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Epstein Barr virus (EBV) related lymphoproliferative diseases may occur in immunocompromised patients or patients with a history of drug use causing immunodeficiency. EBV positive mucocutaneous ulceration in the new classification of lymphoproliferative diseases in 2016 is very rare in children. Involvement occurs in the skin, oral mucosa, and gastrointestinal system. Gastric involvement is very rare in the literature. There is no case of gastric involvement in children. There are no specified modalities in the treatment of EBV positive mucocutaneous ulceration. We presented our pediatric patient with ataxia telangiectasia who presented with abdominal pain and difficulty swallowing and diagnosed with EBV positive mucocutaneous ulceration in the stomach. We started brentuximab vedotin during the treatment process, and complete remission was achieved after 6 cures of treatment. Our patient is the first case of EBV positive mucocutaneous ulceration in the pediatric case series.

The number of patients with type 2 diabetes using dipeptidylpeptidase-4 (DPP-4) inhibitors is increasing across the world.Although this class of antidiabetic medications is generallysafe and associated with less side effects compared to otheroral antidiabetic medications, they could also cause some sideeffects such as skin rashes. Herein we report a case of type 2diabetes patient who developed a painful maculopapular rashinduced by linagliptin, a widely used DPP-4 inhibitor.A localized painful maculopapular rash developed on thepalmar faces of the patient’s hands almost 1 day after theinitiation of the drug. The patient was using intensive insulintherapy before linagliptin was started. There was no eruptionon the other body parts except the palmar faces of the hands.Following the discontinuation of the drug, the rash disappearedin about four days. The patient had no history of urticaria anddid not use an ACE inhibitor. As far as we know, this is the firstcase report of a skin rash induced by linagliptin in the Turkishliterature. This case report highlights a rare and lesser knownside effect of linagliptin, a new member of DPP-4 inhibitors. Dipeptidil peptidaz-4 (DPP-4) inhibitörleri kullanan tip 2 diyabet hastalarının sayısı dünya genelinde artmaktadır. Bu antidiyabetik ilaç sınıfı genelde güvenli olmakla birlikte diğer oral antidiyabetik ilaçlarla karşılaştırıldığında daha az yan etki ile ilişkili olsa da, deri döküntüleri gibi bazı yan etkilerle ilişkili olabilirler. Burada yaygın olarak kullanılan bir DPP-4 inhibitörü olan linagliptin ile indüklenen ağrılı makülopapüler döküntü gelişen tip 2 diyabetli bir hastayı sunuyoruz. Linagliptin başlandıktan 1 gün sonra hastamızın ellerinin palmar yüzünde lokalize ağrılı makülopapüler bir döküntü gelişti. Linagliptin başlanmadan önce hasta intensif insülin tedavisi altındaydı. Vücudun diğer bölgelerinde herhangi bir döküntü yoktu. Linagliptin kesildikten sonra 4 gün içerisinde döküntü kayboldu. Hastanın ürtiker öyküsü yoktu ve Anjiyotensin dönüştürücü enzim inhibitörü kullanmıyordu. Bildiğimiz kadarıyla bu, Türk literatüründe Linagliptine bağlı deri döküntüsü geliştirdiği rapor edilen ilk olgudur. Bu olgu sunumu, DPP-4 inhibitörlerinin nadir görülen ve daha az bilinen bir yan etkisini vurgulamaktadır.

A 50-year-old male patient presented to a dermatology clinic with a mass on the neck (Fig. 39.1) and a biopsy was performed from the lesion.

A 71-year-old man presented to the dermatology outpatient clinic because of pigmented lesions on his inguinal area. In the inguinal area, 5 cm diameter, verrucous pigmented lesion was observed dermoscopic examination of this lesion revealed fissures and ridges cerebriform appearance, hairpin blood vessels, and moth-eaten border (Fig. 38.1). Verrucous carcinoma and melanoma were considered and biopsy was taken.

Intranodal palisaded myofibroblastoma (IPM) is a benign mesenchymal neoplasm originating from smooth muscle cells and myofibroblasts. The inguinal region is the most common site of this rare tumor. As there are only about 89 such cases reported in the literature, the precise etiology and pathogenesis have yet to be explained adequately. It is characterized by spindle cells, amianthoid fibers, and by the proliferation of hemosiderin-containing histiocytes in the lymph node. A nodular lesion was excised from the inguinal region of a 47-year-old female patient with the clinical diagnosis of lymphoma and/or metastase. Macroscopic examination of a section of the lesion demonstrated a solid appearance. Microscopic examination revealed spindle-cell proliferation, amianthoid fibers, hemosiderin pigment, and extravasated erythrocytes. Nuclei of the spindle cells displayed a palisaded appearance. Compressed lymphoid tissue was observed around the lesion. Neoplastic cells were identified by the presence of vimentin, SMA, Cyclin D1, and beta-catenin. The Ki67 index was less than 1%. Histological examination confirmed the diagnosis of IPM. Although IPM is benign, it is frequently confused with metastatic lesions and lymphomas.

Cholesteatoma in the urinary system is a rarely seen benign condition. Rosina firstly defined this condition in the year 1953. Histopathologically it is characterized with keratinization, and squamous metaplasia of urothelial epithelium associated with desquamation of keratinized layers. Flank pain is the most common symptom that is caused by elimination of keratinous material. In our case we will discuss cholesteatoma developed in an ectopic kidney which has not been described in the literature before.

PURPOSE Intra-arterial injection of medications are related to mortality and morbidity. It was aimed to investigate the histopathological effects caused by two different intra-arterial doses of sugammadex, a new selective relaxant binding agent used to reverse the effects of steroidal systemic muscle relaxants used in surgeries carried out under general anesthesia. METHODS A total of 15 rabbits were randomly divided into 3 groups. The control group was given 1 mL saline bolus into the central artery of the ear. The other two groups (Group Sgdx2 and group Sgdx16) were given 2 and 16 mg/kg sugammadex, respectively, intra-arterially. RESULTS In control group, histopathological evaluation was in normal limits. The cross-sections belonging to Group Sgdx2 did not have any significant pathological change compared with control group (p > 0.05). Edema and single-cell necrosis were significantly higher in Group Sgdx16 when compared to control group (p < 0.05). In comparison to Group Sgdx2, single-cell necrosis was significantly higher in Group Sgdx16 (p < 0.05). CONCLUSION Being broadly used in anesthesia, sugammadex should be administered with care because when given by intra-arterial route it may cause tissue damage and tissue loss and the patients' arteries should be carefully checked.

WOS: 000340257800020 PubMed: 25006940 Oropharyngeal and tonsillar masses are a very rare cause of dysphagia in children. In this article, we describe a rare cause of dysphagia in children, a lymphangiomatous lesion of the palatine tonsil, and discuss the clinical and histopathologic features of these lesions.

A 60-year-old woman presented with a 2-year history of two large nodules on her head. She also reported a 1-year history of intermittent mild headache. On physical examination, two nodules were seen, located on the occipital region of the patient’s head. The larger nodule was 51 9 45 mm in size, of a greyish-white colour, and was ulcerated, lobulated and sharply demarcated from neighbouring structures (Fig. 1). The smaller nodule was smooth and rounded, with a diameter of 39 mm (Fig. 1). Both nodules were totally excised and sent for histological examination.

A 54-year-old woman with immune thrombocytopenic purpura (ITP) referred to our dermatology department with a three-week-history of a purple-colored lesion on her right arm. The patient was on treatment with oral prednisone at 20 mg/day for ITP and levothyroxine at 25 mg/day for hypothyroidism. No topical treatment was prescribed or used before our consultation. Dermatological examination revealed a 12.5 x 7.5 mm solitary purple papule located on the right upper extremity (Figure 1). Dermatoscopic examination disclosed bluish-red coloration (Figure 2). Surgical excision of the lesion was performed. Histopathological examination of the lesion revealed nodular vascular proliferation in dermis, pronounced congestion and extravagated erythrocytes (Figure 3). What is your diagnosis? What is your diagnosis? A solitary purple papule on the arm

Below is the answer to the quiz by Dr. Senel et al presented in the previous issue of Dermatology Practical & Conceptual [2014;4(4):13]. Diagnosis: Kaposi sarcoma. Kaposi sarcoma (KS) was first described by Kaposi in 1872. There are four clinical types of the disease: classic, endemic, epidemic and iatrogenic [1]. Iatrogenic KS develops in patients taking immunosuppressive treatment. Bluish-reddish coloration is seen in 84% of KS lesions in dermatoscopy. Rainbow pattern and scaly surface are other dermatoscopic features of KS (36% and 15%, respectively) [2]. Multicolored rainbow pattern is the most diagnostic appearance of KS in dermatoscopic evaluation and is associated with vascular lumen-rich histological sub-type [3]. This pattern can be rarely seen in the dermatoscopy of melanoma [4]. Congratulations to Dr. Arina Vashkevich (ur.liam@khsavaa), who was the first to send us the correct answer!

Intraosseous ganglia of the proximal humerus are rare and their etiology is unknown. This report describes a case of an intraosseous ganglion of the proximal humerus. The patient was a 47-year-old woman with a painful left shoulder with a limited range of motion. On magnetic resonance imaging a cystic lesion of the proximal humerus was detected. There was no communication between the cyst and the joint space. On macroscopic examination, a multiloculated cystic lesion was seen. Microscopically it was clear that it was a cyst of intraosseous ganglia. At 2 weeks after the surgery, the patient was almost free of pain. Though there were few reports earlier, the pathological feaures were not highlighted. We describe here more about the pathologic features of the lesion.

Objectives: Chondrodermatitis nodularis chronica helicis (CNH) is a painful nodule affecting the pinna. The etiology of the disease is unknown. We devised to show a correlation between CNH and systemic health problems of the patients. Materials and Methods: This study included 17 patients with CNH and the other lesions of the ear that incoming differential diagnoses of CNH, including basal cell carcinoma, squamous cell carcinoma, verruca vulgaris, neurofibroma, fibroepithelial polyp, seborrheic ceratose, and cystic lesions, a total of 131 patients that were diagnosed between 2011 and 2012 in the Clinics of Dermatology and Pathology of Cankiri State Hospital. Cardiovascular problems of the patients were queried meticulously and recorded. Results: With 17 patients 12.97% of the 131 patients were CNH. The mean age of the patients was 47.41 and the age range of the CNH patients was 32-79 years, with a mean age of 54.9 years (SD ± 13.23 years). The mean diameter of the lesions was 4.57 mm for CNH patients. The lesions were located at the right air mostly (85.71%) and all of them were located at the helix of ear. The laboratory results of the CNH patients showed that most of them (88.2%, 15 patients) have high cholesterol and lipid levels. By the way six of them (35.2%) also had cardiac problems. Conclusion: Our results showed that the main problem is the defect of arterial blood supply of the pinna. Also we detected that12.97% of the lesions were CNH, while cystic lesions take the first place among all other ear lesions.