A. Polat Ekinci, Sule Ozturk Sari, N. Buyukbabani, C. Baykal
Nevoid hyperkeratosis of the nipple and areola (NHNA) is a rare clinicopathological entity showing persistent and strictly localized hyperkeratotic lesions of the nipple, areola or both with unknown etiopathogenesis. A similar clinical appearance may also be seen in different diseases with specific histopathological features. There are a few anecdotal reports on the association of NHNA with mycosis fungoides (MF), but they do not describe a uniform condition. In this report, we present 3 patients with hyperkeratotic lesions of the nipple and areola associated with MF but showing different histopathological features. We also review similar cases in the literature and discuss possibilities concerning this association. Two of our cases represent the association between MF and NHNA without histopathological features of MF on the nipple-areola complex. The other case represents hyperkeratosis of the nipple and areola with specific histological and immunohistochemical features of MF. Hence, we would like to hypothesize that MF may involve the nipple and areola and have an appearance similar to NHNA. Intriguingly, however, NHNA may occasionally also be seen in association with MF. However, this peculiar association requires further explanation.
{"title":"The Dilemma of Coexisting Nevoid Hyperkeratosis of the Nipple and Areola in Mycosis Fungoides: A Report of Three Cases","authors":"A. Polat Ekinci, Sule Ozturk Sari, N. Buyukbabani, C. Baykal","doi":"10.1159/000441618","DOIUrl":"https://doi.org/10.1159/000441618","url":null,"abstract":"Nevoid hyperkeratosis of the nipple and areola (NHNA) is a rare clinicopathological entity showing persistent and strictly localized hyperkeratotic lesions of the nipple, areola or both with unknown etiopathogenesis. A similar clinical appearance may also be seen in different diseases with specific histopathological features. There are a few anecdotal reports on the association of NHNA with mycosis fungoides (MF), but they do not describe a uniform condition. In this report, we present 3 patients with hyperkeratotic lesions of the nipple and areola associated with MF but showing different histopathological features. We also review similar cases in the literature and discuss possibilities concerning this association. Two of our cases represent the association between MF and NHNA without histopathological features of MF on the nipple-areola complex. The other case represents hyperkeratosis of the nipple and areola with specific histological and immunohistochemical features of MF. Hence, we would like to hypothesize that MF may involve the nipple and areola and have an appearance similar to NHNA. Intriguingly, however, NHNA may occasionally also be seen in association with MF. However, this peculiar association requires further explanation.","PeriodicalId":42885,"journal":{"name":"Dermatopathology","volume":"76 1","pages":"61 - 66"},"PeriodicalIF":1.9,"publicationDate":"2015-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000441618","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64944503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laure-Anne Prisse, P. Jayasooriya, B. R. Mendis, T. Lombardi
Benign fibrous histiocytomas (BFH) of the skin are common lesions, although they only rarely involve the oral mucosa. This article presents 3 additional cases of BFH of the oral mucosa, with a review of previously published cases. Although a malignant variant of BFH also exists, the present review focuses only on benign lesions. The clinical presentation, diagnosis, histopathological and immunohistochemical features of BFH are discussed. According to the present analysis, the majority of oral mucosal BFH have occurred in middle-aged and elderly patients, with a slight female predilection. Within the oral cavity, BHF may occur at any mucosal site, including the lips, tongue, buccal mucosa, mandibular and maxillary gingiva as well as the palate. Histopathology is essential to diagnose the lesion, while immunohistochemical investigations may be utilized to exclude the histopathological differential diagnoses such as juvenile xanthogranulomas and nevi. This review also revealed total excision as the treatment of choice for BFH, with a very good prognosis and an extremely low rate of relapse.
{"title":"Benign Fibrous Histiocytomas of the Oral Mucosa: Report on Three Cases and Review of the Literature","authors":"Laure-Anne Prisse, P. Jayasooriya, B. R. Mendis, T. Lombardi","doi":"10.1159/000381618","DOIUrl":"https://doi.org/10.1159/000381618","url":null,"abstract":"Benign fibrous histiocytomas (BFH) of the skin are common lesions, although they only rarely involve the oral mucosa. This article presents 3 additional cases of BFH of the oral mucosa, with a review of previously published cases. Although a malignant variant of BFH also exists, the present review focuses only on benign lesions. The clinical presentation, diagnosis, histopathological and immunohistochemical features of BFH are discussed. According to the present analysis, the majority of oral mucosal BFH have occurred in middle-aged and elderly patients, with a slight female predilection. Within the oral cavity, BHF may occur at any mucosal site, including the lips, tongue, buccal mucosa, mandibular and maxillary gingiva as well as the palate. Histopathology is essential to diagnose the lesion, while immunohistochemical investigations may be utilized to exclude the histopathological differential diagnoses such as juvenile xanthogranulomas and nevi. This review also revealed total excision as the treatment of choice for BFH, with a very good prognosis and an extremely low rate of relapse.","PeriodicalId":42885,"journal":{"name":"Dermatopathology","volume":"2 1","pages":"52 - 60"},"PeriodicalIF":1.9,"publicationDate":"2015-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000381618","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64783890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Immunohistochemistry (IHC) is an important adjunct in the diagnosis of neoplastic skin diseases. In addition to the many established IHC markers currently in use, new markers continue to emerge, although their general acceptance and routine application requires robust validation. Here, we summarize the most well-established and commonly used biomarkers along with an array of newer ones reported in the past several decades that either demonstrate or hold high clinical promise in the field of cutaneous pathology. We also highlight recent applications of novel IHC markers in melanoma diagnosis including genetic mutation status markers [e.g. BRAF (v-raf murine sarcoma viral oncogene homolog B) and NRAS (neuroblastoma RAS viral oncogene homolog)] and an epigenetic alteration marker (e.g. 5-hydroxymethylcytosine). We specifically focus on the role of IHC in the differential diagnosis of cutaneous lesions that fall under the following categories: melanoma, epidermal tumors with an intraepidermal epitheliomatous pattern, spindle cell lesions of the dermis, small round blue cell tumors of the dermis, and cutaneous adnexal tumors. While IHC is a valuable tool in diagnostic dermatopathology, marker selection and interpretation must be highly informed by clinical context and the histologic differential diagnosis. With rapid progress in our understanding of the genetic and epigenetic mechanisms of tumorigenesis, new IHC markers will continue to emerge in the field of diagnostic dermatopathology.
{"title":"Diagnostic Immunohistochemistry in Cutaneous Neoplasia: An Update","authors":"L. Compton, G. Murphy, C. Lian","doi":"10.1159/000377698","DOIUrl":"https://doi.org/10.1159/000377698","url":null,"abstract":"Immunohistochemistry (IHC) is an important adjunct in the diagnosis of neoplastic skin diseases. In addition to the many established IHC markers currently in use, new markers continue to emerge, although their general acceptance and routine application requires robust validation. Here, we summarize the most well-established and commonly used biomarkers along with an array of newer ones reported in the past several decades that either demonstrate or hold high clinical promise in the field of cutaneous pathology. We also highlight recent applications of novel IHC markers in melanoma diagnosis including genetic mutation status markers [e.g. BRAF (v-raf murine sarcoma viral oncogene homolog B) and NRAS (neuroblastoma RAS viral oncogene homolog)] and an epigenetic alteration marker (e.g. 5-hydroxymethylcytosine). We specifically focus on the role of IHC in the differential diagnosis of cutaneous lesions that fall under the following categories: melanoma, epidermal tumors with an intraepidermal epitheliomatous pattern, spindle cell lesions of the dermis, small round blue cell tumors of the dermis, and cutaneous adnexal tumors. While IHC is a valuable tool in diagnostic dermatopathology, marker selection and interpretation must be highly informed by clinical context and the histologic differential diagnosis. With rapid progress in our understanding of the genetic and epigenetic mechanisms of tumorigenesis, new IHC markers will continue to emerge in the field of diagnostic dermatopathology.","PeriodicalId":42885,"journal":{"name":"Dermatopathology","volume":"2 1","pages":"15 - 42"},"PeriodicalIF":1.9,"publicationDate":"2015-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000377698","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64774532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nilay Duman, G. Erkin, Ö. Gököz, S. Karahan, A. Kayıkçıoğlu, I. Çelik
Aim: The aim of this study was to determine if nevus-associated melanoma differs in characteristics and prognosis from de novo melanoma. Patients and Methods: The study included 118 melanoma patients. Clinical findings were retrospectively evaluated. For histopathological parameters, HE sections were reexamined. The differentiation between de novo and nevus-associated melanoma was based on the histopathological evidence of a precursor nevus. In addition, all analyses were repeated in all cases in which nevus-associated melanoma was defined based on patient anamnesis. Results: Among all patients, 28 (23.7%) had nevus-associated melanoma. Nevus-associated melanoma was most commonly located on the extremities (50%), followed by the trunk (25%), whereas de novo melanoma was most commonly located in the head and neck region (32.2%), followed by the acral region (31.1%). Other clinical findings and histopathological parameters did not differ significantly between the two groups (p > 0.05). The findings remained consistent following the repeated analysis of all cases in which nevus-associated melanoma was defined based on patient anamnesis. Conclusions: Nevus-associated melanoma was most commonly located on the extremities and the trunk, whereas de novo melanoma was most commonly located in the head and neck and the acral region. Furthermore, nevus-associated melanoma was similar to de novo melanoma in terms of prognosis and other disease characteristics.
{"title":"Nevus-Associated versus de novo Melanoma: Do They Have Different Characteristics and Prognoses?","authors":"Nilay Duman, G. Erkin, Ö. Gököz, S. Karahan, A. Kayıkçıoğlu, I. Çelik","doi":"10.1159/000375490","DOIUrl":"https://doi.org/10.1159/000375490","url":null,"abstract":"Aim: The aim of this study was to determine if nevus-associated melanoma differs in characteristics and prognosis from de novo melanoma. Patients and Methods: The study included 118 melanoma patients. Clinical findings were retrospectively evaluated. For histopathological parameters, HE sections were reexamined. The differentiation between de novo and nevus-associated melanoma was based on the histopathological evidence of a precursor nevus. In addition, all analyses were repeated in all cases in which nevus-associated melanoma was defined based on patient anamnesis. Results: Among all patients, 28 (23.7%) had nevus-associated melanoma. Nevus-associated melanoma was most commonly located on the extremities (50%), followed by the trunk (25%), whereas de novo melanoma was most commonly located in the head and neck region (32.2%), followed by the acral region (31.1%). Other clinical findings and histopathological parameters did not differ significantly between the two groups (p > 0.05). The findings remained consistent following the repeated analysis of all cases in which nevus-associated melanoma was defined based on patient anamnesis. Conclusions: Nevus-associated melanoma was most commonly located on the extremities and the trunk, whereas de novo melanoma was most commonly located in the head and neck and the acral region. Furthermore, nevus-associated melanoma was similar to de novo melanoma in terms of prognosis and other disease characteristics.","PeriodicalId":42885,"journal":{"name":"Dermatopathology","volume":"2 1","pages":"46 - 51"},"PeriodicalIF":1.9,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000375490","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64772200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Porokeratoma is a rare, relatively newly described and still unclear entity. Here, we describe the case of a 52-year-old male patient who presented with four well-defined, verrucous and hyperkeratotic lesions. Microscopically, one of the lesions showed acanthopapillomatosis overlying compact orthokeratosis. Prominent broad and confluent cornoid lamellae were present, with no granular layer and some dyskeratotic keratinocytes. PCR sequencing and in situ hybridization revealed the presence of human papillomavirus (HPV) type 16 in the lesion. The association of porokeratoma and HPV infection has not previously been reported.
{"title":"Porokeratoma: A Possible Association with Human Papillomavirus Infection","authors":"Patricia Caseiro Silverio, X. Pham, G. Kaya","doi":"10.1159/000379745","DOIUrl":"https://doi.org/10.1159/000379745","url":null,"abstract":"Porokeratoma is a rare, relatively newly described and still unclear entity. Here, we describe the case of a 52-year-old male patient who presented with four well-defined, verrucous and hyperkeratotic lesions. Microscopically, one of the lesions showed acanthopapillomatosis overlying compact orthokeratosis. Prominent broad and confluent cornoid lamellae were present, with no granular layer and some dyskeratotic keratinocytes. PCR sequencing and in situ hybridization revealed the presence of human papillomavirus (HPV) type 16 in the lesion. The association of porokeratoma and HPV infection has not previously been reported.","PeriodicalId":42885,"journal":{"name":"Dermatopathology","volume":"2 1","pages":"43 - 45"},"PeriodicalIF":1.9,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000379745","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64775048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cutaneous myopericytoma is a rarely reported mesenchymal neoplasm with a benign biologic behavior. It is seen more commonly in males and typically occurs in adults on the distal extremities. To the best of our knowledge, there are only 13 reports describing 45 cases of cutaneous myopericytoma in the literature. The 3 cases in this report expand the clinical presentation and reinforce the histopathologic features of cutaneous myopericytoma. While the clinical presentation in 2 cases (located on the scalp and heel) was in keeping with that reported previously of a slow-growing painless firm nodule, the third case, located on the dorsal wrist, presented as a scaly keratotic nodule. Histopathologic examination of all 3 cases revealed an unencapsulated dermal nodule with concentric perivascular arrangement of plump, spindle-shaped myoid cells admixed with thin-walled blood vessels. Immunohistochemical staining revealed the lesional cells to be actin- (3/3) and caldesmon- (2/3) positive and negative for other smooth muscle markers, compatible with perivascular myopericytic differentiation.
{"title":"Cutaneous Myopericytoma: A Report of 3 Cases and Review of the Literature","authors":"P. Aung, L. Goldberg, M. Mahalingam, J. Bhawan","doi":"10.1159/000371875","DOIUrl":"https://doi.org/10.1159/000371875","url":null,"abstract":"Cutaneous myopericytoma is a rarely reported mesenchymal neoplasm with a benign biologic behavior. It is seen more commonly in males and typically occurs in adults on the distal extremities. To the best of our knowledge, there are only 13 reports describing 45 cases of cutaneous myopericytoma in the literature. The 3 cases in this report expand the clinical presentation and reinforce the histopathologic features of cutaneous myopericytoma. While the clinical presentation in 2 cases (located on the scalp and heel) was in keeping with that reported previously of a slow-growing painless firm nodule, the third case, located on the dorsal wrist, presented as a scaly keratotic nodule. Histopathologic examination of all 3 cases revealed an unencapsulated dermal nodule with concentric perivascular arrangement of plump, spindle-shaped myoid cells admixed with thin-walled blood vessels. Immunohistochemical staining revealed the lesional cells to be actin- (3/3) and caldesmon- (2/3) positive and negative for other smooth muscle markers, compatible with perivascular myopericytic differentiation.","PeriodicalId":42885,"journal":{"name":"Dermatopathology","volume":"2 1","pages":"9 - 14"},"PeriodicalIF":1.9,"publicationDate":"2015-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000371875","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64769424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Wong-type dermatomyositis (DM) exhibits simultaneous pityriasis rubra pilaris (PRP) features. Case Report: A 50-year-old woman presented with a heliotrope rash, Gottron's papules, and a poikilodermic, erythematous rash in shawl distribution without evidence of muscle weakness. Despite topical corticosteroids, the eruption progressed 9 months later to include generalized hyperkeratotic follicular papules, islands of sparing, and atrophic macules with a collarette of scale suggestive of porokeratosis. Mild dysphonia was the only sign of muscle weakness. Serology showed positive ANA. Histopathology revealed interface dermatitis with dermal mucin and melanophages, irregular psoriasiform hyperplasia, alternating mounds of para- and orthokeratosis, and tiers of dyskeratotic cells (columnar dyskeratosis). Systemic corticosteroid therapy was not tolerated; acitretin diminished the hyperkeratosis. While hyperpigmentation persisted, no progression of cutaneous or muscular symptoms has occurred after 22 months of follow-up and cessation of the therapy. Overall, her course did not differ from the natural history documented in the literature review of Wong-type DM. The most similar case also exhibited pseudocornoid lamella changes. Conclusion: Wong-type DM is a clinicopathologic DM-PRP hybrid that can also exhibit porokeratosis-like features best described as columnar dyskeratosis. Recognizing these types of lesions in DM is warranted in order to make an accurate assessment of their prognostic significance.
{"title":"Wong-Type Dermatomyositis Showing Porokeratosis-Like Changes (Columnar Dyskeratosis): A Case Report and Review of the Literature","authors":"Nicole Umanoff, A. Fisher, J. Carlson","doi":"10.1159/000371573","DOIUrl":"https://doi.org/10.1159/000371573","url":null,"abstract":"Background: Wong-type dermatomyositis (DM) exhibits simultaneous pityriasis rubra pilaris (PRP) features. Case Report: A 50-year-old woman presented with a heliotrope rash, Gottron's papules, and a poikilodermic, erythematous rash in shawl distribution without evidence of muscle weakness. Despite topical corticosteroids, the eruption progressed 9 months later to include generalized hyperkeratotic follicular papules, islands of sparing, and atrophic macules with a collarette of scale suggestive of porokeratosis. Mild dysphonia was the only sign of muscle weakness. Serology showed positive ANA. Histopathology revealed interface dermatitis with dermal mucin and melanophages, irregular psoriasiform hyperplasia, alternating mounds of para- and orthokeratosis, and tiers of dyskeratotic cells (columnar dyskeratosis). Systemic corticosteroid therapy was not tolerated; acitretin diminished the hyperkeratosis. While hyperpigmentation persisted, no progression of cutaneous or muscular symptoms has occurred after 22 months of follow-up and cessation of the therapy. Overall, her course did not differ from the natural history documented in the literature review of Wong-type DM. The most similar case also exhibited pseudocornoid lamella changes. Conclusion: Wong-type DM is a clinicopathologic DM-PRP hybrid that can also exhibit porokeratosis-like features best described as columnar dyskeratosis. Recognizing these types of lesions in DM is warranted in order to make an accurate assessment of their prognostic significance.","PeriodicalId":42885,"journal":{"name":"Dermatopathology","volume":"2 1","pages":"1 - 8"},"PeriodicalIF":1.9,"publicationDate":"2015-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000371573","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64766615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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