Scott R. Dalton

Smooth muscle pattern is more reliable than the presence or absence of an internal elastic lamina in distinguishing an artery from a vein

Background:  Major pathology textbooks suggest that the shape of the vessel and the presence or absence of an internal elastic lamina are the best means to distinguish an artery from a vein. Because the shape of the vessel is highly dependent upon the plane of section, the internal elastic lamina is often cited as a more reliable criterion. After evaluating a patient with superficial thrombophlebitis, in whom these conventional criteria had led to a misdiagnosis of polyarteritis nodosa, we sought to determine whether the pattern of smooth muscle in the media is a more sensitive discriminator between an artery and a vein.

Melanoma or Pseudo melanoma Change in a pigmented lesion after application of topical 5-Fluorouracil

Abstract : 5-fluorouracil (5-FU) is a topical chemotherapeutic agent used to treat actinic keratosis and superficial basal cell carcinomas. Common side effects include photosensitivity, erythema, ulceration and rarely hyperpigmentation. We present the case of a 56 year old, skin type 1 female that demonstrated a morphologic change in a pigmented lesion following topical field therapy with 5-FU for actinic damage on the trunk. After four weeks of twice daily application, a previously benign appearing pigmented lesion displayed a change in clinical morphology that included border irregularity, pigmentary change, scaling and erythema. A biopsy of the lesion demonstrated a poorly circumscribed and asymmetric compound proliferation of melanocytes with irregularly distributed junctional nests, solitary units and prominent pagetoid scatter. The epidermis showed large clusters of necrotic keratinocytes, dense pigment and sub-epidermal clefting. Fluorescent in-situ hybridization (FISH) was performed on additional sections and did not demonstrate chromosomal aberrations. Review of the literature demonstrated few reports of eruptive lentigo-maligna and atypical nevi occurring in patients undergoing therapy with oral 5-FU suggesting immunosuppression induced melanocytic proliferations or malignant transformation. No reports were found with topical 5-FU therapy.

Histopathology of bilateral lower extremity inflammatory lymphedema in military basic trainees: A leukocytoclastic vasculitis of the deep vascular plexus

Bilateral lower extremity inflammatory lymphedema (BLEIL) is a recently described condition that presents with exquisite tenderness, erythema and edema of the lower leg, ankle and dorsal foot resembling an acute cellulitis. It was first reported in healthy, young adult military basic trainees with a normal body mass index during the first 72 hours of arrival to basic training. It occurs while standing at attention for many hours, and shows rapid resolution with elevation and rest. We report an additional case of BLEIL and describe the histopathology of this case and 2 of the previously reported cases. All 3 biopsies showed a deep perivascular infiltrate of neutrophils with karyorrhectic debris and prominent red blood cell extravasation. One of the 3 cases was positive for complement by direct immunofluorescence. We postulate this condition represents a deep leukocytoclastic vascultis with secondary reactive lymphedematous changes.

The significance of melanoma subsets

To the Editor: I read with interest the article by Johnson in the December 2008 issue of the Journal. The author does not mention an important ethical issue: guest authorship. This problem—also known as gift, honorary, or unjustified authorship—is perhaps hard to detect. It occurs when the name of an individual who did not contribute substantially to the paper appears on the byline. One reason why guest authorship exists is to increase the chance for publication. One solution, as mentioned by Johnson, is to clarify each author’s contribution to a paper.

Interpretation of Vertical vs. Transverse Sections in Alopecia

Abstracts Presented at the ISDP 8th Joint Meeting, New Orleans, Louisiana, February 16–17, 2005s Presented at the ISDP 8th Joint Meeting, New Orleans, Louisiana, February 16–17, 2005 XIAP Upregulation in Cutaneous Malignancy P.O. Emanuel, G. Xiao, R.G. Phelps, D.E. Burstein. Department of Dermatopathology, Mount Sinai Medical Center, New York, NY. The X-linked inhibitor of apoptosis (XIAP) is the most potent caspase inhibitor of all known IAP family members and may be responsible for resistance to tumor therapy. 26 Archival sections were stained with antiXIAP antibody using routine immunohistochemical methods: 10 lowintermediate grade SCCs (in-situ lesions and tumors invasive to ,10 mm), 7 high grade SCCs of the skin (.10 mm), 4 invasive SCCs from the upper airways, 3 melanomas, and 2 Merkel cell carcinomas. 4 of 7 high grade cutaneous SCCs and 3 of 4 head and neck exhibited XIAP positivity (20–60% of malignant cells). The highest proportion of positive cells were in the periphery of invading nests, and areas with marked pleomorphism or sarcomatoid differentiation. Staining was negative in in-situ and low grade SCCs. 1 of 2 Merkel cell carcinomas and 1 of three melanomas exhibited XIAP positivity. XIAP may be a useful marker of higher grade in SCCs. Its strong positivity in high grade SCCs and possibly other tumors indicates anti-XIAP therapeutic possibilities. Atypical Epithelioid Cellular Neurothekeoma: Case Report With Immunohistochemical and Ultrastructural Studies A. Andea, E. Satter, K. Benbenisty, Z. Argenyi, J. Metcalf. MUSC,