Primary Cutaneous Angiosarcoma of the Scalp with Cranial Invasion in a Patient with Metastatic Breast Cancer.

Idiopathic cutaneous angiosarcoma (CA) of the head and neck is a distinct subtype of angiosarcoma most commonly presenting as a single or multiple purple, bruise-like patches that arise de novo and enlarge over several months. In clinical practice, both misdiagnosis and delayed diagnosis are frequently encountered. Here, we present a case of idiopathic CA on the scalp with invasion to the cranium in a patient with breast cancer metastatic to the brain. The patient was initially misdiagnosed and mistreated with herpes zoster and breast cancer metastatic to the skin, which led to a delayed diagnosis by two months until dermatologic evaluation. The diagnosis was then firmly established as CA based on consistent clinical and histological features. Since the tumor was inoperable, radiotherapy and chemotherapy were been considered as the appropriate adjuvant modes of therapy. Despite an initial favorable response, the disease demonstrated a rapidly progressive course and the patient succumbed to the disease within six months. This report briefly reviews the clinical and histological portrait and management options for this aggressive tumor.

Does it take three to tango? An unsuspected multimorbidity of CD8+ T cell lymphoproliferative disorder, malaria, and EBV infection.

BACKGROUND: Malaria is known to cause acute and deadly complications. However, malaria can cause unforeseen pathologies due to its chronicity. It increases the risk of endemic Burkitt Lymphoma development by inducing DNA damage in germinal centre (GC) B cells, and leading higher frequency of Epstein-Barr virus (EBV)-infected cells in GCs. EBV is well known for its tropism for B cells. However, less is known about EBV's interaction with T cells and its association with T cell lymphoma. CASE PRESENTATION: A 43-year-old Sudanese male admitted to hospital in Istanbul, Turkey, a non-endemic country, with hyperpigmented painful skin rashes on his whole body. A complete blood count and a peripheral blood smear during admission revealed large granular lymphocytes (LGLs) with abnormally higher CD8 T cell numbers. Additional skin biopsy and pathology results were compatible with CD8+ T cell lymphoproliferative disorder with skin involvement. Patient was treated and discharged. However, a pathologist noticed unusual structures in skin tissue samples. Careful evaluation of skin biopsy samples by polarized microscopy revealed birefringent crystalloid structures resembling malarial haemozoin mainly loaded in macrophages and giant histiocytes. After purification of DNA from the skin biopsy samples, nested PCR was performed for the detection of Plasmodium parasites and Plasmodium falciparum DNA was amplified. Because, the co-presence of EBV infection with malaria is a well-known aetiology of lymphoma, EBV-early RNA (EBER) transcripts were investigated in paraffin-embedded tissue samples and found to be positive in macrophage-like histiocytes. CONCLUSIONS: This is a unique case of malaria and EBV infection in a T-LGL lymphoma patient who presented in a non-endemic country. This case emphasizes the clinical importance of EBV monitoring in T-LGL patients with skin involvement. Notably, Plasmodium infection should be examined in patients from malaria endemic regions by pathological and molecular investigations.

Onychomatricoma masquerading as candidal onychomycosis and paronychia.

Onychomatricoma is a benign slow-growing fibroepithelial tumor arising from the nail matrix. The tumor was described as a new entity almost two decades ago. Although the clinical appearance is typical, most cases are probably misdiagnosed by physicians because of unfamiliarity with the condition. Herein we describe a case of onychomatricoma masquerading as candidal onychomycosis and paronychia and treated erroneously as such.

Arborizing vessels under dermoscopy: a case of cellular neurothekeoma instead of basal cell carcinoma.

Neurothekeoma is a slow-growing, benign tumor of nerve sheath origin. Herein we present a 62-year-old female who presented with a 5-month history of a nodule that had shown a slight enlargement. She had a diagnosis of non-Hodgkin lymphoma for 10 years for which she had received multiple sessions of chemotherapy and radiotherapy. Cutaneous examination showed a well-defined, firm, 2 cm, pink-red nodule of the right supraclavicular area, which showed thick and arborizing vessels under dermoscopy. A diagnosis of cellular neurothekeoma was made after histopathologic examination with immunohistochemistry. Thick and arborizing vessels have been described as the dermoscopic hallmark of nodular and cystic basal cell carcinoma. In the past, hydradenoma and intraepidermal poroma have been defined as dermoscopic mimics of basal cell carcinoma because of the characteristic appearance of arborizing vessels. With this report a neurogenic tumor has been added to this list.

Sclerosing cellular blue nevus simulating melanoma.

Sclerosing blue nevus is an uncommon variant of common blue nevus and shows an amorphous blue appearance at the edges with a hypopigmented center. Herein we present a 48-year-old female with sclerosing cellular blue nevus with extraordinary clinical and dermoscopic features simulating melanoma. The association of a whitish scarlike area with a pigmented dot pattern prominent throughout the lesion was unusual for a sclerosing cellular blue nevus. Besides pattern asymmetry, polychromasia and linear irregular vessels increased the mimicry. This case illustrates the importance of surgical excision and histopathological examination.

Plasmacytoid dendritic cell tumor: A case report.

A 62-year-old man presented with a painless eruption on his arms and trunk. Physical examination showed 2 well-demarcated erythematous plaques on the anterior trunk and 6 purple-red papules on the back and upper extremities. Blood chemistry and computed tomography results were normal. Herein we describe a patient with plasmacytoid dendritic cell neoplasm in the absence of systemic symptoms.