Radiotherapy of primary cutaneous follicle center lymphoma: case report and review of literature

Primary cutaneous follicle center lymphoma is an indolent primary cutaneous B-cell lymphoma originating from the follicle center cells, composed of a combination of centrocytes (small and large cleaved cells) and centroblasts (large noncleaved cells) with a follicular, follicular/diffuse, or diffuse growth pattern. Lesions are mostly located on the head, neck and trunk. A case is presented of a 56-year-old male patient with primary cutaneous follicle center lymphoma, with lesions involving the skin of the back, shoulders, presternal area and right forearm. As the patient presented a disseminated cutaneous form of the disease that involved several anatomical regions, complete work-up was followed by superficial fractionated radiotherapy of eight fields in VI expositions, with total irradiation dose of 1400 cGy upon the following fields: right and left pectoral region, left and right shoulders, right suprascapular region, and proximal third of the right forearm. Total irradiation dose applied upon each field for the lesions located on the left and right side of the back was 1500 cGy. This therapy resulted in significant reduction of visible tumor. The patient was regularly followed up on outpatient basis for 12 months of radiotherapy, being free from local recurrence and systemic spread of the disease.

Descriptive epidemiology of cutaneous squamous cell carcinoma in Croatia

The aim of the study was to investigate the squamous cell carcinoma (SCC) incidence in Croatia in the 2003-2005 period. The cases of SCC were retrospectively studied. Data were collected from University Department of Dermatology and Venereology, Zagreb University Hospital Center and National Cancer Registry. In the study period, there were 1,860 cases of SCC (934 men and 926 women). The crude incidence rate for the Croatian population of 100,000 was 14.6 for men and 13.4 for women. The age-standardized incidence rate (adjusted for the world standard population) was 8.9 for men and 5.2 for women. The head was almost exclusive localization of SCC in both sexes. The highest SCC incidence was recorded in Zadar County. These results will serve for the SCC trend monitoring in Croatia and Europe in the forthcoming years.

Skin cancers in Croatia, 2003-2005: epidemiological study

This study presents the incidence of major nonmelanoma skin cancers (major NMSCs), other nonmelanoma skin cancers (other NMSCs) and malignant melanoma (MM) in Croatia. The skin cancers recorded between 1 January 2003 and 31 December 2005 were retrospectively analyzed. Until 2003, the incidence of major NMSCs and other NMSCs was not estimated in Croatia. Incident cases of NMSCs were identified by the use of a questionnaire distributed to dermatology departments in Croatia and then collected at the University Department of Dermatology and Venereology, Zagreb University Hospital Center, and from the records kept at the National Cancer Registry. Incident cases of MM were extracted from the National Cancer Registry. During the 3-year period, 9,479 cases of major NMSCs are recorded, 4,622 (49%) in male and 4,857 (51%) in female patients. The crude incidence rate was 72.1/100,000 for males and 70.3/100,000 for females. Basal cell carcinoma (BCC) was the most common major NMSC in both sexes. In the total number of major NMSCs, there were 7,244 cases of BCC. Squamous cell carcinoma (SCC) was the second most common major NMSC. There were 1,860 SCC cases. The crude incidence rate was 54.9/100,000 for BCC in males, 53.9/100,000 in females, and 14.6/100,000 for SCC in male and 13.4/100,000 in female patients. Other NMSCs were registered in 119 cases (53% male and 47% female). The crude incidence rate was 0.9/100,000 for male and 0.8/100,000 for female patients. MM was registered in 1,427 cases (48% male and 52% female.) The crude incidence rate was 10.7/100,000 for males and females. These results will serve as reference for studying the patterns of descriptive epidemiology of major NMSCs, other NMSCs and MM in Croatia and Europe in the forthcoming years.

Halo phenomenon with regression of acquired melanocytic nevi: a case report

We report a case of halo-phenomenon in excisional biopsy of junctional nevi in a 19-year-old girl. The diagnosis was established histopathologically because of the lack of clinical halo and unspecific dermoscopic features. Clinicopathologic difficulties in establishing the diagnosis of these pigmented lesions, etiopathogenesis and differential diagnosis of halo nevi are emphasized. Dermatologists should be familiar with the possible changes in benign melanocytic nevi, halo reactions and possible complete regression of melanocytic nevi. Diagnostic difficulties are seen in the ultimate phase of regression when melanocytes are diminished or destroyed with immune reaction.

Acute hemorrhagic edema of infancy: case report

Acute hemorrhagic edema of infancy (AHEI) is a benign form of leukocytoclastic vasculitis that typically affects children between 4 and 24 months of age. The etiology remains unknown. The potential triggers of AHEI include preceding bacterial or viral infections, immunizations and drugs. The onset of AHEI is often dramatic with petechiae, ecchymoses, and annular, nummular or targetoid purpuric lesions usually appearing on the extremities, face, or ears. We report on a case of AHEI that occurred after upper respiratory tract infection.

Epidemiology of nonmelanoma and melanoma skin cancer in Zagreb, Croatia

The purpose of this retrospective and hospital-based study was to evaluate the epidemiology of nonmelanoma and melanoma skin cancer at University Department of Dermatology and Venereology, Zagreb University Hospital Center and School of Medicine during the 2003-2006 period. The study yielded population based results on 2911 cases of skin tumors in 2402 patients out of 16938 biopsies performed at Laboratory of Dermatologic Histopathology, University Department of Dermatology and Venereology, Zagreb University Hospital Center nd School of Medicine during the study period. All newly diagnosed invasive and in situ skin cancers were recorded by use of the histopathology record forms. Basal cell carcinoma was most commonly identified in the histopathology material (n=2002), followed by squamous cell carcinoma (n=533), melanoma (n=46) and cutaneous lymphoma (n=35). Other, less common tumors were noted. The number of tumors, and differences in age, sex and localization were analyzed. During the study period, there was no increase in the total number of cases recorded: 4305, 4202, 4116 and 4315, respectively. Study results showed skin tumors to be mostly diagnosed in elderly population (median age, 71 years). There were no significant sex differences, with the exception of the adult age group in 2006. As expected, skin tumors were mostly found in sun-exposed areas with some specific localization of individual tumor types. Study results were consistent with recent literature data.

Macular amyloidosis: a case report

Macular amyloidosis is a major cause of skin pigmentation and a rare form of localized primary cutaneous amyloidosis in western countries, with a higher prevalence in Asia and South America. The etiopathogenesis of macular amyloidosis has not yet been fully clarified; a number of risk factors are involved, among them chronic friction in particular. A 54-year-old patient with macular amyloidosis is presented. The diagnosis of macular amyloidosis was based on history data on long-term persistence of the disorder, localized pruritus and constant scratching urge, grayish-brown pigmentation over the scapula, and detection of amyloid in histologic slides. Three-month tretinoin therapy resulted in pruritus alleviation, with no change in the appearance of hyperpigmentation. The exact incidence of macular amyloidosis in Croatia is not known, however, the issue appears to be underestimated or neglected in dermatology routine.

Löfgren's syndrome presenting with erythema nodosum-like eruption

Löfgren's syndrome is an acute form of sarcoidosis that mostly presents with erythema nodosum, periarticular ankle inflammation, arthritis, conjunctivitis, and unilateral or bilateral hilar or right paratracheal lymphadenopathy. Erythema nodosum is the most common cutaneous lesion in acute sarcoidosis, but it is histologically nonspecific, as it does not reveal sarcoidal granulomas upon microscopic examination. We present a case of a 57-year-old woman with acute onset of tender erythematous nodules on the calves, which were clinically erythema nodosum-like lesions. Histologic analysis revealed sarcoidal granulomas located in the dermis and subcutaneous tissue. Upon further work-up, the patient was found to have both pulmonary and ocular sarcoidosis. Based on this case, we recommend that all patients with erythema nodosum-like lesions undergo biopsy and further work-up for sarcoidosis is recommended in case of biopsy proven sarcoidal granulomas.

Regressing seborrheic keratosis - clinically and dermoscopically mimicking a regressing melanoma

The diagnosis of seborrheic keratosis is a clinical diagnosis. In a certain percentage of cases, differential diagnosis between seborrheic keratosis and malignant melanoma is difficult. We describe a case of regressing seborrheic keratosis simulating malignant melanoma. Clinical, dermoscopic and histopathologic examinations were performed for the occurrence of an asymmetric, irregularly demarcated, irregularly pigmented lesion measuring 1.3 x 1.5 cm on the right part of the abdomen in a 76-year-old male Caucasian. In order not to miss melanoma, the excision and histopathologic examination of the lesion with peppering is essential.

Normalization in the appearance of severly damaged psoriatic nails using soft x-rays. A case report

The prevalence of nail psoriasis varies considerably among different studies, ranging from 10% to 55%. In psoriatic arthritis, its prevalence is as high as 85%. In spite of the high prevalence of the disease, considerable functional, psychical and cosmetic discomforts for the affected patients, and recent advances in the management of skin psoriasis, an efficacious and longlasting treatment for psoriatic nails remains elusive. A 51-year-old male patient with skin psoriasis and severe psoriatic lesions of all his finger nails and toe nails is presented. Some nail plates were up to 30 times thicker than normal. The patient received radiotherapy with soft x-rays in a total dose of 13.5 Gy administered in nine fractionated doses of 1.5 Gy (43 kV, 25 mA, 0.6 mm aluminum filter) at one-week and two-week intervals. Upon therapy completion, the appearance of nail plates gradually improved to normalize completely at 12 months of therapy. Almost three years of therapy completion, the patient is free from both disease relapse and radiotherapy sequels. Considering the high therapeutic efficacy and longlasting remission achieved, this type of radiotherapy should be used in the treatment of severe psoriatic nail lesions with massive nail plate thickening, to alleviate psychical and functional difficulties associated with the disease.

Febrile ulceronecrotic pityriasis lichenoides et varioliformis acuta with fatal outcome

Ulceronecrotic Mucha-Habermann disease is a severe, febrile form of pityriasis lichenoides et varioliformis acuta. The condition may sometimes have a fatal outcome, especially in elderly patients. In this paper, we are reporting on a 60-year-old male patient who suffered from the eruption of erythematous, haemorrhagic, ulceronecrotic papules accompanied by high temperature. Erosions and ulceronecrotic papules covered over 80% of his body. Three weeks after his admittance to our hospital, clinical signs resembling ileus together with the leucocytosis occurred. The patient was transferred to the department of internal medicine and later to the surgery department. The fulminant course of the disease could not be stopped, and the patient died of severe intestinal and colon gangrene caused by the massive thrombosis of superior mesenteric artery. Up to date, only 23 cases of this severe form of the disease have been reported, and even with the early recognition, fulminant course may lead to death.

Disseminated Hailey-Hailey disease treated with topical tacrolimus and oral erythromycin: Case report and review of the literature

Hailey-Hailey disease is a rare autosomal dominant skin disorder that typically affects the intertriginous areas. The responsible defect has been identified in the gene named ATP2C1 on chromosome 3q21-24. We present a 50-year-old man with a 16-year history of blistering eruptions and positive familial history where this disease had appeared through four generations. The diagnosis was confirmed by histopathologic studies and negative immunofluorescence findings. A combination of topical tacrolimus therapy and oral erythromycin seemed to play a considerable part in this case, in which all of the lesions healed within 2 weeks.

Pyoderma gangrenosum associated with ulcerative colitis

We report the case of a 45-year old man with non-healing ulcers located on his chest, lumbal, sacral, retroauricular areas and forehead. Both clinical and histopathological examinations suggested pyoderma gangrenosum (PG). For six months the diagnosis of ulcerative colitis was established. PG in our patient was presented as a rapidly enlarging, painful ulcer with purple, undermined edges and a necrotic, haemorrhagic base. Initially, he was treated with a high dosage of peroral glucocorticosteroid, sulfasalazine, and systemic antibiotics, together with daily wound care. Ulceration partially regressed. Total colonoscopy showed pancolitis. When the dose of glucocorticosteroids was tapered down to 35 mg, new ulcerations on his right thigh and abdomen were formed. He also developed E. coli sepsis and flare up of bowel disease. Azathioprine, together with two pulse doses of glucocorticosteroids and antibiotics, were administered. He was scheduled for a total colectomy. The management of PG continues to be a therapeutic challenge.

Folliculotropic mycosis fungoides with follicular mucinosis--case report

Reports on clinical and histologic follicular alterations in patients previously diagnosed with mycosis fungoides (MF) or at the time of MF diagnosis are rare. The clinical and histologic criteria to distinguish MF associated with follicular mucinosis from follicular MF are a matter of debate. A patient is described with advanced clinical and histologic alterations predominated by follicular lesions and presence of mucin. In the early stage of the disease, folliculotropism was clinically and histologically present but less pronounced than epidermotropism and classic plaque-like lesions. The patient died four years after the diagnosis. As the term 'folliculotropic' describes a particular histopathologic finding, we consider it correct to use the term "folliculotropic MF" to denote atypical lymphocyte folliculotropism in the absence or presence of mild epidermotropism, presence of mucin, or no evidence for intrafollicular mucin. Folliculotropic MF seems to represent a specific clinicopathologic entity which may have a poorer prognosis than classic MF.

What do we really know about "tinea incognita"?

The term "tinea incognita" refers to diverse clinical presentation of mycotic infections modified by inappropriate use of topical or systemic corticosteroids. A 67-year-old male patient with a five-year history of generalized erythematous plaques on the trunk and extremities, previously treated with topical corticosteroids, is described. The lesions mainly showed a psoriasiform, some eczematous appearance, few of them showing a clinical picture of folliculitis. The native mycologic specimen was negative. The diagnosis was made on the basis of mycologic culture finding of Trichophyton interdigitale growth. Systemic and topical antimycotic therapy administered for two months resulted in complete regression of skin lesions.

Primary anetoderma associated with antiphospholipid antibodies and micromorphologic vascular lesions: case report and literature review

A 40-year-old male patient with primary anetoderma is presented in whom antiphospholipid antibodies were detected while not fulfilling diagnostic criteria for antiphospholipid syndrome. The possible pathogenic role of antiphospholipid antibodies in the disease development is postulated.

A eleven-year retrospective study of metastatic carcinomas of the skin: own experience

A brief overview of some metastatic carcinomas of the skin is given. The basic principles of the metastatic process, the distribution of metastases and clinical features of the most common metastatic carcinomas of the skin are presented, along with an account of our own data based on the records of Dermatohistology Registry of the University Department of Dermatology and Venereology, Zagreb University Hospital Center, for the 1994-2004 period and presentation of 22 cases of cutaneous metastases from this eleven-year period.

Caustic reaction caused by cement

A case is reported of a patient who developed full thickness chemical burns of the skin after a prolonged contact while working with wet cement. The history, course of disease, and therapy are described. Cement is an alkaline substance (pH >12) leading to colliquative necrosis. Tissue damage is due to the exothermic reaction of calcium oxide and water forming calcium hydroxide. Patch test was performed to test sensitization to chromium, chromate and cobalt, the usual cement ingredients. In our opinion, such lesions may not be rare because cement is widely used in construction, but are rarely described or under-recognized.

Xanthoma disseminatum: case report

Xanthoma disseminatum is a rare, benign, non-Langerhans' cell histiocytic disorder of unknown etiology. A case is presented of a 71-year-old man with a three-year history of disseminated symmetric yellowish papules and plaques on the skin of the face, neck, flexor regions, trunk, extremities and oral mucosa, with fatty infiltration of the liver and pancreas, and cardiac complaints. Xanthomatous rhinophyma predominated on the face. Clinical, immunohistochemistry and histology findings indicated the diagnosis of xanthoma disseminatum. Although the patient had a positive family history of cardiovascular diseases and a number of symptoms that are often associated with hyperlipidemia, repeat plasma levels were always within the normal limits. The case was interesting because of a number of etiologic factors that could be connected with the appearance of xanthomas in our patient. Therefore it was difficult to classify the disease into one of well-defined nosologic entities. The case report is supplemented with a review of relevant literature.

Zoon plasma cell balanitis: an overview and role of histopathology

Balanitis circumscripta plasmacellularis or Zoon's balanitis is an idiopathic, benign condition of the genitalia that mostly presents as a solitary, persistent plaque on the glans of primarily uncircumcised, middle-aged to older men. Its etiology and pathogenesis remains speculative. This article provides an overview of the clinical morphology, microscopic features, differential diagnosis and therapy. Particular attention is paid to histopathologic features. Besides, a case is presented of an uncircumcised man with clinical and histologic features of balanitis circumscripta plasmacellularis who was successfully cured by circumcision. The distinction of this lesion from similar lesions is rather important, and a large group of disorders such as premalignant, infective and other inflammatory penile diseases should be definitely taken into consideration on the differential diagnosis. It seems that circumcision might be the current 'gold standard' for treatment of this disorder.

Biomechanical aspect of supravesical urine derivation by Bricker's method

The findings obtained by excretory urography in 15 patients of various age and occupation confirmed the study premise that in the upright position after the procedure of supravesical urine derivation as described by Bricker, the isolated segment of the ileum does not function as a conduit but forms a siphon-like receptaculum which, according to the laws of liquid mechanics, prevents or reduces the ascent of gases and bacteria into the upper urinary ducts. This also appears to be a logical explanation for a decreased incidence of infection of proximal urinary ducts in Bricker's method of supravesical urine derivation as compared to other mechanically comparable surgical procedures.

The biomechanical aspect of testis hydrocele

The liquid content of the hydrocele or watery hernia presses blood vessels of the testis. This pressure occurs in the accordance with hydrostatic and hydraulic laws. However, none of 223. 568 studies on the pressure in mammalian organisms registered worldwide has reported on the pressure values in case of testis hydrocele. Results obtained by observation of 20 patient with testis hydrocele suggested that the hydrostatic pressure of testis hydrocele always surpassed the pressure of blood vessels within the scrotum, proving that the pressure of a fluid as a mechanical factor plays an important role in the malfunction of spermatogenesis as well as in hypoxemic hypoxia of the testis.