bluuebunny/crossref_metadata_2025 huggingface dataset:
Mixed carcinoma in situ: an immunohistochemical study
Authors: Peralta O. C. , Barr R. J. , Romansky S. G.
Published: April 2006

A case of mixed carcinoma in situ, of the skin, is presented. The lesion, located on the right temple of a 71–year‐old man, showed histologic features of Bowen's disease and cxtramammary Paget's disease. This case suggests that Bowen's disease and extramammary Paget's disease may arise from pluripotential adnexal epithelium capable of keratinocytic and glandular differentiation. Utilization of the peroxidase‐antiperoxidase technique for demonstrating carcino‐embryonic antigen was performed in order to identify the component interpreted as extramammary Paget's disease. This procedure is apparently more sensitive than the commonly employed histochcmical stains for demonstrating glandular differentiation.
Nevi and melanoma induced by chemical carcinogens in laboratory animals: similarities and differences with human lesions
Authors: Pawlowski A. , Lea P. J.
Published: April 2006

The isolation of benzo(a)pyrene (BP) from coal tar, and the synthesis of dibenzanthracene (DBA), methylcholanthrene (MCA), and dimethylbenzanthracene (DMBA) in the 1930's, facilitated the induction of epidermal tumors in experimental animals. It was soon found that chemical carcinogens affect not only keratinocytes, hut also the melanocytes (Szabo 1963). “Painting” the skin of small laboratory animals, with carcinogens, became the principal method of studying the mechanisms of chemical carcinogenesis (Yuspa et a). 1976a).

Pigmented nevi and melanoma are perhaps two of the most interesting problems in dermatology, oncology and pathology. Questions related to histogenesis, classification, diagnosis, treatment and eventual prevention remain unanswered.

A substantial amount of our work is used to support most of the main points regarding the development of nevi and melanoma in laboratory animals.
Demodectic infestation of the pilosebaceous follicle
Authors: Crosti C. , Menni S. , Sala F. , Piccinno R.
Published: April 2006

Scanning electron microscopy revealed Demodex folliculorum on the face surface of twenty healthy subjects. The ultrastruclural morphology of Demodex and the follicle parasitization process are briefly illustrated.
Measurement of collagen‐fibre diameter in human skin
Authors: Barton S.P. , Marks R.
Published: April 2006

A method for the measurement of collagen fibre diameter in human skin is described. Photographic reduction of electron micrograph negatives onto positive transparency film allows the use of a Quantimet 720 image analysis system for relatively rapid determination of mean collagen fibre diameter based upon the mean cross‐sectional area of a single electron microscope field. The mean collagen fibre diameter from papillary and reticular dermis in normal skin was 56.2 ± 2.5 nm and 62.8 ± 4.3 nm respectively, and exhibited slightly skewed Unimodal distributions.
An ultrastructural study of pretibial myxedema utilizing improved ruthenium red stain
Authors: Ishii M. , Nakagawa K. , Hamada T.
Published: April 2006

A case of pretibial myxedema associated with Graves' diseases has been studied by electron microscopy utilizing an improved ruthenium red stain. An organized network of microfibrils with knobs were found within the widened interfibrous spaces. This network was clearly demonstrated by the ruthenium red stain, but only a weak trace could be observed when conventional staining techniques were utilized. Knobs of the network seemed to be composed of ruthenium red‐positive granules which surrounded normal fibers and granules of degrading collagen fibers. Many fibroblasts showed dilated rough endoplasmic reticulum containing much amorphous material which indicated a significant role of fibroblasts in the pathogenesis of this disease.
Diagnosis of bullous disease and studies in the pathogenesis of blister formation using immunopathological techniques
Authors: Ahmed A. Razzaquk
Published: April 2006

Several skin diseases may present as vesicles or bullae. Immunofluorescent studies arc very helpful in differentiating the various disease entities. Familiarity with the procedure and the various kinds of patterns that are specific and non‐specific is essential for the practicing dermatologist. Imminofluorescent patterns are particularly helpful in differentiating pemphigus, bullous pemphigoid, cicatrical pemphigoid, herpes gestationis, dermatitis herpetifomis, linear IgA dcrmatosis and porphyria. Immunofluoiescent studies of the skin and sera of these patients were vital to an understanding their pathogenesis. Imminoelectron microscopy has further helped in delineating the exact sites of immunoglobulin deposition, and, thus, identifying the location of the antigens. In pemphigus, studies at the molecular level reveal that the basic pathological process is mediated by an anti‐cellular cement substance antibody. The binding of this antibody at the cell surface level results in a process that is seen at the light microscopy level in the form of acantholysis. In bullous pemphigoid cells may play an important role. It appears that the mast cell, eosinophil. and the lymphocyte in harmony with the poly‐morphonuclear leucocyte work together to bring about an enzymatic degradation of the basement membrane. The specific role of the anti‐basement membrane zone antibody is also under current study. With advances in molecular immunology, especially monoclonal antibodies and gene technology, it is hoped that these cellular and molecular interactions will be better understood and further defined.
Eosinophilic ulcers of the tongue
Authors: Borroni G. , Pericoli R. , Gabba P. , Rosso R. , Rabbiosi G.
Published: April 2006

A case of eosinophilic ulcer of the tongue is presented. Although the entity is rarely described, the distinctive histopatologic pattern featuring the remarkable presence of eosinophils in the superficial corium and in between muscle bundles, together with the benign clinical course, make a diagnosis possible.
The cutaneous pathology of facial lesions in Cowden's disease
Authors: Starink T. M. , Hausman R.
Published: April 2006

A study of 11 facial lesions from 7 patients with Cowden's disease indicated that most belong to a spectrum of related follicular malformations. The most distinctive lesions included multiple facial trichilemmomas, which were frequently cylindrical, resembling a blown‐up hair follicle, but could he lobular. Four of the 5 trichilemmomal lesions were from the centrofacial area. Three periauricular lesions showed the pattern of tumor of follicular infundibulum without trichilemmonal features. Two lesions were epidermal without a follicular component and resembled digitate warts. No evidence of virus infection was found using an antiserum to papilloma virus.
Unusual vascular tumour of the scalp in association with lymphoid aggregates: a variant of angiolymphoid hyperplasia?
Authors: Dawson J. , Mauduit G. , Kanitakis J. , Euvrard S. , Thivolet J.
Published: April 2006

A 51‐year‐old mason presented with a large tumour on his scalp which had developed over the previous 2 years. Histological examination showed the presence of large vessels with muscular coats some of which appeared to be venules and others arterioles. They had markedly swollen cuboidal endothelial cells and a surrounding mononuclear cell infiltrate which in areas formed lymphoid follicles some of which had germinal centers. There was no evidence of tissue or blood eosinophilia. The unusual clinical and histological features of this case are emphasized and the nosology of this rare condition is discussed.
Evaluation of carcinoembryonic antigen in extramammary Paget's disease
Authors: Fukukawa F. , Kashihara M. , Miyauchi H. , Yamabe H. , Hamashima Y. , Imamura S.
Published: April 2006

An autopsied case of extramammary Paget's disease associated with the elevation of serum CHA level is reported. An abnormally high level of scrum CEA was found in 46% of patients with this disease.
A study of intermediate filaments (cytokeratin, vimentin, neurofilament) in two cases of Merkel cell tumor
Authors: Dreno B. , Mousset S. , Stalder J. F. , Bureau B. , Litoux P. , Barrièare H.
Published: April 2006

In two cases of Merkel cell tumor, the study of intermediate filaments, using monoclonal antibodies (vimentin, cytokeratin, neurofilaments), confirmed the double differentiation (neuroendocrine and epithelial) of this tumor as previously observed in histological, electron microscopical and histochemical analyses. Labelling of the tumor cells was positive with monoclonal antibodies against neurofilament proteins and cytokeratin.
Correlative studies of Verruca vulgaris by H & E, PAP immunostaining, and electronmicroscopy
Authors: Eng A. M. , Jin Y.‐T. , Matsuoka L. Y. , Grgurich C. V. , Robinson J. , Armin A.
Published: April 2006

Twenty‐one specimens of Verruca vulgaris were used for an investigation to define what portion of the papillomatous structures seen in H & E stain will correspond to Che areas of positive staining for pupilloma virus antigen utilizing the peroxidase‐antiperoxidase immunostaining technique. Vacuolar spaces filled with thready material and large ovoid parakeratotic cells seen in H & E stain stained positively for papilloma virus antigen. In the granular layer, viral antigens stained heavily, the nuclei of cells showing koilocytosis. Both round and irregularly shaped kerathohyaline granules did not stain positively for viral antigen stain. Eight of the 21 specimens showed marked positivity for papilloma virus antigen. Three other cases were positive in only focal sites. Of the 8 immunostained‐positive selected cases used for ultrastructural studies, only 2 showed the viral particles. The study suggests that the PAP immunostaining is a more sensitive and yet less cumbersome method than electronmicroscopy for demonstration of papilloma virus
Histopathology of Gottron's papules
Authors: Hanno R. , Callen J. P.
Published: April 2006

We studied Gottron's papules in 11 cases of known dermatomyositis to determine whether the findings were similar to those in the poikilodermatous eruption usually biopsied in this disease. As in typical poikilodermatous dermatomyositis, basal layer vaculopathy, PAS‐positive basement membrane thickening, upper dermal niucin deposition and a mild diffuse upper dermal mononuclear infiltrate were frequent findings. In contrast to poikilodermatous dermatomyositis, however, epidermal hyperplasia consisting of acanthosis or papillomatosis was often present and epidermal atrophy was rare. We conclude that a specific diagnosis of dermatomyositis can often be made on biopsy of a Gottron's papule.
Cutaneous extraskeletal Ewing's sarcoma
Authors: Peters M. S. , Reiman H. M. , Muller S. A.
Published: April 2006

Extraskeletal Ewing's sarcoma has been recognized as being histologically indistinguishable from Ewing's sarcoma of bone. Although the occurrence of extraosseous Ewing's sarcoma in deep soft tissues has been well described, such cutaneous lesions arc rare. We report the clinical history, histopathologic findings, and results of ultrastructural study of this rare variant occurring in a 12‐year‐old girl. She presented with a dermal and subcutaneous tumor of the left third toe, without osseous involvement. The lesion was composed of masses of round‐oval cells, with perilobular fibrosis, focal hemorrhage, ill‐defined pale cytoplasm containing glycogen, and absent pericellular reticulin. Ultrastructural study showed a monotonous cell population, with focal thickening of apposing membranes, high nuclear/cytoplasmic ratio, copious intracytoplasmic glycogen, and paucity of organ cells except mitochondria. We present this case along with discussion of the literature and problems concerning differential diagnosis of small cell malignancies in the skin.
The cutaneous pathology of Cowden's disease: new findings
Authors: Starink T. M. , Meijer C. J. L. M. , Brownstein M. H.
Published: April 2006

Histological, histochemical and immunohistochemical findings were studied in 40 cutaneous biopsies from 7 patients with Cowden's disease. Most facial biopsies showed a spectrum of trichilemmomas and related follicular malformations, including cylindrical trichilemmomas, lobulate trichilemmomas (14 lesions), and a keratinizing type sharing features with inverted follicular keratosis. One facial growth showed trichilemmomal changes without apparent follicular origin. Studies for common papilloma virus structural antigens were negative, apart from a typical common wart in one patient. Immunohistochemical studies in 6 facial trichilemmomas and acral keratoses, using a panel of anti‐keratin antibodies, disclosed only abnormal differentiation with lack of large keratins in the lobulate trichilemmomas. Nine biopsies revealed a distinctive type of fibroma characterized by an organized pattern of interwoven fascicles of collagen bundles with a laminated or tortuous appearance, embedded in abundant mucin. A number of fibromas showed striking hyalinizalion; these may represent a second microscopic hallmark of Cowden's disease in addition to facial trichilemmomas.
The nature of pigment in pigmented apocrine hidrocystoma
Authors: Malhotra R. , Bhawan J.
Published: April 2006

Apocrine hidrocystomas are often pigmented clinically. The cause of this pigmentation is not known. A case of pigmented apocrine hidrocystoma is presented with evidence of melanin as the underlying mechanism of the pigmentation. Review of an additional 150 cases suggests that this is rare. The Tyndall effect, analogous to that seen in blue dome cysts of fibrocystic disease of the breast may be the likely explanation of the pigmentation seen clinically in most cases of apocrine hidrocystomas.
Neuroendocrine differentiation in basal cell carcinomas: a retrospective immunohistochemical and ultrastructural study
Authors: Visser R. , Bosman F. T.
Published: April 2006

Recent investigations have suggested that in addition to basaloid cells, basal cell carcinomas (BCC) may also contain Langerhans cells and neuroendocrine cells. In order to establish the relative frequency of neuroendocrine differentiation in BCC, we performed a retrospective study of 50 consecutive BCC using conventional histochemical, immunocytochemical and ultrastructural methods. Argyrophil staining according lo Grimelius was used for initial identification. Tumors containing argyrophil cells, as well as randomly selected tumors without these cells, were immunocytochemically stained with a panel of antisera against neurohormonal pep‐tides. Only 2 tumors with argyrophil cells showed occasional somatostatin immunoreactivity; peptide hormone immunoreactivity could not be detected in any of the others. The somatostatin immunoreactive tumors, as well as 3 others, were subjected to electronmicroscopy to study the presence of dense‐core secretory granules. However, these characteristic intracytoplasmatic structures could be detected in none. It is concluded that if neuroendocrine differentiation exists at all in BCC, it must be extremely rare. Our results indicate that reliable identification of multiple lines of differentiation in neoplasms can only be performed using combinations of (immuno) histochemical and ultrastructural techniques.
Intraepidermal Bullous Diseases
Authors: Farmer E. R.
Published: April 2006

ASn approach to the light microscopic of intraepidermal bullous diseases is presented
Non‐polarizable collagen in dermatofibrosarcoma protuberans: a useful diagnostic aid
Authors: Barr R. J. , Young E. M. , King D. F.
Published: April 2006

The stroma in dermatofibrosarcoma protuberans (DFSP) stains with trichrome, but is not polarizable (birefi ingeiit. doubly retractile). The usefulness of polarizing neo‐plastic stroma as a diagnostic aid in distinguishing DFSP from dermatofibroma and fibromatosis was evaluated. Forty cases of dermatofibroma of all types, 12 cases of dermal fibromatosis, and 15 cases of DFSP were examined. None of the DFSPs contained polarizable collagen, whereas 11 of the 12 (92%) fibromatoses and 35 of the 40 (88%) dermatofibromas did. Of the 5 dermatofibromas that did not polarize, all were composed primarily of round to polyhedral histiocytic cells, including foam cells, frequently surrounding small obliterated capillaries. Although not puthognomonic, the presence of nonpolarizable collagen appears to he an additional histological marker useful in differentiating DFSP from dermatofibroma and fibromatosis.
Primitive neuroectodermal tumor in the skin with features of neuroblastoma in an adult patient*
Authors: Argenyi Z. B. , Bergfeld W. F. , Mcmahon J. T. , Goeken J. A. , Garewal G. S.
Published: April 2006

A case of primitive neuroectodermal tumor of an 81‐year‐old man is presented, which was located in the cutis. The occurrence in this age and this superficial location is unusual and raises wide differential diagnostic possibilities. The tumor demonstrated Homer Wright rosettes, was positive for neuron‐specific enolase and ultrastructurally revealed neurosecretory granules. These features support the diagnosis of a peripheral neuroblastoma. We discuss the controversy about the terminology of peripheral neuroblastoma vs. neuroepithelioma, as well as the differential diagnosis of these tumors.
Multiple hereditary trichoepitheliomas and basal cell carcinomas
Authors: Pariser R. J.
Published: April 2006

A 45‐year‐old man with multiple hereditary trichoepitheliomas developed 2 tumors which showed malignant behavior. These tumors contained some undifferentiated basal cell carcinoma‐like areas, but also some regions with a high degree of follicular differentiation. In addition he had several small tumors with predominantly undifferentiated features interspersed with the trichoepitheliomas. The relationship between multiple hereditary trichoepitheliomas and basal cell carcinomas is reviewed.
Variation of the distribution pattern of SH groups and SS linkages in the human epidermis
Authors: Ito M. , Suzuki M. , Makuyama T. , Sato Y. , Hashimoto K.
Published: April 2006

Normal epidermis of various sites of human body was examined by N‐(7‐dimethyl‐amino‐4‐methyl‐3‐coumarinyl)maleimidc (DACM) method for SH groups and SS linkages. The horny cells in the palm and sole showed a gradual occurrence of a SH membranous pattern, while those in other sites revealed an abrupt formation of the SH membranous pattern just above the granular layer. In the palm and sole epidermis the number of layers which exhibit membranous pattern of SH‐positivity was thicker than that in the other epidermis; the low‐ through mid‐layers of horny cells in the former sites seemed to contain not only SS‐positive but also SH‐positive substance at cell peripheries. The DACM staining for SS linkages showed the presence of a granular fluorescence in the cytoplasm of the granular cells of the epidermis in the human palm and sole, but not in other sites. The granular cells in human lip displayed a granular fluorescence in the cytoplasm by cither SH or SS DACM staining. All the SH‐ or SS‐positive granular fluorescence was related to keratohyaline granules. These findings indicate that there may be some variations of the distribution pattern of the epidermal cellular proteins with SH and/or SS and a difference in chemical composition of keratohyaline granules between different anatomical sites of human body.
Immunohistochemical markers of sweat gland tumors
Authors: Maiorana A. , Nigrisoli E. , Papotti M.
Published: April 2006

Using immunoperoxidase methods, normal sweat glands, 44 benign and 4 malignant sweat gland tumors were tested for the presence of carcinoembryonic antigen (CEA), pregnancy‐specific‐B1‐glycoprotein (SPI) and actin (ACT). CEA and SP1 stained the secretory and duct‐lining cells of normal eccrine glands. Among benign tumors, 74% were positive for CEA and 44% for SPI. The staining reaction was found mainly in luminal secretions and surrounding cells. Staining by SPI was reduced, but not suppressed, after absorption with the purified antigen. ACT was found in myoepithelial cells of the secretory tract of normal glands and in basal cells of all cases of hidradenoma papilliferum. Only 3 sweat gland carcinomas reacted for CEA. In a malignant chondroid syringoma, no ACT‐positive cells were seen in the myxochondroid stroma. The potential value of CEA, SP1 and ACT in the diagnosis of sweat gland tumors is discussed.
Morphometric analysis of capillary and cavernous hemangiomas
Authors: Pesce C. , Colacino R.
Published: April 2006

This work is concerned with the morphometric analysis of 19 subcutaneous hemangiomas of capillary and cavernous types, to investigate their evolution. Our results suggest that hemangiomas in adults arc of malformative nature, and that there is no clear‐cut separation between the above types, which only designate extreme patterns of non‐intermittent series. Cavernous changes are probably due to blood flow and intravascular pressure in originally capillary hemangiomas.
Granular cell basal cell carcinoma
Authors: Mrak R. E. , Baker G. F.
Published: April 2006

Granular cell basal cell carcinoma (BCC) is a rare histologic variant of BCC. In this, the third reported case, the tumor consisted almost entirely of granular cells. By electron microscopy, these cells were filled with pleomorphic lysosome‐like granules lined by unit membranes and containing homogeneous or granular electron‐dense bodies, membranous debris and amorphous material. The epithelial origin of the tumor was suggested by the characteristic light microscopic appearance of tumor cell islands with some areas of peripheral palisading, and was confirmed by electron microscopic features of numerous well‐formed pentalaminate desmosome junctions and sparse cytoplasmic tonofilament bundles, some of which showed attachments to the desmosomes. Histochemical immunoperoxidase stains for lyso‐zyme showed no cytoplasmic lysozyme activity, in common with other granular cell tumors, but ultrastructural examination did not reveal angulate bodies, in contrast to findings in non‐epithelial granular cell tumors.
Linear cutaneous neuromas (dermatoneurie en stries): a limited phakomatosis with striated pigmentation corresponding to cutaneous hyperneury (featuring multiple endocrine neoplasia syndrome?)
Authors: Guillet G. , Gauthier Y. , Tamisier J. M. , Geniaux M. , Leroy J. P. , Texier L. , Surleve‐Bazeille J. E.
Published: April 2006

A 60‐year‐old woman developed a progressive linear pigmentation on the trunk. Skin biopsy demonstrated an increase in the number and size of neural fibers in the dermis. Clinical and paraclinical investigations of this unusual disease showed findings similar to the hereditary type of Sipple syndrome (multiple endocrine neoplasia syndrome, Type 2b). Such findings as Marfanoid habitus, abnormal electromyography and hypertrophy of the conical nerves suggest that our patient's disease and Sip‐pie syndrome are identical. However, such other symptoms of Sipple syndrome as presence of endocrine tumors are absent. Questions of long‐term prognosis and physiopathogenicity are raised, since no nerve growth factor was detected in this patient. The name of linear cutaneous neuromas is suggested for the patient's lesions, and a possible association with the pigmentation and cutaneous neuromas of the MEN 2b syndrome.
Elastic fibers in scar tissue: scanning and transmission electron microscopic studies
Authors: Tsuji T. , Sawabe M.
Published: April 2006

Cutaneous scar tissue (atrophic and hypertrophic) and normal dermis were examined using scanning (SEM) and transmission electron microscopy (TEM) as well as light microscopy (LM). Although LM revealed only a few Weigert stain‐positive elastic fibers in scar tissue, SEM and TEM disclosed the presence of a large number of fine elastic fibers which was not present in normal dermis. Atrophic scar tissue contained more Weigert stain‐positive fibers and fewer fine elastic fibers than hypertrophic scar tissue. In addition, findings suggestive of newly synthesized elastic fibers were seen in some hypertrophic scar tissue. These results indicate that there is elastogenesis in scar tissue.
Minocycline‐related cutaneous hyperpigmentation as demonstrated by light microscopy, electron microscopy and X‐ray energy spectroscopy*
Authors: Argenyi Zsolt B. , Finelli L. , Bergfeld W.F. , Tuthill R.J. , McMahon J. T. , Ratz J. L. , Petroff N.
Published: April 2006

Argenyi ZB, Finelli L, Bergfeld WF, Tuthill RJ, McMahon JT, Ratz JL, Pefroff N. Minocycline‐related cutaneous hyper‐pigmentation as demonstrated by light microscopy, electron microscopy and X‐ray energy spectroscopy.

A 70‐year‐old patient with a chronic cutaneous ulcer treated by minocyclinc hydrochloride developed hyperpigmentation of the forearms. Biopsy material was studied by light microscopy, electron microscopy and X‐ray energy spectroscopy. Granular gold‐brown pigment was found in dermal histiocytes and eccrine myoepithelial cells, which gave positive reaction with Prussian blue and Fontana‐Masson stains. Electron microscopy revealed intracytoplasmic granules of dark, homogeneous material and small fine particles. X‐ray energy spectroscopy showed iron and other elements in smaller amounts. The different types of minocycline‐related hyperpigmentation and the possible patho‐mechanism are discussed with special regard to the importance of the diagnostic methods.
Neutrophilic eccrine hidradenitis associated with induction chemotherapy
Authors: Fitzpatrick J. E. , Bennion S. D. , Reed O.M. , Wilson T. , Reddy V. V. B. , Golitz L.
Published: April 2006

We report three new cases of neutrophilic eccrine hidradenitis associated with induction chemotherapy which resolves two major points. First, because two of our patients had testicular carcinoma; this firmly establishes that NEH is not exclusively seen in patients with acute myelogenous leukemia or Hodgkin's lymphoma as previously reported. Second, because two of our patients did not receive cytarabine which has previously been suspected of being the causative agent, it is apparent that this disorder may be produced by more than one chemotherapeutic agent or combination of agents. The histologic features with a discussion of the spectrum of changes which may be seen are presented.
A comparison of the dermal lymphoid infiltrates in discoid lupus erythematosus and Jessner's lymphocytic infiltrate of the skin using the monoclonal antibody Leu 8
Authors: Ashworth J. , Turbitt M. , MacKie R.
Published: April 2006

Jessners lymphocytic infiltration of the skin (14 cases) and discoid lupus erythematosus (13 cases) were studied and the lymphoid infiltrates in the dermis were compared in the two conditions, using a standard immunoperoxidase technique. Mouse monoclonal antibodies were used to identify T helper lymphocytes, T suppressor lymphocytes and, using the antibody Leu 8, “immunoregulatory lymphocytes”. It was shown that the proportions of Leu 8 positive cells was significantly different in the two conditions. The average percentage of Leu 8 positive lymphocytes in the dermal infiltrate found in the cases of Jessner's was 65% (range 40–80%) whereas the average percentage in the cases of discoid LE was 15% (range 2–30%). This observation is further evidence that Jessner's lymphocytic infiltration and chronic discoid lupus erythematosus should be regarded as separate entities.
Medullary carcinoma of the thyroid metastatic to the skin: report of two cases
Authors: Ordóñez N. G. , Samaan N. A.
Published: April 2006

The skin is a rare site for metastases from the thyroid. We report 2 cases of skin metastases from a thyroid medullary carcinoma. This is the first report of metastasis to the skin from a medullary carcinoma. The diagnosis was confirmed by immunocytochemical studies performed on the skin biopsy specimens.
Cutaneous pathology following etoposide therapy
Authors: Yokel B. K. , Friedman K. J. , Farmer E. R. , Hood A. F.
Published: April 2006

Etoposide (VP‐16) is a semisynthetic podophyllotoxin derivative that is active against a number of solid and hematologic malignancies. Previously reported cutaneous complications include Stevens‐Johnson syndrome and radiation recall. We report 4 cases of cutaneous eruptions with distinctive histopathologic changes following etoposide therapy. Diffuse erythematous macules and papules developed 5–9 days after initiation of etoposide therapy and resolved spontaneously within 3 weeks. Histologic examination revealed epidermal maturation disturbances with scattered markedly enlarged individual keratinocytes. These cells had pale cytoplasms and fragmented, haphazardly dispersed nuclear chromatin in a starburst pattern (“starburst cells”). Many keratinocytes showed notable nuclear enlargement with multiple prominent nucleoli. In addition, numerous dyskeratotic cells and basilar mitotic figures in metaphase were present. Some of these changes have been described in condylomata acuminata treated with topical applications of podophyllin, a compound structurally related to etoposide. Starburst cells have not been reported in cutaneous eruptions produced by other chemotherapeutic agents. These cells may represent abnormal mitotic arrest secondary to podophyllin and its related compounds.
Clear cell basal cell epithelioma: light and electron microscopic study of an unusual variant
Authors: Barnadas M. A. , Freeman R. G.
Published: April 2006

We report the light and electron microscopic study of 7 examples of an unusual clear cell variant of basal cell epithelioma (BCE). The clear cells show cytoplasmic vacuoles that contain glycogen but do not stain with mucicarmine or fat stains. By electron microscopy the cytoplasmic vacuoles consist of empty spaces not surrounded by membranes. The clear cell pattern may occupy all or part of a given tumor. Typical nodular BCE was found in all 7 cases, but not in every section. Some nodules were composed of mixed solid and clear cell types. Differentiation of this uncommon variant from other clear cell tumors is important.
Necrobiosis lipoidica diabeticorum with cholesterol clefts in the differential diagnosis of necrobiotic xanthogranuloma
Authors: Gibson L. E. , Reizner G. T. , Winkelmann R. K.
Published: April 2006

The histopathologic findings in 331 cases of necrobiosis lipoidica diabeticorum seen during a 50‐year period were reviewed. Three cases showing cholesterol cleft formation were found. All 3 cases were associated with severe diabetes mellitus. The differential diagnosis of importance is necrobiotic xanthogranuloma. Common features included extensive hyaline necrobiosis and foreign‐body giant cells. Atypical and Touton‐typc giant cells are more common in necrobiotic xanthogranuloma. Vascular changes in necrobiotic xanthogranuloma may include granulomatous involvement of muscular walls with thrombosis. Explanations for cholesterol cleft formation arc offered. When cholesterol clefts are seen in biopsy specimens of necrobiosis, necrobiotic xanthogranuloma must be ruled out. In addition, when found in necrobiosis lipoidica diabeticorum, these clefts may imply diabetes mellitus with complications.
Proliferation of eccrine sweat ducts associated with alopecia areata
Authors: Barnhill R. L. , Goldberg B. , Stenn K. S.
Published: April 2006

Proliferation of sweat ducts has been described as a reactive process in a variety of benign and malignant neoplasms and inflammatory conditions in the skin, including scarring alopecia. However, to our knowledge this phenomenon has not been observed in non‐scarring alopecia. The following case documents such a proliferation arising in an alopecia consistent with alopecia areata. An 83‐year‐old female developed progressive, fairly well circumscribed patches of alopecia over a 2–3 year period. Unequivocal scarring was not present. Histopathological examination revealed non‐scarring alopecia with miniaturized and telogen follicles and a proliferation of eccrine ductal structures in the reticular dermis. These ductal structures varied in size and degree of cystic dilatation and resembled a primary eccrine neoplasm, such as syringoma. Only minimal focal fibrosis was observed in association with the eccrine proliferation. In summary, this case indicates that eccrine sweat duct proliferation may occur in non‐scarring alopecia and must be differentiated from a primary eccrine neoplasm.
Ganglioneuromatous tumor of the skin: a combined heterotopia of ganglion cells and hamartomatous neuroma: report of a case
Authors: Lee J. Y. , Martinez A. J. , Abell E.
Published: April 2006

We report the histologic and ultrastructural findings of a solitary, unusual cutaneous tumor in a 69‐year‐old woman. The tumor is characterized by many mature ganglion cells in the papillary dermis and fascicles of unmyelinated axons in the lower dermis. The lesion is ganglioneuromatous but differs from the other ganglioneuromas histologically in that the ganglion cells do not intermingle with the neuromatous elements. It may represent a combined heterotopia of ganglion cells and hamartomatous neuroma. The histologic differential diagnosis and the possible pathogenesis are discussed.
Actinic granuloma (O'Brien)
Authors: Steffen C.
Published: April 2006

Twelve cases of actinic graculoma (O'Brien) are reported. It is concluded that actinic granuloma is a specific disease characterized by clinical lesions indistinguishable from granuloma annulare, but occurring on solar damaged skin. Histologically, clastic tissue is destroyed by the granulomatous process in actinic granuloma. But not in granuloma annulare. It would appear that actinic granuloma, granuloma multiforme, necrobiosis lipoidica of the face and scalp (Wilson‐Jones) and Miescher's granuloma of the face (Mehregan and Altman) are the same desease.
Malignant rhabdoid skin tumor: an uncommon primary skin neoplasm. Ultrastructural and immunohistochemical analysis
Authors: Dabbs D. J. , Park H.K.
Published: April 2006

Rhabdomyosarcomatoid renal tumors were initially described as subset of tumors in the National Wilms Tumor Study that had light microscopic features similar to rhabdomyosarcomas. Subsequent studies failed to reveal evidence of muscle differentiation, thus the genesis of the term “rhabdoid” tumor. Such renal tumors are rapidly lethal. Recent reports suggest the occurrence of tumors with similar morphology in other anatomic sites. We wish to report primary malignant rhabdoid tumor of the facial skin with detailed immunohistochemical and Ultrastructural studies. Vimentin was expressed in the tumor cells, but there Was no immunoreactivity for cytokeratins, neurofilaments, muscle actin, synaptophysin, S‐100, melanoma antigen HMB‐45, epithelial membrane antigen, neuron specific enolase, Leu‐7, leucocyte common antigen or lysozyme/alpha‐1‐antitrypsin. Ultrastructure revealed typical whorled cytoplasmic aggregates of intermediate filaments. These studies along with literature review reveal the heterogeneous immunohistochemical profiles of these tumors with common morphologic features. While the histogenesis of these tumors remain uncertain, it is necessary to recognize that these aggressive neoplasms may occur primarily in the skin.
Scrotal calcinosis: origin from dystrophic calcification of eccrine duct milia
Authors: Dare A. J. , Axelsen R. A.
Published: April 2006

Scrotal calcinosis is a rare benign disorder considered idiopathic by most recent authors, although an origin from dystrophic calcification of epidermoid cysts has been proposed. In 3 of 4 cases which were otherwise typical of scrotal calcinosis, there was calcification of the contents of small cysts lined by stratified squamous epithelium. These structures were identified as eccrine duct milia because some of them communicated with eccrine ducts and there were ultrastructural features of eccrine duct differentiation in one case. The eccrine nature of the milia was confirmed using the immunoperoxidase technique for the demonstration of carcitioembryonic antigen (CEA) which serves as a marker of eccrine sweat glands. Since a transition could be seen between degenerating calcified milia and typical nodules, it appeared that the calcific deposits of scrotal calcinosis result from the breakdown of such lesions. Staining of deposits unassociated with cyst walls with the technique for the demonstration of CEA supported this conclusion. An advanced stage of evolution of the disease could account for the absence of visible cysts in many cases. We propose the term “hidrocalcinosis of the scrotum” for this distinctive form of cutaneous calcification.
Congenital agminated Spitz nevi: immunoreactivity with a melanoma‐associated monoclonal antibody
Authors: Palazzo J. P. , Duray P. H.
Published: April 2006

Agminated, or grouped Spitz nevi are a curious expression of nevomelanocytic growth; and represent an uncommon manifestation of these nevi. We encountered an example of agminated Spitz nevi present at birth, which showed progression and rapid growth over months. All showed histologic Spitz nevus features. Avidin‐biotin immunohistochemical techniques using anti S‐100 protein, neuron‐specific enolase (NSE), and melanoma‐specific monoclonal antibody, HMB‐45 labelled the nevi as follows: diffuse S‐100 and NSE staining in most and HMB‐45 positivity in sporadic cells deep in the dermis. HMB‐45 reactivity occurred in both spindle cells and epithelioid forms.
Morphometrical analysis of mycosis fungoides on paraffin‐embedded sections*
Authors: Rieger E. , Smolle J. , Hoedl S. , Juettner F.‐M. , Kerl H.
Published: April 2006

Morphometry was carried out on H & E stained paraffin sections of 29 cases of contact dermatitis (CD) and 35 cases of mycosis fungoides (MF) (patch stage 12; plaque stage 11; tumor stage 12); 9 nuclear parameters, mean thickness of the infiltrate and 5 stereological parameters were assessed for each slide. Application of a non‐parametric discriminant analysis (k‐nearest neighbour method) which is based on median of nuclear areas, mean maximal nuclear diameter, volume density and numerical density of nuclei provided discrimination between CD and patch stage MF at an efficiency of 82.9% (specifity 86.7%, sensitivity 61.5%). Efficiency of discrimination between CD and plaque stage was 92.5% (specifity 89.7%, sensitivity 91.7%) and between CD and tumor stage 100% when discriminant analysis was based on the mean thickness of the infiltrate. Although unequivocal discrimination between CD and MF cannot be achieved in each individual case, morphometry on routine paraffin material obviously provides additional objective criteria for the diagnosis of early MF.
Rippled‐pattern trichomatricoma
Authors: Hashimoto K. , Prince C. , Kato I. , Ito M. , Tazawa T. , Pelachyk J. M. , Mikhail G. R.
Published: April 2006

A hair matrix tumor showing an unusual tumor cell arrangement was found at the base of a solitary trichoepithelioma. Coexisting with solid epithelial islands and immature hair follicle‐like structures, areas of alternating epithelial cords and hand‐like stroma resembling the Verocay bodies of neurilemmoma or “ripplemarks” on waves were found. In other areas myxomatous degeneration of the stroma changed the rippling into a cribriform pattern. In some parts of the tumor there was a dense melanin pigment associated with MEL5 stained melanocytes. S‐100 and GDI (OKT6) antigen stains demonstrated Langerhans cells scattered in the parenchyma and less frequently in the stroma. The majority of tumor cells were considered immature pilar cortical cells because of the following: 1. HKN‐6 was strongly positive; 2. a large number of melanocytes were associated with tumor cells in some foci; 3. ultrastructurally immature tumor cells, which had electron‐dense tonofilaments and many desmosomes, were transformed without production of trichohyalin granules into semikeratinized cells which showed nuclear degeneration and loss of electron density in tonofilaments. This tumor, however, has not attained the degree of differentiation observed in trichoblastoma (1) another example of an immature cortical cell tumor. Squamous eddy‐like or horn pearl‐like foci of incomplete keratinization and large keratin‐filled cysts were also present within the immature parenchyma, indicating that some immature cells were differentiating toward non‐cortical cells, as found in the outer sheath. We would like to designate this tumor “rippled pattern trichomatricoma”, a new entity.
Rudimentary meningocele: a variant of “primary cutaneous meningioma”
Authors: Sibley D. A. , Cooper P. H.
Published: April 2006

We studied 5 primary cutaneous meningiomas. All were congenital. Four were nodules or plaques on the scalp, and one was a lumbar polyp. Two were alopecic. A skull defect was present deep to one lesion, and the lumbar polyp was attached to dura. The tumors were concentrated in the subcutis, where strands of meningocytes were embedded in dense collageous tissue. Meningocytes wrapped around colleigcnous fibers, producing “collagen bodies”. These formed the nidus for calcification that included psammoma bodies. Meningocytes also dissected between collagenous fibers, creating anastomosing spaces that mimicked a vascular tumor. Meningothelial‐lined clefts, several milimeters in length, were present in 4 cases. Two lesions extended through dermal defects into the superficial dermis, where adnexa were reduced or absent. The meningocytes contained vimentin and epithelial membrane antigen. They lacked cytokeratin, S100 protein, and endothelial markers. The meningothelial lesions described herein lack the nodular and sheet‐like growth patterns that typify meningiomas of the central nervous system and most primary ectopic meningiomas, including some that develop within the skin. They appear closely related to meningoceles and should be viewed as developmental abnormalities rather than neoplasms. The term “rudimentary meningocele” seems appropriate for these lesions.
Acantholytic dermatosis localized to the vulvocrural area
Authors: Cooper P.H.
Published: April 2006

This report describes 6 women with acantholytic lesions localized to the vulvocrural area. Clinically, multiple papules or solitary papules or plaques were situated on the labia majora or adjacent skin. None of the patients had similar abnormalities elsewhere on the body or family histories of similar eruptions. Two patients had concurrent candidal vaginitis. Microscopic findings consisted of acantholytic dyskeratosis resembling that observed in Darier's disease or acantholysis with minimal dyskeratosis similar to that seen in Hailey‐Hailey disease. In one patient, acantholytic dyskeratosis with a cup‐like configuration resembled the microscopic appearance of warty dyskeratoma. Immunofluorescence microscopy was negative in one patient. Solitary lesions were cured by local excision, but the papular eruption of one patient was recalcitrant to therapy. The literature contains descriptions of eight additional women with comparable lesions. Acantholytic reactions localized to the vulvocrural area are not apparently rare and need to be distinguished from other acantholytic dermatoses that can affect this anatomic site.
Proliferative fasciitis: ultrastructure and histogenesis
Authors: Diaz‐Flores L. , Martin Herrera A. I. , Garcia Montelongo R. , Gutierrez Garcia R.
Published: April 2006

The ultrastructure was studied of 2 cases of proliferative fasciitis (PF) which affected the fascia and subcutaneous fat. Two basic cell types were observed in the lesions: fibroblast‐like, and giant cells. The fibroblast‐like cells had myofibroblastic ultrastructural characteristics. The giant cells showed a well‐developed, rough endoplasmic reticulum, irregularly distributed filaments and clear lipid droplets in their cytoplasms. Ultrastructurally, the giant cells seemed to belong to a cellular line capable of synthesizing ground substances and extracellular fibers, but with a modified phenotype. A consistent feature was the presence of nodular aggregates of numerous proliferating perivascular cells. Transitional forms between perivascular, fibroblast‐like, and giant cells were observed. Our hypothesis is that perivascular cells (activated pericytes) are the source of the fibroblast‐like and giant cells in proliferative fasciitis.
Subcutaneous fat necrosis of the newborn: light, ultrastructural and histochemical microscopic studies
Authors: Friedman S. J. , Winkelmann R. K.
Published: April 2006

Multiple subcutaneous plaques and nodules appeared on the back and the dorsal proximal area of the extremities of a 9‐day‐old male infant after a complicated prenatal period necessitating cesarean section. The clinical and histological features were diagnostic of subcutaneous fat necrosis of the newborn. Light microscopy revealed adipocyte necrosis, a lymphohistiocytic infiltrate, and needle‐shaped clefts within adipocytes and macro‐phages. Ultrastructurally, there were aggregations of electron‐lucent spaces in the form of spindles and needles arranged in parallel within the altered adipocytes; macrophages surrounded these cells or their fragments and invaded the fat lobules. Enzyme histochemical staining, not previously reported in the literature, showed that acid phosphatase, leucine aminopeptidase, and indoxyl and non‐specific esterases were present in the areas of fat necrosis.
Secretory immunoglobulin A in sweat gland tumors
Authors: Metze D. , Jurecka W. , Gebhart W. , Schuller‐Petrovic S.
Published: April 2006

The presence of immunoglobulin A (IgA) and secretory component (SC) was investigated in normal human skin and in cutaneous neoplasms including a variety of sweat gland tumors. Immunohistochemistry in normal sweat glands revealed the occurrence of secretory IgA (sIgA) as indicated by reactivity for IgA and SC in serial sections. The majority of 28 cases of sweat gland tumors could be demonstrated to retain their ability to produce IgA and SC. In normal as well as in neoplastic sweat glands heaviest staining for sIgA could be found in the lumina and at the surface of lining epithelia. This is comparable with the presence of sIgA in breast or intestinal neoplasms. In contrast other epidermal cysts or solid tumors were not labelled. In view of recent immunohistochemical studies the demonstration of IgA and SC may be of differentiating value in cutaneous glandular neoplasms.
A case of tubular apocrine adenoma with syringocystadenoma papilliferum
Authors: Ansai S. , Watanabe S. , Aso K.
Published: April 2006

We report a new case of a Japanese man who developed a tubular apocrine adenoma in association with syringocystadenoma papilliferum. The differences in the histopathological and immunohistochemical findings in these 2 tumors are described. This is the first immunohistochemical study of tubular apocrine adenoma.
Factor XIIIa is expressed by fibroblasts in fibrovascular tumors*
Authors: Nemeth A. J. , Penneys N. S.
Published: April 2006

Factor XIIIa (FXIIIa), a blood and intracellularly produced coagulation factor, has been found in a variety of cell types including fibroblast‐like mesenchymal cells, and has been shown to stimulate the proliferation of fibroblasts and some neoplastic cells in vitro. We have already shown that the dendritic fibroblasts composing the fibrous papule contain this factor. We hypothesized that histopathologically similar fibrovascular tumors may also express FXIIIa and, in this report, show that the large stellate fibroblasts found in acquired digital fibrokeratomas, angiofibromas (adenoma sebaceum of Pringle), and oral fibroma (oral fibrous hyperplasia) also express FXIIIa. We postulate that FXIIIa, possibly acting as a growth factor, may be a common denominator in the pathogenesis of these tumors. Another possibility is that these tumors may be the consequence of a local overproduction of FXIIIa in response to an, as yet, unidentified stimulus.