A Longstanding, Persistent and Recurrent Case of Cryptogenic Panniculitis.

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare subtype of cutaneous T-cell lymphoma. There may be a significant histologic overlap with traumatic panniculitis and lupus profundus. We describe a 54-year-old woman who had received a diagnosis of SPTCL based upon a left parietal scalp biopsy 5 years earlier. This diagnosis was supported by immunohistochemistry (IHC) demonstrating a CD8+ predominant lymphocyte population in the subcutis. T-cell gene rearrangement studies were not performed at that time. The patient was treated and showed significant clinical improvement. When several tender erythematous subcutaneous nodules appeared on the upper back, left plantar surface and pretibial region, repeat biopsy was performed. Histology revealed a lobular and septal panniculitis with no vasculitis. The infiltrate contained abundant eosinophils and histiocytes not seen in the original biopsy specimen. IHC demonstrated a mixture of CD4+, CD8+ and CD7+ lymphocytes with abundant CD68+ histiocytes. T-cell gene rearrangement studies performed on one of the lesions failed to demonstrate clonality. It is important to recognize that patients with SPTCL are not exempt from other types of panniculitis, and complete histologic, IHC and molecular workups are essential to properly classify all cutaneous lesions in these patients.

Conventional Versus Giant Basal Cell Carcinoma, a Review of 57 Cases: Histologic Differences Contributing to Excessive Growth.

BACKGROUND: Giant basal cell carcinoma (GBCC) is defined as a basal cell carcinoma (BCC) exceeding 5 cm in size. While these tumors impart significant morbidity due to local tissue destruction and have a higher rate of metastatic disease than their conventional (smaller) counterparts, reasons for their large size remain unclear. While theories relating to neglect or faster growth rate are often invoked; to date, there has not been a comprehensive evaluation of the histologic features of these large tumors that may contribute to their size. METHODS: Histologic features of GBCCs (n = 29) were evaluated and compared to those of conventional BCC (n = 28). Available clinical demographic data were also reviewed. RESULTS: GBCCs, in addition to overall larger size, more often were thicker, displayed ulceration, and showed a more infiltrative growth pattern than their conventional counterparts. These rare tumors also displayed an insignificant increased propensity for a brisk host immune response, and the infiltrate significantly more often included clusters of plasma cells. CONCLUSIONS: Most histologic features seen in GBCCs likely reflect their large size. Histologic features alone are unlikely to explain the size of these rare tumors. The possibility of an altered host immune response contributing to the growth of these tumors requires further investigation.

Collapsing angiokeloidal dermatofibroma.

A heterogeneous group of benign fibrohistiocytic lesions has been assembled under the umbrella term, dermatofibroma. These lesions share a morphology of bland spindled cells encompassed by and intercalating through thick dermal collagen; unique variants have been described based on secondary histologic features, some of which include aneurysmal, myxoid, lipidized, signet ring, angiomatous, and keloidal. Here, we present a distinct dermatofibroma variant henceforth known as collapsing angiokeloidal dermatofibroma identified in 2 patients with slowly growing nodules of the buttock and the arm. Microscopically, the lesions have a characteristic dermatofibroma appearance but are accompanied by unusual diffuse small caliber vessels whose walls are collapsed by a thick, eosinophilic, keloid-like substance. The eosinophilic material resembles the adjacent dermal collagen; however, it does not stain for type-4 collagen or type-1 procollagen, amyloid, or glycogen. Although the exact composition of the keloidal material remains ambiguous, the architectural novelty of collapsing angiokeloidal dermatofibroma serves to further expand the morphologic spectrum of benign fibrous histiocytomas, although highlighting the difficulty in distinguishing between it and similar lesions.

Sarcina organisms in the gastrointestinal tract: a clinicopathologic and molecular study.

Sarcina organisms were first observed in and recorded from the stomach contents of a patient suffering from vomiting by John Goodsir in 1842. Since that time, their fine structure, phylogenetic classification, and biochemical characteristics have been described. Although numerous cases of fatal disease have been attributed to this organism in the veterinary literature, only a few human cases have been documented. As a result, whether this organism causes disease in humans has not been definitively established. We report the clinicopathologic findings in a series of 5 patients with Sarcina-like organisms identified in upper gastrointestinal endoscopic biopsies with molecular confirmation. Our findings have shown that the organism is most commonly found in patients with a history of gastric outlet obstruction or delayed gastric emptying. Although many of the patients do not demonstrate direct mucosal injury from the organism, the presence of a concurrent gastric ulcer puts the patient at increased risk for complications such as emphysematous gastritis or perforation. The finding of Sarcina organisms should prompt further investigation for functional causes of gastric outlet obstruction and delayed gastric emptying, such as occult malignancy.