Cristina de las Heras

Unilateral Agminated Melanocytic Nevi

A 55-year-old woman presented for the examination of numerous moles on her anterior abdominal wall. The pigmented lesions had been present at birth and had not recently changed in size, color or texture. Clinical examination showed multiple dark brown macules that ranged from 2 to 8 mm in size, arranged from the midline of the anterior abdominal wall to the right side of the abdomen following a Blaschko linear pattern ( fig. 1 ). No signs of dysplastic nevi were present. Skin biopsy of one pigmented lesion showed numerous pigmented nevus cell nests along the dermoepidermal junction with melanophages in the dermis ( fig. 2 ). ‘Agminated’ is derived from the Latin word ‘agmen’, meaning ‘aggregation’. Agminated melanocytic nevi tend to be clustered together in a circumscribed region, sometimes in a segmental area. Few reports of unilateral multiple melanocytic nevi are present in the literature [1, 4, 7–9] , sometimes, as in our case, arranged in a linear distribution resembling the lines of Blaschko [7–9] . Other reports describe a segmental distribution corresponding to the trigeminal dermatome [4] . This linear distribution may be due to a clonal outgrowth of cells which carry a major gene responsible for the development of melanocytic nevi. This clone is thought to originate from a somatic mutation at an early stage of embryogenesis. The risk of malignant change in agminated melanocytic nevi is unknown. However, melanoma arising from agminated melanocytic nevus has been described [10] , and longterm follow-up is recommended.

Escrofuloderma con linfadenitis tuberculosa

Fundamento El escrofuloderma se produce por la extension directa a la piel de un foco tuberculoso subyacente en ganglio linfatico, huesos, articulaciones o incluso el epididimo. Entre las formas extrapulmonares de enfermedad tuberculosa, la mas frecuente es la afeccion de ganglios linfaticos perifericos. Pacientes y metodo Analizamos prospectivamente a todos los pacientes mayores de 12 anos con el diagnostico de escrofuloderma y linfadenitis tuberculosa vistos en el area sanitaria de Ferrol (poblacion actual, 220.000) en un periodo de 15 anos. Describimos los datos clinicos, histopatologicos y microbiologicos de los pacientes. Resultados Encontramos 12 casos de escrofuloderma con tuberculosis ganglionar. Esta serie incluye a 10 mujeres y 2 varones entre 15 y 71 anos de edad. La linfadenitis cervical fue la forma mas frecuente (83,3%). Se encontro afeccion de organos internos en 3 (25%); en 2 pacientes concurrian VIH y escrofuloderma. Conclusiones La tuberculosis ganglionar es el 30% de todas las infecciones tuberculosas extrapulmonares. El escrofuloderma ocurre con mayor frecuencia sobre linfadenitis cervical. Esta suele tener relacion con una afeccion tuberculosa en otra parte, sobre todo los pulmones.