Sonographic Characteristics of Leiomyomatous Tumors of Skin and Nail—A Case Series

Introduction

The clinical appearance of the uncommon cutaneous leiomyomatous tumors (LMT) is nonspecific, leading to an extensive differential diagnosis. A non-invasive tool such as high-frequency ultrasound (HFUS) is required for characterizing LMTs in the clinical setting. Although the sonographic features of their uterine counterpart had been well reported, there are only scant reports on the use of ultrasound for studying leiomyomatous neoplasms of the skin and nail.

Objectives

To identify and well characterize common sonographic features of LMT.

Methods

A retrospective analysis of HFUS images of LMT in three different patients, two of them with multiple cutaneous leiomyomas and another with a subungual leiomyosarcoma.

Results

In all cases, several shared ultrasound characteristics were found. Moreover, we describe a new ultrasonographic sign in cutaneous leiomyomas called the “pine tree” sign, with other features not previously reported.

Conclusions

These ultrasonographic characteristics would strengthen the clinical diagnosis, assist with treatment management, and may help avoid serial biopsies in cases with multiple cutaneous lesions.

Pseudoatrophoderma colli: distinct entity or just a variant of confluent and reticular papilomatosis of Gougerot-Carteaud

Pseudoatrophoderma colli is a rare entity described in the same time period as confluent and reticular papillomatosis of Gougerot-Carteaud and the two conditions have certain similarities. Pseudoatrophoderma colli is clinically characterized by lesions with an atrophic and wrinkled appearance, which are mainly located on the trunk and neck (hence the name colli). Few references exist in the literature and most of them are very old. Histopathological findings are nonspecific, showing mild hyperkeratosis, thinning of the stratum granulosum, and acanthosis and papillomatosis in some areas. In the papillary dermis there is vascular dilatation with a sparse inflammatory lymphohistiocytic perivascular infiltrate. Fragmentation of elastic tissue has been described only in one case. There is no specific treatment, with variable responses to diverse therapies including ultraviolet light, vitamin A, lactic acid and minocycline. We describe in detail two patients with pseudoatrophoderma colli and show histology. The first patient was treated with minocycline 100mg per day for two months and the second patient was treated with lymecycline 600mg per day for three months and 300mg per day for another two months. Both patients demonstrated a good response within the first month of treatment.

Sonographic Characteristics of Apocrine Nodular Hidradenoma of the Skin

Nodular hidradenomas are benign sweat gland-derived tumors that can produce clinical and dermatoscopic misdiagnoses. Histologically, these tumors can be classified into eccrine and apocrine subtypes. We present the sonographic characteristics of 6 cases of apocrine nodular hidradenomas, which, to our knowledge, is so far the largest series reported. A detailed sonographic analysis included layers, body location, shape, diameters, echostructure patterns, and vascularity. Two sonographic signs not previously reported in these or other common dermatologic lesions were detected: "snow falling" and "fluid-fluid level." The sonographic characteristics of apocrine nodular hidradenomas can support their earlier and more precise diagnosis.

Two episodes of axillary granular parakeratosis triggered by different causes: case report

Granular parakeratosis is an acquired disorder of keratinization characterized by keratotic papules and plaques located in the intertriginous areas. Its etiology is unknown. Some cases have been related to the application of deodorants and antiperspirants, local irritation or increased sweating; in other cases no precipitant factors have been found. We report a case of axillary granular parakeratosis in an adult male in whom the lesions appeared twice under different circumstances: the first time the lesions appeared after local irritation produced by an antiperspirant and/or the use of a paste containing zinc oxide; two years later, an identical eruption reappeared in both axillae, while using his habitual deodorant and without a preceding irritation of the zone; only excessive sweating was mentioned this time after a weight gain of 20 kg. On both occasions, the lesions disappeared completely a few days after using topical calcipotriol. A constitutional factor may predispose the development of granular parakeratosis, which must be considered a reaction pattern that can be induced by multiple different causes.

DNA extraction from formalin-fixed laryngeal biopsies: Comparison of techniques

CONCLUSION

PCR-quality DNA could be extracted from formalin-fixed paraffin-embedded (FFPE) samples with amplicons of at least 390 bp. Paraffin removal was not a necessary step. Proteinase K digestion was as efficient as the commercial kit for DNA extraction with a lower cost.

OBJECTIVES

To compare different DNA extraction protocols for FFPE samples and to describe the suitability of the extracted DNA for PCR reactions.

METHODS

For deparaffinization the following techniques were compared: alkaline heat, xylene, and no removal. For DNA extraction, proteinase K digestion and organic extraction were compared. A commercial extraction kit was included as standard. DNA quality was assessed by PCR amplification of the HFE gene, for amplicons of 208 and 390 bp.

RESULTS

Extraction with the commercial kit and proteinase K digestion were more efficient than other techniques, with no statistical difference between them for both amplicons. The proteinase K digestion buffer had a cost of U$ 0.2 per sample and the commercial kit of U$7 per sample.

[Scedosporium apiospermum rhinosinusal infection in an immunocompetent host]

Scedosporium species can cause colonization, superficial and deep localized infection or systemic disease, especially in immunocompromised hosts. We report a case of localized infection due to Scedosporium apiospermum in a 47 year old woman, with previous nasal surgery. She consulted for recurrent mucopurulent post-nasal discharge not responding to antibiotics. Computed tomography showed opacification of right maxillary sinus. Surgery was performed to removed abnormal tissue from sinus; biopsy revealed chronic sinusitis with aggregate of tightly packed hyphae suggestive of filamentous fungi. The microbiology fungal culture reported Scedosporium apiospermum.

Circumscribed palmar hypokeratosis: clinical evolution and ultrastructural study after prolonged treatment with topical calcipotriol

Circumscribed palmar hypokeratosis is a recently described condition that consists of a solitary area of depressed skin affecting the palm (or sole). Its histopathological features include a thinned horny layer, a slightly diminished granular cell layer, and intraepidermal vacuolated cells. Prolonged treatment with topical calcipotriol resulted in complete recovery of the affected zone in the case reported here. A second biopsy of the lesion taken at around the fourth year of therapy showed a normalization of the granular layer, a reduction in the intraepidermal vacuolated cells, and a somewhat thicker horny layer. An ultrastructural study carried out at the same time showed a reduction in keratin bundles and keratohyalin granules, and an increase in lipid droplets up to the horny layer. These findings and the therapeutic response to topical calcipotriol support the concept that circumscribed palmar hypokeratosis is a focalized abnormal keratinization defect morphologically expressed at the granular and horny layers.

[Recessive dystrophic epidermolysis bullosa. Report of one case]

We report a female newborn with a dystrophic epidermolysis bullosa. The diagnosis was made by electron microscopy of a bullous skin lesion. The importance of reaching a specific diagnosis is underscored. Close relatives can therefore be informed and educated about prognosis, etiology and the possibility of having new affected offspring. An accurate diagnosis can be reached through electronic microscopy or modern immunohistochemical techniques. Further complementary information given by conventional histology is required. A complete study is recommended to minimize errors in the intepretation of morphology.

Circumscribed palmar or plantar hypokeratosis: a distinctive epidermal malformation of the palms or soles

BACKGROUND

Epidermal malformations of the skin include a group of heterogeneous developmental defects that result from errors in morphogenesis of the epidermis during intrauterine life.

OBJECTIVE

The purpose of this study was to report the clinical and histopathologic features of a distinctive epidermal malformation involving the skin of the palms or soles.

METHODS

Ten patients were included in this study. All of them showed the same clinical features that consisted of a solitary circumscribed and circular area of erythematous depressed skin on the palm or on the sole. Diagnosis was confirmed by histopathologic study.

RESULTS

All patients were middle aged or elderly. Nine patients were women and one was a man. The lesions showed predilection for the skin of the thenar and hypothenar regions of the palm or the medial side of the sole. Histopathologic study demonstrated a depression of the epidermis, with a sharp stair between normal and involved skin. The epidermis covering the depression showed markedly thinner horny layer and a slightly diminished granular cell layer when compared with adjacent noninvolved skin. Keratinocytes of the squamous cell layer, granular cells, and corneocytes showed, otherwise, a normal appearance. Serial sections failed to demonstrate cornoid lamellation.

CONCLUSION

On the basis of the clinical and histopathologic findings in these 10 patients, we have named this malformation circumscribed palmar or plantar hypokeratosis. This lesion seems to be a distinctive entity that has not been previously described.

[Extra meningeal cryptococcosis in a patient with AIDS]

We report a young homosexual male with AIDS that presented a systemic Cryptococcus neoformans infection. He had skin, lymph node and colonic involvement but the central nervous system was spared. Treatment was started with amphotericin B, achieving a good remission of skin lesions. However, malaise and digestive symptoms did not abate and the patient died.