Case and Research Letter
Vertically Orientated Telangiectasias and Pruritus on the Thorax of a Patient With Early Superior Vena Cava Syndrome Secondary to a Malignant Thymoma
Telangiectasias verticalizadas y prurito en el tórax en un paciente con síndrome de cava superior inicial secundario a un timoma maligno
C. Laguna
Departamento de Dermatología, Hospital Lluís Alcanyís, Xàtiva, Valencia, Spain
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B, Light-brownish areas tending to converge; multiple linear and branching vessels can be seen. C, Nearly total absence of elastic fibers in the papillary dermis; in contrast, elastic fibers (black arrows) can be seen in the reticular dermis (orcein, original magnification ×100). D, Melanophages (red arrows) dispersed in the papillary dermis (hematoxilin-eosin ×400). E, Von Kossa staining revealed no calcifications of elastic fibers (original magnification ×<span class="elsevierStyleHsp" style=""></span>100).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Vázquez-Osorio, E. Rosón, J.M. Suárez-Peñaranda, H. Vázquez-Veiga" "autores" => array:4 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Vázquez-Osorio" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Rosón" ] 2 => array:2 [ "nombre" => "J.M." "apellidos" => "Suárez-Peñaranda" ] 3 => array:2 [ "nombre" => "H." 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Caro-Gutiérrez, J.L. López-Estebaranz, E. Naz-Villalba, L. Ayala-Bernaldo de Quiros" "autores" => array:4 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Caro-Gutiérrez" ] 1 => array:2 [ "nombre" => "J.L." "apellidos" => "López-Estebaranz" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Naz-Villalba" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Ayala-Bernaldo de Quiros" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731014004505" "doi" => "10.1016/j.ad.2014.07.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731014004505?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015000621?idApp=UINPBA000044" "url" => "/15782190/0000010600000004/v2_201505051007/S1578219015000621/v2_201505051007/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Vertically Orientated Telangiectasias and Pruritus on the Thorax of a Patient With Early Superior Vena Cava Syndrome Secondary to a Malignant Thymoma" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "331" "paginaFinal" => "332" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "C. Laguna" "autores" => array:1 [ 0 => array:3 [ "nombre" => "C." "apellidos" => "Laguna" "email" => array:1 [ 0 => "cecipru@comv.es" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Dermatología, Hospital Lluís Alcanyís, Xàtiva, Valencia, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Telangiectasias verticalizadas y prurito en el tórax en un paciente con síndrome de cava superior inicial secundario a un timoma maligno" ] ] "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" => 732 "Ancho" => 976 "Tamanyo" => 89941 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Computed tomography revealed a tumor in the anterior mediastinum (MT) with compression of the superior vena cava (arrow).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Thymoma is the most common primary tumor of the anterior mediastinum. Symptoms are due to compression by the tumor or to various paraneoplastic syndromes. However, 50% of patients are asymptomatic at the time of diagnosis.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> We describe the case of a patient who developed pruritus and telangiectasias on the trunk as the initial signs of a malignant thymoma.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 78-year-old man who was seen in outpatients for the progressive appearance of telangiectasias on the skin of the anterior chest wall over the previous 3 months. He reported that he had previously had a skin rash in the area but that it had resolved by the time of consultation. The patient complained of intense pruritus and malaise that even affected nighttime rest.</p><p id="par0015" class="elsevierStylePara elsevierViewall">He did not report chest pain or respiratory difficulty. His past history included a bladder tumor that was in remission. A chest x-ray and abdominal ultrasound performed 2 years earlier had shown no alterations. Physical examination revealed telangiectasias in a vertical distribution, most prominent on the left hemithorax, with no other changes and no other dilated, larger caliber vessels (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). There were no relevant findings on examination of the face and neck and no palpable masses or lymph nodes. In view of the intensity of the symptoms reported by the patient, cervical and thoracic computed tomography (CT) was requested to rule out an underlying lesion. The CT revealed a retrosternal mass of 5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2.5<span class="elsevierStyleHsp" style=""></span>cm with enlarged perilesional and pericardial lymph nodes and compression of the superior vena cava (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The differential diagnosis included teratoma, lymphoma, and thymoma. The patient did not report weight loss or night sweats, and his general state of health was normal. Cytology from a fine-needle aspiration biopsy was compatible with thymoma. The patient was evaluated by the thoracic surgeons and the tumor was considered inoperable. The final diagnosis was malignant sclerosing thymoma. Studies of tumor spread excluded metastatic disease and there were no symptoms of paraneoplastic syndromes, such as myasthenia gravis. The patient started combined treatment with adriamycin and radiation therapy with a partial regression of the mass. The telangiectases did not vary, but the pruritus reported by the patient resolved with the treatment.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Thymoma is the most common tumor of the anterosuperior mediastinum. It typically starts in the midline and spreads unilaterally. Symptoms described by patients with thymoma can be due to the mass effect, such as chest pain, respiratory difficulty, cough, or superior vena cava syndrome.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1–3</span></a> This syndrome occurs when venous return from the upper part of the body is obstructed. One of the earliest and most prominent signs of this syndrome is the appearance of numerous vertically orientated, dilated and tortuous capillaries and venules.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> Other typical signs of superior vena cava syndrome are edema of the face and of the upper limbs, cyanosis, and visual changes due to papilledema. Bruno et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> published a case caused by lymphoma in which the patient also presented a transient skin rash and telangiectases. Other causes of telangiectases on the chest wall are chronic actinic damage and poikiloderma, essential telangiectasia, connective tissue diseases such as lupus, dermatomyositis or scleroderma, hyperestrogenic states such as cirrhosis and pregnancy, and malignant causes such as intravascular B-cell lymphoma or skin metastases.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Other manifestations in patients with thymoma include a high prevalence of infections and immunological disturbances.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> Myasthenia gravis develops in at least 30% of patients.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> There have also been cases of red cell aplasia, hypogammaglobulinemia, endocrine disturbances, chronic mucocutaneous candidiasis, connective tissue diseases such as lupus or dermatomyositis, and paraneoplastic pemphigus.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Surgery is the treatment of choice. Patients with advanced invasive thymoma require treatment with radiation therapy and chemotherapy.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> Cases have been seen of invasive thymoma affecting the pleura and lung, thoracic vertebrae, thyroid gland, central nervous system, liver, extrathoracic lymph nodes, and overlying dermis.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">At no time did our patient present extracutaneous symptoms, and it was the skin manifestations that led to the diagnosis of his serious underlying disease. Thus, in a patient with intense pruritus on the chest with no causative skin lesions and/or vertically oriented telangiectasias of rapid onset, we must exclude an intrathoracic space-occupying lesion.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Laguna C. Telangiectasias verticalizadas y prurito en el tórax en un paciente con síndrome de cava superior inicial secundario a un timoma maligno. Actas Dermosifiliogr. 2015;106:331–332.</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" => 662 "Ancho" => 995 "Tamanyo" => 109423 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Telangiectasias on the left hemithorax. Examination revealed no other alterations. The rash described by the patient had resolved at the time of diagnosis.</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" => 662 "Ancho" => 995 "Tamanyo" => 82800 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Detail of the vertically oriented telangiectasias on the skin of the anterior wall of the chest. Examination revealed no dilated vessels of larger diameter.</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" => 732 "Ancho" => 976 "Tamanyo" => 89941 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Computed tomography revealed a tumor in the anterior mediastinum (MT) with compression of the superior vena cava (arrow).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumours of the mediastinum" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B.V. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 8 | 15 |
| 2024 October | 73 | 45 | 118 |
| 2024 September | 73 | 43 | 116 |
| 2024 August | 107 | 71 | 178 |
| 2024 July | 112 | 52 | 164 |
| 2024 June | 94 | 81 | 175 |
| 2024 May | 86 | 52 | 138 |
| 2024 April | 80 | 26 | 106 |
| 2024 March | 69 | 47 | 116 |
| 2024 February | 62 | 38 | 100 |
| 2024 January | 63 | 41 | 104 |
| 2023 December | 76 | 33 | 109 |
| 2023 November | 93 | 40 | 133 |
| 2023 October | 83 | 38 | 121 |
| 2023 September | 74 | 44 | 118 |
| 2023 August | 62 | 28 | 90 |
| 2023 July | 86 | 50 | 136 |
| 2023 June | 85 | 34 | 119 |
| 2023 May | 75 | 43 | 118 |
| 2023 April | 68 | 25 | 93 |
| 2023 March | 72 | 38 | 110 |
| 2023 February | 106 | 36 | 142 |
| 2023 January | 48 | 41 | 89 |
| 2022 December | 72 | 50 | 122 |
| 2022 November | 68 | 39 | 107 |
| 2022 October | 52 | 36 | 88 |
| 2022 September | 55 | 38 | 93 |
| 2022 August | 56 | 69 | 125 |
| 2022 July | 39 | 51 | 90 |
| 2022 June | 24 | 65 | 89 |
| 2022 May | 31 | 42 | 73 |
| 2022 April | 50 | 43 | 93 |
| 2022 March | 42 | 56 | 98 |
| 2022 February | 37 | 23 | 60 |
| 2022 January | 46 | 60 | 106 |
| 2021 December | 38 | 44 | 82 |
| 2021 November | 53 | 64 | 117 |
| 2021 October | 52 | 49 | 101 |
| 2021 September | 35 | 55 | 90 |
| 2021 August | 40 | 55 | 95 |
| 2021 July | 32 | 54 | 86 |
| 2021 June | 36 | 59 | 95 |
| 2021 May | 31 | 40 | 71 |
| 2021 April | 55 | 103 | 158 |
| 2021 March | 50 | 29 | 79 |
| 2021 February | 68 | 24 | 92 |
| 2021 January | 34 | 19 | 53 |
| 2020 December | 40 | 14 | 54 |
| 2020 November | 23 | 10 | 33 |
| 2020 October | 22 | 4 | 26 |
| 2020 September | 58 | 7 | 65 |
| 2020 August | 23 | 23 | 46 |
| 2020 July | 34 | 14 | 48 |
| 2020 June | 36 | 27 | 63 |
| 2020 May | 40 | 29 | 69 |
| 2020 April | 39 | 23 | 62 |
| 2020 March | 35 | 20 | 55 |
| 2020 February | 7 | 6 | 13 |
| 2020 January | 4 | 3 | 7 |
| 2019 December | 8 | 5 | 13 |
| 2019 November | 4 | 5 | 9 |
| 2019 October | 0 | 7 | 7 |
| 2019 September | 10 | 8 | 18 |
| 2019 August | 4 | 5 | 9 |
| 2019 July | 4 | 16 | 20 |
| 2019 June | 4 | 18 | 22 |
| 2019 May | 6 | 34 | 40 |
| 2019 April | 2 | 5 | 7 |
| 2019 March | 0 | 4 | 4 |
| 2019 February | 4 | 3 | 7 |
| 2019 January | 2 | 0 | 2 |
| 2018 December | 0 | 1 | 1 |
| 2018 November | 2 | 2 | 4 |
| 2018 October | 0 | 8 | 8 |
| 2018 September | 7 | 1 | 8 |
| 2018 August | 0 | 7 | 7 |
| 2018 July | 0 | 22 | 22 |
| 2018 June | 0 | 13 | 13 |
| 2018 May | 0 | 6 | 6 |
| 2018 April | 0 | 6 | 6 |
| 2018 March | 12 | 3 | 15 |
| 2018 February | 44 | 5 | 49 |
| 2018 January | 49 | 7 | 56 |
| 2017 December | 85 | 13 | 98 |
| 2017 November | 39 | 13 | 52 |
| 2017 October | 30 | 10 | 40 |
| 2017 September | 33 | 13 | 46 |
| 2017 August | 49 | 8 | 57 |
| 2017 July | 46 | 10 | 56 |
| 2017 June | 40 | 19 | 59 |
| 2017 May | 38 | 13 | 51 |
| 2017 April | 50 | 17 | 67 |
| 2017 March | 17 | 18 | 35 |
| 2017 February | 19 | 7 | 26 |
| 2017 January | 22 | 16 | 38 |
| 2016 December | 33 | 11 | 44 |
| 2016 November | 43 | 23 | 66 |
| 2016 October | 32 | 8 | 40 |
| 2016 September | 0 | 6 | 6 |
| 2016 August | 0 | 3 | 3 |
| 2016 July | 9 | 1 | 10 |
| 2016 June | 8 | 1 | 9 |
| 2016 May | 13 | 6 | 19 |
| 2016 April | 9 | 5 | 14 |
| 2016 March | 15 | 1 | 16 |
| 2016 February | 10 | 1 | 11 |
| 2016 January | 16 | 1 | 17 |
| 2015 December | 11 | 1 | 12 |
| 2015 November | 6 | 4 | 10 |
| 2015 October | 0 | 1 | 1 |
| 2015 August | 0 | 1 | 1 |
| 2015 July | 18 | 4 | 22 |
| 2015 June | 12 | 6 | 18 |
| 2015 May | 14 | 4 | 18 |
Show all
