Brown Nodules Research Articles

Merkel Cell Carcinoma Case Reports With Merkel Cell Polyomavirus Test and Review of the Literature.

Merkel cell carcinoma (MCC) is known as a rare and highly malignant neuroendocrine skin cancer and often occurs in the sun-exposed parts of the elderly individuals. In this article, we reported 2 cases of MCC and reviewed relative literature. Case 1 was a 91-year-old woman who presented with a half-year history of a brown nodule on the left temple. The histopathological and immunohistochemistry examination diagnosis was MCC with negative staining of Merkel cell polyomavirus large T antigen (CM2B4). Case 2 was a 76-year-old man with a nodule on his right buttock that gradually increased from approximately 3 mm to 1.5 cm in diameter in 1 month without pain. The biopsy diagnosis was MCC with positive staining of CM2B4. Previous studies have found that the genetic mutation and prognosis of polyomavirus-associated MCC (MCCP) and nonviral MCC (MCCN) are significantly different. Large T antigen plays a crucial role in Merkel cell polyomavirus (MCPyV) oncogenesis. Testing for the MCPyV at the onset of MCC is recommended, which is helpful in predicting the prognosis of patients.

First Report of Rugonectria rugulosa Causing Dieback of Prunus salicina "Banbianhong" in China.

Banbianhong (Prunus salicina) is a valuable fruit crop cultivated in the southwestern regions of China for its high quality fruit and substantial economic benefits (Wang et al. 2021). In July 2023, dieback disease was observed in Banbianhong in Suijiang County, Zhaotong, Yunnan Province, with an incidence of up to 10%. The disease caused brownish nodules in the cortex of the infected plant, leading to dry cracking, and exposing grayish-brown xylem, which caused the plant to wither and die. Upon longitudinal cutting of twigs, lesions were evident and characterized by browning and necrosis of the cauline bundle and pith within the tissue. The diseased tissues were sectioned into 2 mm2 pieces and surface disinfected with 70% ethanol and 1% NaClO and rinsed with double distilled water. The tissue fragments were plated onto potato dextrose agar (PDA), and incubated for 7 days at 28°C. A total of six isolates were obtained, and two isolates (WG2-1 and WG2-3) were selected for morphological, molecular identification and pathogenicity testing. On PDA, the colony diameter of WG2-1 and WG2-3 were recorded as 5.50±0.56 mm/day and 6.08±0.37 mm/day, respectively. The microconidia of both isolates were zero-septate, smooth, greenish, subglobose to ellipsoidal, and measured 5 to 10 × 1.5 to 3 µm (n = 50) in size. However, macroconidia were not observed. The internal transcribed spacer rDNA (ITS) and β-tubulin 2 (TUB2) genes were amplified using the primer pairs ITS1/4 (White et al. 1989) and Bt2a/2b (Glass and Donaldson 1995). BLAST analysis of the obtained ITS sequences (accession Nos. PP581792) and TUB2 sequences (accession Nos. PP2815212) sequences showed 100% identity with Rugonectria rugulosa (accession nos. MG991753 for ITS and KM232007 for TUB2). Based on these characteristics, the isolates have been identified as R. rugulosa and have been deposited in the Agricultural Environment and Resource Research Institute plant pathogen lab at Yunnan Academy of Agricultural Sciences. In this study, Pathogenicity tests were conducted on one-year-old Prunus salicina "Banbianhong" twigs to complete Koch's postulates. The twigs were wounded using a 1-mm sterile corking borer and 14-day-old mycelium plugs of isolate (WG2-1) were inoculated and covered with sealing films. Sterile PDA plugs were placed into the wounds of control twigs. Eighteen healthy twigs were inoculated with isolates or PDA plugs (n = 6 twigs/treatment, the size of the twigs: 8 cm length and diameter about 0.7 cm, with three replications) and were placed in a closed sterile tray with the wet filter papers in a thermostatic incubator (type, HYC-260) at 28°C, respectively. The twigs inoculated with the isolates exhibited brown lesions site of inoculation, whereas the controls remained asymptomatic. R. rugulosa was successfully reisolated from the lesions but not from these control wounds and was identified by the methods described above. R. rugulosa has been reported to be associated with the die-back disease of Falcataria moluccana in China (Wang et al. 2019). The occurrence and spread of R. rugulosa in growing areas of Prunus salicina "Banbianhong" in Suijiang county have caused severe economic losses. To our knowledge, this is the first report of the die-back disease of Prunus salicina "Banbianhong" caused by R. rugulosa. These results confirm the pathogenicity of R. rugulosa in Prunus salicina "Banbianhong" and provide valuable insights for developing disease management and prevention strategies.

Erythema Elevatum Diutinum in Association with IgA Monoclonal Gammopathy of Undetermined Significance

Erythema Elevatum Diutinum (EED) is a distinctive form of chronic leukocytoclastic vasculitis characterized by red to brown papules, plaques, and nodules that favor the extensor aspect of the extremities. EED is a benign condition but may be associated with several systemic diseases, including hematologic disorders, infections, and autoimmune conditions. EED is a rare entity of vasculitis, with less than 400 cases being reported in world literature to date. We present a rare case of a 61-year-old male with IgA monoclonal gammopathy of undetermined significance (MGUS) and a 17-year history of EED that improved significantly with dapsone treatment.

Line‐field confocal optical coherence tomography and optical coherence tomography for distinguishing basal cell carcinoma from dermal nevus: A case report

AbstractBasal cell carcinoma (BCC) is the most frequent skin cancer with a rising incidence. It can imitate benign lesions for example, dermal nevus clinically and dermoscopically. Both entities show specific morphologic features in line‐field confocal optical coherence tomography (LC‐OCT) and optical coherence tomography (OCT). The aim was to differentiate both lesions via noninvasive imaging to prevent unnecessary surgery. A 63‐year‐old woman presented with a light brownish nodule on the left cheek and a brownish nodule on the right nasal slope/cheek, which were both evident since a few months. The clinical and dermoscopic appearance of both lesions was very similar including the differential diagnosis of a dermal nevus or BCC. Dynamic OCT of the lesion on the left cheek showed multiple hyporeflective nodules in the dermis with hypervascularization. Using LC‐OCT several hyporeflective round to ovoid nodules with hyporeflective clefting embedded in a hyperreflective surrounding connective tissue could be observed. These specific morphological criteria called millefeuille pattern led to the diagnosis of a nodular BCC. The lesion of the right cheek presented with a thickened epidermis and elongated rete ridges in dynamic OCT. Upon LC‐OCT examination a so‐called large wave like pattern presenting as undulating hyporeflective and hyperreflective lobular structures could be identified. Therefore, the diagnosis of a dermal nevus was made. Both lesions were identified correctly as confirmed histopathologically after shave excision. Since BCC can imitate benign lesions for example, dermal nevi, the use of OCT and LC‐OCT can facilitate the identification of BCC and its imitators. Noninvasive imaging can help to avoid unnecessary biopsy especially in areas where the skin is vulnerable to punch biopsy.

Disseminated Cryptococcosis Involving Skin and Lung in an Immunocompromised Patient After Kidney Transplantation: A Case Report

Cryptococcus neoformans can cause detrimental cryptococcosis and other severe complications, especially in immunocompromised populations. Disseminated cryptococcosis in organ transplantation patients is extremely rare and often involves lungs, brains, skin, nails, and other organs. In this paper, we report a rare disseminated cryptococcosis case involving skin and lung that presented with recurrent dark brown abscesses and nodules in an immunocompromised female after kidney transplantation. The K-Set detection result of Cryptococcus capsular polysaccharide in serum is positive. The identification of pus culture by Autof MS 1000 indicates that the patient was infected with Cryptococcus neoformans var. grubii. In addition to treatment using liposomal amphotericin B, fluorocytosine, and fluconazole, local extraction of pus and simultaneous injection of liposomal amphotericin B into skin lesions were performed. This comprehensive treatment method proved effective, as the patient recovered from fever and skin symptoms. The innovative treatment may contribute to helping more disseminated cryptococcosis patients.

Granuloma faciale in a patient with remitting seronegative symmetric synovitis with pitting edema.

Granuloma faciale (GF) is a rare benign chronic inflammatory dermatologic disease which is characterized by facial lesions. The diagnosis is mainly based on clinical and histopathology findings. It may be resistant to treatments and prone to relapse. Different treatment modalities include corticosteroid therapy, tacrolimus, cryotherapy and surgical methods. We report a case of GF in a patient with remitting seronegative symmetric synovitis with pitting edema (RS3PE). A male patient with RS3PE presented with reddish brown soft nodules on and over lateral aspects of his nose and adjacent areas on his face which were diagnosed histologically as GF. He was treated with prednisolone, methotrexate and clobetasol propionate cream successfully without recurrence. To the best of our knowledge this is the first case report of GF occurring in a patient with RS3PE.

Ectopic liver tissue adherent to the gallbladder serosa: two cases report from Syria.

Case 1 involved a 52-year-old man who was admitted to the hospital due to an abdominal grip in the right hypochondrium and epigastrium for 1 month. The patient underwent laparoscopic cholecystectomy. During the gross examination, a well-circumscribed brownish nodule with a smooth outer surface, located at the fundus region was found. Case 2 involved a 40-year-old man with 2 months history of epigastric pain radiating to the right shoulder. Calculus chronic cholecystitis was diagnosed by ultrasound. The patient undergoes elective laparoscopic cholecystectomy. A gross inspection showed a small nodule attached to the serosa of the gallbladder. Microscopically, both cases revealed ectopic liver tissue. Ectopic liver tissue is an uncommon entity that occurs during the embryological development of the liver and can be found below and above the diaphragm, especially the gallbladder. Histologically, it usually has the normal architecture of the liver. Although ectopic liver tissue is an exceptional finding, pathologists should be aware of it because it has a high risk of transformation into malignancy. Hepatic choristoma is a rare failure of embryological liver development. It should be removed when recognized and examined histologically to rule out malignancy.

S1-guideline cutaneous and subcutaneous leiomyosarcoma.

Superficial leiomyosarcomas (LMS) are rare skin cancers (2-3% of cutaneous sarcomas) that originate from dermally located hair follicle muscles, dartos or areolar muscles (cutaneous/dermal LMS), or from vascular muscle cells of the subcutaneous adipose tissue (subcutaneous LMS). These superficial LMS are distinct from LMS of the deep soft tissues. Leiomyosarcomas are typically localized at the lower extremities, trunk or capillitium, and present as painful, erythematous to brownish nodules. Diagnosis is made by histopathology. The treatment of choice for primary LMS is complete (R0) microscopically controlled excision, with safety margins of 1cm in dermal LMS, and 2cm in subcutaneous LMS, if possible. Non-resectable or metastatic LMS require individual treatment decisions. After R0 resection with 1cm safety margins, the local recurrence rate of dermal LMS is very low, and metastasis is very rare. Subcutaneous LMS, very large, or incompletely excised LMS recur and metastasize more frequently. For this reason, clinical follow-up examinations are recommended every six months for cutaneous LMS, and every three months for subcutaneous LMS within the first two years (in subcutaneous LMS including locoregional lymph node sonography). Imaging such as CT/MRI is indicated only in primary tumors with special features, recurrences, or already metastasized tumors.

Schwannoma: Another dermoscopic pitfall?

Schwannoma: Another dermoscopic pitfall?

P317 Phaeohyphomycosis caused by Phialophora verrucosa in a patient with CARD9 mutations

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectivesTo study an intractable case of phaeohyphomycosis caused by Phialophora verrucosa and the underlying genetic and immunological mechanisms.MethodsClinical and laboratory findings of the patient were studied. The patient's DNA was sequenced for CARD9. Innate and adaptive immunological responses of patient-derived PBMCs were evaluated with ELISA and flow cytometry.ResultsA 29-year-old Chinese male, born to nonconsanguineous parents, developed an enlarging plaque on his right anterior tibia at 25 years and underwent a 15-month treatment of oral itraconazole at the local hospital. Upon discontinuation of the medication, the plaque spread over his face, upper limbs, and back. Physical examination indicated dark brown verrucous plaques and nodules with surface ulcers and scabs on his right leg, upper limbs, and face. Skin biopsy revealed pigmented yeast cells with budding and yeast cell chain in the dermis. Based on tissue culture, we identified P. verrucosa as the causative pathogen, which was further validated by ITS, BT, and TEF gene sequencing. Thus, subcutaneous phaeohyphomycosis was diagnosed, and itraconazole combined with amphotericin B was prescribed. The lesions improved only marginally. We, therefore, gave him oral posaconazole instead, based on in vitro antifungal susceptibility results. After 1 month of posaconazole treatment, the serum BG assay value decreased and the lesions improved markedly.Based on previous reports linking CARD9 deficiency to phaeohyphomycosis, as well as early onset and recalcitrance characters, Sanger sequencing was performed in this patient and identified two compound heterozygous mutations in exon 6 (R373P) and exon 8 (D274GfsX60) of CARD9. We then evaluated the functional effect of the CARD9 mutations by assessing the stimuli-dependent release of proinflammatory cytokines and helper T cell differentiation. Cytokine production was markedly impaired in PBMCs post 24 h of stimulation with LPS, curdlan, TDB, mannan, MDP, β‐glucan, and various fungal ligands. Moreover, the patient showed a significant absence in Th22 and Th17 cell proportions, as well as lower IL-17A and IL-22 production after six days of co-incubation with the stimuli mentioned above.ConclusionOur report highlighted that otherwise healthy patients diagnosed with early-onset, unexplained, and recalcitrant phaeohyphomycosis should be analyzed for CARD9 mutations and immune deficiency. Furthermore, posaconazole may be an alternative worth trying after the failure of other antifungals due to its ideal results achieved in our case.

Erythema Elevatum Diutinum Associated with Tuberculosis

Erythema elevatum diutinum (EED) is a rare small vessel vasculitis with cutaneous manifestations most commonly presenting as red or brown papules, plaques, and nodules on extensor surfaces. It is a chronic, relapsing disease that is often associated with states of immunocompromise, e.g., HIV, gammaglobulinemias, and, more rarely, tuberculosis. Currently oral dapsone is the current treatment of choice, and while most patients respond well, it is imperative that the diagnosis be made early. We report a rare case of EED associated with underlying tuberculosis infection. Recognizing the distinct manifestations of EED and understanding its immunologic and infectious disease associations may enable clinicians to properly recognize, manage, and treat patients with EED.

CONGENITAL LABIAL NEVUS TREATED WITH PLASTIC SURGERY AND CRYOSURGERY

Congenital melanocytic nevi are lesions that present pigmentation at birth resulting from the accumulation of melanocytes in an ectopic location. In the labial region, they are rare. The diagnosis is clinical and must be confirmed with histopathology, because malignant lesions such as melanoma must be included in the differential diagnosis. A 32-year-old Black female patient presented with a lesion on the upper lip since birth. The patient did not have any health problems. On physical examination, a dark brown nodule located in the region of the tubercle of the upper lip, measuring 10 × 8 mm, sessile, painless, and with precise limits, was noted. Plastic surgery was performed by means of an excisional biopsy with a modified triangular incision, sutured by planes with catgut 5-0 and nylon 6-0 in the skin. The histopathologic exam confirmed the diagnosis of congenital nevus. The patient presented a discrete keloid that was treated with 3 cryosurgery sessions for aesthetic purposes, improving her lip appearance.

A Rare Presentation of Angiolymphoid Hyperplasia with Eosinophilia Involving the Scrotum

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare vascular proliferation that typically manifests as pink to reddish brown papules or nodules. These lesions classically affect the face or neck. Involvement of other structures including the tongue, colon, salivary glands, and muscle are rare. Male urogenital involvement for example, had less than 30 cases reported. Here we present the third reported case of ALHE involving the scrotum in a 17-year-old male.

Facial milia-like eruption in a patient with alopecia

Facial milia-like eruption in a patient with alopecia

Compound spitz nevi – A case report

Spitz nevi is a very rare and an acquired lesion 1 described by Sophie Spitz in 1948. Spitz nevus is a melanocytic lesion composed of epithelioid and spindled cells, with a remarkable histological resemblance to malignant melanoma, first interpreted as juvenile melanoma, these lesions were later characterized as benign and were observed to affect all age groups. Its incidence is less than 1% of all nevi. Clinically it appears as a solitary, dome shaped, firm, red or brown papule or nodule located most commonly over the face or leg. We report a case of 15 year old female patient who visited us with an asymptomatic lesion on her right knee of 1month duration. On examination it was found to be a single well-defined round to oval dome shaped skin colored to reddish papule, probable diagnosis of adnexal tumor was made, and excisional biopsy was planned, on histopathological examination it was confirmed to be a case of compound spitz nevi.

Atypical Seborrheic Keratosis of the Umbilicus

Seborrheic keratosis is one of the most common skin tumors. It most often presents as a light brown to brown nodule with a papillomatous or squamous surface. However, it may vary in color and shape and can thus resemble the pattern of other skin tumors. We report the case of an atypical seborrheic keratosis located at the umbilicus with misleading dermoscopy.

Firm, enlarging papule on an infant's proximal thigh

Firm, enlarging papule on an infant's proximal thigh

Cutaneous Plasmacytosis: Diagnostic and Therapeutic Challenge in a Patient with an Atypical Presentation

Cutaneous plasmacytosis is a rare dermatosis that is classically characterized by the presence of multiple papules and reddish- -brown nodules mainly in the trunk. It most commonly affects elderly Asians, with few reports in Caucasians and young patients. On histopathology there is a polyclonal proliferation of mature plasm cells. The objective of this report is to present a case of atypical manifestation of this rare disease, both due to clinical and epidemiological aspects.

Facies Analysis and Depositional Environments of the Ubaid Formation, Western Iraq

The Early Jurassic (Liassic) sequence crops out in numerous anticlines of the high folded zone of north and north-east Iraq and in the Rutba subzone (including Ubaid Formation) in west Iraq. The present study deals with siliciclastic / carbonate rocks of the 58 m-thick Ubaid Formation at Zor Hauran valley in south western Iraq. The formation consists of two parts; the lower part is composed of pebbly coarse sandstone and greenish to yellowish soft marl alternated with marly dolostone, while the upper part is characterized by light brown, well bedded dolostone, with stromatolite structure in some locations. Oval, light to dark brown nodules of chert are also present.
 A detailed field lithological description and facies analysis of the Ubaid Formation were performed for thin sections. It is composed of five main microfacies; dolomitized mudstone, dolomitized bioclastic wackstone, dolomitized pelloidal packstone, dolomitized oolitic grainstone, and bindstone, in addition to two lithofacies: marl and pebbly sandstone. These facies reflect the deposition from the environment of the lower supratidal to intertidal zone and the encompassing shallow scaffold secured shoal - marine environment with cautious water circulation.

Kaposi Sarcoma of the Lower Extremity with HIV and Kaposi's Sarcoma

Kaposi's sarcoma is the most common malignancy seen with HIV infection. It is a lymphoangioproliferous tumor first described by Moritz Kaposi in 1872. It is characterized by bluish red or dark brown plaques and nodules, especially in the distal of the lower extremities, often the heels and feet. Organ involvement without skin findings is observed in approximately 15% of the cases. There are four clinical variants, the classical, endemic, iatrogenic and the epidemic associated with AIDS. Kaposi's sarcoma in AIDS cases apart from the skin, it can also be seen in the oral cavity, gastro-intestinal system and respiratory system. Antiretroviral therapy (ART) should be started immediately in newly diagnosed HIV infected patients. In this research, a 65 year old male patient, who was diagnosed AIDS and Kaposi's sarcoma at the same time, is described.