I. Chelly

Neuroendocrine differentiation in basal cell carcinoma

ABSTRACT Basal cell carcinoma (BCC) is the prototypical basaloid tumor of the skin. It may show various patterns simulating other cutaneous tumors due to its pleomorphism. It may have an unusal pattern of differentiation such as squamous, sebaceous, apocrine, eccrine, pilar, and endocrine differentiation. In order to establish the relative frequency of neuroendocrine differentiation in BCC, we performed a retrospective study of 33 consecutive BCCs using conventional immunohistochemistry with two neuroendocrine antibodies: Chromogranine A and synaptophysine. The age of the patients ranged from 17–83 years with mean of 65 years. The male to female ratio was 16:17. In immunohistochimestry, Chromogranine A was seen in 72.2% (24/33) while Synaptophysine was positive in 9.09% (3/33). Their expression was cytoplasmic and membranous and was seen in the periphery of these tumors in the overlying cells. Positive staining of chromogranine A was high (75–100% of tumors cells) in 9%, intermediate (25–75% of tumors cells) in 33% of cases and relatively low (<25%) in 30.3% of cases.

Ostéosarcome cutané primitif

BACKGROUND Osteosarcoma is a malignant tumor of mesenchymatous origin that chiefly affects the metaphysis of long bones. The extraskeletal form of the disease is rare, and even rarer is a cutaneous site, whether metastatic or primary. Herein, we report a new case of primary cutaneous osteosarcoma. PATIENTS AND METHODS A 54-year-old woman presented a hard subcutaneous nodular tumor on her left arm noted 1 year earlier. The diagnosis of cutaneous osteosarcoma was made on the basis of histological analysis of the lesion, which showed a sarcomatous dermal-hypodermal proliferation secreting osteoid. Clinical and radiological staging ruled out any extra-cutaneous spread, particularly to bone, thus confirming the primary cutaneous nature of the osteosarcoma. DISCUSSION Primary cutaneous osteosarcoma is a rare tumor, diagnosis of which is normally based on histopathological features.

Pellagra in a patient with primary Sjögren's syndrome.

A 27-year-old woman presented with persistent dryness of the mouth and eyes. She presented with permanent photodistributed rash involving the face and distal extremities. Laboratory tests showed positive Sjögrens syndrome (SS)-A and SS-B antibodies. Histological examination of minor salivary gland biopsy revealed inflammatory infiltration grade 4 according to Chisholms classification. Skin biopsy showed acanthosis, hyperkeratosis in the epidermis and little inflammatory infiltrate in the dermis. There was an infiltration of CD4 T lymphocytes in the dermis. Based on the characteristics of the dermatitis and on a rapid response to niacin replacement, the diagnosis of pellagra was carried out. A complete resolution of the dermatological signs was obtained within 2 months. To the best of our knowledge, the association between primary SS and pellagra has never been reported. We emphasise the possible mechanisms of this association.

Acute generalized exanthematous pustulosis induced by the essential oil of Pistacia lentiscus

Acute generalized exanthematous pustulosis (AGEP) is an uncommon pustular eruption characterized by small nonfollicular pustules on an erythematous background, sometimes associated with fever and neutrophilia. Over 90% of cases are drug‐induced; however, it can be caused in rare cases by other agents. We report two cases of AGEP secondary to ingestion of Pistacia lentiscus essential oil, the first two such cases to our knowledge. The cutaneous morphology, disease course and histological findings were consistent with a definite diagnosis of AGEP, based on the criteria of the EuroSCAR study group. These two cases highlight the need to consider herbal extracts as a potential rare cause of AGEP and to ensure the safety of herbal medicines.

Lésion blanche de la muqueuse buccale

Une femme âgée de 68 ans était suivie en stomatologie depuis plus de 35 ans pour lésions gingivales chroniques. Plusieurs extractions dentaires avaient été alors pratiquées. L’anamnèse retrouvait la notion de lésions gingivales blanchâtres lentement extensives, occasionnant une gêne à l’alimentation, pour lesquelles elle avait reçu des traitements symptomatiques sans aucune amélioration. La patiente ne présentait pas d’antécédents pathologiques notables, en particulier il n’y avait pas de notion de tabagisme. L’examen de la cavité buccale relevait des lésions blanchâtres verruqueuses, confluant en plaques à bords irréguliers, atteignant de façon diffuse la région antérieure de la gencive inférieure et la face interne de la lèvre inférieure jusqu’aux prémolaires (Fig. 1). Il n’y avait pas d’infiltration. La langue et le palais étaient indemnes de toute lésion. Le reste de l’examen cutanéo-muqueux était normal, en particulier il n’y avait pas d’adénopathies cervicales.

Pigmented tumor in the nostril.

A 64-year-old man was noted to have a single pigmented lesion in the nostril of his nose. Clinical examination revealed a 5 mm nodular growth and brown lesion. With a presumed clinical diagnosis of malignant skin tumor, a biopsy was performed. The histological examination revealed the unexpected diagnosis of pigmented inverted follicular keratosis. The inverted follicular keratosis is an uncommon benign lesion that is usually diagnosed histologically rather than clinically. It commonly simulates other proliferative skin lesions.