RESUMEN
A 45-year-old African American man presented with a small, solitary, nonulcerated cutaneous lesion of the right thigh of many years duration, which was excised. Light microscopically, the lesion consisted of an oval, well-circumscribed, intradermal proliferation of tubules, which were often dilated and lined by a double layer of tumor cells with conspicuous intraluminal papillations. Ultrastructurally, there was evidence of both intradermal eccrine duct and eccrine secretory coil differentiation. Although the majority of tumor cells resembled cells of the intradermal eccrine duct, occasional myoepithelial tumor cells and rare tumor cells having secretory granules and resembling dark mucous cells were indicative of eccrine secretory coil differentiation. The positive immunohistochemical staining for S-100 protein, CEA, EMA, and vimentin supported these ultrastructural findings.
Asunto(s)
Adenoma/ultraestructura , Glándulas Ecrinas/ultraestructura , Neoplasias de las Glándulas Sudoríparas/ultraestructura , Adenoma/metabolismo , Adenoma/patología , Biomarcadores de Tumor/metabolismo , Glándulas Ecrinas/metabolismo , Glándulas Ecrinas/patología , Humanos , Técnicas para Inmunoenzimas , Masculino , Microscopía Electrónica , Persona de Mediana Edad , Neoplasias de las Glándulas Sudoríparas/metabolismo , Neoplasias de las Glándulas Sudoríparas/patologíaRESUMEN
A 42-year-old, African-American man presented with a 2-month history of weight loss and fever for 2 weeks. Presumptive diagnoses of human immunodeficiency virus infection (HIV) and acquired immunodeficiency syndrome were made on the basis of a CD4 lymphocyte count of 23 lymphocytes/mL. Chest x-ray revealed right paratracheal adenopathy and a miliary pattern. The etiology of the patient's pulmonary infection was not known, but tuberculosis was an important consideration. Over 5 days, the pulmonary infection progressed and was complicated by acute respiratory distress syndrome (ARDS), septic shock, and death, despite vigorous antibiotic and supportive therapy. Serologic tests for HIV infection were reported as positive after the patient's demise. The etiology of the patient's pulmonary infection, ARDS, and sepsis was not known until autopsy study revealed enumerable yeast-like cells of Blastomyces dermatitidis in the extensively consolidated lungs and in disseminated foci of infection in most other major organs. Diffuse alveolar damage was closely associated with the pulmonary blastomycosis. Electron microscopic study of the yeast-like cells of B. dermatitidis in the autopsy lung obtained and fixed 5 days after the patient's death revealed excellent preservation of viable organisms.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/patología , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Blastomicosis/patología , Enfermedades Pulmonares Fúngicas/patología , Pulmón/patología , Pulmón/ultraestructura , Enfermedad Aguda , Adulto , Autopsia , Blastomicosis/complicaciones , Resultado Fatal , Humanos , Enfermedades Pulmonares Fúngicas/complicaciones , Masculino , Microscopía Electrónica , Síndrome de Dificultad Respiratoria/etiologíaRESUMEN
In human immunodeficiency virus-infected persons the clinical and radiographic appearance of pulmonary tuberculosis is frequently atypical, and extrapulmonary involvement is more frequent. We describe what we believe is the first case of a human immunodeficiency virus-infected person with acute miliary tuberculosis of the skin.