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Subcutaneous Nodules (subcutaneous + nodule)
Selected AbstractsRole of fine-needle aspiration cytology in evaluation of cutaneous metastasesDIAGNOSTIC CYTOPATHOLOGY, Issue 12 2009Sonal Sharma M.D. Abstract Skin is an uncommon site for metastasis. This study was done to evaluate the role of FNAC as an important tool for investigating cutaneous and subcutaneous nodules in patients with known malignancy or as a primary manifestation of an unknown malignancy. All the FNAC done from January 2003 to August 2008 were reviewed (n = 55,556). Ninty-five patients (49 males and 46 females with age range of 4,96 years) with cutaneous/subcutaneous nodules which were diagnosed as metastasis were analyzed. Primary tumors of skin/subcutis were excluded from the study. In our study, 63 out of 95 cases had a known primary malignancy. Of these, five had underlying hematological malignancy and 58 patients had solid organ tumors. Lung carcinoma was seen to metastasize most commonly to skin in males and breast carcinoma in females. The most common site for a cutaneous/subcutaneous metastasis was chest wall [40 followed by abdominal wall (14) and scalp (9)]. Multiple site involvement was also observed (8). In 32 cases primary site was not known. They were most commonly diagnosed as poorly differentiated carcinoma followed by adenocarcinoma. FNAC can diagnose a variety of tumors in the skin and support the diagnosis of a metastasis in case of a known primary and offer a clue to underlying malignancy in case of an occult primary. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc. [source] Microcystic adnexal carcinoma: report of four cases treated with Mohs' micrographic surgical techniqueINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 6 2005Amor Khachemoune MD Background, Microcystic adnexal carcinoma (MAC) is a rare and aggressive malignant tumor of the sweat glands. Clinically, it often presents as a firm subcutaneous nodule on the head and neck regions. On histology, MAC exhibits both pilar and sweat duct differentiation with a stroma of dense collagen. It often extends beyond the clinical margins with local spreading in the dermal, subcutaneous, and perineural tissue planes. It has a high local recurrence rate after standard excision. Recent preliminary reports have indicated more favorable cure rates with Mohs' micrographic surgery (MMS). Objective, To present our data on four cases of MAC treated by MMS. We also compared our findings with more recently reported series in the English language literature. Methods, We reviewed the medical records of four patients (two males and two females) with MAC treated by MMS over the last 3 years. We also obtained follow-up data. Results, In all four patients with MAC treated by MMS, there were no recurrences, with a mean follow-up of 1 year. Conclusion, We report an additional four MAC cases treated by MMS. The accumulated data continue to confirm that, if the diagnosis of MAC is made early, and if the anatomic location is accessible to excision by MMS, a favorable outcome can be expected. [source] Metastatic cutaneous leiomyosarcoma from primary neoplasm of the mesenteryINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 8 2001Kyoung Jin Kim MD A 31-year-old South Korean woman was referred to the dermatology department from the oncology department for the evaluation of a subcutaneous nodular lesion on the back. Three years before, she noted a palpable, fingertip-sized, nontender mass on her right lower abdomen. The mass had increased in size slowly. One year ago, she visited a local clinic and physical examination revealed a 7 × 8 × 7 cm, slightly tender, deep-seated mass on the right lower quadrant of the abdomen. The mass on the ilial mesentery was resected by surgical exploration and tissue examination revealed leiomyosarcoma. She refused adjuvant chemotherapy. Approximately 3 months later, she re-visited the clinic with a tender, subcutaneous nodule on the back. Cutaneous examination revealed a solitary, 2 × 2 cm, well-defined, hard, movable, subcutaneous nodule on the upper back without skin color change (Fig. 1). She complained of tenderness on touching the lesion. Histologic examination of a biopsy specimen showed irregularly arranged spindle cells scattered throughout the dermis. They were arranged in haphazardly oriented or interweaving fascicles. Most of the spindle cells possessed elongated nuclei with blunt ends and some cells had a polygonal outline with irregularly shaped nuclei (Fig. 2). There were many mitoses: 3,4 per high-power (× 400) field. Immunohistochemically, smooth muscle actin and desmin were positive in most of the tumor cells (Fig. 3). S-100 reactivity was not observed. A diagnosis of metastatic leiomyosarcoma was made. About 1 month later, computed tomography showed two, ill-defined, heterogeneous, low attenuation masses in the right lobe of the liver, suggesting liver metastasis. The patient was treated with chemotherapy for 2 months and remains in good condition. Figure 1. 2 × 2 cm, solitary, well-defined, hard, movable, subcutaneous nodule without any overlying skin change Figure 2. (a) Characteristic findings of cutaneous leiomyosarcoma with markedly high cellularity and densely packed transverse and longitudinal fascicles of cells (hematoxylin and eosin, × 40). (b) High magnification of the neoplasm revealing spindle cells with blunt-ended nuclei, pleomorphism, and mitotic figures (hematoxylin and eosin, × 200) Figure 3. Dense cytoplasmic reactivity for smooth muscle actin is apparent (smooth muscle actin, × 200) [source] Tuberculid of the penis with a scab on the noduleINTERNATIONAL JOURNAL OF UROLOGY, Issue 10 2004SHIGENORI YONEMURA Abstract, Tuberculids of the penis are extremely rare. The clinical features of tuberculids of the penis have been reported as ulceration or scars. We have experienced a case of tuberculid of the penis that appeared as a scab on nodule. A 56-year-old man presented with a 4-month history of a painless subcutaneous nodule at the glans penis. Pathological findings of the nodule showed granulomatous inflammation. Tuberculin tests were strongly positive, but tubercle bacilli could not be detected. The diagnosis was tuberculid of the penis and the patient received antituberculosis chemotherapy. The present paper reports an interesting and rare case of tuberculid of the penis with a scab on nodule. [source] Subcutaneous dirofilariasis caused by Dirofilaria repens in Greece: a case reportJOURNAL OF CUTANEOUS PATHOLOGY, Issue 8 2009Konstantina Tzanetou Dirofilaria repens (formerly Dirofilaria conjunctiva) is a natural parasite of the subcutaneous tissues of dogs, cats and wild carnivores in Europe, Africa and Asia. Microfilariae are transmitted to humans by various species of mosquito. An autochthonous case of subcutaneous dirofilariasis is reported in a Greek patient from the island of Corfu. The clinical manifestation of the infection was a palpable, painless, subcutaneous nodule in the region of the groin, which 2 days before the patient consulted the doctor developed symptoms and signs of inflammation (pain, edema and redness). The entire lesion was surgically removed, and the nematode worm D. repens was identified on histological sections of biopsy material. The aim of this report was (a) to describe the microscopic morphological features of D. repens that enable identification of the parasite on histological examination and (b) to emphasize the importance of consideration of subcutaneous dirofilariasis in the differential diagnosis of subcutaneous nodules with inflammatory eosinophilic infiltration in countries where the infection is endemic. [source] Epithelioid srcoma of the penis: A case report and review of the literaturePATHOLOGY INTERNATIONAL, Issue 7 2000Giulio Rossi A rare case of epithelioid sarcoma (ES) of the penis is presented. The patient, a 35-year-old man, was initially treated as having Peyronie's disease, but the subsequent appearance of a subcutaneous nodule displayed a ,distal-type' ES. At immunohistochemical phenotypification, the tumor was positive for vimentin, cytokeratins and epithelial membrane antigen (EMA), as well as for some other multidirectional antibodies, including a membranous reaction for CD99. The review of 11 similar cases so far reported in the literature led to the conclusion that the clinicopathological characteristics of penile ES are basically the same as those of tumors in more classical locations: the age at diagnosis ranged from 23 to 43 years, the interval between first manifestations and diagnosis averaged 37 months (delayed diagnosis being common because of the slow growth rate and the harmless appearance of the lesion), the typical sign was a superficial nodule or mass, usually accompanied (better preceded) by urethral stenosis, dysuria and erectile disturbances. Total or partial penectomy was the treatment of choice in most patients, but lack of adequate follow up did not permit any definitive conclusion to be reached regarding its efficacy. [source] Angiomatoid Fibrous Histiocytoma in a Six-Year-Old ChildPEDIATRIC DERMATOLOGY, Issue 5 2009CHRISTINA CERNIK B.S. AFH is a fibrohistiocytic tumor of intermediate malignancy. Predominantly seen in children and young adults, AFH presents as a deep dermal or subcutaneous nodule usually on the extremities. The histology is characterized by a fibrous capsule, surrounding lymphocytic infiltrate and blood-filled cystic spaces lined by flattened tumor cells. AFH cells express desmin, epithelial membrane antigen, and CD 68 in over 60% of cases; they are negative for myogenin, MYOD1, and endothelial markers. Rate of local recurrence is 2% to 20%. The metastatic rate is 1%. Management is with wide surgical excision and careful follow-up. [source] Plexiform Fibrohistiocytic Tumor in Three ChildrenPEDIATRIC DERMATOLOGY, Issue 1 2006Fatemeh Jafarian M.D. It can occur at any age but is more prevalent in children and in young adults. Here we present the clinicopathologic findings of three girls with this tumor. The patients were 8 months, 14 months, and 7 years of age. They each presented with a solitary, nontender, subcutaneous nodule or plaque. Light microscopy and immunohistochemical study findings were compatible with plexiform fibrohistiocytic tumor. We also review the previously published cases in the English-language literature. [source] Cutaneous sarcoid with varied morphology associated with hypercalcaemia and renal impairmentCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 8 2009H. Miida Summary Sarcoidosis is a multisystem disorder of unknown aetiology, which presents with hilar lymphadenopathy, pulmonary infiltration, and ocular and cutaneous involvement. Cutaneous lesions often present as erythema nodosum, maculopapular, plaque, scar, subcutaneous nodule or lupus pernio. Most patients with cutaneous involvement have a single type of skin lesion, but some cases may have , 2 types. We report a case of sarcoidosis presenting with various types of skin lesions. The case was also complicated by hypercalcaemia and renal dysfunction, and was successfully treated with oral corticosteroids. Presentation of various skin lesions may indicate systemic organ involvement requiring treatment with systemic corticosteroid. [source] Role of fine-needle aspiration cytology in evaluation of cutaneous metastasesDIAGNOSTIC CYTOPATHOLOGY, Issue 12 2009Sonal Sharma M.D. Abstract Skin is an uncommon site for metastasis. This study was done to evaluate the role of FNAC as an important tool for investigating cutaneous and subcutaneous nodules in patients with known malignancy or as a primary manifestation of an unknown malignancy. All the FNAC done from January 2003 to August 2008 were reviewed (n = 55,556). Ninty-five patients (49 males and 46 females with age range of 4,96 years) with cutaneous/subcutaneous nodules which were diagnosed as metastasis were analyzed. Primary tumors of skin/subcutis were excluded from the study. In our study, 63 out of 95 cases had a known primary malignancy. Of these, five had underlying hematological malignancy and 58 patients had solid organ tumors. Lung carcinoma was seen to metastasize most commonly to skin in males and breast carcinoma in females. The most common site for a cutaneous/subcutaneous metastasis was chest wall [40 followed by abdominal wall (14) and scalp (9)]. Multiple site involvement was also observed (8). In 32 cases primary site was not known. They were most commonly diagnosed as poorly differentiated carcinoma followed by adenocarcinoma. FNAC can diagnose a variety of tumors in the skin and support the diagnosis of a metastasis in case of a known primary and offer a clue to underlying malignancy in case of an occult primary. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc. [source] Disseminated subcutaneous nocardiosis caused by Nocardia farcinica diagnosed by FNA biopsy and 16S ribosomal gene sequencingDIAGNOSTIC CYTOPATHOLOGY, Issue 4 2008Ronald M. Angeles M.D. Abstract Nocardia is an infrequent but significant cause of infections in the immunocompromised host. Clinical syndromes are varied and ranges from pulmonary, disseminated, cutaneous, and CNS involvement. Here we describe a case of disseminated subcutaneous nodules in a patient with multiple myeloma caused by Nocardia farcinica. The diagnosis was made by FNA biopsy which revealed gram positive filamentous bacilli in background of acute inflammation on smears. This was confirmed by 16S ribosomal gene sequencing. Prompt identification of N. farcinica is important because of its intrinsic resistance to broad spectrum cephalosporins and high risk of dissemination. Diagn. Cytopathol. 2008;36:266,269. © 2008 Wiley-Liss, Inc. [source] Fine-needle aspiration of subcutaneous panniculitis-like T-cell lymphomaDIAGNOSTIC CYTOPATHOLOGY, Issue 5 2004Frances Manosca M.D. Abstract We report the fine-needle aspiration (FNA) cytology findings of Subcutaneous Panniculitis-like T-cell Lymphoma (SCPTCL) in a 66-year-old woman who presented with a four month history of asymptomatic subcutaneous nodules on her right chest wall and back. An excisional biopsy of the right chest nodules was performed, and the diagnosis of SCPTCL was rendered. On a follow-up visit, several skin lesions were noted throughout her body. A fine-needle aspiration (FNA) of the right inguinal region was performed. The FNA yielded cellular smears, composed mainly of sheets of epithelioid histiocytes and scattered multinucleated cells. However, no distinct granulomas were noted. The background of the cytological smears showed scattered atypical lymphoid cells, some of which displayed nuclear membrane irregularities. To the best of our knowledge, the cytological features on FNA material of SCPTCL have not been described. Diagn. Cytopathol. 2004;31:338,339. © 2004 Wiley-Liss, Inc. [source] Cutaneous sarcoid-like granulomas with alveolar hemorrhage and c-ANCA PR-3INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 9 2004Natividade Rocha MD A 28-year-old woman, employed as a leather factory worker, noted asymptomatic, well-delimited plaques on both knees, 6 years ago. The plaques were violaceous with a smooth surface. One appeared over a post-traumatic scar from childhood (Fig. 1). Two years later, she began to complain of symptoms suggestive of polyarthritis, first of the small joints of the hands (proximal interphalanges) and then of the larger joints (wrists, elbows, and knees). She was diagnosed with rheumatoid arthritis and began treatment with nonsteroidal anti-inflammatory drugs for 1 month without any change. Deflazacort, 12 mg/day, and hydroxychloroquine, 400 mg/day, were administered for 3 months, with improvement of her articular complaints, but not her skin lesions. Figure 1. Well-delimited, violaceous plaques with a smooth surface on the knees, one over an old post-traumatic scar One year later, she complained of dysphonia, which remitted spontaneously after some weeks. After one additional year, she noted papules, with similar characteristics to the plaques, on the elbows, and two well-delimited orange-to-brown plaques on the forehead (Fig. 2). Figure 2. Orange,brown plaques symmetrically placed on the forehead During the fifth year of the disease, she was referred for the first time to a dermatologist, who biopsied one of the knee lesions. The histologic result was compatible with "sarcoid granuloma." At that time, she presented with skin lesions as her only complaint. Sarcoidosis was suspected based on a chest X-ray, which revealed hilar lymphadenopathy and diffuse accentuation of the interstitium. In November 2000, she suddenly developed fever (40 °C), cough with hemoptysis, dysphonia, and subcutaneous nodules on the palmar surface of the fingers of both hands that were painless, well-delimited, 5 mm in diameter, and firm (Fig. 3). She reported a weight loss of 12 kg in the previous 3 months. Pulmonary condensation was found on auscultation, and she had palpable hepatomegaly. Peripheral lymphadenopathy was not present. Figure 3. Painless, well-delimited, firm subcutaneous nodules on the palmar surface of the fingers Laboratory investigations revealed normochromic, normocytic anemia (hemoglobin, 7.7 g/dL), iron deficit, a white blood cell count of 16,000/µL with neutrophilia, an erythrocyte sedimentation rate of 130 mm/h, elevation of liver enzymes, a slight increase in angiotensin-converting enzyme (ACE) level (72 U/L), hypergammaglobulinemia (IgG, 3350 mg/dL), antinuclear antibody (ANA) of 1 : 320, and a slight increase in CD4 and decrease in CD8 lymphocytes with normal cellular morphology in blood. Renal function, urine sediment, urine and serum calcium, complement (C4), dsDNA, antimitochondrial antibody, direct and indirect Coombs test, antineutrophil cytoplasmic antibody (ANCA), tuberculin skin tests, viral markers of hepatitis B, C, and human immunodeficiency virus (HIV), electrocardiogram (ECG), ophthalmic examinations, and culture for infectious agents in blood and sputum were all normal or negative. Computed tomography (CT) scan showed an infiltrate in the upper right pulmonary lobule with a central cavity and bilateral hilar lymphadenopathy (Fig. 4). Homogeneous hepatosplenomegaly was present. The bronchoalveolar lavage (BAL) showed a slight lymphocytic increase predominantly of CD8 cells and hemosiderosis. Stains for infectious agents, including acid-fast bacillus, fungi, Mycoplasma, and Legionella, were negative. Three biopsies from the forehead, elbows, and knees showed well-formed noncaseating epithelioid cell granulomas with giant cells of the Langhans type in the dermis, suggestive of sarcoidosis (Figs 5 and 6). A fourth biopsy from a finger nodule demonstrated inflammatory infiltration of the dermis and necrosis with cellular debris. Vasculitis was not seen (Fig. 7). Figure 4. Computed tomography scan showing an infiltrate in the upper right pulmonary lobule with a central cavity Figure 5. Beneath a flattened epidermis, several sarcoid granulomas composed of epithelioid histiocytes and several multinucleated giant cells of Langhans type can be seen (hematoxylin and eosin, ×10) Figure 6. Less well-formed sarcoid granulomas in a hyperkeratotic area, surrounded by a sparse rim of lymphocytes (hematoxylin and eosin, ×20) Figure 7. Foci of necrosis and fibrinoid degeneration with some neutrophil infiltration and nuclear dusting (hematoxylin and eosin, ×40) The patient was treated with a broad-spectrum empirical antimicrobial (levofloxacin, 500 mg daily intravenously) over 12 days, with prompt improvement in her symptoms and remission of the forehead and finger lesions. Nevertheless, on the first evaluation after hospitalization, the CT scan showed persistence of the pulmonary cavity (Fig. 8). A repeat ANCA determination was positive (cytoplasmic pattern, c-ANCA) at 1 : 640 by indirect immunofluorescence (IIF). Antiproteinase-3 antibody was demonstrated at 78 by enzyme-linked immunosorbent assay (ELISA). Figure 8. Computed tomography scan showing persistence of the pulmonary cavity She underwent an open lung biopsy which revealed intra-alveolar hemorrhage and scanty noncaseating epithelioid cell granulomas of the sarcoidosis type in the peripheral blood vessels without vasculitis. A diagnosis of Wegener's granulomatosis was made and she began prednisolone (1 mg/kg/day) and oral cyclophosphamide (2 mg/kg/day). One year later, she is asymptomatic, the skin lesions have completely remitted, c-ANCA is negative, and the CT scan shows partial regression of the pulmonary cavity. [source] Subcutaneous dirofilariasis caused by Dirofilaria repens in Greece: a case reportJOURNAL OF CUTANEOUS PATHOLOGY, Issue 8 2009Konstantina Tzanetou Dirofilaria repens (formerly Dirofilaria conjunctiva) is a natural parasite of the subcutaneous tissues of dogs, cats and wild carnivores in Europe, Africa and Asia. Microfilariae are transmitted to humans by various species of mosquito. An autochthonous case of subcutaneous dirofilariasis is reported in a Greek patient from the island of Corfu. The clinical manifestation of the infection was a palpable, painless, subcutaneous nodule in the region of the groin, which 2 days before the patient consulted the doctor developed symptoms and signs of inflammation (pain, edema and redness). The entire lesion was surgically removed, and the nematode worm D. repens was identified on histological sections of biopsy material. The aim of this report was (a) to describe the microscopic morphological features of D. repens that enable identification of the parasite on histological examination and (b) to emphasize the importance of consideration of subcutaneous dirofilariasis in the differential diagnosis of subcutaneous nodules with inflammatory eosinophilic infiltration in countries where the infection is endemic. [source] Clinical spectrum and histological analysis of 32 cases of specific cutaneous sarcoidosisJOURNAL OF CUTANEOUS PATHOLOGY, Issue 12 2006Cristina Mangas Background:, Sarcoidosis is a multisystem granulomatous disorder of unknown aetiology in which skin involvement is frequent. Objective:, To review histological characteristics of biopsies of specific cutaneous lesions of sarcoidosis and their relationship with clinical course. Patients and methods:, Biopsies from 32 patients with specific cutaneous sarcoidosis were reviewed. Histological findings and clinical characteristics of these patients were analysed. Results:, The initial clinical lesions of the patients were ten infiltrated nodule-plaques, eight papules, four maculopapular eruptions, five scar sarcoidosis, four subcutaneous nodules and one lupus pernio. Sarcoidal granulomas were located at dermis in 31 cases (74%) and at subcutaneous fat in 12 (28%) but only four were subcutaneous exclusively. Perivascular or periannexial distribution of granulomas was observed in eight cases (19%) and they had coalescence in 29 samples. The presence of foreign material was demonstrated in 11 cases (26%). Conclusions:, Clinical spectrum of specific lesions of cutaneous sarcoidosis showed a good correlation with granulomas localization in the biopsies. However, traditional classification of specific cutaneous sarcoidosis is often overlapping. On the other hand, foreign bodies and other atypical histological findings were more common than initially expected. [source] Multiple mucinous and lipomatous variant of eccrine angiomatous hamartoma associated with spindle cell hemangioma: a novel collision tumor?JOURNAL OF CUTANEOUS PATHOLOGY, Issue 4 2006Hae-Woong Lee In most cases, EAH arises as a single lesion; however, multiple variants have been reported. We report a 35-year-old female patient with multiple, sudoriparous, subcutaneous nodules on the right foot, which showed typical histopathological findings of EAH, and vascular components of the tumor consisted of thin-walled dilated vascular spaces intermixed with spindle cells and some histiocytoid endothelial cells representing spindle cell hemangioma (SCH). To our knowledge, the co-existence of EAH with SCH is a novel finding and not yet described. [source] Light-chain-restricted plasmacellular infiltrates in necrobiosis lipoidica , a clue to an underlying monoclonal gammopathyJOURNAL OF CUTANEOUS PATHOLOGY, Issue 4 2005Adina M. Cioc Background:, Necrobiosis lipoidica (NL) is a member of the palisading granulomatous dermatitides that is associated, in most cases, with diabetes mellitus. However, there are an increasing number of cases of NL associated with other forms of systemic disease. We describe a novel case of NL associated with a light-chain-restricted plasmacellular infiltrate; subsequent investigations established an underlying monoclonal gammopathy. Methods:, Skin biopsy material was obtained and was processed in the usual fashion for hematoxylin and eosin (H&E) examination. Immunohistochemical staining was performed by utilizing kappa and lambda monoclonal antibodies (Dako Corporation, Carpentiera, CA, USA). Kappa and lambda in situ hybridization was also performed (Ventana Medical Systems, Tucson, AZ, USA). Results:, A 55-year-old woman with a 5-year history of bilateral thigh subcutaneous nodules underwent a skin biopsy, showing typical changes of NL; there was a concomitant prominent perivascular plasmacellular infiltrate. Kappa light chain restriction was observed amid the plasmacellular infiltrate. Bone marrow biopsy and immunophenotyping studies revealed a clonal plasmacytosis with kappa light chain restriction. Conclusions:, Granulomatous inflammation, including NL, may be a cutaneous paraneoplastic expression of low-grade B-cell lymphoproliferative disease in the context of an underlying plasma cell dyscrasia. [source] Intra-oral Dirofilaria repens infection: report of seven casesJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 8 2003W. M. Tilakaratne Abstract Cutaneous dirofilariasis usually affects animals such as cats and dogs which are known to be the natural host of Dirofilaria. Dirofilariasis displays a worldwide distribution. Certain geographic regions account for the majority of reported cases. South-eastern United States, Australia and Europe have been identified as endemic regions (1, 2). However, new endemic areas are arising with increased awareness in African and Asian regions. Out of about 40 different species of Dirofilaria only a few species are commonly known to infect man, namely Dirofilaria immitus, D. tenices and D. repens. Human infection occurs when a human becomes a blood meal of an infected arthropod vector and on accidental entering of the worm. Rarely this zoonotic infection affects the oral mucosa (3). Man is the dead end of this parasite. Since the human body is an abnormal environment for the parasite, the development of the larvae is inhibited by means of retardation of sexual maturity. Lesions are presented as single non-tender subcutaneous nodules, and most patients are asymptomatic. Diagnosis is established by H&E sections prepared from excised nodules. In a majority of the cases, only a single worm either a male or a female could be identified. The worm is usually dead and degenerated with a massive inflammatory cell infiltration. Seven new cases presented as intra-oral nodules with their clinicopathological correlation are discussed. [source] A case of nodular cystic fat necrosis with systemic lupus erythematosus presenting the multiple subcutaneous nodules on the extremitiesJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 7 2008T Demitsu [source] Deep dermatophytosis caused by Trichophyton rubrum: report of two casesMYCOSES, Issue 2 2007J. Q. Gong Summary Two patients presenting with subcutaneous nodules, plaques, papules and ulceration caused by Trichophyton rubrum are described in this report. The first case was a 46-year-old woman referred with erythema and desquamation over her trunk, hands and feet for 30 years, progressing to nodules and ulceration over her trunk, arms and scalp for the last 2 years. The second case was a 34-year-old man who presented with a 2-year-history of itchy, erythema and desquamation over the trunk, progressing to papules, nodules and cyst around his ear, on the neck and scalp for 1 year. The diagnoses were suspected after direct microscopical examinations of the discharge materials, which revealed the presence of hyaline hyphae. The histological examinations showed granulomatous inflammatory infiltrates with fungal elements in the dermis including epithelioid cells, giant cells, lymphocytes and eosinophils, and the periodic acid-Schiff stain showed hypha within the granulomas. Cultures of puncture materials, skin biopsies and nails confirmed the diagnosis identifying T. rubrum. Antifungal therapies with itraconazole were successful in both patients, the lesions were completely clear with atrophic scars after 3 months. Side effects were not noticed during the medication. We discuss the clinical types of granulomatous cutaneous lesions caused by dermatophyte infections and evaluate the therapeutic effect of itraconazole. [source] Farber's disease diagnosed by nerve biopsyNEUROPATHOLOGY & APPLIED NEUROBIOLOGY, Issue 2 2002J. Jacobs Introduction:, Farber's disease (granulomatosis) is a rare inherited lipid storage disease caused by a deficiency of lysosomal acid-ceramidase. Clinical features include contractures of limbs with swelling of joints and multiple subcutaneous nodules. In a few cases there is prominent involvement of central and peripheral nervous systems. Ceramide accumulates in the nodules and in cells of many other tissues including brain. Electron microscopy of affected cells shows membrane-bound inclusions, some of which have a highly characteristic curved or ,banana' shape (Farber bodies). Nerve biopsy findings have been described in a few cases but our patient appears to be the first to have been diagnosed by nerve biopsy. Case report:, This male infant presented at 6 months with joint pain and swelling, fever weakness and nystagmus: EMNG demonstrated sensory-motor polyneuropathy with features of demyelination. Semi-thin resin sections show a moderately reduced density of myelinated fibres. The myelin sheaths of most fibres are inappropriately thin, which was confirmed morphometrically: some axons are demyelinated. Vacuolar inclusions are seen in some Schwann cells. Teased fibres show de- and remyelination. Electron microscopy shows oval, boomerang- or banana-shaped inclusions in Schwann cells associated with myelinated and unmyelinated axons, but not in other cell types. Conclusion:, Farber's disease is associated with a demyelinating neuropathy. [source] Primary Cutaneous Fungal Infections in Solid Organ Transplantation: A Case SeriesAMERICAN JOURNAL OF TRANSPLANTATION, Issue 7 2002Peter S. Miele Cutaneous fungal infections in solid-organ transplant patients present in a variety of nonspecific ways, requiring a high index of suspicion to diagnose correctly. In the present series of four transplant recipients, subsequent primary cutaneous fungal infections presented as papules, plaques, ulcers and subcutaneous nodules. Transplantations included one cardiac, two renal and one renal,pancreatic transplant. Fungal infections were limited to the skin; there was no evidence of disseminated disease in any case. The pathogens isolated were Scedosporium apiospermum (Pseudallescheria boydii), Alternaria species, Aspergillus fumigatus, and a coelomycete in the Coniothyrium-Microsphaeropsis complex of dark molds. Individuals were successfully treated with surgical debridement, antifungal agents, and reduction of immunosuppressive therapy. All patients and allografts survived. Accurate diagnosis, aggressive surgery and appropriate antifungal therapy, combined with close outpatient follow-up, optimize the likelihood of a cure in a transplant population. [source] Bilateral tibialis anterior muscle herniation simulating a soft tissue tumour in a young amateur football playerAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 2 2010Ali Murat Ceyhan ABSTRACT Muscle herniation is a focal protrusion of muscle tissue through a defect in the deep fascial layer. Anterior tibial muscle is the most commonly affected muscle of the lower extremities because its fascia is the most vulnerable to trauma. Clinically it is characterized by asymptomatic or painful, skin-coloured, soft, subcutaneous nodules of various size depending on the position. The diagnosis is usually made clinically based on its typical manifestations, but ultrasonographic examination is useful for detecting the fascial defect and excluding other conditions caused by soft tissue tumours such as lipomas, angiolipomas, fibromas, scwhannomas or varicosities. Although this entity is not rare, it has been less well documented in the dermatological literature. We report a case of bilateral tibialis anterior muscle herniation mimicking a soft tissue tumour in a young amateur football player. [source] Unusual case of subcutaneous panniculitis-like T-cell lymphomaAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 2 2004Jillian Wells SUMMARY An unusual case of subcutaneous panniculitis-like T-cell lymphoma is presented involving multiple organ systems, which eventually culminated in rapid demise from the haemophagocytic syndrome, after an initial protracted course. A 44-year-old man presented in April 2001 with bronchiolitis obliterans organising pneumonia that initially responded well to corticosteroids. However, the condition relapsed on attempted prednisone withdrawal in January 2002 and the patient was noted to have developed truncal subcutaneous nodules. Initial skin biopsy revealed lobular panniculitis, with negative microbiological culture. In July 2002, mononeuritis multiplex was diagnosed after the patient presented with paresthesiae and was treated with pulse cyclophosphamide therapy. By November 2002 there was ulceration of the subcutaneous nodules. Repeat skin biopsy revealed subcutaneous panniculitis-like T-cell lymphoma. The clinical manifestations were supportive of an unifying diagnosis of malignancy involving pulmonary, cutaneous and nervous systems. Combination chemotherapy with fludarabine, mitoxantrone and dexamethasone was commenced. However, the patient deteriorated, with fevers, weight loss, pancytopenia and laboratory features consistent with the haemophagocytic syndrome. Despite maximal supportive therapy the patient succumbed to his disease. [source] Subcutaneous sarcoidosis,clinicopathological study of 10 casesBRITISH JOURNAL OF DERMATOLOGY, Issue 4 2005J. Marcoval Summary Background, Subcutaneous sarcoidosis is a specific cutaneous lesion of sarcoidosis that is rarely reported. Objective, Our purpose was to analyse the clinicopathological features of 10 patients with subcutaneous sarcoidosis and its relationship with the systemic features of the disease. Patients and methods, The patients with systemic sarcoidosis, diagnosed from 1974 to 2002 at a university hospital in Barcelona, Spain, who developed subcutaneous involvement, were included in the study. The diagnosis of systemic sarcoidosis was made according to conventional criteria. All the patients were monitored prospectively at the sarcoidosis clinic of the hospital. Skin biopsies were performed when granulomatous cutaneous involvement was suspected clinically. Results, Granulomatous cutaneous involvement was demonstrated in 85 of 480 patients with systemic sarcoidosis. In 10 of these 85 patients subcutaneous sarcoidosis was diagnosed (11·8%). The lesions were most frequently located in the extremities, involving the forearms in nine patients. Indurated linear bands from the elbow to the hand were observed in five patients. In all of our patients the subcutaneous nodules appeared at the beginning of the disease. In six patients, the nodules remitted spontaneously in less than 2 years. In two cases foreign particles were detected under polarized light. Conclusions, Subcutaneous sarcoidosis is a quite uniform clinicopathological entity usually appearing at the beginning of the disease. It usually heralds forms of sarcoidosis with nonsevere systemic involvement and is not associated with chronic fibrotic disease. [source] | |||||||||||||||||||||||||