E. González-Guerra

Immunohistochemical study of calretinin in normal skin and cutaneous adnexal proliferations.

Abstract: Calretinin is a calcium-binding protein member of the EF-hand family. The presence of calretinin has been demonstrated in certain stages of the cellular cycle in a wide variety of normal and neoplastic tissues. The main aims of our study were (1) to investigate what structures of the normal skin and cutaneous adnexal proliferations express immunoreactivity for calretinin and (2) to determine the value of immunohistochemical expression for calretinin as a marker for follicular, sebaceous, apocrine, and eccrine differentiation in cutaneous adnexal proliferations. We studied 139 biopsy specimens, including 10 cases of normal skin of different locations and 129 benign and malignant cutaneous adnexal proliferations. In normal skin, we found that calretinin is expressed in the innermost cell layer of the outer root sheath in anagen hair follicle, in both the duct and sebolemma of the sebaceous gland, in the secretory portion of eccrine glands, and in mast cells of the stroma. In cutaneous adnexal proliferations, we found strong immunoreactivity for calretinin in tricholemmal cysts, tricholemmomas/inverted follicular keratoses, tumors of follicular infundibulum, and in some basal cell carcinomas. Focal positivity was also seen in trichoadenomas, trichoblastomas/trichoepitheliomas, pilomatricomas, proliferating tricholemmal tumors, pilar sheath acanthomas, trichofolliculomas, follicular hybrid cysts, cutaneous mixed tumors, steatocystomas, sebaceous hyperplasias, and sebaceomas. These results demonstrate that immunohistochemical study for calretinin may be helpful to identify the innermost cell layer of the outer root sheath in anagen hair follicle and the cutaneous adnexal proliferations showing differentiation toward this structure. Calretinin immunoreactivity supports eccrine differentiation in some sweat gland neoplasms, and it is also useful in identifying neoplasms with ductal sebaceous differentiation.

Estudio inmunohistoquímico de la calretinina en el folículo piloso normal y neoplasias con diferenciación folicular

Resumen Introduccion La inmunotincion selectiva con calretinina evidencia la capa mas interna de la vaina radicular externa del foliculo piloso normal, dificil de distinguir con la tincion de hematoxilina-eosina. Objetivo Conocer si calretinina nos permite identificar neoplasias anexiales con diferenciacion hacia la vaina radicular externa del foliculo piloso. Material y metodos Hemos analizado el patron de inmunotincion para calretinina en 49 biopsias de distintas neoplasias anexiales cutaneas con diferenciacion folicular. Resultados Quince de las 49 tinciones correspondian a tricolemomas/queratosis folicular invertida, observandose positividad con calretinina en el epitelio de las areas mas superficiales de la lesion y en los remolinos escamosos; 10 quistes tricolemicos con positividad en su pared, tres carcinomas basocelulares con positividad variable dependiendo del tipo de diferenciacion folicular de cada variante, un panfoliculoma con positividad focal, dos hamartomas sebaceos infundibulo-quisticos con positividad en el conducto excretor de las glandulas sebaceas, dos pilomatricomas y tres tumores tricolemales proliferantes con positividad en las capas celulares cercanas a la luz de las estructuras quisticas, 9 tricoblastomas/tricoepiteliomas, dos quistes infundibulares, un poro dilatado de Winer y dos acantomas de la vaina folicular resultaron negativos. Conclusion El estudio inmunohistoquimico de la calretinina nos permite identificar neoplasias anexiales del foliculo piloso o componentes de este, con diferenciacion hacia la vaina radicular externa del foliculo piloso.

Acroqueratodermia siríngea acuagénica. Presentación de dos casos

Aquagenic syringeal acrokeratoderma is an infrequently described acquired, transitory keratoderma that is exacerbated when the palms and/or soles are immersed in water. It manifests as whitish or yellowish flattened, translucent papules and plaques, located in areas of pressure or trauma on the palms and/or soles. Involvement is usually bilateral. The histologic features are non-specific, showing a slight dilation of the intraepidermal portion of the eccrine sweat duct. The process tends to remit spontaneously. We present the case of two women, aged 20 and 21.

Leukemia cutis presenting as localized cutaneous hyperpigmentation

The usual clinical presentations of leukemia cutis include solitary infiltrated erythematous or violaceous plaques or nodules and multiple localized or generalized papules. On the other hand, cutaneous hyperpigmentation is a frequent finding in patients with malignancies, most of the cases because of chemotherapy or other drugs that the patient is taking. We present a case of cutaneous hyperpigmentation as the presenting sign of leukemia cutis. A 61‐year‐old male presented with cutaneous hyperpigmentation, which had appeared during the last chemotherapy cycle for treatment for biphenotypic leukemia. Cutaneous lesions consisted of bluish to brownish irregular well‐defined discoloration of the skin involving the upper part of the trunk and the temporal regions of the forehead. The patient was asymptomatic and the skin was not infiltrated at all. However, histopathologic study showed nodular infiltrates involving the full‐thickness of the dermis and destroying pre‐existing adnexa. This infiltrate was composed of atypical basophilic cells with large hyperchromatic nuclei and scant cytoplasm. Immunohistochemical studies showed intense immunoexpression for CD43, CD68, CD45RO and myeloperoxidase within these cells. A diagnosis of biphenotypic leukemia cutis was established. In our review of the literature we have not found any report of cutaneous hyperpigmentation as the presenting manifestation of leukemia cutis.

Lipedematous alopecia: an uncommon clinicopathologic variant of nonscarring but permanent alopecia

A 52‐year‐old black woman presented with a 5‐year history of gradual swelling and slowed hair growth involving the vertex and both parietal regions of the scalp. Gradually, the swelling progressed to involve the entire scalp, only sparing a peripheral crown. She reported no history of trauma or medications. Slight pruritus of the involved area was the only accompanying symptom. There was no family history of a similar condition. Her past medical history included surgery for ovarian cysts, 10 years previously, and cholelithiasis.

Immunohistochemical Study of Calretinin in Normal Hair Follicles and Tumors With Follicular Differentiation

BACKGROUND Selective immunostaining for calretinin labels the innermost layer of the outer root sheath of normal hair follicles, which is difficult to distinguish with hematoxylin-eosin staining. OBJECTIVE The aim of this study was to determine whether immunohistochemistry for calretinin allows identification of cutaneous adnexal tumors with follicular differentiation towards cells of the outer root sheath. MATERIAL AND METHODS We analyzed the staining pattern for calretinin by immunohistochemistry in 49 biopsies of cutaneous adnexal tumors with follicular differentiation. RESULTS Fifteen biopsies corresponded to trichilemmomas/inverted follicular keratosis and had staining for calretinin in the epithelium of the most superficial areas of the lesions and in squamous eddies. Ten were trichilemmal cysts, which displayed staining of the cyst wall. Three were basal cell carcinomas with variable staining according to the type of follicular differentiation in each variant. One was a panfolliculoma that had focal staining. Two were folliculosebaceous cystic hamartomas with staining of the excretory duct of the sebaceous glands. Two pilomatricomas and 3 proliferative trichilemmal tumors had positive staining in the cellular layers close to the lumen of the cystic structures. Nine trichoblastomas/trichoepitheliomas, 2 infundibular cysts, 1 dilated pore of Winer, and 2 acanthomas of the follicular sheath were negative for calretinin. CONCLUSION Immunohistochemistry for calretinin allows identification of cutaneous adnexal tumors of the hair follicle or a component of the follicle with differentiation towards cells of the outer root sheath.

Mastocitosis del adulto. Descripción de 9 casos clinicopatológicos

Resumen Introduccion La mastocitosis es un proceso hiperplasico caracterizado por la infiltracion de diversos organos y tejidos por mastocitos maduros. Se trata de una enfermedad que es mas frecuente en la infancia, aunque tambien se dan casos en los adultos. Existen notables diferencias entre las formas de presentacion de la mastocitosis del adulto y de la infancia, asi como en su evolucion y pronostico. Material y metodos En este trabajo describimos los hallazgos clinicopatologicos de 9 pacientes adultos con mastocitosis. Se comparan las caracteristicas clinicas, evolutivas y geneticas de la mastocitosis del adulto con la mastocitosis infantil. Resultados En contraste con la mastocitosis infantil, las lesiones cutaneas de la mastocitosis en adultos son muy monomorfas, y consisten en maculas y papulas de menos de 1 cm de diametro y coloracion pardo-rojiza. La sintomatologia es escasa y lo mas habitual suele ser un discreto prurito. El signo de Darier es con gran frecuencia negativo. Ademas, las lesiones cutaneas no tienden a la regresion espontanea, que es lo habitual en el nino. Por ultimo, la afectacion sistemica en el adulto es practicamente constante, con infiltracion mastocitaria de la medula osea en mas del 90 % de los casos y afectacion osea en mas del 50 % de los casos, mientras que en los ninos la afectacion sistemica es mas rara. De todas formas, a pesar de que exista infiltracion de organos sistemicos en la mastocitosis de adultos, no suele existir sintomatologia acompanante. La mutacion del protooncogen c-kit consistente en la sustitucion de Asp por Val en el codon 816, se encuentra casi constantemente en las mastocitosis del adulto y es menos frecuente en la mastocitosis infantil. Conclusiones Todos estos hallazgos permiten separar la mastocitosis del adulto como una entidad clinicopatologica diferente de las mastocitosis infantiles.

Espiradenomas múltiples con distribución lineal

Resumen —Presentamos el caso de una mujer de 32 anos que acudio a nuestra consulta con multiples nodulos en el brazo izquierdo y mama homolateral de 15 anos de evolucion. Estas lesiones tenian una coloracion azulada y eran dolorosas. Pocos anos atras le habian extirpado en el brazo izquierdo otras tres lesiones similares con el diagnostico histopatologico de espiradenoma. Todos los nodulos estaban dispuestos siguiendo un trayecto lineal y bajo una lesion maculopapulosa eritematosa que clinicamente parecia corresponder a un nevo epidermico. Los casos de espiradenomas multiples son muy raros y mas aun los espiradenomas multiples que adoptan una disposicion lineal.

Cuerno tricolémico: presentación de un nuevo caso y revisión de la literatura

TRICHILEMMAL HORN: A NEW CASE AND REVIEW OF THE LITERATURE Abstract. Trichilemmal horn, or trichilemmal keratosis, is an uncommon benign neoplasm of follicular lineage with trichilemmal differentiation. The essential characteristics of this tumor are its clinical presentation in the form of a cutaneous horn with trichilemmal keratinization apparent in the histology study (with a hyperplastic epithelium giving rise to dense, orthokeratotic eosinophilic keratin). We present a new case of this type of tumor in an 82-year-old woman who developed a solitary lesion on her scalp after surgical removal of a trichilemmal cyst. On the basis of the pathology report, the tumor was diagnosed as trichilemmal horn. We review the 33 reports of this tumor in the literature to date.

Trichilemmal Horn: a New Case and Review of the Literature

Trichilemmal horn, or trichilemmal keratosis, is an uncommon benign neoplasm of follicular lineage with trichilemmal differentiation. The essential characteristics of this tumor are its clinical presentation in the form of a cutaneous horn with trichilemmal keratinization apparent in the histology study (with a hyperplastic epithelium giving rise to dense, orthokeratotic eosinophilic keratin). We present a new case of this type of tumor in an 82-year-old woman who developed a solitary lesion on her scalp after surgical removal of a trichilemmal cyst. On the basis of the pathology report, the tumor was diagnosed as trichilemmal horn. We review the 33 reports of this tumor in the literature to date.