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Myospherulosis: further ultrastructural observations.

The changes of myospherulosis were observed in masses from the buttocks of three patients. Ultrastructural examination of parent bodies and spherules from two patients revealed some spherules to contain dense bodies and filaments. Spherules had a double electron dense wall: the outer layer had a thickness corresponding to that of a cell membrane. Incubation of packed red blood cells with tetracycline ointment produced a similar electron dense deposit on the inner aspect of the cell membrane of the erythrocytes. No filaments or parent bodies were seen. Our findings support the hypothesis that myospherulosis represents altered red blood cells. The filaments seen in our patients may represent polymers of haemoglobin. It is suggested that parent bodies may be derived from histiocytes.

Adult↗

The prevalence of pressure sores within an area health authority.

A point prevalence survey carried out to determine the number of pressure sores within the Nottingham Health Authority revealed that 5.3% patients were affected (132 patients out of 2513). The majority of patients were elderly (80.3% aged over 65), female (76.5%), and either categorized as immobile or having very limited mobility (77.2%). There were 233 pressure sores, 54.9% of which were on the buttocks or sacrum, and 24.9% of which were on or near the heels and ankles. Nine different cleansing agents were in use, 31 different preparations were applied to the sores and nine types of dressings were employed, with little standardization of use. The most popular aids used for the relief of pressure areas included synthetic sheepskin pads (supplied to 46.2% of the affected patients) and ripple mattresses (supplied to 28.8% of the affected patients). The prevalence of pressure sores within the health authority is indicated. These findings are similar to those of a previous study and may be applicable to other health areas.

Aged↗

Tricoadenoma of Nikolowski.

The patient, aged 50 years, with no relevant clinical history, complained of a symptomless, soft tumor of the right buttock that had been present for many years. On examination, it was found to be pediculate, oval, somewhat erythematous, firm on palpation, and with a central keratin plug. The greatest diameter of the lesion was 1.2 cm (Fig. 1). On surgical removal of the lesion, it was seen to be composed of a symmetric intradermal proliferation of cystic formations, uniformly distributed throughout and made up of flat, pluristratified epithelium with laminated keratin. There was little difference in the thickness of the walls of the cysts (Fig. 2). Some cysts were attached to a short tadpole-shaped, epithelial cord and surrounded by a scanty fibroblastic stroma. No hairmatrix-like differentiation nor basaloid structures were seen, nor were atypical cells present. There was hardly any inflammatory infiltration.

Buttocks↗

Alpha-1-antitrypsin deficiency associated with panniculitis treated with plasma exchange therapy.

BACKGROUND: Alpha-1-antitrypsin is the principal serum protease inhibitor. In addition to the well-recognized association with early-onset emphysema and cirrhosis, alpha-1-antitrypsin deficiency may be associated with panniculitis. The treatment of this type of panniculitis presents a significant challenge. Previous attempts using immunosuppressive, anti-inflammatory, and cytotoxic drugs have shown variable results. AIM: To report a case of alpha-1-antitrypsin deficiency-associated panniculitis treated with plasma exchange therapy. METHODS: A 23-year-old patient developed painful red nodules on her thighs and buttocks with spontaneous ulceration and discharge of oily fluid. A skin biopsy specimen showed septal and lobular panniculitis. The serum alpha-1-antitrypsin level was 22 mg/dL. She was treated with plasma exchange therapy. RESULTS: Treatment of this patient with plasma exchange therapy led to the control of the cutaneous lesions. CONCLUSIONS: Plasma exchange therapy represents an alternative treatment which restores serum and tissue alpha-1-antitrypsin levels. This method is proposed because of its clinical benefits and greater availability.

Adult↗

Benign lichenoid keratosis due to constant pressure.

Two well-circumscribed keratotic plaques in an elderly man, one each on symmetrically identical locations over the sides of the buttocks, are described. Clinical and histopathological features supported the diagnosis of benign lichenoid keratosis, which had probably resulted from constant pressure over the site and regressed when this factor was eliminated.

Aged↗

Merkel cell carcinoma: a challenge.

A 70-year-old man presented with an enlarging, recurrent tumor of the left buttock which, on initial biopsies, was interpreted as a histiocytic malignant lymphoma. Further biopsies showed numerous monomorphic, hyperchromatic, noncohesive cells, arranged in compact sheets, throughout the dermis, the fat, and the underlying muscle. Neuron specific enolase stain for neuroendocrine granules was positive. Electron microscopy showed cytoplasmic perinuclear microfilaments and round membrane-bound dense core granules. The histologic, enzymatic, and ultrastructural findings confirmed the diagnosis of Merkel cell carcinoma. Early diagnosis and treatment are imperative for a favorable outcome.

Adenocarcinoma↗

Liposuction surgery of the lateral thigh.

We report our experience in 50 patients who underwent liposuction surgery of the lateral thighs with or without concomitant liposuction surgery of the hip and buttock areas. This procedure has proven to be a remarkably safe and effective method for removal of fat in properly selected individuals. The operation avoids the problems of blood loss and scarring associated with other operations used to remove fat and makes for extremely satisfied patients.

Adult↗

Squamous cell carcinoma arising in hidradenitis suppurativa.

The case reported concerns a 57-year-old man with a 35-year history of hidradenitis suppurativa lesions confined to his buttocks and recently complicated by a large, ulcerated, well-differentiated squamous cell carcinoma. Wide surgical excision and grafting, requiring temporary colostomy, were performed with no recurrence or metastasis during the following 12 months. The relevant literature is reviewed and discussed.

Buttocks↗

Eruptive vellus hair cysts: case report and review of the literature.

A 6-year-old Caucasian girl had dozens of asymptomatic, flesh-colored, 2- to 5-mm eruptive vellus hair cysts. These papules on the buttocks, thighs, and groin increased in number for three months. Histologic examination revealed poorly defined, keratin-filled cysts in the upper middermis, containing numerous transversely or obliquely cut portions of vellus hair. The histopathologic differential diagnosis with other epithelial cysts containing hair shafts is debated, and new clinical differential diagnoses are proposed. Review of the literature suggests that eruptive vellus hair cyst is not a rare disorder, but its frequency is probably underestimated due to paucity of symptoms. Nevertheless, the clinical relevance of some of the differential diagnoses should convince clinicians to obtain histologic confirmation.

Buttocks↗

The baboon syndrome: systemically-induced allergic contact dermatitis.

The catchword "baboon syndrome" is used to denote a characteristic distribution pattern of systemic allergic contact dermatitis. Diffuse erythema of the buttocks, upper inner surface of the thighs, and axillae are characteristic features. We describe 3 cases provoked by ampicillin, nickel and mercury. The condition may be overlooked and suspected of being a textile dermatitis or seborrhoeic dermatitis of the elderly.

Adult↗

Nevus lipomatosus cutaneus superficialis (Hoffmann-Zurhelle).

We are reporting seven cases with nevus lipomatosus cutaneus superficialis. A review of the literature indicates that this is a relatively rare type of connective tissue nevus with little more than 50 cases recorded. Localization of the cutaneous nodular lesions over the upper thigh and buttock and histologic findings of fat lobules within the substance of the nevoid malformation differentiate these lesions from other varieties of the connective tissue nevi.

Adolescent↗

Verrucous carcinoma of skin.

Five different cases of verrucous proliferative lesions of skin are described and discussed. One of each developed in a chronic ulcer on a heel, in a scar on a lower leg, and on the penis, and two appeared in the region of the buttock in relation to chronic inflammatory sinuses. All these lesions showed morphological and clinical features of verrucous carcinoma which are described. It has been concluded that the variously named verrucous lesions in the literature (epithelioma cuniculatum, florid papillomatosis, giant cutaneous papilloma and papillomatosis cutis carcinoides), as well as our five cases represent a verrucous carcinoma which is a particular type of squamous cell carcinoma. This tumor develops typically in moist areas which are frequently sites of chronic inflammation. Despite the favorable prognosis, it is a potentially invasive tumor.

Bacterial Infections↗

Eccrine spiradenoma and dermal cylindroma.

The homologous nature and morphological similarities between cutaneous and salivary gland tumors have been well documented. This is especially true of the monomorphic adenoma, eccrine spiradenoma and cylindroma. Prior to the first full clinical and pathological description, about twenty-five years ago, the lesion of eccrine spiradenoma had been given multiple synonyms. This report is of a patient with an eccrine spiradenoma in the buttock and dermaltype cylindroma of the parotid gland. This may represent the transformation of pleuripotential basal cells originating in the parotid and eccrine sweat gland.

Adenoma, Sweat Gland↗

Threshold level for measurement of UV sensitivity: reproducibility of phototest.

The ultraviolet (UV) sensitivity is determined by a phototest where the skin is exposed to well-defined doses of UV radiation and the resulting erythema is graded by visual scoring after 20-24 h. In this study we wanted to estimate the reproducibility of erythema assessment in phototesting. Twenty-one healthy Caucasians with skin types I to IV were phototested on UV un-exposed buttock skin using a xenon lamp solar simulator. Twenty-four hours after UV exposure eight physicians independently graded the erythema reactions two times. Data were analysed using inter- and intra-observer agreement and kappa statistics, which adjusts for agreement that could be caused by chance alone. Observed agreement and kappa statistics were found to decrease with increasing intensity of erythema and to be lower for skin types III and IV compared to skin types I and II. Intra-observer agreement was uniformly better than inter-observer agreement. The difference between observers assessment could be as much as three clinical erythema grades. Physicians's previous experience with phototesting only had a minor influence on agreement. In conclusion, phototesting is based on subjective assessment of erythema and is not as precise and reproducible as expected. Agreement was better for barely perceptible erythema than for erythema with a well-defined border and we therefore recommend that the barely perceptible erythema reaction should be used for measurement of the minimal erythema dose.

Adult↗

Systemic sclerosis with unusual panniculitis and overlying discoid lupus erythematosus-like lesions.

A 33-year-old men presented with systemic sclerosis accompanied by both unusual panniculitis and overlying discoid lupus erythematosus (DLE)-like skin changes on the left buttock. The lesion did not completely match either lupus erythematosus profundus or morphea profunda but featured clinical and pathological findings halfway between the two entities. No case report of co-existence of systemic sclerosis and morphea profunda was found in the literature, but there are three case reports of patients with systemic sclerosis and lupus erythematosus profundus. One of the three cases had DLE-like changes on the surface of the lesion, a clinical picture similar to our case. We speculated that the DLE-like changes in the overlying skin were due to local tissue ischemia. The accompanying panniculitis in our case was considered to be unique and somehow different from morphea profunda or lupus erythematosus profundus.

Adult↗

Size of adipose cells in infancy.

Seventy-three samples of adipose tissue from 59 infants, aged from 25 weeks' gestation to 18 months of age, were obtained at necropsy, or at operations, or by needle biopsy. Adipose cell size was measured by microscopy. During fetal life the mean cell diameter increases from about 40 mum at 25 weeks' gestation to 50-80 mum at term. Adipose cells from the buttocks are larger than those from abdominal wall. After birth, adipose cell size continues to increase so that by 3 months the mean cell diameter is about 90 mum. Observations made on infants that had been born preterm showed that the growth of adipose cells proceeds at the same rate whether development in intrauterine or extrauterine.

Abdominal Muscles↗

Tumoral calcinosis--an unrecognized disease.

Twenty-six cases of tumoral calcinosis are reported from Kenya. The disease, frequently misdiagnosed, is of unknown origin. It presents as calcified tumours, usually around the hips and buttocks, in muscle and subcutaneous tissue. The tumours are partly solid, partly multiloculated cysts which contain a chalky fluid. They may grow rapidly or very slowly, and are found in children and adults. Both sexes are affected and there is no obvious tribal or geographical localization.

Adolescent↗