DOCSLIB.ORG

Puzzling out Difficult Pediatric Skin Diagnoses

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Puzzling out Difficult Pediatric Skin Diagnoses 32 Skin Disorders FAMILY P RACTICE N EWS • September 15, 2005 Puzzling Out Difficult Pediatric Skin Diagnoses BY HEIDI SPLETE celes or hetero- Senior Writer topic brain tissue. O RLANDO — Pediatric skin conditions Pilomatricoma often pose diagnostic challenges because A 15-month-old many cutaneous disorders have similar girl presented clinical features. with a bump on Annular lesions of granuloma annulare her cheek—a may be mistaken for tinea corporis; fol- firm, bluish, cys- licular papules of keratosis pilaris may be tic papule that confused with follicular eczema; and nail moved back and psoriasis may be misdiagnosed as ony- forth under pres- chomycosis. sure. When one At a meeting sponsored by the Ameri- end of the lesion can Academy of Pediatrics, Albert C. Yan, was palpated, the A collar of hair around membranous aplasia cutis Pilomatricomas may be associated with systematic M.D., director of pediatric dermatology at other end would congenita can indicate cranial dysraphism. disorders such as Gardner’s syndrome or sarcoidosis. the Children’s Hospital of Philadelphia, pop up, a phe- provided some helpful diagnostic tips for nomenon also known as a “teeter-totter had swollen hands and feet. She had been distinguishing some of these potentially sign.” otherwise healthy and was taking no med- puzzling skin problems. Although these lesions may resemble ications. The condition arose suddenly; the dermoid cysts or epidermal inclusion parents noticed the rings and swelling one The Hair Collar Sign cysts, the diagnosis in this case was pilo- morning when picking up the child from HILADELPHIA A boy is born with an area of localized, cir- matricoma, distinguished by its bluish col- her bed. On closer inspection, the rings P cular alopecia covered by a glossy mem- or and the presence of the teeter-totter were red and blanchable, with clear white brane. The area is surrounded by a col- sign. The lesions most often occur on the centers. Some were imperfect circles. OSPITAL OF lection of dark, terminal hairs. Palpation head or neck, although other areas occa- The diagnosis is annular urticaria. H S reveals that a lump is present. sionally are affected. Pilomatricomas gen- “These types of cases are frequently re- ' Occasionally mistaken for fetal scalp erally are solitary, benign, frequently cal- ferred for suspected erythema multi- HILDREN monitor trauma, neonatal herpes simplex cified, and arise from hair follicles. In forme,” Dr. Yan noted. “Lesions of annu- C infection, or a nevus sebaceus of Jadas- some cases, the lesions resolve sponta- lar urticaria are evanescent; the lesions sohn, this characteristic pattern—a collar neously, but more often, they persist and fade and move, and the lesions can form of coarse hair surrounding an area of grow, and surgical intervention is recom- imperfect circles with clear centers. The le- membranous aplasia cutis congenita—can mended. Pilomatricomas may rupture, sions may disappear within 24 hours, only HOTOS COURTESY be a marker for cranial dysraphism, a de- which can cause inflammation and scar- to show up elsewhere,” he said. By con- P velopmental defect of the skull potential- ring. Although pilomatricomas generally trast, erythema multiforme appears as Urticaria multiforme, often mistaken for ly associated with structural neurologic are isolated findings, they may be associ- fixed target, or “bull’s-eye,” lesions with annular urticaria, is linked to allergy. defects. The scalp defect may represent ated with systemic disorders such as Gard- dusky centers and is associated with mu- only the tip of the iceberg, Dr. Yan noted, ner’s syndrome, myotonic dystrophy, and cous membrane ulcers. history to determine underlying causes, since underlying bony defects or ectopic sarcoidosis. The two conditions are treated quite dif- removal or treatment of those causes, and brain tissue may be present. ferently, Dr. Yan emphasized. Annular ur- consideration of steroid therapy if indi- In such cases, magnetic resonance imag- Annular Urticaria/Urticaria Multiforme ticaria responds to combinations of anti- cated. Dr. Yan often refers to annular ur- ing is essential to rule out underlying ab- A 3-year-old girl presented with red, histamines or occasionally steroids; ticaria as “urticaria multiforme” because normalities, including atretic encephalo- swollen, annular plaques on her skin, and erythema multiforme requires a detailed these cases are so regularly mistaken. ■ Early, Aggressive Surgery Is Best Distinguish Diaper Psoriasis Course for Neurofibroma in Children From Seborrheic Dermatitis BY SHARON quence of exposure to stool BY PATRICE WENDLING Tumors may grow back and in neurofibromatosis 2 (NF2), WORCESTER and urine. Chicago Bureau greater numbers, and they could which is rarer, occurring in 1 in Southeast Bureau It can be difficult to distin- be fibrosarcoma, said Dr. Mc- 40,000 births. guish napkin psoriasis from se- PARIS — Resection can’t be too Kinnon, a plastic and reconstruc- NF2 is characterized by multi- B AL H ARBOUR, FLA. — borrheic dermatitis, but there early or too aggressive when tive surgeon with the University ple tumors on the cranial and Diaper-area psoriasis, also are certain characteristics that treating neurofibroma in chil- of Chicago. Early surgery, even in spinal nerves and by other le- known as napkin psoriasis, is a can help, said Dr. Paller, pro- dren, reported McKay McKin- infancy, may be indicated. sions of the brain and spinal cord. fairly common finding in chil- fessor and chair of dermatol- non, M.D., at the Fourth Inter- “In my experience, a very ag- Its primary characteristic is bilat- dren, Amy Paller, M.D., said at ogy at Northwestern Universi- national Academy of Cosmetic gressive surgery can often pro- eral tumors of the eighth cranial the annual Masters of Pediatrics ty, Chicago. Dermatology World Congress. duce nonrecurrence for many nerve, resulting in hearing loss conference sponsored by the Plaques associated with nap- Neurofibroma is a usually be- years or forever,” he said. “That’s beginning in the patient’s teens University of Miami. kin psoriasis are sharply de- nign tumor of the peripheral hard to prove, but I think that or early 20s. Although inclusion of this fined, brightly erythematous, nerves caused by abnormal pro- should be the principle.” Because patients with neurofi- “rash” in the realm of psoriasis and larger than those in sebor- liferation of Schwann cells. Viable structure may remain broma may have recurrence has been controversial, Dr. rheic dermatitis. They also tend The development of neurofi- after excision of large tumors throughout life and/or develop Paller said she “truly believes” it to have drier scale, which in the bromas, multiple café au lait from the ear. But ocular tumors neurosarcoma, they need con- should be considered a psoriat- diaper area often can be seen spots, and freckling in the pose a wide range of problems, tinued surgical surveillance, Dr. ic condition. only when the skin is scratched. armpits or groin area are com- particularly if the tumor extends McKinnon said. About 13% of children pre- This is caused by the constant mon symptoms of neurofibro- into the extraocular muscles. The National Institutes of sent with napkin psoriasis with moisture in the area, which also matosis 1 (NF1), which occurs in If at all possible, surgeons Health is launching a study to in- dissemination; about 4% pre- can obscure diagnosis in some 1 in 4,000 births. should not sacrifice the impor- vestigate whether genetic differ- sent with localized disease. cases, Dr. Paller noted. There is no way to tell which tant structures of the face or the ences explain differences in disease The frequency of this condi- For treatment, she uses a patients will develop a mild case facial nerve, he said. severity among patients with NF1. tion in infants reflects the short course (about 3 weeks) of and which patients will have se- A careful and early diagnosis of Participants must be at least 16 Koebner phenomenon—a re- nonhalogenated topical steroid rious complications such as neurofibroma is important and years old. For more information, sponse to the constant trauma or topical calcineurin inhibitor painful or disfiguring tumors. can help distinguish NF1 from write to [email protected]. ■ to the skin that is a conse- and a lot of protective paste. ■.
Load more

Recommended publications
  • Network Scan Data
    CTEP Protocol No: T-99-0090 CC Protocol No: 01-C-0222 Amendment: J Revised: 4/21/09 IRB Approval Date: A Phase II Randomized, Cross-Over, Double-Blinded, Placebo-Controlled Trial of the Farnesyltransferase Inhibitor R115777 in Pediatric Patients with Neurofibromatosis Type 1 and Progressive Plexiform Neurofibromas Coordinating Center: Pediatric Oncology Branch, NCI Principal Investigator: Brigitte Widemann, M.D.* (POB, NCI) NIH Associate Investigators: Frank M. Balis, M.D. (POB, NCI) Beth Fox, M.D. (POB, NCI) Kathy Warren, M.D. (NOB, NCI) Andy Gillespie, R.N. (ND, CC) Eva Dombi, MD (POB, NCI)** Nalini Jayaprakash, (POB, NCI) Diane Cole, (POB, NCI) Seth Steinberg, Ph.D. (BDMB, DCS, NCI) Nicholas Patronas, M.D. (DR, CC)** Maria Tsokos, M.D., (Laboratory of Pathology, NCI)** Pamela Wolters, Ph.D. (HAMB, NCI) Staci Martin, Ph.D. (HAMB, NCI) Jeffrey Solomon, (NIH and Sensor Systems, Inc.) Non-NIH Associate Investigators: Wanda Salzer, M.D. ** Keesler Air Force Base, Biloxi, Mississippi) 81st MDOS/SGOC 301 Fisher Street, Room 1A132 Keesler AFB, MS 39534-2519 Phone: 228-377-6524 E-mail: [email protected] Bruce R. Korf, M.D., Ph.D. ** Chair, Department of Genetics Univeristy of Alabama at Birmingham 1530 3rd Ave. S. Birmingham, AL 35294 Phone: (205)-934-9411, Fax: (205)-934-9488 E-mail: [email protected] David H. Gutmann, M.D., Ph.D. ** Department of Neurology Washington University School of Medicine St. Louis Children’s Hospital Box 8111, 660 S. Euclid Avenue St. Louis, MO 63110 Phone: (314)-632-7149, Fax: (314)-362-9462 E-mail: [email protected] 1 4/21/2009 T-99-0090, 01-C-0222 Arie Perry, M.D.
    [Show full text]
  • Depo-Provera
    PRODUCT MONOGRAPH INCLUDING PATIENT MEDICATION INFORMATION PR ® DEPO-PROVERA medroxyprogesterone acetate injectable suspension, USP Sterile Aqueous Suspension 50 mg/mL and 150 mg/mL Progestogen Pfizer Canada Inc. Date of Revision: 17,300 Trans-Canada Highway February 13, 2018 Kirkland, Quebec H9J 2M5 Submission Control No: 210121 ® Pharmacia & Upjohn Company LLC Pfizer Canada Inc., Licensee © Pfizer Canada Inc., 2018 Table of Contents PART I: HEALTH PROFESSIONAL INFORMATION......................................................... 3 SUMMARY PRODUCT INFORMATION ........................................................................ 3 INDICATIONS AND CLINICAL USE .............................................................................. 3 CONTRAINDICATIONS ................................................................................................... 4 WARNINGS AND PRECAUTIONS: ................................................................................ 5 ADVERSE REACTIONS ................................................................................................. 18 DRUG INTERACTIONS .................................................................................................. 27 DOSAGE AND ADMINISTRATION .............................................................................. 28 OVERDOSAGE ................................................................................................................ 30 ACTION AND CLINICAL PHARMACOLOGY ............................................................ 30 STORAGE AND
    [Show full text]
  • Cutaneous Neurofibromas: Clinical Definitions Current Treatment Is Limited to Surgical Removal Or Physical Or Descriptors Destruction
    ARTICLE OPEN ACCESS Cutaneous neurofibromas Current clinical and pathologic issues Nicolas Ortonne, MD, PhD,* Pierre Wolkenstein, MD, PhD,* Jaishri O. Blakeley, MD, Bruce Korf, MD, PhD, Correspondence Scott R. Plotkin, MD, PhD, Vincent M. Riccardi, MD, MBA, Douglas C. Miller, MD, PhD, Susan Huson, MD, Dr. Wolkenstein Juha Peltonen, MD, PhD, Andrew Rosenberg, MD, Steven L. Carroll, MD, PhD, Sharad K. Verma, PhD, [email protected] Victor Mautner, MD, Meena Upadhyaya, PhD, and Anat Stemmer-Rachamimov, MD Neurology® 2018;91 (Suppl 1):S5-S13. doi:10.1212/WNL.0000000000005792 Abstract RELATED ARTICLES Objective Creating a comprehensive To present the current terminology and natural history of neurofibromatosis 1 (NF1) cuta- research strategy for neous neurofibromas (cNF). cutaneous neurofibromas Page S1 Methods NF1 experts from various research and clinical backgrounds reviewed the terms currently in use The biology of cutaneous fi for cNF as well as the clinical, histologic, and radiographic features of these tumors using neuro bromas: Consensus published and unpublished data. recommendations for setting research priorities Results Page S14 Neurofibromas develop within nerves, soft tissue, and skin. The primary distinction between fi fi Considerations for cNF and other neuro bromas is that cNF are limited to the skin whereas other neuro bromas development of therapies may involve the skin, but are not limited to the skin. There are important cellular, molecular, for cutaneous histologic, and clinical features of cNF. Each of these factors is discussed in consideration of neurofibroma a clinicopathologic framework for cNF. Page S21 Conclusion Clinical trial design for The development of effective therapies for cNF requires formulation of diagnostic criteria that cutaneous neurofibromas encompass the clinical and histologic features of these tumors.
    [Show full text]
  • 9Th Clinical Dermatology Congress Psoriasis, Psoriatic Arthritis & Skin
    conferenceseries.com Joint Conference Mi Hye Lee et al., J Clin Exp Dermatol Res 2017, 8:6 (Suppl) DOI: 10.4172/2155-9554-C1-066 9th Clinical Dermatology Congress & 2nd International Conference on Psoriasis, Psoriatic arthritis & Skin infections October 16-18, 2017 New York, USA Nonsurgical treatment using micro-insulated needle on neurofibroma Mi Hye Lee, Hak Tae Kim, Woo Jin Lee, Chong Hyun Won, Sung Eun Chang, Mi Woo Lee and Jee Ho Choi University of Ulsan, Korea any studies have investigated the application of micro-insulated needles with radiofrequency (RF) for acne treatment or skin Mrejuvenation. However, there is no study investigating the effects of using micro-insulated needles with RF to treat multiple neurofibroma (NF) lesions. Many patients with multiple neurofibromas usually hesitate to remove all the lesions surgically due to cosmetic concerns. The aim of this study was to evaluate the clinicopathologic outcome, including efficacy and side effects after treatment, using newly developed micro-insulated needles with RF treatment. In this study, two human volunteers received multiple sessions of the micro-insulated needle RF treatment to multiple lesions. Seven to 40 shots were performed on each lesion. The treatment settings were as follows: microneedle penetrating depth of 5.0 mm; insulated 1.0 mm; power 16~46 (level 12~25); and a RF exposure time of 180~400 milliseconds. Skin biopsies were performed before and after the treatment. Outcome assessments included standardized photography, objective measurements of lesion size, histopathologic comparison between before and after the treatment, a physician’s global assessment, and patient satisfaction scores. RF energy could be delivered to the lesions without epidermal damage because the micro-insulation on the needle protects the epidermis from skin burns.
    [Show full text]
  • Clinical Guideline Treatment and Removal of Benign Skin Lesions
    Clinical Guideline Guideline Number: CG015, Ver. 5 Treatment and Removal of Benign Skin Lesions Disclaimer Clinical guidelines are developed and adopted to establish evidence-based clinical criteria for utilization management decisions. Oscar may delegate utilization management decisions of certain services to third-party delegates, who may develop and adopt their own clinical criteria. Clinical guidelines are applicable to certain plans. Clinical guidelines are applicable to members enrolled in Medicare Advantage plans only if there are no criteria established for the specified service in a Centers for Medicare & Medicaid Services (CMS) national coverage determination (NCD) or local coverage determination (LCD) on the date of a prior authorization request. Services are subject to the terms, conditions, limitations of a member’s policy and applicable state and federal law. Please reference the member’s policy documents (e.g., Certificate/Evidence of Coverage, Schedule of Benefits) or contact Oscar at 855-672-2755 to confirm coverage and benefit conditions. Summary The integumentary system is comprised of the skin, hair, and nails. The skin is divided into two layers: the dermis and epidermis; diseases of these protective outer layers are among the most common conditions worldwide. Lesions of the skin can be either benign (non-malignant), pre-malignant (potential for evolving into malignancy), or malignant (cancerous). Such lesions arise from congenital malformations or are acquired, often due to extensive UV exposure or underlying illness. Diagnosis is primarily through history, clinical exam, and the appearance of the lesion(s). While the vast majority of benign lesions require no intervention, some cases may necessitate intervention due to bothersome symptoms, for definitive diagnosis, or for exclusion of malignant features.
    [Show full text]
  • Supermicar Data Entry Instructions, 2007 363 Pp. Pdf Icon[PDF
    SUPERMICAR TABLE OF CONTENTS Chapter I - Introduction to SuperMICAR ........................................... 1 A. History and Background .............................................. 1 Chapter II – The Death Certificate ..................................................... 3 Exercise 1 – Reading Death Certificate ........................... 7 Chapter III Basic Data Entry Instructions ....................................... 12 A. Creating a SuperMICAR File ....................................... 14 B. Entering and Saving Certificate Data........................... 18 C. Adding Certificates using SuperMICAR....................... 19 1. Opening a file........................................................ 19 2. Certificate.............................................................. 19 3. Sex........................................................................ 20 4. Date of Death........................................................ 20 5. Age: Number of Units ........................................... 20 6. Age: Unit............................................................... 20 7. Part I, Cause of Death .......................................... 21 8. Duration ................................................................ 22 9. Part II, Cause of Death ......................................... 22 10. Was Autopsy Performed....................................... 23 11. Were Autopsy Findings Available ......................... 23 12. Tobacco................................................................ 24 13. Pregnancy............................................................
    [Show full text]
  • A Case of Isolated Plexiform Neurofibroma in a Patient with Myasthenia Gravis
    Ann Dermatol (Seoul) Vol. 21, No. 1, 2009 CASE REPORT A Case of Isolated Plexiform Neurofibroma in a Patient with Myasthenia Gravis Seung Ju Back, M.D., Dae Hun Kim, M.D., Nari Kim, M.S., Young Lee, M.D., Young Joon Seo, M.D., Jang Kyu Park, M.D., Jeung Hoon Lee, M.D. Department of Dermatology, College of Medicine, Chungnam National University, Daejeon, Korea We report a case of an isolated plexiform neurofibroma often arising from the branches of a major nerve1. In this occurring in a patient with myasthenia gravis. A 48-year-old tumor, the nerve is converted into a convoluted mass man presented with asymptomatic skin-colored nodules on which has been likened to a 'bag of worms'. The the tip of his 4th finger. Microscopically, a plexiform plexiform neurofibroma is considered to be pathognomic neurofibroma was identified located in the dermis that of neurofibromatosis 1 (NF1)1,2. However, a few cases of appeared to originate from small superficial nerves. He had isolated plexiform neurofibroma that were not associated a 20-year history of treated myasthenia gravis; otherwise, his with NF1 have been reported. personal and family histories were unremarkable. Given that Myasthenia gravis is a relatively rare autoimmune disorder myasthenia gravis is a disorder of the peripheral nerves, of the peripheral nerves associated with pemphigus, plexiform neurofibromas could be associated with my- alopecia areata and psoriasis3-5. The development of an asthenia gravis. However, the development of an isolated isolated plexiform neurofibroma in myasthenia gravis has plexiform neurofibroma in a case of myasthenia gravis has not been reported.
    [Show full text]
  • NSJ-Spine January 2004
    Neurosurg Focus 22 (6):E25, 2007 Granular cell tumor: a rare tumor of the ulnar nerve Case report GAVIN A. DAVIS, M.B.B.S., F.R.A.C.S. Department of Neurosurgery, Cabrini Hospital, Victoria, Australia PGranular cell tumors of the ulnar nerve are extremely rare, with only two cases previously reported in the English literature. The author presents a case of granular cell tumor of the ulnar nerve, in which the tumor was resected and the nerve was repaired with a nerve graft. The histopathological characteristics, imaging findings, and clinical data regarding these tumors are reviewed, and based on all the available evidence, a new treatment paradigm is proposed, which differs from that used in the earlier reported cases and takes into account the reported rate of tumor recurrence after incomplete resection. KEY WORDS • granular cell tumor • nerve tumor • peripheral nerve • ulnar nerve ENIGN GRANULAR CELL TUMORS are uncommon tu- vated by the proximal ulnar nerve (the flexor carpi ulnaris mors that most frequently involve skin and subcu- and flexor digitorum profundus) were normal. Strength in B taneous tissue. Their involvement in major nerves the intrinsic hand muscles innervated by the ulnar nerve is exceptionally rare, and only two cases involving the ul- was LSUMC Grade 0, with the exception of the ulnar nar nerve have been identified in the English literature.2,9 nerve–innervated lumbrical muscles, in which it was Grade This report adds a new case of granular cell tumor involv- 2. Sensory examination revealed reduced sensation in the ing the ulnar nerve and reviews the previously published ulnar distribution, but sensory localization was still pres- cases in light of this most recent one.
    [Show full text]
  • Metalloproteinase 1 Downregulation in Neurofibromatosis 1
    Tsuji et al. Cell Death and Disease (2021) 12:513 https://doi.org/10.1038/s41419-021-03802-9 Cell Death & Disease ARTICLE Open Access Metalloproteinase 1 downregulation in neurofibromatosis 1: Therapeutic potential of antimalarial hydroxychloroquine and chloroquine Gaku Tsuji1,2, Ayako Takai-Yumine 1, Takahiro Kato3 and Masutaka Furue1,2,4 Abstract Neurofibromatosis type 1 is an autosomal dominant genetic disorder caused by mutation in the neurofibromin 1 (NF1) gene. Its hallmarks are cutaneous findings including neurofibromas, benign peripheral nerve sheath tumors. We analyzed the collagen and matrix metalloproteinase 1 (MMP1) expression in Neurofibromatosis 1 cutaneous neurofibroma and found excessive expression of collagen and reduced expression of MMP1. To identify new therapeutic drugs for neurofibroma, we analyzed phosphorylation of components of the Ras pathway, which underlies NF1 regulation, and applied treatments to block this pathway (PD184352, U0126, and rapamycin) and lysosomal processes (chloroquine (CQ), hydroxychloroquine (HCQ), and bafilomycin A (BafA)) in cultured Neurofibromatosis 1 fibroblasts. We found that downregulation of the MMP1 protein was a key abnormal feature in the neurofibromatosis 1 fibroblasts and that the decreased MMP1 was restored by the lysosomal blockers CQ and HCQ, but not by the blockers of the Ras pathway. Moreover, the MMP1-upregulating activity of those lysosomal blockers was dependent on aryl hydrocarbon receptor (AHR) activation and ERK phosphorylation. Our findings suggest that lysosomal blockers are potential candidates for the treatment of Neurofibromatosis 1 neurofibroma. 1234567890():,; 1234567890():,; 1234567890():,; 1234567890():,; Introduction manifestations are variable, unpredictable, and potentially Neurofibromatosis type 1 (Neurofibromatosis 1) is a life-threatening. Malignant peripheral nerve sheath tumors genetic disorder that affects one in 2600 to 4500 live are generally associated with a fatal outcome.
    [Show full text]
  • An Elderly Woman
    Self-assessment corner 827 1 Ridolfi RL, Bell WR. Thrombotic thrombocytopenic 4 Rose M, Eldor A. High incidence of relapses in thrombotic purpura. Report of 25 cases and review of the literature. thrombocytopenic purpura. Am J Med 1987; 83: 437-44. Medicine 1981; 60: 413-28. 5 Ridolfi RL, Hutchins GM, Bell WR. The heart and cardiac 2 Bell Wr, Braine HG, Ness PM, Kuckler TS. Improved conduction system in thrombotic thrombocytopenic pur- Postgrad Med J: first published as 10.1136/pgmj.73.866.827 on 1 December 1997. Downloaded from survival in thrombotic thrombocytopenic purpura-hemo- pura. A clinicopathological study of 17 autopsied patients. lytic uremic syndrome: clinical experience in 108 patients N Ann Intern Med 1979; 9: 357 - 63. Engl J Med 1991; 325: 398-403. 6 Eagle KA, Fallon JT. A 41-year-old woman with 3 Harrison CN, Lawrie AS, Iqbal A, Hunter A, Machin SJ. thrombocytopenia, anemia, and sudden death. N Engl JT Plasma exchange with solvent/detergent-treated plasma of Med 1994; 331: 661-7. resistant thrombotic thrombocytopenic purpura. Br J Haematol 1996; 94: 756-8. Epigastric pain and a left upper quadrant mass in an elderly woman R Joarder, AC Harris, M Gibson, A Al-Kutoubi An 81-year-old woman presented to her general practitioner complaining of epigastric discomfort radiating to her back. This was associated with weakness, fatigue, diarrhoea, and a microcytic anaemia (haemoglobin 8.6 g/dl). On examination, she was found to have a smooth mass in the left hypochondrium. Upper gastrointestinal tract endoscopy was normal. An abdominal ultrasound scan showed an 11 x 7 x 5 cm mass in the left hypochondrium which had air running through it.
    [Show full text]
  • Cd34+ Stromal Cells/Telocytes in Normal and Pathological Skin
    International Journal of Molecular Sciences Review Cd34+ Stromal Cells/Telocytes in Normal and Pathological Skin Lucio Díaz-Flores 1,* , Ricardo Gutiérrez 1, Maria Pino García 2, Miriam González-Gómez 1 , Rosa Rodríguez-Rodriguez 1 , Nieves Hernández-León 1 , Lucio Díaz-Flores, Jr. 1 and José Luís Carrasco 1 1 Department of Basic Medical Sciences, Faculty of Medicine, University of La Laguna, 38071 Tenerife, Spain; [email protected] (R.G.); [email protected] (M.G.-G.); [email protected] (R.R.-R.); [email protected] (N.H.-L.); [email protected] (L.D.-F.J.); [email protected] (J.L.C.) 2 Department of Pathology, Eurofins Megalab–Hospiten Hospitals, 38100 Tenerife, Spain; [email protected] * Correspondence: [email protected]; Tel.: +34-922-319-317; Fax: +34-922-319-279 Abstract: We studied CD34+ stromal cells/telocytes (CD34+SCs/TCs) in pathologic skin, after briefly examining them in normal conditions. We confirm previous studies by other authors in the normal dermis regarding CD34+SC/TC characteristics and distribution around vessels, nerves and cutaneous annexes, highlighting their practical absence in the papillary dermis and presence in the bulge region of perifollicular groups of very small CD34+ stromal cells. In non-tumoral skin pathology, we studied examples of the principal histologic patterns in which CD34+SCs/TCs have (1) a fundamental pathophysiological role, including (a) fibrosing/sclerosing diseases, such as systemic sclerosis, with loss of CD34+SCs/TCs and presence of stromal cells co-expressing CD34 and αSMA, and
    [Show full text]
  • Skin Elasticity in Neurofibromatosis Type 1
    erimenta xp l D E e r & m l a a t c o i l n o i Journal of Clinical & Experimental Assoul et al., J Clin Exp Dermatol Res 2014, 5:2 l g y C f R DOI: 10.4172/2155-9554.1000213 o e l ISSN: 2155-9554 s a e n a r r u c o h J Dermatology Research Research Article Open Access Skin Elasticity in Neurofibromatosis Type 1: Rheological and Histological Analysis Nabila Assoul3*, Camille Ozil1#, Romain Bosc1#, Mickael Hivelin1, Mustapha Zidi2 and Laurent Lantieri1 1Department of Plastic Surgery Hospital Henri Mondor and the XII Medical School, Université Paris-Est Créteil, Créteil, France 2CNRS EAC 4396, Surgical Research Center and the XII Medical School, Université Paris-Est Créteil, Créteil, France 3INSERM, Unit 698, Hemostasis, Bio-engineering and Cardiovascular Remodelling, University Hospital 46, Rue Henri Huchard 75877 Paris Cedex 18 X. Bichat, France #Authors have contributed equivalently to this paper Abstract Neurofibromatosis type 1 (NF1) also known as von Recklinghausen’s disease, is an autosomal dominant disorder characterized by benign tumors called neurofibromas. It is a serious disease, often overlooked. Indeed, people with NF1 have a lower life expectancy, because some of them develop malignant tumors and for many, there is deterioration in their life quality. In the absence of medical treatment, only surgery is in place for now. However, the problem of neurofibromatosis surgery is that it is potentially very hemorrhagic and neurofibroma skin elasticity seems recurrent after few years. The aim of this study was to evaluate structure alterations in NF1 skin.
    [Show full text]