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1.
J Am Acad Dermatol ; 45(3): 397-400, 2001 Sep.
Article in English | MEDLINE | ID: mdl-11511837

ABSTRACT

BACKGROUND: Atypical melanocytic nevi and cutaneous melanoma are often marked by variation in color. However, there are examples of "benign" explanations for irregularities in pigmentation, such as perifollicular hypopigmentation or hyperpigmentation. OBJECTIVE: The purpose of this study was to correlate the clinical and histologic features of 3 unusual melanocytic nevi consisting exclusively of multiple, tiny, dark brown to black dots on a skin-colored background, which we have termed pointillist nevi. METHODS: Histologic examination was performed of the single pointillist nevus from each of 3 patients (all women; aged 28, 39, and 47 years). RESULTS: The diameters of the pointillist nevi were 2, 3.5, and 5.5 mm. Individual dots were approximately 0.1-0.25 mm. Each of the 3 nevi showed a different histologic correlate for the dots, either (1) discrete, densely pigmented, junctional melanocytic nests; (2) isolated dermal pigmented melanocytic nests; or (3) discrete clusters of melanophages in the papillary dermis. CONCLUSION: Pointillist nevi are benign melanocytic nevi with histologic correlates similar to those of the "brown globules" observed by dermoscopy in uniformly pigmented nevi. However, the dots seen in pointillist nevi can be visualized without magnification. The clinical and histologic features of pointillist nevi add to the spectrum of unusual patterns of pigmentation that may be encountered in benign melanocytic lesions.


Subject(s)
Nevus/pathology , Skin Neoplasms/pathology , Adult , Ankle , Back , Diagnosis, Differential , Female , Groin , Humans , Middle Aged , Nevus/classification , Skin Neoplasms/classification
4.
Clin Plast Surg ; 27(3): 323-9, vii, 2000 Jul.
Article in English | MEDLINE | ID: mdl-10941556

ABSTRACT

Predicting the biologic behavior of melanocytic neoplasms (benign versus malignant) based on histology is one of the most difficult challenges in surgical pathology and dermatology. Success in the field of melanocytic neoplasia can be achieved by two means: performing excisions or biopsies that maximize the obtainable histologic information and providing sufficient history.


Subject(s)
General Surgery , Nevus, Pigmented/pathology , Pathology , Skin Neoplasms/pathology , Biopsy/methods , Diagnosis, Differential , Humans , Microscopy , Nevus, Pigmented/classification , Skin Neoplasms/classification
5.
J Am Acad Dermatol ; 42(2 Pt 1): 283-5, 2000 Feb.
Article in English | MEDLINE | ID: mdl-10642687

ABSTRACT

Ten patients, mean age 61 years, who presented with unilesional cutaneous T-cell lymphoma (CTCL) were studied. Lesional structure and distribution were similar to disseminated CTCL. Ablative therapy was successful in all patients. The relatively benign behavior of unilesional CTCL may reflect the prognostic importance of minimal tumor burden. Locally ablative therapy in the management of localized CTCL appears effective.


Subject(s)
Lymphoma, T-Cell, Cutaneous , Mycosis Fungoides/pathology , Skin Neoplasms , Administration, Topical , Adult , Aged , Antineoplastic Agents, Alkylating/therapeutic use , Carmustine/therapeutic use , Female , Humans , Lymphoma, T-Cell, Cutaneous/drug therapy , Lymphoma, T-Cell, Cutaneous/pathology , Male , Middle Aged , Mycosis Fungoides/drug therapy , Mycosis Fungoides/radiotherapy , Recurrence , Skin Neoplasms/drug therapy , Skin Neoplasms/pathology , Treatment Outcome
7.
Am J Dermatopathol ; 21(4): 315-9, 1999 Aug.
Article in English | MEDLINE | ID: mdl-10446770

ABSTRACT

Morphea (localized scleroderma) is a disease of unknown etiology, presenting as circumscribed areas of indurated skin. Histologically, most cases of morphea feature thickened collagen bundles in the deep reticular dermis, sometimes also extending into the superficial dermis or into the subcutis. We present six cases of morphea in which typical histologic features were restricted to the superficial dermis and contrast these with 27 additional biopsies of conventional morphea seen during the same time period. Sections were stained for elastic fibers, and dermal dendritic cells were labeled with antibodies to CD34 and Factor XIIIa. All six cases showed thickened collagen bundles restricted to the superficial dermis, sparing the deep dermis and without associated evidence of lichen sclerosus et atrophicus (LSA). Dermal elastic fibers were not appreciably decreased in number. There was loss of CD34-positive dermal spindle cells in each of our six superficial examples of morphea, which was restricted to the area of altered collagen in four of the six cases. This report highlights the distinctly uncommon phenomenon of morphea presenting solely as alteration of the superficial reticular dermis, without features of LSA. The selective loss of CD34-labeled spindle cells may provide information regarding the role of these putative immune accessory cells in morphea. Recognition of this manifestation of morphea may be helpful diagnostically.


Subject(s)
Dendritic Cells/pathology , Dermis/pathology , Scleroderma, Localized/pathology , Adult , Aged , Antigens, CD34/metabolism , Dendritic Cells/metabolism , Dermis/metabolism , Female , Humans , Immunoenzyme Techniques , Lichen Sclerosus et Atrophicus/pathology , Middle Aged , Scleroderma, Localized/metabolism , Transglutaminases/metabolism
8.
Dermatol Clin ; 17(3): 601-14, ix, 1999 Jul.
Article in English | MEDLINE | ID: mdl-10410861

ABSTRACT

The term cutaneous T-cell lymphoma was originally coined to encompass the spectrum of mycosis fungoides and Sézary syndrome. It has become increasingly evident that the histopathologic diagnosis of CTCL can be exceedingly challenging. A series of recent studies, however, have helped clarify the nature of the histologic findings in CTCL. Recently reported histologic data on mycosis fungoides, Sézary syndrome, and their variants is emphasized in this article, with special focus given to the findings in early lesions. A brief summary of lymphocyte immunophenotyping and the role of T-cell reception gene rearrangements in CTCL is included.


Subject(s)
Lymphoma, T-Cell, Cutaneous/pathology , Skin Neoplasms/pathology , Diagnosis, Differential , Female , Humans , Lymphoma, T-Cell, Cutaneous/diagnosis , Male , Mycosis Fungoides/diagnosis , Mycosis Fungoides/pathology , Sezary Syndrome/diagnosis , Sezary Syndrome/pathology , Skin Neoplasms/diagnosis
9.
Cutis ; 63(5): 267-70, 1999 May.
Article in English | MEDLINE | ID: mdl-10349541

ABSTRACT

Fusarium species are ubiquitous plant and grain phytopathogens that rarely cause opportunistic infections in immunocompromised patients. While disseminated Fusarium infections are almost always fatal, localized infections may be responsive to a combination of systemic antibiotic therapy and surgical debridement. We present a diabetic renal transplant patient who developed a foot abscess due to Fusarium solani. Infection persisted despite aggressive surgical debridement and a 3-month course of intravenous liposomal amphotericin B.


Subject(s)
Abscess/microbiology , Foot Dermatoses/microbiology , Fusarium , Immunocompromised Host , Kidney Transplantation/immunology , Opportunistic Infections/microbiology , Abscess/drug therapy , Abscess/surgery , Combined Modality Therapy , Foot Dermatoses/drug therapy , Foot Dermatoses/surgery , Fusarium/isolation & purification , Humans , Male , Middle Aged , Opportunistic Infections/drug therapy , Opportunistic Infections/surgery
10.
J Cutan Pathol ; 26(3): 119-24, 1999 Mar.
Article in English | MEDLINE | ID: mdl-10235376

ABSTRACT

Cutaneous lymphadenoma is an uncommon basaloid epithelial tumor of uncertain histogenesis, most recently classified as a variant of trichoblastoma. Because characteristic immunohistochemical findings have been reported in trichoblastomas, we evaluated the staining patterns of five cutaneous lymphadenomas and compared the results to those of ten trichoblastomas and ten nodular basal cell carcinomas (BCCs), using antibodies to cytokeratin 20 (CK20), bcl-2, and CD34. In addition, because lymphadenomas contain intraepithelial S100-positive putative Langerhans cells, we compared staining of all tumor groups for S100 protein and CD1a. We also attempted to corroborate recent reports of CD30-positive activated lymphocytes in lymphadenomas. We identified CK20-positive Merkel cells in 3/5 lymphadenomas, 7/10 trichoblastomas, and none of the BCCs. Staining for bcl-2 accentuated the peripheral epithelial layer in all lymphadenomas and in 3/10 trichoblastomas, while the remaining trichoblastomas and all BCCs stained diffusely. There was stromal staining with CD34 in two lymphadenoma, 4 trichoblastomas, and 3 BCCs. All lymphadenomas featured numerous intraepithelial S100-positive cells which were also positive for CD1a in three cases tested. In addition, 8/10 trichoblastomas and 2/10 BCCs contained modest numbers of cells labelling for S100 and CD1a. Two of three lymphadenomas contained rare single cells resembling histiocytes faintly positive for CD30, and similar cells labelled for CD68. We conclude that the similar staining patterns of lymphadenomas and trichoblastomas support the classification of lymphadenoma as a variant of trichoblastoma. Staining with CD34 does not reliably distinguish between these tumors and BCCs. Lymphadenomas, trichoblastomas, and BCCs may all contain Langerhans' cells. The relationship between these cells and the striking lymphoid infiltrates seen in lymphadenomas is not clear. In our cases, the CD30-positive cells in lymphadenomas appear to represent histiocytes rather than activated lymphocytes.


Subject(s)
Adenolymphoma/classification , Carcinoma, Basal Cell/classification , Skin Neoplasms/classification , Adenolymphoma/metabolism , Adenolymphoma/pathology , Adult , Aged , Aged, 80 and over , Antigens, CD1/metabolism , Antigens, CD34/metabolism , Biomarkers, Tumor/metabolism , Carcinoma, Basal Cell/metabolism , Carcinoma, Basal Cell/pathology , Female , Hair Follicle/metabolism , Hair Follicle/pathology , Humans , Immunoenzyme Techniques , Intermediate Filament Proteins/metabolism , Keratin-20 , Male , Merkel Cells/metabolism , Merkel Cells/pathology , Middle Aged , Proto-Oncogene Proteins c-bcl-2/metabolism , S100 Proteins/metabolism , Skin Neoplasms/metabolism , Skin Neoplasms/pathology
12.
Am J Dermatopathol ; 21(1): 1-7, 1999 Feb.
Article in English | MEDLINE | ID: mdl-10027517

ABSTRACT

Epithelioid cell histiocytoma (ECH) is an unusual and still poorly recognized variant of benign fibrous histiocytoma. Epithelioid cell histiocytoma differs from most benign fibrous histiocytomas in five important ways: the predominance of epithelioid cells, relative lack of secondary elements (such as giant cells, foamy, or hemosiderin-laden macrophages), relative sharp circumscription, prominent vascularity, and centering in the papillary dermis in most cases. A strong resemblance to melanocytic and vascular lesions has been noted, and a recent case was reported with features suggesting endothelial origin. Fifteen new cases of ECH, including one example of the rare deep cellular variant, are presented herein, with emphasis on features mimicking vascular and melanocytic neoplasms. Labeling with endothelial markers, including previously unreported CD-31 labeling, showed abundant vascular staining, which may be challenging to interpret, but which does not indicate an endothelial origin of ECH.


Subject(s)
Histiocytoma, Benign Fibrous/pathology , Skin Neoplasms/pathology , Adult , Aged , Antigens, CD34/analysis , Diagnosis, Differential , Female , Histiocytoma, Benign Fibrous/metabolism , Humans , Immunohistochemistry , Male , Melanocytes/pathology , Melanoma/pathology , Middle Aged , Neoplasms, Vascular Tissue/pathology , Platelet Endothelial Cell Adhesion Molecule-1/analysis , Skin Neoplasms/metabolism , Transglutaminases/analysis
13.
J Clin Gastroenterol ; 28(1): 56-60, 1999 Jan.
Article in English | MEDLINE | ID: mdl-9916670

ABSTRACT

Mycosis fungoides is a cutaneous T-cell lymphoma that can disseminate to multiple organs. We report a patient who presented with obstructive jaundice caused by isolated involvement of the extrahepatic biliary tree by mycosis fungoides. Initially, endoscopic examinations and biopsies of the biliary tree and liver failed to reveal a cause for the obstructive symptoms. Finally, surgical resection of the gallbladder and extrahepatic ducts was performed. Examination revealed a dense, mixed lymphocytic infiltrate with atypical cells within the mucosa. Gene rearrangement studies confirmed the presence of a monoclonal T-cell population. The pattern of the gene rearrangement in the biliary tree was identical to that found in a previous skin biopsy that showed mycosis fungoides. Although liver involvement by mycosis fungoides is not uncommon, disease isolated to the extrahepatic biliary tree has not previously been reported. This case should alert clinicians and pathologists to yet another cause of obstructive jaundice.


Subject(s)
Bile Ducts, Extrahepatic/pathology , Cholestasis, Extrahepatic/etiology , Mycosis Fungoides/complications , Skin Neoplasms/complications , Adult , Biopsy , Cholestasis, Extrahepatic/pathology , Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor , Humans , Male , Mycosis Fungoides/pathology , Polymerase Chain Reaction , Skin Neoplasms/pathology
14.
Yale J Biol Med ; 72(6): 365-75, 1999.
Article in English | MEDLINE | ID: mdl-11138932

ABSTRACT

Cutaneous T-cell lymphoma is typically a clonal neoplasm of epidermotropic CD4+ T-lymphocytes that includes the entity mycosis fungoides (MF). After identification of patients with recurrent MF treated with total skin electron beam therapy (TSEBT) at the Yale University School of Medicine, this study attempted to compare T-cell receptor (TCR) gamma gene rearrangements via polymerase chain reaction (PCR) in both original and recurrent skin biopsies from these patients. Between 1974 and 1996, a total of 95 T2 MF patients were treated with TSEB, and four of these were identified for the study. Slides and tissue samples of both primary and recurrent skin biopsies for each patient were confirmed as being consistent with ME DNA for PCR was isolated from paraffin-embedded tissue samples. Using consensus primers that hybridize with conserved regions of the TCR gene, these regions of the genome were amplified. The PCR products were then analyzed by acrylamide gel electrophoresis. Of the primary and recurrent samples from four patients with a median disease-free interval (DFI) of 1222 days, only two showed evidence of a dominant TCR clone. A number of factors, including lack of sequence homology between the primers and the gene segments, the existence of multiple neoplastic cell lines, DNA degradation in the archival samples, and the presence of reactive as well as malignant lymphocytes, may have prevented the detection of dominant TCR rearranged clones in the samples. Despite the results of this study, TCR analysis via PCR and gel electrophoresis continues to be of utility in the evaluation of patients with MF when used in conjunction with other diagnostic modalities and in cases with nonspecific clinical, histopathological, and immunophenotyping findings.


Subject(s)
Gene Rearrangement, T-Lymphocyte/genetics , Mycosis Fungoides/genetics , Mycosis Fungoides/therapy , Receptors, Antigen, T-Cell/genetics , Skin Neoplasms/genetics , Adult , Aged , Electrons/therapeutic use , Female , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/genetics
15.
Am J Dermatopathol ; 20(3): 271-5, 1998 Jun.
Article in English | MEDLINE | ID: mdl-9650701

ABSTRACT

There has been ongoing debate about the nature of Woringer-Kolopp disease (unilesional pagetoid reticulosis). Despite the histologic resemblance to mycosis fungoides, these lesions are typically solitary and indolent. Recently, cutaneous plaques of epidermotropic lymphocytes restricted to acral sites resembling Woringer-Kolopp disease were reported to show T-cell clonality, leading to the designation mycosis fungoides palmaris et plantaris. We describe a similar case of recurrent plaques on palms and soles of a 45-year-old man that persisted for >14 years without other cutaneous or systemic disease. Histologically, the lesions were comprised of epidermotropic atypical lymphocytes with sparse dermal infiltrates. Immunohistochemically, the majority of intraepidermal lymphocytes labeled as CD8-positive suppressor/cytotoxic T cells and expressed alphaE beta7 (CD103), an integrin associated with epitheliotropism. Polymerase chain reaction studies revealed similar clonal gene rearrangements of T-cell receptors beta and gamma in tissue from both palm and sole. In view of these findings, the diagnosis of mycosis fungoides palmaris et plantaris may be appropriate. To date, however, the lesions have remained localized and continue to resolve spontaneously. As such, the behavior is similar to what has been described as pagetoid reticulosis. Long-term follow-up will be necessary to determine the biologic potential of this disease.


Subject(s)
Foot , Hand , Lymphatic Diseases/pathology , Mycosis Fungoides/pathology , Skin Neoplasms/pathology , Antigens, CD/biosynthesis , Diagnosis, Differential , Gene Rearrangement , Genes, T-Cell Receptor beta/genetics , Genes, T-Cell Receptor gamma/genetics , Humans , Immunohistochemistry , Male , Middle Aged , Polymerase Chain Reaction , Skin/chemistry , Skin/metabolism , Skin/pathology
17.
J Cutan Pathol ; 25(3): 153-9, 1998 Mar.
Article in English | MEDLINE | ID: mdl-9550314

ABSTRACT

The distinction between squamoid basal cell carcinoma and basaloid squamous cell carcinoma (or between BCC and trichoepithelioma variants) is usually made readily on the basis of defined histological criteria. However, these differential diagnoses occasionally can pose difficult morphological problems. The stated distinctions are clinically important because the risk of progressive disease is significantly higher with squamous carcinoma of the skin than with basal cell carcinoma (BCC), and a trichoepithelioma misinterpreted as BCC burdens the patient with an inaccurate diagnosis that may result in inappropriate surgery. Recent reports have suggested that reactivity with the monoclonal antibody Ber-EP4 is capable of separating histologically similar basal cell and squamous carcinomas, and that the expression of bcl-2 or CD34 antigen is able to distinguish BCC from trichoepithelioma. However, corroborative studies of these contentions are few in number. In order to investigate the usefulness of the stated immunostains in the above-cited differential diagnoses, the authors analyzed 45 basal cell carcinomas and 22 squamous carcinomas, as well as 36 trichoepitheliomas. The monoclonal antibodies Ber-EP4, My10 (CD34), and anti-bcl-2 were applied to formalin-fixed paraffin sections in all cases, using a standard avidin-biotin-peroxidase complex method. Most BCCs demonstrated strong, diffuse cytoplasmic labeling with Ber-EP4 and anti-bcl-2. In contrast, the squamous carcinomas were uniformly negative for the former marker and only focally reactive for the latter in four examples. 'Peripheral' bcl-2 staining of trichoepitheliomas was noted in 24 of 33 of the immunoreactive tumors, but the remainder were marked diffusely and similarly to most BCCs. Among the latter, immature trichoepitheliomas were diffusely reactive for this marker in 6 of 8 cases. Labeling of epithelium for CD34 failed to discriminate between any of the tumor types under evaluation, whereas staining of peritumoral stroma was characteristic of the majority of trichoepitheliomas and more than one-third of metatypical basal cell carcinomas. These data support the suggestion that Ber-EP4 and bcl-2 are useful in the separation of BCC from squamous carcinomas. Nevertheless, they also serve to caution against reliance upon bcl-2 and CD34 immunostains in attempting to distinguish BCC from trichoepithelioma in histologically enigmatic cases. There is currently no certain method other than conventional microscopy that can be applied successfully to the latter problem.


Subject(s)
Carcinoma, Basal Cell/pathology , Carcinoma, Squamous Cell/pathology , Skin Neoplasms/pathology , Skin/pathology , Antibodies, Monoclonal , Antigens, CD34/metabolism , Biopsy , Carcinoma, Basal Cell/metabolism , Carcinoma, Squamous Cell/metabolism , Diagnosis, Differential , Humans , Immunologic Techniques , Proto-Oncogene Proteins c-bcl-2/metabolism , Skin Neoplasms/metabolism , Staining and Labeling
18.
Am J Dermatopathol ; 19(6): 557-61, 1997 Dec.
Article in English | MEDLINE | ID: mdl-9415610

ABSTRACT

Ninety-seven cases of non-mycosis fungoides (non-MF) cutaneous lymphoma were evaluated employing published criteria for the categorization of B- and T-cell cutaneous malignancies. Included in the study were 77 primary and secondary cutaneous B-cell lymphomas, in which the diagnosis was supported by immunohistochemical studies identifying lineage. These cases were randomized with 20 cases of non-MF and T-cell lymphoma. Hematoxylin and eosin (H & E)-stained slides from each case were reviewed by at least two dermatopathologists, who were unaware of the previous diagnoses, and a judgment regarding histologic pattern was rendered. The histologic criteria employed emphasized architectural features. For B-cell patterns, these included the presence of dense perivascular, periappendageal and/or nodular collections of lymphocytes, centering in the deep dermis, and separation from the epidermis by a grenz zone. Employed criteria for cutaneous T-cell pattern included location restricted primarily to the upper dermis, interstitial pattern, the presence of epidermotropism, and the lack of a grenz zone. Three B-cell lymphomas were judged to have indeterminate patterns. Four of 74 (5.4%) of the remaining B-cell lymphomas were incorrectly categorized as T-cell lymphomas by architectural criteria. The most striking findings included epidermotropism in rare B-cell lymphomas. Three of the four miscategorized cases were large-cell lymphomas. A preference for B-cell pattern was also confirmed in non-MF T-cell lymphomas. We conclude that most B-cell lymphomas in the skin demonstrate a recognizable B-cell pattern, but rarely a pattern more reminiscent of T-cell lymphoma may be seen. This may occur more often with B-large-cell lymphomas. In addition, this study supports previous work indicating that many non-MF T-cell lymphomas show prominent architectural features typically ascribed to B-cell lymphomas. In summary, our findings support the impression that the vast majority of non-MF lymphomas show a B-cell pattern regardless of their lineage. As such, caution is indicated with regard to pattern interpretation.


Subject(s)
Lymphoma, B-Cell/pathology , Lymphoma, T-Cell, Cutaneous/pathology , Mycosis Fungoides/pathology , Skin Neoplasms/pathology , Adult , Aged , Biopsy , Cell Lineage , Diagnosis, Differential , Evaluation Studies as Topic , Female , Humans , Immunohistochemistry , Lymphoma, B-Cell/classification , Lymphoma, T-Cell, Cutaneous/classification , Male , Middle Aged , Skin/cytology , Skin/pathology , Skin Neoplasms/classification
20.
J Cutan Pathol ; 21(5): 413-8, 1994 Oct.
Article in English | MEDLINE | ID: mdl-7868753

ABSTRACT

T lymphocytes bearing the gamma/delta T-cell receptor are a rare component of normal human GI epithelium and skin. Recently, however, an unusually high percentage of T lymphocytes with gamma/delta receptors has been described in gastrointestinal biopsies from patients with dermatitis herpetiformis, implicating the gamma/delta T cell subset in the pathogenesis of this disease. We investigated a possible role for this subset of lymphocytes in the pathogenesis of the cutaneous lesions of dermatitis herpetiformis. Using a standard immunoperoxidase technique, we labelled perilesional skin biopsies from patients with dermatitis herpetiformis and other inflammatory dermatoses with monoclonal antibodies to CD3, CD4, CD8, alpha/beta T cell receptor, gamma/delta T cell receptor, and IL-2 receptor. We found no differences in the percentage of gamma/delta positive T lymphocytes in skin lesions of dermatitis herpetiformis as compared to other selected inflammatory conditions. These findings suggest that the pathogenesis of the cutaneous lesions of dermatitis herpetiformis is not mediated through gamma/delta T cells, and that the cutaneous lesions may develop through mechanisms different from those operative in the gastrointestinal tract.


Subject(s)
Dermatitis Herpetiformis/pathology , Receptors, Antigen, T-Cell, gamma-delta/analysis , T-Lymphocytes/pathology , Dermatitis Herpetiformis/immunology , Gastric Mucosa/immunology , Gastric Mucosa/pathology , Humans , Immunoenzyme Techniques , Skin/immunology , Skin/pathology
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