Solange Corrêa Garcia Pires D'Avila

Características histopatológicas e imunohistoquímicas das lesões cutâneas e da mucosa oral na histoplasmose disseminada de portadores da síndrome da imunodeficiência adquirida (AIDS)

A analise histopatologica e imunohistoquimica de 25 biopsias cutâneas e da mucosa oral de portadores da associacao AIDS e histoplasmose mostrou o seguinte: 1) em 18 casos as lesoes cutâneas eram multiplas e se apresentavam sob a forma de papulas (eritematosas, violaceas ou acastanhadas), ulceras, vesiculo-pustulas e eram distribuidas por todo tegumento cutâneo; Em sete casos as lesoes se localizavam na mucosa da lingua, palato, uvula e eram do tipo ulcerado ou moruliforme; 2) histologicamente as lesoes apresentavam quatro aspectos distintos: macrofagico difuso; granulomatoso; vasculitico com leucocitoclasia; e com escassa reacao inflamatoria; 3) a tipagem dos linfocitos T e B e dos macrofagos atraves dos anticorpos monoclonais mostrou que a resposta imunologica ao Histoplasma capsulatum e predominantemente do tipo celular nos quatro tipos histologicos; 4) o teste imunohistoquimico para o fungo nas lesoes confirmou o diagnostico morfologico de H. capsulatum.Biopsy specimens of the skin and oral mucosa from twenty-five patients bearing the disseminated form of histoplasmosis (H. capsulatum) associated with AIDS (acquired immunodeficiency syndrome) were studied by histologic and immunohistochemistry techniques. Histologically, the skin lesions showed four different patterns: diffuse macrophage, granulomatous, vasculitic with leukocytoclastic and scarce inflammatory reaction. The cell markers for macrophages, lymphocytes B and T and H. capsulatum revealed CD68, UCHL-1 and L26 associated with variable amounts of fungi.

Histopathological detection of entry and exit holes in human skin wounds caused by firearms

The judiciary needs forensic medicine to determine the difference between an entry hole and an exit hole in human skin caused by firearms for civilian use. This important information would be most useful if a practical and accurate method could be done with low-cost and minimal technological resources. Both macroscopic and microscopic analyses were performed on skin lesions caused by firearm projectiles, to establish histological features of 14 entry holes and 14 exit holes. Microscopically, in the abrasion area macroscopically observed, there were signs of burns (sub-epidermal cracks and keratinocyte necrosis) in the entrance holes in all cases. These signs were not found in three exit holes which showed an abrasion collar, nor in other exit holes. Some other microscopic features not found in every case were limited either to entry holes, such as cotton fibres, grease deposits, or tattooing in the dermis, or to exit holes, such as adipose tissue, bone or muscle tissue in the dermis. Coagulative necrosis of keratinocytes and sub-epidermal cracks are characteristic of entry holes. Despite the small sample size, it can be safely inferred that this is an important microscopic finding, among others less consistently found, to define an entry hole in questionable cases.

Correlation between dermoscopic and histopathological diagnoses of atypical nevi in a dermatology outpatient clinic of the Medical School of São José do Rio Preto, SP, Brazil

BACKGROUND The incidence of cutaneous melanoma is increasing worldwide. Since it is an aggressive neoplasm, it is difficult to treat in advanced stages; early diagnosis is important to heal the patient. Melanocytic nevi are benign pigmented skin lesions while atypical nevi are associated with the risk of developing melanoma because they have a different histological pattern than common nevi. Thus, the clinical diagnosis of pigmented lesions is of great importance to differentiate benign, atypical and malignant lesions. Dermoscopy appeared as an auxiliary test in vivo, playing an important role in the diagnosis of pigmented lesions, because it allows the visualization of structures located below the stratum corneum. It shows a new morphological dimension of these lesions to the dermatologist and allows greater diagnostic accuracy. However, histopathology is considered the gold standard for the diagnosis. OBJECTIVES To establish the sensitivity and specificity of dermoscopy in the diagnosis of pigmented lesions suspected of malignancy (atypical nevi), comparing both the dermatoscopic with the histopathological diagnosis, at the Dermatology Service of the outpatient clinic of Hospital de Base, São José do Rio Preto, SP. METHODS Analysis of melanocytic nevi by dermoscopy and subsequent biopsy on suspicion of atypia or if the patient so desires, for subsequent histopathological diagnosis. RESULTS Sensitivity: 93%. Specificity: 42%. CONCLUSIONS Dermoscopy is a highly sensitive method for the diagnosis of atypical melanocytic nevi. Despite the low specificity with many false positive diagnoses, the method is effective for scanning lesions with suspected features of malignancy.

Um Caso de Criptococose Cutânea Primária

A criptococose constitui doenca causada pelo fungo Cryptococcus neoformans, comumente encontrado em fezes de aves, como pombos. Este microorganismo pode causar doenca em seres humanos, podendo acometer diversos orgaos, dentre eles a pele. Mais comumente ocasiona doenca em individuos imunossuprimidos. O caso relatado e o de uma paciente do sexo feminino de 44 anos que fazia uso cronico de corticosteroide sem prescricao medica e apresentou lesao em face lateral de braco esquerdo, cujos exames laboratoriais confirmaram o diagnostico de criptococose cutânea primaria.