Jorge Abulafia

Leprosy: pathogenesis updated.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which can express itself in different clinico-pathologic forms, with a Mitsuda reactiondependent bipolar distribution. A spherical model of leprosy (Fig. 1) shows two hemispheres and an equatorial zone. The tuberculoid hemisphere, with variably positive Mitsuda reaction, includes polar (TT) and subpolar (Tt) tuberculoid leprosy, and macular (Tm), maculoanesthetic (Mal), and low resistant (Lrtl) tuberculoid leprosy. The lepromatous hemisphere, with negative Mitsuda reaction, includes polar (LL) and subpolar (sLL) lepromatous leprosy. At the equator, intermediate variants may develop: Mitsuda-positive borderline tuberculoid (BT), Mitsudanegative borderline lepromatous (BL) and borderline borderline (BB) leprosy. Histopathologically, at the tuberculoid hemisphere, cellmediated immunity prevails and epithelioid granulomas with scarce or no bacilli predominate. At the lepromatous hemisphere, a specific inflammation represented by lepromatous granulomas or virchowcytic granulomas, containing modified macrophages called lepra cells or virchowcytes, is seen. In borderline leprosy, both types of granulomas may coexist, not infrequently with modified epithelioid or lepra cells. Indeterminate leprosy (IL) reveals lymphocytic infiltrates, perhaps related to immune mechanisms that precede the development of tuberculoid granulomas and epidermal lichenoid reactions, or the appearance of only a few lepra cells, with no epidermal lesions; both types of indeterminate leprosy are associated with perineuritis. This thorough classic classification (Fig. 1) has been replaced by a simpler and briefer one that considers two polar (TT, LL) and several borderline forms. Since then, the spectrum of leprosy as a continuum, with transitions in either direction, has been accepted.1–5 The notion of a

Multiple disseminated pyogenic granuloma

A 15‐month‐old baby girl with extensive skin burns developed within the burned areas multiple lesions with the clinical and histological characteristics of granuloma pyogenicum.

Angina bullosa hemorrhagica

Background In 1967, Badham used the term angina bullosa hemorrhagica (ABH) to describe an entity we already knew as traumatic oral hemophlyctenosis (TOH) (1933) and later renamed recurrent oral hemophlyctenosis (ROH) (1971).

Melanoma on dysplastic nevus spilus

Background Nevus spilus is found with relative frequency. It is observed as a tan to brown macule serving as base to a speckle of smaller and darker maculo‐papular elements. On rare occasions it turns into a malignant melanoma.

Van der Woude Syndrome. A Case Report

Abstract: We describe several members of a family with Van der Woude syndrome, a genetic and congenital malformation syndrome with autosomal dominant inheritance and 70% to 80% penetrance with variable expressivity. It is characterized by clinical signs localized to the face, such as bilateral or unilateral pits on conical elevations in babies or extensive depressions in adults, both in the vermilion border of the lower lip, with cleft lip, with or without cleft palate and uvula. Small accessory or heterotopic salivary glands empty into sinuses or fistulas in the lips. This eight member family had various clinical signs of the condition. All had cleft lip and palate. We studied the major characteristics of the eight patients and describe histopathologic and immunohistochemical features.

Metastatic involvement of four eyelids

CASE REPORT A 58-year-old woman had a right radical mastectomy in 1973 and several courses of chemotherapy. Five years later progressive eyelid inflammation, induration, and narrowing of the palpebral fissures occurred. Peritoneal involvement was noted. Both eyes showed palpebral overlapping, swelling, red discoloration, and woody induration that precluded the assessment of the eyeballs (Fig. 1). 1 A biopsy specimen of the left lower eyelid showed epidermal atrophy and edema associated with blood and lymph vessel enlargement in the papillary dermis. The reticular dennis was hypertrophic, and confluent cords of cuboid cells with a pale cytoplasm and a hyperchromatic nucleus invaded the connective tissue (Fig. 2). No inflammatory infiltrate was present. The adnexa were atrophic. A diagnosis of skin metastasis from breast carcinoma was made. A specimen from the right lower eyelid had similar features. Roentgenograms demonstrated spine and peritoneal metastases. The patient received 3000 rads to each eye, but died 4 months later.

Squamous cell carcinoma of the nail bed.

A case is presented of squamous cell carcinoma developed from carcinoma in situ of the nail bed of the first finger in a 79-year-old patient. Stress is laid upon the importance of the differential diagnosis. Surgery is considered the treatment of choice for this uncommon condition.

Nevo anelástico zoniforme. Su probable relación con las anetodermias primarias no inflamatorias congénitas

Resumen —El nevo anelastico es una malformacion del tejido conectivo con una histopatologia caracterizada por ausencia parcial o total del tejido elastico. Presentamos un caso de un nevo anelastico de aparicion connatal, localizado en el hemitorax derecho de disposicion zoniforme. Sugerimos la probable vinculacion de este nevo con las anetodermias primarias, no inflamatorias y congenitas.