Plaque-Type Syringoma Masquerading as Microcystic Adnexal Carcinoma: Review of the Literature and Description of a Novel Technique That Emphasizes Lesion Architecture to Help Make the Diagnosis
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - August 21, 2019 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Pigmented Lesion on the Buttock: Challenge
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - August 21, 2019 Category: Pathology Tags: Clinical Pathologic Challenge Source Type: research

A Man With Fever and Bullous Plaques on the Thigh: Challenge
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - August 21, 2019 Category: Pathology Tags: Clinical Pathologic Challenge Source Type: research

Periungual Finger-Like Projections: Challenge
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - August 21, 2019 Category: Pathology Tags: Clinical Pathologic Challenge Source Type: research

A Female Infant With Linear Erythema and Papulovesicles at Birth and 5-Year Follow-up: Challenge
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - August 21, 2019 Category: Pathology Tags: Clinical Pathologic Challenge Source Type: research

WHO (2018) Classification of Skin Tumors
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - August 21, 2019 Category: Pathology Tags: Book Review Source Type: research

In response
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - August 21, 2019 Category: Pathology Tags: Letters to the Editor Source Type: research

Re-evaluation of “Polymorphous Sweat Gland Carcinoma”
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - August 21, 2019 Category: Pathology Tags: Letters to the Editor Source Type: research

SOX10 Dot-Like Paranuclear Positivity in Merkel Cell Carcinoma: Report of 2 Cases
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - August 21, 2019 Category: Pathology Tags: Letters to the Editor Source Type: research

Nevus Trichilemmocysticus: A Mild Case
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - August 21, 2019 Category: Pathology Tags: Letters to the Editor Source Type: research

Pigmented Lesion on the Buttock: Answer
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - August 21, 2019 Category: Pathology Tags: Clinical Pathologic Challenge Answer Source Type: research

A Man With Fever and Bullous Plaques on the Thigh: Answer
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - August 21, 2019 Category: Pathology Tags: Clinical Pathologic Challenge Answer Source Type: research

Periungual Finger-Like Projections: Answer
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - August 21, 2019 Category: Pathology Tags: Clinical Pathologic Challenge Answer Source Type: research

A Female Infant With Linear Erythema and Papulovesicles at Birth and 5-Year Follow-up: Answer
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - August 21, 2019 Category: Pathology Tags: Clinical Pathologic Challenge Answer Source Type: research

Extramedullary Hematopoiesis: An Unusual Finding in Angiolymphoid Hyperplasia With Eosinophilia
This report describes an adolescent boy with an isolated preauricular facial lesion. After excision, histopathology confirmed a diagnosis of ALHE with the additional finding of trilineage extramedullary hematopoiesis. To the authors' knowledge, this is the first reported case of extramedullary hematopoiesis in ALHE. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - August 21, 2019 Category: Pathology Tags: Extraordinary Case Report Source Type: research

IgG4-Related Skin Disease Presenting as a Pseudolymphoma in a White Adolescent Girl
Abstract: Immunoglobulin gamma (Ig) type 4–related disease (IgG4-RD) is a chronic immunologic systemic disorder that has gained worldwide recognition in the past decade. This entity can affect almost every organ system, and its characteristic lesions have been found in a variety of organs such as lacrimal and salivary glands, pancreas, liver, bile ducts, lungs, kidneys, retroperitoneum, breast, aorta, thyroid, and prostate. This case reports a very rare case of IgG4-RD presenting with a cutaneous lesion in a young female patient mimicking a lymphoproliferative disorder. IgG4-RD affecting the skin is a rare entity a...
Source: The American Journal of Dermatopathology - August 21, 2019 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Spontaneous Hair Repigmentation in an 80-Year-Old Man: A Case of Melanoma-Associated Hair Repigmentation and Review of the Literature
We present the first case of this phenomenon in a man. A gray-haired, 80-year-old man presented to dermatology clinic with a 3-cm lock of black hair on his vertex scalp that developed over 1 year. Punch biopsies showed an increase in junctional dendritic melanocytes with rare pagetoid cells and extension along the follicular outer root sheath epithelium and interfollicular epidermis, associated with prominent dendritic melanocytic hyperplasia and pigment-containing melanocytes within the hair bulbs. Although the findings on the biopsies were not diagnostic of melanoma in situ, an irregular interfollicular distribution of m...
Source: The American Journal of Dermatopathology - August 21, 2019 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Subcutaneous Panniculitis-Like T-Cell Lymphoma With Granulomas as the Predominant Feature
We present a case of SPTCL in which granulomas are the predominant feature, composing 75%–80% of the inflammatory infiltrate. The top differential diagnoses included infectious and autoimmune etiologies. However, special stains for microorganisms were negative, and immunohistochemical analysis of the atypical lymphocytes showed a CD3+, CD8+, TIA-1+, T-cell receptor (TCR) beta+, and CD4− infiltrate with a high Ki67 proliferation index of approximately 30%. TCR gene rearrangement studies by polymerase chain reaction with confirmation by high-throughput sequencing were necessary to exclude an autoimmune etiology, ...
Source: The American Journal of Dermatopathology - August 21, 2019 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Necrotizing Granulomas in a Patient With Psoriasis and Sarcoidosis After Adalimumab—Medication-Induced Reaction or Reactivation of Latent Disease?
In this report, we describe a case of a patient with a clinical history of systemic sarcoidosis and psoriasis who developed biopsy-confirmed perforating and necrotizing cutaneous granulomas after 12 months of treatment with adalimumab, a tumor necrosis factor-alpha–inhibiting, anti-inflammatory, biologic medication, prescribed for the patient's psoriasis. Although rare reports of a “sarcoidosis-like” reaction associated with select tumor necrosis factor-alpha agents exist, to the best of our knowledge, perforating and necrotizing cutaneous granulomas after treatment with adalimumab has not been previously...
Source: The American Journal of Dermatopathology - August 21, 2019 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Primary Orbital Synovial Sarcoma Mimicking a Periocular Cyst
Abstract: Synovial sarcoma (SS) is a high-grade soft-tissue sarcoma occurring predominantly in older children and young adults. Only approximately 7% occur in the head and neck region, with SS representing less than 0.1% of all head and neck cancers. Orbital location is exceedingly rare with only 8 cases reported so far in the literature. It is noted for its propensity for late local recurrences and metastases. Histologically, SS is monophasic, biphasic, or poorly differentiated and harbors a specific chromosomal translocation t(X;18)(p11.2;q11.2) in>95% of cases. In this article, we describe a case of monophasic SS p...
Source: The American Journal of Dermatopathology - August 21, 2019 Category: Pathology Tags: Brief Report Source Type: research

Granulomatous Reaction to Intralesional Kenalog (Triamcinolone) Injection in Acne: A Case Report
Abstract: Intralesional Kenalog (triamcinolone) injection is a useful treatment for several skin conditions. Although dermal deposition of triamcinolone has been described in the literature, histopathologic findings of foreign body reactions to it have seldom been reported. Here, we describe a case of a granulomatous reaction to the intralesional injection of triamcinolone acetonide in the treatment of nodulocystic acne. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - August 21, 2019 Category: Pathology Tags: Brief Report Source Type: research

Collision of Subungual Neurofibroma and Onychomatricoma: S100 Positivity as a Clue
In conclusion, as “subungual NF” is so rare and, in our case, seems to collide with a typical onychomatricoma, we recommend adding S100 staining to properly characterize tumors involving nail plate, to detect underlying neural tumors, as has happened in our case. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - August 21, 2019 Category: Pathology Tags: Brief Report Source Type: research

Primary Cutaneous Acral CD8+ T-Cell Lymphoma—A Single Center Review of 3 Cases and Recent Literature Review
Abstract: The recently published 2016 revision of the WHO classification of lymphoid neoplasms includes primary cutaneous acral CD8-positive T-cell lymphoma (PCATCL) as a provisional entity. This is a rare indolent lymphoma characterized by papules or nodules on the ear and a dermal infiltrate of CD8-positive T-lymphocytes with cytotoxic marker expression. A retrospective review of a single institutional experience with PCATCL identified 3 patients (mean age 54; range 49–62) with papules or nodules on the ear. Lesional biopsies demonstrated a dense diffuse dermal infiltrate of atypical lymphocytes with a Grenz zone...
Source: The American Journal of Dermatopathology - August 21, 2019 Category: Pathology Tags: Original Study Source Type: research

Spindle Cell Predominant Trichodiscoma or Spindle Cell Lipoma With Adnexal Induction? A Study of 25 Cases, Revealing a Subset of Cases With RB1 Heterozygous Deletion in the Spindle Cell Stroma
Abstract: In our routine and consultative pathology practices, we have noticed that a relatively high proportion of spindle cell predominant trichodiscomas demonstrate a remarkable stromal admixture of adipose tissue, which along with spindle cells, prominent collagen bundles and myxoid change closely resembles spindle cell lipoma (SCL). To clarify their possible relationship to SCL, 25 cases of trichodiscoma and fibrofolliculoma with stromal “lipomatous metaplasia” were collected and examined using immunohistochemical stains [CD34 and retinoblastoma-1 (RB1) protein] and fluorescence in situ hybridization (RB...
Source: The American Journal of Dermatopathology - August 21, 2019 Category: Pathology Tags: Original Study Source Type: research

αEβ7 Expression Increases With the Extent of Cutaneous Involvement in Mycosis Fungoides
Conclusions: The findings presented here support the idea that the lymphocyte migratory mechanism observed in neoplasms is similar to that of inflammatory processes of the skin. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - August 21, 2019 Category: Pathology Tags: Original Study Source Type: research

Melanocytic Skin Neoplasms: What Lesson From Genomic Aberrations?
Abstract: Studies on the genomic aberrations in melanocytic neoplasms have shown a complex genomic landscape. In nevi and melanomas, a MAP-kinase pathway activation was generally found, produced by different chromosomal aberrations, including BRAF, NRAS, HRAS, GNAQ, GNA11, BAP1, CTNNB1, MAP2K1, PRKAR1A, and NF1 mutations, and ALK, ROS1, NTRK1, RET, MET, BRAF, NTRK3, and PRKCA fusions. Melanomas also showed a variable number of additional mutations ablating tumor-suppression mechanisms and activating other oncogenic pathways, including CDKN2A loss, PTEN loss, as well as TP53 and TERT-promoter mutations. Moreover, borderli...
Source: The American Journal of Dermatopathology - August 21, 2019 Category: Pathology Tags: CME Article Source Type: research

An Atypical Fibroxanthoma and Intradermal Nevus Collision Tumor—Potential for Misdiagnosis
In this study, we describe such a lesion for its novelty and challenge in diagnosis, as this case was originally considered to be melanoma arising in a nevus. On histologic examination, there were 2 distinct populations of cells; one composed of markedly atypical and pleomorphic epithelioid and oval to spindled cells, consistent with AFX, and the other, a bland-appearing intradermal nevus with congenital features. The AFX population stained positive with smooth muscle actin, CD10, and CD68 and was negative for S100, SOX10, Melan-A, desmin, pancytokeratin, CK5/6, and p63. Deep to this was a second population of small, bland...
Source: The American Journal of Dermatopathology - July 24, 2019 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Cutaneous Crospovidone: A Newly Described Foreign Body Due to Illicit Drug Abuse
We present 2 cases of cutaneous crospovidone deposition resulting from subcutaneous injection of crushed tablets, commonly known as “skin popping.” Clinical presentation includes painful, inflamed papules, nodules, or ulcers with overlying eschar. Crospovidone has a distinct and reproducible histochemical staining profile. Histologic recognition of this material is important because it can guide clinicians in their diagnosis and management decisions. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - July 24, 2019 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Diffuse Papular Rash in a Young Woman: Challenge
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - July 24, 2019 Category: Pathology Tags: Clinical Pathologic Challenge Source Type: research

Papular Lesion on the Knee of a 7-Year-Old Girl: Challenge
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - July 24, 2019 Category: Pathology Tags: Clinical Pathologic Challenge Source Type: research

Ecchymotic Nodule on the Scalp: Challenge
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - July 24, 2019 Category: Pathology Tags: Clinical Pathologic Challenge Source Type: research

Protruding Hyperkeratotic Tumor Underneath the Big Toe Nail: Challenge
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - July 24, 2019 Category: Pathology Tags: Clinical Pathologic Challenge Source Type: research

Bright Red Papules in a HIV-Positive 20-Year-Old Man: Challenge and Answer
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - July 24, 2019 Category: Pathology Tags: Letters to the Editor Source Type: research

Primary Cutaneous Adenoid Cystic Carcinoma Connecting to the Epidermis
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - July 24, 2019 Category: Pathology Tags: Letters to the Editor Source Type: research

A Case of Oral Florid Papillomatosis (Verrucous Carcinoma) With Lack of Evidence for Human Papillomavirus Involvement
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - July 24, 2019 Category: Pathology Tags: Letters to the Editor Source Type: research

Diffuse Papular Rash in a Young Woman: Answer
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - July 24, 2019 Category: Pathology Tags: Clinical Pathologic Challenge Answer Source Type: research

Papular Lesion on the Knee of a 7-Year-Old Girl: Answer
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - July 24, 2019 Category: Pathology Tags: Clinical Pathologic Challenge Answer Source Type: research

Ecchymotic Nodule on the Scalp: Answer
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - July 24, 2019 Category: Pathology Tags: Clinical Pathologic Challenge Answer Source Type: research

Protruding Hyperkeratotic Tumor Underneath the Big Toe Nail: Answer
No abstract available (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - July 24, 2019 Category: Pathology Tags: Clinical Pathologic Challenge Answer Source Type: research

Superficial and Deep Cutaneous Involvement by RAS-Associated Autoimmunne Leukoproliferative Disease (RALD Cutis): A Histologic Mimicker of Histiocytoid Sweet Syndrome
Abstract: RAS-associated autoimmune leukoproliferative disease (RALD) is a recently described noninfectious and nonmalignant clinical syndrome characterized by autoimmune disorders, massive splenomegaly, modest lymphadenopathy, and monocytosis. On the molecular level, RALD is defined by somatic mutations of either NRAS or KRAS gene in a subset of hematopoietic cells. To date, there is a dearth of well-documented histopathologic description of cutaneous involvement by RALD in the literature. In the current case report, a 43-year-old female patient with a history of RALD presented with clinical pictures of sepsis and an er...
Source: The American Journal of Dermatopathology - July 24, 2019 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Primary Cutaneous Anaplastic Lymphoma Kinase–Positive Large B-Cell Lymphoma
We describe the first case of a primary cutaneous ALK-positive large B-cell lymphoma in a 48-year-old man with a solitary nodule on the back, and describe the histologic and phenotypic features. Accurate staging confirmed the absence of other lesions, and so surgical excision and postoperative local radiation therapy were initiated and resulted in complete remission. Two years later, extracutaneous spread with involvement of axillary lymph nodes occurred. Complete remission was achieved again by multiagent chemotherapy. Our case demonstrates that a primary cutaneous form of ALK-positive large B-cell lymphoma exists. The im...
Source: The American Journal of Dermatopathology - July 24, 2019 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Cutaneous B-Cell Lymphoblastic Lymphoma
We present a case of simultaneous cutaneous and systemic presentation of B-LBL in an otherwise healthy 28-year-old man in which the lymphoblastic infiltrate stained positive for CD79a, Tdt, CD10, and CD20. A diagnosis of cutaneous B-LBL was made, and systemic work-up revealed widespread involvement of the skin, bone, and lymph nodes. Review of all currently described cases of cutaneous B-LBL with or without systemic involvement revealed that the most frequently positive tumor markers were CD79a (92.3%), Tdt (90.6%), and CD10 (83.3%). Systemic involvement of B-LBL was found in nearly half of all cases with cutaneous present...
Source: The American Journal of Dermatopathology - July 24, 2019 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Endometriosis of the Eyelid, an Extraordinary Extra-abdominal Location Highlighting the Spectrum of Disease
In this report, we present the first known case of cutaneous endometriosis on the eyelid. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - July 24, 2019 Category: Pathology Tags: Extraordinary Case Report Source Type: research

A Unique and Rare Case of Extramammary Paget Disease With Concomitant Herpes Simplex
We describe a rare and unique case of extramammary Paget disease in the genitals with concomitant histological features of herpes virus infection. This is a very rare and interesting association that has only been reported in 1 article in the literature so far. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - July 24, 2019 Category: Pathology Tags: Extraordinary Case Report Source Type: research

Cytoimmunofluorescence Diagnosis in Surgically Induced Pemphigus Foliaceus
Abstract: Pemphigus foliaceus is an autoimmune bullous disease with autoantibodies against desmoglein 1. Case reports of pemphigus after surgery have also been described, which may simulate an infection of the surgical wound, a contact dermatitis, or even a tumor recurrence. Cytoimmunofluorescence can help to establish a rapid diagnosis. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - July 24, 2019 Category: Pathology Tags: Brief Report Source Type: research

Selection Criteria of Program Directors for Dermatopathology Fellows
Abstract: Dermatopathology represents a unique field at the intersection of dermatology and pathology. Although programs are approved by the ACGME, there is neither uniformity in application materials, timetables, and deadlines, nor a centralized application process. Despite the competitive nature of dermatopathology fellowships, no formal studies have thoroughly examined the selection criteria by program directors. Our study fills this gap in the literature and evaluates the impact of selection criteria for dermatopathology fellows. Applicants can now gain insight into the most important and meaningful aspects of their ...
Source: The American Journal of Dermatopathology - July 24, 2019 Category: Pathology Tags: Brief Report Source Type: research

Polypoid Compound Melanocytic Proliferations: A Clinicopathological Study
Abstract: Nevi can show a polypoid appearance both clinically and histologically. Anecdotally, polypoid compound melanocytic nevus may exhibit a spectrum of junctional architectural and cytologic atypia, at times creating a diagnostic challenge by mimicking the radial growth phase of melanoma. To investigate this issue, we prospectively reviewed 40 polypoid compound melanocytic proliferations without overt malignant features. The lesions frequently occurred in young female patients and were predominantly from the trunk and intertriginous areas. Commonly observed atypical features included asymmetry (30%), shouldering (47...
Source: The American Journal of Dermatopathology - July 24, 2019 Category: Pathology Tags: Original Study Source Type: research

Renal Cell Carcinoma Antigen Expression in Primary Cutaneous Endocrine Mucinous Carcinomas: A Case Series of 14 Patients and Review of the Literature
We present 9 cases of EMPSGC and 5 cases of PCMC with strong and diffuse immunoreactivity to renal cell carcinoma antigen. This novel finding can be useful in the diagnosis of EMPSGC and PCMC in combination with other known positive markers to differentiate them from other cutaneous neoplasms. In addition, it provides further evidence that EMPSGC could be a precursor lesion to PCMC with both existing on a spectrum. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - July 24, 2019 Category: Pathology Tags: Original Study Source Type: research

Role of Histopathology in the Diagnosis of Cutaneous Leishmaniasis: A Case–Control Study in Sri Lanka
In conclusion, in the presence of clinical suspicion, dermal granulomata in ill-formed coalescent morphology with high plasma cell density in a diffuse arrangement are positive factors for the diagnosis of CL, especially when the discernible Leishmania amastigotes are absent. Resource utilization such as polymerase chain reaction and other ancillary techniques during the diagnosis of CL can be minimized by using a range of histopathological features and special attention should be focused on this in the future. (Source: The American Journal of Dermatopathology)
Source: The American Journal of Dermatopathology - July 24, 2019 Category: Pathology Tags: Original Study Source Type: research

PD-L1 Detection—Pearls and Pitfalls Associated With Current Methodologies Focusing on Entities Relevant to Dermatopathology
Abstract: PD-L1 is a transmembrane glycoprotein with an extracellular as well as an intracellular cytoplasmic domain. Physiologically, it plays a pivotal role in regulating T-cell activation and tolerance. Many tumor cells have exploited this regulatory mechanism by overexpressing PD-L1 in an effort to escape immunologic surveillance. In this review, we parse the literature regarding the prognostic value of tumoral PD-L1 expression before discussing the various methodologies as well as the pearls and pitfalls associated with each for predicting response to anti–PD-1/PD-L1 therapies. Special attention is given to cu...
Source: The American Journal of Dermatopathology - July 24, 2019 Category: Pathology Tags: CME Article Source Type: research