CUMC Dermatopathology publications,2006 - 2009

Deba P Sarma, MD Professor of Pathology Director of Dermatopathology Creighton University Medical Center, Omaha, NE

Man, 58, with a tumor mass in the leg amputation stump

.

Fig.1

Fig.2

Diagnosis: Verrucous carcinoma Ref: Deba P. Sarma, Thomas P. Hansen, Edward D. Adickes: Carcinoma Arising In The Leg Amputation Stump . The Internet Journal of Dermatology. 2006. Volume 4 Number 1.

Male, 41, presented with disseminated subcutaneous abscesses one month after amputation for septic right leg and removal of Groshon vascular catheter tip.

Fig.1

Fig.2

Fig,3, AFB stain Diagnosis: Dermal abscess due to Mycobacterium abscessus.

Ref. Hansen TP, Sarma DP(2006): Multiple subcutaneous nodules associate with Mycobacterium abscessus infection following removal of an infected Groshon vascular catheter tip. Dermatol Online J 12(4):12. PMID:17083867 [PubMed - indexed for MEDLINE]

Man, 29, with a painless slow-growing nodule of left forearm for a year. Fig.2 Fig.1

Diagnosis: Sinusoidal hemangioma.

Ref. Wang B, Santos E, Sarma DP(2006). Sinusoidal hemangioma in an adult male. The Internet J Dermatol. 4(1):2006. Indexed by Google Scholar.

Man, 59, phimosis, excised foreskin. Fig.1 Fig.2

Diagnosis: Hemangioma. Ref. Santos E, Sarma D(2006): Hemangioma of the prepuce. The InternetJ Dermatol.4(1). Indexed by Google Scholar.

Fig.1

Man,74, 1-cm keratotic lesion of forehead Fig.2

Diagnosis: Bullous actinic keratosis Ref. Sarma DP, Sharma P(2006) Bullous solar keratosis. The Internet J Dermatol , 4(1). Indexed by Google Scholar.

Man,69, left cheek lesion, suspected of squamous cell carcinoma

Fig.1

Fig.2

The tumor cells were immunoreactive for EMA, BerEp-4, CK7, and, AE1/3 with variable positive stains of Androgen receptor, CK8/18, and Vimentin, but were negative for immunostains of S100, HMB45, CK20, TTF-1, RCC, and PSA. The neoplastic cells from the foci of apocrine differentiation were immunoreactive for GCDFP-15 and CK8/18. Immunostains for mismatch repair genes includnig hMLH1, hMSH2, hMSH6, PMSH2 and RT-PCR for microsatellite instability studies including MSI (T) and MSI(C) were negative.

Diagnosis: Sebaceous carcinoma with apocrine differentiation

Ref.

Wang B, Sarma DP(2006). Sebaceous carcinoma with apocrine differentiation. The Internet J Dermatol, 4(2). Indexed by Google Scholar.

Woman, 51, 1-cm nodule, left arm

Diagnosis: Proliferating trichilemmal cyst

Ref.

Sharma P, Sarma DP(2006). Proliferating trichilemmal cyst of the arm. The Internet J Dermatol,4(2), 2006. Indexed by Google Scholar.

cheek.

Diagnosis: Squamous cell carcinoma in situ associated with osteoma cutis.

Ref. Poonam Sharma, Deba P. Sarma: Squamous Cell Carcinoma In Situ Associated With Osteoma Cutis. The Internet Journal of Dermatology. 2006. Volume 4 Number

An 80-year-old man presented with a long-standing skin lesion on his mid forehead.

Diagnosis: Seborrheic keratosis with in-situ squamous cell carcinoma changes Ref.
Sharma P, Sarma DP, Adickes ED (2006). Seborrheic keratosis with in-situ carcinoma changes. Dermatology Online J 12(7):19. PMID: 17459305 [PubMed - indexed for MEDLINE]

A few interesting memories from more than 30-year of dermatopathology practice

Deba P. Sarma: From The Diary Of A Dermatopathologist. The Internet Journal of Dermatology. 2006. Volume 4 Number 2.

A 63-year-old man with a 20-year history of diabetes mellitus, peripheral vascular disease and hypertension presented with a nonhealing ulcer of left foot

Diagnosis: Verrucous carcinoma. Ref. Deba P. Sarma, Jeff F. Wang, Chhanda Bewtra, Lisa M. J. Lee: Verrucous Carcinoma Arising In A Chronic Non-Healing Ulcer Of The Foot Of A Diabetic Patient. The Internet Journal of Dermatology. 2007. Volume 5 Number 1.

A 69-year-old female presented a 0.5 cm flat, pigmented skin lesion on the right dorsal forearm.

Melan A stain

S-100 stain

Diagnosis: Pigmented neurofibroma. Ref.

Zenggang Pan, Deba P. Sarma: Pigmented Neurofibroma Of The Skin: A Case Report And Review Of The Literature. The Internet Journal of Dermatology. 2007. Volume 5 Number 1.

A 34-year-old woman noticed multiple slow-growing painful and itchy nodules on her face (1 lesion) and extremities(1 on arm and 5 on both legs).

Diagnosis: Dermatofibroma. Ref.

Mingkui Chen, Deba Sarma: Multiple Dermatofibromas in an Adult Female. The Internet Journal of Dermatology. 2007. Volume 5 Number 1.

Abstract We report a case of dermal malignant melanoma that stained negatively for commonly done immunostains, HMB-45, and Melan-A. It stained weakly positive for S-100 protein, a less specific marker for melanocytes. The diagnosis was established by strongly positive immunostaining by MITF ( microphthlmia-associated transcription factor). A brief review of the MITF and its usefulness in the diagnosis of melanoma are presented.

MITF

Ref. Jeff F. Wang, Deba P. Sarma, Pamela Ulmer: Diagnostic dilemma: HMB-45 and Melan-A negative tumor, can it be still a melanoma?: MITF (Microphthalmiaassociated transcription factor) stain may confirm the diagnosis. The Internet Journal of Dermatology. 2007. Volume 5 Number 1.

Abstract A benign adnexal skin tumor showing sebaceous and hair differentiation occurring in an 84-year-old man is reported. Such a tumor may be called a sebotrichoma.

Diagnosis: Sebotrichoma Ref. Sarma DP, Santos EE, Wang B (2007). Sebotrichoma. The Internet J Dermatol 5(1). Indexed by Google Scholar.

Abstract A skin biopsy from a nasal lesion showed a dermal infiltrating neoplasm composed of polygonal cells with small nuclei and abundant coarsely granular eosinophilic cytoplasm. Light microscopic features were that of a granular cell tumor. However, the results of the immunohistologic studies and the observations of the electron microscopic studies did not identify the nature of the cells nor did they confirm that it was a granular cell tumor. We interpret the lesion as a pseudogranular cell tumor of the skin.

Diagnosis: Pseudogranular cell tumor Ref. Deba P. Sarma, Eric E. Santos, William J. Hunter, Zoran Gatalica: Pseudogranular Cell Tumor Of The Skin. The Internet Journal of Dermatology. 2007. Volume 5 Number 1.

A case of acquired perforating osteoma cutis occurring on the finger of a 43-year-old man is reported. English literature on the topic is briefly reviewed.

Diagnosis: Osteoma cutis Ref. Wang JF, Sarma DP (2007). Acquired perforating osteoma cutis. The Internet J Dermatol 5(1). Indexed by Google Scholar.

Abstract We are reporting a case of cutaneous leiomyosarcoma occurring on the face of a 98-year-old woman with a brief review of the literature

SMA stain Diagnosis: Leiomyosarcoma cutis. Ref. Eric E. Santos, Deba P. Sarma: Cutaneous Leiomyosarcoma of the Face. The Internet Journal of Dermatology. 2007. Volume 5 Number 1.

I find no good reason to separate keratoacanthoma from well differentiated squamous cell carcinoma. I am now reporting crateriform squamous epithelial lesions (that I used to report as keratoacanthoma) as well differentiated squamous cell carcinoma, keratoacanthoma type'. They may then be treated as a well differentiated squamous cell carcinoma with a superficial complete resection, and the patient is relieved of a fast-growing lesion. A small scar is definitely acceptable!

Ref. Deba P. Sarma: Keratoacanthoma Should Be Reported As 'Well Differentiated Squamous Cell Carcinoma, Keratoacanthoma Type': A Dermatopathologist's View. The Internet Journal of Dermatology. 2007. Volume 5 Number 1.

The picture is that of the palms of a 44-year old man of Chinese heritage who had had red hands since birth. His 74-year-old mother and his 7-year-old daughter also had bright red palms all their life.

Diagnosis: Erythema palmare hereditarium Ref Sarma DP, Wang B (2007). Erythema palmare hereditarium (Red palms): Lanes Disease. Dermatol Online J. 13(2). PMID: 17498447 [PubMed - indexed for MEDLINE

Abstract A case of a wooden splinter dermatitis occurring in the foot of a 69-year old female is reported. The clinical features, pathology and treatment of this common injury are briefly reviewed.

Diagnosis: Wooden splinter dermatitis Ref. Chen M, Sarma DP (2007). Wooden splinter dermatitis. The Internet J Dermatol 5(2). Indexed by Google Scholar.

Abstract Cutaneous ossification is as a primary event or secondary to a wide variety of inflammatory, traumatic, or neoplastic conditions. We describe a case of pilomatricoma with extensive ossification

Diagnosis: Ossified pilomatricoma Ref. Sharma P, Sarma DP (2007). Ossified pilomatricoma. The Internet J Dermatol 5(2). Indexed by Google Scholar.

Abstract Caucasian female. A brief review of the literature is presented. We report a case of a Merkel cell carcinoma of the dermis with a Bowen's disease of the overlying epidermis arising in the left thigh in an 88-yearold

CK20 Ref. Deba P. Sarma, Bo Wang, James Shehan, Lisa Linder-Stephenson: Concurrent Merkel cell carcinoma and Bowen's disease of the thigh. The Internet Journal of Dermatology. 2007. Volume 5 Number 2.

Abstract We report a case of metatypical basal cell carcinoma on the nose of a 79-year-old woman with a brief review of the literature bcl2 Ber-Ep4

Diagnosis: Metatypical basal cell carcinoma Ref. Eric E. Santos, Deba P. Sarma, Mingkui Chen, Bo Wang: Metatypical Basal Cell Carcinoma of the Nose. The Internet Journal of Dermatology. 2007. Volume 5 Number

Abstract Fibrofolliculoma is a very rare benign tumor of the skin that is derived from the perifollicular sheath. Histologically, it shows a well-formed central hair follicle with a dilated infundibulum containing laminated keratin with anastomosing epithelial strands that radiate from the central hair follicle into the perifollicular fibrotic stroma. The patients with multiple fibrofolliculomas have an association with Birt-Hogg-Dube syndrome. We report a case of a solitary nasal fibrofolliculoma occurring in a 60-yearold male and briefly review the literature.

Diagnosis: Fibrofolliculoma Ref. Zenggang Pan, Deba P. Sarma: Solitary Nasal Fibrofolliculoma. The Internet Journal of Dermatology. 2007. Volume 5 Number 2.

Abstract A case of intramuscular angioma in the frontalis muscle of the forehead is reported. The etiology, pathology and treatment of this rare tumor are briefly reviewed.

Diagnosis: Intramuscular angioma. Ref. Mingkui Chen, Deba P. Sarma: Intramuscular Angioma of the Frontalis Muscle. The Internet Journal of Dermatology. 2007. Volume 5 Number 2.

We report a rare case of a dermal nerve sheath myxoma of the left intranasal skin occurring in a 33year-old female. A brief review of nerve sheath myxoma and a similar tumor, neurothekeoma, is presented.

S-100

Diagnosis: Dermal nerve sheath myxoma

Ref. Jeff F. Wang, Deba P. Sarma, Eric E. Santos, Bo Wang: Dermal Nerve Sheath Myxoma. The Internet Journal of Dermatology. 2007. Volume 5 Number 2.

Abstract
Medical students and the trainees in dermatology and pathology have a curiosity about the names, such as, acne vulgaris or verruca vulgaris. The word vulgaris sounds like vulgar, commonly meaning crudely indecent, coarse, or obscene. However, the word vulgar is derived from the Latin word vulgaris, meaning of or belonging to the common people. In medical terminology, the word vulgaris means common or ordinary. A search through the indexes in Dermatology and Pathology text books revealed seven dermatologic conditions with vulgaris in their names. These included very common diseases, such as, acne vulgaris and verruca vulgaris as well as now rarely diagnosed disease, such as, lupus vulgaris. We are briefly reviewing the seven vulgaris diseases of the skin.

Ref. Mingkui Chen, Erin Bruno, Eric E. Santos, Deba P. Sarma: A brief review of the vulgaris lesions of the skin. The Internet Journal of Dermatology. 2007. Volume 6 Number 1.

Abstract We present a case of an 81-year-old male with an asymptomatic skin nodule on his left upper cheek

Ref Bo Wang, Deba P. Sarma: Sebaceous Carcinoma and Mismatch Repair Gene Expression. The Internet Journal of Dermatology. 2007. Volume 6 Number 1

Case Report This is a photomicrograph (Figure 1) of a biopsied asymptomatic skin nodule from the anterior neck of a 45-year-old man. There was no history of trauma or previous surgical procedure in this location. The epidermis is somewhat raised with hyperkeratosis and acanthosis. The upper dermis shows fibrosis. A well-circumscribed dermal tumor nodule shows no extension into the subcutis. The tumor is composed of mature hyaline cartilage with normal chondrocytes within a homogeneous basophilic stroma. The chondrocytes show mostly single small nuclei without any significant atypia (Figure 2). There is no necrosis or mitotic figures. Secondary ossification or calcification is not present. The periphery of the tumor is free of any giant cell reaction, granulation tissue or any evidence of traumatic tissue reaction. The lesion appears to be a true chondroma in the dermis.

Ref Deba P. Sarma, Mingkui Chen, Bo Wang: Chondroma Cutis. The Internet Journal of Dermatology. 2007. Volume 6 Number 1.

Case presentation We report a case of a 59-year-old woman with a cutaneous leiomyosarcoma associated with osteoclast-like giant cells arising from the subcutaneous artery of the leg. The nature of the giant cells is discussed in light of the findings from the immunostaining as well as survey of the literature.

Ref. Sarma DP, Santos EE, Wang B (2007). Leiomyosarcoma of the skin with osteoclast -like giant cells: a case report. J Med Case Reports 1(1):108. PMID: 18081931 [PubMed - in process

Abstract Dermatomyofibroma is a rare, benign cutaneous tumor derived from myofibroblasts. It is predominantly found in young women, and only a few cases have been reported in males. This entity is not generally well known and often misdiagnosed. We report such a case of dermatofibroma occurring in a 23-year-old male with a brief review of the English literature.

SMA Ref. Zenggang Pan, Edward D. Adickes, Deba P. Sarma: Dermatomyofibroma: A Case Report And Review Of The Literature. The Internet Journal of Dermatology. 2008. Volume 6 Number 2.

Abstract Mycobacterium mucogenicum is a recently characterized organism that rarely may cause human infections. This rapidly growing mycobacterium is commonly identified in tap water. Both immunosuppressed and immunocompetent patients may develop infections from Mycobacterium mucogenicum. Some patients have experienced lethal disease, including sepsis. Infections occurring in the skin and soft tissues have been described only after a preceding injury. We present the first case of infection with Mycobacterium mucogenicum occurring in a patient on the TNF- antagonist etanercept and without any prior soft tissue injury.

AFB stain

Ref. Shehan JM, Sarma DP. (2008). Mycobacteriun mucogenicum : Report of a skin infection associated with the use of Etanercept . Dermatology Online J. 14(1): 5. PMID: 18319022 [PubMed - indexed for MEDLINE]

Abstract We report a case of a 50-year-old man who developed a possible implantation carcinoma of the scalp within the craniotomy scar 19 months after a metastatic renal cell tumor nodule was removed from the brain. The English literature on the implantation carcinoma is briefly reviewed.

RCC immunostain

Ref.

Sarma DP, Wang JF, McAllister MV, Wang B, Shehan JM. (2008) Possible implantation carcinoma of the scalp following craniotomy for metastatic renal c PMID: 18713600 [PubMed - indexed for MEDLINE

Abstract A 58-year-old Caucasian woman presented with a cystic lump behind the right ear that was clinically diagnosed as an infected sebaceous cyst. The lesion was treated with incision and drainage followed by antibiotics for 3 months. Because there was no resolution, a biopsy was performed that revealed a high grade angiosarcoma. She expired 2 months later. Cutaneous angiosarcoma is an extremely aggressive tumor. Therefore early diagnosis and management is crucial in providing better patient care.

CD34

Ref.

Factor VIII

Pan Z, Albertson D, Bhuller A, Wang B, Shehan JM, Sarma DP. (2008) Angiosarcoma of the scalp mimicking a sebaceous cyst. Dermatolgy Online J 14 (6): 13. PMID: 18713594 [PubMed - indexed for MEDLINE

Abstract We are reporting a rare case of an acantholytic seborrheic keratosis and briefly reviewing the relevant literature.

Ref. Wang JF, Wang W, Shehan JM, Sarma DP. (2008). Acantholytic seborrheic keratosis. The Internet J Dermatol 6 (2). Indexed by Google Scholar.

Abstract
We are reporting a case of CD34-positive fibroma of the lip. English literature is briefly reviewed.

Case Report
A 56-year-old female presented with a slightly raised nodule on the lower lip measuring 0.7 x 0.7 cm. This lesion was noted by the patient for about a month. There was no history of trauma or previous biopsy at this site. An excisional biopsy was performed.

CD34

Vimentin

Ref.

Wang JF, Sarma DP. (2008). CD34-positive fibroma of the lip. The Internet J Dermatol 6 (2). Indexed by Google Scholar.

Abstract We are reporting a case of desmoplastic malignant melanoma that was confirmed by immunostaining for microphthalmia-associated transcription factor (MITF). A brief review of utility of MITF for diagnosis of melanoma is presented.

S100 Ref.

MITF

Wang JF, Wang B, Shehan JM, Sarma DP. (2008). Use of MITF ( Microphthalmia-Associated Transcription Factor) immunostain for diagnosis of desmoplastic melanoma. The Internet J Dermatol 6 (2). Indexed by Google Scholar.

Abstract A rare case of a nodulocystic hidradenoma with intracystic carcinoma in-situ occurring in the scalp of a 79-year-old man is reported.

Ref. Wang B, Sarma DP, Javadzadeh BM, Shehan JM, (2008). Solid and cystic clear cell hidradenoma with focal intracystic carcinoma in-situ. The Internet J Dermatol 6(2). Indexed by Google Scholar.

Abstract Paraganglioma-like dermal melanocytic tumor is a rare subtype of benign dermal melanocytic tumors. Its histopathologic features resemble those of paraganglioma, but the immunostaining characteristics are those of melanocytic lesions. We report a case of a 60-year-old male with a paraganglioma-like dermal melanocytic tumor of his left cheek and briefly review the English literature.

S100

Ref. Sarma DP, Teruya B, Wang B (2008). Paraganglioma-like dermal melanocytic tumor: a case report. Cases Journal 1:48. PMID: 18638402 [PubMed - in process]

Abstract We are reporting two cases of glomus tumor of the cheek that we had recently encountered during the last six months. English literature is briefly reviewed. Case Reports
A 51-year-old male presented with an asymptomatic red right lower cheek lesion that was clinically diagnosed as a venous lake.

Ref. Wang B, Wang J, Shehan J, Sarma DP.(2008). Glomus tumor of the cheek. The Internet J of Dermatology 6 (2). Indexed by Google Scholar.

Abstract Fibroepithelioma of Pinkus (FEP) is a rare indolent variety of basal cell carcinoma that is typically polypoid and located on the trunk of adult males aged 4060 years. Basal cell carcinoma (including FEP) is very rare in the pediatric population. We are reporting such a case occurring in a 9-year-old boy. Case presentation A 9-year-old boy presented with a 6.0-mm polypoid erythematous nodule with ulceration on his left chest. An excisional biopsy was done. Histologically, the tumor revealed several foci of superficial basal cell carcinoma along the epidermis. In the dermis, the tumor was composed of basaloid epithelial anastomosing cords that were separated by fibrovascular stroma connected to the overlying epidermis (Figure 1). The histopathological features were that of a fibroepithelioma of Pinkus. The lesion was completely removed with clear biopsy margin. The patient is being followed for any possible local recurrence.

Ref. Pan Z, Huynh N, Sarma DP. (2008). Fibroepithelioma of Pinkus in a 9-year-old boy: a case report. Cases Journal 1:21. PMID: 18588684 [PubMed in process]

Abstract
We are reporting two cases of perianal squamous cell carcinoma in-situ, negative for high-risk (HR) and low-risk (LR) human papilloma viruses. A brief review of anal and perianal squamous cell carcinoma and the role of HPV are presented. Introduction Squamous cell carcinoma, the second most common form of skin cancer, most often affects sun-exposed surfaces. However, squamous cell carcinoma can involve skin surfaces not previously exposed to sunlight, such as in the anal and perianal regions. Invasive perianal squamous cell carcinoma is a locally infiltrative malignant skin tumor that exhibits destructive growth. It is a relatively uncommon tumor, which develops from the precursor lesion anal intraepithelial neoplasia (AIN). Immunosuppression is felt to be a risk factor.

Ref. Shehan J, Wang JF, Repertinger S, Sarma DP.(2008). Perianal squamous cell carcinoma in-situ: a report of two human papilloma virus-negative cases. Cases J 1(1):114. PMID: 18715505 [PubMed - in process]

An-86-year-old male with a history of multiple actinic keratoses and seborrheic keratoses of the head and trunk presented with a mid-back skin lesion. The lesion was poorly circumscribed, flat, and gray, with a pink-tan, well-circumscribed scaly nodule within it. The biopsied lesion was composed of the usual features of hyperkeratotic seborrheic keratosis, but with focal atypical melanocytic proliferation with nesting along the dermal-epidermal junction. We interpreted this lesion as a melanoma in-situ arising within a seborrheic keratosis.

MITF

Ref. Repertinger S, Wang J, Adickes E, Sarma DP. (2008). Melanoma in-situ arising in seborrheic keratosis : a case report. Cases J 1 (1):263. PMID: 18947402 [PubMed - in process]

Abstract Fibroepithelioma of Pinkus is a rare, indolent variant of basal cell carcinoma (BCC). The presence of pleomorphic giant cells in such a tumor is extremely rare and to our knowledge, only one such case has been previously reported in the literature. We report another case occurring as a pedunculated, gluteal lesion in an 82-year-old man. The nodule was lightly pigmented, polypoid, and measured 1.0 cm in greatest dimension. Immunohistochemical staining confirmed that the giant cells were of epithelial origin and that the proliferative rate of these cells was low

CD68

p63 Ref. Repertinger SK, Stevens T, Markin N, Klepacz H, Sarma DP.(2008). Fibroepithelioma of Pinkus with pleomorphic epithelial giant cells. Dermatology Online J 14(12):13. {Pubmed- in process].

Abstract Although 50%-65% of metastatic gallbladder tumors come form malignant melanoma, clinically diagnosed cases are very rare. We are reporting such a symptomatic case of metastatic melanoma in the gall bladder occurring in a 40-yearold man. Figure 1: Microscopic picture of metastatic melanoma in the gallbladder, H&E, X20

Ref. Liu H, Wang J, Bewtra C, Sarma DP. (2009). Symptomatic gallbladder metastasis from cutaneous melanoma. The Internet J Gastroenterol 7(2). Indexed by Google Scholar

Capillary hemangiomas are very common benign vascular neoplasms which frequently occur in the skin and intraoral mucous membranes. The intravascular variant of this lesion, however, is distinctly uncommon and has been reported rarely in the English literature. Those reported cases describe this tumor as arising in veins in cutaneous and extracutaneous sites. Here we report two cases of intravascular capillary hemangioma arising in the skin.

An excisional biopsy of a painless subcutaneous nodule that had been present for an unknown period of time in the right forearm of a 44-year-old woman was submitted.

Ref: S. K. Repertinger, E. E. Santos, M. Chen & D. P. Sarma : Intravascular Capillary Hemangioma of the Skin . The Internet Journal of Dermatology. 2009 Volume 7 Number 1

An excisional biopsy of a skin papule was taken of the left cheek from a 45-year-old man. The asymptomatic lesion has been present for an unknown period of time.

Ref. D. P. Sarma & S. Repertinger : Cutaneous Mixed Tumor . The Internet Journal of Dermatology. 2009 Volume 7 Number 1

Diagnostic microscopic images of condyloma acuminatum and scabies are presented with a brief discussion of the diagnostic features.
CASE 1. Biopsy of a 5-mm raised skin lesion from the vulva of a 25-year-old woman.

Low risk HPV

Diagnosis: Condyloma acuminata CASE 2. Biopsy of an extremely pruritic rash on the right hand of a 20-year-old man with similar rash on the left foot.

Diagnosis: Scabies

Ref. D. P. Sarma, S. Panganiban & D. Albertson : Diagnostic Microscopic Images: Condyloma Acuminatum and Scabies . The Internet Journal of Dermatology. 2009 Volume 7 Number 1

This is a photomicrograph (Figure 1) of a biopsied painless, 6-mm scrotal nodule from a 47-year-old man that has been present for an unknown period of time. There was no history of trauma or previous surgical intervention. The epidermis is raised due to an eosinophilic dermal soft tissue tumor. The overlying epidermis is essentially normal. The dermal nodule is composed of bundles and fascicles of smooth muscle cells containing red fibrillar cytoplasm and elongated nuclei with blunted ends (Figure2). There is no cytologic atypia, increased or atypical mitosis, or necrosis.

Diagnosis: Leiomyoma Ref. D. P. Sarma, E. E. Santos, C. E. Hagen & S. Repertinger : Scrotal Leiomyoma . The Internet Journal of Dermatology. 2009 Volume 7 Number 1

A 46-year-old female presented with a subcutaneous nodule in her right neck. On gross examination, this well circumscribed nodular lesion measured 1.0 0.7 0.4 cm and showed a firm, gray-pink cut surface.

Diagnosis: Vascular spiradenoma

Ref. Z. Pan, J. F. Wang, N. Huynh, S. Repertinger & D. P. Sarma : Vascular Spiradenoma . The Internet Journal of Dermatology. 2009 Volume 7 Number 1

Poroma is a benign adnexal skin tumor seen in middle aged individuals with no sex predilection. The acral sites are the most commonly affected regions. Hip or buttock as a location of origin has rarely been reported. We report two cases of poroma, one located on the hip of a 75-year-old man and the other on the buttock of a 60-year-old man.

Ref: Sarma DP, Zaman SU, Santos EE, Shehan JM. (2009). Poroma of the hip and buttock. Dermatology Online J 15(5):10. PMID: 19624988 [Pubmedindexed for MEDLINE].

A 55-year-old obese woman presented with a 4-month history of hemorrhagic discharge from the umbilicus. Deep from the base of the umbilicus, a 0.8 cm gray-tan mass was removed that on microscopic examination revealed a lint ball.

Fig 1. Refracile lint material, keratin, neutrophils

Fig 2. Lint under polarized light

Ref: Sarma DP, Teruya B (2009). Lint ball omphalitis , a rare cause of umbilical discharge in an adult woman: a case report. Cases J 2: 77 [Pubmed- indexed for MEDLINE].

Dilated Pore of Winer, Dr. Louis H Winer and Wine Glass

Ref: Sarma DP (2009). Dilated pore of Winer, Dr.Louis H Winer and wine glass. The Internet J Dermatol 7(2). Indexed by Google Scholar

Common Spindle Cell Malignant Neoplasms of the Skin: Differential Diagnosis and Review of the Literature

Malignant and borderline-malignant neoplasms of the dermis can pose diagnostic challenges. Because these tumors can share similar clinical and histologic features, including a predominantly spindle cell morphology, the pathologist must be familiar with these entities in order to facilitate accurate diagnosis, as treatment for these tumors may be different. We review several of these lesions with respect to clinical and histologic features: desmoplastic melanoma, spindle cell carcinoma, spindle cell atypical fibroxanthoma, dermatofibrosarcoma protuberans, and cutaneous leiomyosarcoma. Ref; Repertinger S, Teruya B, Sarma DP (2009).Common spindle cell malignant neoplasms of the skin: Differential diagnosis and review of the literature. The Internet J Dermatol 7(2). Indexed by Google Scholar.

A 37-year-old woman presented with a 5 mm, smooth papule of the chin. The lesion was present for an unknown duration.

S-100: Positive EMA: Capsule is positive Ref: Repertinger S, Sarma DP (2009). Palisaded encapsulated neuroma (PEN). The Internet J Dermatol 7(2). Indexed by Google Scholar

Desmoplastic trichilemmoma is a rare trichilemmoma variant arising from the outer root sheath or infundibular epithelium and occurring predominately on the face of affected individuals. The patient commonly presents with a slow-growing, solitary, dome-shaped papule. Simple excision of the lesion is the treatment of choice and is curative.

Ref: Sarma DP, Santos EE (2009). Desmoplastic trichilemmoma . The Internet J Dermatol 7(2). Indexed by Google Scholar.

A 44-year-old woman presented with a 5-mm, smooth, flesh-colored papule of the cheek. The lesion had been present for an unknown duration. Microscopically (Figures 1 and 2), the epidermis was unremarkable. The upper dermal tumor was composed of large epitheliod cells containing bland nuclei with occasional large nucleoli. There were no mitotic figures or necrosis. There were a few multinucleated giant cells but no foam cell. The tumor cells were strongly positive for Vimentin (Figure 3) and focally positive for CD68 (Figure 4) and were negative for CK AE1/3, S-100, MITF, SMA, Myogenin, and CD34

CD 68 Ref: Sarma DP, Repertinger SK (2009). Epithelioid cell histiocytoma: a case report and brief review of the literature, with an em

A brief review of the variations of microscopic appearances of seborrheic keratosis is presented.

Ref: Sarma DP, Repertinger S (2009). Seborrheic keratosis : A pictorial review of thehistologic variations. The Internet J Dermatol 7(2). Indexed by Google Scholar.

A 31-year-old woman underwent an excision of a ruptured epidermal cyst of the left axilla. One month later, the previous excision site was re-excised secondary to a nonhealing, inflamed papule in order to exclude recurrent epidermal cyst formation. Microscopic examination revealed that the cause of the papular lesion was acquired trichostasis, rather than a recurrent epidermal cyst. Conclusion A papular or nodular lesion at a postoperative site may rarely be caused by acquired trichostasis and should be considered as one of the differential diagnosis.

Ref:

Sarma DP, Maertins BA, Santos EE (2009). Acquired trichostasis in postoperative site: a case report. Cases J 2: 9310. [Pubmed-indexed for MEDLINE].

F 32 with a painless 0.5 cm subareolar nodule of left nipple present for several months. A biopsy revealed an infiltrating adnexal neoplasm with features similar to those seen in syringomas commonly occurring in the face and pubis. The infiltrating syringomatous adenoma of the nipple occurs almost exclusively in women of all ages and is cured by simple excision. Microscopic appearance this rare benign infiltrating neoplasm of eccrine duct origin occurring in woman's breast should not be misinterpreted as more common infiltrating primary breast carcinoma.

Sarma DP, Stevens T (2009). Infiltrating syringomatous adenoma of the nipple: a case report. Cases J. 2: 9 Pubmed-indexed for MEDLINE].