Pilomatricoma: A tumor with hidden depths.

Background: Pilomatricoma is a benign tumor of hair matrix differentiation and has been classically described as comprising of basaloid and shadow cells admixed with multinucleated giant cells and areas of calcification. However, there are a diverse range of histologic features this tumor displays that are often unrecognized. Aims: This study was undertaken to record the histopathologic features of pilomatricoma with an emphasis on the occurrence of other forms of differentiation. Methods: The study included all skin biopsy specimens over a 13-year period from 1995 to 2007 that had a histologic diagnosis of pilomatricoma. Hematoxylin and eosin-stained slides were reviewed. Results: This study included 21 cases of pilomatricoma. Supramatrical differentiation was seen in all cases and three-quarters of the cases showed matrical differentiation. Also observed in some of the cases were clear cell differentiation toward the outer root sheath, infundibular differentiation, calcification, ossification and secondary inflammation with a foreign body giant cell reaction. Epidermal induction in the form of a downward plate-like growth of the epidermis was seen in a few cases. Conclusion: Pilomatricoma, although considered a tumor of hair matrix differentiation, can show cellular evolution toward the other parts of the hair follicle, such as the outer and inner root sheaths, sebaceous and infundibular components and, therefore, can be considered a panfollicular neoplasm.

Clinicopathologic analysis of 21 cases of nevus sebaceus: a retrospective study.

BACKGROUND: Nevus sebaceus (NS), otherwise designated as 'organoid nevus', involves proliferative changes of the sebaceous glands, sweat glands, and the hair follicles. It displays a range of appearances, depending on the lesion's age. AIMS: To study the histopathological features of NS and correlate these with clinical findings. METHODS: All skin biopsy specimens over a 12-year period from 1995 to 2007 which had a diagnosis of NS were included. Clinical data with follow-up notes and histopathology were reviewed. RESULTS: Half of the cases had a verrucous clinical appearance, while the rest presented as papules, plaques, or patches. All the cases showed immature hair follicles, and 24% of cases showed immature sebaceous glands. Normal terminal hair follicles were characteristically absent in the lesion. Nineteen percent of the cases showed dilated apocrine glands, and 14% showed hyperplasia of eccrine glands. Epidermal changes in the form of acanthosis, papillomatosis, and hyperkeratosis were seen in 86% of cases. Dilated keratin-filled infundibula were observed in 24% of cases. One case was associated with a squamous cell carcinoma. CONCLUSIONS: Nevus sebaceus is a cutaneous hamartoma, consisting of various elements indigenous to the organ. Normal terminal hair follicles are characteristically absent in the lesion although the same may be seen in rest of the epidermis, a feature of diagnostic importance, not usually highlighted in literature. The divergent differentiation observed in NS is consistent with the common embryologic origin of the folliculosebaceous-apocrine unit and should not mislead the pathologist.

Malignant lymphoma without lymphadenopathy.

Hepatosplenic T-Cell lymphoma (HSTCL) is a rare form of extra-nodal post-thymic T-cell non-Hodgkin's lymphoma that primarily involves liver and spleen with B symptoms, with a characteristic absence of lymphadenopathy. We report such an entity in a 65-year-old man who was diagnosed to have multiple myeloma and treated for the same for two years. A clinical diagnosis of secondary myelofibrosis was suspected and was investigated, when he developed pancytopenia and massive hepatosplenomegaly at one of his follow-up visits. The patient underwent therapeutic splenectomy with a simultaneous wedge biopsy of the liver and with their corresponding histopathological and immunohistochemical features, the diagnosis of HSTCL was clinched.

Glycogen storage disease: report of 17 cases from southern India.

BACKGROUND: There are only four reports of glycogen storage disease (GSD), totalling six cases, from India. OBJECTIVE: To determine the clinical phenotypes of children diagnosed with GSD in southern India. METHODS: Liver biopsy reports from 1994 to 2005 were reviewed and GSD was confirmed in 17 patients. All 17 patients were tested for the three commonest GSD 1a mutations by restriction fragment length polymorphism: R83C, Q347X and G727T. RESULTS: They presented at mean age of 15 months (range, birth to 46 months) with hypoglycemia, hepatomegaly and delayed milestones. None of the patients showed R83C, Q347X or G727T mutation. CONCLUSION: Glycogen storage disease may not be rare in India. The commonest 1a mutations are probably rare here.

Clinical profile and cervical cytomorphology in symptomatic postmenopausal women.

The atrophic changes in menopause reflected in cytology is known, but relevance of other features in menopausal management is relatively unknown. One hundred postmenopausal patients who presented with symptoms related to urogenital atrophy were studied (September 1999 - March 2000). Adequacy, density of inflammation with numerical scoring, specific pathogens and predominant cell type were assessed in each smear and correlated with presenting symptoms and duration of menopause. The most common presenting urinary symptom was dysuria followed by frequency and UTI. Smears of all patients showed inflammation, varying in intensity, irrespective of the presenting symptoms with a high incidence of candidiasis (12%). Three patients who had ASCUS on smears had carcinoma on follow up. Six patients who opted for HRT were followed up with cytology. Cytology in postmenopause can be used other than to assess hormonal status, to screen for malignancy, pathogens in inflammation and to monitor hormone replacement therapy.