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Dermatoscopia práctica
Un nódulo rosado en la mano de una paciente de 12 años
Pink Nodule on the Hand of a 12-Year-old Patient
M. Valiuškytėa,
Corresponding author
m.valiuskyte@gmail.com

Autor para correspondencia.
, C. Gonçalves-Castrob, A. Miroux-Catarinob
a Department of Skin and Venereal Diseases, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, Lituania
b Dermatology Department, Hospital de Egas Moniz, Lisboa, Portugal
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2</a>&#41;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">&#191;Cu&#225;l es su diagn&#243;stico&#63;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Comentario</span><p id="par0020" class="elsevierStylePara elsevierViewall">La dermatoscopia de la lesi&#243;n revel&#243; la presencia de una &#8220;nube&#8221; de zona amarilla m&#225;s clara central&#44; de la que part&#237;an vetas blancas brillantes&#44; vasos lineales en la periferia&#44; vasos en horquilla en el centro&#44; y pocas escamas&#46; Se extirp&#243; la lesi&#243;n con anestesia local&#44; realiz&#225;ndose sutura discontinua simple de la herida quir&#250;rgica&#46; El diagn&#243;stico diferencial incluy&#243; nevus de Spitz&#44; reticulohistiocitoma solitario&#44; dermatofibroma y xantogranuloma juvenil &#40;XJ&#41;&#46; El examen histopatol&#243;gico revel&#243; principalmente la presencia de c&#233;lulas gigantes multinucleadas de tipo Touton&#44; escasos histiocitos mononucleados con gran citoplasma vacuolado eosinof&#237;lico y abundante infiltrado inflamatorio linfoplasmocitario &#40;<a class="elsevierStyleCrossRefs" href="#fig0015">figs&#46; 3 y 4</a>&#41;&#46; La inmunohistoqu&#237;mica fue positiva para CD68 y S100&#44; y negativa para CD1a&#44; Sox 10&#46; Dichos hallazgos&#44; junto con la exploraci&#243;n cl&#237;nica y la dermatoscopia&#44; respaldaron el diagn&#243;stico de XJ&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">La forma m&#225;s com&#250;n de histiocitosis de c&#233;lulas no Langerhans es XJ&#46; Su presentaci&#243;n cl&#237;nica son las lesiones papulonodulares amarillas&#44; rojas o marrones&#44; que se observan normalmente en individuos de las dos primeras d&#233;cadas de vida&#44; y que se resuelven espont&#225;neamente a menudo<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a>&#46; La dermatoscopia demuestra ser valiosa a la hora de distinguir XJ de otras lesiones cut&#225;neas&#44; considerando sus diversas presentaciones cl&#237;nicas a lo largo de las diferentes etapas de su evoluci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Histopatol&#243;gicamente&#44; el primer estadio de XJ se caracteriza por la proliferaci&#243;n diseminada de peque&#241;as c&#233;lulas histioc&#237;ticas monomorfas&#46; A medida que progresa hacia su estadio desarrollado xantomatizado las c&#233;lulas gigantes de Touton se hacen m&#225;s prominentes&#46; Durante la etapa de transici&#243;n&#44; se observan reacciones moderadas de tejido fibr&#243;tico con incremento del n&#250;mero de c&#233;lulas fusiformes<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; El patr&#243;n dermatosc&#243;pico t&#237;pico de &#8220;sol poniente&#8221; caracterizado por un fondo amarillento con eritema perif&#233;rico sutil se observa principalmente durante las etapas temprana y desarrollada de la enfermedad&#46; En la etapa de transici&#243;n&#44; son m&#225;s comunes las &#8220;nubes&#8221; de zonas amarillas m&#225;s claras&#44; que representan posiblemente la evoluci&#243;n del fondo amarillo al aspecto de &#8220;sol poniente&#8221;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#44;3&#44;5</span></a>&#46; Debido a la fibrosis d&#233;rmica en las etapas m&#225;s tard&#237;as&#44; pueden observarse vetas blancas brillantes o zonas blanquecinas con distribuci&#243;n estelada<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; En todas las etapas de la XJ&#44; se describen hallazgos vasculares&#44; mientras que los vasos lineales&#44; que pueden partir desde la periferia al centro&#44; son los m&#225;s frecuentemente observados&#46; En ciertos casos&#44; pueden presentarse vasos moteados&#44; en forma de coma&#44; en espiral&#44; globulares&#44; arboriformes y de tipo horquilla&#44; e incluso vasos polim&#243;rficos<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#8211;6</span></a>&#46; Tambi&#233;n se han reportado caracter&#237;sticas dermatosc&#243;picas tales como red pigmentada&#44; fol&#237;culos&#44; erosiones y escamas asociadas a esta entidad<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3&#44;4</span></a>&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicto de intereses</span><p id="par0030" class="elsevierStylePara elsevierViewall">Los autores declaran la ausencia de conflicto de intereses&#46;</p></span></span>"
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ISSN: 00017310
Original language: Spanish
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