Search

A 72-year-old patient came to our department for a large annular lesion with small islands of pigmentation, mainly at the edges of the lesion located on the left part of the forehead, 6.5 × 4.5 cm in diameter. The patient was a retired person who spent his whole working life on construction sites with significant photo-exposure. The dermoscopic examination of lesion revealed the central hypopigmented part presented by regression, while in pigmented parts of the lesions annular granular pattern in the form of gray dots around hair follicles and obliterated hair follicles were detected. The presence of regression and obliterated hair follicles are both dermoscopic features of the invasive phase of lentigo maligna, e.g., lentigo maligna melanoma. The patient was referred immediately to a plastic surgeon who excised the lesion and the lesion was histopathologically confirmed as a lentigo maligna melanoma, Breslow thickness 2.8 m.

Granuloma annulare (GA) is a benign, inflammatory and granulomatous disease which can be seen in both children and adults, with no known etiology. In this report, a 69-year-old female patient who was admitted with multiple non-annular papular lesions on the extensor sides of both arms was presented. [Med-Science 2018; 7(2.000): 416-7]

Porokeratosis (PK) is a rare skin disease, of unknown etiology, probably due to a disorder of epidermal keratinization. We describe a 24 year-old male patient, with porokeratosis of Mibelli confirmed histopathologically. A young man of 24, from a non-consanguineous marriage, presented to our department with 4 years history of one hyperkeratotic lesion, symmetric, painless and non-pruritic on the nose. Clinical examination revealed the presence in the left wing of the nose, one annular lesion, measuring about 0.5 cm, the centres was atrophic and surrounded by a raised hyperkeratotic border.

O’Brien first described the actinic granuloma in 1975, as an infrequent granulomatous disorder occurring in sun-exposed skin, with a slow but often self-limited course. Ever since its initial description, the actinic physiopathogenic hypothesis has been debated by many authors. We report a 60-year-old female rural worker that presented with a 14 × 7 cm annular lesion with erythematous elevated borders and an atrophic center on the right calf. The lesion was evolving for 2 years, and histopathology confirmed actinic granuloma. She started acitretin with halting of disease progression after 6 months of therapy. Our case can also be associated to actinic damage, despite its unusual location, therefore highlighting the role of solar elastosis in the development of O’Brien actinic granuloma.

PURPOSE To report a case of a traumatic corneal endothelial ring sustained from a nonblast injury and its resolution with corneal optical coherence tomography (OCT) imaging. METHODS The authors present a report of the clinical case with imaging of the lesion using corneal OCT. RESULTS A 59-year-old man presented 1 day after sustaining a nonpenetrating foreign body injury to his cornea. Slit-lamp examination showed an endothelial annular lesion of 3.3 mm in diameter, which was grey-white in color. No other signs of traumatic injury were present. Stromal edema and endothelial disruption were demonstrated on corneal OCT. This resolved completely on review. CONCLUSIONS We describe a concussive injury that specifically disrupts endothelial cells in an annulus on the perimeter of the impact zone. This results in transient stromal edema immediately anterior to the injured endothelial cells. These OCT findings corroborate previous animal studies on the mechanism and sequelae of injury.

An 82-year-old woman presented with a longstanding, slowly enlarging annular lesion on the medial aspect of the ankle. Histology confirmed the clinical diagnosis of Porokeratosis of Mibelli. The lesion slowly involuted and resolved over 26 weeks of 5% imiquimod cream applied topically and has not recurred during a 36 month follow-up period.

A 45-year-old woman with personal history of hypertension presented with an erythematous lesion in the neckline for a year and with a progressive growth. A physical examination revealed an annular lesion with erythematous papules in the edge. Histological exam showed phagocytosis of elastic fibers by multinucleated cells compatible with annular elastolytic giant-cell granuloma. The patient did not present any other associated systemic manifestation. Treatment with tacrolimus 0.1 percent ointment was prescribed with a very good response after two months. Yes Una mujer de 45 años de edad con antecedentes personales de hipertensión presenta una lesión eritematosa en el cuello durante un año y con un crecimiento progresivo. El examen físico reveló una anular lesión con pápulas eritematosas en el borde. Examen histológico reveló la fagocitosis de las fibras elásticas de las células multinucleadas compatible con anular elastolíticas granuloma de células gigantes. El paciente no presentó ninguna otra manifestación sistémica asociada. El tratamiento con pomada de tacrolimus 0,1 por ciento fue recetado con una muy buena respuesta después de dos meses.

Nowadays, patients have high expectations when it comes to minimization of postoperative scarring after dermatologic surgical procedures. When an annular lesion is being excised, normal skin should be excised, as well, to prevent a dog ears resulting in a long scar. We introduce a new flap reducing the scar length in annular defects. In order to avoid a long scar, we designed a quadruple fan flap (O-X flap) that is a variation of the rotation flap. It consists of four rotation flaps arranged like fans, with open and closed configuration. We suggest that the quadruple fan flap (O-X flap) is a viable option for treating annular skin defects, because it shortens the scar line, preserves normal tissue, and provides a cosmetically favorable outcome.

The objective of this study was to assess the impact of a landmark annular lesion model on our understanding of the etiopathogenesis of IVD degeneration and to appraise current IVD repairative strategies. A number of studies have utilised the Osti sheep model since its development in 1990. The experimental questions posed at that time are covered in this review, as are significant recent advances in annular repair strategies. The ovine model has provided important spatial and temporal insights into the longitudinal development of annular lesions and how they impact on other discal and paradiscal components such as the NP, cartilaginous end plates, zygapophyseal joints and vertebral bone and blood vessels. Important recent advances have been made in biomatrix design for IVD repair and in the oriented and dynamic culture of annular fibrochondrocytes into planar, spatially relevant, annular type structures. The development of hyaluronan hydrogels capable of rapid in situ gelation offer the possibility of supplementation of matrices with cells and other biomimetics and represent a significant advance in biopolymer design. New generation biological glues and self-curing acrylic formulations which may be augmented with slow delivery biomimetics in microcarriers may also find application in the non-surgical repair of annular defects. Despite major advances, significant technical challenges still have to be overcome before the biological repair of this intractable connective tissue becomes a realistic alternative to conventional surgical intervention for the treatment of chronic degenerate IVDs.

Neoplasms of the small bowel are rare lesions that account for less than 5% of all gastrointestinal tumors. Although the differential diagnosis for a small bowel tumor is extensive, various small bowel neoplasms have characteristic features at computed tomography (CT) that may aid in making a diagnosis. Small bowel adenocarcinoma may appear at CT as an annular lesion, a discrete nodular mass, or an ulcerative lesion. Non-Hodgkin lymphoma may appear as a segmental bulky mass that gradually merges into the normal bowel wall. Lymphoma is characteristically associated with marked luminal dilatation. Carcinoid tumor may appear as an ill-defined homogeneous mass that displaces bowel loops. Calcification and desmoplastic reaction in a mesenteric mass suggest the diagnosis of carcinoid tumor. Gastrointestinal stromal tumors (GISTs), both benign and malignant, may be submucosal, subserosal, or intraluminal. The CT appearance of a GIST may include a sharply defined mass with homogeneous attenuation, sometimes with calcification. Lipoma appears at CT as a well-circumscribed, intraluminal homogeneous mass with fat attenuation. Most malignant small bowel tumors are actually metastases that have spread intraperitoneally, hematogenously, or by local extension. Intraperitoneal seeding usually manifests at CT as multiple small nodular metastases along the small bowel serosa, mesentery, and omentum. In patients with Peutz-Jeghers syndrome, nonneoplastic lesions may mimic small bowel neoplasms.

REPORT OF A CASE A 3-month-old girl presented with a 10-week history of multiple enlarging plaques on the face and extremities. She was the product of a full-term pregnancy to a healthy 19-year-old primigravida. The day before delivery, the mother's membranes ruptured, and a fever developed over the next 24 hours. A cesarean section was performed due to an increase in fetal heart rate. After delivery, antibiotics were administered to the baby, who had no further complications. The mother continued to have a fever and high blood pressure. Both infant and mother remained in the hospital for 23 days. Approximately 1 week after discharge, an annular lesion appeared on the infant's cheek that became progressively enlarged. Similar lesions appeared on the extremities. Cutaneous examination revealed annular erythematous scaly plaques, some with central clearing, ranging from 2 to 4 cm on the face, arms, and legs (Figure 1). Routine laboratory studies

Sarcoidosis of the skull is quite rare, only 3 cases confirmed by bone biopsy being reported in the literature (1–3). The case to be presented here is the fourth to be confirmed by histopathologic study and, in addition, showing complete regression without treatment. Osseous lesions occur in a small percentage of patients with sarcoidosis and are usually in the hands and feet. Case Report A 51-year-old white housewife was seen at the Marshfield Clinic (Marshfield, Wisc.) on Oct. 31, 1958, because of intermittent swelling of the neck for three years, along with occasional pains over the right side of her head and face. She had also noticed a “spot” on the left labium majus, with intermittent swelling and ulceration for two years. Physical examination revealed an almond-sized node in the right anterior cervical chain and a small right submandibular node, with no other adenopathy. The heart and lungs were normal, and the liver and spleen were not palpable. An annular lesion, 1 cm. in diameter, with an ulcera...

A 20 year old man presented with eight thin walled, ring shaped shadows, 1-3 cm in diameter, on a chest radiograph. Pulmonary sarcoidosis was diagnosed on the basis of histopathological examination of a cervical lymph node, transbronchial lung biopsy, and increased activity of angiotensin converting enzyme and lysozyme in serum. The lesions disappeared within six months of his starting corticosteroid treatment.

From the Departments of Pediatrics and Dermatology, Northwestern University Medical School. Reprint requests: Amy S. Paller, M.D., Department of Dermatology, Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614. of dusky red tiny papules was present on the dorsum of the right foot (Figure, A). Slightly elevated, deeply erythematous lesions with figurate borders and clear centers, which became suffused with dependency or crying, were located on the soles of both feet. By 3 months of age, the lesions were resolving. Although a few new rings had appeared, they were clearing as well. The lymphedema was unchanged. By 6 months of age, both lymphedema and hemangiomas were resolved. Patient 2 was first noted to have pedal lesions at 4 weeks of age. There were six violaceous annular patches with soft edematous centers on the lateral and plantar surfaces of the feet (Figure, B); the largest measured 2 cm in diamete/'. A biopsy of one of the lesions demonstrated the features of a capillary hemangioma. By 6 weeks of age, the lesions had almost disappeared, although the lymphedema persisted. Over the following six months of pedal vascular lesions have not cleared entirely. New, similar ringed lesions have developed on the feet. All of these rings wax and wane in intensity, as does the persisting lymphedema. There appears to be no correlation between the extent of the lymphedema and lesions at any fixed time. Patient 3 was observed to have a 2 cm annular lesion with a raised red border on the dorsum of the right foot at the base of the

A case of an unusual type of rectal obstruction is reported and the surgical management employed in this particular instance is described. The thought process in arriving at a preoperative working diagnosis is considered. The microscopic study of the tissue making up the obstructing lesion suggests that the lesion was in no way a manifestation of lupus erythematosus. On the other hand, particularly since there had been only one previous abdominal operation, the findings strongly indicated that the annular lesion had probably resulted from the prolonged suppurative process the patient had experienced in 1932.

A case of annular carcinoid tumor arising in the ascending colon is presented , and some features of gastrointestinal carcinoids are considered. Although preoperative differentiation from adenocarcinoma is important, this is not possible unless features of the carcinoid syndrome are present.

To the Editor.— I read with great interest the report by Eng 1 on erythematous generalized granuloma annulare. Both patients had pulmonary emphysema, and one had noted the onset of her dermatosis after a sunburn. The results of elastic tissue stains were not noted. It is well known that some patients with emphysema have a genetic deficiency of α 1 -antitrypsin, the major human leukocyte elastase inhibitor. 2 In 1975, O'Brien 3 popularized the concept of actinic granuloma, a granuloma-annulare-like dermatosis in a sun-exposed distribution. Histologically, actinic elastosis was absent inside an annular lesion but present outside it. The granulomatous infiltrate in the anulus showed histiocytes containing elastic material. The author views actinic granuloma as a specific entity that is a response to actinically damaged elastic tissue. 3 O'Brien has more recently extended his concept to include temporal arteritis. He found more severe granuloma

To the Editor.— Lichen sclerosus et atrophicus (LSA) is a skin disease that begins as papules that may coalesce to form plaques and eventually become atrophic white spots. 1 Although reports of verrucous plaques have been noted, 2 this is uncommon. We report the following case to emphasize this unusual clinical presentation and to document the occurrence in a vaccination site. Report of a Case.— A 13-year-old girl was seen on May 21, 1975, for evaluation of her vaccination site. She had been vaccinated at age 2 years and revaccinated at age 6 years. The initial lesion appeared a few months following revaccination and remained unchanged until two years prior to evaluation, when it enlarged and several discrete but similar new lesions appeared. Physical Examination.— Four discrete, elevated, verrucous hyperpigmented plaques were distributed over the left deltoid area. The largest annular lesion measured 3 cm in diameter and surrounded an

To the Editor.— Recently we observed a case of neonatal lupus erythematosus (NLE) that has prompted us to reemphasize the need for testing for anti-SSA/Ro antibody in all cases of annular skin eruptions in infancy. We suspect that several previous reports of annular skin eruptions in infants were actually cases of NLE, but at the time they were reported, the specific marker for this disorder, the anti-SSA/Ro antibody, had not yet been elucidated. Report of a Case.— A 4-week-old male infant who was a product of a normal pregnancy and delivery presented with a two-week history of symmetric annular 2-cm lesions on the soles of his feet. The lesions had erythematous raised borders, but no signs of central atrophy (Figure). He also had a 2-mm red papule over the right temple (which subsequently enlarged to an annular lesion) and a 5-mm annular lesion on the right thigh. The remainder of

Excerpt In 1909, the Swedish physician Arvid Afzelius described for the first time a migrating annular lesion, erythema chronicum migrans, on a patient bitten by the ixodid tick,Ixodes ricinus. Sub...

A patient is described with a histologically proved annular wart of the wrist within which is a central verrucal mass. The bizarre development of the annular lesion is unexplained.