Şennur İlvan

Non-pustular palmoplantar psoriasis: is histologic differentiation from eczematous dermatitis possible?

Abstract:  The differential diagnosis of psoriasis affecting palmoplantar skin might be troublesome because of the anatomic properties of this region. Both palmoplantar psoriasis and eczematous dermatitis of this skin area share similar histologic features. The punch biopsies from 17 patients with psoriasis and 25 with eczematous dermatitis were evaluated, blind to the clinical diagnosis. Vertically situated multiple foci of parakeratosis, alternating with orthokeratosis, were the only statistically significant feature in the differential diagnosis of palmoplantar psoriasis [76.5% (13/17), p = 0.005]. In contrast, multiple foci of parakeratosis [70.6% (12/17)], loss of granular layer at least in focal areas [41.2% (7/17)], presence of neutrophils at the summits of parakeratosis [4% (1/17)], presence of neutrophils and/or plasma in the parakeratotoic foci [94.1% (16/17) and 11.8% (2/17)], psoriasiform epidermal hyperplasia [88.2% (15/17)], spongiosis restricted to the lower parts of the epidermis [47.1% (8/17)], dyskeratotic cells [82.4% (14/17)], thinning of suprapapillary plate [58.8% (10/17)], edema of the papillary dermis [29.4% (5/17)], presence of tortous and dilated capillaries in the papillary dermis [52.9% (9/17) and 76.5% (13/17)] and extravasated erythrocytes [29.4% (5/17)] were found to be more common in palmoplantar psoriasis compared with eczematous dermatitis; but none of them was statistically significant. Interestingly, spongiotic vesicles were seen in most of the patients with psoriasis [76.5% (13/17)]. In conclusion, according to our findings, many features of palmoplantar psoriasis overlapped with those of eczematous dermatitis. However, detection of multiple parakeratotic foci, placed vertically, alternating with orthohyperkeratosis, could be considered in favor of palmoplantar psoriasis.

Mammary Pseudoangiomatous Stromal Hyperplasia Composed of Predominantly Giant Cells: An Unusual Variant

Abstract:  Pseudoangiomatous stromal hyperplasia (PASH) is a benign proliferative lesion of mammarian stroma that presents as a localized mass. We describe the clinical, radiologic, cytologic, and histopathologic features of a case of PASH with giant cells that presented as a rapidly growing localized mass in the breast in a 32‐year‐old woman. An unusual feature of our case was the presence of multinucleated giant cells lining pseudovascular spaces and dispersing in collagenous stroma. To the best of our knowledge, this is the second case in the English literature and PASH with predominance of multinucleated giant cells has never been described previously in a female patient.

Expression of cyclooxygenase‐2, c‐kit, progesterone and estrogen receptors in uterine smooth muscle tumors: differential diagnosis

We examined the expression pattern of cyclooxygenase‐2 (COX‐2) and c‐kit in uterine smooth muscle neoplasms and tried to determine the role of these markers in differential diagnosis. Archival tissue from 64 patients with uterine smooth muscle neoplasms (20 leiomyomas (LMs), 22 atypical leiomyomas (ALMs), and 22 leiomyosarcomas (LMSs)) was immunostained with antibodies against estrogen (ER) and progesterone receptors (PR), COX‐2 and c‐kit. 7 of 20 LM cases and 5 of 22 ALM cases were immunopositive for COX‐2, whereas none of the LMS cases stained immunopositive (p≤0.05). 4 of 20 LM cases and 5 of 22 ALM cases were immunopositive for c‐kit, whereas 15 of 22 LMS cases showed c‐kit immunopositivity (p≤0.05). In conclusion, very few LMs and ALMs show COX‐2 immunopositivity. LMSs usually do not express COX‐2. COX‐2 expression in smooth muscle tumors is not a prominent feature. Therefore, COX‐2 inhibitors may not be useful in LMS therapy. C‐kit was significantly expressed in uterine LMSs.

Malignant proliferating tricholemmal tumor: report of three cases

Abstract We report three cases of malignant proliferating tricholemmal tumors, two of which displayed rapid growth of long-standing scalp nodules. The third case was a nodule on the scapula with axillary lymph node metastasis. Although some investigators believe that the diagnosis of malignancy is certain only with evidence of metastasis; in our first two cases morphologic features suggested malignancy which included infiltration of adjacent tissues, high degree of cytologic atypia, abundant dyskeratotic cells, monstrous multinucleated cells and atypical mitotic figures. We emphasize the possibility of malignancy in long-standing proliferating tricholemmal tumors that show rapid enlargement.