Adrienne Berke

Pleomorphic fibroma of the skin: a benign neoplasm with cytologic atypia. A clinicopathologic study of eight cases.

A clinicopathologic study of eight examples of polypoid and dome-shaped cutaneous fibrous lesions with sparse cellularity but striking nuclear atypia and rare mitotic figures is presented. Positive immunohistochemical staining for vimentin and actin supported the fibroblastic nature of these lesions. All eight cases were adults whose ages ranged from 33 to 67 years (mean 52 years). Five were women and three were men. Five lesions were located on extremities, two on the trunk, and one on the face and they measured from 4 to 16 mm in greatest dimension. The lesions were clinically followed from 4 months to 5 years. They all showed benign clinical behavior, with only one local recurrence in a lesion that had been incompletely removed. The nuclear atypia seen in these fibrous lesions may be similar to that which occurs in other benign mesenchymal neoplasms, such as pleomorphic lipoma, pleomorphic leiomyoma, ancient schwannoma, and variants of dermatofibroma with atypical cells. We suggest that “pleomorphic fibroma” is an appropriate term for this lesion based on its histologic differentiation, cytologic atypia, and benign clinical course.

Ocular melanomas and melanocytic lesions of the eye

This article describes several melanocytic lesions of the eye. Benign and malignant lesions will be discussed as well as a review of the dysplastic nevus syndrome and its proposed association with ocular melanoma. Ocular melanomas arise from the same embryologically derived melanocytes as their cutaneous counterparts. However, ocular and cutaneous melanomas differ in many respects. The diagnosis and management of these ocular tumors rely heavily on the ophthalmologist. However, knowledge of melanocytic lesions will aid the dermatologist in detection and in proper referral of these patients.

Infectious eccrine hidradenitis caused by nocardia

Neutrophilic eccrine hidradenitis is a nonspecific clinical reaction pattern classified as a neutrophilic dermatosis that typically occurs in the setting of chemotherapy for hematologic malignant disease. Neutrophilic eccrine hidradenitis more rarely has been reported in association with infectious agents, including Serratia, Enterobacter, Staphylococcus, and HIV. We describe the first case of infectious eccrine hidradenitis occurring in a patient with cutaneous Nocardia infection.

Melanoma on the move: The progression of melanoma: Novel concepts with histologic correlates

Careful observation and pattern recognition is the realm of the dermatopathologist. Although specific criteria have been described that define the histologic diagnosis of melanoma, morphologic and architectural variations have been observed for this tumor. And while the immunohistochemical profile of melanoma is well characterized, some melanomas exhibit immunophenotypic aberrations not typical of melanocytic differentiation. These findings can make the microscopic diagnosis of melanoma difficult. In this review article, we have assembled some of the recent advances in melanoma research that challenge the traditional models of melanoma pathogenesis and progression. We describe concepts that are associated with changes identifiable under light microscopy, which may explain some of the variable histologic and aberrant immunohistochemical profiles of melanoma. These advances are still the subject of active investigation and are best viewed as ‘‘works in progress’’ rather than widely accepted principles.

Prominent papillary dermal edema in dermatophytosis (tinea corporis).

Background: Commonly described histologic ‘clues’ to the diagnosis of dermatophytosis include neutrophils in the stratum corneum and/or epidermis, compact orthokeratosis and identification of fungal hyphae between two zones of cornified cells. Prominent (striking) papillary dermal edema (PPDE) is not commonly reported with dermatophytosis (tinea corporis).

Collagen biosynthesis in rabbit intraarticular patellar tendon transplants

Autogenous patellar tendon grafts were transplanted into the knees of 40 New Zealand White adult rabbits. Grafts were subsequently analyzed for rate of collagen synthesis, collagen content, collagen type, histologic change, and cyanogen bromide cleavage patterns of collagen to closely assess the nature of collagen in tendon grafts up to 2 years from the time of transplan tation. Tendon grafts were placed in rabbit knees as free fragments or were attached to synovium. These studies show that tendon grafts, even without vascularization or stress, remain viable after intraartic ular transfer. Vascularization produces a trend toward increased collagen synthesis, but statistical analysis suggests that control levels of collagen synthesis con tinue after tendon transfers into rabbit knees. Cyanogen bromide cleavage peptides showed appropriate colla gen formed by unstressed autogenous tendon trans plants removed from rabbit knees up to 2 years from transplantation. All tendon grafts degenerated initially, but began to form histologically healthy looking con nective tissue by 18 to 24 weeks after transplantation. Overall, the results are encouraging with regard to the fate of intraarticular tendon grafts.

The sensitivity and specificity of "caterpillar bodies" in the differential diagnosis of subepidermal blistering disorders.

Caterpillar bodies are eosinophilic, elongated, segmented bodies located within the roofs of blisters and are considered to represent a specific histopathologic feature of porphyric bullous eruptions, including porphyria cutanea tarda and erythropoietic protoporphyria. The possibility that similar or identical bodies may be present in other disorders prompted further study exploring the specificity of caterpillar bodies in the differential diagnosis of subepidermal vesiculobullous disorders. Seventy-six cases exhibiting subepidermal clefting were reviewed by light microscopy. “Classic” caterpillar bodies were present in porphyria cutanea tarda (6 of 14) and 1 case representing either venous stasis-associated bulla or possibly bullosis diabeticorum. Caterpillar body-like clusters were present in porphyria cutanea tarda (5 of 14), erythropoietic protoporphyria (1 of 3), bullous pemphigoid (7of 24), and junctional or dystrophic epidermolysis bullosa (3 of 5). In some cases, classic caterpillar body and caterpillar body-like clusters coexisted in a blister roof. Caterpillar bodies or caterpillar body-like clusters were not identified in any cases of dermatitis herpetiformis, linear IgA bullous dermatosis, bullous erythema multiforme, epidermolysis bullosa acquisita, or wound-healing reactions. In contrast to caterpillar bodies, caterpillar body-like clusters were negative for PAS or Type IV collagen stains. In conclusion, caterpillar bodies appear to represent a specific feature of porphyria cutanea tarda (specificity, 98%) but were present in less than half of those cases in this study (sensitivity, 43%). Caterpillar body-like clusters are less specific and may be present in porphyria cutanea tarda, erythropoietic protoporphyria, pseudoporphyria, bullous pemphigoid, epidermolysis bullosa, and epidermolysis bullosa acquisita.

Congenital Multiple Clustered Dermatofibroma in a 12‐Year‐Old Girl

Abstract:  Congenital multiple clustered dermatofibroma (MCDF) is a rare, idiopathic, benign tumor presenting at birth as an asymptomatic hyperpigmented patch that is stable until puberty, at which time it enlarges and develops papules. Ultimately, MCDF appears to follow a stable, benign course. We present a case of a 12‐year‐old girl with congenital MCDF. To our knowledge, this is only the third reported case of congenital presentation of MCDF and the only case featuring atrophoderma‐like depression.

Cutaneous metastasis of renal cell carcinoma with Zellballen-like inflammatory reaction pattern on immunohistochemical studies.

Skin tumors show variable infiltration by subtypes of inflammatory cells. The composition of these cellular infiltrates, particularly tumor-associated macrophages and dendritic cell numbers, may be responsible for skin tumor progression or regression. In addition, these cells may give rise to diagnostic dilemmas on immunohistochemical studies. The authors report on the local inflammatory reaction to a metastatic renal cell carcinoma to the skin. Histologic examination and immunohistochemical studies demonstrated zellballen-like changes with S-100-positive spindled cells identified around and within tumor cell nests. The role of tumorassociated macrophages and dendritic cells in the skin is discussed.

Type 1 Diabetes Mellitus Associated with Livedo Reticularis: Case Report and Review of the Literature

Abstract: Livedo reticularis (LR) has been associated with numerous systemic diseases. Its reiationship to diabetes mellitus (DM), however, has been poorly characterized. We report a case of LR in a 17‐year‐old with type 1 DM.