What's Eating You? Carpet Beetles (Dermestidae).

Carpet beetle larvae of the family Dermestidae have been documented to cause both acute and delayed hypersensitivity reactions in susceptible individuals. These larvae have specialized horizontal rows of spear-shaped hairs called hastisetae, which detach easily into the surrounding environment and are small enough to travel by air. Exposure to hastisetae has been tied to adverse effects ranging from dermatitis to rhinoconjunctivitis and acute asthma, with treatment being mostly empiric and symptom based. Due to the pervasiveness of carpet beetles in homes, improved awareness of dermestid-induced manifestations is valuable for clinicians.

T-Cell-Rich Angiomatoid Polypoid Pseudolymphoma: A Case Report and Comparison With Key Differential Diagnoses.

T-cell-rich angiomatoid polypoid pseudolymphoma (TRAPP) is a rare and recently defined entity, conceptualized just over a decade ago. Recognition of TRAPP is important because it can be clinically and microscopically confused with low-grade cutaneous lymphomas and other vascular proliferations. We report a case of a 28-year-old male with a solitary 1.2 cm red polypoid papule on the middle posterior base of the neck. The histopathological examination revealed a well-circumscribed dermal nodular proliferation of banal-appearing lymphovascular spaces with plump endothelial cells. Immunohistochemical analysis showed a T-cell-rich infiltrate. The clinical-pathological differential diagnosis for TRAPP includes pyogenic granuloma, angiolymphoid hyperplasia (epithelioid hemangioma), acral pseudolymphomatous angiokeratoma of children, cutaneous lymphoid hyperplasia, and low-grade cutaneous lymphomas and lymphoproliferative disorders. We review the literature and discuss the key differentiating features between TRAPP and its common differential diagnoses.

What's Eating You? Noble False Widow Spider (Steatoda nobilis).

Noble false widow spider (Steatoda nobilis) bites have been documented to cause symptoms ranging from pain and pruritus to systemic bacterial infection resulting in death. This species is found in a broad range of environments, often alongside human activity, and the spiders most often bite defensively when disturbed or when the body is compressed. Due to the rapid expansion of noble false widow spiders and their relatively recent emergence in the United States, it is important for dermatologists to be aware of how to manage their bites.

KAT6A::EP300 fusion in congenital myeloid sarcoma: Yet another novel molecular marker indicating spontaneous remission?: A case report.

RATIONALE: Acute myeloid leukemia (AML)/myeloid sarcoma (MS) is risk-stratified based on cytogenetics. Although most congenital AML/MS have a dismal prognosis, certain genetic variants such as t (8, 16) [KAT6A::cAMP response element-binding protein (CREB) - binding protein fusion] and more recently t (8, 22) [KAT6A::EP300 fusion] have shown spontaneous remissions. KAT6A located on chromosome 8p11 encodes KAT6A protein, a histone/lysine acetyltransferase enzyme. Numerous partner genes associated with KAT6A include cAMP response element-binding protein (CREB) - binding protein (16p13), EP300 (22q13), LEUTX (9q13), NCOA2, NCOA3, and ASXL2. PATIENT CONCERNS: In this article, we describe an otherwise healthy infant who presented with skin nodules on the face and scalp without any systemic or CNS involvement. A biopsy of the cutaneous lesion was consistent with congenital MS. DIAGNOSES: Through molecular testing, we found that our patient had the KAT6A::EP300 mutation. This is one of the rare recurrent cytogenetic abnormalities that are linked to congenital AML. INTERVENTION: Our patient underwent spontaneous remission with watchful waiting. OUTCOME: Our patient has remained in spontaneous remission for 24 months. LESSONS: Even though the KAT6A::EP300 mutation in adults is a poor prognostic marker, a similar mutation in congenital AML has a higher likelihood of spontaneous remission. Hence, conservative management might be an initial management strategy for clinically stable patients.

Automated digital TIL analysis (ADTA) adds prognostic value to standard assessment of depth and ulceration in primary melanoma.

Accurate prognostic biomarkers in early-stage melanoma are urgently needed to stratify patients for clinical trials of adjuvant therapy. We applied a previously developed open source deep learning algorithm to detect tumor-infiltrating lymphocytes (TILs) in hematoxylin and eosin (H&E) images of early-stage melanomas. We tested whether automated digital (TIL) analysis (ADTA) improved accuracy of prediction of disease specific survival (DSS) based on current pathology standards. ADTA was applied to a training cohort (n = 80) and a cutoff value was defined based on a Receiver Operating Curve. ADTA was then applied to a validation cohort (n = 145) and the previously determined cutoff value was used to stratify high and low risk patients, as demonstrated by Kaplan-Meier analysis (p ≤ 0.001). Multivariable Cox proportional hazards analysis was performed using ADTA, depth, and ulceration as co-variables and showed that ADTA contributed to DSS prediction (HR: 4.18, CI 1.51-11.58, p = 0.006). ADTA provides an effective and attainable assessment of TILs and should be further evaluated in larger studies for inclusion in staging algorithms.

Deep Learning Based on Standard H&E Images of Primary Melanoma Tumors Identifies Patients at Risk for Visceral Recurrence and Death.

PURPOSE: Biomarkers for disease-specific survival (DSS) in early-stage melanoma are needed to select patients for adjuvant immunotherapy and accelerate clinical trial design. We present a pathology-based computational method using a deep neural network architecture for DSS prediction. EXPERIMENTAL DESIGN: The model was trained on 108 patients from four institutions and tested on 104 patients from Yale School of Medicine (YSM, New Haven, CT). A receiver operating characteristic (ROC) curve was generated on the basis of vote aggregation of individual image sequences, an optimized cutoff was selected, and the computational model was tested on a third independent population of 51 patients from Geisinger Health Systems (GHS). RESULTS: Area under the curve (AUC) in the YSM patients was 0.905 (P < 0.0001). AUC in the GHS patients was 0.880 (P < 0.0001). Using the cutoff selected in the YSM cohort, the computational model predicted DSS in the GHS cohort based on Kaplan-Meier (KM) analysis (P < 0.0001). CONCLUSIONS: The novel method presented is applicable to digital images, obviating the need for sample shipment and manipulation and representing a practical advance over current genetic and IHC-based methods.

What's eating you? clothes moths (Tineola species).

Common household insects can be confused with ectoparasites. Understanding the basic identification and monitoring techniques of clothes moths will help the clinician identify if a patient has an infestation of the household versus his/her body. Clothes moth larvae are not parasites but are found on infested clothing and can be confused with myiasis.

Acute hemorrhagic edema of infancy: guide to prevent misdiagnosis.

We report the case of a 10-month-old previously healthy boy who presented with acute rash, edema, and low-grade fever in the setting of recent diarrhea. We differentiate between acute hemorrhagic edema of infancy (AHEI) and Henoch-Schönlein purpura (HSP).