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Olayinka O, Cox SE, Nasrazadani A, Resetkova E, Ivan D, Middleton LP. Invasive Carcinoma With Skin Adnexal Trichilemmal Hair Follicular Differentiation Occurring in the Breast: A Case Report With Detailed Immunohistochemical and Molecular Analysis. Int J Surg Pathol 2024; 32:796-802. [PMID: 37525555 DOI: 10.1177/10668969231189166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Cutaneous-type adnexal tumors involving the breast are rare and create a diagnostic dilemma as they are often indistinguishable from primary mammary neoplasms. Tumors showing hair follicular differentiation are particularly challenging due to their rarity and the subtle appreciation of the intricate microanatomy of the hair follicle. We report a triple negative cutaneous-type adnexal carcinoma with follicular differentiation involving the breast to bring attention to the existence of these specialized group of tumors which should be managed differently from conventional triple negative carcinomas of the breast.
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Affiliation(s)
| | - Solange E Cox
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Erika Resetkova
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Doina Ivan
- The University of Texas MD Anderson Cancer Center, Houston, USA
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Pogrel MA, Graham J. Apical Abscess on a Zygomaticus Implant Initially Diagnosed as a Cutaneous Carcinoma. J ORAL IMPLANTOL 2024:500526. [PMID: 38699937 DOI: 10.1563/aaid-joi-d-23-00116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
We present a case of an infection on a zygomaticus implant presenting on the skin, mimicking a cutaneous carcinoma, and presenting to a head and neck tumor board. The clinical findings were an intermittently discharging lesion over the zygomatic bone, which resolved upon removing the offending zygomaticus implant. It is essential to be aware that infections on a zygomaticus implant can occur well away from the normal tooth-bearing areas, and having a dentist with knowledge of these implants on a tumor board can prevent misdiagnosis and treatment.
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Affiliation(s)
| | - Jymie Graham
- The University of California San Francisco Department of Oral and Maxillofacial Surgery
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Shen Y, Wang R, Zhao C, Liu L, Sun D, Chen X. Investigations on ultrasonography in the diagnosis of nodular localized cutaneous neurofibroma. J Clin Ultrasound 2024; 52:359-367. [PMID: 38264918 DOI: 10.1002/jcu.23639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/29/2023] [Accepted: 01/12/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To describe the ultrasound characteristics of nodular localized cutaneous neurofibroma (NLCN). MATERIALS AND METHODS Clinical features and ultrasound characteristics of 43 lesions of 40 patients pathologically proven as NLCNs at Peking University Shenzhen Hospital from October 2014 to May 2022 were analyzed retrospectively. The location, length-to-thickness (L/T) ratio, thickness-to-width (T/W) ratio, shape, margin, capsule, echogenicity, echotexture, posterior features, vascularity, and "rat tail sign" were evaluated. RESULTS All ultrasound findings showed almost perfect agreement. More than a half of NLCNs (n = 24, 55.8%, p < 0.001) were located in the subcutaneous fat layer wholly with well-demarcation from dermis and deep fascia. Most of the NLCNs were fusiform shape (n = 27, 62.8%, p < 0.001) in the long axis and oval shape (n = 35, 81.4%, p < 0.001) in the short axis. The other ultrasound findings of NLCNs included well-defined (n = 42, 97.7%, p < 0.001), encapsulated (n = 39, 90.7%, p < 0.001), predominately hypoechoic (n = 34, 79.1%, p < 0.001), homogeneous (n = 39, 90.7%, p < 0.001), posterior enhancement (n = 29, 67.4%, p = 0.033), and avascularity (n = 37, 86.0%, p < 0.001). Only a quarter (n = 11, 25.6%, p = 0.002) of lesions were recognized with the "rat tail sign." CONCLUSION NLCNs present as fusiform shape in long axis and round shape in short axis. The common ultrasound findings of NLCNs are well-defined, encapsulated, predominately hypoechoic, homogeneous lesion with posterior enhancement, and poor blood supply. The "rat tail sign" has low sensitivity in NLCNs.
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Affiliation(s)
- Yuzhou Shen
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Run Wang
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Chenyang Zhao
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Li Liu
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Desheng Sun
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Xiangmei Chen
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
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Workman L, Fang L, Ayoub S, Bach K, Simman R. A rare presentation of Rosai-Dorfman-Destombes disease with central nervous system involvement and cutaneous wounds. J Wound Care 2024; 33:S10-S13. [PMID: 38683815 DOI: 10.12968/jowc.2024.33.sup5.s10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVE The aim of this case report is to investigate an uncommon presentation of Rosai-Dorfman-Destombes (RDD) disease, and discuss possible differential diagnoses and treatment options for this pathology. RDD is a rare disorder of histiocytes that typically presents in patients as painless cervical lymphadenopathy. However, this case involves a patient with the central nervous system (CNS) type of RDD who later developed cutaneous lesions. METHOD Several differential diagnoses were examined, including hidradenitis suppurativa, pilonidal cyst and pressure ulcers. It is important to be able to exclude these diagnoses based on the presentation, patient demographic and wound location. RESULTS Biopsies verified the presence of RDD in the patient's suprasellar hypothalamic mass and skin lesions, confirming the patient had both CNS-RDD and cutaneous-RDD in the absence of lymphadenopathy. CONCLUSION Recognising the unique manifestations of rare diseases such as RDD prevents delay of proper intervention and treatment.
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Affiliation(s)
- Lauren Workman
- University of Toledo, College of Medicine and Life Science, Toledo, Ohio, US
| | - Lauren Fang
- University of Toledo, College of Medicine and Life Science, Toledo, Ohio, US
| | - Samar Ayoub
- University of Toledo, College of Medicine and Life Science, Toledo, Ohio, US
| | - Karen Bach
- University of Toledo, College of Medicine and Life Science, Toledo, Ohio, US
| | - Richard Simman
- Jobst Vascular Institute, ProMedica Health Network, Wound Care Program, Toledo, Ohio, US
- University of Toledo, College of Medicine and Life Science, Department of Surgery, Toledo, Ohio, US
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Beaudet P, Giunta JC, Agu C, van Rooij F, Saffarini M, Nogier A. Accuracy of Cutaneous Landmarks Compared to Ultrasound to Locate the Calcaneal Footprint of the CFL. J Foot Ankle Surg 2024; 63:353-358. [PMID: 38218343 DOI: 10.1053/j.jfas.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/05/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024]
Abstract
The purpose was to determine the accuracy of the techniques of Lopes et al. and Michels et al., compared to ultrasound, to locate the center of the calcaneal footprint of the CFL in healthy volunteers. The authors recruited 17 healthy adult volunteers at 1 center with no current ankle pathologies and no previous surgical antecedents on either ankle. The authors recorded the age, sex, height, BMI, and ankle side for each volunteer. Measurements were made on both ankles of the 17 volunteers to increase the sample size and ensure less dispersion of data, independently by 2 surgeons: 1 senior surgeon with 15 years' experience and 1 junior with 3 years' experience. The location of the center of the calcaneal footprint of the CFL was determined by each surgeon using 3 methods: (1) the cutaneous technique of Lopes et al., (2) the cutaneous technique of Michels et al., and (3) ultrasound imaging. The 17 volunteers (34 feet) had a mean age of 26.3 ± 8.7 and a BMI of 21.7 ± 2.9. The Michels point was significantly closer (4.6 ± 3.7 mm) than the Lopes point (11.1 ± 5.4 mm) to the true center of the calcaneal footprint of the CFL determined by ultrasound, notably in the vertical direction. The Michels point was located significantly closer to the true center of the calcaneal footprint of the CFL and demonstrated less dispersion than the Lopes point, indicated by significantly lower absolute mean deviation from the true center of the calcaneal footprint of the CFL, and that ultrasound is therefore preferred to locate the footprint the CFL.
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Fiedler LS, Daaloul H. An overview of current assessment techniques for evaluating cutaneous perfusion in reconstructive surgery. J Biophotonics 2024; 17:e202400002. [PMID: 38596828 DOI: 10.1002/jbio.202400002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/30/2024] [Accepted: 04/02/2024] [Indexed: 04/11/2024]
Abstract
This article provides a comprehensive analysis of modern techniques used in the assessment of cutaneous flaps in reconstructive surgery. It emphasizes the importance of preoperative planning and intra- and perioperative assessment of flap perfusion to ensure successful outcomes. Despite technological advancements, direct clinical assessment remains the gold standard. We categorized assessment techniques into non-invasive and invasive modalities, discussing their strengths and weaknesses. Non-invasive methods, such as acoustic Doppler sonography, near-infrared spectroscopy, hyperspectral imaging thermal imaging, and remote-photoplethysmography, offer accessibility and safety but may sacrifice specificity. Invasive techniques, including contrast-enhanced ultrasound, computed tomography angiography, near-infrared fluorescence angiography with indocyanine green, and implantable Doppler probe, provide high accuracy but introduce additional risks. We emphasize the need for a tailored decision-making process based on specific clinical scenarios, patient characteristics, procedural requirements, and surgeon expertise. It also discusses potential future advancements in flap assessment, including the integration of artificial intelligence and emerging technologies.
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Affiliation(s)
- Lukas Sebastian Fiedler
- ENT and Head and Neck Surgery, Plastic Operations, SLK Kliniken Heilbronn, Heilbronn, Germany
- Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Houda Daaloul
- Department of Neurology, Klinikum Rechts der Isar, Medical Faculty, Technical University of Munich, Munich, Germany
- Caire Health AI GmbH, Munich, Germany
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Pasco Peña A, Nova-Camacho LM, Fernandez I, Pelegay JP, Panizo Á, Guerrero-Setas D, Córdoba A. Primary Cutaneous Acral CD8-Positive Lymphoproliferative Disorder: A Case Report With Nonacral Presentation. Int J Surg Pathol 2024:10668969241248587. [PMID: 38689481 DOI: 10.1177/10668969241248587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
In this study, we describe a patient of primary cutaneous acral CD8-positive lymphoproliferative disorder located in a nonacral region. A 65-year-old male presented with an ill-defined lesion of rubbery consistency and a maximum diameter of 2.5 cm localized in the right thigh. Histologically, it was composed of a diffuse dermal infiltration of medium-sized atypical lymphocytes that expressed CD3, CD8, and TIA-1. In addition, a characteristic paranuclear positivity with CD68 was observed. During the follow-up, the patient had a recurrence of the disease in the abdomen with a lesion showing similar morphology and phenotype. To our knowledge, < 20 patients of primary cutaneous acral CD8-positive lymphoproliferative disorder with a nonacral presentation have been described in English literature. Although rare, its identification is essential to differentiate it from other T-cell lymphoma that express CD8 and cytotoxic markers, and whose clinical courses are very aggressive.
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Affiliation(s)
- Alejandro Pasco Peña
- Department of Pathology, University Hospital of Navarra, Pamplona, Navarra, Spain
| | | | - Irene Fernandez
- Department of Pathology, University Hospital of Navarra, Pamplona, Navarra, Spain
| | | | - Ángel Panizo
- Department of Pathology, University Hospital of Navarra, Pamplona, Navarra, Spain
| | - David Guerrero-Setas
- Department of Pathology, University Hospital of Navarra, Pamplona, Navarra, Spain
| | - Alicia Córdoba
- Department of Pathology, University Hospital of Navarra, Pamplona, Navarra, Spain
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Shi W, Zheng Y, Wang H, Zhang R. Misdiagnosis of cutaneous facial sporotrichosis: An analysis of five cases. J Cosmet Dermatol 2024. [PMID: 38654514 DOI: 10.1111/jocd.16335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/27/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Facial cutaneous sporotrichosis presents with diverse clinical manifestations, often leading to misdiagnosis. OBJECTIVE This study aims to present the clinical characteristics of five misdiagnosed cases of facial cutaneous sporotrichosis, aiming to enhance understanding of this disease and prevent misdiagnosis and mistreatment. METHODS Clinical data, histopathology, and fungal culture results of these five cases were comprehensively analyzed. RESULTS Among these five patients, three presented with lymphocutaneous sporotrichosis, while two had the fixed cutaneous type. Due to misdiagnosis, initial treatments were ineffective for all patients. Upon histopathological examination and fungal culture confirming sporotrichosis, treatment with itraconazole for 3 months led to complete resolution of lesions. While one patient experienced a relapse due to noncompliance with the prescribed medication. CONCLUSION Facial sporotrichosis, with its diverse clinical manifestations and obscure trauma history, is prone to misdiagnosis. Timely and thorough examinations are crucial for precise diagnosis and management. Itraconazole treatment demonstrated notable efficacy, and patient compliance is also essential for favorable outcomes.
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Affiliation(s)
- Weiwei Shi
- Department of Dermatology, Affiliated Hospital 2 of Nantong University, Nantong, China
- Department of Dermatology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yunyan Zheng
- Department of Dermatology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Huiying Wang
- Department of Dermatology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Ruzhi Zhang
- Department of Dermatology, The Second Affiliated Hospital of Wannan Medical College, Wuhu, China
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Rocha R, Conceição C, Gonçalves L, Carvalho AC, Maia A, Martins A, Carujo A, Maio A, Forra C, Melita C, Couto D, Fernandes D, Pereira D, Leal E, Sarmento H, Sousa I, Gonçalves JP, Marinho J, Vasconcelos J, Cunha J, Rodrigues J, Silva JM, Caley L, Malheiro L, Santos L, Garcia M, Cunha M, Lima M, Andrade MM, Marques M, Alpalhão M, Silva M, Ferraz R, Soares R, Fernandes S, Llobet S, Cruz S, Guimarães T, Branco T, Robalo-Nunes T, Almeida V, Maia C. Epidemiological and Clinical Aspects of Cutaneous and Mucosal Leishmaniases in Portugal: Retrospective Analysis of Cases Diagnosed in Public Hospitals and Reported in the Literature between 2010 and 2020. Microorganisms 2024; 12:819. [PMID: 38674763 PMCID: PMC11052487 DOI: 10.3390/microorganisms12040819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Leishmania infantum, a zoonotic vector-born parasite, is endemic in the Mediterranean region, presenting mostly as visceral (VL), but also as cutaneous (CL) and mucosal leishmaniasis (ML). This study aimed to describe the epidemiological and clinical aspects of the CL and ML cases diagnosed in mainland Portugal between 2010 and 2020. Collaboration was requested from every hospital of the Portuguese National Health System. Cases were screened through a search of diagnostic discharge codes or positive laboratory results for Leishmania infection. Simultaneously, a comprehensive literature search was performed. Descriptive statistics and hypothesis testing were performed using IBM® SPSS® Statistics. A total of 43 CL and 7 ML cases were identified, with a predominance of autochthonous cases (86%). In CL, immunosuppressed individuals constituted a significant proportion of patients (48%), and in this group, disseminated CL (22%) and simultaneous VL (54%) were common. In autochthonous cases, lesions, mostly papules/nodules (62%), were frequently observed on the head (48%). The approach to treatment was very heterogeneous. ML cases were all autochthonous, were diagnosed primarily in older immunosuppressed individuals, and were generally treated with liposomal amphotericin B. The findings suggest a need for enhanced surveillance and reporting, clinical awareness, and diagnostic capacity of these forms of leishmaniasis to mitigate underdiagnosis and improve patient outcomes. A holistic One Health approach is advocated to address the multifaceted challenges posed by leishmaniases in Portugal and beyond.
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Affiliation(s)
- Rafael Rocha
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal; (R.R.); (C.C.)
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal
- Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Cláudia Conceição
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal; (R.R.); (C.C.)
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal
| | - Luzia Gonçalves
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal; (R.R.); (C.C.)
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal
- Centro de Estatística e Aplicações da Universidade de Lisboa, Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal
- Z-Stat4life, Espaço Cowork Baldaya, Palácio Baldaya, Estrada de Benfica N° 701ª, 1549-011 Lisboa, Portugal
| | | | - André Maia
- Centro Hospitalar de Trás-os-Montes e Alto Douro, Avenida da Noruega, 5000-508 Vila Real, Portugal
| | - André Martins
- Hospital da Senhora da Oliveira Guimarães, Rua dos Cutileiros, Creixomil, 4835-044 Guimarães, Portugal
| | - António Carujo
- Centro Hospitalar Universitário de Santo António, Rua Prof. Vicente José de Carvalho N° 37, 4050-366 Porto, Portugal
| | - António Maio
- Centro Hospitalar do Baixo Vouga, Av. Artur Ravara, 3810-501 Aveiro, Portugal
| | - Catarina Forra
- Unidade Local de Saúde de Castelo Branco, Avenida Pedro Álvares Cabral, 6000-085 Castelo Branco, Portugal
| | - Catarina Melita
- Hospital Professor Doutor Fernando Fonseca, IC 19, 2720-276 Amadora, Portugal
| | - Daniela Couto
- Centro Hospitalar Universitário Cova da Beira, Alameda Pêro da Covilhã, 6200-251 Covilhã, Portugal
| | - Diana Fernandes
- Centro Hospitalar de Leiria, Rua das Olhalvas, 2410-197 Leiria, Portugal
| | - Dulce Pereira
- Centro Hospitalar Tondela-Viseu, Avenida Rei D. Duarte, 3504-509 Viseu, Portugal
| | - Ema Leal
- Centro Hospitalar Universitário de Lisboa Central, Rua José António Serrano, 1150-199 Lisboa, Portugal
| | - Helena Sarmento
- Hospital da Senhora da Oliveira Guimarães, Rua dos Cutileiros, Creixomil, 4835-044 Guimarães, Portugal
| | - Inês Sousa
- Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal
| | - Jean-Pierre Gonçalves
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto, 1099-023 Lisboa, Portugal
| | - Joana Marinho
- Centro Hospitalar Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal
| | - Joana Vasconcelos
- Centro Hospitalar de Lisboa Ocidental, Rua da Junqueira N° 126, 1349-019 Lisboa, Portugal;
| | - João Cunha
- Hospital Distrital de Santarém, Avenida Bernardo Santareno, 2005-177 Santarém, Portugal
| | - João Rodrigues
- Unidade Local de Saúde da Guarda, Avenida Rainha Dona Amélia, 6300-858 Guarda, Portugal
| | - José Miguel Silva
- Unidade Local de Saúde do Norte Alentejano, Avenida de Santo António, Apartado 234, 7301-853 Portalegre, Portugal
| | - Lídia Caley
- Centro Hospitalar do Médio Tejo, Avenida Maria de Lourdes de Mello Castro, Ap. 118, 2304-909 Tomar, Portugal
| | - Luís Malheiro
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, 4434-502 Vila Nova de Gaia, Portugal
| | - Luís Santos
- Centro Hospitalar Universitário de Lisboa Central, Rua José António Serrano, 1150-199 Lisboa, Portugal
| | - Margarida Garcia
- Centro Hospitalar Universitário de Lisboa Central, Rua José António Serrano, 1150-199 Lisboa, Portugal
| | - Maria Cunha
- Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Maria Lima
- Centro Hospitalar de Setúbal, Rua Camilo Castelo Branco, Apartado 140, 2910-446 Setúbal, Portugal
| | - Maria Margarida Andrade
- Hospital de Cascais Dr. José de Almeida, Avenida Brigadeiro Victor Novais Gonçalves, 2755-009 Alcabideche, Portugal
| | - Marta Marques
- Centro Hospitalar Tondela-Viseu, Avenida Rei D. Duarte, 3504-509 Viseu, Portugal
| | - Miguel Alpalhão
- Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal
| | - Mónica Silva
- Centro Hospitalar Barreiro Montijo, Avenida Movimento das Forças Armadas, 2834-003 Barreiro, Portugal
| | - Rita Ferraz
- Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo, N° 210, Guilhufe, 4560-136 Penafiel, Portugal;
| | - Rui Soares
- Instituto Português de Oncologia de Coimbra Francisco Gentil, Avenida Bissaya Barreto N° 98, 3000-075 Coimbra, Portugal
| | - Salomão Fernandes
- Hospital Beatriz Ângelo, Avenida Carlos Teixeira, N° 3, 2674-514 Loures, Portugal
| | - Samuel Llobet
- Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal
| | - Sofia Cruz
- Hospital de Vila Franca de Xira, Estrada Carlos Lima Costa N°2, 2600-009 Vila Franca de Xira, Portugal
| | - Teresa Guimarães
- Unidade Local de Saúde do Nordeste, Avenida Abade de Baçal, 5301-852 Bragança, Portugal
| | - Tiago Branco
- Centro Hospitalar Universitário do Algarve, Rua Leão Penedo, 8000-386 Faro, Portugal
| | - Tomás Robalo-Nunes
- Hospital Garcia de Orta, Avenida Torrado da Silva, 2805-267 Almada, Portugal
| | - Vasco Almeida
- Centro Hospitalar Universitário de Lisboa Central, Rua José António Serrano, 1150-199 Lisboa, Portugal
| | - Carla Maia
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal; (R.R.); (C.C.)
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal
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Tinca AC, Szoke AR, Lazar BA, Szász EA, Tomuț AN, Sabău AH, Cocuz IG, Cotoi TC, Niculescu R, Chiorean DM, Ungureanu IA, Turdean SG, Cotoi OS. H-VISTA Immunohistochemistry Score Is Associated with Advanced Stages in Cutaneous and Ocular Melanoma. Int J Mol Sci 2024; 25:4335. [PMID: 38673920 PMCID: PMC11049914 DOI: 10.3390/ijms25084335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Melanoma represents a public health issue. One of the biggest goals of current research is to develop new therapeutic options for patients affected by this aggressive tumor. We conducted a retrospective study including 105 patients diagnosed with cutaneous and ocular melanoma, with stages varying from pT1a to pT4b and pT4e, respectively, and we performed immunohistochemistry reactions with the new potential prognostic marker, VISTA (V-domain Ig suppressor of T cell activation). We quantified the expression by applying the H-score adapted for VISTA and divided the patients, based on the median value, into groups that presented high, low, and negative expression. Therefore, we obtained 65 cases with positive expression for cutaneous melanoma and 8 cases with positive expression for ocular melanoma. Forty-one cases presented high expression in cutaneous melanoma and three cases presented high expression in ocular melanoma. In cutaneous melanoma, analytic statistics showed that VISTA expression was associated with a high Breslow index, high mitotic count, high Ki67 expression, and advanced clinicopathological stage. The majority of ocular melanoma cases demonstrating a positive reaction were classified as stage pT3, whereas earlier stages showed a negative reaction. Our findings underscore a significant correlation between VISTA expression and key prognostic factors in melanoma. Looking ahead, the prospect of future randomized studies holds promise in corroborating the clinical relevance of our findings. By further elucidating the intricate relationship between VISTA expression and melanoma progression, new treatment strategies could be found, improving patient outcomes in this challenging neoplasm.
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Affiliation(s)
- Andreea Cătălina Tinca
- Doctoral School of Medicine and Pharmacy, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania; (A.C.T.); (A.H.S.); (R.N.); (D.M.C.)
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania; (B.A.L.); (E.A.S.); (I.-G.C.); (S.G.T.); (O.S.C.)
- Pathophysiology Department, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania
| | - Andreea Raluca Szoke
- Doctoral School of Medicine and Pharmacy, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania; (A.C.T.); (A.H.S.); (R.N.); (D.M.C.)
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania; (B.A.L.); (E.A.S.); (I.-G.C.); (S.G.T.); (O.S.C.)
- Pathophysiology Department, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania
| | - Bianca Andreea Lazar
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania; (B.A.L.); (E.A.S.); (I.-G.C.); (S.G.T.); (O.S.C.)
| | - Emőke Andrea Szász
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania; (B.A.L.); (E.A.S.); (I.-G.C.); (S.G.T.); (O.S.C.)
- Faculty of Medicine, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania; (A.N.T.); (I.A.U.)
| | - Alexandru Nicușor Tomuț
- Faculty of Medicine, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania; (A.N.T.); (I.A.U.)
| | - Adrian Horațiu Sabău
- Doctoral School of Medicine and Pharmacy, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania; (A.C.T.); (A.H.S.); (R.N.); (D.M.C.)
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania; (B.A.L.); (E.A.S.); (I.-G.C.); (S.G.T.); (O.S.C.)
- Pathophysiology Department, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania
| | - Iuliu-Gabriel Cocuz
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania; (B.A.L.); (E.A.S.); (I.-G.C.); (S.G.T.); (O.S.C.)
- Pathophysiology Department, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania
| | - Titiana-Cornelia Cotoi
- Faculty of Pharmacy, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania;
| | - Raluca Niculescu
- Doctoral School of Medicine and Pharmacy, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania; (A.C.T.); (A.H.S.); (R.N.); (D.M.C.)
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania; (B.A.L.); (E.A.S.); (I.-G.C.); (S.G.T.); (O.S.C.)
- Pathophysiology Department, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania
| | - Diana Maria Chiorean
- Doctoral School of Medicine and Pharmacy, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania; (A.C.T.); (A.H.S.); (R.N.); (D.M.C.)
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania; (B.A.L.); (E.A.S.); (I.-G.C.); (S.G.T.); (O.S.C.)
| | - Ioana Ancuța Ungureanu
- Faculty of Medicine, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania; (A.N.T.); (I.A.U.)
| | - Sabin Gligore Turdean
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania; (B.A.L.); (E.A.S.); (I.-G.C.); (S.G.T.); (O.S.C.)
- Faculty of Medicine, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania; (A.N.T.); (I.A.U.)
| | - Ovidiu Simion Cotoi
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania; (B.A.L.); (E.A.S.); (I.-G.C.); (S.G.T.); (O.S.C.)
- Pathophysiology Department, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania
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11
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Liu Q, Su H, Hong C, Han J, Chen X, Tang X. Toxic epidermal necrolysis complicated with primary cutaneous aspergillosis: A report of four cases. J Dermatol 2024. [PMID: 38605474 DOI: 10.1111/1346-8138.17226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/11/2024] [Accepted: 03/28/2024] [Indexed: 04/13/2024]
Abstract
Primary cutaneous aspergillosis (PCA) is a rare opportunistic infection caused by Aspergillus that can be life-threatening. PCA is mainly reported in immunocompromised hosts such as patients with AIDS, those with hematologic malignancy, or infants with occlusive dressings. However, no study has previously reported PCA associated with toxic epidermal necrolysis (TEN). This study reports four cases of TEN complicated with PCA, presenting with discrete gray or black spots over newly formed epithelia. Risk factors of PCA in patients with TEN include host factors, iatrogenic factors, indoor environment, and wound care. Two of the four cases eventually died, highlighting the importance of further exploring PCA in patients with TEN.
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Affiliation(s)
- Qianru Liu
- Department of Dermatology, The First Affiliated Hospital of sun Yat-Sen University, Guangzhou, China
| | - Huilin Su
- Department of Dermatology, The First Affiliated Hospital of sun Yat-Sen University, Guangzhou, China
| | - Chunli Hong
- Department of Dermatology, The First Affiliated Hospital of sun Yat-Sen University, Guangzhou, China
| | - Jiande Han
- Department of Dermatology, The First Affiliated Hospital of sun Yat-Sen University, Guangzhou, China
| | - Xiaohong Chen
- Department of Dermatology, The First Affiliated Hospital of sun Yat-Sen University, Guangzhou, China
| | - Xuhua Tang
- Department of Dermatology, The First Affiliated Hospital of sun Yat-Sen University, Guangzhou, China
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12
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Serrage HJ, O’ Neill CA, Uzunbajakava NE. Illuminating microflora: shedding light on the potential of blue light to modulate the cutaneous microbiome. Front Cell Infect Microbiol 2024; 14:1307374. [PMID: 38660491 PMCID: PMC11039841 DOI: 10.3389/fcimb.2024.1307374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Cutaneous diseases (such as atopic dermatitis, acne, psoriasis, alopecia and chronic wounds) rank as the fourth most prevalent human disease, affecting nearly one-third of the world's population. Skin diseases contribute to significant non-fatal disability globally, impacting individuals, partners, and society at large. Recent evidence suggests that specific microbes colonising our skin and its appendages are often overrepresented in disease. Therefore, manipulating interactions of the microbiome in a non-invasive and safe way presents an attractive approach for management of skin and hair follicle conditions. Due to its proven anti-microbial and anti-inflammatory effects, blue light (380 - 495nm) has received considerable attention as a possible 'magic bullet' for management of skin dysbiosis. As humans, we have evolved under the influence of sun exposure, which comprise a significant portion of blue light. A growing body of evidence indicates that our resident skin microbiome possesses the ability to detect and respond to blue light through expression of chromophores. This can modulate physiological responses, ranging from cytotoxicity to proliferation. In this review we first present evidence of the diverse blue light-sensitive chromophores expressed by members of the skin microbiome. Subsequently, we discuss how blue light may impact the dialog between the host and its skin microbiome in prevalent skin and hair follicle conditions. Finally, we examine the constraints of this non-invasive treatment strategy and outline prospective avenues for further research. Collectively, these findings present a comprehensive body of evidence regarding the potential utility of blue light as a restorative tool for managing prevalent skin conditions. Furthermore, they underscore the critical unmet need for a whole systems approach to comprehend the ramifications of blue light on both host and microbial behaviour.
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Affiliation(s)
- Hannah J. Serrage
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Catherine A. O’ Neill
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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13
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Marteles D, Gómez Á, Villanueva-Saz S, Naranjo C, Aceña MC. Intermammary mass in a 13-year-old intact female Spanish Alano dog. J Am Vet Med Assoc 2024:1-3. [PMID: 38579766 DOI: 10.2460/javma.24.01.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/02/2024] [Indexed: 04/07/2024]
Affiliation(s)
- Diana Marteles
- 1Department of Animal Pathology, Veterinary Faculty, University of Zaragoza, Zaragoza, Spain
- 2Clinical Immunology Laboratory, Veterinary Faculty, University of Zaragoza, Zaragoza, Spain
| | - Álex Gómez
- 1Department of Animal Pathology, Veterinary Faculty, University of Zaragoza, Zaragoza, Spain
- 3Instituto Agroalimentario de Aragón-IA2 (University of Zaragoza-CITA), Zaragoza, Spain
| | - Sergio Villanueva-Saz
- 1Department of Animal Pathology, Veterinary Faculty, University of Zaragoza, Zaragoza, Spain
- 2Clinical Immunology Laboratory, Veterinary Faculty, University of Zaragoza, Zaragoza, Spain
- 3Instituto Agroalimentario de Aragón-IA2 (University of Zaragoza-CITA), Zaragoza, Spain
| | | | - María C Aceña
- 1Department of Animal Pathology, Veterinary Faculty, University of Zaragoza, Zaragoza, Spain
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14
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Mortada H, Albrahim R, Alrobaiea S, Ahmad M, Abdelraheem EHA, Hakami M. A rare case of mucormycosis in a diabetic patient: diagnostic challenges and clinical management of mucormycosis hand infection. Case Reports Plast Surg Hand Surg 2024; 11:2333879. [PMID: 38567104 PMCID: PMC10986432 DOI: 10.1080/23320885.2024.2333879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
Mucormycosis hand infection in poorly controlled diabetic presented as rapidly progressive swelling, redness, pain, and necrosis unresponsive to antibiotics. Prompt diagnosis and aggressive surgery, antifungals, and diabetes management were critical, highlighting the need for early recognition and treatment of mucormycosis in diabetics.
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Affiliation(s)
- Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Department of Plastic Surgery and Burn, King Saud Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Razan Albrahim
- College of Medicine and Surgery, Princess Noura Bin Abdulrahman University, Riyadh, Saudi Arabia
| | - Saad Alrobaiea
- Department of Plastic Surgery and Burn Unit, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Moinuddin Ahmad
- Division of Plastic Surgery, Department of Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Muath Hakami
- Division of Plastic Surgery, Department of Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
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15
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Guglielmo A, Zengarini C, Agostinelli C, Motta G, Sabattini E, Pileri A. The Role of Cytokines in Cutaneous T Cell Lymphoma: A Focus on the State of the Art and Possible Therapeutic Targets. Cells 2024; 13:584. [PMID: 38607023 PMCID: PMC11012008 DOI: 10.3390/cells13070584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/13/2024] Open
Abstract
Cutaneous T cell lymphomas (CTCLs), encompassing mycosis fungoides (MF) and Sézary syndrome (SS), present a complex landscape influenced by cytokines and cellular responses. In this work, the intricate relationship between these inflammatory proteins and disease pathogenesis is examined, focusing on what is known at the clinical and therapeutic levels regarding the most well-known inflammatory mediators. An in-depth look is given to their possible alterations caused by novel immunomodulatory drugs and how they may alter disease progression. From this narrative review of the actual scientific landscape, Interferon-gamma (IFN-γ) emerges as a central player, demonstrating a dual role in both promoting and inhibiting cancer immunity, but the work navigates through all the major interleukins known in inflammatory environments. Immunotherapeutic perspectives are elucidated, highlighting the crucial role of the cutaneous microenvironment in shaping dysfunctional cell trafficking, antitumor immunity, and angiogenesis in MF, showcasing advancements in understanding and targeting the immune phenotype in CTCL. In summary, this manuscript aims to comprehensively explore the multifaceted aspects of CTCL, from the immunopathogenesis and cytokine dynamics centred around TNF-α and IFN-γ to evolving therapeutic modalities. Including all the major known and studied cytokines in this analysis broadens our understanding of the intricate interplay influencing CTCL, paving the way for improved management of this complex lymphoma.
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Affiliation(s)
- Alba Guglielmo
- Institute of Dermatology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, 40138 Bologna, Italy
| | - Corrado Zengarini
- Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, 40138 Bologna, Italy
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Claudio Agostinelli
- Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, 40138 Bologna, Italy
- Haematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Giovanna Motta
- Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, 40138 Bologna, Italy
- Haematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Elena Sabattini
- Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, 40138 Bologna, Italy
- Haematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alessandro Pileri
- Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, 40138 Bologna, Italy
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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16
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Nepal B, McCormick-Baw C, Patel K, Firmani S, Wetzel DM. Cutaneous Leishmania mexicana infections in the United States: defining strains through endemic human pediatric cases in northern Texas. mSphere 2024; 9:e0081423. [PMID: 38421172 PMCID: PMC10964424 DOI: 10.1128/msphere.00814-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 03/02/2024] Open
Abstract
Over a 6-month span, three patients under 5 years old with cutaneous leishmaniasis presented to the Pediatric Infectious Diseases Clinic at the University of Texas Southwestern Medical Center/Children's Health Dallas. None had traveled outside of northern Texas/southern Oklahoma; all had Leishmania mexicana infections confirmed by PCR. We provide case descriptions and images to increase the awareness of this disease among United States (US) physicians and scientists. Two patients responded to fluconazole, but the youngest required topical paromomycin. Combining these cases with guidelines and our literature review, we suggest that (i) higher doses (10-12 mg/kg/day) of fluconazole should be considered in young children to maximize likelihood and rapidity of response and (ii) patients should transition to alternate agents if they do not respond to high-dose fluconazole within 6 weeks. Furthermore, and of particular interest to the broad microbiology community, we used samples from these cases as a proof of concept to propose a mechanism to strain-type US-endemic L. mexicana. For our analysis, we sequenced three housekeeping genes and the internal transcribed sequence 2 of the ribosomal RNA gene. We identified genetic changes that not only allow us to distinguish US-based L. mexicana strains from strains found in other areas of the Americas but also establish polymorphisms that differ between US isolates. These techniques will allow documentation of genetic changes in this parasite as its range expands. Hence, our cases of cutaneous leishmaniasis provide significant evolutionary, treatment, and public health implications as climate change increases exposure to formerly tropical diseases in previously non-endemic areas. IMPORTANCE Leishmaniasis is a parasitic disease that typically affects tropical regions worldwide. However, the vector that carries Leishmania is spreading northward into the United States (US). Within a 6-month period, three young cutaneous leishmaniasis patients were seen at the Pediatric Infectious Diseases Clinic at the University of Texas Southwestern Medical Center/Children's Health Dallas. None had traveled outside of northern Texas and southern Oklahoma. We document their presentations, treatments, and outcomes and compare their management to clinical practice guidelines for leishmaniasis. We also analyzed the sequences of three critical genes in Leishmania mexicana isolated from these patients. We found changes that not only distinguish US-based strains from strains found elsewhere but also differ between US isolates. Monitoring these sequences will allow tracking of genetic changes in parasites over time. Our findings have significant US public health implications as people are increasingly likely to be exposed to what were once tropical diseases.
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Affiliation(s)
- Binita Nepal
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Clare McCormick-Baw
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Karisma Patel
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sarah Firmani
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Dawn M. Wetzel
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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17
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Schmid U, Galambos J, Pfaltz K, Hegyi I, Courvoisier S, Kempf W. Cutaneous Reactions after COVID-19 Vaccines: Analysis of the Clinical and Histopathological Spectrum-Case Series and Review of the Literature. Dermatopathology (Basel) 2024; 11:130-141. [PMID: 38534266 DOI: 10.3390/dermatopathology11010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 03/09/2024] [Accepted: 03/12/2024] [Indexed: 03/28/2024] Open
Abstract
(1) Background: Various cutaneous adverse drug reactions (ADRs) are observed with the implementation of mRNA COVID-19 vaccines. To gain insight into the clinicopathologic features, we analyzed the correlation of histological and clinical data in 48 patients with these ADRs. (2) Methods: Single-center retrospective study in patients with ADRs after mRNA COVID-19 vaccination (mRNA-1273 and BNT162b2 vaccines). (3) Results: Distant generalized ADRs prevailed (91%), often appearing clinically as spongiotic dermatitis or maculopapular exanthema. Histopathological analysis revealed spongiotic changes (46%) and dermal superficial perivascular predominantly lymphocytic infiltrates (17%). Eosinophils were found in 66% of biopsies, neutrophils in 29%, and plasma cells only in 8% of biopsies. Most ADRs occurred after the second vaccine dose (44%). Histologically spongiotic changes were associated with clinical features of spongiotic dermatitis in only 50% of patients and maculopapular exanthema in the remaining patients. ADRs represented an aggravation of preexisting skin disease in 23% of patients. ADRs regressed within 28 days or less in 53% of patients and persisted beyond a month in the remaining patients. (4) Conclusions: Our study demonstrates a diverse spectrum of generalized ADRs, revealing correlations between histology and clinical features but also instances of divergence. Interestingly, in about half of our patients, ADRs were self-limited, whereas ADRs extended beyond a month in the other half.
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Affiliation(s)
- Ursina Schmid
- Kempf und Pfaltz Histologische Diagnostik, Affolternstrasse 56, CH-8050 Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Jörg Galambos
- Kempf und Pfaltz Histologische Diagnostik, Affolternstrasse 56, CH-8050 Zurich, Switzerland
| | - Katrin Pfaltz
- Kempf und Pfaltz Histologische Diagnostik, Affolternstrasse 56, CH-8050 Zurich, Switzerland
| | - Ivan Hegyi
- Kempf und Pfaltz Histologische Diagnostik, Affolternstrasse 56, CH-8050 Zurich, Switzerland
| | | | - Werner Kempf
- Kempf und Pfaltz Histologische Diagnostik, Affolternstrasse 56, CH-8050 Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, CH-8091 Zurich, Switzerland
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18
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Wan Q, Deng Y, Wei R, Ma K, Tang J, Deng YP. Tumor-infiltrating macrophage associated lncRNA signature in cutaneous melanoma: implications for diagnosis, prognosis, and immunotherapy. Aging (Albany NY) 2024; 16:4518-4540. [PMID: 38475660 DOI: 10.18632/aging.205606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/08/2024] [Indexed: 03/14/2024]
Abstract
Along with the increasing knowledge of long noncoding RNA, the interaction between the long noncoding RNA (lncRNA) and tumor immune infiltration is increasingly valued. However, there is a lack of understanding of correlation between regulation of specific lncRNAs and tumor-infiltrating macrophages within melanoma. In this research, a macrophage associated lncRNA signature was identified by multiple machine learning algorithms and the robust and effectiveness of signature also validated in other independent datasets. The signature contained six specific lncRNAs (PART1, LINC00968, LINC00954, LINC00944, LINC00518 and C20orf197) was constructed, which could diagnose melanoma and predict the prognosis of patients. Moreover, our signature achieves higher accuracy than the previous well-established markers and regarded as an independent prognostic indicator. The pathway enrichment revealed that these lncRNAs were closely correlated with many immune processes. In addition, the signature was associated with different immune microenvironment and applied to predict response of immune checkpoint inhibitor therapy (low risk of patients well respond to anti-PD-1 therapy and high risk is insensitive to anti-CTLA-4 therapy). Therefore, our finding supplies a more accuracy and effective lncRNA signature for tumor-infiltrating macrophages targeting treatment approaches and affords a new clinical application for predicting the response of immunotherapies in melanomas.
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Affiliation(s)
- Qi Wan
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yuhua Deng
- Department of Infection Control, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ran Wei
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ke Ma
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jing Tang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ying-Ping Deng
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Budair FM, Nomura T, Hirata M, Kabashima K. PNAd-expressing vessels characterize the dermis of CD3+ T-cell-mediated cutaneous diseases. Clin Exp Immunol 2024; 216:80-88. [PMID: 38227774 PMCID: PMC10929698 DOI: 10.1093/cei/uxae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 10/04/2023] [Accepted: 01/15/2024] [Indexed: 01/18/2024] Open
Abstract
T-cell recruitment to skin tissues is essential for inflammation in different cutaneous diseases; however, the mechanisms by which these T cells access the skin remain unclear. High endothelial venules expressing peripheral node address in (PNAd), an L-selectin ligand, are located in secondary lymphoid organs and are responsible for increasing T-cell influx into the lymphoid tissues. They are also found in non-lymphoid tissues during inflammation. However, their presence in different common inflammatory cutaneous diseases and their correlation with T-cell infiltration remain unclear. Herein, we explored the mechanisms underlying the access of T cells to the skin by investigating the presence of PNAd-expressing vessels in different cutaneous diseases, and its correlation with T cells' presence. Skin sections of 43 patients with different diseases were subjected to immunohistochemical and immunofluorescence staining to examine the presence of PNAd-expressing vessels in the dermis. The correlation of the percentage of these vessels in the dermis of these patients with the severity/grade of CD3+ T-cell infiltration was assessed. PNAd-expressing vessels were commonly found in the skin of patients with different inflammatory diseases. A high percentage of these vessels in the dermis was associated with increased severity of CD3+ T-cell infiltration (P < 0.05). Additionally, CD3+ T cells were found both around the PNAd-expressing vessels and within the vessel lumen. PNAd-expressing vessels in cutaneous inflammatory diseases, characterized by CD3+ T-cell infiltration, could be a crucial entry point for T cells into the skin. Thus, selective targeting of these vessels could be beneficial in cutaneous inflammatory disease treatment.
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Affiliation(s)
- Fatimah Mohammad Budair
- Department of Dermatology, King Fahd University Hospital, Alkhobar, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Takashi Nomura
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Drug Development for Intractable Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Hirata
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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20
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Bagit A, Sachdeva M, Sood S, Akuffo-Addo E, Alli S, Maliyar K, Georgakopoulos JR, Mufti A, Yeung J. Onset of Vitiligo Within Patients Receiving Immune Checkpoint Inhibitors: An Evidence-Based Review. J Cutan Med Surg 2024:12034754241239250. [PMID: 38468185 DOI: 10.1177/12034754241239250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Affiliation(s)
- Ahmed Bagit
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Muskaan Sachdeva
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Siddhartha Sood
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Edgar Akuffo-Addo
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sauliha Alli
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Khalad Maliyar
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jorge R Georgakopoulos
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Asfandyar Mufti
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Dermatology, Women's College Hospital, Toronto, ON, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Dermatology, Women's College Hospital, Toronto, ON, Canada
- Probity Medical Research, Waterloo, ON, Canada
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21
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McLennan AL, Cockerell CJ, Ren VZ. Sarcoidosis Resembling Angiokeratomas: A Case Report. Cureus 2024; 16:e56322. [PMID: 38628994 PMCID: PMC11020630 DOI: 10.7759/cureus.56322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 04/19/2024] Open
Abstract
Sarcoidosis, a multifaceted systemic disorder characterized histologically by the presence of non-caseating granulomas, has a wide array of cutaneous manifestations. We describe a case of a 74-year-old woman with a complex medical history, who presented with asymptomatic hyperpigmented papules on her lower extremities. Histological examination of a punch biopsy specimen showed nodular and angiocentric patterns of granulomatous inflammation consistent with sarcoidosis, and chest radiography demonstrated bilateral hilar opacities, supporting the diagnosis. To our knowledge, this specific cutaneous presentation of sarcoidosis has not been described before, and it can easily be mistaken for other conditions. Therefore, this case underscores the importance of recognizing atypical cutaneous morphologies of sarcoidosis, particularly in patients with complex medical histories, to facilitate accurate diagnosis and timely intervention. We aim to increase awareness among clinicians regarding the diverse manifestations of sarcoidosis, thereby enhancing diagnostic acumen and patient care.
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Affiliation(s)
| | | | - Vicky Z Ren
- Dermatology, Baylor College of Medicine, Houston, USA
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22
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Kim DY, Swetter SM, Huhmann L, Dizon MP, Ferguson JM, Osborne TF, Spence AC, Ziad A, Fillmore N, Hartman RI. Real-world effectiveness of immune checkpoint inhibitors and BRAF/MEK inhibitors among veteran patients with cutaneous melanoma. J Am Acad Dermatol 2024; 90:620-623. [PMID: 37924953 DOI: 10.1016/j.jaad.2023.10.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/25/2023] [Accepted: 10/22/2023] [Indexed: 11/06/2023]
Affiliation(s)
- Daniel Y Kim
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Susan M Swetter
- Department of Dermatology, Stanford University Medical Center, Palo Alto, California; Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Linden Huhmann
- Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Matthew P Dizon
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
| | - Jacqueline M Ferguson
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
| | - Thomas F Osborne
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Department of Radiology, Stanford University School of Medicine, Palo Alto, California
| | - Allyson C Spence
- Department of Medical Oncology, Stanford University Medical Center, Palo Alto, California
| | - Amina Ziad
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nathanael Fillmore
- Harvard Medical School, Boston, Massachusetts; Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts; Dana Farber Cancer Institute, Boston, Massachusetts
| | - Rebecca I Hartman
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Dermatology Section, VA Integrated Service Network 1 (VISN-1), Jamaica Plain, Massachusetts.
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23
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Patel A, Bandino F, Achanta M, Walker SL, Joseph JA. Ear, nose and throat manifestations of leishmaniasis: Case series from a tertiary centre in the United Kingdom. Clin Otolaryngol 2024; 49:258-263. [PMID: 37997482 DOI: 10.1111/coa.14127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/12/2023] [Accepted: 10/27/2023] [Indexed: 11/25/2023]
Affiliation(s)
- A Patel
- Department of Rhinology, Royal National Ear, Nose and Throat Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - F Bandino
- Department of Rhinology, Royal National Ear, Nose and Throat Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Achanta
- Department of Rhinology, Royal National Ear, Nose and Throat Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - S L Walker
- Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, UK
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK
| | - J A Joseph
- Department of Rhinology, Royal National Ear, Nose and Throat Hospital, University College London Hospitals NHS Foundation Trust, London, UK
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Balgobind S, Cheung VKY, Luk P, Low THH, Wykes J, Wu R, Lee J, Ch'ng S, Palme CE, Clark JR, Gupta R. Prognostic and predictive biomarkers in head and neck cancer: something old, something new, something borrowed, something blue and a sixpence in your shoe. Pathology 2024; 56:170-185. [PMID: 38218691 DOI: 10.1016/j.pathol.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/26/2023] [Accepted: 11/28/2023] [Indexed: 01/15/2024]
Abstract
A biomarker is a measurable indicator of biological or pathological processes or the response to an exposure or intervention and is used to guide management decisions. In head and neck pathology, biomarkers are assessed by histological criteria and immunohistochemical and molecular studies. Surgical resection remains the mainstay of management of many head and neck malignancies. Adjuvant radiotherapy and/or systemic therapy may be administered depending on the presence of adverse prognostic factors identified on histopathological or immunohistochemical examination. In this review, we outline the clinically relevant prognostic and predictive factors in head and neck malignancies including conventionally recognised factors such as tumour size, depth of invasion, lymphovascular and perineural invasion and margin status as well as novel evolving factors such as recurrent genetic rearrangements and assessment of immune checkpoints. Practical issues are discussed to assist with recognising and reporting of these factors. A summary of useful tools such as structured pathology report formats is also included to assist with comprehensive reporting of all clinically relevant parameters, minimise risk and improve workflow efficiencies.
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Affiliation(s)
- Sapna Balgobind
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, NSW, Australia.
| | - Veronica K Y Cheung
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, NSW, Australia
| | - Peter Luk
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Tsu-Hui Hubert Low
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia; Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - James Wykes
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Raymond Wu
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia; Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Jenny Lee
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia; Melanoma Institute Australia, University of Sydney, Sydney, NSW, Australia; Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Sydney Ch'ng
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Carsten E Palme
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Jonathan R Clark
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia; Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Ruta Gupta
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia
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Zahid A, Sheikh A. Rare but Still There: An Interesting Case of Cytokeratin 20-Negative Merkel Cell Carcinoma. Cureus 2024; 16:e55612. [PMID: 38586649 PMCID: PMC10995648 DOI: 10.7759/cureus.55612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/09/2024] Open
Abstract
Merkel cell carcinoma (MCC) of the skin is a rare and aggressive primary neuroendocrine tumor that mainly involves sun-exposed areas and can metastasize to other parts of the body. Due to varied clinical features and the sharing of similar histological features with other neuroendocrine tumors, diagnosis can be challenging. Therefore, immunohistochemistry plays an important role in diagnosis, and the characteristic perinuclear staining with cytokeratin 20 (CK 20) helps to differentiate it from other morphologically similar tumors, especially metastatic small cell carcinoma of the lung. We describe an interesting case of a 78-year-old female who was referred by a general practitioner (GP) with a few months' history of asymptomatic, rapidly enlarging, erythematous, nodular lesion on her left upper arm. Due to clinical findings and the location of the lesion on the sun-exposed area, wide differential diagnoses were considered. The lesion was excised for histological diagnosis. Surprisingly, morphological features favour the diagnosis of a neuroendocrine tumor. However, histological features including immunohistochemistry rendered it difficult to differentiate between primary cutaneous neuroendocrine carcinoma (Merkel cell CA) and metastatic small cell carcinoma of the lung due to the lack of specific and sensitive marker of CK 20 on immunohistochemistry. Subsequently, the patient had computer tomography of the chest/abdomen and pelvis (CTTAP) and positron emission tomography (PET) scans to rule out underlying primary malignancy. The case was also discussed at local and specialist skin multidisciplinary team meetings (MDT) including neuroendocrine MDT and a consensus diagnosis of Merkel cell carcinoma of the skin with negative CK 20 was established.
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Affiliation(s)
- Amna Zahid
- Dermatology, Ormskirk District General Hospital (Mersey and West Lancashire Teaching Hospitals), Ormskirk, GBR
| | - Arsalan Sheikh
- Dermatology, Ormskirk District General Hospital (Mersey and West Lancashire Teaching Hospitals), Ormskirk, GBR
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26
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Alghamdi WM, Aljehani FH, Alharthi AM, Bakhsh RI. Primary Cutaneous Diffuse Large B-cell Lymphoma Successfully Treated With R-CHOP Chemotherapy. Cureus 2024; 16:e55300. [PMID: 38559516 PMCID: PMC10981783 DOI: 10.7759/cureus.55300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Primary cutaneous diffuse large B-cell lymphomas (PCDLBCLs) represent approximately 10%-20% of primary cutaneous B-cell lymphomas. They present as nodules in the skin or as rapidly growing aggressive behavior tumors with a poor prognosis. In this article, we report a case of PCDLBCL presented with an aggressively enlarging skin lesion on the right cheek. This case was diagnosed based on clinicopathological features and characteristic immunohistochemical expression. During the 11-month follow-up period, the patient showed significant clinical improvement after undergoing rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone, abbreviated as R-CHOP chemotherapy, without evidence of extracutaneous dissemination or disease relapse.
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Affiliation(s)
| | | | | | - Reda I Bakhsh
- Medical Oncology, Al-Noor Specialist Hospital, Makkah, SAU
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27
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Gill HS. Microneedle technology for allergen immunotherapy via the skin. J Allergy Clin Immunol 2024; 153:656-662. [PMID: 38211644 DOI: 10.1016/j.jaci.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
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28
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Nepal B, McCormick-Baw C, Patel K, Firmani S, Wetzel DM. Cutaneous Leishmania mexicana Infections in the United States: Defining Strains Through Endemic Human Pediatric Cases in Northern Texas. medRxiv 2024:2024.01.11.23300611. [PMID: 38260515 PMCID: PMC10802665 DOI: 10.1101/2024.01.11.23300611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Over a six-month span, three patients under five years old with cutaneous leishmaniasis presented to the Pediatric Infectious Diseases Clinic at the University of Texas Southwestern Medical Center/Children's Health Dallas. None had traveled outside of the United States (US); all had confirmed L. mexicana infections by PCR. We provide case descriptions and images to increase the awareness of this disease among US physicians and scientists. Two patients responded to fluconazole, but one required topical paromomycin. Combining these cases with guidelines and our literature review, we suggest that: 1) higher doses (ten-twelve mg/kg/day) of fluconazole should be considered in young children to maximize likelihood and rapidity of response and 2) patients should transition to alternate agents if they do not respond to high-dose fluconazole within six weeks. Furthermore, and of particular interest to the broad microbiology community, we used samples from these cases as a proof-of-concept to propose a mechanism to strain-type US-endemic L. mexicana. For our analysis, we sequenced three housekeeping genes and the internal transcribed sequence 2 of the ribosomal RNA gene. We identified genetic changes that not only allow us to distinguish US-based L. mexicana strains from strains found in other areas of the Americas, but also establish polymorphisms that differ between US isolates. These techniques will allow documentation of genetic changes in this parasite as its range expands. Hence, our cases of cutaneous leishmaniasis provide significant evolutionary, treatment and public health implications as climate change increases exposure to formerly tropical diseases in previously non-endemic areas.
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Affiliation(s)
- Binita Nepal
- Department of Pediatrics, University of Texas Southwestern Medical Center
- Department of Biochemistry, University of Texas Southwestern Medical Center
| | | | - Karisma Patel
- Department of Pediatrics, University of Texas Southwestern Medical Center
| | - Sarah Firmani
- Department of Pediatrics, University of Texas Southwestern Medical Center
| | - Dawn M. Wetzel
- Department of Pediatrics, University of Texas Southwestern Medical Center
- Department of Biochemistry, University of Texas Southwestern Medical Center
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29
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Dibs K, Gogineni E, Jhawar SM, Baliga S, Grecula JC, Mitchell DL, Palmer J, Haglund K, Andraos TY, Zoller W, Ewing A, Bonomi M, Bhateja P, Tinoco G, Liebner D, Rocco JW, Old M, Gamez ME, Chakravarti A, Konieczkowski DJ, Blakaj DM. Scalp Irradiation with 3D-Milled Bolus: Initial Dosimetric and Clinical Experience. Cancers (Basel) 2024; 16:688. [PMID: 38398079 PMCID: PMC10887235 DOI: 10.3390/cancers16040688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/31/2024] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND AND PURPOSE A bolus is required when treating scalp lesions with photon radiation therapy. Traditional bolus materials face several issues, including air gaps and setup difficulty due to irregular, convex scalp geometry. A 3D-milled bolus is custom-formed to match individual patient anatomy, allowing improved dose coverage and homogeneity. Here, we describe the creation process of a 3D-milled bolus and report the outcomes for patients with scalp malignancies treated with Volumetric Modulated Arc Therapy (VMAT) utilizing a 3D-milled bolus. MATERIALS AND METHODS Twenty-two patients treated from 2016 to 2022 using a 3D-milled bolus and VMAT were included. Histologies included squamous cell carcinoma (n = 14, 64%) and angiosarcoma (n = 8, 36%). A total of 7 (32%) patients were treated in the intact and 15 (68%) in the postoperative setting. The median prescription dose was 66.0 Gy (range: 60.0-69.96). RESULTS The target included the entire scalp for 8 (36%) patients; in the remaining 14 (64%), the median ratio of planning target volume to scalp volume was 35% (range: 25-90%). The median dose homogeneity index was 1.07 (range: 1.03-1.15). Six (27%) patients experienced acute grade 3 dermatitis and one (5%) patient experienced late grade 3 skin ulceration. With a median follow-up of 21.4 months (range: 4.0-75.4), the 18-month rates of locoregional control and overall survival were 75% and 79%, respectively. CONCLUSIONS To our knowledge, this is the first study to report the clinical outcomes for patients with scalp malignancies treated with the combination of VMAT and a 3D-milled bolus. This technique resulted in favorable clinical outcomes and an acceptable toxicity profile in comparison with historic controls and warrants further investigation in a larger prospective study.
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Affiliation(s)
- Khaled Dibs
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Emile Gogineni
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Sachin M. Jhawar
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Sujith Baliga
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - John C. Grecula
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Darrion L. Mitchell
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Joshua Palmer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Karl Haglund
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Therese Youssef Andraos
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Wesley Zoller
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Ashlee Ewing
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Marcelo Bonomi
- Department of Medical Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (M.B.); (P.B.); (G.T.); (D.L.)
| | - Priyanka Bhateja
- Department of Medical Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (M.B.); (P.B.); (G.T.); (D.L.)
| | - Gabriel Tinoco
- Department of Medical Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (M.B.); (P.B.); (G.T.); (D.L.)
| | - David Liebner
- Department of Medical Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (M.B.); (P.B.); (G.T.); (D.L.)
| | - James W. Rocco
- Department of Otolaryngology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (J.W.R.); (M.O.)
| | - Matthew Old
- Department of Otolaryngology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (J.W.R.); (M.O.)
| | - Mauricio E. Gamez
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA;
| | - Arnab Chakravarti
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - David J. Konieczkowski
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Dukagjin M. Blakaj
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
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30
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Spies E, Andreu T, Hartung M, Park J, Kamudoni P. Exploring the Perspectives of Patients Living With Lupus: Retrospective Social Listening Study. JMIR Form Res 2024; 8:e52768. [PMID: 38306157 PMCID: PMC10873798 DOI: 10.2196/52768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/07/2023] [Accepted: 11/16/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease affecting various organs with a wide range of clinical manifestations. Cutaneous lupus erythematosus (CLE) can manifest as a feature of SLE or an independent skin ailment. Health-related quality of life (HRQoL) is frequently compromised in individuals living with lupus. Understanding patients' perspectives when living with a disease is crucial for effectively meeting their unmet needs. Social listening is a promising new method that can provide insights into the experiences of patients living with their disease (lupus) and leverage these insights to inform drug development strategies for addressing their unmet needs. OBJECTIVE The objective of this study is to explore the experience of patients living with SLE and CLE, including their disease and treatment experiences, HRQoL, and unmet needs, as discussed in web-based social media platforms such as blogs and forums. METHODS A retrospective exploratory social listening study was conducted across 13 publicly available English-language social media platforms from October 2019 to January 2022. Data were processed using natural language processing and knowledge graph tagging technology to clean, format, anonymize, and annotate them algorithmically before feeding them to Pharos, a Semalytix proprietary data visualization and analysis platform, for further analysis. Pharos was used to generate descriptive data statistics, providing insights into the magnitude of individual patient experience variables, their differences in the magnitude of variables, and the associations between algorithmically tagged variables. RESULTS A total of 45,554 posts from 3834 individuals who were algorithmically identified as patients with lupus were included in this study. Among them, 1925 (authoring 5636 posts) and 106 (authoring 243 posts) patients were identified as having SLE and CLE, respectively. Patients frequently mentioned various symptoms in relation to SLE and CLE including pain, fatigue, and rashes; pain and fatigue were identified as the main drivers of HRQoL impairment. The most affected aspects of HRQoL included "mobility," "cognitive capabilities," "recreation and leisure," and "sleep and rest." Existing pharmacological interventions poorly managed the most burdensome symptoms of lupus. Conversely, nonpharmacological treatments, such as exercise and meditation, were frequently associated with HRQoL improvement. CONCLUSIONS Patients with lupus reported a complex interplay of symptoms and HRQoL aspects that negatively influenced one another. This study demonstrates that social listening is an effective method to gather insights into patients' experiences, preferences, and unmet needs, which can be considered during the drug development process to develop effective therapies and improve disease management.
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Affiliation(s)
| | | | | | | | - Paul Kamudoni
- The Healthcare Business of Merck KGaA, Darmstadt, Germany
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He S, Lin Y. Primary cutaneous nocardiosis in an immunocompetent host. Clin Case Rep 2024; 12:e8516. [PMID: 38374880 PMCID: PMC10875629 DOI: 10.1002/ccr3.8516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/21/2024] Open
Abstract
Nocardiosis is a rare opportunistic infection that is classically observed in immunocompromised patients but can also affect immunocompetent individuals. It tends to involve the lung, central nervous system, and skin and is often misdiagnosed.
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Affiliation(s)
- Shihuan He
- Department of Dermatology and VenereologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Youkun Lin
- Department of Dermatology and VenereologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
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Nadir U, Yi MD, Koza E, Shi VJ, Dave L, Hisham FI, Maisel-Campbell A, Lin KA, Ibrahim SA, Kang BY, Anvery N, Dirr MA, Christensen RE, Riley JM, Kundu RV, Aylward JL, Bari O, Bhatti H, Bolotin D, Cherpelis BS, Cohen JL, Condon S, Farhang S, Firoz B, Garrett AB, Geronemus RG, Golda NJ, Humphreys TR, Hurst EA, Jacobson OH, Jiang SB, Karia PS, Kimyai-Asadi A, Kouba DJ, Council ML, Le M, MacFarlane DF, Maher IA, Miller SJ, Moioli EK, Morrow M, Neckman J, Peterson SR, Poblete-Lopez C, Prather CL, Ranario JS, Rubin AG, Swanson AM, Urban C, Xu YG, Pearlman R, Cahn BA, Yoo S, Harikumar V, Weil A, Schaeffer M, Iyengar S, Poon E, Alam M. Outcomes of cutaneous surgery for nonmelanoma skin cancer in patients with different Fitzpatrick skin types: A nationwide, multicenter, prospective study. J Am Acad Dermatol 2024:S0190-9622(24)00137-3. [PMID: 38296200 DOI: 10.1016/j.jaad.2023.11.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 02/23/2024]
Affiliation(s)
- Umer Nadir
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Michael D Yi
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Eric Koza
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Victoria J Shi
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Loma Dave
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | | | - Amanda Maisel-Campbell
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois; Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Katherine A Lin
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Sarah A Ibrahim
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Bianca Y Kang
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Noor Anvery
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - McKenzie A Dirr
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | | | - Julia M Riley
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Roopal V Kundu
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Juliet L Aylward
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Omar Bari
- Mohs and Dermatologic Surgery Center, University of California, San Diego, San Diego, California; Division of Dermatology, University of California, Los Angeles, Los Angeles, California
| | - Hamza Bhatti
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey; The Skin Institute of South Florida, Coral Springs, Florida
| | - Diana Bolotin
- Section of Dermatology, University of Chicago, Chicago, Illinois
| | - Basil S Cherpelis
- Department of Dermatology and Cutaneous Surgery, University of South Florida College of Medicine, Tampa, Florida
| | - Joel L Cohen
- AboutSkin Dermatology, Denver, Colorado; Department of Dermatology, University of California, Irvine, Irvine, California
| | - Sean Condon
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio; The Center For Dermatology Care, Thousand Oaks, California
| | - Sheila Farhang
- Department of Dermatology and Cutaneous Surgery, University of South Florida College of Medicine, Tampa, Florida; Avant Dermatology and Aesthetics, Tucson, Arizona
| | - Bahar Firoz
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
| | | | - Roy G Geronemus
- Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York, New York; Laser and Skin Surgery Center of New York, New York, New York
| | - Nicholas J Golda
- Department of Dermatology, University of Missouri School of Medicine, Columbia, Missouri
| | - Tatyana R Humphreys
- Main Line Center for Skin Surgery, Bala Cynwyd, Pennsylvania; Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Eva A Hurst
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri; Distinctive Dermatology, Fairview Heights, Illinois
| | - Oren H Jacobson
- Revere Health Central Utah Mohs, Provo, Utah; St. George's University School of Medicine, Grenada, West Indies
| | - Shang Brian Jiang
- Mohs and Dermatologic Surgery Center, University of California, San Diego, San Diego, California
| | - Pritesh S Karia
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - David J Kouba
- Wayne State University School of Medicine, Detroit, Michigan; Toledo Clinic Facial Plastics and Dermatology, Toledo, Ohio
| | - Martha Laurin Council
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Marilyn Le
- Main Line Center for Skin Surgery, Bala Cynwyd, Pennsylvania
| | | | - Ian A Maher
- Department of Dermatology, Saint Louis University, St. Louis, Missouri; Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | | | - Eduardo K Moioli
- Section of Dermatology, University of Chicago, Chicago, Illinois
| | - Meghan Morrow
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Julia Neckman
- Laser and Skin Surgery Center of New York, New York, New York; MetroDerm, Atlanta, Georgia
| | - Samuel R Peterson
- Revere Health Central Utah Mohs, Provo, Utah; ERderm, Newport Beach, California
| | | | | | | | - Ashley G Rubin
- Mohs and Dermatologic Surgery Center, University of California, San Diego, San Diego, California; Bernardo Dermatology Medical Group, Poway, California
| | - Andrew M Swanson
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Christopher Urban
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri; Carolina Mountain Dermatology, Arden, North Carolina
| | - Yaohui Gloria Xu
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ross Pearlman
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Brian A Cahn
- University of Illinois Chicago, Chicago, Illinois
| | - Simon Yoo
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Vishnu Harikumar
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Alexandra Weil
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Matthew Schaeffer
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Sanjana Iyengar
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois.
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V M A, Suresh S, Kumar A, K P, N M R, Rangappa S, Murthy SN, H N S. Overcoming challenges in dermal and transdermal delivery of herbal therapeutics with polymeric microneedles. J Biomater Sci Polym Ed 2024; 35:364-396. [PMID: 37982815 DOI: 10.1080/09205063.2023.2286033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/16/2023] [Indexed: 11/21/2023]
Abstract
Natural products are generally preferred medications owing to their low toxicity and irritancy potential. However, a good number of herbal therapeutics (HT) exhibit solubility, permeability and stability issues that eventually affect oral bioavailability. Transdermal administration has been successful in resolving some of these issues which has lead in commercialization of a few herbal transdermal products. Polymeric Microneedles (MNs) has emerged as a promising platform in transdermal delivery of HT that face problems in permeating the skin. Several biocompatible and biodegradable polymers used in the fabrication of MNs have been discussed. MNs have been exploited for cutaneous delivery of HT in management of skin ailments like skin cancer, acne, chronic wounds and hypertrophic scar. Considering the clinical need, MNs are explored for systemic delivery of potent HT for management of diverse disorders like asthma, disorders of central nervous system and nicotine replacement as it obviates first pass metabolism and elicits a quicker onset of therapeutic response. MNs of HT have found good number of aesthetic applications in topical delivery of HT to the skin. Interestingly, MNs have emerged as an attractive option as a minimally invasive diagnostic aid in sampling biomarkers from plants, skin and ocular interstitial fluid. The review updates the progress made by MN technology of HT for multiple therapeutic interventions along with the future challenges. An attempt is made to illustrate the challenging formulation strategies employed in the fabrication of polymeric MNs of HT. Efforts are on to extend the potential applications of polymeric MNs to HT for diverse therapeutic applications.
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Affiliation(s)
- Anusha V M
- Institute for Drug Delivery and Biomedical Research, Bengaluru, India
| | - Sarasija Suresh
- Institute for Drug Delivery and Biomedical Research, Bengaluru, India
| | - Avichal Kumar
- Department of Pharmaceutics, KLE College of Pharmacy, Bengaluru, India
| | - Paranjyothy K
- Institute for Drug Delivery and Biomedical Research, Bengaluru, India
| | - Reena N M
- Topical Products Testing LLC, Oxford, Mississippi, USA
| | | | - S Narasimha Murthy
- Institute for Drug Delivery and Biomedical Research, Bengaluru, India
- Topical Products Testing LLC, Oxford, Mississippi, USA
| | - Shivakumar H N
- Institute for Drug Delivery and Biomedical Research, Bengaluru, India
- Department of Pharmaceutics, KLE College of Pharmacy, Bengaluru, India
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Ruan S, Zhang P, Huang J, Gong T, Ji C. Multiple cutaneous myxofibrosarcoma on the right arm: Clinicopathological features and differential diagnosis. Clin Case Rep 2024; 12:e8346. [PMID: 38371344 PMCID: PMC10870797 DOI: 10.1002/ccr3.8346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 11/29/2023] [Accepted: 12/07/2023] [Indexed: 02/20/2024] Open
Abstract
The clinical presentations and pathological features of low-grade myxofibrosarcoma can be misleading, frequently resulting in diagnostic errors. An accurate diagnosis requires the application of immunohistochemistry techniques and the discerning diagnostic acumen of experienced pathologists. A 62-year-old male patient visited our outpatient clinic with multiple painful and rapidly enlarging subcutaneous nodules on his right forearm. Initially, the condition was misdiagnosed as multiple lipomas. The final pathology revealed characteristics consistent with low-grade myxofibrosarcoma.
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Affiliation(s)
- Shi‐Fan Ruan
- Department of Dermatologythe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Peng Zhang
- Department of Dermatologythe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Jinwen Huang
- Department of Dermatologythe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Ting Gong
- Central Laboratory, the First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Chao Ji
- Department of Dermatologythe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
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35
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Bertin C, Sitterlé E, Scemla A, Fraitag S, Delliere S, Guegan S, Hermoso DG, Leclerc-Mercier S, Rouzaud C, Lanternier F, Bougnoux ME. Deep cutaneous mycoses in kidney transplant recipients: Diagnostic and therapeutic challenges. Med Mycol 2024; 62:myae001. [PMID: 38228404 DOI: 10.1093/mmy/myae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/29/2023] [Accepted: 01/15/2024] [Indexed: 01/18/2024] Open
Abstract
Deep cutaneous mycoses (DCMs) are rare infections that extend throughout the dermis and subcutis, often occurring after inoculation with pathogenic fungi. Trends toward a growing incidence have been observed that may be partially related to an increasing population of solid organ transplant patients. The aim of this study is to describe the diagnostics and the outcomes of DCM among kidney transplant recipients so as to optimize their management. We performed a retrospective review of cases of DCM occurring among kidney transplant recipients in our institution over 12 years. Twenty cases were included. Lesions were only located on the limbs and presented mainly as single (10/20, 50%) nodular lesions (15/20, 75%), with a mean size of 3 cm. Direct mycological examination was positive for 17 patients (17/20, 85%) and the cultures were consistently positive. Thirteen different fungal species were observed, including phaehyphomycetes (n = 8), hyalohyphomycetes (n = 3), dermatophytes (n = 1), and mucorale (n = 1). The (1-3) beta-D-glucan antigen (BDG) was also consistently detected in the serum (20/20, 100%). Systematic imaging did not reveal any distant infectious lesions, but locoregional extension was present in 11 patients (11/14, 79%). Nineteen patients received antifungal treatment (19/20, 95%) for a median duration of 3 months, with surgery for 10 (10/20, 50%). There is a great diversity of fungal species responsible for DCMs in kidney transplant recipients. The mycological documentation is necessary to adapt the antifungal treatment according to the sensitivity of the species. Serum BDG positivity is a potentially reliable and useful tool for diagnosis and follow-up.
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Affiliation(s)
- Chloé Bertin
- Unité de Parasitologie-Mycologie, Service de Microbiologie clinique, GHU Necker-Enfants-Malades, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Emilie Sitterlé
- Unité de Parasitologie-Mycologie, Service de Microbiologie clinique, GHU Necker-Enfants-Malades, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Anne Scemla
- Service de Néphrologie-Transplantation, GHU Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Sylvie Fraitag
- Service d'Anatomo-pathologie, GHU Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Sarah Delliere
- Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Mycology Department, Université de Paris, Paris, France
- Laboratoire de parasitologie-mycologie, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France
| | - Sarah Guegan
- Service de Dermatologie, GHU Cochin, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Dea Garcia Hermoso
- Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Mycology Department, Université de Paris, Paris, France
| | - Stéphanie Leclerc-Mercier
- Service de Dermatologie, GHU Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Claire Rouzaud
- Service de Maladies Infectieuses, GHU Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Fanny Lanternier
- Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Mycology Department, Université de Paris, Paris, France
- Service de Maladies Infectieuses, GHU Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Marie-Elisabeth Bougnoux
- Unité de Parasitologie-Mycologie, Service de Microbiologie clinique, GHU Necker-Enfants-Malades, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
- Institut Pasteur, Université Paris Cité, INRAE, USC2019, Unité Biologie et Pathogénicité Fongiques, F-75015 Paris, France
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Eachus E, Schwartz K, Rasul T, Bergholz D, Keri J, Henderson A. REDCap as a Platform for Cutaneous Disease Management in Street Medicine: Descriptive Study. JMIR Dermatol 2024; 7:e48940. [PMID: 38194246 PMCID: PMC10806445 DOI: 10.2196/48940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/21/2023] [Accepted: 11/29/2023] [Indexed: 01/10/2024] Open
Affiliation(s)
- Emily Eachus
- Miami Street Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Kayla Schwartz
- Miami Street Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Taha Rasul
- Miami Street Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Daniel Bergholz
- Miami Street Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Jonette Keri
- Miami Street Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Armen Henderson
- Miami Street Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
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Sadigh S, DeAngelo DJ, Garcia JS, Hasserjian RP, Hergott CB, Lane AA, Lovitch SB, Lucas F, Luskin MR, Morgan EA, Pinkus GS, Pozdnyakova O, Rodig SJ, Shanmugam V, Tsai HK, Winer ES, Zemmour D, Kim AS. Cutaneous Manifestations of Myeloid Neoplasms Exhibit Broad and Divergent Morphologic and Immunophenotypic Features but Share Ancestral Clonal Mutations With Bone Marrow. Mod Pathol 2024; 37:100352. [PMID: 37839675 DOI: 10.1016/j.modpat.2023.100352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/14/2023] [Accepted: 09/20/2023] [Indexed: 10/17/2023]
Abstract
In this study, we performed a comprehensive molecular analysis of paired skin and peripheral blood/bone marrow (BM) samples from 17 patients with cutaneous myeloid or cutaneous histiocytic-dendritic neoplasms. The cutaneous manifestations included 10 patients with cutaneous acute myeloid leukemia (c-AML), 2 patients with full or partial Langerhans cell differentiation, 2 patients with blastic plasmacytoid dendritic cell neoplasms (BPDCN), 1 patient with both Langerhans cell differentiation and BPDCN, and 2 patients with full or partial indeterminate dendritic cell differentiation. Seven of the 10 c-AML patients (70%) exhibited concurrent or subsequent marrow involvement by acute myeloid leukemia, with all 7 cases (100%) demonstrating shared clonal mutations in both the skin and BM. However, clonal relatedness was documented in one additional case that never had any BM involvement. Nevertheless, NPM1 mutations were identified in 7 of the 10 (70%) of these c-AML cases while one had KMT2A rearrangement and one showed inv(16). All 3 patients (100%) with Langerhans cell neoplasms, 2 patients with BPDCN (100%), and one of the 2 patients (50%) with other cutaneous dendritic cell neoplasms also demonstrated shared mutations between the skin and concurrent or subsequent myeloid neoplasms. Both BM and c-AML shared identical founding drivers, with a predominance of NPM1, DNMT3A, and translocations associated with monocytic differentiation, with common cutaneous-only mutations involving genes in the signal transduction and epigenetic pathways. Cutaneous histiocytic-dendritic neoplasms shared founding drivers in ASXL1, TET2, and/or SRSF2. However, in the Langerhans cell histiocytosis or histiocytic sarcoma cases, there exist recurrent secondary RAS pathway hits, whereas cutaneous BPDCN cases exhibit copy number or structural variants. These results enrich and broaden our understanding of clonally related cutaneous manifestations of myeloid neoplasms and further illuminate the highly diverse spectrum of morphologic and immunophenotypic features they exhibit.
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Affiliation(s)
- Sam Sadigh
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel J DeAngelo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jacqueline S Garcia
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Robert P Hasserjian
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Christopher B Hergott
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew A Lane
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Scott B Lovitch
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Fabienne Lucas
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marlise R Luskin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Elizabeth A Morgan
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Geraldine S Pinkus
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Olga Pozdnyakova
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Scott J Rodig
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vignesh Shanmugam
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Harrison K Tsai
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eric S Winer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - David Zemmour
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Annette S Kim
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Now with Department of Pathology, University of Michigan, Ann Arbor, Michigan.
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Chatzopoulos K, Hytiroglou P, Charville GW, Toland AMS, Martinez-Lage M, Cimino PJ, Rosenblum MK, Linos K. When a dermatopathologist encounters the ultra-rare: A case series of superficial soft tissue/ cutaneous myxopapillary ependymomas. J Cutan Pathol 2024; 51:20-29. [PMID: 37317818 PMCID: PMC10721733 DOI: 10.1111/cup.14475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/16/2023]
Abstract
Myxopapillary ependymoma (MPE) is an uncommon variant of ependymoma, almost exclusively seen in conus medullaris or filum terminale. MPE can be diagnostically challenging, especially when arising extra-axially. Here we report 5 cases of superficial soft tissue/cutaneous MPE, identified across three tertiary institutions. All patients were female and three of them (3/5, 60%) were children (median age 11 years, range 6-58 years). The tumors presented as slow-growing masses of the sacrococcygeal subcutaneous soft tissues, occasionally identified after minor trauma and clinically favored to be pilonidal sinuses. Imaging showed no neuraxis connection. Macroscopically, tumors were well-circumscribed, lobulated, and solid and microscopically they exhibited typical histopathology of MPE, at least focally. Two of the tumors (2/5, 40%) showed predominantly solid or trabecular architecture with greater cellular pleomorphism, scattered giant cells, and increased mitotic activity. All tumors (5/5, 100%) showed strong diffuse immunohistochemical expression of GFAP. One tumor clustered at the category "ependymoma, myxopapillary" by methylome analysis. Two patients (2/5, 40%) had local recurrence at 8 and 30 months after the initial surgery. No patients developed metastases during the follow-up period (median 60 months, range 6-116 months). Since a subset of extra-axial MPEs behaves more aggressively, timely and accurate diagnosis is of paramount importance.
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Affiliation(s)
| | | | - Gregory W. Charville
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Angus M. S. Toland
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Patrick J. Cimino
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD, USA
| | - Marc K. Rosenblum
- Department of Pathology & Laboratory Medicine, Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | - Konstantinos Linos
- Department of Pathology & Laboratory Medicine, Memorial Sloan Kettering Cancer Center, NY, NY, USA
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Alatawi AM, Alanazi AMM, Albalawi IAS, Abujaser NSM, Alblowi YH, Alfuhaymani AMM, Alatawi OMS, Alanazi TFS, Albalawi DMA, Alanazi NMM. Knowledge and Attitude Regarding Cutaneous Leishmaniasis Among Adult Population in Tabuk, Saudi Arabia. Cureus 2024; 16:e52614. [PMID: 38374837 PMCID: PMC10875712 DOI: 10.7759/cureus.52614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2024] [Indexed: 02/21/2024] Open
Abstract
Background Cutaneous leishmaniasis (CL) is a major health problem in Saudi Arabia. It is caused by the protozoa Leishmania. The vector is female sand flies. In order to develop preventive strategies to reduce the burden of this health problem, public awareness of the disease should be assessed. Objective This study aimed to investigate the knowledge and attitude toward CL among the adult population in Tabuk, Saudi Arabia. Methods A cross-sectional survey study was conducted on 385 adult participants of Tabuk between April and May 2022. The investigators assembled the survey questions from peer-reviewed articles with some modifications. Google Forms was used to create the online survey. Social media were used to distribute the survey. Results The study revealed that hearing about CL was much more common among participants older than 61 years and Saudi males. The most prominent sources of information for the participants on which their answers were based were as follows: families and friends, health care professionals, television or radio, and lastly, newspapers. Subjects older than 61 years also showed more knowledge of the risk factors for contracting CL. However, the participants showed overall poor knowledge of the clinical presentation of the disease, which gender or age group was mostly affected, or how the disease was transmitted. Likewise, their knowledge of sand flies was poor. Most participants did not know if CL was a health problem or not. Conclusions The study revealed overall poor awareness of the epidemiological aspects of CL, how it is transmitted, its clinical presentation, and proper management. Our study could help authorities correct the gap in knowledge regarding CL in Tabuk.
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Affiliation(s)
- Amirah M Alatawi
- Department of Family and Community Medicine, Faculty of Medicine, University of Tabuk, Tabuk, SAU
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Rodriguez GF, Shah A, Maderal AD. Telangiectasias induced by combination tucatinib and ado-trastuzumab emtansine in a patient with metastatic breast cancer. Breast Dis 2024; 43:61-64. [PMID: 38578876 DOI: 10.3233/bd-230053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
BACKGROUND Tucatinib is a tyrosine kinase inhibitor currently used in salvage therapy for human epidermal growth factor receptor 2 (HER2)-positive breast and colorectal cancer. The use of tucatinib alone or in combination with ado-trastuzumab emtansine (T-DM1) in the treatment of advanced HER2-positive cancers is rapidly expanding. OBJECTIVE/METHODS We report the case of a 66-year-old female who presented to the dermatology clinic with a one-year history of widespread telangiectasias that began after initiation of combination chemotherapy with tucatinib and T-DM1 for metastatic HER2-positive invasive ductal carcinoma. RESULTS The patient's lesions regressed upon cessation of combination therapy and reappeared in the setting of tucatinib re-initiation, with gradual improvement over the following four months following electrocautery to the affected regions. CONCLUSIONS We postulate that telangiectasias may be a previously unreported dermatologic side effect of combination treatment with tucatinib and T-DM1. Electrocautery is a safe and effective procedure to reduce the appearance of telangiectasias and improve patient satisfaction during chemotherapy.
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Affiliation(s)
| | - Anuj Shah
- Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Andrea D Maderal
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Okorie CL, Nayudu K, Nambudiri VE. Cutaneous findings and treatments in deficiency of interleukin-36 receptor antagonist (DITRA): A review of the literature. Exp Dermatol 2024; 33:e14934. [PMID: 37726967 DOI: 10.1111/exd.14934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/30/2023] [Accepted: 08/13/2023] [Indexed: 09/21/2023]
Abstract
Deficiency of the interleukin-36 receptor antagonist (DITRA) is a rare autoinflammatory disorder caused by mutations in the IL36RN gene. This mutation leads to a lack of functional interleukin-36 receptor antagonists (IL-36Ra), which results in an overactive immune system and chronic inflammation. Despite its rarity, numerous case series and individual reports in the literature emphasize the importance of recognizing and managing DITRA. Early identification of the cutaneous signs of DITRA is crucial for accurate diagnosis and timely administration of appropriate treatment. This review article provides a comprehensive overview of the current understanding of the cutaneous, non-cutaneous and histopathological manifestations of DITRA, with a focus on reported treatments. The disease typically presents in early childhood, although the age of onset can vary. Patients with DITRA exhibit recurrent episodes of skin inflammation, often with a pustular or pustular psoriasis-like appearance. Additionally, non-cutaneous manifestations are common, with recurrent fevers and elevated acute-phase reactants being the most prevalent. The exact prevalence of DITRA is unknown. Some cases of loss-of-function mutations in the IL36RN gene, considered a hallmark for diagnosis, have been identified in patients with familial generalized pustular psoriasis (GPP). Biological therapies with inhibition of IL-12/23 and IL-17 are promising treatment options; paediatric patients with DITRA have shown complete response with mild relapses. New and emerging biologic therapeutics targeting the IL-36 pathway are also of interest in the management of this rare autoinflammatory disorder.
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Affiliation(s)
| | | | - Vinod E Nambudiri
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Jung F. History of the cutaneous microcirculation from antiquity to modern times. Clin Hemorheol Microcirc 2024; 86:29-50. [PMID: 38363606 DOI: 10.3233/ch-248001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
This review spans a wide arc from the first observations of the early anatomists to the present day. William Harvey was the first to describe the heart as the centre of the large and small circulatory system. He thus replaced the previously valid system of Galenos, It was Marcello Malpighi who first described that the capillary system connects the arteries with the veins. In 1688 Antoni van Leeuwenhoek (1632-1686) confirmed these results with a paper on capillary perfusion in the caudal fin of the glass eel. It was then Hermann Boerhave (1668-1738, Leiden) who was the first to carry out microcirculation tests on patients. He studied the microcirculation in the human bulbar conjunctiva. Even today, microcirculation studies in the conjunctiva bulbi of patients are carried out today. Until 1831, it was never quite clear whether the observations reported belonged mainly to the field of microcirculation, which had not yet been defined. This was done in Great Britain by Marshall Hall (1790-1857). Technical Improvements allowed increasingly sophisticated studies of the morphological structure of the terminal vasculature. According to Gustav Ricker (1870-1948, Vienna), the terminal vasculature comprises the functional unit of the smallest arteries, arterioles, capillaries and venules. In 1921 it was still thought that the blood circulation was the sole response to the pumping action of the heart. Even the classic work by Bayliss on the myogenic hypothesis (later referred to as "blood flow autoregulation") initially received little attention. More strikingly, even the findings of August Krogh, for which he received the Nobel Prize in Medicine in 1920 (for his discovery of the mechanisms of capillary motor regulation), were ignored. During an outstanding autoregulation symposium held in 1963 a broad consensus was reached on active and passive mechanisms, which is more or less valid till today. The mechanisms of regulation of capillary blood flow are now largely understood, although not completely resolved. The development of video systems with recording capability and automated off-line recording of capillary erythrocyte velocities allowed the application of morphological and dynamic studies of cutaneous capillaries in humans. These reopened the field of physiological or pathophysiological questions again for many groups worldwide. Since 1955, many publications on "microcirculation (5423)" and "capillary microscopy (2195)" have been listed in pubmed.
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Affiliation(s)
- F Jung
- Institute of Biotechnology, Molecular Cell Biology, Brandenburg University of Technology, Senftenberg, Germany
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Offer KS, Dixon CE, Sutton DGM. Treatment of equine sarcoids: A systematic review. Equine Vet J 2024; 56:12-25. [PMID: 36917551 DOI: 10.1111/evj.13935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/09/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND The sarcoid is the most common equine cutaneous neoplasm. Evidence-based treatment of this condition is often lacking, and selection of treatment modality based on clinical experience or anecdotal evidence. OBJECTIVES To assess the quality of the currently available best evidence regarding the treatment of the equine sarcoid. STUDY DESIGN Systematic review. METHODS In compliance with PRISMA guidelines, literature searches were performed in PUBMED, Web of Science, CAB Abstracts, EMBASE (Ovid) and Scopus in April 2021. Included papers were required to describe an interventional study examining sarcoid treatment strategy, of level 4 evidence or greater. The case definition required confirmation of at least some included lesions on histopathology, and a minimum of 6 months of follow-up was required on treated cases. Studies were assessed by two independent reviewers (KO, CD). Data extraction was performed manually, followed by risk of bias assessment. Methodological quality was assessed using the GRADE system. RESULTS In total, 10 studies were included in the review. Case definition was confirmed via histopathology in all included lesions in 60% of papers. Time to follow-up was variably reported. Overall risk of bias ranged from 'some concerns' to 'critical'. Reported sarcoid regression rate ranged from 28% to 100% on an individual sarcoid level, and 9%-100% on a whole horse level. Transient local inflammation was reported following most treatment strategies, with further adverse events reported infrequently. MAIN LIMITATIONS Review methodology excluded a large proportion of available literature regarding the equine sarcoid. Significant heterogeneity between included studies prevented quantitative synthesis and most included papers were at significant risk of bias, indirectness, and imprecision. CONCLUSIONS There is insufficient evidence currently available to recommend one sarcoid treatment over another. There is an urgent need for sufficiently powered, randomised, placebo-controlled trials in order to allow more definitive comparison of the efficacy of different treatment strategies.
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Affiliation(s)
- Katie S Offer
- School of Biodiversity, One Health and Veterinary Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Claire E Dixon
- Tufts Equine Center at the Hospital for Large Animals, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
| | - David G M Sutton
- School of Biodiversity, One Health and Veterinary Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Cha SH, Kim K, Song YK. Comparison of cutaneous adverse events between second-generation tyrosine kinase inhibitors and imatinib for chronic myeloid leukemia: a systematic review and meta-analysis. Acta Oncol 2023; 62:1767-1774. [PMID: 37787749 DOI: 10.1080/0284186x.2023.2263152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/20/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Patients with chronic myeloid leukemia (CML) treated with tyrosine kinase inhibitors (TKIs) often experience cutaneous adverse events, such as rashes and pruritus. In this study, we aimed to compare the risks of cutaneous adverse events between imatinib- and second-generation TKI-treated patients with CML. MATERIAL AND METHODS Paired reviewers independently obtained studies from PubMed, Embase, and Cochrane Library published until 15 March 2022. The following terms were searched: (Leukemia, Myelogenous, Chronic and BCR-ABL Positive), chronic myeloid leukemia, tyrosine kinase inhibitor, TKI, imatinib, dasatinib, nilotinib, bosutinib, and radotinib. Two independent reviewers screened the results and selected articles on cutaneous adverse events. RevMan 5.4 and the Cochrane Collaboration tool were used to perform the meta-analysis and risk of bias assessment. RESULTS AND CONCLUSION Eleven trials involving 4502 patients were analyzed in this study. Patients treated with second-generation TKIs were significantly more likely to experience cutaneous adverse events than those treated with imatinib with a relative risk (RR) of 1.62 (95% confidence interval [CI], [1.25-2.09]). Except dasatinib (RR [95% CI], 1.39 [0.75-2.56]), the risk of adverse events was more with second-generation TKIs than with imatinib as follows: nilotinib (2.11 [1.53-2.90]), bosutinib (1.41 [1.07-1.86]), and radotinib (1.87 [1.33-2.63]). Rash was the most common cutaneous adverse event that was observed in 21.6% of cases across all grades, followed by pruritus (5.7%) and alopecia (4.3%). In conclusion, our findings suggest that cutaneous adverse events occur more frequently with second-generation TKIs than with imatinib. Therefore, effective management of the cutaneous outcome is necessary to achieve high patient adherence to medication and successful treatment with TKIs.
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Affiliation(s)
- Seung-Hyeon Cha
- College of Pharmacy, Daegu Catholic University, Gyeongbuk, Republic of Korea
| | - Kyungim Kim
- College of Pharmacy, Korea University, Sejong, Republic of Korea
| | - Yun-Kyoung Song
- College of Pharmacy, Daegu Catholic University, Gyeongbuk, Republic of Korea
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45
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Vincent SA, Maceyko M, Altshuler PJ, Davis Z, Mark J, Chung PH, Bowne WB. Genital cutaneous necrosis: a delayed sequela of intraperitoneal Mitomycin-c. Pleura Peritoneum 2023; 8:175-176. [PMID: 38144216 PMCID: PMC10739289 DOI: 10.1515/pp-2023-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/28/2023] [Indexed: 12/26/2023] Open
Affiliation(s)
- Sage A. Vincent
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Meghan Maceyko
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Peter J. Altshuler
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Zachary Davis
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - J. Ryan Mark
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Paul H. Chung
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Wilbur B. Bowne
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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Kaul S, Kaur I, Mehta S, Singal A. Cutaneous tuberculosis. Part I: Pathogenesis, classification, and clinical features. J Am Acad Dermatol 2023; 89:1091-1103. [PMID: 35149149 DOI: 10.1016/j.jaad.2021.12.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/12/2021] [Accepted: 12/31/2021] [Indexed: 11/23/2022]
Abstract
Tuberculosis is an ancient disease that continues to affect an estimated 10 million people per year and is responsible for 1.4 million deaths per year. Additionally, the HIV epidemic and multidrug resistance present challenges to disease control. Cutaneous tuberculosis is an uncommon, often indolent, manifestation of mycobacterial infection that has a varied presentation. Its diagnosis is challenging, as lesions mimic other, more common conditions and microbiological confirmation is often not possible. Cutaneous tuberculosis can be broadly categorized into multibacillary and paucibacillary forms. Approximately one-third of skin tuberculosis is associated with systemic involvement. By recognizing cutaneous tuberculosis early, dermatologists can play an important role in disease control. The first article in this 2-part continuing medical education series describes the latest epidemiology, microbiology, and pathogenesis of tuberculosis. Furthermore, we review the classification, clinical manifestations, common clinical differentials, and systemic involvement that occur in cutaneous tuberculosis.
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Affiliation(s)
- Subuhi Kaul
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois
| | | | - Shilpa Mehta
- Division of Dermatology, John H Stroger Hospital of Cook County, Chicago, Illinois.
| | - Archana Singal
- Department of Dermatology, University College of Medical Sciences & GTB Hospital, Delhi, India
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Bondagji MF, Qul H, Nahhas A, Allehaibi ES, Banjer AA, Alghamdi GA, Al Hawsawi K. Primary Adrenal Insufficiency (Addison's Disease) Presenting as Sun Tan-Like Skin Pigmentation: A Case Report. Cureus 2023; 15:e49837. [PMID: 38164302 PMCID: PMC10758258 DOI: 10.7759/cureus.49837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2023] [Indexed: 01/03/2024] Open
Abstract
Primary adrenal insufficiency (PAI), also known as Addison's disease (AD), is a condition resulting from adrenal gland diseases that lead to glucocorticoid and/or mineralocorticoid deficiency, in addition to androgen deficiency in females. Here, we report a 40-year-old male indoor worker with an insignificant past medical history who presented to the dermatology clinic with a history of asymptomatic, slowly progressive skin hyperpigmentation for the past three years. It was associated with fatigue and weight loss. Skin examination revealed diffuse, non-scaly hyperpigmented patches on his face, dorsae of the hands, and palms. Early morning cortisol and adrenocorticotropic hormone (ACTH) serum levels were 1.00 µg/dl (5.0-19.4 µg/dl) and 2000 pg/mL (7.2-63.3 pg/mL), respectively. Based on the above clinical and laboratory findings, a diagnosis of AD was made. The patient was started on the following medications for 14 days: hydrocortisone 20 mg in divided doses (15 mg am/5 mg pm) and fludrocortisone 0.1 mg once daily (od). On the second visit, the patient's symptoms (both the cutaneous hyperpigmentation and fatigue) significantly improved, but he was complaining of edema in both upper and lower limbs, so the dose of fludrocortisone was reduced to 0.05 mg od.
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Affiliation(s)
- Mohammed F Bondagji
- Medicine and Surgery, College of Medicine, Umm Al-Qura University (UQU), Makkah, SAU
| | - Hamzah Qul
- Internal Medicine, Endocrinology Unit, King Abdulaziz Hospital, Makkah, SAU
| | - Ali Nahhas
- Internal Medicine, Endocrinology Unit, King Abdulaziz Hospital, Makkah, SAU
| | | | - Amal A Banjer
- Internal Medicine, Neurology Unit, King Abdulaziz Hospital, Makkah, SAU
| | - Ghadi A Alghamdi
- Medicine and Surgery, College of Medicine, Umm Al-Qura University (UQU), Makkah, SAU
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Kaul S, Jakhar D, Mehta S, Singal A. Cutaneous tuberculosis. Part II: Complications, diagnostic workup, histopathologic features, and treatment. J Am Acad Dermatol 2023; 89:1107-1119. [PMID: 35149148 DOI: 10.1016/j.jaad.2021.12.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/12/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
Abstract
Despite the availability of effective treatment regimens for cutaneous tuberculosis, challenges to disease control result from delayed diagnosis, infection with multidrug-resistant mycobacterial strains, and coinfection with HIV. Delayed diagnosis can be mitigated when dermatologists are sensitized to the clinical signs and symptoms of infection and by the incorporation of appropriate diagnostic tests. All cases of cutaneous tuberculosis should be confirmed with histopathology and culture with or without molecular testing. In each case, a thorough evaluation for systemic involvement is necessary. Mycobacteria may not be isolated from cutaneous tuberculosis lesions and therefore, a trial of antituberculosis treatment may be required to confirm the diagnosis. The second article in this 2-part continuing medical education series describes the sequelae, histopathology, and treatment of tuberculosis.
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Affiliation(s)
- Subuhi Kaul
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois
| | | | - Shilpa Mehta
- Division of Dermatology, John H Stroger Hospital of Cook County, Chicago, Illinois.
| | - Archana Singal
- Department of Dermatology, University College of Medical Sciences & GTB Hospital, Delhi, India
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Fernandez AP, Gallop J, Polly S, Khanna U. Efficacy and safety of repository corticotropin injection for refractory cutaneous dermatomyositis: a prospective, open-label study. Rheumatology (Oxford) 2023:kead595. [PMID: 37941470 DOI: 10.1093/rheumatology/kead595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/19/2023] [Accepted: 10/19/2023] [Indexed: 11/10/2023] Open
Abstract
OBJECTIVES Cutaneous dermatomyositis (DM) is often refractory to multiple medications. Repository corticotropin injection (RCI) is FDA-approved for DM, but little is known about its efficacy and safety for treating cutaneous DM. We conducted a prospective, open-label trial assessing efficacy and safety of RCI for treating refractory cutaneous DM. METHODS DM patients with moderate-to-severe cutaneous activity [Cutaneous Dermatomyositis Disease Area and Severity Index activity (CDASI-A)] >14 despite prior treatment with ≥2 systemic agents were enrolled. Patients were initiated on 80 u RCI twice weekly for 6 months. Primary outcomes included significant decreases in CDASI-A and Physician's Global Assessment (PGA) scores at 6 months. RESULTS Of nineteen patients enrolled, fifteen patients (11 females, 4 males) with DM (7 classic, 8 amyopathic) completed 6 months of RCI treatment. Patients were treated with a median 3.0 systemic medications prior to enrolment and were taking a median of 2.0 systemic medications at enrolment. Median baseline CDASI-A score was 19.0 and median PGA activity score was 2.5/10. For patient-reported outcomes, baseline median patient global skin score (PtGSS) was 3.0/10 and median dermatology life quality index (DLQI) score was 7.0/10. At 6 months, there were statistically significant improvements in CDASI-A scores (median= 10.0), PGA scores (median= 0.8/10), PtGSS scores (median= 7.0) and DLQI scores (median= 2.0), among others. Adverse effects were mild. CONCLUSIONS RCI treatment resulted in statistically significant and clinically meaningful improvement in cutaneous DM activity and quality of life. Our results suggest RCI is an effective, safe, and well-tolerated treatment for patients with refractory cutaneous dermatomyositis. CLINICAL TRIAL REGISTRATION This clinical trial was registered with ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT01906372).
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Affiliation(s)
- Anthony P Fernandez
- Departments of Dermatology and Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Josh Gallop
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Samantha Polly
- Department of Dermatology, Duke University, Durham, North Carolina, USA
| | - Urmi Khanna
- Division of Dermatology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA
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50
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Trivedi A, Yabe M, Dogan A, Epstein-Peterson ZD, Myskowski PL, Arcila ME, Linos K. A Rare Case of Primary Cutaneous Gamma-Delta T-cell Lymphoma with Aberrant B-cell Marker Expression. Am J Dermatopathol 2023; 45:768-772. [PMID: 37856740 PMCID: PMC10593491 DOI: 10.1097/dad.0000000000002557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
ABSTRACT Primary cutaneous gamma-delta T-cell lymphoma (PCGDTL) is a rare and diagnostically challenging primary skin lymphoma. We present a case of a 78-year-old otherwise healthy man who developed nonhealing nodules on his right posterior calf. Initial biopsy showed a dense, atypical, lymphoid infiltrate with gamma-delta and cytotoxic T-cell immunophenotypes. The diagnosis of PCGDTL was rendered; however, concurrent flow cytometry revealed expression of aberrant B-cell markers, including CD19 and cytoplasmic CD79a. Subsequent immunohistochemical studies corroborated this result. We report the extremely rare phenomenon of aberrant B-cell marker expression in PCGDTL, the first formally reported case to our knowledge.
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Affiliation(s)
- Apoorva Trivedi
- Dermatopathology Service, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065
| | - Mariko Yabe
- Hematopathology Service, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065
| | - Ahmet Dogan
- Hematopathology Service, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065
| | - Zachary D Epstein-Peterson
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065
| | - Patricia L Myskowski
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
| | - Maria E Arcila
- Diagnostic Molecular Pathology Laboratory, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065
| | - Konstantinos Linos
- Dermatopathology and Bone & Soft Tissue Services, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065
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