Granular cell cutaneous epithelioid angiomatous nodule.

Cutaneous epithelioid angiomatous nodule is an uncommon vascular lesion usually described as composed of epithelioid endothelial cells with vesicular nuclei and eosinophilic cytoplasm. A granular cell variant has not been previously described. Endothelial cells can present with granular cytoplasm as documented with reports of granular cell angiosarcoma. The granularity is thought to be due to increased intracytoplasmic lysosomes. We present a case of a benign superficial vascular lesion composed of a sheet-like proliferation of epithelioid endothelial cells with distinctly granular cytoplasm confirmed as of endothelial origin with positive staining for CD31 and ERG.

Grape Cells (Multinucleated Keratinocytes) in Noninfectious Dermatoses: Case Series and Review of the Literature.

Multinucleated keratinocytes (also known as multinucleated epidermal giant cells) are a frequently overlooked histological finding in noninfectious inflammatory dermatoses. They are sometimes found in conditions characterized by chronic rubbing and pruritus, such as lichen simplex chronicus or prurigo nodularis, and may be a helpful clue in making the clinical diagnosis. This finding must be differentiated from other conditions characterized by multinucleated keratinocytes on histopathology, specifically herpes simplex, varicella zoster, or measles viral infections. The authors present a case series of 2 patients with unique clinical noninfectious diagnoses but similar histopathologic findings on biopsy. The histopathologic findings on both cases demonstrated multinucleated keratinocytes, which were related to manipulation of the epidermis.

Hailey-Hailey disease exacerbated by multiple pregnancies: case report and review of the literature.

Hailey-Hailey disease is a rare chronic skin disorder that is inherited in an autosomal dominant manner. The disease is characterized by development of vesicles and bullae typically in the intertriginous areas. On histology, there is widespread intraepidermal acantholysis causing the "dilapidated brick-wall" appearance. Mutations in the ATP2C1 gene, encoding for P-type Ca2+ transport ATPase, is the primary cause of the disease. The disease manifests around puberty and runs a chronic course with remissions and exacerbations. Ultraviolet light exposure, sweating, friction, stress, and cutaneous infections are the known precipitants of the disease. We report a case of a woman with recurrent flare-ups of Hailey-Hailey disease with repeated pregnancies and remission of her disease during non-pregnancy periods. To our knowledge, this is the first reported case of Hailey-Hailey disease exacerbated by pregnancy.

Myxoid stroma and delicate vasculature of a superficial angiomyxoma give rise to the red planet sign.

Superficial angiomyxomas are uncommon benign mesenchymal tumors. They often recur locally if partially removed. This case report demonstrates not only the characteristic pathological findings of a superficial angiomyxoma in a 33- year-old man, but also shows a unique dermatoscopic image, which in our estimation resembles a celestial red planet such as the blood moon seen during a lunar eclipse. We propose to call this the "red planet" sign for a superficial angiomyxoma on dermoscopic examination.

Sea urchin spines in the stratum corneum: an early finding related to trauma.

Penetrating trauma from sea urchin (Echinoidea) spines has been shown to cause numerous cutaneous reactions, ranging from initial pain that rapidly dissipates and resolves to chronic inflammation and formation of characteristic sea urchin granulomas. Many of these skin-colored or violaceous papules and nodules form weeks to months after injury, and may be surgically excised. Histopathologic examination commonly shows well-defined granulomas, the majority of which represent sarcoidal-type granulomas. Other microscopic patterns, such as foreign body reactions and chronic inflammation, have also been shown. Retained spine fragments are birefringent on polarized microscopic examination and are most likely found in the dermal layer. Herein, we describe a case of traumatic sea urchin cutaneous injury with a unique early cutaneous trauma reaction in a young male who lived in Hawaii. Histopathologic exam was significant for retained spines in the layer of the stratum corneum, but no signs of granulomatous inflammation were observed. This case report emphasizes the unique features of our case and reviews the common clinical and histopathologic features of sea urchin cutaneous reactions.

Multicentric infantile hemangiopericytoma: case report and review of the literature.

Hemangiopericytomas are rare tumors in which outcome varies with age of onset. Those developing in adults and older children tend to be aggressive with a poor prognosis. However, infantile hemangiopericytomas often behave in a more benign manner. Recent findings suggest aggressive lesions may be histogenetically distinct. Multicentric disease is exceptionally rare, but tends to occur in infants and poses a therapeutic challenge. We present a case with extensive cutaneous and intracranial involvement, which resolved spontaneously. Tumor behavior is a key consideration in management, with careful observation recommended in uncomplicated cases and intervention indicated if more aggressive growth or spread occurs.

Classic and atypical Spitz nevi: review of the literature.

Both classic and atypical Spitz nevi are uncommon melanocytic lesions usually presenting in children and adolescents. The classic Spitz nevus typically is benign and has characteristic clinical and histologic features. In contrast, the atypical Spitz nevus has an unknown clinical prognosis, and its clinical and histologic traits are loosely defined. Melanoma can have similar features to both classic and atypical Spitz nevi and must be ruled out in all cases. We review the literature on classic and atypical Spitz nevi, advances in differentiating both types of nevi from melanoma, and treatment options.

Rheumatoid arthritis in a military aviator.

Rheumatoid arthritis is a chronic inflammatory condition whose pathogenesis is determined partially by genetic and environmental factors. Without treatment, 20 to 30% of individuals with this condition will become permanently disabled in a few years. Rheumatoid arthritis and its potential complications can cause significant disability and could seriously affect the performance of an aviator. Traditionally, disease-modifying anti-rheumatic drugs (DMARD) and biologics have not been used until disease progression occurs, but they recently have been added earlier in the course of disease for a more aggressive approach to treatment. It has been shown to significantly reduce the number of affected joints, pain, and disability. This newer treatment regimen has helped a military pilot continue his aviation career. We present the case of an experienced designated military pilot who was diagnosed with rheumatoid arthritis. He was initially treated early with a DMARD and biologic medication. He has remained in remission and currently only uses etanercept (biologic medication) and a non-steriodal anti-inflammatory drug to control his disease. He has responded favorably to therapy and has few limitations. Due to his positive response to treatment, the aviator was granted military aeromedical waivers for rheumatoid arthritis and chronic medication use.

Cutaneous psoriasis in a military flight surgeon.

Cutaneous psoriasis is a common, non-infectious, hyperproliferative, papulosquamous, inflammatory skin disease whose pathogenesis is unknown. The course of psoriasis is typically chronic and unpredictable. Psoriasis can range from a small, local pathological area of skin to widespread dermatologic disease, such as generalized pustular psoriasis and erythroderma. Symptoms can range from mildly symptomatic to life threatening. Complications can range from psychological problems to systemic medical disease, such as psoriatic arthritis and inflammatory bowel disease. Treatment options can have adverse side effects which negatively affect multiple organ systems such as the hematological, neurological, and immunological systems. Therefore, psoriasis is a dermatologic disease that should be taken seriously in military aviation. The disease, its complications, and its therapies can interfere with concentration, mission accomplishment, the ability to operate aircraft safely, and compliance with safety equipment use. In this case report, we present the case of a naval flight surgeon who presented with inverse psoriasis and plaque psoriasis, which ultimately became well controlled with topical medications. The flight surgeon was recommended for military aeromedical waivers for psoriasis and chronic medication use. We also review the medical literature on cutaneous psoriasis, discuss its complications, and review its aeromedical implications in military aviation.

Psoriatic arthritis in a military aviator.

Psoriatic arthritis is a chronic spondyloarthropathy whose pathogenesis is unknown. We present a case of a naval flight officer who presented with chronic psoriatic arthritis, which ultimately became well controlled with etanercept treatment. The naval flight officer was granted military aeromedical waivers for psoriatic arthritis, cutaneous psoriasis, and chronic medication use. We also review the medical literature on psoriatic arthritis disease and etanercept and discuss their aeromedical implications in military aviation.

Discrete papular form of lichen myxedematosus: a case report and review of the literature.

The discrete papular form of lichen myxedematosus (LM) is a rare idiopathic skin disorder. We present a case of this type in an 80-year-old African American woman. She was treated with pimecrolimus cream, which resulted in symptomatic relief. To our knowledge, this is the first report of the discrete papular form of LM occurring in an African American, as well as the first report on the disorder's response to pimecrolimus therapy. We also review the English medical literature on this rare disease and examine and summarize the findings.