[Report of a case of T-cell peripheral lymphoblastic lymphoma in an HIV patient]. / Presentación de un caso de linfoma linfoblástico periférico de células T en paciente VIH.

T-cell lymphomas in human immunodeficiency virus infections are rare, first case have being described in 1987, by Presant. Our purpose is to report the first T-cell Lymphoma case without epidermotropism in an HIV patient in Extremadura, and pioneer in Spain. Clinic extensive and histopathologic studies of cutaneous lesions were realized, including monoclonal antibodies tests. Peculiar clinical features were small bowel disease (MALT), gingiva, pericardium and skin involvement, with spontaneous resolution of skin nodules. Polychemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisone was not effective, causing serious myelotoxicity. We outline the rarity of T-cell Lymphomas, the predominance of T4 phenotype, its relation with Epstein-Barr virus, the increase in 6-interleukin production, and the prognostic value of these factors, in correlation with advanced clinical status and unfavorable outcome.

Achromic verrucous large cell acanthoma.

Large cell acanthoma (LCA) is an epidermal neoplasm whose nature has been variously explained. Though frequently hyperpigmented, we describe for the first time an achromic case located on the dorsum of the right hand of a 83-year-old woman. This observation is largely inconsistent with one of the theories about the nature of this condition: that it is merely a solar lentigo with large nuclei of keratinocytes.

Trichilemmal cyst under a compound melanocytic nevus.

Cystic dilatation of a hair follicle, folliculitis, abscess formation and epidermoid cysts are not infrequent findings in an intradermal melanocytic nevus. We herein report a trichilemmal cyst under a compound melanocytic nevus. To the best of our knowledge this association has not been previously reported.

Periungual porocarcinoma.

We describe a patient who developed a porocarcinoma in the nail bed. His profession had exposed him to X-rays for many years, resulting in chronic radiodermatitis of several digits on both hands. He displayed an ulcer in the lateral nail fold of the right third digit which extended into the nail bed. The histology of the lesion was consistent with malignant eccrine poroma. Porocarcinoma has not been previously published in this location and this tumor must be considered in differential diagnosis of subungual malignant tumors.

Pseudo-Kaposi sarcoma induced by minor trauma in a patient with Klippel-Trenaunay-Weber syndrome.

Arteriovenous malformations (AVM) are vascular anomalies containing a communication between an artery and a vein without an intervening capillary bed. In 1990, Klippel and Trenaunay reported a patient with limb overgrowth, cutaneous angiomata and varicose veins. In 1918, Parkes Weber mentioned the additional feature of AVM terming the condition 'hemangiectatic hypertrophy'. Most authors now consider both the Klippel-Trenaunay syndrome and the syndrome of multiple congenital arteriovenous fistulae to be two forms of Parkes Weber's hemangiectatic hypertrophy. Clinical and histological 'Kaposi sarcoma'-like lesions in the Klippel-Trenauny-Weber syndrome are well documented. We report an additional case appearing after minor trauma.

Aggressive keratoacanthoma of the eyelid: "malignant" keratoacanthoma or squamous cell carcinoma?

We report an aggressive keratoacanthoma of the upper eyelid that recurred at the site of a previously excised keratoacanthoma. The diagnosis was confirmed by biopsy. Because the surgery required would be extensive, medical therapy was tried first. The tumor was treated with intralesional injections of 5-fluorouracil and radiotherapy. Despite this therapy, the orbital computed tomogram showed tumor extension into the orbit, and an orbital exenteration was performed. Histopathology of the excised tumor was consistent with squamous cell carcinoma. We discuss the topic of malignant transformation of the keratoacanthoma.

Cutaneous lymphangiectases after therapy for carcinoma of the cervix--a case with unusual clinical and histological features.

Secondary lymphangioma (lymphangiectasis) has been reported as a consequence of lymphatic damage. No specific histological criteria can be used to differentiate primary lymphangioma circumscriptum from lymphangiectasis. We describe a woman who developed lymphangiectases on both non-lymphoedematous upper thighs after hysterectomy and radiation therapy for carcinoma of the cervix. This case differs from the secondary lymphangiomas reported previously in that the vascular channels appeared in newly formed adventitial dermis without histological changes in the epidermis.

Angiolymphoid hyperplasia with eosinophilia limited to the vulva.

A patient with angiolymphoid hyperplasia with eosinophilia is described. This is, to our knowledge, the first case report in which the lesions were located on the vulva.

Clear-cell syringoma. Immunohistochemistry and electron microscopy study.

Clear-cell syringoma is a histologic variant of syringoma that is otherwise clinically indistinguishable from ordinary syringoma. This variant is formed by cells that have pale or clear cytoplasm as a result of glycogen accumulation. There is a high association of clear-cell syringoma and diabetes mellitus. A case of clear-cell syringoma associated with diabetes mellitus is described. Electron microscopic examination revealed that periluminal cells showed intra- and extracytoplasmic multivesicular bodies that may be characteristic of the clear-cell variant. Immunohistochemistry for carcinoembryonic antigen (CEA) showed ordinary syringomas as in the presence of CEA within and surrounding duct-like spaces.

Basal cell carcinoma with matrical differentiation.

Three cases of basal cell carcinoma showing shadow cells within basaloid islands have been described using the term basal cell carcinoma with matrical differentiation for this histologic variant. We present four new cases of basal cell carcinoma with evidence of matrical differentiation. Unlike the cases previously published, these lesions showed nests of shadow cells either within the lobules of basaloid cells or forming nests in the stroma. We also noted the presence of a foreign body reaction and calcification. These neoplasms illustrate the capability of basal cell carcinoma to differentiate toward hair matrix cells. Basal cell carcinoma with matrical differentiation must be added to the uncommon variants of basal cell carcinoma showing adnexal differentiation. A parallel between the degrees of differentiation of the cutaneous sebaceous neoplasms with those showing matrical differentiation is proposed.

Solitary keratoacanthoma: a self-healing proliferation that frequently becomes malignant.

To discuss the relation between solitary keratoacanthoma (KA) and crateriform squamous cell carcinoma (cSCC), the clinical and histologic features of cutaneous crateriform squamous cell proliferations were studied. Two hundred twenty cases of wholly excised crateriform squamous cell proliferations were studied both clinically (age, sex, location, and duration) and histologically (hematoxylin-eosin-stained sections). For comparison, we studied 100 consecutive cases of wholly excised noncrateriform squamous cell carcinoma (ncSCC). One hundred forty-four of the 220 cases of crateriform squamous cell proliferations were histologically classified as KA. In 47 other cases, a relatively large area of the KA showed frank histologic and cytologic malignant transformation (mKA); this event could happen during every stage of the KA. Twenty-nine lesions were cSCCs without remnants of KA. The patients in the KA group were significantly younger (p = 0.000) than those in the other three groups. The ages of the patients in these three groups were not significantly different (p = 1.0). More KAs (16%) were located in areas that are not usually exposed to the sun than was the case with the other groups of neoplasms considered (2%, 3%, and 3%, respectively), and this difference was statistically significant (p = 0.001). Regarding the duration of the lesion, only the differences between KA and cSCC, KA and ncSCC, and mKA and ncSCC were statistically significant. Not every cutaneous crateriform squamous cell proliferation is a KA; in KA, the crater must be multilocular, the "lips" must be perforated, and the cornified contents do not usually project out of the "mouth." At least a quarter of KAs undergo malignant transformation, which occurs more frequently in older patients and photoexposed areas. This transformation is a focal event and may happen at any stage of KA development. Consequently, a suspected KA must be wholly excised and studied in serial paraffin blocks so as to disclose any focus of malignant transformation.

Epidermotropic metastases from internal carcinomas.

Four cases of epidermotropically metastatic carcinoma are reported. One of them originated from a breast adenocarcinoma; in two other cases, the primary tumor was located in the large intestine; and, in the fourth case, the primary malignancy was a laryngeal squamous cell carcinoma. Clinically, the cutaneous metastases were nodular lesions and histologically, in addition to the involvement of the dermis by malignant cells, in three cases there was intraepidermal involvement by glandular structures. In the fourth case, the cutaneous metastatic tumor cells showed striking "folliculotropism." We review the literature of epidermotropically metastatic carcinoma and discuss its differential diagnosis.