Pathology
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Atlas of dermatopathology
Josef Feit, Hana Jedličková, Günter Burg, Luděk Matyska, Spasoje Radovanovic et al.
Index
Contents
Authors
ExpSys: non-tumors
ExpSys: tumors
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+ Introduction
+ Literature
+ Support
+ Skin biopsy
+ Non-tumorous skin diseases
+ Skin tumors
+ Cysts of the skin and subcutis
+ Soft tissue lesions
+ Some lesions of the oral cavity
+ Dermatovenerology
+ Collection of histological slides by prof. Günter Burg
+ Collection of histological slides by prof. Werner Kempf
+ Collection of histological slides of dr. Ram Chandra Adhikari
Pretibial myxedema
Clinical signs
  • associated with thyreotoxicosis (and exophaltmos), often worsens after therapy
  • limited to pretibial areas and dorsa of feet, rarely other location
  • waxy (pink, yelow) induration of the skin
  • orange peel skin, sometimed nodules
Pictures

Pretibial myxedema, larger nodules: Pretibial myxedema, Clinical picture (840)

Histology

Large amounts of mucin in the dermis:

Pictures

Pretibial myxedema: Pretibial myxedema, HE 5x (456)

Stained with alcian blue: Pretibial myxedema, alcian blue 5x (455) Pretibial myxedema, alcian blue 40x (454)

Another case: Pretibial myxedema, HE 20x (2538) Pretibial myxedema, alcian blue 20x (2536) Pretibial myxedema, Halle 20x (2537)

Another case: Pretibial myxedema, HE 20x (4952) Pretibial myxedema, alcian blue 20x (4951)

Another case: Pretibial myxedema, HE 60x (10717)

Case study
Pretibial myxedema
Hana Jedličková, PhD.
Introduction

Pretibial myxedema is observed in patients treated for thyroid gland hyperfunction. The patients are usually euthyroid at the time of the occurrence of myxedema. Excessive thyroid stimulating hormone (TSH) probably stimulates fibroblasts of the lower extremities. Mucinous deposits are formed predominantly by hyaluronic acid and chondroitin sulphate.

Although the shins are the most common site, the deposits can occur on the arms, neck, in the scars, etc.

History

33-year-old man presented with tough nodules on the anterior aspects of lower legs of 2 months duration. The last year he was treated for thyreotoxicosis by levothyroxium, thiamazolum and bisoprolol and he was preparing for thyroid gland surgery. Further he had exophthalmia and strabismus since childhood (after meningitis) and hepatopathy.

Clinical signs

Bilaterally on the anterior aspects of the lower legs asymptomatic pink or skin colored tough nodules 2 – 4 cm in diameter, slightly elevated.

Mild edema of the lower legs, excoriations and hyperpigmentations

Palpable enlarged thyroid gland, exophthalmia.

Pictures

Pretibial myxedema: Pretibial myxedema, Clinical picture (6157)

Histology

Dermis is thickened with mucin deposits (alcian blue strongly positive), collagen fibres are widely separated by mucin. No inflammation.

Pictures

Pretibial myxedema, HE and alcian blue: Myxedema, pretibial in thyreotoxicosis, HE 40x (6104) Myxedema, pretibial in thyreotoxicosis, alcian blue 40x (6103)