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Sinha SR, Prakash P, Keshari JR, Prasad RV. The Correlation Between Serum Fibroblast Growth Factor 21 and the Severity and Occurrence of Coronary Artery Disease. Cureus 2024; 16:e51924. [PMID: 38333506 PMCID: PMC10851179 DOI: 10.7759/cureus.51924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND The burden of cardiovascular diseases (CVDs) is increasing worldwide with CVD being one of the leading causes of death, including atherosclerosis, myocardial infarction, cardiomyopathy, and heart failure (HF). Fibroblast growth factor 21 (FGF21) is an endocrine hormone that regulates carbohydrate and lipid metabolism. It exerts direct effects on the cardiovascular system and can serve as an early indicator of CVDs. FGF21's therapeutic properties include reducing obesity, dyslipidaemia, and hyperglycemia, which can help treat metabolic disorders, autophagy, and apoptosis. Atherosclerosis is developed due to chronic inflammatory conditions, and the immune system's reaction to oxidized lipoproteins is mainly responsible for the development of atherosclerosis. FGF21's precise role in the pathogenesis of coronary artery disease (CAD) remains elusive. Aim: This study aimed to assess the role of FGF21 in predicting the severity and magnitude of CAD in individuals diagnosed with stable angina pectoris (SAP). MATERIALS AND METHODS A prospective cross-sectional study was conducted on 110 consecutive patients with SAP reported to the cardiology department of the Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, India. They were divided into two groups based on coronary angiography findings. Control groups included patients not showing any atherosclerotic lesions and case groups with atherosclerotic lesions. The SYNTAX score is a grading system that measures the location and complexity of coronary arteries using anatomical principles. The Gensini score assessment technique was employed to determine the severity of CAD. We compared serum FGF21 levels,left ventricular ejection fraction (LVEF), and inflammatory biomarker C-reactive protein (CRP) levels between the two groups. Moreover, we examined the correlation between the serum FGF21 level and the SYNTAX and Gensini scores. The statistical analysis was done using Version 23.0 of SPSS Statistics. P-values below 0.05 were considered statistically significant. RESULTS The study found that the case group had a higher average age and a higher proportion of male patients. The case group had considerably higher levels of FGF21 (166.59 ± 94.49791 pg/mL) compared to the control group (54.13 ± 48.467 pg/mL) (p=0.034). The LVEF exhibited a significant difference between the case and control groups, with mean values of 50.3056 ± 7.8242% and 56.078 ± 5.3987%, respectively (p=0.031). CRP levels were comparable in both groups. The case group had mean values of SYNTAX and Gensini scores of 23.19±7.43 and 50.03±27.30, respectively. We found that there was no statistically significant association between the risk assessments for CAD severity and the levels of serum FGF21 (correlation coefficient r=0.14070, p>0.05, and r=0.206415, p>0.05, respectively) Conclusions: FGF21 is gaining recognition as a prospective addition to the FGF family, potentially playing a significant role in cardiovascular disease, particularly atherosclerosis. A statistically significant difference was seen in the serum FGF21 levels between the case and control groups, indicating that it can help in the diagnosis of CAD. However, there was no apparent correlation found between the serum FGF21 levels and the SYNTAX and Gensini scores. The role of FGF21 in the development of atherosclerosis and whether FGF21 could serve as a reliable marker need to be studied further.
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Affiliation(s)
- Seema R Sinha
- Biochemistry, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Prem Prakash
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - J R Keshari
- Biochemistery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Ravi V Prasad
- Cardiology, Indira Gandhi Institute of Medical Sciences, Patna, IND
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2
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Pillai GS, Shah SS, Ferringer T, Salzler GG, Ryer EJ. Diffuse dermal angiomatosis of the thigh as the presenting sign of critical limb ischemia. J Vasc Surg Cases Innov Tech 2023; 9:101303. [PMID: 37767346 PMCID: PMC10520431 DOI: 10.1016/j.jvscit.2023.101303] [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: 05/25/2023] [Accepted: 08/03/2023] [Indexed: 09/29/2023] Open
Abstract
Diffuse dermal angiomatosis (DDA) is a rare, benign disease that can serve as the precursor to critical limb ischemia. Pruritic, erythematous plaques form from a proliferation of endothelial cells in response to dermal hypoxia. We present the case of a 63-year-old female patient with DDA of the left medial thigh, followed by ischemia of her distal extremities. Revascularization of her left leg resulted in resolution of the DDA and healing of her ulcers. DDA can be an important clue to identify significant peripheral vascular disease.
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Affiliation(s)
| | - Sahaj S. Shah
- Geisinger Commonwealth School of Medicine, Scranton, PA
| | | | | | - Evan J. Ryer
- Department of Vascular Surgery, Geisinger Medical Center, Danville, PA
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3
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Matos AL, Nogueira R, Flor D, Alves F, Cardoso J, Vieira R. Diffuse dermal angiomatosis: a rare cause of painful ulceration in renal insufficiency. Clin Exp Dermatol 2022; 47:1182-1183. [PMID: 35014721 DOI: 10.1111/ced.15101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/01/2022] [Accepted: 01/10/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Ana L Matos
- Dermatology Department, Coimbra University Hospital Centre, Coimbra, Portugal
| | - Rui Nogueira
- Nephrology Department, Coimbra University Hospital Centre, Coimbra, Portugal
| | - Duarte Flor
- Dermatology Department, Coimbra University Hospital Centre, Coimbra, Portugal
| | - Francisca Alves
- Dermatology Department, Coimbra University Hospital Centre, Coimbra, Portugal
| | - José Cardoso
- Dermatology Department, Coimbra University Hospital Centre, Coimbra, Portugal.,Dermatology Department, Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Ricardo Vieira
- Dermatology Department, Coimbra University Hospital Centre, Coimbra, Portugal.,Dermatology Department, Faculty of Medicine, Coimbra University, Coimbra, Portugal
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4
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Nar G, Cetin SS, Nar R, Kilic O, Furkan OM, Gunver G, Ilyas SC. Is serum Fibroblast Growth Factor 21 associated with the severity or presence of coronary artery disease? J Med Biochem 2021; 41:162-167. [PMID: 35510201 PMCID: PMC9010040 DOI: 10.5937/jomb0-30191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/03/2021] [Indexed: 12/04/2022] Open
Abstract
Background Recent studies have shown that increased circulating concentrations of fibroblast growth factor 21 (FGF21) are associated with obesity, metabolic disorder, and atherosclerosis. However the relationship between FGF21 and coronary artery disease (CAD) is controversial This study was planned to investigate the role of FGF21 in CAD development and CAD severity. Methods Seventy-eight patients with stable angina pectoris (SAP) (lesion positive) and 40 control patients (lesion negative) with similar cardiovascular risk factors were included in the study. Serum FGF21 levels were measured by ELISA method. CAD severity was evaluated by using SYNTAX and GENSINI risk scores. Results FGF21 concentrations were found significantly higher in the SAP group than in the control group. [101.18 ± 141.62 vs. 47.93 ± 58.74 pg/mL; p = 0.03], no correlation was found between the SYNTAX (r = 0.146 and p = 0.134) and GENSINI (r = 0.211 and p = 0.084) scores with serum FGF21 levels. There was a negative relationship between serum FGF21 and serum HDL-C levels in correlation analysis (r = - 0.272; p = 0.026). Conclusions The serum FGF21 levels are different between SAP and control patients. FGF21 is a marker for CAD diagnosis, but not for the evaluation of CAD severity.
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Affiliation(s)
- Gokay Nar
- Pamukkale University, Faculty of Medicine, Department of Cardiology, Denizli, Turkey
| | | | - Rukiye Nar
- Pamukkale University, Faculty of Medicine, Department of Medical Biochemistry, Denizli, Turkey
| | - Oguz Kilic
- Ismail Karakuyu State Hospital, Department of Cardiology, Kutahya, Turkey
| | - Ozen Mehmet Furkan
- Pamukkale University, Faculty of Medicine, Department of Cardiology, Denizli, Turkey
| | - Guven Gunver
- Istanbul Medical Faculty, Department of Biostatistics, Istanbul, Turkey
| | - Sevgican Cihan Ilyas
- Pamukkale University, Faculty of Medicine, Department of Cardiology, Denizli, Turkey
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5
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Azarfar A, Bég S. Diffuse dermal angiomatosis: case report of a distinct skin presentation. Rheumatology (Oxford) 2021; 59:e134-e135. [PMID: 32653908 DOI: 10.1093/rheumatology/keaa311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 05/04/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Azin Azarfar
- Department of Internal Medicine, University of Central Florida HCA GME Healthcare
| | - Shazia Bég
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL, USA
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6
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Diffuse dermal angiomatosis of the breast: an emerging entity in the setting of cutaneous reactive angiomatoses. Clin Dermatol 2020; 39:271-277. [PMID: 34272021 DOI: 10.1016/j.clindermatol.2020.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
New and emerging types of cutaneous vascular (capillary) proliferations have been described or better categorized in the last few years. They include reactive angioendotheliomatosis, acroangiodermatitis (pseudo-Kaposi sarcoma), diffuse dermal angiomatosis, intravascular histiocytosis, glomeruloid angioendotheliomatosis, and angiopericytomatosis (angiomatosis with cryoproteins). Clinically, they are characterized by multiple, red violaceous, and purpuric patches and plaques, sometimes evolving toward necrosis and ulceration with a wide distribution but a propensity to involve the extremities. Histologically, they are characterized by different patterns of intravascular or extravascular lobular or diffuse hyperplasia of endothelial cells, pericytes, and sometimes histiocytes. Although these angioproliferations can histologically have a pseudoangiosarcomatous pattern, they are reactive in that they originate from the (sub)occlusion of vascular lumina by different localized or systemic disorders. The vascular proliferation stops after the inducing hypoxic stimulus has been withdrawn. Among them, diffuse dermal angiomatosis of the breast is a variant of diffuse dermal angiomatosis involving middle-aged women with macromastia, obesity, smoking, and vasculopathic disorders, considered a distinct disorder in the spectrum of cutaneous reactive angiomatoses. It presents with reticulated erythematous to purple patches with sometimes a tendency to ulcerate and bleeding, appearing on large, pendulous breasts. The pathogenesis is related to tissue hypoxemia resulting from subclinical torsion, compression, and increased venous hydrostatic pressure due to the macromastia, aggravated by the associated ischemic conditions such as hypertension and diabetes. There is no evidence-based therapy, but reduction mammoplasty is a viable treatment option. This should be evaluated in all patients who fail conservative therapy.
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7
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Tedbirt B, Courville P, Carvalho P. Diffuse dermal angiomatosis: A potential predictor of fatal outcome in hemodialysis patients. Nephrology (Carlton) 2020; 25:950-951. [PMID: 32748447 DOI: 10.1111/nep.13755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 06/30/2020] [Accepted: 07/05/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Billal Tedbirt
- Department of Dermatology, Rouen University Hospital, Rouen, France
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8
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Nguyen N, Silfvast-Kaiser AS, Frieder J, Zaayman M, Menter A. Diffuse dermal angiomatosis of the breast. Proc (Bayl Univ Med Cent) 2020; 33:273-275. [PMID: 32313486 DOI: 10.1080/08998280.2020.1722052] [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: 11/05/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 10/25/2022] Open
Abstract
Diffuse dermal angiomatosis of the breast can be a painful, irritating, and persistent inflammatory condition. It tends to present in middle age and is associated with a number of risk factors, mainly relating to tissue hypoxia. There are no standard treatment guidelines, and current treatment focuses on mitigating tissue hypoxia by addressing atherosclerosis through lifestyle changes and medical and/or surgical intervention. Herein, we present a case of diffuse dermal angiomatosis of the breast, describing the condition and current treatment approaches and the likelihood that this diagnosis is more common than previously believed.
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Affiliation(s)
| | | | | | - Marcus Zaayman
- Division of Dermatology, Baylor Scott & WhiteDallasTexas
| | - Alan Menter
- Division of Dermatology, Baylor Scott & WhiteDallasTexas
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9
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O'Connor HM, Wu Q, Lauzon SD, Forcucci JA. Diffuse dermal angiomatosis associated with calciphylaxis: A 5‐year retrospective institutional review. J Cutan Pathol 2019; 47:27-30. [DOI: 10.1111/cup.13585] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/03/2019] [Accepted: 09/27/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Heather M. O'Connor
- Department of Pathology and Laboratory MedicineMedical University of South Carolina Charleston South Carolina
| | - Qiong Wu
- Department of Dermatology, Renji Hospital, School of MedicineShanghai Jiao Tong University Shanghai China
- Department of Dermatology and Dermatologic SurgeryMedical University of South Carolina Charleston South Carolina
| | - Steven D. Lauzon
- Department of Public Health SciencesMedical University of South Carolina Charleston South Carolina
| | - Jessica A. Forcucci
- Department of Pathology and Laboratory MedicineMedical University of South Carolina Charleston South Carolina
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10
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Purpuric Plaque Overlaying Femoral Bypass Surgery Scar: Answer. Am J Dermatopathol 2019; 41:530. [PMID: 31232736 DOI: 10.1097/dad.0000000000001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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A case of suspected diffuse dermal angiomatosis associated with severe atherosclerosis. Aging Clin Exp Res 2018; 30:213-215. [PMID: 28466447 DOI: 10.1007/s40520-017-0764-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
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12
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Zhang Y, Liu Z, Zhou M, Liu C. Therapeutic effects of fibroblast growth factor‑21 against atherosclerosis via the NF‑κB pathway. Mol Med Rep 2018; 17:1453-1460. [PMID: 29257234 PMCID: PMC5780083 DOI: 10.3892/mmr.2017.8100] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 04/19/2017] [Indexed: 12/21/2022] Open
Abstract
Fibroblast growth factor‑21 (FGF‑21) is a pleiotropic protein predominantly secreted in the liver, adipose tissue and pancreas. It has been reported that the metabolic hormone effects of FGF‑21 on energy metabolism are essential for human vascular endothelial cells. The aim of the present study was to investigate the therapeutic effects and the underlying primary mechanism of FGF‑21 on atherosclerosis in a rat model induced by vitamin D3 and a high fat diet. The rats with atherosclerosis were randomly divided into vehicle (PBS; negative control), FGF‑21 (6 mg/kg/d) and atorvastatin (6 mg/kg/d; positive control) groups (n=40 in each group). The rats with atherosclerosis received continuous drug or PBS administration via intravenous injection for a treatment period of 30 days, following which all animals were sacrificed. The expression levels of FGF‑21 were determined prior to and following treatment with the drug or PBS. Alterations in ultrastructure and histopathology in vascular endothelial cells were examined, and the expression of nuclear transcription factor kappa B (NF‑κB) and levels of blood lipids in the thoracic aorta tissues were also determined. The results showed that typical atheromatous plaques formed, and the mRNA and protein expression levels of FGF‑21 were lower in the vascular endothelial cells of the rats with atherosclerosis, compared with the normal rats. FGF‑21 significantly reduced blood lipids and glucose in the rats with atherosclerosis, compared with those in the PBS and atorvastatin groups (P<0.01). The expression levels of Rho kinase and NF‑κB were significantly lower in the FGF‑21 group, compared with the normal control group (P<0.01). Statistically significant differences were found in atheromatous plaques and inflammatory factors in the FGF‑21 group, compared with the PBS and atorvastatin groups (P<0.01). In conclusion, FGF‑21 significantly downregulated the levels of blood lipids, Rho kinase and NF‑κB, which contributed to atherosclerosis therapy in the model rats and indicated the potential mechanisms against atherosclerosis in the model rats.
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Affiliation(s)
- Yiming Zhang
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
| | - Zhao Liu
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
| | - Min Zhou
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
| | - Changjian Liu
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
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13
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Galambos J, Meuli-Simmen C, Schmid R, Steinmann LS, Kempf W. Diffuse Dermal Angiomatosis of the Breast: A Distinct Entity in the Spectrum of Cutaneous Reactive Angiomatoses - Clinicopathologic Study of Two Cases and Comprehensive Review of the Literature. Case Rep Dermatol 2017; 9:194-205. [PMID: 29282392 PMCID: PMC5731186 DOI: 10.1159/000480721] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 08/28/2017] [Indexed: 12/12/2022] Open
Abstract
Diffuse dermal angiomatosis (DDA) is a rare reactive angioproliferation in the skin and considered to be a subtype in the group of cutaneous reactive angiomatoses. DDA is clinically characterized by livedoid patches and plaques with tender ulceration. Its histologic features are a reactive diffuse proliferation of bland endothelial cells and pericytes within the dermis, forming small capillary vessels. Previously described cases of DDA most commonly involved the limbs and were associated with a wide spectrum of predisposing comorbidities, especially advanced atherosclerotic vascular disease and arteriovenous fistula. However, several cases of DDA of the breast (DDAB) have been reported in recent years. In this study we present 2 additional patients with DDAB and review all 36 cases of DDAB published in the literature. We describe the clinical and histopathologic characteristics, hypothesized pathogenetic mechanisms, and predisposing conditions of this rare skin disorder and discuss treatment options. The breast is a more commonly involved site of DDA than previously believed. DDAB typically occurs in middle-aged women and is associated with macromastia, overweight or obesity, and probably smoking. Predisposing comorbid conditions differ from those of DDA involving other parts of the body, making DDAB a unique clinicopathologic entity in the spectrum of cutaneous reactive angiomatoses. Currently there is no consensus on the best therapeutic approach. Isotretinoin and other medical therapies have been used with limited success. Breast reduction surgery appears to be a viable treatment option for DDAB in women with macromastia and might provide definitive healing.
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Affiliation(s)
- Jörg Galambos
- Kempf und Pfaltz Histologische Diagnostik, Zurich, Switzerland
| | - Claudia Meuli-Simmen
- Clinic of Hand, Reconstructive, and Plastic Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | | | | | - Werner Kempf
- Kempf und Pfaltz Histologische Diagnostik, Zurich, Switzerland.,Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
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14
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Diffuse Dermal Angiomatosis of the Breast With an Apparent Etiology of Underlying Calcified Thrombosed Artery With Adjacent Fat Necrosis. Am J Dermatopathol 2016; 38:838-841. [DOI: 10.1097/dad.0000000000000581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Sriphojanart T, Vachiramon V. Diffuse Dermal Angiomatosis: A Clue to the Diagnosis of Atherosclerotic Vascular Disease. Case Rep Dermatol 2015; 7:100-6. [PMID: 26120304 PMCID: PMC4478308 DOI: 10.1159/000430944] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Diffuse dermal angiomatosis (DDA) is a benign, acquired, reactive vascular proliferation. DDA is clinically characterized by painful purpuric plaque with central ulceration. The histopathologic hallmark is diffuse proliferation of endothelial cells that are arranged interstitially between collagen bundles of the reticular dermis. DDA has been reported in association with peripheral atherosclerotic disease, arteriovenous fistula and heavy smoking. We report the case of a 49-year-old Asian male with DDA who presented with a painful stellate-shaped purpuric patch on the right thigh. Histopathologic examination showed proliferation of CD34-positive spindle cells in the dermis. Our patient underwent vascular bypass surgery along with tight control of cardiovascular risk factors, which yielded successful results.
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Affiliation(s)
- Tueboon Sriphojanart
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Vasanop Vachiramon
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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