Site Of Previous Trauma Research Articles

Eumycetoma With Exophiala jeanselmei 27 Years After a Splinter

Mycetoma is a chronic infectious disease of either bacterial (actinomycetoma) or fungal (eumycetoma) origin and is rarely encountered in the United States. Infections are usually associated with trauma and implantation ofthe organism into the skin/soft tissue, but symptoms may not occur for some time after the infecting event. Classically, findings include a subcutaneous infection at the site of previous trauma with the development of draining sinuses extruding grains of the causative microorganism. A variety of organisms can be associated with the disease, and diagnosis and treatment can be difficult. We report a case of eumycetoma with Exophiala jeanselmei that presented 27 years after presumed inoculation and review the literature on presentation, diagnosis, and treatment.

Keratoacanthoma developing in sites of previous trauma: A report of two cases and review of the literature

Keratoacanthoma is a common benign squamous neoplasm that only rarely progresses to metastatic carcinoma. The cause of keratoacanthoma is unclear; however, suspected causes include ultraviolet light, genetic factors, immunosuppression, chemical carcinogens, viruses, and trauma. Keratoacanthomas have been reported only rarely to arise in sites of previous trauma. We report 2 cases of keratoacanthomas arising shortly after episodes of cutaneous trauma and provide a review of the literature of similar cases previously reported. It is likely that an interaction exists between a variety of factors in the development of keratoacanthomas; however, it appears that a predilection exists for these lesions to arise in trauma sites. (J Am Acad Dermatol 2003;48:S35-8.)

Are keloids really “gli-loids”?: High-level expression of gli-1 oncogene in keloids

Background: Keloids are a common lesion arising from sites of previous trauma and are a considerable source of morbidity because of continued growth of lesions, pruritus, and physical appearance. They consist of mesenchymal cells embedded in a stroma of disordered collagen matrix. Clinically, keloids are distinguished from scars in that keloids demonstrate continued growth over the borders of the original injury. Keloids appear with increased frequency in patients of African and Asian descent. Currently, no entirely satisfactory method of treatment exists for these lesions. Recently, a patient who was enrolled in a clinical trial of topical tacrolimus for atopic dermatitis applied this drug to a keloid and noted clearing. Objective: Based on this clinical observation and the observation that rapamycin, a chemically similar compound to tacrolimus, is known to inhibit signaling from the gli-1 oncogene, we examined keloids and scars for expression of Gli-1 protein. Methods: Skin sections from keloids and scars were examined by immunohistochemical staining for gli-1. To further confirm the presence of gli-1 expression in keloids, reverse transcriptase-polymerase chain reaction was carried out. Results: Expression of gli-1 was strongly elevated in keloids compared with scars. Conclusion: These results provide a rationale for the treatment of keloids with topical rapamycin analogs, including tacrolimus. Clinical trials of topical tacrolimus are warranted. (J Am Acad Dermatol 2001;45:707-11.)

Granular cell traumatic neuroma: a lesion occurring in mastectomy scars.

○ Background.-Granular cell changes can be observed in a variety of benign and malignant tumors, and are seen more commonly in granular cell tumors, which in about 5% of cases develop in the breast. Granular cells also have been observed in sites of previous trauma, such as surgery, and are found to be inflammatory reactions of histiocytic origin. Methods and Results.-We investigated, morphologically and immunohistochemically, 2 granular cell lesions occurring in mastectomy scars after surgery for carcinoma. Both lesions were composed of strands and nests of large granular cells, haphazardly set in a background of fibrous tissue, with sparse inflammatory infiltrates. Several tortuous hypertrophic nerve bundles were also embedded in the fibrous tissue. A few of these nerve bundles showed degenerative changes and contained granular cells. Immunohistochemically, granular cells were positive for S100 protein, neuron-specific enolase, vimentin, and CD68 antigen. Conclusions.-We consider these proliferative lesions of peripheral nerves to have the features of both granular cell tumor and traumatic neuroma. These cases indicate that traumatic neuroma can undergo extensive granular cell changes and constitute a previously unrecognized entity, which we provisionally label granular cell traumatic neuroma. Granular cell traumatic neuroma has to be taken into consideration when evaluating lesions occurring at mastectomy scars and should be differentiated from malignant tumors with granular cells, such as apocrine carcinoma and alveolar soft part sarcoma.

Granular Cell Traumatic Neuroma

Abstract Background.—Granular cell changes can be observed in a variety of benign and malignant tumors, and are seen more commonly in granular cell tumors, which in about 5% of cases develop in the breast. Granular cells also have been observed in sites of previous trauma, such as surgery, and are found to be inflammatory reactions of histiocytic origin. Methods and Results.—We investigated, morphologically and immunohistochemically, 2 granular cell lesions occurring in mastectomy scars after surgery for carcinoma. Both lesions were composed of strands and nests of large granular cells, haphazardly set in a background of fibrous tissue, with sparse inflammatory infiltrates. Several tortuous hypertrophic nerve bundles were also embedded in the fibrous tissue. A few of these nerve bundles showed degenerative changes and contained granular cells. Immunohistochemically, granular cells were positive for S100 protein, neuron-specific enolase, vimentin, and CD68 antigen. Conclusions.—We consider these proliferative lesions of peripheral nerves to have the features of both granular cell tumor and traumatic neuroma. These cases indicate that traumatic neuroma can undergo extensive granular cell changes and constitute a previously unrecognized entity, which we provisionally label granular cell traumatic neuroma. Granular cell traumatic neuroma has to be taken into consideration when evaluating lesions occurring at mastectomy scars and should be differentiated from malignant tumors with granular cells, such as apocrine carcinoma and alveolar soft part sarcoma.

Axillary and subclavian vein stenosis: percutaneous angioplasty.

Twenty-nine percutaneous balloon dilations of the axillary and subclavian veins were performed in 19 patients. Stenoses occurred in typical locations of anatomic narrowing or at sites of previous trauma. The initial success rate was 76%, with a 1-year patency rate of 35% and a 2-year patency rate of 6%. Angioplasty can be performed on an outpatient basis with a very low rate of significant complications and can be repeated numerous times to keep a vein patent for many years. This procedure is especially valuable in dialysis patients who have limited access sites.

Kaposi's sarcoma in acquired immune deficiency syndrome (AIDS).

Of 22 patients with Kaposi's sarcoma, 16 had the acquired immune deficiency syndrome (AIDS). The histological pattern in AIDS differs from the more familiar classical Kaposi's sarcoma. The features most useful in making the diagnosis are: dissection of collagen; lymphatic vessel like spaces; angiomatoid lesions; premonitory sign; and spindle cell proliferation. It is important to examine multiple levels of small biopsy specimens and to be cautious in making the diagnosis of patch Kaposi's sarcoma in the presence of recent or healed ulceration and at sites of previous trauma. Only four of 16 patients with AIDS had evidence of systemic Kaposi's sarcoma, supporting the view that Kaposi's sarcoma in AIDS does not necessarily have an aggressive clinical course.

Cutaneous and Cardiac valvular pigmentation with minocycline

Summary A case of a 57-year-old male with pigmentation of aortic and mitral valves associated with 5 years of minocycline therapy is reported. Hyper-melanosis in sun-exposed areas and deposition of blue-black pigment in sites of previous trauma also occurred. The implications of the widespread use of long-term minocycline therapy for acne in adolescents and young adults are considered.

Rare metastasis of primary bronchogenic carcinoma to sigmoid colon

The authors present a case of a rare metastasis of bronchogenic carcinoma to sigmoid colon. Carcinoma of the lung usually spreads locally to adjacent mediastinum or paratracheal lymph nodes via the lymphatics. When tumor invades the pulmonary vein, distal metastases are most often to brain, suprarenal glands, or bones. Primary bronchogenic carcinoma has been reported to metastasize to jejunum, maxillary antrum, small bowel, tongue, and rarely to other organs. The authors believe that metastasis to the large intestine is most exceptional. Occurrences of rare metastasis are not well understood, though one theory implicates sites of previous trauma.

Reactive granular cells in sites of trauma. A cytochemical and ultrastructural study.

Granular cells resembling the cells of true myoblastoma have been observed in various sites of previous trauma (usually surgical). They may be differentiated from myoblastoma cells in routine light microscopic sections, with simple histochemical procedures, and with electron microscopic studies. The granules are dense bodies with acid phosphatase activity (lysosomes). Most cells resemble histiocytes, but some have a prominent endoplasmic reticulum and many mitochondria. Others have basement membranes, marked surface activity, a fibrillar system with condensations resembling that in smooth muscle, glycogen and desmosomal connections. These observations suggest their derivation from multipotential cells capable of forming either fibroblasts or smooth muscle cells.

Sarcoma at the site of previous trauma in Paget's disease.

Sarcoma at the site of previous trauma in Paget's disease.