Case for diagnosis
Sessile Nodule on the Gingival Mucosa
Nódulo sésil en mucosa gingival
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He was referred with a 2-week history of a single asymptomatic lesion in the mouth that caused occasional bleeding and discomfort when eating.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Examination revealed a sessile, exophytic nodule with a fleshy appearance and smooth surface; it measured 8<span class="elsevierStyleHsp" style=""></span>mm in diameter and was located on the inner surface of the lower gum (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The general assessment of the patient confirmed the absence of palpable locoregional lymph nodes or associated skin or mucosal lesions.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">The lesion was removed by shave excision, followed by coagulation of the base. Histologic examination by hematoxylin-eosin staining revealed a diffuse dermal proliferation of spindle cells that penetrated between the collagen bundles, along with the formation of blood-filled vascular spaces (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Several preexisting blood vessels were also observed protruding towards the newly formed vessels (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Immunohistochemistry was positive for herpes virus type 8 (HHV-8).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Oral Kaposi sarcoma.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Course</span><p id="par0030" class="elsevierStylePara elsevierViewall">Screening studies excluded visceral involvement. The lesion was completely removed by shave excision at the first visit and required no additional treatment.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">Kaposi sarcoma is the most commonly diagnosed tumor in patients with acquired immunodeficiency syndrome and accounts for 90% of all cancers in this group.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The oral cavity is a common site of epidemic Kaposi sarcoma and it is estimated that 71% of HIV-positive patients with Kaposi sarcoma present lesions in this location. In 22% of cases the tumor initially presents in the mouth.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The most common clinical manifestations are dark red to violaceous macules and ulcerated nodular lesions, mainly located on the palate.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Favorable conditions created by HIV infection include a predominance of T<span class="elsevierStyleInf">H</span>1 cytokines, such as interferon-gamma, tumor necrosis factor alpha, and interleukins 1 and 6, all of which are known to induce Kaposi sarcoma.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The introduction of HAART promotes the healing of Kaposi sarcoma lesions and prevents the appearance of others, mainly due to the reduction of the HIV and HHV-8 load<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> and a decrease in antiangiogenic and antiinflammatory factors. However, after starting treatment with HAART, patients may also experience inflammatory immune reconstitution syndrome, a paradoxical reaction, with exacerbation of opportunistic infections in the context of immunological recovery.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The example we present is the result of the combination of both factors: immune response to a preexisting opportunistic HHV-8 infection and the inflammatory component of inflammatory immune reconstitution syndrome (reflected by the rapid growth and pedunculated form of the tumor).</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" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical Course" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 6 => 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: Catalá A, et al. Nódulo sésil en mucosa gingival. Actas Dermosifiliogr.2012;103:433-4.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 599 "Ancho" => 475 "Tamanyo" => 71313 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 788 "Ancho" => 665 "Tamanyo" => 276181 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×5.</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" => 501 "Ancho" => 665 "Tamanyo" => 147724 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×20.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalencia y características de las dermatosis relacionadas con la infección por VIH en la actualidad" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. 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Lemmer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1750-9378-3-1" "Revista" => array:5 [ "tituloSerie" => "Infect Agent Cancer" "fecha" => "2008" "volumen" => "3" "paginaInicial" => "1" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18208585" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010300000005/v1_201304241308/S1578219012001746/v1_201304241308/en/main.assets" "Apartado" => array:4 [ "identificador" => "6171" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Cases for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010300000005/v1_201304241308/S1578219012001746/v1_201304241308/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012001746?idApp=UINPBA000044" ]
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|---|---|---|---|
| 2024 Noviembre | 16 | 12 | 28 |
| 2024 Octubre | 127 | 33 | 160 |
| 2024 Septiembre | 128 | 19 | 147 |
| 2024 Agosto | 141 | 60 | 201 |
| 2024 Julio | 115 | 34 | 149 |
| 2024 Junio | 106 | 27 | 133 |
| 2024 Mayo | 117 | 26 | 143 |
| 2024 Abril | 91 | 24 | 115 |
| 2024 Marzo | 79 | 27 | 106 |
| 2024 Febrero | 72 | 29 | 101 |
| 2024 Enero | 60 | 31 | 91 |
| 2023 Diciembre | 77 | 13 | 90 |
| 2023 Noviembre | 73 | 30 | 103 |
| 2023 Octubre | 58 | 20 | 78 |
| 2023 Septiembre | 60 | 29 | 89 |
| 2023 Agosto | 41 | 13 | 54 |
| 2023 Julio | 40 | 30 | 70 |
| 2023 Junio | 48 | 21 | 69 |
| 2023 Mayo | 54 | 28 | 82 |
| 2023 Abril | 44 | 27 | 71 |
| 2023 Marzo | 47 | 22 | 69 |
| 2023 Febrero | 51 | 19 | 70 |
| 2023 Enero | 41 | 28 | 69 |
| 2022 Diciembre | 59 | 40 | 99 |
| 2022 Noviembre | 41 | 21 | 62 |
| 2022 Octubre | 25 | 20 | 45 |
| 2022 Septiembre | 33 | 44 | 77 |
| 2022 Agosto | 26 | 42 | 68 |
| 2022 Julio | 19 | 33 | 52 |
| 2022 Junio | 31 | 17 | 48 |
| 2022 Mayo | 62 | 40 | 102 |
| 2022 Abril | 114 | 41 | 155 |
| 2022 Marzo | 70 | 66 | 136 |
| 2022 Febrero | 59 | 25 | 84 |
| 2022 Enero | 99 | 35 | 134 |
| 2021 Diciembre | 72 | 29 | 101 |
| 2021 Noviembre | 63 | 34 | 97 |
| 2021 Octubre | 112 | 48 | 160 |
| 2021 Septiembre | 58 | 37 | 95 |
| 2021 Agosto | 80 | 23 | 103 |
| 2021 Julio | 84 | 25 | 109 |
| 2021 Junio | 53 | 28 | 81 |
| 2021 Mayo | 82 | 41 | 123 |
| 2021 Abril | 215 | 80 | 295 |
| 2021 Marzo | 153 | 23 | 176 |
| 2021 Febrero | 97 | 27 | 124 |
| 2021 Enero | 57 | 19 | 76 |
| 2020 Diciembre | 81 | 17 | 98 |
| 2020 Noviembre | 39 | 24 | 63 |
| 2020 Octubre | 72 | 20 | 92 |
| 2020 Septiembre | 47 | 11 | 58 |
| 2020 Agosto | 36 | 15 | 51 |
| 2020 Julio | 40 | 11 | 51 |
| 2020 Junio | 41 | 23 | 64 |
| 2020 Mayo | 36 | 13 | 49 |
| 2020 Abril | 44 | 18 | 62 |
| 2020 Marzo | 39 | 20 | 59 |
| 2020 Febrero | 4 | 0 | 4 |
| 2020 Enero | 4 | 2 | 6 |
| 2019 Diciembre | 8 | 2 | 10 |
| 2019 Noviembre | 4 | 3 | 7 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 7 | 2 | 9 |
| 2019 Agosto | 4 | 5 | 9 |
| 2019 Julio | 4 | 8 | 12 |
| 2019 Junio | 6 | 16 | 22 |
| 2019 Mayo | 4 | 20 | 24 |
| 2019 Abril | 4 | 10 | 14 |
| 2019 Marzo | 2 | 14 | 16 |
| 2019 Febrero | 2 | 1 | 3 |
| 2019 Enero | 2 | 3 | 5 |
| 2018 Noviembre | 3 | 0 | 3 |
| 2018 Octubre | 5 | 0 | 5 |
| 2018 Septiembre | 3 | 0 | 3 |
| 2018 Junio | 0 | 1 | 1 |
| 2018 Mayo | 0 | 3 | 3 |
| 2018 Abril | 0 | 2 | 2 |
| 2018 Marzo | 17 | 1 | 18 |
| 2018 Febrero | 77 | 4 | 81 |
| 2018 Enero | 60 | 11 | 71 |
| 2017 Diciembre | 108 | 9 | 117 |
| 2017 Noviembre | 46 | 9 | 55 |
| 2017 Octubre | 59 | 7 | 66 |
| 2017 Septiembre | 46 | 21 | 67 |
| 2017 Agosto | 58 | 24 | 82 |
| 2017 Julio | 44 | 9 | 53 |
| 2017 Junio | 75 | 27 | 102 |
| 2017 Mayo | 53 | 10 | 63 |
| 2017 Abril | 49 | 15 | 64 |
| 2017 Marzo | 28 | 45 | 73 |
| 2017 Febrero | 50 | 6 | 56 |
| 2017 Enero | 42 | 19 | 61 |
| 2016 Diciembre | 57 | 6 | 63 |
| 2016 Noviembre | 97 | 22 | 119 |
| 2016 Octubre | 104 | 26 | 130 |
| 2016 Septiembre | 101 | 13 | 114 |
| 2016 Agosto | 88 | 12 | 100 |
| 2016 Julio | 56 | 16 | 72 |
| 2016 Junio | 16 | 0 | 16 |
| 2016 Mayo | 6 | 15 | 21 |
| 2016 Abril | 4 | 0 | 4 |
| 2016 Marzo | 6 | 2 | 8 |
| 2016 Febrero | 9 | 7 | 16 |
| 2016 Enero | 4 | 0 | 4 |
| 2015 Diciembre | 9 | 2 | 11 |
| 2015 Noviembre | 18 | 6 | 24 |
| 2015 Octubre | 15 | 0 | 15 |
| 2015 Septiembre | 5 | 9 | 14 |
| 2015 Agosto | 8 | 4 | 12 |
| 2015 Julio | 137 | 13 | 150 |
| 2015 Junio | 79 | 6 | 85 |
| 2015 Mayo | 94 | 7 | 101 |
| 2015 Abril | 94 | 13 | 107 |
| 2015 Marzo | 102 | 10 | 112 |
| 2015 Febrero | 110 | 8 | 118 |
| 2015 Enero | 103 | 22 | 125 |
| 2014 Diciembre | 87 | 12 | 99 |
| 2014 Noviembre | 81 | 18 | 99 |
| 2014 Octubre | 109 | 19 | 128 |
| 2014 Septiembre | 87 | 15 | 102 |
| 2014 Agosto | 89 | 19 | 108 |
| 2014 Julio | 108 | 24 | 132 |
| 2014 Junio | 113 | 13 | 126 |
| 2014 Mayo | 47 | 6 | 53 |
| 2014 Abril | 45 | 4 | 49 |
| 2014 Marzo | 53 | 7 | 60 |
| 2014 Febrero | 50 | 9 | 59 |
| 2014 Enero | 35 | 4 | 39 |
| 2013 Diciembre | 41 | 7 | 48 |
| 2013 Noviembre | 38 | 9 | 47 |
| 2013 Octubre | 25 | 5 | 30 |
| 2013 Septiembre | 30 | 4 | 34 |
| 2013 Agosto | 18 | 5 | 23 |
| 2013 Julio | 5 | 17 | 22 |
| 2013 Junio | 8 | 12 | 20 |
| 2013 Mayo | 12 | 11 | 23 |
| 2013 Abril | 19 | 8 | 27 |
| 2013 Marzo | 16 | 7 | 23 |
| 2013 Febrero | 28 | 3 | 31 |
| 2013 Enero | 37 | 7 | 44 |
| 2012 Diciembre | 13 | 7 | 20 |
| 2012 Noviembre | 0 | 3 | 3 |
| 2012 Agosto | 2 | 2 | 4 |
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