Primary Anetoderma and Acquired Cutis Laxa associated with Glomerulonephritis in a 37-year-old Filipino male: A case report

@#A 37-year-old Filipino man presented with a 9-month history of sagging skin progressing cephalocaudally from the chin and neck to the axillae, side of the trunk, and pelvic area. This was followed by a 2-month history of increasing serum creatinine levels associated with periorbital and bipedal edema, generalized weakness, decreased appetite, vomiting, and headache. Subsequently, skin-colored, non-tender sac-like plaques appeared on the abdomen, inguinal, and intergluteal areas. Histopathology of the latter lesions showed increased spaces between collagen bundles in the dermis. Staining with Verhoeff-van Gieson revealed focal sparse elastic fibers in the papillary dermis compared to that of the reticular dermis consistent with anetoderma. Further work-up revealed normal ANA titer and low serum C3. Kidney biopsy showed IgG deposition in the tubular basement membrane and trace C3 deposition in the glomerular mesangium, giving a diagnosis of rapid progressive glomerulonephritis. On subsequent follow-up, the sac-like plaques became lax and presented as generalized wrinkling of the skin, raising the question whether cutis laxa and anetoderma are occurring in a spectrum instead as distinct entities. Based on the current review of literature, this is the first reported case of primary anetoderma co-occurring with cutis laxa in a patient with glomerulonephritis. Deposition of immunoglobulins along the elastic fibers could have activated the complement system, mediating the destruction of the elastic fibers, resulting to cutis laxa and anetoderma. This case also considers the possibility of anetoderma and type I acquired cutis laxa occurring either in a spectrum or as distinct diseases in a single patient. Further investigations may identify an ultrastructural pattern that can help differentiate the two entities.

Decoded: A case report on dedifferentiated Liposarcoma on the Gluteal area

@#Dedifferentiated liposarcoma is a soft tissue sarcoma of adipocytic lineage. Histopathology and immunohistochemistry are essential for diagnosis. A 51-year-old Filipino woman presented with a rapidly enlarging left gluteal tumor. Histopathology revealed a multilobulated tumor having prominent myxoid stroma with numerous stellate-shaped, atypical cells bearing atypical mitotic figures. Other lobules were composed of sheets of pleomorphic cells, with atypical mitotic figures. The tumor stained positively with alcian blue, vimentin, MDM2 and p16 stains. Other immunohistochemical (IHC) studies done (pancytokeratin, CK7, CK 20, CD 34, CEA, desmin, EMA, SMA, S100) showed negative results. After a 2 cm wide excision of the sarcoma, patient was free from local tumor recurrence for 2 months, after which she was lost to follow-up. We report this case and a brief review of the current literature on dedifferentiated liposarcoma.

Immunohistochemical expression of CK19, AR, PHLDA1, CD10 and Ki67 in the differentiation between Trichoepithelioma and Basal Cell Carcinoma: A systematic review

Background@#Basal cell carcinoma (BCC) and trichoepithelioma (TE) are follicular adnexal neoplasms that arise from the follicular germ but with divergent biological behavior. The gold standard in the differentiation is through histopathological examination using hematoxylin and eosin (H and E) stain. There are cases, however, when the distinction is not straightforward. @*Objective@#To assess the association and diagnostic accuracy of the immunohistochemical (IHC) expressions of CD10, Ki67, CK19, androgen receptor (AR), and PHLDA1 in distinguishing between basal cell carcinoma and trichoepithelioma. @*Methods@#We conducted a comprehensive search on cross-sectional studies on human tissue from 2000 to 2020 in MEDLINE (PubMed), CENTRAL and EMBASE for comparative studies and reference lists. The data were summarized and analyzed using Microsoft Excel and RevMan. We used Chi-square test for independence, summary receiver operator curves (sROC), and diagnostic odds ratio (OR). @*Results@#We included 15 articles containing 686 BCC and 367 TE in the systematic review. The pooled staining of biomarkers showed a significant difference in the staining of CK19 (p<0.05) and AR (p<0.0001), and PHLDA1 (p<0.0001). Diagnostic odds ratio was used to confirm these associations. AR was found to have the highest odds in the diagnosis of BCC (OR 27.92, 95% CI 10.69, 72.86). The pattern of staining of CD10 is significant (p<0.001) with staining of both tumor and stroma (OR 8.09, 95% CI 4.57, 13.53) and staining of tumor alone (OR 8.15, 95% CI 4.56, 14.35) (p<0.001) in the diagnosis of BCC. CD10 stromal staining, on the other hand, is significantly associated with the diagnosis of TE (OR 7.26, 95% CI 5.06, 10.44) (p<0.0001). There is no significant association between Ki67 staining (OR 1.22, 95% CI 0.48, 3.09) (p=0.67) and the diagnosis of BCC. The forest plot and sROC showed that AR had high specificity across all included studies in the diagnosis of basal cell carcinoma, while PHLDA1 demonstrated high specificity and high sensitivity in diagnosing trichoepithelioma. @*Conclusion@#The biomarkers AR and PHLDA1 are useful as an initial panel to distinguish between BCC and TE, given that both showed high sensitivity as well as significant association with BCC and TE respectively. CD10 and CK19 may also be used with AR and PHLDA1 for further confirmation.

Verrucous carcinoma of the foot arising on a muscle flap and skin graft site in a 74-year-old Filipino female: A case report

@#Verrucous carcinoma is an uncommon low-grade well-differentiated malignant neoplasm that commonly arises on acral and mucosal sites. It is often both clinically and histologically misdiagnosed because of its slow growth and low cytologic atypia, respectively. We describe the case of a 74-year-old female with a papillomatous mass arising on a muscle flap and skin graft site on the left foot that had delay in diagnosis for more than 30 years. This case highlights verrucous carcinoma as consideration for both clinical and histologic differential diagnoses in chronic non-healing fungating tumor on the foot. Though non-aggressive in its course, the tumor can cause extensive local destruction of contiguous structures, hence, timely diagnosis and excision is paramount to prevent limb amputation.

Chromoblastomycosis, overlooked and undiagnosed: The disease as a mimic of other neglected tropical diseases

@#Chromoblastomycosis is an endemic mycoses which has been misdiagnosed or underdiagnosed in the past. This may be due to the clinicopathologic characteristics that it shares with other neglected tropical diseases such as leprosy and cutaneous tuberculosis. Correlating clinical findings with histopathologic cues will lead clinicians to correct diagnosis and subsequent treatment success.

Clinicopathologic and Dermoscopic features of acquired perforating dermatosis: A case report

@#Acquired perforating dermatosis represents one of the perforating skin disorders showing transepidermal elimination of dermal contents. Dermoscopy showing concentric zones of a central keratotic plug, white-gray structureless area and peripheral brown pigmentation may aid in diagnosis and in sample selection for biopsy.

A case of Mucocutaneous Colloid Milium in an adult Filipino female with chronic kidney disease

@#A 65-year-old female with chronic kidney disease (CKD) presented with a six-month history of asymptomatic translucent skin-colored and yellow plaques on the face. Similar yellow papules and nodules were noted in the oral cavity and eyelid margins. Biopsies were taken from the face and oral cavity showed homogeneous eosinophilic deposits with clefts in the dermis consistent with colloid milium. The patient was treated with fractional and surgical carbon dioxide (CO2) laser with improvement after one session.

Arsenicosis presenting with cutaneous squamous cell carcinoma: A case report

A 29-year-old male with eleven-year history of hyperkeratotic papules and speckled pigmentation developed cutaneous squamous cell carcinoma. Arsenicosis was confirmed by elevated hair arsenic level, and histopathologic findings of arsenical keratosis and one lesion showing carcinoma-in-situ. Chronic arsenic exposure has been found to activate inflammatory and carcinogenic pathways leading to development of pre-malignant and malignant lesions. A multi-disciplinary approach involving healthcare specialists and environmentalists is crucial in source control and management of long-term complications.

Clinically amyopathic dermatomyositis associated with a metastatic undifferentiated carcinoma in an adult Filipino male: A case report

A 40-year old Filipino male was managed as a case of clinically amyopathic dermatomyositis (CADM) after presenting only with pruritic photodistributed symmetric erythematous-violaceous patches, nail fold telangiectasia and the pathognomonic Gottron papules. There was no clinical evidence of muscle involvement. The patient shortly presented with a metastatic undifferentiated carcinoma on the cervical lymph nodes. This case demonstrates that dermatomyositis can present uncommonly as CADM with associated metastatic undifferentiated carcinoma.

Histopathologic review of calcemic uremic arteriolopathy: A case series

@#<p style="text-align: justify;">Calcemic uremic arteriolopathy or calciphylaxis is an uncommon disorder presenting clinically as skin ischemia and necrosis, and histologically as vascular calcification and thrombosis of dermal and subdermal vasculature. This study described two Filipino females with end-stage renal disease on chronic dialysis with non-healing ulcers on the lower extremities as a result of calcification in the vessels of the dermis and subcutaneous fat with associated fat necrosis. Current understanding of its various histologic features was reviewed for proper diagnosis.</p>

Systematized verrucous epidermal nevus partially responsive to acitretin: A case report

@#<p style="text-align: justify;">A 5-year-old female presented a 4-year history of generalized well-demarcated asymptomatic brown to dark brown thin verrucous plaques with a Blaschkoid distribution. Histopathology was consistent with an epidermal nevus. Patient was diagnosed to have systematized verrucous epidermal nevus. Due to the extent of the lesions, surgical management was not feasible. Hence acitretin was given which showed partial decrease in the thickness of the lesions.</p>

A case of cutaneous tuberculosis presenting with generalized xanthogranulomas

@#<p>A 33-year-old male had a 22-year history of generalized xanthogranulomas but had a normal lipid profile. He also developed ulcerating plaques on his arm and back that were consistent with cutaneous tuberculosis on histopathologic and polymerase chain reaction PCR studies. In a normolipemic patient with generalized xanthogranulomas, a reactive granulomatous response of histiocytes to infection is explored since these share a common CD 14+ precursor with the macrophages that are vital in tuberculosis.</p>

Lepromatous leprosy and human immunodeficiency virus: A rare co-infection

@#<p style="text-align: justify;">We report a 23-year-old male with lepromatous leprosy atypically presenting with 5-year history of asymptomatic, verrucous papules, and nodules. Human Immunodeficiency Virus (HIV) testing was positive with depressed CD4 count. In HIV/leprosy co-infection, most of the documented patients were diagnosed with paucibacillary leprosy as immune reconstitution disease (IRD) from treatment-induced immunological recovery. Rarely, multibacillary lepromatous leprosy is encountered in the setting of untreated, severe immunodeficiency. Atypical clinical presentation warrants investigation for concurrent HIV infection.</p>

Arsenicosis presenting with cutaneous squamous cell carcinoma: A case report

@#A 29-year-old male with eleven-year history of hyperkeratotic papules and speckled pigmentation developed cutaneous squamous cell carcinoma. Arsenicosis was confirmed by elevated hair arsenic level, and histopathologic findings of arsenical keratosis and one lesion showing carcinoma-in-situ. Chronic arsenic exposure has been found to activate inflammatory and carcinogenic pathways leading to development of pre-malignant and malignant lesions. A multi-disciplinary approach involving healthcare specialists and environmentalists is crucial in source control and management of long-term complications.

Clinically amyopathic dermatomyositis associated with a metastatic undifferentiated carcinoma in an adult Filipino male: A case report

@#A 40-year old Filipino male was managed as a case of clinically amyopathic dermatomyositis (CADM) after presenting only with pruritic photodistributed symmetric erythematous-violaceous patches, nail fold telangiectasia and the pathognomonic Gottron papules. There was no clinical evidence of muscle involvement. The patient shortly presented with a metastatic undifferentiated carcinoma on the cervical lymph nodes. This case demonstrates that dermatomyositis can present uncommonly as CADM with associated metastatic undifferentiated carcinoma.

Multiple eruptive myxoid dermatofibroma in a male with chronic hepatitis B infection

@#<p style="text-align: justify;">We report the first published case of multiple eruptive myxoid dermatofibroma (MEMDF) in a male with chronic hepatitis B infection presenting with eruptive lesions showing marked deposits of dermal mucin. Alcian blue and immunohistochemistry confirmed the diagnosis of myxoid dermatofibroma. Further work-up showed asymptomatic chronic hepatitis B infection without cirrhosis.This case highlights an extremely rare histologic variant and the importance of screening for altered immunity in patients with eruptive dermatofibromas.</p>