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." "apellidos" => "Vázquez-Veiga" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731014004554" "doi" => "10.1016/j.ad.2014.10.002" "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/S0001731014004554?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015000645?idApp=UINPBA000044" "url" => "/15782190/0000010600000004/v2_201505051007/S1578219015000645/v2_201505051007/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1578219015000621" "issn" => "15782190" "doi" => "10.1016/j.adengl.2015.03.012" "estado" => "S300" "fechaPublicacion" => "2015-05-01" "aid" => "1066" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2015;106:329-31" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1532 "formatos" => array:3 [ "EPUB" => 53 "HTML" => 1252 "PDF" => 227 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Herpes Zoster in Children Vaccinated Against Varicella-Zoster Virus: Experience in our Hospital" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "329" "paginaFinal" => "331" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Herpes zóster en niños vacunados contra el virus varicela zóster: experiencia en nuestro hospital" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 884 "Ancho" => 1600 "Tamanyo" => 182550 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical characteristics of the herpes zoster lesions in 4 of the patients in our series.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. 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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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 6 | 8 | 14 |
| 2024 Octubre | 73 | 45 | 118 |
| 2024 Septiembre | 73 | 43 | 116 |
| 2024 Agosto | 107 | 71 | 178 |
| 2024 Julio | 112 | 52 | 164 |
| 2024 Junio | 94 | 81 | 175 |
| 2024 Mayo | 86 | 52 | 138 |
| 2024 Abril | 80 | 26 | 106 |
| 2024 Marzo | 69 | 47 | 116 |
| 2024 Febrero | 62 | 38 | 100 |
| 2024 Enero | 63 | 41 | 104 |
| 2023 Diciembre | 76 | 33 | 109 |
| 2023 Noviembre | 93 | 40 | 133 |
| 2023 Octubre | 83 | 38 | 121 |
| 2023 Septiembre | 74 | 44 | 118 |
| 2023 Agosto | 62 | 28 | 90 |
| 2023 Julio | 86 | 50 | 136 |
| 2023 Junio | 85 | 34 | 119 |
| 2023 Mayo | 75 | 43 | 118 |
| 2023 Abril | 68 | 25 | 93 |
| 2023 Marzo | 72 | 38 | 110 |
| 2023 Febrero | 106 | 36 | 142 |
| 2023 Enero | 48 | 41 | 89 |
| 2022 Diciembre | 72 | 50 | 122 |
| 2022 Noviembre | 68 | 39 | 107 |
| 2022 Octubre | 52 | 36 | 88 |
| 2022 Septiembre | 55 | 38 | 93 |
| 2022 Agosto | 56 | 69 | 125 |
| 2022 Julio | 39 | 51 | 90 |
| 2022 Junio | 24 | 65 | 89 |
| 2022 Mayo | 31 | 42 | 73 |
| 2022 Abril | 50 | 43 | 93 |
| 2022 Marzo | 42 | 56 | 98 |
| 2022 Febrero | 37 | 23 | 60 |
| 2022 Enero | 46 | 60 | 106 |
| 2021 Diciembre | 38 | 44 | 82 |
| 2021 Noviembre | 53 | 64 | 117 |
| 2021 Octubre | 52 | 49 | 101 |
| 2021 Septiembre | 35 | 55 | 90 |
| 2021 Agosto | 40 | 55 | 95 |
| 2021 Julio | 32 | 54 | 86 |
| 2021 Junio | 36 | 59 | 95 |
| 2021 Mayo | 31 | 40 | 71 |
| 2021 Abril | 55 | 103 | 158 |
| 2021 Marzo | 50 | 29 | 79 |
| 2021 Febrero | 68 | 24 | 92 |
| 2021 Enero | 34 | 19 | 53 |
| 2020 Diciembre | 40 | 14 | 54 |
| 2020 Noviembre | 23 | 10 | 33 |
| 2020 Octubre | 22 | 4 | 26 |
| 2020 Septiembre | 58 | 7 | 65 |
| 2020 Agosto | 23 | 23 | 46 |
| 2020 Julio | 34 | 14 | 48 |
| 2020 Junio | 36 | 27 | 63 |
| 2020 Mayo | 40 | 29 | 69 |
| 2020 Abril | 39 | 23 | 62 |
| 2020 Marzo | 35 | 20 | 55 |
| 2020 Febrero | 7 | 6 | 13 |
| 2020 Enero | 4 | 3 | 7 |
| 2019 Diciembre | 8 | 5 | 13 |
| 2019 Noviembre | 4 | 5 | 9 |
| 2019 Octubre | 0 | 7 | 7 |
| 2019 Septiembre | 10 | 8 | 18 |
| 2019 Agosto | 4 | 5 | 9 |
| 2019 Julio | 4 | 16 | 20 |
| 2019 Junio | 4 | 18 | 22 |
| 2019 Mayo | 6 | 34 | 40 |
| 2019 Abril | 2 | 5 | 7 |
| 2019 Marzo | 0 | 4 | 4 |
| 2019 Febrero | 4 | 3 | 7 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 0 | 1 | 1 |
| 2018 Noviembre | 2 | 2 | 4 |
| 2018 Octubre | 0 | 8 | 8 |
| 2018 Septiembre | 7 | 1 | 8 |
| 2018 Agosto | 0 | 7 | 7 |
| 2018 Julio | 0 | 22 | 22 |
| 2018 Junio | 0 | 13 | 13 |
| 2018 Mayo | 0 | 6 | 6 |
| 2018 Abril | 0 | 6 | 6 |
| 2018 Marzo | 12 | 3 | 15 |
| 2018 Febrero | 44 | 5 | 49 |
| 2018 Enero | 49 | 7 | 56 |
| 2017 Diciembre | 85 | 13 | 98 |
| 2017 Noviembre | 39 | 13 | 52 |
| 2017 Octubre | 30 | 10 | 40 |
| 2017 Septiembre | 33 | 13 | 46 |
| 2017 Agosto | 49 | 8 | 57 |
| 2017 Julio | 46 | 10 | 56 |
| 2017 Junio | 40 | 19 | 59 |
| 2017 Mayo | 38 | 13 | 51 |
| 2017 Abril | 50 | 17 | 67 |
| 2017 Marzo | 17 | 18 | 35 |
| 2017 Febrero | 19 | 7 | 26 |
| 2017 Enero | 22 | 16 | 38 |
| 2016 Diciembre | 33 | 11 | 44 |
| 2016 Noviembre | 43 | 23 | 66 |
| 2016 Octubre | 32 | 8 | 40 |
| 2016 Septiembre | 0 | 6 | 6 |
| 2016 Agosto | 0 | 3 | 3 |
| 2016 Julio | 9 | 1 | 10 |
| 2016 Junio | 8 | 1 | 9 |
| 2016 Mayo | 13 | 6 | 19 |
| 2016 Abril | 9 | 5 | 14 |
| 2016 Marzo | 15 | 1 | 16 |
| 2016 Febrero | 10 | 1 | 11 |
| 2016 Enero | 16 | 1 | 17 |
| 2015 Diciembre | 11 | 1 | 12 |
| 2015 Noviembre | 6 | 4 | 10 |
| 2015 Octubre | 0 | 1 | 1 |
| 2015 Agosto | 0 | 1 | 1 |
| 2015 Julio | 18 | 4 | 22 |
| 2015 Junio | 12 | 6 | 18 |
| 2015 Mayo | 14 | 4 | 18 |
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