Clinical and histological patterns of dermatofibroma without gross skin surface change: A comparative study with conventional dermatofibroma.

BACKGROUND: Dermatofibroma sometimes clinically presents as a nodular lesion without gross skin surface change. Clinicopathologic features of this variant of dermatofibroma have not been evaluated. AIMS: To assess clinicopathologic features of dermatofibroma presenting as a subcutaneous nodule. METHODS: This study reviewed the clinical and histological features of 42 cases of subcutaneous dermatofibromas and compared them with 95 cases of conventional dermatofibroma. RESULTS: Dermatofibroma without gross skin surface change was associated with a shorter pre-diagnosis duration than conventional dermatofibroma. Increase in size during the pre-diagnosis period was significantly more frequent in the conventional type. In addition, these dermatofibromas were more likely than the conventional type to occur in the head and neck region. Although tumor depth was deeper than in the conventional type, less than half of the dermatofibromas without gross skin surface change were found histologically to be "subcutaneous" or "deep-penetrating dermatofibroma". Subcutaneous extension was more frequent in these dermatofibromas while focal stromal hyalinization and hemosiderin deposits were more common in the conventional type. LIMITATIONS: This study is a retrospective, single center design. CONCLUSION: The present study suggests that dermatofibroma without gross skin surface change is a variant type with distinct clinical and histological features that distinguish them from conventional dermatofibroma.

The conundrum of parapsoriasis versus patch stage of mycosis fungoides.

Terminological confusion with benign dermatosis, such as parapsoriasis en plaques, makes it difficult to diagnose mycosis fungoides in the early patch stage. Early diagnosis of mycosis fungoides (MF) is important for deciding on type of therapy, prognosis and for further follow-up. However, until recently, there has been no consensus on criteria that would help in diagnosing the disease early. Some believe that large plaque parapsoriasis (LPP) should be classified with early patch stage of MF and should be treated aggressively. However, there is no firm clinical or laboratory criteria to predict which LPP will progress to MF and we can only discuss about statistical probability. Moreover, long-term outcome analysis of even patch stage of MF is similar to that of control population. We therefore believe that LPP should be considered as a separate entity at least to prevent the patient from being given a frightening diagnosis. We also feel that patients need not be treated with aggressive therapy for LPP and will need only a close follow-up. This article emphasizes the criteria for diagnosing early MF and has highlighted the importance of considering LPP as a distinct benign entity.

Nevus of Ota: a series of 15 cases.

BACKGROUND: The nevus of Ota is a dermal nevus characterized by bluish pigmentation in the distribution of the first and the second division of the trigeminal nerve. AIM: Our aim was to study the cutaneous and extracutaneous manifestations of the nevus of Ota. METHODS: A total of 15 cases were included in our study. A detailed history, clinical examination along with direct ophthalmoscopy and otoscopy were done for all the cases. RESULTS: Most of the patients (60%) had lesions at birth and the majority (86.7 %) were females. Five (33.3%) patients belonged to Tanino class II. Combined dermal and ocular involvement was observed in 60% of the cases. CONCLUSION: Tanino class II was the most common type observed in our studies. A few rarer associations such as nevus of Ito and hemangioma were also noted in our patients.

Different histologic patterns of cutaneous granulomas in systemic lymphoma.

BACKGROUND: Patients with Hodgkin's and non-Hodgkin's lymphomas may develop non-infectious granulomas in both involved and uninvolved organs, but rarely in the skin. Cutaneous granulomas in the setting of a systemic lymphoma are of two types. The first type is characterized by granulomatous infiltrates admixed with neoplastic cells within specific skin lesions of malignant lymphomas. The second type consists of granulomatous skin processes that are non-specific manifestations of the underlying lymphoma. OBJECTIVE: To describe the variegate histologic patterns of cutaneous granulomatous reactions of the second type in patients with systemic lymphomas. METHODS: We describe three patients with systemic lymphomas who exhibited three different histologic patterns of cutaneous granulomatous lesions. RESULTS: The first patient had non-Hodgkin's lymphoma with cutaneous tuberculoid-type granuloma mimicking tuberculoid leprosy; the second patient had Hodgkin's lymphoma with palisaded, necrobiotic granuloma of granuloma annulare-type; and the third patient had non-Hodgkin's lymphoma with sarcoid-type granuloma. No evidence of the underlying systemic lymphoma was found in the cutaneous lesions involved by the granulomatous process. CONCLUSIONS: Cutaneous granulomas may be a non-specific sign of an underlying systemic lymphoma. Their histologic patterns are variegate and include sarcoid-type granuloma, palisaded and necrobiotic granuloma of granuloma annulare-type, and tuberculoid granuloma. In patients who present with non-infectious, granulomatous skin reactions in the absence of another sound explanation, the possibility of a systemic lymphoma should be considered.

Megacarcinomas cutáneos históricos

Se expone la gran frecuencia del cáncer cutáneo, tanto epiteliomas como melanomas, resaltando los casos de tumores malignos cutáneos de gran tamaño, de otras épocas, algunos en enfermos de lepra que gracias al diagnóstico y tratamiento precoz, son actualemte excepcionales.

Clinical classification of African Kaposi's sarcoma: time for reappraisal.

PIP: African Kaposi's sarcoma (KS) remains a medical curiosity which continues to intrigue and elude medical science. While impaired cell-mediated immunity has been associated with some subtypes of African KS before and after the advent of AIDS, its role in the pathogenesis of African KS has never been defined. Determining the role of host immunity in the pathogenesis of African KS could, however, yield important insights into the tumor. The author notes that immune impairment from causes other than AIDS could exert similar influences upon the biological and clinical behavior of African KS. Unfortunately, preoccupation with the relationship between AIDS and atypical KS has overshadowed interest in the relation between immunosuppression in general and African KS. That different morphologic subtypes of African KS have identical histology suggests that they are manifestations of the same disease. Clinical manifestations of African KS in a susceptible host is probably determined by a complex interplay between host immunity and putative cofactors such as infectious agents, KS antigens, hormones, and genetic and environmental factors. African KS has a clinical spectrum ranging from localized to generalized. Hosts with relatively good cellular immunity develop localized lesions, while hosts with markedly impaired immunity develop generalized cutaneous or lymphadenopathic KS. The author draws an analogy with leprosy to help clarify the role of host immunity in the clinical manifestations and behavior of African KS.^ieng