32 results on '"Puri PK"'
Search Results
2. Banding pattern on polarized hair microscopic examination and unilateral polymicrogyria in a patient with steroid sulfatase deficiency.
- Author
-
Puri PK, Reddi DM, Spencer-Manzon M, Deak K, Steele SU, and Mikati MA
- Abstract
Background: Several forms of ichthyosis are associated with neurologic manifestations, including Sjögren-Larsson syndrome, Refsum disease, and mental retardation-enteropathy-deafness-neuropathy-ichthyosiskeratoderma (MEDNIK) syndrome. We report a case of X-linked steroid sulfatase deficiency, ichthyosis, seizures, abnormal hair banding pattern, and unilateral polymicrogyria. Observations: A 3-year-old Caucasian male with a history of ichthyosis since birth presented with generalized tonic seizures. Findings from a physical examination were remarkable for thin hair, retinitis pigmentosa, and poor dentition. Polarized light microscopic examination of all the hair samples demonstrated a banding pattern. Magnetic resonance imaging of the brain revealed left hemispheric polymicrogyria with decreased sulcal pattern and stable asymmetric dilation of the left lateral ventricle. Constitutional microarray revealed the typical approximately 1.5-Mb deletion of the steroid sulfatase gene. Conclusions: Steroid sulfatase deficiency is a cause of X-linked ichthyosis; however, our patient also had retinitis pigmentosa, seizures, and abnormal hair findings. The presence of abnormal hair with a banding pattern on polarized microscopy may be helpful for diagnosis; however, this pattern is not specific to this disease. In addition, to our knowledge, the presence of a malformation of cortical development has not been previously reported in patients with steroid sulfatase deficiency. [ABSTRACT FROM AUTHOR]
- Published
- 2012
3. Sinonasal carcinoma after irradiation for medulloblastoma in nevoid basal cell carcinoma syndrome.
- Author
-
Wallin JL, Tanna N, Misra S, Puri PK, and Sadeghi N
- Published
- 2007
- Full Text
- View/download PDF
4. Fontana-Masson stain in fungal infections.
- Author
-
West KL, Proia AD, and Puri PK
- Subjects
- Humans, Dermatomycoses pathology, Silver Nitrate
- Abstract
Background: Fontana-Masson (FM) staining is a histopathology technique used to identify dematiaceous fungi. The result often guides initial species identification and antifungal treatment; however, there is evidence that nondematiaceous fungi might react with this stain. Few studies in the current literature address this issue., Objective: Our aim was to classify the FM staining patterns of common fungal pathogens for use by pathologists attempting to accurately identify fungi on histopathologic examination., Methods: In total, 132 cases of culture proven mycoses were identified. We stained tissue with 2 different FM protocols and recorded the intensity and distribution of results., Results: There was variability in staining, and many nondematiaceous fungi showed positivity, including Zygomycetes, Aspergillus, and Fusarium spp., Limitations: The study was limited by the number of cases. Of 132 cases identified, 112 cases had adequate tissue left after sectioning deeper into the block., Conclusion: Nondematiaceous fungi frequently stained positive with FM. The course of treatment should not be based on the result of this stain alone. Histopathology should be examined in multiple tissue sections, and therapy should be determined on the basis of clinical context and culture results., (Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
5. Onchocerciasis.
- Author
-
Puri PK
- Subjects
- Diagnosis, Differential, Humans, Onchocerciasis pathology, Onchocerciasis diagnosis
- Published
- 2015
6. Immunohistochemical markers in fibrohistiocytic lesions: factor XIIIa, CD34, S-100 and p75.
- Author
-
West KL, Cardona DM, Su Z, and Puri PK
- Subjects
- Antigens, CD34 analysis, Diagnosis, Differential, Factor XIIIa analysis, Humans, Immunohistochemistry, Nerve Tissue Proteins analysis, Receptors, Nerve Growth Factor analysis, S100 Proteins analysis, Biomarkers, Tumor analysis, Dermatofibrosarcoma diagnosis, Histiocytoma, Benign Fibrous diagnosis, Skin Neoplasms diagnosis
- Abstract
Background: The distinction between dermatofibroma (DF), dermatofibrosarcoma protuberans (DFSP), and other benign and malignant cutaneous spindle cell lesions frequently requires immunohistochemical staining. CD34 and factor XIIIa are the most commonly used immunostains; however, they may exhibit aberrant expression and introduce the potential for misdiagnosis. There is some data supporting that p75 and S100A6 may be additional helpful immunohistochemical markers., Methods: We undertook a large case series examining the use of CD34 and factor XIIIa as well as p75 and S100A6 in DF, cellular DF, DFSP, indeterminate fibrohistiocytic lesion, and scar., Results: As expected, CD34 stained DFSP, although it was usually negative in DF. Factor XIIIa was generally positive in DF and negative in DFSP. There were exceptions in both cases of DF and DFSP. S100A6 was routinely negative in all entities studied. P75 was negative in all cases except DFSP, approximately half of which showed weak and/or patchy positivity., Conclusions: We conclude that to date, CD34 and factor XIIIa remain the most reliable immunohistochemical markers for DF and DFSP.
- Published
- 2014
- Full Text
- View/download PDF
7. Review of neoplastic mimics in dermatopathology, by mark R. Wick and james w. Patterson.
- Author
-
Puri PK and Hurt MA
- Published
- 2013
- Full Text
- View/download PDF
8. The future of dermatopathology.
- Author
-
Puri PK, Somani N, Roehmholdt BF, Pollack B, Winfield H, and Knopp E
- Subjects
- Humans, Dermatology trends, Pathology, Clinical trends
- Published
- 2013
- Full Text
- View/download PDF
9. Scleroderma and IgG4-related disease.
- Author
-
Reddi DM, Cardona DM, Burchette JL, and Puri PK
- Subjects
- Adult, Aged, Aged, 80 and over, Biomarkers analysis, Biopsy, Female, Fibrosis, Humans, Immunohistochemistry, Male, Middle Aged, Retrospective Studies, Scleroderma, Systemic pathology, Skin pathology, Young Adult, Immunoglobulin G analysis, Plasma Cells immunology, Scleroderma, Systemic immunology, Skin immunology
- Abstract
IgG4-related disease is a syndrome which involves lymphoplasmacytic infiltrates and soft tissue sclerosis, elevated serum IgG4 titer, and increased IgG4-positive plasma cells in a variety of tissues. Scleroderma is also characterized by fibrosis and lymphoplasmacytic infiltrates. To our knowledge, the presence of IgG4-positive cells has not been well characterized in scleroderma. A retrospective review of scleroderma and related disorders (calcinosis, raynaud's syndrome, esophageal dysmotility, sclerodactyly, telangiectasia (CREST) syndrome, progressive systemic sclerosis, morphea) was performed. Thirty-four cases of scleroderma and related disorders were identified; IgG4-positive and IgG-positive plasma cells were counted in 10 HPF and an IgG4:IgG ratio determined. A cutoff ratio of 0.3 was used to define significant elevation. Three of the scleroderma cases had IgG4:IgG greater than 0. Only 1 case had a significant elevation. Of the 3 cases with elevated ratio, IgG4-positive cells ranged from 2 to 64 (median = 14), with an IgG4:IgG ranging from 0.06 to 0.34 (median = 0.22). Similar results were produced with the other sclerosing disorders. These results suggest that scleroderma is not part of the IgG4-related disease spectrum.
- Published
- 2013
- Full Text
- View/download PDF
10. Verruciform xanthoma of the earlobe in an immunosuppressed patient.
- Author
-
Aldabagh B, Al-Dabagh A, Usmani AS, and Puri PK
- Subjects
- Aged, Body Piercing, Ear, External, Female, Histiocytes metabolism, Humans, Immunocompromised Host, Skin Diseases pathology, Xanthomatosis pathology
- Abstract
Verruciform xanthoma (VX) is an uncommon mucocutaneous lesion of uncertain etiology. Originally thought to be limited to the oral mucosa, its occurrence in other mucosal and nonmucosal sites also has been documented. Histologically, VX is characterized by subepithelial foamy histiocytes associated with papillomatosis, parakeratosis, and dyskeratosis. Subepithelial foamy cells are lipid-containing, non-Langerhans cell histiocytes. A variety of etiologies have been proposed without much consensus, including infectious (bacterial, viral, and fungal), degenerative, reactive/ reparative, inflammatory, metabolic, reactive/ multifactorial, and immunosuppressive factors. Verruciform xanthoma of the external ear is exceedingly rare. Herein, we report a rare case of VX occurring on the earlobe at a piercing site in an immunosuppressed patient and provide a discussion of the possible pathogenetic mechanism(s).
- Published
- 2013
11. Expression of focal TTF-1 expression in a case of CK7/CK20-positive Merkel cell carcinoma.
- Author
-
Reddi DM and Puri PK
- Subjects
- Aged, 80 and over, Carcinoma, Merkel Cell metabolism, Carcinoma, Merkel Cell therapy, Combined Modality Therapy, Humans, Male, Skin Neoplasms metabolism, Skin Neoplasms therapy, Transcription Factors, Biomarkers, Tumor metabolism, Carcinoma, Merkel Cell pathology, DNA-Binding Proteins metabolism, Keratin-20 metabolism, Keratin-7 metabolism, Skin Neoplasms pathology
- Published
- 2013
- Full Text
- View/download PDF
12. Vulvar vascular tumors: a clinicopathologic study of 85 patients.
- Author
-
Papalas JA, Sangueza OP, Puri PK, Robboy SJ, and Selim MA
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Biopsy, Child, Child, Preschool, Dilatation, Pathologic, Female, Humans, Hyperplasia, Infant, Middle Aged, Neoplasms, Vascular Tissue classification, Neoplasms, Vascular Tissue surgery, Predictive Value of Tests, Prognosis, Stromal Cells pathology, Time Factors, Vascular Malformations classification, Vascular Malformations pathology, Vulvar Neoplasms classification, Vulvar Neoplasms surgery, Young Adult, Neoplasms, Vascular Tissue pathology, Vulvar Neoplasms pathology
- Abstract
The subepidermal hormonally sensitive tissue of the vulva is anatomically unique and may give rise to a wide variety of vascular tumors. As a consequence, classifying vulvar vascular lesions has been challenging due both to the wide variety of lesions that may be encountered and the heterogeneity in reporting across several disciplines. The purpose of this study is to present an institutional experience of vulvar vascular lesions. Overall, 85 patients were identified over a 26-year period. Vascular lesions belonging to the following classes included (n, %total) benign vascular tumors (32, 38%), dilatations of preexisting vessels (31, 36%), hyperplasia/reactive (7, 8%), tumors with significant vascular component (11, 13%), malformations (3, 4%), and malignant vascular tumors (1, 1%). Two reaction patterns based on vulvar lymphatic pathology were identified: one is a stromal dominant pattern and the other is a vascular dominant pattern. Vulvar vascular malformations and true vascular malignancies, although rare, may have associated high morbidity. To accurately classify vulvar lymphatic lesions, the pathologist must carefully consider the patient's clinical history taking into account features such as preexisting lymphedema.
- Published
- 2013
- Full Text
- View/download PDF
13. Leukocytoclastic vasculitis as the presenting feature of dermatitis herpetiformis.
- Author
-
Naylor E, Atwater A, Selim MA, Hall R, and Puri PK
- Subjects
- Biopsy, Dermatitis Herpetiformis diet therapy, Dermatitis Herpetiformis immunology, Diet, Gluten-Free, Fluorescent Antibody Technique, Direct, Humans, Male, Middle Aged, Transglutaminases immunology, Vasculitis, Leukocytoclastic, Cutaneous etiology, Vasculitis, Leukocytoclastic, Cutaneous immunology, Dermatitis Herpetiformis diagnosis, Immunoglobulin A immunology, Vasculitis, Leukocytoclastic, Cutaneous diagnosis
- Abstract
Background: Dermatitis herpetiformis is an autoimmune disease typically characterized by pruritic vesicles located on the extensor surfaces. Classic disease consists of neutrophils in the dermal papillae. Additional histopathologic findings include fibrin deposition and edema within the dermal papillae. Subepidermal vesicles also may be present. Direct immunofluorescence demonstrates granular IgA in the dermal papillae., Observations: A 58-year-old man with tender and pruritic erythematous macules and papules ranging from 2 to 6 mm in diameter had bilateral knee, elbow, forearm, scalp, and neck involvement. Petechiae also were present on the hands, thigh, knee, and ankle. A biopsy specimen initially demonstrated leukocytoclastic vasculitis. The results of workup for systemic vasculitis were negative. Subsequent biopsy specimens and direct immunofluorescence showed histologic evidence of dermatitis herpetiformis and leukocytoclastic vasculitis in the setting of an elevated serum IgA antitissue transglutaminase level. Marked improvement of the lesions was observed with a reduction of gluten in the patient's diet., Conclusions: Physicians should consider the possibility of dermatitis herpetiformis in patients with petechiae and leukocytoclastic vasculitis because leukocytoclastic vasculitis may be a prominent feature of dermatitis herpetiformis.
- Published
- 2011
- Full Text
- View/download PDF
14. Cutaneous alternariosis microscopically mimicking blastomycosis.
- Author
-
Osmond GW, Walters RW, and Puri PK
- Subjects
- Alternariosis drug therapy, Alternariosis microbiology, Antifungal Agents therapeutic use, Combined Modality Therapy, Dermatologic Surgical Procedures, Diagnosis, Differential, Humans, Immunocompromised Host, Immunosuppressive Agents adverse effects, Knee, Male, Middle Aged, Pyrimidines therapeutic use, Skin microbiology, Skin pathology, Triazoles therapeutic use, Voriconazole, Alternaria isolation & purification, Alternariosis diagnosis, Blastomycosis diagnosis
- Abstract
A 57-year-old man status post several myocardial infarcts and heart transplantation presented with a slowly growing violaceous plaque on his lateral left knee at the site of prior minor trauma. A biopsy revealed a suppurative dermatitis with associated pseudocarcinomatous epithelial hyperplasia. There were multiple non-pigmented eosinophilic organisms with clear cytoplasmic halos within the infiltrate. A methenamine silver stain showed round to ovoid organisms of slightly variable size. Rare uni-polar budding, some of which was broad based, was apparent. A few short hyphae with indeterminate septa were also noted. Fontana-Masson, mucicarmine, Alcian blue and Fite stains were all negative. These findings suggested a diagnosis of blastomycosis. However, a fungal culture grew colonies of Alternaria species. Alternariosis has been previously shown to possess morphologic characteristics that can simulate other fungal infections. To our knowledge, a striking similarity to blastomycosis, as seen in our case, has not been previously reported. Dermatopathologists should be aware that alternariosis may mimic blastomycosis, especially when hyphal forms are rare or absent in tissue specimens. Culture is necessary for definitive classification., (Copyright © 2011 John Wiley & Sons A/S.)
- Published
- 2011
- Full Text
- View/download PDF
15. Primary cutaneous, composite, Epstein-Barr virus-associated, diffuse large B-cell lymphoma and peripheral T-cell lymphoma.
- Author
-
Papalas JA, Puri PK, Sebastian S, and Wang E
- Subjects
- Humans, Klinefelter Syndrome complications, Lymphoma, Large B-Cell, Diffuse virology, Lymphoma, T-Cell, Peripheral virology, Male, Middle Aged, Neoplasms, Multiple Primary virology, Skin Neoplasms virology, Epstein-Barr Virus Infections pathology, Lymphoma, Large B-Cell, Diffuse pathology, Lymphoma, T-Cell, Peripheral pathology, Neoplasms, Multiple Primary pathology, Skin Neoplasms pathology
- Abstract
T-cell lymphomas have a broad spectrum of cutaneous involvement. Several subtypes of T-cell lymphomas are associated with Epstein-Barr virus (EBV)-driven lymphoproliferative processes. We present a case of a composite, primary, cutaneous, EBV-associated, diffuse, large B-cell lymphoma and mature T-cell lymphoma occurring in a patient with Klinefelter karyotype (47, XXY). The patient had a characteristic clinical course of a systemic mature T-cell lymphoma before the presentation of the composite, primary, EBV-associated, diffuse, large B-cell lymphoma. Although similar cases have been described in extracutaneous locations, we believe that this is the first description with a primary cutaneous presentation.
- Published
- 2011
- Full Text
- View/download PDF
16. Evaluation of 39 cases of pediatric cutaneous head and neck melanoma.
- Author
-
Tcheung WJ, Marcello JE, Puri PK, Abernethy AP, and Nelson KC
- Subjects
- Academic Medical Centers, Adolescent, Age Distribution, Child, Cohort Studies, Combined Modality Therapy, Disease-Free Survival, Female, Head and Neck Neoplasms pathology, Head and Neck Neoplasms therapy, Humans, Incidence, Male, Melanoma therapy, Neoplasm Invasiveness pathology, Neoplasm Staging, North Carolina epidemiology, Prognosis, Registries, Retrospective Studies, Risk Assessment, Sentinel Lymph Node Biopsy methods, Sex Distribution, Skin Neoplasms therapy, Survival Analysis, Head and Neck Neoplasms epidemiology, Melanoma epidemiology, Melanoma pathology, Sentinel Lymph Node Biopsy statistics & numerical data, Skin Neoplasms mortality, Skin Neoplasms pathology
- Abstract
Background: Studies examining head and neck (H&N) melanoma in the pediatric population are scarce., Objective: The goal of this study is to describe pediatric H&N melanoma with the intent of increasing understanding of the course of disease., Methods: The Duke Melanoma Database and Duke Tumor Registry Database were searched for patients with a diagnosis of melanoma occurring on the H&N before age 18 years, with exclusion of ocular/mucosal/aerodigestive melanomas., Results: Queries yielded 39 Caucasian pediatric patients, 24 (61.5%) of them male. The mean age at diagnosis was 14.2 years (15 years, median). The primary sites were represented as follows: cutaneous auricular (1/39, 2.6%), facial (15/39, 38.5%), and scalp/neck (23/39, 59%). The follow-up time ranged from 2 months to 23 years with a median of 9.9 years (95% confidence interval: 6.2-13 years). At the time of follow-up, there were 12 (12/39, 30.8%) melanoma-associated deaths. The anatomic distribution of primary melanoma for these 12 patients follows: 4 (33.3%) facial and 8 (66.7%) scalp/neck. Histologic data revealed 24 (61.5%) tumors classified as superficial spreading melanoma with nodular melanoma (12.8%) a distant second. The mean Breslow depth for patients with melanoma-related mortality was 2.4 mm, compared with 1.8 mm for those who were alive at last follow-up., Limitations: Small sample size limited this study., Conclusion: This study found that the majority (59%) of H&N melanomas presented as scalp or neck lesions with a predilection for adolescents and boys. Those who experienced melanoma-related mortality had thicker lesions. Superficial spreading melanoma was the most common subtype., (Copyright © 2010 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
17. Lesions of the lacrimal caruncle with an emphasis on oncocytoma.
- Author
-
Kapil JP, Proia AD, and Puri PK
- Subjects
- Diagnosis, Differential, Adenoma, Oxyphilic pathology, Lacrimal Apparatus Diseases pathology
- Abstract
Lesions of the lacrimal caruncle vary widely due to its unique composition. Rarely, dermatologists and dermatopathologists encounter biopsies taken from this location. The aims of this study were to (1) retrospectively review caruncular lesions of the eye examined at Duke University Medical Center and (2) review the literature associated with caruncle pathology with emphasis on oncocytoma. A retrospective search of all lesions of the caruncle examined at Duke University Medical Center from 1991 to 2009 was performed. Fifty-nine lesions of the caruncle were identified. Nevi (40.7%) were the most common lesions observed, although squamous papillomas were the second most common entity (8.5%). Three oncocytomas were identified (5.1%), and were the next most common lesion present at this body site. These 3 entities represented 54.3% of the lesions found in the caruncle. Fifteen percent of the caruncular biopsies contained malignant or borderline malignant lesions, whereas the remaining 85% were benign entities. Most lesions present in the caruncle are benign. Although relatively rare, oncocytomas may be encountered by the dermatopathologist and may be confused for other neoplasms. Oncocytomas should be considered in the differential diagnosis based on this location in addition to histopathologic features.
- Published
- 2011
- Full Text
- View/download PDF
18. Statistical analysis of the concordance of immunohistochemical stains with the final diagnosis in spitzoid neoplasms.
- Author
-
Puri PK, Ferringer TC, Tyler WB, Wilson ML, Kirchner HL, and Elston DM
- Subjects
- Cell Cycle Proteins biosynthesis, Diagnosis, Differential, Eosine Yellowish-(YS), Hematoxylin, Humans, Ki-67 Antigen biosynthesis, Melanoma diagnosis, Nevus, Epithelioid and Spindle Cell classification, Nevus, Epithelioid and Spindle Cell metabolism, Reproducibility of Results, S100 Calcium Binding Protein A6, S100 Proteins biosynthesis, Skin Neoplasms classification, Skin Neoplasms metabolism, Staining and Labeling, Biomarkers, Tumor analysis, Immunohistochemistry, Nevus, Epithelioid and Spindle Cell diagnosis, Skin Neoplasms diagnosis
- Abstract
Introduction: The classification of spitzoid melanocytic tumors can be difficult, and pathologists rely on both histological features and clinical information to arrive at a diagnosis. We proposed that an immunohistochemical panel could be useful in classifying these neoplasms and designed a study to test the independent contribution of the panel to the final diagnosis., Methods: We identified 121 cases previously signed out either as (1) Spitz nevus, (2) atypical spitzoid neoplasm, favor Spitz nevus, (3) atypical spitzoid neoplasm of uncertain malignant potential, (4) atypical spitzoid neoplasm, favor melanoma, and (5) spitzoid melanoma. The slides were reveiwed in random order by 4 pathologists. For the first review, the pathologists received only hematoxylin and eosin sections and patient age. Subsequently, the same pathologists interpreted the immunohistochemically stained slides (S-100A6, HMB-45, and MIB-1) on the same cases in randomized order without the benefit of either hematoxylin and eosin sections or patient age. The original diagnosis (based on a combination of clinical information, hematoxylin and eosin-stained sections and immunohistochemical stains) was the gold standard used for statistical analysis. The primary aim of the study was to determine the level of agreement between interpretions based on hematoxylin and eosin sections and age, the immunostains alone, and the gold standard, thus providing a measurement of the degree to which each of these elements contributes to the final diagnosis. The agreement between the gold standard and external review was also determined for those cases sent for external review., Results: The generalized kappa statistic was 0.95 for both the hematoxylin and eosin-stained slides alone and the immunohistochemical stains alone, implying a high level of agreement among the 4 pathologists. The combined weighted kappa statistic for the comparison of hematoxylin and eosin sections and patient age to the gold standard was 0.49, and for the immunohistochemically stained slides to the gold standard 0.48, indicating that a diagnosis based on hematoxylin and eosin sections alone or immunostains alone show only a moderate and similar level of agreement with the gold standard diagnosis. Only the most controversial cases were sent for external review. The weighted kappa statistic estimate was 0.30 for the gold standard diagnosis on those cases and the external review., Conclusions: Spitzoid neoplasms remain a difficult area in dermatopathology and experts frequently disagree on the most challenging cases. An immunohistochemical panel contributes to the diagnosis of spitzoid tumors, and the contribution is statistically similar to that of hematoxylin and eosin sections and age. Interpretation remains subjective, as evidenced by the comparison of the gold standard and external review.
- Published
- 2011
- Full Text
- View/download PDF
19. The staining pattern of pigmented spindle cell nevi with S100A6 protein.
- Author
-
Puri PK, Elston CA, Tyler WB, Ferringer TC, and Elston DM
- Subjects
- Female, Humans, Nevus, Spindle Cell metabolism, S100 Calcium Binding Protein A6, Skin Neoplasms metabolism, Biomarkers, Tumor analysis, Cell Cycle Proteins metabolism, Nevus, Spindle Cell diagnosis, S100 Proteins metabolism, Skin Neoplasms diagnosis
- Abstract
Background: Spitz nevi typically show strong diffuse staining with S100A6, whereas staining in melanomas is commonly patchy and weak. To our knowledge, S100A6 has not been studied in pigmented spindle cell nevus (PSCN), considered by many to be a variant of Spitz nevus., Methods: Forty-six archived PSCNs were stained with S100A6 and then categorized by predominant cell size and staining pattern., Results: Eighteen (55%) of the small cell predominant nevi showed patchy staining, eight showed diffuse staining and seven were negative for S100A6. Two predominantly large-celled 'PSCNs' were diffusely positive and had many histopathological attributes of classical Spitz nevi. On review, these two cases were reclassified as Spitz nevi and excluded from the remainder of this study. Of the nevi with mixed cell size, one had no expression of S100A6. In the remaining tumors, the small cells showed patchy staining in eight (80%) and diffuse staining in two (20%). The large cells showed patchy staining in four (40%) and diffuse staining in six (60%)., Conclusion: In contrast to the strong diffuse S100A6 staining typical of Spitz nevi, the small spindle cells of PSCN commonly show patchy staining or fail to stain completely. In melanocytic neoplasms composed of small spindle cells, patchy S100A6 staining should not be interpreted as evidence of supporting a diagnosis of melanoma., (Copyright © 2010 John Wiley & Sons A/S.)
- Published
- 2011
- Full Text
- View/download PDF
20. Regional squamous cell carcinomas following systemic sorafenib therapy and isolated limb infusion for regionally advanced metastatic melanoma of the limb.
- Author
-
Raymond AK, Puri PK, Selim MA, Tyler DS, and Nelson KC
- Subjects
- Aged, Antineoplastic Agents administration & dosage, Benzenesulfonates administration & dosage, Carcinoma, Squamous Cell diagnosis, Drug Administration Routes, Follow-Up Studies, Humans, Leg, Male, Melanoma secondary, Neoplasm Metastasis, Niacinamide analogs & derivatives, Phenylurea Compounds, Pyridines administration & dosage, Receptors, Vascular Endothelial Growth Factor, Skin Neoplasms diagnosis, Sorafenib, Antineoplastic Agents adverse effects, Benzenesulfonates adverse effects, Carcinoma, Squamous Cell chemically induced, Melanoma drug therapy, Pyridines adverse effects, Skin Neoplasms chemically induced
- Published
- 2010
- Full Text
- View/download PDF
21. Neuronal ceroid lipofuscinosis diagnosed via skin biopsy.
- Author
-
Puri PK, Leilani Valdes C, Angelica Selim M, and Bentley RC
- Subjects
- Biopsy, Brain physiopathology, Child, Preschool, Electroencephalography, Epilepsy etiology, Humans, Magnetic Resonance Imaging, Male, Microscopy, Electron, Transmission, Neuronal Ceroid-Lipofuscinoses complications, Eccrine Glands ultrastructure, Inclusion Bodies ultrastructure, Neuronal Ceroid-Lipofuscinoses diagnosis, Skin ultrastructure
- Abstract
We aim to report that skin biopsy, a non-invasive test by neurological standards, may lead to a diagnosis. A 4-year-old male presented with a 2-year history of epilepsy and progressive developmental regression. The patient had a mildly elevated ammonia level; however, evaluation for the accumulation of excess serum amino acids and evaluation of urine for organic acids was negative. MRI revealed cerebral atrophy, and an electroencephalogram demonstrated multifocal sharp and slow waves. Due to the progressive degenerative neurologic presentation, a neurologic storage disease was favored. An axillary skin biopsy was performed, revealing eosinophilic intra-cytoplasmic inclusions within the eccrine glands. A periodic acid-Schiff stain also highlighted these inclusions. Electron microscopic studies demonstrated characteristic multiple membrane-bound inclusions within the eccrine epithelial cells, containing curvilinear inclusion material characteristic of neuronal ceroid lipofuscinosis. The clinical, histological, electron microscopic and enzymatic studies were diagnostic of late-infantile onset neuronal ceroid lipofuscinosis., (Copyright © 2010 Elsevier Ltd. All rights reserved.)
- Published
- 2010
- Full Text
- View/download PDF
22. Cutaneous metastatic cholangiocarcinoma: a report of three cases and review of the literature.
- Author
-
West KL, Selim MA, and Puri PK
- Subjects
- Carcinoma pathology, Carcinoma therapy, Female, Humans, Maxillary Sinus Neoplasms pathology, Maxillary Sinus Neoplasms therapy, Middle Aged, Neoplasm Metastasis, Skin Neoplasms therapy, Time Factors, Neoplasm Recurrence, Local, Skin Neoplasms pathology, Skin Neoplasms secondary
- Abstract
Cutaneous metastasis from cholangiocarcinoma is an extremely rare event. Herein, we present three cases with review of the literature. Case 1 is that of a young female with scalp metastasis. Cases 2 and 3 involve cutaneous metastasis to the sites of prior biliary drains, one occurring in a young female with a history of multiple biliary surgeries and one in a male with a history of sclerosing cholangitis. Review of the literature shows that the presentation of cutaneous metastases from cholangiocarcinoma can vary in terms of anatomic location and clinical features. The pathological and immunohistochemical profile of metastatic cholangiocarcinoma can be non-specific, and accurate diagnosis relies in part on clinical correlation. In summary, metastatic disease should always be included in the differential diagnosis of cutaneous lesions in patients with known malignancy., (Copyright © 2010 John Wiley & Sons A/S.)
- Published
- 2010
- Full Text
- View/download PDF
23. Accurate identification of proliferative index in melanocytic neoplasms with Melan-A/Ki-67 double stain.
- Author
-
Puri PK, Valdes CL, Burchette JL, Grichnik JM, Turner JW, and Selim MA
- Subjects
- Biomarkers, Tumor metabolism, Cell Proliferation, Humans, Immunoenzyme Techniques methods, Lymph Nodes pathology, MART-1 Antigen, Melanoma metabolism, Melanoma secondary, Nevus, Epithelioid and Spindle Cell metabolism, Retrospective Studies, Skin Neoplasms metabolism, Antigens, Neoplasm metabolism, Ki-67 Antigen metabolism, Melanocytes pathology, Melanoma diagnosis, Neoplasm Proteins metabolism, Nevus, Epithelioid and Spindle Cell diagnosis, Skin Neoplasms diagnosis
- Published
- 2010
- Full Text
- View/download PDF
24. CD4/CD8 double negative pagetoid reticulosis: a case report and literature review.
- Author
-
Mourtzinos N, Puri PK, Wang G, and Liu ML
- Subjects
- Adult, Antigens, CD immunology, Biomarkers, Tumor immunology, CD4-Positive T-Lymphocytes pathology, CD8-Positive T-Lymphocytes pathology, Humans, Immunohistochemistry, Immunophenotyping, Male, Pagetoid Reticulosis pathology, Pagetoid Reticulosis radiotherapy, Skin Neoplasms pathology, Skin Neoplasms radiotherapy, Treatment Outcome, CD4-Positive T-Lymphocytes immunology, CD8-Positive T-Lymphocytes immunology, Pagetoid Reticulosis immunology, Skin Neoplasms immunology
- Abstract
Pagetoid reticulosis is an indolent primary cutaneous T-cell lymphoma. It typically presents as a solitary and slowly growing patch or plaque on the extremity, histologically characterized by an acanthotic epidermis infiltrated with atypical lymphocytes. Here, we present histological, immunophenotypical and molecular findings of a 29-year-old Jamaican man with bilateral wrist plaques. Histology showed marked acanthosis, hyperkeratosis and an intraepidermal infiltration consisting of large atypical lymphocytes. Immunohistochemical stains showed CD3 and CD5 positive T cells with significant loss of CD7, double negative CD4 and CD8 and strong positive CD30. Molecular analysis showed a monoclonal T-cell receptor (TCR) gamma gene rearrangement. Review of the literature confirms that the immunophenotype of pagetoid reticulosis is variable with decreasing frequency of CD8+ cytotoxic/suppressor T cell, CD4+ helper T cell and least commonly CD4/CD8 double negative phenotypes. Although CD4/CD8 double negative phenotype appears to be associated with higher proliferation index, it does not appear to confer prognostic significance.
- Published
- 2010
- Full Text
- View/download PDF
25. Trichothiodystrophy with dysmyelination and central osteosclerosis.
- Author
-
Harreld JH, Smith EC, Prose NS, Puri PK, and Barboriak DP
- Subjects
- Child, Preschool, Demyelinating Diseases diagnosis, Humans, Magnetic Resonance Imaging, Male, Osteosclerosis diagnosis, Demyelinating Diseases complications, Osteosclerosis complications, Trichothiodystrophy Syndromes complications
- Abstract
Trichothiodystrophy (TTD) is a rare group of autosomal recessive disorders of DNA repair unified by the presence of sulfur-deficient brittle hair. We report a 3-year-old boy with classic clinical features of TTD, including ichthyosis, alopecia, developmental delay, and tiger-tail banding of the hair shaft on polarizing microscopy. Brain MR imaging showed both diffuse dysmyelination and osteosclerosis, findings that, in combination, may be specific for TTD.
- Published
- 2010
- Full Text
- View/download PDF
26. Neurofibroma with clear cell change.
- Author
-
Puri PK, Tyler WB, and Ferringer TC
- Subjects
- Diagnosis, Differential, Humans, Immunohistochemistry, Male, Middle Aged, Neurofibroma metabolism, Nevus pathology, Skin Neoplasms metabolism, Neurofibroma pathology, Skin Neoplasms pathology
- Abstract
Cutaneous clear cell proliferations and degenerative change have been seen in a variety of entities including nevi, dermatofibromas, fibrous papules, atypical fibroxanthomas, basal cell carcinomas, and squamous cell carcinomas, to name a few. However, there have been no reports of clear cells within neurofibromas. We received a biopsy and excision from a 61-year-old man with a papule on his right lateral clavicle. The initial biopsy showed a proliferation of clear cells that stained positive with S-100 and focally with CD68. A clear cell granular cell tumor was favored. Subsequent excision showed the same population of clear cells as seen on the initial biopsy. Interestingly, a neurofibroma was also present immediately beneath the clear cells with areas of transition. A p75 stain highlighted both populations of cells. This is the first case of neurofibroma with clear cells reported in the literature. We postulate that the clear cells are due to degenerative change.
- Published
- 2009
- Full Text
- View/download PDF
27. Check Sample Abstracts.
- Author
-
Alter D, Grenache DG, Bosler DS, Karcher RE, Nichols J, Rajadhyaksha A, Camelo-Piragua S, Rauch C, Huddleston BJ, Frank EL, Sluss PM, Lewandrowski K, Eichhorn JH, Hall JE, Rahman SS, McPherson RA, Kiechle FL, Hammett-Stabler C, Pierce KA, Kloehn EA, Thomas PA, Walts AE, Madan R, Schlesinger K, Nawgiri R, Bhutani M, Kanber Y, Abati A, Atkins KA, Farrar R, Gopez EV, Jhala D, Griffin S, Jhala K, Jhala N, Bentz JS, Emerson L, Chadwick BE, Barroeta JE, Baloch ZW, Collins BT, Middleton OL, Davis GG, Haden-Pinneri K, Chu AY, Keylock JB, Ramoso R, Thoene CA, Stewart D, Pierce A, Barry M, Aljinovic N, Gardner DL, Barry M, Shields LB, Arnold J, Stewart D, Martin EL, Rakow RJ, Paddock C, Zaki SR, Prahlow JA, Stewart D, Shields LB, Rolf CM, Falzon AL, Hudacki R, Mazzella FM, Bethel M, Zarrin-Khameh N, Gresik MV, Gill R, Karlon W, Etzell J, Deftos M, Karlon WJ, Etzell JE, Wang E, Lu CM, Manion E, Rosenthal N, Wang E, Lu CM, Tang P, Petric M, Schade AE, Hall GS, Oethinger M, Hall G, Picton AR, Hoang L, Imperial MR, Kibsey P, Waites K, Duffy L, Hall GS, Salangsang JA, Bravo LT, Oethinger MD, Veras E, Silva E, Vicens J, Silva E, Keylock J, Hempel J, Rushing E, Posligua LE, Deavers MT, Nash JW, Basturk O, Perle MA, Greco A, Lee P, Maru D, Weydert JA, Stevens TM, Brownlee NA, Kemper AE, Williams HJ, Oliverio BJ, Al-Agha OM, Eskue KL, Newlands SD, Eltorky MA, Puri PK, Royer MC, Rush WL, Tavora F, Galvin JR, Franks TJ, Carter JE, Kahn AG, Lozada Muñoz LR, Houghton D, Land KJ, Nester T, Gildea J, Lefkowitz J, Lacount RA, Thompson HW, Refaai MA, Quillen K, Lopez AO, Goldfinger D, Muram T, and Thompson H
- Abstract
The following abstracts are compiled from Check Sample exercises published in 2008. These peer-reviewed case studies assist laboratory professionals with continuing medical education and are developed in the areas of clinical chemistry, cytopathology, forensic pathology, hematology, microbiology, surgical pathology, and transfusion medicine. Abstracts for all exercises published in the program will appear annually in AJCP.
- Published
- 2009
- Full Text
- View/download PDF
28. The histopathology of Phthirus pubis.
- Author
-
Puri PK, House NS, Williams L, and Elston D
- Subjects
- Aged, Animals, Humans, Hypertension complications, Hyperthyroidism complications, Lice Infestations complications, Lice Infestations pathology, Male, Pruritus etiology, Pulmonary Disease, Chronic Obstructive complications, Phthirus, Skin Diseases, Infectious pathology
- Published
- 2009
- Full Text
- View/download PDF
29. Hydroxychloroquine-induced hyperpigmentation: the staining pattern.
- Author
-
Puri PK, Lountzis NI, Tyler W, and Ferringer T
- Subjects
- Aged, Antacids therapeutic use, Anti-Inflammatory Agents therapeutic use, Anti-Inflammatory Agents, Non-Steroidal therapeutic use, Anti-Ulcer Agents therapeutic use, Arthritis, Rheumatoid complications, Arthritis, Rheumatoid drug therapy, Aspirin therapeutic use, Atorvastatin, Calcium Carbonate therapeutic use, Cardiomyopathy, Restrictive complications, Citalopram therapeutic use, Connective Tissue Diseases drug therapy, Diuretics therapeutic use, Female, Furosemide therapeutic use, Glucosamine therapeutic use, Heptanoic Acids therapeutic use, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Lupus Erythematosus, Systemic complications, Lupus Erythematosus, Systemic drug therapy, Magnesium therapeutic use, Metolazone therapeutic use, Middle Aged, Naproxen therapeutic use, Omeprazole therapeutic use, Potassium Chloride therapeutic use, Prednisone therapeutic use, Pyrroles therapeutic use, Selective Serotonin Reuptake Inhibitors therapeutic use, Spironolactone therapeutic use, Antirheumatic Agents adverse effects, Hydroxychloroquine adverse effects, Hyperpigmentation chemically induced
- Abstract
We report two cases of hydroxychloroquine-induced hyperpigmentation presenting in a 50-year-old Caucasian female (case 1) and a 78-year-old female (case 2), both receiving 400 mg per day. Case 1 had an arthritis predominant undifferentiated connective tissue disease, which was treated with hydroxychloroquine for 4-5 years. She presented with a mottled, reticulated macular gray pigmentation involving the upper back and shoulders. Case 2 had a history of systemic lupus erythematosus and rheumatoid arthritis, treated with hydroxychloroquine for 1.5 years. She presented to the hospital for treatment of constrictive cardiomyopathy and was noted to have a blue macular pigmentation involving the right temple. The biopsies from both patients showed superficial dermal, yellow-brown, non-refractile and coarsely granular pigment deposition. A Fontana-Masson stain highlighted some of these granules, while the Perl's iron stain was negative. Rare, previous reports of hyperpigmentation indicate the presence of both melanin and hemosiderin in patients being treated with antimalarial medication. To our knowledge, this staining pattern for hydroxychloroquine has not been previously reported in the literature and supports that hydroxychloroquine, in addition to chloroquine, binds to melanin.
- Published
- 2008
- Full Text
- View/download PDF
30. S100 A6 immunohistochemical staining for spindle cell and desmoplastic melanomas.
- Author
-
Puri PK, Forman SB, Ferringer T, and Elston D
- Subjects
- Humans, Immunohistochemistry, Biomarkers, Tumor analysis, Melanoma metabolism, S100 Proteins metabolism, Skin Neoplasms metabolism
- Published
- 2008
- Full Text
- View/download PDF
31. Metastatic cutaneous carcinoid tumor mimicking an adnexal poroid neoplasm.
- Author
-
Puri PK, Galan A, Glusac EJ, and Cowper SE
- Subjects
- Biomarkers, Tumor analysis, Carcinoid Tumor chemistry, Carcinoid Tumor secondary, Carcinoid Tumor surgery, Diagnosis, Differential, Humans, Male, Middle Aged, Skin Neoplasms chemistry, Skin Neoplasms surgery, Adenoma, Sweat Gland diagnosis, Apocrine Glands pathology, Carcinoid Tumor diagnosis, Skin Neoplasms diagnosis, Sweat Gland Neoplasms diagnosis
- Abstract
Objective: Metastatic cutaneous neoplasms may be difficult to differentiate from primary cutaneous neoplasms. Herein, we report an unusual case of metastatic cutaneous carcinoid tumor mimicking an adnexal poroid neoplasm., Methods: A 53-year-old male man presented with a neoplasm on the vertex of the scalp, clinically resembling a pigmented basal cell carcinoma., Results: A shave biopsy was suggestive of an apocrine poroma, however, a metastatic carcinoma could not be excluded. After acquiring additional clinical information and the complete excision of the neoplasm, further immunohistochemical stains supported the diagnosis a metastatic carcinoid tumor., Conclusion: To our knowledge, this is the first case of metastatic carcinoid tumor reported that has mimicked a poroid neoplasm.
- Published
- 2008
- Full Text
- View/download PDF
32. Extra-adrenal pheochromocytoma: a cause of ureteral obstruction.
- Author
-
Yadav S, Singh SK, Sharma SK, and Puri PK
- Subjects
- Adolescent, Humans, Male, Pheochromocytoma complications, Ureteral Neoplasms complications, Ureteral Obstruction etiology
- Published
- 2000
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.