Involvement Of Subcutaneous Tissue Research Articles

Mucocutaneous manifestations of COVID-19-associated mucormycosis: A retrospective cross-sectional study.

Background Cutaneous mucormycosis has shown a significant upsurge during the COVID-19 pandemic. Due to the rapid progression and high mortality of cutaneous mucormycosis in this context, it is important to identify it early. However, very few studies report detailed clinical descriptions of cutaneous mucormycosis in COVID-19 patients. Objectives To describe mucocutaneous lesions of COVID-19-associated mucormycosis based on clinical morphology and attempt to correlate them with radiological changes. Methods A retrospective cross-sectional study was conducted at a tertiary care centre from 1st April to 31st July 2021. Eligibility criteria included hospitalised adult patients of COVID-19-associated mucormycosis with mucocutaneous lesions. Results All subjects were recently recovering COVID-19 patients diagnosed with cutaneous mucormycosis. One of fifty-three (2%) patients had primary cutaneous mucormycosis, and all of the rest had secondary cutaneous mucormycosis. Secondary cutaneous mucormycosis lesions presented as cutaneous-abscess in 25/52 (48%), nodulo-pustular lesions in 1/52 (2%), necrotic eschar in 1/52 (2%) and ulcero-necrotic in 1/52 (2%). Mucosal lesions were of three broad sub-types: ulcero-necrotic in 1/52 (2%), pustular in 2/52 (4%) and plaques in 1/52 (2%). Twenty out of fifty-two patients (38%) presented with simultaneous mucosal and cutaneous lesions belonging to the above categories. Magnetic resonance imaging of the face showed variable features of cutaneous and subcutaneous tissue involvement, viz. peripherally enhancing collection in the abscess group, "dot in circle sign" and heterogeneous contrast enhancement in the nodulo-pustular group; and fat stranding with infiltration of subcutaneous tissue in cases with necrotic eschar and ulcero-necrotic lesions. Limitations The morphological variety of cutaneous mucormycosis patients in a single-centre study like ours might not be very precise. Thus, there is a need to conduct multi-centric prospective studies with larger sample sizes in the future to substantiate our morphological and radiological findings. Conclusions COVID-19-associated mucormycosis patients in our study presented with a few specific types of mucocutaneous manifestations, with distinct magnetic resonance imaging findings. If corroborated by larger studies, these observations would be helpful in the early diagnosis of this serious illness.

Appearance-related concerns and their impact on health-related quality of life in patients with peripheral vascular malformations.

Peripheral vascular malformations (VMs) may lead to disfigurement of the body and face, potentially impairing aesthetic appearance. Yet, data on appearance in this population is limited. This study aimed to examine appearance-related concerns and their impact on health-related quality of life (HR-QoL) in patients with VMs. In this cross-sectional study, 384 adults and 194 children with VMs were invited to complete the Outcome Measures for VAscular MAlformations (OVAMA) questionnaire to evaluate potential appearance-related concerns on a five-point verbal-rating scale, with higher scores indicating more appearance-related concerns (e.g., colour-difference, facial-distortion, reduced self-esteem, and dissatisfaction with appearance). HR-QoL was evaluated using Patient-Reported Outcome Measurement Information System (PROMIS). Subgroups of patients reporting more appearance-related concerns were identified using univariate analysis. Associations between appearance-related concerns and various HR-QoL domains (e.g., anxiety and social participation) were assessed. A total of 184 patients (32%) completed the questionnaires; 121 patients (66%) reported that one or more appearance outcome was severely affected (i.e., 4-5 out of 5). The following factors statistically significant associated with more appearance-related concerns: capillary/combined origin, facial localization, subcutaneous tissue involvement, larger size, overgrowth, and diagnosis of a syndrome. In adults, dissatisfaction with appearance and reduced self-esteem due to the appearance of the VM correlated with more anxiety and depression symptoms. Reduced self-esteem correlated with less social participation. In children, bodily distortion and being stared at were correlated with less peer relationships. Severe appearance-related concerns were present in two-thirds of patients with VMs, impairing their mental HR-QoL. Clinicians should acknowledge appearance-related aspects, monitor psychological well-being, and offer intervention aimed at improving satisfaction with appearance.

Subcutaneous Mycosis in Hospitals: Study of 3 Cases at The National University Hospital Centre Hubert Koutoukou Maga in Cotonou (Benin)

Introduction: Deep subcutaneous mycosis results from the involvement of subcutaneous tissue by microscopic fungi. Few studies have been conducted on these diseases in Benin. Patients and methods: This was a retrospective descriptive study that included all cases of subcutaneous mycosis recorded in the Dermatology-Venerology Department of the CNHU-HKM from 2009 to 2020. Results: 3 cases of deep subcutaneous mycosis were recorded in 12 years, including two cases of basidiobolomycosis and one case of fungal mycetoma. The cases of basidiobolomycosis were observed in two girls aged 7 and 8 years whose lesions were located on the right buttock, in the form of indurated placards, adherent to the superficial plane, measuring respectively 10cm by 5cm and 14cm by 7cm. Mycological examination of the biopsy specimens isolated Basidiobolus ranarum. The only case of fungal mycetoma was observed in a 39-year-old man, in the form of a nodular placard measuring 14cm by 12cm, polyfistulised, inflammatory and squamous-crusty with an irregular border that had been evolving for 15 years. Mycological examination of the pus revealed the presence of black grains and the identification of Madurella mycetomatis. Treatment with Ketoconazole was initiated in all three patients but the evolution could not be appreciated. Conclusion : Subcutaneous mycosis is rare in Cotonou, but probably underestimated. Keywords: Subcutaneous Mycosis; Mycetoma; Basidiobolomycosis; Benin

Invasive candidiasis in children

The prevalence of invasive candidiasis (IC) in pediatric hospitals is from 4,3 to 15,2 per 10,000 hospitalized, in ICU – from 3,5 to 7 cases per 1,000, with HSCT – 2,9%. The average length of stay of a patient in the hospital before the development of IC varies from 21 to 56 days, in the ICU – more than 15 days. Knowledge of risk factors (ICU stay for ≥15 days, use of antibacterial drugs and parenteral nutrition, active malignant neoplasm, etc.) makes it possible to identify patients with a high (10-46%) risk of developing IC. Candida albicans remains the leading causative agent of IC in children, but infections with non-albicans Candida spp. have increased and an increase in the resistance of IC pathogens to azole antimycotics was noted. The main clinical variant of IC in children is candidemia, other forms include the central nervous system, abdominal organs, eyes, heart, bones and joints, kidneys, skin and subcutaneous tissue involvement, as well as chronic disseminated (hepatolienal) candidiasis. Blood culture, the main method of laboratory diagnostics of IC, is characterized by low sensitivity and requires a long time. Methods of noncultural diagnostics of IC (1,3-β-D-glucan, mannan and antimannan antibodies, T2 Candida etc) in children have not been sufficiently studied. The main drugs for the treatment of IC in children are echinocandins (anidulafungin, etc.), and CVC removal/replacement is necessary. The overall mortality rate in pediatric patients within 30 days after the diagnosis of IC is 37% to 44%.

Case of pyoderma gangrenosum with visceral involvement: severely recurrent disease with lung, spleen, mesorectum and subcutaneous tissue involvement

Case of pyoderma gangrenosum with visceral involvement: severely recurrent disease with lung, spleen, mesorectum and subcutaneous tissue involvement

Clinicopathologic, immunophenotypic, and molecular analysis of subcutaneous panniculitis-like T-cell lymphoma: A retrospective study in a tertiary care center.

Subcutaneous panniculitis-like T-cell lymphoma (SPTL) as strictly defined by World Health Organization-European Organization for Research and Treatment of Cancer classification is a rare cytotoxic α/β T-cell lymphoma, characterized by primary involvement of subcutaneous tissue mimicking panniculitis. To describe the clinicopathologic, immunophenotypic, and molecular features of SPTL. A 10-year retrospective study of 18 patients diagnosed with SPTL was thoroughly reviewed according to clinicopathology, immunophenotype, and T-cell receptor (TCR) gene rearrangement. Of the 18 patients, 16 patients were definitely diagnosed with SPTL. The median age was 26 years (ranged 14-53 years) with female predominance. Most patients presented with prolonged fever and subcutaneous nodules and/or plaques, usually located on lower extremities. 37.5% of patients had hemophagocytic syndrome. The main histopathology was lobular panniculitis with rimming of atypical lymphocytes highlighted by CD3+, CD8+, Beta-F1+, granzyme B+, and Ki-67 (50%-90%). Monoclonal TCR gene rearrangement was found in 50% of patients and upper extremities involvement indicated a poor prognosis. The correlation between clinicopathologic and immunophenotypic study is the most helpful method to give a precise diagnosis of SPTL. Rimming of CD8+ atypical lymphocytes highlighted by high Ki-67 index is highly specific for the diagnosis of SPTL.

An unexpected etiology of a subcutaneous mass: hydatid cyst.

Hydatid disease is a parasitic infestation that is caused by the cestode Echinococcus granulosus (E. granulosus) that has a higher prevalence in South American, Mediterranean, Middle Eastern, and East Asian countries. Humans are incidental intermediate hosts because of the ingestion of embryonated eggs in food contaminated with dog feces. In humans, the liver and the lungs are the most commonly affected sites of the body; the other sites include the peritoneum, spleen, kidney, uterus, and pancreas [[1]]. A solitary subcutaneous hydatid cyst is extremely rare. In a different series, the frequency of subcutaneous tissue involvement was approximately 2%; however, primary lesions without secondary damage to any organs have been very rarely reported [[2]]. We herein present an unexpected and uncommon etiology of a subcutaneous cyst diagnosed as a hydatid cyst, which might be of interest to surgeons.

The use of ultrasonography (US) in non traumatic musculo-skeletal disorders in infants and children

Ultrasongraphy (US) is a powerful diagnostic imaging tool for evaluating musculo-skeletal disorders in children. US is relatively cheap, non invasive and does not require sedation thus it is generally well-tolerated. Lack of ionizing radiation and dynamic imaging capabilities are significant advantages compared to CT and MRI too. US is ideally suited to the evaluation of the bone, cartilage and soft-tissue structures, including tendons and ligaments, joints and muscles [1]. The combined use of new generation high frequency transducers and of Power Doppler increases the diagnostic accuracy of US. US is widely used in the diagnosis of hip disorders in children [2]. In developmental displasia, it is essential for establishing an early diagnosis in order to allow a prompt treatment. In transient synovitis and hip infections US is able to demonstrate joint effusion, synovial thickening and cartilage damage. In Perthes disease US is a reliable technique to identify hip effusion, femoral head cartilage thickening as well as irregular, fragmented and flattened femoral epiphysis. In epiphysiolysis US allows the assessment of the severity of epiphyseal slipping by measuring the width of the physeal step [1]. Besides hip’s disorders, US can be employed in many other pathological conditions of the pediatric musculoskeletal system, including congenital, infectious, neoplastic and inflammatory disorders [3]. Particularly, in juvenile idiopathic arthritis (JIA) US is crucial for the diagnosis of the disease, the assessment of its severity and prognosis, the monitoring of disease progression and treatment response and the evaluation of complications related to the disease or its therapy. The US assessment of disease activity has been proven to be more informative than clinical examination. Moreover, multiple locations can be assessed during the same ultrasonographic session. US can guide intra-articular steroid injections for therapeutic purposes too. In acute osteomyelitis US is able to identify early abnormalities in the soft tissues overlying the bone just few days after the onset of symptoms before the appearance of radiographic signs. As infection progresses, US can depict interruption of the cortical profile related to bone destruction and diffuse involvement of subcutaneous tissue with formation of abscesses. Due to the peculiarities of the growing skeleton, the knowledge of musculoskeletal pediatric anatomy and especially of growth-related changes in healthy children is extremely important in establishing whether the US findings reflect pathology or are part of normal development [4].

Weekly low-dose Semustine in a patient with peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) coupled with subcutaneous involvement and positive O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation

Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) is a heterogeneous group of aggressive T-cell lymphomas with no treatment consensus and poor prognosis. We herein described an extraordinary refractory case of PTCL-NOS with widely involvement of subcutaneous tissue, which showed an excellent response to Semustine personalized chemotherapy based on the detection finding of positive O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation. This is the first english report to indicate that single nitrosourea agent such as Semustine may have good efficacy and safety for widespread subcutaneous involvement of PTCL-NOS with positive MGMT promoter methylation.

Unusual Subcutaneous Swellings on the Hand as Primary Presenting Feature of Sarcoidosis

Sarcoidosis usually presents with typical signs and symptoms, often found through chest radiographs. However, sometimes sarcoidosis is diagnosed from unusual manifestations. A soft-tissue swelling in the hands, for example, without significant systemic disease is a rare sign, but it could indicate sarcoid involvement of subcutaneous tissue. A 41-year-old man presented with a 4-month history of progressive, painless soft-tissue nodular swellings in his left hand. He denied symptoms of systemic illness or history of chronic disease. Examination revealed 2 nodular masses, one with a diameter of 1 cm on the thenar eminence and the other 2 cm, involving the third metacarpophalangeal joint (Figures …

MRI evaluation of soft tissue sarcomas

e21523 Background: Althouth soft tissue constitute large part of the body, STS are rare (1% of all neoplasms) and can arise anywhere in the body. Imaging is require to confirm the diagnosis and for staging. We conducted a prospective study to evaluate the role of MRI scan in characterization and staging of the tumor. Methods: This study between 2006 and 2008 included 20 patients with histologically proven soft tissue sarcoma in whom preoperative MRI of the local site was performed and the findings were correlated with the surgical and histopathological findings. Only those patients in whom surgical and histopathological findings were available were included in the study. All MRI were performed on 1.5 T MRI using body and appropriate surface coil. T1W, T2W, and STIR sequences were acquired in axial, coronal, and sagittal planes. Contrast enhanced MRI was performed in four patients. Surgical findings were recorded by the operating surgeon and resected specimens were analyzed by pathologist for assessing extent and histologic typing. All demographic data of the patient, the clinical features, preoperative imaging analysis, operative and histopathological findings were tabulated as per the given proforma. Results: Age of the patients was 16 - 72 years (mean age 44.4 years). Male female ratio was 2.3:1 . Eleven cases were recurrent. Most common histologic type was MFH (30%) while synovial sarcoma was second most common (20%) type of the STS in our study. Eighteen of 20 soft tissue sarcomas were of high grade. Average size on MRI was 9.25 cm (range) and operative size was 9.8 cm (range). Statistically significant agreement existed between MR and operative size. The sensitivity of MRI for individual muscle involvement was 92.3% and specificity was 96.5%. MRI had a sensitivity of 93% and specificity of 100% in predicting fascial involvement. MRI had 100% sensitivity and specificity in showing skin and subcutaneous tissue involvement. MRI had 100% negative predictive value in predicting NV bundle involvement. None of the patients had bone or joint involvement. No distant parenchymal metastases were seen. Specific diagnosis based on MRI image characteristics was suggested in 35% patients. Conclusions: Overall staging accuracy of MRI was 75% in staging of STS when correlated with surgical and histopathological MSKCC staging. No significant financial relationships to disclose.

First case report of pharyngeal cysticercosis

An 86-year-old woman with pharyngeal cysticercosis presented to Victoria Hospital, Cape Town, South Africa in February 2007 with active neurocysticercosis and subcutaneous tissue involvement. Diagnosis was based on clinical, radiological and histopathological grounds. The patient was successfully managed with surgical excision of the oropharyngeal cyst and subsequent chemotherapy with albendazole. This was a rare case of pharyngeal cysticercosis and illustrates that Taenia solium can invade the upper aerodigestive tract. The occurrence of cysticercosis in pharyngeal tissue adds a new dimension to the manifestation of this disease and should alert to more severe generalised disease.

Subcutaneous Panniculitis-like T-cell Lymphoma

Subcutaneous panniculitis-like T-cell lymphoma (SPTL) is defined as a rare cytotoxic alpha/beta T-cell lymphoma characterized by primary involvement of subcutaneous tissue mimicking panniculitis and a predominant CD3+/CD4-/CD8+ phenotype in 2005 World Health Organization-European Organization for Research and Treatment of Cancer (WHO-EORTC) classification for cutaneous lymphomas. We presented a detailed study of SPTL, describing clinicopathologic, immunophenotypic, and molecular features of 22 cases in China. Strict diagnostic criteria according to the WHO-EORTC definition were applied to the diagnosis of all SPTL cases. Besides the common features described before, unusual CD4+/CD8- and CD4-/CD8- T-cell phenotypes were noted in 2 of our cases, respectively. CD30 was negative in all cases and CD56 was focally positive in 2 cases. Mortality in cases with angioinvasion (75%) was significantly higher than that in cases without angioinvasion (14.3%). Epstein-Barr virus (EBV) infection was detected in 1 immunocompetent patient by in situ hybridization. The frequency of rearranged TCRB, TCRG, and TCRD genes detected by BIOMED-2 multiplex polymerase chain reaction tubes was 80%, 67%, and 13%, respectively, with a total clonality detection rate of 100%. Clinical follow-up was available in 18 patients, ranging from 6 to 80 months. Most patients obtained complete or partial remission after therapy including one accompanied with EBV infection; 5 patients died: 3 of disease progression, 1 of severe infection, and 1 of complications caused by diabetes and hypertension. We conclude that SPTL as a cytotoxic lymphoma derived from alpha/beta T cell has a predominant CD4-/CD8+ phenotype, but unusual CD4+/CD8- and CD4-/CD8- phenotypes do exist. Owing to its indolent clinical course and relatively high survival rate, SPTL should be differentiated from cutaneous gamma/delta T-cell lymphoma. EBV is generally absent in SPTL but can rarely be detected especially in Asian population. Angioinvasion is a poor prognostic factor in SPTL.

Subcutaneous Panniculitic-Like T-Cell Lymphoma and Other Primary Cutaneous Lymphomas with Prominent Subcutaneous Tissue Involvement

The concept of subcutaneous T-cell lymphoma defines a reduced group of primary cutaneous lymphomas characterized morphologically by a prominent or exclusive subcutaneous tissue involvement. Subcutaneous panniculitic-like T-cell lymphoma is a rare subtype of primary cutaneous T-cell lymphoma clinically mimicking panniculitis. The clinical course is usually protracted with recurrent cutaneous lesions but rarely with early extracutaneous dissemination. The clinical, histopathologic, immunophenotypic, and evolutive features of this heterogeneous and rare group of primary cutaneous lymphomas are reviewed.

Risperidone‐induced recurrent giant urticaria

Psychotropic drugs such as olanzapine [1], droperidol [2, 3], chlorpromazine [4], clozapine [5–9] and risperidone [10, 11] have been known to cause drug rashes and cutaneous eruptions. These can have various degrees of severity ranging from generalized cutaneous rashes (50–95%) and urticaria (5–22%) to more severe lesions which warrant emergency attention, such as angio-oedema, acute generalized exanthematous lesions, toxic epidermal necrolysis and ‘Steven–Johnsons’ syndrome [12]. Urticaria can manifest as anything from mild erythematous, pruritic lesions to involvement of subcutaneous tissue and, in extreme cases, life-threatening anaphylaxis [12]. We report a patient who developed giant urticaria following treatment with risperidone which resolved rapidly on discontinuation of the drug and which recurred on rechallenge. A 46-year-old male diagnosed with undifferentiated schizophrenia was started on risperidone 3 mg day−1 after a history of poor response to various typical antipsychotics including trifluoperazine and pimozide. Within 3 days of starting risperidone, he developed an erythematous pruritic and painful rash over the face and neck. No soft tissue swelling was present. An in-house dermatological consultation diagnosed it as giant urticaria. Risperidone was stopped and the patient was treated with steroids and antihistamines for 5 days, after which the lesions disappeared. A rechallenge with risperidone was not done on ethical grounds. He was then maintained on chlorpromazine 300 mg day−1 and depot fluphenazine. Other antipsychotics were not considered because of financial reasons. However, due to poor response, guardians of the patient requested risperidone to be restarted even after being informed of the possible complications. Risperidone was therefore restarted. He again developed symptoms and signs of giant urticaria. Risperidone was stopped, he was treated with steroids and antihistamines and, within 5 days, the urticaria disappeared. He was discharged on fluphenazine depot. On evaluation with the Naranjo algorithm [13], we obtained a score of 10, which is highly probable that the adverse reaction was caused by the drug. Urticaria has various causes but drug-induced urticaria is believed to be IgE mediated with a link to the major histocompatibility complex allele, HLA-DRB1*. The drug acts as an allergen, triggering IgE-mediated degranulation of mast cells, causing release of histamine and a spectrum of skin manifestations [14]. Urticaria is a condition characterized by local elevated ridges (weals) and erythema of the skin. Giant urticaria is a more severe form which is larger in size than papular urticaria or ‘hives’ [15]. Angio-oedema, however, is the presence of urticaria along with involvement of subcutaneous tissue resulting in additional painful oedema [16]. However, differentiation is usually difficult as both may coexist and overlap [17]. Our patient, unlike the previous reports, developed only a limited erythematous skin reaction without the presence of subcutaneous swelling and was hence diagnosed as suffering from giant urticaria. Considering the negative family or past history, recurrence of giant urticaria with introduction of risperidone and the response to antihistamines and steroids, the patient probably developed an allergic form of urticaria due to risperidone. Clinicians need to be aware of this potential complication and be able to recognize it.

The protean spectrum of non‐Hodgkin lymphomas with prominent involvement of subcutaneous fat

Subcutaneous T-cell lymphoma (STCL) represents a controversial entity and a confused concept in the field of cutaneous T-cell lymphomas (CTCLs). Recently, alpha/beta+/CD8+ STCL has been recognized by the new World Health Organization (WHO)-European Organization for Research and Treatment of Cancer (EORTC) classification of primary cutaneous lymphomas as a distinct entity in the group of CTCLs. We reviewed a series of 53 biopsies from 26 patients (F : M = 19:7; median age: 48; range 18-87) of cutaneous B- and T-cell lymphomas characterized by prominent involvement of the subcutaneous tissue. We could classify our cases according to the following seven categories--(i) STCL: n = 16; (ii) extranodal NK/T-cell lymphoma, nasal type: n = 2; (iii) cutaneous gamma/delta T-cell lymphoma: n = 2; (iv) anaplastic CD30+ large T-cell lymphoma: n = 1; (v) diffuse large B-cell lymphoma, secondary cutaneous: n = 3; (vi) lymphoplasmacytic lymphoma, secondary cutaneous: n = 1; (vii) specific cutaneous manifestations of myelogenous leukemia: n = 1. We demonstrated the protean nature of lymphomas with prominent involvement of the subcutaneous fat tissues. The term STCL should be restricted to a homogeneous group of cases characterized morphologically by an exclusive involvement of subcutaneous tissues, immunohistochemically by a T-cytotoxic alpha/beta phenotype, and biologically by a relatively good prognosis.

An approach to the management of necrotising fasciitis in neonates

Necrotising fasciitis is a severe, life-threatening soft tissue infection. It produces an extensive cellulitis with severe involvement of subcutaneous tissue, fascia, muscle or both, resulting in necrosis of the tissue. All age groups, including neonates, can be affected. Patients with necrotising fasciitis present with more severe constitutional symptoms and have a poor outcome, unless aggressive antibiotic therapy and surgical debridement are instituted promptly. The debridement of necrotic tissue is imperative to control the infection, but results in deep wounds that require further treatment. In this study, the neonate was treated with alginate dressings and negative pressure therapy after resolution of cellulitis, with excellent results and no untoward events.

Primary Subfascial Cyst Hydatic Disease In Proximal Thigh: An Unusual Localisation: A Case Report

The incidence of musculoskeletal hydatidosis is not clear. According to several authors, the incidence of musculoskeletal echinococcosis including involvement of subcutaneous tissue is 1% - 5.4% among all cases of hydatid disease 1. The commonest clinical presentation is an asymptomatic slow growing mass. It is usually associated with involvement of other solid organs. Preoperative radiological diagnosis is very important to avoid biopsy. Diagnosis of echinococcosis should be excluded to avoid leakage of cyst contents and the accompanying risks of anaphylaxis and even death 2,3,4,5 . We presented a primary and subfascial involvement of echinococcal disease in the posterior compartment of the proximal thigh has not been reported previously.

Skin Involvement in Invasive Breast Carcinoma: Safety of Skin-Sparing Mastectomy

There is concern about the oncological safety of preserving most of the breast skin in skin-sparing mastectomy (SSM). Most supportive evidence for SSM evaluates the local recurrence rate on clinical follow-up. The skin and 10 mm of the subcutaneous tissue of 30 total mastectomy specimens were studied with a step-serial sectioning technique. The incidence and mode of involvement of the skin and subcutaneous tissue were recorded in detail. This was correlated with other clinical and pathologic parameters. The incidence of skin involvement outside the nipple-areola complex was 20% (6 of 30). This was significantly related to the clinical T stage, site of the tumor, skin tethering, pathologic tumor size, and perineural infiltration. When the effects of both skin and subcutaneous tissue involvement were considered, the incidence of skin-flap involvement outside the nipple-areola complex was 23% (7 of 30). The significant parameters related to skin-flap involvement were skin tethering (75% vs. 15%; P <.05), pathologic tumor size (P <.03), and perineural infiltration (63% vs. 9%; P <.01). It would be oncologically safe to perform SSM in T1 and T2 tumors, because the chance of skin involvement is small. It is safe to preserve the skin overlying the tumor if there is no skin tethering.

Subcutaneous tissue involvement by T-cell lymphoma. A report of 2 cases

T-cell lymphomas may involve the subcutaneous tissue as a manifestation of generalized disease. However, T-cell lymphomas rarely present with extensive involvement of the subcutaneous fat without other sites of disease. We describe 2 women who presented with fever and subcutaneous nodules or masses. In case 1, the nodules were generalized and did not respond to chemotherapy. The patient died 2 months after diagnosis. In case 2, the mass was large but localized and responded to chemotherapy. The tumor subsequently recurred in a cervical lymph node 9 months later, and the patient was being treated with chemotherapy 15 months after initial diagnosis. Histologically, biopsy specimens from both patients revealed malignant lymphoma involving the subcutaneous tissue. The dermis and epidermis were not involved. At low power the lesions resembled panniculitis, but high-power examination revealed cytologic atypia of the malignant lymphoid cells. Immunohistochemical studies revealed T-cell lineage. In case 2, the neoplastic cells also expressed the CD30 antigen, were positive for Epstein-Barr virus RNA, and carried the t(2;5) (p23;q35) chromosomal translocation. We interpreted case 1 as an example of subcutaneous panniculitic T-cell lymphoma. We believe that case 2 is best classified as anaplastic large cell lymphoma of T-cell lineage. A variety of T-cell lymphomas rarely present with only subcutaneous tissue involvement. Knowledge of this phenomenon and recognition of the cytologic atypia of the lymphoid cells will help to prevent misdiagnosis.