V těhotenství dochází vlivem hormonálních, ale i dalších fyziologických faktorů k celé řadě změn, které jsou zaměřené na podporu vývoje nového jedince. Jedním z orgánů, který je těmito změnami ovlivněn, je kůže. Fyziologické projevy na kůži jsou vyjádřeny u těhotných žen ve vyšší či nižší míře, z toho důvodu různou měrou ženy zatěžují a mohou ovlivnit i psychickou stránku během těhotenství. Základem správného přístupu zůstává diferenciální diagnostika, pochopení mechanismu vzniku kožních změn a vhodně zvolený terapeutický přístup se zaměřením na specifika těhotných. Přehledový článek poukazuje na nejčastější přirozené změny na kůži, které se mohou objevit během těhotenství.

During pregnancy, hormonal and other physiological factors cause a number of changes aimed at supporting the development of a new individual. One of the organs affected by these changes is the skin. Physiological manifestations on the skin are expressed in pregnant women to a greater or lesser extent, which is why they burden women to varying degrees and can also affect the psychological aspect during pregnancy. The basis of the correct approach remains differential diagnosis, understanding the mechanism of skin changes and a suitably chosen therapeutic approach focusing on the specifics of pregnant women. The review article points out the most common natural changes on the skin that can occur during pregnancy.

• MeSH
• acne vulgaris diagnóza   etiologie   MeSH
• diferenciální diagnóza MeSH
• fyziologie kůže * MeSH
• hyperpigmentace diagnóza   etiologie   MeSH
• lidé MeSH
• melanóza diagnóza   MeSH
• nemoci cév diagnóza   etiologie   klasifikace   MeSH
• pruritus diagnóza   etiologie   MeSH
• těhotné ženy * MeSH
• vlasy, chlupy fyziologie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• přehledy MeSH

We report a very unusual case of melanocytic neoplasm appearing clinically as a 0.5-cm dome-shaped pigmented papule on the chest of a 63-year-old man. Microscopically, it was an asymmetric, entirely dermally based neoplasm characterized by a multinodular, vaguely plexiform architecture composed of moderately pleomorphic spindled melanocytes with ample, dusty pigmented cytoplasm and scattered multinucleated cells. The tumor cells were strongly positive for Melan-A, HMB45, S100, and PRAME, whereas p16 showed diffuse nuclear loss. β-catenin presented a strong and diffuse cytoplasmic staining, while nuclei were negative. Despite an increased cellularity, mitotic count was low (1/mm 2 ). Fluorescence in situ hybridization revealed no copy number alteration in melanoma-related genes ( CDKN2A, MYB, MYC, CCND1 and RREB1 ). DNA and RNA sequencing identified KIT c.2458G>T and APC c.6709C>T mutations. No further genetic alteration was detected including TERT-promoter (TERT-p ) hot-spot mutation. A re-excision was performed. A sentinel lymph node biopsy was negative. Clinical investigations revealed no extracutaneous involvement. The patient is disease-free after a follow-up period of 8 months. Given the peculiar morphologic and molecular findings, we hypothesize the lesion may represent a novel subtype of an intermediate grade melanocytic tumor (melanocytoma).

• MeSH
• antigeny nádorové MeSH
• biopsie sentinelové lymfatické uzliny MeSH
• hybridizace in situ fluorescenční MeSH
• lidé středního věku MeSH
• lidé MeSH
• melanocyty patologie   MeSH
• melanom * patologie   MeSH
• mutace MeSH
• nádory kůže * patologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Oncocytic renal neoplasms are a major source of diagnostic challenge in genitourinary pathology; however, they are typically nonaggressive in general, raising the question of whether distinguishing different subtypes, including emerging entities, is necessary. Emerging entities recently described include eosinophilic solid and cystic renal cell carcinoma (ESC RCC), low-grade oncocytic tumor (LOT), eosinophilic vacuolated tumor (EVT), and papillary renal neoplasm with reverse polarity (PRNRP). A survey was shared among 65 urologic pathologists using SurveyMonkey.com (Survey Monkey, Santa Clara, CA, USA). De-identified and anonymized respondent data were analyzed. Sixty-three participants completed the survey and contributed to the study. Participants were from Asia (n = 21; 35%), North America (n = 31; 52%), Europe (n = 6; 10%), and Australia (n = 2; 3%). Half encounter oncocytic renal neoplasms that are difficult to classify monthly or more frequently. Most (70%) indicated that there is enough evidence to consider ESC RCC as a distinct entity now, whereas there was less certainty for LOT (27%), EVT (29%), and PRNRP (37%). However, when combining the responses for sufficient evidence currently and likely in the future, LOT and EVT yielded > 70% and > 60% for PRNRP. Most (60%) would not render an outright diagnosis of oncocytoma on needle core biopsy. There was a dichotomy in the routine use of immunohistochemistry (IHC) in the evaluation of oncocytoma (yes = 52%; no = 48%). The most utilized IHC markers included keratin 7 and 20, KIT, AMACR, PAX8, CA9, melan A, succinate dehydrogenase (SDH)B, and fumarate hydratase (FH). Genetic techniques used included TSC1/TSC2/MTOR (67%) or TFE3 (74%) genes and pathways; however, the majority reported using these very rarely. Only 40% have encountered low-grade oncocytic renal neoplasms that are deficient for FH. Increasing experience with the spectrum of oncocytic renal neoplasms will likely yield further insights into the most appropriate work-up, classification, and clinical management for these entities.

• MeSH
• karcinom z renálních buněk * patologie   diagnóza   MeSH
• lidé MeSH
• nádorové biomarkery analýza   MeSH
• nádory ledvin * patologie   diagnóza   MeSH
• oxyfilní adenom * patologie   diagnóza   MeSH
• patologové * MeSH
• průzkumy a dotazníky MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Cellular encapsulation associated with melanization is a crucial component of the immune response in insects, particularly against larger pathogens. The infection of a Drosophila larva by parasitoid wasps, like Leptopilina boulardi, is the most extensively studied example. In this case, the encapsulation and melanization of the parasitoid embryo is linked to the activation of plasmatocytes that attach to the surface of the parasitoid. Additionally, the differentiation of lamellocytes that encapsulate the parasitoid, along with crystal cells, is accountable for the melanization process. Encapsulation and melanization lead to the production of toxic molecules that are concentrated in the capsule around the parasitoid and, at the same time, protect the host from this toxic immune response. Thus, cellular encapsulation and melanization represent primarily a metabolic process involving the metabolism of immune cell activation and differentiation, the production of toxic radicals, but also the production of melanin and antioxidants. As such, it has significant implications for host physiology and systemic metabolism. Proper regulation of metabolism within immune cells, as well as at the level of the entire organism, is therefore essential for an efficient immune response and also impacts the health and overall fitness of the organism that survives. The purpose of this "perspective" article is to map what we know about the metabolism of this type of immune response, place it in the context of possible implications for host physiology, and highlight open questions related to the metabolism of this important insect immune response.

• MeSH
• buněčná diferenciace MeSH
• Drosophila melanogaster MeSH
• Drosophila * MeSH
• larva MeSH
• sršňovití * MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

Herein, a case of a 45-year-old woman is reported with left atrial myxoma showing unique histological findings mimicking malignancy. For 3 months before surgery, the patient suffered from a long-standing fever of unknown etiology, malaise and weight loss; she had no history of malignancy. The CT scan revealed a tumorous mass in the left atrium. Grossly, the tumor had a smooth rounded surface with areas of haemorrhage on the cut surface. Microscopic examination revealed two distinct regions. One showed classical myxoma histology, the other atypical and highly cellular population with sarcoma-like or melanoma-like features mixed with inflammatory cells and posthemorrhagic changes. Immunohistochemically, the atypical cells expressed calretinin and CD31, analogous to the neighbouring bland myxoma cells. Negative markers included SOX10, S100, Melan A, HMB45, CD34, desmin, ERG, CK, LCA, CD68 and MDM2; SMARCB1/INI1 was retained. The proliferation index Ki67 was low, in about 1 % of atypical cells. The results suggest exaggerated reactive and degenerative changes of the myxoma cells rather than true malignant transformation. Similar case reports of cardiac myxomas and diagnostic challenges are discussed.

• MeSH
• lidé středního věku MeSH
• lidé MeSH
• melanom * MeSH
• myxom * patologie   MeSH
• nádory srdce * patologie   MeSH
• sarkom * MeSH
• srdeční síně patologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Leiomyomas with adipocytic differentiation typically occur in the uterus although they may arise at several sites in the female genital tract. While these are most commonly spindled leiomyomas with a component of adipocytic tissue ("conventional lipoleiomyomas"), there is a relatively ill-defined assortment of leiomyoma variants with adipocytic differentiation. We performed a morphologic, immunohistochemical and MDM2 gene amplification analysis of a large series of gynecologic leiomyomas with adipocytic differentiation to better define the clinicopathologic spectrum. Forty four tumors from 44 patients were identified and classified as conventional lipoleiomyoma (n = 21), adipocyte-rich lipoleiomyoma (defined as tumor volume >80 % adipocytes, n = 9); cellular lipoleiomyoma (n = 9); hydropic lipoleiomyoma (n = 3); and lipoleiomyoma with bizarre nuclei (n = 2). Patient age ranged from 32 to 83 years (mean 63; median 63). Primary location included uterine corpus (35), uterine cervix (3), uterine corpus/cervix (1), broad ligament (2), parametrium (2), and round ligament (1). Tumor size was 0.6-30 cm (mean 8; median 6). None of the 34 patients with follow up developed further disease (range 1-311 months; mean 65; median 41). Immunohistochemical expression of ER, PR, HMB45, Melan A, Cathepsin K and WT-1 in lipoleiomyomas and variants was similar to patterns in non-adipocytic gynecologic leiomyomas. MDM2 amplification fluorescence in situ hybridization performed on 14 tumors was negative in all. Our findings suggest female genital tract conventional lipoleiomyomas and lipoleiomyoma variants largely parallel their non-adipocytic counterparts in morphology and immunophenotype, and may be categorized using non-adipocytic leiomyoma histologic criteria.

• MeSH
• dospělí MeSH
• hybridizace in situ fluorescenční MeSH
• leiomyom * patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lipom * genetika   patologie   MeSH
• nádor z hladké svalové tkáně * MeSH
• nádory dělohy * patologie   MeSH
• protoonkogenní proteiny c-mdm2 genetika   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• uterus patologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Hyperpigmentace není onemocnění, ale označení pro stav kůže, která je tmavší. Pigmentace patří mezi časté esteticky nevhodné projevy, které se nejčastěji vyskytují v obličeji, ale mohou být kdekoliv na těle. Zvýšené pigmentace nebývají obvykle škodlivé. Mohou vzniknout na základě hormonálních změn, použitím nevhodných přípravků, ale také jako následek infekčního nebo jiného kožního onemocnění. Tzv. melazma vzniká na základě hormonálních změn např. během těhotenství, v období kojení nebo menopauzy. Samozřejmě může vzniknout v kterémkoliv věku. Ve sdělení je popsán případ klientky s výskytem melazma a jeho následného ošetření.

Hyperpigmentation is not a disease, but a label for a skin condition that is darker. Pigmentation is among the frequent aesthetically inappropriate manifestations that most often occur on the face, but can be anywhere on the body. Increased pigmentation is usually not harmful. They can arise on the basis of hormonal changes, the use of inappropriate products, but also as a result of an infectious or other skin disease. The so-called melasma arises on the basis of hormonal changes, e.g. during pregnancy, breastfeeding or menopause, of course it can arise at any age. The communication describes the case of a client with melasma and her subsequent treatment.

• MeSH
• chemická exfoliace MeSH
• dospělí MeSH
• hyperpigmentace * etiologie   MeSH
• lidé MeSH
• melanóza diagnóza   farmakoterapie   MeSH
• niacinamid terapeutické užití   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Cutaneous tumors with melanocytic differentiation represent a broad group of neoplasms of both melanocytic and non-melanocytic origin. Besides traditional members such as clear-cell sarcoma (CCS) and PEComa, the latter group has recently expanded to also include MITF::CREM fusion-associated tumors, but the available data are limited. Herein, we present a third case of this rare neoplasm which occurred in the temporal region in a 1-year-old girl. It was an infiltratively growing polypoid dermal-based lesion lacking an intraepidermal component. It consisted of cellular solid sheets or small nests of epithelioid to spindled cells with a predominantly eosinophilic and much less commonly clear cytoplasm. The nuclei had round to ovoid shape and exhibited moderate to high-grade atypia and prominent nucleoli. The mitotic activity was 11 mitoses per 10 high-power fields, and atypical mitotic figures were present. Immunohistochemically, the tumor was strongly positive with S100 protein, SOX10, and MITF, while HMB45, tyrosinase, and Melan A were negative. Extensive molecular analysis revealed only MITF::CREM gene fusion. There had no evidence of disease 9 months after the diagnosis. These tumors need to be distinguished from malignant tumors with melanocytic differentiation, primarily from melanoma. However, additional cases still need to be studied to precisely define their biological potential and establish their nosologic status.

• MeSH
• buněčná diferenciace MeSH
• kojenec MeSH
• lidé MeSH
• melanocyty patologie   MeSH
• melanom * diagnóza   MeSH
• modulátor elementu responzivního pro cyklický AMP metabolismus   MeSH
• nádorové biomarkery analýza   MeSH
• nádory kůže * patologie   MeSH
• sarkom z jasných buněk * genetika   MeSH
• transkripční faktor spojený s mikroftalmií genetika   metabolismus   MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Introduction: Ganglioneuromas (GNs) are slow-growing, benign tumors arising from Schwann cells, gangliocytes, and neuronal tissues. Case Presentation: We report a rare intraparotid ganglioneuroma in a 42-year-old female presented with a parotid mass. The onset of the lesion dated back to 2021, but the growth was remarkable only in November 2022. The FNA suggested a plexiform neurofibroma. The post-surgical microscopic examination of the excised lesion revealed neoplastic large, rounded cells with abundant, finely granular eosinophilic cytoplasm and a large, eccentric nucleus with a prominent nucleolus as well as fasciculated, with an elongated cytoplasm with fine fibrillar extensions. No mitosis or tumor necrosis was observed. The periphery of the tumor showed perineural entrapment. The immunohistochemical staining for S100 protein, synaptophysin, and chromogranin A were positive. However, the neoplastic cells showed no immunoreactivity for cytokeratin (CK5/6, CK7, AE1/AE3), epithelial membrane antigen, HMB45, Melan A, CD30, CD117 and p40. The case was signed out as mature intraparotid ganglioneuroma. Conclusion: The treatment of choice was surgical resection without adjuvant radiotherapy. No recurrence or post-surgical complications were hitherto reported. To the best of our knowledge, this is the first reported case of intraparotid ganglioneuroma. Caution should be taken not to diagnose this benign neoplasm as a metastasis (e.g. metastatic neuroblastoma) or to request unnecessary overtreatment (e.g., postoperative chemotherapy and radiotherapy).

• Publikační typ
• časopisecké články MeSH

Hyperpigmentace se klinicky projevují jako ohraničené nebo difuzní ztmavnutí kůže, které nejčastěji vznikají poruchou tvorby a distribuce melaninu. Častěji se objevují u lidí s tmavým fototypem v důsledku intenzivnější syntézy melaninu. V prevenci a léčbě hyperpigmentací je důležité léčit i základní onemocnění, které je vyvolává. Zároveň symptomaticky aplikujeme lokální zesvětlující přípravky, chemický peeling, kryoterapii, microneedling, plazmaterapii, světelnou nebo laserovou terapii. V praxi často musíme volit kombinaci jednotlivých metod a důslednou fotoprotekci. Pečlivá dermatologická anamnéza, kožní vyšetření a případně kožní biopsie z projevu mohou pomoci včas vyloučit malignitu. U difuzních hyperpigmentací je potřeba zvážit autoimunitní, metabolickou nebo infekční etiologii. Terapie hyperpigmentací bývá často zdlouhavá a obtížná, proto je velmi důležité pacienta správně motivovat, čímž zvýšíme vzájemnou důvěru a podpoříme ochotu pacienta spolupracovat a dodržovat naše doporučení.

Hyperpigmentation of the skin manifests itself clinically as circumscribed or diffuse darkening of the skin, which is most often caused by a disorder in the production and distribution of melanin. They are more common in people with a dark phototype due to more intense melanin synthesis. In the prevention and treatment of hyperpigmentation, it is important to treat the underlying disease that causes them. At the same time, we symptomatically remove hyperpigmentation with local lightening preparations, chemical peels, cryotherapy, microneedling, plasmatherapy, light or laser therapy. In practice, we often have to choose a combination of individual methods accompanied by consistent photoprotection. A thorough dermatological history, skin examination and possibly skin biopsies from the manifestation can help to eliminate malignancy. For diffuse hyperpigmentation, autoimmune, metabolic or infectious etiology should be considered. Hyperpigmentation therapy is often lengthy and difficult, so it is very important to motivate the patient properly, which will increase mutual trust and support the patient's willingness to cooperate and follow our recommendations.

• Klíčová slova
• pozánětlivá hyperpigmentace,
• MeSH
• hyperpigmentace * prevence a kontrola   terapie   MeSH
• lidé MeSH
• melanóza terapie   MeSH
• přípravky chránící proti slunci MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH