Raffaele Gianotti

Reticulohistiocytoma of the dorsum.

To clarify the nature of reticulohistiocytoma of the dorsum, 19 cases, including three of the seven original cases described by Crosti, were evaluated clinically, histologically, and immunologically. In seven cases gene rearrangement analysis was also performed. Results indicate that reticulohistiocytoma of the dorsum must be considered a primary cutaneous B cell lymphoma of follicular center cell origin. This localized skin disease has a very slowly progressive course, with many patients showing no systemic involvement even after prolonged follow-up.

Clinical Review of 247 Case Records of Spitz Nevus (Epithelioid Cell and/or Spindle Cell Nevus)

BACKGROUND Spitz nevus has clinically been described as a dome-shaped usually nonpigmented papular or nodular lesion variable in color from pink to red. OBJECTIVES To give an exhaustive description of the clinical features of the Spitz nevus from a large series of 247 patients. METHODS A retrospective analysis of the clinical features of 247 Spitz nevi excised from 1974 to 1993 has been performed. We evaluated the following features: age, sex, anatomical location, clinical and histopathologic features; descriptive statistics were calculated and relationships among the above variables were assessed. RESULTS Most lesions were pigmented (71.7%), located on the lower extremities (43.3%), more frequent in the first decade (55.8%) and in females (57.9%). The nonpigmented type was more frequent in the head or neck region, whereas the pigmented types were more frequent on the lower extremities. Besides, these types showed different histopathologic features: the spindle cells usually predominated in the flat pigmented type, whereas dome-shaped types were usually composed of both spindle and epithelioid cells. CONCLUSIONS In our patients, the pigmented Spitz nevi were more common than the nonpigmented ones; furthermore pigmented and nonpigmented Spitz nevi showed different anatomical locations and different histopathologic features.

Primary anaplastic large cell lymphoma of the skin.

Anaplastic large cell lymphoma is a subtype of nodal and extranodal lymphoproliferative disorder characterized by peculiar histopathological features and the positivity of lymphoid proliferating cells for Ki-1/Ber-H2 monoclonal antibody. A case, misdiagnosed as cutaneous metastasis and treated by surgery, in a woman with a history of previous neoplasms, is reported. In spite of the histopathological malignancy of the tumor, the patient is alive and free from recurrent or metastatic disease after 3 years of follow-up.

Review of 120 biopsies performed on the balanopreputial sac. from zoon's balanitis to the concept of a wider spectrum of inflammatory non-cicatricial balanoposthitis.

Background: Long-lasting erythematous lesions involving the balanopreputial sac may be clinically difficult to classify, and biopsies may be performed in order to clarify the nature of the disease. However, our previous experience led us to consider several cases as histopathologically unclassifiable. Objective: To establish the causes of such unsatisfactory findings. Methods: We reviewed 120 balanopreputial sac biopsies performed at the surgical unit of our institute from January 1999 to December 2002 examining also the patients’ clinical records. Results: We found that a small group of previously unclassified cases showed common clinical and histopathological features. Clinically, all patients were uncircumcised and had long-lasting asymptomatic erythematous plaques on the balanopreputial sac with no erythroplastic or lichenoid features and no correlation with sexual intercourse. Histologically, all specimens showed a thinned and spongiotic epithelium, a band-like infiltrate of lymphocytes and histiocytes with a variable number of plasma cells in the upper part of the chorion and further signs of acute, subacute or chronic inflammation. Conclusions: In our view, these cases fall within a spectrum of inflammatory non-cicatricial disorders, ranging from almost pure lymphohistiocytic forms to forms which fulfil all criteria to be classified as balanitis circumscripta plasmacellularis of Zoon. We propose to classify these cases histologically as inflammatory non-cicatricial balanoposthitis and clinically as idiopathic inflammatory non-cicatricial balanoposthitis.

Primary cutaneous pleomorphic T-cell lymphoma expressing CD30 antigen

Pleomorphic peripheral T-cell lymphomas (PPTL) arising primarily in the skin are uncommon. The observation of pleomorphic T-cell lymphoma composed of 100% CD30+ cells is rare. We report the case of a woman in whom such a tumor manifested itself with a single cutaneous lesion. It was composed of medium to large cells expressing markers of helper/inducer T-lymphocytes, as well as activation (CD30) and proliferation antigens (Ki-67), but not the CD25 activation antigen. The lesion was excised and the patient is alive and disease free 2 years after the diagnosis. This case confirms previous reports about the favorable course of some cutaneous pleomorphic lymphomas, and shows that the activation antigen expression and proliferation antigen (Ki-67) expression do not seem to worsen the prognosis.

Paederus fuscipes dermatitis: a report of nine cases observed in Italy and review of the literature

Paederus sp. is a beetle belonging to Staphylinidae family and Coleoptera order. Its distribution is worldwide, especially in hot climates. Over 600 species of Paederus are known, approximately 50 are able to cause an irritant contact dermatitis. When the beetle is accidentally crushed on the skin, it releases pederin, a potent toxin with vesicating action. In Europe, only anecdotical cases of Paederus sp. dermatitis have been reported. Since 1993, we have observed approximately 25 patients with suspected Paederus sp. dermatitis. In 9 the clinical diagnosis was confirmed because Paederus fuscipes were found. The case list includes 6 males and 3 females, ages ranging from 6 to 53 years (mean age: 26.3 years). Six patients presented with one lesion and 3 with 2 lesions. Eyelids (3 patients), shoulders (3), neck (2), cheek (1), breast (1), back (1) and calf (1) were involved. All patients showed erythema, 2 oedema, 2 blisters, 1 vesicles, 1 pustules and 1 crusts. In the patient with pustules, bacteriological examinations were negative. A biopsy was carried out in 4 patients. In the early stages, spongiosis with exocytosis of neutrophils was observed. Vesicles with neutrophils and necrosis of the epidermis were typical of the advanced stage. Oedema of the dermis and a mixed infiltrate, with eosinophils, neutrophils and lymphocytes, in the papillary and upper reticular dermis, were also observed. Direct immunofluorescence was negative in all patients. Paederus sp. should also be considered in temperate climates as a possible aetiological agent in cases of acute dermatitis.

Soft fibroma-like lesions on the legs of a patient with Kaposi's sarcoma and lymphedema.

The case of a patient who developed multiple soft fibroma-like lesions on his lower extremities affected by lymphedema and Kaposis sarcoma is reported. To the best of our knowledge, the coexistence of these three pathologic processes is unusual and has never been described before in the literature.

A Short History of Tattoo

Tattoo is a permanent pigmentation of the skin resulting from the introduction of exogenous substances. If this happens unintentionally—for example, after road injuries—it is called traumatic tattoo. However, the most common tattoos are decorative, related to current fashion or to a symbolic meaning. The etymological origin of the word tattoo is believed to have 2 major derivations: the first is from the Polynesian word “ta” which means “striking something,” and the second is the Tahitian word “tatau” which means “to mark something.” This word was introduced in Europe by the English explorer James Cook, who described the Polynesian technique of “tattaw” in his narrative of the voyage. The oldest example of tattoo dates back to 3000 BC and is represented by a mummy called “Ötzi the Iceman” discovered from the area of the Italian-Austrian border in 1991. Radiological examination of his bones showed osteochondrosis in areas where tattoos had been present. It has been speculated that these tattoos may have been related to pain relief treatments similar to acupuncture. If so, this practice may have existed at least 2000 years before its previously known earliest use in China. In ancient times the tattoo spread throughout Egypt and Rome until it was banned by the Emperor Constantine after his conversion to Christianity. Constantine believed that the human image was a representation of God and should not be disfigured or defiled. The practice of tattooing the body was never fully accepted by any of the 3 great monotheistic religions (Christianity, Judaism, and Islam). Although tattoos were forbidden among Christians by Pope Hadrian I in 787, the habit of tattooing the body survived secretly, especially in some places of Christian worship, like the Sanctuary of Loreto, where the “Friars-Tattooist” (“Frati-marcatori”) tattoo, a small devotional sign to the pilgrims, was used. The reintroduction of the tattoo in the Western world occurred after the ocean expeditions of the 18th century. At the end of the 19th century the use of tattooing spread among highest European social classes: famous “celebrity” tattoos included those of Tsar Nicholas II and Sir Winston Churchill. In recent decades the practice of tattoo has widely spread in the Western world to all social classes, with an increase of complications related to it, such as allergic, lichenoid, granulomatous, and pseudolymphomatous reactions or induction of skin diseases.

Clear Cell Papulosis (Pagetoid Papulosis) in a Non-Asian Patient

Clear cell papulosis is a recently described disorder which is characterized by multiple flat, slightly elevated, hypopigmented papules, distributed mainly on the lower part of the trunk of healthy children. Histologically, the disease shows ‘clear cells’ with a pagetoid appearance spread among keratinocytes in basal and suprabasal layers of the epidermis. These cells stain for AE1, CEA and EMA, making a relationship to eccrine or apocrine elements likely. All cases reported until now describe Asian children. The first European child with clear cell papulosis is presented.

Simultaneous occurrence of multiple trichoblastomas and steatocystoma multiplex

We present a 55-year old man who, since age 21, progressively developed multiple papules and nodules on the face and upper trunk. Light microscopic examination of some of the neoplasms showed trichoblastomas, while others had histopathological features of trichoepithelioma and steatocystoma. Simultaneous occurrence of multiple trichoblastomas/trichoepitheliomas and steatocystomas, not reported previously, could represent multiple neoplasms involving differentiation toward different components of the folliculosebaceous unit.