Three Cases of Clear Cell Hidradenoma With “Benign” Lymph Node Involvement
We report 3 cases of CCH with lymph node involvement. Ages ranged from 29 to 51 years old. All cases involved the inguinal lymph nodes: 2 of them presented with an isolated lymph node lesion, and the third case had lymph node and cutaneous involvement following the resection of a previous cutaneous lesion. Imaging studies showed no systemic involvement. None of the lesions exhibited histopathologic features of malignancy. All neoplasms were well circumscribed, had cystic spaces, did not display atypia or necrosis, and had less than 4 mitoses per high power field. No recurrence has been observed at follow-up after resection...
Source: The American Journal of Dermatopathology - May 27, 2021 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Ulcerated Nipple Nodule, Clinicopathologic Challenge: Challenge
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 27, 2021 Category: Pathology Tags: Clinical Pathologic Challenge Source Type: research

Multiple Dermatofibroma-Like Lesions in a 37-Year-Old Man: Challenge
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 27, 2021 Category: Pathology Tags: Clinical Pathologic Challenge Source Type: research

A Verrucous Plaque With Linear Fissures in a Patient With Crohn's Disease: Challenge
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 27, 2021 Category: Pathology Tags: Clinical Pathologic Challenge Source Type: research

Disseminated Inflammatory Lesions in 2 COVID-19 Patients: Challenge
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 27, 2021 Category: Pathology Tags: Clinical Pathologic Challenge Source Type: research

Apocrine (Nodular) Hidradenoma and Adenomyoepithelioma Most Likely Do Not Form a Biological Continuum of Adnexal Neoplasia
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 27, 2021 Category: Pathology Tags: Letters to the Editor Source Type: research

“Dark Paget” Cells in Extramammary Paget Disease: A Staining Artifact and Diagnostic Pitfall
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 27, 2021 Category: Pathology Tags: Letters to the Editor Source Type: research

Elastophagocytosis in Juvenile Xanthogranuloma: A Case Report
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 27, 2021 Category: Pathology Tags: Letters to the Editor Source Type: research

Ulcerated Nipple Nodule, Clinicopathologic Challenge: Answer
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 27, 2021 Category: Pathology Tags: Clinical Pathologic Challenge Answer Source Type: research

Multiple Dermatofibroma-Like Lesions in a 37-Year-Old Man: Answer
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 27, 2021 Category: Pathology Tags: Clinical Pathologic Challenge Answer Source Type: research

A Verrucous Plaque With Linear Fissures in a Patient With Crohn's Disease: Answer
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 27, 2021 Category: Pathology Tags: Clinical Pathologic Challenge Answer Source Type: research

Disseminated Inflammatory Lesions in 2 Patients With COVID-19: Answer
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 27, 2021 Category: Pathology Tags: Clinical Pathologic Challenge Answer Source Type: research

Primary Cutaneous B-Cell Lymphoma Complicated by Clonal T-Cell Populations: A Diagnostic Dilemma
In this study, we report a unique case of T-cell gene rearrangement positivity complicating the diagnosis of primary cutaneous low-grade B-cell lymphoma along with a review of reported cases containing dual receptor rearrangement to identify trends among final diagnostic decisions. As one might guess, for cutaneous lymphomas presenting with clonality for both T-cell and B-cell receptors, diagnosis can be difficult and confusing because the differential is broad. The literature suggests the majority of these cases may be cutaneous composite lymphomas. However, immunohistochemical, clinical, and histomorphologic features mus...
Source: The American Journal of Dermatopathology - May 27, 2021 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Extramedullary Blast Crisis of Chronic Myelogenous Leukemia With a Skin Lesion: A Case Report and Literature Review
Abstract: Extramedullary blast crisis of chronic myeloid leukemia (CML) is defined as extramedullary disease composed of blasts regardless of the proliferation of blasts in the bone marrow. The commonly affected sites are the lymph node, central nervous system, bone, skin, and soft tissue. However, skin infiltration of CML patients as the initial presentation while their bone marrow is still in the chronic phase is extremely rare. In this article, we present a case of a 51-year-old woman who was admitted to our hospital complaining about a skin nodule in her right calf and easy fatigability for 1 week. The peripheral b...
Source: The American Journal of Dermatopathology - May 27, 2021 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Pleomorphic Leiomyosarcoma Presenting as a Upper Back Epidermal Inclusion Cyst
Abstract: Leiomyosarcoma is a common sarcoma of both organs and soft tissues; however, large intradermal tumors are extremely rare. Presented is a pleomorphic leiomyosarcoma in a 64-year-old man, initially considered to be a ruptured epidermal inclusion cyst. The patient had a mildly tender, enlarging soft-tissue mass with a central pore on his right upper back. Incomplete extirpation showed a 5 × 5 cm heterogeneous, predominantly pleomorphic sarcoma with areas of fascicular and storiform spindled cells infiltrating the subcutaneous soft tissue to the underlying fascia and extending upward into the middle and upp...
Source: The American Journal of Dermatopathology - May 27, 2021 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Recurrent Antineutrophil Cytoplasmic Antibody–Associated Vasculitis Induced by Levamisole-Adulterated Cocaine
We present a case of recurrent levamisole-induced vasculitis initially misdiagnosed as systemic lupus erythematosus to highlight this easily misdiagnosed entity and to demonstrate re-exposure leading to recurrent vasculitis with more extensive clinical manifestations. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 27, 2021 Category: Pathology Tags: Brief Report Source Type: research

Multiple Basal Cell Carcinomas of the Scalp After Radiotherapy: Genomic Study in a Case With Latency Period Over 80 Years
We present a 93-year-old woman with 4 BCCs of the scalp after radiotherapy for tinea capitis, diagnosed after a latency period of over 80 years. The largest lesion was located on the right temporal region and corresponded to a BCC of mixed type, with nodular, infiltrative, and micronodular components. We performed genomic study with array comparative genomic hybridization in samples from each BCC, which revealed more imbalances in the largest lesion than in the remaining ones, correlating with its higher histological complexity. Furthermore, this was the only lesion presenting loss at 2p22.3, where is mapped the BIRC6 gene...
Source: The American Journal of Dermatopathology - May 27, 2021 Category: Pathology Tags: Brief Report Source Type: research

Histopathology of Pemphigus Vulgaris Revisited
Abstract: Pemphigus vulgaris (PV) is a severe, potentially life-threatening autoimmune blistering disease, which is common in India. Although there is abundant literature on clinical and immunologic features, comprehensive studies on its histopathology are lacking. The aim of this study was to describe the histopathologic and immunofluorescence features as well as discuss various diagnostic pitfalls of PV. Histopathologic and immunofluorescence (DIF/IIF) findings were reviewed for 169 biopsies from 2007 to 2017 (11 years). The 169 samples included 152 skin, 16 oral mucosal, and 1 corneal biopsy. Maximum prevalence was ...
Source: The American Journal of Dermatopathology - May 27, 2021 Category: Pathology Tags: Original Study Source Type: research

Value of PD-L1, PD-1, and CTLA-4 Expression in the Clinical Practice as Predictors of Response to Nivolumab and Ipilimumab in Monotherapy in Patients With Advanced Stage Melanoma
Conclusions: Nivolumab produces a better response compared with ipilimumab in patients with melanoma. The IHC expression of PD‐L1 and CTLA-4 are associated with a higher response rate to nivolumab and ipilimumab, respectively, and better PFS, but the existence of responder patients with negative expression suggests that they are not adequate biomarkers to select candidate patients for ICI in the clinical practice. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - May 27, 2021 Category: Pathology Tags: Original Study Source Type: research

Vulvar Elastosis: A Novel Diagnostic Entity
Abstract: In vulvar biopsies, we have observed histopathologic abnormalities of elastic fibers identical to solar elastosis, with thick, curled, and irregular pale grey fibers in the dermis. In severe cases, changes resemble nodular solar elastosis. We retrospectively evaluated 238 vulvar biopsies with the goal of defining and characterizing changes of vulvar elastosis. Of 238 vulvar biopsies reviewed, 107 (45%) exhibited vulvar elastosis. Patients with vulvar elastosis were older (mean = 65 years old) compared to those without (mean = 44 years old). Sixty-six (62%) were graded as mild, 27 (25%) moderate, and 14 (13%) ...
Source: The American Journal of Dermatopathology - May 27, 2021 Category: Pathology Tags: Original Study Source Type: research

MAP2K1-Mutated Melanocytic Neoplasms With a SPARK-Like Morphology
Abstract: Specific alterations involving MAPK genes (MAP3K8 fusions, MAP3K3 fusions) have been recently detected in a subgroup of spitzoid neoplasms that seem to constitute a distinctive clinicopathologic group, occur mostly in younger patients (median age 18 years) and present with atypical histologic features associated with frequent homozygous deletion of CDKN2A, qualifying a high proportion of them as Spitz melanoma (malignant Spitz tumor). Apart from lesions with spitzoid morphology harboring MAP3K8 or MAP3K3 fusion, a single case with MAP2K1 deletion has been identified. The authors report herein 4 melanocytic le...
Source: The American Journal of Dermatopathology - May 27, 2021 Category: Pathology Tags: Original Study Source Type: research

Histologic Patterns of Cutaneous Metastases of Breast Carcinoma: A Clinicopathologic Study of 232 Cases
Abstract: Cutaneous metastasis may be the initial sign of internal malignancy but more often represents a late manifestation of widely disseminated disease. Breast carcinoma is the most common malignancy to metastasize to the skin. Although several studies have detailed the histopathologic patterns of cutaneous metastasis from internal malignancies, very little has been published regarding metastases of breast carcinoma to the skin. Furthermore, the histopathologic and clinical features observed in the cases of breast carcinoma with local skin involvement as opposed to cases exhibiting distant cutaneous metastases have...
Source: The American Journal of Dermatopathology - May 27, 2021 Category: Pathology Tags: CME Article Source Type: research

Epidermodysplasia Verruciformis After Hematopoietic Stem Cell Transplantation in a Patient With Severe Combined Immunodeficiency Syndrome
We report an extraordinary case of disseminated epidermodysplasia verruciformis seen in a 7-year-old boy diagnosed with severe combined immunodeficiency syndrome who had undergone HSCT. He had plane, brown papules involving his face, forearms, neck, anterior chest, nape, back, and knees. Cutaneous biopsy showed typical characteristic findings of EV: large cells with gray–blue cytoplasm and keratohyaline granules of different sizes in the granular and spinous layers. Herein, we present an unusual case of disseminated EV in a HSCT patient with typical histopathologic findings and treatment options. (Source: The America...
Source: The American Journal of Dermatopathology - April 30, 2021 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Atypical Cellular Blue Nevus With Necrosis Mimicking Melanoma Ex-Blue Nevus
We present an unusual case of an atypical cellular blue nevus with extensive necrosis mimicking melanoma ex-blue nevus. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - April 30, 2021 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Asymptomatic Solitary Nodule in the Interdigital Space: Challenge
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - April 30, 2021 Category: Pathology Tags: Clinical Pathologic Challenge Source Type: research

Multiple Lesions Arising Within a Tattoo: Challenge
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - April 30, 2021 Category: Pathology Tags: Clinical Pathologic Challenge Source Type: research

Hypopigmented Papules in Infancy: A Diagnostic Challenge: Challenge
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - April 30, 2021 Category: Pathology Tags: Clinical Pathologic Challenge Source Type: research

Corrugated Purple-Black Plaque on the Left Cheek: Challenge
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - April 30, 2021 Category: Pathology Tags: Clinical Pathologic Challenge Source Type: research

Linear Comedonal Epidermolytic Nevus: A Rare Entity
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - April 30, 2021 Category: Pathology Tags: Letters to the Editor Source Type: research

Unusual Histopathological Features in a Case of Seronegative Lues Maligna
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - April 30, 2021 Category: Pathology Tags: Letters to the Editor Source Type: research

Pityriasis Rubra Pilaris-Like Reaction Induced by a Tyrosine Kinase Inhibitor, the Ponatinib
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - April 30, 2021 Category: Pathology Tags: Letters to the Editor Source Type: research

Asymptomatic Solitary Nodule in the Interdigital Space: Answer
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - April 30, 2021 Category: Pathology Tags: Clinical Pathologic Challenge Answer Source Type: research

Multiple Lesions Arising Within a Tattoo: Answer
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - April 30, 2021 Category: Pathology Tags: Clinical Pathologic Challenge Answer Source Type: research

Hypopigmented Papules in Infancy: A Diagnostic Challenge: Answer
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - April 30, 2021 Category: Pathology Tags: Clinical Pathologic Challenge Answer Source Type: research

Corrugated Purple Plaque on the Left Cheek: Answer
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - April 30, 2021 Category: Pathology Tags: Clinical Pathologic Challenge Answer Source Type: research

Rare Initial Manifestation of Lupus as Lobular Panniculitis of the Breast—A Case Report and Review of the Literature
In conclusion, we bring much needed awareness to lupus mastitis as the first presentation of disease. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - April 30, 2021 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Metastatic Melanoma With Features of Desmoplastic Melanoma in a Patient With Primary Cutaneous Superficial Spreading Melanoma With Epithelioid Features
We present a case of a 30-year-old man who developed an irregular, purple, tender plaque measuring 2.5 cm on the right pretibial region. Wide excision of the right leg lesion showed superficial spreading melanoma with epithelioid cells and no spindle cell component. Sentinel lymph node (SLN) biopsy showed an atypical melanocytic proliferation involving one inguinal lymph node with subcapsular and intraparenchymal components. There were spindled tumor cells in lymph node capsule with hyperchromatic nuclei, which were nested within desmoplastic stroma, and were S100- and SOX10-positive and MART1- and HMB-45 negative; in addi...
Source: The American Journal of Dermatopathology - April 30, 2021 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Iatrogenic Arsenism Characterized by Palmoplantar Hyperkeratosis and Diffused Skin Cancers for Over Decades
Abstract: Chronic arsenism usually occurs after a long-term unawareness of arsenic exposure from environment, occupation, food, and water. We here reported 3 cases with diffused arsenic keratosis and skin cancers derived from long-term arsenic medication ingestion. In these cases, hyperkeratotic skin lesions were initially found on palms and soles, slowly progressed to every part of the skin and lasted maximally for over 30 years. Skin cancers were diagnosed and removed intermittently within decades, but with no malignancies in other organs. Oral retinoids combing with topical 5- fluorouracil and photodynamic treatment...
Source: The American Journal of Dermatopathology - April 30, 2021 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Oral Lichen Planus Associated With Lichen Planus Pigmentosus and Lichen Sclerosus in Monozygotic Twins
This report is even rarer because one of the patients had cutaneous lesions of an unusual variant of LP (LP pigmentosus) and the other had an uncommon association with lichen sclerosus. The etiology and pathogenesis of LP are still uncertain. However, despite being rare, its occurrence in family members and monozygotic twins suggests that genetic factors are involved in its development. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - April 30, 2021 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Combined Nevus–Mastocytosis; Random Coincidence or Complex Biological Relationship?
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - April 30, 2021 Category: Pathology Tags: Brief Report Source Type: research

Irradiated Skeletal Muscle Cells Mimicking Those of Atypical Fibroxanthoma on Mohs Frozen Sections
Abstract: Radiation can induce changes to skeletal muscle cells that may mimic and thus be confused with cells of atypical fibroxanthoma (AFX), pleomorphic dermal sarcoma, spindle cell squamous cell carcinoma, and other spindle soft-tissue tumors. An 80-year-old White man presented for Mohs micrographic surgery of an AFX on the left lateral neck. The medical history was notable for a tongue squamous cell carcinoma 9 years before that had been treated with wide local excision, left neck dissection, and radiation to the oral cavity and left neck. Frozen sections from the first stage of Mohs did not show typical AFX, but ...
Source: The American Journal of Dermatopathology - April 30, 2021 Category: Pathology Tags: Brief Report Source Type: research

Different Immunohistochemical Localization of Fatty Acid Binding Protein 5 in Actinic Keratosis Compared with That in Bowen's Disease: A Retrospective Study
This study is the first to investigate the role of FABP5 in premalignant skin lesions. The unique immunohistochemical localization of the FABP5 can be a helpful diagnostic marker, and altered fatty acid metabolism may be the key in understanding the different pathophysiology of AK and BD. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - April 30, 2021 Category: Pathology Tags: Original Study Source Type: research

Distinction Between Hypertrophic Lichen Planus and Squamous Cell Carcinoma Requires Clinicopathologic Correlation in Difficult Cases
This study characterizes histopathological features in HLP and SCC, assessing their utility in diagnosing atypical squamous proliferations. We compared 12 histopathological features of 15 HLP and 11 SCC biopsies from the lower extremities. We then reviewed 16 cases that were diagnosed as atypical squamous proliferations with differential diagnoses of HLP versus SCC. Clinical follow-up allowed for retrospective categorization of these difficult cases as HLP or SCC. HLP showed significant differences in hyperorthokeratosis (P = 0.04), wedge-shaped hypergranulosis (P = 0.0033), and irregular psoriasiform hyperplasia (P = 0.00...
Source: The American Journal of Dermatopathology - April 30, 2021 Category: Pathology Tags: Original Study Source Type: research

Acute Generalized Exanthematous Pustulosis (AGEP) in 12 Patients Treated for SARS-CoV-2 Positive Pneumonia
Abstract: The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is rapidly spreading throughout the world. The study describes 12 patients with SARS-CoV-2 pneumonia, who developed an acute erythematous rash with nonfollicular pinhead-sized pustules, without mucosal involvement. The clinical differential diagnosis was viral rash, acute generalized exanthematous pustulosis (AGEP), or multiform erythema. computed tomography with a diagnosis of interstitial pneumonia and a respiratory tract sample positive for SARS-CoV-2 in a reverse transcriptase polymerase ch...
Source: The American Journal of Dermatopathology - April 30, 2021 Category: Pathology Tags: Original Study Source Type: research

Histopathological Findings in Nail Clippings With Periodic Acid-Schiff–Positive Fungi
Background: Periodic acid–Schiff (PAS) staining of nail clippings is an adjunct diagnostic tool for onychomycosis. Objective: To detect histopathological findings as clues to the presence of PAS-positive (+) fungal elements in nail clippings. Methods: Four hundred sixteen consecutive nail clippings suspected of onychomycosis were stained with hematoxylin and eosin, and with PAS stains. All cases were studied histopathologically. The clinical files of the cases with neutrophils were reviewed. Results: PAS+ staining for fungi were demonstrated in 159 (38%) of the nail clippings. Neutrophils, pa...
Source: The American Journal of Dermatopathology - April 30, 2021 Category: Pathology Tags: Original Study Source Type: research

Histopathology of Red Tattoo Reactions
Conclusions: In this cohort we demonstrated that cutaneous reactions to red tattoo ink are frequently characterized by the combination of dermal predominantly histiocytic infiltrates and epidermal interface dermatitis. Allergic reactions to red tattoo pigments probably represent a combination of a subtype IVa and IVc allergic reaction. Clinicians should be aware of the specific histopathology of these reactions and therefore the importance of taking a diagnostic skin biopsy. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - April 30, 2021 Category: Pathology Tags: Original Study Source Type: research

Histopathologic PD-L1 Tumor Expression and Prognostic Significance in Nonmelanoma Skin Cancers: A Systematic Review
Abstract: PD-L1 and PD-1 inhibitors are being increasingly used to treat a variety of nonmelanoma skin cancers (NMSCs). This systematic review summarizes PD-L1 expression in NMSCs and determines its use for prognosis using targeted immunotherapy. A primary search of peer-reviewed English-language medical literature was conducted for studies on PD-L1 tumor expression in biopsied or excised NMSCs. Fifty-nine articles met criteria for inclusion. PD-L1 expression in advanced NMSCs ranged from 22%–89% for basal cell carcinomas, 42%–50% for Merkel cell carcinomas, and 26%–100% for squamous cell carcinomas. ...
Source: The American Journal of Dermatopathology - April 30, 2021 Category: Pathology Tags: CME article Source Type: research

COVID Purpura (Toes) Case Series: A Chilblains-Like Vasculopathy
Abstract: Biopsies were taken from 4 patients who presented to their dermatologist with violaceous papules and plaques of the dorsal toes (COVID Toes) associated with varying degrees of severe acute respiratory syndrome coronavirus 2 exposure and COVID-19 testing. Major histopathologic findings were lymphocytic eccrine inflammation and a spectrum of vasculopathic findings to include superficial and deep angiocentric–perivascular lymphocytic inflammation, lymphocytes in vessel walls (lymphocytic vasculitis), endothelial swelling, red blood cell extravasation, and focal deposits of fibrin in both vessel lumina, and...
Source: The American Journal of Dermatopathology - March 27, 2021 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Comedonal Lesions on the Trunk and Proximal Extremities: Challenge
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - March 27, 2021 Category: Pathology Tags: Clinical Pathologic Challenge Source Type: research

Multiple Mucosal Papules in a Pediatric Patient: Challenge
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - March 27, 2021 Category: Pathology Tags: Clinical Pathologic Challenge Source Type: research