Spontaneous vertebral aspergillosis, the state of art: a systematic literature review

Objective: Vertebral aspergillosis are quite rare conditions, often misdiagnosed, that requires long-term antibiotic therapy and, sometimes, surgical treatments. The present investigations was aimed to investigate epidemiology, clinical-radiological aspects, treatment protocols, and outcomes of Aspergillus-mediated vertebral osteomyelitis. Methods: A systematic review of the pertinent English Literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. The research was conducted on Cochrane library, MEDLINE, PubMed and Scopus using as search-terms “Aspergillus”, “vertebral osteomyelitis”, “spondylodiscitis”, “spine infection”. A case of vertebral apsergillosis conservatively managed was also reported. Results: Eighty-nine articles were included in our systematic review. Including the reported case, our analysis covered 112 cases of vertebral aspergillosis. Aspergillus fumigatus was isolated in 68 cases (61.2%), Aspergillus flavus in 14 (12.6%), Aspergillus terreus in 4 (3.6%), Aspergillus nidulans in 2 (1.8%). Seventy-three patients (65.7%) completely recovered at last follow-up evaluation; in 7 (6.3%) patients radiological signs of chronic infection were reported, whereas 32 (28.8%) patients died during the follow-up. Conclusion: This systematic review summarized the state of the art on vertebral aspergillosis, retrieving data on clinical features, diagnostic criteria and current limitations, treatment alternatives and their outcomes

A case report of eccrine porocarcinoma = Porocarcinoma eccrino: caso clinico

Il porocarcinoma eccrino (PCE) è un tumore cutaneo che si sviluppa dalle ghiandole sudoripare eccrine. Descritto per la prima volta da Pinkus e Mehregan nel 1963 come “ carcinoma epidermotropico eccrino” è di rado riportato in letteratura e rappresenta lo 0,005-0,010% di tutti i tumori cutanei. Gli AA descrivono il caso relativo ad una paziente di sesso femminile, razza caucasica, di 88 anni, che ha presentato sulla coscia sinistra una neoformazione nodulare polipoide, di colore rosso-brunastro, procidente sul piano cutaneo, a base irregolarmente circolare, di consistenza duro-fibrosa, asintomatica. Tale neoformazione sarebbe insorta 15 anni prima ,accrescendosi rapidamente negli ultimi mesi. Praticata l’asportazione chirurgica in anestesia locale, l’esame istologico ha permesso di inquadrare la neoformazione come “poroma eccrino maligno insorto su poroma”. Gli AA, dopo avere riferito sul quadro clinico-istologico e dopo breve disamina della letteratura corrente, ne discutono le possibili strategie terapeutiche.Eccrine porocarcinoma (EPC) is a rare malignant skin appendage tumour deriving from the intraepithelial ductal parts of the sweat glands. First described by Pinkus e Mehregan nel 1963 as an epidermotropic eccrine carcinoma, it is rarely reported in medical literature and represents 0.005-0.01% of all skin tumors. We report a case of a 88-year-old Caucasian female presented to our Clinic with an asymptomatic, red-brown , irregularly shaped firm nodule on the left thigh aroused 15 years earlier. The lesion has been excised and histopathological examination showed an "eccrine porocarcinoma aroused on eccrine poroma". Review of the literature on this rare condition and possible therapeutic strategies are also discussed