Large Plaques Research Articles

CRT-100.22 Frequency of Very Large Lipid-Rich Plaques Identified by NIRS at Non-Culprit Sites

CRT-100.22 Frequency of Very Large Lipid-Rich Plaques Identified by NIRS at Non-Culprit Sites

Large Culprit Plaque and More Intracranial Plaques Are Associated with Recurrent Stroke: A Case-Control Study Using Vessel Wall Imaging.

Intracranial atherosclerotic plaque features are potential factors associated with recurrent stroke, but previous studies only focused on a single lesion, and few studies investigated them with perfusion impairment. This study aimed to investigate the association among whole-brain plaque features, perfusion deficit, and stroke recurrence. Patients with ischemic stroke due to intracranial atherosclerosis were retrospectively collected and categorized into first-time and recurrent-stroke groups. Patients underwent high-resolution vessel wall imaging and DSC-PWI. Intracranial plaque number, culprit plaque features (such as plaque volume/burden, degree of stenosis, enhancement ratio), and perfusion deficit variables were recorded. Logistic regression analyses were performed to determine the independent factors associated with recurrent stroke. One hundred seventy-five patients (mean age, 59 [SD, 12] years; 115 men) were included. Compared with the first-time stroke group (n = 100), the recurrent-stroke group (n = 75) had a larger culprit volume (P = .006) and showed more intracranial plaques (P < .001) and more enhanced plaques (P = .003). After we adjusted for other factors, culprit plaque volume (OR, 1.16 per 10-mm3 increase; 95% CI, 1.03-1.30; P = .015) and total plaque number (OR, 1.31; 95% CI, 1.13-1.52; P < .001) were independently associated with recurrent stroke. Combining these factors increased the area under the curve to 0.71. Large culprit plaque and more intracranial plaques were independently associated with recurrent stroke. Performing whole-brain vessel wall imaging may help identify patients with a higher risk of recurrent stroke.

Dual-source strength seed loading for eye plaque brachytherapy using eye physics eye plaques: A feasibility study.

This study quantifies the dosimetric impact of incorporating two iodine-125 (125I) seed source strengths in Eye Physics eye plaques for treatment of uveal melanoma. Plaque Simulator was used to retrospectively plan 15 clinical cases of three types: (1) Shallow tumors (< 5.5 mm) with large base dimensions (range, 16-19 mm); (2) Tumors near the optic nerve planned with notched plaques; and (3) Very shallow (< 3.0 mm) tumors with moderate base dimensions (range, 13.5-15.5 mm) planned with larger plaques than requested by the ocular oncologist. Circular plaques were planned with outer ring sources twice the source strength of inner sources, and notched plaques with the six seeds closest to the notch at twice the source strength. In cases of type (1), the dual-source strength plan decreased prescription depth, and doses to critical structures were lower: inner sclera -25% ±2%, optic disc -7% ±3%, and fovea -6% ±3%. In four out of five cases of type (2), the dual-source strength plan decreased prescription depth, and dose to inner sclera was lower (-22% ±5%), while dose to optic disc (17% ±7%) and fovea (20% ±12%) increased. In cases of type (3), a smaller dual-source strength plaque was used, and scleral dose was lower (-45% ±3%), whereas dose to optic disc (1% ±14%) and fovea (5% ±5%) increased. Dual-source strength loading as described in this study can be used to cover tumor margins and decrease dose to sclera, and therefore the adjacent retina, but can either decrease or increase radiation dose to optic disc and fovea depending on location and size of the tumor. This technique may allow the use of a smaller plaque, if requested by the ocular oncologist. Clinical determination to use this technique should be performed on an individual basis, and additional QA steps are required. Integrating the use of volumetric imaging may be warranted.

A Case of Facial Discoid Lupus Erythematosus (LE) with Oral Lichen Planus (LP): A Dig into Co-existence and LE-LP Overlap

A distinction between ‘co-existence of Lupus Erythematosus (LE) and Lichen Planus (LP)’ and ‘LE-LP overlap’ bears importance as the criterion for true overlap necessitates histological and immunological features of both LE and LP to be found in the same tissue specimen. However, in the present case report the lesions of LE and LP were present in two different sites. A 51-year-old male presented with a large erythematous scaly atrophic plaque on the right cheek with similar lesions on chin and lips for 10 years. He also had violaceous lesions on the bilateral buccal mucosa and a white lesion over the left buccal mucosa for three years. Discoid Lupus Erythematosus (DLE) and Oral Lichen Planus (OLP) were suspected. Dermoscopy of the facial plaque showed features consistent with DLE. Histopathology of the facial plaque confirmed the diagnosis of DLE, whereas the white plaque on the left buccal mucosa showed features of early invasive squamous cell carcinoma. Violaceous lesion over the right buccal mucosa showed features suggesting OLP. A Direct Immunofluorescence (DI) was also performed for the buccal mucosa to rule out the possibility of DLE with oral involvement, which turned out to be negative. Therefore, a diagnosis of synchronous presentation of DLE and OLP along with Squamous Cell Carcinoma (SCC) of the buccal mucosa was made and patient was treated with topical corticosteroids, systemic hydroxychloroquine and surgical intervention for the squamous cell carcinoma. It is also imperative that not only long standing cutaneous lesions, but also oral lesions like LP should be investigated and kept under observation to look for any early malignant changes.

Cortical microstructural associations with CSF amyloid and tau

AbstractBackgroundMulti‐shell diffusion MRI (dMRI) biophysical models can estimate intracellular (ICVF), extracellular (ECVF) and free water (ISOVF) volume fractions (VFs) in brain tissue, and may offer insight into Alzheimer's disease pathological processes. These microstructural measures can be calculated in the cortex using a gray matter specific model that may be sensitive to amyloid and tau burden. Here, we evaluated relationships between regional cortical microstructural VFs and CSF amyloid and tau biomarkers.MethodMulti‐shell dMRI and CSF biomarker data were available for 50 ADNI‐3 participants (age: 72.4±6.4 yrs; 20 male; 36 cognitively normal, 12 MCI, 2 dementia). Cortical ICVF, ECVF and ISOVF were estimated with the multi‐tissue spherical mean technique (MT‐SMT). Mean cortical measures were extracted from 4 lobes and the cingulate cortex, parcellated with FreeSurfer. Random‐effects linear regressions tested associations between regional dMRI measures and CSF pTau or Aβ42/Aβ40 burden, adjusting for age, sex, education, and grouping by scanning site. FDR (q=0.05) was used to correct for multiple comparisons across 5 regions, 3 diffusion measures, and 2 tests.ResultHigher Aβ42/Aβ40 was associated with lower ISOVF throughout the cortex (Figure 1), and higher ECVF and ICVF in the cingulate, frontal and temporal lobes. Higher ICVF was also found in the parietal cortex. Higher pTau was associated with higher ISOVF in the occipital and parietal lobes, and lower ECVF in the frontal and parietal lobes (Figure 2). No pTau ICVF associations were detected.ConclusionLower ICVF and higher ISOVF with greater amyloid and tau may indicate neuronal loss or edema, while lower ECVF could reflect, for example, as neuronal swelling or an influx of activated microglia. Lower ECVF with greater amyloid and tau burden may also reflect accumulation of large hydrophobic amyloid plaques and neurofibrillary tangles in the extracellular space. These results are preliminary and, as many factors influence dMRI measures, should be interpreted with caution. Future work will incorporate multimodal imaging to map associations of diffusion measures with localized PET‐derived amyloid and tau measures.

Abstract 10382: Large Lipid-Rich Plaque Predicts Intra-Stent Thrombus Formation After Primary Pci in Patients with Acute Coronary Syndrome: Insights from Near-infrared Spectroscopy and Optical Coherence Tomography Imaging Analysis

Backgrounds: The formation of intrastent thrombus is a PCI-related complication in subjects with ACS, which infrequently causes acute stent thrombosis. Given that lipid-rich plaque, a substrate for ACS, activates inflammation inducing prothrombotic state, the degree of lipidic plaque materials may associate with intrastent thrombus formation. Methods: Culprit lesions in 70 ACS subjects (=STEMI/NSTEMI/uAP=28/27/15) receiving newer-generation DES implantation were evaluated by both near-infrared spectroscopy (NIRS) and optical coherence tomography (OCT) imaging. NIRS-derived 4-mm maximum lipid-core-burden index (maxLCBI 4mm ) at culprit lesion was measured prior to PCI. OCT-derived intrastent thrombus-burden index (ITBI) after stent implantation were calculated as follows: [Σ(every 1-mm cross sectional thrombus-arc score: 1=1-90°,2=91-180°,3=181-270°,4=271-360°)/analyzed length]x(averaged longitudinal length). ITBI was compared between subjects with maxLCBI 4mm &lt;400 and ≥400. Result: The averaged maxLCBI 4mm was 525±236, and dual-antiplatelet therapy with aspirin and clopidogrel, and aspirin and prasugrel was used in 43 and 56%, respectively. On OCT imaging analysis, maxLCBI 4mm was significantly associated with ITBI (r=0.55, p &lt;0.001, Figure), whereas there were no significant relationships of minimum stent area (MSA) (r=0.18, p=0.13) and stent malapposition diameter with ITBI (r=0.00. p=0.97). Multivariate analysis demonstrated maxLCBI 4mm as an independent predictor of higher ITBI even after adjusting MSA, stent malapposition and other clinical characteristics (Table). Conclusions: The presence of lipid-rich plaque was associated with intrastent thrombus formation in the setting of ACS. Our findings suggest the potential importance to modulate activated prothrombotic cascade by using more potent antiplatelet agent in ACS patients exhibiting lipid-rich plaques.

Leprosy Masquerading as Tinea Faciale

A male in his 40s presented to the dermatology department of Post Graduate Institute of Medical Education and Research, Chandigarh, in December 2019 with a non-pruritic, large annular plaque of size 20 × 25 cm over face for 6 months ([Fig. 1A–C]). He had been treated for tinea faciale for ∼3 to 4 months, with no improvement. On examination, a well-defined annular plaque with elevated erythematous border and scaling was observed. There was appendageal loss overlying the lesion, but no regional or peripheral nerve thickening was observed. Potassium hydroxide examination and slit skin smear were negative. Histopathological examination showed epithelioid cell granulomas with peripheral lymphocytes in the dermis along the nerve bundles and Langhans giant cells; however, no acid-fast bacilli were seen ([Fig. 2A, B]). He was diagnosed with borderline tuberculoid Hansen and was prescribed WHO multidrug therapy multibacillary regimen with monthly follow-ups, leading to complete resolution of the lesion. Leprosy can have a polymorphous presentation and there are reports of leprosy lesions mimicking psoriasis, pityriasis versicolor, granuloma annulare, leishmaniasis, sarcoidosis, syphilis, and vitiligo. Both leprosy and tinea faciale may present as annular lesions and at times it is difficult to differentiate between the two clinically. The differentiating features that help in diagnosis are tinea faciale lesions which are annular, pruritic, with preserved appendages and sensations. Whereas the lesions of borderline tuberculoid leprosy are non-pruritic/asymptomatic, hypopigmented, or erythematous plaques (more infiltrated), with loss of appendages and regional/peripheral nerve thickening. With the current epidemic-like situation of dermatophytosis, awareness regarding these atypical presentations is important in countries where leprosy is still prevalent for early diagnosis and treatment to prevent disabilities.

Differences in Clinical Features and Comorbid Burden between HLA-C∗06:02 Carrier Groups in >9,000 People with Psoriasis

The identification of robust endotypes-disease subgroups of clinical relevance-is fundamental to stratified medicine. We hypothesized that HLA-C∗06:02 status, the major genetic determinant of psoriasis, defines a psoriasis endotype of clinical relevance. Using two United Kingdom-based cross-sectional datasets-an observational severe-psoriasis study (Biomarkers of Systemic Treatment Outcomes in Psoriasis; n= 3,767) and a large population-based bioresource (UK Biobank, including n= 5,519 individuals with psoriasis)-we compared demographic, environmental, and clinical variables of interest in HLA-C∗06:02-positive (one or two copies of the HLA-C∗06:02 allele) with those in HLA-C∗06:02‒negative (no copies) individuals of European ancestry. We used multivariable regression analyses to account for mediation effects established a priori. We confirm previous observations that HLA-C∗06:02-positive status is associated with earlier age of psoriasis onset and extend findings to reveal an association with disease expressivity in females (Biomarkers of Systemic Treatment Outcomes in Psoriasis: P= 2.7× 10-14, UK Biobank: P= 1.0× 10-8). We also show HLA-C∗06:02-negative status to be associated with characteristic clinical features (large plaque disease, OR for HLA-C∗06:02= 0.73, P= 7.4× 10-4; nail involvement, OR= 0.70, P= 2.4× 10-6); higher central adiposity (Biomarkers of Systemic Treatment Outcomes in Psoriasis: waist circumference difference of 2.0 cm, P= 8.4× 10-4; UK Biobank: waist circumference difference of 1.4 cm, P= 1.5× 10-4), especially in women; and a higher prevalence of other cardiometabolic comorbidities. These findings extend the clinical phenotype delineated by HLA-C∗06:02 and highlight its potential as an important biomarker to consider in future multimarker stratified medicine approaches.

Keratoacanthoma, Verruca Vulgaris Arising over Porokeratosis of Mibelli : A New Association

Introduction: This case report highlighting the presence of keratoacanthoma and verruca vulgaris over the lesion of porokeratosis of mibelli. Case Report: In this case a 50-year-old housewife came with large well-defined asymptomatic plaque over the upper part of back of the trunk for last 10 years. After evaluation we got the presence of keratoacanthoma and verruca vulgaris on the plaque of porokeratosis of mibelli. Discussion: Porokeratosis is a clonal expansion of keratinocytes. Among the neoplasm squmous cell carcinoma (SCC) is the most commonly reported malignancy in porokeratosis. But in our case we didn’t find lesion of SCC. Porokeratosis of Mibelli, Keratoacanthoma and Verruca vulgaris have an association with human papilloma virus(HPV). This eithopathogenesis may be related to our clinical finding. Conclusion: There were reporting of squmous cell carcinoma or keratoacanthoma on Porokeratosis of Mibelli. But in our case we found both Keratoacanthoma and Verruca Vulgaris over Porokeratosis of Mibelli. Medicine Today 2021 Vol.33(2): 172-175

Plaque-Associated Oligomeric Amyloid-Beta Drives Early Synaptotoxicity in APP/PS1 Mice Hippocampus: Ultrastructural Pathology Analysis.

Alzheimer’s disease (AD) is a devastating neurodegenerative disorder characterized by initial memory impairments that progress to dementia. In this sense, synaptic dysfunction and loss have been established as the pathological features that best correlate with the typical early cognitive decline in this disease. At the histopathological level, post mortem AD brains typically exhibit intraneuronal neurofibrillary tangles (NFTs) along with the accumulation of amyloid-beta (Abeta) peptides in the form of extracellular deposits. Specifically, the oligomeric soluble forms of Abeta are considered the most synaptotoxic species. In addition, neuritic plaques are Abeta deposits surrounded by activated microglia and astroglia cells together with abnormal swellings of neuronal processes named dystrophic neurites. These periplaque aberrant neurites are mostly presynaptic elements and represent the first pathological indicator of synaptic dysfunction. In terms of losing synaptic proteins, the hippocampus is one of the brain regions most affected in AD patients. In this work, we report an early decline in spatial memory, along with hippocampal synaptic changes, in an amyloidogenic APP/PS1 transgenic model. Quantitative electron microscopy revealed a spatial synaptotoxic pattern around neuritic plaques with significant loss of periplaque synaptic terminals, showing rising synapse loss close to the border, especially in larger plaques. Moreover, dystrophic presynapses were filled with autophagic vesicles in detriment of the presynaptic vesicular density, probably interfering with synaptic function at very early synaptopathological disease stages. Electron immunogold labeling showed that the periphery of amyloid plaques, and the associated dystrophic neurites, was enriched in Abeta oligomers supporting an extracellular location of the synaptotoxins. Finally, the incubation of primary neurons with soluble fractions derived from 6-month-old APP/PS1 hippocampus induced significant loss of synaptic proteins, but not neuronal death. Indeed, this preclinical transgenic model could serve to investigate therapies targeted at initial stages of synaptic dysfunction relevant to the prodromal and early AD.

Clinical significance of aortic arch plaques simultaneously assessed with coronary atherosclerosis on cardiovascular outcomes in patients undergoing coronary CT angiography

Abstract Aims Computed tomography (CT) coronary angiography is a useful diagnostic imaging modality in assessing presence, severity, and extent of coronary artery disease (CAD). Aortic arch plaques have been shown to be an underlying cause of embolic stroke and also related to increased risk of cardiovascular events. Yet, conventional CTCA imaging protocol does not include aortic arch for the reduction of radiation exposure. This study aimed to investigate prevalence of aortic arch plaques simultaneously assessed by CTCA and their clinical significance in combination with the presence of obstructive CAD for prediction of CVD events in patients with suspected CAD. Methods This study consisted of 310 (mean age, 66 years old, 42% female) patients with suspected CAD undergoing CTCA between 2017 and 2019. All CTCA examination was performed with 320-row detector scanner using ECG-triggered prospective gating method. Aortic arch images were simultaneously acquired during CTCA scanning without an increase of contrast media. Using Agatston method, coronary artery calcium score (CACS) was categorized into either of the groups having CACS of 0, 0–99, 100–299, or more than 300. The presence of CAD was reported as non-obstructive or obstructive CAD. High-risk featured aortic plaque was defined as large plaques &amp;gt;4 mm in thickness showing ulceration or protrusion. A composite event of cardiovascular disease, including all-cause mortality, non-fatal myocardial infarction, unplanned hospitalization requiring revascularization or stroke was defined as the primary endpoint. Results Patients having CACS of 0, 0–99, 100–299, and &amp;gt;300 were found in 41%, 24%, 15%, 20%%, respectively, where obstructive CAD was diagnosed in 11%. Aortic HRPs in ascending aorta, aortic arch, and thoracic descending aorta were observed in 1.6%, 6.9%, and 15%, respectively. During a mean follow-up period of 2.2 years, the primary endpoint was observed in 27 patients (8.7%). Cox regression hazard model demonstrated an independent association of aortic arch high-risk plaques (HR; 3.2, 95% CI; 1.20–8.64, p=0.02) and obstructive CAD (HR; 3.3, 95% CI; 1.45–7.92, P=0.005) when adjusted by age, CACS, and chronic kidney disease. Kaplan-Meier curve analysis showed a worse outcome of patients with aortic HRP and obstructive CAD compared to those without aortic plaques and obstructive CAD (p&amp;lt;0.001). Conclusion This study demonstrated an independent association of aortic arch high-risk featured plaques with CVD events. Further study is warranted whether pharmacological interventional therapies can reduce future CVD risks in patients with CAD and aortic arch plaques. Funding Acknowledgement Type of funding sources: None.

Usefulness of rapid MR angiography using two-point Dixon for evaluating carotid and aortic plaques

Recently, various magnetic resonance imaging (MRI) modalities have been developed to easily detect carotid and aortic plaques, but these techniques are time-consuming and vulnerable to motion artifacts. We investigated the utility of a gradient echo MRI technique known as liver acquisition with volume acceleration flexible (LAVA-Flex) to detect carotid and aortic atherosclerotic plaques. Ten patients who underwent carotid endarterectomy (CEA) were assessed regarding the correspondence between LAVA-Flex findings and the histopathology of excised carotid plaques. In addition, 47 patients with cryptogenic ischemic stroke underwent LAVA-Flex and transesophageal echocardiography (TEE) for detection of embolic sources in the thoracic aorta. We analyzed the relationship between the thickness of the aortic plaque measured by TEE and the presence of high-intensity lesions on LAVA-Flex. Nine of 10 patients (90.0%) who underwent CEA showed a high-intensity carotid lesion on LAVA-Flex, which corresponded pathologically to plaques containing large lipid cores and hemorrhage. Twenty-four (51.1%) of 47 cryptogenic stroke patients showed a high-intensity lesion in the thoracic aorta on LAVA-Flex; of these, 21 (87.5%) also demonstrated a large plaque (thickness ≥4 mm) on TEE. Twenty-two (95.7%) of 23 patients without a high-intensity lesion on LAVA-Flex demonstrated no large plaque on TEE. LAVA-Flex had a sensitivity of 95.5% and a specificity of 88.0% in patients with large plaques. This study showed that LAVA-Flex successfully detected carotid and aortic plaques. This imaging technique may be useful to rapidly diagnose and evaluate carotid and aortic plaques, which are critical risk factors for aortogenic stroke.

Regional Variation of Gap Junctional Connections in the Mammalian Inner Retina.

The retinas of many species show regional specialisations that are evident in the differences in the processing of visual input from different parts of the visual field. Regional specialisation is thought to reflect an adaptation to the natural visual environment, optical constraints, and lifestyle of the species. Yet, little is known about regional differences in synaptic circuitry. Here, we were interested in the topographical distribution of connexin-36 (Cx36), the major constituent of electrical synapses in the retina. We compared the retinas of mice, rats, and cats to include species with different patterns of regional specialisations in the analysis. First, we used the density of Prox1-immunoreactive amacrine cells as a marker of any regional specialisation, with higher cell density signifying more central regions. Double-labelling experiments showed that Prox1 is expressed in AII amacrine cells in all three species. Interestingly, large Cx36 plaques were attached to about 8–10% of Prox1-positive amacrine cell somata, suggesting the strong electrical coupling of pairs or small clusters of cell bodies. When analysing the regional changes in the volumetric density of Cx36-immunoreactive plaques, we found a tight correlation with the density of Prox1-expressing amacrine cells in the ON, but not in the OFF sublamina in all three species. The results suggest that the relative contribution of electrical synapses to the ON- and OFF-pathways of the retina changes with retinal location, which may contribute to functional ON/OFF asymmetries across the visual field.

Ischémie subaiguë bilatérale des membres inférieurs, une présentation rare de périartérite noueuse

Study's goalAs there are no guidelines. This short report shows our experience in management of sub-acute limb ischemia with polyarteritisnodosa. IntroductionAcute limb ischemia is rarely seen in periarteritisnodosa. Case ReportHere, we present a case with peripheral vascular disease of both lower limbs leading to foot claudication and then a subacute limb ischemia with large necrotic plaques on the lower limb. Angioscan showed occlusion of both superficial femoral arteries. Angiographic imaging showed abnormalities in medium-sized arteries. Pathological study of biopsy from the artery, vein, nerve and skin of the amputated leg confirm the diagnosis of periarteritisnodosa. She benefited from femoral popliteal bypass in both legs, anticoagulant drug and steroids. The non-amelioration of the left leg led to his amputation. The right leg was healed.

V07-07 CORPORAL RECONSTRUCTION USING LIGHTWEIGHT MESH DURING PENILE PROSTHETIC SURGERY

You have accessJournal of UrologySexual Dysfunction & Transgender (V07)1 Sep 2021V07-07 CORPORAL RECONSTRUCTION USING LIGHTWEIGHT MESH DURING PENILE PROSTHETIC SURGERY Wai Gin Lee, Luca Venturino, and David Ralph Wai Gin LeeWai Gin Lee More articles by this author , Luca VenturinoLuca Venturino More articles by this author , and David RalphDavid Ralph More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002034.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Options for reconstruction of the corpora cavernosa are limited. Synthetic grafts like Dacron™ (Maquet, Sweden) and GORE-TEX™ (Gore Medical, USA) are used but have high infection rates. Lightweight macroporous mesh is a promising alternative due to better integration and surrounding tissue ingrowth. This video illustrates the technique for corporal reconstruction using a lightweight mesh following erosion and septal crossover of an inflatable penile prosthesis. METHODS: The patient is a 41-year-old insulin dependent diabetic with erectile dysfunction and a 90° dorsal curvature from a large ossified plaque. He had an inflatable penile prosthesis inserted with concomitant plaque excision and grafting. He represented with a penile deformity 15 months following surgery and was found to have distal erosion of both prosthesis cylinders and septal crossover of the left sided cylinder. Via a penoscrotal incision, the cylinders were retrieved, and two tubed mesh grafts were fashioned to reinforce the tunical defect. A macroporous lightweight composite mesh (Ultrapro®; Ethicon) made of polypropylene (Prolene®; Ethicon) and poliglecaprone-25 (Monocryl®; Ethicon) was chosen. The mesh is partially absorbable and therefore minimises the amount of residual foreign material and may reduce the risk of post-operative infection. The device was kept partially inflated for a week and the patient was asked to refrain from sexual intercourse for 6 weeks post-surgery. RESULTS: Post-operative course was uneventful. The patient is sexually active and remains satisfied after 8 months of follow-up. CONCLUSIONS: This video demonstrates that a lightweight macroporous mesh may be an alternative synthetic graft for corporal reconstruction. The polypropylene/poliglecaprone-25 mesh has several advantages because it is partially absorbable and easy to handle while providing a strong scaffold to prevent further device erosion. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e552-e553 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wai Gin Lee More articles by this author Luca Venturino More articles by this author David Ralph More articles by this author Expand All Advertisement Loading ...

26414 An uncommon presentation of Sweet syndrome

Sweet syndrome (SS) is a neutrophilic dermatosis characterized by an abrupt onset of painful erythematous skin lesions in association to fever, leukocytosis and occasionally, pathergy. Giant cellulitis-like SS is a rare variant characterized by large painful erythematous plaques resembling cellulitis. A 42-year-old female with acute myeloid leukemia (AML) presented with fever and two erythematous tender plaques localized to the left antecubital fossa and the left proximal medial thigh. Histopathologic evaluation of a biopsy from the left thigh lesion demonstrated findings suggestive of erythema nodosum.

Nitrosamine (and/or Irbesartan) Induced Large Plaque Parapsoriasis and Urothelial Carcinoma: First Report in the Medical Literature!

A presenting case of a 64-year-old gentleman with a complaint of disseminated skin rash on the trunk, upper and lower limbs. He was diagnosed with type II hypertension in January 2017 and was started on irbesartan 150 mg one oral tablet daily (1-0-0). After 6 months, this dose was reduced to half a tablet which he continues to take to this day. He was also diagnosed with type two diabetes mellitus for which he is actively treated with metformin 1500 mg (1-1-1) daily. The patient noticed subtle skin changes in 2019 and upon seeking medical advice, he was diagnosed with an incidental finding of low grade papillary urothelial carcinoma, (T1 N0 M0). He was subsequently treated with transurethral surgical interventions and hospitalised for four different sessions before being sent to our dermatological clinic for evaluation of the skin condition. On examination, multiple large psoriasiform plaques were observed bilaterally, predominantly on the trunk, upper and lower extremities (Figure A-D), the greatest measuring approximately 6 cm in diameter. The plaques were variable in size and polymorphic in nature exhibiting a salmon-pink discoloration. There were no signs of pruritis or poikilodermatous changes. Based on the clinical data, a drug-induced parapsoriasis was suspected. Histopathological examination revealed generalised parakeratosis with perivascular lymphocytic infiltrations in the upper dermis. No signs of mycosis fungoides was noted, keeping in line with a clinicopathological diagnosis of large plaque parapsoriasis.

Axillary Paget disease with a visible satellite: a case report and literature review

BackgroundExtramammary Paget disease (EMPD) is an uncommon malignancy affecting apocrine gland–bearing skin, such as vulvar, perianal, axillary and penoscrotal areas. Paget cells are sometimes detected outside clinical border in a phenomenon called subclinical extension. Satellite is one of the patterns of subclinical extension which is likely to be invisible. The standard management strategy for EMPD without distant metastasis is a complete surgical removal, sometimes called wide local excision. However, there is no consensus regarding surgical margin width to decrease the high recurrence rate. Here we describe the first macroscopically visible satellite of axillary EMPD and wide local excision of both main lesion and the satellite lesion with only 0.5 cm margin, succeeded by a short review of the literature.Case presentationA 48-year-old female with a red macule in the right axilla was presented to our clinic. A well-demarcated 4 cm × 3 cm erythematous plaque was observed in the right axilla, and a similar lesion measuring 0.5 cm × 0.3 cm was found 3.5 cm away from the primary site. Breast and axillary node examination was unremarkable. Biopsy of the large plaque revealed Paget disease, then we performed a local extended excision of both lesions with a 0.5 cm margin, all margins negative indicated, by frozen pathology. Pathology revealed the nature of the satellite beside the main lesion also as Paget disease. The patient is currently followed-up for 20 months and has shown no signs of recurrence, with normal shoulder motor function.ConclusionWe have report the first visible satellite of extramammary Paget disease, indicating the necessity of an extended local resection of both the main leision and the satellite lesion. Considering the anatomical structure of axillary Paget disease, a 0.5 cm negative surgical margin indicated by frozen pathology might be sufficient to sustain the shoulder motor function.

Periocular Necrobiotic Xanthogranuloma Response to Cladribine.

A 42-year-old woman presented to the Ophthalmology department with bilateral large nodular lesions around her eyes for the past 2 years (panel A). On examination, yellow to skin colored, ill as well as well-defined multiple papules and nodules were noted around the periorbital area, forehead, and neck. Many papules had coalesced to form large plaques. Blood investigations including electrophoresis were performed to rule out paraproteinemia. A biopsy from the periocular lesion revealed necrobiotic granulomatous inflammation, atypical giant cells, cholesterol clefts, plasma cells, and minimal fibrosis. A diagnosis of xanthogranuloma necrobiotica was made. Intralesional steroids were injected, and the patient was started on oral steroids. However, there was no response. Eventually, 4 cycles of intravenous cladribine were administered with routine monitoring of liver function, kidney function, and other blood parameters. A marked reduction in the size of the lesions were noted. (Panel B) There was no obvious systemic adverse reaction of the drug and the lesions did not flare up once the chemotherapy was halted. Necrobiotic xanthogranuloma is a rare, chronic and gradually progressive disease characterized by yellowish plaque lesions typically involving the periorbital area and unlike other orbital xanthogranulomas, having a high propensity to ulcerative and fibrose. The clinical condition principally involves the skin and subcutaneous tissue and is known to be associated with characteristic dermatopathologic findings, monoclonal gammopathy, and less commonly malignant tumors. Medical management including chemotherapy with alkylating agents and antimetabolites as well as administration of intralesional, topical and systemic steroids has yielded varied results. Although multiple other modes of treatment have also been advocated in the management of xanthogranuloma necrobiotica ranging from, radiation therapy, plasmapheresis, surgical excision, or a combination of them, there still remains a dispute regarding the definite management. In the recent times, cladribine has shown encouraging results in the management of xanthoma disseminatum, with that knowledge in background the authors used the drug in the management of xanthogranuloma necrobiotica.FIG.: A, Clinical picture of the patient at presentation showing bilateral huge periocular nodular lesions. B, Clinical picture of the patient after 4 cycles of Cladribine showing reduction in size of the lesions.

Giant Subcutaneous Granuloma Annulare

Subcutaneous granuloma annulare is an uncommon, benign self-limiting cutaneous disease, almost exclusively seen in young children. We report a case of 31-year-old male patient, presented with asymptomatic firm plaques over the left lateral malleoli and dorsum of the feet. Histopathological examination was done to confirm the diagnosis and the lesions responded well to monthly doses of the combination of rifampicin, ofloxacin, minocycline (ROM) therapy and intralesional steroid therapy. This case is reported for its unusual presentation of very large plaque in an adult male and its resolution after combined ROM and intralesional steroid therapy.