Steven J. Hunt

Giant eccrine acrospiroma

Four cases of large eccrine acrospiroma (three benign, one malignant) are reported. The benign tumors involved the lower extremities of two women and one man (73 to 89 years of age). The duration of the lesions ranged from 10 to 20 years. The malignant tumor involved the left side of the chest of a 60-year-old man. Its occurrence in a lesion that had been present for 40 years suggested malignant transformation of a pre-existing benign eccrine acrospiroma. Each tumor showed little to no cellular atypia. Mitotic rates (mitotic figures per 10 high-power fields) varied both between and within lesions. Average mitotic rates did not differentiate the benign from the malignant tumors. The most important distinguishing features of large benign eccrine acrospiromas are the relative circumscription, the lack of cellular atypia, and the absence of stromal, perineurial, and angiolymphatic invasion.

Necrolytic migratory erythema: Dyskeratotic dermatitis, a clue to early diagnosis

A 57-year-old woman with a 6-year history of a dermatitis that evolved into typical necrolytic migratory erythema is reported. Four biopsy specimens were obtained in 5 years. The early lesions revealed superficial perivascular inflammation in the dermis, minor epidermal spongiosis, and scattered dyskeratotic cells in the upper epidermis. The differential diagnosis of this pattern of dyskeratotic dermatitis, particularly in a chronic eruption, should include consideration of hyperglucagonemia and the possibility of an associated pancreatic islet cell tumor.

Cutaneous T-cell lymphoma: Utility of antibodies to the variable regions of the human T-cell antigen receptor

BACKGROUND The clonotypic 90 kd Ti heterodimer of the human T-cell antigen receptor is composed of two distinct chains (alpha beta or rarely tau delta) that result from the recombination of variable (V), constant, joining, and, in the case of beta chains, additional diversity regions. OBJECTIVE The variable region expression of human cutaneous T-cell lymphoma (CTCL) was studied. METHODS Biopsy specimens from 13 patients with CTCL (7 plaque, 3 tumor stage, 3 Sézary syndrome) were examined immunohistochemically by a panel of seven commercially available monoclonal V-region antibodies. RESULTS Two patients had significant anti-V-region staining. One patient with Sézary syndrome had two lesions, subjected to biopsy 4 months apart, that reacted with beta V5(a), a specificity previously documented by flow cytometry of leukemic cells. A patient with plaque-stage CTCL, negative for T-cell gene rearrangement by Southern blot, demonstrated reactivity with beta V5(c) largely limited to epidermotropic lymphocytes. CONCLUSION Panels of V-region antibodies should be useful reagents for diagnosis and follow-up of CTCL.

Linear and punctate porokeratosis associated with end-stage liver disease

A periodic eruption of porokeratosis developed in a 31-year-old black woman with chronic idiopathic hepatitis requiring liver transplantation. The clinicopathologic features were chiefly those of linear and punctate porokeratosis but overlapped those of porokeratosis plantaris, palmaris et disseminata and hyperkeratotic or verrucous porokeratosis. Typical cornoid lamellae were visible on histologic examination. Outbreaks of the lesions occurred during exacerbations of the liver disease. The skin condition rapidly improved after operation, with concomitant improvement in liver function.

Cutaneous necrosis and multinucleate epidermal cells associated with intravenous phenytoin

&NA; A 23‐year‐old white man experienced burning pain up his right forearm while receiving phenytoin intravenously in the dorsal wrist. Swelling occurred, followed a few days later by an erythematous eruption that eventuated in superficial skin sloughing. The histopathology of two right forearm biopsies, taken a few days apart 3 to 4 weeks after the infusion, was characterized by partial epidermal necrosis and frequent multinucleate keratinocytes. Localized cutaneous reactions to phenytoin and the occurrence of multinucleate epidermal cells in inflammatory skin disease are reviewed.