Atul M Dongre

A study of clinicopathologic profile of 15 cases of hypopigmented mycosis fungoides.

BACKGROUND Mycosis fungoides (MF) is cutaneous lymphoma of the T-cell lineage. Hypopigmented MF is a clinical variant of MF, described mainly in Asians. This is a retrospective clinicopathologic analysis of hypopigmented MF at a tertiary care center. AIMS To describe the clinicopathologic profile of hypopigmented MF. METHODS Records of clinicopathologic notes over a 5-year period ranging from January 2005 up to December 2009 were reviewed over a period of 3 months, of which 15 cases were diagnosed with hypopigmented MF based on clinicopathologic correlation. RESULTS Hypopigmented MF was found to be more common in males, and between second and fourth decades of life. The latent period between onset and diagnosis was around 3.83 years. Most of the patients were asymptomatic 80% (12/15), with skin changes of subtle atrophy in 46.66% (7/15), scaling in 20% (3/15) and focal changes of poikiloderma in 26.66% (4/15) patients. Most common sites of distribution of the lesions were the trunk and extremities. Many of the cases had been clinically mistaken for Hansens disease prior to correct diagnosis. Marked epidermotropism and tagging of epidermis by large lymphocytes characterizes the condition histopathologically. Of the 15 cases, immunohistochemistry was possible in 10 cases, of which 8 showed predominant CD8 positive epidermotropic infiltrates and two cases showed absence of CD8 positive and CD4 positive lymphocytic infiltrate in the epidermis. CONCLUSION Hypopigmented MF presents as hypopigmented asymptomatic patches without any erythema or infiltration in its early stage and mimics Hansens disease. Skin biopsy clinches the diagnosis.

Kaposi's sarcoma in an HIV-positive person successfully treated with paclitaxel

Epidemic Kaposis sarcoma is one of the malignant neoplasms, which can develop in HIV-infected patients. Although the prevalence of HIV infection is reported to be high in Asian countries, Kaposis sarcoma is rarely reported. We report a case of Kaposis sarcoma involving the skin and oral mucosa along with extensive bilateral lymphedema of lower extremities, treated successfully with paclitaxel and antiretrovirals.

A retrospective analysis of histopathology of 64 cases of lepra reactions

Background: Lepra reactions are not always diagnosable under the microscope. We analyzed skin histopathology in 64 cases of lepra reaction. Aim: To make detailed observations on histopathologic features of type 1 and type 2 lepra reaction (erythema nodosum leprosum, ENL). Materials and Methods: In this retrospective study, we included 64 patients diagnosed during a 3-year period as lepra reaction based on clinico-pathological co-relation. Results: Out of the 64 patients, 22 were of type 1 reaction and 42 of ENL. The most consistent finding in type 1 reaction was papillary dermal edema (86%) followed by pyknosis of lymphocytes (77%) and intercellular edema within granuloma (73%). Surprisingly, folliculotropism of lymphocytes was seen in 55% and subcutaneous infiltration in 36%. In ENL, the most common finding was presence of neutrophils within the granuloma (100%), followed by leukocytoclasia (81%), papillary dermal edema (81%), and neutrophilic panniculitis (69%). Fibrin in the vessel wall or/and granulomas was noted in only 38% while fibrin thrombi in the vessel walls were seen in only 12% of cases. Conclusion: Infiltration of macrophage granulomas by neutrophils is a reliable sign of ENL. Classical signs of vasculitis are not always present in ENL. Folliculotropism and lymphocytic panniculitis were frequent in type 1 reactions while neutrophilic panniculitis was common with ENL.

Tattoo reactions-An epidemic on the surge: A report of 3 cases

Tattooing has been practiced in India since ancient era. It has tremendous religious and spiritual significance. In addition, tattooing for cosmetic purposes has become quite popular in recent times. With this increasing trend, there is also an increased risk of adverse effects. Here, we have described two cases of lichenoid reaction developing to red ink in double- colored tattoos and a case of sarcoidal reaction to green tattoo.

Ectodermal dysplasia-skin fragility syndrome

Ectodermal dysplasia-skin fragility (EDSF) syndrome is a rare and first described inherited disorder of desmosomes. It occurs due to loss-of-function mutations in PKP1 gene resulting in poorly formed desmosomes and loss of desmosomal and epidermal integrity. We report a case of a 2-year-old Indian male child who presented with palmoplantar hyperkeratosis with fissuring, short, sparse, and easily pluckable scalp hair, nail dystrophy, and multiple erosions over the skin. Skin biopsy showed epidermal hyperplasia with widening of intercellular spaces. His developmental milestones were delayed but intelligence was normal. Echocardiography, X-ray chest, and electrocardiogram were normal. Very few cases of this syndrome have been reported in the literature. We consider this as the first case report from India.

Polarized light microscopy

Polarized light is the light in which all the rays vibrate in one plane. A polarizing microscope has two disk accessories. They are made up of polarizing plastic that allows light vibrating in one plane to pass. One of them is called a polarizer (placed below the condenser). Another similar disc is placed in the top part of the microscope and cuts off all the light vibrating in a perpendicular plane. This disc is called analyzer. The placement of the discs is such that they allow light vibrating in planes perpendicular to each other. Hence when both the Figure 1: Principle of polarizing microscopy disks are in place no light can pass on to the eyepieces. Hence through the eyepieces only dark background is seen unless Foreign body (ies) a doubly refractile object is placed in the path of polarized On polariscopic examination different foreign bodies have light, in which case, the doubly refractile object appears characteristic appearance. They can be found amidst foreign illuminated against a dark background [Figure 1]. body granulomas (both allergic and non-allergic type) and most commonly within the multinucleated giant cells. Usually organic and inorganic substances with rigid yet Various foreign bodies can be identified on the basis of repeatable structure like crystals, sand, talc, wood, amyloid and other fibrillary structures are seen on polarized light microscopy. Certain foreign bodies can be detected on routine hematoxylin and eosin staining (H and E) while special stains are required for metabolic or deposition disorders.

Fibroepithelioma of Pinkus in continuity with nodular basal cell carcinoma: A rare presentation

Fibroepithelioma of Pinkus and nodular basal cell carcinoma (BCC) are different morphological variants of BCC. It is very rare to see both the variants together in a single lesion. Here we report a case of a 56-year-old female who presented with a nodule on the trunk, which on biopsy showed features of both nodular BCC and fibroepithelioma of Pinkus.

Reversed pigmentary network pattern in evolving lesions of vitiligo

Normal reticulate pattern of pigmentation seen over normal skin corresponds to the pigmentation of the keratinocytes along the rete ridges while the pale area in between corresponds to the papillary dermis.[1] In vitiligo there is gradual loss of melanocytes and melanin due to which light directly passes into the dermis without being reflected by the melanocytes and melanin. This leads to a window through which light passes into the dermis and is reflected by dermal collagen. In initial stages of evolving vitiligo this leads to area of relative hyperpigmentation produced by the pale area corresponding to papillary dermis in normal reticulate pattern of pigmentation. This leads to the appearance of “reversed pigmentary network pattern” in evolving vitiligo.

Acquired cutis laxa of face with multiple myeloma

Indian Journal of Dermatology, Venereology, and Leprology | September-October 2014 | Vol 80 | Issue 5 454 6. Takayama K, Satoh T, Hayashi M, Yokozeki H. Psoriatic skin lesions induced by BCG vaccination. Acta Derm Venereol 2008;88:621‐2. 7. Monacelli M. Koebner reaction in psoriasis. In: Farber EM, Cox AJ, editors. Psoriasis: Proceedings of the International Symposium. Vol. 99. Stanford: Stanford University press; 1971. p. 104‐11. 8. Rambukkana A, Das PK, Witkamp L, Yong S, Meinardi MM, Bos JD. Antibodies to mycobacterial 65‐kDa heat shock protein and other immunodominantantigens in patients with psoriasis. J Invest Dermatol 1993;100:87‐92.

Acquired smooth muscle hamartoma

Smooth muscle hamartoma is an uncommon, usually congenital, cutaneous hyperplasia of the arrectores pilorum muscles. When it is acquired, it may be confused with Beckers nevus. We report a case of this rare tumor in a 19-year-old man. The disease started several years ago as multiple small skin-colored papules that subsequently coalesced to form a large soft plaque on the back of the left shoulder. The diagnosis of acquired smooth muscle hamartoma was confirmed on histopathology. The patient was reassured about the benign nature of the lesion and was not advised any treatment.