Artefaktni dermatitis: prikaz slučaja

Automutilating behavior is becoming ever more frequent in patients seeking dermatologic care. Psychocutaneous disorders encompass a wide range of dermatologic conditions, all of which have in common the important role of psychological factors. Dermatitis artefacta syndrome is characterized by unconscious self-injury behavior, while dermatitis para-artefacta syndrome is labeled with manipulation of an existing specific dermatosis. Consciously stimulated injuries with the purpose of obtaining material gain is known as malingering. Here we present a 20-year-old female patient with a sudden pain and an oval, yellowish skin defect on her left lower leg, 3x3.5 cm in diameter, with an erythematous, clearly defined border, surrounded by erythematous, painful skin resembling pyoderma gangrenosum. The patient had a clinically typical skin presentation but with atypical therapeutic outcome. The diagnosis of dermatitis artefacta was made. Liaison psychiatry can reaffirm the diagnosis of dermatitis artefacta and provide necessary psychopharmacotherapy and psychotherapy.Samoozljeđivajuće ponašanje postaje učestalije kod bolesnika koji traže dermatološku skrb. Psihokutani poremećaji obuhvaćaju širok raspon dermatoloških stanja kojima je zajednička važna uloga psiholoških čimbenika. Sindrom artefaktnog dermatitisa je obilježen nesvjesnim samoozljeđivanjem, dok sindrom paraartefaktnog dermatitisa označava manipulaciju određene postojeće dermatoze. Svjesno izazivanje ozljede u svrhu stjecanja materijalne koristi smatra se simuliranjem. Ovdje prikazujemo slučaj 20-godišnje bolesnice s iznenadnom boli i ovalnim, žućkastim defektom kože na lijevoj potkoljenici, 3x3,5 cm u promjeru, s eritematoznim, jasno ograničenim rubom, okruženim eritematoznom, bolnom kožom, što podsjeća na piodermu gangrenozum. Bolesnica je imala klinički tipičan prikaz kože, ali s atipičnim terapijskim ishodom. Postavljena je dijagnoza artefaktnog dermatitisa. Liason psihijatrija može potvrditi dijagnozu artefaktnog dermatitisa i omogućiti potrebnu psihofarmakološku terapiju i psihoterapiju

Melanoma – Clinical, Dermatoscopical, and Histopathological Morphological Characteristics

Melanoma is one of the most malignant skin tumours with the constant rise in its incidence worldwide, especially in white populations. Melanoma is usually diagnosed at the average age of 50 years. However, in the last decades, it is more frequently diagnosed in younger adults, and very rarely in children. There is no unique or specific clinical presentation of melanoma. Clinical presentation of melanoma varies depending on the anatomic localization and the type of growth, namely the histopathologic type. There are four major histopathologic types of melanoma – superficial spreading melanoma, nodular melanoma, lentigo maligna melanoma and acral lentiginous melanoma. Dermatoscopy is very useful tool in the early melanoma detection however, dermatoscopic features of melanoma are also variable. Therefore, experience and education in dermatoscopy is crucial in the evaluation of skin tumours. Differential diagnosis of melanoma includes a wide range of benign and malignant skin lesions due to its clinical presentation and resemblance with various dermatological entities. In this review, authors are presenting the most important aspects of clinical, dermatoscopical and histopathologic features of melanoma.</p

Ne-melanomski tumori i predtumorske promjene u periodu od 1996. - 2002. Godine

Non-melanoma skin cancers and precancerous skin lesions have a significant morbidity although with relatively low mortality rates in geriatric population. These lesions developed especially on every day sun exposed skin regions. The aim of this study was to determine the prevalence, age and sex distribution of non-melanoma skin cancers and precancerous skin lesions among biopsy specimens collected during seven years (1996-2002) in the University Department of Pathology "Ljudevit Jurak". Also is analyzed their relationship with sun exposure on different body regions. During observed period there were2486 basal cell carcinoma, 419 squamous cell carcinoma and 468 precancerous skin lesions. Basal cell carcinoma was more common in males then in females with ratio 1:0,9 as well as squamous cell carcinoma with male to female ratio 1:0,8. Precancerous skin lesions were more frequent in the female population with male to female ratio 1:1,3. Maximal incidence for booth types of non-melanoma tumours was between 7and 79 years in both sexes while precancerous skin lesions appeared one-decade earlier. Also is found that analyzed skin lesions appear in 60-70% on skin of the head, which is almost permanently sun exposed body region.Nemelanomski tumori kože i predtumorske kožne promjene imaju značajan pobol iako uz nisku smrtnost u pacijenata treće životne dobi. Ove promjene se posebno razvijaju na dijelovima kože koji su svakodnevno izloženi suncu. Cilj ovog rada je prikazati učestalost, razdiobu po spolu i dobi nemelanomskih kožnih tumora i predtumorskih kožnih promjena u bioptičkom materijalu sedmogodišnjeg razdoblja (1996-2002) na Zavodu za Patologiju "Ljudevit Jurak". Također je proučavan odnos kožnih promjena i izloženosti različitih dijelova tijela suncu. U proučavanom periodu bilo je 2486 karcinoma bazalnih stanica, 419 karcinoma pločastih stanica i 468 predtumorskih kožnih promjena. Karcinom bazalnih stanica češće je bio prisutan u muškaraca nego u žena s omjerom 1:0.9 kao i karcinom pločastih stanica s omjerom 1:0,8. Predtumorske kožne lezije bile su češće prisutne kod žena, omjer muškaraca prema ženama bio je 1:1,3. Najveća učestalost za oba nemelanomska kožna tumora bila je između 70 i 79godina starosti u oba spola dok se predtumorske promjene nalaze desetljeće ranije. Proučavane kožne promjene u 60-70% nađene su na koži glave koja je skoro stalno suncu izloženo područje tijela

Pregled novopredložene molekularne klasifikacije karcinoma mokraćnog mjehura: nova era - nova taksonomija

The management of bladder cancer patients largely depends on pathologic staging and grading, and current morphological classification does not always show the individual patient’s risk. Despite modern surgical techniques, pre- and postoperative therapies, clinical outcomes of these patients have not changed over decades. Today, there are new biomarkers for bladder cancer showing changes in tumor biology and progression, as a result of changes in the pathways affecting cell signaling, proliferation, apoptosis, epigenetic changes, angiogenesis, and modulation of host immune response. Assessment of multiple biomarkers associated with those pathways offers new understanding of tumor behavior while identifying important panels of predicting patient management and outcomes. In this review, the most important molecules and basics of the novel molecular classification of bladder cancer are presented.Liječenje karcinoma mokraćnog mjehura uvelike ovisi o patohistološkom tipu, gradusu i stadiju tumora, a današnja morfološka klasifikacija ne može u potpunosti odrediti individualne potrebe i procjenu rizika za pojedinačne bolesnike. Unatoč modernim kirurškim tehnikama i novijim terapijskim mogućnostima klinički ishod bolesnika s tumorom mokraćnog mjehura u posljednjih nekoliko desetljeća nije se promijenio. Danas su poznati brojni biološki biljezi koji se odnose na karcinom mokraćnog mjehura, a pokazuju promjene u biologiji i progresiji tumora te su rezultat različitih promjena u signalnim putovima stanice, proliferaciji, apoptozi, epigenetskim promjenama, angiogenezi ili modulaciji imunog odgovora domaćina. Procjena više bioloških biljega povezanih s navedenim putovima omogućuje prikaz ponašanja tumora, jer identificira važne panele predviđanja terapije i ishoda. U ovom prikazu stavlja se naglasak na najvažnije molekule koje čine osnovu novopredložene molekularne klasifikacije karcinoma mokraćnog mjehura

Gigantski liposarkom mezenterija miješanog tipa

Primary mesenteric liposarcomas are very rare, especially when they are of mixed histologic pattern. Patient prognosis is based upon the most aggressive histologic type of liposarcoma. A case is reported of a 77-year-old man with a history of slowly increasing abdominal volume over 3 years. The diagnosis of giant intra-abdominal mass suspect of liposarcoma was confirmed by computed tomography and ultrasound scans. The patient underwent resection of 24 tumor masses weighing together 23.5 kg. The microscopic diagnosis was mixed-type liposarcoma of the mesentery. Although this type of tumor is rare, tumor tissue should be thoroughly collected and analyzed on histologic examination to reach definitive diagnosis. Recognition of the underappreciated subtype of liposarcoma is important for proper prognosis and treatment of the patient. According to our knowledge, this is the largest size of mixed-type mesenteric liposarcoma described in the English literature.Primarni liposarkomi mezenterija su rijetki, osobito ako su miješanog histološkog izgleda. Prognoza pacijenta ovisi o najagresivnijem histološkom tipu liposarkoma. Prikazujemo slučaj 77. godišnjeg muškarca s anamnezom spororastućeg volumena abdomena tijekom 3 godine. Dijagnoza ogromne intra-abdominalne mase suspektne na liposarkom potvrđena je CT-om i ultrazvukom. Pacijentu su resecirane 24 tumorske mase koje su zajedno težile 23.5 kg. Histološka dijagnoza je bila miješani tip liposarkoma mezenterija. Iako je ovaj tip tumora rijedak, tumorsko tkivo treba pomno preuzeti i pregledati histološki kako bi se postavila ispravna zaključna dijagnoza. Pronalazak nepovoljnog tipa liposarkoma je važan zbog točne prognoze i daljnjeg liječenja pacijenta. Prema našim saznanjima, ovo je najveći opisani liposarkom mezenterija miješanog tipa u engleskoj literaturi