fibrose rétropéritonéale sur l'appareil urinaire. Ces lésions aspécifiques miment des foyers d'infarctus rénaux, des séquelles de néphrite et l'atteinte rénale d'un lymphome non Hodgkinien. Les malades atteints de MS IgG4 avec PAI bénéficient d'une IRM pancréatique de suivi. L'atteinte rénale, discrète sur les séquences T1 et T2, se traduit par un hypersignal diffusion (figure 2). On propose la réalisation d'une séquence diffusion lors du suivi des PAI ou de l'exploration d'anomalie rénale découverte au scanner. La TEP TDM trouve sa place dans le diagnostic de la maladie, en complément des autres méthodes d'imagerie, en réalisant une cartographie précise des sites atteints avec guidage d'une éventuelle biopsie, et dans le suivi de la réponse au traitement [5]. Toutefois, la faible résolution spatiale de la TEP TDM limite son usage, en particulier sur les reins (zones pathologiques contiguës de régions rénales naturellement fixantes non détectées) [5]. Les caractéristiques de l'imagerie ne dispensent pas de la biopsie rénale qui confirme la NI IgG4. Le traitement repose sur la corticothérapie [2,4], la réponse dépend du nombre de sites atteints [5]. Déclaration d'intérêts : les auteurs déclarent ne pas avoir de conflits d'intérêts en relation avec cet article.
Références [1]
[2]
[3]
[4] [5]
Nishi S, Imai N, Yoshida K, Ito Y, Saeki T. Clinicopathological findings of immunoglobulin G4-related kidney disease. Clin Exp Nephrol 2011; 15:810–9. Takahashi N, Kawashima A, Fletcher JG, Chari ST. Renal involvement in patients with auto-immune pancreatitis: CT and MR imaging findings. Radiology 2007;242:791–801. Triantopoulou C, Malachias G, Maniatis P, Anastopoulos J, Siafas I, Papailiou J. Renal lesions associated with auto-immune pancreatitis: CT findings. Acta Radiol 2010;51:702–7. Saeki T, Kawano M. IgG4-related kidney disease. Kidney Int 2014;85: 251–7. Ebbo M, Grados A, Guedj E, Gobert D, Colavolpe C, Zaidan M, et al. Usefulness of 2-[18F]-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography for staging and evaluation of treatment response in IgG4-related disease: a retrospective multicenter study. Arthritis Care Res (Hoboken) 2014;66:86–96.
Melanoma on a tattoo Un mélanome sur un tatouage ancien
Case report A 50-year-old Finnish male presented for a pigmented lesion that developed on the upper part of an old tattoo of the left arm. His past medical history was unremarkable except that he had been previously operated for a basal-cell carcinoma of left shoulder. There was no history of skin cancer or melanoma in the family. Upon examination, he had a heterogenous multicolored and asymmetric pigmented lesion, highly evocative of a melanoma (figure 1). The tattoo nearby had been performed in the 1950s. He reported no history of trauma or irritation to the area. However, the patient was not able to say when the lesion first appears or if there was a preexisting naevus before tattooing. Using the two-step method [1], dermoscopy disclosed a melanocytic lesion based on the presence of a pigment network (brownish interconnected lines overlying background of tan diffuse pigmentation and the lack of any criteria for a nonmelanocytic lesion) (figure 2). The overall lesion is asymmetric with at least two different colors, brown and dark brown. The pigment network is atypical with thick lines, irregular brown streaks are noted on the periphery of the lesion and regression structures in the center (white scar like depigmentation). Tattoo pigments are noted on the periphery of the lesion as dark blue pigmentation. Overall, the dermoscopic features were evocative
Letters to the editor
Lettres à la rédaction
Florian Maxwell1, Félix Ackermann2, Laurence Rocher1 1
2
AP–HP, hôpital Bicêtre, service de radiologie diagnostique et interventionelle, 94270 Le Kremlin Bicêtre, France AP–HP, hopital Bicêtre, service de médecine interne, 94270 Le Kremlin Bicêtre, France Correspondance : Florian Maxwell, AP–HP, hôpital Bicêtre, service de radiologie diagnostique et interventionnelle, 78, avenue du Général-Leclerc, 94270 Le Kremlin Bicêtre, France [email protected] Reçu le 8 mai 2014 Accepté le 22 septembre 2014 Disponible sur internet le : 13 janvier 2015
Figure 1
tome 44 > n84 > avril 2015
Heterogenous asymmetric pigmented lesion on a 50-year-old tattoo
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http://dx.doi.org/10.1016/j.lpm.2014.09.017 © 2014 Elsevier Masson SAS. Tous droits réservés.
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Letters to the editor
Figure 2 Dermoscopy showing a pigmented network with think lines (a), several colors (b), irregular streaks (c) and a central white scar like patch (d) in favour for a melanoma. Dark blue pigments on the lower part of the lesion is related to the tattoo exogenous pigments in the dermis (e)
of a possible melanoma prompting full excision of the lesion. Microscopic analysis confirmed a diagnosis of melanoma in situ. Discussion
474
We report here an additional case of melanoma that developed in the vicinity of a permanent tattoo. So far, approximately 20 melanomas have been reported in the literature [1–5]. Overall cutaneous malignancies (melanoma and non-melanocytic skin cancers) arising in tattoos have been reported for the past 40 years in the literature. A potential causative link has been widely debated ever since [1]. The role of the trauma induced by the procedure, the potential carcinogenic components contained in tattoo inks and introduced during tattooing or the by-products that appear as a result of the local metabolism of these very same tattoo pigments, the role of chronic UV exposure on tattooed skin, and a possible genetic predisposition background are also possible explanations [1]. However, as we stressed so far, the number of cases of melanoma remain exceedingly low when compared to the number of tattooed individuals in the population. In Finland, like in France, the incidence of melanoma is rising increasing [6,7]. As the popularity of tattoo increase, the risk that a coincidental melanoma develops on a tattoo increases. Besides, as illustrated by a recent report [3], tattoos make more difficult the detection and the surveillance of pigmented lesions, which develops in a tattoo. The typical features that make a pigmented lesion a suspicious ugly duckling are hindered by the colored tattoo. To date, there are been no case of "double'' melanoma on a single tattoo that would make more plausible a real risk between tattooing and melanoma. In our
case, the melanoma developed in a 50–60-year-old tattoo. Besides, the patient had a past history of basal-cell carcinoma as well as 2nd lesion in the back, which illustrated his past history of sun damage and chronic sun exposure. Our case is another illustrative case of coincidental melanoma on a tattoo. However, this case should be a reminder that pigmented melanocytic lesions may arise in tattoos that they are more difficult to diagnose and follow on dark tattoos. Heightened vigilance and careful inspection of tattooed skin are warranted to ensure early detection and removal. Patients should undergo regular skin examinations to monitor pigmented lesions that can arise in tattoos. Disclosure of interest: the authors declare that they have no conflicts of interest concerning this article.
References [1]
[2] [3]
[4]
[5]
Braun RP, Rabinovitz H, Oliviero M, Kopf AW, Saurat JH, Thomas LL. Dermatoscopies des lésions pigmentées. Ann Dermatol Venereol 2002; 129:187–202. Kluger N, Koljonen V. Tattoos, inks, and cancer. Lancet Oncol 2012;13: e161–8. Pohl L, Kaiser K, Raulin C. Pitfalls and recommendations in cases of laser removal of decorative tattoos with pigmented lesions: case report and review of the literature. JAMA Dermatol 2013;149:1087–9. Nolan KA, Kling M, Birge M, Kling A, Fishman S, Phelps R. Melanoma arising in a tattoo: case report and review of the literature. Cutis 2013; 92:227–30. € Kluger N, Koskenmies S, Jeskanen L, Overmark M, Saksela O. Melanoma on tattoos: two Finnish cases. Acta Derm Venereol 2014;94:325–6.
tome 44 > n84 > avril 2015
[7]
NORDCAN. Cancer stat fact sheets Finland - Melanoma of skin; 2014 Accès au site le 10/01/1015 http://www-dep.iarc.fr/NORDCAN/English/ StatsFact.asp?cancer=290&country=246. Le Blanc C, Corven C, Courville P, Duval-Modeste AB, Boivin C, Ziadé J, et al. Évolution de l'incidence et de la mortalité du mélanome en SeineMaritime sur une période de 20 ans. Ann Dermatol Venereol 2013;140: 97–104. Nicolas Kluger1, Kari Saarinen2 1
Institute of Clinical Medicine, University of Helsinki, Skin and Allergy Hospital, Helsinki University Central Hospital, Departments of dermatology, allergology and venereology, 00029 Helsinki, Finland
tome 44 > n84 > avril 2015
2
Lahti Central Hospital, Department of dermatology, Lahti 15850, Finland
Correspondence: Kari Saarinen, Lahti Central Hospital, Department of dermatology, Lahti 15850, Finland [email protected] Received 2 October 2014 Accepted 29 October 2014 Available online: 20 February 2015
http://dx.doi.org/10.1016/j.lpm.2014.10.016 © 2015 Elsevier Masson SAS. All rights reserved.
475
[6]
Letters to the editor
Lettres à la rédaction
Références [1]
[2]
[3]
[4] [5]
Nishi S, Imai N, Yoshida K, Ito Y, Saeki T. Clinicopathological findings of immunoglobulin G4-related kidney disease. Clin Exp Nephrol 2011; 15:810–9. Takahashi N, Kawashima A, Fletcher JG, Chari ST. Renal involvement in patients with auto-immune pancreatitis: CT and MR imaging findings. Radiology 2007;242:791–801. Triantopoulou C, Malachias G, Maniatis P, Anastopoulos J, Siafas I, Papailiou J. Renal lesions associated with auto-immune pancreatitis: CT findings. Acta Radiol 2010;51:702–7. Saeki T, Kawano M. IgG4-related kidney disease. Kidney Int 2014;85: 251–7. Ebbo M, Grados A, Guedj E, Gobert D, Colavolpe C, Zaidan M, et al. Usefulness of 2-[18F]-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography for staging and evaluation of treatment response in IgG4-related disease: a retrospective multicenter study. Arthritis Care Res (Hoboken) 2014;66:86–96.
Melanoma on a tattoo Un mélanome sur un tatouage ancien
Case report A 50-year-old Finnish male presented for a pigmented lesion that developed on the upper part of an old tattoo of the left arm. His past medical history was unremarkable except that he had been previously operated for a basal-cell carcinoma of left shoulder. There was no history of skin cancer or melanoma in the family. Upon examination, he had a heterogenous multicolored and asymmetric pigmented lesion, highly evocative of a melanoma (figure 1). The tattoo nearby had been performed in the 1950s. He reported no history of trauma or irritation to the area. However, the patient was not able to say when the lesion first appears or if there was a preexisting naevus before tattooing. Using the two-step method [1], dermoscopy disclosed a melanocytic lesion based on the presence of a pigment network (brownish interconnected lines overlying background of tan diffuse pigmentation and the lack of any criteria for a nonmelanocytic lesion) (figure 2). The overall lesion is asymmetric with at least two different colors, brown and dark brown. The pigment network is atypical with thick lines, irregular brown streaks are noted on the periphery of the lesion and regression structures in the center (white scar like depigmentation). Tattoo pigments are noted on the periphery of the lesion as dark blue pigmentation. Overall, the dermoscopic features were evocative
Letters to the editor
Lettres à la rédaction
Florian Maxwell1, Félix Ackermann2, Laurence Rocher1 1
2
AP–HP, hôpital Bicêtre, service de radiologie diagnostique et interventionelle, 94270 Le Kremlin Bicêtre, France AP–HP, hopital Bicêtre, service de médecine interne, 94270 Le Kremlin Bicêtre, France Correspondance : Florian Maxwell, AP–HP, hôpital Bicêtre, service de radiologie diagnostique et interventionnelle, 78, avenue du Général-Leclerc, 94270 Le Kremlin Bicêtre, France [email protected] Reçu le 8 mai 2014 Accepté le 22 septembre 2014 Disponible sur internet le : 13 janvier 2015
Figure 1
tome 44 > n84 > avril 2015
Heterogenous asymmetric pigmented lesion on a 50-year-old tattoo
473
http://dx.doi.org/10.1016/j.lpm.2014.09.017 © 2014 Elsevier Masson SAS. Tous droits réservés.
Lettres à la rédaction
Letters to the editor
Figure 2 Dermoscopy showing a pigmented network with think lines (a), several colors (b), irregular streaks (c) and a central white scar like patch (d) in favour for a melanoma. Dark blue pigments on the lower part of the lesion is related to the tattoo exogenous pigments in the dermis (e)
of a possible melanoma prompting full excision of the lesion. Microscopic analysis confirmed a diagnosis of melanoma in situ. Discussion
474
We report here an additional case of melanoma that developed in the vicinity of a permanent tattoo. So far, approximately 20 melanomas have been reported in the literature [1–5]. Overall cutaneous malignancies (melanoma and non-melanocytic skin cancers) arising in tattoos have been reported for the past 40 years in the literature. A potential causative link has been widely debated ever since [1]. The role of the trauma induced by the procedure, the potential carcinogenic components contained in tattoo inks and introduced during tattooing or the by-products that appear as a result of the local metabolism of these very same tattoo pigments, the role of chronic UV exposure on tattooed skin, and a possible genetic predisposition background are also possible explanations [1]. However, as we stressed so far, the number of cases of melanoma remain exceedingly low when compared to the number of tattooed individuals in the population. In Finland, like in France, the incidence of melanoma is rising increasing [6,7]. As the popularity of tattoo increase, the risk that a coincidental melanoma develops on a tattoo increases. Besides, as illustrated by a recent report [3], tattoos make more difficult the detection and the surveillance of pigmented lesions, which develops in a tattoo. The typical features that make a pigmented lesion a suspicious ugly duckling are hindered by the colored tattoo. To date, there are been no case of "double'' melanoma on a single tattoo that would make more plausible a real risk between tattooing and melanoma. In our
case, the melanoma developed in a 50–60-year-old tattoo. Besides, the patient had a past history of basal-cell carcinoma as well as 2nd lesion in the back, which illustrated his past history of sun damage and chronic sun exposure. Our case is another illustrative case of coincidental melanoma on a tattoo. However, this case should be a reminder that pigmented melanocytic lesions may arise in tattoos that they are more difficult to diagnose and follow on dark tattoos. Heightened vigilance and careful inspection of tattooed skin are warranted to ensure early detection and removal. Patients should undergo regular skin examinations to monitor pigmented lesions that can arise in tattoos. Disclosure of interest: the authors declare that they have no conflicts of interest concerning this article.
References [1]
[2] [3]
[4]
[5]
Braun RP, Rabinovitz H, Oliviero M, Kopf AW, Saurat JH, Thomas LL. Dermatoscopies des lésions pigmentées. Ann Dermatol Venereol 2002; 129:187–202. Kluger N, Koljonen V. Tattoos, inks, and cancer. Lancet Oncol 2012;13: e161–8. Pohl L, Kaiser K, Raulin C. Pitfalls and recommendations in cases of laser removal of decorative tattoos with pigmented lesions: case report and review of the literature. JAMA Dermatol 2013;149:1087–9. Nolan KA, Kling M, Birge M, Kling A, Fishman S, Phelps R. Melanoma arising in a tattoo: case report and review of the literature. Cutis 2013; 92:227–30. € Kluger N, Koskenmies S, Jeskanen L, Overmark M, Saksela O. Melanoma on tattoos: two Finnish cases. Acta Derm Venereol 2014;94:325–6.
tome 44 > n84 > avril 2015
[7]
NORDCAN. Cancer stat fact sheets Finland - Melanoma of skin; 2014 Accès au site le 10/01/1015 http://www-dep.iarc.fr/NORDCAN/English/ StatsFact.asp?cancer=290&country=246. Le Blanc C, Corven C, Courville P, Duval-Modeste AB, Boivin C, Ziadé J, et al. Évolution de l'incidence et de la mortalité du mélanome en SeineMaritime sur une période de 20 ans. Ann Dermatol Venereol 2013;140: 97–104. Nicolas Kluger1, Kari Saarinen2 1
Institute of Clinical Medicine, University of Helsinki, Skin and Allergy Hospital, Helsinki University Central Hospital, Departments of dermatology, allergology and venereology, 00029 Helsinki, Finland
tome 44 > n84 > avril 2015
2
Lahti Central Hospital, Department of dermatology, Lahti 15850, Finland
Correspondence: Kari Saarinen, Lahti Central Hospital, Department of dermatology, Lahti 15850, Finland [email protected] Received 2 October 2014 Accepted 29 October 2014 Available online: 20 February 2015
http://dx.doi.org/10.1016/j.lpm.2014.10.016 © 2015 Elsevier Masson SAS. All rights reserved.
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[6]
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Lettres à la rédaction
