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Head and Neck Pathology Jun 2017Lichen sclerosus (LS) is a chronic inflammatory mucocutaneous disease that often affects the anogenital area and causes significant discomfort and morbidity. Oral... (Review)
Review
Lichen sclerosus (LS) is a chronic inflammatory mucocutaneous disease that often affects the anogenital area and causes significant discomfort and morbidity. Oral mucosal lesions in LS are extremely rare and might be associated with genital and/or skin manifestations. As a unique manifestation of LS, oral lesions are even more rare, with only 20 cases reported in English-language literature. In reviewing that literature in this paper, we present the case of a 44-year-old white man who sought dental assistance with a complaint of a white spot on his upper lip. Extraoral clinical examination revealed a slight white macule on the left upper lip vermilion next to the labial commissure. Intraoral examination revealed that the macule was approximately 3.5 × 2.0 cm, extended to the upper left labial mucosa, and presented an ivory-white color. Following an incisional biopsy and microscopy, the lesion was shown to be covered by a stratified squamous epithelium showing hyperkeratosis and atrophy. The superficial lamina propria revealed a well-marked band of subepithelial hyalinization and, below it, a band-like mononuclear inflammatory infiltrate. Sections stained by Verhoeff's technique revealed a scantiness of elastic fibers in the superficial lamina propria. The diagnosis of LS was then established. The patient was referred for dermatologic evaluation, which identified no skin or genital lesions, and no treatment was employed. After 6 years, no significant changes in clinical features were observed. Altogether, this rare case makes an important contribution to knowledge on this uncommon condition.
Topics: Adult; Humans; Lichen Sclerosus et Atrophicus; Male; Mouth Diseases
PubMed: 27807761
DOI: 10.1007/s12105-016-0766-x -
New Microbes and New Infections 2022causes Tinea nigra, a rare superficial mycosis. It has not been reported in Iran yet. We report a case of an Iranian boy resident of Amol (Mazandaran, Iran) that...
causes Tinea nigra, a rare superficial mycosis. It has not been reported in Iran yet. We report a case of an Iranian boy resident of Amol (Mazandaran, Iran) that developed brown macules on his left palm. Direct microscopic examination and culture confirmed the diagnosis of Tinea nigra.
PubMed: 36276912
DOI: 10.1016/j.nmni.2022.101032 -
Genes Jul 2022McCune-Albright is a rare syndrome, caused by mutation of the gene, and is characterized by an appearance of multiple endocrinopathies, most commonly premature puberty,...
BACKGROUND
McCune-Albright is a rare syndrome, caused by mutation of the gene, and is characterized by an appearance of multiple endocrinopathies, most commonly premature puberty, polyostotic fibrous dysplasia and skin changes called macules.
CASE REPORT
We present the case of a patient who is, to the best of our knowledge and after extensive review of literature, the youngest McCune-Albright syndrome patient with growth hormone excess, diagnosed at 8.9 months of age. An extensive diagnostic procedure was done upon the diagnosis. Hormonal assessment was performed and all hormone levels were within reference range, and an additional oral glucose suppression that noted the presence of growth hormone excess. Magnetic resonance imaging of the pituitary gland did not detect a tumor process. The genetic analysis of the gene from skin punch biopsy came back negative. Octreotide was administered as therapy for growth hormone excess at 9.8 months. After the introduction of therapy, we noted a decrease in growth rate from 29.38 to 16.6 cm/year.
CONCLUSION
This case report emphasizes the lack of available data on treatment of growth hormone excess and follow-up in pediatric population and the need for further research.
Topics: Acromegaly; Cafe-au-Lait Spots; Child; Fibrous Dysplasia, Polyostotic; Humans; Syndrome
PubMed: 36011254
DOI: 10.3390/genes13081345 -
JAMA Dermatology Aug 2017Pigmented facial macules on photodamaged skin are a clinical, dermoscopic, and histopathologic challenge.
IMPORTANCE
Pigmented facial macules on photodamaged skin are a clinical, dermoscopic, and histopathologic challenge.
OBJECTIVES
To clinically and dermoscopically characterize, by means of reflectance confocal microscopy (RCM), ambiguous pigmented facial macules and establish a correlation between RCM, histopathologic, and immunohistochemical findings.
DESIGN, SETTING, AND PARTICIPANTS
A prospective study of ambiguous pigmented facial macules on photodamaged skin was conducted in a tertiary referral center for dermatology between January 1, 2009, and December 31, 2015. Sixty-one patients with 63 ambiguous pigmented facial macules and 12 control photodamaged facial areas were included in the study. Melanocyte density in 1-mm basal layers was determined in skin biopsy specimens from all lesions stained with hematoxylin-eosin and immunohistochemical markers (melan-A, microphthalmia-associated transcription factor, and SRY-related HMG-box gene 10). Dermoscopic, RCM images, and histopathologic preparations were systematically evaluated for the presence of lentigo maligna (LM) criteria. Confocal evaluation was blinded to clinical and dermoscopic diagnosis. Sensitivity and specificity of RCM for LM diagnosis and κ value to establish correlations between dermoscopy, RCM, and histopathology were performed.
MAIN OUTCOMES AND MEASURES
Sensitivity and specificity of RCM for LM diagnosis.
RESULTS
Of the 61 patients included in the study, 31 (51%) were women; mean (SD) age was 71.8 (13.1) years. Twenty-four of the 63 (38%) lesions were diagnosed as LM or LM melanoma (LMM) and 39 (62%) as benign pigmented lesions. Reflectance confocal microscopy enhanced the diagnosis of pigmented facial macules with 91.7% sensitivity and 86.8% specificity. Multivariate analysis showed 2 dermoscopic and 2 confocal features associated with LM or LMM: (1) asymmetric follicular pigmentation and targetlike structures, and (2) round, large pagetoid cells and follicular localization of atypical cells, respectively. Continuous proliferation of atypical melanocytes was found in 21 (88%) LM or LMM and in 3 (77%) benign lesions. Asymmetric pigmented follicular openings by dermoscopy correlated with follicular localization of pagetoid cells by RCM (κ = 0.499, P < .001). The presence of 3 or more atypical cells at the dermal-epidermal junction (DEJ) by RCM correlated with hyperplasia of melanocytes in hematoxylin-eosin sections (κ = 0.422, P < .001).
CONCLUSIONS AND RELEVANCE
Reflectance confocal microscopy improves LM diagnosis in photodamaged skin with good histopathologic correlation although false-positive and false-negative cases exist. False-positives obtained with RCM in photodamaged skin are due to the presence of basal melanocyte hyperplasia and intraepidermal Langerhans cells. Histopathologic features of these lesions sometimes are not enough for a definite diagnosis and immunohistochemical studies may be required.
Topics: Adult; Aged; Aged, 80 and over; Biopsy; Dermoscopy; Face; False Negative Reactions; False Positive Reactions; Female; Humans; Hutchinson's Melanotic Freckle; Immunohistochemistry; Male; Melanocytes; Microscopy, Confocal; Middle Aged; Prospective Studies; Sensitivity and Specificity; Skin; Skin Aging
PubMed: 28564685
DOI: 10.1001/jamadermatol.2017.1323 -
BMC Veterinary Research Apr 2022In animals, only few reports exist about the occurrence and causes of subconjunctival bleedings, especially in newborn calves. Most case reports and studies showed that...
BACKGROUND
In animals, only few reports exist about the occurrence and causes of subconjunctival bleedings, especially in newborn calves. Most case reports and studies showed that the major risk factors for subconjunctival bleedings in animals are traumatic events such as birth trauma and traffic accidents, respectively. In neonatal babies, it is suggested that compression of the thorax and abdomen during delivery or forces generated in utero during labor may raise venous pressure to conjunctival vessels and can cause subconjunctival bleedings.
RESULTS
The incidence of bleedings in neonatal Holstein-Friesian calves was 2.4 per cent of 289 neonatal calves examined over a six-year period. In general, two types of subconjunctival bleedings were seen. One was usually in a semilunar fashion immediately outside the limbus of the eye. The other type was a stripe or macule of variable size at different positions of the sclera. The subconjunctival bleedings were not related to gestational time. In all cases, affected calves were born without assistance. Multiparous cows were more often involved in the calves with subconjunctival bleedings. Two calves examined haematologically did not show signs of anemia or thrombocytopenia.
CONCLUSIONS
Subconjunctival bleedings in neonatal calves appear not to be incidental findings. Main causes or associated conditions of subconjunctival bleedings were not found.
Topics: Animals; Cattle; Cattle Diseases; Female; Hemorrhage; Parity; Pregnancy; Research
PubMed: 35477564
DOI: 10.1186/s12917-022-03254-z -
Head and Neck Pathology Jun 2019Laugier-Hunziker syndrome (LHS, also termed idiopathic lenticular mucocutaneous hyperpigmentation) is an unusual condition characterized by progressive pigmentation of...
Laugier-Hunziker syndrome (LHS, also termed idiopathic lenticular mucocutaneous hyperpigmentation) is an unusual condition characterized by progressive pigmentation of the mucous membranes. LHS displays a benign course and is not associated with malignancy. Here we present a case of LHS with a 7-year follow-up. We document metachronous oral melanoacanthomas in this individual. In addition, we found that the oral melanotic macules in this patient waxed and waned in a cyclical manner. To our knowledge, this is the first report of these findings in the context of LHS. Finally, we provide an overview of other conditions that can present with mucosal hyperpigmentation. It is critical to distinguish LHS from other conditions characterized by mucosal pigmentation in order to facilitate optimal patient care.
Topics: Acanthoma; Female; Humans; Hyperpigmentation; Middle Aged; Mouth Neoplasms; Skin Neoplasms
PubMed: 29450847
DOI: 10.1007/s12105-018-0897-3 -
Indian Journal of Dermatology,... 2020Hypopigmented macules are seen in a variety of disorders and the diagnosis rests on clinicopathological correlation. However, some cases are difficult to classify and...
BACKGROUND
Hypopigmented macules are seen in a variety of disorders and the diagnosis rests on clinicopathological correlation. However, some cases are difficult to classify and pose a diagnostic challenge.
AIM
To describe the clinical and histopathological features of patients with hypopigmented macules and follicular spongiosis on histopathology.
MATERIALS AND METHODS
We undertook a retrospective analysis of clinical and histopathological findings in 12 patients who presented with clinically nondiagnostic hypopigmented macules and showed follicular spongiosis on skin biopsy, at All India Institute of Medical Sciences, New Delhi, India between January 2015 and October 2016. The findings were compared with 12 patients with "unclassified" hypopigmented macules, who did not show follicular spongiosis on skin biopsy.
RESULTS
A total of 12 patients with hypopigmented macules showed spongiosis affecting the follicular epithelium on histopathology. There were eight men and four women, most in their second decade (mean age 19.1 ± 8.05 years), presenting with hypopigmented macules most commonly on the upper limbs, for a mean duration of 6.33 ± 5.10 months. Clinically evident lesional hair loss was seen in all patients, and follicular prominences in seven (58%) patients. Histological features suggestive of other diagnosis, namely leprosy, mycosis fungoides or sarcoidosis were not seen in any biopsy. Alcian blue stain revealed an minimal amount of mucin in one biopsy. Clinically apparent hair loss and follicular prominences were found to be statistically significantly associated with histological evidence of follicular spongiosis (P < 0.001 and 0.003, respectively).
LIMITATIONS
Our study is limited by its retrospective design and small sample size.
CONCLUSIONS
Patients with hypopigmented macules and follicular spongiosis on histopathology may represent a distinct clinicopathological entity that is associated with lesional hair loss and follicular prominences. It is probably a variant of an endogenous dermatitis similar to pityriasis alba.
Topics: Adolescent; Adrenal Cortex Hormones; Adult; Alopecia; Biopsy; Child; Female; Hair Follicle; Humans; Hypopigmentation; Male; Retrospective Studies; Young Adult
PubMed: 30688218
DOI: 10.4103/ijdvl.IJDVL_679_17 -
Dermatology Practical & Conceptual May 2021Pagetoid spread of melanocytes in the epidermis is a common indicator of melanocytic atypia, both histopathologically and with reflectance confocal microscopy (RCM).... (Review)
Review
Pagetoid spread of melanocytes in the epidermis is a common indicator of melanocytic atypia, both histopathologically and with reflectance confocal microscopy (RCM). Specifically on RCM, large, bright, atypical dendritic and/or roundish cells are characteristic of melanoma. However, intraepidermal Langerhans cells (ILC) create the potential for diagnostic ambiguity on RCM. We describe one case of a pigmented facial lesion that was initially diagnosed as lentigo maligna (LM) due to numerous atypical perifollicular dendritic cells on RCM. Additionally, we present the findings of a literature review for similar reported cases conducted by searching the following terms on PubMed: reflectance confocal microscopy, RCM, lentigo maligna, melanoma, Langerhans cells, dendritic cells, and atypical cells. In our case, the lesion was determined to be a solar lentigo on histopathology. Immunohistochemistry (IHC) with CD1a identified the atypical-appearing cells as ILC, as it did in 54 reported cases of benign lesions (benign melanocytic nevus, Sutton/halo nevus, labial melanotic macule, and solar lentigo) misdiagnosed as malignant on RCM (melanoma, lip melanoma, lentigo maligna, and LM melanoma). According to our case and the literature, both ILC and atypical melanocytes can present with atypical-appearing dendritic and/or roundish cells under RCM. Currently, there is no method to distinguish the two without IHC. Therefore, the presence of pagetoid cells should continue to alert the confocalist of a potential neoplastic process, prompting biopsy, histopathologic diagnosis, and IHC differentiation.
PubMed: 34123568
DOI: 10.5826/dpc.1103a78 -
Journal of Nippon Medical School =... 2015Hobnail hemangioma is a small, solitary, benign vascular tumor that shows a biphasic histological pattern of dilated vascular spaces in the superficial dermis and narrow...
Hobnail hemangioma is a small, solitary, benign vascular tumor that shows a biphasic histological pattern of dilated vascular spaces in the superficial dermis and narrow vascular structures in the deeper dermis. In the superficial dermis, dilated, irregular, thin-walled vascular spaces are lined by plump endothelial cells with large nuclei which protrude into the lumina like hobnails. A 43-year-old Japanese man presented with an 11×8-mm bluish-red macule surrounding a 6×3-mm violaceous, slightly elevated papule of the lumbar region of 6 months' duration. Total resection was performed under local anesthesia. Microscopic examination revealed a biphasic pattern with dilated superficial vessels whose endothelial cells were plump with intraluminal papillary projections, showing a "hobnail" appearance, in the papillary layer and upper dermis, and vascular spaces forming slitlike spaces, some of them dissecting collagen fibers, in the deeper dermis. Neither true atypia nor mitotic figures were present. The findings were consistent with those of hobnail hemangioma. Immunohistochemical analysis of the endothelia of the superficial vessels showed that CD31 and D2-40 were expressed, factor VIII was focally expressed, and CD34 and α-SMA were not expressed. In the endothelia of the deeper vessels, CD31, CD34, factor VIII, and α-SMA were expressed, but D2-40 was not expressed. These findings suggest that hobnail hemangioma also shows a biphasic immunohistochemical pattern because of its origin from both lymphatic vessels and blood vessels.
Topics: Adult; Blood Vessels; Endothelial Cells; Hemangioma; Humans; Immunohistochemistry; Male; Platelet Endothelial Cell Adhesion Molecule-1; Vascular Neoplasms
PubMed: 26156669
DOI: 10.1272/jnms.82.151 -
Cureus Nov 2021Lichen planus pigmentosus (LPP), an uncommon variant of lichen planus (LP), is characterized by diffuse hyperpigmented dark brown macules in sun-exposed areas. We report...
Lichen planus pigmentosus (LPP), an uncommon variant of lichen planus (LP), is characterized by diffuse hyperpigmented dark brown macules in sun-exposed areas. We report an unusual case of LPP with a blaschkoid distribution in an area of radiotherapy for breast cancer. This description is rarely reported. Its pathogeny is poorly understood and suggests an embryological origin by genetic mosaicism and also discusses the immunomodulatory role of radiotherapy in the disease.
PubMed: 34987928
DOI: 10.7759/cureus.20047