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 © 2001-2009, DermAtlas | Image Name: | colloid_goiter_2_080613 | File Type: | jpg | |
| Diagnosis: | GOITER | Category: | endocrine disorder / thyroid disease associated / cutaneous sign of systemic disease | ||
| Body Site: | neck | Age: | 35 years | ||
| Contributor: | Javad Khodadoust, MD | ||||
| Description: | larg soft non-tender anterior neck mass | ||||
| Comments: | A 35-year-old woman had a huge soft and diffuse goiter since childhood. Laboratory studies revealed that she was euthyroid with normal T3, T4, and TSH. She complained of pressure over the trachea especially during hyperextension of the neck. | ||||
 © 2001-2009, DermAtlas | Image Name: | pretibial_myxedema_1_060327 | File Type: | jpg | |
| Diagnosis: | MYXEDEMA, PRETIBIAL | Category: | thyroid disease associated / Metabolic disorders | ||
| Body Site: | leg | Age: | 63 years | ||
| Contributors: | David Cowan Greg Hosler, MD, PhD | ||||
| Description: | Histologic sections of skin show a band-like area of clear matrix deposition with increased intercellular space at mid-dermal levels. The deposition is ill-defined, not forming a discrete mass. The adnexal structures are undisturbed. The overlying epidermis is slightly acanthotic. | ||||
| Comments: | This 63-year-old African-American woman presented to dermatology with a 1-year history of an asymptomatic nodule on her right shin. The lesion was biopsied to rule out panniculitis. Following the biopsy findings, a remote history of poorly controlled hyperthyroidism was ascertained. This histology is classic for pretibial myxedema. The etiology is unclear, but it is often seen in patients with hyperthyroidism. The pathogenesis is thought to relate to circulating fibroblastic stimulating factors, causing production of mucinous matrix. | ||||
| Related Images: | All related Images pretibial_myxedema_3_060327 pretibial_myxedema_2_060327 | ||||
 © 2001-2009, DermAtlas | Image Name: | pretibial_myxedema_2_060327 | File Type: | jpg | |
| Diagnosis: | MYXEDEMA, PRETIBIAL | Category: | thyroid disease associated / Metabolic disorders | ||
| Body Site: | leg | Age: | 63 years | ||
| Contributors: | David Cowan Greg Hosler, MD, PhD | ||||
| Description: | An alcian blue stain confirms the presence of mucin. | ||||
| Comments: | This 63-year-old African-American woman presented to dermatology with a 1-year history of an asymptomatic nodule on her right shin. The lesion was biopsied to rule out panniculitis. Following the biopsy findings, a remote history of poorly controlled hyperthyroidism was ascertained. This histology is classic for pretibial myxedema. The etiology is unclear, but it is often seen in patients with hyperthyroidism. The pathogenesis is thought to relate to circulating fibroblastic stimulating factors, causing production of mucinous matrix. | ||||
| Related Images: | All related Images pretibial_myxedema_3_060327 pretibial_myxedema_1_060327 | ||||
 © 2001-2009, DermAtlas | Image Name: | pretibial_myxedema_3_060327 | File Type: | jpg | |
| Diagnosis: | MYXEDEMA, PRETIBIAL | Category: | thyroid disease associated / Metabolic disorders | ||
| Body Site: | leg | Age: | 63 years | ||
| Contributors: | David Cowan Greg Hosler, MD, PhD | ||||
| Description: | At higher power of the same lesion, spindled-to-stellate fibroblasts float within this myxoid stroma. Cytologic atypia is not noted. | ||||
| Comments: | This 63-year-old African-American woman presented to dermatology with a 1-year history of an asymptomatic nodule on her right shin. The lesion was biopsied to rule out panniculitis. Following the biopsy findings, a remote history of poorly controlled hyperthyroidism was ascertained. This histology is classic for pretibial myxedema. The etiology is unclear, but it is often seen in patients with hyperthyroidism. The pathogenesis is thought to relate to circulating fibroblastic stimulating factors, causing production of mucinous matrix. | ||||
| Related Images: | All related Images pretibial_myxedema_2_060327 pretibial_myxedema_1_060327 | ||||
 © 2001-2009, DermAtlas | Image Name: | generalized_myxedema_2_060327 | File Type: | jpg | |
| Diagnosis: | MYXEDEMA, GENERALIZED | Category: | thyroid disease associated / Metabolic disorders / deposition disorders | ||
| Body Site: | wrist / thigh | Age: | 16 years | ||
| Contributor: | Greg Hosler, MD, PhD | ||||
| Description: | At medium power of the same lesion, spindled-to-stellate fibroblasts float within this mucinous matrix. There is no significant inflammation. An alcian blue stain confirmed the presence of mucin (not shown). | ||||
| Comments: | This 16-year old girl had a several-year history of uncontrolled undiagnosed hypothyroidism. She developed generalized indurated plaques, mostly involving the extremities. Generalized myxedema often affects patients with hypothyroidism, as in this case. The pathogenesis is unknown. The histology in this case is typical with increased interstitial dermal mucin throughout the dermis, accentuated around adnexal structures. The amount of mucin varies. Definitive diagnosis rests on clinicopathologic correlation, because many conditions cause cutaneous mucinosis. | ||||
| Related Images: | generalized_myxedema_1_060327 | ||||
 © 2001-2009, DermAtlas | Image Name: | generalized_myxedema_1_060327 | File Type: | jpg | |
| Diagnosis: | MYXEDEMA, GENERALIZED | Category: | thyroid disease associated / Metabolic disorders / deposition disorders | ||
| Body Site: | wrist / thigh | Age: | 16 years | ||
| Contributor: | Greg Hosler, MD, PhD | ||||
| Description: | Histologic sections of skin show an increase in intercollagenous space within the dermis. This deposition appears more concentrated in a periadnexal distribution. The epidermis is unremarkable. | ||||
| Comments: | This 16-year old girl had a several-year history of uncontrolled undiagnosed hypothyroidism. She developed generalized indurated plaques, mostly involving the extremities. Generalized myxedema often affects patients with hypothyroidism, as in this case. The pathogenesis is unknown. The histology in this case is typical with increased interstitial dermal mucin throughout the dermis, accentuated around adnexal structures. The amount of mucin varies. Definitive diagnosis rests on clinicopathologic correlation, because many conditions cause cutaneous mucinosis. | ||||
| Related Images: | generalized_myxedema_2_060327 | ||||
 © 2001-2009, DermAtlas | Image Name: | pretibial_myxedema_2_060306 | File Type: | jpg | |
| Diagnosis: | MYXEDEMA, PRETIBIAL | Category: | thyroid disease associated / Metabolic disorders | ||
| Body Site: | thigh | Age: | 51 years | ||
| Contributor: | Greg Hosler, MD, PhD | ||||
| Description: | An alcian blue stain confirms the mucinous nature of the deposition within the superficial reticular dermis. | ||||
| Comments: | This 51-year-old has a long history of hyperthyroidism and fairly recently developed ill-defined plaques on the extensor surfaces of her lower extremities. The biopsy was submitted to rule out panniculitis. This is a classic case of pretibial myxedema. Patients often have a history of hyperthyroidism, although the skin manifestations may not correlate with the level of hyperthyroidism. The etiology is uncertain, but fibroblastic stimulators/growth factors have been implicated. The histology shows copious amounts of mucin within the interstitium, sometimes in the deep dermis and other times in the superficial reticular dermis, as in this case. Mucin stains confirm the diagnosis. | ||||
| Related Images: | pretibial_myxedema_1_060306 | ||||
 © 2001-2009, DermAtlas | Image Name: | pretibial_myxedema_1_060306 | File Type: | jpg | |
| Diagnosis: | MYXEDEMA, PRETIBIAL | Category: | thyroid disease associated / Metabolic disorders | ||
| Body Site: | thigh | Age: | 51 years | ||
| Contributor: | Greg Hosler, MD, PhD | ||||
| Description: | Histologic sections of skin show epidermal papillomatosis and acanthosis with a band-like deposition within the superficial reticular dermis. The extracellular space is expanded, splaying collagen fibers and leaving only a sparse cellular network of spindled-to-stellate cells. The matrix deposits around vascular and adnexal structures, without distortion. | ||||
| Comments: | This 51-year-old has a long history of hyperthyroidism and fairly recently developed ill-defined plaques on the extensor surfaces of her lower extremities. The biopsy was submitted to rule out panniculitis. This is a classic case of pretibial myxedema. Patients often have a history of hyperthyroidism, although the skin manifestations may not correlate with the level of hyperthyroidism. The etiology is uncertain, but fibroblastic stimulators/growth factors have been implicated. The histology shows copious amounts of mucin within the interstitium, sometimes in the deep dermis and other times in the superficial reticular dermis, as in this case. Mucin stains confirm the diagnosis. | ||||
| Related Images: | pretibial_myxedema_2_060306 | ||||
 © 2001-2009, DermAtlas | Image Name: | hypothyroid_ptosis_1_050714 | File Type: | jpg | |
| Diagnosis: | PTOSIS / HYPOTHYROIDISM | Category: | thyroid disease associated / endocrine disorder / cutaneous sign of systemic disease / clinical sign | ||
| Body Site: | face / eye lid | Age: | 84 years | ||
| Contributor: | Ajoy Biswas, MD | ||||
| Description: | ptosis | ||||
| Comments: | This elderly woman demonstrates ptosis as a manifestation of her hypothyroidism. | ||||
 © 2001-2009, DermAtlas | Image Name: | Grave_2_030306 | File Type: | jpg | |
| Diagnosis: | EXOPTHALMOS / GRAVE DISEASE | Category: | cutaneous sign of systemic disease / Metabolic disorders / thyroid disease associated | ||
| Body Site: | face | Age: | 67 years | ||
| Contributor: | Rebecca Kazin, MD | ||||
| Description: | acropachy with soft tissue swelling of digits, joint enlargement, and clubbing of fingers | ||||
| Comments: | This 67-year-old man had a history of hypothyroidism for which he received L-thyroxine. Two years later he was diagnosed with ophthalmopathy from Grave disease. He was treated with propylthiouracil and prednisone. He subsequently developed pretibial myxedema and acropachy. | ||||
| Related Images: | Grave_1_030306 | ||||
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