Respiratory papillomatosis pathology outlines


Insulinemia joacã un rol cheie în dezvoltarea leziunilor de acanthosis negricans. La valori peste normal insulina se leagã preferenþial de receptorii IGF insuliln-like growth factor ºi devine trigger-ul pentru hiperproliferare dermoepidermicã. Summary Acanthosis nigricans is consdered to be primarly a marker of insulin-resistance and secondarily a marker of a subclinical malignant process. The serum level of insulin plays a key role in the development of AN lesions. When it reaches respiratory papillomatosis pathology outlines beyond normal, insulin binds preferentially to IGF insulin-like growth factor and becomes the trigger for epidermal and dermal proliferation.

Un procent important din cei bolnavi vor dezvolta în cursul vieþii respiratory papillomatosis pathology outlines cutanate. Pentru unele dintre leziunile cutanate, legãtura cu diabetul este bine stabilitã sau foarte probabilã dermopatia diabeticã, bulele diabetice, reducerea mobilitãþii articulare, necrobioza lipoidicã, acanthosis nigricans ; pentru altele, asocierea cu Diabetes mellitus is a common chronic disorder theat affects all age groups, irrespective of the socio-economic status.

Many DM patients will develop skin lesions during their lifetime. Data in literature estimate this percentage as ranging from 30 to 68 per cent. Acanthosis nigricans AN este considerat, în primul rând, un marker cutanat al insulinorezistenþei ºi în mod secundar, al prezenþei unui proces respiratory papillomatosis pathology outlines cu evoluþie subclinicã.

Congenital anomalies of the heart and vessels 10 Heart malformations are determined by various factors, some with severe movement disorders and oxygen that are incompatible with life, other compatible although initially not generally allow a long-term survival. They occur in animals as lack or excess malformations by malformations of position, or structural alterations septs or the heart valves. Shows theoretical and practical importance: Acardia total lack of heartlack of closing the pericardial sac, diplocardia double heart multiplicitas cordis multiple cordsdextrocardia heart on the right side of the mediastinumcardiac ectopia presence of heart in the cervical region, pectoral or abdominaletc.

Se manifestã clinic sub forma unor plãci pigmentare verucoase localizate flexural, cu un caracter catifelat la palpare. Afecteazã în primul rând pliurile axilare, feþele laterale ale gâtului ºi ceafa.

Ulterior, leziunile pot fi localizate ºi la nivel genital, perineal, pe coapse, sâni, dosul articulaþiilor interfalangiene, ariile flexurale ale genunchilor ºi coatelor.

respiratory papillomatosis pathology outlines

Rareori, erupþia poate deveni generalizatã sau pot apãrea determinãri ale mucoaselor. Interesarea mucoaselor se manifestã ca acantoza ºi papilomatoza la nivelul pleoapelor, conjunctivei, buzelor, mucoasei orale, faringiene, esofagiene, laringiene sau anogenitale, cu tulburãri funcþionale secundare. Etiopatogenie Etiologia helminti u stolici cutanate din AN rãmâne neclarã.

Mount Sinai's Dept. of Otolaryngology Recurrent Respiratory Papillomas Grand Rounds 9-15

Primul pas spre înþelegerea patogeniei acestui sindrom l-au fãcut Kahn ºi colectivul sãu de cercetãtoricare au descris douã tipuri de sindroame de insulinorezistenþã. Tipul A, prezent la femei cu AN, hiperandrogenism ºi virilizare, este caracterizat prin anomalii ale receptorilor insulinici.

Tipul B, prezent la femei cu AN ºi boli autoimune, este asociat cu prezenþa autoanticorpilor circulanþi anti-receptori insulinici. Insulinemia joacã un rol cheie în dezvoltarea leziunilor de AN. La nivele normale ale insulinei serice, aceasta se leagã preferenþial de receptorii clasici, pe când la niveluri crescute, insulina se leagã preferenþial de receptorii IGF insulin-like growth factorreprezentând trigger-ul pentru proliferare.

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Keratinocitele ºi fibroblastele dermice exprimã ambele tipuri de receptori, astfel cã la valori crescute ale insulinei, activarea receptorilor IGF va declanºa proliferarea epidermicã ºi dermã, având ca expresie clinicã AN. Acanthosis nigricans AN is first and foremost considered a skin marker of insulin resistance and, secondly, of the presence of a malign process with subclinical evolution.

Its clinical manifestation consists in flexural verrucous pigmentary scales of velvety touch. It is mainly localised in axillar folds, the lateral sides of the neck and the backhead.

Later, the lesions may spread to genital and perineal areas, to thighs, breasts, the back of the interphalangeal articulations, the flexural areas of the knees and elbows.

Most of these tests will be commented on in the context of the various diseases. Haematology, biochemistry, serology and cardiac biomarkers They can have limited benefit in diagnosis, but haematology is worth undertaking as it can identify leucocytosis with neutrophilia, suggestive of broncho-pneumonia or circulating eosinophilia suggestive of hypersensitivity disorders and parasitic disease. Biochemistry analysis has minimal value in diagnosis of respiratory diseases, but can give information on general health and involvement of other systems.

Seldom the eruption may generalize or affect the mucosae. The the latter case, it takes the form of acanthosis and papillomatosis, affecting the eyelids, the conjunctiva, the lips, the oral, pharyngeal, esophageal, laryngeal or anogenital mucosae, and respiratory papillomatosis pathology outlines accompanied by secondary functional disorders. Ethiopathogenesis The etiology of skin modifications in DM is still subject to discussion. The first step towards the understanding of the pathogenesis of this syndrome was made by Kahn and collaboratorswho described two types of insulin resistance.

Type A, to be found in DM female patients with hyperandrogenemia and virilization, is characterized by anomalies in insulin receptors.

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Type B, present in DM female patients with autoimmune diseases, is associated with insulin antireceptor circulating autoantibodies [3]. Insulin resistance is defined as hyperinsulinemia that does not concord with plasmatic glucose levels. Insulinemia plays a key role in DM lesions.

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When serum insulin has normal levels, it mainly binds to classic receptors, while when high levels are reached, insulin mainly binds to IGF insulinlike growth factorthat triggers proliferation. Dermic keratinocytes and fibroblasts express both types of receptors, so that in high levels of insulin, the activation of IGF factors shall actuate the epidermic intraductal papilloma with focal atypical hyperplasia dermic proliferation that clinically manifests as AN [6].

Rolul etiologic al androgenilor respiratory papillomatosis pathology outlines sugerat de ameliorarea leziunilor de AN la unele femei sub tratament antiandrogenic. În alte respiratory papillomatosis pathology outlines, însã, nu s-a citat ameliorarea leziunilor de AN ºi nici a insulino-rezistenþei, ci doar a hirsutismului, în caz de sindrom de insulino-rezistenþã de respiratory papillomatosis pathology outlines A, dupã tratament anti-androgenic.

Obezitatea este cel mai frecvent asociatã cu toleranþa scãzutã la glucozã, diabet zaharat tip II, ca ºi cu dislipidemie, hipertensiune arterialã ºi hiperandrogenism.

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Studiile genetice sugereazã cã AN, valorile insulinei serice a jeun, ca ºi DZ tip II sunt sub puternice influenþe pleiomorfe. Lawrence-Seip, sd. Rabson- Mendenhall, pseudoacromegalie, au fost identificate mutaþii ale genei care codificã receptorul pentru insulinã sau defecte post receptor. Dupã înlãturarea chirurgicalã a tumorii maligne, s-a înregistrat revenirea la normal a acestor valori.

A fost descrisã o formã respiratory papillomatosis pathology outlines de boalã, cu debut de la naºtere sau de la vârste fragede, cu caracter familial ºi transmitere probabil autosomal recesivã, cu penetranþã variabilã. AN prevalence in females with hyperandrogenemia is estimated to 5 to 29 per cent. The etiologic role of androgens is suggested by the improvement of AN lesions in some cases under antiandrogenic treatment.

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However, other studies have not concluded as to the amelioration of AN lesions, nor of insulin resistance, but only of the hirsuitism in type A insulin-resistant syndrome following the antiandrogenic treatment [14]. Hiperinsulinemia is almost respiratory papillomatosis pathology outlines present in obsese patients. Obesity is most frequently associated with low tolerance to glucose, to type II diabetes mellitus, as well as to dyslipidemia, arterial hypertension and hyperandrogenemia.

Genetic studies suggest that AN, serum insulin values a jeun and DM type II are stongly respiratory papillomatosis pathology outlines by pleiomorphs [15]. A study performed on the obese Africanamerican population in which AN incidence is higher than in the hispanic and caucasian ones has revealed a correlation between AN severity and plasmatic levels a jeun of serum insulin [4, 5].

In other cases of insulin resistance, such as the Lawrence-Seip and Rabson-Mendenhall syndromes or pseudoacromegalia, mutations in the insulin receptor codifying gene or post-receptor defects have been highlighted [7].

respiratory papillomatosis pathology outlines

As to AN association with neoplasia, researches have shown increased urinary values of transforming growth factor-alfa TGFaprobably of tumoral origin, and a higher presence of EGF factors epidermal growth factor in the lesional skin. After the surgical removal of the malign tumor, these values came back to normal. Researchers have described an idiopathic form of the disease, starting at birth or early age, with genetic character, probable recessive autosomal transmission and variable penetration [8].

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Clinical aspect When it sets in, the characteristic aspect of this disorder is that of dirty skin, due to the presence respiratory papillomatosis pathology respiratory papillomatosis pathology outlines greyish-brown verrucous flexural scales of velvety touch. Pigmentation is followed 4 urmatã de hipertrofie, papilomatozã ºi accentuarea desenului cutanat.

Localizãrile erupþiei sunt, în ordinea frecvenþei: axilã, ceafã, laterocervical, faþa internã a coapselor, organele genitale externe, scrotul, plicile antecubitala ºi poplitee, faþa, perineul ºi ombilicul. Pe zonele de AN, dar ºi pe tegument normal, pot apãrea numeroase acrochordoane.

Hiperkeratoza palmo-plantarã tylosis ºi pahidermatoglifia apar mai ales în AN paraneoplazic. Acantoza palmo-plantarã poate avea un aspect exuberant, asemuit cu burta de vitã. Tot în formele paraneoplazice sunt papillomavirus remede de grand mere frecvente determinãri ale mucoaselor, manifestate ca îngroºare ºi papilomatozã cu hiperpigmentare minimalã.

De cele mai multe ori acanthosis nigricans precede diagnosticul tumorii primare. De obicei, aceasta are agresivitate mare sau este deja într-un stadiu inoperabil. AN poate fi acompaniatã ºi de alte semne clinice sugestive pentru malignitate semnul Leser-Trelat, papilomatoza floridã cutanatã. Asocierile frecvente ale AN sunt enumerate în tabelul 1 2. Sorted by frequency, AN chiefly affects the axillae, the back of the neck, the lateral sides of the cervix, the inside of thighs, the external genital organs, the groin, the antecubital and popliteal foldsm the face, the perineum and the navel.

On AN areas, but also on the normal tegument, numerous acrochordons may appear. Palmoplantar hyperkeratosis tylosis and pachydermatoglyphia mainly occur respiratory papillomatosis pathology outlines paraneoplasic AN.

Palmo-plantar acanthosis can take an exuberant form, resembling that of a cow belly. Mucosa delimitations are also more frequent in paraneoplasic forms of the condition and manifest as skin thickening and papillomatosis with minimal hyperpigmentation. In most cases, acanthosis nigricans precedes the diagnosis of respiratory papillomatosis pathology outlines tumor. It is ususally very aggressive or already unoperable. AN can also be accompanied by other clinical markers that suggest malignity, such as the Leser- Trelat sign or florid cutaneous papillomatosis.

Alte neoplazii: endocrine carcinoid, feocromocitom, neoplasm tiroidianpulmonare cancer bronhoalveolar, cu celule mici, cu celule scuamoasereno-urinare tumora Wilms, carcinom de vezicã urinarãlimfoame inclusiv mycosis fungoidmelanom malign Human papillomavirus p16, corticosteroizi, contraceptive orale, acid fusidic topic, dietilstilbestrol, testosteron, somatotropinã Sd.

Bloom, sd. Prader-Willi, sd. Lawrence- Seip, sd. Crouzon, respiratory papillomatosis pathology outlines. Beare-Stevenson, acromegalie Lupus, dermatomiozita, sclerodermie autoimmune Association "Benign" Obesity Malignity Drugs Syndromes Comments Skin nevus form; possibly associated with multiple other nevi; posible autosomal dominant transmission Most common disorder type; insulinresistant; high incidence of type II DM Prevalence in adults, seldom in children; respiratory papillomatosis pathology outlines occurrence and fast evolution; mainly as intra-abdominal adenocarcinoma 45 to 61 per cent.

Other neoplasias: endocrine carcinoid, pheochromocytoma, thyroid neoplasm respiratory papillomatosis pathology outlines, pulmonary bronchoalveolar carcinoma, with small cells, with squamous cellsrenal-urinary Wilms' tumor, urinary vesicle carcinomalymphomae including fungoid mycosismalign melanoma Niacin, corticosteroids, oral contraceptives, topic fusidic acid, diethylsilbestrol, testosteron, somatotropin Bloom, Prader-Willi, Lawrence-Seip, polycystic ovarian syndrome, Crouzon, Beare-Stevenson, acromegalia Auto-immune Lupus, dermatomyositis, scleroderma diseases 5 Au fost descrise mai multe variante clinice de AN: tipul acral, cu afectare a dosului mâinilor, picioarelor ºi respiratory papillomatosis pathology outlines, mai frecvent la persoanele cu fototip închis; tipul unilateral, cu distribuþie nevoidã poate persista nemodificat sau poate progresa spre forma bilateralã ; tipul mixt, care sumeazã caracteristici ale tuturor formelor descrise mai sus.

Culoarea brunã a leziunilor este datã de hiperkeratoza ºi nu de hipermelanozã, care este minimã sau absentã. La nivelul mucoaselor, aspectul poate fi de parakeratoza focalã, acantozã mai accentuatã ºi hiperplazia epiteliului papilar.

Diagnosticul pozitiv se stabileºte relativ uºor pe baza aspectului clinic. Examenul histopatologic este rareori necesar. În rare cazuri, leziunile pun problema diagnosticului diferenþial.

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Astfel, leziunile unilaterale pot respiratory papillomatosis pathology outlines diferenþierea de un nev pigmentar nev Becker, nev epidermic, nev melanocitar. Boala Dowling-Degos este o genodermatozã rarã, care debuteazã la adultul tânãr, cu pigmentare de aspect macular ºi reticulat în axile ºi perineal. Histologic, lipseºte papilomatoza ºi sunt prezente proiecþii epidermice filiforme care implicã ºi infundibulul folicular. Diskeratoza congenitã este o altã genodermatozã rarã, la care hiperpigmentarea de aspect reticulat este asociatã cu atrofie unghialã, hiperkeratoza ºi atrofie palmo-plantarã, leucokeratozã a mucoaselor cu potenþial crescut de malignizare.

Debutul este în decada a doua de viaþã.

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Tot în categoria hiperpigmentarilor reticulate intra ºi papilomatoza confluentã ºi reticulatã Gougerot-Carteaud, la care localizarea tipicã este medio-toracicã intermamar, interscapular. Leziunile pigmentare conflueazã central ºi au aspect reticulat în periferie. Au fost descrise asocieri de AN, obezitate, hiperinsulinism ºi papilomatozã Gougerot-Carteaud. Uneori, stadiul incipient al unui micosis fungoid poate mima aspect de AN unilateral Several clinical variants of AN have been described: the acral type, that affects the back of the hands, feet and phalanges, more frequently in persons with dark complexion; the unilateral type, with nevoid distribution it can persist unmodified or evolve towards the bilateral type ; the mixed type, that sums up characteristics of the above mentioned forms [1].

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Histopathology Irrespective of the clinical form the condition takes, the anatomo-pathological aspect is the same, characterized by hyperkeratosis, whorled acanthosis and papillamatosis. The brown colour is given by hyperkeratosis, and not by hypermelanosis, which has minimal values or is completely absent.

At the level of mucosae, the aspect can be that of focal parakeratosis, more acute acanthosis and the hyperplasia of the papillary epithelium.

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Positive diagnosis is relatively easily established by taking into account the clinical aspect. Lesions can seldom require differential diagnosis.