Dermatofibrosarcoma protuberans (DFSPs) are a slowly growing locally aggressive tumor of disputed histogenesis with low-grade malignancy and a marked tendency to local recurrence but rarely metastasize to distant sites. Few reports have suggested that DFSPs may enlarge more rapidly during pregnancy. This article describes a lesion of the atrophic variant of DFSP that increased in size during pregnancy which is an unusual presentation, and a review of the literature.
Eccrine poroma is a benign sweat gland tumor. The palm and sole are common sites for these tumors. It rarely involve the facial region and has been exceptional reported in the nose. We report a case of nasal eccrine poroma.
A 45-year-old male presented with a nodule on the nose tip for the last 16 years. It started as a pink-colored papule that gradually grew to the present size tumor. An excisional biopsy confirmed the diagnosis of eccrine poroma.
Eccrine poroma is a rare benign sweat gland tumor. It resembles to other more common malignant skin tumors. The nose is exceptionally involved. Its potentially malignant transformation and its unaesthetic appearance justify its removal.
Eccrine poroma is a benign tumor for which a misdiagnosis may lead to large amputation in especially aesthetically sensitive regions.
This study was performed to determine the pattern of skin cancer among Saudis attending King AbdulAziz University Hospital, Jeddah.
Histologically diagnosed skin cancers between January 2000 and December 2010 were reviewed and analyzed. Trends in incidence of skin cancers by their age, sex and anatomic location were examined.
Of the 106 cases of skin cancer among Saudis there were 28.3% BCC, 24.5% SCC, 18% mycosis fungoidis (MF), 10.3% malignant melanoma (MM), 5.7% dermatofibrosarcoma protuberance (DFSP), 2.8% basosquamous cell carcinoma (BSCC), 1.9% Kaposi sarcoma (KS). The mean age was 46.6 years and the male to female ratio was 2.1:1. In the descending order of frequency the anatomic locations were head and neck, lower limbs, chest and abdomen, upper limbs and genitals.
Most common skin cancers seen are BCC and SCC followed by MF and MM. The study revealed a low frequency and stable trend in BCC and SCC which is similar to studies from other parts of Saudi Arabia. Site of distribution of BCC and SCC is similar to Caucasians. MF is showing a trend towards increased frequency at our institution. MM showed a dominant acral distribution different from the West.
Primary cutaneous aggressive CD8+ T-cell lymphoma is an extremely rare entity with distinct clinicopathological features. We report a case of a 28-year-old man that clinically presented with an ulcerated nodule on his trunk and extremities. Histopathologic sections showed an ulcerated epidermis with a diffuse lymphocytic infiltrate in the superficial dermis with focal epidermotropism. Immunohistochemically, the tumor cells were positive for CD3 and CD8 but negative for CD4, CD20, CD30 and CD56. Granzyme B was positif. He received UVB therapy subsequently associated to interferon with an important regression of the nodules.
We report the clinical and histopathological features of discoid lupus erythematosus (DLE) in a group of Saudi patients, and provide a basic framework for a subsequent larger, prospective study.
DLE patients seen and diagnosed at the Dermatology Clinic of King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia, between January 1998 and December 2010 were retrospectively studied. Data included demographics, duration of the disease, precipitating and aggravating factors, clinical type, immunological markers and histopathological findings.
Of the 56 DLE patients, females outnumbered males by 1.5:1. Mean age of onset was 36.5 ± 13.7 years and mean duration of the disease was 18.5 ± 24.6 months. Majority of patients (91.1%) had atrophic type. The scalp and face were the commonest sites of involvement. Antinuclear antibodies (ANA) were positive in nine patients (16.1%). Eight (14.3%) were positive for DsDNA. Fifty-two (92.9%) showed dermal infiltration, 38 (67.9%) with periappendigeal infiltrates and 31 (55.4%) with lichenoid reaction and vacuolar degeneration. Fifty-one patients (91.1%) received treatment; 31 (60.8%) had improvement of the lesions whereas six patients (11.8%) progressed to systemic lupus erythematosus (SLE). Progression of the disease was significantly correlated with age of onset (p = 0.044) but not to duration of the disease, gender, immunological markers, histopathological features or treatment.
The propensity of some patients progressing to systemic lupus should be given attention through early diagnosis, patient education and appropriate management.
Mycosis fungoides is the most common type of Cutaneous T-cell Lymphoma. Data on clinical characteristics and disease progression in children with mycosis fungoides are limited. Five patients from the Middle East with childhood mycosis fungoides are reported here. Four of those patients presented with hypopigmented patches as the sole manifestation of the disease. Histopathologic features were consistent with mycosis fungoides in all patients and in four of five patients CD4+ phenotype was over-represented immunohistochemically. All patients had excellent prognosis. Only one patient with the classic erythematous patch/plaque type progressed to stage IIA. It seems the phenotype expression with either CD4+ or CD8+ has no implication on disease progression. However, the clinical morphologic type might impact disease progression with the hypopigmented type being the variant with the best prognosis. Further studies with large number of patients are required for better characterization of Middle Eastern patients with childhood MF.
Leprosy reactions are rare expression of immunological perturbations that interrupt the usual chronic course and the clinical stability of patients with leprosy. Erythema nodosum leprosum (ENL) is an immune complex-mediated reaction that may complicate the course of multibacillary leprosy. It generally occurs during antimycobacterial treatment and characterized by the appearance of crops of brightly erythematous tender nodules or plaques. Severe ENL can become vesicular or bollous and break-down and is termed erythema necroticans [Jobling, W.H., Mc Dougall, A.C., 1996. Leprosy reactions. In: Handbook of leprosy, 5th ed. CBS Publishers, New Delhi, pp. 82–91]. We present here a case of erythema necroticans, misdiagnosed as sweet’s syndrome, because he had never been presented with pre-existing evidence of leprosy nor had any antimycobacterial treatment. The clinical diagnosis is confirmed by microscopic pathology. The lesions resolved completely following multibacillary MDT, corticosteroids and Azathioprine.
To determine the frequency and significance of thyroid auto-antibodies and antinuclear antibody among Saudi patients with chronic urticaria and to identify markers of chronic urticaria disease.
Non-interventional, prospective analytical study carried out among consecutive patients with chronic urticaria in the Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia between January 2005 and December 2007. Patients were divided into two groups: Group 1 – with hypothyroidism, Group 2 – without hypothyroidism, both age-matched to normal healthy controls. All patients were investigated for the presence of antithyroglobulin (ATG), antimicrosomal (AMA), antinuclear antibodies (ANA) as well as rheumatoid factor (RF) and antibodies to hepatitis B and C.
A total of 90 participants were included in the study. Significant elevation of anti thyroglobulin antibodies was found in patients with hypothyroidism than in those without hypothyroidism and in the control group (30.4% vs. 24.4% vs. nil, p = 0.022). Elevated titers of antimicrosomal antibodies were seen in chronic urticaria patients with or without hypothyroidism compared to control group. Positive antinuclear antibodies were detected in all groups. There were no significant differences in the severity of the disease in between study groups (p = 0.234). Chronic urticaria was statistically significantly associated with hypothyroidism (p = 0.0014) and with the presence of antithyroglobulin antibodies (p = 0.022). The duration of urticaria was significantly associated with positive antithyroid and anti-nuclear antibodies (p = 0.0315 and p = 0.0056, respectively). Disease severity was not significantly associated with elevations of ANA, TMA and TGA titers (p = 0.558, 0.827 and 0.324, respectively).
Chronic immunologic urticaria may be entertained in patients with long standing urticaria especially in the presence of hypothyroidism and elevated antithyroid antibodies. Assays for thyroid antibodies, TSH and ANA may be justified for early diagnosis of autoimmune urticaria to institute appropriate treatment modalities, hence improve the quality of life.
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