Korelacija histoloških i imunohistoloških svojstava T-staničnoga limfoma kože (Mycosis fungoides) s kliničkom slikom, stadijem i ishodom bolesti u desetogodišnjem razdoblju [Correlation of histological and immunohistochemical properties of T-cell skin lymphoma (mycosis fungoides) with the clinical picture, stage and patient outcome in ten-year period]

The aim of this study was to identify predictors of disease progression and death in patients with early stage mycosis fungoides (MF). Eighty-three patients diagnosed with early-stage MF at the Departments of Dermatovenerology and Pathology, UHC Zagreb between 01/2003 and 12/2012 were included in this retrospective-prospective study. Following parameters were analyzed: clinical picture, response to therapy, disease progression, lichenoid dermal lymphocyte infiltrate, „guardian“ lymphocytes, atypical lymphocytes and loss of surface CD2, CD3, CD5 and/or CD7 markers on T lymphocytes. Patients with initial stage IIA had inferior overall and progression-free survival than those with initial stage IB and IA. Patients with plaques also had inferior survivial than those with patches. Worse overall and progression-free survival was noted in patients with a premycotic stage lasting 48 months or less in comparison to those lasting more than 48 months. The same was seen in patients with more than 30 „guardian“ lymphocytes/100 keratinocytes (compared to those with 30 and less). Patients with more than 50% atypical lymphocytes had a faster progression rate than those with 50% or fewer atypical lymphocytes. Patients with loss of CD7 have faster progression than those without it. Initial disease stage IIA, presence of plaques in the initial clinical presentation, skin lesion encompassing >10% of total body surface, enlarged lymph nodes, disease progression, disease without response to therapy, dense lichenoid dermal infiltrate of lymphocytes and >30 „guardian“ lymphocytes/100 keratinocytes increase the risk for mortality within five years of diagnosis. Response to therapy statistically significantly affects the progression of the disease in the first five years after the diagnosis. Disease unresponsive to therapy increases the risk of progression within five years of diagnosis, while a complete response reduces this risk. This study identified potential new prognostic factors for early stage MF. Larger studies are needed to confirm these results that could improve our ability to identify patients with increased risk of disease progression and poor prognosis

Ten-Year Study on the Correlation of Clinical and Patohistological Diagnosis of Dysplastic Nevi

The aim of the study was to analyze the clinical prevalence and pathohistological correlation of dysplastic nevi. In the period between 2000 and 2009, in the Outpatient Clinic of Referral Centre for Melanoma of the Ministry of Health and SocialWelfare of the Republic of Croatia, 12,344 patients were examined, and 35.07% of them were surgically removed in the same institution. Among the patients, 69.16% had clinically diagnosed melanocytic tumor. Out of them, 28.39% were dysplastic. Dysplastic nevus was pathohistologically diagnosed in 20.02% of pathohistologically diagnosed melanocytic tumors. There was women predominace among patients with clinically diagnosed dysplastic nevi (65.22%). The most frequent localization was the trunk in both sexes, women 78.18%, men 76.75%. The coincidence of clinical and pathohistological diagnosis of dysplastic nevus was 30.70%. The results of this study, based on a large number of patients could be a significant contribution in understanding characteristics of dysplastic nevus, its clinical and pathohistological complexity. We hope that the data will contribute to the creation of general accepted protocols in the diagnostics of dysplastic nevus

Kardiovaskularni rizik kod žena s preeklampsijom

In this study, possible biochemical and functional cardiovascular markers were assessed in women with preeclampsia. Fifty-five pregnant women with manifest moderate (mild) preeclampsia (PE) and fifty healthy women as a control group were included in this prospective study. Laboratory tests including lipid panel, C-reactive protein (CRP), and homocysteine levels as biohumoral markers of atherogenesis, as well as ergometry and the main cardiovascular risk factor markers were performed in all women during pregnancy and six months after delivery. In our study, cholesterol and LDL levels in the PE group did not differ from those in the control group. Triglyceride levels in the PE group were higher than the corresponding values found in normal pregnancies, while HDL levels were significantly lower in the PE group than in the normal pregnancy group (p<0.001). The values of total cholesterol, LDL, HDL, and triglycerides in the PE group were higher compared to those in the same group six months after delivery (p<0.001). The effect of PE as an inflammatory disease could be confirmed to a certain extent by elevated CRP levels (p<0.001). A very high percentage of negative exercise stress tests indicated a good cardiovascular response to the current PE in the otherwise healthy pregestational women. It could be concluded that the development of possible cardiovascular comorbidities in preeclamptic pregnant women is a long process, but also due to etiologic factors of coexistent metabolic disorders such as dyslipidemia, as well as elevated inflammatory markers and homocysteine, PE can be considered even an early predictor of cardiovascular disease.U ovom članku prikazani su mogući biokemijski i funkcionalni kardiovaskularni pokazatelji kod žena s preeklampsijom. U ovu prospektivnu studiju uključeno je pedeset i pet trudnica s umjerenom (blagom) preeklampsijom (PE) te pedeset zdravih žena u kontrolnoj skupini inicijalno tijekom trudnoće te šest mjeseci nakon porođaja. Laboratorijska analiza je uključivala određivanje lipidograma, C-reaktivnog proteina (CRP) i razine homocisteina kao biohumoralnog pokazatelja aterogeneze, kao i test opterećenja na pokretnom sagu uz izdvajanje osnovnih poznatih kardiovaskularnih čimbenika rizika. U našoj studiji razina ukupnog kolesterola i LDL kolesterola u skupini s PE nije se razlikovala od onih u kontrolnoj skupini. Razine triglicerida u skupini s PE bile su više od odgovarajućih vrijednosti u normalnim trudnoćama, dok su razine HDL u skupini s PE bile značajno niže nego u kontrolnoj skupini (p<0,001). Vrijednosti ukupnog kolesterola, LDL-a, HDL-a i triglicerida u skupini s PE bile su značajno više u trudnoći u usporedbi s onima u istoj skupini šest mjeseci nakon porođaja (p<0,001). Učinak PE kao upalne bolesti može se u određenoj mjeri potvrditi povišenim razinama CRP-a (p<0,001). Vrlo visok postotak negativnih testova na testu opterećenja pokazao je dobru kardiovaskularnu funkcionalnu sposobnost naspram PE u inače pregestacijski zdravih žena. Može se zaključiti da je razvoj mogućih kardiovaskularnih supostojećih bolesti kod trudnica s PE dug proces, ali svakako zbog etiologije metaboličkih poremećaja kao što je dislipidemija, kao i povišenih upalnih pokazatelja i homocisteina, ujedno i rani prediktor kardiovaskularnih bolesti

Hyperpigmented mycosis fungoides – a rare entity

No abstract availabl

Nodular Prurigo Associated with Mycosis Fungoides - Case Report

Mycosis fungoides (MF) is the most common type of cutaneous lymphoma and accounts for approximately 50% of all lymphomas arising primarily in the skin. The three types of MF lesions are patches, plaques, and tumors, according to which the disease is traditionally divided into three clinical stages. The clinical course can be protracted and take years or decades. In the final stage, MF evolves to a systemic form of the disease. Nodular prurigo (NP) is still a condition of unknown etiology characterized by papulonodular eruption and intense pruritus. Multiple diseases, including dermatological, systemic, and psychiatric diseases, have been assumed to cause NP. Pruritic skin lesions have been known to precede clinically evident B and T cell lymphomas for years. In the literature, pruritus and NP have been reported in patients affected by systemic Hodgkin and non-Hodgkin lymphomas. Only two cases of cutaneous lymphoma as underlying disease in patients with PN have been reported in the literature. We report a rare case of a patient with concomitant non-Hodgkin skin lymphoma – MF and NP. Our female patient with a 10-year history of MF stage IIb during the last three years had been presenting for regular check-up with itchy, newly formed, rarely disseminated nodules 5-8 mm in diameter on the forearms and lower legs. Sharply limited erythematosquamous, slightly infiltrated foci (as part of MF as the underlying disease) were visible on the trunk and extremities. Extracutaneous involvement of MF was excluded. We performed a biopsy on a nodule from the lower leg to rule out tumor stage MF; the biopsy confirmed NP. We conclude that prurigo nodules should not be confused with tumor stage MF. NP is a therapeutic challenge for any dermatologist. Any underlying diseases should be treated first.</p

Poikilodermatous mycosis fungoides – rare entity, different treatment modalities

Poikilodermatous mycosis fungoides (PMF) is a rare clinical variant of early-stage MF with peculiar histological features. Poikiloderma occurs in many different clinical conditions, which makes a diagnostic procedure more complicated. PMF belongs to a group of MF variants with low risk of disease progression. We report a case of a 64-year-old woman, who presented with mottled skin aspect of erythema, poikilodermatous patches (hypopigmentation, hyperpigmentation, atrophy, and telangiectasia) on more than 80% of the body. Based on clinical, histopathological, and immunohistochemical findings, we established the diagnosis of PMF. Staging procedure determined stage IIA. As skin-directed therapy was the treatment of choice, the patient was successfully treated with psoralen-UVA (PUVA), nbUVB plus retinoid (Re-nbUVB), and PUVA plus retinoid (Re-PUVA), however, with rapid recurrence. </p

Poikilodermatous mycosis fungoides – rare entity, different treatment modalities

Poikilodermatous mycosis fungoides (PMF) is a rare clinical variant of early-stage MF with peculiar histological features. Poikiloderma occurs in many different clinical conditions, which makes a diagnostic procedure more complicated. PMF belongs to a group of MF variants with low risk of disease progression. We report a case of a 64-year-old woman, who presented with mottled skin aspect of erythema, poikilodermatous patches (hypopigmentation, hyperpigmentation, atrophy, and telangiectasia) on more than 80% of the body. Based on clinical, histopathological, and immunohistochemical findings, we established the diagnosis of PMF. Staging procedure determined stage IIA. As skin-directed therapy was the treatment of choice, the patient was successfully treated with psoralen-UVA (PUVA), nbUVB plus retinoid (Re-nbUVB), and PUVA plus retinoid (Re-PUVA), however, with rapid recurrence. </p