Congenital naevus with 'Spitzoid starting' in an 8-year-old child: dermoscopic and histological features.
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Child↗
Biomedical subjects
M Pippione
Publications and source records attributed to M Pippione.
Histological features used in the diagnosis of melanoma are frequently found in benign melanocytic naevi.
AIMS: The histological features used in the diagnosis of melanoma may be present in benign naevi, but quantitative data are not available. The aim of this study was to establish the real prevalence of such features in naevi. METHODS: Ten dermatopathologists, from nine Italian institutions, studied a series of naevi. Eleven histological parameters currently used in melanoma diagnosis were analysed: asymmetry, poor circumscription, predominance of single melanocytes, irregular confluent nests, suprabasal melanocytes, hair follicle involvement, absence of maturation, cytological atypia, dermal lymphocytic infiltrate, mitoses, and necrosis. RESULTS: Ninety one naevi were examined: 22 junctional, 59 compound, and 10 intradermal. None of the studied parameters was seen in 22 of the benign naevi studied. One or more investigated features were found in 69 naevi. Poor circumscription was found in 49 cases, single melanocytic predominating in 42, asymmetry in 41, irregular confluent nests in 16, cytological atypia in 14, suprabasal melanocytes in seven, and hair follicle involvement in seven; absence of maturation, mitoses and necrosis were not found. CONCLUSIONS: The histological features used for the histological diagnosis of melanoma are often present in benign melanocytic naevi. This suggests a critical, non-mechanical use of them in melanoma diagnosis.
Adult↗
Interobserver reproducibility of histological features in cutaneous malignant melanoma.
AIMS: To assess the interobserver reproducibility of certain histological features proposed for the diagnosis of melanoma. METHODS: In a series of melanomas, 13 histological parameters were analysed: dimension > 6 mm, asymmetry, poor circumscription, irregular confluent nests, single melanocytes predominating, absence of maturation, suprabasal melanocytes, asymmetrical melanin, melanin in deep cells, cytological atypia, mitoses, dermal lymphocytic infiltrate, and necrosis. RESULTS: The agreement (reproducibility) between the nine observers was excellent (kappa > 0.75) for 10 of the 13 examined features (dimension > 6 mm, poor circumscription, irregular confluent nests, single melanocytes predominating, absence of maturation, suprabasal melanocytes, asymmetrical melanin, melanin in deep cells, mitoses, and necrosis). The agreement for asymmetry was very close to excellence (kappa = 0.74), and that for cytological atypia (kappa = 0.65) and dermal lymphocytic infiltrate (kappa = 0.47) was slightly lower, but in the fair to good agreement range. The kappa values obtained by comparison with the majority diagnosis were generally high (> or = 0.85); the mean value of kappa was lower (0.70) for only one parameter (dermal lymphocytic infiltrate). CONCLUSIONS: The parameters investigated showed an overall good reproducibility.
Humans↗
Melanocytic nevi of the breast: a histologic case-control study.
BACKGROUND: Melanocytic nevi in the genital, acral, and flexural sites often display clinical and histologic features that may simulate melanoma. We verified whether this is the case also for nevi of the breast. METHODS: Eleven dermatopathologists, from nine Italian Institutions, collected the specimens of melanocytic lesions from the breast and other body sites, excluding the acral, genital, and flexural areas, as controls. Cases and controls were matched for sex and age. All nevi were observed 'blindly' and simultaneously by all participants. For each lesion, 10 histological parameters were analyzed: asymmetry, absence of lateral demarcation of melanocytes, lentiginous proliferation, nested and dyshesive pattern, intraepidermal melanocytes above the basal layer, involvement of the hair follicle, absence of maturation of dermal melanocytes, melanocytic atypia, fibroplasia of the papillary dermis, and lymphocytic dermal infiltrate. Each parameter was scored 2 when present and 1 when absent or not valuable. A total score was calculated for each lesion. Results were statistically analyzed by the chi-square test and the Mann-Whitney U-test. RESULTS: One hundred and one nevi came from the breast area and 97 from elsewhere. Breast nevi exhibited significantly more atypical features than nevi from other sites. In particular, breast nevi with intraepidermal melanocytes, melanocytic atypia, and dermal fibroplasia were significantly more numerous. We did not find any sexual difference. CONCLUSIONS: To avoid undue concerns, dermatopathologists should be aware that melanocytic nevi of the breast may show a high degree of atypical features.
Adolescent↗
The clinicopathologic spectrum of rhinophyma.
We report the results of a clinicopathologic study of 17 patients with rhinophyma in different stages of evolution, with particular attention paid to the severe form of this disease. On the basis of clinical features, we identified 2 groups of patients: the first group (12/17 patients) included patients with the common form of rhinophyma, whereas the second one (5/17 patients) included patients with the severe form of the disease. There was no link between the clinical aspect and the duration of the disease. Microscopic examination of specimens obtained from the classic type of rhinophyma substantially showed the histopathologic features of fully developed rosacea, except for the presence of prominent sebaceous hyperplasia. The second group showed a very different histologic pattern displaying marked dermal thickness, absence of folliculosebaceous structures, sclerotic collagen bundles with large amounts of mucin, and spreading telangiectasia. The inflammatory infiltrate was inconspicuous, with numerous interstitial spindle and bizarre cells. Most of the interstitial cells were reactive to factor XIIIa. The severe form of rhinophyma shares many histologic characteristics with elephantiasis caused by chronic lymphedema.
Adult↗
Angioendotheliomatosis in a woman with rheumatoid arthritis.
Reactive angioendotheliomatosis (RA) is a rare self-limited skin condition characterized histopathologically by a proliferation of endothelial cells within vascular lumina, usually as a result of different stimuli such as systemic infections, cryoproteinemias, monoclonal gammopathies, allergic conditions, severe peripheral vascular atherosclerotic disease, and iatrogenic arteriovenous fistulas. We report on a 67-year-old woman with a 20-year history of seropositive rheumatoid arthritis who presented with violaceous swelling of her left forearm. A skin biopsy revealed the histopathologic finding of RA with focal glomeruloid features and deposition of periodic acid-Schiff-positive material. In this systemic disorder, cutaneous manifestations may occur secondary to an immune complex-mediated vasculitic mechanism.
Aged↗
Immature myeloid precursors in chronic neutrophilic dermatosis associated with myelodysplastic syndrome.
Sweet syndrome (SS) associated with myeloproliferative disorders has been considered an inflammatory process mediated by neutrophils in which immunologic mechanisms are operative. The authors report the case of a 68-year-old man suffering from a myelodysplastic syndrome, who presented with a relapsing skin eruption resembling SS. Histopathologically, the skin infiltrates showed prominent neutrophilic features masking the underlying malignant process. Extensive immunophenotypic studies of skin revealed the presence of a few immature myeloid cells intermingled with an overwhelming infiltrate of neutrophils. The atypical cells in the skin had a phenotype identical to that of leukemic cells in the peripheral blood and bone marrow. Whether or not immature myeloid cell precursors constitute a specific infiltrate of leukemia cutis or are a result of recruitment of circulating leukemic cells to this area of inflammation is discussed.
Aged↗
Interstitial granulomatous dermatitis with plaques.
We report on the clinical and histopathologic findings of four patients who had asymptomatic, erythematous to violaceous plaques symmetrically distributed on the upper aspect of the thighs, lateral chest, and in two cases also on the abdomen and flexor surface of the elbows. All of the patients were women; two of them had arthritis, which in one case was associated with an autoimmune disorder, and another had autoimmune thyroiditis. Histopathologically, all cases showed similar changes consisting of an interstitial granulomatous dermatitis involving mostly the lower reticular dermis. Histiocytes were the predominant cellular component, arranged interstitially and in small palisades around foci of degenerated collagen bundles in concert with large numbers of neutrophils and eosinophils. Interstitial granulomatous dermatitis can present different clinical expressions, including linear cords, papules, and, as in our cases, plaques. This peculiar histopathologic pattern falls into the spectrum of cutaneous extravascular necrotizing granuloma, a condition that is often associated with systemic autoimmune disease.
Aged↗
Dermatofibroma with granular cells: a report of two cases.
We describe two examples of an unusual variant of dermatofibroma (DF) in which areas of granular cells were a prominent feature. The diagnosis of DF was confirmed by immunohistochemistry and by ultrastructural studies. Granular cell changes can be observed in numerous benign and malignant cutaneous tumors of different cellular lineage. Cellular granularity is a nonspecific phenomenon characterized by intracytoplasmic accumulation of lysosomes and may cause diagnostic difficulties. Traumatic factors may be involved in the pathogenesis of cellular granularity.
Adult↗
Parallel risk assessment of melanoma and basal cell carcinoma: skin characteristics and sun exposure.
In this study we compared the strength of the association of constitutional factors and sun exposure with cutaneous malignant melanoma (CMM) and basal cell carcinoma (BCC). We analysed 260 incident cases of CMM, 425 incident cases of BCC and two sets of population controls from previous case-control studies conducted in Turin, Italy. Simultaneous comparison was accomplished by comparing separate simple logistic and polytomous logistic regressions. Tendency to sunburn was shown to be the most important risk indicator for both types of tumours, being associated with a two- to three-fold increase in risk for CMM and a two-fold increase in risk for BCC. Intermittent and intense sun exposure, as during beach holidays, increased the risk of both CMM and BCC, while prolonged exposure to sun, as during outdoor occupations, was not associated with CMM or BCC. The increase in risk during beach holidays occurred mainly during childhood for CMM cases, while for BCC cases it also continued during adulthood. Analysis of the independent effect of risk factors confirmed the role of skin phenotype (eye colour odds ratio [OR] = 1.6, tendency to sunburn OR = 2.1) and intermittent sun exposure (sunburns in childhood OR = 3.8, sun exposure during beach holidays OR = 1.2) in CMM. Risk of CMM showed a significant increase when sun exposure exceeded the threshold of about 3500 h during beach holidays cumulated in a lifetime. In contrast, the role of skin phenotype in BCC is less strong, but cumulated hours of sun exposure during beach holidays in a lifetime showed a constant risk rise with an early plateau at a low exposure level.
Basal Cell Carcinoma↗
Multinucleate cell angiohistiocytoma: a report of two cases.
We report the clinical, histological and immunological features of two cases of multinucleate cell angiohistiocytoma (MCAH) in women of 32 and 53 years of age, respectively. Clinically, MCAH occurs mostly in middle-aged women and consists of crops of reddish-purple, dome-shaped papules especially on the limbs. Histologically, the reticular dermis presents an increased number of small vascular channels with plump endothelial cells embedded in a fibrohistiocitic stroma with numerous bizarre multinucleate cells. Bizarre multinucleated cells are not specific to MCAH; they can be observed in numerous other cutaneous conditions. However, MCAH presents quite distinctive clinico-pathological findings and may be easily differentiated from other cutaneous disorders.
Adult↗
Vulvodynia and HIV: causal or casual association?
BACKGROUND: No study exists on HIV and vulvodynia. OBJECTIVE: To evaluate vulvodynia in HIV infected women and its possible association with HIV. DESIGN: Cross sectional study. SETTING: Department of Medical and Surgical Sciences, Section of Infectious Diseases, University of Turin. METHODS: 235 HIV positive and 272 HIV negative women were studied for vulvar pain between June 1995 and January 1997. Diagnosis of vulvodynia was based on clinical history, dermatological and vulvovaginal examination, and bacteriology. Colposcopy and vulvar biopsy were performed and psychometric examination was done. RESULTS: Vulvodynia was diagnosed in five women with HIV and in one uninfected woman (odds ratio = 2.5; 95% confidence interval: 0.1-62.6). High neuroticism scores were observed in women with history of vulvar pain, the highest in HIV infected vulvodynia patients (p = 0.000). CONCLUSIONS: Confirming the association of gynaecological pain with neurotic personality, our study suggests causal link between HIV and vulvodynia.
Adult↗
Psoriatic erythroderma: a histopathologic study of forty-five patients.
BACKGROUND: There are conflicting opinions about the diagnostic value of skin biopsy in erythrodermic psoriasis. OBJECTIVE: The purpose of the present study was to establish the specificity of the histopathologic changes of psoriatic erythroderma. METHODS: We reviewed 52 skin biopsies from 45 erythrodermic patients having a final diagnosis of psoriasis on the basis of combined clinical and laboratory data, in addition to response to therapy and follow-up. In 5 patients, erythroderma was the presenting sign of psoriasis. A control group of nonpsoriatic erythrodermic patients was also included in the study. RESULTS: Among the group of patients with a discharge diagnosis of psoriatic erythroderma, the histopathologic changes were specific for psoriasis in 40 cases (88%). The changes of early macular and squamous lesions of psoriasis were more often found in the biopsy specimens of our series than those of fully developed or late lesions of psoriasis. They included mainly slight epidermal hyperplasia, focal disappearance of the granular layer, mounds of parakeratosis and extravasated erythrocytes within edematous dermal papillae associated with perivascular and interstitial infiltration of lymphocytes and histiocytes. CONCLUSION: When features of early lesions of psoriasis are found during the evaluation of a biopsy specimen from a patient with a clinically nonspecific erythroderma, the dermatopathologist should be aware that this patient could have psoriasis and a renewed anamnesis and a close follow-up should be made.
Adolescent↗
Vulvar adenosis after diathermy treatment for condylomas.
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Adult↗
Folliculosebaceous cystic hamartoma with perifollicular mucinosis.
An 8-year-old boy had a congenital, solitary verrucous lesion on his ear that histologically showed numerous maloriented infundibulocystic structures from which radiated immature sebaceous lobules as well as hair germs with rudimentary papillae. The surrounding stroma was fibrillary, containing large quantities of mucin. We conclude that perifollicular mucinosis, considered to be specific to Carney's syndrome, can also be observed in solitary folliculosebaceous hamartoma.
Child↗
Malignant cellular blue nevus: a clinicopathological study of 6 cases.
BACKGROUND: Malignant cellular blue nevus (MCBN) is a rare entity due to the malignant transformation of a preexisting cellular blue nevus (CBN). OBJECTIVE AND METHODS: The clinical and pathologic features of 6 patients with MCBN are described. RESULTS: Three tumors were located on the scalp, 2 on the trunk and 1 on the neck. The lesions, present from birth or childhood, had enlarged rapidly in the last months before excision. Histologically, there was a dermal proliferation of spindle and epithelioid atypical melanocytic cells. Some of them were heavily pigmented. Numerous atypical mitoses were seen. In 2 cases, foci of necrosis were detected. In 2 cases, remnants of CBN were also noted. MCBN has a poor prognosis and may be difficult to differentiate from so-called atypical blue nevus, metastasis of malignant melanoma and malignant transformation of combined nevus. CONCLUSIONS: CBN may represent a precursor of malignant melanoma. In MCBN, malignant changes seem to occur in clear cells.
Adult↗
Cellular neurothekeoma.
We describe the histological and immunohistochemical findings of two cases of cellular neurothekeoma, a recently recognized benign neoplasm considered to be of neural origin. Morphologically they were characterized by a dermal proliferation of plexiform fascicles and small nests of pale eosinophilic, epithelioid or spindle-shaped cells which ramified in an ill-defined pattern between collagen bundles. Scant to moderate amounts of mucin were detected only in the plexiform lobules. Purely myxoid and cellular lobules concurred in these neoplasms. Immunohistochemically, both neoplasms exhibited focal immunoreactivity of the cells for factor XIIIa, providing further evidence for perineural differentiation. Problems of differential diagnosis with other plexiform neoplasms of uncertain origin are discussed.
Adult↗
Linear pruritic papulovesicular eruption in a woman. Lichen striatus.
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Adult↗