Case for Diagnosis
Violaceous erythematous plaques on a lower limb
Placas eritematovioláceas en miembro inferior
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La belleza «radiante»" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1013 "Ancho" => 805 "Tamanyo" => 193370 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Advertisement for Ramey’s Crème Radiacée, which not only made skin feel velvety and removed wrinkles but also regenerated the epidermis. <span class="elsevierStyleInterRef" id="intr0015" href="http://media.topito.com/wp-content/uploads/2015/04/500x603xramey-e1295787652834.jpeg.pagespeed.ic_.G-sZwoBPZR.jpg">http://media.topito.com/wp-content/uploads/2015/04/500x603xramey-e1295787652834.jpeg.pagespeed.ic_.G-sZwoBPZR.jpg</span>.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R.M. 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Villegas-Romero, K. Tello-Collantes, D. Jiménez-Gallo" "autores" => array:3 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "Villegas-Romero" "email" => array:1 [ 0 => "imvr91@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "K." "apellidos" => "Tello-Collantes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "D." "apellidos" => "Jiménez-Gallo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Puerta del Mar, Cádiz, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Puerta del Mar, Cádiz, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Placas eritematovioláceas en miembro inferior" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1250 "Ancho" => 1250 "Tamanyo" => 162829 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">An 8-month-old boy consulted for a lesion on the right lower limb that had been present from birth. Since then, it had grown progressively, although its appearance remained unchanged. The patient’s medical history revealed no diseases of note. After a controlled pregnancy, he had been born at full term by caesarean section, without complications.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed 5 well-defined, dark red plaques, the largest of which was 1.5 cm long, that had irregular borders and were distributed between the medial malleolus and the dorsum of the right foot (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Dermoscopy showed wine colored dots on a homogeneous pink background (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Histology showed an orthokeratotic epidermis with acanthosis and papillomatosis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A) and dilated vessels in a lobular pattern, surrounded by scant perivascular inflammatory infiltrate in the superficial and deep dermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B and C). Immunohistochemical staining was positive for Wilms tumor 1 (WT1) and glucose transporter 1 (GLUT1) and negative for D2-40 (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">Ultrasound showed that the lesions were superficial, and revealed a slight increase in soft tissue thickness in the medial dorsal region of the right foot, with no detectable flow. A complete laboratory work-up revealed no alterations in the hemogram, liver or kidney profile, or D-dimer levels.</p></span><span id="sec0021" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0021">What is Your Diagnosis?</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Verrucous venous malformation (VVM).</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Course and Treatment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Daily topical treatment with 0.5% timolol was prescribed for 6 months, but was discontinued in the absence of any improvement.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">VVM is a vascular anomaly. There has been much discussion as to whether it constitutes a malformation or a tumor. The lesions, which are usually present at birth or appear in early childhood, consist of single or multiple dark red patches. These most frequently occur on the lower limbs, tend to darken, thicken, and become hyperkeratotic, and rarely undergo remission.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> VVM is characterized by compact hyperkeratosis of the epidermis and papillomatosis, irregular acanthosis, and dilated capillaries in the papillary and deep dermis and the subcutaneous cellular tissue.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Although its clinical characteristics resemble those of a vascular malformation, it was initially considered a vascular tumor by the International Society for the Study of Vascular Anomalies due to its positive immunostaining for WT1 and GLUT1.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Clinically, VVM can be confused with other vascular lesions, such as angiokeratoma, and with capillary, venous, and lymphatic vascular malformations that are negative for GLUT1 and WT1, despite displaying hyperkeratosis and acanthosis.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Recently, Couto et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> described the presence in VVM tissue of a somatic missense mutation in mitogen-activated protein kinase kinase kinase 3, which is involved in the angiopoietin-1 and tunica intima endothelial cell kinase signaling cascade, and is implicated in both hereditary and sporadic venous malformations.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Based on its clinical course and recent genetic findings, VVM is currently considered a venous malformation,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> despite its immunohistochemical characteristics.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Additional Tests" ] 4 => array:3 [ "identificador" => "sec0021" "titulo" => "What is Your Diagnosis?" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Diagnosis" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Clinical Course and Treatment" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Comment" ] ] ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of Interest" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Villegas-Romero I, Tello-Collantes K, Jiménez-Gallo D. Placas eritematovioláceas en miembro inferior. Actas Dermosifiliogr. 2020;111:861–862.</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" => 1250 "Ancho" => 1250 "Tamanyo" => 162829 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1333 "Ancho" => 1333 "Tamanyo" => 593849 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×1 (A) and ×10 (B and C).</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 884 "Ancho" => 1333 "Tamanyo" => 274581 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemistry for glucose transporter 1 (GLUT1) (A), Wilms tumor 1 (WT1) (B), and D2-40 (C); original magnification ×10.</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" => "Linear verrucous hemangioma-a rare case and dermoscopic clues to diagnosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 4 | 6 |
| 2024 October | 91 | 41 | 132 |
| 2024 September | 96 | 20 | 116 |
| 2024 August | 109 | 62 | 171 |
| 2024 July | 112 | 35 | 147 |
| 2024 June | 111 | 37 | 148 |
| 2024 May | 97 | 31 | 128 |
| 2024 April | 70 | 23 | 93 |
| 2024 March | 82 | 33 | 115 |
| 2024 February | 84 | 29 | 113 |
| 2024 January | 76 | 37 | 113 |
| 2023 December | 65 | 13 | 78 |
| 2023 November | 100 | 27 | 127 |
| 2023 October | 85 | 23 | 108 |
| 2023 September | 62 | 24 | 86 |
| 2023 August | 46 | 16 | 62 |
| 2023 July | 75 | 36 | 111 |
| 2023 June | 51 | 18 | 69 |
| 2023 May | 73 | 27 | 100 |
| 2023 April | 38 | 22 | 60 |
| 2023 March | 68 | 28 | 96 |
| 2023 February | 54 | 30 | 84 |
| 2023 January | 65 | 24 | 89 |
| 2022 December | 68 | 43 | 111 |
| 2022 November | 20 | 25 | 45 |
| 2022 October | 32 | 18 | 50 |
| 2022 September | 21 | 38 | 59 |
| 2022 August | 22 | 38 | 60 |
| 2022 July | 22 | 37 | 59 |
| 2022 June | 24 | 19 | 43 |
| 2022 May | 82 | 53 | 135 |
| 2022 April | 69 | 26 | 95 |
| 2022 March | 89 | 62 | 151 |
| 2022 February | 62 | 21 | 83 |
| 2022 January | 89 | 43 | 132 |
| 2021 December | 76 | 48 | 124 |
| 2021 November | 68 | 54 | 122 |
| 2021 October | 73 | 73 | 146 |
| 2021 September | 57 | 54 | 111 |
| 2021 August | 52 | 51 | 103 |
| 2021 July | 35 | 42 | 77 |
| 2021 June | 35 | 43 | 78 |
| 2021 May | 56 | 50 | 106 |
| 2021 April | 155 | 88 | 243 |
| 2021 March | 123 | 65 | 188 |
| 2021 February | 76 | 69 | 145 |
| 2021 January | 73 | 47 | 120 |
| 2020 December | 39 | 25 | 64 |
| 2020 November | 27 | 19 | 46 |
| 2020 October | 5 | 8 | 13 |
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