Verrucous cyst.

Human papillomavirus has been detected in a variety of cutaneous premalignant and malignant conditions, as well as in benign cutaneous warts. Changes consistent with epidermis papilloma virus infection occurring in epidermal cysts have recently been reported in the dermatologic literature only in plantar epidermal cysts. We report five examples of a form of cutaneous cyst that is histologically distinctive and that has not been previously reported, to our knowledge. We describe five cases of epidermal cysts showing marked verrucous changes of their stratified squamous inner linings, some of which also show proliferative changes. Human papillomavirus genomes were detected via polymerase chain reaction. None of the DNA probes for Southern blot hybridization demonstrated homology with the human papillomavirus types usually associated with cutaneous warts or carcinoma. We believe this cyst to represent a newly described manifestation of human papillomavirus infection, and propose the name verrucous cyst for this entity. Further studies may reveal the specific human papillomavirus type(s) associated with the verrucous cyst.

Papular protothecosis of the chest. Immunologic evaluation and treatment with a combination of oral tetracycline and topical amphotericin B.

A 65-year-old woman presented with cutaneous, pruritic papules of the upper part of her chest. Histologic findings and culture of a biopsy specimen confirmed that these papules were caused by an infection with Prototheca wickerhamii, an achloric alga that rarely infects humans. Natural killer cell activity in this patient was significantly depressed before initiation of therapy. Reevaluation following successful treatment with oral tetracycline hydrochloride and topical amphotericin B cream revealed an improvement in natural killer cell activity. This patient is presented to demonstrate a rare clinical presentation of protothecosis; to document that cutaneous protothecosis can be successfully treated without the risk of toxic side effects associated with systemic antifungal agents; and to illustrate that although most patients with cutaneous protothecosis are immunosuppressed, infection with this alga appears to be at least partially responsible for the immunosuppression.

Diaphragmatic pain in pulmonary endometriosis.

The diagnosis of pulmonary endometriosis is difficult and requires a high index of suspicion in patients with pelvic endometriosis. We have reported a case in which a history of periscapular pain associated with menses proved useful in delineating the cause of the hemothorax.

Dermatofibrosarcoma non-protuberans: description and report of five cases of a morpheaform variant of dermatofibrosarcoma.

Five cases of dermatofibrosarcoma are reported. All showed features typical of dermatofibrosarcoma protuberans except that in four cases, and a portion of the fifth case, no protusion of the tumor was noted clinically despite the rather advanced stage of growth of the tumor. These lesions resembled morphea or a morpheaform basal cell carcinoma clinically but could be recognized as "dermatofibrosarcoma non-protuberans" by physicians who had observed a previous case.

Colonization of nonmelanocytic cutaneous lesions by dendritic melanocytic cells: a simulant of acral-lentiginous (palmar-plantar-subungual-mucosal) melanoma.

Four cases of colonization of nonmelanocytic lesions by dendritic melanocytic cells are reported, one in a verruca vulgaris of the lip, one in a squamous cell carcinoma in situ of mucous membrane overlying a tonsil, one in a lesion of lichen simplex chronicus with a nevocellular nevus of the external ear, and one in a dermatofibrosarcoma protuberans (Bednar tumor). This is an important biological process of melanocytes that must not be confused with the acral-lentiginous (palmar-plantar-subungual-mucosal (P-S-M) melanoma. It is probably much more common than the paucity of published reports would indicate.