Cholesterol embolism after colonoscopy: a case report.
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Adult↗
Biomedical subjects
Carlo Tomasini
Publications and source records attributed to Carlo Tomasini.
Targetoid hemosiderotic nevus. A trauma-induced simulator of malignant melanoma.
BACKGROUND: Simulators of malignant melanoma comprise a heterogenous group of melanocytic and nonmelanocytic lesions of the skin. Among frequent clinical mimickers of melanoma are injured melanocytic nevi. Any change in the clinical appearance of a pre-existing nevus should alert the clinician to exclude the possibility of malignant transformation in order to early identify a lesion at a stage when complete cure can still be achieved. OBJECTIVE: The purpose of this study was to present the clinical, dermoscopic and histopathologic findings of a series of acquired melanocytic nevi which abruptly developed a pigmented peripheral halo, presumably following minor trauma. METHODS: A series of 6 cases of acquired melanocytic nevi which suddenly developed a targetoid halo were included in the study. All lesions were evaluated by dermoscopy. Three cases were surgically removed at different stages of evolution and submitted to histopathologic examination. In all cases, follow-up was obtained. RESULTS: All the lesions arose on trauma-prone skin sites of young women. The sudden development of an asymptomatic, targetoid halo on a long-lasting, acquired exophytic nevus was the main presentation. Whereas the central nevus persisted, the ecchymotic halo ultimately disappeared. Histopathologic examination disclosed changes of the traumatized nevus in the central part, whereas the ring showed hemorrhage and hemosiderin deposits. Increased numbers of small vessels with hobnail characteristics were associated features. CONCLUSIONS: Targetoid hemosiderotic nevus is a distinctive clinicopathologic variant of traumatized acquired melanocytic nevus which should be included in the list of clinical simulators of melanoma.
Adolescent↗
Cutaneous intravascular lymphoma following extravascular lymphoma of the lung.
Intravascular lymphoma (IL) is a rare aggressive disease characterized by exclusive or predominant accumulation of malignant lymphoid cells within the lumina of small arteries, veins and capillaries. We describe a 74-year-old woman with IL presenting in the skin as asymptomatic teleangiectatic plaques on the thighs. The cutaneous neoplasm developed 18 months after an extravascular large B cell lymphoma of the lung and heralded its relapse. No neurologic symptoms were present during the course of the fatal disease. Immunophenotypic and immunogenotypic studies confirmed a unique B cell subtype. This case of IL is unusual for the association with an extravascular B cell lymphoma suggesting a link between the two diseases.
Aged↗
Cutaneous angiosarcoma arising in an irradiated breast. Case report and review of the literature.
Angiosarcoma (AS) is a rare, aggressive tumour of endothelial origin occurring in various clinical settings, including idiopathic AS on the head and neck in elderly people, lymphoedema-associated AS, post-irradiation AS, soft-tissue AS, and various others. Despite the widespread use of radiation therapy in the treatment of breast carcinoma, AS developing in the wake of a radiation therapy is extremely infrequent. Although there is little doubt that radiation in therapeutic doses can induce sarcomas, quantification of that risk is complicated by many variables, among them chronic lymphoedema. We describe a 70-year-old woman in generally good health who presented with a 2-year history of a maculo-papular eruption on the skin of her right breast. There was no lymphoedema of the thoracic area. The lesions developed 3 years after she had undergone ipsilateral quadrantectomy for an invasive ductal carcinoma followed by 25 tangent field radiotherapy sessions on the breast. The oncological follow-up did not disclose local recurrence of the tumour or metastases of breast carcinoma. Histopathologic examination of a papule was diagnostic for AS. In addition, signs of chronic radiation dermatitis were found in the biopsy specimens. The patient underwent monthly cycles of chemotherapy with intravenous doxorubicin with partial remission of the affected area after 24 months, followed by the occurrence of liver metastases and exitus 30 months after diagnosis. From the review of the literature, it appears that post-irradiation mammary AS mainly affects women over 60 who have undergone breast-sparing surgery and that it is usually associated with axillary lymphadenectomy. Whereas the role of lymphoedema does not seem relevant to the pathogenesis of this malignancy, the association with chronic radiation dermatitis in our case reinforces the supposed role of radiation in the development of this tumour. Onset of AS should be taken into consideration when treating patients who develop multiple lesions on the skin above the irradiated area, even many years after the therapy.
Aged↗
Psoriasis-like dermoscopic pattern of clear cell acanthoma.
BACKGROUND: Dermoscopy provides additional criteria for the diagnosis of skin lesions. OBJECTIVE: To investigate the dermoscopic aspect of clear cell acanthoma (CCA). METHODS: Six consecutive cases of CCAs were observed under conventional dermoscopy (Case 1-4) or videodermoscopy (Case 5-6). RESULTS: Common dermoscopic findings were: (i) squamous surface with translucid collarette; (ii) dilated capillary loops, mainly perpendicularly orientated to the skin surface, as dotted, pinpoint-like structures, regularly distributed in a reticular array over the surface. CONCLUSIONS: The vascular psoriasis-like dermoscopic findings seem to be a clue for CCA and provide evidence of an inflammatory process for CCA formation.
Aged↗
Interstitial granulomatous dermatitis with plaques.
BACKGROUND: Interstitial granulomatous dermatitis is a histopathologic pattern with variable clinical appearance associated with autoimmune systemic diseases. The frequency of its different cutaneous expressions and its association with autoimmune diseases are not known. OBJECTIVE: We describe the clinical, serologic, and histologic features in 17 patients with interstitial granulomatous dermatitis with a clinical presentation consisting of large erythematous plaques. METHOD: Skin biopsy specimens fulfilling criteria for diagnosis of interstitial granulomatous dermatitis were selected and correlated with the clinical and laboratory findings. RESULTS: The study included 1 man and 16 women with multiple, asymptomatic, round to oval, erythematous plaques, most often on folds of the skin, in a bilateral and somewhat symmetric distribution. Most of patients had rheumatoid polyarthralgias along with various serologic abnormalities, often connected to collagen vascular diseases. Histologic examination disclosed a distinctive interstitial granulomatous dermatitis characterized by a diffuse infiltration of the interstitium by histiocytes with piecemeal fragmentation of collagen and formation of small granulomas around degenerative areas in concert with variable numbers of polymorphonuclear leukocytes sprinkled within the infiltrate. Churg-Strauss granulomas in miniature and flame figures were occasionally observed and indicated continued or increased activity of the associated autoimmune disease(s). CONCLUSIONS: Interstitial granulomatous dermatitis with plaques is a distinct entity with highly reproducible clinical and histopathologic features; recognition of these features identifies a patient who may have an underlying systemic autoimmune disorder.
Adult↗
Eyelid swelling: think of metastasis of histiocytoid breast carcinoma.
Metastatic breast carcinoma may assume many clinicopathological patterns. We here describe a case of histiocytoid breast carcinoma metastasis in the eyelids of a 73-year-old woman. Clinically, the patient presented painless swelling and nodular infiltration of the lateral and medial portions of the eyelids recalling a xanthomatous process or cystic lesions. Physical examination revealed similar lesions on the neck and right thigh. Medical history had revealed breast carcinoma 5 years previously. A biopsy specimen taken from a nodule on the eyelids revealed a relatively symmetric dermal tumor composed mainly of large, uniform, round-to-oval cells embedded in a fibrous stroma with moderate mucin deposits. The cells had abundant, coarsely granular eosinophilic cytoplasm and scant or absent nuclear atypia. No lobular arrangement of the cells or overt ductal formation were seen. Only occasional intracytoplasmic lumina were observed. Most cells demonstrated a positive immunoreaction for carcinoembryonic antigen. It is important to recognize histiocytoid breast carcinoma metastasis in the eyelids, because it may easily be overlooked clinically and histopathologically. This tumor should not be confused histopathologically with other benign and malignant skin tumors containing similar granular cells, but which have a different significance or a different prognosis. The immunohistochemical study, in conjunction with the medical history of the patient, facilitated the diagnosis.
Aged↗
Infantile erythema elevatum diutinum: report of a vesiculo-bullous case.
Erythema elevatum diutinum (EED) is a localized, low-grade form of leukocytoclastic vasculitis mainly affecting adults, with only a few pediatric cases reported in the literature. The pathogenesis of this dermatosis is unknown, although an Arthus-type reaction to bacterial and viral antigens seems involved. We describe a case of EED in a 9 year-old child suffering from recurrent pharyngotonsillitis induced by Streptococcus pyogenes. Clinical presentation of the dermatosis was atypical, with vesicles and bullae intermingled with red-purple papules and plaques distributed mainly over the extensor aspects of the extremities. Histopathological examination of a vesiculo-bullous lesion revealed a subepidermal bulla containing neutrophils and nuclear dust suggesting dermatitis herpetiformis. Fibrin in vessel walls was observed throughout the dermis. Direct immunofluorescence was negative. A prompt and complete response to sulphone therapy was obtained in conjunction with tonsillectomy. Clinicians should be aware of atypical presentations of EED in children with vesicles and bullae mimicking During's disease.
Child↗