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    • cathepsin inhibitors In our case the epithelioid

    2018-11-12

    In our case, the epithelioid tumor cathepsin inhibitors showed moderate-to-strong positivity for S-100, Melan-A, and HMB-45, while the giant or gigantic cells were mostly S-100-negative but Melan-A- and HMB-45-positive. Although some gigantic cells were CD68-positive, they were negative for CD163, a more specific marker for histiocytes. Other differential diagnoses of AFX-like melanoma include MFH and a rare example of Merkel cell carcinoma with AFX-like features. The tumor cells in MFH were mostly S-100- and HMB-45-negative, although two cases of S-100-positive MFH have been reported. Merkel cell carcinoma, recently found to be associated with clonal integration of the Merkel cell polyomavirus, is usually neuron-specific enolase-positive and shows characteristic paranuclear dot-like positivity for monokeratin. It may be difficult to differentiate epidermotropic metastatic melanoma from primary melanoma, and the importance of distinguishing a local persistence of primary lesions from metastatic lesions has been re-emphasized. With our patient, although the possibility of a metastatic melanoma could not be completely excluded histologically, the finding of an intraepidermal proliferation of atypical melanocytes off to one side of the dermal tumor in conjunction with an absence of dermal scarring favored the diagnosis of primary melanoma. This was further supported by negative findings from the positron emission tomography examination and sentinel lymph node biopsy. The two lesions may represent a primary amelanotic melanoma and a satellite metastasis. The tumor was N2c according to the staging system of the American Joint Committee on Cancer, and should be treated as having nodal metastases. In addition to AFX-like malignant melanoma, collision tumors of AFX and invasive melanoma have also been reported. Wilsher reported a 76-year-old male who presented with a 17 mm ulcerated nodule on his scalp. Similarly, McGregor et al. reported a 71-year-old male with a 0.6 cm pearly papule on his back. With immunohistochemical staining, both cases were confirmed to contain two distinct but contiguous neoplastic components of AFX and melanoma.
    Introduction In 1995, Lucker et al described a 34-year-old man with a 9-year history of pruritic lesions confined to the natal cleft, which was termed \"porokeratosis ptychotropica\". In Greek, the word \"ptyche\" means fold and \"trope\" means turning. Later in 1999, Stone et al described a similar case, in which a 32-year-old man with a 13-year history of pruritic lesions also confined to the natal cleft. It was named “perianal inflammatory verrucous porokeratosis”. Until now, this is still a rare variant of the disease. It is also termed porokeratosis ptychotropica, hyperkeratotic porokeratosis, and genitogluteal porokeratosis. In this report, we present a 43-year-old man with this rare disorder.
    Case report This 43-year-old, otherwise healthy man, presented with long-standing itchy skin lesions on the buttocks for more than 20 years. It first appeared as a single lesion on his right buttock at 15 years old. He went through a surgical excision of the lesion at a dermatology clinic. However, the skin lesion progressed and extended from the natal cleft and buttocks to the penis and scrotum. During the following years, he had been diagnosed as having psoriasis, viral warts, and condyloma. Various treatments were given including medical medications, surgical excision, cryotherapy, and electrocauterization at different hospitals and dermatology clinics. The lesion seemed to disappear initially, but recurred a few months later. During the past 28 years, the lesions had gradually increased both in size and number. There is no associated family history. The skin lesions were itchy and appeared reddish or brownish in color. During physical examination, numerous verrucous to flat papules and plaques were seen on buttocks, natal cleft, penis, and scrotum (Figure 1). Epidermodysplasia verruciformis was suspected clinically and a skin biopsy of the hyperkeratotic plaque on the left buttock was performed.