Arvind Ahuja

Nodular Lymphoid Hyperplasia

An 18-year-old woman presented with recurrent episodes of diarrhea associated with epigastric discomfort and bloating. Examination of the stool revealed trophozoites of the species Giardia lamblia. Gastroduodenoscopy revealed multiple nodules in the duodenum.

Ciliated Foregut Cyst of Gallbladder: A First in Childhood and Review of Literature

ABSTRACT Ciliated foregut cyst (CFC) is a rare developmental anomaly. We report first case of CFC of gallbladder diagnosed in a 9-year-old child. CFCs are usually located above the diaphragm, commonly in a bronchus or oesophagus. A duplex gallbladder was originally suspected, but histology confirmed the CFC. gallbladder.

Lymphangioma circumscriptum treated with combination of Bleomycin sclerotherapy and Radiofrequency ablation

ABSTRACT Lymphangioma circumscriptum (LC) is a lymphatic malformation presenting with vesiculo-papules or warty lesions, resembling a “frog-spawn”. Many treatment modalities have been described but random excision is still often needed. Bleomycin is a safe sclerosant with specific action on the vascular endothelial cells. It has been used extensively in cystic hygromas but its use in LC of the skin has not been documented previously. We present this case with extensive LC of the flank treated with a combination of intralesional bleomycin and radiofrequency ablation in the same sitting. As the lesion was extensive, treatment was done in three sittings, one to each third. Near complete resolution, with no significant recurrence was achieved with a single sitting to each third.

Wolf's isotopic nonresponse in healed herpes zoster in erythroderma.

217 Indian Journal of Dermatology, Venereology and Leprology | Volume 84 | Issue 2 | March-April 2018 References 1. Puizina‐Ivic N, Bezic J, Marasovic D, Gotovac V, Carija A, Bozic M. Angiosarcoma arising in sclerodermatous skin. Acta Dermatovenerol Alp Pannonica Adriat 2005;14:20‐5. 2. Fonder MA, Douglas DK. Angiosarcoma complicating systemic sclerosis: A case report. Cutis 2008;81:468‐72. 3. Kubota N, Fujisawa Y, Nakamura Y, Tanaka R, Saito A, Maruyama H. Angiosarcoma of the Scalp in a Patient with System Sclerosis. The Journal of Dermatology 2015:42:102‐4. 4. Carter B, Jaworsky C, Fox M. Systemic sclerosis associated angiosarcoma: A case report and review of the literature. Int J Dermatol Clin Res 2016;2(1):14‐7. 5. Arbiser JL, Larsson H, Claesson‐Welsh L, Bai X, LaMontagne K, Weiss SW, et al. Overexpression of VEGF 121 in immortalized endothelial cells causes conversion to slowly growing angiosarcoma and high level expression of the VEGF receptors VEGFR‐1 and VEGFR‐2 in vivo. Am J Pathol 2000;156:1469‐76. 6. Shah AA, Rosen A, Hummers L, Wigley F, Casciola‐Rosen L. Close temporal relationship between onset of cancer and scleroderma in patients with RNA polymerase I/III antibodies. Arthritis Rheum 2010;62:2787‐95. How to cite this article: Mendiratta V, Rana S, Manickavasagam S, Nangia A, Chander R. Cutaneous angiosarcoma in a patient with systemic sclerosis: First case from India. Indian J Dermatol Venereol Leprol 2018;84:214-7.

Primary cutaneous non-Hodgkin's lymphoma, clinically mimicking a soft tissue sarcoma

Primary cutaneous B-cell lymphomas (PCBCL) are a heterogeneous group of neoplasms with distinct biology and clinical course when compared to their nodal counterparts. They usually present as violaceous, erythematous plaques, and nonulcerated nodules, which are confined to skin at the time of presentation. We present an unusual case of primary cutaneous diffuse large B-cell lymphoma, clinically mimicking a sarcoma. This case highlights the uncommon aggressive behavior and ulcerated type of nodular lesions seen in PCBCL and also revisits the cytomorphological findings of the same.

Description of a new pigmentary demarcation line (Type I)

A 52-year-old man presented with hypopigmented lesions on his chest, which had been present since childhood. The lesions were asymptomatic. They were not scaly, and sensation in the areas was normal. There was no history of any preceding inflammatory skin lesions or topical applications. Physical examination revealed a hypopigmented lesion on the chest, extending laterally along the medial aspect of the arm and posteriorly involving the nape of the neck and the upper back. The lateral border of the lesion and its extension upwards and posteriorly on the back was sharply demarcated, whereas the lower border on the chest merged imperceptibly into the surrounding normal skin (Fig. 1). Potassium hydroxide smear was noncontributory. Histopathological examination revealed decreased basal layer pigmentation in the hypopigmented area compared with the normal skin with normal number of melanocytes on S-100 staining (Fig. 2). A diagnosis of pigmentary demarcation line (PDL) was made. The anterior pattern roughly corresponded with the previously described Miura type A-III PDL, with some variation. The pattern seen over the upper back is previously unreported. We labelled this presentation as Type I PDL. PDLs are physiological, abrupt transitions between darker and lighter pigmented skin areas, and were described initially by Maztumoto in Japanese patients and Futcher in African patients. Miura classified these lines into four groups (lines A to D) based on his observation in Japanese patients; later, line E and lines F, G and H, described in Africans and Indians respectively, were added. Further, these PDLs have been divided into subtypes based on their location and extension. For instance, Group A lines, seen on the anteromedial aspect of upper arms, have been divided into four subtypes based on the variations in the pattern of their transpectoral extension observed among Japanese patients. However, the presence and frequency of transpectoral extension has not been described in other populations (except in an African patient with Type I PDL) and has not been reported previously in the Indian population. The aetiology of PDLs remains unknown. According to some authors, PDLs are atavistic remnants. Racial differences in their frequency suggest the role of genetic factors, and their appearance during pregnancy suggests a role of hormonal factors. Krivo proposed the clonal– Blaschko linear theory, suggesting that PDLs are due to pigmentary mosaicism and follow the lines of Blaschko. Others believe that they correspond to the axial lines of Sherrington. Recently, Maleville proposed the axial neural theory, suggesting that PDLs arise due to different homeobox genes controlling melanogenesis in various neural territories. Our patient presented with a PDL that did not conform to any pattern described previously. It started as a group A line, having a wavy transpectoral extension (corresponding to Muiro group A III line); however, its upward extension towards the neck has not been reported (a)

Leiomyosarcoma of inferior vena cava with intracardiac extension presenting as Budd-Chiari syndrome: Report of a rare case

Primary leiomyosarcoma of vascular origin is a rare malignant smooth muscle tumor. This report describes a case of primary leiomyosarcoma of the inferior vena cava (IVC) in a 52-year-old male who presented with complaints of abdominal pain, chest pain, and bilateral lower limb swelling for 4 months. Imaging of the chest and abdomen revealed a mass in the IVC extending into right atrium, heterogeneous enhancement of liver, hepatosplenomegaly, and ascites. Histopathological examination showed a malignant spindle cell tumor with cells arranged in fascicular and hemangiopericytomatous pattern. Immunohistochemistry for smooth muscle actin and desmin confirmed smooth muscle origin of the tumor. Recognition of this tumor in this rare location and Budd-Chiari syndrome-like presentation is imperative for proper management of the patient.

Pyogenic granuloma: Adiagnostic dilemma

A 27‐year‐old woman presented with a 10 month history of an asymptomatic, thick, scaly lesion over the plantar aspect of left foot. It appeared during her third trimester of pregnancy. It was nonprogressive and not associated with bleeding. Physical examination revealed a well‐defined, erythematous, hyperkeratotic partially blanchable, and a compressible plaque of size approximately1 cm in diameter, covered with semi‐adherent whitish coarse scales, present over plantar aspect of the left foot [Figure 1]. Dermoscopic examination revealed reddish homogeneous areas with white scales more marked at some places [Figure 2].