Skin Tags Research Articles

Oculo-auriculo-vertebral Spectrum (Goldenhar Syndrome): Presentation of Three Cases

BackgroundThe oculo-auriculo-vertebral spectrum (OAVS) includes three closely related rare congenital diseases of different severity with an incidence of 1/3500-7000 individuals. The involvement is usually unilateral; however, bilateral involvement may also occur. In addition to craniofacial anomalies, defects in the cardiovascular, genitourinary, vertebral, and central nervous systems can be observed as well. The phenotype of the cases is highly variable. Goldenhar syndrome is the most severe form of this condition.Case reportIn total, three instructive cases of Goldenhar syndrome with different features have been reported in the present case study. The most common ear anomalies among these three cases included external auditory canal atresia, helix deformities, preauricular skin tag and/or ear pitting, microtia, and conductive hearing loss. The second case was presented with hemifacial microsomia on the more severely affected right side, and the third case had bilateral Brushfield spots and a dermolipoma ophthalmological findings.ConclusionBased on the findings of the present study, OAVS should also be considered in the differential diagnosis of the cases with facial and ear anomalies.

A rare association in a patient with non-muscle invasive bladder cancer: ureteral fibroepithelial polyp and ipsilateral renal cell carcinoma: a case report

BackgroundFibroepithelial polyps located in the ureter constitute 2–6% of all benign tumors in the urinary system. Distinguishing these lesions from transitional cell carcinoma is essential to avoid unnecessary nephroureterectomy.Case presentationA 59-year-old asymptomatic caucasian male patient was enrolled in follow-up for Ta low-grade transitional cell bladder cancer 4 years ago in our clinic. A suspicious, solid, contrast-enhancing mass 15 × 9 mm in diameter in the anteromedial mid-section of the left kidney, which was causing minimal washout and largely located in the parenchyma, was reported as renal cell carcinoma on computed tomography during routine controls. In the excretory phase, soft-tissue densities of approximately 30 mm in length, which were located in the distal part of the left ureter at a distance of 40 mm from the ureterovesical junction, extending towards the lumen suggested a urethral carcinoma. Urothelial lesion was reported as fibroepithelial polyp after histopathological examination. Partial nephrectomy for the mass, which was reported as renal cell carcinoma in the left kidney, was performed in the first postoperative month. Histopathological examination revealed Fuhrman grade 1 papillary type renal cell carcinoma. No recurrence was observed in the first year after treatment.ConclusionsAlthough our patient had a bladder transitional cell carcinoma and a suspicious renal cell carcinoma mass of 15 mm in the ipsilateral kidney, the patient was safeguarded from unnecessary nephroureterectomy early on by cross-sectional and endoscopic imaging of the ureter.

Vitamin D level and telogen hair loss: A Case control study

Abstract
 
 Background: Hair loss is a common skin condition. Hair is not a vital organ but losing it has a worse effect on the psychological state of the patient and may interrupt his daily social activities. Telogen effluvium founded to be the commonest noninflammatory cause to diffuse hair loss. Since nutritional disturbances are one of the triggering factors for it. It might be useful in the management of TE Due to the limited number of studies& little information is available on this subject possible role of vitamin D or its deficiency should be studied further.
 Aim of the study: to determine the association between Telogen effluvium and vitamin D level.
 Materials and methods: This is a case-control study performed in a period between December 2018 until June 2020; in Baghdad dermatology center at medical city. One hundred women who were seeking treatment for diffuse hair shedding and who hadn’t received treatment or supplements yet and One hundred fifty control subjects are chosen from patients who were referred to the dermatology clinic for the treatment of nevi and who are not pregnant or lactating, had no systemic or local scalp diseases are included in the study. Full History, physical examination performed for all cases including looking for cutaneous diseases, supplements & drug intake. Serum Vitamin D3 is measured using (Ichroma (TM), Boditech Med Inc., Korea).
 Result: A total of 250 females were included in this study, 100 of them got telogen effluvium & 150 were patients who attend dermatology clinic seeking treatments for nevi or skin tag (control group) .The mean age of cases was (22.59 ±4.837 year) that wasn’t significantly different from mean age of control group (23.647±6.022 years) (p-value =0.127). The mean level of Vitamin D was significantly lower than that of control group (11.16±4.49) Vs (18.98±10.65), P value <0.001. Vitamin D mean level in acute phase was significantly higher than that of chronic phase pts. (11.68±4.77 & 9.93 ±3.55 respectively), p value=0.04. Mean vit. D among symptomatic patients. (9.7 ± 3.5) was significantly lower than that among asymptomatic pts. (13±4.19) (p=0.001).No significant association were noticed between job & residence of the patients of both groups, (P-value =0.283 & 0.069 respectively (.
 Conclusion: Age mean difference was not significant among cases and controls. Deficiency in vitamin D may assume a possible leading cause of telogen effluvium among women with hair loss. Cases were significantly associated with low level of Vitamin D3 than controls.Low level of vitamin D was dominant among housewives, urban women, and among symptomatic patients with acute duration.

Transanal Hemorrhoidal Dearterialization (THD) Anolift-Prospective Assessment of Safety and Efficacy.

The adjunct of a mucopexy to conventional dearterialization has become a routine part of the transanal hemorrhoidal dearterialization procedure in order to facilitate the management of the prolapsing component and has helped to expand the indications of this technique to more advanced stages of hemorrhoidal disease. A simple technical modification of THD with targeted mucopexy (TM), called Anolift, is described. The aim of the study was to evaluate the safety and effectiveness of this technical variation. The procedure consisted of two parts: one aimed at the dearterialization and the other concentrated on the management of the prolapsing component. Once all the arteries were identified and transfixed an Anolift targeted mucopexy was performed using a continuous barbed suture with a synthetic absorbable monofilament (Polydioxanone) 2/0 Filbloc (Assut Europe) stitch mounted on a 4/8 30 mm needle. Severity of hemorrhoidal symptoms was scored from 0 to 20 using a dedicated questionnaire: the Hemorrhoidal Assessment Severity Score (HASS). From May 2018 to November 2020, 60 patients with hemorrhoidal disease (HD) underwent a THD Anolift procedure. Three patients experienced severe post-operative pain and 10 (23%) suffered with difficulty in evacuation. The median follow-up period was 15.5 months (range 2–32 months). The mean HASS changed from 16.43 pre-operatively to 1.95 post-operatively (p < 0.0001). Pre-operative HASS very strongly correlated with the degree of hemorrhoids (p < 0.001), while there was no correlation between the pre-operative HASS or the degree of hemorrhoids and the post-operative HASS (p = 0.163). There was no significant difference in predicted post-operative HASS according to the pre-operative HD stage. One patient (1.6%) with circumferential IV hemorrhoids had a recurrence and required a further THD. Two patients had excision of skin tags (3%). The Anolift technique is safe and effective for the management of HD even in patients with advanced stages.

Histopathological spectrum of vulvar lesions on a remote Indian Island

A wide spectrum of normal, benign, premalignant, and malignant lesions may occur on the vulva. Symptoms of vulvar disorders may be non-specific. Empiric treatment of vulvovaginal symptoms is common but usually not helpful. Though the varied clinical presentation and diverse histopathological spectrum of vulvar lesions have amazed Pathologists, only a few studies have been reported in the literature. The present study consists of a histopathological spectrum of vulvar lesions. 1.To evaluate the histopathological spectrum of vulvar lesions. 2. To compare the incidences of non-neoplastic and neoplastic lesions of the vulva. Present study includes all types of vulvar lesion specimens received in the Department of pathology over a period of four years. All thirty-nine vulvar biopsies received in the Department of Pathology were studied for histomorphologic features. The lesions were categorized as non-neoplastic, neoplastic. The neoplastic ones were further divided into benign, malignant, and premalignant. The age of the women ranged from 15 to 69 years (mean 36.18±12.71) with the maximum number of patients between 30 to 40 years of age. Non neoplastic lesions were more common (22; 56.4%) than the (17; 43.6%) neoplastic lesions. There were 15(38.5%) benign lesions while 2 cases (5.13%) were malignant. Among the non-neoplastic lesions, Bartholin's duct cyst was the most common histopathologic diagnosis (35.9%). The fibroepithelial polyp was the most common benign neoplastic lesion constituting 15.3%. In the present study nonneoplastic lesions were more common than neoplastic lesions. Among the neoplastic lesions, benign neoplasms were more frequent than malignant lesions.

Cutaneous manifestation of polycystic ovary syndrome.

The aim of this cross-sectional study, that included 146 polycystic ovary syndrome (PCOS) patients, was to evaluate the prevalence, severity and pattern of cutaneous manifestation in Jordanian women with PCOS, as well as their correlation with hormonal abnormalities. A thorough complete cutaneous examination, hormonal assays (Luteinizing hormone [LH], follicle stimulating hormone [FSH], prolactin, total testosterone, free testosterone, dehydroepiandrosterone sulfate) and pelvic ultrasonography were done. The most common cutaneous features of PCOS were acne vulgaris (75.3%) followed by hirsutism (59.6%) then seborrhea (43.2%) and androgenetic alopecia (42.5%). Patients who had acne vulgaris presented at a younger age than patients who did not. Patients who had androgenetic alopecia and stria were older than patients with no such features. Moreover, all cutaneous manifestations of PCOS, except for acne, were associated with higher body mass index (BMI). Elevated LH:FSH ratio of more than 2:1 was the most common hormonal abnormality, followed by increased LH and total testosterone. Acne, hirsutism, androgenetic alopecia, seborrhea, acanthosis nigricans and skin tags are common cutaneous manifestations among Jordanian patients with PCOS. The existence of one or more of these features, especially in overweight and obese patients, should alert the physician towards the possibility of having PCOS.

Hemorrhoidal artery ligation without using a doppler guide: Is it a feasible and safe technique?

The objective of this work was to analyze the results of the hemorrhoidal artery ligation technique without using a doppler guide, in patients with grade 3 hemorrhoidal disease; by evaluating cost-effectiveness, operation time, recurrence rate, postoperative pain, and secondary outcomes. A hemorrhoidal artery ligation procedure, without using a doppler guide, was performed on 43 patients (15 females, 28 males) with grade 3 symptomatic hemorrhoidal disease, from June 2015 to June 2019, in the Haseki Training and Research Hospital, Istanbul, Turkey. Patients were followed up clinically for one month. They completed a questionnaire within one year after their procedure. The median age was 46 years (range: 24 to 82 years). The main complaints were bleeding in 27 patients, pain in 22 patients, and skin tag in 14 patients. The mean preoperative VAS score was 3.4. The mean operating time was 18 mins (range: 13 to 25 min). All patients remained hospitalized for 24 h. Reoperation was necessary for only one patient because of bleeding. One year after the surgery, the pain was resolved in 21 (95.4%) out of 22 patients with preoperative pain, and bleeding resolved in 25 (92.5%) out of 27 patients with preoperative bleeding. The hemorrhoidal artery ligation is a simple method with a shorter learning curve producing similar postoperative results to other surgical procedures. The surgical technique is cost-effective as it does not require any particular device (anoscope with Doppler ultrasound) to apply.

V02-10 ROBOTIC ASSISTED LAPAROSCOPIC EXCISION OF A FIBROEPITHELIAL POLYP OF THE URETER

You have accessJournal of UrologyMisc. Benign Disease & Transplant & Renovascular (V02)1 Sep 2021V02-10 ROBOTIC ASSISTED LAPAROSCOPIC EXCISION OF A FIBROEPITHELIAL POLYP OF THE URETER Zain Hyder, and Nathaniel Polnaszek Zain HyderZain Hyder More articles by this author , and Nathaniel PolnaszekNathaniel Polnaszek More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001979.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Fibroepithelial polyps of the urinary tract are rare tumors and are considered to be benign. We aim to present an exceedingly rare case of a large fibroepithelial polyp and describe its management. METHODS: The patient was a 32-year-old healthy female who presented with gross hematuria. Workup including CT IVP (computed tomography and intravenous pyelogram) demonstrated a large left mid ureteral mass. The patient underwent diagnostic ureteroscopy with biopsy of the mass followed by robotic excision of the mass and reconstruction of the ureter. RESULTS: The total operative time for the case was 185 minutes. In this time, diagnostic ureteroscopy was performed defining the large intramural mass with multiple sites of attachment. Frozen sections of the mass were obtained and demonstrated benign pathology. Robotic assisted laparoscopic exposure of the ureter was performed. A longitudinal ureterotomy was made and the mass was delivered out of the ureter. The mass measuring 7.1cm was entirely excised. The remaining ureter was tailored and reconstructed around an indwelling ureteral stent. The patient was discharged on post-operative day 1. A five month follow up with an Xray IVP showed a patent ureter without hydronephrosis. CONCLUSIONS: Fibroepithelial polyps are rare benign tumors. We demonstrated with an interesting case that robotic management of even very large masses is feasible with favorable post-operative outcomes. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e136-e136 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zain Hyder More articles by this author Nathaniel Polnaszek More articles by this author Expand All Advertisement Loading ...

The Mus musculus Papillomavirus Type 1 E7 Protein Binds to the Retinoblastoma Tumor Suppressor: Implications for Viral Pathogenesis.

ABSTRACTThe species specificity of papillomaviruses has been a significant roadblock for performing in vivo pathogenesis studies in common model organisms. The Mus musculus papillomavirus type 1 (MmuPV1) causes cutaneous papillomas that can progress to squamous cell carcinomas in laboratory mice. The papillomavirus E6 and E7 genes encode proteins that establish and maintain a cellular milieu that allows for viral genome synthesis and viral progeny synthesis in growth-arrested, terminally differentiated keratinocytes. The E6 and E7 proteins provide this activity by binding to and functionally reprogramming key cellular regulatory proteins. The MmuPV1 E7 protein lacks the canonical LXCXE motif that mediates the binding of multiple viral oncoproteins to the cellular retinoblastoma tumor suppressor protein, RB1. Our proteomic experiments, however, revealed that MmuPV1 E7 still interacts with RB1. We show that MmuPV1 E7 interacts through its C terminus with the C-terminal domain of RB1. Binding of MmuPV1 E7 to RB1 did not cause significant activation of E2F-regulated cellular genes. MmuPV1 E7 expression was shown to be essential for papilloma formation. Experimental infection of mice with MmuPV1 expressing an E7 mutant that is defective for binding to RB1 caused delayed onset, lower incidence, and smaller sizes of papillomas. Our results demonstrate that the MmuPV1 E7 gene is essential and that targeting noncanonical activities of RB1, which are independent of RB1’s ability to modulate the expression of E2F-regulated genes, contribute to papillomavirus-mediated pathogenesis.

Metabolic syndrome in skin tags: a hospital based observational study

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;The aim was to evaluate the parameters of metabolic syndrome in patients of skin tags and to investigate the possibility of an existing relationship between metabolic syndrome and skin tags.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This cross-sectional observational study included 47 patients with skin tags attended Outpatient department (OPD) of Department of Dermatology at a tertiary care center during a period of 1 year. Clinical and laboratory parameters were noted in each patient.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;This study included 47 patients with skin tags (28 males and 19 females). In the present study maximum number of patients belonged to the age group &amp;gt;40 years with 19 patients, followed by 30-40 years with 13 patient. In this study no. of students were 15, and no of employee were 11. Most patients had skin tags in more than one area, neck and axilla were involved in 9 patients each. In this study out of 47 patients. 11 patients had derangement of clinical and laboratory parameters of metabolic syndrome based on NCEP adult treatment panel III.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; In the present study we observed significant derangement of clinical and laboratory parameters of metabolic syndrome in patients of skin tags. &lt;/p&gt;

Investigation of Genetic Causes in a Developmental Disorder: Oculoauriculovertebral Spectrum.

Oculoauriculovertebral spectrum (OAVS) is a genetically and clinically heterogeneous disorder that occurs due to a developmental field defect of the first and second pharyngeal arches. Even though recent whole exome sequencing studies (WES) have led to identification of several genes associated with this spectrum in a subset of individuals, complete pathogenesis of OAVS remains unsolved. In this study, molecular genetic etiology of OAVS was systematically investigated. A cohort of 23 Turkish patients with OAVS, referred to Hacettepe University Hospital, Department of Pediatric Genetics from 2008 to 2018, was included in this study. Minimal diagnostic criteria for OAVS were considered as unilateral microtia or hemifacial microsomia with preauricular skin tag. The cohort was clinically reevaluated for craniofacial and extracranial findings. Molecular etiology was investigated using candidate gene sequencing following copy number variant (CNV) analysis. WES was also performed for 2 of the selected patients. Patients in the study cohort presented similar demographic and phenotypic characteristics to previously described patients in the literature except for a higher frequency of bilaterality, cardiac findings, and intellectual disability/developmental delay. CNV analysis revealed a possible genetic etiology for 3 patients (13%). Additional WES in 1 of the 2 patients uncovered a novel heterozygous nonsense variant in Elongation factor Tu GTP-binding domain-containing 2 (EFTUD2) causing mandibulofacial dysostosis with microcephaly (MFDM), which clinically overlaps with OAVS. Detailed clinical evaluation for any patient with OAVS is recommended due to a high rate of accompanying systemic findings. We further expand the existing genetic heterogeneity of OAVS by identifying several CNVs and a phenotypically overlapping disorder, MFDM.

Prevalence And Management Outcome Of Gestational Trophoblastic Disease In A Low Resource Setting, North-western Nigeria

Fibrolipoma is one of the variants of lipoma. Lipoma is a rare benign tumour of upper aerodigestive tract, but occur commonly in limbs and trunk. We present a 65 year old man who presented with huge recurrent fibrolipoma of the larynx causing upper airway obstruction which recurred five (5) years after an initial endoscopic excision of a benign laryngeal lesion with histological diagnosis of fibro epithelial polyp.

DICER1-Mutated Botryoid Fibroepithelial Polyp of the Parotid Duct: Report of the First Case

DICER1, a member of the ribonuclease III family, is involved in the biogenesis of microRNAs and, hence, it influences gene expression regulation. DICER1 germline (associated with the inherited DICER1 syndrome) or somatic mutations have been linked to tumorigenesis in histogenetically diverse benign and malignant neoplasms in different organs including pleuropulmonary blastoma, cystic nephroma, embryonal rhabdomyosarcoma, nasal chondromesenchymal hamartoma, poorly differentiated thyroid carcinoma, thyroblastoma, intracranial sarcoma and gonadal Sertoli-Leydig cell tumors in addition to others. Moreover, rare botryoid (giant) fibroepithelial polyps may harbor this mutation. Herein, we describe the first reported case of a DICER1-mutated botryoid fibroepithelial polyp occurring within the parotid duct of a 65-year-old female who has no other features or family history of the DICER1 syndrome. Based on its distinctive morphology, we tested this lesion specifically for DICER1 mutations and confirmed the presence of a pathogenic DICER1 variant with a low allele frequency, consistent with a somatic mutation.

Cd34+ Stromal Cells/Telocytes in Normal and Pathological Skin.

We studied CD34+ stromal cells/telocytes (CD34+SCs/TCs) in pathologic skin, after briefly examining them in normal conditions. We confirm previous studies by other authors in the normal dermis regarding CD34+SC/TC characteristics and distribution around vessels, nerves and cutaneous annexes, highlighting their practical absence in the papillary dermis and presence in the bulge region of perifollicular groups of very small CD34+ stromal cells. In non-tumoral skin pathology, we studied examples of the principal histologic patterns in which CD34+SCs/TCs have (1) a fundamental pathophysiological role, including (a) fibrosing/sclerosing diseases, such as systemic sclerosis, with loss of CD34+SCs/TCs and presence of stromal cells co-expressing CD34 and αSMA, and (b) metabolic degenerative processes, including basophilic degeneration of collagen, with stromal cells/telocytes in close association with degenerative fibrils, and cutaneous myxoid cysts with spindle-shaped, stellate and bulky vacuolated CD34+ stromal cells, and (2) a secondary reactive role, encompassing dermatitis—e.g., interface (erythema multiforme), acantholytic (pemphigus, Hailey–Hailey disease), lichenoid (lichen planus), subepidermal vesicular (bullous pemphigoid), psoriasiform (psoriasis), granulomatous (granuloma annulare)—vasculitis (leukocytoclastic and lymphocytic vasculitis), folliculitis, perifolliculitis and inflammation of the sweat and sebaceous glands (perifolliculitis and rosacea) and infectious dermatitis (verruca vulgaris). In skin tumor and tumor-like conditions, we studied examples of those in which CD34+ stromal cells are (1) the neoplastic component (dermatofibrosarcoma protuberans, sclerotic fibroma and solitary fibrous tumor), (2) a neoplastic component with varying presentation (fibroepithelial polyp and superficial myxofibrosarcoma) and (3) a reactive component in other tumor/tumor-like cell lines, such as those deriving from vessel periendothelial cells (myopericytoma), epithelial cells (trichoepithelioma, nevus sebaceous of Jadassohn and seborrheic keratosis), Merkel cells (Merkel cell carcinoma), melanocytes (dermal melanocytic nevi) and Schwann cells (neurofibroma and granular cell tumor).

Plaque-Type Variant of Acquired Rhabdomyomatous Mesenchymal Hamartoma on the Chin: A Case Series.

Rhabdomyomatous mesenchymal hamartoma (RMH) is a rare benign tumor composed of skeletal muscle fibers and other mesenchymal-derived cells. The lesions are generally solitary sessile papules or skin tag lesions that occur during childhood. We retrospectively reviewed patients diagnosed with RMH pathologically between January 2001 and June 2020 at a tertiary medical center. A literature review was conducted. Seven plaque-type RMHs on the chin were found, including 6 in adults and one in a 14-year-old boy. The average age was 45.7 years. The onset of the RMH appearance was between several months and years. Pathologically, all patients showed a scattered haphazard arrangement of skeletal muscle bundles in the dermis and/or subcutis. Subcutis replaced by fibrous tissue and skeletal muscle bundles was present in 2 cases. Some skeletal muscles had a periadnexal distribution. This case series demonstrated a distinct clinical presentation of acquired RMH specifically located on the chin.

Germ Line Mutations in the Thyroid Hormone Receptor Alpha Gene Predispose to Cutaneous Tags and Melanocytic Nevi.

Background: Many physiological effects of thyroid hormone (TH) are mediated by its canonical action via nuclear receptors (TH receptor α and β [TRα and TRβ]) to regulate transcription of target genes. Heterozygous dominant negative mutations in human TRα mediate resistance to thyroid hormone alpha (RTHα), characterized by features of hypothyroidism (e.g., skeletal dysplasia, neurodevelopmental retardation, constipation) in specific tissues, but near-normal circulating TH concentrations. Hitherto, 41 RTHα cases have been recorded worldwide.Methods: RTHα cases (n = 10) attending a single center underwent cutaneous assessment, recording skin lesions. Lesions excised from different RTHα patients were analyzed histologically and profiled for cellular markers of proliferation and oncogenic potential. Proliferative characteristics of dermal fibroblasts and inducible pluripotent stem cell (iPSC)-derived keratinocytes from patients and control subjects were analyzed.Results: Multiple skin tags and nevi were recorded in all cases, mainly in the head and neck area with a predilection for flexures. The affected patients had highly deleterious mutations (p.E403X, p.E403K, p.F397fs406X, p.A382PfsX7) involving TRα1 alone or mild/moderate loss-of-function mutations (p.A263V, p.L274P) common to TRα1 and TRα2 isoforms. In four patients, although lesions excised for cosmetic reasons were benign intradermal melanocytic nevi histologically, they significantly overexpressed markers of cell proliferation (K17, cyclin D1) and type 3 deiodinase. In addition, oncogenic markers typical of basal cell carcinoma (Gli-1, Gli-2, Ptch-1, n = 2 cases) and melanoma (c-kit, MAGE, CDK4, n = 1) were markedly upregulated in skin lesions. Cell cycle progression and proliferation of TRα mutation-containing dermal fibroblasts and iPSC-derived keratinocytes from patients were markedly increased.Conclusions: Our observations highlight frequent occurrence of skin tags and benign melanocytic nevi in RTHα, with cutaneous cells from patients being in a hyperproliferative state. Such excess of skin lesions, including nevi expressing oncogenic markers, indicates that dermatologic surveillance of RTHα patients, monitoring lesions for features that are suspicious for neoplastic change, is warranted.

Polydactyly presentations: A case report

Polydactyly is a duplication of the digits of the hands or feet. It is a congenital anomaly and can manifest as a single disorder or as a component of a syndrome. It is typically an autosomal dominant inherited condition with variable expression and incomplete penetrance. It is genetically heterogenic being caused by mutations in different genes. It manifests in different forms, based on the position of occurrence of the extra digit. It can occur as a single disorder as a component of a syndrome. Its presentation ranges from just a skin tag to a complete digit with the accompanying metatarsal or metacarpal bone. It can result in functional impairment or it may just be a cosmetically unacceptable digit with no functional impairment. Treatment depends on the nature of the extra digit as well as any functional impairment it may be causing. Surgical excision is employed and various reconstruction procedures are also employed in treatment, and must be well planned out to avoid a worsening of function. We present two cases; a 3-month-old baby girl presenting with a hereditary preaxial polydactyly (PPD) (Wassel type V) of both feet and a 29-year-old man with isolated postaxial polydactyly of the right foot with which was symptomatic.

Prevalence and predictors of colon polyps in patients with skin tags: A cross sectional study.

Acrochordons (fibroepithelial polyps, skin tags, papillomas) are common benign neoplasms of the skin. To identify the prevalence of colonic polyps among patients presenting with skin tags and to determine a useful criteria for screening with colonoscopy. Two hundred patients who fulfilled the selection criteria underwent physical, biochemical evaluation (fasting blood sugar (FBS), body mass index (BMI) calculation, occult blood in stool), and histopathological examination of the skin tags. Colonoscopy was performed in patients with positive blood in stool, and any polyps identified were resected or biopsied. Occult blood in stool was insignificantly detected in 12 (6%) of the 200 subjects (p<0.001), and they were referred for colonoscopy. A prevalence rate of 3.5% was reported, and of twelve colonoscopies performed, three patients were polyp-free, two were diagnosed with ulcerative colitis (UC), and seven patients were diagnosed with polyps that were removed and/or biopsied (p=0.421). Of the seven polyps, three were hemorrhoidal polyps and the four other polyps were adenomatous polyps (villous adenoma). The mere presence of skin tags does not significantly correlate with existence of colonic polyps and does not justify screening colonoscopy unless other metabolic, GIT, and biochemical markers are identified.

Hairy polyp of the nasal vestibule

A male infant was born with a pendulous fleshy mass attached to the right nasal vestibule ([figure 1A][1]). The mass caused nasal deviation and interfered with feeding. Bilateral preauricular skin...

Doppler-guided hemorrhoidal artery ligation with suture mucopexy compared with LigaSure™-assisted pile excision for the treatment of grade III hemorrhoids: a prospective randomized controlled trial.

Doppler-guided hemorrhoid artery ligation and stapled hemorrhoidopexy have been used in surgical practices to avoid post-hemorrhoidectomy pain. Our study compared Doppler-guided hemorrhoid artery ligation with suture mucopexy (DGHAL-SM) and ligature-assisted pile excision (LAP) for greater than three grades of internal hemorrhoids. Eighty patients with greater than 3 grades of internal hemorrhoids were selected (age range: 20-28 years; average age: 23 years) between January and June 2015. The patients were randomly divided into group A (DGHAL-SM) and group B (LAP); each group had 40 patients. With respect to the postoperative cure rate and anal skin tags, group A was inferior to group B, but the postoperative pain assessment and satisfaction were better than group B (P<0.001). The DGHAL-SM cure rate was high; the postoperative pain was mild; 97.5% of the patients did not return to hospital because of pain. LAP has a higher cure rate than DGHAL-SM, but the postoperative pain and return rate within 6 h was as high as 65%, and the postoperative satisfaction assessment was lower than DGHAL-SM. Therefore, we recommend that DGHAL-SM for outpatient surgery in patients with greater than three grades of internal hemorrhoids.