The juxtaoral organ of Chievitz.

Juxtaroral organs were found in 14 of 25 consecutive autopsies in adults who did not have carcinoma or other lesions of the oral mucosa. Nearly all of the epithelium was squamous-like, but an occasional lumen was present, lined with cuboidal cells. Small nerves were intimately associated with the epithelial component. Awareness of this normal structure may be crucial in preventing unnecessarily extensive surgery should it be misinterpreted as perineural invasion by carcinoma.

Cutaneous manifestations of histoplasmosis in the acquired immune deficiency syndrome.

The clinical and histologic features of cutaneous histoplasmosis in three patients with acquired immunodeficiency syndrome (AIDS) are described. The patients presented with multiple discrete papules on the extremities, trunk, and face, some of which were follicular. Histologically, the skin biopsies were characterized by a sparse perivascular infiltrate with polymorphonuclear leukocytes, lymphocytes, and occasional histiocytes. Prominent leukocytoclasia and associated dermal necrosis were seen around the superficial blood vessels of the dermis. The Histoplasma capsulatum organisms were for the most part extracellular and difficult to visualize on the hematoxylin and eosin-stained sections. A diagnosis of atypical leukocytoclastic vasculitis was considered. Histoplasmosis is a relatively common mycosis among AIDS patients, and it is sometimes the first manifestation of the syndrome. The clinical and histologic findings described herein may be relatively common among AIDS patients and are quite different from those of classic disseminated histoplasmosis.

Nonmelanized macromelanosomes in a cellular blue nevus. Light and electron microscopic observations.

We noted nonmelanized and partially melanized macromelanosomes in a cellular blue nevus and studied their light microscopic and ultrastructural features. Numerous intracytoplasmic eosinophilic inclusions were found in the lesion; individual cells contained up to nine, although most cells demonstrated two or three. The "macromelanosomelike" inclusions ranged in size from 1 to 15 microns. Most of them were partially melanized, and some were nonmelanized. These globules were periodic acid-Schiff positive and diastase resistant, with a centrally melanized core, best seen with the Fontana-Masson technique. S100 protein stained positively the cytoplasm of some nevus cells but not the inclusions. Electron microscopy confirmed the centrifugal melanization of these structures and their targetlike morphologic characteristics. Nine other cellular blue nevi from our files failed to show similar intracytoplasmic inclusions.

Treatment of malignant carcinoid syndrome with a long-acting somatostatin analogue.

A patient with malignant carcinoid syndrome was treated with a long-acting somatostatin analogue. The cutaneous and systemic improvement our patient had while receiving this therapy is described.

Detection of human papillomavirus in nongenital Bowen's disease by in situ DNA hybridization.

Genital Bowen's disease has been strongly linked in recent studies to human papillomavirus (HPV). Nongenital Bowen's disease has been less well investigated, although isolated reports, all of which involved detection of HPV after extraction of DNA from fresh-frozen tissue, have been made. We investigated 25 cases of nongenital Bowen's disease in 5 black and 20 white patients for the presence of HPV types 1, 6, 11, 16, and 18 using paraffin-embedded tissues. Human papillomavirus was present in six specimens from 3 of the 5 black patients (one previously reported to be positive on Southern blot) and 3 of the 20 white patients; HPV 16 was detected in all 6 cases on low-stringency testing, but only 4 remained positive on high-stringency testing. This suggests an HPV closely related to but not entirely homologous with HPV 16 in the 2 remaining cases. Five of the 6 positive specimens were lesions from the hands and feet and 1 was from the volar aspect of the arm. Clinical factors associated with the presence of HPV included black race, location on the palmar surface and the feet, young age, and verrucous or hyperkeratotic clinical appearance. Of the 6 positive cases, all 5 of the patients available for examination also had evidence of HPV-associated genital lesions. No specific histopathologic features were found to be indicative of the presence or absence of HPV.

Simultaneously active lesions of vitiligo and erythema dyschromicum perstans.

Recently, a patient presented to us with skin that had areas of normal pigmentation, hyperpigmentation, and depigmentation. Workup eventually showed him to have simultaneously active lesions of a depigmenting disorder, vitiligo, and a hyperpigmenting disorder, erythema dyschromicum perstans.

Chromomycosis. The association of fungal elements and wood splinters.

In two separate specimens received for histopathologic examination, pigmented fungal elements were found within or on embedded wood splinters associated with a foreign-body reaction. The fungus was found to be in direct contact with the surrounding dermis. These findings support the concept of inoculation as a pathogenetic mechanism in cutaneous chromomycosis.

Pachyonychia congenita. Electron microscopic and epidermal glycoprotein assessment before and during isotretinoin treatment.

Two patients, a father and son, with pachyonychia congenita were treated with orally administered isotretinoin because the extreme deformity and discomfort associated with their massive keratoderma interfered with their work and school, respectively. While clinical benefits could not be sustained, electron microscopic findings compatible with suppression of abnormal keratinization were observed. In addition, skin biopsy samples were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and the gels were then subjected to a lectin overlay technique with concanavalin A labeled with iodine 125. The distribution of specific glycoproteins was found to be different for lesional as against normal epidermis. The procedure was repeated after oral treatment with isotretinoin. The labeled glycoprotein pattern of the lesional epidermis was clearly distinguishable from both the pretreatment lesional and the normal epidermis; it was mostly intermediate between the two. The normal epidermis was virtually unaffected by the retinoid treatment.

Cutaneous manifestations of dysproteinemias.

A number of cutaneous lesions may represent signs of underlying dysproteinemia. The lesions may result from direct infiltration by plasmacytes and immunoblasts--such as plasmacytomas seen with multiple myeloma--or they may result from indirect effects of the immunoglobulins by a number of different mechanisms. Because the spectrum of cutaneous lesions is so large and at times nonspecific, it is important to keep dysproteinemia in one's differential diagnosis at all times. Careful monitoring of these patients is important since the latency period for the actual development of a plasma cell malignancy may be years.

Eyelid pigment implantation: early and late histopathology.

Full-thickness sections of upper and lower eyelids were obtained from patients who had eyelid pigment implantation performed by one surgeon. These four patients represented eyelid pigment implantation at varying postoperative stages ranging from 6 months to 4 years. Light microscopic evaluation revealed pigment within dermis and superficial orbicularis muscle. Light and electron microscopic evaluation revealed the vast majority of the pigment to be located intracellularly, primarily within macrophages. No foreign-body reaction was seen around the implanted material. Electron probe analysis of the pigment showed only the presence of iron. Analysis of the unused pigment revealed small amounts of silica and magnesium. These substances could not be identified by electron probe analysis in the eyelid tissues.

Renal cell carcinoma metastatic to skin.

A case of renal cell carcinoma metastatic to the skin is reported. Renal cell carcinoma is a relatively uncommon malignancy that frequently metastasizes to the skin.

Malignant histiocytosis.

Malignant histiocytosis, also known as histiocytic medullary reticulosis, is a rare neoplasm of malignant histiocytes. Clinical findings include fever, weight loss, hepatosplenomegaly, lymphadenopathy, anemia, thrombocytopenia, and a rapidly worsening course. Approximately 7 percent of patients have skin manifestations early in the course of their disease. In these patients, diagnosis based on examination of a skin biopsy specimen may be crucial. A case of malignant histiocytosis is presented in which the diagnosis was first suggested by findings on the skin biopsy specimen.

Disciform erythrasma.

A case of disciform erythrasma is presented. This unusual manifestation of a common cutaneous infection may mimic other dermatologic disorders, including lichen sclerosus et atrophicus and plaque-type parapsoriasis. The condition is characterized by an atrophic appearing surface, located in nonintertriginous areas. Appropriate diagnostic procedures easily differentiate disciform erythrasma. These include Wood's light examination, potassium hydroxide preparation, and skin scrapings or tissue sections stained with Gram stain, periodic acid-Schiff, Giemsa, or methylene blue.

Giant molluscum contagiosum of the sole.

Molluscum contagiosum is usually diagnosed on the basis of clinical findings. However, when this common lesion is present in an unusual location, such as the sole of the foot, diagnosis may be more difficult. The following case demonstrates that molluscum contagiosum infection should be considered in the differential diagnosis of lesions of the soles.

Sweet's syndrome with an exogenous cause.

A sixty-six-year-old white man presented with a five-day history of painful erythematous papules, plaques, pustules, and hemorrhagic bullae on both hands. His history was remarkable for having prepared and pickled fifteen quarts of home-grown jalapeño peppers several days before the eruption occurred. The light microscopic examination of sections of lesional skin stained with hematoxylin and eosin revealed pathologic findings characteristic of Sweet's syndrome. We report this case because of its unusual presentation and apparent exogenous cause.

Localized cicatricial pemphigoid (Brunsting-Perry syndrome).

A patient who presented with scarring alopecia from a vesicular disorder was diagnosed as having localized cicatricial pemphigoid. The diagnosis was confirmed by histopathology and immunofluorescent studies. The clinical, immunologic, and therapeutic features of this entity are reviewed.

Erythema elevatum diutinum.

First described by Hutchinson in 1878, erythema elevatum diutinum (EED) is a rare disease characterized by persistent red, raised nodules and plaques in a symmetrical, acral distribution. The disease occurs equally in the sexes, primarily in the 30- to 60-year age group. We report a representative case of EED which responded to current agents, and briefly review the status of the disease.

Tunga penetrans.

We describe a patient who acquired tungiasis while traveling in an area where the condition is endemic. The pathogenesis, diagnosis, and treatment of this tropical disease are presented.

Calcifying panniculitis and systemic calciphylaxis in an end-stage renal patient.

A patient with a history of end-stage renal failure who had been receiving hemodialysis for approximately six months experienced painful plaques bilaterally on the medial aspects of her thighs. A biopsy specimen of the affected subcutaneous tissue demonstrated calcification in the subcutaneous tissue. In this case of calcifying panniculitis, the conditions for systemic calciphylaxis appear to have been present.

Granulomatous reaction to collagen implant: light and electron microscopic observations.

A fifty-three-year-old woman noted bilateral linear confluent papules involving the nasolabial folds following injection of bovine collagen (Zyderm). On light microscopic examination the dermis contained epithelioid granulomas centered around the degenerated bovine collagen. Electron microscopic examination demonstrated the degraded collagen fibers, which could be easily differentiated from the native collagen. The patient's clinical findings, management, and the pathogenetic mechanisms of this entity are reviewed.