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OBJECTIVE: To present a series of conjunctival keratoacanthomas and provide clinical, histopathological, immunohistochemical, and imaging results that characterize this rare entity. METHODS: A retrospective chart review of records from 2005 to 2023 from the Florida Lions Ocular Pathology Laboratory was conducted. Nine patients with histologically proven conjunctival keratoacanthoma were identified. Data extracted includes demographics, clinical history, diagnostic testing, histopathological and immunohistochemical testing, treatment modalities, and recurrences. RESULTS: Patients' mean age was 55.2 ± 21.1 years (range: 22-83). 77.8% (7/9) of patients were male. 55.6% (5/9) were Hispanic. 55.6% of lesions (5/9) were in right eyes. 55.6% of lesions (5/9) were on the temporal, bulbar conjunctiva. The lesions were rapidly growing, with mean onset time of 4.71 ± 3.30 weeks (range: 2-12). High-resolution anterior segment optical coherence tomography of three lesions revealed hyper-reflective, thickened epithelium with abrupt transition between normal and abnormal epithelium. Underlying disorganized subepithelial tissue was noted. However, the overlying abnormal epithelium caused considerable shadowing, which obscured subepithelial structures. Prominent, keratin-filled, cup-shaped lesions with faulty maturational sequencing that extend full thickness, variably pale cytoplasm, and foci of dyskeratosis and hyperkeratosis were present on all lesions' histopathology. All lesions were surgically excised, but two demonstrated partial spontaneous resolution before surgery. Two patients were lost to follow-up; the remaining seven had no signs of recurrence at a of mean of 36.9 ± 45.4 months (range: 3 to 141 months) of follow-up. CONCLUSIONS: Conjunctival keratoacanthomas are rare lesions of the ocular surface with distinct clinical, histopathologic, and diagnostic features.
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Mycobacterium avium-intracellulare (MAC) infection may have different skin manifestations, including cutaneous granulomas. Granulomatous skin reactions have distinct morphologic and histopathologic appearances. We present the case of an adolescent male with cutaneous MAC, misdiagnosed as sarcoidosis after initial biopsy results, demonstrated preservation of reticulin fibers and absence of organisms within granulomas. Sarcoidal granulomas often stain positive for reticulin fibers, which could be used to distinguish them from the infectious kind. This case should alert clinicians to the fact that the presence or quantity of intact reticular fibers may not be a reliable tool to differentiate between a sarcoidal and an infectious granuloma. Our case also highlights the diagnostic challenge of cutaneous MAC infection.
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Infecção por Mycobacterium avium-intracellulare , Sarcoidose , Humanos , Masculino , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Diagnóstico Diferencial , Sarcoidose/diagnóstico , Adolescente , Dermatopatias Bacterianas/diagnóstico , Dermatopatias Bacterianas/microbiologia , Complexo Mycobacterium avium/isolamento & purificação , BiópsiaRESUMO
Squamoid eccrine ductal carcinoma (SEDC) is a rare cutaneous neoplasm that often manifests as a plaque or nodule in sun-exposed areas of older patients. Herein, the authors report the first case of SEDC in the eyelid. A 76-year-old man presented with a 2.5 × 1.5 mm area of left upper eyelid erythema, thickening, ulceration, and scaling with madarosis superotemporally just above the lash line. Full-thickness wedge biopsy demonstrated irregular epithelial tubules with nuclear atypia and focal squamous differentiation, consistent with SEDC. The patient underwent Mohs resection and has had no recurrence approximately 27 months after surgical removal. The authors present this case to raise awareness of SEDC to ophthalmologists as all previous cases have been described in the nonophthalmic literature. A full-thickness biopsy is recommended to avoid misdiagnosing SEDC as squamous cell carcinoma (SCC), a less aggressive tumor. With greater awareness, there may be increased recognition of this likely underreported, more malignant entity.
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Adenocarcinoma de Células Claras , Neoplasias Ósseas , Neoplasias da Mama , Carcinoma Ductal , Carcinoma de Células Escamosas , Neoplasias Palpebrais , Neoplasias das Glândulas Sudoríparas , Idoso , Neoplasias Ósseas/patologia , Neoplasias da Mama/patologia , Carcinoma Ductal/patologia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Glândulas Écrinas/patologia , Neoplasias Palpebrais/diagnóstico , Neoplasias Palpebrais/patologia , Neoplasias Palpebrais/cirurgia , Pálpebras/patologia , Humanos , Masculino , Neoplasias das Glândulas Sudoríparas/diagnóstico , Neoplasias das Glândulas Sudoríparas/patologia , Neoplasias das Glândulas Sudoríparas/cirurgiaAssuntos
Dermatologistas , Neoplasias , Biópsia , Humanos , Indicadores de Qualidade em Assistência à Saúde , PeleRESUMO
Blister beetles are a group of insects that include the Meloidae, Oedemeridae, and Staphylinidae families. The most well-known family, Meloidae, has more than 200 species known for causing a blistering dermatitis in humans by emitting the substance cantharidin, which has been pharmacologically used as a vesicant and can cause deleterious effects if ingested. Most recently, blister beetles have been studied for their anticancer properties.
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Besouros , Dermatite/etiologia , Dermatite/patologia , Animais , Cantaridina , HumanosRESUMO
BACKGROUND: Skin reactions to the sting of the imported fire ant have characteristic clinicopathological features. METHODS: One case of experimental envenomation was prospectively followed during 48 hours, with biopsies. In addition, 6 cases from our laboratory were retrospectively evaluated histopathologically for the following features: spongiosis, exocytosis (and type of cells), pustule formation, erosion/ulceration, epidermal necrosis, scale/crust, papillary dermal edema, inflammatory dermal infiltrate (cell type, density, depth, distribution, shape), red blood cell extravasation, vasculopathy and vasculitis. RESULTS: The typical lesion follows a very distinctive clinical and histopathologic evolution over 48 hours, with the formation of a subepidermal pustule overlying a wedge-shaped area of dermal collagen basophilic degeneration with scattered neutrophils. In the 6 cases retrieved from our files, the main features were a superficial and deep dermal, perivascular, periadnexal and interstitial infiltrate consisting of neutrophils, with basophilic degeneration of the collagen. A subepidermal pustule was noted in half of the cases. CONCLUSIONS: In biopsies taken in a clinical setting, even in the absence of the characteristic subepidermal pustule, the diagnosis of imported fire ant sting can be suspected if there is a superficial and deep perivascular, periadnexal and interstitial infiltrate composed of neutrophils, with some basophilic denaturation of collagen.
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Venenos de Formiga/efeitos adversos , Artrópodes , Mordeduras e Picadas/patologia , Derme/patologia , Edema/patologia , Epiderme/patologia , Exantema/patologia , Neutrófilos/patologia , Dermatopatias/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Venenos de Formiga/toxicidade , Formigas , Biópsia , Mordeduras e Picadas/diagnóstico , Mordeduras e Picadas/veterinária , Colágeno , Edema/etiologia , Edema/veterinária , Feminino , Humanos , Inflamação/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Dermatopatias/etiologia , Dermatopatias/veterinária , ViolênciaRESUMO
IMPORTANCE: Mutations driving melanoma growth have diagnostic, prognostic, and therapeutic implications. Traditional classification systems do not correlate optimally with underlying melanoma growth-promoting mutations. Our objective was to determine whether unique dermoscopic growth patterns directly correlate with driving mutations. OBSERVATIONS: We evaluated common driving mutations in 4 different dermoscopic patterns (rhomboidal, negative pigmented network, polygonal, and dark homogeneous streaks) of primary cutaneous melanomas; 3 melanomas per pattern were tested. Three of the 4 patterns lacked common mutations in BRAF, NRAS, KIT, GNAQ, and HRAS. One pattern, the dark homogeneous streaks pattern, had unique KIT mutations in the second catalytic domain of KIT in exon 17 for all 3 samples tested. Two tumors with the dark homogeneous streaks pattern turned out to be different primary melanomas from the same patient and had different sequence mutations but had an impact on the same KIT domain. CONCLUSIONS AND RELEVANCE: While future study is required, these results have multiple implications. (1) The underlying melanoma-driving mutations may give rise to specific dermoscopic growth patterns, (2) BRAF/NRAS mutations in early melanomas may not be as common as previously thought, and (3) patients may be predisposed to developing specific driving mutations giving rise to melanomas or nevi of similar growth patterns.
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Dermoscopia , Melanoma/genética , Melanoma/patologia , Mutação , Proteínas Proto-Oncogênicas c-kit/genética , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/patologia , HumanosRESUMO
Fungal infection is a common clinical problem in dermatology. While most cases in practice are superficial infections, invasive subcutaneous mycoses are important to recognize and treat, as these conditions often have significant morbidity and mortality. Deep fungi demonstrate species-specific syndromes and may be identified by clinical and histological features in addition to serological evaluation and culture. Identification of the common innoculation subcutaneous mycoses, as well as those associated with pulmonary primary infection and dissemination to the skin is important, as treatments vary by organism and clinical setting. This overview will help to identify the key dermatological presentations of subcutaneous fungal infection, and the clues they give to cause.
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Dermatomicoses/diagnóstico , Biópsia , Dermatomicoses/patologia , Dermatomicoses/terapia , Dermatomicoses/transmissão , Diagnóstico Diferencial , Humanos , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/patologia , Infecções Oportunistas/terapia , Infecções Oportunistas/transmissão , Tela Subcutânea/patologiaRESUMO
BACKGROUND: The cutaneous form of Rosai-Dorfman disease (RDD) is a rare entity that manifests solely with skin papules or nodules and does not present with the usual myriad of symptoms of classical RDD. AIMS: To analyze the most recent publications regarding cutaneous RDD to point out updated, relevant aspects regarding future directions for clinical recognition and management. To identify histopathologic and immunohistochemical findings in skin lesions that permit diagnosis. MATERIALS AND METHODS: We present a case of a gentleman with a history of multiple lipomas with a new solitary nodule on physical exam; microscopic examination shows the typical findings of RDD with the associated diagnostic immunohistochemical profile, as well as the expected finding of histiocytes engulfing other intact inflammatory cells. RESULTS: Our patient was managed with surgical excision of the entire lesion, one of the several available treatment options. Long-term follow-up 2 years later did not reveal any complications, recurrences, or new lesions. CONCLUSION: The diagnosis of cutaneous RDD is differentiated from other histiocytic conditions by the combination of clinical findings accompanied by histopathologic and immunohistochemical confirmation.
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Transformação Celular Neoplásica/patologia , Linfonodos/patologia , Melanoma/patologia , Nevo de Ota/patologia , Neoplasias Cutâneas/patologia , Biópsia por Agulha , Criança , Progressão da Doença , Face , Evolução Fatal , Humanos , Imuno-Histoquímica , Linfonodos/cirurgia , Masculino , Melanoma/fisiopatologia , Melanoma/cirurgia , Esvaziamento Cervical/métodos , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Nevo de Ota/fisiopatologia , Nevo de Ota/cirurgia , Glândula Parótida/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Neoplasias Cutâneas/fisiopatologiaAssuntos
Elafina/sangue , Eritema/sangue , Rejeição de Enxerto/sangue , Doença Enxerto-Hospedeiro/sangue , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Idoso , Biomarcadores/sangue , Biópsia por Agulha , Neoplasias do Sistema Nervoso Central/patologia , Neoplasias do Sistema Nervoso Central/cirurgia , Elafina/genética , Eritema/etiologia , Seguimentos , Doença Enxerto-Hospedeiro/diagnóstico , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Imuno-Histoquímica , Linfoma/patologia , Linfoma/cirurgia , Masculino , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Medição de Risco , Sensibilidade e Especificidade , Síndrome , Resultado do TratamentoRESUMO
We report the first documented case of an atypical form of transient reactive papulotranslucent acrokeratoderma (TRPA) in a patient heterozygous for the ΔF508 CFTR(cystic fibrosis transmembrane conductance regulator) mutation. TRPA represents a condition that classically presents with translucent to white plaques that become evident after water exposure. An atypical form with persistent lesions has also been described. Our patient is a 16-year-old girl with small, white papules coalescing into pebbly plaques on the palms. This condition is exacerbated after 5-10 min of water exposure and is associated with discomfort. The skin biopsy showed expanded stratum corneum, orthohyperkeratosis and dilation of eccrine ducts consisting with TRPA. A cystic fibrosis carrier state, barrier function defect, hyperhidrosis and the intake of cyclooxygenase inhibitors may have been pathogenic factors in our patient.
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Fibrose Cística/complicações , Epiderme/patologia , Ceratodermia Palmar e Plantar/etiologia , Adolescente , Fibrose Cística/genética , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Feminino , Mãos , Heterozigoto , Humanos , Ceratodermia Palmar e Plantar/genética , Ceratodermia Palmar e Plantar/patologia , Mutação , Pele/patologiaRESUMO
Coma blisters are self-limited cutaneous bullae that occur in the setting of loss of consciousness because of a drug, illness, or accident, with the most common settings being barbiturate overdose and neurological disorders. The etiology behind coma blisters is poorly understood and is not related to underlying infections or autoimmune conditions. The clinical presentation consists of bullae, erosions, and violaceous plaques usually involving sites of pressure. The skin lesions usually occur within 48-72 hours of the start of a coma and resolve within 2-4 weeks. We present one case of a 5-month-old infant with severe valvular disease who required surgical repair. He was placed on extra corporeal membrane oxygenation and developed multiple tense coma blisters during the course of therapy. Skin biopsy revealed a noninflammatory subepidermal blister with necrosis of the overlying epidermis and necrosis of the eccrine ducts. We also present a second case of an 18-year-old female patient who underwent surgical resection of a benign mandibular tumor. She subsequently developed bullae on both arms 4 days after surgery. The skin biopsy showed a necrotic epidermis, a subepidermal blister, and diffuse necrosis of the eccrine coils.
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Vesícula/etiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Coma/induzido quimicamente , Sedação Profunda/efeitos adversos , Procedimentos Cirúrgicos Bucais/efeitos adversos , Pele/patologia , Adolescente , Biópsia , Vesícula/patologia , Vesícula/terapia , Feminino , Humanos , Lactente , Masculino , Necrose , Fatores de TempoRESUMO
BACKGROUND Human growth hormone (HGH) and insulin-like growth factor-1 (IGF-1) have been shown to play a role in the malignant transformation and progression of a variety of cancers. HGH is also known to upregulate molecular signaling pathways implicated in the pathogenesis of melanoma. Although HGH has previously been implicated in promoting the clinical growth of both benign and malignant melanocytic neoplasms, to our knowledge there are no conclusive studies demonstrating an increased risk of melanoma following HGH therapy. Nevertheless, there are reports of melanoma developing subsequent to HGH coadministered with either other hormones or following irradiation. OBSERVATION A 49-year-old white man presented with a new pigmented papule that was diagnosed as melanoma. The patient reported using HGH for 3 months prior to the diagnosis. His 51-year-old wife, who also was white, had also been using exogenous HGH for 3 months and had been diagnosed as having a melanoma 2 weeks prior. CONCLUSIONS Given the unlikelihood of 2 unrelated people developing melanoma within a short time span, it is reasonable to assume that a common environmental component (HGH or other shared exposure) contributed to the development of both melanomas. Because of the increased use of exogenous HGH as an antiaging agent, it is important to be aware of the growth-promoting effects of this hormone. Until better data are available that determines the true risk of exogenous HGH, its use as an antiaging agent merits increased surveillance.
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Hormônio do Crescimento Humano/efeitos adversos , Melanoma/induzido quimicamente , Neoplasias Cutâneas/induzido quimicamente , Envelhecimento , Feminino , Humanos , Injeções Subcutâneas , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Automedicação , Neoplasias Cutâneas/patologiaRESUMO
Basal cell carcinomas (BCC) have a specialized microvasculature system that can be targeted by the 585-nm pulsed dye laser (PDL) utilizing the theory of selective photothermolysis. Seven volunteers with nine well-defined, biopsy-proven BCCs, were treated with the PDL (585-nm wavelength, a single 450-µs pulse, 7-mm spot size, and 9.0 J/cm(2) energy). The lesions, along with a 4-mm border of normal skin were treated. Pain assessment was carried out immediately after the laser treatment. A deep shave biopsy with histological examination occurred 4 weeks after the laser treatment. Pain was assessed on a scale of 0 (no pain) to 10 (worst pain possible). The average patient score was 2.1 (range 1-4). On histology, 5/9 (55.6%) sites demonstrated no evidence of BCC; however, 4/9 (44.4%) sites showed residual BCC. Although the PDL was able to clear over half of the BCCs in this study, there was an unacceptably high persistence rate of 44.4%. The PDL did not achieve the clearance rate that can be attained with current standard BCC treatment modalities. At this time, we do not recommend that a single treatment with the 585-nm PDL can be used as a primary therapy for BCC.
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Carcinoma Basocelular/cirurgia , Lasers de Corante/uso terapêutico , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Carcinoma Basocelular/irrigação sanguínea , Feminino , Humanos , Lasers de Corante/efeitos adversos , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/irrigação sanguínea , Falha de Tratamento , Resultado do TratamentoRESUMO
Endometriosis is a condition where endometrial glands and stroma are ectopically located in sites other than the uterine cavity. Cutaneous endometriosis is very rare, representing approximately 1.1% of cases of extrapelvic endometriosis. We report a case of a 44-year-old female with no prior surgical history who presented with multiple tan brown periumbilical nodules. Histopathological examination revealed multiple glandular structures in the dermis with surrounding stroma. Immunohistochemistry cinches the diagnosis, as CD10, estrogen receptor and progesterone receptor are strongly positive in our case. The mainstay of treatment of cutaneous endometriosis is surgical excision of the lesion.