Use of Ultrasound to Observe Mycosis Fungoides: A Case Report and Review of Literature

Background: Mycosis fungoides (MF) is the most common form of cutaneous T-cell lymphoma with many clinicopathological variants, thus difficult to diagnose in its early stages. Case Presentation: This case report is about a 76 years old Chinese woman presented with 2 years history of erythematous plaque on the lateral right thigh, after combining clinical manifestations with results of pathological examinations, it is consistent with the diagnosis of MF. Discussion: Mycosis fungoides (MF) is the most common form of cutaneous T-cell lymphoma. Patient in this case had a long course of disease and repeated attacks. Ultrasound shows small patch of liquid dark area of the lesion. Color Doppler image shows rich blood flow which just looks like lacustrine. Thick and nourishing blood vessels could be seen in the depth. Conclusion: Our case report using ultrasound to observe MF and demonstrate that ultrasound is helpful in diagnosing and evaluating effectiveness in treating MF.

Pink plaque on the hypogastrium

Bowen’s disease is a type of intraepidermal squamous cell carcinoma usually affecting the elderly and occurring on sun-exposed areas, such as the face, scalp, and limbs. The development of Bowen’s disease in other locations such as the abdomen is rare. In these cases, dermoscopy proves to be a helpful tool in making the diagnosis [1]. A 65-year-old male with no previous medical history presented himself with a nonhealing asymptomatic lesion on the abdomen slowly growing for the last ten years. A dermatological examination revealed a 6-cm well-limited erythematous plaque on the hypogastrium with peripheral pigmentation (Fig. 1). Dermoscopy found central keratin as well as white shiny structures, including white shiny lines, white shiny areas, and rosettes (Fig. 2) as well as brown linear globules and dots on the periphery and looped vessels (Fig. 3). Bowen’s disease was the most likely diagnosis, which was confirmed by histopathology. The patient underwent surgery for excision of the lesion with 5-mm margins.

An erythematous plaque on the nose: What is your diagnosis?

A 55-year-old male presented to our dermatology department with 3 months history of an asymptomatic and red raised plaque on the nose. There was no history of discoloration of skin prior to the development of this lesion. His only medical history was type 2 diabetes and high blood pressure. He had never undergone radiation therapy. On clinical examination, a well-defined glistening bluish-erythematous plaque 3 * 3 cm was present on the nose which was soft and non-tender (Fig. 1). Nasal mucosa was completely spared. No cervical lymphadenopathy was found. Head and neck examination was unremarkable. A CT scan of head and neck founded a soft tissue mass without infiltration of underlying structures. Figure 1: A well-defined glistening bluish-erythematous plaque 3*3 cm on the nose. DERMOSCOPY FINDINGS The dermoscopy revealed homogeneous pattern with combinations of colors (pinkish, bluish, and violaceous) and whitish veil areas without well-defined vessels or lacunae (Fig. 2). Figure 2: Homogeneous pattern with combinations of colors (pinkish, bluish, and violaceous) and whitish veil areas. HISTOLPATHOLOGY The histological examination of the first biopsy revealed a benign fibtoblastic reaction around normal vessels with fibrin deposits and without nuclear atypia. The second skin biopsy showed anastomosing vascular structures of variable diameter in the dermis, lined by plump endothelial cells with marked cellular, nuclear polymorphism and occasional mitosis, dissecting the collagen bundles (Fig. 3a). On immunohistochemistry, tumor cells expressed CD31, ERG, CD34 and VIII Factor. Ki67 was high in tumor cells (60%) (Fig. 3b). Figure 3: (a) HE x 400. Vascular proliferation with atypical endothelial cells (arrow). (b) IHC x 200, Elevated proliferation index Ki67.

Axillary Paget disease with a visible satellite: a case report and literature review

Background Extramammary Paget disease (EMPD) is an uncommon malignancy affecting apocrine gland–bearing skin, such as vulvar, perianal, axillary and penoscrotal areas. Paget cells are sometimes detected outside clinical border in a phenomenon called subclinical extension. Satellite is one of the patterns of subclinical extension which is likely to be invisible. The standard management strategy for EMPD without distant metastasis is a complete surgical removal, sometimes called wide local excision. However, there is no consensus regarding surgical margin width to decrease the high recurrence rate. Here we describe the first macroscopically visible satellite of axillary EMPD and wide local excision of both main lesion and the satellite lesion with only 0.5 cm margin, succeeded by a short review of the literature. Case presentation A 48-year-old female with a red macule in the right axilla was presented to our clinic. A well-demarcated 4 cm × 3 cm erythematous plaque was observed in the right axilla, and a similar lesion measuring 0.5 cm × 0.3 cm was found 3.5 cm away from the primary site. Breast and axillary node examination was unremarkable. Biopsy of the large plaque revealed Paget disease, then we performed a local extended excision of both lesions with a 0.5 cm margin, all margins negative indicated, by frozen pathology. Pathology revealed the nature of the satellite beside the main lesion also as Paget disease. The patient is currently followed-up for 20 months and has shown no signs of recurrence, with normal shoulder motor function. Conclusion We have report the first visible satellite of extramammary Paget disease, indicating the necessity of an extended local resection of both the main leision and the satellite lesion. Considering the anatomical structure of axillary Paget disease, a 0.5 cm negative surgical margin indicated by frozen pathology might be sufficient to sustain the shoulder motor function.

TYPE 1 LEPRA REACTION MIMICKING BULLOUS FIXED DRUG ERUPTION

Leprosy is a chronic infectious disease with varied clinical presentations. Leprosy reactions generally manifest as erythematous edematous tender plaques or evanescent erythematous nodules with or without neuritis. Bullous type of reactions are rare in leprosy. We hereby report a case of borderline tuberculoid leprosy with bullous eruption. A 24 year old male, known case of borderline tuberculoid leprosy who has completed MB MDT after which he continued Dapsone and Rifampicin for another 6 months, now presented with acute onset of fever, malaise, swelling of both feet and painful raised reddish lesions followed by uid lled lesions over the pre existing lesions of leprosy i.e.,on right ear and right sole since 10 days. There is no history of similar episodes. On examination patient looks toxic with bilateral pitting type of pedal edema. Cutaneous examination revealed a single well dened erythematous plaque with vesicles and crusting over pinna and helix of right ear. A single well dened erythematous plaque with central vesicle surrounded by edematous ring noted over medial aspect of right sole. No other skin lesions & mucosal lesions were present. Nikolsky and bulla spread sign was negative. Nerve examination revealed ulnar & common peroneal nerve thickening and tenderness over right side. Routine investigations revealed raised ESR & bilirubin levels. Tzanck smear and slit skin smear was negative. Histopathological examination showed dermal edema with few ill dened granulomas. Based on the above ndings a diagnosis of BT leprosy in Type 1 reaction with bullous eruption was made which is rare after completing MB MDT. However it needs to be differentiated from other causes of bullous eruption

Cutaneous B-Cell Pseudolymphoma Successfully Treated with Triamcinolone Acetonide

BACKGROUND: Cutaneous pseudolymphoma (PSL) is a reactive polyclonal benign lymphoproliferative process in the skin that simulate cutaneous lymphomas clinically, histologically, or both, predominantly composed of either B-cells or T-cells, localized or disseminated. PSL clinically manifests as solitary nodules or plaque on the face. In cases where cutaneous PSL is suspected, the most crucial part is diagnosis, to differentiate benign or malignant lesion. Diagnosis required a combination of clinical, histopathological, and immunohistochemistry examination. CASE REPORT: A 59-year-old man presented with asymptomatic erythematous plaque on her cheek for 6 months before. Histopathological examination revealed dense small lymphocytic infiltration forming lymphoid follicles with centrum germinativum that partially destructed skin appendice glands. Immunohistochemistry examination showed positive result on cluster of differentiation (CD)20 and CD3 staining. With domination of CD20 treatment: Patient was treated with intralesional injection of triamcinolone acetonide 10 mg/ml and showed satisfying result after 3 times injection. CONCLUSION: A cutaneous B-cell PSL in a 59-year-old man was diagnosed based on history and physical, histopathological, and also immunohistochemistry examination. Intralesional injection of 10 mg/ml triamcinolone acetonide gave satisfying result.

Unusual erythematous plaque with white scales, a case of acquired syphilis in a child and literature review

Background Syphilis in children is uncommon with the mode of infection for this rare condition likely being congenital or acquired. While most acquired cases of syphilis in children result from sexual abuse, children can also be infected with syphilis through kissing, breastfeeding, sharing of daily necessities or pre-chewed food. Here, we report a case of acquired secondary syphilis in a child due to consumption of pre-chewed-food and provide a review of the literature on the characteristics of acquired syphilis in preschool children. Case presentation A 3-year-old girl presented with erythematous plaques and scales on her head, neck, and thighs as well as flat red papules with a moist, well circumscribed surface covered with a grayish-white film. The grandmother who cared for the girl was in the habit of pre-chewing food before giving it to the girl. The child and grandmother tested positive for RPR. The girl, who was not sexually abused, was diagnosed with acquired secondary syphilis, resulting from the transmission of pre-chewed food from her grandmother. Conclusions Our case report and literature review reveal that close contact among family members can result in the transmission of syphilis. We recommend that pre-chewing food should be discouraged by caregivers when caring for their children to avoid disease transmission.