ABSTRACT
This case highlights a primary cutaneous rhabdomyoma presenting as a slowly enlarging subcutaneous nodule on the mentum of an 82-year-old White man with a medical history of two intracranial rhabdomyomas. Although they are rarely syndromic, it is important to note that the most common demographic for presentation of rhabdomyomas includes older males presenting as a subcutaneous nodule on the head, neck, or oral cavity. They are most often seen in isolation but can be multifocal in up to 25% of all cases. Being a rare entity, there is no generally recognized treatment consensus; however, complete surgical excision is recommended to prevent recurrence and morbidity from local tissue destruction.
Subject(s)
Rhabdomyoma , Skin Neoplasms , Aged, 80 and over , Humans , Male , Chin , Neck , Rhabdomyoma/diagnosis , Rhabdomyoma/surgery , White People , Skin Neoplasms/diagnosis , Skin Neoplasms/surgeryABSTRACT
Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor with metastatic potential. EHE can have single- or multiorgan involvement, with presentations ranging from asymptomatic disease to pain and systemic symptoms. The extremely heterogeneous clinical presentation and disease progression complicates EHE diagnosis and management. We present the case of a 24-year-old woman with two periauricular erythematous papules, leading to the discovery of metastatic EHE through routine biopsy, despite a noncontributory medical history. Histology revealed the dermal proliferation of epithelioid cells and vacuoles containing red blood cells. Immunohistochemistry markers consistent with EHE solidified the diagnosis. Although extremely rare, prompt diagnosis of EHE is essential for informed decision-making and favorable outcomes. Key clinical and histopathological findings are highlighted to aid dermatologists in diagnosing and managing this uncommon condition.
Subject(s)
Hemangioendothelioma, Epithelioid , Humans , Hemangioendothelioma, Epithelioid/diagnosis , Hemangioendothelioma, Epithelioid/pathology , Female , Young Adult , Skin Neoplasms/pathology , Skin Neoplasms/diagnosis , Biopsy , ImmunohistochemistryABSTRACT
Clear cell acanthoma is a benign epidermal lesion with a variable clinical appearance and distinct histopathology features. Although, it is considered an entirely benign entity, few case reports describe unusual or atypical variants of clear cell acanthoma. We observed a case of a large clear cell acanthoma that also has features of a keratoacanthoma.
Subject(s)
Acanthoma/pathology , Keratoacanthoma/pathology , Skin Neoplasms/pathology , Acanthoma/chemistry , Acanthoma/diagnosis , Biomarkers, Tumor , Diagnosis, Differential , Glycogen/analysis , Humans , Keratinocytes/chemistry , Keratinocytes/pathology , Male , Middle Aged , Periodic Acid-Schiff Reaction , Skin Neoplasms/chemistry , Skin Neoplasms/diagnosisABSTRACT
CONTEXT: Metastatic basal cell carcinoma (BCC) is relatively rare and is seldom considered a complication in the routine treatment and follow-up of patients with BCC. Although multiple studies have tried to distinguish aggressive from nonaggressive BCCs, to our knowledge, no consistent clinical, histopathologic, or immunohistochemical features have yet been reported. OBJECTIVE: To report 4 cases of metastatic BCCs and to evaluate these in addition to known nonmetastatic BCCs with specific immunostains in an attempt to find distinct morphologic or immunohistochemical patterns that could be helpful in identifying aggressive BCCs. DESIGN: We reviewed 4 cases of metastatic BCCs and recorded the clinical and morphologic findings. We then searched our archives for 14 cases of BCC that followed the usual nonaggressive course. We evaluated these 18 cases with immunohistochemical stains for Ki-67, p53, and bcl-2. RESULTS: In metastasizing BCC, Ki-67 staining was slightly higher in metastatic sites than in primary sites (average 63% and 51%, respectively). p53 was expressed in 3 of 4 primary sites and 2 of 4 metastatic sites. Bcl-2 was positive in both primary and metastatic sites in 3 of 4 cases. In the 14 cases of nonaggressive BCC, staining for Ki-67 averaged 38%, p53 was positive in 11 cases, and Bcl-2 staining was noted in 13 cases. CONCLUSIONS: Overall, in the small sample that we evaluated, the immunohistochemical markers for Ki-67, p53, and Bcl-2 did not distinguish between metastatic and nonaggressive BCCs.
Subject(s)
Carcinoma, Basal Cell/secondary , Skin Neoplasms/pathology , Adult , Aged , Aged, 80 and over , Biomarkers, Tumor/analysis , Carcinoma, Basal Cell/chemistry , Fatal Outcome , Female , Humans , Immunohistochemistry , Ki-67 Antigen/analysis , Male , Neoplasm Metastasis/pathology , Proto-Oncogene Proteins c-bcl-2/analysis , Skin Neoplasms/chemistry , Tumor Suppressor Protein p53/analysisABSTRACT
Warthin's tumors are benign lesions of the head and neck that have a characteristic morphologic appearance. The etiology of Warthin's tumors is controversial and whether they are true neoplasms or developmental malformations continues to be debated. In this study, we examined 12 Warthin tumors with a molecular and immunohistochemical approach. Immunostains for p53 and p16ink were performed. The epithelial and lymphoid components of each lesion were microdissected and PCR was performed for 13 microsatellite markers at or near common tumor suppressor genes. The results were analyzed semiquantitatively using capillary electrophoresis. Frequency of allelic loss was calculated. The epithelial component of all tumors was negative for p53 and p16ink. By molecular genotyping there was only one case that had one locus with allelic imbalance, while the remainder had no evidence of clonal allelic loss. The immunohistochemical and molecular results in this study lend support to the hypothesis that Warthin tumors are non-neoplastic, as there was no evidence of aberrant staining for tumor suppressor gene protein products and no evidence of consistent clonal allelic losses.