A5.19 Usefulness of punch biopsy in cutaneous lesions with autoimmune profile in rheumatology: Abstract A5.19 Table 1

Erythema nodosum is a delayed-type hypersensitivity reaction with an unknown trigger in the majority of cases. It is characterized by the development of erythematous tender nodules on the shins. Septal panniculitis without vasculitis is a characteristic histopathological finding. We report the case of a 26-year-old woman who presented with a four-day history of an erythematous swollen left lower limb. She was treated with intravenous clindamycin for suspected cellulitis. However, her symptoms persisted. Punch biopsy revealed findings consistent with erythema nodosum. Two days later, she developed colicky abdominal pain associated with non-bloody diarrhea. Stool culture yielded Salmonella enterica serotype enteritidis. Two days after discharge, she presented again with a right breast abscess for which she underwent incision and drainage along with antibiotic therapy. After discharge, she was symptom-free with complete resolution of the cutaneous lesions. The presented case is unique as it had multiple clinical manifestations of Salmonella infection including erythema nodosum, diarrhea, and presumably a breast abscess. It should be kept in mind that gastrointestinal symptoms are not necessarily the initial presentations of Salmonella infection.

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Cutaneous Angiomatosis in a Young Dog

Veterinary Pathology ◽

10.1354/vp.42-3-378 ◽

2005 ◽

Vol 42 (3) ◽

pp. 378-381 ◽

Cited By ~ 18

Author(s):

Y. Kim ◽

S. Reinecke ◽

D. E. Malarkey

Keyword(s):

Blood Vessels ◽

Skin Lesions ◽

Punch Biopsy ◽

Cutaneous Lesions ◽

Mixed Breed ◽

Skin Punch Biopsy ◽

Surgical Preparation ◽

Well Differentiated ◽

The Right ◽

Extensive Involvement

A 1-year-old, spayed, female, mixed-breed dog had two reddish-purple cutaneous lesions, one on the right dorsal antebrachium and the other on the right shoulder. The lesions consisted of approximately 13 x 3 cm and 15 x 10 cm, irregular, patchy regions of 0.5-3.0 cm, circular, sometimes raised, reddish-purple swellings resembling ecchymoses. The lesion on the antebrachium had been noticed since the dog was adopted at 6 months of age and appeared to have increased in size over an 11-week period, at which time skin punch biopsy revealed an infiltrative pattern of well-differentiated blood vessels leading to an interpretation that the lesion was a well-differentiated hemangiosarcoma. The second lesion was revealed when the dog had its fur shaved in that area during surgical preparation to excise the antebrachial lesion. No other skin lesions were found on the dog. Microscopically, there was a widely disseminated and infiltrative-like pattern of benign-appearing small blood vessels, which were throughout the superficial and deep dermis and subcutis. Although the disseminated nature suggested malignancy, the histologic appearance of well-differentiated small blood vessels and nonprogressive clinical features indicate that the lesions were benign. The dog has been followed for 6 years and to date has no evidence of progression of the antebrachial lesion or shoulder lesion. To the authors' knowledge, this is the first report of a congenital angiomatosis-like lesion in a young dog, with extensive involvement of the forelimb.

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The study of epidemiological, clinical, histopathological and dermoscopic features of lichen planus

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20212553 ◽

2021 ◽

Vol 7 (4) ◽

pp. 558

Author(s):

Laxmi B. Horatti ◽

Abhiram Rayapati ◽

Dilip Kumar N. R. ◽

Shashikiran A. R.

Keyword(s):

Lichen Planus ◽

Histopathological Examination ◽

Punch Biopsy ◽

Diagnostic Feature ◽

Cutaneous Lesions ◽

Cell Degeneration ◽

Exclusion Criteria ◽

Male Preponderance ◽

Lymphocytic Infiltrates ◽

Important Diagnostic Feature

Background: Lichen planus (LP) is a common papulosquamous condition seen by the dermatologists. It can involve the skin, mucous mebranes, hair and nails. There are many subtypes of LP with various clinical, histopathological and dermoscopic features. In this study we intended to study the epidemiological, clinical, histopathological and dermoscopic features of LP.Methods: A total of 73 patients of LP, above the age of 18 years who qualified the inclusion and exclusion criteria were included in the study. A proforma of epidemiological details was noted, clinical and dermoscopic examination of the lesions were done. The punch biopsy specimens of cutaneous lesions were subjected to histopathological examination and the findings noted.Results: Out of the 73 patients included in the study, 44 were males and 29 females with a ratio of 1.51:1. Classic LP was the commonest type of LP. Wickham’s striae (WS) was the most typical and commonest dermoscopic feature of cutaneous LP except lichen planus pigmentosus. Hyperkeratosis, hypergranulosis, acanthosis, band shaped lymphocytic infiltrate, melanophages, basal cell degeneration and saw tooth shaped rete ridges were the significant histopathological features.Conclusions: LP is more common in young adults and shows a male preponderance. WS is the most important diagnostic feature seen on dermoscopy of all the cutaneous types of LP excluding LPP. Interface dermatitis with a band of lymphocytic infiltrates and dermal melanophages is a notable feature of histopathology of LP.

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Cutaneous Metastasis in the Setting of Both Colon and Breast Primary Malignancies

Case Reports in Gastrointestinal Medicine ◽

10.1155/2020/8852459 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Mary Junak ◽

Hunter Jecius ◽

Jennifer Erdrich ◽

Shiro Kikuchi

Keyword(s):

Ductal Carcinoma ◽

Case Reports ◽

Colon Adenocarcinoma ◽

The United States ◽

Punch Biopsy ◽

Left Breast ◽

Cutaneous Metastasis ◽

Cutaneous Lesions ◽

Cutaneous Metastases ◽

Colonic Primary

Colorectal cancer (CRC) is the third most diagnosed cancer in the United States, and many patients unfortunately have metastases at the time of their diagnosis. Cutaneous metastases of CRC have been reported in few journals and primarily as case reports due to their rarity. Here, we present the case of an 83-year-old woman with recently resected colon cancer, T4aN1bMx stage IIIB. She presented to our clinic for evaluation of a right midback mass, and a punch biopsy revealed dermal involvement by invasive, poorly differentiated carcinoma with epidermoid features. The mass was excised, and we ordered a PET scan in search of the primary tumor, which at that time was suspected to be of skin cancer origin. Surprisingly, this revealed a second malignancy triple-negative invasive ductal carcinoma of the left breast. The back mass stained positive for CK20, which was compatible with a metastasis from a colonic primary. After initially declining adjuvant therapy, the patient completed one cycle of capecitabine and oxaliplatin, which she tolerated poorly. She continued to further decline, developed widespread cutaneous metastases, and went home on hospice. Cutaneous lesions are an exceedingly rare site of metastasis for colon adenocarcinoma, and their clinical presentation can vary widely. It is important for providers to investigate any new skin lesion in a patient with a recent or remote history of malignancy, even if there were no sites of distant metastasis at initial diagnosis.

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Diagnosis of cutaneous sarcoidosis: clinical and the prognostic significance of skin lesions

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2013.502 ◽

2013 ◽

Vol 8 ◽

Author(s):

Halil Yanardag ◽

Cuneyt Tetikkurt ◽

Muammer Bilir ◽

Sabriye Demirci ◽

Aydin Iscimen

Keyword(s):

Skin Biopsy ◽

Progressive Disease ◽

Clinical Laboratory ◽

Elevated Serum ◽

Skin Lesions ◽

Punch Biopsy ◽

Skin Involvement ◽

Cutaneous Sarcoidosis ◽

Cutaneous Lesions ◽

Noncaseating Granulomas

Background: Sarcoidosis is a systemic disease characterized by the formation of noncaseating granulomas in various tissues. Cutaneous involvement occurs in 20 to 35 percent of the patients and may be the initial manifestation of the disease. Our study was performed to discriminate the clinical, laboratory, and prognostic differences between patients with specific and nonspecific cutaneous involvement. The second aim was to asses the diagnostic usefulness of punch biopsy in sarcoidosis. Methods: The clinical, laboratory, pathological features, and skin biopsy results of 120 patients with cutaneous sarcoidosis were evaluated. The patients fulfilled clinical, radiologic or both features of sarcoidosis supported by the histopathologic evidence of noncaseating granulomas. Skin involvement was the initial finding in 30% of the patients. Erythema nodosum and lupus pernio were the most common skin lesions. Almost all of the patients with LP were either stage 0 or 1. Respiratory symptoms occurred in 72.2% of the patients with specific skin involvement. Bronchoalveolar Lavage (BAL) lymphocytosis, high ratio of CD4/ CD8 and elevated serum Angiotensin Converting Enzyme (ACE) were more frequent in patients with specific cutaneous lesions. The frequency of progressive disease was significantly higher in this group. Punch skin biopsy was diagnostic in 81.6% of the patients with a complication rate of 4%. Conclusions: Specific cutaneous lesions along with BAL lymphocytosis, high CD4/CD8 ratio and elevated serum ACE levels may be predictors of progressive disease in sarcoidosis. Punch biopsy is a simple technique with a high diagnostic yield and a low complication rate for cutaneous sarcoidosis.

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