Adam Hessel

Calciphylaxis associated with metastatic breast carcinoma.

Calciphylaxis is a rare disorder associated with calcification of small- and medium-sized blood vessels, and progressive skin necrosis usually seen in the setting of end-stage renal disease (ESRD) and secondary hyperparathyroidism. It has also been observed in primary hyperparathyroidism, hypercalcemia of malignancy (extensive bony metastasis of breast cancer), and an isolated case reported with end-stage liver disease. We report an unusual case of calciphylaxis associated with metastatic breast carcinoma in the absence of renal or parathyroid disease. Calciphylaxis has generally been associated with end-stage renal disease and hyperparathyroidism. One previous case report described calciphylaxis occurring in a patient with metastatic adenocarcinoma of the breast and hypercalcemia. Our case represents the second reported case of calciphylaxis associated with osteolytic, metastatic breast cancer. Although ESRD with secondary hyperparathyroidism is the most common presentation of calciphylaxis, this case demonstrates that other conditions that alter normal calcium metabolism must be considered in the differential diagnosis.

Autosomal Dominant Keratoderma, Ichthyosiform Dermatosis and Elevated Serum Beta-Glucuronidase

Five patients in a large pedigree with autosomal dominant palmoplantar keratoderma and/or an ichthyosiform dermatosis were studied. Biopsies of the keratoderma, a remote hyperkeratotic plaque on an arm and the ichthyosis all revealed the same histopathologic changes including hyperkeratosis with round retained nuclei. All 5 patients had elevated serum beta-glucuronidase activity. The significance of beta-glucuronidase in this and other skin diseases is discussed.

Sebaceous neoplasm with reticulated and cribriform features: a rare variant of sebaceoma

Troy and Ackerman defined the term sebaceoma (Am J Dermatopathol 1984: 6: 7‐13) as benign neoplasm of basaloid cells with varying numbers of mature sebocytes. Steffen and Ackerman (Neoplasms with sebaceous differentiation. Philadelphia: Lee and Febiger, 1994: 401‐425) illustrated many examples of sebaceoma, two of which had a reticulated and cribriform pattern. We report a case of sebaceoma from the scalp of a 52‐year‐old white female. Histologically, it displayed reticulated and cribriform basaloid epithelial islands. This is the third reported case of sebaceoma, to our knowledge, with these unusual features.

Trichoblastic neoplasm with apocrine differentiation.

Trichoblastoma is a benign neoplasm with primitive hair follicle differentiation. The tumor is characterized by nests and cords of epithelial cells in an organized relation to stroma. The epithelial cells differentiate toward follicular germ and follicular sheath. More divergent differentiation in the form of sebaceous elements in trichoblastoma has infrequently been reported in the literature. We report a trichoblastic neoplasm showing typical features of trichoblastoma as well as areas of apocrine differentiation. The neoplasm, which was present for several months, was removed from the chin of a 31-year-old woman. Histologic examination showed a neoplasm composed of basaloid nests with occasional papillary mesenchymal bodies as well as ducts and glands exhibiting apocrine differentiation. Trichoblastoma with apocrine features is rarely reported in the literature.

Molluscum contagiosum involving an epidermoid cyst with xanthogranuloma-like reaction in an HIV-infected patient.

Background: Molluscum contagiosum (MC) causes characteristic cutaneous lesions that occur mainly in children, sexually active adults, and immunocompromised individuals, especially those with human immunodeficiency virus (HIV) infection. Patients infected with HIV, particularly those with advanced disease, have an increased incidence, up to 33.3%, of MC in non‐anogenital areas. MC has been rarely found to be associated with epidermoid cysts.