Detection of Beta-Human Papillomavirus in a Child With Polyomavirus-Associated Trichodysplasia Spinulosa.

Viral associated trichodysplasia spinulosa (VATS) is a rare cutaneous eruption characterized by folliculocentric papules, keratin spicules, and alopecia associated with trichodysplasia spinulosa-associated polyomavirus (TSPyV) infection. We report a case of a 6-year-old male child who presented with a generalized papular eruption during chemotherapy for acute lymphoblastic leukemia. The papules were tested for human papillomavirus (HPV) DNA by nested polymerase chain reaction (PCR) and TSPyV using PCR and gene sequencing studies. The lesions were positive for TSPyV by PCR combined with sequencing and showed high copy number with real-time PCR, and beta-papillomavirus was identified by PCR and sequencing. Immunohistochemistry revealed inner root sheath keratinocytes expressing nuclear HPV L1 capsid antigen. To our knowledge, this is the first case of concomitant productive HPV and TSPyV infection in a VATS-affected patient. The presence of HPV may be coincidental, however, further studies are needed to establish whether specific HPV genotypes influence the development of abnormal inner root sheath trichohyalin granules found in VATS.

Nephrogenic fibrosing dermopathy and calciphylaxis with pseudoxanthoma elasticum-like changes.

Nephrogenic fibrosing dermopathy (NFD) and calciphylaxis are rare conditions that are associated with chronic kidney disease. Histopathologic changes, including dystrophic dermal calcification, often in association with elastic fibers have been observed in NFD and calciphylaxis. A pattern of dermal elastic fiber calcification that mimics pseudoxanthoma elasticum (PXE) has been previously reported as an incidental finding in the setting of calciphylaxis. Despite a shared association with renal disease and abnormal calcium deposits, however, NFD and calciphylaxis are discrete pathologic processes with distinct clinical and histopathologic features. Criteria for each are reviewed through case presentation of a patient meeting the clinical and histopathologic criteria for both NFD and calciphylaxis with histologic features mimicking PXE.

Proliferating multicentric reticulohistiocytosis associated with papillary serous carcinoma of the endometrium.

Multicentric reticulohistiocytosis (MRH) is a rare histocytic disease characterized by destructive arthritis in association with classic skin findings. Although MRH is not strictly a paraneoplastic disease, one quarter of cases are malignancy related. We report a case of MRH with an initial remission followed by an acute exacerbation several years later heralding the clinical presentation of endometrial carcinoma. During this flareup a skin biopsy specimen revealed a diffuse dermal infiltrate composed of histiocytes with ground-glass cytoplasm and multiple atypical mitoses. Approximately 40% of the cells stained with the proliferation marker Ki-67. Treatment of endometrial carcinoma resulted in improvement of skin and joint symptoms, and a repeat biopsy specimen no longer demonstrated mitotic figures. These findings support a reactive and proliferative cause of MRH.

Spiradenocylindrocarcinoma: a malignant hybrid tumor.

BACKGROUND: Eccrine spiradenomas and cylindromas are benign, slowly growing, cutaneous adnexal neoplasms, recently hypothesized to arise from a common pluripotential cell; malignant variants are rare. We found 48 cases of malignant spiradenomas and 33 cases of malignant cylindromas reported in the English literature. Benign tumors demonstrating both spiradenomatous and cylindromatous features have been infrequently reported. Recent immunohistochemical studies of these two tumors have provided compelling evidence that these two tumors may merely represent a single tumor type with a spectrum of histological features. CASE REPORT: We describe two cases of a malignant variant of this rare hybrid tumor occurring in a 62-year-old male and a 72-year-old female. CONCLUSION: We propose the term 'spiradenocylindrocarcinoma' to describe malignant tumors with features of both a spiradenoma and a cylindroma. In conjunction with histological features of malignancy, p53 and Ki-67 immunohistochemical staining may provide helpful clues in determining the malignant potential of this tumor. Further studies are needed to clarify the biologic behavior of such lesions.

Linear nevus comedonicus with epidermolytic hyperkeratosis.

BACKGROUND: Nevus comedonicus (NC) is rarely associated with the histopathologic pattern of follicular epidermolytic hyperkeratosis (EHK). We found eight cases reported. In one case, the condition was transmitted to the offspring in the form of generalized EHK. METHODS: We describe a case of linear NC with EHK in a 46-year-old woman. RESULTS: Histopathologic examination revealed the typical features of NC. Additionally, the follicular epithelial walls showed EHK with characteristic perinuclear vacuolization in the stratum spinosum and stratum granulosum and large, irregular keratohyalin granules in the granular cell layer. CONCLUSIONS: The clinical and histopathologic features of this case are consistent with a diagnosis of linear NC with EHK. Lesions of NC suspected by clinical exam should be examined microscopically to look for features of EHK. If present, patients should be educated about the risk, albeit rare, of passing on a more severe form of the disorder to subsequent generations.

Compound melanocytic nevi with granular cell changes.

Two cases of compound melanocytic nevi with granular cell changes were studied. Histological examination revealed compound melanocytic nevi with a portion of the dermal component exhibiting a sheet like proliferation of nevoid cells with granular cytoplasm. Immunohistochemically, both populations of cells stained positive for S-100 and Melan-A. However, HMB-45 was positive only for the nevus cells with granular cytoplasm. We believe this represents granular cytoplasmic changes of nevus cells and does not denote malignant transformation.

Cardiac catheterization-induced acute radiation dermatitis presenting as a fixed drug eruption.

Acute radiation dermatitis is an uncommon complication of fluoroscopic procedures. Cases secondary to cardiac catheterization are infrequently reported in the literature. The risk of developing this reaction is directly related to the skin dose of radiation, which is affected by the type of procedure, the technique used to achieve appropriate penetration, the duration of exposure, and the patient's body habitus. We report a case of acute radiation dermatitis following prolonged coronary angiography initially presenting as a fixed drug eruption.