RESUMEN
OBJECTIVE: To analyze the dermatologic lesions and possible effects of immunosuppression treatment and p53 gene mutations on dermatologic findings in renal transplant recipients. MATERIALS AND METHODS: The study included 163 renal transplant recipients. After dermatologic examination, cultures, and histopathologic and genetic analyses were performed. A single-strand conformation polymorphism technique was used to analyze p53 gene mutations. Patients were categorized into 3 groups according to time since the transplantation procedure. Results were analyzed using the χ(2) test, using a software program (SPSS version 13.0; SPSS, Inc, Chicago, Illinois). RESULTS: Mean (SD) age of the 163 transplant recipients (65 women and 98 men) was 40 (11) years, and posttransplantation follow-up was 65 (55) months. The most frequently observed drug-related lesion was hypertrichosis, in 46 of 150 patients. Of 115 lesions, the most commonly observed were verruca vulgaris (n = 34) from viruses, and pityriasis versicolor (n = 21) from superficial fungal infections. Of the total group, 20 patients (12.2%) were mutation carriers. Compared with the entire cohort, the group with premalignant lesions demonstrated more p53 mutations (11% vs 50%; P = .004). Patients given cyclosporine therapy exhibited more premalignant or malignant cutaneous lesions compared with patients who received other agents (P = .03). CONCLUSION: Patients carrying p53 mutations developed a malignant lesion in the late posttransplantation period, which suggests the importance of prediction of risk.
Asunto(s)
Genes p53 , Terapia de Inmunosupresión/efectos adversos , Inmunosupresores/efectos adversos , Trasplante de Riñón/inmunología , Mutación , Neoplasias Cutáneas/genética , Adulto , Dermatomicosis/epidemiología , Quimioterapia Combinada , Exones/genética , Femenino , Estudios de Seguimiento , Humanos , Inmunosupresores/uso terapéutico , Trasplante de Riñón/fisiología , Masculino , Persona de Mediana Edad , Polimorfismo Conformacional Retorcido-Simple , Complicaciones Posoperatorias/genética , Lesiones Precancerosas/genética , Enfermedades Cutáneas Bacterianas/epidemiología , Enfermedades Cutáneas Virales/epidemiología , Factores de TiempoRESUMEN
A 48-year-old woman presented with red papules on the thigh. Histopathological examination indicated pyogenic granuloma, and the patient was treated with total excision in 2003 and electrocauterization in 2005. Three months later, upon recurrence of the lesions, a diagnosis of composite haemangioendothelioma (CHE) was made. The patient was treated by total excision and lymph-node dissection, which revealed inguinal lymph-node metastasis. Despite the surgery, a further local recurrence occurred, subsequently treated by wide excision en bloc, with adjuvant radiotherapy and chemotherapy. Although CHE is defined as a vascular tumour with low-grade malignancy, the local recurrences and lymph-node metastases resulted in treatment difficulties in this case. Unlike earlier cases, the tumour in our patient presented as localized numerous small papulonodules, and lymph-node metastasis was detected within a relatively short time. Dermatologists and pathologists should be aware of this rare condition and include it in the differential diagnosis of vascular lesions.
Asunto(s)
Hemangioendotelioma/secundario , Neoplasias Cutáneas/patología , Femenino , Hemangioendotelioma/cirugía , Humanos , Escisión del Ganglio Linfático , Metástasis Linfática , Persona de Mediana Edad , Neoplasias Cutáneas/cirugía , Muslo/patología , Resultado del TratamientoRESUMEN
Atypical presentations of molluscum contagiosum (MC) infection can be expected in renal transplant recipients, as a result of long-term immunosuppression. However, giant MC has rarely been reported in this population. We present a 28-year-old female renal transplant recipient receiving immunosuppressive therapy who developed multiple giant MC lesions on her axillary folds. The lesions were treated successfully with curettage and electrocauterization.