No abstract

Erythema annulare centrifugum is a figurate erythema of unknown etiology. It has been associated with many different entities, including infections, food allergy, drug reactions and malignant neoplasms. Herein, we report a case of erythema annulare centrifugum as presenting sign of activation of breastcancer.

ÖZETHipofarenks ve özofagusun fibrovasküler polipleri, nadir görülen benign, intraluminal ve submukozal tümörlerdir. En sık proksimal özofagusda görülmektedir. Hasta, solunum ve yutma güçlüğü, boğazda takılma ve kitle hissi ile tarafımıza başvurdu. Endoskopik tanı sonrasında, transvers özofagotomi ile polip eksizyonu yapıldı. Damarsal yapılardan zengin olması nedeniyle, endoskopik polipektomi güç olabilir. Bu tür olgularda cerrahi eksizyon planlanmalıdır. Biz solunum sıkıntısı, asfiksi ve tanısal problemlere neden olabilmesi nedeniyle fibrovasküler polipli bir olguyu tartışmayı amaçladık. (JAREM 2013; 3: 126-8) Anahtar Sözcükler: Fibrovasküler polip, transvers özofagotomi, asfiksi ABSTRACT Fibrovascular polyps of the esophagus and hypopharynx are rare, benign intraluminal and submucosal tumors. They arise most commonly in the upper esophagus. The patient presented to us with dyspnea, difficulty in swallowing and a feeling of mass. Polyp excision was made with tranverse esophagotomy after the endoscopic diagnosis. Endoscopic polypectomy may be difficult due to the rich vascular structure. Therefore surgical excision should be made in such patients. We aim to discuss a case with fibrovascular polyp, for it can cause asphyxia, respiratory distress and diagnostic problems. (JAREM 2013; 3: 126-8) GİRİŞHipofarinks ve yemek borusunun fibrovasküler polipleri, nadir görülen intraluminal, submukozal yerleşimli benign tümörlerdir. Genellikle proksimal özofagusta ve krikofarengeal kas yakınında ortaya çıkar (1-3). En sık karşılaşılan yakınmalar, ilerleyen solunum ve yutma güçlükleri ve boğazda yabancı cisim hissinin varlığıdır. İlerleyici solunum sıkıntısı en ciddi yakınma olup, polibin solunum yolunu tıkaması asfiksiye yol açabilir. Bu olgu çok nadir görülmesi ve yaşamsal risk taşıması nedeniyle tartışmaya sunulmuştur. OLGU SUNUMUKırk beş yaşında kadın hasta, son 6 aydır giderek artan boğazda takılma hissi, özellikle katı gıdalara karşı yutma güçlüğü ve solunum zorluğu şikâyetleri ile tarafımıza başvurmuş ve son 3 ay içeri-sinde solunum sıkıntısının giderek arttığını ifade etmiştir. Yapılan özofagoskopide üst özofagus başlangıcında, sol postero-lateral duvarda, yüzeyi düzgün, 4 cm çapında büyük bir polip tespit edilmiş ve kitlenin yutkunmakla supraglottik bölgeyi işgal ettiği (asfiksi tehlikesi) anlaşılmıştır (Resim 1).Kitle çapının büyük ve görünümünün vasküler yoğunluklu olması nedeniyle cerrahi eksizyona karar verilmiş, sol transvers servikal insizyonu takiben kitle üzerine yapılan özofagotomi sonrasında, krikofarengeal kasın hemen altındaki polip eksize edilmiştir (Resim 2).Ameliyat sonrasındaki takipleri sorunsuz seyreden hasta, normal beslenmeyi takiben 7. günde evine gönderilmiştir.Histopatolojisinde, fibröz stromalı, bazıları dilate ve konjesyone olmak üzere çok sayıda vasküler yapıdan oluşan, çevresinde mükoz bezler barındıran, prolifere polipoid kitle belirlenmiştir. İnflamasyon, displazi veya malignite bulgusu saptanmayan kitle, fibrovasküler polip olarak adlandırılmıştır (Resim 3).Eylül 2012'de yapılan ...

No abstract

Letter to the Editor Sir,Acitretin is a systemic retinoid drug used in the treatment of severe psoriasis and various other skin disorders, such as lichen planus, ichthyosis, lupus erythematosus. The mechanism of action of acitretin is still incompletely understood although, like retinoic acid, it is thought to interfere with the terminal differentiation of keratinocytes. The most frequent adverse reactions associated with this drug are the mucocutaneous effects on the lips, eyes, mouth, and other epidermal surfaces [1]. Herein, we present a case of a 54-year old man who developed rectal bleeding and detection of early stage colon carcinoma during the treatment with systemic acitretin for psoriasis vulgaris. A 54-year old man with 15-year history of psoriasis vulgaris, resistant to several topical agents, was presented to our out-patient clinic. He had generalised erythematous plaques. His only other medical problem was diabetes mellitus. Routine laboratory tests were normal. Therapy with oral acitretin (25 mg/day) was initiated. A month after starting the acitretin treatment, he developed symptoms of rectal bleeding which was intensified by defecation. He also complained of cheilitis, xerosis, and eye dryness. The patient was referred to department of general surgery. Abdominal examination was unremarkable. Pelvic ultrasonography did not revealed any abnormalities. Stool examination for occult blood was negative, and tumor markers (CEA, CA19.9) were normal. The colonoscopy was performed and this revealed a flat polyp measuring 2,5×1,7x1,5 cm located in the sigmoid colon. Snear polypectomy was performed. A histological evaluation revealed a well differentiated adenocarcinoma penetrating the submucosa. Histologically, the tumor was composed of neoplastic cells that had invaded the lamina propria without venous or perineural invasion. Abdominal computed tomography (CT) and CT scanning with positron-emission tomography (PET-CT) showed no evidence of primary lesions or distant metastasis. Based on clinical and histopathological features, a diagnosis of early stage colon carcinoma was made. We suspected that the acitretin was causing the complaints and recommended discontinuation of the drug. Once this occurred, the problems subsided gradually over the next two weeks. Acitretin is a retinoid drug used for systemic treatment of severe cases of psoriasis and keratinization disorders. The most common side-effects of acitretin are dry lips and cheilitis, occuring in up to 75-100 % of patients. Other mucocutaneous effects include conjunctivitis, dry nose, epistaxis and sticky skin [1,2]. Rectal bleeding are not commonly documented side effects in dermatological practice. Previously, Erpolat et al. reported a case who developed anal fissures, rectal bleeding soon after receiving systemic retinoid therapy [3]. But detection of occult malignancy after the use of acitretin has never been documented. Interestingly, our patient had a malignancy but he was not aware of this condition. Because the tumor was very small and did not ...