Practical Dermoscopy
Pink Nodule on the Hand of a 12-Year-old Patient
Un nódulo rosado en la mano de una paciente de 12 años
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"apellidos" => "Valiuškytė" "email" => array:1 [ 0 => "m.valiuskyte@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "C." "apellidos" => "Gonçalves-Castro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Miroux-Catarino" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Skin and Venereal Diseases, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, Lithuania" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Dermatology Department, Hospital de Egas Moniz, Lisboa, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Un nódulo rosado en la mano de una paciente de 12 años" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 814 "Ancho" => 1083 "Tamanyo" => 312649 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Large dermal nodule (hematoxylin–eosin, magnification 20×).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case presentation</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 12-year-old female, with Fitzpatrick phototype II, presented to the Dermatology outpatient clinic with a 4-month history of anasymptomatic pink nodule on the dorsum of her left hand. A 0.8<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>0.8<span class="elsevierStyleHsp" style=""></span>cm well-demarcated, smooth, exophytic nodule measuring was observed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Dermoscopy of the lesion (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>)</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">What is your diagnosis?</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Comment</span><p id="par0020" class="elsevierStylePara elsevierViewall">The dermoscopy of the lesion revealed the presence of a “cloud” of a paler yellow area at the center, shiny white streaks radiating from the it, linear vessels in the periphery, hairpin vessels in the center, and a few scales. The lesion was excised under local anesthesia followed by the simple interrupted suture of the surgical wound. Differential diagnosis included Spitz nevus, solitary reticulohistiocytoma, dermatofibroma and juvenile xanthogranuloma (JXG). Histopathological examination revealed mainly the presence of Touton-type multinucleated giant cells, a few mononucleated histiocytes with large eosinophilic vacuolated cytoplasm, and abundant lymphoplasmacytic inflammatory infiltrate (<a class="elsevierStyleCrossRefs" href="#fig0015">Figs. 3 and 4</a>). Immunohistochemistry was positive for CD68, S100, and negative for CD1a, Sox 10. These findings, along with clinical examination and dermoscopy, supported the diagnosis of JXG.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The most common form of non-Langerhans cell histiocytosis is JXG. Its clinical presentation are yellow, red, or brown papulonodular lesions, typically seen in individuals within the first two decades of life, often regressing spontaneously.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Dermoscopy proves to be valuable in distinguishing JXG from other skin lesions, considering its diverse clinical presentations across different stages of evolution.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,3</span></a> Histopathologically the early stage of JXG is characterized by sheet-like proliferation of small monomorphous histiocytic cells. As it progresses to its developed stage-xanthomatized cells-Touton giant cells become more prominent. During the transition stage, moderate fibrotic tissue reactions with an increased number of spindle-shaped cells are observed.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,3</span></a> The typical dermoscopic “setting sun” pattern characterized by a yellowish background with subtle peripheral erythema is mostly seen during the early, developed stages of the disease. In the transition stage, “clouds” of paler yellow areas are more common, possibly representing the evolution of the yellow background in the “setting sun” appearance.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,3,5</span></a> Due to dermal fibrosis at later stages, shiny white streaks or whitish areas with a stellate distribution may be observed.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,3</span></a> In all stages of JXG, vascular findings are described, while linear vessels, which may radiate from the periphery to the center, are the most frequently observed. In some cases, dotted, comma-like, coiled, globular, arboriform, hairpin-like and even polymorphic vessels may be present.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2–6</span></a> Dermoscopic features such as pigment network, follicles, erosions, and scales have also been reported associated with this entity.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3,4</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interests</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case presentation" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Comment" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interests" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2008 "Ancho" => 1508 "Tamanyo" => 212103 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Solitary pink nodule on the dorsum of the left hand.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2008 "Ancho" => 1508 "Tamanyo" => 176775 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Contact polarized dermoscopic image of the lesion.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 814 "Ancho" => 1083 "Tamanyo" => 312649 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Large dermal nodule (hematoxylin–eosin, magnification 20×).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 814 "Ancho" => 1083 "Tamanyo" => 326531 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The nodule is mainly composed of Touton-type multinucleated giant cells (hematoxylin–eosin, magnification 400×).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Juvenile xanthogranulomas in the first two decades of life: a clinicopathologic study of 174 cases with cutaneous and extracutaneous manifestations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L.P. 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Hernandez San Martın" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000510265" "Revista" => array:6 [ "tituloSerie" => "Dermatology" "fecha" => "2020" "volumen" => "19" "paginaInicial" => "1" "paginaFinal" => "6" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30611259" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00017310/0000011500000008/v1_202409020432/S0001731024002680/v1_202409020432/en/main.assets" "Apartado" => array:4 [ "identificador" => "19290" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Dermatoscopia práctica" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00017310/0000011500000008/v1_202409020432/S0001731024002680/v1_202409020432/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731024002680?idApp=UINPBA000044" ]
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