New-onset childhood extensive cutaneous lichen planus following asymptomatic COVID-19 infection: report of a case / Líquen plano cutâneo extenso de início recente na infância após infecção assintomática por COVID-19: relato de caso

ABSTRACT Objective: The objective of this study was to describe a case of cutaneous lichen planus (LP) that appeared following COVID-19 infection. Case description: We report a case of extensive cutaneous classic familial LP in a 4-year-old male child after an asymptomatic serologically confirmed COVID-19 infection. The patient developed intensely itchy, purple, flat-topped papules and plaques, mainly on the dorsal surface of the hands, feet, forearms, and shins. Histopathological examination of the skin biopsy showed vacuolar and apoptotic degeneration of the basal cell layer with a band-like lymphocyte infiltrate at the dermo-epidermal junction and confirmed the diagnosis of LP. Comments: LP could be considered among the differential diagnoses of pediatric post-COVID inflammatory skin lesions, either in the patients recovering from COVID-19 infection or in the suspicious asymptomatic cases in close contact with COVID-19-infected patients.

RESUMO Objetivo: Descrever um caso de líquen plano cutâneo (LP) após infecção por COVID-19. Descrição do caso: Relatamos um caso de LP familiar clássico extenso cutâneo em uma criança de quatro anos de idade após uma infecção por COVID-19 assintomática e sorologicamente confirmada. O paciente desenvolveu pápulas e placas intensamente pruriginosas, roxas e achatadas, principalmente na superfície dorsal das mãos, pés, antebraços e canelas. O exame histopatológico da biópsia de pele mostrou degeneração vacuolar e apoptótica da camada basal com infiltrado de linfócitos em faixa na junção dermoepidérmica e confirmou o diagnóstico de líquen plano. Comentários: O líquen plano pode ser considerado entre os diagnósticos diferenciais de lesões cutâneas inflamatórias pós-COVID pediátricas, tanto em pacientes em recuperação de infecção por COVID-19 quanto em casos assintomáticos suspeitos em contato próximo com pacientes infectados por COVID-19.

Intermittent chronic telogen effluvium with an unusual dermoscopic finding following COVID-19.

Various conditions, including infections, can cause telogen effluvium (TE). One of them is coronavirus disease 2019 (COVID-19), where hair loss usually begins between 2 and 12 weeks after the illness. TE can be acute or chronic, and the chronic type can be intermittent. Here, we present the case of a 17-year-old girl with severe and widespread hair loss following an upper respiratory infection suspected to be COVID-19, with the patient having a history of such attacks since childhood. Evidence from biopsy and dermoscopy indicated a diagnosis of TE.

Comparison of Frozen and Permanent Section Diagnosis in Ovarian Neoplasms: Analysis of Factors Affecting Accuracy.

Ovarian cancer is the seventh most common form of cancer among women worldwide. The aim of the study was to determine the accuracy of a frozen section and the factors affecting the accuracy of frozen diagnosis of ovarian neoplasms. This retrospective, cross-sectional study was conducted on 401 patients with ovarian masses with frozen section diagnosis in Shahid Faghihi Hospital affiliated to Shiraz University of Medical Sciences between 2014 and 2018. Each ovarian tumor sample was evaluated for histopathologic diagnosis using frozen and paraffin-embedded sections, which were reviewed by an expert gynecologic pathologist. Accuracy and diagnostic values were estimated by comparing the results of the 2 techniques, using the paraffin section as the gold standard. The overall accuracy of the frozen section was 94.5%. Its sensitivity was 85.3% for malignant, 88.2% for borderline, and 99.6% for benign tumors. Its specificity was also 99.7% for malignant, 98.0% for borderline, and 90.9% for benign tumors. The positive predictive value was 98.9% for malignant, 86.5% for borderline, and 94.6% for benign tumors. Most false negatives occurred in mucinous and borderline tumors. The sensitivity of malignant tumors of germ cell and sex cord-stromal cell types were 64.3% and 95.5%, respectively. The specificity of germ cell and sex-cord stromal tumors were 100% and 93.8%, respectively. Frozen section seems to be a precise technique for histopathologic diagnosis of ovarian tumors. However, borderline and mucinous tumors are the most problematic issues during frozen section diagnosis and malignant germ cell tumors have the lowest sensitivity.

Value of CD123 Immunohistochemistry and Elastic Staining in Differentiating Discoid Lupus Erythematosus from Lichen Planopilaris.

BACKGROUND: Differentiating scarring alopecia secondary to lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) has always been a challenge clinically and pathologically. Plasmacytoid dendritic cells (PDCs) have been reported in the cutaneous lupus erythematosus by CD123 immunostaining. This study assesses CD123 marker positivity and patterns of elastic fiber loss in scalp biopsy to differentiate DLE from LLP. PATIENTS AND METHODS: Forty-three cases with clinical and pathological diagnosis of LPP and DLE were selected, and CD123 immunohistochemistry staining and elastic staining were performed on them. The presence of CD123-positive cells, clustering and distribution of cells, and patterns of elastic fibers loss in the dermis were evaluated. To analyze the data, the Chi-square test was used; moreover, the sensitivity and specificity of CD123 were calculated based on a diagnostic test for 2-by-2 tables. RESULTS: Infiltration of PDC was seen in 90% of DLE cases. The presence of more than 10% and 20% PDC cells in inflammatory cells had 90% and 85% sensitivity and 34.7% and 91.3% specificity, respectively. PDC clusters more than 20 cells had 100% specificity for DLE. Location and patterns of PDC infiltration were not statistically significant (P = 0.378). The wedge-shaped loss of elastic fibers and the diffuse loss were the dominant patterns in LPP and DLE, respectively (P = 0.006). CONCLUSION: Our results suggested that CD123 along with elastic staining and histological features might be useful to diagnose challenging cases of lymphocytic scarring alopecia with clinical differential diagnosis of LPP and DLE.

Comparison of Serum Level of Sex Hormones in Patients with Frontal Fibrosing Alopecia with Control Group.

CONTEXT: Although etiopathogenesis of frontal fibrosing alopecia (FFA) is not fully discovered, it seems that hormonal factors play a role. AIMS: The aim of this study was to investigate the serum level of sex hormones in patients with FFA compared to a control group. SETTINGS AND DESIGN: This was a case-control study. SUBJECTS AND METHODS: All patients who referred to the Dermatology Clinic of Faghihi Hospital, Shiraz University of Medical Sciences, between 2013 and 2018 and were pathologically and clinically diagnosed with FFA were considered as the case group. The control group was selected from community people who did not have alopecia, and each was matched with its counterpart in the case group in terms of gender, age, and menstrual status. Both the groups were evaluated for serum level of sex hormones. STATISTICAL ANALYSIS USED: SPSS software version 23 was used in this study. RESULTS: Of 20 patients, who were all female, 8 were postmenopausal and 12 were cyclic. There was no significant difference between sex hormone levels of the case and control groups regardless of their menstrual statuses. Similarly, there was no significant difference between hormonal levels in postmenopausal women of both the groups. However, follicle-stimulating hormone (FSH) was significantly lower in the case group cyclic women. Moreover, postmenopausal patients with premenopausal onset of FFA had lower levels of FSH and luteinizing hormone than those with postmenopausal onset. Free testosterone correlated inversely with duration of FFA. CONCLUSIONS: It seems that the pathogenesis of FFA is not associated directly with serum concentrations of sex hormones. Therefore, future studies are recommended to investigate possible tissue mechanisms of hormonal factors involved in its pathogenesis.

Clinicopathological evaluation of patients with rippled pattern pigmentation of the skin: A single-center study.

The aim of the present study was to investigate the clinical association between rippled pattern pigmentation and the positivity of histopathological analysis for amyloid. A total of 50 patients (90% women) with rippled pattern pigmentation referring to Dermatology Clinic of Shahid Faghihi Hospital, Shiraz, Iran, in 2015 participated in this study. Two biopsies were performed for all the cases from the most frequently affected sites. The specimens were evaluated for amyloid deposits with hematoxylin-eosin (H&E), Congo red (CR), and crystal violet (CV) stains. The upper back was the most frequently affected area in the patients. Family history (28%), atopy (14%), pruritus as a common finding (86%), and history of friction (54%) were positive. The prevalence of disease was higher in patients with skin photo Type 3. Amyloid deposit was not detected in most patients by these stains. No statistically significant difference was found between the amyloid positive cases stained with H&E, CR, and CV (p-value > 0.05). Only the difference in positive results between biopsy number 2 and the total biopsy (1 and 2) was significant (p-value < .05). In conclusion, it seems that it is useful to increase the number of biopsies and other more sensitive staining methods to detect small focal amyloid deposits.

Cutaneous lymphoid hyperplasia induced by Hirudo medicinalis (leeches).

For centuries, Hirudo medicinalis (medicinal leech) has been used as a remedy to treat many discomforts, such as muscle and joint pain. Nowadays, using leech in reconstructive surgery, microsurgery, wound and flap healing, venous insufficiency, varicosities and many other disorders has increased. In this study, we report a 45 year old female patient with six pruritic papules on her legs since10 months ago that appeared about 4 weeks after one session of leech application. Skin biopsy was performed on one of the papules, and in histopathology, superficial ulceration with a dense superficial and deep inflammatory infiltrate within the dermis composed of lymphocytes and eosinophils detected that considering history of leech application at this site, these constellation of data was compatible with the diagnosis of cutaneous lymphoid hyperplasia induced by leeches and the patient was cured by a topical steroid and cryotherapy.

Fallopian Tube Epithelial Changes in Ovarian Serous Tumors Compared with Control Group: A Single-Center Study.

BACKGROUND: Recent studies have hypothesized that distal end of fallopian tube is a possible origin of ovarian serous carcinoma. This study investigated histopathological changes in fallopian tube epithelium (FTE) of the patients with ovarian serous tumors compared with control group. MATERIALS AND METHODS: In a prospective cross-sectional study, fallopian tubes (right and left) of 34 cases with ovarian serous tumors were collected from patients who underwent surgery in two major gynecological centers affiliated to Shiraz University of Medical Sciences, Shiraz, Iran (2012-2015). They are composed of 21 (61.8%) high-grade serous carcinomas (HGSCs), 5 (14.7%) borderline ones, and 8 (23.5%) benign serous tumors. As control group, fallopian tubes of 72 hystrectomy cases without ovarian tumor were added to the study. Both tubes of all of the cases were submitted entirely, according to the protocol of sectioning and extensively examining the fimbriated end. The results were statistically analyzed using SPSS-PC windows and Chi-square tests. RESULTS: Significant differences were found between the cases and control group in tubal epithelial cell stratification (especially >3 cell layers thickness), atypia, mitosis, glandular complexity, tufting, and detached epithelial cells (P < 0.05). These findings particularly atypia and mitosis were more frequently seen in the ampulla and fimbriated end of high-grade ovarian serous carcinomas. CONCLUSION: Our results showed that premalignant epithelial changes of the ampulla and the distal end of FTE were seen in some of the patients with ovarian HGSCs. Therefore, FTE could be one of the sources of ovarian serous carcinoma.

Primary intrauterine dysgerminoma in a pregnant woman: A rare case report.

Primary extraovarian dysgerminoma is very rare. Nearly all reported uterine germ cell tumors are nondysgerminoma. Herein, we reported a primary intrauterine dysgerminoma. A 21-year-old pregnant woman G2 L1 with a gestational age of 33 weeks referred to an obstetric ward with a chief complaint of labor pain and membrane rupture. Ultrasonography showed a large hypoechoic lobulated area adjacent to the lower part of her uterus. She underwent an operation and a huge mass was detected in her uterus, which was extended to her pelvic floor. Histopathological and immunohistochemical examinations were consistent with dysgerminoma.

Crusted scabies masquerading as psoriasis plaques in a patient suffering from burn scars.

A 30-year-old woman, presented with erythematous scaling plaques on her trunk with severe pruritus and a burning sensation that began 3 months prior to her visit. She had a history of a thermal burn in that area, three years prior. Topical corticosteroid application for 3 months had no positive effects. Skin biopsy was done and scabies mites were found.

Satisfactory treatment of a large connective tissue nevus with intralesional steroid injection.

Collagenoma is a type of connective tissue nevi, a rare hamartomatous malformation characterized by the predominant proliferation of normal collagen fibers and normal, decreased, or increased elastic fibers. Collagenomas present as multiple or solitary, hereditary or sporadic, asymptomatic, skin-colored papules, nodules, and plaques with variable sizes, and are usually located on the trunk, arm, and back. Here, we report on a 14-year-old boy who presented with an isolated giant collagenoma of the frontal area that dramatically responded to intralesional triamcinolone acetonide.

Hypo-pigmented mycosis fungoides is a rare malignancy in pediatrics.

Hypopigmented mycosis fungoides (HMF) is an uncommon form of cutaneous T-cell lymphoma. It can be seen in children and is usually mistaken for eczema, vitiligo, or progressive macular hypomelanosis, clinically and histopathologically. We present a boy with HMF confirmed by histopathology. The patient had a course with slow clinical progression without Sezary syndrome.

Autoimmune progesterone dermatitis presenting as fixed drug eruption: a case report.

Autoimmune progesterone dermatitis (APD) is a rare disorder characterized by periodic skin lesions that erupt during the luteal phase of the menstrual cycle. Clinical manifestations of APD is caused by an unusual allergy to progesterone and has a wide range of clinical manifestations from eczema and urticaria to angioedema and erythema multiforme. A 46-year-old woman described recurrent, round erythematous plaques on the lower lip, both forearms and buttocks. These skin eruptions waxed and waned for 10 months, reoccurring 3-4 days before menstruation. Based on her medical history and physical examination, APD was suspected and the progesterone challenge test showed positive results. After treatment with oral prednisolone (30 mg/day) before menstruation, the severity of eruptions decreased dramatically but recurrence did not cease completely.

Infantile multiple large pyogenic granuloma on burned skin. Case report and review of literature.

Pyogenic granuloma (PG) is a benign vascular lesion of the skin and mucous membranes, presenting as a solitary, red, pedunculated papule that bleeds easily and which appears to be a reactive vascular proliferation to minor injury. These lesions are more common in children and are mostly seen in exposed sites. Multiple disseminated PG is a rare condition. This report describes an infant with multiple, disseminated, pyogenic granulomas following burns from boiling milk. We reviewed literature published in English and found 9 cases. Six cases were provoked by hot milk, 2 by hot water, while the cause of the other case is unknown. Angiogiogenetic activity in milk may explain PG development in these patients.

Infantile multiple large pyogenic granuloma on burned skin. Case report and review of literature

Abstract Pyogenic granuloma (PG) is a benign vascular lesion of the skin and mucous membranes, presenting as a solitary, red, pedunculated papule that bleeds easily and which appears to be a reactive vascular proliferation to minor injury. These lesions are more common in children and are mostly seen in exposed sites. Multiple disseminated PG is a rare condition. This report describes an infant with multiple, disseminated, pyogenic granulomas following burns from boiling milk. We reviewed literature published in English and found 9 cases. Six cases were provoked by hot milk, 2 by hot water, while the cause of the other case is unknown. Angiogiogenetic activity in milk may explain PG development in these patients.

A metastatic cancer to skin in an otherwise asymptomatic young man: an unusual presentation.

Cutaneous metastasis is a rare complication of visceral malignancies. We present a very unusual case of a 33 year-old seemingly healthy man with a sudden and rapidly enlarging skin lesion that was diagnosed as a skin metastasis of his visceral malignancy. Abdominopelvic CT scan revealed thickening of the anterior wall of the urinary bladder and the fundus and body of the stomach. Skin biopsy histopathological findings were suggestive of poorly differentiated metastatic carcinoma. The origin of the primary carcinoma was bladder adenocarcinoma or/and gastric adenocarcinoma, but the tumor was so poorly differentiated that the original source of the tumor could not be defined with certainty.

A young woman with multiple cutaneous epithelioid angiomatous nodules (CEAN) on her forearm: a case report and follow-up of therapeutic intervention.

Cutaneous epithelioid angiomatous nodule (CEAN) is regarded as a very rare entity of benign vascular hyperplasia that clinically manifests as mainly single, small, rapidly-growing reddish to bluish nodules or papules, mainly on the head and neck of adults. Most patients present with solitary lesions. We present a 39-year-old female with multiple, rapidly-growing, erythematous nodules on her left forearm during a one-year period. The overall histologic picture suggested Cutaneous Epithelioid Angiomatous Nodule (CEAN). In this case we tried different treatments and compared the results.

Unknown: A middle-aged woman with a solitary targetoid lesion on her shin.

We report a 42-year-old woman with an asymptomatic solitary targetoid patch on her shin of 1 month duration. Histopathologic evaluation revealed intact epidermis with vascular proliferation in the papillary dermis. Vascular channels were irregular, thin walled, and dilated. They were lined by prominent endothelial cells having plumped protruding nuclei and scanty cytoplasm. There was a mild extravasation of red blood cells and mild lymphocytic infiltration around blood vessels in the upper and mid dermis.