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Journal of Cutaneous Pathology

Maya Farah, Priyadharsini Nagarajan, Carlos A Torres-Cabala, Jonathan L Curry, Rodabe N Amaria, Jennifer Wargo, Hussein Tawbi, Doina Ivan, Victor G Prieto, Michael T Tetzlaff, Phyu P Aung
Epithelioid cells with foamy cytoplasm (histiocytoid features) are typical histopathologic findings among benign and malignant histiocytic neoplasms such as xanthoma and atypical fibroxanthoma. However, these changes are unusual in melanoma, which is typically composed of nested and variably pigmented atypical epithelioid cells. Here, we report a patient with metastatic melanoma in lymph nodes presenting with prominent balloon cell/histiocytoid features expressing melanocytic markers, after treatment with nivolumab...
April 19, 2018: Journal of Cutaneous Pathology
Ferdinand Toberer, Alexander Enk, Wolfgang Hartschuh, Carsten Grüllich
A 19-year-old man suffering from testicular choriocarcinoma presented to the dermatology department with a cutaneous metastasis on his head. This metastasis was the first sign of disease that led to medical consultation. Histopathology revealed cytotrophoblasts and syncytiotrophoblasts, the later expressing human chorionic gonadotropin antigen. Whole body computed tomography showed multiple metastases of the brain, lung, liver, bone, paraaortic lymph nodes and left uvea, the primary was found in the left testicle...
April 17, 2018: Journal of Cutaneous Pathology
Tsetan Dolkar, Celestine M Trinidad, Kelly C Nelson, Rodabe N Amaria, Priyadharsini Nagarajan, Carlos A Torres-Cabala, Doina Ivan, Victor G Prieto, Michael T Tetzlaff, Jonathan L Curry, Phyu P Aung
LL-37 is a naturally occurring 37-amino acid that is part of innate immunity in human skin. Preclinical studies have demonstrated that intra-tumoral injections of LL-37 stimulate the innate immune system by activation of plasmacytoid dendritic cells, which mediate tumor destruction. LL-37 intra-tumoral injections have been utilized in a Phase 1 clinical trial for melanoma patients with cutaneous metastases. We report dermatologic toxicity in a 63-year-old woman with stage IIIC melanoma of the right calf and inguinal lymph nodes...
April 17, 2018: Journal of Cutaneous Pathology
Robert Schnietz, Morgan L Wilson
Although often used to identify fungi within granulomatous infiltrates, Grocott's methenamine silver (GMS) and periodic acid-Schiff (PAS) stains have also been reported to stain Mycobacterium leprae (1). There is limited literature concerning the results of these stains when applied to other mycobacterial species. We have recently observed prominent GMS and PAS positivity in a case of cutaneous Mycobacterium avium complex (MAC) infection.
April 17, 2018: Journal of Cutaneous Pathology
Amir Qorbani, Farzad Fereidouni, Richard Levenson, Sana Yasmine Lahoubi, Zachary T Harmany, Austin Todd, Maxwell A Fung
Traditional histology relies on processing and physically sectioning either frozen or formalin-fixed, paraffin-embedded (FFPE) tissue into thin slices (typically 4-6 microns) prior to staining and viewing on a standard wide-field microscope. MUSE represents a novel alternative microscopy method that works with ultraviolet (UV) excitation using oblique cis-illumination which can generate high-quality images from the cut surface of fresh or fixed tissue after brief staining, with no requirement for fixation, embedding and histological sectioning of tissue specimens...
April 16, 2018: Journal of Cutaneous Pathology
Wei Ba, Yi Yang, Ziyan Zhang, Xuanjin Wei, Wenjuan Wang, Zigang Zhao, Liqiang Zheng, Chengxin Li
The histopathological characteristics of lymphomatoid papulosis (LyP) vary. Currently, six subtypes have been reported, including a new subtype with perifollicular infiltration and different degrees of folliculotropism of CD30+ atypical lymphocytes, known as follicular LyP. However, LyP pathologically manifesting with folliculotropism, eccrinotropism and neurotropism has been rarely reported. We present a case of LyP demonstrating CD30+ atypical lymphocytes around the hair follicle, eccrine gland and neurofiber, with varying degrees of infiltrates...
April 16, 2018: Journal of Cutaneous Pathology
Vanessa Szablewski, Valérie Costes, Caroline Bret, Olivier Dereure, Hicheri Yosr, Melissa Alame, Valère Cacheux
Acute myeloid leukemia (AML) may initially present as cutaneous lesions corresponding to blasts involving the skin as the first clinical manifestation prior to blood and bone marrow (BM) infiltration. Such presentation is known as myeloid leukemia cutis (LC). Blastic plasmocytoid dendritic cell neoplasm (BPDCN) is an aggressive tumour derived from the precursors of plasmocytoid dendritic cells with cutaneous and bone marrow (BM) involvement and leukemic dissemination. Myeloid LC and BPDCN may be difficult to distinguish as they share similar clinical and histopathological features, in particular AML with monocytic differentiation...
April 16, 2018: Journal of Cutaneous Pathology
Pukhraz Basra, Juan Paramo, John Alexis
Kaposi sarcoma is an oligoclonal HHV8-driven vascular proliferation that was first described in 1872 as an "idiopathic multiple pigmented sarcoma of the skin" by a Viennese dermatologist Dr. Moriz Kaposi (1).
April 16, 2018: Journal of Cutaneous Pathology
Celestine Trinidad, Kelly C Nelson, Isabella C Glitza Oliva, Carlos A Torres-Cabala, Priyadharsini Nagarajan, Michael T Tetzlaff, Doina Ivan, Wen-Jen Hwu, Victor G Prieto, Jonathan L Curry, Phyu P Aung
Immunotherapies targeting cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) and the programmed cell death 1 (PD-1) receptor and its ligand (PD-L1) have showed significant therapeutic benefit in patients with clinically advanced solid malignancies, including melanoma. However, immune-related adverse events (irAE) are common, and novel dermatologic toxicities continue to emerge as more patients are treated with immunotherapy. Here we describe a patient treated with combination immunotherapy of ipilimumab and pembrolizumab, who developed asymptomatic erythematous patches on bilateral legs...
April 6, 2018: Journal of Cutaneous Pathology
Erin Heuring, Suephy C Chen
United States Cancer Statistics are derived from two central registries (1, 2), which gather data reported by individual state cancer registries, which in turn rely on healthcare providers to report malignancies. Despite an established legal requirement to report cases, underreporting is thought to be a significant source of inaccuracies in US Cancer Statistics.
April 6, 2018: Journal of Cutaneous Pathology
Celeste Sánchez-Romero, Ana Isabel Cuenca Arriaga, Oslei Paes de Almeida, Evangelina Gutiérrez Cortés
Juvenile Xanthogranuloma (JXG) is a non-Langerhans cell histiocytosis (non-LCH) affecting normolipemic infants and children most frequently in the first year of life, often showing spontaneous regression within 3 to 6 years. Classic JXG is characterized by a yellowish asymptomatic papule or nodule, often located in the skin of the head, neck and upper trunk. Oral JXG have been reported, but is rare. Histologically JXG is composed mainly by an infiltrate of macrophages with a variable degree of lipidization (foamy macrophages), and (most of the times) scattered Touton type giant cells...
April 6, 2018: Journal of Cutaneous Pathology
Jonathan C Banta, Justin P Bandino
We report two cases of benign intradermal melanocytic nevi with discrete glandular elements and mucin deposition engendering a diagnostic dilemma. The preliminary differential included entrapment of adnexal structures, collision with an adnexal neoplasm such as adenoid cystic carcinoma, or metastatic adenocarcinoma. A colloidal iron special stain confirmed the deposition of mucin, however a pankeratin AE1/AE3 immunohistochemical cocktail was surprisingly negative. Closer cytological examination of the discrete "glands" combined with nearby pseudoangiomatous (almost Kaposiform) change hinted at melanocytic origin, and was confirmed with a positive MART-1 immunohistochemical stain...
April 6, 2018: Journal of Cutaneous Pathology
Angel Fernandez-Flores, David S Cassarino
Pilomatrical (pilomatrix) carcinoma is a rare cutaneous adnexal tumor with matrical differentiation and recurrent and metastatic potential. Sarcomatoid pilomatrix carcinoma is a rare variant which shows a sarcomatoid component intermingling with the epithelial one. There are only four cases previously published. We present an additional case on the hand of a 78 year-old man which appeared as a 6 mm hyperkeratotic ─focally ulcerated─ plaque. A shave biopsy demonstrated a dermal infiltrative neoplasm, composed of markedly atypical-appearing basaloid cells with focal necrotic/ghost cells, as well as an intimately associated population of atypical oval to spindle-shaped cells...
April 6, 2018: Journal of Cutaneous Pathology
Emily Yiping Gan, See Ket Ng, Chee Leok Goh, Siong See Joyce Lee
BACKGROUND: There are patients with recalcitrant psoriasiform plaques that do not fit into conventional categories of facial dermatoses. Our study aims to describe the clinico-pathological characteristics of several patients with a unique presentation of persistent psoriasiform facial rashes. METHODS: This retrospective cross-sectional study analyzed clinical and histological data of known cases of recalcitrant psoriasiform dermatosis of the face diagnosed at National Skin Centre, Singapore, over 10 years...
March 31, 2018: Journal of Cutaneous Pathology
Patricia A Carney, Paul D Frederick, Lisa M Reisch, Linda Titus, Stevan R Knezevich, Martin A Weinstock, Michael W Piepkorn, Raymond L Barnhill, David E Elder, Donald L Weaver, Joann G Elmore
BACKGROUND: Little is known about how pathologists process differences between actual and perceived interpretations. OBJECTIVE: To compare perceived and actual diagnostic agreement before and after educational interventions. METHODS: Pathologists interpreted test sets of skin and/or breast specimens that included benign, atypical, in situ and invasive lesions. Interventions involved self-directed learning, one skin and one breast, that showed pathologists how their interpretations compared to a reference diagnoses...
March 30, 2018: Journal of Cutaneous Pathology
Anjela Galan, Paul Kupernik, Shawn E Cowper
BACKGROUND: Lyme disease (LD) is one of the most common tick-borne diseases caused by several Borrelia species of spirochetes. Ixodes scapularis is responsible for the transmission of LD in the northeastern United States. The rate of infection varies with the duration of tick attachment to the host, however this information may be unknown. In skin biopsies it is often difficult to identify spirochetes. Testing of ticks is not routinely performed. Treatment is established by clinical presentation...
March 22, 2018: Journal of Cutaneous Pathology
David Romero-Pérez, Marie-Hélène Jegou, Claire Lecointre, Isabelle Penchet, Bernard Cribier
Cutaneous ganglioneuromas (CGN) are exceptional. We aim to describe the anatomoclinical profile of primary CGN and report 4 cases. Patients were 2 men and 2 women aged 53-to-76-years-old, who had flesh-colored nodules on the back, associated with adjacent keratotic changes, i.e. epidermal nevus (1 case) or seborrheic keratosis (3 cases). Histopathology showed ganglion cells within a proliferation of Schwann cells. The epidermis was acanthotic, associated with sebaceous induction in 2 cases, and with follicular hyperplasia as in fibroepithelial tumors (1 case), or with tricholemmoma (2 cases)...
March 22, 2018: Journal of Cutaneous Pathology
Claudia I Vidal, Eric A Armbrect, Aleodor A Andea, Angela K Bohlke, Nneka I Comfere, Sarah R Hughes, Jinah Kim, Jessica A Kozel, Jason B Lee, Konstantinos Linos, Brandon R Litzner, Tricia A Missall, Roberto A Novoa, Uma Sundram, Brian L Swick, M Yadira Hurley, Murad Alam, Zsolt Argenyi, Lyn M Duncan, Dirk M Elston, Patrick O Emanuel, Tammie Ferringer, Maxwell A Fung, Gregory A Hosler, Alexander J Lazar, Lori Lowe, Jose A Plaza, Victor G Prieto, June K Robinson, Andras Schaffer, Antonio Subtil, Wei-Lien Wang
BACKGROUND: Appropriate use criteria (AUC) provide physicians guidance in test selection, can affect health care delivery, reimbursement policy, and physician decision-making. OBJECTIVES: The American Society of Dermatopathology (ASDP), with input from the American Academy of Dermatology (AAD) and the College of American Pathologists (CAP), sought to develop AUC in dermatopathology. METHODS: The RAND/UCLA appropriateness methodology, which combines evidence-based medicine, clinical experience and expert judgment, was used to develop AUC in dermatopathology...
March 22, 2018: Journal of Cutaneous Pathology
Ana Ortins-Pina, Mar Llamas-Velasco, Sara Turpin, Luís Soares-de-Almeida, Paulo Filipe, Heinz Kutzner
BACKGROUND: Accurate distinction of epithelioid hemangioma (EH) from its malignant mimics is paramount but it remains challenging due to its wide morphological spectrum and lack of objective molecular markers. FOSB oncogenic activation was recently identified as a key event in endothelial proliferation. We sought to investigate the FOSB staining pattern in EH with angiolymphoid hyperplasia with eosinophilia morphology (EH-AHLE) and to evaluate its value in differential diagnosis of epithelioid vascular tumors...
March 12, 2018: Journal of Cutaneous Pathology
A Khoa Pham, Joi B Carter, Nora R Ratcliffe, Alexander D Fuld, Frederick Lansigan, Nancy J Burnside, Marshall A Guill, Kathryn A Zug, Lesley A Jarvis, Robert E LeBlanc
Mycosis fungoides in palmoplantar localization (MFPP) is a rare variant of MF that is confined to the hands and feet. Patients commonly receive treatment over many years for suspected palmoplantar dermatitis before the diagnosis is made. Most MFPP patients remain at patch or plaque stage, and often respond to treatment with radiotherapy. Herein we describe a 77-year-old man who suffered 6 years of hand and foot dermatitis that failed multiple treatments, most notably TNF-α inhibitors and mycophenolate mofetil...
March 7, 2018: Journal of Cutaneous Pathology
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