Les B. Rosen

Giant cell fibroblastoma. A report of a case and review of the literature.

A 15-year-old white boy with a giant cell fibroblastoma of the skin of the abdomen is described. Giant cell fibroblastoma is a rare soft tissue neoplasm that most commonly occurs in children as a small, painless mass in the dermis and subcutaneous tissue. Although local recurrences have been reported, no metastases have occurred. Giant cell fibroblastoma must be differentiated from other spindle cell neoplasms.

A characteristic vesiculobullous eruption in patients with chronic lymphocytic leukemia

We report ten cases of a characteristic vesiculobullous eruption in patients with chronic lymphocytic leukemia. Clinically, six lesions were thought to represent insect bites. All ten patients had bone marrow examinations that confirmed the diagnosis of chronic lymphocytic leukemia. In six of ten patients serum protein and immunoelectrophoresis were performed. Six patients had immunoglobulin disturbances: one polyclonal IgG and IgM gammopathy, two monoclonal IgM gammopathies, two decreased levels of IgA, and one hypogammaglobulinemia. Direct and indirect immunofluorescence procedures were performed on two patients and results were negative. Immunoperoxidase procedures for IgG stained nonspecifically along torn/separated areas of the basement membrane in five patients. No immunohistochemistry was performed on the remaining three patients. The etiology and pathogenesis of these lesions are unknown. We favor the concept that they represent an unusual reaction to an arthropod bite, secondary to the underlying lymphoproliferative disorder. A second, and less likely theory, is that these lesions represent an unusual clinical presentation of bullous pemphigoid in patients with chronic lymphocytic leukemia.

Mycosis fungoides bullosa.

A case of mycosis fungoides bullosa is presented. The results in our study confirmed that the predominant atypical lymphoid cells in the bullae, peripheral blood, and involved lymph nodes expressed the T-cell helper phenotype using immunophenotyping techniques. The literature is reviewed, confirming that our case demonstrated cells of the T-helper phenotype, not only in the skin but also in the blood and lymph node tissue. Bullous lesions in mycosis fungoides are rare.

Malignant epithelioid schwannoma of the skin: a low-grade neurotropic malignant melanoma?

We studied a polypoid cutaneous neoplasm excised from the left arm of a 23-year-old man by light microscopy, immunohistochemistry, and electron microscopy. Histologically, the tumor was composed of a proliferation of round to oval epithelioid cells that were arranged in fascicles and showed a prominent perineural distribution. Immunohistochemistry revealed the presence of S-100 protein and vimentin within tumor cells. Electron microscopy demonstrated reduplication of basal lamina and abundant long-spacing collagen in intercellular spaces. The findings are consistent with a primary malignant epithelioid schwannoma of the skin. We discuss the relationship of this lesion with other neoplasms in the spectrum of tumors showing schwannian and melanocytic lines of differentiation.

Malignant endovascular papillary angioendothelioma (Dabska tumor) : A case report and review of the literature

Malignant endovascular papillary angioendothelioma is a rare vascular tumor of childhood that was first defined by Dabska in 1969. Microscopically, this tumor is composed of anastomosing vascular channels, some of which contain papillary projections or tuft-like structures sometimes resembling renal glomeruli. Although cases have been reported with metastases to regional lymph nodes, the long term prognosis for patients with these tumors is generally good. We have studied this tumor by light and electron microscopy as well as immunohistochemical techniques in a 10-year-old boy. A review of the literature on this rare entity is presented.

Coexistence of Castleman's disease and Kaposi's sarcoma: report of a case and a speculation

A case report of multicentric Castlemans disease associated with Kaposis sarcoma is presented. Histologic examinations of cutaneous lesions and of an axillary lymph node were made. The cutaneous lesions showed Kaposis sarcoma and a lymph node revealed Castlemans disease and foci of spindle cells characteristic of Kaposis sarcoma. The association of Castlemans disease and Kaposis sarcoma appears too frequently to be due to chance alone. We speculate that these two entities may reflect different tissue reactions to the same causative agent.

Hepatitis B surface antigen positive skin lesions. Two case reports with an immunoperoxidase study.

This study represents the first two case reports of skin lesions positive for hepatitis B surface antigen (HBsAg) with the immunoperoxidase technique. A 25-year-old man and a 64-year-old woman with serologic evidence of acute B viral hepatitis and concurrent skin lesions are presented. Immunoperoxidase study of the skin lesions for HBsAg revealed strong positive staining of squamous epidermal cells, eccrine sweat glands, and endothelial cells in the superficial papillary dermis. Immunoperoxidase staining for hepatitis B core antigen (HBcAg) was negative in both cases. Electron microscopy failed to reveal viral particles.

Bacillary angiomatosis in an immunocompetent child: a case report and review of the literature.

Bacillary angiomatosis is an infectious disease caused by 2 gram-negative bacilli, Bartonella henselae and Bartonella quintana. This disease is characterized by vascular proliferations in the skin and/or visceral organs, and typically manifests in immunocompromised patients. However, we report a case of a 10-year-old immunocompetent female child with a questionable history of being scratched by a cat. Although initially diagnosed as a pyogenic granuloma, a diagnosis of bacillary angiomatosis was made based on histologic examination of the excised lesion demonstrating interstitial bacillary deposition on Warthin-Starry silver stain. The patient was successfully treated with 2 weeks of azithromycin after which all symptoms resolved.

Mast cells in sun-exposed and non-sun-exposed skin. An autopsy study.

One hundred ten skin biopsies were taken from 55 consecutive autopsies to evaluate the number and location of mast cells in the dermis. For each autopsy, one biopsy was taken from the V of the neck (sun-exposed area) and the other from the upper thigh (non–sun-exposed area). Normal-appearing skin was biopsied. There were 28 men and 27 women ranging in age from 16 to 94 years. Fifty-three patients were Caucasian and two were Negro. Mast cells were counted in 10 random high-power fields in the papillary dermis only. The average number of mast cells per high-power field (x 400) in sun-exposed skin for both men and women was 8.19 (65/mm2 or 13,000/mm3) with one standard deviation of 4.08, while that of non–sun-exposed skin was 7.52 (60/mm2 or 11,900/mm3) with one standard deviation of 3.62. The difference between the number of mast cells in sun-exposed and non–sun-exposed skin was not statistically significant. In addition, no statistically significant differences were observed for the average number of mast cells per high-power field in regard to sex or the presence of malignancies.