Arthur E. Pellegrini

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.

Inflammatory myofibroblastic tumor of the skin.

We report a case of inflammatory myofibroblastic tumor (IMF) of the skin in a female with a history of Wegeners granulomatosis. The patient had a painless, erythematous, and indurated lesion of the left elbow. The resected specimen revealed a 4 cm x 3 cm nodule involving the entire dermis and superficial portions of subcutis with a stellate profile at scanning magnification. There were spindle cells in fascicles and whorls and a mixed inflammatory cell infiltrate of plasma cells, lymphocytes, neutrophils, and eosinophils. The spindle cells were immunoreactive for vimentin, muscle specific actin, and smooth muscle actin. The polyclonal and polymorphous nature of the inflammatory cells was confirmed by immunohistochemical studies. This is the first case of IMF of the skin documented by immunostaining.

Spindle cell hemangioendothelioma: A neoplasm associated with Maffucci's syndrome

A case of a 21‐year‐old male with Maffuccis syndrome is presented in which the patient developed multiple cutaneous spindle cell hemangioendotheliomas (SHE). Recent reports suggest an association between spindle cell hemangioendotheliomas (SHE) and Maffuccis syndrome. Our case supports the interpretation that SHE is associated with Maffuccis syndrome.

Nodular tertiary syphilis mimicking granuloma annulare

We describe a 47-year-old man with annular plaques on the arms and torso that were treated as granuloma annulare, based on clinical and histopathologic findings. Exacerbation of the lesions during treatment with topical corticosteroids prompted a search for an infectious cause, which proved to be syphilis in the tertiary stage. The clinician should maintain a high index of suspicion for syphilis in the differential diagnosis of unusual annular skin lesions in a patient with noncaseating granulomas seen on skin biopsy.

Solitary fibrous tumor of the vagina

We report of a solitary fibrous tumor (SFT) of the vagina and discuss the differential diagnosis. This is the first SFT documented, to our knowledge. SFTs should be included in the differential diagnosis of fibroblastic, myofibroblastic, and neural lesions of the skin, subcutaneous tissue, and mucosa and can be distinguished from other spindle cell neoplasms at those sites.

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.

Probable Congenital Melanocytic Nevus of the Oral Mucosa: Case Report

Abstract: There are few case reports of congenital melanocytic nevi affecting the oral mucosa. We report the clinical and histologic features of an Intraoral melanocytic lesion that in our opinion meets the criteria for the diagnosis.

Sclerosing B-cell lymphoma involving the skin

We report a case of sclerosing B‐cell lymphoma involving the skin. The patient is a 43‐year‐old man who came to our institution with a 4‐year history of multinodular masses in the back. A thoracic CT scan demonstrated subcutaneous masses with extension to the posterior parietal pleura and compression of several epidural spaces. An incisional biopsy was performed and demonstrated an infiltrative process in the lower dermis composed of interconnected thick sclerosing bands forming compartments around groups of large neoplastic cells. These neoplastic cells were shown to be B lymphocytes using immunohistochemical stains. A diagnosis of diffuse sclerosing B‐cell lymphoma, large cell type, was made. Our case is reported to alert dermatologists and dermatopathologists lo the occurrence of this neoplasm in the skin which could be confused with a deep inflammatory process or other neoplastic conditions.

Nevoid Hypertrichosis: Multiple Patches Associated With Premature Graying of Lesional Hair

Abstract: A 23‐month‐old Caucasian girt had congenital circumscribed areas of deeply pigmented terminal hairs that gradually lost their pigment over the next two years. Physical examination revealed no other abnormalities. Histologlc examination demonstrated terminal hair in otherwise normal skin consistent with nevold hypertrichosis. The clinical and histologic characteristics of nevoid hypertrichosis are compared with other types of hypertrichotic patches.

Dermatofibroma-like granular cell tumor.

There have been several reports in the literature of dermatofibromas with granular cells. Here we report a granular cell tumor with the architecture of a dermatofibroma. This is the first report of this histological variant of granular cell tumor. The lesion was a 2.5‐cm oval, hyperpigmented plaque present for “years” on the back of a 60‐year‐old African‐American woman.