1-Dermatological Case Presentation
Transcript of 1-Dermatological Case Presentation
Dermatological Case Presentationfrom the Department of Dermatology
at Preah Kossamak Hospitalin Phnom Penh
Sithach MeyDepartment of DermatologyPreah Kossamak-Hospital
Dermatological Case Presentation from the Department of Dermatology AtPreahKossamak Hospital in Phnom PenhSithachMey, MDPreahKossamak Hospital, Phnom PenhParticularly in third world countries, dermatology tends to be not high on the list of priorities, because it is not considered to be a serious medical issue. In the Dermatology-consultation in PreahKossamak Hospital we met very often severs, life-threatening Problems. Sometimes patients can die from complications of dermatological diseases. Here, we report about some difficult and rare cases we met so far:1- A young man presented with an ulcerated, painless plaque on the left wing of the nose which progressed rapidly for about 4 months. His operation in the ENT-Hospital did not render a clear diagnosis. A second diagnostic biopsy was done in our dermatology department which was sent to Germany. Using immunohistopathology, a NK-cell lymphoma was diagnosed. Prevalence of the disease is higher in people of Asian descent than in whites. When compared with other subtypes of lymphoma found in the head and neck region, NK-/T-cell lymphoma carries a much higher mortality rate. Overall, median survival time is reported as 12.5 months. Our patient died three months after the diagnosis from respiratory obstruction. 2- A 56 year- old man presented with multiple infiltrated tumors on trunk and limbs. He had been treated for cutaneous tuberculosis for 6 months already in Cambodia, subsequently he received therapy for deep mycosis for 4 months in Viet Nam. A biopsy was diagnosed as melanoma metastasis in Cambodia. As the diagnosis did not match the clinical picture, German pathologists were asked for additional staining. Thus the diagnosis of malignant Histiocytosis was confirmed. The patient was lost from observation thereafter. 3- The third and the fourth reports we would like to show simple, but rather rare of different types of T-cell Lymphoma (plaque stage and Sezarysyndrom).
Abstract
A young man presented with eczematous plaque on the buttock which was treated for nearly two years by colleagues out side our department as Eczema and Tinea. A biopsy confirmed diagnosis of Mycosis Funggoid. The fourth case report about a 45 years old woman presented with multiple disseminated tumors which are rapidly growing. Her general status was altered (35 kg BW). Histology confirmed about Sézary Syndrome. 4- 7 months old girl referred by Pediatric hospital kunthabopha with a large, infiltrated congenital naevus which is partly ulcerated and presented some nodules in the middle. The girl has breathing difficulty. Malignant melanoma in a giant congenital naevus was diagnosed. The tumor dept was from 2,6 mm to 4, 2 mm. Surgeon in KuthaBopha decided not send her to Oncologist as the tumor was too big for an operative treatment.
Can dermatological problems pose a danger to the patient’s life?
Some dermatoses may threaten the patient’s life indeed, e.g.:
● Erysipelas ● Lupus erythematosus● TEN● Systemic scleroderma● Dermatomysitis● blistering diseases like Pemphigus● some neoplasms of the skin
We report some difficult and/or rare cases we met in the outpatient department of the Department of Dermatology in Preah Kossamak-Hospital (DDPKH) in 2010.
Case 1: History
A young man presented with:- ulcerated, painless plaque on the leftwing of the nose
- which progressed rapidly for about 4months.
Case 1: History
An operation in the Department of ENT of Ang Duong Hospital did not render a clear diagnosis
A second diagnostic biopsy which was sent to a specialized laboratory in Germany was performed in DDPKH
Case 1: Clinical Presentation
Case 1: Histopathological Findings
Necrosis of epidermis
Dense infiltrate of lymphocytes involving dermis and subcutis
Case 1: Histopathological Findings
Small and medium-seized atypical lymphoid cells
Case 1: Histopathological Findings
Immuno-histopathology with - CD3- CD4- CD8 - CD56- cytotoxic marker-> negative
Case 1: Diagnosis
Extranodal NK/T-cell lymphoma
nasal type
Case 1: Comment
the disease affects people of Asian descent more frequently than whites
the mortality rate is higher compared with other subtypes of lymphoma found in the head and neck region
Overall median survival time is 12.5 months
Our patient died three months after diagnosis from respiratory obstruction
Case 2: History A 60 year old man presented with multiple
purple and skin-colored, infiltrated, ulcerated tumors on head, trunk and limbs
He had been treated for cutaneous tuberculosis for 6 months in Cambodia
He received therapy for deep mycosis for 4 months in Viet Nam
Case 2: Clinical Findings
Case 2: Clinical Findings
Case 2: Findings A biopsy was diagnosed as melanoma
metastasis in Cambodia
Additional staining by German pathologists was done as the diagnosis did not match the clinical picture
Diagnosis of malignant histiocytosis was confirmed
Case 2: Comment
Malignant histiocytosis is a malignant condition in which there is uncontrolled proliferation of histiocytes
Atypical histiocytes spread throughout the body; usually affecting liver, spleen, lymph nodes and bone marrow
Diagnosis can be made by blood tests, bone marrow aspirate and tissue biopsies
Case 2: TherapyMalignant histiocytosis responds in most
patients to chemo- or radiotherapy Malignant histiocytosis progresses very
quickly and treatment must be started as early as possible
Some people will not respond to treatment and some people will die before the condition can be diagnosed and treated.
Case 3: History
A young man presented with eczematous plaques on the left hip and on buttocks
He was treated to no avail for nearly two years for eczema and tinea
Case 3: Clinical Findings
Case 3: Clinical Findings
Case 3: Diagnosis and Therapy
Histopathology performed in Hamburg (Germany) confirmed mycosis fungoides
Mycosis fungoides is the most common type of cutaneous T-cell lymphoma
Treatment consisted of a topical betamethasone combined with exposure to ultraviolet light
Case 4: History A 45 year old woman presented with
multiple disseminated, skin-colored, ulcerated nodules and tumors which were growing rapidly
TB and HIV could not be confirmed
Her general status extremely reduced:35 kg BW, weakness, loss of appetite, general malaise
Case 4: Clinical Findings
Case 4: Clinical Findings
Case 4: Clinical Findings
Case 4: Clinical Findings
Case 4: Diagnosis and Comment
Immunohistology:Sézary syndrome
Sézary syndrome is a variant of mycosis fungoides, which occurs in about 5% of all cases of mycosis fungoides
Case 5: History and Findings 7 month old girl referred by Kantha-Bopha
Pediatric Hospital with a large, infiltrated hyperpigmented plaque on lower and middle part of trunk
Plaque was partly ulcerated and presented some central nodules
Patient had respiratory distress due to serious infiltration of the plaque
Case 5: Clinical Findings
Case 5: Diagnosis
Two diagnostic biopsies were taken from a nodule and from a plaque
Immunohistology Münster (Germany): malignant melanoma on giant congenital naevus
Tumor depth:- 2,6 mm (plaque)- 4,2 mm (nodular lesion)
Case 5: Therapy
Prednisolone 1mg/kg BW to improve infiltration
After one month, softening of plaques allowing the patient to breath normally
Surgeon in Kantha-Bopha Pediatric Hospital decided to refer her to oncology as the tumor was too extended for an excision
Case 6: History 33 year old woman, pregnancy month III
Weakness, accompanied by joint and muscle-pain for one month
For about 3 weeks development of multiple purpuric macules and ecchymotic patches on entire body
Gingivorrhagia, erosion and oedema of gums
Case 6: Clinical Findings
Case 6: Clinical Findings
Case 7: History 20 year old woman
Weakness, joint- and muscle-pain,severe head-ache
multiple purpuric macules and ecchymotic patches on body and oral mucosa
Gingivorrhagia, oedema of gums
Case 7: Clinical Findings
Case 7: Clinical Findings
Case 6 and 7:Diagnosis, Comment and TherapyScurvy
Scurvy arises from ascorbic acid (vitamin C) deficiency
Vitamin C plays a crucial role in the formation of collagen, a major component of connective tissue
Treatment: Vitamin C 500mg BIDNutritional education:Intake of fruit and vegetables containing Vitamin C (citrus fruit, kiwi, cabbage and liver)