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Intradermal nodular fasciitis is a rare but not extraordinary pathological finding with approximately 100 cases reported since originally described in 1990. Intradermal proliferative fasciitis, however, has only been reported twice and both arose in the postauricular region. Herein, we report a third case of intradermal proliferative fasciitis and the first to occur on the finger. This case was also unusual in its slow growth, and complete lack of smooth muscle actin expression that has only been reported once before.

Multiple clustered dermatofibromas describes a confluence of dermatofibromas in one anatomic location. We describe a 32-year-old man who presented for evaluation owing to skin papules and plaques and concerns about malignancy. Repeat histopathological evaluation found no evidence for dermatofibrosarcoma protuberans. Our case presents this relatively rare condition and discusses observation along with potential treatment options.

Cutaneous metastases are infrequently encountered in dermatology. We describe a rare case of a urolethial carcinoma metastatic to the skin in an elderly female. The metastasis expanded rapidly and was thought to possibly be infectious on her initial evaluation by her primary team. We were called in as consultants and biopsied this mass to confirm our concern for metastatic disease. In this case there was an unknown primary tumor. Histologic staining patterns were used to suggest that the tumor may have originated from her urinary bladder.

We present a case of a primary cutaneous carcinosarcoma (PCS). Histopathologically, PCS is defined as a biphasic tumor composed of malignant epithelial (carcinoma) and mesenchymal (sarcoma) elements. The diagnosis of PCS can be challenging, not only because of its rarity but also because superficial biopsies can result in sampling errors. Accurate diagnosis is essential, as PCS carries a higher recurrence and metastatic rate than epithelial carcinomas, thus requiring wider excision or Mohs micrographic surgery as well as closer clinical follow-up.

Atypical fibroxanthoma (AFX) is an undifferentiated pleomorphic sarcoma that typically has low-grade malignant potential. Although recurrences do occur, only approximately 25 cases of metastasizing AFX have been reported. Herein a patient with an AFX that metastasized and eventuated in death is described. Although AFX remains a diagnosis of exclusion, through this pedagogic case, the clinical, immunohistochemical, and genetic features that can assist in diagnosis are discussed.

We describe two full-term infants who presented with congenital cutaneous candidiasis (CCC) and compare their clinical presentation and outcome with that of neonatal candidiasis and chronic mucocutaneous candidiasis. Although candidal vulvovaginitis occurs in up to one-third of pregnancies, CCC is uncommon and can be confused with more-serious pustular disorders that present in neonates. Greater awareness of CCC is essential to make an early diagnosis and distinguish it from other infections., (© 2011 Wiley Periodicals, Inc.)

The term "signet ring" is used to describe a cell with an eccentric nucleus that is compressed to the periphery of the cell by a large cytoplasmic vacuole or by a substance accumulated within the cytoplasm. In pathology, these cells have been traditionally associated with adenocarcinomas. We describe two cases of cutaneous tumors that contained signet ring-like cells. Because of the morphology of the cells and the fact that one patient had a past history of lung cancer, the possibility of metastatic adenocarcinoma was considered. Upon further investigation, the tumors proved to be a primary cutaneous squamous cell carcinoma and a basal cell carcinoma; surgical management was curative. Because signet ring changes may pose a diagnostic challenge, we review the various benign and malignant cutaneous lesions that have been reported to contain signet ring cells and we explore the possible causative mechanisms of this phenomenon.

Histiocytosis refers to a diverse collection of disorders unified by a proliferation and accumulation of histiocytes into a variety of organs. The following review article will discuss and briefly describe the clinical and histological findings of some of the more common histiocytic disorders. The article is divided into sections according to the current classification system and prevalence of the condition.

Although yaws is rare in developed countries, as worldwide travel has become commonplace, it is essential to recognize this condition when evaluating patients who traveled from endemic regions. Herein, we discuss a case of secondary yaws presenting as extensive expanding annular lesions to raise awareness of this condition.

The US military in conjunction with allied military services and nongovernmental organizations have embarked on various humanitarian missions to underserved areas worldwide. These missions illustrate what interoperability between nations can accomplish. Dermatologists involved with humanitarian missions encounter many conditions rarely seen in developed countries and learn to practice general dermatology with limited resources in austere environments.

Cat-scratch disease (CSD) and bacillary angiomatosis (BA) are caused by a gram-negative bacilli classified under the genus Bartonella (formerly Rochalimaea). Patient history, symptoms, and histopathology often fall along a continuum; therefore, both conditions should be considered in the differential diagnosis. We report a case of an 83-year-old immunocompetent woman who presented with a pyogenic granuloma-like lesion on her dorsal left wrist. The histologic differential diagnosis included an inoculation site from a cat scratch infected with Bartonella and BA. Because the patient had only 1 lesion at the site of a prior cat scratch, the lesion was diagnosed as inoculation bartonellosis. We also review the epidemiologic, clinical, and histopathologic features of CSD and BA.

Superficial angiomyxoma (SA) is a distinct soft tissue tumor characterized by a circumscribed collection of spindled and stellate fibroblasts that are admixed with thin-walled blood vessels and embedded in a mucinous stroma. Because of its relative infrequent occurrence, the purpose of this article was to present a classical example of an isolated superficial angiomyxoma and discuss the differential diagnosis.

The advent of electron microscopy and immunohistochemical stains allowed for reclassification of the histiocytoses based on the predominant cell in the infiltrate. Although the current schema simplicity provides a good foundation, some patients display overlapping clinical and immunohistochemical features that defy classification. The patient herein illustrates bridging between histiocytic disorders. Through this case we review the various conditions classified under the non-Langerhans cell histiocytosis and Langerhans cell histiocytosis rubric.

Tinea imbricata (TI) is a chronic superficial mycosis caused exclusively by Trichophyton concentricum. Characteristically, the lesions are composed of multiple concentric annular plaques that have thick adherent peripheral rims of scale. A brief review of this infection is presented.

Over the last 30 years, there have been approximately 49 case reports of tumors composed of both malignant epithelial and malignant melanocytic populations. Herein, we present four additional cases of combined tumors that consist of two phenotypically distinct but intermingled populations of malignant cells. Each tumor was composed of an invasive melanoma closely associated with either a basal cell carcinoma or a squamous cell carcinoma. We review all previous case reports in the English literature and attempt to clarify the terminology and summarize what is currently known about these unique tumors.

Herein we present a 9-year-old boy with a constellation of clinical findings most consistent with Kindler syndrome, and report a new finding, severe corneal ectasia, which resulted in exposure keratitis requiring enucleation.

Merkel cell carcinoma (MCC) is a rare aggressive neoplasm that typically presents as a solitary nodule or plaque on sun-exposed skin of the elderly. Although multiple MCC have been described, they are rare, and metastases must be excluded. We report a case of a 59-year-old white male who presented with abrupt onset of multiple small bluish papules on his frontal scalp. On low power, the tumor had the overall histological silhouette of a nodular basal cell carcinoma. However, because of the lack of an epithelial connection and the cell's cytomorphological features, a MCC was considered and was subsequently confirmed using immunohistochemical stains. The MCC described in this report is unusual in that it presented as multiple cutaneous lesions that arose synchronously, along with micrometastases to sentinel lymph nodes.

Adrenal cortical carcinoma (ACC) is an uncommon and aggressive malignancy. Patients often have metastatic disease at initial presentation, with the most common sites being the liver, local lymph nodes, lungs, peritoneum and bone. Despite a high frequency of metastases, there are only isolated reports of ACC that have metastasized to the skin. Herein, we report a case of an 82-year-old woman who presented with a cyst-like lesion on her back, which on biopsy proved to be ACC metastatic from a primary tumor diagnosed 30 years previously.

As an ancillary part of physical therapy, ice, heat, transcutaneous electrical nerve stimulation, and interferential currents are often used as nonpharmacological modalities to treat pain and reduce edema. Although medical electrical stimulation devices are touted as having few side effects, cutaneous irritation, contact dermatitis, and burns have been noted. The following article describes a patient who incurred third-degree burns in an area treated with interferential currents.

Langerhans cell histiocytosis is a rare proliferative disorder where pathologic Langerhans cells accumulate in a variety of organs. Historically, the nomenclature regarding this entity has been confusing because the disease had been subcategorized simply based upon the different clinical manifestations. In the following article, we summarize the current recommendation of the Histiocyte Society regarding the classification, evaluation, prognosis, and treatment of Langerhans cell histiocytosis.

Langerhans cell histiocytosis (LCH) is a rare proliferative disorder in which pathological Langerhans cells (LCs) accumulate in a variety of organs. Historically, the nomenclature regarding LCH has been confusing because the disease had been sub-categorized simply based upon different clinical manifestations. Herein, we report a child with the classic finding of disseminated LCH and summarize the current recommendation of the Histiocyte Society regarding the classification, evaluation, prognosis and treatment of LCH.

Although dendritic, melanin-containing melanocytes can be seen in a variety of epithelial neoplasms, only 0.01% to 7% of all squamous cell carcinomas (SCC) are pigmented. Furthermore, most reported cases have occurred in the oral and ocular mucosa, with relatively few cases reported to originate in the skin. Herein we report a case of a 61-year-old Caucasian male who presented with a large blue-black nodule on his left cheek, clinically suspicious for a melanoma; however, histological evaluation revealed an acantholytic pigmented squamous cell carcinoma. Previous cases are reviewed and the clinical and histological differential diagnoses are discussed.

We present a unique case of an infant with acute monocytic leukaemia who presented at birth with multiple rubbery, erythematous to violaceous subcutaneous nodules secondary to leukaemia cutis. As these infiltrates regressed with chemotherapy, numerous white to yellow linear confluent papules appeared in a scratch-like pattern. These lesions were widely disseminated but were concentrated across her face, trunk and extremities with relative sparing of the napkin area and back. We propose that these lesions represent a form of dystrophic calcinosis cutis that occurred secondary to koebnerization in an infant with congenital leukaemia cutis.

We present the case of a 25-year-old man who presented with a slowly enlarging nodule on the upper lip. This nodule first appeared after minor trauma to the area. Our original differential diagnosis included foreign body granuloma, mucocele, inclusion cyst, and adnexal tumor. Histopathology results showed an encapsulated tumor consisting of 2 discrete lobules composed of numerous aggregates of cuboid epithelial cells with tubuloalveolar structures and keratinous cysts within a chondroid stroma-consistent with a chondroid syringoma. We compare and contrast the clinical and histologic characteristics of chondroid syringomas (arising from sweat glands) with those of pleomorphic adenomas (arising from salivary glands).

A 7-year-old Filipino girl presented to the dermatology clinic with a slowly enlarging plaque on the inner aspect of her upper left arm. Although she had this lesion since birth, it had gradually enlarged and become indurated and slightly painful. The histopathologic examination showed a vascular proliferation within the dermis, with a "cannonball" appearance consistent with a tufted angioma. We review the literature and discuss the clinical presentation of this rare vascular tumor.

Deficits at the earliest stages of information processing are among the most consistent abnormalities found in schizophrenics. To better understand the deficit, the present study indirectly evaluated the functional status of two visual channels, transient and sustained, which have been implicated in early information processing. A forced-choice, two-pulse detection task was used to determine the duration that subjects required to detect a blank interval (ISI) separating a two pulse grating vs. a single pulse grating. Threshold ISI was used as the index of visible persistence. Four groups of subjects participated in the study: schizophrenics, schizoaffectives, major depressives, and normal controls. The results of the ANOVA showed a significant main effect for diagnosis, position, and spatial frequency, as well as a significant effect for diagnosis x position and diagnosis x spatial frequency. The results are discussed in terms of the differential response and retinal distribution of each channel.