Ocular leech infestation initially misdiagnosed as conjunctival pigmented nevus

Dear sir,Iam Dr.Wen-Wei Li,from the Department of Ophthalmology,Zhejiang Provincial People’s Hospital,Hangzhou,China.I write to present a case of ocular leech infestation initially misdiagnosed as conjunctival pigmented nevus.Although human interaction with leeches is not uncommon

Giant Cerebriform Nevus Cell Nevus of the Scalp: A Case Report

Giant cerebriform nevus cell nevus of the scalp is an extremely rare form of congenital melanocytic nevus. Giant cerebriform nevus of the scalp has a major psychosocial impact because of its unsightly appearance with fetid maceration. We report the case of a 35-year-old woman who had a painless, malodorous swelling of the cerebriform scalp measuring 20 × 17 cm in diameter with a wide base of insertion at the occipital level adhering to the deep planes. The excision associated with a skin plasty was carried out. Histology concluded that there was a giant cerebriform naevo-cellular nevus of the scalp.

Blue Nevus Hidden within the Nevus of Ota

A 3-year-old boy presented with bluish patch and scattered blue spots on the left side of his face.After several sessions of laser treatment,the azury patch in the periorbital area became even darker.Histopathology showed many bipolar,pigment-laden dendritic cells scattered in the papillary and upper reticular dermis.Immunohistochemically,these cells were positive for S100,SOX-10,melan-A,P16,and HMB-45.The positive rate of Ki-67 was less than 5%.Finally,the lesion was diagnosed with nevus of Ota concurrent with common blue nevus.Therefore,for cases of the nevus of Ota with poor response to laser treatment,the possible coexisting diseases should be suspected.

Reed Nevus (Pigmented Spindle Cell Nevus) in an 11-Month-Old Japanese Infant

Reed nevus (pigmented spindle cell nevus) is a nevus with the histopathological features of abundant melanin, monomorphic spindle-epithelioid melanocytes, spindle cell nests confined within the epidermis and papillary dermis, and occasional upward interepidermal progression of melanocytes. Here, we reported an unusual case of Reed nevus in an 11-month-old Japanese male infant. Infantile Reed nevus should be included as a differential diagnosis for nevus pigmentosus in infancy.

LIN28A attenuates high glucose-induced retinal pigmented epithelium injury through activating SIRT1-dependent autophagy

AIM:To evaluate the effects of LIN28A(human)on high glucose-induced retinal pigmented epithelium(RPE)cell injury and its possible mechanism.METHODS:Diabetic retinopathy model was generated following 48h of exposure to 30 mmol/L high glucose(HG)in ARPE-19 cells.Quantitative real-time polymerase chain reaction(qRT-PCR)and Western blot tested the expression of the corresponding genes and proteins.Cell viability as well as apoptosis was determined through cell counting kit-8(CCK-8)and flow cytometry assays.Immunofluorescence assay was adopted to evaluate autophagy activity.Caspase 3 activity,oxidative stress markers,and cytokines were appraised adopting their commercial kits,respectively.Finally,ARPE-19 cells were preincubated with EX527,a Sirtuin 1(SIRT1)inhibitor,prior to HG stimulation to validate the regulatory mechanism.RESULTS:LIN28A was downregulated in HG-challenged ARPE-19 cells.LIN28A overexpression greatly inhibited HGinduced ARPE-19 cell viability loss,apoptosis,oxidative damage as well as inflammatory response.Meanwhile,the repressed autophagy and SIRT1 in ARPE-19 cells challenged with HG were elevated after LIN28A overexpression.In addition,treatment of EX527 greatly inhibited the activated autophagy following LIN28A overexpression and partly abolished the protective role of LIN28A against HG-elicited apoptosis,oxidative damage as well as inflammation in ARPE-19 cells.CONCLUSION:LIN28A exerts a protective role against HG-elicited RPE oxidative damage,inflammation,as well as apoptosis via regulating SIRT1/autophagy.

History and prospect of melanocytic nevus treatment:A bibliometric analysis

Background:Melanocytic nevus is mainly treated by complete or partial removal.However,predicting the risk of malignant transformation of melanocytic nevi and which treatment patients should receive,surgical or nonsurgical management,to gain the best results and aesthetic outcomes is controversial.Methods:Global literature on melanocytic nevus treatment,published between 1997 and 2022,was scanned using the Web of Science Core Collection database.Microsoft Office Excel,CiteSpace V,VOSviewer,Scimago Graphica,Bibliometrix,and Biblioshiny packages in R were used for the bibliometric analysis to summarize the leading countries,institutions,professors,and research trends in this field.Results:This study included 1723 articles.Publications and citations exhibited positive trends over the past 20 years.The United States had the most productive organizations and publications in the comprehensive worldwide cooperation network,and China was recently one of the most active major participants.Professor Giovanni Pellacani,whose H-index,G-index,and M-index ranked first in this field,founded a virtual biopsy using reflectance confocal microscopy.In addition,Krengel and Kinsler contributed significantly to diagnosing and treating melanocytic nevi.The top 25 keywords in recent years were mostly about the mechanisms and risk factors for the malignant transformation of nevi.Conclusion:The future trend for melanocytic nevi treatment is to specify genotype-phenotype and genotypeoutcome correlations,choose proper therapy to reduce the risk of malignant transformation,and simultaneously achieve the best aesthetic outcomes.

Plantar Spitz Nevus Resembling Malignant Melanoma: Description of Immunohistochemical Findings

Spitz nevus (SN) is predominantly distributed throughout the lower extremities, while an acral location is rare. Since SN occasionally resembles the clinicopathological presentation of malignant melanoma (MM), it presents a diagnostic challenge, especially on glabrous skin. Past reports suggest that several genetic aberrations are associated with specific clinicopathological subtypes of melanocytic tumors. Immunohistochemistry can provide a clue to the presence or absence of a molecular aberration typical of Spitz tumors. We describe a case of a plantar SN with genetic analysis, including anaplastic lymphoma kinase (ALK), ROS proto-oncogene 1 (ROS1), BRAF (V600E) protein, and BRCA1-associated protein-1 (BAP1). However, we were not able to detect a characteristic gene aberration. To the best of our knowledge, no genetic aberrations in plantar SN cases have been reported. A comprehensive understanding of tumor genomics is expected to play an essential role in the classification of melanocytic tumors. Further genetic research on plantar SN is required to establish new criteria for distinguishing between SN and MM.

Phenolic Profile,Antioxidant,Antihyperlipidemic and Cardiac Risk Preventive Effect of Pigmented Black Rice Variety Chakhao poireiton in High-Fat High-Sugar Induced Rats

The present study aimed to investigate the hypolipidemic,antioxidant and cardiac risk-suppressing effects of Chakhao poireiton(CP),a GI-tagged pigmented black rice from India.In vitro and ex vivo studies confirmed that whole rice extracts of CP have potent antioxidant,3-hydroxy-3-methylglutaryl-CoA reductase,cholesterol esterase inhibitory,and antilipase effects.An in vivo study was conducted to evaluate the effects of the ethanol extracts of CP on high-fat high-sugar induced hyperlipidemic rats.The ethanol extract significantly ameliorated lipid parameters and liver enzymes to normal.Levels of lactate dehydrogenase,creatine kinase-N-acetyl cysteine,C-reactive protein,and lipoprotein a were significantly lower in the extract-treated groups than those in the disease control group.A marked reduction of ApoB/ApoA1 and other atherogenic indices were observed in extract-treated groups.Twelve phenolic compounds,i.e.rosamarinic acid,gallic acid,protocatechuic acid etc.,were quantified in CP.This study provided the first evidence of the antihyperlipidemic and cardiac risk inhibitory effects of CP,which would be beneficial in preventing and managing hyperlipidemia,associated oxidative stress,and cardiac complications.

Blue rubber bleb nevus syndrome:A case report and literature review

Blue rubber bleb nevus syndrome(BRBNS)is a rare disease characterized by multiple venous malformations and hemangiomas in the skin and visceral organs.The lesions often involve the cutaneous and gastrointestinal systems.Other organs can also be involved,such as the central nervous system,liver,and muscles.The most common symptoms are gastrointestinal bleeding and secondary iron deficiency anemia.The syndrome may also present with severe complications such as rupture,intestinal torsion,and intussusception,and can even cause death.Cutaneous malformations are usually asymptomatic and do not require treatment.The treatment of gastrointestinal lesions is determined by the extent of intestinal involvement and severity of the disease.Most patients respond to supportive therapy,such as iron supplementation and blood transfusion.For more significant hemorrhages or severe complications,surgical resection,endoscopic sclerosis,and laser photocoagulation have been proposed.Here we present a case of BRBNS in a 45-year-old woman involving 16sites including the scalp,eyelid,orbit,lip,tongue,face,back,upper and lower limbs,buttocks,root of neck,clavicle area,superior mediastinum,glottis,esophagus,colon,and anus,with secondary severe anemia.In addition,we summarize the epidemiology,clinical manifestations,diagnosis,differential diagnosis and therapies of this disease by analyzing all previously reported cases to enhance the awareness of this syndrome.

Radiofrequency ablation micro-dissecting of eyelid nevus with XL-RFA device under operating microscope

AIM: To study the effect of an innovative micro-dissection procedure by radiofrequency ablation (MRA) in removing eyelid nevus.METHODS: Fifty-six consecutive outpatients with eyelid nevus were treated with MRA using a monopolar device. The effect of MRA was determined after following-up for 6mo to 5y.RESULTS: Fifty-two cases (52 eyes, 92.9%) were cured once, and 4 cases (4 eyes, 7.1%) received second treatment for small residual. All cases healed well after surgery, with no pigmentation, no scars, no loss of eyelashes, no deformation of eyelid margin. There was no visual impairment after healing.CONCLUSION: MRA of eyelid nevus using the XL-RFA device is highly efficient without significant complications.

Endoscopic therapy for esophageal hematoma with blue rubber bleb nevus syndrome

A 57-year-old woman previously diagnosed with blue rubber bleb nevus syndrome(BRBNS) reported hematemesis. BRBNS is a rare vascular anomaly syndrome consisting of multifocal hemangiomas of the skin and gastrointestinal(GI) tract but her GI tract had never been examined. An upper gastrointestinal endoscopy revealed a large bleeding esophageal hematoma positioned between the thoracic esophagus and the gastric cardia. An endoscopic injection of polidocanol was used to stop the hematoma from bleeding. The hematoma was incised using the injectionneedle to reduce the pressure within it. Finally, argon plasma coagulation(APC) was applied to the edge of the incision. The esophageal hematoma disappeared seven days later. Two months after the endoscopic the rapy, the eso phage alulcerhealed and the hemangioma did not relapse. This rare case of a large esophageal hematoma originating from a hemangioma with BRBNS was treated using a combination of endoscopic therapy with polidocanol injection, incision, and APC.

Application of stem cell-derived retinal pigmented epithelium in retinal degenerative diseases： present and future

As a constituent of blood-retinal barrier and retinal outer segment（ROS） scavenger, retinal pigmented epithelium（RPE） is fundamental to normal function of retina. Malfunctioning of RPE contributes to the onset and advance of retinal degenerative diseases. Up to date, RPE replacement therapy is the only possible method to completely reverse retinal degeneration. Transplantation of human RPE stem cell-derived RPE（h RPESC-RPE） has shown some good results in animal models. With promising results in terms of safety and visual improvement, human embryonic stem cell-derived RPE（h ESC-RPE） can be expected in clinical settings in the near future. Despite twists and turns, induced pluripotent stem cell-derived RPE（i PSC-RPE） is now being intensely investigated to overcome genetic and epigenetic instability. By far, only one patient has received i PSCRPE transplant, which is a hallmark of i PSC technology development. During follow-up, no major complications such as immunogenicity or tumorigenesis have been observed. Future trials should keep focusing on the safety of stem cell-derived RPE（SC-RPE） especially in long period, and better understanding of the nature of stem cell and the molecular events in the process to generate SC-RPE is necessary to the prosperity of SC-RPE clinical application.

Endoscopic treatment of blue rubber bleb nevus syndrome in a 4-year-old girl with long-term follow-up:A case report

BACKGROUND Blue rubber bleb nevus syndrome(BRBNS)is a rare vascular disease,difficult to diagnose and choose a treatment method,especially in young children.There are several limiting factors to the use of enteroscopy for diagnostics and treatment in pediatric patients,in general.The literature on BRBNS cases is limited and presents various therapeutic approaches.CASE SUMMARY We present here a case of BRBNS involving a 4-year-old female,whose intestinal venous lesions were successfully treated by endoscopic sclerotherapy and aethoxysklerol foam.Skin lesions,typical for BRBNS,appeared on the 8th d of the child’s life and their number increased over the next several months.The child also experienced episodes of critical decrease in hemoglobin level(by as much as 52 g/L)for several years,requiring iron supplementation and several blood transfusions.Video capsule endoscopy revealed numerous vascular formations in the small bowel.The combined findings of gastrointestinal venous formations and skin lesions prompted BRBNS diagnosis.Single-balloon enteroscopy was used to perform sclerotherapy,with aethoxysklerol foam.A positive effect was observed within 19 mo of follow-up.We continue to monitor the patient’s hemoglobin level,every 2 wk,and it has remained satisfactory(>120 g/L).CONCLUSION Endoscopic sclerotherapy can be effective in the clinical management of gastrointestinal manifestations of BRBNS in young children.

Giant congenital cerebriform pigmented nevus of scalp:case report

Giant pigmented nevus is a kind of congenital malformation that derived from ectodermal neural crest cells. In this article, we report a case of giant gyms-like pigmented nevus of the scalp.

Follow the nevus: the cost-utility of monitoring for growth of choroidal nevi

AIM: To develop a model to evaluate the cost-utility of choroidal nevi monitoring recommendations with varying clinical risk factors.METHODS: A Markov model was created to evaluate the cost-utility in cost per quality-adjusted life-year($/QALY) for monitoring patients with choroidal nevus. This probabilistic model was applied both to a hypothetically monitored and unmonitored group of patients beginning at different ages and with varying clinical risk factors of the nevus. Duration of screening was modeled for the remainder of the patients’ life expectancy. Best available clinical data on the prevalence and incidence of choroidal nevi/melanoma, and relative risk of nevus transformation were combined with the initial and downstream costs of screening, downstream costs of melanoma-related mortality, and QALY saved by monitoring, to estimate the best monitoring regimen. Main outcome measures were average $/QALY saved by consensus recommended monitoring scenarios for the duration of a patient’s remaining life expectancy in comparison with no follow-up, and the cost-utility of modified regimens. RESULTS: The $/QALY of the recommended monitoring scenarios varied substantially based on nevus clinical risk factors, patient age, frequency of follow-up, and objective testing utilized. The $/QALY for the recommended monitoring scenario of a flat nevus without risk factors in a 60-yearold patient was $77 180. The $/QALY for monitoring a nevus with 3 clinical risk factors in a 60-year-old patient was $85 393. The $/QALY values for differently-aged patients were larger, and intermediate degrees of risk factors for nevus growth varied, depending largely upon the specifics of the modeled monitoring scenarios.CONCLUSION: The average $/QALY of currently recommended monitoring scenarios fall within economically acceptable standards and could provide insight for formulating appropriate clinical strategies. Cost-utility could be enhanced by targeting higher risk groups and considering less frequent monitoring for the lower risk groups.

Long term clinical and dermoscopic follow-up of a child with a Spitz nevus

Background: Spitz nevus is uncommon, benign melanocytic neoplasm that may show some clinical, dermoscopical and histological features of melanoma. It occurs often in childhood, but may appear also in early adulthood. Rare congenital cases have been reported in literature. It is frequently located on the face and the lower extremities, but in some cases may appears on the trunk. Methods: We report a case of a 9-years-old girl presented to our Dermatology Unit because of the presence of a pigmented lesion on her right leg, 4 mm in diameter, which was clinically and dermoscopically diagnosed as Spitz nevus. We described the clinical and dermoscopic features that we observed every six months, over 11 years follow-up period. Objective: Our observation show that the globular, the starburst, the homogeneous patterns and diffuse brown colour with diffuse hypopigmented areas may be the different expression that correspond to possible evolutionary phases of pigmented Spitz nevus.

Trichilemmomal Horn Arising from a Nevus Sebaceus and Pilar Cyst: A Case Report and Review of the Literature

Nevus sebaceus can give rise to multiple neoplasms, some of which have the potential to become malignant. We describe the occurrence of a previously unreported combination of a cutaneous horn proliferating from a trichilemmoma overlying a multilocular pilar cyst and nevus sebaceus. An elderly woman with a several years’ history of multiple scalp subcutaneous nodules and an enlarging cutaneous horn presented to our clinic. The nodule underlying the large exophytic horn was tender and occasionally bled. The lesion was removed by excisional biopsy due to concern for malignancy. Histologically, a verrucous trichilemmoma was identified overlying irritated pilar cysts and a nevus sebaceus. Phosphatase and tensin homolog (PTEN) mutations are frequently found in trichilemmomas and HRAS mutations in nevus sebaceus. Mammalian target of rapamycin (mTOR) is a part of the final common pathway for HRAS and PTEN raising the therapeutic question if rapamycin can be used to treat these neoplasms.

Intracranial Intermediate-Grade Melanocytic Neoplasm: Case Report Associated with Nevus of Ota

Melanocytic lesions of the CNS are rare tumours originating from melanocytes that are present in the leptomeninges. They consist of a spectrum of pigmented tumours ranging from melanocytoma to melanoma. A small group of these tumours have histopathological features between those of a benign melanocytoma and a malignant melanoma;these present as intermediate grade melanocytic neoplasms. Naevus of Ota is a blue hyperpigmented dermal lesion characterized by increased number of melanocytes in the distribution of ophthalmic and maxillary divisions of the trigeminal nerve. The association of an intracranial intermediate-grade melanocytic neoplasm with a nevus of Ota is extremely rare, with only 2 cases reported in the literature to date. As a result, their behavior and progression are still poorly understood. We present the first case of a familial naevus of Ota associated with intermediate-grade melanocytic neoplasm.

Perianal verrucous epidermal nevus masquerading as warts

Verrucous epidermal naevus(VEN) is a rare form of epidermal naevus. We present a case of VEN occurring over the perianal region of a 7-year-old boy. The lesion was initially thought to be an area of chronic dermatitis; however it was refractory to treatment. Histopathology confirmed the diagnosis of VEN. VEN in the inguinogenital region may be misdiagnosed as flexural psoriasis, genital warts or sexual abuse. This is what precisely happened to our patient for a duration of more than 1 year.

Sirolimus treatment for neonate with blue rubber bleb nevus syndrome:A case report

BACKGROUND Blue rubber bleb naevus syndrome(BRBNS)is a rare disease that usually presents with multiple venous malformations in the skin and gastrointestinal tract.Lesions located in the gastrointestinal tract always result in chronic gastrointestinal bleeding and severe anemia.The successful management of BRBNS with sirolimus had been reported in many institutions,due to its impact on signaling pathways of angiogenesis.However,the experience in treatment of neonates with BRBNS was limited.CASE SUMMARY A 38-day-old premature female infant born with multiple skin lesions,presented to our center complaining of severe anemia and hematochezia.Laboratory examination demonstrated that hemoglobin was 5.3 g/dL and contrast-enhanced abdominal computed tomography showed multiple low-density space-occupying lesions in the right lobe of the liver.She was diagnosed as having BRBNS based on typical clinical and examination findings.The patient was treated by transfusions twice and hemostatic drugs but symptoms of anemia were difficult to alleviate.A review of BRBNS case reports found that patients had been successfully treated with sirolimus.Then the patient was treated with sirolimus at an average dose of 0.95 mg/m2/d with a target drug level of 10-15 ng/mL.During 28 mo of treatment,the lesion was reduced,hemoglobin returned to normal,and there were no adverse drug reactions.CONCLUSION This case highlights the dosing regimen and plasma concentration in neonates,for the current common empiric dose is high.