Search

We report three cases of tinea nigra in children caused by Hortaea werneckii. The patients were all girls, aged 2, 2 and 3 years, respectively. All patients presented with asymptomatic brown or black rash on either one palm or both palms. Dermoscopy showed scattered or overlapping dark brown pigmented granules forming a striated or reticulated structure with clear borders and uniform color. Direct microscopic examination revealed branched, curved, brown septate hyphae. The fungal culture showed black, shiny, yeast-like colonies at early stage, and elevated irregular colonies with flocculent mycelium surrounded by a black edge after 14 days. The strain of Hortaea werneckii was identified by ITS rDNA sequencing. Diagnosis of tinea nigra was confirmed by clinical symptoms and laboratory examinations. All patients were cured with topical antifungal drugs and with no recurrence at 3 months of follow-up. [ABSTRACT FROM AUTHOR]

Background: Micronized acellular dermal matrix (mADM) can induce tissue regeneration and repair, and filling. Objectives: The efficacy and safety of (mADM) were evaluated in the treatment of atrophic acne scar. Methods: In this single‐blinded, self‐controlled, split‐face study, 16 patients (48 scar sites) were divided into treatment group (24 scar sites) and control group (24 scar sites). One side of the affected area was treated with mADM combined with platelet rich plasma (PRP) injection as the treatment group; the other side of the affected area was treated with PRP injection as the control group. The efficacy was evaluated by the Acne scar assessment scale (ASAS) and Acne Scar Weight Rating Scale (ECCA) 3 months after treatment. Results: After 3‐month treatment in 16 patients, the atrophic acne scars in both groups were all improved. The ASAS score and ECCA weight score in the treatment group was significantly lower than that in the control group (2.50 ± 0.51 vs. 3.62 ± 0.77 and 14.17 ± 10.18 vs. 31.88 ± 13.25; p < 0.001). Limitations: Short‐term 3‐month treatment period. Small sample size limits generalizability of results. Conclusion: The curative effect of mADM combined with PRP is significantly better than that of PRP alone. [ABSTRACT FROM AUTHOR]

This article discusses the case of a male infant who developed ALK-positive histiocytosis, a rare histiocytic proliferative disorder. The infant initially experienced jaundice, which resolved but then reoccurred along with other symptoms such as anemia and skin blemishes. Laboratory investigations and histological examination confirmed the diagnosis of ALK-positive histiocytosis. However, in a rare occurrence, the infant's lesions completely disappeared without any intervention during follow-up. The article highlights the variability in clinical presentation and the need for individualized treatment approaches for ALK-positive histiocytosis. [Extracted from the article]

Objective To report a case of hemophagocytic lymphohistiocytosis syndrome (HLH) secondary to systemic hydroa vacciniforme lymphoproliferative disorder (systemic HV-LPD) and review relevant literature, in order to improve understanding of the disease. Methods Clinical data of the case, laboratory examination, histopathology, immunohistochemistry, TCR gene rearrangement, and whole exon gene sequencing were collected for analyses. Results A 19 years old man was admitted to the hospital due to generalized papules, blisters, necrotic scabs and fever for 7 months. The clinical manifestations included hydroa vacciniforme-like rashes, lymphad-enopathy, splenomegaly, pancytopenia, hypertriglyceridemia, decreased NK cell activity, high levels of sIL-2r, positive for VCA-IgA and EA-IgA, and elevated EBV DNA load. The whole exon sequencing did not show pathogenic gene mutations. Histopathological changes in the skin lesions included liquefaction degeneration of epidermal and follicular basal cells, pigmentary incontinence, lymphocytic infiltrates of the epidermis and follicular epithelium, perivascular and perifollicular infiltrates of lymphocytes and eosinophils in the dermis, extravasation of erythrocytes, as well as focal infiltrates of atypical lymphoid cells around appendages and small blood vessels. Pathologic mitosis was visible. Immunohistochemistry showed CD3 (+), CD5 (+), CD20 (individual +), CD30 (small patch +), CD79a (individual +), CD4 (+), CD7 (+), CD8 (+), TIA-1 (+), CD56 (scattered lymphocyte +), ≈ 50% of Ki-67 (+), and in situ hybridization EBER (+). TCRβ gene monoclonal rearrangements were detected. According to the results of clinical and auxiliary examination, patient was diagnosed with HLH secondary to systemic HVLPD. After 8 months of follow-up, the patient passed away while waiting for transplantation of allogeneic hematopoietic stem cells. Conclusions Systemic HVLPD is rare and requires vigilance for the development of secondary hemophagocytic syndrome. The awareness of hemophagocytic syndrome should be improved to avoid possible misdiagnosis and delayed treatment. [ABSTRACT FROM AUTHOR]

Background: Nuclear pleomorphism and tumor microenvironment (TME) play a critical role in cancer development and progression. Identifying most predictive nuclei and TME features of basal cell carcinoma (BCC) may provide insights into which characteristics pathologists can use to distinguish and stratify this entity. Objectives: To develop an automated workflow based on nuclei and TME features from basaloid cell tumor regions to differentiate BCC from trichoepithelioma (TE) and stratify BCC into high‐risk (HR) and low‐risk (LR) subtypes, and to identify the nuclear and TME characteristics profile of different basaloid cell tumors. Methods: The deep learning systems were trained on 161 H&E ‐stained sections which contained 51 sections of HR‐BCC, 50 sections of LR‐BCC and 60 sections of TE from one institution (D1), and externally and independently validated on D2 (46 sections) and D3 (76 sections), from 2015 to 2022. 60%, 20% and 20% of D1 data were randomly splitted for training, validation and testing, respectively. The framework comprised four stages: tumor regions identification by multi‐head self‐attention (MSA) U‐Net, nuclei segmentation by HoVer‐Net, quantitative feature by handcrafted extraction, and differentiation and risk stratification classifier construction. Pixel accuracy, precision, recall, dice score, intersection over union (IoU) and area under the curve (AUC) were used to evaluate the performance of tumor segmentation model and classifiers. Results: MSA‐U‐Net model detected tumor regions with 0.910 precision, 0.869 recall, 0.889 dice score and 0.800 IoU. The differentiation classifier achieved 0.977 ± 0.0159, 0.955 ± 0.0181, 0.885 ± 0.0237 AUC in D1, D2 and D3, respectively. The most discriminative features between BCC and TE contained Homogeneity, Elongation, T‐T_meanEdgeLength, T‐T_Nsubgraph, S‐T_HarmonicCentrality, S‐S_Degrees. The risk stratification model can well predict HR‐BCC and LR‐BCC with 0.920 ± 0.0579, 0.839 ± 0.0176, 0.825 ± 0.0153 AUC in D1, D2 and D3, respectively. The most discriminative features between HR‐BCC and LR‐BCC comprised IntensityMin, Solidity, T‐T_minEdgeLength, T‐T_Coreness, T‐T_Degrees, T‐T_Betweenness, S‐T_Degrees. Conclusions: This framework hold potential for future use as a second opinion helping inform diagnosis of BCC, and identify nuclei and TME features related with malignancy and tumor risk stratification. [ABSTRACT FROM AUTHOR]

Diagnosis of HLP relies on its characteristic histopathological features including compact hyperkeratosis and epidermis atrophy with band-like lymphocytic infiltration in the superficial dermis.[1] HLP usually develops late in life, typically in the fourth or fifth decade. Https://doi.org/10.1093/ced/llad061 Dear Editor, Flegel disease, also known as hyperkeratosis lenticular perstans (HLP), is a rare keratinization disorder characterized by multiple asymptomatic papules predominantly distributed on the distal extremities. [Extracted from the article]

Background: Quick and accurate diagnosis of primary cutaneous amyloidosis (PCA) may be difficult because its symptoms are often subtle and nonspecific. Objective: We sought to review the literature on the roles of various staining methods in the diagnosis of amyloidosis and demonstrate added benefits of using rapid 4,6-diamidino-2-phenylindole (DAPI) staining in the diagnosis of PCA. Methods: Three groups of cases, namely, PCA, neurodermatitis, and prurigo nodularis, were retrieved from a computerized pathology database for study, and their paraffin-embedded tissue blocks were cut following standard procedures. The tissue sections were stained with three stains: hematoxylin-eosin (HE), Congo red, and DAPI stains, and examined under the microscope to compare the staining patterns of these three methods. We also performed amyloid keratin and apolipoprotein E (APOE) staining on the sections of PCA in order to further support our conclusion. The PCA sections were read by junior and senior dermatopathologists for comparison. Results: The sensitivity of DAPI staining for PCA was significantly higher than that of Congo red staining and HE staining (p < 0.001). This statement holds true whether the experiment was grouped in one sample or was divided into groups of junior and senior dermatopathologists (p < 0.001). The DAPI-positive staining areas, except for the nuclei, were consistent with the amyloid deposition areas. In this study, DAPI staining had a sensitivity of 98.6% and a specificity of 100%. Conclusion: DAPI staining could serve as a useful technique to establish the diagnosis of PCA, and its high efficacy in diagnosing PCA makes it less dependent on the experience levels of the evaluators. Additionally, the binding of DAPI to the A-T-rich sequence of double-stranded DNA suggests that amyloid may contain DNA or a similarly structured nucleic acid. [ABSTRACT FROM AUTHOR]

Verruciform xanthoma (VX) is a rare, benign lesion characterized histopathologically by epithelial papillomatous hyperplasia, local hyperkeratosis with incomplete keratosis, infiltration of foam cells and inflammatory cells in the papillary dermis. Cutaneous malakoplakia (CM) is a rare, chronic, granulomatous disease characterized histopathologically by Michaelis-Gutmann bodies (MGB). (a) Scattered infiltrating foam cells or histiocytes confined to the papillary layer of dermis; (b) the superficial lesion showed scattered infiltrating foam cells or histiocytes confined to the papillary layer of dermis. [Extracted from the article]

Buschke‐Ollendorff syndrome (BOS; OMIM 166700) is a rare autosomal dominant disorder characterized by the existence of connective tissue nevus and/or osteopoikilosis. The skin lesions usually present as firm, yellow, or flesh‐colored papules and nodules, which may coalesce into plaques and increase in size and number over time. We present a case of a 26‐year‐old male with multiple subcutaneous nodules on the waist and thigh for more than 20 years. Being deeply seated, his skin lesions were not visible and could only be appreciated by palpation. Accordingly, pathology showed an increase in thick, crossed, or paralleled, elastic fibers arranged between the collagen bundles in the lower part of the reticular dermis and the subcutaneous fat with mucin deposition. Heterozygous point mutation in exon 8 of the LEMD3 gene was detected, which confirmed the diagnosis of BOS. The deeply situated nature of skin lesions noted in our case has not been reported in the literature of BOS. Our case thus expands the clinical and pathological features of the disease. [ABSTRACT FROM AUTHOR]

We reported the successful treatment with oral methylprednisolone and cyclosporine in combination with topical wound care on a boy with pyoderma gangrenosum presenting as huge and deep ulceration on buttocks and legs. [ABSTRACT FROM AUTHOR]

Dear Editor, Poromas are uncommon, benign neoplasms derived from the terminal sweat gland ducts. Epithelial membrane antigen (EMA) locally expressed on the membrane of tumor cells, and EMA positive duct could be seen (Fig. The network-like structure and the globules or dots within the holes of grids together formed the "target network-like structure" and made the whole lesion similar to pineapple-like appearance. [Extracted from the article]

Aims: Persistent pruritic eruptions (PPEs), presenting with dyskeratotic keratinocytes histologically, are characteristic skin rash in patients with adult‐onset Still's disease (AOSD). The lesions may be histologically similar to other entities that present with dyskeratosis. In the present study, we compared the histopathological features between PPEs and other entities presenting with dyskeratosis. Methods and results: To investigate whether histopathological findings can be used to discriminate among PPEs and other entities presenting with dyskeratotic keratinocytes, cutaneous histopathological changes of PPEs associated with AOSD (n = 26) were compared with those of systemic lupus erythematosus (SLE) (n = 16), dermatomyositis (n = 19), and drug eruption (n = 16). Dyskeratosis was observed in the upper one‐third of the epidermal layer in all 26 PPEs. The rate of dyskeratosis for PPEs was higher than that for SLE (18.8%) and dermatomyositis (15.8%). In drug eruptions, the dyskeratotic cells were distributed in all levels of the epidermis. Variable densities of neutrophils were found in the dermis in all PPEs. Conclusions: Although this was a retrospective study conducted at a single centre, presentation of dyskeratotic keratinocytes in the upper one‐third of the epidermal layer is a distinctive histopathological reactive pattern of PPEs. This pattern may be a useful histopathological marker for early diagnosis of AOSD. [ABSTRACT FROM AUTHOR]

Early syphilis can rarely cause erythema multiforme-type eruptions as well as triggering erythema multiforme (EM). EM-like lesions in secondary syphilis are characterized by clinical features of EM and laboratory tests consistent with secondary syphilis and the skin histology shows predominantly a plasma cell infiltrate with the presence of treponemes. When EM is triggered by early syphilis, the skin histology shows mixed inflammatory cells usually in the absence of treponemes in the skin lesion. There may also be mixed histology with the presence of treponemes in the absence of a plasma cell infiltrate and vice versa. We describe a case of secondary syphilis presenting as EM with bullae and histology showing EM features without a plasma cell infiltrate but positive for Treponema pallidum by immunohistochemical staining. The patient was also coinfected with cytomegalovirus, human immunodeficiency virus, and anal warts. The EM eruptions resolved with treatment for secondary syphilis with benzathine penicillin G. [ABSTRACT FROM AUTHOR]

Cutaneous metastases are unusual presenting symptoms of lung cancer. Therefore, they are prone to be misdiagnosed and missed. The report describes a case of a forty-nine-year-old female with painful zosteriform rashes showing multiple vesicle-like papules localized on the left breast for 10 days. The patient had been diagnosed as lung adenocarcinoma at the department of oncology one year ago. Skin biopsy revealed blue nodular lesions in the dermis, composed of clustered heterogeneous tumor cells with glandular formation. Immunohistochemical stains confirmed the diagnosis of metastatic lung adenocarcinoma. [ABSTRACT FROM AUTHOR]

Pityriasis rubra pilaris (PRP) is a rare dermatosis that remains difficult to treat. The current therapy of PRP is based on experience from small case series and case reports.[1] A meta-analysis suggested that isotretinoin, MTX, and biological therapy were the first-line, second-line, and third-line treatments for PRP, respectively.[2] However, biologics such as infliximab, etanercept, adalimumab, ustekinumab, and secukinumab, have also been successfully used for PRP treatment.[3], [4], [5] Biologics could be a promising tool for PRP treatment. [Extracted from the article]

The article presents a case study involving a 51-year-old female, who was presented with a 10-year history of erythematous papules and plaques linked to severe pruritus. Clinical examination confirmed alopecia and erythematous, scaly papules, and plaques spread over the head, neck, trunk, and extremities. She responded suitably to methotrexate, with the initial dose of methotrexate being 10 mg per week and the maximal dose being 15 mg per week.

Onychomycosis is a rare nail disorder in early childhood, while onychomadesis is a periodic idiopathic, non-inflammatory disease that affects the nail matrix and is common in children especially in those who suffer from viral infections. In this study, we investigated recent cases of onychomycosis subsequent to periods of onychomadesis in children. Sixteen young children (six males, 10 females) with a mean age of 36.5 months were diagnosed with onychomadesis, and 13 of the patients had a history of viral infection prior to nail changes. Direct microscopy of nail scaling was positive in 11 cases (68.8%), and culture was positive in the same number of cases. Four Candida species were isolated: Candida glabrata was the most frequent, found in eight cases (72.7%), while C. albicans, C. parapsilosis and C. tropicalis, each were encountered in a single case. All children were treated successfully with or without topical bifonazole therapy. [ABSTRACT FROM AUTHOR]

Background Precancerous high-grade squamous intraepithelial lesion ( HSIL), the current consensus terminology for anogenital squamous cell carcinoma in situ ( SCCIS), often presents with distinctive histopathologic findings that may be a function of anatomic site or associated human papillomavirus infection. Methods Fifty-six specimens of anogenital HSIL were compared with an equal number of specimens of SCCIS from non-anogenital sites in regard to the presence of parakeratosis, flag sign in the stratum corneum, compact stratum corneum, hypergranulosis, koilocytes, small blue cells, clonal populations of keratinocytes, pagetoid scatter of atypical keratinocytes, clear cell change, glassy red cytoplasm, pigmentation, nuclear/cytoplasmic(N/C) ratio >2/1, nuclear hyperchromasia, pleomorphic nuclei, mitotic figures, abnormal mitotic figures, dyskeratotic keratinocytes, involvement of skin appendages, acantholysis and amyloid deposition. Results Hypergranulosis, koilocytes, small blue cells, pigmentation, nuclear hyperchromasia, dyskeratotic keratinocytes and amyloid deposition were more frequently noted in anogenital HSIL. Parakeratosis, clear cell change, pleomorphic nuclei, skin appendages involvement and acantholysis were strongly associated with non-anogenital location. There was no significant difference in the incidence of the remaining features. Conclusion The strongest predicators of an anogenital location included hypergranulosis, koilocytes, small blue cells and nuclear hyperchromasia. Pigmentation and amyloid deposition were also strongly associated with an anogenital location. [ABSTRACT FROM AUTHOR]

The article describes the case of a 45-year-old Chinese male patient with a history of asymptomatic macules on the head and face area which was diagnosed as cutaneous plasmacytosis. The results of histopathology and immunohistopathological study confirmed the diagnosis, which led physicians to prescribe prednisone, thalidomide and tacrolimus. A discussion on the history and clinical features of cutaneous plasmacytosis is offered.

A letter to the editor is presented related to high-quality digital photomicrography utilizing a smartphone without adapter.

Penile tuberculid successfully treated with anti-tuberculosis regimens Tuberculid of penis is extremely rare and easy to be misdiagnosed. Another type of tuberculid, named penile tuberculid, has been considered as a new entity, which usually shows papules, ulcerations, and scars on the penis (Dandale, Dhurat, & Ghate, [2]). [Extracted from the article]

A letter to the editor is presented which discusses a case study of a 40-year-old man who was evaluated for asymptomatic verrucous plaques in the upper gingiva and diagnosed with multiple verruciform xanthomas following his bone marrow transplantation.