José Larrañaga Zubizarreta

Síndrome de Stewart-Treves

Lymphangiosarcoma is an uncommon vascular tumor that usually develops in longstanding lymphedema. We gathered the cases of lymphangioma observed in a hospital and attempted to analyze their characteristics: age, sex, localization, treatment and follow-up data. We studied five cases: three cases of Stewart-Treves syndrome after mastectomy and radiotherapy and two cases that developed in patients with late-onset congenital lymphedema. There were four women and one man. Radical surgery was performed in four patients. The techniques employed were: above-knee amputation (one patient), hip disarticulation (one patient), scapulo-humeral disarticulation (two patients) and gemcitabine and radiotherapy in one patient with metastatic disease at diagnosis. Three patients died in the first 14 months of follow-up, while two are disease free after 46 and 86 months respectively. This study confirms the poor prognosis of patients with Steward-Treves syndrome.

Eritema anular eosinofílico

Resumen —. Introduccion. El eritema anular eosinofilico, inicialmente descrito en la infancia, es una rara enfermedad benigna y autolimitada que se caracteriza por la presencia de lesiones anulares eritematosas recurrentes, que normalmente se localizan en el tronco y las extremidades. El curso es recidivante con intervalos libres de enfermedad. El estudio histologico muestra en la dermis un infiltrado perivascular con linfocitos y eosinofilos. No suele detectarse eosinofilia en sangre periferica. Su etiologia es desconocida. El tratamiento con antipaludicos de sintesis ha demostrado ser eficaz en los 2 casos publicados. Un varon de 59 anos consulto por presentar papulas urticariales y lesiones anulares recurrentes, no pruriginosas, en el tronco, desde hacia 3 meses. La biopsia mostro un infiltrado linfocitico de predominio perivascular con eosinofilos en la dermis. La enfermedad remitio espontaneamente en 10 meses.

Factores predictores de respuesta y revisión de la toxicidad cutánea de cetuximab y panitumumab en 116 pacientes

INTRODUCTION AND OBJECTIVES Cetuximab and panitumumab are monoclonal antibodies that target the epidermal growth factor receptor (EGFR) in the treatment of metastatic colorectal cancer. Most patients develop a papulopustular rash, which may predict tumor response. We studied whether the other adverse cutaneous effects associated with these monoclonal antibodies are also clinical predictors of response. We also reviewed publications describing approaches to treating the papulopustular rash since no evidence-based guidelines have yet been published. MATERIAL AND METHODS We performed a retrospective study of 116 patients with metastatic colorectal cancer receiving anti-EGRF therapy with cetuximab or panitumumab at Hospital Universitario Donostia. RESULTS In total, 81.9% of the patients developed a papulopustular rash. Patients who received the most cycles of treatment with the EGFR inhibitor were at the highest risk of developing the rash, and these patients also had the most severe rash reactions (P=.03). All of the patients who exhibited a complete tumor response had the rash, and the incidence of rash was lower in patients with poor tumor response (P=.03). We also observed an association between tumor response and xerosis (53.4% of the patients who developed xerosis also exhibited tumor response, P=.002). The papulopustular rash was managed according to an algorithm developed by our department. CONCLUSIONS Severe papulopustular rash and xerosis may be clinical predictors of good response to anti-EGFR therapy. Patients who develop a papulopustular rash should be treated promptly because suboptimal treatment of this and other adverse effects can lead to delays in taking the prescribed anti-EGFR dose or to interruption of therapy.

Photodistributed neutrophilic dermatosis in a woman with Legionella pneumonitis

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