Cutaneous Ganglioneuromas With Overlying Epidermal Hyperplasia: A Case Series Presentation and Proposal of Potential Etiopathogenesis.

ABSTRACT: Cutaneous ganglioneuromas (GNs) are exceptionally uncommon tumors, and many reported cases describe association with overlying epidermal hyperplasia that may be interpreted as seborrheic keratosis (SK) or SK-like proliferation. We report 5 cases of cutaneous GN in adult patients; all of which were discovered incidentally in the immediate vicinity of epidermal hyperplasia. A review of the literature demonstrates the current-although likely imperfect-understanding of the etiopathogenesis of both SK and GN in the skin. We explore the putative pathophysiologies of other common, well-characterized skin lesions and, taking them into account, provide rationale for the coexistence of cutaneous GN with overlying SK and SK-like epidermal changes. However, we ultimately acknowledge a dilemma of causality and, given the rarity of their co-occurrence, objectively question whether occasional cameo appearances by GN lying subjacent to SK and SK-like hyperplasia may be due merely to chance.

Case report: Disseminated histoplasmosis in a renal transplant recipient from a non-endemic region.

Histoplasmosis is the most common endemic fungal infection in the USA. The majority of cases are asymptomatic and have clear exposure to endemic regions. In contrast, we present an adolescent immunocompromised patient with systemic and relatively non-specific symptoms including abdominal pain, weight loss, lower extremity edema, and scabbing skin lesions, without known exposure to endemic areas for histoplasmosis. Histologic analysis of gastrointestinal and skin biopsies eventually revealed a diagnosis of disseminated histoplasmosis; the patient was successfully treated with amphotericin B followed by itraconazole maintenance therapy. Ultimately, a high bar of suspicion for fungal disease must be maintained in immunosuppressed individuals even without apparent exposure history to endemic areas. This case report serves as a valuable reference for practitioners evaluating differential diagnosis of infections in immunocompromised patients.

Cutaneous Syncytial Myoepithelioma: A Nondescript Skin Tumor With Serious Diagnostic Pitfalls.

Cutaneous syncytial myoepithelioma (CSM) is a rare tumor with a nondescript clinical presentation in the skin. It represents a relatively uncommon diagnostic entity with approximately 50 examples in the literature to date. We present a 36-year-old man with a new, tender 3-mm firm pink papule on the left bicep, in which a superficial shave technique produced a diagnostic challenge. CSM often poses a diagnostic quandary given shared histomorphological and immunohistochemical attributes with superficial mesenchymal or neurocristic tumors, namely, melanocytic proliferations, fibrous histiocytoma, and epithelioid sarcoma. The molecular profile of CSM may reveal EWSR1 or FUS gene rearrangement, but as we showcase, the diagnosis remains possible in the absence of this oncogenic fusion. Ultimately, there are pitfalls to avoid to correctly distinguish this benign myoepithelial lesion from more biologically aggressive neoplasia.

Chemotherapy-Associated Endometrial Atypia: A Potential Diagnostic Pitfall.

Cytotoxic chemotherapy, typically as a component of a multimodal approach, is a standard of patient care for numerous malignancies. Chemotherapy-associated cytologic alterations in otherwise normal tissues have been reported at several anatomic sites. We describe in this article distinctive cytologic alterations of the endometrium, including severe severe cytologic atypia, that was attributed to chemotherapy.

A rare case of dermatofibrosarcoma protuberans of the forefoot.

Dermatofibrosarcoma protuberans is an extremely rare, potentially malignant tumor type that usually presents on the trunk or proximal extremities. The clinical presentation includes a gradually enlarging painless plaque-like or nodular lesion of the skin with surrounding red to blue discoloration. The diagnosis is based on clinical presentation, computed tomography or magnetic resonance imaging, and biopsy with histologic analysis. An early and timely diagnosis improves chances of complete surgical resection thus improving prognosis. Herein, we present a rare case of dermatofibrosarcoma protuberans with the hopes that its addition to the literature will aid in the earlier recognition of future patients and help prevent this potentially curable disease from becoming deadly.