J Cutan Pathol 2005: 32: 71–123 Copyright # Blackwell Munksgaard 2005 Blackwell Munksgaard. Printed in Denmark Journal of Cutaneous Pathology Abstracts of the Papers Presented at the 41st Annual Meeting of The American Society of Dermatopathology Westin Copley Place Boston, Massachusetts, USA October 14–17, 2004 These abstracts were presented in oral or poster format at the 41st Annual Meeting of The American Society of Dermatopathology on October 14–17, 2004. They are listed on the following pages in alphabetical order by the first author’s last name. 71 Abstracts IN SITU HYBRIDIZATION IS A VALUABLE DIAGNOSTIC A 37-year-old woman with diagnosis of Sjogren’s syndrome (SS) TOOL IN CUTANEOUS DEEP FUNGAL INFECTIONS presented with asymptomatic non-palpable purpura of the lower J.J. Abbott1, K.L. Hamacher2,A.G.Bridges2 and I. Ahmed1,2 extremities. Biopsy of a purpuric macule revealed a perivascular Departments of Laboratory Medicine and Pathology1 and and focally nodular lymphocytic infiltrate with large numbers of Dermatology2, plasma cells, seemingly around eccrine glands. There was no vascu- litis. The histologic findings in the skin were strikingly similar to those Mayo Clinic and Mayo Foundation, Rochester, MN, USA of salivary, parotid, and other ‘‘secretory’’ glands affected in SS. The cutaneous manifestations of SS highlighted in textbooks include Dimorphic fungal infections (histoplasmosis, blastomycosis, coccidiomy- xerosis, annular erythema, small-vessel vasculitis, and pigmented cosis, and cryptococcosis) can occur in immunocompromised and purpura. This case illustrates that purpura in skin of patients with healthy individuals. Cutaneous involvement is often secondary and SS may be caused by a peri-eccrine plasma-rich infiltrate. The link may be the presenting sign of systemic disease. These ominous infections between hypergammaglobulinemia, auto antibodies, plasma cells are frequently clinically indistinct and their prognosis is influenced by infiltration, and development of extranodal B-cell lymphoma in SS their timely diagnosis and treatment. Morphological differentiation remains to be elucidated. between these organisms is not definitive and tissue cultures represent the diagnostic gold standard in current day practice. However, not uncommonly tissue cultures are not obtained and merely represent an MYCOBACTERIUM FORTUITUM FURUNCULOSIS IN afterthought in seemingly unsuspecting cases. Furthermore, when per- PEDICURE RECIPIENTS; AN EPIDEMIC? formed, they may take several days to weeks for completion. In situ P. Abrishami and C. Cockerell hybridization (ISH) utilizing oligonucleotide probes directed against Department of Dermatology, University of Texas Southwestern fungal ribosomal RNA represents a rapid and accurate assay for the Medical Center, Dallas, TX, USA diagnosis of dimorphic fungi in paraffin-embedded tissue sections. We present 7 patients in whom ISH both prospecitively and retrospectively Isolated cases and outbreaks of mycobacterial furunculosis among confirmed the presence of a cutaneous infection (2 histoplasmosis, 2 patients receiving pedicures have been reported. The transmission blastomycosis, 1 coccidiomycosis, 2 cryptococcosis). In all of the skin of the mycobacteria likely occurs while soaking the legs in a whirlpool sections analyzed, dimorphic fungi were morphologically apparent but foot bath prior to the pedicure. Oils are often applied to the legs not diagnostically discernable. In summary, ISH represents a valuable following the foot bath. Typically, patients present with multiple tool in the prompt diagnosis of cutaneous deep fungal infections. papules and pustules below the knees that, after several weeks or months, may become large, tender, and fluctuant furuncles. Histology ADENOCARCINOMA OF MAMMARY-LIKE GLANDS OF usually demonstrates a suppurative folliculitis with or without asso- THE VULVA ciated suppurative granulomatous inflammation. We present a cul- J.J. Abbott1 and I. Ahmed1,2 ture-proven case of M. fortuitum furunculosis in a patient after 1Department of Pathology and receiving whirlpool leg soaking and pedicure in a foot salon. We also illustrate several other highly suspected cases in which cultures 2Department of Dermatology, Mayo Clinic and Mayo Foundation, failed to grow the organism. It is important for clinicians and patho- Rochester, MN, USA logists to recognize the gross and histological patterns of this under- reported condition as cultures, particularly swabs, often fail to grow Mammary-like glands are a poorly recognized structure of the normal the organism. vulvar skin. Adenocarcinomas occur rarely in these glands and repre- sent a distinct clinicopathologic entity that must be distinguished from metastatic tumors. We present a case of a 51-year-old patient with a NEPHROGENIC FIBROSING DERMOPATHY long-standing nodule on her right labium majus. Excision with sub- M. Mubashir Ahmed, Richard Kim and Li Ma sequent Mohs micrographic surgery revealed an infiltrating adeno- Department of Pathology, Louisiana State University Health Sciences carcinoma of the mammary-like glands involving the dermis and Center- Shreveport, LA, USA subcutis. We review all cases thus far reported (including the case presented herein) and identify important clinical and morphologic Nephrogenic fibrosing dermopathy is a rare, recently described fibro- features of this tumor. A significant histopathological and immuno- tic skin condition that primarily affects patients with a history of renal histochemical overlap between this neoplasm, sweat gland carcin- disease.We report 2 cases of nephrogenic fibrosing dermopathy and omas, and invasive extramammary Paget’s disease was recognized; review clinical and histopathologic features with differential diagnosis suggesting the existence of a morphologic spectrum between these and more.Case #1 was a 64-year-old black male with chronic renal entities. Criteria for establishing the diagnosis of adenocarcinoma of insufficiency which progressed to end stage renal disease requiring mammary-like glands are reviewed, including the importance of hemodialysis. After two days, he developed blisters on both his hands. identifying transition zones between normal mammary-like glands By a month, his blister lesions resolved leaving scaly skin with some and malignant glands. We believe that this tumor is best categorized skin thickening and tightening in the hands and forearms. Over the as a locally aggressive neoplasm with a low metastatic potential and course of one month, skin over above-mentioned areas began to death from disease is uncommon. The successful treatment of this harden and stiffen. His fingers began to coalesce and contract result- case by Mohs micrographic surgery suggests that an alternate man- ing in fixation of hand grip. He also developed flexing contracts at the agement approach may be adopted for these tumors, particularly in elbows bilaterally. Skin biopsy revealed the diagnosis of nephrogenic elderly patients. fibrosing dermopathy with giant cells reaction. Case #2 was a 44- year-old black male with a hx of nephropathy. He eventually devel- A NEW LOOK AT CUTANEOUS FEATURES OF oped end stage renal disease requiring hemodialysis. One month SJOGREN’S SYNDROME after, he was found to have thickened, sclerotic appearing skin invol- P. Abrishami, ving the upper back, hands, and forearms with flexing contracts of the Department of Dermatology, University of Minnesota, all the small joints. Histopathology was most consistent with nephro- Minneapolis, MN, USA genic fibrosing dermopathy. 72 Abstracts BASAL CELL CARCINOMA WITH MATRICAL the overlying epidermis, so too does sebaceous carcinoma of the eyelid. DIFFERENTIATION IN A TRANSPLANT PATIENT: A Accordingly, just as mammary Paget’s disease is often misdiagnosed as CASE REPORT AND REVIEW OF THE LITERATURE an inflammatory condition, so too is sebaceous carcinoma. F. Ali, A. Brown, L. Gottwald and J. Thomas Departments of Pathology and Dermatology, Medical College of Ohio, Toledo, OH, USA AXILLARY METASTASIS OF MALIGNANT MELANOMA MIMICKING A BREAST CARCINOMA Background: Shadow cells are characteristic of pilomatricoma, a A. Andea, E. Satter, J.R. McEvoy, K. Williams, K. Mikhitarian and distinct neoplasm of hair matrix differentiation. Shadow cells within J. Metcalf an otherwise classic basal cell carcinoma (BCC) has been referred to Department of Pathology, Medical University of South Carolina, as ‘‘BCC with matrical differentiation’’. We present a case of BCC Charleston, SC, USA with matrical differentiation in a transplant patient. To our know- ledge, none have been reported arising on the background of immuno- We describe here the case of a female patient with an otherwise suppression. Methods: A 58-year-old male cardiac transplant classic invasive melanoma of the upper extremity, demonstrating patient had a left hand nodule, which was excised and submitted for the typical immunohistochemical profile, who presented three years routine histologic review. Results: The lesion revealed multiple later with massive ipsilateral axillary node metastases. The metastatic basaloid tumor masses. In some areas, there was peripheral tumor had morphologic features similar to the primary melanoma, palisading with stromal retraction artifact, typical of basal cell however at immunohistochemical level the tumor cells not only carcinoma, extending into the deep reticular dermis. The tumor gained expression of pan-cytokeratin (AE1/AE3) but also lost expres- also contained a population of shadow cells, similar to those