1/39. Cerebriform plantar hyperplasia: ultrastructural study of two cases.In the present work we report the histopathological features of the cerebriform plantar hyperplasia observed in two patients with a mild form of the proteus syndrome. light microscopy revealed increased fibro-adipose tissue and adnexal structures in the dermis. Ultrastructurally, densely packed collagen fibrils variable in diameter and configuration, described as composite fibrils and unraveled fibrils, as well as a few fragmented elastic fibrils presenting an altered ratio between the elastin and the microfibrillar components were the major features observed. We consider that these histopathological findings will contribute to further delineate cerebriform plantar hyperplasia and also to establish clues for the early diagnosis of the proteus syndrome.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
2/39. Sebaceous hyperplasia: a clue to the diagnosis of dermatofibroma.We describe a man with an indurated lesion on his upper back that showed a dermatofibroma with overlying sebaceous hyperplasia. Characteristic dermal features of a dermatofibroma may be sparse or absent in a lesional specimen that has been submitted subsequent to a superficial shave biopsy. hyperplasia of sebaceous glands in a nonfacial lesion is a histologic feature that should prompt the search for a dermatofibroma in the underlying dermis.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
3/39. An unusual melanocytic lesion associated with eccrine duct fibroadenomatosis and syringoid features.The intimate association of nevomelanocytic nevi with eccrine ducts commonly seen in congenital nevi was emphasized by Mishima, who described as eccrine-centered nevi those lesions characterized by nevomelanocytic cells predominantly proliferating around and within the eccrine sweat duct walls. However, there were no changes in the overlying epidermis, dermis, or eccrine acrosyringeal or dermal duct proliferation in these lesions. We present the case of a 16-year-old boy with a 1-year-history of a 0.6-cm diameter single tan papule on the right heel, clinically thought to be a Spitz nevus. Histopathologic examination revealed a compound nevomelanocytic nevus associated with epidermal hyperplasia, thin anastomosing cords of acrosyringeal epithelium extending within the dermis, and eccrine ductal proliferation in a syringoma-like pattern associated with a dense fibrous stroma. Features that distinguish our case from eccrine-centered nevus are that the latter lacks epidermal and eccrine duct hyperplasia and a dense fibrous stroma. The location of the lesion on the heel in our case suggests the possibility that the pathologic changes observed could result from repetitive trauma.- - - - - - - - - - ranking = 3keywords = dermis (Clic here for more details about this article) |
4/39. Pseudoepitheliomatous hyperplasia secondary to cutaneous aspergillus.Cutaneous aspergillosis commonly occurs in immunocompromised hosts and may also complicate burn wounds. Pseudoepitheliomatous hyperplasia (PH) is a histologic reaction secondary to a wide range of stimuli, including fungal infection. We describe a case of an 18-year-old man, status-post burns over 70% of his total body surface area, with cutaneous aspergillosis of the axilla and secondary PH. A single case of PH secondary to primary aspergillosis has been described in the larynx but, to our knowledge, has never been described cutaneously. Histologic examination of the lesion reveals an irregularly acanthotic epidermis with deep invaginations within the dermis. There is an intense inflammatory reaction within the superficial and deep dermis. Numerous fungal forms are identified within the dermis. Special stains demonstrate septate hyphae with dichotomous branching, which is morphologically consistent with aspergillus. Therefore, we conclude that cutaneous aspergillosis should be included in the differential diagnosis of causes of PH, especially in a patient population at risk for this infection.- - - - - - - - - - ranking = 4keywords = dermis (Clic here for more details about this article) |
5/39. Pseudoepitheliomatous hyperplasia in lichen sclerosus of the vulva.Small tentacles or separated nests of squamous cells in the dermis are not uncommonly seen in long-standing vulvar lichen sclerosus (LS) associated with epidermal thickening. We recently encountered a case where separated nests of well-differentiated squamous cells in the dermis were difficult to distinguish from squamous cell carcinoma (SCC). Further biopsies showed similar nests originating from every hair follicle. We postulated a diagnosis of multifocal pseudoepitheliomatous hyperplasia (PEH) to explain this phenomenon. Because we could find no reference to PEH in the setting of LS, we reviewed the biopsies of 92 women with extragenital and vulvar LS with and without carcinoma to determine its frequency and histological appearance. The study population, which excluded the index case, comprised 10 women with extra-anogenital LS, 58 with vulvar LS without carcinoma, and 24 with vulvar LS with carcinoma. The presence of PEH, epidermal thickness, predominant dermal collagen change, degree of inflammation, and presence of fibrin and red blood cells were recorded. The presence or absence of lichen simplex chronicus (LSC), squamous cell hyperplasia (SCH), and differentiated vulvar intraepithelial neoplasia (VIN) were recorded. PEH was identified only in vulvar LS, where it was seen in 7/58 (12.1%) women without carcinoma, 1/24 (8.3%) with carcinoma, and 0/10 (0%) with extra-anogenital LS. Two forms of PEH were seen: predominantly epidermal 7/8 (87.5%) and predominantly follicular 1/8 (12.5%). PEH was associated with increased epidermal thickness, less dermal edema, more dermal inflammation, fresh fibrin, and red blood cell extravasation. In all cases, there was associated LSC, but there was no SCH or differentiated VIN. In conclusion, PEH may explain many of the cases of dermal tentacles and separated squamous nests in vulvar LS with LSC. The association with fresh fibrin and red blood cells suggests that PEH might be a reaction to tissue damage. PEH is distinguished from SCC by its lack of atypia, confinement to the abnormal collagen, and limited growth. The pathologist must be careful about making a diagnosis of PEH in LS with epidermal thickening, looking carefully for basal atypia and other features of differentiated VIN in the overlying epidermis or dermal proliferation. We do not know whether PEH occurs in differentiated VIN and, if it does, how it could be distinguished from SCC.- - - - - - - - - - ranking = 3keywords = dermis (Clic here for more details about this article) |
6/39. Pachydermodactyly: a forme fruste of knuckle pads?A 16-year-old boy presented with painless swellings localized to the radial and ulnar aspects of his second through to the fifth fingers on the left hand, with more subtle changes affecting two fingers on the opposite hand. This had developed in the absence of mechanical trauma. Investigations for an arthropathy were negative, while a biopsy showed marked epidermal hyperplasia and an expanded dermis. These features are typical of pachydermodactyly, a benign dermatosis of uncertain aetiology. The interesting feature of this case is the presence of knuckle pads in the father of the patient, which raises the possibility that these two similar entities are related.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
7/39. Massive pseudoepitheliomatous hyperplasia: an unusual reaction to a tattoo.We document an unusual tattoo reaction presenting as verrucous plaques, which on histopathologic examination showed marked pseudoepitheliomatous epidermal hyperplasia. The patient is a 27-year-old female who presented to her dermatologist complaining of itchy overgrowth of her tattoo. Her symptoms began 2 months after tattoo placement approximately 1 year ago. physical examination revealed verrucous plaques in the purple areas of the tattoo, suggesting a clinical diagnosis of a granulomatous tattoo reaction. A superficial biopsy showed epidermal hyperplasia somewhat reminiscent of a regressing keratoacanthoma. No tattoo was identified. A repeat shave biopsy demonstrated marked epidermal hyperplasia with focal keratin filled cystic dilatations, and local mild reactive keratinocytic atypia. In the surrounding dermis, there was dense chronic inflammation, fibrosis, and granules of dark red pigment. These findings suggest marked pseudoepitheliomatous hyperplasia secondary to the tattoo. Different reaction patterns have been described in association with tattoos, such as granulomatous and/or perivascular lymphocytic inflammation. However, there have been few cases reported of pseudoepitheliomatous hyperplasia arising at a tattoo site. Therefore, we encourage physicians to consider massive epidermal hyperplasia in the differential diagnosis of a verrucous tattoo reaction.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
8/39. Plate-like sebaceous hyperplasia overlying dermatofibroma.Epidermal hyperplasia, sometimes with primitive hair follicle-like differentiation, is a characteristic finding overlying dermatofibroma. We here report plate-like sebaceous hyperplasia overlying a dermatofibroma. Such changes are interpreted as a result of inductive epithelial effect by the dermatofibroma on the overlying epidermis.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
9/39. Primary cutaneous CD30 anaplastic large cell lymphoma with keratoacanthoma-like pseudocarcinomatous hyperplasia and marked eosinophilia and neutrophilia.BACKGROUND: Pseudocarcinomatous hyperplasia (PCH) and marked tissue neutrophilia have been observed in cutaneous CD30( ) anaplastic large cell lymphoma (ALCL) occasionally and may cause misdiagnosis. methods: An unusual case of CD30( ) ALCL of the skin resembling keratoacanthoma (KA) both clinically and pathologically was described. Histologic examination and immunostaining were performed. RESULTS: A 55-year-old woman presented with a 3-month history of an enlarging hyperkeratotic tumor on the forehead with a central keratinous plug. Microscopic examination showed epithelial hyperplasia resembling KA and a diffuse background infiltrate of large atypical lymphoid cells in the dermis. The atypical cells resembled epithelial cells and were obscured by a massive infiltrate of eosinophils and neutrophils. Immunostaining confirmed the presence of a diffuse infiltrate of CD30( ) cells; these cells were negative for CD45RO, CD20, CD15, epithelial membrane antigen, anaplastic lymphoma kinase-1, and cytokeratin. There was no evidence of extracutaneous involvement. The findings were consistent with primary cutaneous CD30( ) ALCL of null cell phenotype with KA-like epithelial hyperplasia and marked eosinophilia and neutrophilia. CONCLUSIONS: Our case illustrates that primary cutaneous ALCL may be associated with KA-like PCH and concurrent marked tissue eosinophilia and neutrophilia. Diagnosis in such cases is challenging both clinically and histologically because the large atypical lymphoid cells may easily be obscured by the massive infiltrates of eosinophils and neutrophils or confused with invasive squamous cell carcinoma.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
10/39. Reactive syringofibroadenomatous hyperplasia in peristomal skin with formation of hybrid epidermal-colonic mucosa glandular structures, intraepidermal areas of sebaceous differentiation, induction of hair follicles, and features of human papillomavirus infection: a diagnostic pitfall.We report a case of reactive syringofibroadenomatous hyperplasia in peristomal skin. The patient was a 62-year-old woman who had undergone abdominoperineal resection of the rectum for rectal adenocarcinoma with subsequent colostomy 2 years earlier. Clinically, a nodule and small, whitish, warty lesions developed at the outer margin of the stoma extending onto the adjacent skin. Following a clinical suspicion of adenocarcinoma, recurrent at the colostomy site, a 5 x 4 x 3-cm excision of the peristomal skin and the affected portion of the stoma was performed and submitted for histologic examination. The biopsy revealed a peculiar composite lesion of reactive syringofibroadenomatous hyperplasia and the excised part of the stoma. Several unusual histopathological features were detected in the syringofibroadenomatous part of the lesion such as the formation of plentiful hybrid epidermal-colonic mucosa glandular structures, intraepidermal areas of sebaceous differentiation, koilocytic changes, induction of rudimentary hair follicles, and intradermal mucinous lakes. The cellular composition of the glandular structures was mainly similar to that seen in a normal colonic mucosa epithelium. They also contained occasional paneth cells. Being located at a distance from the stoma, these accentuated colonic mucosa epithelial glands reaching the epidermis may be a diagnostic pitfall prompting the consideration of adenocarcinoma involving the stoma. The rudimentary follicles and sebaceous differentiation were probably induced by an altered stroma and/or human papillomavirus (HPV): HPV, type 36 was identified by PCR using consensus primers followed by sequencing of the PCR products.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
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