Retiform Purpura as a Complication of Microsphere Emboli Following Transarterial Chemoembolization for Primary Hepatocellular Carcinoma: A Case Report and Literature Review
We report an elderly man with hepatocellular carcinoma who developed a rash after undergoing transarterial chemoembolization (TACE). On examination, there was a reticulated macular pigmentation over the chest and upper abdomen. Skin biopsy revealed foreign material that occluded the small dermal cutaneous vessels. These structures were perfectly spherical, homogeneously eosinophilic, and were also nonrefractile. They had a maximum diameter of 40 μm, consistent with the size of the microspheres used in TACE. TACE is a palliative measure used to treat hepatocellular carcinoma in patients who are not surgical candidates. V...
Source: The American Journal of Dermatopathology - June 16, 2020 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Stomatitis and Hyperpigmented Papules and Plaques in a Patient With a Desmoid-Type Fibromatosis Tumor: Challenge
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - June 16, 2020 Category: Pathology Tags: Clinical Pathologic Challenge Source Type: research

An 80-Year-Old Man With Erythematous Papulonodular Plaque on the Mons Pubis: Challenge
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - June 16, 2020 Category: Pathology Tags: Clinical Pathologic Challenge Source Type: research

A Slow-Growing Mass on a Back of a Healthy Woman: Challenge
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - June 16, 2020 Category: Pathology Tags: Clinical Pathologic Challenge Source Type: research

A Man With New Subcutaneous Nodules: Challenge
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - June 16, 2020 Category: Pathology Tags: Clinical Pathologic Challenge Source Type: research

IgA Vasculitis After Initiation of Ivermectin for Scabies: Coincident or Drug-Induced?
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - June 16, 2020 Category: Pathology Tags: Letters to the Editor Source Type: research

Biological Significance of the Association Between Cutaneous Al-amyloidoma and Sjögren Syndrome
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - June 16, 2020 Category: Pathology Tags: Letters to the Editor Source Type: research

Stomatitis and Hyperpigmented Papules and Plaques in a Patient With a Desmoid-Type Fibromatosis Tumor: Answer
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - June 16, 2020 Category: Pathology Tags: Clinical Pathologic Challenge Answer Source Type: research

An 80-Year-Old Man With Erythematous Papulonodular Plaque on the Mons Pubis: Answer
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - June 16, 2020 Category: Pathology Tags: Clinical Pathologic Challenge Answer Source Type: research

A Slow-Growing Mass on a Back of a Healthy Woman: Answer
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - June 16, 2020 Category: Pathology Tags: Clinical Pathologic Challenge Answer Source Type: research

A Man With New Subcutaneous Nodules: Answer
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - June 16, 2020 Category: Pathology Tags: Clinical Pathologic Challenge Answer Source Type: research

Vulvar Pigmented Epithelioid Melanocytoma With a Novel HTT-PKN1 Fusion: A Case Report
Abstract: Pigmented epithelioid melanocytoma is a highly pigmented, predominantly dermal melanocytic neoplasm composed by epithelioid and spindled melanocytes. It is characterized by a limited number of specific genomic alterations principally involving protein kinase A regulatory subunit alpha (PRKAR1A) and fusion of protein kinase C alpha isoform (PRKCA). However, in some of these neoplasms, no genetic aberrations have been detected. We performed genomic analysis of a nodular heavily pigmented intradermal proliferation composed of monomorphic epithelioid melanocytes with slight cytologic atypia consisting with pigmente...
Source: The American Journal of Dermatopathology - June 16, 2020 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Novel EIF5A-USP6 Gene Fusion in Nodular Fasciitis Associated With Unusual Pathologic Features: A Report of a Case and Review of the Literature
Abstract: Nodular fasciitis (NF) is a benign self-limiting soft tissue lesion that has long been considered a reactive process. Recently, however, the USP6 gene rearrangement has been discovered, and the neoplastic nature of this tumor was suggested. Since then, many fusion partners of the USP6 gene have been reported, with the MYH9 gene as the most common. In this article, we describe a case of NF with a novel EIF5A-USP6 gene fusion associated with unusual pathological features. A 41-year-old healthy woman with a painful, rapidly growing subcutaneous mass on the left forearm with a size of 0.8 cm is presented. A soft ti...
Source: The American Journal of Dermatopathology - June 16, 2020 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Perineural Invasion as a Clue to Malignant Behavior in a Dermatofibroma
We report a 64-year-old woman with a long history (years) of a skin lesion on her right arm that became painful during the last months. Histologically, it consisted of a conventional cellular DF in which perineural invasion was present. Subsequently, the lesion showed a clinically aggressive course with recurrences, sarcomatous transformation, and pulmonary metastases. Given that no predictive morphological features have been identified to separate classical benign DF from rare metastasizing forms, perineural invasion in an otherwise conventional DF could be a histopathologic clue for an adverse prognosis and should provok...
Source: The American Journal of Dermatopathology - June 16, 2020 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Basomelanocytic Neoplasms: A Report of Two Similar Tumors With Divergent Treatments
We present 2 separate patients with similar cases of colonizing basomelanocytic tumors that were treated in drastically different ways, highlighting the differing approaches to treatment. We discuss theses treatment modalities and the challenges inherent to diagnosing and treating basomelanocytic neoplasms. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - June 16, 2020 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Band-like Lipomatous Metaplasia of the Superficial Dermis and Nonseptate Subcutaneous Tissue: A Rare Histopathological Phenomenon With Ultrasonographic Correlation
Abstract: Lipomatous metaplasia of the upper dermis is a rare phenomenon scarcely described in the literature which has always been identified in the context of inflammatory or neoplastic processes. Microscopically, it should be distinguished from pseudolipomatosis cutis, dermal lipoma, nevus lipomatosus, and focal dermal hypoplasia (Goltz syndrome). This is the first report of the histologic and ultrasound evaluation of a patient with extensive involvement and the description of the coincidental finding of an anomalous nonseptate subcutaneous tissue. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - June 16, 2020 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Penile Ulcer due to Leukemia Cutis—A Rare Diagnosis Not to Be Missed
We present a rare case of leukemia cutis presenting with an ulcer on the ventral penis. A 60-year-old Chinese man was referred for a penile ulcer of 10 days. He was diagnosed with acute myelomonocytic leukemia 6 months earlier and had received 2 cycles of venetoclax with azacitidine. He developed a spontaneous penile blister. It ulcerated after the patient pricked it with a needle. This enlarged after traditional medicated ointment was applied. He denied pain, itch, urethral discharge, systemic symptoms, or rashes elsewhere. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - June 16, 2020 Category: Pathology Tags: Brief Report Source Type: research

A Helpful Clue to Calciphylaxis: Subcutaneous Pseudoxanthoma Elasticum–like Changes
We report a case of a 49-year-old woman who was diagnosed with uremic calciphylaxis on the basis of the clinical scenario, laboratory testing, and microscopic presence of subcutaneous PXE-like changes that was highlighted with the elastic and von Kossa stains. This case demonstrates the importance of recognizing subcutaneous PXE-like changes on suboptimal skin biopsies that lack microvascular calcification, especially in those patients who are clinically suspect for calciphylaxis as to prevent delay in diagnosis and treatment. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - June 16, 2020 Category: Pathology Tags: Brief Report Source Type: research

Morphologic, Immunohistochemical, and Molecular Distinction Between Fibroepithelioma of Pinkus and “Fenestrated” Basal Cell Carcinoma
Abstract: Fibroepithelioma of Pinkus (FEP) is a rare cutaneous neoplasm with a characteristic fenestrated architecture and a prominent spindle cell stromal component and which invariably pursues an indolent course. The classification of FEP has been much debated since its first description in 1953, with some arguing that it represents a variant of a basal cell carcinoma (BCC) while others view it as a variant of a trichoblastoma. Multiple previous immunohistochemical studies aiming to clarify this issue have yielded conflicting results. To date, there have been no molecular studies of FEP. We identified 16 cases of fenes...
Source: The American Journal of Dermatopathology - June 16, 2020 Category: Pathology Tags: Original Study Source Type: research

Metastatic Crohn Disease: A Clinicohistological Appraisal From a Tertiary Care Center in India
Conclusion: MCD shows a wide spectrum of clinical presentation, with anogenital involvement being the most common. Histology reveals nonnecrotizing granulomas in the dermis in majority of the cases. The diagnosis is extremely challenging in patients without gastrointestinal involvement at presentation, and thus, a high index of suspicion is imperative. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - June 16, 2020 Category: Pathology Tags: Original Study Source Type: research

Follicular Eruption With Folliculotropic Lymphocytic Infiltrates Associated With Iatrogenic Immunosuppression: Report and Study of 3 Cases, and Review of the Literature
Conclusions: Patients undergoing systemic immunosuppressive therapy that includes calcineurin inhibitors might develop follicular eruption with some immunophenotypical variations and a monoclonal TCR gene rearrangement but lack sufficient cytomorphological features of folliculotropic mycosis fungoides. Altering the immunosuppressive agent including calcineurin inhibitors may result in regression of the eruptions. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - June 16, 2020 Category: Pathology Tags: Original Study Source Type: research

Apocrine Hidradenoma and Adenomyoepithelioma: Entities on a Biological Continuum of Adnexal Neoplasia
Abstract: Apocrine hidradenomas (AH) once believed to harbor myoepithelial cells are now considered pure epithelial neoplasms. They are categorized separately from adenomyoepitheliomas which consist of apocrine epithelial and myoepithelial components. Reports of myoepithelial tumors arising in AH have suggested a link between the 2. Our goal was to explore whether cases diagnosed on routine microscopy as AH harbored occult myoepithelial elements, which would be disclosed by an immunohistochemical evaluation. Twenty-nine such cases, derived from a teaching collection of one of the authors, formed the basis of the study. C...
Source: The American Journal of Dermatopathology - June 16, 2020 Category: Pathology Tags: Original Study Source Type: research

Atypical Disseminated Variant of Galli–Galli Disease: A Review of the Literature
Abstract: Galli–Galli disease (GGD) is a rare genodermatoses within the group of reticulated pigmentary disorders of the skin. Traditionally, its clinical presentation is identical to that of Dowling–Degos disease (DDD), with the additional feature of acantholysis on histopathological examination. We have reviewed the published cases of GGD to provide further support for the hypothesis that in fact, 2 phenotypes of GGD exist: the characteristic flexural GGD associated with KRT5 mutations and a disseminated variant with no mutation identified to date. A review of the literature revealed 53 reported cases of GG...
Source: The American Journal of Dermatopathology - June 16, 2020 Category: Pathology Tags: Review Article Source Type: research

Sentinel Lymph Node Biopsy Still Provides No Benefits for Patients With Melanoma
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - June 16, 2020 Category: Pathology Tags: Editorial Source Type: research

Diagnosing Calciphylaxis: A Review With Emphasis on Histopathology
In this study, we review the reported clinical and histopathologic features of calciphylaxis, correlating them with relevant imaging, ancillary studies, and pathophysiology. Although many histopathologic changes seen in calciphylaxis are also reported in other conditions (eg, Mönckeberg sclerosis, lupus panniculitis, pancreatic panniculitis, and peripheral artery disease), calcification of subcutaneous small vessels, thrombosis and/or ischemic changes, pseudoxanthoma elasticum–like changes in the subcutis, and perieccrine calcification may serve as helpful clues. von Kossa and Alizarin red stains can assist in t...
Source: The American Journal of Dermatopathology - June 16, 2020 Category: Pathology Tags: CME Article Source Type: research

Abstracts of Posters Presented at the XL Symposium of the ISDP—Lisbon, September 19–21, 2019
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 21, 2020 Category: Pathology Tags: Abstract Source Type: research

Abstracts of Free Communications Presented at the XL Symposium of the ISDP—Lisbon, September 19–21, 2019
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 21, 2020 Category: Pathology Tags: Abstract Source Type: research

A Novel Spindle Cell Population in a Case of Primary Osteoma Cutis With GNAS Mutation
We report a case of a 15-week-old girl who presented with an enlarging, indurated subcutaneous lesion on her right flank. CT scan showed an extensive subcutaneous sheet of calcification. Histologic evaluation revealed heterotopic calcification and intramembranous ossification within the dermis and mature bone largely replacing the subcutaneous fat compatible with osteoma cutis. Molecular testing was performed and identified an inactivating GNAS mutation. Unique to this case is a dermal proliferation of bland spindle cells that blended with deposited osteoid material. This has not been reported in association with primary o...
Source: The American Journal of Dermatopathology - May 21, 2020 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Photodistributed Rash Progressing to Erythroderma: Challenge
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 21, 2020 Category: Pathology Tags: Clinical Pathologic Challenge Source Type: research

An 81-Year-Old Man With a Growth on the Areola: Challenge
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 21, 2020 Category: Pathology Tags: Clinical Pathologic Challenge Source Type: research

A Rare Soft-Tissue Tumor in a 15-Year-Old Boy With Tuberous Sclerosis Complex: Challenge
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 21, 2020 Category: Pathology Tags: Clinical Pathologic Challenge Source Type: research

Recurrent Pruritic Papules and Reticulated Hyperpigmentation in a Young Woman: Challenge
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 21, 2020 Category: Pathology Tags: Clinical Pathologic Challenge Source Type: research

Oral Lichen Planus Pemphigoides: Three Cases of a Rare Entity
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 21, 2020 Category: Pathology Tags: Letters to the Editor Source Type: research

Comment on “Cutaneous Angiomyolipoma of the Ear: A Case Report and Literature Review” With Report of a Mucosal Lesion
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 21, 2020 Category: Pathology Tags: Letters to the Editor Source Type: research

Photodistributed Rash Progressing to Erythroderma: Answer
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 21, 2020 Category: Pathology Tags: Clinical Pathologic Challenge Answer Source Type: research

An 81-Year-Old Man With a Growth on the Areola: Answer
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 21, 2020 Category: Pathology Tags: Clinical Pathologic Challenge Answer Source Type: research

A Rare Soft-Tissue Tumor in a 15-Year-Old Boy With Tuberous Sclerosis Complex: Answer
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 21, 2020 Category: Pathology Tags: Clinical Pathologic Challenge Answer Source Type: research

Recurrent Pruritic Papules and Reticulated Hyperpigmentation in a Young Woman: Answer
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 21, 2020 Category: Pathology Tags: Clinical Pathologic Challenge Answer Source Type: research

Rubella Vaccine Persistence Within Cutaneous Granulomas in Common Variable Immunodeficiency Disorder
We present a case of treatment-refractory, disfiguring common variable immunodeficiency disorder–associated granulomatous dermatitis. Immunofluorescence microscopy of the biopsy specimen confirmed the presence of rubella vaccine capsid proteins in M2 macrophages within the granuloma, a newly recognized phenomenon in this patient population. This knowledge may serve to identify future therapeutic targets or preventative strategies for granulomatous dermatitis in patients with primary immunodeficiency disorder. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 21, 2020 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Unilateral Periocular Intralymphatic Histiocytosis, Associated With Rosacea (Morbihan Disease)
We report a rare case of intralymphatic histiocytosis associated with rosacea and prominent periocular edema (Morbihan disease). The patient is a 56-year-old woman with a 12-year history of rosacea who suddenly developed edema of the right upper eyelid that persisted 6 months before she sought medical advice. Because of an unclear clinical diagnosis, surgical excision of the edematous upper eyelid was performed. The histologic slides showed interstitial edema of the dermis with dilated vascular channels and small epithelioid cell granulomas around hair follicles. In addition, there were aggregates of cells inside numerous ...
Source: The American Journal of Dermatopathology - May 21, 2020 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Panniculitis-Like Presentation of Extracavitary Primary Effusion Lymphoma
Abstract: Primary effusion lymphoma (PEL) is defined as a HHV-8-associated large B-cell lymphoma, which favors HIV-infected young adults, typically presenting as a serous (pleural, pericardial, or peritoneal) effusion with no identifiable tumor mass. Uncommon instances of lymphoid proliferations with the same morphology, immunophenotype, and molecular features as PEL, but occurring as a solid tumor mass without serous cavities involvement, have been termed extracavitary (or solid) variant of PEL. We hereby report the exceptional case of a HIV-associated extracavitary PEL primarily localized to the skin and exhibiting a p...
Source: The American Journal of Dermatopathology - May 21, 2020 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Spiradenoma With Adenoid Cystic Carcinoma–Like Features
We report the case of a 63-year-old male patient with a recurrent, painful hematoma-like cyst overlying the left lower extremity tibial tuberosity. A firm nodule was located at the base of the cyst, which was histologically consistent with spiradenoma. Interestingly, the lesion contained multifocal ACC-like components composed of epithelial basaloid cells surrounding pseudocystic structures filled with mucinous material. The ACC-like components did not demonstrate infiltration or perineural invasion. To the best of our knowledge, this is the second publication in the English literature regarding spiradenoma with an ACC-lik...
Source: The American Journal of Dermatopathology - May 21, 2020 Category: Pathology Tags: Brief Report Source Type: research

Cutaneous Metastases From a Cribriform Adenocarcinoma of the Minor Salivary Glands
Abstract: Cutaneous metastases from solid tumor malignancies often emanate from breast, gastrointestinal, and lung tumors. Adenocarcinomas from minor salivary gland cancers may involve the skin contiguously but rarely as metastatic deposits. Furthermore, these metastases are usually locoregional and not distal. Recently, an uncommon neoplasm termed cribriform adenocarcinoma of the minor salivary glands has been described, and although it often spreads to cervical lymph nodes, metastatic involvement of the skin has not been reported. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 21, 2020 Category: Pathology Tags: Brief Report Source Type: research

The Prognostic Value of Podoplanin Expression in Nonmelanoma Skin Cancers: Correlation With Lymphatic Vessel Density
Conclusions: Podoplanin plays an evident role in the development and progression of both benign and malignant skin neoplasms and may serve as a potential predictor of their clinical course and prognosis. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 21, 2020 Category: Pathology Tags: Original Study Source Type: research

Histiocytoid Melanoma
We report 5 cases of melanoma characterised by a subtle microscopic appearance reminiscent of a benign dermal histiocytic infiltrate, which we refer to as “histiocytoid melanoma.” These lesions are characterised clinically by ill-defined areas of cutaneous pigmentation, which in several cases reached large proportions. Microscopically, there is a subtle interstitial pattern of infiltration by predominantly single cells with a histiocytoid morphology, often resembling melanophages. Immunohistochemical confirmation was typically required, with the cells showing positive labelling for Sox-10 as well as Melan-A. In...
Source: The American Journal of Dermatopathology - May 21, 2020 Category: Pathology Tags: Original Study Source Type: research

Clinicopathological Analysis of Acquired Melanocytic Nevi and a Preliminary Study on the Possible Origin of Nevus Cells
Conclusion: AMN may have a multicellular origin that commonly follows the mode of Abtropfung. Furthermore, DSCs may partly or independently participate in the formation of nevus cells. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 21, 2020 Category: Pathology Tags: Original Study Source Type: research

Distinct Salivary Gland Features in Sjögren's Syndrome and Lupus Erythematosus Sialadenite
Conclusions: These results indicated that in each disorder, MSG have their specific morphological changes, which lead to xerostomia, and the impairment of MSG in LE is probably due to a lupus sialadenitis. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 21, 2020 Category: Pathology Tags: Original Study Source Type: research

Dermal C4d Deposition and Neutrophil Alignment Along the Dermal–Epidermal Junction as a Diagnostic Adjunct for Hypocomplementemic Urticarial Vasculitis (Anti-C1q Vasculitis) and Underlying Systemic Disease
This study shows that both the alignment of neutrophils along the DEJ and dermal C4d deposition are strongly associated with HUV and SLE. Therefore, these (immuno)histopathological features can be used as an easy diagnostic adjunct for early detection of underlying systemic disease in UV. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 21, 2020 Category: Pathology Tags: Original Study Source Type: research

In Memoriam: Daniel (Danny) Santa Cruz, MD
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 21, 2020 Category: Pathology Tags: Editorial Source Type: research

A Long-Term Study of Persistent Sézary Syndrome: Evidence for Antigen Shift by Multiparameter Flow Cytometry and Its Significance in Overall Survival
Abstract: Sézary syndrome (SS) is a peripheral T-cell lymphoma characterized by erythroderma, diffuse lymphadenopathy, and circulating neoplastic T cells, which classically show a helper T-cell immunophenotype with loss of CD7 and CD26. Flow cytometry is often used to identify and enumerate populations of Sézary cells in the peripheral blood; however, the significance and frequency of antigen shift over time is unclear. In this article, we follow the immunophenotype of the neoplastic T-cell population from 28 patients with SS across 415 flow cytometry studies. Antigen shift for each patient was assigned as ...
Source: The American Journal of Dermatopathology - May 21, 2020 Category: Pathology Tags: CME Article Source Type: research