Murat Demiriz

A central odontogenic fibroma exhibiting pleomorphic fibroblasts and numerous calcifications

A case of an odontogenic fibroma with unusual histopathological features is described. The tumour exhibited numerous, plump, stellate fibroblasts, similar to those found in the so-called giant cell fibroma. This finding has not been described previously in odontogenic fibromas. This case also exhibited an unusually large number of calcifications. Neither of these features should affect the biological behavior of this lesion.

A case of generalized discoid lupus erythematosus: Successful treatment with Imiquimod cream 5%

Discoid lupus erythematosus (DLE) is the most common form of chronic cutaneous lupus erythematosus. Classic DLE lesions begin as red-purple macules, papules, or small plaques and rapidly develop a hyperkeratotic surface. Most patients with untreated classic DLE lesions suffer indolent progression to large areas of cutaneous dystrophy and scarring alopecia that can be psychosocially devastating. A 44-year-old male patient presented to the clinic with erythematous scaly patches that began on his nose 1 y before. His face was most affected, however, lesions were also noted on his scalp, ears, and limbs. Histopathologic examination verified a diagnosis of DLE. Laboratory examinations and consultations revealed no signs of systemic involvement. Imiquimod cream 5% was applied to the lesions once a day 3 times a week. After 20 applications, entire lesions regressed significantly. Imiquimod cream 5% may represent an alternative treatment method for patients with DLE.

Placental chorioangioma associated with fetal cardiac complication

The mother at 27 weeks’ gestation was 25 years-old and presented with severe inguinal pain. Vital findings were normal. The hemoglobin was 11.3 g/dl (normal:14?2). Mean erythrocyte corpuscular volume and mean crythrocytc corpuscular hcmoglobin concentration were 78.5 cu microns (normal: 8725) and 30.6% (normal: 3422) respectively. Peripheral blood smear had the appearance of a microcytic anemia. Other routine hlood and urine parameters were within normal limits. Fetal ultrasonographic examination revealed hypokinesia, polyhydramnios, scalp edema, left cardiac dilatation, pericardial effusion and minimal irregularity of the fetal surface of the placenta. This status was diagnosed as ‘hydrops fetalis’. Further examinations such as hemoglobin electrophoresis, VDRL tests, TORCH tests, and tests for diabetes mellitus were normal. Coombs tests were negative. Cytogenetic studies done on material taken with chordosynthesis were reported as normal. Preterm delivery occurred within the same week. The Apgar score of the female newborn was 2. Widespread edema and minimal hepatomegaly were observed. The newborn was not anemic in appearance. Dcath occurrcd within one hour due to progressive rcspiratory distress. Crown to heel length was 46 cm, the foot length was 6.4 cm and the head circumference was 30 cm. The brain and the cerebellum were found normal. The heart was larger than normal but the left atrium was hypoplastic. The valves were normal. There was a defect, 4 mm in diameter, on the membranous segment of interatrial septum. Marked dilatation of the left ventricle was noticed. The thickness of right and left ventricular walls was 3 4 mm and &5 mm. resDectivelv. There was no tmthological finding in other organs except li)r congestion. Placenta measured 170X 160x40 mm. Fetal and maternal surfaces were normal in appearance. On serial scctions, a well defined and dark colored lesion measuring 25X25X20 Inni was found in the paracentral-subchorial region (Fig. 1 ). Histologically, a hemangiomd consisting of numerous capillary channels filled with blood was seen within a loose fibrous strorna. No increased cellularity, mitotic figures or degenerative changes were present.

An uncommon presentation of the co-existence of morphea and vitiligo in a patient with chronic hepatitis B virus infection: is there a possible association with autoimmunity?

A 30-year-old man presented with indurated violaceous plaques all over his body that had been present for 7 months. The patient had also had vitiligo for 3.5 years, and hepatitis B virus (HBV) infection and cirrhosis for a 2-year period. Histopathologic examination of the indurated plaques confirmed the diagnosis of morphea. Localized scleroderma and vitiligo have only rarely been reported to occur simultaneously. Although the etiologies of vitiligo and morphea are both uncertain, their association with autoimmune diseases favors an autoimmune hypothesis. Both vitiligo and morphea might have appeared coincidentally. However, this association could be significant because it may be related to the presence of HBV and alterations in the immune system that are caused by this virus. Therefore, this rare combination of vitiligo and morphea in a patient with chronic HBV infection warrants attention because it suggests a possible immunologic association, which may merit future study.

Alopecia Neoplastica due to Metastatic Colon Adenocarcinoma

A 46-year-old woman attended our clinic in March 2004 for hair loss that had been present for the last 2 months. Her medical history showed that she had undergone total thyroidectomy for a papillary carcinoma in 1992; and hemicolectomy, total abdominal hysterectomy and bilateral salpingo-oophorectomy in August 2004 for colon adenocarcinoma. However, she did not undergo any chemotherapy or radiotherapy for these diseases. The patient did not report any previous dermatological diseases at the site of the alopecia. On physical examination, the patient was cachectic and oedema was detected on the dorsum of the feet. On dermatological examination, a hairless area was seen, starting from the parietal and frontal regions and extending to the vertex. On the frontal region of the scalp there were grouped millimetric papules (Fig. 1). Routine laboratory tests were within normal levels. Histopathological examination of the biopsy from the area of the alopecia revealed signet ring cells and metastasis of adenocarcinoma (Fig. 2). Depending on both clinical and histopathological findings, the patient was diagnosed with alopecia neoplastica. DISCUSSION

Uncommon presentation of mycosis fungoides : Eyelid margin involvement

Mycosis fungoides is a cutaneous T‐cell lymphoma that has been rarely reported to involve ocular structures. A 33‐year‐old woman who had received therapy for mycosis fungoides on the trunk for 11 years, presented to our clinic with new plaques and tumors on her eyebrows and eyelid margin, and alopecia of her eyelashes and eyebrow. The histopathological examinations supported the diagnosis of mycosis fungoides. There was no intraocular involvement with tumor. The mycosis fungoides was of stage II B, and the patient was referred to medical oncology and radiation oncology clinics for treatment. She was placed on a radiotherapy schedule. The involvement of mycosis fungoides in the ocular area is rare in the published work. The importance of eye involvement is being seen in advanced cases, and there is a possible association between mycosis fungoides and poor prognosis by being an indicator of systemic involvement.

Deep Trichophyton rubrum infection presenting with umbilicated papulonodules in a cardiac transplant recipient

Dermatophytes usually infect the keratinised layers of the epidermis, hair follicles and nails. The fungi rarely enter the dermis or subcutaneous fat tissue and very rarely cause deep or subcutaneous dermatophytosis. These infections usually occur opportunistically in immunosuppressed patients. A patient with multiple umbilicated papulonodules caused by Trichophyton rubrum probably related with immunosuppressive treatments is reported.

Bullous eosinophilic cellulitis succession with eosinophilic pustular folliculitis without eosinophilia

Eosinophilic cellulitis is characterized clinically by an acute dermatitis resembling cellulitis with unknown etiology. Eosinophilic pustular folliculitis is also a rare inflammatory dermatosis characterized by recurrent crops of erythematous follicular papulopustules that coalesce to form annular plaques with unclear etiopathogenesis. We describe a 20‐year‐old white male who had vesiculobullous and plaque‐like lesions on the hands and feet and was diagnosed with bullous eosinophilic cellulitis clinically and histologically without any etiological agents. Following therapy with oral corticosteroid and oral tetracycline capsules, the lesions disappeared. After a 2‐month asymptomatic period, the patient developed pruritic follicular papules and pustules on the lower and upper extremities and upper back. Stool examination revealed Gierdia intestinalis eggs. The patient had complete clearance with treatment of ornidazol for 2 weeks and indomethacin for 2 months. This is the first report of bullous eosinophilic cellulitis coexisting with eosinophilic pustular folliculitis without eosinophilia in the English published work.

Disseminated lobular capillary hemangioma : Two case reports

Lobular capillary hemangioma, also known as pyogenic granuloma, is a common, solitary, benign neoplasm of the skin and mucous membranes. The etiology of this lesion remains unknown. Lobular capillary hemangioma can present rarely in a disseminated form, usually associated with other disorders. Two patients, aged 17 and 33, were admitted to the dermatology clinic with disseminated lobular capillary hemangiomas which appeared suddenly. There was no history of trauma in either case. The histopathology of the lesions was consistent with lobular capillary hemangioma. No associated disorders were found in physical and laboratory examinations other than mental retardation in one patient and a small hemangioma in the liver in the other. We report two cases of disseminated lobular capillary hemangioma without an associated disorder.

Eosinophilic pustular folliculitis: the first case associated with hepatitis C virus.

Eosinophilic pustular folliculitis is a rare disorder that is characterized by recurrent crops of papules and pustules localized on seborrheic areas of the body. The etiopathogenesis of the disease is still unknown, but it has been related to infections and immunosuppressive states. This report is the first case to be found to be related to hepatitis C virus infection.