Thomsen-Friedenreich (T) antigen: a possible tool for differentiating sebaceous carcinoma from its simulators.

The Thomsen-Friedenreich (T) antigen is a cryptic glycoprotein, referred to as tumor antigen or cancer-associated antigen because it is absent or masked by some carbohydrates in normal tissues, but present in many human cancers. The latter include gastrointestinal, lung, pancreatic, mammary, and some ovarian carcinomas. Cancer cells frequently undergo incomplete glycosylation resulting in the appearance of precursor structures that normally would be absent like the case with the T antigen. T antigen can be detected by several different reagents including monoclonal antibodies and several plant lectins-e.g., Arachis hypogea (peanut agglutinin). The aim of the current study was to evaluate the expression of T antigen in sebaceous carcinoma and to compare it with its simulators. The authors studied the immunohistochemical expression of T antigen in 45 skin biopsy and excisional specimens obtained from the archives of their dermatopathology laboratories, including 8 cases of sebaceous carcinoma, 15 cases of sebaceous adenoma, 9 cases of sebaceoma, 1 case of basal cell carcinoma with sebaceous differentiation, and 12 cases of basal cell carcinoma with cytologic atypia. Sebaceous carcinoma was unique in expressing a strong, diffuse cytoplasmic T antigen reactivity (7 of 8 cases) along the immature basaloid cells and the intermediate cells. However, sebaceous adenoma, sebaceoma, and basal cell carcinomas expressed negative reaction in the basaloid cells and mild reactivity in the intermediate cells. Mature sebocytes showed a strong reaction in all cases. The authors concluded that T antigen expression may be a helpful tool in differentiating sebaceous carcinoma from other sebaceous lesions that may simulate it histologically.

Sarcoidal tissue reaction in Sézary syndrome.

Sézary syndrome (SS) is an erythrodermic and leukemic variant of cutaneous T-cell lymphoma (CTCL). Occasionally, the histology of CTCL exhibits evidence of a granulomatous infiltrate in the skin. A case of SS that showed epithelioid granulomas resembling sarcoidosis in the skin and lymph nodes is presented. The clinical course of this patient has been relatively indolent.

Morpheaform sarcoidosis: report of three cases.

Sarcoidosis is a disease of protean manifestations. We describe 3 patients whose unusual presentation of sarcoidosis resembled localized scleroderma (morphea).

Localized cutaneous Nocardia brasiliensis mimicking foreign body granuloma.

Nocardia brasiliensis is recognized in the United States as an infectious agent of the skin that may present as an abscess, ulcer, or granuloma with or without "sporotrichoid" spread, and rarely causes systemic disease. Treatment with trimethoprim/sulfamethoxazole is usually curative. We present a patient with multiple erythematous, painful, draining nodules that developed thirty-six months after trauma and subsequent contamination with soil in Bermuda. A foreign body granuloma was suspected clinically, and excision was performed followed by recurrence of the lesions. Histologic examination and culture were consistent with nocardiosis. Differential diagnosis of foreign body granulomas also should include infection with N. brasiliensis even after a long incubation period. Culture and drug susceptibility testing of affected tissue should be performed for diagnosis and management.

Eosinophils are not a clue to the pathogenesis of granuloma annulare.

Eosinophils are variably present in biopsy specimens of granuloma annulare (GA). A retrospective study of 77 biopsy specimens from 73 patients with GA was performed to quantitate eosinophils and correlate the findings with both histologic and clinical features. Specimens were divided into absent, low (10 > x > or = 1 eosinophils per 3 sections), and high (x > or = 10 eosinophils per 3 sections) eosinophil groups and evaluated for eight histologic and 11 clinical features. Eosinophils were identified in 66% (51/77) of biopsy specimens, with 51.9% (40/77) and 14.3% (11/77) in the low and high eosinophil groups, respectively. Clinically, patients in the high eosinophil group were found to be significantly younger with a propensity towards nonannular, localized disease. These patients also did not have diabetes or use systemic medications. Histologically, the presence of eosinophils was strongly associated with palisaded architectural pattern and the presence of necrobiosis. Eosinophils were not present in areas of necrobiosis but were found predominantly perivascularly. A moderate to marked lymphocytic infiltrate at the periphery of the granulomas and reactive vessel changes were common in all three groups, but vasculitis was not identified. In summary, this study showed eosinophils to be commonly present in GA but was unable to correlate their presence with specific clinical or histologic features supportive of an allergic precipitant. A cell-mediated immune mechanism is likely involved in GA, with eosinophils recruited nonspecifically by mediators released during granuloma formation.

Rowell's syndrome: report of a case.

A 47-year-old woman presented with a long-standing history of an erythema multiforme-like eruption in association with lupus erythematosus. Unusual laboratory and immunologic findings were consistent with a diagnosis of Rowell's syndrome, which includes lupus erythematosus in association with erythema multiforme-like skin lesions, a speckled antinuclear antibody pattern, and a positive rheumatoid factor. We believe that our patient meets the criteria for this rarely reported entity.

Familial lichen sclerosus et atrophicus in association with CREST syndrome: a case report.

Lichen sclerosus et atrophicus is an uncommon disease which appears to be multifactorial in aetiology. We describe a case of a young woman with CREST syndrome (calcinosis, Raynaud's phenomenon, oesophageal dysfunction, sclerodactyly and telangiectasia) who has a documented family history of two sisters with lichen sclerosus et atrophicus. She presented with vulvar pruritus in association with dyspareunia, and biopsy of atrophic white vulvar lesions was consistent with lichen sclerosus et atrophicus. Lichen sclerosus et atrophicus has been previously noted to occur in association with morphoea and lichen planus, although it has never been reported in conjunction with CREST syndrome.

Disseminated acanthamebiasis in patients with AIDS. A report of five cases and a review of the literature.

BACKGROUND: Acanthamoeba and Leptomyxida are free-living amebae that cause granulomatous amebic encephalitis, a rare, slowly progressive, fatal neurologic process seen in immunosuppressed hosts. In addition, these organisms produce disseminated cutaneous lesions and involve other organs, particularly in patients with the acquired immunodeficiency syndrome (AIDS). RESULTS: We report five cases of disseminated acanthamebiasis in patients with AIDS, each with cutaneous manifestations but lacking central nervous system involvement. The medial CD4+ T-cell count was 0.024 x 10(9)/L. Skin lesions included pustules, subcutaneous and deep dermal nodules, and ulcers, most often seen on the extremities and face. Histopathologically, both pustular and vasculitic changes were observed; in all cases, the microscopic identification of organisms was difficult because of the macrophagelike appearance of the microbes in routine sections. CONCLUSIONS: Skin lesions are the most common reported presentation of infections caused by Acanthamoeba and Leptomyxida organisms in patients with AIDS, a minority of whom have central nervous system manifestations. A high index of suspicion is necessary for both the dermatologist and the dermatopathologist. Prognosis is guarded, but early treatment using a combination of intravenous pentamidine and oral fluconazole, sulfadiazine, and flucytosine may be beneficial.

Hepatobiliary pruritus: what are effective treatments?

Pruritus is a common symptom in patients with hepatobiliary disease. Numerous treatments have been attempted. We review published therapeutic trials for hepatobiliary pruritus and utilize statistical analysis to evaluate treatment results. Randomized placebo-controlled studies show cholestyramine, rifampin, naloxone, S-adenosylmethionine, prednisolone, and propofol to be effective. Suggestions for future studies of the treatment of hepatobiliary puruitus are proposed.

Mycosis fungoides palmaris et plantaris.

BACKGROUND: Mycosis fungoides primarily localized to the palms and soles is rare and has been previously reported as cutaneous lymphoma in four patients or as Woringer-Kolopp disease in eight patients. OBSERVATIONS: Four patients were initially diagnosed and treated unsuccessfully for various palmoplantar dermatitides until histopathologic findings revealed mycosis fungoides. Each case exhibited a clonal rearrangement of T-cell receptor gamma genes and immunohistochemical studies consonant with mycosis fungoides. All patients had limited skin involvement without evidence of extracutaneous involvement. CONCLUSIONS: Mycosis fungoides palmaris et plantaris is an uncommon expression of mycosis fungoides that manifests primarily on the palms and soles and clinically may mimic various inflammatory palmoplantar dermatoses. A biopsy is recommended in the evaluation of recalcitrant palmoplantar dermatoses.

Furuncular myiasis from Dermatobia hominis infestation. Diagnosis by light microscopy.

Myiasis, the infestation of humans or other vertebrates with fly larvae, may appear as furuncular nodules. Furuncular myiasis occurring in the Western hemisphere, especially in Central and South America, is usually caused by Dermatobia hominis infestation. Travel history, gross examination, and histologic evaluation of the submitted fly larvae will allow the clinician and dermatopathologist to identify the causative organism. We report two cases of furuncular myiasis due to Dermatobia hominis and review the clinical and histopathologic findings pertinent to its diagnosis. In addition, we attempted to identify some of the cardinal internal structures of this organism by extrapolating known information about insect internal anatomy and physiology to the structures visualized during serial transverse sectioning of the larvae.

Cutaneous epithelioid hemangioendothelioma without systemic involvement.

Epithelioid hemangioendothelioma (EH) is a unique vascular tumor characterized histologically by epithelioid endothelial cells. A case of EH arising from the dermis and presenting as a nodule of the palm is described. To our knowledge, this is the third report of a cutaneous presentation of EH and the first report of a patient with this rare neoplasm with solitary cutaneous involvement. A review of the literature is also presented.

Dilated pore nevus. A histologic variant of nevus comedonicus.

Histology of a nevus comedonicus showed aggregates of dilated follicular cysts reminiscent of dilated pore of Winer. This finding has not been previously reported. We propose the term dilated pore nevus for this lesion, which we conceive to be a histologic variant of nevus comedonicus, similar to porokeratotic eccrine ostial and dermal duct nevus.