Dermatopathology Cases

Histochemistry : Methenamine silver stain shows Histoplasma capsulatum fungi. Cutaneous Histoplasmosis Visit: Dermatopathology site Visit : Pathology of Histoplasmosis Abstract: Histoplasmosis Presenting as a Cutaneous Malignancy of the Eyelid. Ophthal Plast Reconstr Surg. 2010 Sep 20. Cutaneous histoplasmosis is an uncommon infection and can occur as a primary infection. A manifestation imitating a cutaneous neoplasm is rare, and eyelid involvement is rarer still. The authors report a case of histoplasmosis that presented as an ulcerated lesion on the lower eyelid margin that clinically resembled a basal cell carcinoma. Given its worldwide distribution, it is important to include this disease in the differential diagnosis of nonhealing eyelid lesions. Biopsy and tissue culture are paramount to establishing the diagnosis. This case describes a rare presentation of histoplasmosis on the eyelid and highlights the importance of histopathologic evaluation. Primary Cutaneous Histoplasmosis...

Image1 Image2 Image3 Case 73 Spot diagnosis Answer

Cutaneous Leishmaniasis Visit: Dermatopathology site Visit: Pathology of Leishmaniasis Abstract: Molecular characterization of leishmania species isolated from cutaneous leishmaniasis in yemen. PLoS One.2010 Sep 20;5(9). pii: e12879. BACKGROUND: Cutaneous leishmaniasis (CL) is a neglected tropical disease endemic in the tropics and subtropics with a global yearly incidence of 1.5 million. Although CL is the most common form of leishmaniasis, which is responsible for 60% of DALYs lost due to tropical-cluster diseases prevalent in Yemen, available information is very limited. METHODOLOGY/PRINCIPAL FINDINGS: This study was conducted to determine the molecular characterization of Leishmania species isolated from human cutaneous lesions in Yemen. Dermal scrapes were collected and examined for Leishmania amastigotes using the Giemsa staining technique. Amplification of the ribosomal internal transcribed spacer 1(ITS-1) gene was carried out using nested PCR and subsequent sequencing. The seq...

Image1 Image2 Image3 Case 72 Spot diagnosis Answer

Grover's Disease Visit: Dermatopathology site Abstract: Photo Quiz-Pruritic Papules on the Chest and Back:Am Fam Physician. 2006 Aug 15;74(4):641-642. Grover's disease: clinicopathologic review of 72 cases. Mayo Clin Proc. 1999 Mar;74(3):229-34. OBJECTIVE: To report the clinicopathologic findings in patients with Grover's disease. MATERIAL AND METHODS: We reviewed the medical records and biopsy specimens from 72 patients with transient acantholytic dermatosis (Grover's disease) examined at Mayo Clinic Rochester. Hematoxylin-eosin-stained biopsy specimens (from all patients) were assessed. Immunohistochemistry stains BRST-2, CAM 5.2, and CD44 were used to stain eight specimens. Direct immunofluorescence reports were reviewed. Selected specimens were stained by indirect immunofluorescence to detect major basic protein. RESULTS: Of the 72 patients, 63 (88%) were men, and the mean age was 48 years (range, 31 to 85). Lesions were distributed mainly on the trunk (in 71 patien...

Image1 Image2 Image3 Case 71 A 65 year old man with small, pruritic, erythematous papulovesicles on the upper arm. The patient had persistent fever and sweating. He also had a history of bone marrow transplantation. Answer

Special stain: von Kossa stain Cutaneous Malakoplakia Visit: Dermatopathology site Abstract: Perianal cutaneous malakoplakia in an immunocompetent patient. Dermatol Online J. 2010 Jan 15;16(1):10. Malakoplakia is an uncommon inflammatory condition usually affecting the genitourinary tract, which has been associated with infections, tumors, and immunocompromised states. The condition has been reported in many different organs and it may rarely involve the skin. We describe a case of an isolated perianal cutaneous malakoplakia in an immunocompetent 23-year-old Syrian male. [Vesico-cutaneous fistula revealing abdominal wall malakoplakia accompanied by Boeck's sarcoidosis]Orv Hetil.2010 Feb 7;151(6):220-3. Malakoplakia is an acquired granulomatous disorder first described by Michaelis and Gutmann in 1902. The pathogenesis of malakoplakia is hardly known, but it thought to be secondary to an acquired bactericidal defect in macrophages occurring mostly in immunosuppressed patients. CASE...

Case 70   A 35 yr old immunosuppressed patient with a polypoid mass in the perianal region.       Image1 Image2    Image3             Special stain: PAS     Answer      

Dermatophyte Infection (Dermatophytoses) - Superficial filamentous Infection (Tinea - ringworm) Visit: Dermatopathology site Visit: Pathology of Dermatophytoses Abstract: Current knowledge of host response in human tinea.Mycoses.2009 Jan 21. Summary Skin infection caused by dermatophytes is called tinea. In this short review, the known mechanisms and factors involved in human tinea and important for the host response are briefly delineated. To establish tinea, fungal propagules must attach to the skin, germinate and overcome the epidermal barrier. Keratinases and other enzymes are released in this process and host keratinocytes are activated. This is followed by an inflammatory response mediated by a plentitude of cytokines and receptors, comprising innate as well as acquired immunity, including neutrophilic granulocytes, macrophages, antibodies and T cells. Cellular defence mechanisms appear to be decisive for clearing of infection. Nails and hair follicles are the particular sites of...

Image 1 Image2 Image3 (Special stain-PAS) Image4 (Special stain - Grocott) Case 69 Spot Diagnosis Answer

Scabies Visit: Dermatopathology site Abstract: Langerhans cell hyperplasia of the skin mimicking Langerhans cell histiocytosis: a report of two cases in children not associated with scabies. Fetal Pediatr Pathol.2010;29(4):231-8. Langerhans cells histiocytosis (LCH) affecting the skin most commonly has clinical and histopathologic diagnostic features. We are reporting two examples of Langerhans cell (LC) hyperplasia recognized in the skin biopsies of two children initially interpreted as LCH. The first was an 8-year-old boy finally interpreted as having an atypical type of contact dermatitis, while the second, an 8-year-old girl, was assumed to have Pytiriasis lichenoides et varioliformis acuta. None showed evidences of scabies. Both presented spongiotic dermatitis with numerous CD1a+ cells. As more cases of LC hyperplasia are recognized, new details emerge helping in the differential diagnosis. Strict clinical-pathologic correlation is suggested in order to avoid misdiagnosis. Scabie...

Image1 Image2 Image3 Image4 Section of the superficial dermis Case 68 Intensely pruritic papules in the inframammary region of a 35 year old woman. Spot diagnosis! Answer

Special stain: Congo red Lichen Amyloidosus Visit: Dermatopathology site Abstract: Lichen amyloidosis in a dark skinned patient.G Ital Dermatol Venereol. 2010 Feb;145(1):135-8. Lichen amyloidosis is a primary localized cutaneous amyloidosis without systemic involvement, characterized by a persistent pruritic eruption of multiple discrete hyperkeratotic papules. The etiology is unknown, but chronic irritation of the skin has been proposed as an etiological factor. We herein report a typical case of lichen amyloidosis in a dark skinned patient. Physical examination revealed slightly shiny, brownish and fine uniform papules approximately 1 cm in diameter, with no accompanying macular lesions. Biopsy specimens taken from some of these papules on the legs showed small globular deposits of an amorphous and slightly eosinophilic substance in the dermis. This substance stained positively with Congo red, indicating the presence of amyloid. In addition, amyloid gave an apple green birefringence ...

Image1 Image2 Case 67 A 48 yr old male with pruritic, waxy papules on the extensor surface of the left lower limb. Answer

Melanocytic Nevus of the Vulva (Site specific nevus) Visit: Dermatopathology site Abstract: Precursors to melanoma and their mimics: nevi of special sites.Mod Pathol.2006 Feb;19 Suppl 2:S4-20. Melanocytic nevi, which are benign tumors of melanocytes, may have occasional cosmetic significance but, for the most part, they are important only in relation to melanoma. Nevi are the most important simulants of melanoma, both clinically and histologically, and can usually be reliably distinguished from melanomas using published criteria. Some lesions are characterized by greater degrees of atypia and may be more difficult to diagnose. Dysplastic nevi are among the most important simulants of melanoma. Nevi may also be important as potential precursors of melanoma; however, most nevi are stable and will not progress to malignancy. Nevi are vastly more common than melanomas and the rate of progression of individual lesions is very low. Therefore, nevi are not as a rule managed by wholesale excis...

Image1 Image2 Image3 Image4 Image5 Case 66 A vulval lesion in a 65 yr old female. Answer

Trichilemmal Carcinoma Visit: Dermatopathology site Visit: Pathology of Trichilemmal Carcinoma Abstract: Trichilemmal carcinoma of the upper eyelid: a case report.Korean J Ophthalmol. 2009 Dec;23(4):301-5. Epub 2009 Dec 4. We report a very rare case of trichilemmal carcinoma (TLC) involving the upper eyelid. To the best of our knowledge, this is the first report of trichilemmal carcinoma of the upper eyelid in Korea. A 51-year-old man presented to our hospital complaining of a bloody discharge from his left upper eyelid. He had a soft and lobulated mass on the palpebral conjunctiva. An incisional biopsy revealed trabecular growth of tumor cells with clear cytoplasm, prominent nucleoli, frequent mitoses, and foci of trichilemmal keratinization. Immunohistochemically, the lesion was positive for p53 and negative for CD 34. A diagnosis of TLC was made, and total excision of the mass and reconstruction of the eyelid were performed. Trichilemmal carcinoma is a rare malignant tumor, though ...

Image1 Image2 Image3 Image4 Image5 Image6 Case 65 A solitary nodule on the left upper arm of a 78 yr old man. Answer

Immunohistochemistry: CD34 is strongly positive. Dermatofibrosarcoma Protuberans Visit: Dermatopathology site Abstract: Cutaneous CD34+ Spindle Cell Neoplasms: Histopathologic Features Distinguish Spindle Cell Lipoma, Solitary Fibrous Tumor, and Dermatofibrosarcoma Protuberans.Am J Dermatopathol. 2010 Jun 17. Spindle cell lipoma (SCL), dermatofibrosarcoma protuberans (DFSP), and solitary fibrous tumors (SFT) are cutaneous CD34+ spindle cell tumors that may exhibit histopathologic and immunophenotypic overlap. We sought ways to reliably distinguish among these lesions even in small or superficial biopsies. Ten morphologic characteristics were analyzed in a group of 5 SCLs, 6 cutaneous SFTs, and 12 DFSPs. SFT and DFSP exhibited extensive histopathologic overlap in small or partial biopsies. However, adnexal entrapment, defined as diffuse proliferation of tumor cells around pilosebaceous and eccrine structures with minimal disruption or expansion of the dermis, was a feature seen in 10 o...

Image1 Image2 Image3 Image4 Case 64 A slow growing solitary reddish nodule in a 55 year old male. The nodule is 5 cm in diameter and is located on the right upper arm. Answer

Cutaneous Sarcoidosis Visit: Dermatopathology site Visit: Pathology of Cutaneous Sarcoidosis Abstract: Sarcoidosis of the skin--a dermatological puzzle: important differential diagnostic aspects and guidelines for clinical and histopathological recognition. J Eur Acad Dermatol Venereol.2010 Feb;24(2):125-37. Epub 2009 Aug 17. Sarcoidosis of the skin may have an extremely heterogeneous clinical presentation, so that the definitions of 'great imitator' and 'clinical chameleon' have long been used. There is, in fact, a large group of skin diseases that can enter the differential diagnosis with cutaneous sarcoid manifestations, either clinically or/and pathologically. As the clinical consequences and the prognosis of these groups of diseases are often very different, it is important to correctly plan the diagnostic workup. The diagnostic process in this case often presents a challenge as no single test is sufficiently specific, so that a certain diagnosis can be only made ...