greenville, North Carolina 27834, USA.
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Rishpon A, Matz H, Gat A, Brenner S. Telangiectasia macularis eruptiva perstans: unusual presentation and treatment. Skinmed 2007; 5:300-2. [PMID: 17086000 DOI: 10.1111/j.1540-9740.2006.05018.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 41-year-old woman presented with a 2-month history of pruritus and a generalized dermatitis that developed initially on the head and spread to the trunk, legs, and buttocks. The pruritus caused extreme discomfort and was not relieved by antihistamines or topical steroid treatment. The patient denied flushing, syncope, and vomiting. Her medical history included asthma treated with salmeterol/fluticasone propionate inhaler, and status post silicone breast augmentation. Physical examination revealed a papular dermatitis on the trunk and extremities composed of lesions up to 0.5 cm in diameter, surrounded by excoriation marks (Figure 1). There was no hepatosplenomegaly or lymphadenopathy. Darier's sign was negative. Results of complete blood count, peripheral blood film examination, and liver function tests were all with normal limits. A biopsy specimen taken from a lesion and stained with hematoxylin-eosin showed telangiectasias, with an increased number of mast cells around blood vessels (Figure 2). Positive Giemsa (Figure 3) and c-kit stain (Figure 4) indicated an increased number of mast cells. Bone marrow aspiration and total body CT performed to rule out systemic involvement showed no pathology. Protein electrophoresis was normal. Serum tryptase and histamine were within normal limits, and 24-hour urine collection for histamine was normal. Narrow-band UV-B treatment was begun 3 times weekly, reduced to twice weekly after 2 months, and then stopped. The first few treatments resulted in significant relief of the pruritus and regression of lesions. After 3 months without treatment, the patient remained free of pruritus and lesions.
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Affiliation(s)
- Ayelet Rishpon
- Department of Dermatology, Tel Aviv-Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Martin LK, Romanelli P, Ahn YS, Kirsner RS. Telangiectasia macularis eruptiva perstans with an associated myeloproliferative disorder. Int J Dermatol 2004; 43:922-4. [PMID: 15569020 DOI: 10.1111/j.1365-4632.2004.02249.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Telangiectasia macularis eruptiva perstans (TMEP) is a cutaneous form of mastocytosis. It has been rarely associated with an underlying myeloproliferative disorder. We report the case of a patient, while receiving treatment for thrombocytosis, with both platelet production and function inhibitors presented with TMEP. TMEP is often refractory to therapy; however, our patient responded to treatment with PUVA.
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Affiliation(s)
- Lucy K Martin
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, University of Miami, Miami, FL 33125, USA
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Abstract
Mastocytosis is defined by a pathological increase in mast cell numbers in tissues. Recent clinical observations on rare manifestations highlight the diversity of this disease. The diagnosis is now aided by new surrogate markers. At the molecular level, recent studies have reinforced the role of activating mutations in KIT in the etiology of mastocytosis. These findings provide a conceptual basis for the development for new therapeutic strategies.
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