Dark Red Nodules Research Articles

Merkel cell carcinoma overlapping Bowen’s disease: two cases report and literature review

PurposeMerkel cell carcinoma (MCC) is a rare neuroendocrine tumor of the skin, which mainly occurs in the sun exposed sites of white patients over 65 years, with a higher recurrence and metastasis rate. Clinically, MCC overlapping Bowen’s disease (BD) is a very rare subtype of MCC. Few cases in the literature have been described and the management is not well defined. We summarize and update the epidemiology, clinical and histopathological features, metastasis characteristics, local recurrence rate and management of it by presenting two cases of MCC overlapping BD and reviewing the literature over the last 11 years.DesignWe consulted databases from PubMed, ResearchGate and Google Scholar by MeSh “Merkel cell carcinoma” and “Bowen’s disease”, “Bowen disease” or “squamous cell carcinoma in situ”, from January 2013 to December 2023 and reviewed the literatures. We reported two additional cases.ResultsTotal 13 cases of MCC overlapping BD were retrospectively analyzed, in whom mainly in elderly women over 70 years, the skin lesions were primarily located on the faces, followed by the extremities and trunk. Most of them were asymptomatic, firm, dark red nodules arising on rapidly growing red or dark brown patches, or presenting as isolated nodules. Dermoscopy evaluation was rarely performed in the pre-operative diagnostic setting. All cases were confirmed by histopathology and immunohistochemistry. The most definitive treatment was extended local excision, but local recurrences were common. Of the 13 cases, 4 cases experienced local or distant metastasis. One suffered from an in-transit recurrence of MCC on the ipsilateral leg after local excision and lymph node dissection, whose metastasis completely subsided after avelumab treatment and without recurrence or metastasis during 6 months of follow-up.ConclusionsMCC overlapping BD is a very rare skin tumor mainly predisposed on the faces, with high misdiagnosis rate and recurrence rate. Advanced disease at diagnosis is a poor prognostic factor, suggesting that earlier detection may improve outcome. The acronym, AEIOUN, has been proposed to aid in clinical identification. Our reports and the literature review can provide a better awareness and management of it.

Adult-onset severe acral angiokeratoma-like pseudolymphoma: A case report and review of the literature.

Adult-onset severe acral angiokeratoma-like pseudolymphoma: A case report and review of the literature.

186 The effects of different concentrations of MgSO4 in osteogenic differentiation

Tissue engineering offers a viable alternative to bone grafts in repairing large bone defects. Magnesium-based materials are biocompatible in vivo, and it is possible to determine the degradation period according to the necessities (Farraro et al. 2014 J. Biomech. 47, 1979-1986). Magnesium (Mg) is part of many physiological processes, and it promotes the osteogenesis of mesenchymal stem cells (Díaz-Tocados et al. 2017 Sci. Rep. 7, 7839.). Moreover, Mg up-regulates important genes associated with the osteogenic differentiation (Yoshizawa et al. 2014 Acta Biomater. 10, 2834-2842). The aim of this study was to evaluate the effect of different Mg concentrations in the osteogenic medium on the number of nodules of bone. Swine adipose stem cells (ASC) were previously isolated as described (Monaco et al. 2009 Open Tissue Eng. Regen. Med. J. 2, 20-33). In this in vitro study, ASC were cultured during 4 weeks in osteogenic medium with addition of 0.1, 0.2, 1, 2, 10, or 20mM MgSO4. The medium was changed twice a week. Alizarin Red and Von Kossa staining were performed to evaluate the formation of nodules by mineralization of extracellular matrix (ECM), evidenced by dark red nodules and calcium deposit. The experiment was replicated 3 times in triplicate. Data were analysed using the generalized linear model (GLM) procedure, and Bonferroni’s post hoc test was used to perform statistical multiple comparison (SPSS Inc./IBM Corp., Chicago, IL, USA). The results showed enhanced nodule formation with 2mM Mg in the osteogenic medium (35.6v. 15.3, respectively for 2mM and Control). This result confirms the ability of magnesium to act in bone formation. There was no statistical difference among the different groups when we evaluated the Von Kossa staining results, indicating that the quality of the new formations was comparable to that of the control group even in an elevated nodule formation. In conclusion, a higher concentration of magnesium can improve nodule formation into osteogenic differentiation in vitro; the 2mM concentration showed the best nodule formation compared with the other groups. These results showed the value of magnesium in bone physiology.

Nodular hepatocellular carcinoma in a Labrador dog with metastases

A 10 year old male Labrador retriever was presented for necropsy with the clinical history of vomition and pain on palpation of abdomen. Ultrasound examination revealed enlarged and abnormal liver borders. Haemato-biochemical studies revealed anaemia, leukocytosis and elevated liver specific enzymes. Necropsy examination of the carcass revealed mottled liver with multiple variably sized round, discrete to coalescing grey white to brown soft friable nodules on all the lobes. A few nodules were cystic with accumulation of viscid fluid. Similarly, multifocal variable sized dark red nodules were also found randomly scattered on both the lungs. Pancreas and kidneys also revealed metastasis. Histologically, the liver nodules appeared as nodular hepatocellular carcinoma with adenoid pattern. Metastatic foci were observed in the lungs, pancreas and kidneys. Immunohistochemical detection of tumour markers such as alpha fetoprotein, proliferating cell nuclear antigen, pancytokeratin, vimentin, chorioembryonic antigen were carried out for differential diagnosis.

Typhocolitis by Cyathostomins Larvae on a Donkey

Background: Cyathostomosis is the infection by nematode larvae of small strongyles belonging to the subfamily Cyathos tominae (cyathostome). It is primarily a disease of young horses with global distribution. The parasites cause severe injuries to the intestine and the clinically affected animals have severe diarrhea, colic, intussusception, and less frequently intestinal infarction. The aim of this study is to describe the pathological fndings of enteritis by cyathostome on a donkey in Brazil.Case: A donkey (Equus asinus), crossbred female mongrel, approximately four-months-old, was referred to the Veterinary Hospital of the Federal University of Campina Grande, Patos, PB, Brazil with a history of trauma. On clinical examination, complete fracture of the left femur was identifed. After performing euthanasia the donkey was necropsied. The animal wasskinny with pale mucous membranes. The perineal region, base of the tail and hind limbs were dirty with yellowish fecal content. At necropsy, the large intestine had a pasty content and the mucosa was thickened with the multifocal whitish or dark red nodules. The cut surface of these nodules showed caseous material, sometimes associated with larvae in the submucosa. Microscopically, it was observed granulomatous and eosinophilic chronic multifocal associated with intralesional larvae of cyathostome-like nematodes. In the mucosa and submucosa of the colon and cecum, there were multifocal to coalescing granulomas composed by moderate inflammatory infltrate composed of eosinophils, macrophages, epithelioidcells, neutrophils and occasional multinucleated giant cells, surrounded by fbrous tissue and infltrated by lymphocytes and plasma cells. At the center of these granulomas transverse and longitudinal sections of nematode larvae with approximately 160-550μm in diameter were observed within the necrotic material. The parasites presented a smooth, thick andeosinophilic outer cuticle, clear platymyarian muscles, internal cuticular crests, vacuolated lateral strings, and intestine composed of multinucleated cells in the large colon and caecum. There were no mature gonads, featuring the larval stage.Discussion: Parasitic infections are the most common diseases that threaten donkey health and performance. In this species, small strongyles infections are severe, since the larvae can infltrate and form cysts in the wall of the large intestine causing serious damage. The most common clinical signs caused by cyathostome are weight loss and diarrhea, which are non-specifc and consequently can lead to an underestimation of the disease occurrence. In this case, massive infection of small strongyles was observed in the large colon and caecum. In contrast to the large strongyles, the small strongyles do not migrate through tissue but severely injure the large intestine of donkeys, zebras and horses. Other possible causes of enteritis in horses include Salmonella spp., Rhodococcus equi, Clostridium perfringens, Clostridium diffcile, Neorickettsia (Ehrlichia) ristcii infections, and idiopathic and neoplastic conditions (lymphoma). In the present report, the diagnosis of larval ciatostomose was based on clinical signs, and especially in the severity of pathological fndings associated withmorphological characteristics of the larvae of nematodes compatible with cyathostome in the large intestine.Keywords: nematodes, diarrhea, donkey, cyathostomins.

Extranodal natural killer/T-cell lymphoma, nasal type, involving the skin, misdiagnosed as nasosinusitis and a fungal infection: A case report and literature review.

The present study reports a case of extranodal natural killer (NK)/T-cell lymphoma, nasal type, involving the skin. The clinical manifestations, pathological characteristics, treatment and prognosis of the case were analyzed to improve the clinical diagnosis and treatment for this disease. The patient was a 56-year-old male, presenting with dark red nodules and plaques that had been visible on the nose for half a year. Based on the skin lesions and histopathological and immunohistochemical examination results, the patient was diagnosed with extranodal NK/T-cell lymphoma, nasal type. This disease has unique histopathological and immunohistochemical features and a high malignancy. The condition tends to be misdiagnosed and has a poor prognosis, but seldom involves the skin. In the present case, only radiotherapy was performed, with no relapse occurring within 6 months.

Widespread epithelioid angiosarcoma with ventricular wall involvement in a dog.

This paper reports on a canine angiosarcoma, presenting as an "undifferentiated metastasizing tumor". A 14-year-old female Cocker Spaniel was referred to the University of Extremadura Veterinary Clinic for clinical examination after suffering rapid deterioration, with chronic cough, anorexia and cachexia. One week after clinical examination, the dog died of right congestive heart failure and ventricular arrhythmia. Blood counts revealed lymphopenia and platelet depletion. The biochemistry profile was within normal limits, except for a drop in blood urea nitrogen. Cytological evaluation of liver and spleen biopsies revealed clustered anaplastic cells that lacked convincing tissue differentiation. Major findings at necropsy were enlarged spleen and multiple, beige to dark-red nodules ranging from 0.5 to 3 cm in diameter in the heart, lung, liver and spleen. At histological examination, multiple nests of anaplastic epithelioid cells were found in sections from all affected organs. Immunohistochemistry revealed widespread expression of CD31 and Factor VIII-related antigen. The neoplastic cells were negative for CD 18. The diagnosis of epithelioid angiosarcoma, localized in the myocardium, lung, liver and spleen was made. The primary site of the neoplasm could not be determined.

Tricuspid valve blood cysts in infancy

A 2.5 months old boy was found dead in bed with his mother. He had been delivered by normal vaginal delivery after an unremarkable pregnancy at 41 weeks gestation. His only significant history had been an admission to hospital for dehydration secondary to viral gastroenteritis at 7 weeks of age. Prior to his death he had a cough, wheezing and runny nose for several days, attributed to a viral upper respiratory infection. On the night of his death he had been taken to bed by his mother at approximately 0100 hours, fed at approximately 0330 hours and found unresponsive in a supine position at 1,100. He had last been seen alive in the supine position. At autopsy there was mild pulmonary congestion, mild pallor and mottling of the cut surfaces of the liver, reactive enlargement of cervical and paratracheal lymph nodes and turbid fluid within the left and right middle ear cavities. There were no signs of injury. A finding of note on the atrial surface of the tricuspid valve were two 0.5 mm diameter dark red nodules adjacent to the free margin of the mildly dysplastic valve (Fig. 1). Histologic evaluation of the lungs revealed congestion and mild edema with patchy post mortem bacterial overgrowth. Smaller bronchioles showed mild focal peribronchiolar infiltrates of mononuclear cells, variable numbers of neutrophils and occasional eosinophils. The lumina of the affected bronchioles contained necrotic cellular debris and occasional multinucleate syncytial epithelial cells. The appearances were of bronchiolitis in keeping with a viral infection. These changes were not severe and were seen in only some of the sections. There was also mild microvesicular steatosis of the liver and reactive follicular hyperplasia of lymph nodes. Neuropathological examination of the brain showed early hypoxic-ischemic changes with widespread granular b-amyloid precursor protein axonal immunoreactivity possibly related to the hypoxic-ischemic injury. Sections of the small nodules noted macroscopically on the tricuspid valve showed small cystic cavities within the valve leaflet adjacent to the free margin lined by flattened endothelium that contained degenerate red blood cells. The appearances were those of tricuspid valve blood cysts (Fig. 2). Bacteriological studies yielded mixed growths from the right lung, blood and left and right middle ears, in keeping with post mortem contamination. Virological studies

Cellular Blue Nevus of the Uterus

Cellular blue nevus is extremely rare in the gynecologic tract with only 2 cases reported thus far, one in the myometrium and the other in the cervix/vagina/hymenal ring. In this report, we present the clinicopathologic features of the second case of cellular blue nevus arising in the myometrium. The patient was a 48-year-old woman who underwent a hysterectomy with bilateral salpingo-oophorectomy for uterine leiomyomas. On gross examination, the uterus showed a subserosal, 1.0×0.5×0.3 cm, dark red nodule in the anterior uterine wall in addition to multiple leiomyomas. Microscopically, the subserosal dark nodule had an irregular contour with only focal areas of pushing circumscribed border. The tumor cells were arranged either in sheets or confluent nests. The tumor cells were mostly epithelioid with clear cytoplasm, but in some areas the tumor cells were spindle-shaped with eosinophilic cytoplasm. Both types of cells contained intracytoplasmic melanin. The nuclei of the tumor cells were either oval, round, or elongated with no or minimal irregularities of the nuclear membrane, evenly distributed chromatin, inconspicuous nucleoli, and no obvious mitotic figures. Focally some of the epithelioid cells showed enlargement of the nucleus, irregularities in the nuclear contour, and rare nuclear pseudoinclusions. The tumor cells were positive for S-100, HMB-45 antigen (strong and diffuse pattern), and MART-1. Anti-Ki-67 showed a low proliferative activity (only a rare cell marked for this immunomarker). Thus, a diagnosis of cellular blue nevus was established. After a follow-up of 2 months, the patient had no evidence of the disease.

Intravascular Papillary Endothelial Hyperplasia Associated with Venous Pool Arising in the Lower Lip: A Case Report

Intravascular papillary endothelial hyperplasia is a benign nonneoplastic vascular lesion that consists of endothelial cells with abundant vascular tissue with papillary proliferation. An adult female had a painless growing dark red nodule on the left side of the lower lip and often touched and gnawed at it for more than 4 years. The lesion was a tender, smooth mass approximately 1 cm in diameter without discoloration reaction. Magnetic resonance imaging of the lesion showed specific findings. She was diagnosed clinically as having mimicked hemangioma, and the lesion was totally excised under local anesthesia. Histopathological examination revealed that papillary proliferated endothelial cells with venous pool, and the lesion was diagnosed as intravascular papillary endothelial hyperplasia associated with venous pool. There has been no recurrence for more than 1 year. Despite the benign nature of this lesion, it could have been mistaken for a malignant tumor because of its clinical course and radiologic findings.

Rippled-Pattern Sebaceoma: A Report of a Lesion on the Back With a Review of the Literature

A 68-year-old Japanese man presented with a nodule that had been present for 5 to 6 years on the right side of the back. Physical examination revealed a dome-shaped, 12 x 13-mm, dark red nodule. It was excised with a 2 to 3-mm margin. The patient remained free of disease during 77 months of follow-up. Microscopic examination revealed a bulb-like tumor in the dermis, contiguous with the overlying epidermis. It was composed of small, monomorphous, cigar-shaped basaloid cells in linear, parallel rows, resembling the palisading of nuclei of Verocay bodies, and presenting a rippled-pattern. There were scattered cells showing sebaceous differentiation with vacuolated cytoplasm and scalloped nuclei. There were tiny, duct-like spaces. The tumor revealed characteristics of rippled-pattern sebaceoma. The present case is the first reported rippled-pattern sebaceous neoplasm on the back. Many spindle cell tumors, such as basal cell carcinoma, pleomorphic adenoma, dermatofibrosarcoma protuberans, myofibroblastoma, and leiomyoblastoma, in addition to trichoblastoma and sebaceoma, can have a rippled-pattern.

A case of lymphangitic sporotrichosis occurring on both forearms with a published work review of cases of bilateral sporotrichosis in Japan

The patient, 56-year-old man who was working as a clerk and a farmer, presented with nodules that had appeared on the dorsa of both his hands 3 months earlier. At the first examination, there were multiple dark-red nodules scattered on the fingers, dorsa and wrists of both hands. The nodules were up to 3 cm in diameter and had crusts in the incenters. The patient was suspected to suffer from prurigo and was subsequently treated with topical steroid, but the nodules did not respond. Therefore, a skin biopsy and fungal culture were performed, and the patient was finally diagnosed as having bilateral multiple sporotrichosis. He was then successfully treated with local thermotherapy and oral potassium iodide. Bilaterally-distributed lymphangitic sporotrichosis is very rare and often difficult to diagnose. Careful attention is required to avoid misdiagnosis.

Role of Radiotherapy in Primary CD30+ and Pleomorphic Small/Medium-sized T-cell Lymphomas

Sir, In the treatment of cutaneous T-cell lymphomas, radiotherapy plays a well-known role in the management of mycosis fungoides (MF) and Sezary syndrome, as localized radiotherapy or total skin electron-beam irradiation. Furthermore, radiotherapy has been indicated as first choice treatment in large cell CD30+ lymphomas (LCCD30+L) (1, 2), and in pleomorphic small/medium-sized cells lymphomas (PSMSL) (1, 3, 4). The former is characterized by a single nodularulcerative lesion or grouped nodules, rarely multifocal, sometimes spontaneously regressing, showing histopathologically a diffuse non-epidermotropic infiltrate of large cells expressing CD30 phenotype. The latter is defined by the occurrence of one or several dark red nodules, due to a neoplastic infiltrate of pleomorphic small/medium-sized cells, without clinical evidence of concurrent patches typical for mycosis fungoides. In this short report we update our data on the radiological treatment of LCCD30+L (5), evaluate the results of radiotherapy in the treatment of PSMSL, and compare our findings with those reported in the literature (1–4, 6).

Ｅｘｏｐｈｉａｌａ ｓｐｉｎｉｆｅｒａによる皮膚黒色真菌感染症の１例

A 66-year-old female had a solitary dark-red nodule measuring 1 cm in diameter on her left forearm. She often had trauma to her hands and arms. A histopathologic examination demonstrated granulomatous changes in the dermis. Under the high-power magnification yeast-like cells and short toruloid hyphal elements were observed in the granuloma. A few giant cells contained fungal elements. No sclerotic cells were found. On the basis of the histopathologic and mycologic findings, the lesion was diagnosed as a dematiaceous fungal infection caused by Exophiala spinifera. She was treated with oral itraconazole (200 mg/day) and topical heat therapy. The lesion was clinically improved within 58-days. However, E. spinifera was still isolated from the excisional specimen 92-days later. We believe that surgical excision is the choice of therapy if the lesion is small.

成人に発症したＬａｎｇｅｒｈａｎｓ ｃｅｌｌ ｈｉｓｔｉｏｃｙｔｏｓｉｓの１例

Langerhans cell histiocytosis (LCH) is a rare disease of Langerhans cell proliferation, has a broad spectrum of clinical symptoms, course and prognosis. We report the case of a 41-year-old man with LCH who exhibited dark red nodules on the trunk. The patient also exhibited swelling of the cervical lymph nodes and bilateral lung and skull lesions in X-ray examination. As there were no signs of severe physical symptoms or organ failure, we prescribed a course of oral treatment only (PSL 30mg/day for 7 weeks) and prohibited smoking. After treatment, the skin lesions disappeared. In this report, we present a case of the typical LCH case and in addition, examined the statistical relationship between clinical cutaneous symptoms and prognosis of 66 adult LCH cases reported from 1993 to 1998 in Japan. In result, cutaneous lesions in adult LCH are relatively common, mostly present as papules or nodules. Not infrequently, there are petechiae or purpuric lesions, which are considered as poor signs, and a rapid enlargement of cutaneous lesions is also. Lahey score is almost correlate with prognosis of adult LCH. These factors may be useful way to determine a prognosis of adult LCH.

Rapid Colored-Nodule Assay for Assessing Root Exudate-Enhanced Competitiveness of Bradyrhizobium japonicum

The effects of root exudate (RE) treatment on nodule occupancy by Bradyrhizobium japonicum were investigated by a rapid colored-nodule assay, which is based on the observation that B. japonicum L-110 and its antibiotically marked derivatives form dark-red nodules on certain soybean (Glycine max) cultivars, whereas other strains form beige nodules. The efficacy of the assay was confirmed by direct immunofluorescence and by antibiotic platings of nodule bacteria. Both logarithmic- and stationary-phase cultures of the reference strain, L-110Nal, were used in paired-competition studies with RE-treated or untreated cells of seven challenge strains. On the basis of field and greenhouse competition studies, these strains were placed into three competitiveness groups: high (AN-11, AN-16aStrRif, and AN-6), intermediate (AN-3 and 122SR), and low (I-110ARS and AN-18). Seedlings of G. max cv. Centennial were inoculated with two ratios of challenge to reference strain, 1:1 and 1:9, and nodule occupancy was determined after the V4 to V5 stage of ontogeny. Two of the strains showed increased occupancy in response to RE treatment at the 1:1 inoculation ratio. Logarithmic- and stationary-phase cultures of AN-6 showed increased occupancy, from 22 to 38% (P < 0.10) and from 23 59 39% (P < 0.05), respectively. While the maximum increase for stationary-phase cultures of AN-16aStrRif was from 34 to 47% (P < 0.05), logarithmic-phase cultures failed to respond to RE treatment. The results of these studies indicate that RE treatment increases the nodule occupancy of some, but not all, B. japonicum strains and that the colored-nodule assay could be rapidly and reliably used to determine the competitive ability of B. japonicum.

Chronic malignant catarrhal fever: a case in a sika deer (Cervus nippon)

A condition resembling chronic malignant catarrhal fever was seen in a 9-month-old pet sika hind (Cervus nippon). From an initial acute depression, pyrexia, and anorexia, the condition progressed to include hypopyon, keratitis, lethargy, loss of condition, sloughing of one hoof and eventually death after seven weeks. There were multiple, 5 to 8mm diameter dark-red nodules throughout the mesenteries and mediastinum, along abdominal organ ligaments, and about the uterus and kidneys. Histopathology showed the nodules to be organising vascular thrombi. Concurrent perivascular mononuclear infiltrations and intravascular thrombi in many tissues confirmed that the condition was malignant catarrhal fever.

Panniculitis of the legs with urate crystal deposition

Dark red nodules that drained an opaque amber liquid developed on the extensor surfaces of both legs in a 69-year-old woman receiving furosemide and spironolactone for congestive heart failure. In addition to asymptomatic cholelithiasis, the serum amylase, lipase, and uric acid levels were elevated. Other skin signs and joint manifestations of gout were absent. A biopsy revealed a granuloma with the needle-like crystals characteristic of gout.

Panniculitis of the Legs With Urate Crystal Deposition

• Dark red nodules that drained an opaque amber liquid developed on the extensor surfaces of both legs in a 69-year-old woman receiving furosemide and spironolactone for congestive heart failure. In addition to asymptomatic cholelithiasis, the serum amylase, lipase, and uric acid levels were elevated. Other skin signs and joint manifestations of gout were absent. A biopsy revealed a granuloma with the needle-like crystals characteristic of gout. ( Arch Dermatol 113:655-656, 1977)