Biomedical subjects
Publications and source records attributed to Maria Letícia Cintra.
We report the case of a 34-year-old white man with a 7-year history of nodules on the face, neck, upper torso, and arms which evolved to anetodermic lesions. After onset of these lesions, deep vein thrombosis developed in the patient's right arm and leg in association with circulating antiphospholipid antibodies.
Explore the source record for details and available documents.
CONTEXT AND OBJECTIVE: The technique of obtaining human skin with dermis and epidermis reconstructed from cells isolated from patients can enable autologous skin grafting on patients with few donor sites. It also enables in vitro trials on chemicals and drugs. The objective of this work was to demonstrate a method for obtaining human skin composed of associated dermis and epidermis, reconstructed in vitro. DESIGN AND SETTING: Experimental laboratory study, in the Skin Cell Culture Laboratory of Faculdade de Ciências Médicas, Universidade Estadual de Campinas. METHODS: Cells from human fibroblast cultures are injected into bovine collagen type I matrix and kept immersed in specific culturing medium for fibroblasts. This enables human dermis reconstruction in vitro. On this, by culturing human keratinocytes and melanocytes, differentiated epidermis is formed, leading to the creation of human skin composed of associated dermis and epidermis, reconstructed in vitro. RESULTS: We showed that human skin composed of associated dermis and epidermis can be successfully reconstructed in vitro. It is histologically formed in the same way as human skin in vivo. Collagen tissue can be identified in the dermis, with cells and extracellular matrix organized in parallel to multilayer epidermis. CONCLUSIONS: It is possible to obtain completely differentiated human skin composed of associated dermis and epidermis, reconstructed in vitro, from injection of human fibroblasts into bovine collagen type I matrix and culturing of human keratinocytes and melanocytes on this matrix.
Mycosis fungoides (MF) is the most common form of primary cutaneous T-cell lymphoma. In its early stage it may mimic benign dermatoses both on a clinical and histologic basis. MF usually expresses CD3 and CD4 (T-cell) markers. CD7 is expressed on about 90% of CD4 T cells and is often deficient on malignant T cells. Thus, CD7 may be useful in evaluating the nature of dermal lymphoid infiltrates. The aim of this study was to evaluate the usefulness of immunohistochemical detection of T-cell markers on paraffin-embedded sections, CD3 and CD7 (clone CBC.37), in the differential diagnosis of MF and benign dermatoses. Forty-two patients with diffuse dermal T-lymphocytic infiltrates were selected. Previous clinicopathologic correlation and follow-up had established the diagnosis of MF in 31 patients and benign dermatoses in 11. The mean value of stained cells in MF was 86.45% for CD3 and 53.09% for CD7 (P<0.001); in benign dermatoses it was 79.09% for CD3 and 73.63% for CD7 (P=0.669). CD7 immunolabeling was significantly lower in the MF group (P=0.048). A semiquantitative evaluation revealed a considerable loss of CD7 immunolabeling in comparison with CD3 in patients with MF. The authors conclude that CD7 study may represent a valuable tool in the distinction between inflammation and neoplasia in T-lymphoproliferative skin disorders.
CONTEXT: Erythema elevatum diutinum is a chronic and rare dermatosis that is considered to be a variant of leukocytoclastic vasculitis. It is probably mediated by immune complexes. It is generally associated with autoimmune, neoplastic and infectious processes. Recently, it has been added to the group of specific dermatoses that are associated with HIV. CASE REPORT: We report on the case of a patient who had erythema elevatum diutinum as the first clinical evidence for diagnosing HIV infection. Dapsone was used in the treatment of this patient, and partial regression of the lesions was achieved within 15 days, even before anti-retroviral therapy was prescribed. CONCLUSION: When there is a diagnosis of erythema elevatum diutinum, HIV infection should be investigated, especially in atypical and exacerbated clinical manifestations.
CONTEXT: Non-specific lymphocytic infiltrates of the skin pose difficulties in daily practice in pathology. There is still a lack of pathognomonic signs for the differential diagnosis between benign and malignant lymphocytic infiltrates. OBJECTIVE: To evaluate the morphological and immunohistochemical profile of lymphocytic infiltrations of the skin according to clinical outcome. TYPE OF STUDY: Retrospective; histopathological and immunohistochemical analysis. SETTING: Referral center, university hospital. SAMPLE: 28 cases of lymphocytic infiltrates of difficult differential diagnosis selected from the records. MAIN MEASUREMENTS: Eighteen histological variables and the immunophenotypic profile were assessed using the CD4, CD8, CD3, CD20 and CD30 lymphoid markers and compared to subsequent follow-up. RESULTS: The most common diagnoses were: initial mycosis fungoides (eight cases) and drug reactions (five cases). Single morphological variables did not discriminate between benign and malignant infiltrates except for the presence of Pautrier-Darier's microabscesses, which were found only in mycosis fungoides (p = 0.015). Patterns of superficial and deep infiltration (p = 0.037) and also the presence of eosinophils (p = 0.0207) were more frequently found in benign lymphocytic infiltrates. Immunohistochemical profile of T-cell subsets showed overlap between benign and malignant infiltrates with a predominance of CD4-positive (helper) lymphocytes in the majority of cases. CONCLUSIONS: A combination of clinical and histological features remains the most reliable approach for establishing a definite diagnosis in cases of lymphoid skin infiltrates.
Keratoacanthoma generally occurs on the skin; it is rarely found in the conjunctiva. A case of a 34-year-old woman with a rapidly growing conjunctival mass is reported. The tumor was excised with a safety margin to exclude squamous cell carcinoma. Histopathologically it was crateriform and consistent with atypical keratoacanthoma. There has been no recurrence in 2 years of follow-up. Conjunctival keratoacanthoma is rare; differential diagnosis of conventional squamous cell carcinoma and keratoacanthoma can be difficult. We recommend complete surgical excision and careful follow-up of crateriform squamous proliferations.
Cysticercosis is a human infestation, which is considered the most common cause of seizures worldwide. The subcutaneous lesions can help in the diagnosis of neurocysticercosis. We describe a case of a 45-year-old patient with multiple cutaneous nodules first seen 2 years ago that were increasing in number, and normal neurologic and fundoscopic examination. Neurologic symptoms started 3 months before hospital admission as a mild headache and muscular weakness. The imaging examinations showed a massive central nervous system involvement. Physicians must be aware of the importance of subcutaneous nodule examination for the diagnosis of neurocysticercosis.
Lymphoedema and skin naevi are common in children with Turner syndrome (TS). Lymphoedema in the early stages of fetal life is thought to cause several of the phenotypic characteristics in patients with TS such as nuchal folds and pterygium colli. We present two patients with TS who have unusual lesions on the scalp. The first patient had an oval circumscribed lesion. Two biopsies were obtained from the lesion. Increased numbers of collagen fibres were seen in the reticular dermis suggesting the diagnosis of connective tissue naevus. The second patient presented with an area with skin folds on the scalp, similar to cutis verticis gyrata. Although unusual in TS, both lesions could be considered as resolving stages of lymphoedema. We suggest that karyotyping should be performed in cases of female infants presenting with similar lesions.
Melkersson-Rosenthal syndrome is an uncommon disorder of uncertain aetiology characterized by orofacial oedema, facial nerve palsy and lingua plicata. The triad is seldom seen in its complete form, and oligo-symptomatic or mono-symptomatic forms are more common. An unusual case of Melkersson-Rosenthal syndrome involving the left upper eyelid is presented. The pathology, clinical features and management of this disorder are discussed.
A case of massive Ancylostoma sp. larval infestation is presented in a patient who had received systemic corticosteroid therapy. What attracts attention in this case is the exuberance and rarity of clinical manifestation. Based on the pertinent literature, we discuss the mechanisms of parasital infection, the natural history of the disease and its treatment.
BACKGROUND: Hypertrophic lupus erythematosus (HLE) is a distinct and rare subset of lupus erythematosus (LE). It is characterized by verrucous lesions, chronic in its course, and resistant to treatment. The purpose of this study was to identify clinical and histological characteristics of HLE. METHODS: We review our experience with 14 cases of HLE identified in a group of 220 patients with different forms of LE, at the UNICAMP Hospital, between 1976 and 2002. RESULTS: All patients presented verrucous plaques concomitantly with discoid lesions. The most common sites of involvement were the face and the arms. Histology of HLE lesions revealed pseudoepitheliomatous hyperplasia engulfing elastotic material. Elastic fibers were seen in migration throughout the epidermis. Classic features of LE were noted in all cases. Three of the patients developed hyperkeratotic papules with central keratinous plug on their arms at the previous LE sites. These lesions resemble clinically and histopathologically keratoacanthomas. In one patient, HLE lesion progressed to squamous cell carcinoma (SCC), 26 years after the onset of the disease. CONCLUSIONS: Transepithelial elimination of the elastotic material may be a feature of HLE. Some HLE lesions may present as keratoacanthoma, but classical features of LE aid the correct diagnosis. SCC may arise on a long-standing HLE lesion; therefore HLE requires clinical and histopathological follow up.
The human bartonelloses are a group of diseases with a rapidly increasing clinical spectrum. Well known manifestations such as Carrion's disease, trench fever, cat-scratch disease, and bacillary angiomatosis are examples of Bartonella sp. infection. Along with these diseases, recurrent bacteremia, endocarditis, septicemia, erythema nodosum, erythema multiforme, trombocytopenic purpura and other syndromes have been reported having been caused by bacteria of this genus. The infectious process and the pathogenesis of these microorganisms are poorly understood. The bartonelloses may have a benign and self-limited evolution in a host, or a potentially fatal one. These bacteria can provoke a granulomatous or an angioproliferative histopathologic response. As these diseases are not yet well defined, we have reviewed the four main human bartonelloses and have examined unclear points about these emergent diseases.
A 31-year-old male patient with ectodermal dysplasia and acanthosis nigricans is described. Clinical findings included hypotrichosis, hypohidrosis, palmoplantar hyperkeratosis, nail dystrophy, early onset loss of permanent dentition, mental retardation, and acanthosis nigricans. The findings suggest the diagnosis of Lelis syndrome, as described on the basis of seven unrelated cases. A review concerning this condition is also presented.
Sjögren-Larsson syndrome is a rare disorder that consists of congenital ichthyosis and neurological symptoms due to an enzymatic defect of fatty aldehyde dehydrogenase in the fatty alcohol cycle. We report three cases of Sjögren-Larsson syndrome in which the primary biochemical defect was established in two patients (patient 2: 175 pmol/min/mg; patient 3: 103 pmol/min/mg protein enzimatic activity in fibroblasts in skin, while normal controls were 8,860 +/- 1,624, n: 22 ). A dietary program was proposed: reduced total fatty intake at 30% of total calories, n-3 and n-6 acids (canola oil) as well as unsaturated fatty acids (Milupan milk). Topical keratolytic agents were used too. Good clinical course was observed in one of the patients in whom dietary intervention was started in early infancy. In the other two patients, who started the therapy later (five and three years old), cutaneous symptoms were improved after treatment.