Ulcerated Nodule Research Articles

DRUG-INDUCED SARCOIDOSIS-LIKE REACTION IN THE ORAL CAVITY: A CASE REPORT

Drug-induced sarcoidosis-like reaction (DISR) is almost indistinguishable from sarcoidosis, and it manifests as a systemic granulomatous tissue reaction occurring in a temporal association with initiation of an offending drug. This study presents a rare case of DISR with oral involvement. A 63-year-old woman with a history of rheumatoid arthritis who has been treated with adalimumab presented with multiple ulcerative nodules on the hard palate, with 15 days of duration. Imaging exams did not exhibit any alteration. Blood tests and serological investigations were negative. An incisional biopsy was performed. Microscopic examination demonstrated a granulomatous inflammatory process in the connective tissue, consisting of multiple granulomas, without evidence of caseating necrosis or microorganisms. Histochemical reactions were negative for acid-fast bacilli and fungi, and immunohistochemical assessment for CD3, CD20, and CD68 highlighted the presence of normal lymphocytes and histiocytes. Adalimumab was ceased and after 17 months complete resolution of the lesions was observed.

MUCOEPIDERMOID CARCINOMA IN A YOUNG PATIENT—CASE REPORT

Mucoepidermoid carcinoma is the most common malignant tumor of the salivary glands and represents 5% of all neoplasms of the head and neck. The main risk factors reported are genetic disorders, radiation, and smoking. A 30-year-old woman presented with a painless swelling in the hard palate region that evolved over a period of 5 months. The lesion was found between the premolars and was an ulcerated nodule measuring about 5 mm in diameter. On extraoral examination, no lymph node changes were found. Tomography revealed a hypodense area with poorly defined margins. To determine the diagnosis, an incisional biopsy was performed, and the immunohistochemical report was positive for proteins CK-7, CK-8, CK-14, periodic acid-Schiff stain (PAS) PAS-clusters of differentiation (CD) and negative for acute myeloyd leukemia (AML) and vimentin, confirming the diagnosis of salivary gland neoplasm. The patient was referred to an oncology center.

Bilateral yellow plaques on the upper eyelids

Bilateral yellow plaques on the upper eyelids

Development of a Highly Sensitive Nested PCR and Its Application for the Diagnosis of Cutaneous Leishmaniasis in Sri Lanka.

The recent surge in cutaneous leishmaniasis (CL) in Sri Lanka has rendered clinical diagnosis difficult; thus, laboratory confirmation is indispensable. A modified (two novel inner primers to detect CL caused by Leishmania donovani) nested Internal Transcribed Spacer-1 (ITS1) PCR-Restriction Fragment Length Polymorphism (RFLP) method was developed and tested. The sensitivity of the modified nested PCR was tested using serial dilutions (103 to 10−2) of the DNA extract of a cultured L. donovani DD8 strain. Patients (n = 194) from Southern Sri Lanka were examined clinically, microscopically (Slit Skin Smear-SSS) and using the modified nested PCR. The modified nested PCR detected 2.55 fg of parasite DNA compared to ITS1 PCR (25 fg) and detected more cases than SSS (94.3% vs. 77.3%; p < 0.01). The RFLP pattern was L. donovani in all cases. The modified nested PCR performed well in clinically doubtful lesions (95% by PCR vs. 60% by SSS; p < 0.01), ulcerated nodules (91% vs. 71.8%; p < 0.01) and plaques (100% vs. 66.7%; p < 0.01). SSS demonstrated sensitivity (80.9%), specificity (81.8%), PPV (98.7%) and NPV (20.5%) against modified PCR. Low parasite loads and atypical lesions can be diagnosed by the proposed method with higher accuracy.

Tumor venéreo nodular transmisible en área extragenital: Reporte de caso

Canine transmissible venereal tumour (TVT) is a contagious venereal round-cell tumour with high incidence in stray dogs. TVT is commonly transmitted by copula, so it occurs mainly at the mucous membrane of the external genital of male and female dogs. This study aimed to report a case of a dog with TVT at an extragenital area, presented as a nodular cutaneous lesion. The dog presented a large nodular mass located in the cervical region. Clinical examination also revealed micronodules in the left forearm and an ulcerated nodule located on the back. After the diagnosis of TVT by cytological examination, a chemotherapeutic protocol based on vincristine sulphate (0.75 mg / m2) was established in four applications, with 7 days of interval. The treatment was effective in the regression of nodular lesions, observed clinically at the end of the protocol. Although it has already been described metastasis, TVT complications usually are related to the growth of the tumor in the tissue in which it is implanted. Our study confirmed that the treatment of intravenous administration of vincristine sulphate weekly for 4 weeks was effective in the remission of the nodules. This report indicates that TVT extragenital must be present among the differential diagnoses in the occurrence of cutaneous nodules in the canine patient when considering its historic.

Painful, erythematous, and ulcerated nodules on the thigh

A 27-year-old man with no significant past medical history presented due to concern for bumps on his leg that had persisted for several months. On physical examination, multiple firm pink nodules ranging from 1 to 3 cm were observed on the lateral aspect of the left thigh, some of which were ulcerated (Fig 1). An excisional biopsy was performed, which revealed spindled-to-epithelioid cells with infiltrative borders and focal neutrophilic infiltrate (Fig 2). The lesional cells stained for pancytokeratin (AE1/AE3), CD31, ETS-related gene (ERG), and integrase interactor 1 (INI1), and were negative for CD34, S100, and factor XIIIa (Fig 3).

Lagoquilascaríase em felino doméstico (Felis catus domesticus) - relato de caso

ABSTRACT Lagoquilascariasis is a zoonotic disease caused by a nematode parasite of the genus Lagochilascaris (Family Ascarididae), with the ingestion of contaminated rodents being the main source of infection. The main clinical signs are dysphagia and the presence of ulcerated nodules in the cervical region. The objective was to describe a case of lagaroquilascariasis in a domestic cat, in the city of Caxias do Sul / RS. A young adult male feline, without defined breed presented lethargy, dehydration, bilateral fistulas in the oropharynx cavity, right eyeball with exophthalmos, corneal opacity, third eyelid prolapse and periocular ulcerated skin lesion in the upper medial region. The diagnosis was made through the visualization and microscopic identification of the parasite Lagochilascaris minor and coproparasitological examination with the presence of eggs. Treatment was based on the use of doramectin and sanitary measures. According to the current literature, there are few reports of lagoquilascariasis in felines with clinical presentation similar to this case, since the most common is the formation of an abscess in the neck region. Morover, it is the first case described in the municipality, thus contributing to the epidemiology of the disease.

Persistent perianal “warts”

Persistent perianal “warts”

Disseminated Ulcerated Nodules: A Quiz.

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The Clinical Phenotypes of Cutaneous Leishmaniasis in Central and Southwest Regions of Yemen.

Cutaneous leishmaniasis (CL) is endemic in Yemen. CL displays a spectrum of typical and atypical morphologies yet understudied in the central and southwest regions of Yemen. To identify the typical and atypical clinical phenotypes of CL in the central and southwest regions of Yemen. A survey of 145 patients who visited Prof. Al-Qubati Clinic in Taiz between 2010 and 2015, was conducted. Children and residents of the rural areas were at high risk of exposure to the insect vector. The typical phenotype was single (67%), facial (58%) and ulcerated nodule (35%). Other usual phenotypes were small ulcers (21.4%) and non-ulcerative papules and nodules (21%). Unusual phenotypes constituted 12% of the cohort and included psoriasiform, eczematous, erysipeloid, lupoid, verrucous, large ulcerative, leishmania recidivens, satellite, granulomatous infiltrative and hyperkeratotic plaques. Mucous membrane involvement was evident in 10.6% and was also polymorphic. CL has many morphologic patterns in central and southwest regions of Yemen, some are clinically deceptive.

Unresolved chronic ulcerated nodules: Disseminated Cutaneous Sporotrichosis

We present a case of disseminated cutaneous sporotrichosis in a 72-year-old male patient who has multiple ulcerated painless nodules over the left side of his chest and on his upper and lower left limbs for three years. He was initially diagnosed to have nodular vasculitis based on early repeated biopsies. Despite the patient’s good compliance with his prednisolone medication, no significant clinical improvement was observed. Another biopsy, which was arranged after two years of treatment for nodular vasculitis, supported the diagnosis of sporotrichosis. Itraconazole was initiated, and all the lesions showed a remarkable response toward the treatment. The delay in finding the correct diagnosis unnecessarily exposed the patient to the side effects of steroid and caused the disease to worsen. Bangladesh Journal of Medical Science Vol. 21(1) 2022 Page : 191-195

Presumed herpes simplex virus ulcerative nodular episcleritis treated by topical acyclovir alone

A 7-year-old female child was referred to the cornea clinic with a painless, ulcerated, and inflamed nodule near the limbus which did not respond to 1-week antibiotic therapy and worsened on starting topical steroids. Clinical examination showed ulcerative nodular episcleritis and raised a suspicion of herpes simplex virus etiology. The patient responded well and resolved completely on topical antiviral therapy alone.

Multiple distal lower limbs exophytic ulcerated nodules

A 31-year-old woman, originally from Nigeria, presented to the dermatology clinic with a 6-month history of insidious, painful, exophytic nodules and ulcerations with multiple purulent discharging sinus tracts bilaterally in the gaiter area (Fig 1). She had experienced a similar episode 5 years ago, which was managed with intravenous antibiotics. Other medical history included hypertension and childhood hepatitis B. She had no history of foreign travel for the past 7 years, no history of trauma to the affected areas, and no other associated symptoms.

A-T flap for cheek reconstruction

Pilomatricoma is a benign skin tumor derived from the hair follicle. It has a varied etiology, and the traumatic one is often described as a triggering factor. The surgical treatment is curative and, therefore, the choice. We report a case of an atypical clinical presentation pilomatricoma – an ulcerated nodule topped by a central hematic crust, with peripheral telangiectasias probably triggered by the HPV vaccination. The ultrasound examination suggested the possibility of a chronic inflammatory granuloma, although the histopathological examination was definitive and confirmed the diagnosis of pilomatricoma.

Micropapillary Carcinoma in a dog: Case report

Mammary neoplasms in female dogs present a high incidence. Several histological types are observed, among them, micropapillary carcinoma is considered one of the most aggressive because it is related to vascular invasion, metastases and low survival time. Aimed to describe a case of micropapillary breast carcinoma, with cutaneous metastasis, in a dog. A canine, female, 14 years old, 8kg, not defined breed, uncastrated, nulliparous, with pseudocyesis and no contraceptives administration history was attended at the Veterinary Reproduction and Obstetrics Service from "Governador Laudo Natel” Hospital, FCAV, UNESP, Jaboticabal, presenting a breast ulcerated nodule, with one month estimated evolution. After stabilization and preoperative exams, radical unilateral mastectomy and ipsilateral axillary and inguinal lymphadenectomy were performed. Histopathologic diagnosis revealed micropapillary carcinoma and free surgical margins from neoplasm, however, there were metastasis in both lymph nodes. The tutors did not adhere to antineoplastic chemotherapy. In 60th post-surgical day, there was inflammatory reaction in the surgical scar region, with small cutaneous ulceration, where the elastogram revealed rigidity and shear velocity of 7.84m/s. Skin biopsy revealed metastasis of micropapillary breast carcinoma. There was progression of ulcerations, compromising animal’s welfare and its physiological activities, when on the 110th post-surgical day, it was decided to euthanize the patient. The correct diagnosis and knowledge of tumor biological behavior are importants points to choose the correct treatment. The adjuvant chemotherapy treatment can impact on average survival time and ARFI elastography is an accurate predictor of rapid and non-invasive diagnosis of micropapillary carcinoma recurrence.

Successful Treatment of Ulcerative Colitis, Rectovaginal Fistula, and Skin Erythema Nodule With Adalimumab.

Successful Treatment of Ulcerative Colitis, Rectovaginal Fistula, and Skin Erythema Nodule With Adalimumab.

S2346 Bumpy Stomach: High-Grade Stage IV Diffuse Large B-cell Lymphoma Presenting as Numerous Ulcerated Bleeding Gastric Nodules

S2346 Bumpy Stomach: High-Grade Stage IV Diffuse Large B-cell Lymphoma Presenting as Numerous Ulcerated Bleeding Gastric Nodules

The rodent ulcer

A rodent ulcer refers to the slowly growing, ulcerated, locally invasive basal-cell carcinoma (BCC) which is the most common cutaneous malignancy in Caucasians but is rare in people with dark skin. We report two morphologically different presentations of nodular BCC in Nigerian patients. The first was a large, slowly growing ulcer on the right side of the face which had been present for many years, with the diagnosis not being made despite visits to various health centers, whereas the second was a much smaller ulcerated nodule on the right alar nasi and dorsum of the nose. We highlight the need for vigilance to make the correct diagnosis early and institute appropriate treatment.

Histopathological Aspects of Cutaneous Leishmaniasis due to Leishmania-Major in Libya

Aims: To describes the histopathological characteristics of skin lesions from patients with cutaneous leishmaniasis caused by Leishmania major in northwestern Libya and correlate with clinical presentation.&#x0D; Study Design: case series study.&#x0D; Place and Duration of Study: This study was carried on patients referred by the region's healthcare institutions and those presented at the Tripoli Central Hospital or the Libyan National Centre for Disease Control between July 2017 to January 2018.&#x0D; Methodology: The study included 38 patients, aged between 1-73 years, of both sexes, and came from 18 endemic areas in North-Western of Libya. The inclusion criteria were clinical symptoms and microscopic visualization of the parasite on a Giemsa-stained skin smear, in addition, clinical by the slit and smear technique, polymerase chain reaction for L. major. In addition, statistical analysis was conducted for the Histopathological examination.&#x0D; Results: The study found that 36 (94%) of the cases studied were positive by the slit and smear technique, and 32 (88.9%) were positive by PCR for L. major. Five histopathological patterns were observed: (i) diffuse cellular reaction without necrosis (25%); (ii) diffuse cellular reaction with necrosis (31.3%); (iii) exudative and necrotic granulomatous reaction (25%); (iv) exudative granulomatous reaction without necrosis (9.3%); (v) exudative-tuberculoid reaction with typical tuberculoid granuloma (organized) (9.3%). Inflammatory cellular infiltration ranged from mild to severe. Lymph plasmacytosis and lymph histiocytosis were predominant (34.4% and 21.7%, respectively). Necrosis was diffuse or local. The clinical features were correlated with this histological pattern. Epidermal changes included acanthosis, exocytosis, spongiosis, hyperkeratosis, and atrophy.&#x0D; Conclusion: The histopathological changes observed in CL caused by L. major in North-Western of Libya are characterized by an intense diffuse inflammatory reaction in the dermis with the predominance of lymphoplasmacytic infiltration. Overall, the granulomatous presentation was the main one. Various clinical forms, including papule, plaque, erythematous nodule with hemorrhagic crust, or violaceous nodule with adherent crust and ulcerated nodule, are significantly correlated with the histopathological stages, whereas disease progression could be related to age. The histopathological diagnosis of CL caused by L. major has a sensitivity of 78% relative to PCR.

Yaws: The forgotten tropical skin disease

Yaws is a rare skin disease endemic to tropical countries caused by Treponema pertenue. It is highly infectious and spreads through physical contact. In Malaysia, it was presumably eradicated during the 1960s, with the last reported case published in 1985. Due to its rarity, the disease often goes unrecognised and misdiagnosed. Here, we report the case of a 5-year-old aboriginal boy diagnosed with secondary yaws who presented with fever and an incidental finding of chronic painless ulcerated nodules and plaques on his lower limbs and gluteal region. His diagnosis was confirmed serologically with a venereal disease research laboratory lab test and he was successfully treated with a single dose of intramuscular benzathine penicillin G. Primary care physicians should not ignore this disease since its early recognition and appropriate treatment is vital to its eradication, especially in high-risk communities.