RESUMEN
Hemophagocytosis may be encountered in association with a variety of underlying conditions, including primary or familial disorders, and secondary forms induced by infections, malignancy, and metabolic disorders. It is usually observed in organs such as the spleen, lymph nodes, bone marrow, and central nervous system, but rarely in the skin. When hemophagocytosis coexists with a sepsis-like systemic disorder it is termed hemophagocytic syndrome or hemophagocytic lymphohistiocytosis. Recently, 2 cases with evidence of perivascular hemophagocytosis in skin biopsy specimens of patients without additional findings of hemophagocytic lymphohistiocytosis have been reported. We report 2 additional cases of patients with cutaneous lesions suggestive of leukocytoclastic vasculitis whose skin biopsies showed a perivascular and interstitial infiltrate of neutrophils with nuclear dust and extravasated erythrocytes, and the presence of histiocytes with phagocytized red blood cells and nuclear fragments. There was also evidence of fibrin in the walls of the venules. One patient presented with a sepsis-like clinical scenario, but an extensive work-up failed to demonstrate any underlying disease or infection. The second patient was asymptomatic at the time of presentation, but further work-up revealed an underlying B-cell lymphoma. Whether these histologic findings represent late lesions of leukocytoclastic vasculitis or an incomplete presentation as part of a hemophagocytic syndrome is debatable, because both are associated with activated immunity and cytokine release, which could account for the presence of hemophagocytosis. Although the histopathologic finding alone of hemophagocytosis is insufficient to label as a syndrome, it should incite the clinician for further systemic evaluation.
Asunto(s)
Eritrocitos/patología , Histiocitos/patología , Fagocitosis , Enfermedades de la Piel/patología , Anciano de 80 o más Años , Niño , Femenino , Humanos , Leucocitosis/patología , Masculino , Piel/irrigación sanguínea , Piel/patología , Vasculitis/patologíaRESUMEN
BACKGROUND: The incidence of cutaneous malignant melanoma continues an increasing trend worldwide and has had the highest rise in incidence of all malignancies during the last decades. Mortality rates for melanoma have remained relatively stable in most countries despite the increase in incidence rates. The purpose of this study is to describe the epidemiological trends of malignant melanoma in Puerto Rico from 1987 to 2002 and to compare these findings with those previously reported for Puerto Rico as well as with those reported for other countries. METHODS: All cases of malignant melanoma reported to the Puerto Rico Cancer Registry from 1987 to 2002 were included. Age-adjusted incidence and mortality rates were calculated. Trends were compared by age, gender, anatomical location of the tumor and tumor thickness. RESULTS: There were 1,568 new melanoma cases reported between 1987 and 2002 in Puerto Rico, comprising a 50% overall increase in incidence during this period. Male to female incidence ratio was 1:0.86. The most common anatomical location in women was the lower extremity followed by the head and neck region. In men, the most common anatomical location was the trunk, followed by the head and neck region. Most of the superficial tumors (< 1mm) were located on the trunk followed by the lower limb. The most common specific histologic diagnosis reported was melanoma in situ. In 40.8% of the cases the tumor thickness value was not provided. The number of thinner melanomas (< 1mm) reported increased during the study period. Mortality rates were slightly higher for men than for women, still mortality rates remained stable for both genders and all age groups analyzed. CONCLUSIONS: Melanoma incidence rates continue to increase in Puerto Rico. This, in combination with an increase in the diagnosis of thin melanomas, suggests that the stable mortality rates may be due, in part, to earlier diagnosis and improved overall prognosis.
Asunto(s)
Melanoma/epidemiología , Neoplasias Cutáneas/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Puerto Rico/epidemiologíaRESUMEN
This is a case report of a patient who developed a nodule in one foot, which upon biopsy, was diagnosed as tungiasis, a cutaneous infestation caused by a human flea. The natural life cycle, clinical and pathological expressions are discussed.