Sherlock Holmesian dermatopathology. Parakeratosis as a diagnostic clue.
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Biomedical subjects
Publications and source records attributed to A B Ackerman.
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Follicular mucinosis is described to our knowledge for the first time in angiolymphoid hyperplasia. In general, follicular mucinosis may be regarded as a peculiar, nonspecific histological reaction pattern in follicular epithelium that may occur on its own or in association with other pathological processes, particularly lymphomas. The unusual and characteristic features of angiolymphoid hyperplasia revealed by electron microscopy are irregular vessels lined by atypical endothelial cells with convoluted nuclei and large cytoplasmic vacuoles.
Three cases of Becker's nevus are described in which acneform lesions were confined strictly within the limits of the hyperpigmentation. The combined phenomenon has not been reported previously, and we conceive it to be either a rare variant of the anomaly or a still rarer coincidence of Becker's nevus and nevus comedonicus.
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By now it is well recognized that there is a benign melanocytic nevus, common in the young and common enough in adults, that has histological features that are confusable with those of malignant melanoma. The anomaly is usually referred to as benign juvenile melanoma, sometimes as Spitz's nevus, and, by some histopathologists, as spindle and epithelioid cell nevus. All the histological subtleties and variations of the condition are still not fully appreciated and some of them are still being misinterpreted as those of malignant melanoma. We herewith present a study designed to clarify the issue and offer firm criteria for histological differentiation of the nevus in point from malignant melanoma. We also suggest a new name for it and supporting arguments therefor.
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Ample scalp biopsies, including subcutaneous fat, are easily obtained by excision or punch biopsy. Using a knowledge of normal hair patterns and histologic features, the physician can identify common baldness, trichotillomania, alopecia areata, discoid lupus erythematosus, lichen planopilaris, tinea capitis and follicular mucinosis. While hair loss is usually of more psychologic than physiologic significance, accurate diagnosis can be of great importance.
Histologic sections from a solitary cystic cutaneous lesion that showed atypical mononuclear cells in the dermis and within blood vessels were diagnosed by several general pathologists and dermatopathologists as leukemia cutis. The patient, who had no other cutaneous lesions, was consequently submitted to an extensive investigation for leukemia, which proved negative. Additional and deeper sections from the original block revealed that the cellular infiltrate so suspicious of leukemia cutis was secondary to rupture of a lesion of molluscum contagiosum. The correct histopathologic diagnosis, therefore, was pseudoleukemia cutis. The lessons of the case are that 1) further study of the specimen, solitary as it was and asymptomatic as the patient was, would have obviated worry and the expense and inconvenience of an extensive systemic investigation, and that 2) the diagnosis of leukemia cutis should never be made solely on the basis of histologic sections of skin, but rather after examination of blood and bone marrow.
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The histologic findings in the papular, vesicular, nodular, and Norwegian variant of scabies have in common a superficial and deep perivascular mixed inflammatory cell infiltrate of lymphocytes, histiocytes, and numerous eosinophils. A spongiotic vesicle occurs in the papulovesicular type, a dense cellular infiltrate in the nodular type, and a hyperkeratotic psoriasiform dermatitis in the Norwegian type. Eggs, larvae, and adult mites are abundant in the cornified layer of Norwegian scabies, are practically never found in biopsy specimens from lesions of nodular scabies, and are discovered only episodically in papulovesicular lesions.
Transient acantholytic dermatosis is a self-limited, primary acantholytic disease that occurs predominantly in persons over 50 years old. The primary lesions, discrete papules and papulovesicles, are distributed mainly on the chest, back, and thighs and may be intensely pruritic. The disease lasts less than three months in the majority of patients, but occasionally may go on for two or three years. Four distinct histologic patterns are present in the biopsy specimens, namely, Darier-like in which there is focal acantholysis and dyskeratosis overlying suprabasilar clefts; pemphigus vulgaris-like, in which there are a few acantholytic cells above discrete suprabasal clefts having a mostly intact overlying epidermis; Hailey-Hailey-like, in which there are numerous acantholytic cells overlying suprabasilar clefts; and, finally, spongiotic, in which a few acantholytic cells are present within, or contiguous with, spongiotic foci. Some cases show a predominance of one pattern, but more frequently two or more of these patterns can be found in a single biopsy specimen.
A patient with unusual manifestations of transient acantholytic dermatosis (Grover disease) has lesions that have persisted for more than three years. Biopsy specimen showed histologic changes previously unreported in Grover disease. In order to emphasize that this condition is not always transient, we have titled this entity "persistent acantholytic dermatosis."