George P. Lupton

Seronegative Secondary Syphilis in a Patient Infected with the Human Immunodeficiency Virus (HIV) with Kaposi Sarcoma: A Diagnostic Dilemma

Reagin and treponemal antibody tests are highly reliable in diagnosing secondary syphilis. However, patients infected with the human immunodeficiency virus (HIV) respond abnormally to antigenic stimulation and may fail to develop typical serologic responses to infections. We report the case of an HIV-infected man with Kaposi sarcoma and secondary syphilis whose VDRL test and fluorescent treponemal antibody-absorbed test were repeatedly nonreactive. Correct diagnosis required biopsy of a skin lesion with silver staining to show spirochetes. Clinicians treating HIV-infected patients should be aware of the problems of serologic diagnosis of syphilis in these patients. Biopsy samples of appropriate tissues and staining for spirochetes may be needed to arrive at the correct diagnosis.

Microcystic adnexal carcinoma (sclerosing sweat duct carcinoma).

Microcystic adnexal carcinoma (MAC) is a recently described malignant neoplasm of the adnexal structures of skin that shows a marked propensity for early infiltrative and locally aggressive growth. Its banal clinical appearance may lead to a delay in diagnosing the tumor by biopsy, and its multifaceted histologic features may lead to an incorrect tissue diagnosis. Confusion with benign tumors and less aggressive malignancies can lead to inadequate initial treatment and extensive recurrences. We describe three cases of microcystic adnexal carcinoma and review the clinical and histologic features, treatment, and prognosis of this neoplasm.

Fibrofolliculomas, trichodiscomas, and acrochordons: The Birt-Hogg-Dubé syndrome

The Birt-Hogg-Dubé syndrome is a triad of cutaneous lesions including multiple fibrofolliculomas, trichodiscomas, and acrochordons. The inheritance is autosomal dominant in nature. We present a family of three with multiple firm, skin-colored papules in whom the three types of lesions are documented. In addition, we discuss the clinical differential diagnosis of multiple firm, skin-colored papules.

An Unusual Congenital Leiomyoma

Abstract: Cutaneous leiomyomas are rarely encountered at birth. In their usual form they appear as discrete dermal papules or nodules with a pink or brown discoloration of the overlying skin. We examined an infant with an unusual mass attached to the right heel at birth. Histologically, the lesion was a leiomyoma. It apparently represented a bizarre proliferative anomaly of smooth muscle occurring during fetal development.