Cases for Diagnosis
A Midfacial Nodule of Recent Onset
Nódulo centrofacial de reciente aparición
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Necrotic ulcers in the right nasal cavity and on the upper lip, right cheek, and tongue.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.M. Serrano-Martín, J. del Boz, M. Chaffanel-Peláez, A. Vera-Casaño" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M.M." "apellidos" => "Serrano-Martín" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "del Boz" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Chaffanel-Peláez" ] 3 => array:2 [ "nombre" => "A." 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García-Río, V. Almeida Llamas, V. Moreno" "autores" => array:3 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "García-Río" "email" => array:1 [ 0 => "irene@aedv.es" ] "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" => "V." "apellidos" => "Almeida Llamas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "V." "apellidos" => "Moreno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital de Txagorritxu, Vitoria, Álava, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital de Txagorritxu, Vitoria, Álava, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nódulo centrofacial de reciente aparición" ] ] "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" => 539 "Ancho" => 750 "Tamanyo" => 165912 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">CD20 and CD3 staining, original magnification x40.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case Description</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 44-year-old woman with no relevant medical history consulted for a lesion on the right ala of the nose of 15 days’ duration. She reported that it was slightly painful and had grown rapidly. She did not recall any injuries to the area and there were no accompanying systemic symptoms.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed a well-circumscribed, firm erythematous nodule measuring approximately 1<span class="elsevierStyleHsp" style=""></span>cm on the right ala of the nose. (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Histologic examination showed a diffuse folliculocentric mixed infiltrate throughout the dermis. The infiltrate was composed of lymphocytes, plasma cells, histiocytes, and some eosinophils (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Immunohistochemical staining showed almost equal proportions of CD20<span class="elsevierStyleSup">+</span> and CD3<span class="elsevierStyleSup">+</span> cells in the infiltrate (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Focal CD30 positivity was also observed and S100 protein staining showed some dendritic cells around the follicles. Molecular biology analysis showed the infiltrate to be polyclonal.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">The results of laboratory tests were unremarkable.</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What Is Your Diagnosis?</span></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Pseudolymphomatous folliculitis.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Course and Treatment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Biopsy of the lesion was followed by complete regression of the nodule. At the time of writing, more than a year later, the patient remains asymptomatic.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comments</span><p id="par0040" class="elsevierStylePara elsevierViewall">Pseudolymphomatous folliculitis, a condition first described by McNutt in 1986, is a rare clinicopathologic variant of cutaneous lymphoid hyperplasia, with just under 50 cases described to date.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–6</span></a> It usually presents as a solitary nodule on the face, particularly on the nose, cheeks, or forehead, although it is occasionally found at other sites.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> The nodule grows rapidly, reaching a maximum size of no more than 1.5<span class="elsevierStyleHsp" style=""></span>cm and producing few symptoms; it typically presents in the fourth decade of life and affects men and women equally.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> Biopsy is required for diagnosis, with results showing a polymorphous infiltrate containing abundant lymphocytes in a distinctive arrangement around the hair follicles.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> Characteristic changes in the hair follicles are sometimes observed, including irregular hyperplasia, epithelial deformation, and blurring of the follicle walls.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> Positive immunohistochemical staining for CD3 and CD20 demonstrates the presence of T lymphocytes and B lymphocytes, as does, on occasions, CD1a and S100 protein positivity in the cells around the follicles. Most cases are reported to be polyclonal.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> Although pseudolymphomatous folliculitis and cutaneous lymphoid hyperplasia may be considered to be similar or even overlapping entities, the latter has a number of distinguishing features.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> It presents as a plaque or nodule or a group of plaques or nodules on the face, trunk, or upper extremities and can take months or years to resolve. Histologic examination shows a dense dermal lymphoid infiltrate with germinal centers, which is more intense in the upper dermis.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> Other entities that should be considered in the differential diagnosis of pseudolymphomatous folliculitis are lymphoma, granulomatous rosacea, inflamed cyst, lupus tumidus, lymphocytic infiltrate, and insect or spider bites.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> The clinical course is benign and self-limiting. In all the cases reported to date, including ours, biopsy led to the complete regression of the lesion. Although there is no evidence that pseudolymphomatous folliculitis can progress to lymphoma, some authors recommend close monitoring.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,6</span></a> The etiology and pathogenesis of pseudolymphomatous folliculitis are still poorly understood but the most widely accepted theory is that it is a subtype of cutaneous lymphoid hyperplasia. It has, however, also been speculated that it might be a variant of rosacea or a previously uncharacterized hair follicle disease. On examining the biopsy results of 15 patients with pseudolymphomatous folliculitis, Arai et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> coined the term <span class="elsevierStyleItalic">activation of hair follicles</span> to describe the changes observed.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> It has been postulated that the follicle may contain an antigen that triggers an exaggerated local immune response.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The fact that a biopsy would eliminate the antigen would explain why the lesions disappear following this procedure. We present a new case of pseudolymphomatous folliculitis, a controversial entity or pseudo-entity that should be considered in the differential diagnosis of nodular lesions in the midface region.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Case Description" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Histopathology" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Additional Tests" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Diagnosis" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Clinical Course and Treatment" ] 4 => array:2 [ "identificador" => "sec0040" "titulo" => "Comments" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: García-Río I, Almeida Llamas V, Moreno V. Nódulo centrofacial de reciente aparición. Actas Dermosifiliogr.2012;103:635-636.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1122 "Ancho" => 1505 "Tamanyo" => 185894 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous nodule on the right ala of the nose.</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" => 638 "Ancho" => 855 "Tamanyo" => 196636 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin staining, original magnification x40.</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" => 539 "Ancho" => 750 "Tamanyo" => 165912 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">CD20 and CD3 staining, original magnification x40.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of pseudolymphomatous folliculitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "H.W. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 10 | 24 |
| 2024 October | 113 | 59 | 172 |
| 2024 September | 82 | 30 | 112 |
| 2024 August | 118 | 76 | 194 |
| 2024 July | 105 | 40 | 145 |
| 2024 June | 115 | 50 | 165 |
| 2024 May | 123 | 41 | 164 |
| 2024 April | 85 | 42 | 127 |
| 2024 March | 105 | 41 | 146 |
| 2024 February | 109 | 38 | 147 |
| 2024 January | 93 | 35 | 128 |
| 2023 December | 80 | 25 | 105 |
| 2023 November | 121 | 22 | 143 |
| 2023 October | 101 | 28 | 129 |
| 2023 September | 110 | 34 | 144 |
| 2023 August | 80 | 17 | 97 |
| 2023 July | 77 | 47 | 124 |
| 2023 June | 68 | 40 | 108 |
| 2023 May | 96 | 54 | 150 |
| 2023 April | 100 | 29 | 129 |
| 2023 March | 84 | 21 | 105 |
| 2023 February | 60 | 33 | 93 |
| 2023 January | 67 | 33 | 100 |
| 2022 December | 76 | 49 | 125 |
| 2022 November | 39 | 34 | 73 |
| 2022 October | 59 | 31 | 90 |
| 2022 September | 37 | 28 | 65 |
| 2022 August | 48 | 29 | 77 |
| 2022 July | 64 | 40 | 104 |
| 2022 June | 94 | 37 | 131 |
| 2022 May | 73 | 35 | 108 |
| 2022 April | 67 | 41 | 108 |
| 2022 March | 76 | 56 | 132 |
| 2022 February | 54 | 38 | 92 |
| 2022 January | 55 | 44 | 99 |
| 2021 December | 55 | 53 | 108 |
| 2021 November | 63 | 51 | 114 |
| 2021 October | 65 | 52 | 117 |
| 2021 September | 47 | 47 | 94 |
| 2021 August | 59 | 33 | 92 |
| 2021 July | 39 | 30 | 69 |
| 2021 June | 21 | 37 | 58 |
| 2021 May | 36 | 36 | 72 |
| 2021 April | 41 | 40 | 81 |
| 2021 March | 56 | 34 | 90 |
| 2021 February | 47 | 31 | 78 |
| 2021 January | 43 | 12 | 55 |
| 2020 December | 30 | 21 | 51 |
| 2020 November | 25 | 10 | 35 |
| 2020 October | 26 | 13 | 39 |
| 2020 September | 29 | 5 | 34 |
| 2020 August | 34 | 24 | 58 |
| 2020 July | 34 | 10 | 44 |
| 2020 June | 21 | 26 | 47 |
| 2020 May | 28 | 15 | 43 |
| 2020 April | 29 | 14 | 43 |
| 2020 March | 35 | 19 | 54 |
| 2020 February | 4 | 0 | 4 |
| 2020 January | 4 | 3 | 7 |
| 2019 December | 8 | 2 | 10 |
| 2019 November | 4 | 1 | 5 |
| 2019 September | 5 | 1 | 6 |
| 2019 August | 6 | 6 | 12 |
| 2019 July | 4 | 5 | 9 |
| 2019 June | 6 | 25 | 31 |
| 2019 May | 4 | 20 | 24 |
| 2019 April | 2 | 8 | 10 |
| 2019 March | 4 | 5 | 9 |
| 2019 February | 0 | 5 | 5 |
| 2019 January | 2 | 0 | 2 |
| 2018 December | 5 | 0 | 5 |
| 2018 October | 8 | 0 | 8 |
| 2018 September | 3 | 0 | 3 |
| 2018 February | 115 | 3 | 118 |
| 2018 January | 99 | 5 | 104 |
| 2017 December | 115 | 5 | 120 |
| 2017 November | 76 | 4 | 80 |
| 2017 October | 73 | 7 | 80 |
| 2017 September | 74 | 4 | 78 |
| 2017 August | 59 | 5 | 64 |
| 2017 July | 49 | 6 | 55 |
| 2017 June | 71 | 9 | 80 |
| 2017 May | 98 | 4 | 102 |
| 2017 April | 29 | 7 | 36 |
| 2017 March | 31 | 7 | 38 |
| 2017 February | 166 | 7 | 173 |
| 2017 January | 79 | 8 | 87 |
| 2016 December | 102 | 3 | 105 |
| 2016 November | 148 | 20 | 168 |
| 2016 October | 210 | 19 | 229 |
| 2016 September | 191 | 12 | 203 |
| 2016 August | 198 | 5 | 203 |
| 2016 July | 106 | 8 | 114 |
| 2016 June | 9 | 12 | 21 |
| 2016 May | 9 | 6 | 15 |
| 2016 April | 6 | 1 | 7 |
| 2016 March | 11 | 7 | 18 |
| 2016 February | 8 | 1 | 9 |
| 2016 January | 14 | 7 | 21 |
| 2015 December | 15 | 9 | 24 |
| 2015 November | 32 | 1 | 33 |
| 2015 October | 55 | 7 | 62 |
| 2015 September | 43 | 9 | 52 |
| 2015 August | 11 | 3 | 14 |
| 2015 July | 177 | 8 | 185 |
| 2015 June | 108 | 3 | 111 |
| 2015 May | 106 | 8 | 114 |
| 2015 April | 107 | 10 | 117 |
| 2015 March | 89 | 12 | 101 |
| 2015 February | 64 | 10 | 74 |
| 2015 January | 90 | 20 | 110 |
| 2014 December | 55 | 9 | 64 |
| 2014 November | 60 | 11 | 71 |
| 2014 October | 79 | 16 | 95 |
| 2014 September | 67 | 13 | 80 |
| 2014 August | 38 | 3 | 41 |
| 2014 July | 37 | 4 | 41 |
| 2014 June | 37 | 2 | 39 |
| 2014 May | 39 | 6 | 45 |
| 2014 April | 36 | 3 | 39 |
| 2014 March | 44 | 9 | 53 |
| 2014 February | 28 | 4 | 32 |
| 2014 January | 41 | 8 | 49 |
| 2013 December | 38 | 9 | 47 |
| 2013 November | 22 | 7 | 29 |
| 2013 October | 14 | 7 | 21 |
| 2013 September | 7 | 10 | 17 |
| 2013 August | 19 | 26 | 45 |
| 2013 July | 14 | 5 | 19 |
| 2013 June | 14 | 9 | 23 |
| 2013 May | 16 | 13 | 29 |
| 2013 April | 14 | 8 | 22 |
| 2013 March | 17 | 11 | 28 |
| 2013 February | 34 | 5 | 39 |
| 2013 January | 49 | 5 | 54 |
| 2012 December | 20 | 4 | 24 |
| 2012 November | 0 | 1 | 1 |
| 2012 October | 0 | 1 | 1 |
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