Journal of Cutaneous Pathology最新文献

{"title":"Blue Nevus-Like Metastatic Melanoma in a Patient With Primary Lentigo Maligna Melanoma","authors":"Kristen Fernandez,&nbsp;Mitul B. Modi,&nbsp;Jodi J. Speiser","doi":"10.1111/cup.14765","DOIUrl":"10.1111/cup.14765","url":null,"abstract":"<div>\u0000 \u0000 <p>Metastatic melanoma with unusual histopathology can be diagnostically challenging. One exceptionally rare cutaneous manifestation of metastases is blue-nevus-like metastatic melanoma (BNLMM). A 74-year-old male presented with a blue-gray lesion on his left helix in the same anatomical region of a previously resected lentigo maligna. Histopathological sections demonstrated an atypical biphasic proliferation of dendritic melanocytes with pigment incontinence and epidermal sparing, measuring &gt; 0.05 mm in diameter. Although the majority of the cell population exhibited cytologic features consistent with a blue nevus, there was a subset of dendritic cells with irregular epithelioid contours and rare, typical dermal mitotic figures. Sections showed an increased Mart-1/Ki67 rate. Perineural and angiotropic involvement by the atypical melanocytes was identified. Immunohistochemical (IHC) stains for SOX-10, HMB45, and PRAME highlighted melanocytic proliferation. BAP-1 IHC was retained, and p16 IHC showed complete loss. No previous procedure site changes were present, indicating that the dendritic cell proliferation was separated from the primary invasive melanoma by normal dermis. The histopathological and immunohistochemical findings led to a diagnosis of microsatellite BNLMM. We report this case to highlight the importance of this rare entity and to avoid misdiagnosis of BNLMM, which would significantly impact patient prognosis, treatment, follow-up, and outcomes.</p>\u0000 </div>","PeriodicalId":15407,"journal":{"name":"Journal of Cutaneous Pathology","volume":"52 4","pages":"287-293"},"PeriodicalIF":1.6,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"White Depressed Areas and Tumor Infiltrating Lymphocytes: The Cancer Cure That Lies Within?","authors":"George F Murphy","doi":"10.1111/cup.14768","DOIUrl":"https://doi.org/10.1111/cup.14768","url":null,"abstract":"<p><p>This brief overview is inspired by seminal contributions by the late Dr. Martin C. Mihm, Jr. who provided a basis for recognition and better understanding of interactions between lymphocytes (tumor-infiltrating lymphocytes [TILs]) that home to and permeate cancers. In primary melanomas, this phenomenon may produce what Dr. Mihm called white depressed areas, prescient clues to what would fuel future attempts at harnessing anticancer immunity. The critical and sequential TIL attributes of antigenic stimulation, homing, and effector-target cell apoptotic injury herein are briefly reviewed in light of more recent advances in the field of immuno-oncology. The intent is to emphasize how fundamental clinical and histopathological observations, as forged by Dr. Mihm and his associates, have led to critically important prognostic paradigms as well as to translational insights that now have become transformative in the field of cancer immunotherapy.</p>","PeriodicalId":15407,"journal":{"name":"Journal of Cutaneous Pathology","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Martin C. Mihm, Jr. and Dermatopathology Education at Harvard Medical School.","authors":"Lyn M Duncan, Steven R Tahan, Mai P Hoang, George F Murphy","doi":"10.1111/cup.14747","DOIUrl":"https://doi.org/10.1111/cup.14747","url":null,"abstract":"","PeriodicalId":15407,"journal":{"name":"Journal of Cutaneous Pathology","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aging Skin: A Dermatitis To Which All Flesh Is Heir?","authors":"George F Murphy","doi":"10.1111/cup.14756","DOIUrl":"https://doi.org/10.1111/cup.14756","url":null,"abstract":"<p><p>The human body is composed mostly of water fortified by a variety of proteins, fats, carbohydrates, vitamins, minerals, and other nutrients, all organized into an elegant structurally complex and functionally efficient machine in which our consciousness resides. This heterogeneous assemblage of essential ingredients is enclosed in a container known as the integument, or simply, the skin. The container is as important as its contents; when itself devoid of structural and functional integrity, it will both leak as well as become infused with potentially harmful external agents. As we age, skin loses its integrity, and over time it is not unreasonable to conceive of the skin as becoming progressively \"leaky.\" With this deterioration, skin becomes dry, scaly, accessible to microbes, pruritic, and inflamed, the latter setting up the potentially vicious cycle known as \"inflammaging.\" One major example of the effects of chronological aging on the barrier function of skin involves depletion of filaggrin, a 37-kD histidine-rich protein which originates within keratohyaline granules of the epidermis. Some of the consequences of age-related filaggrin depletion may be inferred by experiments of nature known as ichthyosis vulgaris and atopic dermatitis (AD), the latter with atopy being the most common inflammatory disease worldwide. In AD, loss of function mutations in the FLG gene encoding for the filaggrin precursor, profilaggrin, are associated with skin that, as with aging, is also dry, scaly, accessible to microbes, pruritic and inflamed. In this mini-review, AD will be compared and contrasted with aging in terms of the consequences of deficient filaggrin barrier function. The goal is to enhance recognition that one of the most clinically symptomatic and visible signs of aging is a subtle yet ubiquitous form of \"dermatitis\" due to \"leaky\" skin, one that may be addressed therapeutically with smart combinatorial strategies that restore the molecular basis for skin barrier dysfunction.</p>","PeriodicalId":15407,"journal":{"name":"Journal of Cutaneous Pathology","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genomic and Transcriptomic Profiling of Digital Papillary Adenocarcinomas Reveals Alterations in Matrix Remodeling and Metabolic Genes","authors":"Erol Can Bayraktar,&nbsp;Phyu P. Aung,&nbsp;Pavandeep Gill,&nbsp;Guomiao Shen,&nbsp;Varshini Vasudevaraja,&nbsp;Zongshan Lai,&nbsp;Luis Chiriboga,&nbsp;Doina Ivan,&nbsp;Priyadharsini Nagarajan,&nbsp;Jonathan L. Curry,&nbsp;Carlos A. Torres-Cabala,&nbsp;Victor G. Prieto,&nbsp;George Jour","doi":"10.1111/cup.14782","DOIUrl":"10.1111/cup.14782","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Digital papillary adenocarcinoma (DPAC) is a rare but aggressive cutaneous malignant sweat gland neoplasm that occurs on acral sites. Despite its clinical significance, the cellular and genetic characteristics of DPAC remain incompletely understood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a comprehensive genomic and transcriptomic analysis of DPAC (<i>n</i> = 14) using targeted next-generation DNA and RNA sequencing, along with gene expression profiling employing the Nanostring Technologies nCounter IO 360 Panel. Gene expression in DPAC was compared to that in hidradenoma (<i>n</i> = 10). Immunohistochemistry was employed to validate gene expression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Two out of eight DPACs showed fusion gene rearrangements (<i>CRTC3</i>::<i>MAML2</i> and <i>TRPS1</i>::<i>PLAG1</i>). No uniform mutational signature was detected in DPAC. Comparative gene expression analysis revealed an enrichment of genes related to matrix remodeling, metabolism, and DNA damage repair. Hallmark pathway analysis demonstrated significant upregulation of E2F target genes in DPAC compared to hidradenoma (<i>p =</i> 0.00710). Human papillomavirus-42 was found to be positive in all of our tested DPAC cases. Immunohistochemistry confirmed increased protein expression of CD56, CDC20, and SOX10 in DPAC. Notably, most DPAC tumors also exhibited B-cell infiltration, as indicated by CD20 staining.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings reveal novel fusions and validate altered replication pathways related to HPV42 in DPAC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15407,"journal":{"name":"Journal of Cutaneous Pathology","volume":"52 4","pages":"309-316"},"PeriodicalIF":1.6,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pseudocellulitis in the Setting of Pemetrexed Treatment for Non-Small Cell Lung Cancer","authors":"Cassidy M. Nguyen,&nbsp;Jake C. Robertson,&nbsp;Adam Cardenas,&nbsp;Edgar Martinez,&nbsp;Brett H. Keeling,&nbsp;Khang D. Nguyen","doi":"10.1111/cup.14785","DOIUrl":"10.1111/cup.14785","url":null,"abstract":"<div>\u0000 \u0000 <p>Pemetrexed is a chemotherapeutic, antimetabolite agent that has been used in oncology to treat diseases such as metastatic non-small cell lung cancer and unresectable malignant pleural mesothelioma. Pemetrexed use may result in pseudocellulitis, which presents as poorly demarcated patches or plaques with erythema, edema, warmth, and tenderness. These lesions can present unilaterally or bilaterally on the lower extremities. The histologic appearance includes vacuolar interface dermatitis, squamous metaplasia of eccrine coils and ducts, sparse mixed neutrophilic and lymphocytic interstitial inflammatory infiltrate, and widened subcutaneous fibrous septa with cystic fat degeneration. We present the case of a 58-year-old woman with non-small cell lung cancer and pemetrexed-induced pseudocellulitis with distinctive histological features. The clinical appearance of patients with this hypersensitivity condition may mimic cellulitis, emphasizing the importance of increased awareness and consideration of pseudocellulitis in the differential diagnosis of patients on chemotherapy to avoid unnecessary hospitalization and treatment.</p>\u0000 </div>","PeriodicalId":15407,"journal":{"name":"Journal of Cutaneous Pathology","volume":"52 4","pages":"284-286"},"PeriodicalIF":1.6,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histopathologic Features of Acral Skin Biopsies in Dermatomyositis Patients and Comparison to Histopathologic Features in Non-Acral Biopsies","authors":"Lydia Cassard,&nbsp;Firdous Ali,&nbsp;Elizabeth M. Flatley,&nbsp;Anthony Patrick Fernandez","doi":"10.1111/cup.14786","DOIUrl":"10.1111/cup.14786","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Acral lesions may represent the best/only skin lesions to biopsy in patients suspected to have dermatomyositis (DM). However, histopathologic features of acral DM skin lesions are poorly characterized.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We reviewed 50 acral biopsies from 46 DM patients and assessed numerous histopathologic features. The majority of biopsies (42/50; 84%) were sampled from either Gottron papules or signs. We compared histopathologic features in acral biopsies to those in 197 non-acral DM skin biopsies. We also compared histopathologic features in acral biopsies based on the presence of various clinical features.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Interface dermatitis, dyskeratotic keratinocytes, and superficial perivascular inflammation were common in DM acral biopsies. However, the absence of &gt; 1 hallmark histopathologic feature (interface dermatitis, dyskeratosis, dermal mucin) was relatively common (56%). The presence of all three hallmark histopathologic features was significantly more likely in non-acral compared with acral DM biopsies (68% vs. 44%; <i>p</i> = 0.0021). The hallmark histopathologic feature most commonly lacking in acral compared with non-acral biopsies was increased dermal mucin. Histopathologic features in acral biopsies did not significantly differ based on acral location, DM subtype, therapeutic regimen, or myositis-associated/myositis-specific antibody status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Pathologists should recognize that acral biopsies in DM patients may lack hallmark histopathologic features commonly seen in biopsies from non-acral locations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15407,"journal":{"name":"Journal of Cutaneous Pathology","volume":"52 4","pages":"299-308"},"PeriodicalIF":1.6,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neutrophilic Panniculitis Secondary to BRAF and MEK Inhibitor Therapy to Treat Stage IIIa Cutaneous Melanoma","authors":"Tyra Reed,&nbsp;Steven Rivera,&nbsp;Craig Fisher,&nbsp;William Schaffenburg","doi":"10.1111/cup.14778","DOIUrl":"10.1111/cup.14778","url":null,"abstract":"<div>\u0000 \u0000 <p>Panniculitides are a group of inflammatory disorders of the subcutaneous fat that have been reported as a rare complication of both a serine threonine kinase BRAF inhibitor monotherapy and BRAF inhibition in combination with a mitogen activated protein kinase (MEK) inhibitor combination therapy used to treat metastatic melanoma. The cutaneous manifestations of BRAF and BRAF/MEK therapies have been well documented, but neutrophilic panniculitis remains a less common complication with fewer case reports. Physician awareness of this complication when following patients on similar targeted therapies can decrease delays in appropriate management. We report a case of one patient who developed neutrophilic panniculitis during treatment with the BRAF/MEK combination of dabrafenib and trametinib. We followed the patient from initial presentation in the emergency department to diagnosis to include pathology findings of the disease. In this case of neutrophilic panniculitis, the patient presented with a history of stage IIIa (pT2a N1a M0) cutaneous melanoma of the right flank and developed classic painful nodules on the lower legs and arms with associated fever within the first 2 weeks after initiating adjuvant melanoma targeted therapy. The biopsies showed a mixed, neutrophilic panniculitis, without overlying epidermal changes. Given the patient's clinical history, the biopsy was consistent with a BRAF inhibitor induced neutrophilic panniculitis. The panniculitis resolved with symptomatic care and the patient was maintained on the antitumor therapies.</p>\u0000 </div>","PeriodicalId":15407,"journal":{"name":"Journal of Cutaneous Pathology","volume":"52 4","pages":"278-283"},"PeriodicalIF":1.6,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Patient With Concurrent Hidradenitis Suppurativa and Porokeratosis Palmaris et Plantaris Disseminata: Case Report and Review of Autoinflammatory Keratinization Diseases","authors":"Meredith C. Rogers,&nbsp;Mark Ash,&nbsp;Amanda Hernandez,&nbsp;Gregory A. Hosler","doi":"10.1111/cup.14774","DOIUrl":"10.1111/cup.14774","url":null,"abstract":"<p>The term autoinflammatory keratinization diseases (AIKDs) was recently proposed as a unifying concept for diseases characterized by inflammation in the epidermis and upper dermis which leads to hyperkeratosis, caused by genetic perturbations of the innate immune system. We present a case of a patient with hidradenitis suppurativa and porokeratosis, two AIKDs, followed by a review of these conditions as well as other AIKDs. This case was distinguished by hypertrophic porokeratoses involving cystic hair follicles, showing histopathologic features of both conditions within single biopsy specimens. The patient's course was additionally complicated by SCC arising within a porokeratosis. Our case demonstrates a rare overlap of two AIKDs, occurring not only within the same patient but also within the same lesions.</p>","PeriodicalId":15407,"journal":{"name":"Journal of Cutaneous Pathology","volume":"52 4","pages":"272-277"},"PeriodicalIF":1.6,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cup.14774","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Granuloma Annulare Arising in a Becker Nevus.","authors":"Adam H Krouse, Brandon Zelman, Jenna J Lullo, Jodi J Speiser","doi":"10.1111/cup.14784","DOIUrl":"https://doi.org/10.1111/cup.14784","url":null,"abstract":"","PeriodicalId":15407,"journal":{"name":"Journal of Cutaneous Pathology","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}