Biomedical subjects
Dirk M Elston
Publications and source records attributed to Dirk M Elston.
Atypical junctional melanocytic proliferations in benign lichenoid keratosis.
Melanocytic lesions with lichenoid regression may mimic a benign lichenoid keratosis (BLK) histologically. A total of 336 BLKs were reviewed and deeper sections obtained to determine the frequency of this phenomenon. Two cases (0.6%) showed at least 1 melanocytic nest or junctional multinucleated melanocyte (starburst melanocyte) on deeper sections confirmed by MART-1 immunostaining. Both of these cases demonstrated solar elastosis, and 1 case had an effaced rete ridge pattern. Not included in the histological study are 5 additional cases in which the initial slide showed only lichenoid dermatitis, but deeper sections obtained before to the initial sign-out revealed a melanocytic proliferation. These 5 cases would have been signed out as "consistent with BLK" if deeper sections had not been obtained. Fluorescent in situ hybridization (FISH) was performed on 3 cases; in each case, the melanocytes demonstrated a loss of chromosome 9p21 DNA copy number. The finding of nests of genetically altered melanocytes on severely sun-damaged skin strongly suggests that these cases represent lichenoid regression of melanoma in situ. Pathologists should approach a diagnosis of BLK cautiously in the setting of severely sun-damaged skin.
Giant right plantar keloid treated with excision and tissue-engineered allograft.
Plantar keloids are a management problem as a result of the pain and mechanic restriction with ambulation. We present the treatment of a patient with a particularly large plantar keloid that was refractory to multiple excisions, adjunctive intralesional steroids, and radiation therapy, who was successfully treated with excision, intralesional steroids, and tissue-engineered allograft placement.
What is your diagnosis? Dermatomyositis.
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What's eating you? Strongyloides stercoralis.
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What is your diagnosis? Pseudocyst of the auricle.
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Invasive synergistic fungal infection after motor vehicle collision.
Primary invasive fungal infections occur after direct contact or direct inoculation of the skin with fungal spores. Rhizopus species and Aspergillus terreus are opportunistic fungal species that rarely cause disease in immunocompetent hosts. In susceptible patients, infection may progress rapidly. Aggressive surgical debridement and use of systemic antimycotic agents may successfully control disease and prevent systemic dissemination. We describe the case of a patient with a scalp infection, caused by Rhizopus species and A. terreus, that occurred after contact with pavement during a motor vehicle collision. Control was achieved with repeated debridement and use of systemic antifungal therapy.
What's eating you? Enterobius vermicularis (pinworms, threadworms).
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Primary systemic amyloidosis.
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What is your diagnosis? Exostoses.
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What's eating you? Megalopyge opercularis.
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War and rebuilding: what can we expect in the aftermath of the war in Iraq?
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Bullous eruption: a manifestation of lupus erythematosus.
Bullous lupus erythematosus (BSLE) is a rare subset of systemic lupus erythematosus (SLE), often associated with autoimmunity to type VII collagen. Generally, patients with BSLE meet the criteria for SLE as defined by the American College of Rheumatology. We present a case of a 17-year-old adolescent girl who presented with a vesiculobullous eruption without detectable type VII collagen antibodies and without full criteria for SLE. Differential staining was characteristic for lupus erythematosus (LE), suggesting her eruption is related to LE. We review the spectrum of bullous disease in patients with LE and discuss the pathogenesis and histology of these eruptions, as well as current therapeutic options.
Diseases encountered during war and rebuilding: lessons from past conflicts.
As we face the task of helping to rebuild Iraq, it is worthwhile to review our experience with past humanitarian aid missions and past conflicts. These efforts serve as models for the types of problems we may encounter today. It also is critical to review available data concerning the unique aspects of cutaneous diseases in that part of the world.
What is your diagnosis? Pachyonychia congenita.
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What's eating you? Canine scabies.
Infestation with Sarcoptes scabiei var canis, the causative strain of canine scabies, can produce a pruritic rash in humans. The rash generally manifests within 24 to 96 hours of contact with the affected pet. Scrapings are generally negative, and the correct diagnosis requires a high index of suspicion.
Metastatic aggressive digital papillary adenocarcinoma.
A 52-year-old white man presented with 2 complex cystic masses in his left inguinal region. On histopathologic examination, an asymptomatic nodule between the third and fourth metatarsal heads was diagnosed as an aggressive digital papillary adenocarcinoma (ADPAca), and the complex cysts from the groin represented metastatic disease from the primary acral tumor. The primary tumor was focally positive for immunoreactivity to ferritin antibody, an immunohistologic marker for sweat gland malignancies. Ferritin antibody may prove useful in the diagnosis of aggressive digital papillary adenoma (ADPA) and ADPAca.
What's eating you? Human Dirofilaria infections.
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