Granuloma teleangiectaticum - Oorzaken, symptomen en behandeling van deze huidaandoening

DISCUSSION

The current literature seems to focus on extraordinary VA cases in the world’s biggest centers. 6 Indeed, clinicians are confronted with VA, without realizing that the most common VA, the PG, has been known for more than a century in general surgical practice. 10 In contrast to congenital VA, posttraumatic VA is much more common. Despite this fact, the topic is often only touched upon briefly, usually on the very last pages of textbooks, offering little diagnostic or therapeutic help. 5

Table ​ Table1 1 presents an overview of VA according to the ISSVA to orientate the treating physician. The differentiation between a true neoplasm and a malformation as well as the attribution to the involved vessels facilitates deciding upon the correct treatment algorithm. Posttraumatic onset is not a variable in the ISSVA table. Using these presented illustrative cases, we would like to discuss four clinical pictures in more detail: the PG, the AVF, venous ectasia (venous aneurysm), and venous malformation (Fig. ​ (Fig.14 14 ).

A tumor/swelling originating from an existing vessel which was initially traumatized was the clinical symptom which prompted medical attention in all cases (PG, AVF, ectatic vein with PG, and VAN). This was accompanied by a proliferation of capillary-like blood vessels in three cases [one extravascular (case 1), two intravascular (cases 2 and 3), and one intervascular (case 2)] appearing like active reactions to the prior trauma. Case 4 showed no such additional feature. In contrast, it developed an ectasia with a dysplastic wall in histology which can be interpreted as a passive reaction.

Tables

Diagnosis of bacillary angiomatosis

Histology

Lobular proliferations of small blood vessels with clumpy endothelial cells protruding into the lumen (here: mitoses and atypia). Perivascular predominantly neutrophilic infiltrate with nuclear debris, interstitially granular material in cell dense areas (Whartin-Starry staining: bacterial cluster!).

Immunohistochemistry

Expression of endothelial (factor VIII) and histiocytic (alpha-1-antichymotrypsin) markers

Electron Microscopy

bacteria with typical 3-layer wall structure

Cultivation (cooking blood agar, 35 °C, 5%_{CO2 atmosphere}, 2-6 weeks)

pinhead-sized, heterogeneous, whitish autoadherent colonies

Gram staining

Fine, slightly curved gram-negative rods

Gas Chromatography

Determination of cellular fatty acids

SDS Disc Electrophoresis

Cell membrane proteins

PCR amplification

DNA restriction endonuclease pattern, DNA hybridization and sequencing of the 16S rRNA gene

Penyebab granuloma paru

Mengetahui adanya granuloma di paru-paru Anda mungkin terdengar menakutkan. Tak sedikit pula yang menyangka kemunculan granuloma paru adalah pertanda kanker.

Anda tidak perlu khawatir karena sebagian besar kasus granuloma bersifat jinak sehingga tidak memiliki potensi berkembang menjadi kanker.

Penyebab munculnya granuloma adalah respons tubuh terhadap sel-sel asing yang masuk, termasuk di organ paru.

Saat bakteri atau jamur masuk ke dalam paru-paru, sistem imun tubuh akan berusaha menghalaunya dengan cara membentuk kumpulan sel peradangan, yaitu granuloma.

Lalu, apa saja penyakit serta kondisi kesehatan yang menyebabkan tubuh bereaksi dan membentuk granuloma paru? Berikut adalah beberapa contohnya:

1. Sarkoidosis

Sarkoidosis adalah penyakit yang ditandai dengan kemunculan sel-sel peradangan di bagian tubuh mana pun.

Kebanyakan kasus sarkoidosis terjadi di paru-paru dan kelenjar getah bening.

Penyebab dari sarkoidosis belum diketahui secara pasti, tetapi para ahli menduga hal ini berkaitan dengan respons sistem imun tubuh.

Sarkoidosis dapat menghilang dengan sendirinya. Namun, pada kasus yang parah, penyakit ini bisa berlangsung hingga beberapa tahun dan merusak organ tubuh.

2. Histoplasmosis

Penyakit lain yang berkaitan dengan granuloma paru adalah histoplasmosis.

Menurut Mayo Clinic, histoplasmosis adalah infeksi yang terjadi akibat menghirup spora jamur Histoplasma capsulatum.

Jamur tersebut terdapat di kotoran burung dan kelelawar. Ketika kotoran jatuh di tanah basah atau lembap, kemungkinan jamur untuk menyebar bisa lebih besar.

3. Tuberkulosis (TB)

Tuberkulosis atau TBC adalah infeksi serius yang menyerang paru-paru. Bakteri penyebab tuberkulosis dapat menular dengan mudah melalui udara.

Menurut sebuah studi dari Annals of Thoracic Medicine, tuberkulosis adalah salah satu penyebab granuloma paru yang paling umum.

Loslatende nagels

Bohn Stafleu van Loghum geeft aan het einde van dit jaar het boek Nagelaandoeningen. Handboek voor pedicures, podotherapeuten en andere voetspecialisten uit. Dit naslagwerk is geschreven door dr. Johan Toonstra, dermatoloog en dr. Anton C. de Groot, arts, die eerder al het succesvolle boek Voeten en huid schreven. In het boek worden (nagenoeg) alle afwijkingen die aan nagels en de andere weefsels van het nagelapparaat kunnen optreden, besproken. Met die informatie bent u in staat om gerichter en beter uw cliënten met afwijkingen aan de nagels te diagnosticeren, adviseren en eventueel behandelen. Podosophia licht een tipje van de sluier op. In dit artikel aandacht voor loslatende nagels.

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CASE 4

After increased exertion of the left arm for the duration of 3 months due to immobilization of the right arm following shoulder surgery, a 45-year-old patient developed a swelling of the soft tissue of the intermetacarpal space III/IV, which varied in size depending on the position of the hand and finger. He presented because the swelling prohibited him from wearing his wedding ring and he feared intractable bleeding. A 8 mm large swelling was found in the intermetacarpal web space (Fig. ​ (Fig.11). 11 ). Sonography revealed an enlargement of the vein from 4 mm to its triple size and a variation in blood flow velocity.

Case 4: Depending on the position of his hand the patient recognized a swelling in the intermetacarpal space III/IV which disappeared with elevation of the hand.

Case 4: Venous ectasia - Macroscopic versus microscopic evaulation. A and B, Intraoperative, venous ectasia of the digital vein was found. C, End-to-end anastomosis was performed to restore venous network.