Case and Research Letters
Advanced-Stage Thymoma Associating Multiple Paraneoplastic Syndromes with Good Response to Oral Corticosteroids and Topical Tacrolimus
Timoma de estadio avanzado asociado a síndromes paraneoplásicos con buena respuesta a los corticosteroides orales y tacrolimus tópico
Leído
5908
Vecesse ha leído el artículo
2105
Total PDF
3803
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S1578219018302695" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.07.016" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "1945" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2018" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2019;110:60-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6 "formatos" => array:2 [ "HTML" => 3 "PDF" => 3 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731018301595" "issn" => "00017310" "doi" => "10.1016/j.ad.2017.09.025" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "1945" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2019;110:60-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 356 "formatos" => array:2 [ "HTML" => 196 "PDF" => 160 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científico-clínica</span>" "titulo" => "Timoma de estadio avanzado asociado a síndromes paraneoplásicos con buena respuesta a los corticosteroides orales y tacrolimus tópico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "60" "paginaFinal" => "62" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Advanced-Stage Thymoma Associating Multiple Paraneoplastic Syndromes with Good Response to Oral Corticosteroids and Topical Tacrolimus" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2444 "Ancho" => 3083 "Tamanyo" => 897717 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Antes del tratamiento. TAC: masa tumoral del timoma y metástasis pulmonar (a). A bajos aumentos la biopsia con aguja del timoma presenta predominio de poblaciones de células pequeñas hematoxilina-eosina (H&E), ×20) (b). A mayores aumentos se observan células tumorales epiteliales más grandes positivas para citoqueratina y numerosos linfocitos, AE1-AE3, ×400 (c). Erupción cutánea (d). Hiperplasia epidérmica con numerosos queratinocitos apoptóticos, H&E, ×200 (e). Queratinocitos apoptóticos con linfocitos satélites, H&E, ×400 (f). Lesiones orales (g). Escáner aumentado que muestra lesión bullosa con daño extensivo de células basales, H&E, ×20 (h). El paladar presenta queratinocitos apoptóticos con linfocitos satélites, H&E, ×400 (i).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Sánchez-Pérez, C. Monteagudo-Castro, J.M. Martín-Hernández, M.D. Ramón-Quiles" "autores" => array:4 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Sánchez-Pérez" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Monteagudo-Castro" ] 2 => array:2 [ "nombre" => "J.M." "apellidos" => "Martín-Hernández" ] 3 => array:2 [ "nombre" => "M.D." "apellidos" => "Ramón-Quiles" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219018302695" "doi" => "10.1016/j.adengl.2018.07.016" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018302695?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018301595?idApp=UINPBA000044" "url" => "/00017310/0000011000000001/v1_201901030610/S0001731018301595/v1_201901030610/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219018304025" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.11.006" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "1908" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2019;110:63-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 7 "formatos" => array:2 [ "HTML" => 3 "PDF" => 4 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Mastocytosis With Associated Essential Thrombocythemia" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "63" "paginaFinal" => "64" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mastocitosis asociada a trombocitemia esencial" ] ] "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" => 1031 "Ancho" => 1517 "Tamanyo" => 216050 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical appearance of maculopapular mastocytosis lesions on the thighs (A) and forearm (B).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Marcoval" "autores" => array:1 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Marcoval" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S000173101830070X" "doi" => "10.1016/j.ad.2017.10.022" "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/S000173101830070X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018304025?idApp=UINPBA000044" "url" => "/15782190/0000011000000001/v1_201901030631/S1578219018304025/v1_201901030631/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219018303986" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.11.003" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "1959" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2019;110:57-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1 "PDF" => 1 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Granulocyte Colony-Stimulating Factor (G-Csf)–Producing Giant Squamous Cell Carcinoma of the Scrotum" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "57" "paginaFinal" => "59" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Carcinoma en escroto de células escamosas gigantes productor de factor estimulante de colonias de granulocitos (G-CSF)" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1887 "Ancho" => 2500 "Tamanyo" => 709976 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histologic examination of the fully resected tumor showed undifferentiated atypical squamous cells with extravasation and multiple thrombi (A) (original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>200). The cells were positive for p40 (B) and AE1/AE3 (C) and negative for CD31 (D) (original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>100).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Takako, K. Yasunobu, Y. Toshiyuki" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Takako" ] 1 => array:2 [ "nombre" => "K." "apellidos" => "Yasunobu" ] 2 => array:2 [ "nombre" => "Y." "apellidos" => "Toshiyuki" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731018301972" "doi" => "10.1016/j.ad.2018.03.017" "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/S0001731018301972?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018303986?idApp=UINPBA000044" "url" => "/15782190/0000011000000001/v1_201901030631/S1578219018303986/v1_201901030631/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Advanced-Stage Thymoma Associating Multiple Paraneoplastic Syndromes with Good Response to Oral Corticosteroids and Topical Tacrolimus" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "60" "paginaFinal" => "62" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "S. Sánchez-Pérez, C. Monteagudo-Castro, J.M. Martín-Hernández, M.D. Ramón-Quiles" "autores" => array:4 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Sánchez-Pérez" "email" => array:1 [ 0 => "ssanchez.derma@gmail.com" ] "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" => "C." "apellidos" => "Monteagudo-Castro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J.M." "apellidos" => "Martín-Hernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "M.D." "apellidos" => "Ramón-Quiles" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Dermatología, Hospital Clínico Universitario de Valencia, Valencia, España" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Patología, Hospital Clínico Universitario de Valencia, Valencia, España" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Timoma de estadio avanzado asociado a síndromes paraneoplásicos con buena respuesta a los corticosteroides orales y tacrolimus tópico" ] ] "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" => 1390 "Ancho" => 2333 "Tamanyo" => 491136 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cutaneous rash, elementary lesions.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Paraneoplastic autoimmune syndromes related to thymoma like myasthenia gravis, lupus erythematosus, hypogammaglobulinemia and cytopenia are well-known. Less frequently, this immune dysregulation can lead to different skin manifestations such as bullous diseases, lichen planus, alopecia or TAMA (“thymoma-associated multiorgan autoimmunity”).<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 46-year-old male diagnosed with bone narrow aplasia associated with an unresectable advanced stage thymoma (Type B1/B2, Masaoka stage IVa) was referred to our department. He received multiple lines of chemotherapy (discontinued 3 moths ago) with stabilization of the tumour and he was treated with cyclosporine for 1 year because of the aplasia, which appeared prior to systemic treatments and linked to the autoinmune process triggered by the thymoma.</p><p id="par0015" class="elsevierStylePara elsevierViewall">He had a two-week history of pruritic skin rash showing multiple papular keratotic lesions located on the extremities and trunk (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> a, b). He also had a marked periorbital and peribuccal hyperpigmented lesions, dryness and scaling of the lips and painful eroded whitish reticulated lesions involving the tongue and oral mucosa. Progressive dysphagia and persistent diarrhoea were also present. No blood transfusions or solid-organ transplantation were performed before the onset of the lesions. (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> a, d, g).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Laboratory tests showed no liver or renal anomalies, no hypogammaglobulinemia, but mild positive anti-nuclear and double strand-DNA autoantibodies. Endoscopic findings were submucosal hemorrhages. Stool exams were negative.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Cutaneous and mucosal biopsies were performed. Histopathology of the skin lesion revealed moderate epidermal hyperplasia with parakeratosis and an interface dermatitis with numerous apoptotic epidermal keratinocytes, some of them with satellite lymphocytes. The underlying dermis showed mild lymphocytic perivascular infiltrate. Intraepidermal lymphocytes were predominantly CD4-positive, with a minor component of CD8-positive cells. These findings were consistent with TAMA. Mucosal biopsy was consistent with erosive oral lichen planus. (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> b, c, e, f, h, i).</p><p id="par0030" class="elsevierStylePara elsevierViewall">Oral prednisone (30<span class="elsevierStyleHsp" style=""></span>mg/day) was initiated with slow improvement of the lesions and relapse after dose reducing. Mucosal lesions quickly improved after two months with topical 0.0001% tacrolimus solution two times a day. Cyclosporine was removed and computerized tomography showed decrease in thymoma tumoral mass despite treatment with corticosteroids as monotherapy for a year. (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a> a, b, c).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Thymoma-associated multi-organ auotimmunity (TAMA) is a term fisrt proposed by Wadhera et al in 2007 which describes a multi-organ disease (mainly affecting the liver, intestine and skin) in the setting of a malignant thymoma with clinical and histological findings overlapping those of the graft-vs-host disease but in the absence of hematopoietic transplantation.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> To our best knowledge there are only abut 30 cases of TAMA published in the current literature and it mainly affects middle-aged patients of both sexes with slight female predominance.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> The involved pathogenesis in TAMA is similar to that present in GVHD, so defective T cells originated in a damaged thymus would be unable to differentiate self from foreign antigens, leading to a loss of self-tolerance. Cutaneous lesions in TAMA include an extensive erythematous maculopapular or psoriasiform rash with more or less hyperkeratosis, which can involve the whole body. Differential diagnosis may include true graft-vs-host disease, viral infections, toxicodermia and post-transfusion reactions. TAMA has often a bad outcome, mainly due to opportunistic infections.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5–7</span></a> Moreover, autoinmune disease other than myasthenia gravis are frequently associated with an advanced Masaoka thymoma stage.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Lichen planus has been reported previously as an infrequent finding in patients with thymoma, often found in the context of TAMA and not as an insolated disease. Most cases show an aggresive oral erosive lichen planus which tends to be refractory to treatment and thymectomy does not seem to be effective. Our patient showed an early response to low concentration tacrolimus solution.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2,8</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Multiple systemic treatments (corticosteroids, retinoids, cyclosporine, phototherapy…) have been used in the management of skin lesions associated to thymoma with differents results, however immunosupressive treatments have been related with an increased risk of infections and death. Some authors propose that the treatment must be focused, if possible, on the therapy for thymoma, trying complete resection of the tumour; while others suggest that thymectomy can worsen the course of the autoimmune disease.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2,9,10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In summary, we report a new case of an advanced-stage malignant thymoma associating multiple paraneoplastic syndromes such as TAMA (with skin rash and diarrhoea), erosive oral lichen planus treated with topical tacrolimus, bone narrow aplasia, and positive ANA and ds-DNA autoantibodies. Additionally, despite of unresectable thymoma, the patient is showing an improvement of both tumour and cutaneous rash with the use of prednisone as monotherapy.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">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:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "Références" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Sánchez-Pérez S, Monteagudo-Castro C, Martín-Hernández JM, Ramón-Quiles MD. Timoma de estadio avanzado asociado a síndromes paraneoplásicos con buena respuesta a los corticosteroides orales y tacrolimus tópico. Actas Dermosifiliogr. 2019;110:60–62.</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" => 1390 "Ancho" => 2333 "Tamanyo" => 491136 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cutaneous rash, elementary lesions.</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" => 2444 "Ancho" => 3083 "Tamanyo" => 1077336 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Before treatment.</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">CT showing thymoma tumor mass and lung metástasis (a). Low-power view of thymoma needle biopsy with a predominant small cell population, H-E x20 (b). Higher magnification showing cytokeratin-positive larger epithelial tumor cells and numerous lymphocytes, AE1-AE3, x400 (c).</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Skin rash (d). Epidermal hyperplasia with numerous apoptotic keratinocytes, H-E x200 (e). High power showing apoptotic keratinocytes with satellite lymphocytes, H-E x400 (f).</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Oral lesions (g). Scanning magnification showing bullous lesion with extensive basal cell damage, H-E x20 (h). The roof shows apoptotic keratinocytes with satellite lymphocytes, H-E x400 (i).</p>" ] ] 2 => array:6 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 938 "Ancho" => 3083 "Tamanyo" => 270976 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "Références" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thymoma associated with autoimmune diseases: 85 cases and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Bernard" 1 => "H. Frih" 2 => "F. Pasquet" 3 => "S. Kerever" 4 => "Y. Jamilloux" 5 => "F. Tronc" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.autrev.2015.09.005" "Revista" => array:6 [ "tituloSerie" => "Autoimmun Rev" "fecha" => "2016" "volumen" => "15" "paginaInicial" => "82" "paginaFinal" => "92" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26408958" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multiple paraneoplastic syndromes: Myasthenia gravis, vitiligo, alopecia areata, and oral lichen planus associated with thymoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Qiao" 1 => "G. Zhou" 2 => "Y. Ding" 3 => "D. Zhu" 4 => "H. Fang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Neurol Sci" "fecha" => "2011" "volumen" => "308" "paginaInicial" => "177" "paginaFinal" => "179" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thymoma and autoimmunity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Shelly" 1 => "N. Agmon-Levin" 2 => "A. Altman" 3 => "Y. Shoenfeld" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/cmi.2010.74" "Revista" => array:6 [ "tituloSerie" => "Cell Mol Immunol" "fecha" => "2011" "volumen" => "8" "paginaInicial" => "199" "paginaFinal" => "202" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21317916" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is it lupus? TAMA: An important multi-system autoimmune disease entity physicians need to consider" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Mouyis" 1 => "G. Dollman" 2 => "H. Penn" 3 => "L. John" 4 => "S. Hamdulay" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/qjmed/hcw147" "Revista" => array:6 [ "tituloSerie" => "QJM" "fecha" => "2016" "volumen" => "109" "paginaInicial" => "687" "paginaFinal" => "688" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27516230" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thymoma-associated multiorgan autoimmunity: A graft-versus-host-like disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Wadhera" 1 => "E. Maverakis" 2 => "N. Mitsiades" 3 => "P.N. Lara" 4 => "M.A. Fung" 5 => "P.J. Lynch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2007.02.027" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2007" "volumen" => "57" "paginaInicial" => "683" "paginaFinal" => "689" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17433850" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thymoma-associated multi-organ autoimmunity: Two cases and a review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Shiba" 1 => "Y. Fujita" 2 => "H. Miyazawa" 3 => "K. Muramatsu" 4 => "M. Watanabe" 5 => "M. Nishimura" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jdv.14108" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2017" "volumen" => "31" "paginaInicial" => "e324" "paginaFinal" => "e326" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28052464" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thymoma-associated cutaneous graft-versus-host-like reaction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Holder" 1 => "J. North" 2 => "J. Bourke" 3 => "P. Colloby" 4 => "A. Fletcher" 5 => "R. Graham-Brown" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Exp Dermatol" "fecha" => "1997" "volumen" => "22" "paginaInicial" => "287" "paginaFinal" => "290" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9604457" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of crhonic erosive lichen planus with low concentrations of topical tacrolimus: An open prospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "V. Olivier" 1 => "J.P. Lacour" 2 => "A. Mousnier" 3 => "R. Garraffo" 4 => "R.A. Monteil" 5 => "J.P. Ortonne" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2002" "volumen" => "138" "paginaInicial" => "1335" "paginaFinal" => "1338" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12374539" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "bcr0320113936" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chemotherapy improves thymoma-associated graft-versus-host-disease-like erythroderma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Nagano" 1 => "Y. Kotani" 2 => "K. Kobayashi" 3 => "N. Tomita" 4 => "K. Nakata" 5 => "A. Sakashita" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "BMJ Case Rep" "fecha" => "2011" "volumen" => "2011" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thymoma-associated multi-organ autoimmunity: A case of graft-versus-host disease-like erytroderma complicated by Good syndrome successfully treated by thymectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Fukushima" 1 => "Y. Ichimura" 2 => "S. Obata" 3 => "M. Kinoshita-Ise" 4 => "Y. Fujio" 5 => "M. Takeno" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/1346-8138" "Revista" => array:6 [ "tituloSerie" => "J Dermatol" "fecha" => "2017" "volumen" => "44" "paginaInicial" => "830" "paginaFinal" => "835" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28256733" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011000000001/v1_201901030631/S1578219018302695/v1_201901030631/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011000000001/v1_201901030631/S1578219018302695/v1_201901030631/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018302695?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 11 | 11 | 22 |
| 2024 Octubre | 82 | 40 | 122 |
| 2024 Septiembre | 84 | 29 | 113 |
| 2024 Agosto | 128 | 69 | 197 |
| 2024 Julio | 121 | 39 | 160 |
| 2024 Junio | 103 | 31 | 134 |
| 2024 Mayo | 109 | 34 | 143 |
| 2024 Abril | 106 | 33 | 139 |
| 2024 Marzo | 94 | 35 | 129 |
| 2024 Febrero | 87 | 34 | 121 |
| 2024 Enero | 85 | 32 | 117 |
| 2023 Diciembre | 94 | 9 | 103 |
| 2023 Noviembre | 124 | 36 | 160 |
| 2023 Octubre | 97 | 32 | 129 |
| 2023 Septiembre | 78 | 23 | 101 |
| 2023 Agosto | 68 | 21 | 89 |
| 2023 Julio | 64 | 34 | 98 |
| 2023 Junio | 69 | 23 | 92 |
| 2023 Mayo | 84 | 27 | 111 |
| 2023 Abril | 72 | 35 | 107 |
| 2023 Marzo | 63 | 33 | 96 |
| 2023 Febrero | 62 | 30 | 92 |
| 2023 Enero | 63 | 38 | 101 |
| 2022 Diciembre | 56 | 42 | 98 |
| 2022 Noviembre | 29 | 29 | 58 |
| 2022 Octubre | 39 | 24 | 63 |
| 2022 Septiembre | 35 | 45 | 80 |
| 2022 Agosto | 35 | 43 | 78 |
| 2022 Julio | 28 | 38 | 66 |
| 2022 Junio | 25 | 29 | 54 |
| 2022 Mayo | 53 | 37 | 90 |
| 2022 Abril | 85 | 57 | 142 |
| 2022 Marzo | 62 | 65 | 127 |
| 2022 Febrero | 69 | 32 | 101 |
| 2022 Enero | 88 | 51 | 139 |
| 2021 Diciembre | 57 | 48 | 105 |
| 2021 Noviembre | 81 | 43 | 124 |
| 2021 Octubre | 84 | 75 | 159 |
| 2021 Septiembre | 60 | 48 | 108 |
| 2021 Agosto | 57 | 43 | 100 |
| 2021 Julio | 63 | 44 | 107 |
| 2021 Junio | 48 | 45 | 93 |
| 2021 Mayo | 62 | 62 | 124 |
| 2021 Abril | 140 | 75 | 215 |
| 2021 Marzo | 109 | 55 | 164 |
| 2021 Febrero | 65 | 44 | 109 |
| 2021 Enero | 49 | 45 | 94 |
| 2020 Diciembre | 63 | 32 | 95 |
| 2020 Noviembre | 43 | 46 | 89 |
| 2020 Octubre | 18 | 28 | 46 |
| 2020 Septiembre | 64 | 29 | 93 |
| 2020 Agosto | 20 | 25 | 45 |
| 2020 Julio | 20 | 14 | 34 |
| 2020 Junio | 47 | 33 | 80 |
| 2020 Mayo | 38 | 19 | 57 |
| 2020 Abril | 22 | 12 | 34 |
| 2020 Marzo | 33 | 17 | 50 |
| 2020 Febrero | 5 | 0 | 5 |
| 2019 Mayo | 0 | 1 | 1 |
| 2019 Febrero | 1 | 0 | 1 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Septiembre | 1 | 2 | 3 |
Mostrar todo
