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Aggressive squamous cell carcinoma in Kindler syndrome.
[kindler syndrome]
A
57
-
year
-old
Hispanic
man
with
a
personal
and
family
history
of
bullae
and
photosensitivity
presented
with
a
fungating
,
ulcerated
squamous
cell
carcinoma
on
his
left
hand
(
Figure
1
)
.
Physical
examination
showed
conjunctival
injection
,
ectropion
,
symblepharon
,
urethral
stricture
,
loss
of
teeth
,
short
stature
,
and
nail
dystrophy
.
There
was
reticulated
erythema
,
atrophy
,
hyperpigmentation
and
hypopigmentation
,
and
telangiectasia
of
sun-exposed
skin
of
the
face
,
neck
,
and
hands
consistent
with
poikiloderma
(
Figure
2
)
.
In
addition
,
there
was
foreshortening
of
the
left
thumb
and
sclerodermoid
changes
of
his
hands
(
Figure
3
)
.
Radiation
therapy
was
applied
to
shrink
the
tumor
before
a
local
excision
was
performed
.
However
,
a
local
recurrence
followed
and
axillary
lymph
nodes
became
clinically
palpable
,
necessitating
amputation
and
lymph
node
dissection
.
Extensive
histologic
evaluation
of
the
specimen
obtained
following
left
arm
amputation
and
lymph
node
dissection
showed
moderate
-
to
-
poorly
differentiated
deeply
invasive
squamous
cell
carcinoma
.
Two
of
3
axillary
lymph
nodes
were
positive
for
metastatic
carcinoma
.
A
random
biopsy
of
the
trunk
showed
epidermal
atrophy
,
telangiectasia
,
a
perivascular
lymphocytic
infiltration
,
and
pigment-laden
macrophages
consistent
with
poikiloderma
.
Electron
microscopy
illustrated
extensive
reduplication
of
the
basement
membrane
,
with
loops
,
curls
,
and
free
extensions
of
the
basal
lamina
in
the
superficial
dermis
;
reduced
numbers
of
hemidesmosomes
and
anchoring
fibrils
;
and
a
basement
membrane
focally
devoid
of
basal
cells
(
Figure
4
)
.
On
the
basis
of
the
clinical
features
and
the
characteristic
basement
zone
changes
,
a
diagnosis
of
Kindler
syndrome
was
made
.
Diseases
Validation
Diseases presenting
"telangiectasia"
symptom
coats disease
cowden syndrome
cutaneous mastocytosis
hereditary cerebral hemorrhage with amyloidosis
kallmann syndrome
kindler syndrome
malignant atrophic papulosis
omenn syndrome
pendred syndrome
severe combined immunodeficiency
systemic capillary leak syndrome
triple a syndrome
waldenström macroglobulinemia
werner syndrome
This symptom has already been validated