Emily F. Omura

Histologic variation in the skin lesions of the glucagonoma syndrome

Three cases of glucagonoma syndrome were seen in 1 year. Study of the skin biopsies from the first two cases led to a correct diagnosis from skin biopsy of the third case, although it was not suggested clinically. In each case serum glucagon levels were high and a pancreatic tumor was found, with complete remission of symptoms in cases 1 and 3 after resection; case 2 refused surgery and has died. A total of nine skin biopsies from the three patients showed a variety of findings: (a) epidermal necrosis; (b) subcorneal pustules, either isolated or associated with necrosis of the epidermis; (c) confluent parakeratosis, epidermal hyperplasia, and marked papillary dermal angioplasia; and (d) suppurative folliculitis. The clinical lesions in this syndrome vary from bright red macules to annular superficial erosions and flaccid pustules. Similarly, several histopathologic features of the disease can occur, which may represent the progression of the disease. No single histologic feature was specific for the disease, but a combination of the features is probably diagnostic. Therefore, multiple skin biopsies are recommended when this diagnosis is suspected.

Fibrous hamartoma of infancy

Fibrous harmartoma of infancy is a benign soft tissue tumor that occurs in the first few years of life. Although the lesion is not distinctive clinically, it has a characteristic microscopic appearance. Only 12 cases of fibrous hamartoma of infancy have been reported in the dermatology literature.

Clinical and histologic features of primary oxalosis

Primary oxalosis should be considered in patients with multisystem disease of the kidneys, heart, peripheral vasculature, and skin. Crystalline deposits can lead to nephrolithiasis with kidney failure, complete heart block, peripheral vasospasm, and livedo reticularis, as in our patient. Crystals were first observed in the myocardial biopsy specimen and then identified as calcium oxalate in skin from an area of livedo reticularis.

Alopecia neoplastica—a rare form of cutaneous metastasis

A case of alopecia neoplastica secondary to an infiltrating carcinoma of the right breast is presented. The mechanisms of skin metastasis, cutaneous presentations, sites of origin, theories for an affinity for the scalp, and the prognosis in such cases are reviewed. The differential diagnosis of scalp metastases is discussed.

An epidermal proliferative reaction associated with a silicone gel breast implant.

A variety of local and systemic adverse reactions has been attributed to silicone prostheses used for augmentation or reconstructive mammoplasty. We present a patient who developed an unusual local cutaneous reaction to a silicone breast implant, which was characterized clinically by macular erythema and focal ulceration and histologically by a basaloid proliferative epidermal reaction. The epidermal changes seen histologically simulated those overlying dermatofibromas and were felt to be reactive secondary to silicone leakage and fibrosis. The process resolved postexplantation of the prosthesis.

Noninflammatory bullae associated with ∈-aminocaproic acid infusion

Three patients who had cardiac surgery developed a transient, noninflammatory subepidermal bullous eruption on the legs after ∈-aminocaproic acid infusion. Fibrin thrombi were demonstrated in papillary dermal vessels. The use of ∈-aminocaproic acid as an antifibrinolytic agent may predispose patients to cutaneous vascular thromboses.

Calvarial sarcoid mimicking metastatic disease

A 61-year-old white woman presented with localized cutaneous Boecks sarcoid and multiple lytic skull lesions mimicking metastatic carcinoma. Complete workup revealed no neoplastic process; biopsy of the skull lesions showed noncaseating granulomas consistent with sarcoid. Although rare, calvarial sarcoid can occur.