Laura Carreño

Activity assessment in morphea using color Doppler ultrasound.

BACKGROUND Morphea (circumcripted cutaneous scleroderma) can be difficult to assess for lesion activity. Because variable-frequency ultrasound with color Doppler provides details of skin morphology and function, it may help in the categorization of morphea. OBJECTIVE We sought to evaluate color Doppler ultrasound as a probing tool for assessing activity in morphea lesions. METHODS Consecutive patients with cutaneous morphea referred by dermatologists were studied with color Doppler ultrasound, and the assessment of lesion activity was compared with histologic findings. Normal skin controls were obtained by performing ultrasound scans of healthy subjects or of unaffected areas of the patients themselves. Measurements included cutaneous layer thickness, relative echogenicity, and blood flow with peak systolic velocity. Ultrasound sensitivity and specificity were determined for each phase of morphea activity and the results correlated with histology. RESULTS Fifty-one patients had a total of 104 morphea lesions. Of the lesions, 20% were active, 22% were atrophic, and 58% were inactive. Five of the patients had the Parry-Romberg syndrome with ipsilateral parotid gland inflammatory involvement, and one had an asymptomatic but sonographically active morphea lesion. Sensitivity and specificity for ultrasound diagnosis were 100% and 98.8%, respectively. The most accurate sonographic signs of lesion activity were increased subcutaneous tissue echogenicity and increased cutaneous blood flow (sensitivity and specificity 100% and 100% for each one). LIMITATIONS Ultrasound cannot define lesions less than 0.1-mm deep. CONCLUSIONS The morphologic and functional data obtained noninvasively and in real time with color Doppler ultrasound provide new insight into the pathogenesis of morphea. The technique represents a useful counterpart to histologic examination for the assessment of lesion activity.

Inflammatory Diseases of the Skin

This chapter reviews common inflammatory diseases of the skin that may undergo sonography. Fluid collections and fistulae, lipodermatosclerosis, panniculitis, psoriasis, morphea, warts, and hidradenitis suppurativa are among the several conditions that are covered in this chapter. A correlation of the clinical and sonographic findings is described and well illustrated using selected cases.

Sonographic Anatomy of the Skin, Appendages, and Adjacent Structures

Recognition of normal sonographic anatomy is of utmost importance when performing imaging examinations. The ultrasound morphology of the skin layers, appendages, and adjacent structures in correlation with the histological findings is provided. Common anatomical variants are also discussed

Skin Cancer: The Primary Tumors

Skin cancer is the most frequent form of cancer in human beings and the sonographic imaging support of the primary lesion can provide relevant anatomical data that can improve the prognosis of patients and decrease recurrences. The most frequent types of skin cancer are discussed and include basal cell carcinoma, squamous cell carcinoma, and melanoma. Information on the sonographic morphology, contrast-enhanced ultrasound, and sonoelastography of skin cancer is provided. Other types of malignant skin tumors such as dermatofibrosarcoma protuberans, Merkel cell carcinoma, and cutaneous lymphomas are also covered.

Tumores gastrointestinales estromales (GIST): Experiencia del Servicio de Cirugía del Hospital Clínico de la Universidad de Chile entre 1999 y 2005

BACKGROUND Gastrointestinal stromal tumors (GIST) are the most common mesenchymatous tumors of the digestive tract. The pathological diagnosis is based on microscopy and immunohistochemistiy. AIM To review the experience of our surgical unit in patients with GIST MATERIAL AND METHODS: Review of medical records of 15 patients (aged 66+/-13 years, 11 women), with a pathological diagnosis of GIST, treated between 1999 and 2005. RESULTS The main presenting symptoms were melena in 40%, hematemesis in 20%, abdominal pain in 60% and anemia in 13%. In only one patient, the tumor appeared as an incidentaloma. All patients underwent upper gastrointestinal endoscopy A CAT scan was done in 87%, a barium swallow in 60% and a digestive endosonography in 20%. Thirteen tumors were located in the stomach and two in the small bowel. Mean tumor diameter was 5.3+/-1.7 cm. Surgical management was a tumor resection in 40%, a partial gastrectomy in 27%, a total gastrectomy in 20% and an intestinal excision in the rest. Mean hospital stay was 6.9+/-4.2 days. No postoperative complications were recorded. CONCLUSIONS The main clinical presentation of GIST in this retrospective series was an upper gastrointestinal bleeding. Surgical treatment was devoid of complications.

Cutaneous Vascular Tumors

Vascular tumors comprise a wide spectrum of lesions. Sonography can support the diagnosis and provide anatomical data on their location, thickness, and degree of vascularity, among other features. Benign and malignant vascular entities are reviewed in this chapter and include: angiokeratomas, kaposiform hemangioendothelioma, glomus tumor, pyogenic granuloma, epithelioid hemangioma, cutaneous angiomyxoma, cutaneous angiosarcomas, and Kaposi’s sarcoma, besides other conditions.

Fascioliasis hepática que simularon tumores hepáticos

Two cases of hepatic fascioliasis which simulated hepatic tumors are presented: Patient 1. (42-year-old woman), presented pain in the epigastric and right hypochondrium. US, CAT and MNR suggested a cholangiocarcinoma. She was operated on by practicing hepatic segmentectomy, cholecystectomy and closign of a cholecystogastric fistula. The extirpated hepatic segment presented a tumoral aspect, but its histopathological study revealed numerous granulomas, some of them with F. hepatica eggs and others with Charcot - Leyden crystals. ELISA and complement fixation reaction for fascioliasis resulted positive. Search of F. hepatica eggs in stools was negative. The patient was treated with triclabendazole. Patient 2. (58-year-old woman) also presented pains in the upper hemiabdomen. Hypereosinophilia (32%). Abdominal CAT showed multiple hipondense irregular zones suggesting infiltrative processes in the liver right lobe. The hepatic biopsy, under CAT, eventhough lead to think in a hamartoma, a diagnosis of chronic cholangitis compatible with a parasitic etiology raised. ELISA and complement fixation reaction for fascioliasis were positive. Coproparasitological exams for F. Hapatica resulted negative. She was successfully treated with triclabendazole. Hapatic fascioliasis simulates numerous diseases, among them hepatic tumors.