Indeterminate Dendritic Cell Sarcoma in a Patient With Myelodysplastic Syndrome

No abstract available

http://bit.ly/2GeinOF

Reticulated Purpura in the Abdomen of a Severely Ill Patient: Answer

No abstract available

http://bit.ly/2FYbRw4

A New Histologic Pattern in 6 Biopsies From Early Frontal Fibrosing Alopecia

Abstract: Frontal fibrosing alopecia (FFA) is an irreversible scarring alopecia with unknown etiology and no cure. The goal is to establish the diagnosis in the early stage, before developing a hairless band of atrophy involving the frontal, temporal scalp and sideburns. Pathology is rarely needed once the disease is clinically apparent. The classic histologic features include follicular dropout with the absence or atrophy of the sebaceous glands and lichenoid lymphohistiocytic infiltrate with concentric layered fibrosis at the upper follicular level. We describe a common pattern that was repeatedly seen in 6 horizontally sectioned scalp biopsies from patients with early presentation of FFA suspected on trichoscopy by the focal presence of peripilar casts around terminal hairs. All biopsies revealed overall preserved follicular architecture with average number of 11 vellus follicles, atrophy of the sebaceous glands, and perifollicular lymphohistiocytic infiltrate involving the outer root sheath of the vellus follicles (n = 5). There was no perifollicular fibrosis of the vellus follicles and no lichenoid inflammation and perifollicular fibrosis of the terminal follicles. This new pattern of "inflammatory vellus involvement" most likely corresponds to an early onset of the disease. The absence of the classic features in such biopsies from early FFA can lead to misdiagnosis.

http://bit.ly/2GbIshk

Persistent Asymptomatic Papules on the Chest: Challenge

No abstract available

http://bit.ly/2FWb7Yd

Dickkopf-1 Expression in Androgenetic Alopecia and Alopecia Areata in Male Patients

Background: Androgenetic alopecia (AGA) results from shortening of the anagen phase of the hair cycle and, subsequently, miniaturization of hair follicles. Alopecia areata (AA) is a disease of autoimmunity where T cells attack anagen hair follicles and shows multifactorial etiology. Dickkopf-1 (DKK-1) is a gene that is responsible for transformation of anagen to catagen, which suggests that it is involved in development of both diseases. Objectives: To evaluate the tissue levels of dickkopf-1 in male patients with AGA and AA in comparison with controls, in an attempt to know its role in the pathogenesis of both disorders. Methods: DKK-1 immunohistochemical expression was evaluated in lesional scalp biopsies taken from 20 male patients with AGA evaluated clinically by the modified Norwood–Hamilton score, 20 male patients with AA evaluated clinically by SALT score, and 20 healthy controls within the same age and sex of the studied patients. Results: A highly significant difference in DKK-1 expression between patients with AGA and healthy controls was found (P2

http://bit.ly/2GbTpPW

Persistent Asymptomatic Papules on the Chest: Answer

No abstract available

http://bit.ly/2FTRVKA

Reflectance Confocal Microscopy Can Help the Dermatopathologist in the Diagnosis of Challenging Skin Lesions

Abstract: Despite the successful assignment of Current Procedural Terminology codes, there are barriers to incorporating in vivo reflectance confocal microscopy (RCM) into daily practice. Importantly, the dermatopathologist can play a key role in interpreting RCM images and can use these images to correlate with histopathology. Herein, we describe, using a case series, how RCM can be incorporated into the dermatopothalogist's practice. We also summarize the criteria for RCM diagnosis of common neoplasms.

http://bit.ly/2GaFJEz

Reticulated Purpura in the Abdomen of a Severely Ill Patient: Challenge

No abstract available

http://bit.ly/2FXHd64

Acquired Dermal Melanocytosis Associated With Diffuse Systemic Sclerosis in a White Patient

Abstract: We report a case of a 65-year-old man who developed an asymptomatic bluish spot that affected the flank and left lumbar region with the onset 10 years prior. He had a history of diffuse systemic sclerosis with anti-Scl-70–positive antibodies. The appearance of the skin lesion coincided with the onset of his disease. The skin biopsy was consistent with the diagnosis of acquired dermal melanocytosis. The relationship between the appearance of acquired pigmented macules and spots and systemic sclerosis has been known for years, although it is an infrequent finding.

http://bit.ly/2DJrW6r

Cutaneous Elastic Tissue Anomalies

Abstract: After a review of the physiology in the formation and degradation of cutaneous elastic tissue, we describe the clinicopathologic disorders characterized by increased and decreased cutaneous elastic tissue. Cutaneous disorders characterized by increased and/or abnormal elastic tissue in the dermis include elastoma, also named nevus elasticus, dermatosis lenticularis disseminata, pseudoxanthoma elasticum, late-onset focal dermal elastosis, linear focal elastosis, elastoderma, elastofibroma dorsi, and elastosis perforans serpiginosa. In some of these conditions, the specific histopathologic diagnosis may be rendered with hematoxylin-eosin stain, whereas in other ones special elastic tissue stains are necessary to demonstrate the anomalies. Cutaneous disorders characterized by decreased dermal elastic tissue include nevus anelasticus, papular elastorrhexis, perifollicular elastolysis, anetoderma cutis laxa, postinflammatory elastolysis and cutis laxa, white fibrous papulosis of the neck, pseudoxanthoma elasticum–like papillary dermal elastolysis, and mid dermal elastolysis. In most of these conditions, the histopathologic anomalies are only seen with elastic tissue stains, and cutaneous biopsies of these processes stained with hematoxylin-eosin show appearance of normal skin. The diagnosis of some of these disorders characterized by increased or decreased elastic dermal tissue should be followed by general exploration of the patient to rule out associated severe systemic anomalies, and in some cases, a genetic counseling should be offered to the family.

http://bit.ly/2GbIl5o

Facial Phaeohyphomycosis in an Immunocompetent Individual: A Rare Presentation of a Rare Fungus

Abstract: Phaeohyphomycosis is a rare mycotic infection caused by heterogenous groups of dematiaceous fungi involving the skin and subcutaneous tissue. Here, we report a case of cutaneous phaeohyphomycosis presenting as cauliflower-like verrucous lesion over the face in an immunocompetent individual. Histopathology showed suppurative granulomatous inflammation replete with pigmented broad fungal hyphae which is stained with periodic acid–Schiff stain, Grocott's methanamine silver stain, Schmorl's stain, and Masson-Fontana stain. Culture showed black-colored colonies identified as Exophiala spinifera.

http://bit.ly/2Usfzky

Onychomatricoma in a Patient with Extensive Vitiligo: Answer

No abstract available

http://bit.ly/2FZSxhK

Squamoid Eccrine Ductal Carcinoma: An Aggressive Mimicker of Squamous Cell Carcinoma

Abstract: Squamoid eccrine ductal carcinoma (SEDC) is an uncommon cutaneous adnexal malignancy that has the potential for an aggressive clinical course. The authors present a case of SEDC that resulted in widespread metastases and death. The clinical, histological, and immunohistochemical features of SEDC and several entities on the differential diagnosis are reviewed.

http://bit.ly/2GbI5TY

Eccrine Poroma of the Vulva

No abstract available

http://bit.ly/2FUvNjv

Cutaneous Angiomyolipoma of the Ear: A Case Report and Literature Review

Abstract: Cutaneous angiomyolipoma is a rare mesenchymal tumor, distinct from its renal counterpart. Only few cases have been reported in English language literature to date. Here, we report a case in a 36-year-old man who presented with a painless swelling on his right ear. Microscopy revealed a well-circumscribed tumor, composed of an admixture of mature adipocytes, blood vessels, and bundles of smooth muscles. The tumor cells were positive for desmin and calponin but negative for HMB45, melan-A, SOX10, tyrosinase, and CD10. We present the case to emphasize the uniqueness of cutaneous angiomyolipoma from its renal counterpart. We also review the relevant literature on this topic.

http://bit.ly/2GbToeQ

Multiple Targetoid Plaques: Challenge

No abstract available

http://bit.ly/2FZSen6

Atypical Histiocytic Lesion Preceding a Peripheral T-Cell Lymphoma Involving the Skin Exhibiting the Same Molecular Alterations

Abstract: Peripheral T-cell lymphoma (PTCL), not otherwise specified (NOS) is a diagnosis of exclusion, showing extreme cytological and phenotypic heterogeneity. Skin involvement of PTCL may be primary or secondary. Diagnosis of histiocytosis may be difficult, requiring clinical–pathological correlation. We describe a laryngeal atypical histiocytic lesion (AHL) and a nasal PTCL, NOS with cutaneous involvement in the same patient presenting with peculiar histopathologic and immunophenotypic features. The laryngeal neoplasm showed morphological and immunophenotypic evidence of histiocytic differentiation and does not fit any other category of the WHO classification nor the revised classification of histiocytosis. The nasal and cutaneous lesions presented features close to natural killer/T-cell lymphoma and gamma–delta T-cell lymphoma but did not meet accurately the WHO criteria. A somatic activating Q61K mutation was found on exon 3 of the NRAS gene in both AHL and PTCL, NOS. The mutation on NRAS gene in both AHL and PTCL, NOS may suggest a common origin from a precursor cell.

http://bit.ly/2DHcUOH

Onychomatricoma in a Patient With Extensive Vitiligo: Challenge

No abstract available

http://bit.ly/2GbHO3o

Multiple Targetoid Plaques: Answer

No abstract available

http://bit.ly/2FZRYEE

Osteoma Cutis Arising in Common Blue Nevus (Blue Osteonevus): A Clinicopathologic, Immunohistochemical, and Dermoscopic Study

Abstract: Osteonevus of Nanta is a rare histopathologic variant of melanocytic nevus that results from ossification of the dermis between dermal nests of melanocytes. Most cases described in the literature have been associated with long-standing intradermal nevi and were often located in the upper part of the body. We report a lesion on the shoulder of an elderly man showing the association of a common blue nevus and osteoma cutis, an exceptional feature which has been previously reported in 2 instances. We also describe for the first time the dermoscopic appearance of this "blue osteonevus."

http://bit.ly/2Utjkq8