Stasis papillomatosis. Clinical features, etiopathogenesis and radiological findings

Verrucous hyperplasia of the great toe: a case and a review of the literature

BACKGROUND

Verrucous hyperplasia is a hyperplastic disease that manifests as coalescent warty papules at stump amputation sites. Often overlooked, it can be confused with verrucous carcinoma. As such, it is of concern for dermatologic surgeons.

OBJECTIVE

To present a patient with verrucous hyperplasia and review its literature.

METHODS

We report a 62-year-old diabetic patient with a verrucous nodule that arose at the amputation site of her first three right toes. Despite repeated surgical removals and skin graftings, the verrucous nodule redeveloped. A biopsy revealed digitate epidermal hyperplasia with dilated tortuous capillaries in thin dermal papilla without invasive features, mitotic figures, or acanthotic downgrowth. Polymerase chain reaction did not detect human papilloma virus.

RESULTS

Verrucous hyperplasia secondary to amputation was diagnosed.

CONCLUSION

Verrucous hyperplasia occurs should not be confused with verrucous carcinoma or warts. Moreover, because it recurs after removal, surgery is not indicated; rather, compression therapy is indicated.

Lymphedema: classification, diagnosis and therapy

This review presents the diagnostic features, the pathophysiology and the available therapies for lymphedema. This disease is often able to be diagnosed by its characteristic clinical presentation, yet, in some cases, ancillary tests might be necessary to establish the diagnosis, particularly in the early stages of the disease and in edemas of mixed etiology. These diagnostic modalities are also useful in clinical studies. Available modalities include isotopic lymphoscintigraphy, indirect and direct lymphography, magnetic resonance imaging, computed tomography and ultrasonography. Lymphedema may be primary or secondary to the presence of other disease and/or to the consequences of surgery. Primary lymphedema may occur at any phase of life but it most commonly appears at puberty. Secondary lymphedema is encountered more often. The most prevalent worldwide cause of lymphedema is filariasis, which is particularly common in south-east Asia. In the USA, postsurgical lymphedema of the extremity prevails. Complications of chronic limb lymphedema include recurrent cellulitis and lymphangiosarcoma. Most patients are treated conservatively, by means of various forms of compression therapy, including complex physical therapy, pneumatic pumps and compressive garments. Volume reducing surgery is performed rarely. Lymphatic microsurgery is still in an experimental stage, although a few centers consistently report favorable outcomes.

Mossy leg with eccrine syringofibroadenomatous hyperplasia resembling multiple eccrine syringofibroadenoma

Eccrine syringofibroadenoma (ES) is a histological entity with a polymorphous clinical presentation. We describe a patient who had multiple nodules on both of his legs resembling lymphoedematous keratoderma (mossy leg or elephantiasis) in the absence of any vascular or lymphatic incompetence. The histological features were those of ES. A surgical resection was effective. Our case is probably an eccrine sweat duct reactive hyperplasia rather than a neoplasia or hamartoma.

A case of stasis papillomatosis associated with psoriasis vulgaris

A markedly obese, 41-year-old Japanese man who had suffered from psoriasis vulgaris for several years visited us with elephantiasis-like swelling of his lower legs of three months' duration. His right lower leg showed marked papillomatosis with thick scales, and the left lower leg was eroded and papillomatous. Although direct lymphography of his lower extremities showed no abnormality, indirect lymphography revealed local lymphatic damage in the involved skin. Histological examination showed hyperkeratosis, marked papillomatosis, proliferation of capillaries in the upper dermis, and lymphectasia in the lower dermis. The lesions were much improved by washing and topical use of corticosteroids for two months. It was suspected that obesity and the preceding psoriatic lesions caused local lymphatic disturbances, followed by the development of stasis papillomatosis.