[Inflammatory type cutaneous metastasis of bladder neoplasm: erysipeloid carcinoma]. / Metastasi cutanee ad aspetto infiammatorio da carcinoma vescicale: carcinoma erisipelatoide.

BACKGROUND: Skin metastasis from transitional cell carcinoma of the urinary bladder is quite uncommon. Especially, the inflammatory type of skin metastasis with features of carcinoma erysipeloid is a rare event. CASE REPORT: A 65-year-old man with bladder carcinoma who underwent radical cystectomy developed 6 months later red to violaceous papules, indurated plaques and edema in the perigenital area. The initial presumptive diagnosis was irritative contact dermatitis and cellulitis. Histologic examination of a skin biopsy disclosed dilated lymphatic vessels filled with neoplastic cells resembling transitional cells. COMMENT: Although carcinoma erypeloid is most commonly caused by breast carcinoma, it has also been linked to other carcinomas. Dermal lymphatic involvement is an essential feature shared by cases of inflammatory carcinoma. CONCLUSIONS: Carcinoma erysipeloid may be caused by bladder carcinoma. Skin metastases are generally present in the late stages of this disease and indicate a poor outcome.

Multinucleate cell angiohistiocytoma: a report of two cases.

We report the clinical, histological and immunological features of two cases of multinucleate cell angiohistiocytoma (MCAH) in women of 32 and 53 years of age, respectively. Clinically, MCAH occurs mostly in middle-aged women and consists of crops of reddish-purple, dome-shaped papules especially on the limbs. Histologically, the reticular dermis presents an increased number of small vascular channels with plump endothelial cells embedded in a fibrohistiocitic stroma with numerous bizarre multinucleate cells. Bizarre multinucleated cells are not specific to MCAH; they can be observed in numerous other cutaneous conditions. However, MCAH presents quite distinctive clinico-pathological findings and may be easily differentiated from other cutaneous disorders.

Diffuse and bilateral lichen striatus.

A 5-year-old girl had a papulo-squamous dermatosis arranged in a Blaschko line pattern of 1 month's duration. The skin lesions were asymmetrically distributed bilaterally on the face, neck, trunk, and limbs. Histologically there was a lichenoid infiltrate with foci of spongiosis. The dermatosis cleared spontaneously with hypopigmentation 16 months later. Lichen striatus usually occurs in a solitary and unilateral fashion. Its diffuse and bilateral distribution is an uncommon presentation.

Psoriatic erythroderma: a histopathologic study of forty-five patients.

BACKGROUND: There are conflicting opinions about the diagnostic value of skin biopsy in erythrodermic psoriasis. OBJECTIVE: The purpose of the present study was to establish the specificity of the histopathologic changes of psoriatic erythroderma. METHODS: We reviewed 52 skin biopsies from 45 erythrodermic patients having a final diagnosis of psoriasis on the basis of combined clinical and laboratory data, in addition to response to therapy and follow-up. In 5 patients, erythroderma was the presenting sign of psoriasis. A control group of nonpsoriatic erythrodermic patients was also included in the study. RESULTS: Among the group of patients with a discharge diagnosis of psoriatic erythroderma, the histopathologic changes were specific for psoriasis in 40 cases (88%). The changes of early macular and squamous lesions of psoriasis were more often found in the biopsy specimens of our series than those of fully developed or late lesions of psoriasis. They included mainly slight epidermal hyperplasia, focal disappearance of the granular layer, mounds of parakeratosis and extravasated erythrocytes within edematous dermal papillae associated with perivascular and interstitial infiltration of lymphocytes and histiocytes. CONCLUSION: When features of early lesions of psoriasis are found during the evaluation of a biopsy specimen from a patient with a clinically nonspecific erythroderma, the dermatopathologist should be aware that this patient could have psoriasis and a renewed anamnesis and a close follow-up should be made.

Actinic lichen planus simulating melasma.

A 23-year-old Italian woman presented with asymptomatic, symmetric, hyperpigmented patches on her face. The dermatosis became exacerbated in summer and closely resembled melasma. The histologic examination and immunofluorescence studies revealed typical features of lichen planus. Actinic lichen planus mimicking melasma is a rare dermatosis occurring mostly in women of oriental origin. The differential diagnosis of further facial melanoses will be discussed.

Vulvodynia and HIV: causal or casual association?

BACKGROUND: No study exists on HIV and vulvodynia. OBJECTIVE: To evaluate vulvodynia in HIV infected women and its possible association with HIV. DESIGN: Cross sectional study. SETTING: Department of Medical and Surgical Sciences, Section of Infectious Diseases, University of Turin. METHODS: 235 HIV positive and 272 HIV negative women were studied for vulvar pain between June 1995 and January 1997. Diagnosis of vulvodynia was based on clinical history, dermatological and vulvovaginal examination, and bacteriology. Colposcopy and vulvar biopsy were performed and psychometric examination was done. RESULTS: Vulvodynia was diagnosed in five women with HIV and in one uninfected woman (odds ratio = 2.5; 95% confidence interval: 0.1-62.6). High neuroticism scores were observed in women with history of vulvar pain, the highest in HIV infected vulvodynia patients (p = 0.000). CONCLUSIONS: Confirming the association of gynaecological pain with neurotic personality, our study suggests causal link between HIV and vulvodynia.

Perianal cytomegalovirus ulcer in an HIV-infected patient.

A 51-year-old man with acquired immunodeficiency syndrome presented with a perianal ulcer. Histologically there were numerous cytomegalic inclusions within endothelial cells and stomal fibroblasts. Cytomegalovirus within infected cells was demonstrated by immunohistochemistry and in situ hybridization. No cytopathic typical of Herpes simplex were detected. The ulcer resolved completely after a treatment with ganciclovir.

[Malignant schwannoma of the glans penis]. / Malignes Schwannom an der Glans penis.

A 58-year-old man presented with a solitary, asymptomatic, firm nodular lesion on his glans. A simple excision was carried out. Follow-up for 1 year failed to reveal either recurrence or metastases. Histologically, there was intradermal proliferation of atypical oval and spindle-shaped cells arranged in fascicles simulating the pattern of neural tumours. Mitotic figures were abundant. Stains for melanin, HMB-45 antigen were negative. Immunohistochemically, tumour cells stained for S-100 protein and vimentin. Malignant schwannoma usually occurs in patients with neurofibromatosis and is located in the subcutaneous tissues. Solitary malignant schwannoma of superficial soft tissue is a rare entity, and there are problems of differential diagnosis against other spindle cell tumours, especially malignant spindle cell melanoma. Their appearance on the glans is rare.

[Goltz syndrome]. / La sindrome di Goltz.

Goltz syndrome or focal dermal hypoplasia is a hereditary disorder, is a rare mesodermal hypoplasia found primarily in females. It is characterized by linear hypoplasia of the skin and tumors of fat or lipomatous lesions. There are significant defects of the skeleton, dental structures, eyes, soft tissues and skin. In our work an example of new-born female with this syndrome is reported, and a review of 136 cases from the literature is presented.