RESUMO
Pemphigus vulgaris (PV) is a rare mucocutaneous disease caused by the abnormal production of antibodies against epithelial cell surface glycoproteins, resulting in loss of cell adhesion and intraepithelial blister formation. Cervical involvement in PV has been poorly reported, and there is little information regarding the criteria about consequential cytological changes identified in a Papanicolaou-stained cervicovaginal smear (Pap smear). Here, we report a case of PV manifesting in the cervix as well as the difficulty associated with the cytomorphological identification and interpretation of acantholytic cells. This case involved a 40-year-old patient with no history of Pap test abnormalities and no prior diagnosis of PV. In the cytological assessment, cells were identified both in isolation and in clusters that exhibited round nuclei of increased volume, inconspicuous nucleoli, and perinuclear halos. The patient underwent a cervical biopsy that revealed vesiculobullous lesions and morphological pattern consistent with PV. A skin biopsy confirmed this diagnosis. We concluded that knowledge of PV cytomorphology is important because difficulties associated with the identification and interpretation of acantholytic cells might be responsible for false positive diagnoses of cervical neoplasia. However, a suspected diagnosis of PV is possible if the cytological findings are carefully correlated with the clinical data.
Assuntos
Colo do Útero/patologia , Epiderme/patologia , Pênfigo/diagnóstico , Adulto , Biópsia , Núcleo Celular/patologia , Colo do Útero/cirurgia , Diagnóstico Diferencial , Epiderme/cirurgia , Células Epiteliais/patologia , Feminino , Histocitoquímica , Humanos , Teste de Papanicolaou , Pênfigo/patologia , Pênfigo/cirurgia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgiaRESUMO
Os autores relatam caso de múltiplos carcinomas basocelulares no dorso nasal, tratados comcrioterapia, cirurgia e uso tópico de 5-fluoracil. Os múltiplos tumores não foram recidivas detumores anteriores, mas decorrentes da qualidade da pele do dorso nasal. Isto ficou evidentena biopsia após a ressecção cirúrgica, demonstrando ausência de comprometimento nasmargens da ressecção. A ulceração por uso prolongado do 5-fluoracil ocorreu pela ação doquimioterápico sob o tecido normal. A retirada da pele do dorso até a base da pirâmide nasalfoi realizada para evitar novos tumores sobre a mesma. A reconstrução por dois retalhoscutâneos de hemiface permitiu a reparação do nariz, sem comprometer o contorno facial.
The authors report a case of multiples basal cell carcinoma (BCC) over the dorsum treatedwith criotherapy, surgery and 5-fluoracil. They were not recurrence of former tumors occurringdue to the poor skin quality. It was clearly showed through the biopsy exhibitingno BCC at the margin of resection. The wound caused by excessive use of 5-fluoracil wasdue to chemotherapy action over the normal skin. Removal of the skin from the dorsumto the base of the nose was performed to avoid new BCC. Reconstruction using cutaneousflaps on both sides of the face restored the nose and facial contour.
Assuntos
Humanos , Masculino , Idoso , Carcinoma Basocelular , Crioterapia , Epiderme/cirurgia , Neoplasias Nasais , Retalhos Cirúrgicos , Procedimentos Cirúrgicos Operatórios , Métodos , Pacientes , Técnicas e Procedimentos DiagnósticosRESUMO
BACKGROUND: Refractory and stable defects of vitiligo and piebaldism may be unresponsive to medical therapy. Melanocyte transplantation can restore the normal pigmentation in some selected patients. OBJECTIVES: To evaluate the efficacy of additional mini-grafting with 1.0-1.2-mm punch grafts to complete the restoration of achromic defects when performing surgical correction of leukoderma. METHODS: Eight patients with refractory stable leukoderma were treated with melanocyte transplantation; three with segmental vitiligo had epidermal shave, by removing the hyperpigmented macules at the periphery of achromic lesions; two others received suction epidermal grafts; and three subjects were treated by in vitro cultured epidermal autografts. All patients received additional mini-grafts in areas of residual achromia. RESULTS: The depigmented defects were 100% restored in seven patients, and in one subject 80% improvement was observed. CONCLUSION: Surgical methods, followed by additional mini-grafting, may be helpful to restore completely the depigmented defects when residual achromia, after treatment with the methods described above, is still present.
Assuntos
Piebaldismo/cirurgia , Vitiligo/cirurgia , Células Cultivadas , Terapia Combinada , Epiderme/cirurgia , Epiderme/transplante , Estética , Humanos , Melanócitos/transplante , Transplante de Pele/métodos , Transplante AutólogoRESUMO
The application of laserbrasion by the carbon dioxide (CO2) laser for skin deepithelialization previously has been proven efficacious in numerous clinical experiences. This study in adult Sprague-Dawley rats was designed to compare those known effects of the CO2 laser with the contact neodymium:yttrium-aluminum-garnet (Nd:YAG) laser for skin deepithelialization, since tactile feedback from the handpiece of the latter is a theoretical advantage. This proved that although the contact Nd:YAG laser does have the capability to achieve skin deepithelialization, when compared with more conventional methods, it is laboriously inefficient and therefore at present impractical.
Assuntos
Procedimentos Cirúrgicos Dermatológicos , Terapia a Laser/instrumentação , Animais , Epiderme/cirurgia , Humanos , Ratos , Transplante de PeleRESUMO
Total or partial skin deepithelialization of the transverse rectus abdominis musculocutaneous (TRAM) flap is an integral component of this technique for achieving a successful breast reconstruction. In a manner similar to dermabrasion, the carbon dioxide laser in a defocused mode permits precise removal by vaporization of the epidermis and outer dermis. The extended application of this method for deepithelializing the TRAM flap is simple, rapid, and safe. Because a portion of the dermis always remains intact, another inherent advantage of this method is preservation of the subdermal vascular plexus that may be important for maintaining any precarious flap perfusion.
Assuntos
Músculos Abdominais/transplante , Terapia a Laser , Mamoplastia/métodos , Transplante de Pele/métodos , Retalhos Cirúrgicos/métodos , Dióxido de Carbono , Epiderme/cirurgia , Epitélio/cirurgia , Feminino , Humanos , Terapia a Laser/métodos , Mastectomia/reabilitação , Pessoa de Meia-Idade , Músculos/transplanteRESUMO
Os autores estudaram a retracao primaria dos enxertos de pele relacionando-a com a espessura dos mesmos e a distencao da area doadora, apos a excisao dos enxertos, relacionando-a com a espessura da derme residual. Foram estudados dez areas doadoras e os respectivos enxertos. A espessura media dos enxertos estudados foi 318,0 micra que corresponde a 20,0 por cento da pele doadora. A retracao primaria desses enxertos foi 17,6 por cento da area doadora. Os autores compararam os resultados com aqueles obtidos por Davis e Ketowsk, salientando as diferencas entre os metodos utilizados nos dois trabalhos. A espessura media da derme residual das areas doadoras logo apos a excisao dos enxertos foi 1.287,0 micra que corresponde a 85,2 por cento da espessura media da derme reticular da pele doadora. A distencao da area doadora apos a retirada do enxerto foi de 2,1 por cento da original.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Transplante de Pele/métodos , Epiderme/cirurgia , Epiderme/transplanteRESUMO
In ten patients a study of skin grafts and of the changes that occurred in the donor area was carried out: the primary retraction of the grafts in relation to their thickness was determined as well as the distension of the donor area of the graft after the excision of the same and comparison of it's thickness with that of the residual skin. The average thickness of the grafts was 318.0 micra, which corresponded to 20% of the donor skin. The primary retraction was 17.6%. The mean thickness of the residual skin at the donor area was 1,287.0 micra or 85.2% of the mean thickness of the reticular derma: the distension of the donor skin area after the removal of the graft corresponded to 2.1% of the original size.