Search

Lupus erythematosus is an autoimmune connective tissue disorder showing a broad spectrum of clinical manifestations.

Graham-Little-Piccardi-Lassueur syndrome (GLPLS) is a rare syndrome characterized by the triad of cicatricial alopecia of the scalp, non-cicatricial alopecia of the axilla and groin and follicular lichen planus eruptions on the trunk and extremities. GLPLS is considered to be a variant of lichen planopilaris. We report two cases that have fulfilled all of the criteria for GLPLS. The first case was a 71-year-old woman, admitted to the Department of Dermatology for pruritic perifollicullar erythema and scaling of the scalp, cicatricial scalp alopecia and hair loss of the axilla and pubic region for five months. Subsequently, follicular hyperkeratotic eruptions and hyperpigmented macules on the skin of the chest and abdomen appeared. The second case was a 48-year-old man with pruritic follicular papules on the face, trunk and extremities for four months. All of the laboratory examinations in both patients were within normal limits. No alternation in the general condition of the patients was observed. Histological examinations in both patients confirmed the diagnosis GLPLS. The patients were treated with systemic and local corticosteroid resulting in marked improvement of the skin lesions; however, cicatricial scalp alopecia showed no response to the treatment.

The group of congenital limb overgrowth syndromes associated with vascular malformations include various disorders, often with variable clinical expression. Klippel-Trenaunay syndrome is the most common syndrome in this group, compared to other similar disorders such as Proteus, Parkes-Weber, Sturge-Weber, Cobb, Maffucii and CLOVES syndromes. We present a case of a 55-year-old male who presented with swelling, pain, heaviness, numbness and increased local temperature, involving the right upper extremity and the right side of the chest wall and associated with a livid erythema. The patient had several comorbidities including arterial hypertension and ischemic heart disease. He also had a family history of diabetes mellitus. A multidisciplinary team-based treatment approach, including physicians with expertise in various medical and surgical specialties was applied with the patient being “the unifying focus” of all these experts and their efforts. A personal approach tailored to the patient’s preferences was the key to a successful treatment.

Neurofibromatosis type I is an autosomal dominant genetic disorder with an incidence of about 1 in 3000 births. Apart from the typical skin involvement NF1 may affect multiple organs with ocular, neurological, skeletal and cardiovascular manifestations. We present a case of a 38-year-old man with multiple café-au-lait macules and hundreds of neurofibromas disseminated on the trunk and extremities dating from childhood. To establish the diagnosis and to exclude any complications we performed multiple examinations, including skin biopsy, laboratory investigations, ophthalmologic assessment, consultations with a neurologist, internist and orthopedist, etc. The treatment of cutaneous NF1 is mainly symptomatic. Surgical excision aims to achieve cosmetic results. Recently novel and perspective conservative therapies have been investigated. In order to ensure better outcome for the patients with NF1 long-term multi-disciplinary approach is advised.

The IGF-1R signalling pathway can positively regulate cell-cycle progression and thus play a critical role in cancer development. Although recent studies provide sufficient evidence supporting the functional importance of IGF-1R in cancer, the prognostic significance of IGF-1R expression levels to colorectal cancer (CRC) remains obscure. Expression of IGF-1R mRNA was examined in paired samples of CRC and adjacent normal mucosa, as well as in CRC patients' venous blood. We also investigated the effect of two monocytes stimulus—C3bgp and LPS on induced mRNA of IGF-1R from normal and colorectal human monocytes. The role of a member of MAPK signal transduction pathways—JNK in IGF-1R expression was assessed. The expression of IGF-1R mRNA was measured by relative RT-PCR. The results demonstrated that expression of IGF-1R mRNA in venous blood from CRC was down-regulated compared to venous blood from healthy donors (1.426 vs. 0.645; p=0.024). Mean IGF-1R mRNA level was found to be approximately 5.8 fold higher in tumour tissue compared to adjacent normal mucosa (p=0.02). Strong IGF-1R mRNA expression was found for early stages of CRC. The results showed that both stimuli used, strongly up-regulated mRNA expression for IGF-1R in CRC monocytes, then in monocytes from healthy donors. The highest level of IGF-1R expression was detected after C3bgp stimulation, regardless of JNK inhibitor presence. The significance for increasing expression of IGF-1R was observed for early CRC when patients were divided according to the tumour stage. We can conclude that downregulation of mRNA expression of IGF-1R in peripheral blood cells and stimulated monocytes from patients with advanced stages of colorectal cancer are a hallmark of tumour progression and can be used as a prognostic factor.

Epidermal growth factor (EGF),20 ng/ml,stimulated myelin basic protein (MBP) phosphorylation in crude extracts from human keratinocyte primary cultures. In order to identify the involved kinases, we separated by fast protein liquid chromatography proteins participating in MBP phosphorylation. We detected three MBP kinase activities in the keratinocyte crude extracts. The first MBP kinase activity was the only one stimulated by EGF and reacted with anti-mitogen-activated protein kinase (MAPK) antiserum recognising p42mapk and p44mapk isoforms. However, when protein kinase C (PKC) was either inhibited by the PKC inhibitor GF 109203X or depleted by a prolonged TPA treatment, the stimulation of MBP phosphorylation by EGF was strongly inhibited. The second MBP kinase activity eluted was due to a PKC isoform reacting with an anti-PKC ζ antibody, and the third was not identified. With this work, we have thus shown that, in human keratinocytes, EGF activates MAPK activity by a PKC-dependent pathway.Copyright 1995, 1999 Academic Press, Inc.

IntroductionBowenoid papulosis (BP) is virally induced disease caused by high risk HPV viruses, the most common type 16 and rarely type 18, 32, 39, 42, 48,53, 58. Smoking, early sexual initiation, promiscuity, risk sexualbehavior, uncircumcised sexual partners, immunosuppression, pregnancy, oral contraceptives are other causative factors for BP. The disease affects both sexes equally and is typical of young, sexually active people, aged between 20 and 40.Clinical features of BP are solitary or multiple confluent rapidly increasing papules with red-brown colour and diameter 2–10 mm, with uneven papillary or flat-to verrucous surface. They are localised on external genitalia bilaterally and symmetrically. In men cover foreskin, glans penis, in women labia majora, perianal area. This histology make difficult differential diagnosis with Morbus Bowen in anogenital area. Conducted destructive treatment in outpatient settings is with unsatisfactory therapeutic effect.MethodsWe report the case of 45 year old female who addressed our clinic for multiple confluent papules with red-brown colour and diameter 2–10 mm., with uneven papillary or flat-to verrucous surface on external genitalia area bilaterally and symmetrically.ResultsHistologic examination of a biopsy specimen established acanthosis, parakerathosis, hyperkerathosis, koilocytosis and atypical cells with hyperchromic bi, multinuclei occupying almost half the thickness of the epidermis to the extent of bowenoid dysplasia.ConclusionThe patient was treat with Imiquimod 5% cr. for 8 weeks with non significant results an partial vulvectomy (willingness of the patient) was performed.

IntroductionVerrucous squamous cell carcinoma (SCC), which was first described in 1948 by Ackermann, was reported in the oral cavity, anus, penis and female genitalia. This carcinoma is a low-grade SCC tumour and exhibits slow invasive growth. Regional lymph node metastases are rare and distant metastases have not been reported yet. Penile verrucous SCC carcinoma represents 5% to 16% of all penile SCC and in 33% of cases is associated with HPV type 6,11. Lack of circumcision, poor hygiene, phimosis, tight prepuce and chronic infection are other important causative factors for penile verrucous SCC carcinoma. We are reporting a case of a 70 year-old male patient who has come to our clinic with enlarging erythematous, exophytic papillary mass with foul smell located on glans penis for four- month duration. The patient is a chain-smoker and immunosuppresed due to the treatment of a non- Hodgkin lymphoma. He reported occurrence of multiple condylomata acuminata on genital area with a long lapse, which was treated with local destructive therapy and electrocoagulation. His medical history includes also ischaemic heart disease and coronary insuffiency.Methods:Histological examination established verrucous SCC carcinoma - hyperkeratosis, parakeratosis, acanthosis with bulbous downward projections into the dermis and well-differentiated tumour cells with invasion in reticular derma with depth of 2.122 mm and desmoplastic stromal reaction. Polymerase Chain Reaction for HPV DNA detected HPV type 6.Results and conclusionThe surgical excision and amputation penis partialis in Urology surgical department showed that there was not invasion of the tumour in corpora cavernosaand corpus spongiosumand it was classificated as T1NxMx. The patient remains under the supervision of the dermatology and oncology specialists for eventual relapses.

IntroductionBuschke-Lowenstein tumour (BLT) is a very rare sexually-transmitted disease associated with human papillomavirus (HPV) type 6 and 11, but rare cases of oncogenic HPV types including HPV 16 and HPV 18 were also reported. BLT is located in the genital, anorectal and perianal regions. It is regarded as a type of verrucous carcinoma occurring on anogenital mucosal surfaces where it is locally invasive but displays a benign cytology. Buschke-Lowenstein tumour can be associated with a high rate of recurrence and a risk of malignant transformation to invasive SCC, especially in patients with oncogenic types of HPV.MethodsWe report the case of a 59-year-old female patient who addressed our clinic for a large, exophytic, cauliflower-like tumour involving the vulva, perineum and perianal regions with 20 years duration. The first lesions had been appeared on vulva and after 3 years period they grown slowly and covered perineum and perianal area. They had cauliflower like surface, with different sizes. In some points erosions and yellowish secretion with odour are observed.ResultsHistologic examination of a biopsy specimen of large tumour presented nets of well-differentiated squamous cell carcinom, as well as a marked mononuclear cell infiltrate and conspicuous koilocytosis. HPV DNA for 6, 11 types was detected with PCR.ConclusionThe patient was sent to the gynaecology surgery department for excision and remains under the supervision of the dermatology and oncology department for rapid treatment of relapses and early detection of malignant transformation.

IntroductionLichen planus (LP) is an idiopathic inflammatory disease of the skin and mucous membranes. Classical LP is characterised by pruritic, violaceous papules that favour the extremities. Annular lichen planus (ALP) is a long-recognised clinical variant of lichen planus, but is often considered uncommon in occurrence. ALP commonly involves the male genitalia but also has a predilection for intertriginous areas such as the axilla and groin folds. Distal aspects of the extremities, and less commonly the trunk, may also be involved.MethodsWe report the case of 38 year-old uncircumcised male patient who addressed our clinic for multiple asymptomatic annular lesions on the glans penis and corpus penis and whitish linear bilateral and symmetric lines on buccal mucosa with 2 years duration. During this period the patient was treated several times with antifungal and corticosteroid drugs without improvement.ResultsDiagnosis was based on clinical features and histological examination. The patient was treated with topical pimecrolimus 1% with significant improvement after 3 weeks.ConclusionThis description highlights the importance of patients presenting annular lesion on penis be routinely required to undergo further medical examination for Canddida spec., Sexually transmitted infections and if is necessary to perform the biopsy because the exact diagnosis is basis for proper treatment.