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Torre-Castro J, Recio-Monescillo M, Castillo Bazan E, Díaz de la Pinta J, Rodríguez Pinilla M, Requena L, Córdoba R. Safety and effectiveness of the combination of systemic gemcitabine and intralesional brentuximab vedotin in tumor-stage mycosis fungoides. Int J Dermatol 2024; 63:828-830. [PMID: 38419393 DOI: 10.1111/ijd.17107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/31/2024] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Juan Torre-Castro
- Dermatology Department, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | | | - Eva Castillo Bazan
- Pharmacy Department, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | | | | | - Luis Requena
- Dermatology Department, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Raul Córdoba
- Haematology Department, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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Torre-Castro J, Postigo C, Machan S, Jo-Velasco ME, Díaz de la Pinta J, Rodríguez-Peralto JL, Córdoba R, Requena L, Rodríguez-Pinilla SM. Urticarial mycosis fungoides: A distinctive presentation with blood involvement and a peculiar immunophenotype. J Cutan Pathol 2024. [PMID: 38769716 DOI: 10.1111/cup.14642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 04/14/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024]
Abstract
Mycosis fungoides (MF) has been widely reported to mimick a considerable number of different dermatoses, including scarring alopecia, bullous dermatoses or cysts, and comedones. In atypical presentations, histopathology is essential for the diagnosis. We present two cases of MF with clinical urticarial lesions and a striking blood involvement that responded to mogamulizumab treatment. Histopathologically, both cases had classic MF features and shared a peculiar immunophenotype, with positivity for CD25 and FOXP3. Differential diagnoses included urticarial lymphomatoid drug reactions and other lymphomas, like T-cell prolymphocytic leukemia, atypical Sézary syndrome, or adult T-cell lymphocytic leukemia. A low suspicion threshold is necessary for the diagnosis of atypical presentations of MF.
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Affiliation(s)
- Juan Torre-Castro
- Dermatology Department, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Concepción Postigo
- Dermatology Department, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Salma Machan
- Dermatology Department, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | | | - Javier Díaz de la Pinta
- Pathology Department, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | | | - Raúl Córdoba
- Haematology Department, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Luis Requena
- Dermatology Department, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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Torre-Castro J, Rodríguez M, Alonso-Alonso R, Mendoza Cembranos MD, Díaz-Alejo JF, Rebollo-González M, Borregón J, Nájera Botello L, Mahillo-Fernández I, Samimi M, Kervarrec T, Requena L, Piris MÁ. LT and SOX9 expression are associated with gene sets that distinguish Merkel cell polyomavirus (MCPyV)-positive and MCPyV-negative Merkel cell carcinoma. Br J Dermatol 2024; 190:876-884. [PMID: 38261397 DOI: 10.1093/bjd/ljae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is an aggressive malignant neuroendocrine tumour. There are two subsets of MCC, one related to Merkel cell polyomavirus (MCPyV) and the other to ultraviolet radiation (UVR). MCPyV-positive and MCPyV-negative MCCs have been considered to be different tumours, as the former harbour few DNA mutations and are not related to UVR, and the latter usually arise in sun-exposed areas and may be found in conjunction with other keratinocytic tumours, mostly squamous cell carcinomas. Two viral oncoproteins, large T antigen (LT; coded by MCPyV_gp3) and small T antigen (sT; coded by MCPyV_gp4), promote different carcinogenic pathways. OBJECTIVES To determine which genes are differentially expressed in MCPyV-positive and MCPyV-negative MCC; to describe the mutational burden and the most frequently mutated genes in both MCC subtypes; and to identify the clinical and molecular factors that may be related to patient survival. METHODS Ninety-two patients with a diagnosis of MCC were identified from the medical databases of participating centres. To study gene expression, a customized panel of 172 genes was developed. Gene expression profiling was performed with nCounter technology. For mutational studies, a customized panel of 26 genes was designed. Somatic single nucleotide variants (SNVs) were identified following the GATK Best Practices workflow for somatic mutations. RESULTS The expression of LT enabled the series to be divided into two groups (LT positive, n = 55; LT negative, n = 37). Genes differentially expressed in LT-negative patients were related to epithelial differentiation, especially SOX9, or proliferation and the cell cycle (MYC, CDK6), among others. Congruently, LT displayed lower expression in SOX9-positive patients, and differentially expressed genes in SOX9-positive patients were related to epithelial/squamous differentiation. In LT-positive patients, the mean SNV frequency was 4.3; in LT-negative patients it was 10 (P = 0.03). On multivariate survival analysis, the expression of SNAI1 [hazard ratio (HR) 1.046, 95% confidence interval (CI) 1.007-1.086; P = 0.02] and CDK6 (HR 1.049, 95% CI 1.020-1.080; P = 0.001) were identified as risk factors. CONCLUSIONS Tumours with weak LT expression tend to co-express genes related to squamous differentiation and the cell cycle, and to have a higher mutational burden. These findings are congruent with those of earlier studies.
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Affiliation(s)
| | - Marta Rodríguez
- Pathology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
- Center for Biomedical Network on Cancer (CIBERONC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ruth Alonso-Alonso
- Pathology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
- Center for Biomedical Network on Cancer (CIBERONC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | | | - Jesús Frutos Díaz-Alejo
- Pathology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Marcos Rebollo-González
- Pathology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Jennifer Borregón
- Pathology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Laura Nájera Botello
- Pathology Department, Hospital Universitario Puerta de Hierro, Universidad Autónoma, Madrid, Spain
| | - Ignacio Mahillo-Fernández
- Biostatistics and Epidemiology Unit, Hospital Universitario Fundación Jiménez Díaz, Fundación Instituto de Investigación Sanitaria, Madrid, Spain
| | | | | | | | - Miguel Ángel Piris
- Pathology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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4
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Torre-Castro J, Ríos-Viñuela E, Balaguer-Franch I, Díaz de Lezcano I, Aguado-García Á, Nájera L, Suárez D, Requena L. Perineural Infiltration: A Comprehensive Review of Diagnostic, Prognostic, and Therapeutic Implications. Am J Dermatopathol 2024; 46:271-286. [PMID: 38457673 DOI: 10.1097/dad.0000000000002667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
ABSTRACT Perineural infiltration refers to a neoplastic cell involvement in, around, and through the nerves. It is considered as one of the neoplastic dissemination pathways. Thus, its identification is crucial to establish the prognosis of some malignant skin neoplasms, such as squamous cell carcinoma, and explains the locally aggressive behavior of cutaneous neoplasms, such as microcystic adnexal carcinoma. We have conducted a review of malignant and benign skin tumors in which perineural infiltration has been described, and we also discuss some histopathological findings that may simulate perineural infiltration.
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Affiliation(s)
- Juan Torre-Castro
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Elisa Ríos-Viñuela
- Department of Dermatology, Instituto Valenciano de Oncología, Escuela de Doctorado Universidad Católica de Valencia, Valencia, Spain
| | | | | | | | - Laura Nájera
- Department of Pathology, Puerta de Hierro University Hospital, Universidad Autónoma, Majadahonda, Madrid, Spain
| | - Dolores Suárez
- Department of Pathology, Puerta de Hierro University Hospital, Universidad Autónoma, Majadahonda, Madrid, Spain
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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5
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Recio-Monescillo M, Mendoza-Cembranos MD, Torre-Castro J, Moya-Martínez C, Ruffin-Vicente B, Díaz-Recuero JL, Córdoba R, López-Robles J, Pelayo I, Rodríguez-Pinilla M, Requena L. Ultrasound findings in case series of patients with primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder. J Eur Acad Dermatol Venereol 2024; 38:e320-e322. [PMID: 37907275 DOI: 10.1111/jdv.19597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/27/2023] [Indexed: 11/02/2023]
Affiliation(s)
| | | | - J Torre-Castro
- Dermatology Department, Fundación Jiménez Díaz Universitary Hospital, Madrid, Spain
| | | | - B Ruffin-Vicente
- Dermatology Department, Fundación Jiménez Díaz Universitary Hospital, Madrid, Spain
| | - J L Díaz-Recuero
- Dermatology Department, Fundación Jiménez Díaz Universitary Hospital, Madrid, Spain
| | - R Córdoba
- Hematology Department, Fundación Jiménez Díaz Universitary Hospital, Madrid, Spain
| | - J López-Robles
- Dermatology Department, Fundación Jiménez Díaz Universitary Hospital, Madrid, Spain
| | - I Pelayo
- Dermatology Department, Fundación Jiménez Díaz Universitary Hospital, Madrid, Spain
| | - M Rodríguez-Pinilla
- Pathological Anatomy Deparment, Fundación Jiménez Díaz Universitary Hospital, Madrid, Spain
| | - L Requena
- Dermatology Department, Fundación Jiménez Díaz Universitary Hospital, Madrid, Spain
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6
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Ríos-Viñuela E, Hoyas-Rodríguez I, Cullen-Aravena D, Martín-Broto J, Hindi N, Eraña I, Requena L. Hidradenitis suppurativa secondary to treatment with a gamma secretase inhibitor. J Eur Acad Dermatol Venereol 2024; 38:e219-e221. [PMID: 37793799 DOI: 10.1111/jdv.19544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/27/2023] [Indexed: 10/06/2023]
Affiliation(s)
- E Ríos-Viñuela
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - I Hoyas-Rodríguez
- Department of Endocrinology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - D Cullen-Aravena
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - J Martín-Broto
- Department of Medical Oncology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
- Instituto de Investigación Sanitaria Fundación Jiménez Diaz (IIS/FJD), Madrid, Spain
| | - N Hindi
- Department of Medical Oncology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
- Instituto de Investigación Sanitaria Fundación Jiménez Diaz (IIS/FJD), Madrid, Spain
| | - I Eraña
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - L Requena
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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Prieto-Torres L, Requena L, Rodríguez-Pinilla SM. Clinical, Histopathological and Molecular Spectrum of Cutaneous Lesions in Myelodysplastic Syndrome and Myeloproliferative Neoplasms (MDS/MPN): An Integrative Review. Cancers (Basel) 2023; 15:5888. [PMID: 38136431 PMCID: PMC10742063 DOI: 10.3390/cancers15245888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/07/2023] [Accepted: 12/16/2023] [Indexed: 12/24/2023] Open
Abstract
Myeloid neoplasms and acute leukemias include different entities that have been recently re-classified taking into account molecular and clinicopathological features. The myelodysplastic syndrome/myeloproliferative neoplasm (MDS/MPN) category comprises a heterogeneous group of hybrid neoplastic myeloid diseases characterized by the co-occurrence of clinical and pathological features of both myelodysplastic and myeloproliferative neoplasms. The most frequent entity in this category is chronic myelomonocytic leukemia (CMML) which is, after acute myeloid leukemia (AML), the main myeloid disorder prone to develop cutaneous manifestations. Skin lesions associated with myelodysplastic and myeloproliferative neoplasms include a broad clinical, histopathological and molecular spectrum of lesions, poorly understood and without a clear-cut classification in the current medical literature. The aim of this review is to describe and classify the main clinical, histopathological and molecular patterns of cutaneous lesions in the setting of MDS/MPN in order to improve the diagnostic skills of the dermatologists, hematologists and pathologists who deal with these patients.
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Affiliation(s)
- Lucía Prieto-Torres
- Department of Dermatology, Hospital Clínico Universitario Lozano Blesa, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, 28040 Madrid, Spain;
| | - Socorro Maria Rodríguez-Pinilla
- Department of Pathology, Fundación Jiménez Díaz, Universidad Autónoma, 50019 Zaragoza, Spain;
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28040 Madrid, Spain
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Díaz de la Pinta FJ, Moreno MR, Salgado RN, García NC, Santonja C, Buira SP, Piris MA, Requena L, Manso R, Rodríguez-Pinilla SM. Anaplastic Large Cell Lymphomas With The 6p25.3 Rearrangement Are A Heterogeneous Group Of Tumours With A Diverse Molecular Background. Hum Pathol 2023:S0046-8177(23)00102-8. [PMID: 37127078 DOI: 10.1016/j.humpath.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/03/2023]
Abstract
ALK-negative anaplastic large cell lymphoma (ALCL) cases with 6p25.3 rearrangement are characterized by peculiar morphological and immunohistochemical features compare to 6p25.3-negative ALK-negative ALCL cases. A subgroup of 6p25.3-positive ALK-negative ALCL cases show the t(6,7)(p25.3;q32.3) rearrangement. Aims: To analyse the differences between 6p25.3-rearranged cases with and without t(6,7)(p25.3;q32.3). Using RNA-sequencing we studied a series of 17 samples showing 6p25.3-rearrangement, identified by FISH, consisting of seven systemic and eight primary cutaneous cases including two examples of secondary skin involvement by systemic ALCL. RNA-sequencing exclusively detected a translocation involving a gene in the 6p25.3 region (either IRF4 or DUSP22) in 7/14 cases (50%). In six of these seven cases the partner proved to be the LINC-PINT region in chromosome 7, while an EXOC2::DUSP22 rearrangement was found in one case. All cases but one were primary cutaneous ALCLs. They all were CD3 positive and BCL2 negative, while most of them expressed p-STAT3. On the contrary, cases without the t(6,7)(p25.3;q32.3) were mainly systemic (71%, 5/7) against just two pcALCL. In general, they lose CD3 (50% positive) and p-STAT3 (25% positive) expression, being all of them BCL2 positive. Moreover, in 60% of them other gene fusions were found. At the transcriptional level, they were characterized by the overexpression of TCF3 (TCF7L1/E2A), DLL3, CD58 and BCL2 genes. 75%(6/8) of pcALCL with 6p25.3 rearrangement featured the so-called "biphasic morphologic pattern, which was not found in cutaneous involvement from systemic ALCL. 83% (5/6) of the pcALCL cases with the "biphasic morphologic pattern" showed the t(6,7)(p25.3;q32.3) rearrangement. ALK-negative ALCL cases with 6p25.3 rearrangement are a subgroup of tumours that are heterogeneous with respect to the presence or absence of the t(6,7)(p25.3;q32.3) translocation.
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Affiliation(s)
| | | | - Rocío Nieves Salgado
- Haematology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - Carlos Santonja
- Pathology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Sandra Pérez Buira
- Pathology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Miguel A Piris
- Pathology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Luis Requena
- Dermatology Department, Hospital Universitario, Fundación Jiménez Díaz, Madrid, Spain
| | - Rebeca Manso
- Pathology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
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Rodríguez-Cuadrado FJ, Nájera L, Suárez D, Silvestre G, García-Fresnadillo D, Roustan G, Sánchez-Vázquez L, Jo M, Santonja C, Garrido-Ruiz MC, Vicente-Montaña AM, Rodríguez-Peralto JL, Requena L. Clinical, histopathologic, immunohistochemical, and electron microscopic findings in cutaneous monkeypox: A multicenter retrospective case series in Spain. J Am Acad Dermatol 2023; 88:856-863. [PMID: 36581043 PMCID: PMC9794029 DOI: 10.1016/j.jaad.2022.12.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/22/2022] [Accepted: 12/16/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND The worldwide outbreak of monkeypox has evidenced the usefulness of the dermatologic manifestations for its diagnosis. OBJECTIVE To describe the histopathologic and immunohistochemical findings of monkeypox cutaneous lesions. METHODS This is a retrospective histopathologic and immunohistochemical study of 20 patients with positive Monkeypox virus DNA polymerase chain reaction and immunohistochemical positivity for Vaccinia virus in cutaneous lesions. Four cases were also examined by electron microscopy. RESULTS The most characteristic histopathologic findings consisted of full-thickness epidermal necrosis with hyperplasia and keratinocytic ballooning at the edges. In some cases, the outer root sheath of the hair follicle and the sebaceous gland epithelium were affected. Intraepithelial cytoplasmic inclusion bodies and scattered multinucleated keratinocytes were occasionally found. Immunohistochemically, strong positivity with anti-Vaccinia virus antibody was seen in the cytoplasm of ballooned keratinocytes. Electron microscopy study demonstrated numerous viral particles of monkeypox in affected keratinocytes. LIMITATIONS Small sample size. Electron microscopic study was only performed in 4 cases. CONCLUSION Epidermal necrosis and keratinocytic ballooning are the most constant histopathologic findings. Immunohistochemical positivity for Vaccinia virus was mostly detected in the cytoplasm of the ballooned keratinocytes. These findings support the usefulness of histopathologic and immunohistochemical studies of cutaneous lesions for diagnosis of monkeypox.
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Affiliation(s)
| | - Laura Nájera
- Department of Pathology, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma, Madrid, Spain
| | - Dolores Suárez
- Department of Pathology, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma, Madrid, Spain
| | - Gala Silvestre
- Department of Pathology, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma, Madrid, Spain
| | - Diego García-Fresnadillo
- Department of Pathology, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma, Madrid, Spain
| | - Gaston Roustan
- Department of Dermatology, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma, Madrid, Spain
| | - Laura Sánchez-Vázquez
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Margarita Jo
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Carlos Santonja
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | | | | | | | - Luis Requena
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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10
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Prieto-Torres L, Machan S, Haro R, Cerroni L, Requena L, Rodríguez-Pinilla SM. Concurrent Presentation of Mycosis Fungoides and Primary Cutaneous Marginal Zone LPD: Clinicopathological Study of 4 Cases and Literature Review. Am J Dermatopathol 2023; 45:163-169. [PMID: 36728288 DOI: 10.1097/dad.0000000000002378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Mycosis fungoides is rarely associated to B-cell malignancies, and the few reported cases are mainly internal lymphomas involving secondarily the skin (ie, chronic lymphocytic leukemia). OBJECTIVES The aim of our study is to describe the clinical and histopathological features of 4 patients presenting with 2 concurrent primary cutaneous lymphomas and review the pertinent literature. METHODS We identified 4 cases of concurrent primary cutaneous lymphomas in our institutions. An extracutaneous lymphoma was ruled out on the basis of a complete work out. We performed a PubMed search to identify reported cases of primary cutaneous composite or concurrent lymphomas. RESULTS Eleven cases of primary cutaneous concurrent lymphomas have been described in the literature. Counting all together (our cases and the cases previously described in the literature), mycosis fungoides was the most frequent primary cutaneous T-cell lymphoma (TCL) (13/15), followed by 1 case of peripheral TCL-NOS and 1 case of subcutaneous panniculitis-like TCL. Regarding the associated primary cutaneous B-cell lymphomas, 8/15 cases consisted of low-grade B-cell lymphomas [that is, 5 marginal zone lymphoma (in the most recent classification reclassified as marginal zone lymphoproliferative disorder, MZLD, 2 follicular-center B-cell lymphoma (primary cutaneous follicle-center lymphoma) and 1 low-grade NOS B-cell lymphoma]; 4/15 were associated to Epstein-Barr virus; 1 case consisted of a methotrexate-associated lymphoproliferative disease, and 2 cases consisted of primary cutaneous diffuse large B-cell lymphoma-leg type. CONCLUSIONS Primary cutaneous concurrent lymphomas are exceptional. Clinicopathological correlation and a complete workout to reach the correct diagnosis may guide the appropriate treatment in each case.
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Affiliation(s)
- Lucía Prieto-Torres
- Department of Dermatology, Hospital Clínico Universitario Lozano Blesa, Universidad de Zaragoza, Zaragoza, Spain
| | - Salma Machan
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Rosario Haro
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Lorenzo Cerroni
- Research Unit of Dermatopathology, Medical University of Graz, Graz, Austria; and
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Socorro María Rodríguez-Pinilla
- Department of Pathology, Fundación Jiménez Díaz, Universidad Autónoma, Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
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11
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Recio-Monescillo M, Torre-Castro J, Manzanas C, Ruffin B, Haya L, Rodríguez Pinilla M, Requena L. Papillary dermal elastolysis histopathology mimicking folliculotropic mycosis fungoides. J Cutan Pathol 2023; 50:430-433. [PMID: 36732062 DOI: 10.1111/cup.14402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/23/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023]
Abstract
Papillary dermal elastolysis is a rare acquired disease of the elastic tissue that mainly affects elderly women with a clinical presentation of small firm papules in the neck, the supraclavicular areas and the upper back. Histopathologically, it is characteristic to find a complete or almost complete absence of elastic fibers in the papillary dermis with stains such as orcein or Verhoeff-Van Gieson. We present the case of an adult female patient presenting a clinical picture of years of evolution of elastic skin-colored papules on her neck, occasionally pruritic. Two biopsies were performed. In one of them an inflammatory infiltrate affecting the hair follicles was observed, and she was diagnosed with mycosis fungoides. The other biopsy showed a total absence of elastic fibers in the papillary dermis and was diagnosed as elastolysis of the papillary dermis. In early stages of papillary dermal elastolysis, a perivascular and periadnexal lymphocytic inflammatory infiltrate has been described, as is the case described above. It is important for dermatopathologist to know this atypical but possible presentation, as it may require a differential diagnosis with other entities such as follicular mycosis fungoides.
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Affiliation(s)
| | - Juan Torre-Castro
- Dermatology Departments, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Carolina Manzanas
- Dermatology Departments, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Belen Ruffin
- Dermatology Departments, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Lara Haya
- Dermatology Departments, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | | | - Luis Requena
- Dermatology Departments, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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Prieto-Pérez L, Vicente Montaña AM, Santonja C, Fortes J, García-Fresnadillo D, Jo-Velasco M, Requena L, Cabello A, Fernández-Roblas R, Álvarez B, Carrillo I, Górgolas M. Clinical, histopathological and ultrastructural features of human monkeypox infection in the 2022 outbreak: report of a case with immunohistochemistry for vaccinia virus. Clin Exp Dermatol 2023; 48:60-63. [PMID: 36669191 DOI: 10.1093/ced/llac020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 01/21/2023]
Abstract
We provide a full description of the clinical, histopathological, immunohistochemical and ultrastructural features of the current human monkeypox virus. A skin snip was obtained in a HIV-infected patient in the wake of the monkeypox outbreak in Spain. Immunohistochemistry was strongly positive for anti-vaccinia virus. Under electron microscopy, mature viruses and virions were clearly visible.
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Affiliation(s)
- L Prieto-Pérez
- University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - A M Vicente Montaña
- ICTS-National Centre of Electron Microscopy, Complutense University of Madrid, Spain
| | - C Santonja
- University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - J Fortes
- University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | | | - M Jo-Velasco
- University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - L Requena
- University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - A Cabello
- University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | | | - B Álvarez
- University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - I Carrillo
- University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - M Górgolas
- University Hospital Fundación Jiménez Díaz, Madrid, Spain
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13
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Machan S, Alonso-Dominguez JM, Sánchez García FJ, Nieves Salgado R, Soto C, Castro Y, Pajares R, Manso R, Santonja C, Serrano Del Castillo C, Piris MA, Requena L, Rodríguez Pinilla SM. Plasmacytoid Dendritic Cell Dermatosis Associated to Myeloproliferative/Myelodysplastic Neoplasms. Am J Surg Pathol 2022; 46:1623-1632. [PMID: 36001453 DOI: 10.1097/pas.0000000000001960] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cutaneous lesions in the setting of myeloproliferative neoplasms and myelodysplastic syndromes are poorly understood. We report 6 patients with pruritic papular eruptions composed of mature T-lymphocytes with large clusters of CD123-positive cells. Double immunohistochemical studies demonstrated a lack of myeloid cell nuclear differentiation antigen in the CD123-positive cells, which expressed SPIB, confirming that they were mature plasmacytoid dendritic cells. Four patients were diagnosed with chronic myelomonocytic leukemia and 2 with myelodysplastic syndromes (AREB-I and myelodysplastic syndromes with 5q deletion, respectively). All patients had a long history of hematological alterations, mainly thrombocytopenia, preceding the cutaneous disorder. Nevertheless, the skin lesions developed in all cases coincidentally with either progression or full-establishment of their hematological disease. Most cutaneous lesions disappeared spontaneously or after corticosteroid treatment. Molecular studies performed in both bone marrow and cutaneous lesions in 2 patients demonstrated the same mutational profile, confirming the specific, neoplastic nature of these mature plasmacytoid dendritic cells-composed cutaneous lesions.
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Affiliation(s)
| | | | | | | | | | - Yolanda Castro
- Pathology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Raquel Pajares
- Pathology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Rebeca Manso
- Pathology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Carlos Santonja
- Pathology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
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14
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Torre-Castro J, Nájera L, Salgüero I, Requena L. Bowen Disease Within a Circumscribed Palmar Hypokeratosis. Am J Dermatopathol 2022; 44:961-963. [PMID: 36075575 DOI: 10.1097/dad.0000000000002293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Circumscribed palmar or plantar hypokeratosis is a focal disorder of keratinization that consists of a reduction in the thickness of the corneal layer of the epidermis of palms or soles. Although it is considered a benign entity, the thinning of the stratum corneum facilitates ultraviolet damage in the affected skin, which may result in an increased risk of developing focal epidermal dysplasia. Other factors, such as immunosuppression in transplanted patients, may play a role as well. We present a case of circumscribed palmar or plantar hypokeratosis with features of Bowen disease limited to the hypokeratotic epidermis.
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Affiliation(s)
- Juan Torre-Castro
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain; and
| | | | - Irene Salgüero
- Dermatology, Puerta de Hierro University Hospital, Universidad Autónoma, Madrid, Spain
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain; and
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15
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Santonja C, Sánchez-García FJ, Rodríguez-Rodríguez RN, Manso R, Requena L, Gil-Mateo MDP, Rodríguez-Pinilla SM. Double CD4/CD8-Positive, Nonpoikilodermic Mycosis Fungoides Expressing CD56 in a Young Man. Am J Dermatopathol 2022; 44:936-939. [PMID: 35925554 DOI: 10.1097/dad.0000000000002259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT We report a case of mycosis fungoides (MF) in an 18-year-old man whose neoplastic T cells expressed CD4, CD8, and CD56, with no evidence of TCR-delta or Epstein-Barr virus (EBER) expression. Clinically, neither hypopigmentation nor hyperpigmentation nor poikilodermatous skin lesions were present, and the lesions subsided with oral corticoids and retinoids and environmental solar ultraviolet exposure. Our case represents the oldest patient reported so far with nonpoikilodermatous, CD8/CD56 MF and adds to the phenotypic diversity of MF in the pediatric population. This distinct phenotype does not seem to be linked to a more aggressive course than the classic CD-4 positive one.
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Affiliation(s)
- Carlos Santonja
- PathologyDepartment, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Rebeca Manso
- PathologyDepartment, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Luis Requena
- DermatologyDepartment, Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain; and
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Carrasco L, Torre-Castro J, Ortiz S, Cuevas Santos J, Jo M, Rodríguez Peralto JL, Beer T, Requena L. Median raphe cysts: A clinico-pathologic and immunohistochemical study of 52 cases. J Cutan Pathol 2022; 50:536-543. [PMID: 36442871 DOI: 10.1111/cup.14367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/01/2022] [Accepted: 11/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Median raphe cysts (MRC) are epithelial-lined cystic lesions of the genital area that do not communicate with the urethra or the overlying epidermis. Immunohistochemically, MRC show positivity for cytokeratin (CK) 5-6, CK 7, carcinoembryonic antigen, p63 and uroplakin III (URO III). GATA3 and human milk fat globulin 1 (HMFG1) are immunohistochemical markers that have been not previously studied in MRC. METHODS We conducted a study of 52 patients diagnosed with MRC in the Pathology Departments of eight hospitals between 1990 and 2016. The monoclonal antibodies used were CK5-6, CK7, CK20, URO III, p63, GATA3, and HMFG1. HMFG1 was studied in five cases of apocrine hidrocystomas and compared with five cases of MRC from our series. RESULTS CK 5-6, CK7, and p63 expression showed strong positivity in the urothelial epithelium of 48 cases. CK20 was focally positive in areas of mucinous differentiation in three cases. GATA3 showed intense nuclear staining in 30 cases. HMFG1 was positive in three cases of MRC and in three cases of apocrine hidrocystoma. CONCLUSION Positivity of GATA3 and CK7 in MRC supports the urothelial origin of these cysts. We found no differences in HMFG1 expression between MRC and apocrine hidrocystomas.
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Affiliation(s)
- Loreto Carrasco
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Juan Torre-Castro
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Sebastián Ortiz
- Department of Pathology, Hospital General Universitario Santa Lucia, Cartagena, Murcia, Spain
| | - Jesús Cuevas Santos
- Department of Pathology, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Margarita Jo
- Department of Pathology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | | | | | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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17
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Machado I, Hosler GA, Traves V, Claramunt R, Sanmartín O, Santonja C, Carvajal N, Zazo S, Requena L, Alfonso VS, Domenech EV, Llombart‐Bosch A, Bridge JA, Linos K. Superficial
GLI1
‐amplified mesenchymal neoplasms: Expanding the spectrum of an emerging entity which reaches the realm of dermatopathology. J Cutan Pathol 2022; 50:487-499. [PMID: 36316249 DOI: 10.1111/cup.14345] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/26/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Abstract
Mesenchymal neoplasms with GLI1 alterations (rearrangements and/or amplification) have been reported recently in several anatomic locations, which include head and neck, soft tissue, and gastrointestinal tract. Herein, to the best of our knowledge, we describe the first three cases of superficial/subcutaneous mesenchymal neoplasm with GLI1 amplification. The neoplasms exhibited low-grade cytologic features with predominant round cell morphology, glomangioma-like areas and a rich background capillary network. There were two to three mitotic figures per 10 HPF and focal necrosis in one case. The tumors exhibited variable expression of CDK4, MDM2, STAT6, D2-40, CD56 and cyclin D1. p16 had strong and diffuse nuclear and cytoplasmic expression in two cases. Numerous other stains were negative. Fluorescence in situ hybridization detected GLI1, DDIT3, and CDK4 coamplification in all cases, while next generation sequencing did not detect a GLI1 gene fusion. The overall features were compatible with a GLI1-amplified mesenchymal neoplasm. In Case 1 a new distant skin lesion appeared 1 month after the surgery exhibiting similar morphology albeit with a higher mitotic index. In Cases 2 and 3, there is no evidence of local recurrence or systemic disease after 8 years and 1 month of follow-up, respectively. These new cases of superficial GLI1-amplified neoplasm expand its clinical spectrum and enter the realm of dermatopathology. The combination of CDK4, cyclin D1, D2-40, and p16 expression with variable MDM2, STAT6, CD56, and S100 immunoreactivity in a low-grade neoplasm with round/ovoid cytomorphology resembling a vascular or adnexal neoplasm may suggest the possibility of GLI1-amplified neoplasm.
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Affiliation(s)
- Isidro Machado
- Pathology Department, Instituto Valenciano de Oncología Valencia Spain
- Pathology Department, Patologika Laboratory, Hospital QuironSalud Valencia Spain
| | - Gregory A. Hosler
- Dermatopathology, ProPath, Dallas, TX. University of Texas Southwestern, Department of Dermatology
| | - Victor Traves
- Pathology Department, Instituto Valenciano de Oncología Valencia Spain
| | - Reyes Claramunt
- Laboratory of Molecular Biology, Instituto Valenciano de Oncología Valencia Spain
| | - Onofre Sanmartín
- Department of Dermatology Instituto Valenciano de Oncología Valencia Spain
| | | | - Nerea Carvajal
- Pathology Department Fundación Jiménez Díaz Madrid Spain
| | - Sandra Zazo
- Pathology Department Fundación Jiménez Díaz Madrid Spain
| | - Luis Requena
- Dermatology Department Fundación Jiménez Díaz Madrid Spain
| | | | | | | | - Julia A. Bridge
- Department of Pathology and Microbiology University of Nebraska Medical Center Omaha NE USA
- Division of Molecular Pathology, ProPath Dallas TX USA
| | - Konstantinos Linos
- Memorial Sloan Kettering Cancer Center, Department of Pathology & Laboratory Medicine New York NY USA
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18
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Nirenberg MS, Requena L, Santonja C, Smith GT, McClain SA. Histopathology of Persistent Long COVID Toe: A Case Report. J Cutan Pathol 2022; 49:791-794. [PMID: 35366017 PMCID: PMC9111773 DOI: 10.1111/cup.14240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 11/30/2022]
Abstract
During the 2020 coronavirus (SARS-CoV-2) pandemic, several cutaneous lesions were identified, including: pseudo-chilblain, vesicular, urticarial, maculopapular, and livedo/necrosis. A 59-year-old obese man with probable COVID-19 developed painful cyanosis with histopathologic capillary thrombosis of toes, and the cyanosis persisted for nearly 22 months. Shortly after initial exposure to family members with documented SARS-CoV-2, he developed upper respiratory symptoms, yet his anti-SARS-CoV-2 antibody and nasal swab RT-PCR tests were repeatedly negative. Two family members were hospitalized and one of them succumbed with documented SARS-CoV-2 pneumonia within ten days of exposure. Biopsy of the distal toe 16 weeks after initial exposure demonstrated papillary dermal capillary thrombosis with endothelial swelling, telangiectasia, and peri-eccrine lymphocytic infiltrates resembling pernio. Overall, this is the first case of biopsy of "long COVID toe" following presumed SARS-Cov-2 exposure, with demonstration of thrombotic vasculopathy, toe cyanosis, and pernio-like pathology. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Luis Requena
- Hospital Universitario Fundación Jiménez Díaz, Department of Dermatology, Madrid, ES
| | - Carlos Santonja
- Hospital Universitario Fundación Jiménez Díaz, Department of Pathology, Madrid, ES
| | - Gregory T Smith
- Stony Brook University, Department of Pharmacological Sciences, Stony Brook, NY
| | - Steve A McClain
- Stony Brook University, Departments of Dermatology and Emergency Medicine, Stony Brook, NY
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19
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Ríos-Viñuela E, Manrique-Silva E, Nagore E, Nájera-Botello L, Requena L, Requena C. [Translated article] Subungual Melanocytic Lesions in Pediatric Patients. Actas Dermo-Sifiliográficas 2022. [DOI: 10.1016/j.ad.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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20
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Ríos-Viñuela E, Manrique-Silva E, Nagore E, Nájera-Botello L, Requena L, Requena C. Subungual Melanocytic Lesions in Pediatric Patients. Actas Dermosifiliogr 2022; 113:388-400. [PMID: 35623729 DOI: 10.1016/j.ad.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 01/07/2023] Open
Abstract
The study of subungual melanocytic lesions can present challenges because of the clinical and histologic characteristics of the nail unit and the difficulty of performing nail biopsies and processing specimens. These lesions can be even more challenging in children due to differences in clinical and epidemiological profiles between the adult and pediatric populations. Many of the clinical features of subungual melanocytic lesions that would raise alarm in an adult do not have the same implications in children. Consensus is also lacking on when a nail biopsy is needed to rule out malignancy in the pediatric setting. In view of these considerations and the rarity of subungual melanoma in childhood, the recommended approach in most cases is a watch-and-wait strategy. Subungual melanocytic lesions in children may also show atypical histopathologic features that are not necessarily associated with aggressive behavior. Subungual melanoma is very rare in childhood, with just 21 cases described to date. None of the patients developed visceral metastasis or died as a result and the diagnosis was controversial in many of the cases. Considering the above and the significantly higher frequency and particular characteristics of longitudinal melanonychia with a benign etiology in children, subungual melanocytic lesions should be managed differently in this setting than in adults. In most cases, a watch-and-wait approach is the most appropriate strategy.
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Affiliation(s)
- E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España.
| | - E Manrique-Silva
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - E Nagore
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - L Nájera-Botello
- Servicio de Anatomía Patológica, Hospital Universitario Puerta del Hierro, Madrid, España
| | - L Requena
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, España
| | - C Requena
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
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21
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Torre-Castro J, Moya-Martínez C, Haya-Martínez L, Mendoza-Cembranos MD, Eraña-Tomás I, Requena L. Pigmented epidermotropic breast cancer metastases: A rare variant with a particularly unusual feature. J Cutan Pathol 2022; 49:99-102. [PMID: 34519091 DOI: 10.1111/cup.14132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/26/2022]
Abstract
Pigmented epidermotropic breast cancer metastases are a rarity, often clinically misdiagnosed as melanocytic lesions. Histopathologically, they show a dermal proliferation of neoplastic metastatic cells that extend to the overlying epidermis in a pattern identical to that seen in primary Paget disease (PD). Differential diagnosis should be established with entities with a similar presentation, such as pigmented mammary PD and malignant melanoma. Immunohistochemistry may be useful for this purpose. We present a new case of pigmented epidermotropic breast cancer metastases with a particularly unusual feature: the absence of dermal infiltration by neoplastic cells, thus considered as pure epidermotropic metastatic involvement.
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Affiliation(s)
- Juan Torre-Castro
- Dermatology Department, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Cristina Moya-Martínez
- Dermatology Department, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Lara Haya-Martínez
- Dermatology Department, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | | | - Itziar Eraña-Tomás
- Pathology Department, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Luis Requena
- Dermatology Department, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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22
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Machado I, Alcacer Fernández-Coronado J, Requena C, Través V, Latorre Martínez N, Ortega J, Requena L, Alcacer García J. [Cutaneous Rosai-Dorfman disease with lack of BRAF-V600, KRAS or NRAS mutations: A reactive or neoplastic disorder?]. Rev Esp Patol 2022; 55:52-56. [PMID: 34980442 DOI: 10.1016/j.patol.2019.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/21/2019] [Accepted: 03/24/2019] [Indexed: 06/14/2023]
Abstract
Non-Langerhans cell histiocytosis, including Rosai-Dorfman disease (RDD) and xanthogranuloma are rare disorders with occasional overlapping in the histopathological and immunohistochemical (IHC) findings. We report the case of a 53-year-old woman with erythematous-violaceous plaques on the cheeks and edema in the auricular pavilions. A biopsy was performed and the histopathological examination revealed a histiocytic proliferation with emperipolesis characteristic of RDD and lymphoplasmocitic infiltrate. IHC analysis showed S100 and CD68 positivity in the histiocytes but was negative for CD1a, supporting the diagnosis of RDD. Molecular analysis failed to detect BRAF-V600, NRAS or KRAS mutation. We discuss the differential diagnosis of cutaneous non-Langerhans cell histiocytosis. Pathologist must be aware of unusual presentations of RDD and further treatment options must be explored for patients with unresectable lesions and/or resistance to the classical management of RDD.
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Affiliation(s)
- Isidro Machado
- Departamento de Patología, Instituto Valenciano de Oncología, Valencia, España; Laboratorio Patologika, Hospital Quirón, Valencia, España.
| | | | - Celia Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - Victor Través
- Departamento de Patología, Instituto Valenciano de Oncología, Valencia, España
| | | | - José Ortega
- Departamento de Patología, Hospital Quirón Torrevieja, Torrevieja, Alicante, España
| | - Luis Requena
- Servicio de Dermatología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
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23
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Fernández‐Figueras M, Malvehi J, Tschandl P, Rutten A, Rongioletti F, Requena L, Kittler H, Kerl K, Kazakov D, Cribier B, Calonje E, André J, Kempf W, Cardoso J, Filosa A, Hetzer S, Kervarrec T, Llamas‐Velasco M, Valeska Matter A, Rickaby W, Saggini A, Vandersleyen V. Position paper on a simplified histopathological classification of basal cell carcinoma: results of the European Consensus Project. J Eur Acad Dermatol Venereol 2021; 36:351-359. [DOI: 10.1111/jdv.17849] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/11/2021] [Indexed: 12/26/2022]
Affiliation(s)
- M.T. Fernández‐Figueras
- Department of Pathology Hospital Universitari General de Catalunya Grupo Quironsalud & Universitat Internacional de Catalunya Sant Cugat del Vallés Spain
| | - J. Malvehi
- Department of Dermatology Hospital Clínic de Barcelona (Melanoma Unit) University of Barcelona IDIBAPS Barcelona & CIBERER Barcelona Spain
| | - P. Tschandl
- Department of Dermatology Medical University of Vienna Vienna Austria
| | - A. Rutten
- Dermatopathology Practice Friedrichshafen/Lake Constance Friedrichshafen Germany
| | - F. Rongioletti
- Dermatology Clinic IRCCS San Raffaele Hospital Vita Salute University Milan Italy
| | - L. Requena
- Department of Dermatology Fundación Jiménez Díaz Universidad Autónoma Madrid Spain
| | - H. Kittler
- Department of Dermatology Medical University of Vienna Vienna Austria
| | - K. Kerl
- Department of Dermatology University Hospital Zürich Zürich Switzerland
| | - D. Kazakov
- Sikl's Department of Pathology Medical Faculty in Pilsen Charles University in Prague Pilsen Czech Republic
| | - B. Cribier
- Dermatology Department University Hospital Strasbourg France
| | - E. Calonje
- St John's Institute of Dermatology St Thomas Hospital London UK
| | - J. André
- Department of Dermatology Centre Hospitalier Universitaire Saint‐Pierre Université Libre de Bruxelles Brussels Belgium
| | - W. Kempf
- Kempf Pfaltz Histologische Diagnostik Zurich Switzerland
- Department of Dermatology University Hospital Zurich Zürich Switzerland
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24
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Moya-Martínez C, Haya-Martínez L, Fuertes-Vega L, Santonja C, Requena L. Co-occurring features of scurvy and phrynoderma in the same patient. JAAD Case Rep 2021; 19:14-17. [PMID: 34901361 PMCID: PMC8640163 DOI: 10.1016/j.jdcr.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Lara Haya-Martínez
- Dermatology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Laura Fuertes-Vega
- Dermatology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Carlos Santonja
- Pathology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Luis Requena
- Dermatology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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25
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Salgüero I, Roustán G, Requena L, Suárez D, García-Fresnadillo D, Redondo JI, Nájera L. Immunophenotypic Differences in Tumor-Infiltrating Lymphocytes and Neovascularization Between Primary Cutaneous Melanoma With and Without Metastasis: An Immunohistochemical Study of 80 Cases. Am J Dermatopathol 2021; 43:811-818. [PMID: 33534211 DOI: 10.1097/dad.0000000000001907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The prognostic implications of the immunophenotype of the tumor-infiltrating lymphocytes (TILs) in primary cutaneous melanoma are well known. In recent years, the study of this immunophenotype has also resulted in immunotherapeutic consequences. The aims of this study were to characterize the subpopulations of TILs in primary cutaneous melanoma, in cases with and without metastasis, as well as the neovascularization associated with the primary neoplasm, and its influence on the development of metastasis. To this end, the immunophenotype of TILs and the neovascularization of 80 patients with primary cutaneous melanoma (40 each with metastatic and non-metastatic melanoma) were analyzed by immunohistochemistry for CD3, CD4, CD8, FOXP3, PD-1, CD31, and D2-40 antibodies. We found that higher frequencies of TILs with brisk pattern, and CD4+, CD8+, and CD20+ cells in TILs, and a lower frequency of CD31+ vessels were histopathological features associated with better prognosis in primary cutaneous melanoma. Our results support the notion that the immunohistochemical study of TILs and neovascularization in primary cutaneous melanoma may be helpful tools for identifying patients at increased risk of metastasis development.
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Affiliation(s)
- Irene Salgüero
- Department of Dermatology, Puerta de Hierro University Hospital, Universidad Autónoma, Majadahonda, Madrid, Spain
| | - Gaston Roustán
- Department of Dermatology, Puerta de Hierro University Hospital, Universidad Autónoma, Majadahonda, Madrid, Spain
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Dolores Suárez
- Department of Pathology, Puerta de Hierro University Hospital, Universidad Autónoma, Majadahonda, Madrid, Spain ; and
| | - Diego García-Fresnadillo
- Department of Pathology, Puerta de Hierro University Hospital, Universidad Autónoma, Majadahonda, Madrid, Spain ; and
| | | | - Laura Nájera
- Department of Pathology, Puerta de Hierro University Hospital, Universidad Autónoma, Majadahonda, Madrid, Spain ; and
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Diaz De La Pinta FJ, Eraña I, Jo Velasco M, Diaz Recuero JL, Requena L. Hyperkeratosis lenticularis perstans (Flegel disease) with back and breast involvement. J Cutan Pathol 2021; 48:1525-1527. [PMID: 34418134 DOI: 10.1111/cup.14123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 07/13/2021] [Accepted: 08/12/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Itziar Eraña
- Department of Pathology, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | - Margarita Jo Velasco
- Department of Pathology, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | | | - Luis Requena
- Department of Dermatology, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
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27
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Machan S, Rodriguez M, Manso R, Borregon J, Chamizo C, Alonso‐Alonso R, Pérez Buira S, Rodríguez‐Peralto JL, Cerroni L, Cereceda L, Córdoba R, Án. Piris M, Requena L, María Rodríguez‐Pinilla S. SUBCUTANEOUS PANNICULITIS‐LIKE T‐CELL LYMPHOMA: MOLECULAR AND MUTATIONAL CHARACTERIZATION COMPARED WITH LUPUS PANNICULITIS AND HISTOPATHOLOGIC OVERLAPPING CASES. Hematol Oncol 2021. [DOI: 10.1002/hon.138_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S Machan
- Fundación Jiménez Díaz‐Universidad Autónoma de Madrid, Dermatology Madrid Spain
| | - M Rodriguez
- Fundación Jiménez Díaz, Pathology Madrid Spain
| | - R Manso
- Fundación Jiménez Díaz, Pathology Madrid Spain
| | - J Borregon
- Fundación Jiménez Díaz, Pathology Madrid Spain
| | - C Chamizo
- Fundación Jiménez Díaz, Pathology Madrid Spain
| | | | | | | | - L Cerroni
- Medical University of Graz, Dermatology Graz Austria
| | - L Cereceda
- Fundación Jiménez Díaz, Pathology Madrid Spain
| | - R Córdoba
- Fundación Jiménez Díaz, Hematology Madrid Spain
| | - M Án. Piris
- Fundación Jiménez Díaz, Pathology Madrid Spain
| | - L Requena
- Fundación Jiménez Díaz‐Universidad Autónoma de Madrid, Dermatology Madrid Spain
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28
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Ríos-Viñuela E, Nájera-Botello L, Requena L, Nagore E, Requena C. Subungual Melanocytic Lesions: Key Clinical and Pathologic Concepts and Biopsy Techniques. Actas Dermosifiliogr (Engl Ed) 2021; 112:S1578-2190(21)00166-9. [PMID: 34053897 DOI: 10.1016/j.adengl.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/26/2020] [Indexed: 11/15/2022] Open
Abstract
Both dermatologists and pathologists sometimes find daunting the evaluation of melanonychia (especially subungual melanocytic lesions) because of the fear of performing nail surgery due to the risk of dystrophy, difficulties processing and interpreting nail biopsy specimens, and a general lack of experience in the field. Nevertheless, mastery of nail biopsy techniques, correct processing and orientation of specimens, and familiarity with the histologic particularities of the nail apparatus can attenuate the undoubted complexity and facilitate the tasks involved. Longitudinal excision is the biopsy technique that ensures the simplest histologic interpretation, and it is associated with a low risk of nail dystrophy when performed correctly. Clinical and epidemiological data are crucial. Subungual melanoma in childhood, for instance, is very rare and even lesions with atypical clinical and/or histologic features are probably benign. The presence of suprabasal melanocytes and other findings that would suggest malignancy at other sites are considered normal in the nail apparatus. Subungual melanoma shows a lentiginous pattern in the early stages of disease, and detection of an inflammatory infiltrate accompanying atypical lentiginous subungual lesions would appear to be one of the first diagnostic findings.
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Affiliation(s)
- E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, Spain.
| | - L Nájera-Botello
- Servicio de Anatomía Patológica, Hospital Universitario Puerta del Hierro, Madrid, Spain
| | - L Requena
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, Spain
| | - E Nagore
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - C Requena
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
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29
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Machan S, Rodríguez M, Alonso-Alonso R, Manso R, Pérez-Buira S, Borregón J, Rodríguez-Peralto JL, Cerroni L, Haro R, García C, García Toro E, Estrach T, García-Herrera A, Ferrer B, González-Cruz C, Segues N, Afonso-Martin JL, Peñate Y, Monteagudo C, Limeres-Gonzalez MÁ, González-Núñez MÁ, Torres MÁTN, Cereceda L, Córdoba R, Piris MÁ, Requena L, María Rodríguez-Pinilla S. Subcutaneous panniculitis-like T-cell lymphoma, lupus erythematosus profundus, and overlapping cases: molecular characterization through the study of 208 genes. Leuk Lymphoma 2021; 62:2130-2140. [PMID: 33966586 DOI: 10.1080/10428194.2021.1901098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare cytotoxic cutaneous lymphoma. Differential diagnosis with lupus erythematosus panniculitis (LEP) can be challenging and overlapping cases have been described. In this study, we investigate whether gene expression profiling may or not identify markers that can be used to improve our understanding of the disease and to make a precise differential diagnosis. SPTCL, LEP, and overlapping cases were analyzed using a customized NanoString platform including 208 genes related to T-cell differentiation, stromal signatures, oncogenes, and tumor suppressor genes. Gene expression unsupervised analysis of the samples differentiated SPTCL from LEP samples. Most overlapping cases were clustered with LEP cases. Differentially expressed genes were observed when comparing SPTCL with LEP cases; and overlapping with LEP cases. Gene set enrichment analysis recognized gene sets defining each group. In conclusion, SPTCL and LEP have distinctive molecular profiles and the molecular background of overlapping cases more closely resembles LEP.
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Affiliation(s)
- Salma Machan
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Marta Rodríguez
- Department of Pathology, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain.,CIBERONC (Centro de Investigación Biomédica en Red de Cáncer), Madrid, Spain
| | - Ruth Alonso-Alonso
- Department of Pathology, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain.,CIBERONC (Centro de Investigación Biomédica en Red de Cáncer), Madrid, Spain
| | - Rebeca Manso
- Department of Pathology, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain.,CIBERONC (Centro de Investigación Biomédica en Red de Cáncer), Madrid, Spain
| | - Sandra Pérez-Buira
- Department of Pathology, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain.,CIBERONC (Centro de Investigación Biomédica en Red de Cáncer), Madrid, Spain
| | - Jennifer Borregón
- Department of Pathology, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain.,CIBERONC (Centro de Investigación Biomédica en Red de Cáncer), Madrid, Spain
| | | | - Lorenzo Cerroni
- Department of Dermatology, Dermatopathology Research Unit, Medical University of Graz, Graz, Austria
| | - Rosario Haro
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | | | | | | | | | - Nerea Segues
- Hospital Universitario Donostia, San Sebastián, Spain
| | - Juan Luis Afonso-Martin
- Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - Yeray Peñate
- Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - Carlos Monteagudo
- Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | | | | | | | - Laura Cereceda
- Department of Pathology, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain.,CIBERONC (Centro de Investigación Biomédica en Red de Cáncer), Madrid, Spain
| | - Raúl Córdoba
- Department of Hematology, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Miguel Ángel Piris
- Department of Pathology, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain.,CIBERONC (Centro de Investigación Biomédica en Red de Cáncer), Madrid, Spain
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Socorro María Rodríguez-Pinilla
- Department of Pathology, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain.,CIBERONC (Centro de Investigación Biomédica en Red de Cáncer), Madrid, Spain
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30
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Moya-Martínez C, Núñez-Hipólito L, Barrio-González S, Santonja C, Jo-Velasco M, Lorda-Sánchez I, Fariña-Sabaris MC, Requena L. Azathioprine hypersensitivity syndrome: report of two cases with cutaneous manifestations. Clin Exp Dermatol 2021; 46:1097-1101. [PMID: 33713349 DOI: 10.1111/ced.14643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/06/2021] [Accepted: 03/11/2021] [Indexed: 11/28/2022]
Abstract
Azathioprine is an immunosuppressant drug used in many dermatological and nondermatological pathologies. Azathioprine hypersensitivity syndrome (AHS) is a rare idiosyncratic reaction that is not related to dose or thiopurine methyltransferase activity. Up to half of cases of AHS can present with variable cutaneous manifestations besides fever, malaise and other systemic symptoms. It is important to be aware of AHS, as continuance or reintroduction of the drug can led to multiorgan failure and cardiovascular collapse.
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Affiliation(s)
- C Moya-Martínez
- Departments of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - L Núñez-Hipólito
- Departments of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - S Barrio-González
- Gastroenterology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - C Santonja
- Pathology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - M Jo-Velasco
- Pathology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - I Lorda-Sánchez
- Genetics, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - M C Fariña-Sabaris
- Departments of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - L Requena
- Departments of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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31
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Cieza-Díaz DE, Machan S, Prieto-Torres L, Requena L, Córdoba R. Romidepsin in combination with low-dose methotrexate in advanced-stage mycosis fungoides and Sézary syndrome. Dermatol Ther 2021; 34:e14952. [PMID: 33724662 DOI: 10.1111/dth.14952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/15/2021] [Accepted: 03/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Salma Machan
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Lucía Prieto-Torres
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Luis Requena
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Raúl Córdoba
- Department of Haematology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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32
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Affiliation(s)
- Lucía Núñez-Hipólito
- Dermatology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - Luis Requena
- Dermatology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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33
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Hsu CH, Requena L, LeBoit PE, Gernez Y. Masquerader of Lip Angioedema After Lip Injection. J Allergy Clin Immunol Pract 2021; 9:2472-2473. [PMID: 33664002 DOI: 10.1016/j.jaip.2020.12.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Chih-Hsin Hsu
- Division of Allergy and Immunology, Department of Pediatrics, Stanford School of Medicine, Stanford, Calif.
| | - Luis Requena
- Department of Dermatology, Universidad Autonoma, Madrid, Spain
| | - Philip E LeBoit
- Department of Dermatopathology and Oral Pathology, UCSF, San Francisco, Calif
| | - Yael Gernez
- Division of Allergy and Immunology, Department of Pediatrics, Stanford School of Medicine, Stanford, Calif.
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34
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Moya-Martínez C, Torre-Castro J, Fariña-Sabarís MC, Santiago Sánchez-Mateos D, Eraña-Tomás I, Jo-Velasco M, Requena L. Cutaneous eruption with reactive endothelial atypia due to emerging targeted cancer therapies: Report of two cases with clinico-pathologic correlation. J Cutan Pathol 2021; 48:789-794. [PMID: 33576042 DOI: 10.1111/cup.13981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/27/2021] [Accepted: 02/05/2021] [Indexed: 12/13/2022]
Abstract
Targeted anticancer therapy is being used with greater frequency and dermatologic toxicities are among the most frequent adverse events of these drugs. However, histopathological features of these adverse events are not yet well characterized. We present two cases of clinically different cutaneous toxicities on two patients with hematologic neoplasia. They were treated with different drugs and in both cases medications shared inhibition of PI3K as mechanism of action. The skin biopsy specimen showed endothelial cell atypia with large nuclei and mitotic figures. To the best of our knowledge, no other cases with these striking histopathologic findings have been reported with PI3K inhibitors or other anticancer targeted therapy.
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Affiliation(s)
| | - Juan Torre-Castro
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Itziar Eraña-Tomás
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Margarita Jo-Velasco
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Luis Requena
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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35
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Torre-Castro J, Moya-Martínez C, Mendoza-Cembranos MD, Macías-Del-Toro E, Díaz-Recuero JL, Machan S, Rodríguez-Pinilla M, Córdoba R, Alfageme F, Roustan G, Nájera-Botello L, Requena L. Sonographic appearance of primary cutaneous B-cell lymphomas. Int J Dermatol 2021; 60:1156-1158. [PMID: 33555609 DOI: 10.1111/ijd.15444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/26/2020] [Accepted: 01/12/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Juan Torre-Castro
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Cristina Moya-Martínez
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Maria D Mendoza-Cembranos
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Elena Macías-Del-Toro
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Jose L Díaz-Recuero
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Salma Machan
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - María Rodríguez-Pinilla
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Raul Córdoba
- Department of Hematology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Fernando Alfageme
- Department of Dermatology, Hospital Puerta de Hierro, Majadahonda, Spain
| | - Gaston Roustan
- Department of Dermatology, Hospital Puerta de Hierro, Majadahonda, Spain
| | | | - Luis Requena
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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36
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Ríos-Viñuela E, Nájera-Botello L, Requena L, Nagore E, Requena C. Subungual Melanocytic Lesions: Key Clinical and Pathologic Concepts and Biopsy Techniques. Actas Dermosifiliogr (Engl Ed) 2021; 112:S0001-7310(21)00003-X. [PMID: 33465340 DOI: 10.1016/j.ad.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/11/2020] [Accepted: 12/26/2020] [Indexed: 12/11/2022] Open
Abstract
Both dermatologists and pathologists sometimes find daunting the evaluation of melanonychia (especially subungual melanocytic lesions) because of the fear of performing nail surgery due to the risk of dystrophy, difficulties processing and interpreting nail biopsy specimens, and a general lack of experience in the field. Nevertheless, mastery of nail biopsy techniques, correct processing and orientation of specimens, and familiarity with the histologic particularities of the nail apparatus can attenuate the undoubted complexity and facilitate the tasks involved. Longitudinal excision is the biopsy technique that ensures the simplest histologic interpretation, and it is associated with a low risk of nail dystrophy when performed correctly. Clinical and epidemiological data are crucial. Subungual melanoma in childhood, for instance, is very rare and even lesions with atypical clinical and/or histologic features are probably benign. The presence of suprabasal melanocytes and other findings that would suggest malignancy at other sites are considered normal in the nail apparatus. Subungual melanoma shows a lentiginous pattern in the early stages of disease, and detection of an inflammatory infiltrate accompanying atypical lentiginous subungual lesions would appear to be one of the first diagnostic findings.
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Affiliation(s)
- E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España.
| | - L Nájera-Botello
- Servicio de Anatomía Patológica, Hospital Universitario Puerta de Hierro, Madrid, España
| | - L Requena
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, España
| | - E Nagore
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - C Requena
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
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37
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Machan S, Juárez Martín Á, Cullen Aravena D, Haro R, Pielasinski Ú, Fuertes L, Córdoba R, Santonja C, Rodríguez-Pinilla SM, Requena L. Acral lymphomatoid papulosis: Report of five cases, differential diagnosis, and review. J Cutan Pathol 2021; 48:650-658. [PMID: 33269496 DOI: 10.1111/cup.13929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 11/17/2020] [Accepted: 11/21/2020] [Indexed: 11/26/2022]
Abstract
Acral lymphomatoid papulosis (a-LyP) is a rare clinical variant of LyP whose diagnosis may be challenging. A case series of a-LyP was studied clinically, histopathologically, immunohistochemically, and from molecular point of view. Including ours, 25 cases of a-LyP have so far been reported. Clinically, a-LyP may present as acral involvement exclusively, in combination with mucosal lesions, (in itself a rare presentation), or in association with conventional LyP. The age of presentation was slightly higher than that of conventional LyP (55 vs 45 years) and a male predominance has been observed, as usually reported. Histopathologically, no morphological differences exclusively from conventional LyP were observed. LyP types A and E were the main variants. We describe for the first time one case of type D a-LyP. Acral LyP is a rare entity and correct diagnosis can only be reached with clinical and histopathological correlation, to avoid aggressive treatment of this indolent lymphoproliferative disorder.
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Affiliation(s)
- Salma Machan
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - África Juárez Martín
- Department of Dermatology, Complejo Asistencial Universitario de Palencia, Palencia, Spain
| | | | - Rosario Haro
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Úrsula Pielasinski
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Laura Fuertes
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Raúl Córdoba
- Department of Hematology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Carlos Santonja
- Department of Pathology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | | | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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38
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Colmenero I, Santonja C, Alonso-Riaño M, Andina D, Rodríguez Peralto JL, Requena L, Torrelo A. SARS-CoV-2 has not been detected directly by electron microscopy in the endothelium of chilblain lesions: reply from the authors. Br J Dermatol 2020; 184:186-187. [PMID: 33325537 PMCID: PMC9214004 DOI: 10.1111/bjd.19595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Linked Articles: Colmenero et al. Br J Dermatol 2021; 183:729–737. Brealey and Miller. Br J Dermatol 2021; 184:186. Colmenero et al. Br J Dermatol 2021; 183:1170–1171.
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Affiliation(s)
- I Colmenero
- Department of Pathology, Hospital, Madrid, Spain
| | - C Santonja
- Department of Pathology, Hospital, Madrid, Spain
| | - M Alonso-Riaño
- Department of Pathology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - D Andina
- Emergency Department, Hospital, Madrid, Spain
| | | | - L Requena
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - A Torrelo
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Torre-Castro J, Haya-Martínez L, Ruffin-Vicente B, Moya-Martínez C, Núñez-Hipólito L, Díaz de la Pinta J, Cullen-Aravena D, Jo-Velasco M, Requena L. Toker cell hyperplasia in Zuska disease: A tricky association. J Cutan Pathol 2020; 48:180-183. [PMID: 33128407 DOI: 10.1111/cup.13908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/27/2020] [Accepted: 10/13/2020] [Indexed: 11/29/2022]
Abstract
Toker cells (TCs) are sometimes present in the nipple epidermis as oval cells with pale cytoplasm and roundish nuclei. In most cases, TCs may be easily distinguished from cancerous cells of Paget disease of the nipple (PCs). Especially in TC hyperplasia, in which mild-to-moderate atypia may be present, it may be challenging to distinguish between TCs and PCs. The combination of chronic inflammatory changes in the nipple, in the context of Zuska disease, and TC hyperplasia, may easily lead to an erroneous diagnosis of mammary Paget disease.
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Affiliation(s)
- Juan Torre-Castro
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Lara Haya-Martínez
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Belen Ruffin-Vicente
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Cristina Moya-Martínez
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Lucía Núñez-Hipólito
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Javier Díaz de la Pinta
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Daniella Cullen-Aravena
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Margarita Jo-Velasco
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Luis Requena
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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40
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Moya-Martínez C, Torre-Castro J, Mendoza-Cembranos D, Santonja C, Requena L. Microcystic adnexal carcinoma with germinative follicular differentiation. J Cutan Pathol 2020; 48:123-127. [PMID: 32895957 DOI: 10.1111/cup.13869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 11/26/2022]
Abstract
Microcystic adnexal carcinoma (MAC) is a low-grade adnexal carcinoma with controversial lines of differentiation. We present here an example of MAC showing histopathologic findings of germinative follicular differentiation in the form of solid aggregates of trichoblastoma intermingled with neoplastic aggregates of MAC. Immunohistochemical findings, showing positivity for PHLDA1 and negativity for BerEp4 in neoplastic aggregates of trichoblastoma, also supported a germinative follicular differentiation. Follicular differentiation in MAC supports an apocrine line of differentiation for this neoplasm.
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Affiliation(s)
| | - Juan Torre-Castro
- Dermatology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - Carlos Santonja
- Pathology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Luis Requena
- Dermatology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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41
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Llamas-Velasco M, Ovejero-Merino E, García-Diez A, Requena L, Daudén E, Steegmann JL. Cutaneous side effects in a cohort of patients with chronic myeloid leukemia treated with tyrosine kinase inhibitors: General description and further characterization, correlation with photoexposition and study of hypopigmentation as treatment's prognostic factor. Dermatol Ther 2020; 33:e14428. [PMID: 33073453 DOI: 10.1111/dth.14428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/27/2020] [Accepted: 10/03/2020] [Indexed: 11/29/2022]
Abstract
Cutaneous adverse effects (AE) related to tyrosine-kinase inhibitor (TKI) drugs have been mainly described as case reports. We have characterized their appearance and correlation with patient's photoexposition habits and, further, with treatment response, in 61 patients with chronic myelogenous leukemia (CML) treated with TKI drugs. We have found hypopigmentation in 49.2% of the cases and a statistically significant association with interferon (IFN) intake. Eyelid edema's frequency was 45.4%. Mean photo-exposure was 1.95 h/day and only 8.3% of the patients used sunscreen daily. 44.3% of the patients reported a lighter skin color with the treatment and a statistically significant relationship with conjunctival hemorrhage was also found. Concordance between patients and dermatologist was moderate (kappa index 0.41). We found xerosis (21.3%), eczematous eruptions (21.3%), melasma (4.9%) and other isolated skin problems (ie, granulomatous panniculitis) in up to 16.4% of cases. Appearance of hypopigmented macules is associated to vascular conjunctival fragility and these patients need a slightly longer time to reach a complete molecular response, but without additional changes in survival or relapse frequency. We have stablished a specific dermatologic diagnosis in all the cases and we have not found the previously published as maculopapular rashes. Hypopigmentation, the more frequent AE, was not perceived as a relevant side effect. Photosensitivity, in our cases, was not reported, although imatinib-treated patients avoided sun-exposure. In addition, we identified some nonpreviously described dermatologic conditions in patients taking TKI drugs, like granulomatous panniculitis tufted folliculitis or oral spindle cell lipoma.
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Affiliation(s)
- Mar Llamas-Velasco
- Department of Dermatology, Fundación de Investigación Biomédica de La Princesa, Hospital Universitario de La Princesa, Madrid, Spain.,Voth Laboratorio Diagnóstico, Madrid, Spain
| | | | - Amaro García-Diez
- Department of Dermatology, Fundación de Investigación Biomédica de La Princesa, Hospital Universitario de La Princesa, Madrid, Spain
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Diaz, Madrid, Spain
| | - Esteban Daudén
- Department of Dermatology, Fundación de Investigación Biomédica de La Princesa, Hospital Universitario de La Princesa, Madrid, Spain
| | - Juan Luis Steegmann
- Department of Hematology, Hospital Universitario de La Princesa, Madrid, Spain
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42
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Colmenero I, Santonja C, Alonso‐Riaño M, Andina D, Rodríguez Peralto J, Requena L, Torrelo A. SARS-CoV-2 Has Not Been Detected Directly by Electron Microscopy in the Endothelium of Chilblain Lesions: reply from authors. Br J Dermatol 2020:10.1111/bjd.19579. [PMID: 33000464 PMCID: PMC7549049 DOI: 10.1111/bjd.19579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We fully agree that the interpretation of electron microscopy findings can be challenging, even for experts. Differences between viral pathogens and normal subcellular organelles may be subtle, and some cellular components can masquerade as viruses. The size and shape of the particle shown in our paper fit with other descriptions of SARS-CoV-2, but there may be a bias in interpretation.
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Affiliation(s)
- I. Colmenero
- Department of PathologyHospital Infantil Universitario Nin˜o Jesu’sMadridSpain
| | - C. Santonja
- Department of PathologyHospital Universitario Fundacio´n Jime´nez Dı´azMadridSpain
| | - M. Alonso‐Riaño
- Department of PathologyHospital Universitario 12 de OctubreMadridSpain
| | - D. Andina
- Emergency DepartmentHospital Infantil Universitario Nin˜o Jesu’sMadridSpain
| | | | - L. Requena
- Department of DermatologyHospital Universitario Fundacio´n Jime´nez Dı´azMadridSpain
| | - A. Torrelo
- Department of DermatologyHospital Infantil Universitario Nin˜o Jesu’sMadridSpain
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43
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Colmenero I, Santonja C, Alonso-Riaño M, Andina D, Rodríguez-Peralto JL, Requena L, Torrelo A. Chilblains and COVID-19: why SARS-CoV-2 endothelial infection is questioned. Reply from the authors. Br J Dermatol 2020; 183:1153-1154. [PMID: 32798316 PMCID: PMC7460995 DOI: 10.1111/bjd.19491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- I Colmenero
- Department of Pathology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - C Santonja
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - M Alonso-Riaño
- Department of Pathology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - D Andina
- Emergency Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - L Requena
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - A Torrelo
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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44
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Torre-Castro J, Moya-Martínez C, Núñez-Hipólito L, Mendoza-Cembranos MD, Eraña-Tomás I, Jo-Velasco M, Saus C, Solares J, Requena L, Santonja C. Three additional cases of non-neural granular cell tumor with novel immunohistochemical findings. J Cutan Pathol 2020; 47:1026-1032. [PMID: 32643817 DOI: 10.1111/cup.13801] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/18/2020] [Accepted: 07/01/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Non-neural granular cell tumor (NNGCT) is an uncommon neoplasm of controversial histogenesis and its histopathologic differential diagnosis includes, in addition to conventional GCT, other dermal tumors that may exhibit granular cell change. METHODS Three patients with a diagnosis of NNGCT were identified in the authors' files. Hematoxylin and eosin-stained sections and immunohistochemical studies were performed. RESULTS Histopathological study of the three lesions showed dermal proliferation of granular cells arranged in thick fascicles between collagen bundles. The lesions showed positivity for Factor XIIIa, CD163, CD68, NKIC3, vimentin, ALK, fascin, and cyclin D1. CONCLUSION To our knowledge, positivity for cyclin D1 has not been reported to date in NNGCT. In borderline cases, where the diagnosis is unclear despite histopathologic and immunohistochemical findings, positivity for cyclin D1 may favor the diagnosis of NNGCT. Further investigations to assess the differentiation of this rare neoplasm are needed.
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Affiliation(s)
- Juan Torre-Castro
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Cristina Moya-Martínez
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Lucía Núñez-Hipólito
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | | | - Itziar Eraña-Tomás
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Margarita Jo-Velasco
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Carles Saus
- Department of Pathology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Julia Solares
- Department of Pathology, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Luis Requena
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Carlos Santonja
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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45
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Colmenero I, Santonja C, Alonso-Riaño M, Noguera-Morel L, Hernández-Martín A, Andina D, Wiesner T, Rodríguez-Peralto JL, Requena L, Torrelo A. SARS-CoV-2 endothelial infection causes COVID-19 chilblains: histopathological, immunohistochemical and ultrastructural study of seven paediatric cases. Br J Dermatol 2020; 183:729-737. [PMID: 32562567 PMCID: PMC7323219 DOI: 10.1111/bjd.19327] [Citation(s) in RCA: 309] [Impact Index Per Article: 77.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2020] [Indexed: 12/16/2022]
Abstract
Background Chilblains (‘COVID toes’) are being seen with increasing frequency in children and young adults during the COVID‐19 pandemic. Detailed histopathological descriptions of COVID‐19 chilblains have not been reported, and causality of SARS‐CoV‐2 has not yet been established. Objectives To describe the histopathological features of COVID‐19 chilblains and to explore the presence of SARS‐CoV‐2 in the tissue. Methods We examined skin biopsies from seven paediatric patients presenting with chilblains during the COVID‐19 pandemic. Immunohistochemistry for SARS‐CoV‐2 was performed in all cases and electron microscopy in one. Results Histopathology showed variable degrees of lymphocytic vasculitis ranging from endothelial swelling and endotheliitis to fibrinoid necrosis and thrombosis. Purpura, superficial and deep perivascular lymphocytic inflammation with perieccrine accentuation, oedema, and mild vacuolar interface damage were also seen. SARS‐CoV‐2 immunohistochemistry was positive in endothelial cells and epithelial cells of eccrine glands. Coronavirus particles were found in the cytoplasm of endothelial cells on electron microscopy. Conclusions Although the clinical and histopathological features were similar to other forms of chilblains, the presence of viral particles in the endothelium and the histological evidence of vascular damage support a causal relation of the lesions with SARS‐CoV‐2. Endothelial damage induced by the virus could be the key mechanism in the pathogenesis of COVID‐19 chilblains and perhaps also in a group of patients severely affected by COVID‐19 presenting with features of microangiopathic damage. What is already known about this topic? Despite the high number of cases of chilblains seen during the COVID‐19 pandemic, a definite causative role for SARS‐CoV‐2 has not yet been proven. Different pathogenetic hypotheses have been proposed, including coagulation anomalies, interferon release and external factors.
What does this study add? The demonstration of SARS‐CoV‐2 in endothelial cells of skin biopsies by immunohistochemistry and electron microscopy confirms that these lesions are part of the spectrum of COVID‐19. Virus‐induced vascular damage and secondary ischaemia could explain the pathophysiology of COVID‐19 chilblains. Our findings support the hypothesis that widespread endothelial infection by SARS‐CoV‐2 could have a pathogenetic role in the severe forms of COVID‐19.
Linked Comment: Wetter. Br J Dermatol 2020; 183:611.
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Affiliation(s)
- I Colmenero
- Department of Pathology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - C Santonja
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - M Alonso-Riaño
- Department of Pathology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - L Noguera-Morel
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - A Hernández-Martín
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - D Andina
- Emergency Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - T Wiesner
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - L Requena
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - A Torrelo
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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46
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Santonja C, Heras F, Núñez L, Requena L. COVID-19 chilblain-like lesion: immunohistochemical demonstration of SARS-CoV-2 spike protein in blood vessel endothelium and sweat gland epithelium in a polymerase chain reaction-negative patient. Br J Dermatol 2020; 183:778-780. [PMID: 32585767 PMCID: PMC7361561 DOI: 10.1111/bjd.19338] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 12/31/2022]
Affiliation(s)
- C Santonja
- Department of Pathology, Fundación Jiménez Díaz, Madrid, Spain
| | - F Heras
- Department of Dermatology, Fundación Jiménez Díaz, Madrid, Spain
| | - L Núñez
- Department of Dermatology, Fundación Jiménez Díaz, Madrid, Spain
| | - L Requena
- Department of Dermatology, Fundación Jiménez Díaz, Madrid, Spain
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47
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Prieto-Torres L, Trascasa Á, Manso R, Machan S, Cieza-Diaz D, Olmedilla G, García-García M, Ara-Martín M, Requena L, Piris MÁ, Rodríguez-Pinilla SM. Two independent consecutive lymphoma cases carry an identical MYD88 mutation but differ in their IGVH rearrangement. Br J Haematol 2020; 190:e352-e356. [PMID: 32578872 DOI: 10.1111/bjh.16917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
| | - Álvaro Trascasa
- Department of Pathology, Fundación Jimenez Diaz, Madrid, Spain
| | - Rebeca Manso
- Department of Pathology, Fundación Jimenez Diaz, Madrid, Spain
| | - Salma Machan
- Department of Dermatology, Fundación Jimenez Diaz, Madrid, Spain
| | - Deisy Cieza-Diaz
- Department of Dermatology, Fundación Jimenez Diaz, Madrid, Spain
| | - Gabriel Olmedilla
- Department of Pathology Hospital, Universitario La Paz, Madrid, Spain
| | - Mar García-García
- Department of Pathology, Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | - Mariano Ara-Martín
- Department of Dermatology, Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | - Luis Requena
- Department of Dermatology, Fundación Jimenez Diaz, Madrid, Spain
| | - Miguel Á Piris
- Department of Pathology, Fundación Jimenez Diaz, Madrid, Spain
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48
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Garrido MC, Nájera L, Navarro A, Huerta V, Garrido E, Rodriguez-Peralto JL, Requena L. Combination of Congenital and Deep Penetrating Nevus by Acquisition of β-Catenin Activation. Am J Dermatopathol 2020; 42:948-952. [PMID: 32568834 DOI: 10.1097/dad.0000000000001704] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Deep penetrating nevus (DPN) is an intradermal, sometimes compound benign melanocytic lesion, which involves the reticular dermis, occasionally reaching the subcutis, which can raise concern for melanoma both clinically and histologically. Recently, it has been genetically defined by the combination of MAPK activating and β-catenin activating mutations. We sought to investigate genetic alterations in 2 cases of combined nevi of congenital melanocytic and DPN. Case 1 was a 16-year-old woman with a pigmented lesion on the trunk since birth, which was completely excised. Histopathological examination revealed a combined congenital nevus with a DPN. Comparative genomic hybridization showed no major genetic alterations, except for gain of 6q11.1 and point mutation of B-RAF V600E. Case 2 was a 62-year-old woman with a congenital pigmented lesion on the back. The lesion was diagnosed as a combined nevus of congenital and DPN. Comparative genomic hybridization showed no genetic alterations, and the NRAS Q61K was detected in both components. DPN is in most cases part of a combined nevus. Our cases showed strong and uniform nuclear expression of β-catenin and cyclin D1 in the DPN component suggesting the evolution of the congenital nevus to the DPN clone by acquiring β-catenin activating mutation.
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Affiliation(s)
- Maria C Garrido
- Department of Pathology, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación I+12, Madrid, Spain
| | - Laura Nájera
- Department of Pathology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Antonia Navarro
- Department of Pathology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Victoria Huerta
- Department of Pathology, Hospital Santa Caterina, Girona, Spain; and
| | - Enrique Garrido
- Department of Pathology, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación I+12, Madrid, Spain
| | - Jose-Luis Rodriguez-Peralto
- Department of Pathology, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación I+12, Madrid, Spain
| | - Luis Requena
- Department of Dermatology, Fundación Jimenez-Diaz, Madrid, Spain
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49
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Torre-Castro J, Mendoza-Cembranos MD, Díaz-Recuero JL, Requena L, Santonja C. New-onset subcutaneous nodules on the leg. Int J Dermatol 2020; 59:e352-e353. [PMID: 32530091 DOI: 10.1111/ijd.14986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Juan Torre-Castro
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Luis Requena
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Carlos Santonja
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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50
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Ríos-Viñuela E, Bernia E, Diago A, Requena L, Traves V, Requena C. A unilateral zosteriform cutaneous eruption on the lower extremity. Int J Dermatol 2020; 60:e137-e139. [PMID: 32496581 DOI: 10.1111/ijd.14980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Elisa Ríos-Viñuela
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Eduardo Bernia
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Adrián Diago
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Madrid, Spain
| | - Victor Traves
- Department of Pathology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Celia Requena
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
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