Lucía Martín

Cutaneous tuberculosis: A clinical, histopathologic, and bacteriologic study

BACKGROUND In recent years cutaneous infections with Mycobacterium tuberculosis with an atypical clinical appearance have become more common because of the increasing number of immunocompromised patients. OBJECTIVE We report the clinical, histopathologic, and bacteriologic data of 11 patients with several forms of cutaneous tuberculosis seen during the past 14 years. METHODS Patients from whom M. tuberculosis was isolated from culture of skin biopsy specimens, sinus drainage, or material aspirated from cutaneous abscesses were included. In all but two patients a biopsy specimen was obtained for histopathologic study. All but one patient received combined antituberculous therapy. RESULTS The clinical diagnoses were scrofuloderma (four cases), cutaneous miliary tuberculosis (two), lupus vulgaris (two), tuberculous gumma (two), and one unclassified. All but three patients had evidence of either previous or simultaneous tuberculous foci other than in the skin. Histopathologic findings varied according to the type of cutaneous tuberculosis. CONCLUSION In some patients with cutaneous tuberculosis, lesions are atypical in appearance because of immunodeficiency. Culture for M. tuberculosis should be performed in all suspected cases, even in those in whom special stains for acid-fast bacilli are negative.

Giant dermatofibroma. A little-known clinical variant of dermatofibroma.

BACKGROUND Dermatofibroma is a common cutaneous lesion that usually appears as a slow-growing firm dermal nodule. OBJECTIVE Our purpose was to report the clinical and histopathologic characteristics of eight giant dermatofibromas and review the few cases of this variant of dermatofibroma reported in the literature. METHODS All clinical records of two Departments of Dermatology of University Hospitals from the past 5 years with a diagnosis of dermatofibroma were reviewed. Lesions that measured 5 cm or larger were considered for this study. Biopsy specimens were available from all lesions. RESULTS Giant dermatofibromas are most frequently on the legs, especially below the knee. Often they have a pedunculated appearance. Because of their large size, the correct diagnosis is not suspected clinically; a diagnosis of malignancy is often made. CONCLUSION Our findings indicate that giant dermatofibroma is a distinct but uncommon clinical variant of dermatofibroma that invariably exhibits a benign biologic behavior.

Cutaneous metastases from prostatic carcinoma

Cutaneous metastasis from carcinoma of the prostate is a rare phenomenon. When it occurs, metastases usually appear as multiple nodules involving the suprapubic area and the anterior aspect of the thighs. We report on two cases of cutaneous metastases from prostatic carcinoma, one of them presenting the stereotypical clinical and histopathological findings, whereas in the other one cutaneous metastasis consisted of a morphea‐like plaque on the chest. Histopathologically, the later case revealed accumulations of neoplastic cells distributed in a folliculotropic pattern. In both examples immunohistochemical study with prostatic specific antigen (PSA) confirmed the prostatic origin of the metastases. We review the literature on this subject.

Follicular spicules of the nose: A peculiar cutaneous manifestation of multiple myeloma with cryoglobulinemia

We describe a patient with multiple myeloma and cryoglobulinemia who had spicules with a horny appearance in the follicular openings of the face, particularly on the nose. Histopathologic study demonstrated that these spicules consisted of eosinophilic homogeneous deposits in the intercellular spaces between keratinocytes in the upper layers of the follicular infundibulum. Direct immunofluorescence, ultrastructural, and biochemical investigations revealed that these eosinophilic deposits were cryoprecipitates composed of IgG-kappa with electrophoretic characteristics identical to those of the paraprotein present in the serum of the patient. Hence we believe that these lesions are best referred to as pseudohyperkeratotic spicules of the nose, and that they are a characteristic cutaneous manifestation of patients with multiple myeloma and cryoglobulinemia.

Localization of Sweet's syndrome in radiation-induced locus minoris resistentae.

Sweets syndrome is a reactive dermatosis clinically characterized by fever, leukocytosis, and multiple, erythematous, painful plaques. Histopathologically, the lesions show edema of the papillary dermis and a dermal infiltrate mainly composed of neutrophils, without vasculitis. We describe a patient with breast carcinoma and Sweets syndrome mostly involving previously irradiated skin.

Postirradiation pseudosclerodermatous panniculitis.

Pseudosclerodermatous panniculitis is an unusual variant of panniculitis that results as a complication of megavoltage radiotherapy. Four women developed this unusual entity on the anterior chest and abdominal skin after receiving megavoltage therapy for either breast carcinoma or painful bone metastases from breast carcinoma. Histopathologically, the epidermis and dermis of the involved area showed little or no evidence of radiodermatitis. The main findings were confined to the subcutaneous tissue and consisted of thickened, sclerotic septa composed of both thick and thin collagen bundles, and a lobular panniculitis characterized by lipophagic granulomas and scattered lymphocytes and plasma cells. Additionally, one of the cases showed markedly dilated vascular spaces with the appearance of lymphatics in the upper part of the dermis. Pseudosclerodermatous panniculitis after irradiation is an unusual cutaneous complication of megavoltage radiotherapy that should be distinguished from subcutaneous metastatic disease, cellulitis, or connective tissue diseases involving the subcutaneous fat. The differential diagnosis can be established on the basis of the characteristic histopathologic features of postirradiation pseudosclerodermatous panniculitis.

Acquired hypertrichosis lanuginosa : Case report and review of the literature

Acquired hypertrichosis lanuginosa is a rare cutaneous disorder usually associated with internal malignancy that consists of the development of abnormal hair growth of the lanugo type, often confined to the skin of the face and neck, although other areas also may be involved. We report on a 66‐year‐old woman with a metastatic ductal infitrating carcinoma of the breast who developed growth of fine lanugo type hair on her face and progressive growth of the hair of eyebrows and eyelashes. We review the literature on this uncommon paraneoplastic cutaneous disorder emphasizing the pathogenic mechanisms that have been proposed to explain the striking overgrowth of lanugo type hair. J. Surg. Oncol. 1998;68:199–203.

Clear-cell porocarcinoma : Another cutaneous marker of diabetes mellitus

The relationship between clear-cell syringoma and diabetes mellitus is well established. We present a case of clear-cell porocarcinoma in a diabetic patient. The lesion consisted of a 5-cm nodule on the lateral aspect of the left leg. Histopathologically, the neoplasm was composed of irregular aggregations of neoplastic cells with striking clear-cell appearance, showing features of ductal differentiation. The clear-cell appearance of neoplastic cells was due to glycogen accumulation within their cytoplasm. Immunohistochemistry and ultrastructural studies also supported the diagnosis of a neoplasm with sweat ductal differentiation. Enzyme histochemical reactions for phosphorylase immunoreactivity on fresh, unfixed sections of the neoplasm demonstrated that this immunoreactivity was remarkably decreased. Some adnexal neoplasms of the skin mostly composed of clear cells may be cutaneous markers of diabetes mellitus. Phosphorylase activity deficiency in diabetic patients may be responsible for glycogen accumulation in neoplastic cells resulting in clear-cell appearance of these neoplasms.

Annular Atrophic Lichen planus

We describe the second case of annular atrophic lichen planus. The annular configuration of the lesions resulted from peripheral enlargement with simultaneous central clearing. Histology showed features of lichen planus in the active border of the lesion and a pattern of resolved lichen planus in its center. Elastic fibers had been destroyed in the papillary dermis both in the border and in the center of the lesion, resulting in an atrophic appearance of the lesion. Annular atrophic lichen planus is an uncommon variant of lichen planus that results from elastolytic activity of inflammatory cells with formation of areas of localized acquired cutis laxa.

Linear Pemphigus vulgaris along a Surgical Scar

A 64-year-old female had breast carcinoma of the right breast, and a mastectomy was performed. Three years later she developed a vesiculobullous eruption along the surgical scar. Histopathological and direct immunofluorescence findings were consistent with a diagnosis of pemphigus vulgaris. We discuss the possible pathogenesis for this striking linear distribution of the pemphigus vulgaris lesions.