Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids following influenza vaccination.

Inflammatory processes within the central nervous system are challenging for the clinician, radiologist, and pathologist alike. They often can mimic other more well-known and defined disease processes. We present the case of a patient with a newly described inflammatory process that primarily involves the pons and adjacent structures, which is called chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS). An 80-year-old man presented with numbness of his right hand that ultimately progressed to involve both lower extremities and face and was associated with mild dysarthria and ataxia. He had received the influenza vaccination 2 weeks prior. The biopsy revealed primarily reactive T-cell lymphocytic infiltrates with macrophages and gliosis. Treatment required long-term immunosuppressive therapy. CLIPPERS is a recently described central nervous system inflammatory condition that should be considered in the differential diagnosis when a prominent lymphocytic inflammatory infiltrate is encountered in brainstem, spinal cord, midbrain, or cerebellar biopsies.

Tissue eosinophilia: not an indicator of drug-induced subacute cutaneous lupus erythematosus.

OBJECTIVE: To investigate whether tissue eosinophilia is a differentiating histopathologic feature of drug-induced subacute cutaneous lupus erythematosus (DI-SCLE) compared with non-DI-SCLE. DESIGN: Retrospective medical record review with prospective blinded histopathologic analysis. SETTING: University-affiliated dermatology and dermatopathology practice. PATIENTS: Fifty-nine patients with SCLE were divided into DI (n = 15) and non-DI (n = 44) groups. MAIN OUTCOME MEASURES: A dermatopathologist masked to the etiologic associations reviewed corresponding histopathologic specimens. For each patient, an eosinophil ratio was calculated as the mean eosinophil score (averaging eosinophil counts from 10 high-power histologic fields) divided by the intensity of inflammation. Eosinophil ratios for both groups were compared using the Mann-Whitney test. RESULTS: No significant difference was found in mean eosinophil ratios in the DI vs non-DI groups (0.11 vs 0.004; P = .34). Mucin deposition was present in both populations and was not significantly different (P = .18). The inflammatory infiltrate was superficial and deep in 10 patients (67%) in the DI group vs 24 (55%) in the non-DI group. Periadnexal inflammation was observed in 12 patients (80%) in the DI group vs 37 (84%) in the non-DI group, and basal layer liquefaction with dyskeratosis was seen in 15 patients (100%) in the DI group and in 37 (84%) in the non-DI group. CONCLUSIONS: Tissue eosinophilia is not a differentiating histopathologic feature of DI-SCLE. Careful review of a patient's drug history in correlation with clinical findings remains the standard for identifying a drug as an etiologic or exacerbating factor in patients with SCLE.

Cutaneous protothecosis.

Prototheca species are an achlorophyllic algae that cause infections primarily in immunocompromised individuals. At least one-half of infectious cases are cutaneous. Because protothecosis is seldom suspected clinically, patients may be subjected to various treatment modalities for extended periods without satisfactory results. Cutaneous protothecosis shares similar clinical and pathologic findings with deep tissue fungal mycoses. The typical presentation occurs most commonly on the face and extremities as erythematous plaques, nodules, or superficial ulcers. Prototheca spp are spherical, unicellular, nonbudding organisms that are sometimes noted on routine hematoxylin-eosin staining but are best visualized with periodic acid-Schiff and Gomori methenamine-silver histochemical stains. Although protothecosis can be diagnosed on biopsy, culture of the organism on a medium such as Sabouraud dextrose agar is required for definitive diagnosis. Treatment may require a combination of surgical excision and antifungal agents. Therefore, cutaneous protothecosis should be considered in a lesion that appears suspicious for the more-common fungal infections.

An immunohistochemical comparison between MiTF and MART-1 with Azure blue counterstaining in the setting of solar lentigo and melanoma in situ.

BACKGROUND: Evaluation of cutaneous pigmented lesions can be diagnostically challenging and represents an activity often supplemented by immunohistochemistry. Immunohistochemical studies typically employ 3,3'-diaminobenzidine (DAB) resulting in brown staining of both melanocytes and melanin. Difficulty may thus arise in distinguishing different cell types in heavily melanized lesions. Azure blue counterstaining has been used in conjunction with melanoma antigen recognized by T-cells (MART-1) to differentiate melanocytes from melanin by highlighting the latter blue-green. Microphthalmia transcription factor (MiTF) represents an alternative immunomarker that shows nuclear reactivity, which facilitates ease of interpretation. METHODS: Twenty examples of solar lentigo and melanoma in situ (MIS) were independently evaluated utilizing MiTF and MART-1/Azure blue for melanocyte quantification. Melanocyte counts were averaged over five high-power fields (×400) to obtain a mean melanocytic count. RESULTS: There was no significant difference in the mean melanocytic count between MART-1/Azure blue and MiTF as assessed in the solar lentigo group and as assessed independently in the MIS group. MiTF nuclear staining facilitated interpretation and required less laboratory preparation, as an additional counterstain was not necessary. CONCLUSIONS: MiTF is as effective as MART-1/Azure blue in identifying melanocytes in the context of solar lentigo or MIS. On the basis of our results, we favor expanding the use of MiTF as an immunohistochemical marker, as it provides an efficient alternative to MART-1 with Azure blue counterstaining in the evaluation of cutaneous pigmented lesions.

Anaplastic spindle cell carcinoma, arising in a background of an ovarian mucinous cystic tumor: a case report with clinical follow up, review of the literature.

Anaplastic carcinoma (AC) of spindle cell type is an exceedingly rare ovarian malignant neoplasm. The histo-genesis of these tumors is still controversial. Although it was first thought to carry an invariably unfavorable prognosis, recent data indicates that this does not apply to stage Ia tumors. To date, there have been less than ten cases of anaplastic spindle cell carcinoma reported in the medical literature. Furthermore, our case is the first time this tumor has been described in a 40-year-old female with malignant spindle cells merging with conventional high grade adeno-carcinoma. The differential diagnosis of spindle cell proliferation in the ovary will be discussed and their distinction using a panel of immunohistochemical stains. This report demonstrated that the findings of malignant spindle cell proliferation does not imply this entity to be carcinosarcoma. The distinction of AC from true sarcomas is important because of the poorer prognosis of the later compared with the quite favorable behavior of AC. However, such existence necessitates a careful tissue sampling for the logical distinction between AC and carcinosarcoma, which is critical for planning further management and ultimately the predictor of prognosis.