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e identificados a partir del registro iconogr&#225;fico del Servicio de Dermatolog&#237;a del Hospital Universitario de Bellvitge &#40;Barcelona&#41;&#46; Se trata de un hospital universitario que proporciona asistencia terciaria a una poblaci&#243;n de aproximadamente 1<span class="elsevierStyleHsp" style=""></span>mill&#243;n de personas&#46; Se recogieron datos demogr&#225;ficos &#40;edad&#44; sexo&#44; neoplasia de base&#44; inmunoterapia recibida&#44; antecedentes de enfermedades autoinmunes&#41;&#44; cl&#237;nicos &#40;tipo de lesiones cut&#225;neas y localizaci&#243;n&#44; afectaci&#243;n extracut&#225;nea&#44; gravedad del cuadro y necesidad de tratamiento espec&#237;fico y&#47;o de suspensi&#243;n del ICI&#41;&#44; anal&#237;ticos &#40;funci&#243;n renal y valores de enzima convertidora de angiotensina&#44; calcemia y enzimas hep&#225;ticas&#41; e histol&#243;gicos &#40;tipo y localizaci&#243;n de los granulomas&#44; presencia de cuerpos extra&#241;os&#44; de corona de linfocitos&#44; de necrosis o de fibrosis&#44; cambios epid&#233;rmicos&#41;&#44; y se llev&#243; a cabo un estudio descriptivo&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Resultados</span><p id="par0020" class="elsevierStylePara elsevierViewall">Se identificaron 7 pacientes &#40;6 mujeres y 1 var&#243;n&#41;&#44; con una edad mediana de 65<span class="elsevierStyleHsp" style=""></span>a&#241;os &#40;rango&#58; 44-74&#41;&#46; Ninguno ten&#237;a antecedentes de enfermedades autoinmunes antes de iniciar la inmunoterapia&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Seis pacientes recibieron inmunoterapia en monoterapia &#40;3 un f&#225;rmaco anti-PD1&#44; y otros 3&#44; uno anti-PDL1&#41; y uno recibi&#243; la combinaci&#243;n de un anti-PDL1 con un anti-CTLA-4&#46; Entre las neoplasias de base la m&#225;s frecuente fue el melanoma &#40;3<span class="elsevierStyleHsp" style=""></span>pacientes&#41;&#44; seguida del carcinoma de endometrio &#40;2&#41;&#44; de tiroides &#40;1&#41; y de pulm&#243;n &#40;1&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">La mediana de tiempo desde el inicio del tratamiento hasta el diagn&#243;stico de la sarcoidosis fue de 4<span class="elsevierStyleHsp" style=""></span>meses &#40;rango&#58; 2-9&#41; y la forma de presentaci&#243;n cut&#225;nea m&#225;s frecuente fue la sarcoidosis papulosa de las rodillas&#44; que estuvo presente en 5 de los 7 pacientes&#46; Tres pacientes presentaron n&#243;dulos subcut&#225;neos&#44; uno placas infiltradas en la frente y en la zona alta de la espalda y&#44; por &#250;ltimo&#44; una paciente present&#243; infiltraci&#243;n por granulomas de xantelasmas preexistentes &#40;caso publicado en la literatura&#41;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A nivel extracut&#225;neo&#44; los &#243;rganos m&#225;s afectados por orden de frecuencia fueron los ganglios hiliares y mediast&#237;nicos &#40;4<span class="elsevierStyleHsp" style=""></span>pacientes&#41;&#44; el pulm&#243;n &#40;3<span class="elsevierStyleHsp" style=""></span>pacientes&#44; en forma de m&#250;ltiples n&#243;dulos pulmonares de peque&#241;o tama&#241;o&#41;&#44; las articulaciones<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a>&#44; y un paciente tuvo una nefritis t&#250;bulo-intersticial granulomatosa aguda&#46; Ning&#250;n paciente present&#243; afectaci&#243;n ocular&#44; card&#237;aca&#44; hep&#225;tica o del sistema nervioso central&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">En todos los pacientes se realiz&#243; una biopsia cut&#225;nea para confirmar histol&#243;gicamente el diagn&#243;stico&#44; as&#237; como biopsias de los dem&#225;s &#243;rganos afectados&#46; En todos los pacientes se descart&#243; progresi&#243;n de su neoplasia&#44; as&#237; como infecci&#243;n por hongos y micobacterias&#44; a trav&#233;s de tinciones y de cultivos de los tejidos&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se revisaron las biopsias cut&#225;neas de todos los pacientes&#44; observando granulomas formados por agregados de histiocitos epitelioides con escaso componente linfoc&#237;tico&#46; En los pacientes con sarcoidosis papulosa de las rodillas los granulomas estaban localizados predominantemente en la dermis superficial y era frecuente observar la presencia de cuerpos extra&#241;os &#40;se hallaron en 3 de los 4<span class="elsevierStyleHsp" style=""></span>pacientes biopsiados&#41;&#46; En cambio&#44; en los pacientes con sarcoidosis subcut&#225;nea los granulomas estaban pr&#225;cticamente limitados al tejido celular subcut&#225;neo&#44; rodeados de una mayor cantidad de linfocitos&#44; y se observaba presencia de fibrosis en 2 de los 3<span class="elsevierStyleHsp" style=""></span>pacientes &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> y <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Desde un punto de vista histol&#243;gico no se observaron diferencias respecto a la sarcoidosis idiop&#225;tica&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Las pruebas de laboratorio mostraron una elevaci&#243;n de enzima convertidora de angiotensina en 3<span class="elsevierStyleHsp" style=""></span>pacientes&#59; no se objetiv&#243; hipercalcemia ni elevaci&#243;n de enzimas hep&#225;ticas en ning&#250;n paciente&#46; En los pacientes con afectaci&#243;n pulmonar o adenop&#225;tica se llevaron a cabo pruebas funcionales respiratorias&#44; y en la mitad de ellos se observ&#243; una disminuci&#243;n de la capacidad de difusi&#243;n del mon&#243;xido de carbono&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">La mayor&#237;a de pacientes presentaron un cuadro leve y autolimitado&#44; sin necesidad de tratamiento espec&#237;fico ni de suspensi&#243;n del ICI&#44; excepto dos pacientes&#44; que tuvieron un curso cl&#237;nico m&#225;s agresivo&#44; con afectaci&#243;n renal y pulmonar&#44; que requiri&#243; suspender la inmunoterapia e iniciar corticoides sist&#233;micos a dosis entre 0&#44;5 y 1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#237;a&#44; seguido de mantenimiento con hidroxicloroquina&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">En cuanto a la neoplasia de base&#44; 4<span class="elsevierStyleHsp" style=""></span>pacientes consiguieron una remisi&#243;n completa o parcial&#44; 2<span class="elsevierStyleHsp" style=""></span>pacientes fallecieron por progresi&#243;n de la neoplasia y uno de ellos mantuvo la enfermedad estable&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discusi&#243;n</span><p id="par0065" class="elsevierStylePara elsevierViewall">La sarcoidosis asociada a la inmunoterapia con ICI aparece en alrededor del 5&#37; de los pacientes hacia los 5<span class="elsevierStyleHsp" style=""></span>meses de tratamiento<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">3&#44;4</span></a> y es m&#225;s frecuente en los pacientes en tratamiento con anti-CTLA-4&#44; y especialmente en los que llevan doble inmunoterapia&#44; en los que adem&#225;s puede ser m&#225;s precoz y m&#225;s grave<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">4-7</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">A la hora de establecer el diagn&#243;stico es fundamental la confirmaci&#243;n histol&#243;gica para poder diferenciarlo de una progresi&#243;n tumoral&#44; especialmente en los casos con lesiones pulmonares y mediast&#237;nicas&#44; que pueden ser indistinguibles en las pruebas de imagen&#44; incluso en la PET-TC<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a>&#46; El dermat&#243;logo tiene un papel importante&#44; pues uno de cada cinco pacientes tiene afectaci&#243;n cut&#225;nea y la piel es un &#243;rgano accesible para la biopsia<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a>&#46; El diagn&#243;stico correcto va a determinar la actitud sobre el tratamiento oncol&#243;gico&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">La mayor&#237;a de reacciones sarcoideas por ICI son leves y autolimitadas&#44; como en nuestros pacientes&#44; por lo que cada vez se tiende a ser menos agresivo y a limitar el tratamiento a pacientes muy sintom&#225;ticos o con afectaci&#243;n card&#237;aca&#44; renal&#44; neurol&#243;gica u ocular<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">4&#44;9</span></a>&#46; En estos casos se administran tandas de corticoides sist&#233;micos e hidroxicloroquina&#44; y raramente se requieren inmunosupresores<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a>&#46; Las manifestaciones cut&#225;neas pueden tratarse con corticoides t&#243;picos&#44; aunque es frecuente que se resuelvan espont&#225;neamente<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">3&#44;6</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Seg&#250;n la literatura&#44; en m&#225;s de la mitad de los casos se suspende la inmunoterapia al diagnosticar las reacciones sarcoideas con el objetivo de eliminar el desencadenante<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a>&#46; Sin embargo&#44; cada vez tenemos mayor evidencia de que estas reacciones tienen un curso benigno y de que&#44; en los casos leves&#44; mantener la inmunoterapia no comporta un empeoramiento<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a>&#46; Por todo esto&#44; ligado a la importancia que tiene el tratamiento de la neoplasia en la supervivencia del paciente&#44; se cree que&#44; excepto en los casos graves&#44; debe priorizarse el mantenimiento del ICI<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">7&#44;9&#44;10</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Estudios recientes sugieren que los pacientes en tratamiento con ICI que desarrollan reacciones sarcoideas tienen un pron&#243;stico favorable en lo que refiere a su neoplasia de base<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">2&#44;7&#44;11-13</span></a> y una mayor supervivencia respecto a los grupos control&#44; incluso ajustando la supervivencia por otras variables como la edad&#44; el tipo de tratamiento&#44; las l&#237;neas de tratamiento recibidas y el tumor de base<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Como limitaciones de este trabajo hay que destacar que se trata de un estudio unic&#233;ntrico&#44; retrospectivo y con un n&#250;mero reducido de pacientes&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">En resumen&#44; las reacciones sarcoideas cut&#225;neas relacionadas con la inmunoterapia remedan cl&#237;nica e histol&#243;gicamente las diferentes formas de sarcoidosis cut&#225;nea&#46; Suelen tener un curso leve y autolimitado&#44; y su aparici&#243;n se ha asociado a una mayor supervivencia de los pacientes&#44; por lo que&#44; siempre que sea posible&#44; debe priorizarse el mantenimiento de la inmunoterapia&#46; Aunque los hallazgos cl&#237;nicos&#44; anal&#237;ticos y radiol&#243;gicos sean sugestivos de reacci&#243;n sarcoidea&#44; se recomienda obtener una confirmaci&#243;n histol&#243;gica&#44; pues el principal diagn&#243;stico diferencial es la progresi&#243;n tumoral&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Financiaci&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">No se ha dispuesto de ninguna ayuda financiera para la realizaci&#243;n de este manuscrito&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflicto de intereses</span><p id="par0110" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Introducci&#243;n"
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        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Material y m&#233;todos"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Resultados"
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        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discusi&#243;n"
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        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conflicto de intereses"
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        10 => array:1 [
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    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2022-11-14"
    "fechaAceptado" => "2023-03-01"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1764133"
          "palabras" => array:4 [
            0 => "Sarcoidosis"
            1 => "Granulomas"
            2 => "Inhibidores de puntos de control inmunitario"
            3 => "Inmunoterapia"
          ]
        ]
      ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1764134"
          "palabras" => array:4 [
            0 => "Sarcoidosis"
            1 => "Granulomas"
            2 => "Immune checkpoint inhibitors"
            3 => "Immunotherapy"
          ]
        ]
      ]
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    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Los inhibidores de puntos de control inmunitario &#40;ICI&#41; pueden producir toxicidades cut&#225;neas inmunomediadas entre las que se encuentran las reacciones sarcoideas&#46; Nuestro objetivo fue analizar retrospectivamente los datos cl&#237;nicos e histol&#243;gicos de los pacientes en tratamiento con ICI que desarrollaron reacciones sarcoideas cut&#225;neas entre 2019 y 2022&#46; Se incluyeron siete pacientes &#40;seis mujeres y un var&#243;n&#44; con una edad mediana de 65<span class="elsevierStyleHsp" style=""></span>a&#241;os&#41;&#46; La mediana de tiempo de instauraci&#243;n de la cl&#237;nica fue de 4<span class="elsevierStyleHsp" style=""></span>meses y la forma de presentaci&#243;n m&#225;s frecuente fue la sarcoidosis papulosa de las rodillas&#44; seguida de la sarcoidosis subcut&#225;nea&#46; En todos se confirm&#243; el diagn&#243;stico histol&#243;gicamente y no se observaron diferencias respecto a la sarcoidosis idiop&#225;tica&#46; Solo en dos casos fue preciso retirar la inmunoterapia&#46; Las reacciones sarcoideas por ICI suelen ser leves y no suelen requerir la interrupci&#243;n del tratamiento&#46; Es fundamental obtener una confirmaci&#243;n histol&#243;gica para distinguirlas de la progresi&#243;n tumoral&#46;</p></span>"
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      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Immune checkpoint inhibitors &#40;ICIs&#41; can cause immune-mediated cutaneous adverse events&#44; including sarcoid-like reactions&#46; The aim of this study was to retrospectively analyze clinical and histologic data from patients who developed cutaneous sarcoid-like reactions between 2019 and 2022 while under treatment with ICIs&#46; We studied 7 patients &#40;6 women and 1 man&#41; with a median age of 65<span class="elsevierStyleHsp" style=""></span>years&#46; Median time to onset of symptoms was 4<span class="elsevierStyleHsp" style=""></span>months&#46; The most common presentation was papular sarcoidosis of the knees followed by subcutaneous sarcoidosis&#46; Diagnosis was confirmed histologically in all cases&#44; and no differences were observed relative to idiopathic sarcoidosis&#46; Discontinuation of ICI therapy was required in just two patients&#46; ICI-induced sarcoid-like reactions tend to be mild and generally do not require treatment discontinuation&#46; Histologic confirmation is essential for distinguishing these reactions from tumor progression&#46;</p></span>"
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        "etiqueta" => "Figura 1"
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          "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Aspecto cl&#237;nico e histol&#243;gico de las reacciones sarcoideas relacionadas con ICI&#46; a-c&#41; Sarcoidosis papulosa de las rodillas&#46; Los granulomas est&#225;n localizados predominantemente en la dermis superficial y es frecuente observar la presencia de cuerpos extra&#241;os&#46; d-f&#41; Sarcoidosis subcut&#225;nea&#46; Los granulomas est&#225;n pr&#225;cticamente limitados al tejido celular subcut&#225;neo&#44; rodeados de una mayor cantidad de linfocitos e importante fibrosis&#46;</p>"
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          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">&#43;&#58; escasa cantidad&#46; &#43;&#43;&#58; moderada cantidad&#46; &#8722;&#58; ausencia&#59; retic&#58; reticular&#59; sup&#58; superficial&#46;</p>"
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Localizaci&#243;n biopsia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tipo granuloma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Localizaci&#243;n granulomas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Cuerpo extra&#241;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Corona linfocitos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Necrosis central&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Epidermis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dermatitis interfase&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Eosin&#243;filos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fibrosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Antebrazo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Sarcoideo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Subcut&#225;neos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rodilla&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sarcoideo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dermis sup&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Espalda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sarcoideo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dermis sup&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Antebrazo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sarcoideo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Subcut&#225;neos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rodilla&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sarcoideo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dermis sup&#43;retic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rodilla&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sarcoideo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dermis sup&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hiperqueratosis focal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dedo mano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sarcoideo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Subcut&#225;neos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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          "es" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Informaci&#243;n histol&#243;gica recogida de las biopsias cut&#225;neas de los 7 pacientes estudiados</p>"
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Comunicación breve
Reacciones sarcoideas relacionadas con inhibidores de puntos de control inmunitario
Sarcoid-like Reactions to Immune Checkpoint Inhibitors
C. Torrecilla-Vall-Llosseraa,
Corresponding author
ctorrecillav@bellvitgehospital.cat

Autor para correspondencia.
, A. Jucglà Serraa, J. Molinero Caturlaa, C. Moreno-Vílcheza, R.M. Penín Mosquerab, J. Marcoval Causa
a Servicio de Dermatología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España
b Servicio de Anatomía Patológica, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España
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e identificados a partir del registro iconogr&#225;fico del Servicio de Dermatolog&#237;a del Hospital Universitario de Bellvitge &#40;Barcelona&#41;&#46; Se trata de un hospital universitario que proporciona asistencia terciaria a una poblaci&#243;n de aproximadamente 1<span class="elsevierStyleHsp" style=""></span>mill&#243;n de personas&#46; Se recogieron datos demogr&#225;ficos &#40;edad&#44; sexo&#44; neoplasia de base&#44; inmunoterapia recibida&#44; antecedentes de enfermedades autoinmunes&#41;&#44; cl&#237;nicos &#40;tipo de lesiones cut&#225;neas y localizaci&#243;n&#44; afectaci&#243;n extracut&#225;nea&#44; gravedad del cuadro y necesidad de tratamiento espec&#237;fico y&#47;o de suspensi&#243;n del ICI&#41;&#44; anal&#237;ticos &#40;funci&#243;n renal y valores de enzima convertidora de angiotensina&#44; calcemia y enzimas hep&#225;ticas&#41; e histol&#243;gicos &#40;tipo y localizaci&#243;n de los granulomas&#44; presencia de cuerpos extra&#241;os&#44; de corona de linfocitos&#44; de necrosis o de fibrosis&#44; cambios epid&#233;rmicos&#41;&#44; y se llev&#243; a cabo un estudio descriptivo&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Resultados</span><p id="par0020" class="elsevierStylePara elsevierViewall">Se identificaron 7 pacientes &#40;6 mujeres y 1 var&#243;n&#41;&#44; con una edad mediana de 65<span class="elsevierStyleHsp" style=""></span>a&#241;os &#40;rango&#58; 44-74&#41;&#46; Ninguno ten&#237;a antecedentes de enfermedades autoinmunes antes de iniciar la inmunoterapia&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Seis pacientes recibieron inmunoterapia en monoterapia &#40;3 un f&#225;rmaco anti-PD1&#44; y otros 3&#44; uno anti-PDL1&#41; y uno recibi&#243; la combinaci&#243;n de un anti-PDL1 con un anti-CTLA-4&#46; Entre las neoplasias de base la m&#225;s frecuente fue el melanoma &#40;3<span class="elsevierStyleHsp" style=""></span>pacientes&#41;&#44; seguida del carcinoma de endometrio &#40;2&#41;&#44; de tiroides &#40;1&#41; y de pulm&#243;n &#40;1&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">La mediana de tiempo desde el inicio del tratamiento hasta el diagn&#243;stico de la sarcoidosis fue de 4<span class="elsevierStyleHsp" style=""></span>meses &#40;rango&#58; 2-9&#41; y la forma de presentaci&#243;n cut&#225;nea m&#225;s frecuente fue la sarcoidosis papulosa de las rodillas&#44; que estuvo presente en 5 de los 7 pacientes&#46; Tres pacientes presentaron n&#243;dulos subcut&#225;neos&#44; uno placas infiltradas en la frente y en la zona alta de la espalda y&#44; por &#250;ltimo&#44; una paciente present&#243; infiltraci&#243;n por granulomas de xantelasmas preexistentes &#40;caso publicado en la literatura&#41;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A nivel extracut&#225;neo&#44; los &#243;rganos m&#225;s afectados por orden de frecuencia fueron los ganglios hiliares y mediast&#237;nicos &#40;4<span class="elsevierStyleHsp" style=""></span>pacientes&#41;&#44; el pulm&#243;n &#40;3<span class="elsevierStyleHsp" style=""></span>pacientes&#44; en forma de m&#250;ltiples n&#243;dulos pulmonares de peque&#241;o tama&#241;o&#41;&#44; las articulaciones<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a>&#44; y un paciente tuvo una nefritis t&#250;bulo-intersticial granulomatosa aguda&#46; Ning&#250;n paciente present&#243; afectaci&#243;n ocular&#44; card&#237;aca&#44; hep&#225;tica o del sistema nervioso central&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">En todos los pacientes se realiz&#243; una biopsia cut&#225;nea para confirmar histol&#243;gicamente el diagn&#243;stico&#44; as&#237; como biopsias de los dem&#225;s &#243;rganos afectados&#46; En todos los pacientes se descart&#243; progresi&#243;n de su neoplasia&#44; as&#237; como infecci&#243;n por hongos y micobacterias&#44; a trav&#233;s de tinciones y de cultivos de los tejidos&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se revisaron las biopsias cut&#225;neas de todos los pacientes&#44; observando granulomas formados por agregados de histiocitos epitelioides con escaso componente linfoc&#237;tico&#46; En los pacientes con sarcoidosis papulosa de las rodillas los granulomas estaban localizados predominantemente en la dermis superficial y era frecuente observar la presencia de cuerpos extra&#241;os &#40;se hallaron en 3 de los 4<span class="elsevierStyleHsp" style=""></span>pacientes biopsiados&#41;&#46; En cambio&#44; en los pacientes con sarcoidosis subcut&#225;nea los granulomas estaban pr&#225;cticamente limitados al tejido celular subcut&#225;neo&#44; rodeados de una mayor cantidad de linfocitos&#44; y se observaba presencia de fibrosis en 2 de los 3<span class="elsevierStyleHsp" style=""></span>pacientes &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> y <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Desde un punto de vista histol&#243;gico no se observaron diferencias respecto a la sarcoidosis idiop&#225;tica&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Las pruebas de laboratorio mostraron una elevaci&#243;n de enzima convertidora de angiotensina en 3<span class="elsevierStyleHsp" style=""></span>pacientes&#59; no se objetiv&#243; hipercalcemia ni elevaci&#243;n de enzimas hep&#225;ticas en ning&#250;n paciente&#46; En los pacientes con afectaci&#243;n pulmonar o adenop&#225;tica se llevaron a cabo pruebas funcionales respiratorias&#44; y en la mitad de ellos se observ&#243; una disminuci&#243;n de la capacidad de difusi&#243;n del mon&#243;xido de carbono&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">La mayor&#237;a de pacientes presentaron un cuadro leve y autolimitado&#44; sin necesidad de tratamiento espec&#237;fico ni de suspensi&#243;n del ICI&#44; excepto dos pacientes&#44; que tuvieron un curso cl&#237;nico m&#225;s agresivo&#44; con afectaci&#243;n renal y pulmonar&#44; que requiri&#243; suspender la inmunoterapia e iniciar corticoides sist&#233;micos a dosis entre 0&#44;5 y 1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#237;a&#44; seguido de mantenimiento con hidroxicloroquina&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">En cuanto a la neoplasia de base&#44; 4<span class="elsevierStyleHsp" style=""></span>pacientes consiguieron una remisi&#243;n completa o parcial&#44; 2<span class="elsevierStyleHsp" style=""></span>pacientes fallecieron por progresi&#243;n de la neoplasia y uno de ellos mantuvo la enfermedad estable&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discusi&#243;n</span><p id="par0065" class="elsevierStylePara elsevierViewall">La sarcoidosis asociada a la inmunoterapia con ICI aparece en alrededor del 5&#37; de los pacientes hacia los 5<span class="elsevierStyleHsp" style=""></span>meses de tratamiento<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">3&#44;4</span></a> y es m&#225;s frecuente en los pacientes en tratamiento con anti-CTLA-4&#44; y especialmente en los que llevan doble inmunoterapia&#44; en los que adem&#225;s puede ser m&#225;s precoz y m&#225;s grave<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">4-7</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">A la hora de establecer el diagn&#243;stico es fundamental la confirmaci&#243;n histol&#243;gica para poder diferenciarlo de una progresi&#243;n tumoral&#44; especialmente en los casos con lesiones pulmonares y mediast&#237;nicas&#44; que pueden ser indistinguibles en las pruebas de imagen&#44; incluso en la PET-TC<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a>&#46; El dermat&#243;logo tiene un papel importante&#44; pues uno de cada cinco pacientes tiene afectaci&#243;n cut&#225;nea y la piel es un &#243;rgano accesible para la biopsia<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a>&#46; El diagn&#243;stico correcto va a determinar la actitud sobre el tratamiento oncol&#243;gico&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">La mayor&#237;a de reacciones sarcoideas por ICI son leves y autolimitadas&#44; como en nuestros pacientes&#44; por lo que cada vez se tiende a ser menos agresivo y a limitar el tratamiento a pacientes muy sintom&#225;ticos o con afectaci&#243;n card&#237;aca&#44; renal&#44; neurol&#243;gica u ocular<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">4&#44;9</span></a>&#46; En estos casos se administran tandas de corticoides sist&#233;micos e hidroxicloroquina&#44; y raramente se requieren inmunosupresores<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a>&#46; Las manifestaciones cut&#225;neas pueden tratarse con corticoides t&#243;picos&#44; aunque es frecuente que se resuelvan espont&#225;neamente<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">3&#44;6</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Seg&#250;n la literatura&#44; en m&#225;s de la mitad de los casos se suspende la inmunoterapia al diagnosticar las reacciones sarcoideas con el objetivo de eliminar el desencadenante<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a>&#46; Sin embargo&#44; cada vez tenemos mayor evidencia de que estas reacciones tienen un curso benigno y de que&#44; en los casos leves&#44; mantener la inmunoterapia no comporta un empeoramiento<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a>&#46; Por todo esto&#44; ligado a la importancia que tiene el tratamiento de la neoplasia en la supervivencia del paciente&#44; se cree que&#44; excepto en los casos graves&#44; debe priorizarse el mantenimiento del ICI<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">7&#44;9&#44;10</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Estudios recientes sugieren que los pacientes en tratamiento con ICI que desarrollan reacciones sarcoideas tienen un pron&#243;stico favorable en lo que refiere a su neoplasia de base<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">2&#44;7&#44;11-13</span></a> y una mayor supervivencia respecto a los grupos control&#44; incluso ajustando la supervivencia por otras variables como la edad&#44; el tipo de tratamiento&#44; las l&#237;neas de tratamiento recibidas y el tumor de base<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Como limitaciones de este trabajo hay que destacar que se trata de un estudio unic&#233;ntrico&#44; retrospectivo y con un n&#250;mero reducido de pacientes&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">En resumen&#44; las reacciones sarcoideas cut&#225;neas relacionadas con la inmunoterapia remedan cl&#237;nica e histol&#243;gicamente las diferentes formas de sarcoidosis cut&#225;nea&#46; Suelen tener un curso leve y autolimitado&#44; y su aparici&#243;n se ha asociado a una mayor supervivencia de los pacientes&#44; por lo que&#44; siempre que sea posible&#44; debe priorizarse el mantenimiento de la inmunoterapia&#46; Aunque los hallazgos cl&#237;nicos&#44; anal&#237;ticos y radiol&#243;gicos sean sugestivos de reacci&#243;n sarcoidea&#44; se recomienda obtener una confirmaci&#243;n histol&#243;gica&#44; pues el principal diagn&#243;stico diferencial es la progresi&#243;n tumoral&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Financiaci&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">No se ha dispuesto de ninguna ayuda financiera para la realizaci&#243;n de este manuscrito&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflicto de intereses</span><p id="par0110" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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            1 => "Granulomas"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Los inhibidores de puntos de control inmunitario &#40;ICI&#41; pueden producir toxicidades cut&#225;neas inmunomediadas entre las que se encuentran las reacciones sarcoideas&#46; Nuestro objetivo fue analizar retrospectivamente los datos cl&#237;nicos e histol&#243;gicos de los pacientes en tratamiento con ICI que desarrollaron reacciones sarcoideas cut&#225;neas entre 2019 y 2022&#46; Se incluyeron siete pacientes &#40;seis mujeres y un var&#243;n&#44; con una edad mediana de 65<span class="elsevierStyleHsp" style=""></span>a&#241;os&#41;&#46; La mediana de tiempo de instauraci&#243;n de la cl&#237;nica fue de 4<span class="elsevierStyleHsp" style=""></span>meses y la forma de presentaci&#243;n m&#225;s frecuente fue la sarcoidosis papulosa de las rodillas&#44; seguida de la sarcoidosis subcut&#225;nea&#46; En todos se confirm&#243; el diagn&#243;stico histol&#243;gicamente y no se observaron diferencias respecto a la sarcoidosis idiop&#225;tica&#46; Solo en dos casos fue preciso retirar la inmunoterapia&#46; Las reacciones sarcoideas por ICI suelen ser leves y no suelen requerir la interrupci&#243;n del tratamiento&#46; Es fundamental obtener una confirmaci&#243;n histol&#243;gica para distinguirlas de la progresi&#243;n tumoral&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Immune checkpoint inhibitors &#40;ICIs&#41; can cause immune-mediated cutaneous adverse events&#44; including sarcoid-like reactions&#46; The aim of this study was to retrospectively analyze clinical and histologic data from patients who developed cutaneous sarcoid-like reactions between 2019 and 2022 while under treatment with ICIs&#46; We studied 7 patients &#40;6 women and 1 man&#41; with a median age of 65<span class="elsevierStyleHsp" style=""></span>years&#46; Median time to onset of symptoms was 4<span class="elsevierStyleHsp" style=""></span>months&#46; The most common presentation was papular sarcoidosis of the knees followed by subcutaneous sarcoidosis&#46; Diagnosis was confirmed histologically in all cases&#44; and no differences were observed relative to idiopathic sarcoidosis&#46; Discontinuation of ICI therapy was required in just two patients&#46; ICI-induced sarcoid-like reactions tend to be mild and generally do not require treatment discontinuation&#46; Histologic confirmation is essential for distinguishing these reactions from tumor progression&#46;</p></span>"
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          "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Aspecto cl&#237;nico e histol&#243;gico de las reacciones sarcoideas relacionadas con ICI&#46; a-c&#41; Sarcoidosis papulosa de las rodillas&#46; Los granulomas est&#225;n localizados predominantemente en la dermis superficial y es frecuente observar la presencia de cuerpos extra&#241;os&#46; d-f&#41; Sarcoidosis subcut&#225;nea&#46; Los granulomas est&#225;n pr&#225;cticamente limitados al tejido celular subcut&#225;neo&#44; rodeados de una mayor cantidad de linfocitos e importante fibrosis&#46;</p>"
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          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">&#43;&#58; escasa cantidad&#46; &#43;&#43;&#58; moderada cantidad&#46; &#8722;&#58; ausencia&#59; retic&#58; reticular&#59; sup&#58; superficial&#46;</p>"
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                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dermatitis interfase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Eosin&#243;filos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fibrosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Antebrazo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sarcoideo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Subcut&#225;neos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rodilla&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sarcoideo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dermis sup&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Espalda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sarcoideo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dermis sup&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Antebrazo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sarcoideo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Subcut&#225;neos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rodilla&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sarcoideo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dermis sup&#43;retic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rodilla&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sarcoideo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dermis sup&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hiperqueratosis focal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dedo mano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sarcoideo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Subcut&#225;neos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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          "es" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Informaci&#243;n histol&#243;gica recogida de las biopsias cut&#225;neas de los 7 pacientes estudiados</p>"
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ISSN: 00017310
Original language: Spanish
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