Mycosis fungoides bullosa: report of a case and review of the literature.

Mycosis fungoides, the most common type of cutaneous T-cell lymphoma, can manifest in a variety of clinical and histologic forms. Presentation with vesiculobullous lesions is extremely rare. We report the ninth documented case of mycosis fungoides bullosa in which other concomitant autoimmune blistering diseases were ruled out by negative immunofluorescence. All previously reported cases in the world literature since the first in 1887 are reviewed. We recommend the following defining criteria for the disease: (1) clinically apparent vesiculobullous lesions, with or without typical mycosis fungoides lesions (patches, plaques, tumors); (2) typical histologic features of mycosis fungoides (atypical lyphoid cells, epidermotropism, Pautrier's microabscesses) with intraepidermal or subepidermal blisters; (3) negative immunofluorescence (both direct and indirect, if possible) to rule out concomitant autoimmune bullous diseases; (4) negative evaluation for other possible causes of vesiculobullous lesions (eg, medications, bacterial or viral infection, porphyria, phototherapy).

Ultrasound diagnosis of filarial funiculoepididymitis.

Genital presentation of filarial disease is not uncommon in endemic areas of the world. Acute, febrile illness involving the epididymis and spermatic cord (funiculoepididymitis) is one of many such presentations. With an internationally mobile society, physicians today, even in nonendemic areas, may encounter patients with filarial infestations. We report the first case of presumptive diagnosis of this disease using scrotal ultrasound.

Atrophoderma elastolytica discreta.

Atrophoderma elastolytica discreta is the clinicopathologic name for a unique entity herein first described in a patient with cutaneous lesions simulating atrophoderma of Pasini and Pierini but coupled with histopathologic changes of anetoderma. The clinical and histological findings seen here have not been previously seen in the many variants of anetoderma, and, as such, they are sui generis evidence of a new entity in clinical dermatology.

Enalapril-associated erythema and vasculitis.

Our pharmacologic armamentarium is expanding at a tremendous pace, and requires that we as clinicians maintain a certain level of knowledge of the drugs that we use, as well as their metabolism, and how they may function, both positively and negatively, in a given patient. Certain drugs, such as the angiotensin-converting enzyme inhibitors, interfere with the natural deactivation of certain vasoactive substances normally present in the body. Since many of these systems are functionally interrelated (eg, angiotensin-converting enzyme and kininase II), we may see cutaneous side effects when these drugs are administered. Enalapril is an angiotensin-converting enzyme inhibitor that promoted a cutaneous eruption in a patient with renal failure secondary to diabetes. We suspect that our patient's vasculitis and maculopapular erythema is included in a large number of polymorphic eruptions that can be seen with angiotensin-converting enzyme inhibitors, and review the operative pathogenetic mechanism. Many of these side effects are dose related, and can be controlled or eliminated by lowering the dosage of angiotensin-converting enzyme inhibitor, depending upon the clinical circumstances.

Basal cell carcinoma in North American blacks. Clinical and histopathologic study of 26 patients.

Basal cell carcinoma is rare in blacks. A clinical and histopathologic review of 43 basal cell carcinomas in 26 black patients is reported. Basal cell carcinoma was found to be more common in women than in men. Our data indicated a lower prevalence on the nose and trunk compared with other reports. Multiple tumors were more common in our series. Our study included the youngest black patient with a pure basal cell carcinoma, the first reported superficial basal cell carcinoma, the second reported perianal basal cell carcinoma, and one albino patient with 12 tumors. Histologically there was a positive correlation between the maximum depth of tumor invasion and the maximum diameter of the lesion. Of three basal cell carcinomas arising in scars, metastasis developed in one. Our report includes a review of basal cell carcinomas in North American blacks.

Tungiasis: report of one case and review of the 14 reported cases in the United States.

Tungiasis is a cutaneous parasitic infestation by the fertilized female sand flea Tunga penetrans. It is prevalent in tropical Africa and in Central and South America. Despite increasing air travel to and from these countries, surprisingly the disease is rarely reported in the United States. This report describes another case of tungiasis and reviews the 14 previously reported cases in the United States. Clinical features, differential diagnosis, treatment, and prophylaxis of tungiasis are discussed.

Livedo reticularis and peripheral gangrene associated with primary hyperoxaluria.

We describe a 38-year-old man who developed livedo reticularis and peripheral gangrene after bilateral nephrectomy. Pathologic evaluation revealed extensive crystalline deposits within the walls of subcutaneous blood vessels. The diagnosis of primary hyperoxaluria was established. This case demonstrates that the vasculopathy of primary oxalosis can mimic systemic necrotizing vasculitis.

Pilomatrix carcinoma.

A pilomatrix carcinoma presented as a large ulcerated mass in the left axilla. Histologically, irregular nests of basaloid matrix cells with cystic centers containing necrotic debris and "shadow cells" were seen. The tumor invaded adjacent structures and was characterized by areas of cellular pleomorphism, crowding of cells, and numerous mitotic figures. An occasional atypical mitosis was noted. A review of 16 cases reported in the world literature is included, with emphasis on epidemiology and treatment.

Primary malignant melanoma of the urethra in a black man: a case report.

We report a unique occurrence of primary urethral melanoma in a black man. The biological relationships to melanocyte/melanin site densities or to precursor mucosal lesions are discussed as possible etiological factors in the occurrence of this rare neoplasm.

Carcinoma of eccrine sweat gland: experience with chemotherapy, autopsy findings in a patient with metastatic eccrine carcinoma, and a review of the literature.

Carcinoma of sweat glands is a very rare neoplasm of dermal appendages that is difficult to diagnose clinically and histologically. It has a potential for rapid growth and metastasis. Carcinoma of eccrine sweat glands, also known as eccrine carcinoma, is a distinct histologic subtype of sweat gland carcinoma. We report our autopsy findings and experience with chemotherapy in a patient with metastatic eccrine carcinoma. The pertinent literature and histologic classification of eccrine carcinomas are reviewed.

Metastasizing basal cell carcinoma originating in a stasis ulcer in a black woman.

A case of basal cell carcinoma originated in a long-standing stasis ulcer on the lower extremity and then metastasized to the dermis and subcutaneous tissue of the thigh. The literature on metastasizing basal cell carcinoma is reviewed.

Unicystic ameloblastoma.

The unicystic ameloblastoma should be considered a distinct entity and treated conservatively. The following case report emphasizes the use of computerized axial tomography in the diagnosis of this lesion. The detailed histology and conservative surgical therapy is discussed.

Cervical thymic cyst.

Various types of cysts that originate in embryonal remnants may be observed in the neck. Among these, branchial cleft and thyroglossal duct cysts are more commonly observed, whereas thymic cysts are rare. Most patients with a cervical thymic cyst complain of a painless, enlarging mass in the neck. The histopathologic features of thymic cysts are diagnostic. Cystic thymomas, which seem to have a more aggressive clinical behavior in children, should be differentiated from the benign cervical thymic cyst. Thymic cysts most probably arise from embryonic remnants of the thymopharyngeal duct. Our patient had a cervical thymic cyst with neurofibromatosis.