Bahram Sina

Multiple keratoacanthomas possibly induced by psoralens and ultraviolet A photochemotherapy

We report two patients who developed multiple keratoacanthomas while receiving photochemotherapy (PUVA). Both patients had received excessive doses of PUVA, which resulted in severe phototoxicity. The role of PUVA in the production of these lesions is discussed.

Nephrogenic systemic fibrosis with a spectrum of clinical and histopathological presentation: a disorder of aberrant dermal remodeling

Background: Nephrogenic fibrosing dermopathy (NFD) has emerged as a clinicopathologic entity since 1997 and recently renamed as nephrogenic systemic fibrosis (NSF). The etiology and pathogenesis remain uncertain. Characteristic clinical presentation is described as diffuse thickening and hardening of the skin occurring in patients with renal insufficiency. Typical histological features include proliferation of CD34 positive fibrocytes, increased thick collagen bundles and mucin deposition, without significant inflammatory infiltrate. Variations in clinical presentations have been reported, including papular and plaque‐like skin lesions, focal lesion only, as well as systemic involvement. Histological changes can be subtle and non‐specific, overlapping with other disease processes and harboring features including calcification and osteoclast‐like giant cells with osseous metaplasia.

Umbilical metastasis from prostate carcinoma (Sister Mary Joseph's nodule): a case report and review of literature.

Sister Mary Joseph’s nodule is referred to as metastatic lesion of the umbilicus. Most of the tumors are adenocarcinomas originating from gastroenteric and genital tracts. Only rarely were metastases from other locations reported. We describe here an unusual case of a Sister Mary Joseph’s nodule that was metastasized from prostate carcinoma 3 years after radiation therapy. The lesion was the first sign of metastatic disease, and the diagnosis was made on skin biopsy. The patient died of extensive metastases of prostate carcinoma 4 months later. We report this case to extend the list of differential diagnosis for Sister Mary Joseph’s nodule in male patients and emphasize the importance of Sister Mary Joseph’s nodule as an ominous diagnostic sign.

Localized nephrogenic fibrosing dermopathy: Aberrant dermal repairing?

Nephrogenic fibrosing dermopathy (NFD) has emerged as a clinicopathologic entity since 2000 and was recently renamed nephrogenic systemic fibrosis. The cause and pathogenesis remain uncertain. The classic clinical presentation is diffuse thickening and hardening of the skin that occurs in patients with renal insufficiency, with or without systemic involvement. We report a patient with renal failure who presented to our dermatology clinic with a localized plaque on the left forearm along the vein that was traumatized during the infusion of erythropoietin. Histologic examination revealed a dermal proliferation of CD34(+) fibrocytes with collagen fibers and interstitial mucin accumulation, features characteristic for NFD. We conclude that NFD may present as a localized, scarlike plaque after trauma and exhibit overlapping histopathologic features resembling cicatrix and other dermal reparative/regenerative processes. NFD may, in fact, be a disorder of aberrant extracellular matrix remodeling in patients with renal insufficiency. This is a single case observation with discussion of literature and attempted hypothesis on pathogenesis. No experimental evidence is provided.

Hypomelanosis of Ito: Report of a case and review of the literature

A 5-month-old boy with hypomelanosis of Ito was studied. Lesions presented as bizarre, hypopigmented whorls and streaks. Histologic studies showed that the hypopigmented areas contained normal melanocytes with decreased content of intracellular melanin. A review of the literature revealed the disease to be a discrete entity of hypopigmentation associated with a high percentage of central nervous system abnormalities, particularly seizure disorders and mental retardation.

Intrafollicular mucin deposits in Pityrosporum folliculitis

11. Kuo T-t. Cutaneous extramedullary hematopoiesis presenting as leg ulcers. J AM ACAD DERMATOL 1981;4 592-6. 12. Soga N, Sakai C, Shibata A, et al. An autopsy case of primary myelofibrosis with high value of circulating immune complexes, IgG (kappa) monoclonal gammopathy and extramedullary hematopoietic subcutaneous tumors. Rinsho Ketsueki 1982;23:1713-8. 13. Takashashi F, Ikeda A, Kohgo Y, et al. Primary myelofibrosis with skin nodules terminating in leukemic transformation: an autopsy case. Rinsho Ketsueki 1983;24: 1361-6. 14. Hocking WG, Lazar GS, Lipsett JA, et al. Cutaneous extramedullary hematopoiesis following splenectomy for idiopathic myelofibrosis. Am J Med 1984;76:956-8. 15. Levine LE, Pearson MG, Baron JM, et al. Extramedullary hematopoiesis [Letter]. Arch Dermatol 1984;12@1282. 16. Roupe G. Kutane extramedullare Hamatopoese bei myelofibrose. Hautarzt 1987;38:230-1. 17. Green LK, Klima M, Burns TR. Extramedullary hematopoiesis occurring in a hemangioma of the skin [Letter]. Arch Dermatol 1988;124:1720. 18. Albeda FW, Van Der Meer J, Vellenga E. Vascular proliferation as an unusual cause of hemorrhagic diathesis in myelofibrosis. Am J Clin Path01 1991;95:564-6. 19. Beckman EN, Oehrle JS. Fibrous hematopoietic tumors arising in agnogenic myeloid metaplasia. Hum Path01 1982;13:804-10. 20. Pierard G-E. Hematopoiese cutanee et myelofibrose. Ann Path01 1987;7:73-5. 21. Puig L, Garcia MP, de Moragas JM. Cutaneous extramedullary hematopoiesis in a patient with acute myelofibrosis [Letter]. Arch Dermatol 1988;124:329-30. 22. Schofield JK, Shun JLK, Cerio R, et al. Cutaneous extramedullary hematopoiesis with a preponderance of atypical megakaryocytes in myelofibrosis. J AM ACAD DERMATOL 1990;22:334-7. 23. Mizoguchi M, Kawa Y, Minami T, et al. Cutaneous extramedullary hematopoiesis in myelofibrosis. JAM ACAD DERMATOL 199&221351-5. 24. Del Forno C, Borroni G, Caresana G, et al. Cutaneous extramedullary hematopoiesis in idiopathic myelofibrosis: description of a case. G Ital Dermatol Venereal 1990; 125:205-9. 25. Brough AJ, Jones D, Page RH, et al, Dermal erythropoiesis in neonatal infants: a manifestion of intra-uterine viral disease. Pediatrics 1967;40:627-35. 26. Schwartz JL, Maniscalco WM, Lane AT, et al. Twin transfusion syndrome causing cutaneous erythropoiesis. Pediatrics 198

Cutaneous oxalate granuloma

74:527-9. 27. Argyle JC!, Zone JJ. Dermal erythropoiesis in a neonate. Arch Dermatol 198 1; I 17:492-4. 28. Vakilzadeh F, Dominick HC, Bramswig J. Kutane erythropoese bei fetaler Rh-erythroblastose-blueberry-muffinbaby. Hautarzt 1982;33:440-2. 29. Popoff L, Popoff N. L’Hemope85:157-67. 30. Sarma DP. Extramedullary hematopoiesis of the skin. Arch Dermatol 1981;117:58-9. 3 I. Demory JL, Dupriez B, Fenaux P, et al. Cytogenetic studies and their prognostic significance in agnogenic myeloid metaplasia: a report on 47 cases. Blood 1988;72:855-9.

Skin biopsy for inflammatory and common neoplastic skin diseases: optimum time, best location and preferred techniques. A critical review

10. Veccione TR. Nasal reconstruction in discoid lupus erythematosus. Ann Plast Surg 1980;4:65-9. II. Graham WP, Miller SH, Lapidus SM. Skin grafting: diminishing the stigmata of lupus erythematosus. Pa Med 1977;80:56-7. 12. Kurwa AR, Evans AJ. Discoid lupus erythematosus treated by dermabrasion. Sr J Dermatol 1979; 101 (suppl): 53-4. 13. Roenigk HH Jr. Dermabrasion for miscellaneous cutaneous scars (exclusive of scarring from acne). J Dcrmatol Surg Oneal 1977;3:322-8.

Benign cutaneous pseudoglandular schwannoma: a case report.

The diagnosis of skin diseases, particularly inflammatory dermatoses, is based primarily on clinical information. Pathologic examination of the biopsied specimen often serves as a complementary or confirmative part of the diagnosis. However, the clinical diagnosis of skin diseases may be challenging, as the clinical information and appearance of skin lesions invariably overlap. Evidence for a correct diagnosis may be lacking without histopathologic examination of skin biopsies. It is well known that the histologic diagnosis of inflammatory and other skin diseases requires clinicopathologic correlation, and there is evolution of skin lesions into different stages as the diseases progress. Other factors important for accurate dermatopathologic diagnosis are optimum time, best location and preferred techniques of skin biopsy. In searching for available information concerning when, where and how to take skin biopsies, it is noted that there are only limited practical guidelines currently available. We present this review article in hopes that our collective dermatopathologic and dermatologic experience can provide a quick reference for accurate diagnosis and proper management of skin diseases.

The debate between gadolinium versus erythropoietin in a renal transplant patient with nephrogenic systemic fibrosis

Schwannoma is a common peripheral neural neoplasm that could present as a primary skin lesion. In addition to typical schwannoma with classic Antoni A and Antoni B areas, many variant types have been described, such as plexiform, cellular, epithelioid, and ancient schwannomas. Glandular schwannoma is a rare variant characterized by the presence of glands in an otherwise typical schwannoma. There are also a few reported cases in the literature of pseudoglandular schwannoma from central nervous system, eye, submandible, and shoulder, in which the gland-like structures were lined by Schwann cells. We report here a patient with a benign cutaneous schwannoma composed of predominantly gland-like spaces that contained mucinous material and were lined by Schwann cells confirmed by immunohistochemistry and ultrastructural studies. The tumor was well circumscribed and showed minimal cytologic atypia, indicating benignity. We report this unusual case of benign cutaneous pseudoglandular schwannoma to further awareness of the morphologic diversity of schwannoma.