Biomedical subjects
Publications and source records attributed to L Requena.
We report two cases of epithelial necrosis in comatous patients. The cutaneous lesions were characterized by erythematous plaques which later evolved to bullous lesions. Histologic examination demonstrated epidermal necrosis with subepidermal blisters, sparse neutrophilic inflammatory infiltrate and, characteristically, eosinophilic necrosis of the eccrine sweat gland coils.
A patient with a pruritic vesicular eruption closely resembling dermatitis herpetiformis is described. Histopathologic examination of a biopsy specimen showed a subepidermal blister containing abundant eosinophils and neutrophils, whereas results of direct immunofluorescence studies demonstrated linear and homogeneous deposition of IgG and C3 along the basement membrane zone. Prednisone therapy was necessary to control the clinical symptoms. Similar cases have been described as "vesicular pemphigoid."
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One hundred and seventy cases of nasal and/or sinus polyps diagnosed in the Pathology Service of the Hospital Militar Central GOMEZ/ULLA of Madrid (Spain) between 1.9.79 and 1.9.88 are reviewed. In two cases areas of 'carcinoma in situ' in the epithelium covering the polyps were demonstrated. The literature is reviewed for reports of malignant transformation and dysplastic changes in nasal and sinusal polyps. We suggest that precancerous changes may occasionally be noted in inflammatory lesions, a fact that pathologists should keep in mind.
A case of follicular lymphomatoid papulosis was studied by light- and electron-microscopic methods. The nature of atypical cells was analyzed with monoclonal antibodies. This case proved to be mainly a type B lymphomatoid papulosis with a predominance of T-helper markers in atypical lymphoid cells. All previously reported cases of this rare variant corresponded to type A lymphomatoid papulosis. Therefore we believe this to be the first case report of type B follicular lymphomatoid papulosis.
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We report 22 cases of pigmented spindle cell naevus (PSCN). The usual appearance of these naevi is that of a heavily pigmented papule found mostly on the legs of young patients. Histologically, PSCN was characterized by symmetrical proliferation of spindle-shaped pigmented melanocytes grouped in large junctional nests. Pagetoid spread of single cells in the overlying epidermis was frequently found. In our opinion, PSCN is a distinctive benign acquired melanocytic naevus that in the past has been frequently misdiagnosed as atypical Spitz naevi or malignant melanoma.
A patient with angiolymphoid hyperplasia with eosinophilia is described. This is, to our knowledge, the first case report in which the lesions were located on the vulva.
A patient with a sclerosing-sweat-duct carcinoma of the upper lip is reported. Histologically the tumour showed solid islands and strands of squamous cells and sparse small ductal structures, some of them containing central cores of dense eosinophilic keratin. All this was embedded in a sclerotic stroma. These features, in addition to positive immunoreactivity for carcinoembryonic antigen (CEA) in the lumina of small ducts, and the presence of S-100 protein-positive cells in some cords and ducts, are consistent with the notion that this tumour exhibits differentiation toward eccrine sweat structures.
We report a case of papillary eccrine adenoma. This benign cutaneous tumour had a diagnostic microscopic appearance that consisted of multiple dilated ducts lined by two or more layers of cells. The inner layer often formed intraluminal papillary projections of variable complexity. The lumina were filled by eosinophilic amorphous material. Immunoperoxidase studies showed carcino-embryonic antigen in the luminal border of the ducts, but S-100 protein was absent for tumoral ducts. We discuss the eccrine and apocrine differentiation of this neoplasm on the basis of the immunoperoxidase results. The differential diagnosis includes other cutaneous neoplasms with intraductal papillary proliferation.
Spring eruption of the ears is a distinctive photo-dermatosis characterized by the onset of papules and vesicles on the light-exposed helix of the ears that usually develop in the early spring months and mainly affect juvenile males. Histologically the picture evolves according to evoluntionary stage of the lesions from a nodular dermal inflammatory infiltrate in papular lesions to subepidermal blisters in vesicles. The striking and isolated location on the ears and its onset as small outbreaks are clinical features resulting from unknown mechanisms.
We report an aggressive keratoacanthoma of the upper eyelid that recurred at the site of a previously excised keratoacanthoma. The diagnosis was confirmed by biopsy. Because the surgery required would be extensive, medical therapy was tried first. The tumor was treated with intralesional injections of 5-fluorouracil and radiotherapy. Despite this therapy, the orbital computed tomogram showed tumor extension into the orbit, and an orbital exenteration was performed. Histopathology of the excised tumor was consistent with squamous cell carcinoma. We discuss the topic of malignant transformation of the keratoacanthoma.
Large cell acanthoma (LCA) is an epidermal neoplasm whose nature has been variously explained. Though frequently hyperpigmented, we describe for the first time an achromic case located on the dorsum of the right hand of a 83-year-old woman. This observation is largely inconsistent with one of the theories about the nature of this condition: that it is merely a solar lentigo with large nuclei of keratinocytes.
Cystic dilatation of a hair follicle, folliculitis, abscess formation and epidermoid cysts are not infrequent findings in an intradermal melanocytic nevus. We herein report a trichilemmal cyst under a compound melanocytic nevus. To the best of our knowledge this association has not been previously reported.
We report an angioleiomyoma developed within a cellular histiocytoma on the calf of a 77-year-old man. The lesion consisted of a spherical nodule with two well-defined concentric areas. The outer circular area was a cellular histiocytoma and the inner central area consisted of an angioleiomyoma. Immunoperoxidase investigations for desmin demonstrated positivity in the angio-leiomyoma, whereas the histiocytoma remained negative. Serial sections of the lesion failed to demonstrate a connection between the angioleiomyoma and a normal vein which could have been trapped by the histiocytoma. The angioleiomyoma may have originated from a vessel in the histiocytoma.
We report a trichoblastic fibroma in the groin of a 60-year-old woman. This unusual tumor showed a predominance of epithelial component, with abundant basophilic, well-circumscribed, epithelial lobules and some keratinous cysts. Several areas suggested stromal induction of differentiation, and in the keratinous cysts there were indications of outer hair sheath differentiation. We review the clinical data from published cases of trichogenic hair germ tumors and discuss the differential diagnosis.
We describe a patient who developed a pigmented plaque on the anterior aspect of his right knee clinically mimicking angiokeratoma circumscriptum or malignant melanoma. Histopathological examination demonstrated a multinodular hemosiderotic dermatofibroma in which the cellular tumor islands were separated by areas of hyalinized collagen. Multinucleated giant tumor cells were found in the lumen of a medium-size vein underlying the tumor. The differential diagnosis of angiomatoid malignant fibrous histiocytoma, a tumor with clinical and morphologic similarities, is discussed.