Acral pseudolymphomatous angiokeratoma: case report and literature\nreview
White, female patient, aged 11, complaining of "small lumps on the left wrist since the\nage of two". The dermatological exam revealed erythematous-violaceous papules on the\nleft wrist, which appeared fainter during the vitropression test (). The condition had been evolving for 9 years, without any\nchanges in clinical characteristics, local symptomatology or previous trauma. The\nhistopathological exam revealed an integral epidermis without atypia; and, in the\ndermis, inflammatory infiltrate of superficial and deep, perivascular location, around\nthe pilo-erector muscles, hair follicles, eccrine glands and nerves ( and ). The infiltrate was made up of lymphocytes, some histiocytes, a moderate\nnumber of plasmocytes and small basophilic granulations in the cytoplasmas of the\nhistiocytic cells. Infiltration was noticed in the hypodermal lobules. The search for\nalcohol-acid resistant bacilli using the Ziehl-Neelsen staining procedure culminated in\na negative result. In regard to the inflammatory infiltrate, abundant in plasmocytes, a\nclinical and laboratory investigation was conducted to rule out leishmaniasis and\nsyphilis, with the following findings: non-reactive VDRL and FTA-Abs results (). Surveys for micobacteria, treponema and\nleishmania, by immunohistochemistry, produced negative results. In addition: hemogram,\nhepatic and renal function, ESR, dosage of immunoglobulins and protein electrophoresis,\nwithout changes.\nThus, total excision of the lesions was initiated, to diagnostic and therapeutic ends.\nThe histopathological exam revealed the same histopatholoogical pattern as before. The\nimmunohistochemical study of the biopsy material revealed histological characteristics\nof dermal lymphoid proliferation of small, perivascular and adnexal, T and B\nlymphocytes, with a low proliferative index ( and ).\nThe patient is undergoing outpatient follow-up, with no signs of recurrence at present.