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Se presenta el caso de una mujer de 30 años con antecedente de lupus eritematoso sistémico, con sensación de alza térmica, sudoración nocturna, disnea leve, epigastralgia y baja de peso. La tomografía reveló una masa mediastinal, hepatoesplenomegalia y ganglios retroperitoneales. La anatomía patológica e inmunohistoquímica fue compatible con un timoma B1. El timoma, aunque poco frecuente, es una de las neoplasias a considerar cuando nos enfrentamos a un paciente con LES y una tumoración mediastinal. A 30-year-old woman with a previous diagnosis of systemic lupus erythematosus presented with fever, night sweats, mild dyspnea, epigastric pain, and weight loss. The tomography showed a mediastinal mass. The pathology and immunohistochemistry of the tumor was compatible with a B1 thymoma. Even the low frequency among SLE patients, we must include thymoma in every patient with SLE and a mediastinal mass.

Background: Pachyderma is defined as severely thickened skin with deep folds and is occasionally observed with primary cutaneous NK and T-cell lymphoma (pCNKTCL), primary cutaneous B-cell lymphoma (pCBCL), and leukemia cutis (LC). Aim: To describe the clinical, histological, and therapeutic particularities of a series of pCNKTCL, pCBCL, and LC patients with pachyderma. Results: In a series of pCNKTCL (n = 70), pCBCL (n = 12), and LC (n = 2) patients followed up during 9 years, 6 cases of pachyderma were observed. Pachyderma occurred on the arms (n = 2), thighs (n = 1), forehead (n = 1), and face (n = 2). The mean age of the patients was 69 years (51–82). The stages were erythrodermic (T4) mycosis fungoides (MF) (n = 1), folliculotropic MF (FMF) (n = 2), classic (T2) MF (n = 2), and chronic myeloid leukemia (n = 1). The erythrodermic MF patient with acute pachyderma on the right arm responded rapidly to oral steroids. The other cases were indolent, appeared progressively, and were highly treatment resistant. Histology revealed dense dermal neoplastic infiltration. The immunohistological profile of the pachydermic lesions was similar to common MF and LC. Conclusion: Pachyderma is an atypical manifestation of MF and LC and may occur on the face (FMF) or the extremities (MF). The rapidly appearing pachyderma may be transitory and responds readily to oral steroids.

Pediatric Degos disease is rare, with only 36 cases reported in the medical literature. Classically the diagnosis has been established according to pathognomonic histopathologic findings, but when these features are not present, there may be a delay in diagnosis. We report the second congenital case of Degos disease, highlighting the clinical and dermoscopic findings.

Foreign body reactions after endovascular procedures for brain arteriovenous malformations are extremely rare. We report the case of a cerebral foreign body granuloma reaction after embolization of a frontal arteriovenous malformation with Onyx. A previously treated 36-year-old man underwent re-embolization of a residual and recurrent unruptured right frontal vascular malformation with Onyx. The post-procedural imaging revealed a right frontotemporal heterogeneously enhancing expansive lesion associated with a residual malformation. Following microsurgical resection, the histopathological examination of the expansive lesion revealed basophilic foreign body like deposits adjacent to multi-nucleated giant cells, highly compatible with cerebral foreign body granulomas reaction to Onyx. The clinical and radiological follow-up of the patient was favorable after complete resection of the lesions.

We present the case of a 53-year-old male patient, a man who had sex with men. He described the presence of inguinal adenopathy and non-painful ulcer with indurated edges on his penis that heal spontaneously after 3 months. In the same period of time the patient presented: tenesmus, bleeding and rectal pain. In the proctoscopy was observed at the level of the rectum: deep ulcer with regular and indurated edges, ulcerated bed with abundant mucus; The rectal mucosa around the ulcer had multiple circumferential erosions 2-4 mm in diameter. The biopsy showed infiltration of lymphomonocollar cells and granulomas. The HIV ELISA test was positive, CD 4: 275 cel./uL, HIV viral load: 10 300 copies / ml, VDRL: Non-reactive, FTA-Abs: 1/10 (positive). Warthin-Starry staining was used in the rectal ulcer biopsy sample identifying spirochetes. After the administration of benzatinic Penicillin G, the symptoms and lesions in the rectal region were resolved. Likewise, antiretroviral treatment was initiated. Ulcerative and erosive proctitis is common in people living with HIV infection, however, it is rare to identify spirochetes in the biopsy sample.

Se presenta el caso de una mujer de 51 años que desarrolló paraparesia y una masa abdominal palpable más pérdida de peso en el lapso de cuatro meses. La masa destruía la 5ª vértebra lumbar y se extendía a los tejidos blandos adyacentes. En suero se halló un patrón de gamapatía monoclonal por cadenas ligeras de tipo lambda. La punción aspiración de la masa reveló un plasmocitoma. El paciente recibió radiación y quimioterapia. Fue dada de alta con disminución de la paraparesia.

La leishmaniasis es una enfermedad metaxénica andino-tropical, considerada endémica en Perú. Su forma mucocutánea es poco frecuente. Puede presentarse en coinfección con los virus HTLV-1 y VIH. Se describe un caso de leishmaniasis mucocutánea en un paciente infectado con VIH, con antecedente de leishmaniasis cutánea con tratamiento incompleto 20 años atrás. Es tratado con estibogluconato sódico por 30 días, con adecuada respuesta y regresión de la lesión a las cuatro semanas. La coinfección de leishmaniasis mucocutánea y VIH no es frecuente. Las manifestaciones de leishmaniasis pueden no presentarse de forma típica en pacientes con VIH. Se debe considerar la procedencia de la zona endémica y/o el antecedente de haber presentado la forma cutánea previamente.

Background Strongyloides stercoralis is an intestinal nematode unique in its ability to replicate in the human host, allowing ongoing cycles of autoinfection, persisting for decades within the same host. Although usually asymptomatic, overwhelming infections can occur in Strongyloides and HTLV-1 co-infected individuals (SS/HTLV-1). Regulatory T cells (Tregs) are able to blunt specific Th2 responses necessary to control the parasite. We previously reported that peripheral blood Tregs are increased in SS/HTLV-1 and correlate with low Th2 responses. We hypothesized that Tregs are also increased at the site of infection in duodenal mucosa. Methods Paraffin embedded duodenal biopsies were obtained from 10 SS/HTLV-1 patients, 3 controls with non-parasitic chronic duodenitis, and 2 healthy controls. Immunohistochemistry was performed using monoclonal antibodies against human CD3, CD8, IgE and FoxP3. The number of cells were counted using a conventional light microscope. The number of CD3+, CD8+, FoxP3+ and IgE positive cells per 0.35 mm2 was measured using ImagePro Plus software comparing areas adjacent or distant from parasite material. Results In patients with SS/HTLV-1, T lymphocyte counts and CD8+ cells were lower in areas adjacent to the parasite compared to non-adjacent areas (CD3+: adjacent: 6.5 [Interquartile range (IQR: 2.8–12.3)]; non-adjacent: 24.5 [IQR: 20.9–34.4]; Mann-Whitney p = 0.0003; CD8+: adjacent: 4.5 [IQR: 2.3–11.8]; non-adjacent: 21 [IQR: 15.3–42.9]; Mann-Whitney p = 0.0011). Tregs cells in the intestines (FoxP3+ expressing cells) were increased in patients with SS/HTLV-1 compared with patients with chronic duodenitis (SS/HTLV-1: 1.5 [IQR: 0.7–2.3]; duodenitis controls: 0 [range 0–0.7]; healthy controls: 0; Mann-Whitney p = 0.034). There was also a trend towards fewer eosinophils adjacent to the parasites. Among SS/HTLV-1 patients the number of IgE expressing cells was increased for in areas not adjacent to the parasite compared to non-adjacent areas (ANOVA, p = 0.001). Conclusions Our data shows increased Treg cell numbers localized adjacent to the parasites in the duodenum SS/HTLV-1 patients. In addition, other T lymphocytes and IgE expressing cells were decreased adjacent to the parasites, suggesting an important role for Tregs in down-regulating local parasite effector responses., Author summary Strongyloidiasis is a parasitic infection found worldwide in warm, moist climates. In most people, Strongyloides causes a mild and chronic infection with few symptoms. However, some patients, including those infected with the Human T Lymphotrophic Virus 1 (HTLV-1), can get uncontrolled disease called hyperinfection, which can be fatal. To help determine why this infection is so serious in co-infected patients, we studied biopsies obtained from the small intestine from patients with both infections and compared them to control biopsies. The biopsies from patients with both Strongyloides and HTLV-1 had increased numbers of white blood cells in their biopsies. In particular they displayed a type of lymphocyte that downregulates immune responses. Some of them had increased numbers of cells called eosinophils in the intestines. These cells can help eliminate Strongyloides. However, they were not found near the parasite, suggesting that something near the parasite was suppressing the host response that would control infection. These studies provide more evidence that HTLV-1 suppresses the host response that controls Strongyloides and that the suppression occurs at the site of infection in the small intestines.

1 Profesor Principal de Medicina. Universidad Peruana Cayetano Heredia 2 Medico Residente del Dpto. de Medicina. Universidad Peruana Cayetano Heredia 3 Medico Asistente del Servicio de Endocrinologia del Hospital Nacional Arzobispo Loayza. Profesora Asociada de Medicina. Universidad Peruana Cayetano Heredia 4 Profesor Auxiliar de Patologia. Universidad Nacional Mayor de San Marcos. Medico Asistente del Servicio de Patologia del Hospital Nacional Arzobispo Loayza Caso Clinico

Context.—Acral lentiginous melanoma is the most prevalent clinical presentation of melanoma in ethnic groups other than whites and also occurs in significant numbers in North America and Europe. Despite a clear-cut clinical picture, histologic findings seen in partial biopsies may be too subtle and deceive pathologists dealing with such cases. Objectives.—To make pathologists aware of the histologic findings during early phases of acral lentiginous melanoma (including the in situ phase), to compare those findings with what is seen in acral junctional nevus, and to highlight their similarities and differences. This review will also emphasize the important clinical and dermatoscopic findings to be considered when diagnosing acral lentiginous melanoma. Data Sources.—Review of published articles on the epidemiology; the clinical, dermatoscopic, and histopathologic findings; and the molecular biology of acral lentiginous melanoma as well as the personal experience of the authors when dealing with such cases. Conclusions.—Acral lentiginous melanoma is a clinicopathologic entity with a clear-cut clinical picture: a diameter larger than 0.7 mm; ill-defined, darkly pigmented, flat lesion with irregular borders on acral locations; and the presence of mostly single-cell proliferations of melanocytes along the dermo-epidermal junction. Along with a few additional criteria, these findings should be sufficient to allow the pathologist to make the diagnosis and to recommend complete excision. Fluent communication between clinician and pathologist will facilitate a correct diagnosis.

Mujer de 59 años, natural de Piura y procedente de Jaén, ama de casa. Nota desde hace quince años aumento de volumen a nivel cervical anterior, progresivo y que no producía ninguna molestia. Ocho meses antes del ingreso presenta tos con expectoración blanquecina escasa que luego se hace más productiva. Dos meses antes del ingreso la tos se hace más exigente y se asocia a llenura precoz y dolor abdominal de moderada intensidad; un mes antes del ingreso se asocia sensación de alza térmica no cuantificada, cansancio y disnea con la deambulación, así como edema en miembros inferiores hasta tobillos que se incrementa paulatinamente con los días. Funciones Biológicas: Apetito: conservado. Sed: conservada. Orina: sin alteraciones. Deposiciones: 3 veces/día. Peso: disminución de 20kg en 2 años