William B. Tyler

Calcinosis cutis associated with syringomas: a transepidermal elimination disorder in a patient with Down syndrome.

Several cutaneous disorders have been associated with Down syndrome. An increased frequency of syringomas and of elastosis perforans serpinginosa, a transepidermal elimination disorder, have been described. We report the first case of the simultaneous occurrence of transepidermal elimination of calcium associated with syringomas in a patient with Down syndrome who had lesions clinically suggestive of milia.

Penile squamous cell carcinoma arising from balanitis xerotica obliterans

Squamous cell carcinoma arising from balanitis xerotica obliterans is rarely reported. We describe an 83-year-old man in whom metastatic penile squamous cell carcinoma developed after 18 years of observation for balanitis xerotica obliterans. It is important to recognize the possibility of this uncommon complication of balanitis xerotica obliterans, because survival of patients with squamous cell carcinoma depends on early diagnosis and treatment.

Cutaneous bronchogenic cyst with papilloma and sinus presentation

The thirty-eighth case of bronchogenic cyst in the skin is reported in a 5-year-old boy. This is the first case report of cutaneous bronchogenic cyst presenting as a distinct, pedunculated growth with a sinus tract at the base. Embryogenesis, differential diagnosis, and treatment are discussed.

Hydroxychloroquine-induced hyperpigmentation: the staining pattern

We report two cases of hydroxychloroquine‐induced hyperpigmentation presenting in a 50‐year‐old Caucasian female (case 1) and a 78‐year‐old female (case 2), both receiving 400 mg per day. Case 1 had an arthritis predominant undifferentiated connective tissue disease, which was treated with hydroxychloroquine for 4–5 years. She presented with a mottled, reticulated macular gray pigmentation involving the upper back and shoulders. Case 2 had a history of systemic lupus erythematosus and rheumatoid arthritis, treated with hydroxychloroquine for 1.5 years. She presented to the hospital for treatment of constrictive cardiomyopathy and was noted to have a blue macular pigmentation involving the right temple. The biopsies from both patients showed superficial dermal, yellow‐brown, non‐refractile and coarsely granular pigment deposition. A Fontana‐Masson stain highlighted some of these granules, while the Perl’s iron stain was negative. Rare, previous reports of hyperpigmentation indicate the presence of both melanin and hemosiderin in patients being treated with antimalarial medication. To our knowledge, this staining pattern for hydroxychloroquine has not been previously reported in the literature and supports that hydroxychloroquine, in addition to chloroquine, binds to melanin.

Glomeruloid hemangiomas without POEMS syndrome: series of three cases

To the Editor, Glomeruloid hemangioma is considered to be a specific marker for POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal protein and Skin changes) syndrome. The features of POEMS syndrome were first described by Shimpo in 1968. The actual acronym POEMS, developed by Bardwick et al. in 1980, remains a fixture in the medical literature. The association of the glomeruloid hemangioma with POEMS syndrome has become a fixture, as well. This association was recently reported by Phillips et al. However, recently, we have diagnosed three patients with solitary glomeruloid hemangiomas (Figs. 1 and 2). All three patients had subsequent negative serum protein electrophoresis (SPEP). Our series of patients, a 33-year-old white woman, a 29year-old white man and a 53-year-old white man, also have no evidence of neuropathy. Therefore, the patients fail to meet any of the major criteria for POEMS syndrome proposed by Dispenzieri and Gertz.

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.

Gypsy moth caterpillar dermatitis--revisited.

Gypsy moth caterpillar dermatitis is a pruritic, papular, urticarial eruption on exposed skin that occurs most commonly after direct contact with the first instar larva of the gypsy moth (Lymantria dispar). We present two case reports to illustrate its clinical and histopathologic features. Both cases occurred during the spring of 1990 and coincided with the greatest infestation of L. dispar in the Northeast to date. The pathogenesis of this distinctive gypsy moth dermatitis most likely involves histamine release by the caterpillar and a delayed hypersensitivity reaction in its host.

Association of scabies with a bullous pemphigoid-like eruption

We describe a patient with scabies who had an associated bullous pemphigoid-like eruption. Previous reports of this association have appeared in the literature. However, most case reports have described negative or nonspecific findings with direct immunofluorescence in contrast to the intense linear homogenous band of IgG and C3 found in our patient.

Neurofibroma with clear cell change.

Cutaneous clear cell proliferations and degenerative change have been seen in a variety of entities including nevi, dermatofibromas, fibrous papules, atypical fibroxanthomas, basal cell carcinomas, and squamous cell carcinomas, to name a few. However, there have been no reports of clear cells within neurofibromas. We received a biopsy and excision from a 61-year-old man with a papule on his right lateral clavicle. The initial biopsy showed a proliferation of clear cells that stained positive with S-100 and focally with CD68. A clear cell granular cell tumor was favored. Subsequent excision showed the same population of clear cells as seen on the initial biopsy. Interestingly, a neurofibroma was also present immediately beneath the clear cells with areas of transition. A p75 stain highlighted both populations of cells. This is the first case of neurofibroma with clear cells reported in the literature. We postulate that the clear cells are due to degenerative change.

The staining pattern of pigmented spindle cell nevi with S100A6 protein

Background: Spitz nevi typically show strong diffuse staining with S100A6, whereas staining in melanomas is commonly patchy and weak. To our knowledge, S100A6 has not been studied in pigmented spindle cell nevus (PSCN), considered by many to be a variant of Spitz nevus.