A case of candidal umbilical granuloma

Isolated Cutaneous Granuloma Caused by Candida Parapsilosis: Case Report and Literature Review

Candidal granuloma is an uncommon type of deep chronic cutaneous candidiasis. Candida albican is the most common causative pathogen for candidal granuloma. We report herein the original case of a 69-year-old Chinese woman presented with a 3-year of painful cutaneous lesion on the back of left hand. Physical examination revealed a 4 × 5 cm large infiltrative reddish plaque with unclear boundaries. The yellow-white crusts were observed on the uneven surface of plaque. Histopathological examination of biopsy tissue revealed that yeast cells and the horizontal section of hyphae in the dermis by hematoxylin eosin staining and periodic acid-Schiff staining. Finally, the pathogen was identified as Candida parapsilosis by mycological examination and molecular identification. The patient was treated with itraconazole oral 200 mg twice daily combined with topical terbinafine hydrochloride cream for 2 months. The lesions were fully resolved and no recurrence was observed. Since the cutaneous infection caused by C. parasilosis were rarely reported, we also reviewed all 11 cases of cutaneous infection caused by C. parapsilosis in the PubMed. Our study highlighted that chronic unilateral infiltrated plaques or ulcers should be aware of the occurrence of fungal granuloma including candidal granuloma especially in immunocompromised patients.

Fibrous umbilical polyp: a distinct fasciitis-like proliferation of early childhood with a marked male predominance

Benign fibrous lesions of the umbilicus have not been previously studied in a formal series. Clinical and pathologic findings were reviewed in all patients under age 19 with lesions resected from the umbilical region at Children's Hospital (Boston, MA, USA) during an 8-year period. Fourteen lesions were characterized by a well-circumscribed dome-shaped or pedunculated dermal proliferation of moderately cellular fibrous tissue without significant inflammation. Fibroblastic cells were plump to elongate with abundant pale pink cytoplasm. In a subset of lesions, some cells showed atypia or ganglion cell-like morphology. Collagen ranged from sparse to long narrow bundles. Vascularity was sparse and the lesions were nonencapsulated. Loss of rete ridges and basket-weave hyperkeratosis was common in the overlying epidermis. Immunostaining showed focal staining for muscle-specific actin and desmin in a subset of cases and no staining for cytokeratin, epithelial membrane antigen, CD34, or S-100. Age ranged from 3 to 18 months (mean 9 months, median 8 months). Thirteen (93%) patients were boys. Recurrence was not observed. In conclusion, the "fibrous umbilical polyp" is a distinctive lesion of early childhood with an uncertain pathogenesis. It shows a marked predilection for boys, is not rare, and appears to represent a clinicopathologic entity. Perhaps the umbilicus, a midline defect that is normally filled by dense scar tissue after birth, contains unique fibrogenic factors responsible for the development of this distinct lesion.