Biomedical subjects
Publications and source records attributed to L Requena.
This report describes an example of combined nevus with malignant transformation. The clinical impression was blue nevus. Histologically, the lesion was composed of a cellular blue nevus in the reticular dermis and an overlying compound melanocytic nevus. The junctional component of the melanocytic nevus showed transition to malignant melanoma in situ. A review of the literature failed to find a precedent for the present case.
Currently it is well established that each of the three parts of the hair follicle (infundibulum, isthmus, and the inferior portion) originates different types of cutaneous cysts. Thus, follicular cysts include infundibular, trichilemmal, and matricial cysts. Brownstein in 1983 described a mixed type of cutaneous cyst combining epidermoid, infundibular, and trichilemmal types of keratinization. We review and illustrate the different combinations of follicular hybrid cysts reported to date: infundibular and trichilemmal cyst, infundibular and pilomatricoma cyst, trichilemmal and pilomatricoma cyst, eruptive vellus hair cyst and steatocystoma, and eruptive vellus hair cyst and trichilemmal cyst. Therefore, the concept of hybrid cyst should not be restricted to those composed of infundibular and trichilemmal cysts, because any cyst arising from the various parts of the pilosebaceous unit can combine with others to form a large series of follicular hybrid cysts.
Four cases of epidermotropically metastatic carcinoma are reported. One of them originated from a breast adenocarcinoma; in two other cases, the primary tumor was located in the large intestine; and, in the fourth case, the primary malignancy was a laryngeal squamous cell carcinoma. Clinically, the cutaneous metastases were nodular lesions and histologically, in addition to the involvement of the dermis by malignant cells, in three cases there was intraepidermal involvement by glandular structures. In the fourth case, the cutaneous metastatic tumor cells showed striking "folliculotropism." We review the literature of epidermotropically metastatic carcinoma and discuss its differential diagnosis.
A 23-year-old man with multiple trichodiscomas on his face is described. Four papules were histologically examinated, and all of them showed similar findings, a dermal fibrovascular proliferation with abundant ground substance between collagen bundles and an absence of elastic fibers. We found no evidence to establish a relationship between trichodiscomas and hair disk, and, in our opinion, these lesions should be included into the spectrum of hyperplasia of the adventicial dermis.
A case of erythema elevatum diutinum (EED) closely resembling porphyria cutanea tarda (PCT) is reported. The initial skin biopsies were suggestive for PCT but porphyrin levels in the urine, stool and plasma were normal. A further biopsy from an early cutaneous lesion showed a leucocytoclastic vasculitis with fibrinoid necrosis of the vessel walls.
We describe a patient in whose family 13 of 26 members have a palmo-plantar keratoderma. The histopathological findings in the proband, his brother and father were those of epidermolytic hyperkeratosis. As in other families reported, this disorder was found to be inherited as an autosomal-dominant trait. A review of the literature on the clinical, genetic and associated features of this genodermatosis is presented. We also review the cutaneous conditions that may exhibit the histopathological pattern of epidermolytic hyperkeratosis.
We report a stellate-cell dermal tumour which was studied by immunohistochemistry and electron microscopy. The stellate morphology of the tumour cells appeared to be due to retraction of their cytoplasm resulting in the emergence of intercellular spaces. Results of the immunohistochemical investigations were consistent with a neural tumour, but we could not assign it to any particular category of the known neural tumours. Therefore we have designated this tumour as an unusual, benign, neural-tumour with stellate-cell morphology.
Squamous cell carcinomas (SCCs) usually show a standard histopathologic picture only varying with regard to their degree of differentiation. The authors describe a case of clear cell SCC that was studied by light and electron microscopy. The clear cells showed an empty cytoplasm that was periodic acid-Schiff and alcian blue negative. By electron microscopy these cytoplasms consisted of empty spaces and were not surrounded by membranes, which would be consistent with lipid vacuoles. The differential diagnosis of this uncommon variant of SCC requires consideration of other clear cell tumors.
A case of choriocarcinoma of the testis metastatic to the skin is reported. In this case report the primary tumor was first diagnosed by the histopathologic findings in the cutaneous biopsy of a single nodule that appeared on the chest, with both syncytiotrophoblastic and cytotrophoblastic cells in the metastatic solid tumor islands. Using peroxidase-antiperoxidase techniques, beta-human chorionic gonadotropin (beta-HCG) was positive within the cytoplasm of syncytiotrophoblastic cells. The patient was treated with orchiectomy, chemotherapy, and radiotherapy. With these measures there was a decrease of chorionic gonadotropin serum levels to normal limits and 2 years after this treatment there is no evidence of recurrence.
A case of a keratoacanthoma arising from the center of a superficial spreading malignant melanoma in situ is presented. The keratoacanthoma already showed regressive changes in its central area, and the superficial spreading malignant melanoma had partially disappeared at the site in which the keratoacanthoma had arisen. The possible mechanisms of these interactions are discussed.
We report a case of localized epidermal necrolysis that developed 24 hours after an intravenous injection of vinblastine. Clinically, the lesions consisted of erythematous macules, vesicles, and bullae with a linear arrangement over the injected vein. Histologically, the lesions showed features closely resembling erythema multiforme (epidermal necrolysis). We discuss the pathogenesis of this curious cutaneous drug reaction and review the literature concerning local cutaneous complications associated with intravenously administered chemotherapeutic agents.
Cutaneous effects secondary to lymphography are rare events. We herein report a patient with Hodgkin's disease who developed a linear dermatitis in both lower limbs 6 days after a pedal lymphography. Histopathologic examination of the lesions demonstrated a subacute dermatitis. Patch tests with the substances used in the lymphography yielded negative results. We discuss the possible pathogenic mechanisms of this striking linear dermatitis.
A 64-year-old female had breast carcinoma of the right breast, and a mastectomy was performed. Three years later she developed a vesiculobullous eruption along the surgical scar. Histopathological and direct immunofluorescence findings were consistent with a diagnosis of pemphigus vulgaris. We discuss the possible pathogenesis for this striking linear distribution of the pemphigus vulgaris lesions.
Several types of vasculitis have been described in patients with human immunodeficiency virus infection. Erythema elevatum diutinum is a rare variant of cutaneous leukocytoclastic vasculitis which, with the exception of the case reported herein, has been described only once in human immunodeficiency virus-infected patients. Our male patient, a longtime intravenous drug abuser, had cutaneous lesions, closely resembling Kaposi's sarcoma, on the extensor surfaces of the lower extremities. Cutaneous biopsy specimens, however, demonstrated leukocytoclastic vasculitis with fibrinoid necrosis of the vessel walls and areas of basophilic degeneration of collagen bundles in early lesions, whereas late lesions showed dense diffuse fibrosis with proliferation of dermal spindle cells and some foci of residual leukocytoclastic vasculitis. Oral therapy with dapsone resulted in marked clearing of the cutaneous lesions within few days. This case raises the necessity of histologic confirmation for all cases of suspected Kaposi's sarcoma in patients with acquired immunodeficiency syndrome. We discuss the possible pathogenesis of leukocytoclastic vasculitis in human immunodeficiency virus-infected patients.
A case of Beau's lines secondary to combined chemotherapy for Hodgkin's disease is reported. These transverse nail depressions are interpreted as the result of a transient interruption of the nail matrix activity due to antimitotic drugs. Other causes of Beau's lines are reviewed.
A case of hyperkeratosis lenticularis perstans involving only the back of a thirty-nine-year-old woman is reported. Histologic examination showed foci of compact and eosinophilic hyperkeratosis overlying a thinned stratum malpighii. In the underlying papillary dermis there was no evidence of inflammatory infiltrate. This case demonstrates that hyperkeratosis lenticularis perstans may appear as a localized disorder, and that the inflammation is not an essential pathogenic process in this disorder.
A thirty-six-year-old man presented with a melanocytic nevus on his left shoulder. The lesion was excised and histopathologic examination showed an intradermal nevus with several infundibular cysts among the nevus cells. These cysts showed a cyst wall with epidermoid keratinization and a lumen filled by many cross-sectioned hair shafts. These findings were consistent with a diagnosis of trichostasis spinulosa within an intradermal melanocytic nevus. We note the relationship between these two disorders in the same lesion.
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