Irregular Vessels Research Articles

蓝痣皮肤镜特点分析

Objective To analyze dermoscopic features of blue nevi. Methods Clinical and dermoscopic data were collected from patients with confirmed blue nevi in the Department of Dermatology and Venereology, Wuxi People′s Hospital from January 2008 to May 2018, and analyzed retrospectively. Chi-square test was used to analyze differences between groups. Results Totally, 65 patients with 66 skin lesions were enrolled into this study. A total of 23 skin lesions were subjected to dermoscopy, which showed homogeneous pattern in 20 (87.0%) lesions, pseudo-pigment network pattern in 2 (8.7%) lesions, and cerebriform pattern in 1 (4.3%) lesion, and the homogeneous pattern was more common than the other patterns (χ2 = 8.79, P < 0.05) . Under the dermoscope, 10 lesions were monochromatic (43.5%) , 11 were dichromatic (47.8%) , and 2 were multichromatic (8.7%) . Scar-like hypopigmentation was observed in 4 lesions (17.4%) , and vascular structures were observed in 5 (21.7%) , including punctate vessels in 4 (17.4%) and linear irregular vessels in 1 (4.3%) . Papillary hyperplasia was observed in 2 lesions (8.7%) . Additionally, pigmentation around lesions, white streaks, dots/globules, blotches, comedo-like openings were observed in 1 lesion (4.3%) each. Conclusions Blue homogeneous pattern is the most common dermoscopic feature of blue nevi. Pseudo-pigment network pattern, cerebriform pattern, scar-like hypopigmentation, multiple vascular patterns, papillary hyperplasia, white streaks, dots/globules, blotches, comedo-like openings can also be observed in blue nevus lesions. Key words: Nevus, blue; Dermoscopy; Melanocytes

Narrow-band imaging for scar (NBI-SCAR) classification: from conception to multicenter validation

Surveillance post-endoscopic resection (ER) currently warrants biopsy samples from the resection site scar in most cases, although clinical practice is variable. A classification with standard criteria for scars has not yet been established. We aimed to create and validate a novel classification for post-ER scars by using specific criteria based on advanced imaging. Key endoscopic features for scars with and without recurrence were (1) dark brown color, elongated/branched pit pattern, and dense capillary pattern and (2) whitish, pale appearance, round/slightly large pits, and irregular sparse vessels. Scars were first assessed with high-definition white-light endoscopy (HD-WLE) followed by interrogation with narrow-band imaging (NBI). Scars with at least 2 concordant characteristics were diagnosed with "high confidence" for NBI for scar (NBI-SCAR) classification. The final endoscopic predictions were correlated with histopathology. The primary outcome was the difference in sensitivity between NBI-SCAR and HD-WLE predictions. Secondary outcomes included the validation of our findings in 6 different endoscopy settings (Australia, United States, Japan, Brazil, Singapore, and Malaysia). The validation took place in 2 sessions separated by 2 to 3 weeks, each with 10 one-minute videos of post-ER scars on underwater NBI with dual focus. Inter-rater and intrarater reliability were calculated with Fleiss' free-marginal kappa and Bennett et al. S score, respectively. One hundred scars from 82 patients were included. Ninety-five scars were accurately predicted with high confidence by NBI-SCAR in the exploratory phase. NBI-SCAR sensitivity was significantly higher compared with HD-WLE (100% vs 73.7%, P< .05). In the validation phase, similar results were found for endoscopists who routinely perform colonoscopies and use NBI (sensitivity of 96.4%). The inter-rater and intrarater reliability throughout all centers were, respectively, substantial (κ= .61) and moderate (average S= .52) for this subset. NBI-SCAR has a high sensitivity and negative predictive value for excluding recurrence for endoscopists experienced in colonoscopy and NBI. In this setting, this approach may help to accurately evaluate or resect scars and potentially mitigate the burden of unnecessary biopsy samples.

Radiation-induced angiosarcoma of the breast: A review.

Angiosarcoma is a rare, aggressive malignant vascular neoplasm with poor prognosis that has a predilection for skin and superficial soft tissue. It can arise spontaneously or in association with factors like chronic lymphedema or radiation therapy. Radiotherapy used to treat invasive breast tumors is a known risk factor for the development of the so-called radiation-induced angiosarcoma (RIAS), a condition that has been described in the literature with increasing frequency. Radiation-induced angiosarcoma of the breast usually arises on the previously irradiated skin area several years after radiotherapy and presents as painless multifocal erythematous patches or plaques similar to a hematoma. Cutaneous biopsy is essential for the diagnosis. Histologically, RIAS is characterized by irregular anastomosing vessels lined by endothelial cells showing nuclear atypia. Treatment is mostly surgical, and mastectomy with negative margins is considered the standard procedure. However, recurrences are common, and an approach combining surgery, chemo- and radiotherapy may be more effective. The purpose of this study is to review the most recent medical literature on RIAS of the breast, with emphasis on its pathophysiology, clinical and histological features and current treatment options.

Hyperacute Infarct on Intraoperative Diffusion Imaging of Pediatric Brain Tumor Surgery.

Brain neoplasms are the second-most prevalent cancer of childhood for which surgical resection remains the main treatment. Intraoperative MRI is a useful tool to optimize brain tumor resection. It is, however, not known whether intraoperative MRI can detect complications such as hyperacute ischemic infarcts. A retrospective analysis of pre- and intraoperative MRIs including DWI sequence and correlation with early and 3-month postoperative MRIs was conducted to evaluate the incidence of hyperacute arterial infarct during pediatric brain tumor resection. Patient demographics, pathological type, tumor location, resection type as well as preoperative tumoral vessel encasement, evolution of the area of restricted diffusion were collected and analyzed comparatively between the group with acute infarct and the control group. Extent of the hyperacute infarct was compared to both early postsurgical and 3-month follow-up MRIs. Of the 115 cases, 13 (11%) developed a hyperacute arterial ischemic infarct during brain tumor resection. Tumoral encasement of vessels was more frequent in the infarct group (69%) compared to 25.5% in the control group. Four cases showed additional vessel irregularities on intraoperative MRI. On early follow-up, the infarcted brain area had further progressed in six cases and was stable in seven cases. No further progression was noted after the first week post-surgery. Hyperacute infarcts are not rare events to complicate pediatric brain tumor resection. Tumoral encasement of the circle of Willis vessels appears to be the main risk factor. Intraoperative DWI underestimates the final extent of infarcted tissue compared to early postsurgical MRI.

Label-Free Imaging of Blood Vessels in Human Normal Breast and Breast Tumor Tissue Using Multiphoton Microscopy.

Blood vessels are the important components of the circulatory systems that transport blood throughout the human body and maintain the homeostasis of physiological tissues. Pathologically, blood vessels are often affected by diseases, leading to the formation of unstable, irregular, and hyperpermeable blood vessels. In the tumor microenvironment, abnormal leakage of tumor blood vessels is related to the histological grade and malignant potential of tumors and may also facilitate metastasis of cancer. Visual diagnosis of blood vessels is very important for us to understand the occurrence and development of diseases. Multiphoton microscopy (MPM) is a potential label-free diagnostic tool based on second harmonic generation (SHG) and two-photon excited fluorescence (TPEF). MPM can effectively observe the morphological changes of biological tissues at the molecular and cellular levels. In this work, we demonstrate that label-free MPM can be used to visualize the microstructure of blood vessels in human normal breast and breast tumor tissue. Moreover, MPM can monitor the changes of blood vessels in tumor microenvironment. These results show that the MPM will become a promising technique for clinicians to study the properties of the microstructure of the blood vessels.

Histopathological changes in placenta and liver of pregnant rats administered with aqueous extract of Dioscorea hispida var. daemona (Roxb) Prain & Burkill

Dioscorea hispida var. daemona (Roxb) Prain & Burkill (DH), also known a tropical yam or intoxicating yam is a bitter wild tuber which is consumed as a staple food and traditionally used as a remedy in Malaysia. However, DH is also notorious for its intoxicating effects and there is currently a dearth of study of possible effects of DH on liver and placental tissues and hence its safe consumption warrants in-depth investigation. This study was therefore designed to investigate into the effect of DH on liver and placenta of pregnant rat via histopathological examination. Thirty pregnant Sprague-Dawley rats were randomly divided into five groups consisting of a control (distilled water) and four DH aqueous extract groups (250, 500, 1000 and 2000 mg/kg body weight). The extracts were administered via oral gavage daily throughout the study and animals were sacrificed on day 21. Paraffin-embedded, hematoxylin and eosin stained sections of placenta and liver were examined. Significant changes (p < 0.05) were observed on relative liver and placental weights of animals treated with 2000 mg/kg body weight DH extract. The placental numbers were decreased with the increased of DH extract concentration. Liver histological examination in all treated groups showed that tissues underwent degeneration characterized by hepatocyte swelling, cytoplasmic vacuolation, cytolysis, margination and clumping of nucleus chromatin. Changes of the basal and labyrinth zone were observed in placental tissues in all treated groups. Glycogen cells were reduced with fibrin deposition in the basal zone, while irregular vessel formation was demonstrated in the labyrinth zone. UHPLC-ESI-MS analysis showed the presence four steroidal saponins DH. In conclusion, DH aqueous extract exert hepatotoxicity and adverse effects on the placenta of rats. However, the underlying mechanism and phytochemicals inducing the observed toxicity require further investigation.

Evaluation of dermoscopic criteria for seborrheic keratosis on non‐polarized versus polarized dermoscopy

The two dermoscopic methods, polarized dermoscopy (PD) and non-polarized dermoscopy (NPD), use different types of light sources. Here, we aimed to explore the differences between these two methods in the diagnosis of seborrheic keratosis (SK). The images of 121 cases of SK taken by a digital camera equipped with NPD and PD were evaluated against 14 dermoscopic criteria of SK. The agreement levels between NPD and PD were fair to perfect against the dermoscopic criteria of SK. Perfect agreement was observed in fingerprint-like structures (κ=0.812) and linear irregular vessels (κ=0.807). Substantial agreement was determined in comedo-like openings (κ=0.640), hairpin vessels (κ=0.609), a moth-eaten border (κ=0.642), sharp demarcation (κ=0.637), network-like structures (κ=0.662), and a mica-like pattern (κ=0.639). Moderate agreement was found in milia-like cysts (κ=0.550), fissures and ridges (κ=0.554), dotted vessels (κ=0.496), and color variability (κ=0.438). Fair agreement was obtained only in comma vessels (κ=0.340). Based on our results, we cannot recommend an absolute dermoscopic method for the diagnosis of SK; rather, we suggest that the methods are complementary.

A novel PDCD10 gene mutation in cerebral cavernous malformations: a case report and review of the literature.

Cerebral cavernous malformations (CCMs) are one of the most common types of vascular malformation, which are featured enlarged and irregular small blood vessels. The cavernous cavities are merely composed of a single layer of endothelial cells and lack other support tissues, such as elastic fibers and smooth muscle, which make them elastic. CCMs may develop in sporadic or familial forms with autosomal dominant inheritance. Mutations have been identified in three genes: KRIT1, MGC4607, and PDCD10. Here, we report a typical case of CCMs in a 44-year-old woman associated with a novel mutation in PDCD10 gene. The patient, diagnosed with CCMs, has been suffering from headache for several months. Analyses of the Whole Exome Sequencing revealed a novel disease-associated mutation in the already known disease-associated PDCD10 gene. This mutation consists a nucleotide deletion (c.212delG) within the exon 4, resulting in premature protein termination (p.S71Tfs*18). This novel mutation significantly enriches the spectrum of mutations responsible for CCMs, providing a new evidence for further clarifying the genotype–phenotype correlations in CCMs patients.

Testosterone deficiency reduces the effects of late cardiac remodeling after acute myocardial infarction in rats.

Testosterone is associated with an increased risk of coronary heart disease. This study evaluated cardiac remodeling 60 days after myocardial infarction (MI) in rats with testosterone deficiency. One week after castration, the animals underwent myocardial infarction. Rats were divided into four groups: orchidectomized (OCT); orchidectomized and infarcted (OCT+MI), MI and control (Sham). The myocyte cross-sectional area and the papillary muscle contractility were evaluated 8 weeks after MI. The coronary bed was perfused with Biodur E20 resin to evaluate the neovascularization after MI. Data were expressed as mean ± SEM followed by ANOVA. Castration reduced myocyte hypertrophy when compared to Sham and myocardial infarction alone as well as preserved the contraction force and activation time after myocardial infarction. After beta-adrenergic stimulation, activation and relaxation kinetics were less impaired in the OCT+MI group than in the MI group. Contraction force was preserved in the OCT+MI group after beta-adrenergic stimulation. Multiple scanning electronic microscope images were obtained to characterize changes in the coronary arteries. Capillary density index was increased in the MI and OCT+MI groups compared with control. The MI and OCT+MI groups were characterized by irregular vessel arrangements with distorted shape, abrupt changes in vessel direction, as well as abrupt changes in diameter after bifurcations when compared to Sham and OCT. The results indicated that testosterone deficiency attenuates adverse cardiac remodeling after MI. Novel findings in this study were that testosterone deficiency in rats, induced by castration, changes the later remodeling after MI, when compared with non castrated rats. The absence of this androgenous hormone seems to be benefic against pathological hypertrophy.

Arabidopsis Natural Accessions Display Adaptations in Inflorescence Growth and Vascular Anatomy to Withstand High Salinity during Reproductive Growth.

Plant responses to abiotic stresses entail adaptive processes that integrate both physiological and developmental cues. However, the adaptive traits that are involved in the responses to a high soil salinity during reproductive growth are still poorly studied. To identify new clues, we studied the halophyte, Thellungiella salsuginea, and three Arabidopsis accessions, known as tolerant or salt-sensitive. We focused on the quantitative traits associated with the stem growth, sugar content, and anatomy of the plants subjected to the salt treatment, with and without a three-day acclimation, applied during the reproductive stage. The stem growth of Thellungiella salsuginea was not affected by the salt stress. By contrast, salt affected all of the Arabidopsis accessions, with a natural variation in the effect of the salt on growth, sugar content, and stem anatomy. In response to the high salinity, irregular xylem vessels were observed, independently of the accession’s tolerance to salt treatment, while the diameter of the largest xylem vessels was reduced in the tolerant accessions. The stem height, growth rate, hexoses-to-sucrose ratio, and phloem-to-xylem ratio also varied, in association with both the genotype and its tolerance to salt stress. Our findings indicate that several quantitative traits for salt tolerance are associated with the control of inflorescence growth and the adjustment of the phloem-to-xylem ratio.

Identification of atheroprone shear stress responsive regulatory elements in endothelial cells.

Oscillatory shear stress (OSS) is an atheroprone haemodynamic force that occurs in areas of vessel irregularities and is implicated in the pathogenesis of atherosclerosis. Changes in signalling and transcriptional programme in response to OSS have been vigorously studied; however, the underlying changes in the chromatin landscape controlling transcription remain to be elucidated. Here, we investigated the changes in the regulatory element (RE) landscape of endothelial cells under atheroprone OSS conditions in an in vitro model. Analyses of H3K27ac chromatin immunoprecipitation-Seq enrichment and RNA-Seq in primary human umbilical vein endothelial cells 6 h after onset of OSS identified 2806 differential responsive REs and 33 differentially expressed genes compared with control cells kept under static conditions. Furthermore, gene ontology analyses of putative RE-associated genes uncovered enrichment of WNT/HIPPO pathway and cytoskeleton reorganization signatures. Transcription factor (TF) binding motif analysis within RE sequences identified over-representation of ETS, Zinc finger, and activator protein 1 TF families that regulate cell cycle, proliferation, and apoptosis, implicating them in the development of atherosclerosis. Importantly, we confirmed the activation of EGR1 as well as the YAP/TAZ complex early (6 h) after onset of OSS in both cultured human vein and artery endothelial cells and, by undertaking luciferase assays, functionally verified their role in RE activation in response to OSS. Based on the identification and verification of specific responsive REs early upon OSS exposure, we propose an expanded mechanism of how OSS might contribute to the development of atherosclerosis.

Application of different noninvasive diagnostic techniques used in HMME-PDT in the treatment of port wine stains.

Hematoporphyrin monomethyl ether photodynamic therapy (HMME-PDT) is an effective method for treating port wine stains (PWS). However, methods to evaluate the treatment of HMME-PDT for PWS effectively and objectively are lacking. This study aimed to describe the different noninvasive diagnostic techniques used in the evaluation of treatment response to HMME-PDT for PWS. Thirty-one lesions of 22 patients with PWS were treated with HMME-PDT. Four noninvasive diagnostic techniques including VISIA-CR™ system, dermoscopy, high-frequency ultrasound (HFUS), and laser speckle contrast imaging (LSCI) were used to obtain standard radiographic data on skin color, skin thickness, blood vessel morphology, blood vessel distribution, and blood perfusion from lesions and surrounding normal skin before and after HMME-PDT. The standard image pattern of VISIA-CR™ system showed color change in the lesions of PWS after HMME-PDT. RBX red image of VISIA-CR™ system showed that erythema was highly aggregated even in invisible lesions at baseline but decreased after HMME-PDT. The erythema index reduced value d was related to the efficacy rating (γ = 0.631, P < 0.05). Dermoscopy showed that the number of spot-like and irregular linear vessels increased, which was correlated with the increase in clinical classification. After HMME-PDT, vascular rupture was observed by dermoscopy. The response rate of lesions with vascular rupture was 100.00% (20/20). Moreover, the response rate of lesions without vascular rupture was 63.64% (7/11). Vascular rupture sign was correlated with better efficacy (P < 0.05). HFUS showed that the dermis of PWS thickened and was arranged loosely with scattered linear hypoechoic signal. After HMME-PDT, the dermal layer of the lesions became thinner with a decreased linear hypoechoic signal. The response rate of the lesions with linear hypoechoic signal was 76.92% (10/13), and that without linear hypoechoic signal was 94.44% (17/18). The lesions without linear hypoechoic signal in the dermis showed better efficacy (P < 0.05). In some lesions, LSCI showed high blood perfusion signal in PWS lesions and blood perfusion reduction after HMME-PDT. VISIA-CR™ system can be used to observe not only visible but also invisible lesions of PWS. Moreover, lesions fading after HMME-PDT can be described objectively by VISIA-CR™ system. Dermoscopy played an important role in the clinical classification of PWS, including assessing vascular injury after HMME-PDT, guiding the adjustment of therapeutic dose, and selecting the end point of treatment. Both HFUS and LSCI can be used to assist treatment response evaluation of HMME-PDT.

Evaluation of cervical lymph nodes (duplex scan and color Doppler)

Characterization of lymph nodes is an important clinical issue, as lymph node metastasis is a critical prognostic factor in cancer patients. Yet physical examination of the neck fails to detect 27–38% of lymph node metastases. Cervical US is the method of choice for the identification of LN metastases. US can provide valuable information in the preoperative work-up of head and neck cancers, because it can differentiate lymph nodes from other masses. Besides, US can even be combined with fine-needle aspiration biopsy (FNAB), thus allowing an evaluation of both the primary tumor and possible cervical metastases in a single examination. Regarding to US important diagnostic features such as size, shape, margins, boundaries, echotexture, and abnormal vascularization, differentiation between benign and malignant lymph nodes will be showed in this presentation. US B-mode can study and describe morphology (globular/elongated); echogenicity (habitual/hypoechogenic/hyperechogenic); echotexture (homogenous/heterogeneous); contours (regular/ irregular, defined/poorly defined/ partially defined); hylum (absent, eccentric, thin/thickened, normal); necrosis; calcifications. The ultrasonographic features of cervical metastatic carcinoma include a round shape, loss of the nodal hilum, microcalcifications, necrosis, signs of invasion, hypoechogenicity, irregular contours, heterogeneous texture. The vascularization patterns, studied by a color Doppler US, will be presented and are classified as: (1) normal: the blood flow was hilar or central hilar vascularity, without peripheral vessels or absent (suggestive of benignity) (2) altered: vessels were mapped in the subcapsular region, with a radial distribution, disorganized and tortuous/ irregular vessels, sprinkled, or with a mixed pattern.The malignant lymph nodes show IR higher than the benign (>0,77). The presence of changes in any of these ultrasonographic features during the follow-up of cervical LNs requires an effective investigation with FNA ultrasound-guided. Ultrasonographic assessment of neck lymphadenopathy can be difficult because sometimes the same pattern is seen both in inflammatory (specific or non-specifc) and neoplastic diseases (lymphoproliferative or metastatic).US remains the most important imaging modality in the evaluation of cervical LNs and thyroid cancer, and should be used preoperatively as a routine examination. Then, radiologists should be familiar with the prognostic implications of LN metastases, the limitations of each imaging tool and their role in the differentiation of lymphadenopathy.

Diagnosis of gallbladder polypoid lesions using contrast enhanced ultrasound

Purpose Effectiveness of differential diagnosis of gallbladder polypoid lesions using contrast enhanced ultrasound (CEUS) examination by perflubutane (Sonazoid®:Daiichi-Sankyo, Tokyo). Material & Methods CEUS was performed on 183 patients with gallbladder polypoid lesions.It consists of 10 adenocarcinomas, 2 adenomas, 129 benign polyps and 42 adenomyomatosis (fundal type). For benigndiseases, we examined cases where the size was 6 mm or more and could be observed for more than one year. Ultrasound was performed using TUS-A500 (Aplio 500) (Canon MedicalSystems. Tokyo) and prosound alpha10 (Hitachi Aloka Medical,Ltd.Tokyo). First, the largest cross section of a lesion was visualized using B-mode and infusion of Sonazoid. The characteristics and behavior of blood flow in the lesion in the early vascular phase were examined over approximately 30 sec. Thereafter, observation was continued accordingly for about 3 min. Sonazoid infusion using contrast harmonic imaging and real-time perfusion Imaging. Results Gallbladder carcinoma showed hypervascular staining and “eruption sign” was apparent in 60%. The “eruption sign” showed an image of a vigorously boiling water that was splashing up from the entire lesion. Blood flow imaging revealed irregular size and buckling, including tortuous vessels and erratic blood flow in 70%. Gallbladder adenoma showed “eruption sign” was apparent in 50%. The irregular size, tortuous vessels and eruption signs of blood flow imaging were 83.3% as an index of neoplastic. Gallbladder benign polyp, staining was scattered within them, and “flicker sign” was observed in 93.8%. The “flicker sign” showed an image of bubbling pre-boiled hot water. Five cases (3.9%) showed a diffused and hypervascular staining pattern. The staining time was shorter than gallbladder carcinoma. Blood flow image showed normal vessels without buckling. Linear blood flow of the stalk of gallbladder polyp was also characteristic. Gallbladder adenomyomatosis (fundal type), staining was scattered and mild flicker signs were observed in 85.7%. Blood flow at the surface of the prominence and internal Rokitansky-Aschoff sinus was observed clearity. Conclusions CEUS can clarify the hemodynamics and blood flow images and are useful for the differential diagnosis of gallbladder polypoid lesions.

Dermoscopic diagnosis of epidermal cyst

Aim: The clinical features of epidermal cyst (EC) are well known, however, dermoscopic aspect of the entity has rarely been a subject of investigation. Here we aimed to identify the dermoscopic findings of EC which may increase the accuracy of diagnosis before surgical interventions. Material and Methods: The study included the patients diagnosed with EC those who applied to outpatient dermatology clinic of a tertiary center. Age and gender of the patients, disease durations, symptoms, site and size of the lesions, dermoscopic and histopathological findings were retrospectively reviewed. Results: A total of 24 lesions from 24 patients were enrolled in the study. The most common dermoscopic finding was white structureless background (96%) followed by punctum/pore sign (75%), widely distributed/branched irregular linear vessels (71%), blue-white structureless color (46%), mobility sign (41%), peripheral thick branched vessel (33%) and polychromatic structures (4%).Conclusion: We describe two novel dermoscopic features which were not described previously for EC: Mobility sign and polychromatic structures. Along with the previous studies, our study revealed that EC has a peculiar dermoscopic pattern. Dermoscopic examination may increase diagnostic accuracy before surgery making possible a management with minimal invasive procedures.Keywords: Dermatoscopy; dermoscop; epidermal cyst.

Dermoscopic profile of pityriasis rosea

Background: Pityriasis rosea (PR) is a common, self-limited cutaneous disease characterized by wide distributed erythematous scaly lesions. The diagnosis is usually based on the clinical features. Objectives: Here, we aimed to investigate the dermoscopic features of PR which may provide helpful clues to the diagnosis. Methods: Demographic, clinical, and dermoscopic features of the patients with PR were retrospectively reviewed, and the findings identified were recorded. Results: A total of 100 lesions from 25 different patients were included in the study. The most common dermoscopic finding was peripheral collarette scale (84%), followed by central yellow with peripheral reddish background (40%), peripheral dotted vessels with patchy distribution (35%), diffuse reddish background (31%), scattered dotted vessels (30%), and irregular distributed scales and red globules (20%). Conclusion: To the best of our knowledge, this is the most comprehensive study focusing on the dermoscopic features of PR. Here, we identified new dermoscopic findings which were not described previously for PR. These findings were irregular linear vessels, blood spots, brown globules, and brown structureless areas. It can be concluded that dermoscopy may provide remarkable clues to diagnosis, especially in atypical presentations of the entity.

Dermoscopic Diagnosis of Ashy Dermatosis: A Retrospective Study.

Aim:Ashy dermatosis (AD) is a cutaneous pigmentation disorder with unknown etiology characterized by ash-colored hyperpigmented macules. The diagnosis of Ashy dermatosis is primarily based on the clinical and histopathological findings. In this study, we aimed to identify the dermoscopic features of AD, which may facilitate the diagnosis by reducing the need for invasive procedures.Material and Methods:The study included the patients diagnosed with Ashy dermatosis. Demographic, clinical, dermoscopic and histopathological features of the lesions were reviewed and the findings observed were recorded.Results:A total of 60 lesions from 15 patients were included. The most common dermoscopic finding were irregular linear dots and globules, pinkish brown color was the predominant color of the background, and found to be associated with early lesions. Among the vascular structures observed, irregular linear vessels were the most prevalent. There were no significant differences in terms of dermoscopic structures according to age and localization of the lesions.Conclusion:Dermoscopy can serve as a noninvasive helpful tool for the diagnosis of Ashy dermatosis.

Sinonasal solitary fibrous tumour: A borderline entity with diagnostic challenges

Introduction: Sino nasal Solitary Fibrous Tumour (SFT) has been categorised as borderline/low-grade malignant tumours in the recent WHO classification of Head and Neck Tumours (2017). SFT have been reported in pleura and diverse extra pleural sites of which Sino nasal region accounts for <0.1%. Owing to its overlapping histopathological features with various oval/spindle cell lesions in the region, Sino nasal SFT often poses as a diagnostic dilemma. Materials and methods: Eight cases diagnosed as Sino nasal SFT, over a period of twelve years (January 2006 - December 2017) were retrieved from the archives of Department of Pathology, Kasturba Medical College, Manipal and reviewed for clinical-morphological features. Results: Sino nasal SFT was largely seen in males (M: F-3:1) with a median age of 54.5 years (33-74years). The predominant symptoms were nasal blockage, deviated nasal septum and occasional episodes of epistaxis. Grossly, the tumours appeared polypoidal to irregular masses, filling up the nasal cavity and extending to the nasopharynx and skull base. Microscopically, the tumours were composed of vague lobules of haphazardly arranged bland oval/spindle cells separated by collagen bundles and interspersed irregular vessels and were diffuse and strongly positive for CD34 on immunohistochemistry. Conclusion: SFT is characterized by cytological bland spindle cells with scant cytoplasm separated by thick collagen bundles, arranged in variable architectural patterns. These features show considerable overlap with angiofibroma, leiomyoma, schwannoma and fibrous histiocytomas especially in the presence of high cellularity and hypo/ hyper cellular architecture. The diagnostic clues favouring SFT include bands of collagen and positivity for CD34 and Bcl2. SFT are tumours with borderline/ low-grade histology and can be managed by endoscopic resection. The poor prognostic indicators include old age, presence of tumour necrosis, >4 mitosis/10 HPF, and local recurrence is seen in 10-15% cases.

Dermoscopy of Glomus Tumor.

Glomus tumors are rare, benign, and painful hamartomas, most commonly found in the subungual region. They originate from the myoarterial apparatus composed of an afferent arteriole and vascular channels lined by endothelial cells.[1] A 32-year-old gentleman presented with a painful swelling on the index finger of the left hand present for the preceding 6 years [Figure 1]. The lesion was extremely painful to touch (Love's sign positive), and the quality of life of the patient was significantly impaired. There was aggravation of pain on exposure to cold or even water at room temperature. Dermoscopy of the lesion using Dermlite DL4W dermoscope showed an ill-defined lesion under nail plate with a structure-less bluish area and linear irregular vessels [Figure 2]. Ultrasonography showed 2 cm × 3 cm hypervascular mass in the nail bed.Figure 1: Painful swelling on the index finger of left handFigure 2: Dermoscopy showing an ill-defined lesion under nail plate with structure-less bluish area and linear irregular vessels ([A] Bluish structureless area and [B] Erythematous vascular area). Dermlite DL4W ×10 (Dry dermoscopy)The mass was excised and sent for histopathological examination. Intraoperaitive dermoscopy could not be done. Histology showed collection of monomorphous neoplastic glomus cells surrounding vascular spaces lined by endothelium. The cells had round-to-oval nuclei and eosinophilic cytoplasm [Figure 3]. A diagnosis of glomus tumor was confirmed.Figure 3: Photomicrograph showing monomorphous neoplastic glomus cells surrounding endothelium-lined vascular spaces. Note that the cells have round-to-oval nuclei and an eosinophilic cytoplasm (H and E, ×100)Because glomus tumor is a diagnosis which is difficult to arrive at solely on the basis of clinical features, dermoscopy can help. Previously reported dermoscopic findings include discrete linear vascular structure on nail plate and numerous ramified telangiectasias on nail bed and matrix,[2] altered pigmentary network, and pinkish glow.[3] However, these findings are not universal. In a recent report, instead of the pinkish hue, a homogeneous white discoloration of the nail plate was observed.[4] Thus, dermoscopy can be helpful in screening glomus tumor, however, the role of histopathological examination in the diagnosis cannot be overemphasized. The dermoscopic differentials include hemangioma, angiokeratoma, and subungual hemorrhage. The dermoscopic hallmark of hemangioma is the presence of numerous, round-to-oval areas with a reddish or red-bluish coloration. These red lacunas (red lagoons) are pathognomonic for hemangiomas. Angiokeratoma can also have these red lacunae, alongside white to yellow keratotic structures and a whitish veil. Subungual hemorrhage is characterized by the presence of jet-black pigmentation apart from the red lacuna. Treatment of choice is direct surgical excision. Incomplete removal of the tumor leads to recurrences. To overcome this problem, polarized light dermoscopy may be done to outline the margins of the tumor.[2] Recurrences may also be avoided by the use of sclerotherapy and lasers (CO2, pulsed dye, etc.).[5] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Splenic Rupture Secondary to Vascular Ehlers-Danlos Syndrome Managed by Coil Embolization of the Splenic Artery.

Aim Atraumatic splenic rupture is uncommon and life-threatening. It may be related to underlying pathology and be the initial manifestation of the condition. Vascular Ehlers–Danlos syndrome (V-EDS) is a rare autosomal dominant collagen vascular disorder, associated with vessel fragility and rupture. We describe a child presenting with splenic rupture managed by embolization of the splenic artery. She was subsequently diagnosed with V-EDS. Case Description A 11-year-old girl with thalassemia trait presented with sudden onset of abdominal pain and hypovolemic shock. There was no history of trauma. Following resuscitation, abdominal computed tomography showed hemoperitoneum and active splenic arterial extravasation. Angiography demonstrated four bleeding points, from irregular vessels supplying the upper two-thirds of the spleen. These were not amenable to supraselective embolization. Therefore, coil embolization of the main splenic artery was performed, with no splenic supply seen on the postembolization angiogram. Her postoperative recovery was complicated by pancreatitis secondary to partial ischemia of the pancreatic tail. Subsequent extensive investigations excluded hematological, myeloproliferative, and infective causes for her splenic rupture. A safeguarding investigation was completed, with no pertinent factors identified. Findings of thin skin, abnormal bruising, and hypermobile joints raised a clinical suspicion of a connective tissue disorder. Genetic testing revealed a de novo mutation of the COL3A1 gene. Conclusions There are only four reports of V-EDS causing splenic rupture in the literature to date. These patients were all adults and only one had not previously been diagnosed with V-EDS. All underwent splenectomy. While V-EDS presenting with abdominal visceral rupture in children has been reported, this is the first report of a child with V-EDS presenting with splenic rupture. It is the only case of splenic rupture secondary to V-EDS that has been managed minimally invasively by embolization.