Chandrashekar Laxmisha

Granular cell tumour of the clitoris

Editor An 18-year-old girl presented to the department with a 1-year history of an asymptomatic, slowly progressive growth in the region of the clitoris. There was no ulceration or bleeding from the lesion. On cutaneous examination, a solitary 2.5× -2-cm, firm brownish-black nodule with a verrucous surface was seen arising from the clitoris. Examination of the vagina and rectum was non-contributory. The regional lymph nodes were not enlarged. A provisional diagnosis of an appendageal tumour was made. An excisional biopsy was performed. On histopathological examination using haematoxylin and eosin, a non-encapsulated tumour was seen (fig. 1a). It was composed of plump polygonal cells arranged in nests and fascicles with a plump central hyperchromatic nucleus, and abundant fine granular eosinophilic cytoplasm with indistinct cell boundaries (fig. 1b). There was no significant atypia. A diagnosis of granular cell tumour of the clitoris was finally made. No recurrence was observed after 6 months of follow-up. The granular cell tumour (GCT), previously known as granular cell myoblastoma, is an uncommon, benign tumour of disputed histogenesis. 1 There is a female predominance. The average age of presentation is 40–50 years, but the tumours may arise in children. Most lesions are asymptomatic, solitary, skin coloured nodules, less than 2 cm in diameter. They are multiple in about 10% of cases. They may develop in many anatomical sites; most are found in the oral cavity, especially the tongue and in the skin and subcutaneous tissue. 1 In the female genital tract, this tumour may be found in the vulva, affecting mainly the superficial portion of the labia majora. 2 However, clitoral involvement is rare. 3,4 The origin of this tumour may be from the Schwann cells. On histology the tumours are nonencapsulated and composed of irregularly arranged sheets of large polyhedral cells, with a small hyperchromatic nucleus and abundant, fine to coarse, granular eosinophilic cytoplasm. In some cases, they are plump and irregular. The cytoplasmic granules are PAS-positive and diastase resistant. Elastosis is common in the stroma of GCT. The overlying epithelium often shows prominent pseudoepitheliomatous hyperplasia. GCT usually contains S100 protein, neurone specific enolase, PGP9.5 and the melanomaassociated antigen NK1/C-3. 1 There are no well defined criteria for malignancy. Tumour size greater than 5 cm, vascular invasion, necrosis, and rapid growth are important indicators of malignant behaviour. 1

Pigmentary demarcation lines associated with pregnancy.

© 2006 Blackwell Publishing • Journal of Cosmetic Dermatology , 5 , 168–170 169 2 DeCaprio AP. The toxicology of hydroquinone – relevance to occupational and environmental exposure. Crit Rev Toxicol 1999; 29 (3): 283–330. 3 Pifer JW, Hearne FT, Friedlander BR, McDonough JL. Mortality study of men employed at a large chemical plant, 1972 through 1982. J Occup Med 1986; 28 : 438–44. 4 Deisinger PJ, Hill TS, English JC. Human exposure to naturally occurring hydroquinone. J Toxicol Environ Health 1996; 47 (1): 31–46. 5 Wester RC, Melendres J, Hui X et al. Human in vivo and in vitro hydroquinone topical bioavailability, metabolism, and disposition. J Toxicol Environ Health 1998; 54 (4): 301–17.

Generalized lichen nitidus with Down syndrome

1156 JEADV 2006, 20, 1133–1167

Reliable site for suction blister induction and harvesting.

BACKGROUND Suction blister grafting is a useful modality of treatment of patients with resistant and stable vitiligo. However, there have been no detailed studies to find out the best donor site for blister formation. METHODS The study was conducted between the period of October 2004 and February 2005 in the dermatology department at a tertiary care center. Nine patients with vitiligo (focal vitiligo, 3; mucosal vitiligo, 2; acrofacial vitiligo, 2; vitiligo vulgaris, 1; and segmental vitiligo, 1) were selected for blister harvesting and grafting. The blisters were raised using the method described by Gupta et al. RESULTS Suction blisters were attempted to be raised at 52 sites, but only 38 blisters could be raised, 24 complete and 14 incomplete. Blisters were raised in all the three cases on the flexor aspect of the arm (100%), 15 of 17 cases (88.2%) on the flexor aspect of the forearm, 4 of 5 cases (80%) on the abdomen, 11 of 16 cases (68.7%) on the anterolateral thigh, and less frequently over leg or foot. Complete blisters were formed in 13/15 cases (86.6%) on the flexor aspect of the forearm, 6/11 cases (54.5%) on the anterolateral thigh, and in all cases over leg. CONCLUSION The flexor aspect of the forearm is a good site for suction blister harvesting.

Linear syringocystadenoma papilliferum of the scalp

Editor A 5-year-old girl presented to the skin clinic with an ulcerated plaque over the scalp, present since 6 months of age. On examination, linearly set, grouped, skin-coloured, umbilicated papules were seen extending from the nape of the neck to the occipital scalp ending in a 4 × 3-cm cauliflower-like moist reddish plaque (fig. 1). Alopecia was present over the plaque. No other lesions were present. The child was otherwise in good health. Similar observations were made by histopathological examination of both the

Bindi dermatitis due to thimerosal and gallate mix.

1370 JEADV 2006, 20, 1328–1399

Patch testing in hand eczema at a tertiary care center

Sir, Hand eczema is a descriptive diagnosis for dermatitis largely confined to the hands, and it does not make any presumption about the etiology.[1] It may be endogenous or exogenous (allergic or irritants) in origin.[1] Most of the cases of hand eczema have a multifactorial etiology,[1] wherein the eczema is caused and perpetuated by exogenous factors in individuals who are susceptible to such processes due to endogenous factors.[1,2] Understandably, identification and avoidance of the external contactants is of paramount importance in appropriate management of hand eczema. As clinical differentiation between chronic allergic and irritant hand eczemas is often impossible, patch testing becomes an important diagnostic tool for identification of the allergen/ allergens responsible for the eczema.[3] We undertook a study to identify the allergens showing positive reactions in patch test in patients with hand eczema.

Chondroid syringoma of the ear lobe

1 Koga T, Kubota Y, Nakayama J. Syringocystadenoma papilliferum without an antecedent naevus sebaceous. Acta Derm Venereol 1999; 79: 237. 2 Patterson JW, Straka BF, Wick MR. Linear syringocystadenoma papilliferum of the thigh. J Am Acad Dermatol 2001; 45: 139–141. 3 Laube S, Suarez V, Hardwick N. A cluster of papules on the buttock of a teenager. Clin Exp Dermatol 2005; 30: 197– 198. 4 Saricaoglu H, Baskan EB, Ozuysal S, Tunali S. A case of syringocystadenoma papilliferum: an unusual localization on postoperative scar. J Eur Acad Dermatol Venereol 2002; 16: 534–536.

Subcutaneous swellings due to rhinosporidiosis.

To the Editor: Rhinosporidiosis is a chronic granulomatous mycosis caused by Rhinosporidium seeberi (1, 2). The organism has never been isolated in vitro and its taxonomic position is not clear. Cultivation in an epithelial cell line and in standard media at a pH of 5.8 to 6.5 under an optimum temperature of 23°C has been reported. The disease is endemic in India and Sri Lanka, but it has also been reported from the United States of America, South America and Iran (1, 2). In India, this disease is reported to be highly prevalent in two Southern states, Kerala and Tamil Nadu (3). It is more common in adult males and is possibly transmitted to man by direct contact with spores through dust, infected clothing or fingers and by swimming in stagnant waters (2–4). Rhinosporidiosis frequently involves the nasopharynx (70%) presenting as a painless, friable, polypoidal growth which may hang anteriorly from the nares or posteriorly into the pharynx (1, 5). The lesions are pink or purple red and are studded with minute white spots which are the sporangia containing spores (1–3). Nasal obstruction and bleeding are the most common symptoms (5). The conjunctiva and lacrimal sac are involved in 15% of cases. Occasionally, it affects the lips, palate, uvula, maxillary antrum, epiglottis, larynx, trachea, bronchus, ear, scalp, vulva, vagina, penis, rectum or the skin (3). The infection is usually limited to the surface epithelium, but wide dissemination with visceral involvement can rarely occur (3). We herewith report a case of disseminated rhinosporidiosis who presented with subcutaneous swellings in the lower limbs, a feature not described in the literature. A 40-year-old male fisherman presented to us with asymptomatic multiple swellings over the lower limbs of eight months duraThe Journal of Dermatology Vol. 32: 150–152, 2005