Acral lymphomatoid papulosis associated with poikilodermatous mycosis fungoides.

We present a case of a 51-year-old man with concomitant acral lymphomatoid papulosis and poikilodermatous mycosis fungoides.

Applying perceptual and adaptive learning techniques for teaching introductory histopathology.

BACKGROUND: Medical students are expected to master the ability to interpret histopathologic images, a difficult and time-consuming process. A major problem is the issue of transferring information learned from one example of a particular pathology to a new example. Recent advances in cognitive science have identified new approaches to address this problem. METHODS: We adapted a new approach for enhancing pattern recognition of basic pathologic processes in skin histopathology images that utilizes perceptual learning techniques, allowing learners to see relevant structure in novel cases along with adaptive learning algorithms that space and sequence different categories (e.g. diagnoses) that appear during a learning session based on each learner's accuracy and response time (RT). We developed a perceptual and adaptive learning module (PALM) that utilized 261 unique images of cell injury, inflammation, neoplasia, or normal histology at low and high magnification. Accuracy and RT were tracked and integrated into a "Score" that reflected students rapid recognition of the pathologies and pre- and post-tests were given to assess the effectiveness. RESULTS: Accuracy, RT and Scores significantly improved from the pre- to post-test with Scores showing much greater improvement than accuracy alone. Delayed post-tests with previously unseen cases, given after 6-7 weeks, showed a decline in accuracy relative to the post-test for 1(st)-year students, but not significantly so for 2(nd)-year students. However, the delayed post-test scores maintained a significant and large improvement relative to those of the pre-test for both 1(st) and 2(nd) year students suggesting good retention of pattern recognition. Student evaluations were very favorable. CONCLUSION: A web-based learning module based on the principles of cognitive science showed an evidence for improved recognition of histopathology patterns by medical students.

A case of verrucous psoriasis.

Psoriasis is a common inflammatory disease with a range of clinical presentations and a chronic relapsing course. There have been few reports of verrucous psoriasis, which is distinguished by its warty appearance and characteristic histology. We report a case of this rare form of psoriasis in an elderly woman with a history of plaque-type psoriasis and and discuss the histopathologic findings.

Disseminated coccidioidomycosis in a patient managed with adalimumab for Crohn's disease.

BACKGROUND: A 50-year-old man presented with a 2-3 month history of left lower quadrant abdominal pain, right periorbital headache, blurry vision, tinnitus, polydipsia, right elbow pain, and a 32 kg weight loss over the past year. He had a 34-year history of complicated Crohn's disease that was notable for surgical stricture repair and partial colectomy for bowel perforation. The patient was receiving mesalazine and 6-mercaptopurine and, 2 months before admission, had stopped a 4-month therapy course with the biologic agent adalimumab for treatment of Crohn's disease. INVESTIGATIONS: Physical examination, brain and elbow MRI scans, chest CT scan, routine blood analyses, assessment of coccidioidomycosis antibody levels, immunodiffusion and complement fixation studies in serum and cerebrospinal fluid, full-body technetium-99m nuclear bone scan, hematoxylin and eosin staining of resected tissue specimens. DIAGNOSIS: Disseminated coccidioidomycosis with meningeal, bone, soft tissue and pulmonary involvement. MANAGEMENT: The patient underwent treatment with amphotericin B liposomal complex and oral fluconazole and right elbow surgical debridement and irrigation. All immunosuppressive therapy was stopped.

Interobserver reproducibility of histologic parameters of melanoma deposits in sentinel lymph nodes: implications for management of patients with melanoma.

BACKGROUND: : Histologic parameters of melanoma deposits in sentinel lymph nodes (SLNs) have been shown to be predictive of clinical outcome and the presence or absence of tumor in non-SLNs, but assessment of these parameters is prone to interobserver variation. METHODS: : Histologic sections of 44 SLNs containing metastatic melanoma were examined by 7 pathologists. Parameters assessed included cross-sectional area of tumor deposits, cross-sectional area of SLNs, percentage of SLN area involved by tumor calculated from the 2 previous parameters, estimated percentage of SLN area involved by tumor, tumor penetrative depth, location of tumor within the SLN, and presence of extracapsular spread. Levels of interobserver agreement were measured by using intraclass correlation coefficients (ICC). RESULTS: : There was good to excellent interobserver agreement on measurement of quantitative parameters: maximal size of largest tumor deposits, calculated area of 3 largest tumor deposits, percentage of the area of SLN involved by tumor, and tumor penetrative depth (ICC, 0.88, 0.73, 0.68, and 0.83, respectively). There was moderate agreement on the evaluation of subcapsular versus nonsubcapsular location of tumor deposits (ICC = 0.50). Agreement on assessment of extracapsular spread was fair (ICC = 0.39). CONCLUSIONS: : Assessment of some of the quantitative parameters was highly reproducible between pathologists. However, evaluation of the location of tumor deposits within SLNs and assessment of extracapsular spread was less reproducible. Clearer definitions and training can be expected to improve the reproducibility of assessment. These results have important implications for reliability and reproducibility of these parameters in staging, prediction of outcome, and clinical management of melanoma patients. Cancer 2009. (c) 2009 American Cancer Society.