DOCSLIB.ORG

Invisible Dermatoses

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Invisible Dermatoses Invisible Dermatoses To our knowledge, Martin Brownstein and tle else besides a cornoid lamella. Multiple Asher Rabinowitz first used the term "invisi- sections must be searched to find this struc­ ble dermatoses."* Generations of dermatolo­ ture (p. 176). gists, however, have struggled with biopsy 3. Ichthyosis-Often the only clue to ich­ specimens from diseased skin that appear to be thyosis vulgaris is the absence of a granular normal under the microscope. Since normal layer that is associated with compact hy­ skin is rarely ever biopsied in clinical practice, perkeratosis. In the absence of hyperkera­ one must assume that some disease is present. tosis, this is an easy diagnosis to miss. Technical problems must be eliminated, such 4. Pigment changes-Vitiligo looks almost as sampling errors where normal skin on an normal, except that melanocytes are miss­ edge of the biopsy specimen has been sectioned ing (as is melanin). Conditions that have in­ and the diseased tissue has been left in paraf- creased melanin, but normal numbers of fin. It is wise to check again to see if the cli­ melanocytes (e.g., freckles and cafe au lait nician might have submitted normal skin (e.g., spots) may be mistaken for normal black pruritus, resolved urticaria, patient insisting skin. that normal spot is painful, and normal skin obtained for IF but submitted for H&E stain­ ing). At this point, one needs a strategy for studying skin that appears histologically nor­ Dermal Diseases mal, but must contain disease. We consider the following conditions: 1. Incontinence of pigment-Melanin in the papillary dermis may be the only clue to a der­ matitis that involved the epidermal-dermal Epidermal Diseases junction (e.g., lichen planus or lupus erythematosus ). 2. Amorphous deposits in the papillae-Ma­ 1. Tinea versicolor and fungal disease­ cular amyloidosis can have very subtle deposits Check the stratum corneum for hyphae and of amyloid in the dermal papillae; other forms do a PAS stain. of cutaneous amyloidosis may have deposition 2. Porokeratosis-Porokeratosis may have lit- around blood vessels. Special stains for amy­ loid will help. *Brownstein MH, Rabinowitz AD: The invisible 3. Mast cell infiltrates (p. 161)-Mastocyto­ dermatoses. J Am Acad Dermatol 8:579-588, mas are easy to identy, but both urticaria pig­ 1983. mentosa and telangiectasia macularis eruptiva 209 210 Invisible Dermatoses perstans may have only slightly increased long axis traverses the border between diseased numbers of mast cells. Eosinophils, increased and normal skin or by studying punch biopsy pigment, and increased vessels are adjunctive specimens from diseased and contralateral clues. normal skin (the latter would then, by defini­ 4. Dermal melanocytes-Sometimes, the de­ tion, be an invisible dermatosis if misfiled or position of dermal spindle-shaped melanocytes transposed). in a blue nevus can be quite subtle. In the more Macular atrophy, or anetoderma, is defined diffuse dermal melanocytic conditions (e.g., by the absence of elastin with normal collagen; Mongolian spot in the neonates), it often is im­ in atrophoderma, however, the dermis is sim­ possible to find the melanocytes. ply reduced in thickness, but contains normal 5. Argyria-A patient may be almost silver­ elastin and collagen. Both present as depres­ black clinically with cutaneous silver deposits sions; thus, a careful biopsy procedure, com­ and still have only subtle grains of silver about parison with normal skin, and use of special dermal sweat ducts histologically. Always ex­ stains all are required for an accurate diagno­ amine the basement membrane zone around sis. In focal dermal hypoplasia, the dermis also sweat ducts in otherwise normal skin. is thinned, but to such an extent that the di­ 6. Urticaria-Urticarial lesions often may agnosis is obvious. Connective tissue nevus (or show only minimal edema with a sparse peri­ the shagreen patch in tuberous sclerosis) has vascular lymphocyte infiltrate. Sometimes, a an excess of elastin, collagen, or both. Once resolving urticarial lesion will be normal or a again, only comparison within normal skin and true invisible dermatosis. use of special stains will allow a diagnosis. 7. Connective tissue-Connective tissue ab­ There are many other examples of invisible normalities can be very subtle; here, it often is dermatoses; hopefully, however, these few dis­ necessary to compare normal and abnormal ease entities will give the beginner a means of structures either by studying an ellipse whose approaching the problem. Further Readings Walter H. C. Burgdorf As mentioned in the introduction, this book (As mentioned on p. 57, Dr. Ackerman's was produced without references to help main­ book gives a sense of order to the befuddling tain its simple format. I hope that every reader world of inflammatory skin disorders. I will have access to at least one additional der­ highly commend both his approach and his matopathology textbook and will consult it book.) often; both for further information and for ref­ Ackerman AB, Niven J, Grant-Kels JM: Dif­ erences. This annotated reading list is selec­ ferential Diagnosis in Dermatopathology. tive-not inclusive. Hopefully it provides an Lea & Febiger, Philadelphia, 1982, 195 pp. adequate introduction to the literature of (The format of this effort is unique. Dr. Ack­ derma topa thology. erman and his coworkers contrast 45 pairs of difficult histologic diagnoses, such as Pa­ STANDARD TEXTBOOKS get's disease versus Bowen's disease, with Lever WF, Schaumberg-Lever G: Histopath­ color pictures and lists of diagnostic ology of the Skin. JB Lippincott, Philadel­ criteria.) phia, 1983, 848 pp. (Dr. Lever's book is the classic text with the Enzinger FM, Weiss SW: Soft Tissue Tumors. best references. I cannot imagine studying a The CV Mosby Co, St. Louis, 1983, 840 pp. microscopic slide or writing about skin pa­ (Dr. Enzinger and Dr. Weiss have produced a masterpiece; readable, but unquestion­ thology without a copy at my side.) ably authoritative. Dermal proliferations, Pinkus H, Mehregan AH: A Guide to whether neural, muscular, vascular, or fibro­ Dermatohistopathology. Appleton-Century­ blastic, are reviewed in depth; but, in a prac­ Crofts, New York, 1981,591 pp. tical fashion.) (If you canfind an older edition of this text, buy it. Dr. Pinkus was among the first to em­ McGovern VJ: Melanoma: Histological Diag­ phasize correlation of skin anatomy and dis­ nosis and Prognosis. Raven Press, New ease, an embryologic approach to appenda­ York, 1983, 197 pp. geal tumors, and pattern diagnosis. In later Roses DF, Harris MN, Ackerman AB: Diag­ editions, his text has become more diffuse nosis and Management of Cutaneous Ma­ and encyclopedic.) lignant Melanoma. WB Saunders, Philadel­ phia, 1983, 304 pp. OTHER BOOKS (Malignant melanoma is, at once, the most Ackerman AB: Histologic Diagnosis of In­ important single topic in dermatology and a flammatory Skin Diseases. Lea & Febiger, most difficult subject to adequately cover in Philadelphia, 1978, 863 pp. an introductory textbook. These two new 211 212 Further Readings books have been most helpful to me in trying ology papers appear in the following journals: to keep abreast of this crucial area.) American Journal of Surgical Pathology Archives of Dermatology PERODICALS British Journal of Dermatology No textbook can be up to date; something is Cancer always new in the literature. Two journals are Histopathology devoted specifically to dermatopathology: Journal of the American Academy of American Journal of Dermatopathology Dermatology Journal of Cutaneous Pathology Once again, other valuable dermatopathology These two journals, however, have not cap­ articles appear outside of this short list; how­ tured the market as far as quality skin pathol­ ever, if you read the above journals, you will ogy articles. Many outstanding dermatopath- rarely be too far behind in studying skin. Glossary This glossary is highly restricted; it only in­ Buckshot scatter: Random distribution of cludes those dermatopathologic terms that are melanocytes through epidermis in malignant used in the histologic descriptions in this man­ melanoma. ual. Many important expressions have been omitted simply because of the limited size of Cartwheel pattern: Spindle-shaped tumors the text. Furthermore, no attempt has been may be arranged so that the elongated cells ra­ made to define normal structures or diseases; diate from a central point like a cartwheel. these subjects are listed in the index. Caseation necrosis: Total necrosis, initially described in tuberculosis; histologically, one Abscess: Accumulation of neutrophils. sees no remnants of cell structures, just ne­ Acantholysis: Loss of adhesion between epi­ crotic material. dermal cells. Civatte body: Degenerated keratinocyte, Acanthosis: Thickening of epidermis because which appears homogeneous and eosinophilic; of increased number of keratinocytes (see common in lichen planus. Hypertrophy). Collarette: A little collar; refers to a periph­ Atrophy: Condition of being flattened or eral process, such as scale about a lesion or an thinned; most often refers to a thinned layer, epidermal reaction about a tumor, or such as such as epidermis or dermis. the epidermis encompassing the metastatic Atypia: Cytologic abnormality of cells, with malignant melanoma (p. 138). abnormal irregularly shaped nuclei and mi­ Colloid body: See Civatte body. toses; suggesting a malignant change. Cornoid lamella: Parakeratotic column in porokeratosis. Ballooning degeneration: Epidermal change
Load more

Recommended publications
  • General Pathomorpholog.Pdf
    Ukrаiniаn Medicаl Stomаtologicаl Аcаdemy THE DEPАRTАMENT OF PАTHOLOGICАL АNАTOMY WITH SECTIONSL COURSE MАNUАL for the foreign students GENERАL PАTHOMORPHOLOGY Poltаvа-2020 УДК:616-091(075.8) ББК:52.5я73 COMPILERS: PROFESSOR I. STАRCHENKO ASSOCIATIVE PROFESSOR O. PRYLUTSKYI АSSISTАNT A. ZADVORNOVA ASSISTANT D. NIKOLENKO Рекомендовано Вченою радою Української медичної стоматологічної академії як навчальний посібник для іноземних студентів – здобувачів вищої освіти ступеня магістра, які навчаються за спеціальністю 221 «Стоматологія» у закладах вищої освіти МОЗ України (протокол №8 від 11.03.2020р) Reviewers Romanuk A. - MD, Professor, Head of the Department of Pathological Anatomy, Sumy State University. Sitnikova V. - MD, Professor of Department of Normal and Pathological Clinical Anatomy Odessa National Medical University. Yeroshenko G. - MD, Professor, Department of Histology, Cytology and Embryology Ukrainian Medical Dental Academy. A teaching manual in English, developed at the Department of Pathological Anatomy with a section course UMSA by Professor Starchenko II, Associative Professor Prylutsky OK, Assistant Zadvornova AP, Assistant Nikolenko DE. The manual presents the content and basic questions of the topic, practical skills in sufficient volume for each class to be mastered by students, algorithms for describing macro- and micropreparations, situational tasks. The formulation of tests, their number and variable level of difficulty, sufficient volume for each topic allows to recommend them as preparation for students to take the licensed integrated exam "STEP-1". 2 Contents p. 1 Introduction to pathomorphology. Subject matter and tasks of 5 pathomorphology. Main stages of development of pathomorphology. Methods of pathanatomical diagnostics. Methods of pathomorphological research. 2 Morphological changes of cells as response to stressor and toxic damage 8 (parenchimatouse / intracellular dystrophies).
    [Show full text]
  • Dermatology Eponyms – Sign –Lexicon (P)
    2XU'HUPDWRORJ\2QOLQH Historical Article Dermatology Eponyms – sign –Lexicon (P)� Part 2 Piotr Brzezin´ ski1,2, Masaru Tanaka3, Husein Husein-ElAhmed4, Marco Castori5, Fatou Barro/Traoré6, Satish Kashiram Punshi7, Anca Chiriac8,9 1Department of Dermatology, 6th Military Support Unit, Ustka, Poland, 2Institute of Biology and Environmental Protection, Department of Cosmetology, Pomeranian Academy, Slupsk, Poland, 3Department of Dermatology, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan, 4Department of Dermatology, San Cecilio University Hospital, Granada, Spain, 5Medical Genetics, Department of Experimental Medicine, Sapienza - University of Rome, San Camillo-Forlanini Hospital, Rome, Italy, 6Department of Dermatology-Venerology, Yalgado Ouédraogo Teaching Hospital Center (CHU-YO), Ouagadougou, Burkina Faso, 7Consultant in Skin Dieseases, VD, Leprosy & Leucoderma, Rajkamal Chowk, Amravati – 444 601, India, 8Department of Dermatology, Nicolina Medical Center, Iasi, Romania, 9Department of Dermato-Physiology, Apollonia University Iasi, Strada Muzicii nr 2, Iasi-700399, Romania Corresponding author: Piotr Brzezin′ski, MD PhD, E-mail: [email protected] ABSTRACT Eponyms are used almost daily in the clinical practice of dermatology. And yet, information about the person behind the eponyms is difficult to find. Indeed, who is? What is this person’s nationality? Is this person alive or dead? How can one find the paper in which this person first described the disease? Eponyms are used to describe not only disease, but also clinical signs, surgical procedures, staining techniques, pharmacological formulations, and even pieces of equipment. In this article we present the symptoms starting with (P) and other. The symptoms and their synonyms, and those who have described this symptom or phenomenon. Key words: Eponyms; Skin diseases; Sign; Phenomenon Port-Light Nose sign or tylosis palmoplantaris is widely related with the onset of squamous cell carcinoma of the esophagus.
    [Show full text]
  • Guide to Policy & Practice Questions
    OREGON BOARD OF CHIROPRACTIC EXAMINERS GUIDE TO POLICY & PRACTICE QUESTIONS 530 Center St NE, suite 620 Salem, OR 97301 (503) 378-5816 [email protected] Updated/Adopted: 9/17/2020 TABLE OF CONTENTS SECTION I ............................................................................................................................................................................................... 6 DEVICES, PROCEDURES, AND SUBSTANCES ............................................................................................................................... 6 DEVICES ................................................................................................................................................................ 6 BAX 3000 AND SIMILAR DEVICES................................................................................................................................................ 6 BIOPTRON LIGHT THERAPY ........................................................................................................................................................ 6 CPAP MACHINE, ORDERING ....................................................................................................................................................... 6 CTD MARK I MULTI-TORSION TRACTION DEVICE................................................................................................................... 6 DYNATRON 2000 ...........................................................................................................................................................................
    [Show full text]
  • Benign Tumors and Tumor-Like Lesions of the Vulva
    Please do not remove this page Benign Tumors and Tumor-like Lesions of the Vulva Heller, Debra https://scholarship.libraries.rutgers.edu/discovery/delivery/01RUT_INST:ResearchRepository/12643402930004646?l#13643525330004646 Heller, D. (2015). Benign Tumors and Tumor-like Lesions of the Vulva. In Clinical Obstetrics & Gynecology (Vol. 58, Issue 3, pp. 526–535). Rutgers University. https://doi.org/10.7282/T3RN3B2N This work is protected by copyright. You are free to use this resource, with proper attribution, for research and educational purposes. Other uses, such as reproduction or publication, may require the permission of the copyright holder. Downloaded On 2021/09/23 14:56:57 -0400 Heller DS Benign Tumors and Tumor-like lesions of the Vulva Debra S. Heller, MD From the Department of Pathology & Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, NJ Address Correspondence to: Debra S. Heller, MD Dept of Pathology-UH/E158 Rutgers-New Jersey Medical School 185 South Orange Ave Newark, NJ, 07103 Tel 973-972-0751 Fax 973-972-5724 [email protected] Funding: None Disclosures: None 1 Heller DS Abstract: A variety of mass lesions may affect the vulva. These may be non-neoplastic, or represent benign or malignant neoplasms. A review of benign mass lesions and neoplasms of the vulva is presented. Key words: Vulvar neoplasms, vulvar diseases, vulva 2 Heller DS Introduction: A variety of mass lesions may affect the vulva. These may be non-neoplastic, or represent benign or malignant neoplasms. Often an excision is required for both diagnosis and therapy. A review of the more commonly encountered non-neoplastic mass lesions and benign neoplasms of the vulva is presented.
    [Show full text]
  • Detail Report
    Supplemental Update Report CR Number: 2012319113 Implementation Date: 16-Jan-19 Related CR: 2012319113 MedDRA Change Requested Add a new SMQ Final Disposition Final Placement Code # Proposed SMQ Infusion related reactions Rejected After Suspension MSSO The proposal to add a new SMQ Infusion related reactions is not approved after suspension. The ICH Advisory Panel did approve this SMQ topic to go into the development phase and it Comment: underwent testing in three databases (two regulatory authorities and one company). However, there were numerous challenges encountered in testing and the consensus decision of the CIOMS SMQ Implementation Working Group was that the topic could not be developed to go into production as an SMQ. Most notably, in contrast to other SMQs, this query could not be tested using negative control compounds because it was not possible to identify suitable compounds administered via infusion that were not associated with some type of reaction. In addition, there is no internationally agreed definition of an infusion related reaction and the range of potential reactions associated with the large variety of compounds given by infusion is very broad and heterogenous. Testing was conducted on a set of around 500 terms, the majority of which was already included in Anaphylactic reaction (SMQ), Angioedema (SMQ), and Hypersensitivity (SMQ). It proved difficult to identify potential cases of infusion related reactions in post-marketing databases where the temporal relationship of the event to the infusion is typically not available. In clinical trial databases where this information is more easily available, users are encouraged to provide more specificity about the event, e.g., by reporting “Anaphylactic reaction” when it is known that this event is temporally associated with the infusion.
    [Show full text]
  • Clinicopathological Correlation of Acquired Hyperpigmentary Disorders
    Symposium Clinicopathological correlation of acquired Dermatopathology hyperpigmentary disorders Anisha B. Patel, Raj Kubba1, Asha Kubba1 Department of Dermatology, ABSTRACT Oregon Health Sciences University, Portland, Oregon, Acquired pigmentary disorders are group of heterogenous entities that share single, most USA, 1Delhi Dermatology Group, Delhi Dermpath significant, clinical feature, that is, dyspigmentation. Asians and Indians, in particular, are mostly Laboratory, New Delhi, India affected. Although the classic morphologies and common treatment options of these conditions have been reviewed in the global dermatology literature, the value of histpathological evaluation Address for correspondence: has not been thoroughly explored. The importance of accurate diagnosis is emphasized here as Dr. Asha Kubba, the underlying diseases have varying etiologies that need to be addressed in order to effectively 10, Aradhana Enclave, treat the dyspigmentation. In this review, we describe and discuss the utility of histology in the R.K. Puram, Sector‑13, diagnostic work of hyperpigmentary disorders, and how, in many cases, it can lead to targeted New Delhi ‑ 110 066, India. E‑mail: and more effective therapy. We focus on the most common acquired pigmentary disorders [email protected] seen in Indian patients as well as a few uncommon diseases with distinctive histological traits. Facial melanoses, including mimickers of melasma, are thoroughly explored. These diseases include lichen planus pigmentosus, discoid lupus erythematosus, drug‑induced melanoses, hyperpigmentation due to exogenous substances, acanthosis nigricans, and macular amyloidosis. Key words: Facial melanoses, histology of hyperpigmentary disorders and melasma, pigmentary disorders INTRODUCTION focus on the most common acquired hyperpigmentary disorders seen in Indian patients as well as a few Acquired pigmentary disorders are found all over the uncommon diseases with distinctive histological traits.
    [Show full text]
  • Multi-Organ Teratogenesis Sequels of Bigger Size Particles Colloidal
    ytology & f C H o is Prakash, et al., J Cytol Histol 2018, 9:2 l t a o n l o r DOI: 10.4172/2157-7099.1000501 g u y o J Journal of Cytology & Histology ISSN: 2157-7099 Research Article Open Access Multi-Organ Teratogenesis Sequels of Bigger Size Particles Colloidal Silver in Primate Vertebrates Pani Jyoti Prakash*1, Singh Royana2 and Pani Sankarsan3 1Department of Anatomy, Faculty of Medicine, Institute of Medical Science and Research, Karjat, Bhivpuri, India 2Department of Anatomy, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttarpradesh, India 3Deapartment of Surgery, Institute of Medical Science and Research, Karjat, Bhivpuri, India *Corresponding author: Prakash PJ, Department of Anatomy, Faculty of Medicine, Institute of Medical Science and Research, Karjat, Bhivpuri, India, Tel: 8433668356; E-mail: [email protected] Received date: February 21, 2018; Accepted date: March 12, 2018; Published date: March 16, 2018 Copyright: © 2018 Prakash PJ, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Back ground: In this most recent, update global arena for consumers products most of the daily applications of bigger silver nano particles (20 to 100 nano meter range) are effected as anti-viral and anti-parasitic agents in clinical medicine and diagnosis which is a positive feedback. However, the major negative feedback of bigger size silver nano particles on human, animal and primate vertebrate body is multisystem teratogenicity focuses. Material and methods: This study was designed to investigate teratogenic effects of bigger size nano silver which is poly vinyl pyrollidone coated and sodium borohydride stabilized.
    [Show full text]
  • A Case of Argyria: Multiple Forms of Silver Ingestion in a Patient with Comorbid Schizoaffective Disorder
    A Case of Argyria: Multiple Forms of Silver Ingestion in a Patient With Comorbid Schizoaffective Disorder Sarah J. Schrauben, MD; Dhaval G. Bhanusali, MD; Stuart Sheets, MD; Animesh A. Sinha, MD, PhD Argyria is a rare cutaneous manifestation of silver is an elemental compound often found in drinking deposits in the skin, characterized by a grayish water, various sources in industry, and alternative blue discoloration, particularly in sun-exposed medicine compounds. Silver was first used medically areas. We report the case of a patient with a his- in 980 ad; it was believed to provide a means of tory of schizoaffective disorder and type 2 diabe- blood purification, to treat heart palpitations, and to tes mellitus who presented with argyria of the face serve as an adjunct treatment of epilepsy and tabes and neck. The patient had a history of ingesting dorsalis.1 In the 1900s, silver began being used as a colloidal silver proteins (CSPs) for approximately popular treatment of infections. However, reports of 10 years as a self-prescribed remedy for his medi- unsolicited side effects diminished its popularity as a cal conditions. CUTISmainstay solution for many ailments. Silver recently Colloidal silver protein has gained popularity has regained popularity, with an increase in Internet among patients who seek alternative medical ther- claims promoting the use of oral colloidal silver pro- apies. Argyria is the most predominant manifesta- teins (CSPs) as mineral supplements and as a way to tion of silver toxicity. It is unclear if our patient prevent and treat many diseases.2 began taking CSP becauseDo of his schizoaffectiveNot WeCopy present a patient with argyria as a conse- disorder or if silver toxicity may have induced quence of multiple forms of silver ingestion in an somatic delusions; however, it is important for attempt to treat his type 2 diabetes mellitus and physicians to have a thorough understanding of schizoaffective disorder.
    [Show full text]
  • Red-Brown Patches in the Groin
    DERMATOPATHOLOGY DIAGNOSIS Red-Brown Patches in the Groin Dong Chen, MD, PhD; Tammie C. Ferringer, MD Eligible for 1 MOC SA Credit From the ABD This Dermatopathology Diagnosis article in our print edition is eligible for 1 self-assessment credit for Maintenance of Certification from the American Board of Dermatology (ABD). After completing this activity, diplomates can visit the ABD website (http://www.abderm.org) to self-report the credits under the activity title “Cutis Dermatopathology Diagnosis.” You may report the credit after each activity is completed or after accumu- lating multiple credits. A 66-year-old man presented with reddish arciform patchescopy in the inguinal area. THE BEST DIAGNOSIS IS: a. candidiasis b. noterythrasma c. pitted keratolysis d. tinea cruris Doe. tinea versicolor H&E, original magnification ×600. PLEASE TURN TO PAGE 419 FOR THE DIAGNOSIS CUTIS Dr. Chen is from the Department of Pathology and Anatomical Sciences, University of Missouri, Columbia. Dr. Ferringer is from the Departments of Dermatology and Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania. The authors report no conflict of interest. Correspondence: Dong Chen, MD, PhD, Department of Pathology and Anatomical Sciences, University of Missouri, One Hospital Dr, MA204, DC018.00, Columbia, MO 65212 ([email protected]). 416 I CUTIS® WWW.MDEDGE.COM/CUTIS Copyright Cutis 2018. No part of this publication may be reproduced, stored, or transmitted without the prior written permission of the Publisher. DERMATOPATHOLOGY DIAGNOSIS DISCUSSION THE DIAGNOSIS: Erythrasma rythrasma usually involves intertriginous areas surface (Figure 1) compared to dermatophyte hyphae that (eg, axillae, groin, inframammary area). Patients tend to be parallel to the surface.2 E present with well-demarcated, minimally scaly, red- Pitted keratolysis is a superficial bacterial infection brown patches.
    [Show full text]
  • Surgical Excision of Eyelid Lesions Reference Number: CP.VP.75 Coding Implications Last Review Date: 12/2020 Revision Log
    Clinical Policy: Surgical Excision of Eyelid Lesions Reference Number: CP.VP.75 Coding Implications Last Review Date: 12/2020 Revision Log See Important Reminder at the end of this policy for important regulatory and legal information. Description: The majority of eyelid lesions are benign, ranging from innocuous cysts and chalazion/hordeolum to nevi and papillomas. Key features that should prompt further investigation include gradual enlargement, central ulceration or induration, irregular borders, eyelid margin destruction or loss of lashes, and telangiectasia. This policy describes the medical necessity requirements for surgical excision of eyelid lesions. Policy/Criteria I. It is the policy of health plans affiliated with Centene Corporation® (Centene) that surgical excision and repair of eyelid or conjunctiva due to lesion or cyst or eyelid foreign body removal is medically necessary for any of the following indications: A. Lesion with one or more of the following characteristics: 1. Bleeding; 2. Persistent or intense itching; 3. Pain; 4. Inflammation; 5. Restricts vision or eyelid function; 6. Misdirects eyelashes or eyelid; 7. Displaces lacrimal puncta or interferes with tear flow; 8. Touches globe; 9. Unknown etiology with potential for malignancy; B. Lesions classified as one of the following: 1. Malignant; 2. Benign; 3. Cutaneous papilloma; 4. Cysts; 5. Embedded foreign bodies; C. Periocular warts associated with chronic conjunctivitis. Background The majority of eyelid lesions are benign, ranging from innocuous cysts and chalazion/hordeolum to nevi and papillomas. Key features that should prompt further investigation include gradual enlargement, central ulceration or induration, irregular borders, eyelid margin destruction or loss of lashes, and telangiectasia. Benign tumors, even though benign, often require removal and therefore must be examined carefully and the differential diagnosis of a malignant eyelid tumor considered and the method of removal planned.
    [Show full text]
  • 2016 Essentials of Dermatopathology Slide Library Handout Book
    2016 Essentials of Dermatopathology Slide Library Handout Book April 8-10, 2016 JW Marriott Houston Downtown Houston, TX USA CASE #01 -- SLIDE #01 Diagnosis: Nodular fasciitis Case Summary: 12 year old male with a rapidly growing temple mass. Present for 4 weeks. Nodular fasciitis is a self-limited pseudosarcomatous proliferation that may cause clinical alarm due to its rapid growth. It is most common in young adults but occurs across a wide age range. This lesion is typically 3-5 cm and composed of bland fibroblasts and myofibroblasts without significant cytologic atypia arranged in a loose storiform pattern with areas of extravasated red blood cells. Mitoses may be numerous, but atypical mitotic figures are absent. Nodular fasciitis is a benign process, and recurrence is very rare (1%). Recent work has shown that the MYH9-USP6 gene fusion is present in approximately 90% of cases, and molecular techniques to show USP6 gene rearrangement may be a helpful ancillary tool in difficult cases or on small biopsy samples. Weiss SW, Goldblum JR. Enzinger and Weiss’s Soft Tissue Tumors, 5th edition. Mosby Elsevier. 2008. Erickson-Johnson MR, Chou MM, Evers BR, Roth CW, Seys AR, Jin L, Ye Y, Lau AW, Wang X, Oliveira AM. Nodular fasciitis: a novel model of transient neoplasia induced by MYH9-USP6 gene fusion. Lab Invest. 2011 Oct;91(10):1427-33. Amary MF, Ye H, Berisha F, Tirabosco R, Presneau N, Flanagan AM. Detection of USP6 gene rearrangement in nodular fasciitis: an important diagnostic tool. Virchows Arch. 2013 Jul;463(1):97-8. CONTRIBUTED BY KAREN FRITCHIE, MD 1 CASE #02 -- SLIDE #02 Diagnosis: Cellular fibrous histiocytoma Case Summary: 12 year old female with wrist mass.
    [Show full text]
  • Genetic Heterogeneity Intuberous Sclerosis: Phenotypic Correlations
    J Med Genet: first published as 10.1136/jmg.27.7.418 on 1 July 1990. Downloaded from 4184 Med Genet 1990; 27: 418-421 Genetic heterogeneity in tuberous sclerosis: phenotypic correlations I M Winship, J M Connor, P H Beighton Abstract sistently present in families in whom the gene for There is increasing evidence for genetic hetero- TSC is not on 9q34. We conclude that confetti geneity in tuberous sclerosis (TSC) on the basis of depigmentation and nuchal skin tags may be clinical linkage analysis in affected kindreds. We have per- pointers to an alternative locus for TSC. formed a detailed assessment of an affected South African family in which there is no evidence of linkage to chromosome 9 markers. The affected persons have atypical clinical features, namely Tuberous sclerosis (TSC) is inherited as an autosomal prominent nuchal skin tags, a confetti pattern of dominant trait and is characterised by multisystem hypopigmentation of the skin of the lower legs, and hamartosis. The areas of predilection are the skin, absence of ungual fibromata. Further investigation central nervous system, kidneys, and heart, while of these unusual phenotypic features is warranted in other organs are less frequently affected.' Certain skin order to determine whether these lesions are con- lesions are pathognomonic of TSC (adenoma seba- ceum, periungual fibromata, shagreen patches, fibrous facial plaques). Other skin changes may be copyright. MRC Unit for Inherited Skeletal Disorders, Department suggestive (ash leaf macules) or compatible with the of Human Genetics, University of Cape Town Medical diagnosis of TSC in the appropriate clinical setting School, Observatory 7925, South Africa.
    [Show full text]