Speckled posttraumatic hyperpigmentation by foreign bodies on the lower legs after welding.
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Dermatitis, Occupational↗
Biomedical subjects
Bernd Leinweber
Publications and source records attributed to Bernd Leinweber.
Teledermatopathology: a controlled study about diagnostic validity and technical requirements for digital transmission.
Telepathology is the practice of diagnostic histopathology performed on digital pictures. In this study, we focused on the technical requirements for achievement of a correct diagnosis on digital histopathologic images. A collection of 560 melanocytic lesions was selected from the files of the Department of Dermatology, Medical University of Graz, Austria. From each lesion one histologic slide was completely digitally scanned with a robotic microscope. Digital pictures were reviewed by 4 dermatopathologists using a presentation program, which recorded the number of image calls, applied magnifications, overall time needed, and amount of transmitted bits during the digital sign-out. One month later, the 4 microscopists had to review the corresponding slides and render a direct diagnosis on each case. Telepathologic diagnoses corresponded with the original diagnoses in a range from 90.4% to 96.4% of cases (kappa 0.80 to 0.93; P < 0.001). The median time needed for achievement of a diagnosis was 22 seconds and was significantly higher for melanomas compared with nevi. The median transmission effort for each diagnosis was 510 kilobytes after JPEG compression. Using an ISDN line with a transmission capacity of 64 kilobits/ second, this correlates to a transmission time of about 1 minute. Our results demonstrate that correct reporting on digital histopathologic images is possible with only a little time exposure. For an adequately fast transmission ISDN lines are suffcient after JPEG compression.
Dermatology↗
Histopathologic features of cutaneous herpes virus infections (herpes simplex, herpes varicella/zoster): a broad spectrum of presentations with common pseudolymphomatous aspects.
Cutaneous eruptions caused by herpes simplex 1/2 (HSV-1/2) and herpes varicella/zoster (VZV) represent common dermatoses. In some cases, they present with atypical clinical and/or histopathologic features, including presence of dense lymphoid infiltrates with atypical lymphocytes simulating cutaneous lymphomas. In this study, we reviewed the biopsy specimens of 65 patients (33 males, 32 females; mean age, 61.2 years; median age, 62 years; age range, 19-96 years) with cutaneous eruptions caused by HSV-1/2 or VZV. Histologic examination revealed several atypical findings, including presence of dense lymphoid infiltrates, angiotropism, and atypical lymphocytes simulating malignant lymphoma. Immunohistochemistry performed in 22 cases showed a predominant T-cell infiltrate, in the majority of cases with variable numbers of CD30+ and CD56+ cells. Two cases with a pseudolymphomatous appearance and small clusters of CD30+ cells revealed a monoclonal population of T lymphocytes by PCR analysis, underlying the difficulties in classifying some of these cases correctly. Our study indicates that cutaneous herpes infections can exhibit several atypical histopathologic, immunohistochemical, and molecular features, and that in given cases accurate clinicopathologic correlation and short-term follow-up controls are necessary for differentiation from cutaneous lymphomas.
Adult↗
Confocal examination of untreated fresh specimens from basal cell carcinoma: implications for microscopically guided surgery.
OBJECTIVE: To evaluate the diagnostic accuracy of confocal examination of basal cell carcinoma (BCC) in microscopy-guided surgery. DESIGN: Four independent observers with no previous experience in confocal laser scanning (CLS) microscopy received standardized instruction about diagnostic CLS microscopic features. Subsequently, 120 confocal images of fresh excisions from BCCs or normal skin were evaluated by each observer, imaged using a commercially available, near-infrared, reflectance CLS microscope. Logistic regression analysis was performed on a combination of all morphologic features using the forward-stepwise (Wald) method. Reliability (interobserver agreement) data were evaluated by kappa statistic. SETTING: Department of Dermatology, Medical University of Graz. PATIENTS: Twenty patients with histologically verified BCC. INTERVENTIONS: Evaluation of fresh BCC excisions by CLS microscopy. MAIN OUTCOME MEASURES: Diagnostic accuracy of the method was evaluated by chi2 test. Diagnostic impact and reliability of each morphologic feature were evaluated by logistic regression analysis and kappa statistic, respectively. RESULTS: Overall, high diagnostic accuracy was achieved by the 4 observers. Logistic regression analysis revealed that mainly tumor cell nuclei and tumor nests should be taken into account for diagnostic decisions, whereas disintegration of tumor cells, peripheral palisading, and retraction of stroma were rarely useful. However, most of the features were highly reliable. CONCLUSIONS: This diagnostic validation study of CLS microscopy in microscopy-guided surgery yielded promising results and opens avenues for further studies. In the future, CLS microscopy may guide microsurgery of any skin cancer.
Basal Cell Carcinoma↗
Dermoscopy of fibroepithelioma of pinkus.
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Aged↗
Acrodermatitis chronica atrophicans in a 15-year-old girl misdiagnosed as venous insufficiency for 6 years.
Acrodermatitis chronica atrophicans, the characteristic cutaneous manifestation of late Lyme borreliosis, typically occurs in elderly women. To our knowledge, only 4 cases of acrodermatitis chronica atrophicans in children have been described. Prompt diagnosis and treatment are important to prevent progression of disease and extracutaneous complications. We describe a 15-year-old girl with acrodermatitis chronica atrophicans of the left leg that had been misdiagnosed as chronic venous insufficiency for 6 years. Because of the long-standing disease course, skin changes expanded and progressed to marked atrophy. The correct diagnosis was finally based on clinical, histopathologic, and serologic findings. The girl was treated with oral doxycycline for 6 weeks, but her skin changes did not fully normalize. This case illustrates the possibility of acrodermatitis chronica atrophicans appearing in childhood and the difficulties in differentiating vascular disorders from acrodermatitis chronica atrophicans on the basis of the clinical appearance alone.
Acrodermatitis↗
Pitfalls in the clinical and dermoscopic diagnosis of pigmented actinic keratosis.
Pigmented actinic keratosis and melanoma may exhibit overlapping clinical features, thus representing a diagnostic challenge for dermatologists. Although the differentiation between these two entities is traditionally done by histopathology, dermoscopy has been utilized as a useful additional aid for improving the clinical diagnostic accuracy of such pigmented skin lesions. We report the clinical and dermoscopic features of two pigmented actinic keratoses to discuss the difficulties in their preoperative differential diagnosis.
Aged↗
Dermoscopic features of melanoma on the scalp.
There is a need to improve the early detection of melanoma of the scalp because it is characterized by a poorer prognosis compared with melanoma on other body sites. Dermoscopy is a useful tool for the early detection of melanoma but no previous reports on dermoscopic features of scalp melanoma have been published. We describe the first case of melanoma of the scalp seen by dermoscopy exhibiting a multicomponent global pattern with atypical pigment network, irregular streaks, and regression structures. In contrast to the dermoscopic features usually seen in melanoma occurring on the face, the same morphologic type of pigment network usually seen in melanoma of the trunk was observed in our case of scalp melanoma.
Dermoscopy↗
Differential diagnosis of cutaneous infiltrates of B lymphocytes with follicular growth pattern.
The differential diagnosis of cutaneous B-cell infiltrates with follicular pattern of growth is one of the most vexing problems in dermatopathology. In this study we focused on histopathologic, immunophenotypic, and molecular differential diagnostic criteria between Borrelia burgdorferi (Bb)-associated lymphocytoma cutis (LC), primary cutaneous follicle center cell lymphoma (FCCL), and primary cutaneous marginal zone lymphoma (MZL) with reactive germinal centers (GCs). A total of 47 patients were included in the study, including 12 cases of LC (M:F = 2:1; mean age: 38.0; median: 31; range: 9-75), 29 cases of FCCL (M:F = 1.2:1; mean age: 57.5; median: 57; range: 24-97), and 6 cases of MZL (M:F = 1:1; mean age: 63.8; median: 67.5; range: 38-86). In all cases complete phenotypic data were available. In addition, the IgH gene rearrangement and the t(14;18) were analyzed using the polymerase chain reaction technique (PCR) in 41 (FCCL = 27, LC = 10, MZL = 4) and 18 cases (FCCL = 15, LC = 2, MZL = 1), respectively. Histology revealed in all cases of FCCL one or more atypical feature of the follicles including the lack of or a reduced mantle zone, lack of polarization, tendency to confluence, and absence of tingible body macrophages. In most cases of Bb-associated LC, the GCs were devoid of mantle zone, lacked polarization, and revealed tendency to confluence as well, but all cases showed the presence of several tingible body macrophages. In MZL, follicles showed typical features of reactive GCs. Immunohistology revealed a reduced proliferative activity of neoplastic follicles as detected by MIB-1 antibody in 23 of 29 cases of FCCL (79.3%), but only in 1 case of LC (8.3%). Proliferation of the GCs was normal in all cases of MZL. Positivity for CD10 and/or Bcl-6 was found in small clusters outside the follicles in 19 cases of FCCL (65.5%), and in 3 cases of LC (25%), but in no case of MZL. The intensity of CD10 staining on follicular cells on average was stronger in cases of FCCL, but overlapping features could be observed. Finally, staining for Bcl-2 protein was consistently negative on GC cells in cases of LC and MZL, and was positive on a variable proportion of the cells in 8 cases of FCCL (28.6%). Molecular analyses showed no evidence of the t(14;18) in all cases tested. Analysis of the IgH gene rearrangement revealed a monoclonal pattern in 1 of 10 cases of LC (10%), 14 of 27 cases of FCCL (51.9%), and 2 of 4 cases of MZL (50%) tested. In summary, Bb-associated LC and FCCL show sometimes overlapping histopathologic, immunohistochemical, and molecular features, whereas follicles in MZL show clear-cut aspects of reactive GCs. Absence of tingible body macrophages within follicles, reduced proliferation of the follicles as detected by immunohistology, presence of positivity for Bcl-2 protein within follicular cells, and monoclonality by PCR are the main criteria suggestive of malignancy. Diagnosis of cutaneous infiltrates of B lymphocytes with follicular growth pattern should be achieved by integration of clinical data with histopathologic, immunohistochemical, and molecular features of the lesions.
Adolescent↗
Dermatoscopic follow-up of a changing pigmented melanocytic skin lesion during pregnancy: from nevus to melanoma?
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Adult↗
Borrelia burgdorferi-associated lymphocytoma cutis: clinicopathologic, immunophenotypic, and molecular study of 106 cases.
Lymphocytoma cutis (LC) is considered as the stereotypical example of the cutaneous B-cell pseudolymphomas. It can be induced by various antigenic stimuli including arthropod bites, vaccination, and drugs among others. In endemic regions, Borrelia burgdorferi is the principal causative agent for LC. We studied retrospectively 108 biopsies from 106 patients (male : female, 48 : 58; mean age, 44.6; median, 51.5; range, 3-81) with B. burgdorferi-associated LC retrieved from the files of the Department of Dermatology of the University of Graz (Austria). Only cases with a B. burgdorferi etiology (typical locations, positivity of serologic and/or polymerase chain reaction (PCR) tests, clinical history) were included in the study. Lesions were located on the nipple (63 cases), earlobe (18 cases), genital region (9 cases), and trunk or extremities (16 cases). PCR analysis of B. burgdorferi DNA was positive in 54 of 80 cases tested (67.5%). In 47 cases, we could retrieve data on serologic examination for B. burgdorferi antibodies performed at the time of diagnosis of LC. Positivity was found in 45 patients (IgG+/IgM+, 5 cases; IgG+/IgM-, 37 cases; IgG-/IgM+, 3 cases; IgG-/IgM-, 2 cases). Histology revealed dense lymphoid infiltrates with prominent germinal centers (GCs) in all cases. Atypical morphologic and/or immunophenotypic features of the GCs were commonly observed. In 5 cases, due to confluence of large follicles, the histopathologic pattern simulated that of a large B-cell lymphoma. PCR analysis of the IgH gene rearrangement performed in 33 cases showed a polyclonal pattern in 31 cases and a monoclonal band in 2. In summary, B. burgdorferi-associated LC can present with misleading histopathologic, immunophenotypic, and molecular features, and integration of all data is necessary for a correct diagnosis.
Adolescent↗
Cutaneous zosteriform melanoma metastases arising after herpes zoster infection: a case report and review of the literature.
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DNA, Viral↗
Cutaneous lymphomas with prominent granulomatous reaction: a potential pitfall in the histopathologic diagnosis of cutaneous T- and B-cell lymphomas.
The presence of a granulomatous reaction in lesions of cutaneous lymphomas has been described in the past in several cases. Especially in mycosis fungoides, a "granulomatous" variant of the disease has been well characterized. We studied the clinicopathologic features of cutaneous lymphomas with prominent granulomatous reaction, including both cutaneous T-cell lymphomas and B-cell lymphomas (primary cutaneous lymphoma 22, secondary cutaneous lymphoma one). Biopsies of 23 patients with histopathologic features of cutaneous T-cell lymphoma or cutaneous B-cell lymphoma with prominent granulomatous reaction were included in this study. A prominent granulomatous reaction was defined as the presence of a granulomatous component exceeding 25% of the dermal infiltrate. There were 14 cases of mycosis fungoides, two of subcutaneous panniculitis-like T-cell lymphoma, four of small/medium pleomorphic T-cell lymphoma, one of follicle center cell lymphoma, one of large B-cell lymphoma, and one of secondary cutaneous peripheral T-cell lymphoma. Altogether, a prominent granulomatous reaction could be observed in 1.8% of all patients with cutaneous lymphoma (primary or secondary) registered in the files of the Department of Dermatology of the University of Graz (Graz, Austria), demonstrating that there is a distinct, albeit small, proportion of cases revealing this peculiar reaction pattern. In seven cases a misdiagnosis of granulomatous dermatitis preceded the correct diagnosis for a period of 1-216 months, suggesting that sequential biopsies and complete phenotypic and molecular genetic analyses should be carried out in cases of "unusual" granulomatous dermatitis.
Adult↗