Joan Guitart

Squamous cell carcinoma of the nail bed: a clinicopathological study of 12 cases

Twelve cases were reviewed of squamous cell carcinoma of the nail bed, with emphasis on the aetiological role of human papillomavirus (HPV) infection and radiation damage. Using a hybridization technique, similar HPV genomes were detected in a uterine cervical neoplasia and a subungual squamous cell carcinoma in the same patient.

Primary cutaneous phaeohyphomycosis: report of seven cases

We report seven cases of primary cutaneous phaeohyphomycosis. There were five males and two females, ranging in age from 42–65 years (mean 57.7 years). Two patients were otherwise healthy, but five were immunocompromised. One patient had rheumatoid arthritis and was on oral prednisone; two were renal transplant recipients, one was a heart transplant recipient, and the fifth had dermatomyositis. No history of trauma was elicited from any of the patients, but in two cases, foreign material was seen in the tissue sections. All lesions were oil the extremities. In two cases, tissues were cultured, and these grew Exophiala jean‐selmei. The others were not cultured because fungal infection was not clinically suspected. No systemic disease developed in any of the cases, and all were cured by the simple, complete excision of the lesions.

Fibrous papule of the nose with granular cells : two cases

Two cases of fibrous papule of the nose (FPN) with granular cell features are presented and discussed. Both lesions have classic architectural features of FPN; however, the main stromal cells show large cytoplasmic granules of the type seen in granular cells. We are uncertain of the significance of these findings. Our hypotheses include a perifollicular granular cell reaction and a granular degenerative change of local dermal dendrocytes.

Lichenoid changes in mycosis fungoides

BACKGROUND The lichenoid tissue reaction (LTR) is present in a variety of dermatoses. Numerous histologic variants of mycosis fungoides (MF) have also been described. OBJECTIVE Our purpose was to analyze a subset of patients with mycosis fungoides (MF) who had a prominent LTR at the time of presentation. METHODS Clinical and pathologic features were evaluated in 12 patients with MF and an LTR. RESULTS The primary complaint was intense pruritus (in 10 of 12 patients). An accelerated course was noted in one half of the patients including four with Sézary syndrome. Four patients died: two with Sézary syndrome and two with extensive patch/plaque MF. Lymphocyte atypia, prominent basal cell layer epidermotropism, and the presence of plasma cells and eosinophils may help to distinguish lichenoid MF from lichen planus. CONCLUSION A subset of patients with MF present with lichenoid changes. The pathologic features may have a striking resemblance to lichen planus. Our findings suggest that lichenoid changes in MF tend to be associated with intense pruritus and may connote a poor prognosis.

Solitary cutaneous myofibromas in adults: report of six cases and discussion of differential diagnosis

Six solitary, dermal or subcutaneous lesions occurring in adult patients are presented. These masses had a circumscribed, lobulated configuration; they were composed of fusiform and epithelioid cells that lacked atypical nuclear features. The pattern of growth featured fascicles and nests, a myxofibrous stroma, and prominent blood vessels with a focally “hemangiopericytoid” appearance. Immunohistochemical analyses showed uniform reactivity for vimentin and alpha isoform‐actin, with negativity for desmin and neural determinants. The overall appearance of the lesions was similar to that of “infantile myofibromastosis,” and corresponded to previous descriptions of “solitary myofibroma(tosis)” in adults. Immunophenotypic and ultra‐structural support exists for a proposed myofibroblastic nature for such proliferations. Differential diagnostic considerations include neurothekeomas, plexiform fibrous histiocytomas, nodular fasciitis, cutaneous inflammatory pseudotumors, dermatomyofibromas, leiomyomas, and other forms of fibromatosis affecting the skin and superficial soft tissues.

Granuloma Annulare Associated with Metastatic Adenocarcinoma

• A 59-year-old man with a history of metastatic adenocarcinoma from the cecum and ascending colon was referred to us for evaluation of asymptomatic, red, minimally raised plaques on the elbows and knees. The lesions had been present for a month prior to our evaluation. The patient had no history of psoriasis, diabetes mellitus, or trauma. His family history was noncontributory, and his medical history was significant only for hypertension. He underwent a laparotomy in January, 1988, at which time a right colectomy was also performed. Omental and hepatic metastases were noted at that time. He had no history of bone pain, cough, hemoptysis, or weight loss. He has no known drug allergies and he was only on verapamil at the time of evaluation. A computed tomography (CT) scan of the abdomen on July 13, 1988 showed para-aortic adenopathy and progression of hepatic metastases. The lesions were increased in size when compared to the previous CT scan obtained on May 2, 1988. The adrenal glands appeared to be normal in size and there was no evidence of retroperitoneal lymphadenopathy. Review ofthe slides obtained at the time of laparotomy showed adenocarcinoma ofthe cecum and ascending colon. A lymph node obtained from the region ofthe cecum and ascending colon also showed metastatic adenocarcinoma. The adenocarcinoma was moderately differentiated and deeply infiltrating, extending through the muscular wall ofthe colon into the pedcolic adipose tissue. The tumor appeared to infiltrate at the serosal surface. Portions of five lymph nodes were available for examination. All showed metastatic adenocarcinoma. Carcinoembryonic antigen (CEA) was elevated at 18.8 ng/ml (normal less than 2.3) on September 13, 1988. Results of complete blood count and SMA-17 profile were within normal limits.

OCCULT SYRINGOMA ASSOCIATED WITH ALOPECIA

A 50-year-old white woman presented for evaluation of thinning hair (Fig. 1). She had noted diffuse thinning of her scalp hair over the past 20 years and had been placed on minoxidil 2% solution by an outside dermatologist 7 months previously. The patient had used the minoxidil 2% solution twice daily, but noted no improvement. Physical examination revealed only diffuse alopecia of the scalp. Routine laboratory studies, luteinizing hormone, prolactin, follicle stimulating hormone, antinuclear factor studies, and thyroid hormone levels were all found to be normal. She was postmenopausal and was taking conjugated estrogens and medroxyprogesterone acetate. Her total testosterone and dehydroepiandrosterone-sulfate levels were lower than normal, and her sex hormone binding globulin level was increased. The elevation in sex hormone binding globulin was attributed to her estrogen therapy. She was otherwise in good health. Her cutaneous examination was otherwise unremarkable. She had

A Gradually Enlarging Asymptomatic Nasal Mass

A 12-year-old African-American boy had a one-year history of a slowly enlarging asymptomatic mass on the right ala nasi. He denied contact with biting insects, pets, or travel outside of the United States. He had no associated symptoms, such as fevers, chills, night sweats, cough, nausea, vomiting, diarrhea, anorexia, or weight loss. The patients medical history was unremarkable. On examination, there was a 7-mm, nontender, firm, yellow, dome-shaped papulonodule with a smooth telangiectatic surface on the crease of the right ala nasi (Fig. 1). A shave biopsy of the lesion was performed (Figs. 2 and 3). What is your diagnosis? Figure 1. Yellovy papulonodule with a telangiectatic surface on the right ala nasi.

Diffuse dermal histiocytosis. A variant of generalized granuloma annulare.

A young man had asymptomatic, confluent, annular erythematous/violaceous plaques on the trunk and extremities. Pathology showed a moderately dense dermal infiltrate of spindle cells characterized as non-X histiocytes by immunohistology and ultrastructural analysis. We believe this is an unusual form of diffuse histiocytosis and should be classified as a variant of generalized granuloma annulare.

Cell cycle analysis by flow cytometry of non-exposed, sun-exposed, and tretinoin-treated skin

The percentage of keratinocytes in the proliferative phase of the cell cycle (S + G2+ M) was measured by DNA How cytometry in sun‐exposed, non‐exposed, and tretinoin‐treated skin. Before tretinoin treatment, the percentage of keratinocytes actively cycling was higher in sun‐exposed than in non‐sun‐exposed skin (p = .002) and was correlated with clinically assessed photo‐damage (p = .007). Subsequently, tretinoin‐treated sun‐exposed skin was compared to the pre‐treatment sun‐exposed skin. Overall, there was no statistically significant change. However, there was a trend toward a decrease1 in the percentage of keratinocytes in the S + G2+ M phases immediately after four months of tretinoin us that was limited to the most severely damaged patients. This effect was no longer evident two months after discontinuing treatment. This is the first study, to our knowledge, utilizing flow cytometry to investigate the effects of tretinoin in patients with varying degress of photodamage.