Dermatopathology Cases

Image1 Image2 Image3 Case 91 A nodule on the scalp of a 62 year old male. Diagnosis

Lichen Simplex Chronicus Visit: Dermatopathology site Abstract: Lichen simplex chronicus of the anal region and its differential diagnoses. A case series.Hautarzt.2009 Nov;60(11):907-12. Lichen simplex chronicus (LSC) of the anal region is characterized by massive pruritus, constant itching and a chronic course. Histology is notable for a pseudoepitheliomatous hyperplasia. Correct diagnosis as well as therapy of anal LSC sometimes is difficult. Differential diagnostic considerations include verrucous lichen planus and squamous cell carcinoma. We present three cases and then summarize pathogenesis, diagnostics, differential diagnoses and therapeutic options for lichen simplex chronicus of the anal region. Clinical and histopathological findings of 'psoriatic neurodermatitis' and of typical lichen simplex chronicus. J Eur Acad Dermatol Venereol.2007 Jul;21(6):811-7. BACKGROUND: We have seen several patients with itchy lichenified plaques located bilaterally on the elbows and/or

Image1 Image2 Image3 Image4 Case 90 A 36 year old female with scaly, thickened plaque on the extensor surface of left forearm. There is intermittent severe pruritis. Scratching of the area provides temporary relief. Diagnosis

Digital Mucous Cyst Visit: Dermatopathology site Abstracts: Digital mucous cysts. J Cutan Med Surg. 2010 Sep-Oct;14(5):199-206 BACKGROUND: Digital mucous cyst (DMC) is a common benign condition, but consensus has not been reached regarding its pathogenesis and treatment. OBJECTIVE: This review provides a concise overview of DMCs. METHODS: The review presents the literature pertaining to the etiology, pathogenesis, classification, clinical features, epidemiology, differential diagnoses, diagnosis, and management of DMCs. RESULTS: DMCs have a predilection for middle-aged patients, a good prognosis, and a high recurrence rate. DMCs may occur in one of three locations on the distal digit. They arise owing to a metaplastic or degenerative process. Preexisting osteoarthritis is common and may be an etiologic factor in patients with DMCs. A number of conservative and surgical treatments are available depending on the structures and locations involved. CONCLUSION: Studies with greater sample

Image1 Image2 Image3 Image4 Case 89 A 60 year old woman, with a oval dome-shaped fluctuant nodule. It is covered by thickened overlying skin. The lesion is located on the dorsolateral aspect of the left index finger, between the distal interphalangeal joint and proximal nail fold. The cystic nodule contains a viscous, gelatinous fluid. Diagnosis

Neurothekeoma (Nerve Sheath Myxoma) Visit: Dermatopathology site Visit: Pathology of Neurothekeoma Abstract: Nerve sheath myxoma with bidirectional schwannomatous and perineural differentiation. Cesk Patol.2010 Jul;46(3):73-6. A case of nerve sheath myxoma occurring in occipital region in 70-yr-old woman is presented. The tumor showed typical lobular and myxoid morphology. Immunohistochemically, it showed unusual coexpression of Schwann cell markers S100 protein and GFAP with perineural cell markers EMA and claudin-1. CD34+ fibroblast-like cells were scarce, and nerve axons were not found in the tumor. Clinical pathology and histogenesis of the lesion are discussed. Nerve sheath myxoma (neurothekeoma) of the gingiva, a case report and review of the literature. Head Neck Pathol. 2010 Sep;4(3):242-5. Epub 2010 May 26. Nerve sheath myxoma (NSM) is a benign peripheral nerve sheath tumor that rarely occurs in the oral cavity. Among the 23 reported intraoral cases, no lesion has previous

Image1 Image2 Image 3 Case 88 A 35 year old man with a nodule on the left index finger. Diagnosis

Angiokeratoma Visit: Dermatopathology site Visit: Pathology of Angiokeratoma Abstract: Angiokeratoma: a cutaneous marker of Fabry's disease. Clin Exp Dermatol. 2010 Jul;35(5):505-8. Epub 2009 Oct 19. The initial symptoms of Fabry's disease (FD) may seem harmless and may delay its diagnosis. A survey and screening for FD were performed on men with biopsy-proven angiokeratoma and some of their relatives (n = 29). Three patients were identified. Dermatologists should be aware of this prominent early feature and investigate unexplained cutaneous vascular lesions to detect FD. Solitary angiokeratoma of the tongue in adults. Rom J Morphol Embryol.2010;51 (4):771-3. Angiokeratomas are vascular malformations that usually appear as multiple or solitary cutaneous plaques. Several clinical variants have been described, with the same underlying histopathological lesion. Mucosal involvement, including the oral cavity, is occasionally found either as a component of the systemic variety, call

Image1 Image2 Image3 Image4 Case 87 Skin biopsy- Images for spot diagnosis? Diagnosis

Pilar Sheath Acanthoma Visit: Dermatopathology site Visit: Pathology of Pilar Sheath Acanthoma Abstract: Pilar sheath acanthoma--report of a case with review of the literature.Yonsei Med J.1989 Dec;30(4):392-5. A 52-year-old male presented with a solitary asymptomatic, skin-colored nodule with a central pore on the skin of the left cheek of one year duration. An excisional biopsy was performed. The skin biopsy finding showed the typical histological picture of pilar sheath acanthoma. A description of the lesion and a review of the literature are given. Pilar sheath acanthoma - a benign follicular hamartoma.Dermatologica. 1983;167(6):335-8. A new case of pilar sheath acanthoma is reported. This tumor has been identified in 1978 and shows characteristic histological features: a central sinus with keratinous material, a pore-like opening to the surface, keratinization of the epidermoid type and projecting epithelial tumor lobes containing small keratin cysts resembling incomplete pilar

Image1 Image2 Image3 Image4 Case 86 A 58 year old male with a skin-coloured nodule on the upper lip. The lesion is 1.5 cm in diameter and has a central pore-like opening plugged with keratin. Diagnosis

Graft-Versus-Host Disease Visit: Dermatopathology site Visit: Cutaneous Lesions in Graft versus Host Disease Abstract: Clinicopathologic characteristics of cutaneous chronic graft-versus-host diseases: a retrospective study in Korean patients. Int J Dermatol. 2010 Dec;49(12):1386-92. BACKGROUND: Chronic graft-versus-host disease (cGVHD) is a major complication in long-term survivors of hematopoietic stem cell transplantation (HSCT). Cutaneous manifestations are frequently the presenting features; therefore, the dermatologist needs to be aware of the wide spectrum of cutaneous cGVHD. METHODS: We retrospectively evaluated patients' characteristics, clinical, and histological features of cutaneous cGVHD and analyzed factors influencing the severity of cutaneous cGVHD in 100 Korean HSCT recipients between January 1, 1995, and December 31, 2007. RESULTS: Clinical manifestations of cutaneous cGVHD mainly presented as lichenoid (60.0%), sclerodermoid (12.0%), or erythematous maculopapul

Image1 Image2 Image3 Case 85 A 35 year old male with skin lesions. Patient has a history of hematopoietic stem cell transplantation. Diagnosis

Polymorphous Light Eruption Visit: Dermatopathology site Abstracts Polymorphous light eruption.Photodermatol Photoimmunol Photomed.2008 Jun;24(3):155-61. Polymorphous light eruption is the most common photodermatosis, with a prevalence of as high as 10-20% in Western Europe and in the USA. It starts during the second and third decades of life. Although not life-threatening it can severely impair the quality of life, in particular during leisure activities and in outdoors workers. Polymorphous light eruption belongs to the group of so-called idiopathic photodermatoses. This term denotes dermatoses that occur in otherwise healthy individuals from exposure to sunlight or artificial light without the intervention of an exogenous photosensitizing agent. These diseases have two factors in common: they are precipitated by ultraviolet or visible radiation; and their exact pathomechanism remains obscure but is presumably immunologic in nature. Marked papillary dermal edema--an unreliable discr

Image1 Image2 Case 84 Small pruritic papules on the dorsum of the hands and forearms of a 25 year old male. The patient has a history of exposure to bright sunlight for many hours. Answer

Gouty Tophus Visit: Dermatopathology site Asymptomatic nodule on an elderly lady's thumb tip. Hautarzt. 2011 Jan 26. A 71-year-old woman presented with an asymptomatic growing dermal tumor on her thumb. Clinical picture, ultrasound, laboratory investigations and histology were consistent with the diagnosis of gouty tophus. Pathogenesis, risk factors and therapy of tophaceous gout are discussed. Gouty tophus of the upper eyelid. Ophthal Plast Reconstr Surg. 2008 Sep-Oct;24(5):404-6. A 64-year-old man with gout presented with history of an enlarging mass in the left upper eyelid causing mechanical ptosis. The patient underwent excisional biopsy. The histopathologic findings confirmed the diagnosis of gouty tophus of the eyelid. Role of Melanocortin Receptors in the Regulation of Gouty Inflammation. Curr Rheumatol Rep. 2011 Jan 18. Gouty arthritis is a form of acute joint inflammation provoked by joint deposition of urate crystals. Although this acute pathology resolves after a few da

Image1 Image2 Image3 Case 83 Slide for spot diagnosis. Answer

Rheumatoid Nodule Visit: Dermatopathology site Non-infectious granulomatous diseases of the skin and their associated systemic diseases: an evidence-based update to important clinical questions. Am J Clin Dermatol. 2010;11(3):171-81. Non-infectious granulomatous diseases of the skin are a broad group of distinct reactive inflammatory conditions that share important similarities. As a group, they are relatively difficult to diagnose and distinguish both clinically as well as histologically. Many of these disorders have significant associations with systemic diseases that impact the patient's overall prognosis. In this update, we offer a discussion of emerging concepts and controversies in this field, as presented through evidence-based answers to seven important clinical questions regarding palisading and epithelioid granulomata. These questions offer an opportunity to review ten non-infectious granulomatous conditions that have implications for systemic disease: granuloma annulare,

Image1 Image2 Image3 Image4 Case 82 Slide for spot diagnosis. Answer

Immunohistochemistry: S100 protein is strongly positive. Immunohistochemistry: CD1a is stongly positive Langerhans Cell Histiocytosis 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 h

Image1 Image2 Image3 Image4 Case 81 A 4 year old child with multiple yellow-brown scaly papules on the scalp. Erythematous macules and papules are also present on the neck and back. The child is small for age and there is marked loss of weight. He is also accompanied by anaemia, fever and lymphadenopathy. Answer

Dermatopathology Quiz - Case Index Case 61 = Targetoid Hemosiderotic Hemangioma (Hobnail Hemangioma) Case 62 = Chondroid Syringoma Case 63 = Cutaneous Sarcoidosis Case 64 = Dermatofibrosarcoma Protuberans Case 65 = Trichilemmal Carcinoma Case 66 = Melanocytic Nevus of the Vulva (Site specific nevus) Case 67 = Lichen Amyloidosus Case 68 = Scabies Case 69 = Dermatophyte Infection (Dermatophytoses) - Superficial filamentous Infection (Tinea - ringworm) Case 70 = Cutaneous Malakoplakia Case 71 = Grover's Disease Case 72 = Cutaneous Leishmaniasis Case 73 = Cutaneous Histoplasmosis Case 74 = Atrophie Blanche (Livedoid Vasculopathy) Case 75 = Granuloma Faciale Case 76 = Perniosis (Chilblains) Case 77 = Psoriasis Case 78 = Pustular Psoriasis Case 79 = Alopecia Areata Case 80 = Nodular Vasculitis (Erythema Induratum, Bazin-type)

Nodular Vasculitis (Erythema Induratum, Bazin-type) Visit: Dermatopathology site Abstract: Erythema induratum of Bazin. Dermatol Online J.2010 Apr 15;16(4):1. An 81-year-old woman with a history of renal cell carcinoma and years of slowly, progressively enlarging pulmonary nodules of uncertain etiology presented with several weeks of painful lower extremity nodules. A biopsy revealed changes consistent with nodular vasculitis. A purified protein derivative and QuantiFERON test were positive, favoring the diagnosis of erythema induratum of Bazin. Treatment with a standard four-drug antituberculous regimen resulted in radiographic and clinical improvement. This case emphasizes the importance of dermatologic manifestations in the detection of systemic disease. Vasculitis in erythema induratum of Bazin: a histopathologic study of 101 biopsy specimens from 86 patients. J Am Acad Dermatol. 2008 Nov;59(5):839-51. BACKGROUND: Erythema induratum of Bazin is a mostly lobular panniculitis. There