American Journal of Dermatopathology最新文献

{"title":"The Prognostic Significance of Tumor Budding and Tumor-Infiltrating Lymphocytes in Patients Diagnosed With Malignant Melanoma.","authors":"Ayşen Yavuz, Kübra Şimşek, Cumhur İbrahim Başsorgun, Gülsüm Özlem Elpek, Betül Ünal","doi":"10.1097/DAD.0000000000002902","DOIUrl":"10.1097/DAD.0000000000002902","url":null,"abstract":"<p><strong>Abstract: </strong>The tumor microenvironment plays a critical role in malignant melanoma, influencing progression and patient outcomes, particularly through tumor budding (TB) and tumor-infiltrating lymphocytes (TILs). Despite the importance of TB, its detailed impact still needs to be explored, especially its interaction with TILs. This study evaluates the prognostic significance of TB and TILs in malignant melanoma, assessing their potential as indicators for disease progression and survival. Conducted at Akdeniz University, the research included 92 patients diagnosed between 2014 and 2021. TB was evaluated according to the International Tumor Budding Consensus Conference guidelines, and TILs were assessed by the International Immuno-Oncology Biomarker Working Group standards. The analysis revealed significant correlations between TB and the level of anatomic invasion, Breslow thickness, satellite nodules, lymph node metastasis, distant metastasis, and stage ( P < 0.05). A notable inverse relationship between TB and intratumoral TILs suggested their different roles in tumor progression. Tumor subtype, level of anatomic invasion, satellite nodules, lymphovascular invasion, lymph node metastasis, distant metastasis, stage, TILs, and TB were significant risk factors associated with poor prognosis ( P < 0.005). Multivariate Cox regression identified histologic subtype and TB >10 as independent prognostic factors, underscoring the need for further research to integrate TB and TILs into clinical practice for better patient management and treatment planning.</p>","PeriodicalId":50967,"journal":{"name":"American Journal of Dermatopathology","volume":" ","pages":"292-300"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808309","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":"Expanding the Range of Epithelial Marker and SMA Staining of Superficial CD34 + Fibroblastic Tumors: A Case Report and Review of the Literature.","authors":"Dong Ren, Katherine Wei, Linda Doan","doi":"10.1097/DAD.0000000000002907","DOIUrl":"10.1097/DAD.0000000000002907","url":null,"abstract":"<p><strong>Abstract: </strong>Superficial CD34 + fibroblastic tumor (SCD34FT) is a relatively recently described borderline mesenchymal neoplasm. Owing to a relative lack of specificity in clinical presentation, radiopathologic findings, and immunohistochemical staining, the diagnoses of SCD34FT can be challenging. In this study, we present a case of a 55-year-old woman with an indolent painless nodule on the right shin. Histopathologic evaluation of the resected specimen showed a moderately cellular, subcutaneous lesion composed of spindled cells with mild pleomorphism arranged in sheets and fascicles. Immunohistochemical staining demonstrated diffuse positivity for CD34. Surprisingly, the tumor also showed diffuse expression of smooth muscle actin (SMA) and more than focal (ranging from subset to diffuse) expression of AE1/AE3 and CAM5.2. DNA and RNA next-generation sequencing revealed a t(X; 11)(q13; q24) MED12::PRDM10 fusion, confirming the diagnosis of SCD34FT. To the best of our knowledge, this is the first reported case highlighting SCD34FT with more extensive immunoreactivity to epithelial markers (AE1/AE3 and CAM5.2) and SMA compared with the focal staining reported in the existing literature. We hope that adding this case to the existing literature will raise awareness among pathologists to recognize the more variable staining pattern of epithelial markers and SMA when considering the diagnosis of SCD34FT.</p>","PeriodicalId":50967,"journal":{"name":"American Journal of Dermatopathology","volume":" ","pages":"316-320"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958158","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":"BRCA1-Associated Protein-1 Inactivated Melanoma Arising in a Pre-existing Nevus With ALK Fusion and Low Tumor Mutational Burden.","authors":"Nada Shaker, Robert Phelps, George Niedt, Omar Sangueza, Ramakrishnan Krishnan, Ankush Patel, Carlos Torres-Cabala, Phyu P Aung, Victor Prieto, Catherine I Dumur, Dinesh Pradhan","doi":"10.1097/DAD.0000000000002925","DOIUrl":"10.1097/DAD.0000000000002925","url":null,"abstract":"<p><strong>Abstract: </strong>Breast cancer1-associated protein 1 (BAP-1)-inactivated melanocytic tumors are a group of familial or sporadic lesions with distinctive histology and molecular features. Inherited germline inactivating mutations in BAP1 have been associated with the development of multiple epithelioid melanocytic neoplasms resembling Spitz nevi and increased susceptibility for developing several malignancies, including uveal melanoma, cutaneous melanoma, renal cell carcinoma, mesothelioma, and other tumors. Cutaneous melanoma with loss of BAP1 expression is rare. We present a unique case of BAP1 -inactivated melanoma with anaplastic lymphoma kinase ( ALK ) fusion arising in a pre-existing BAP1 -inactivated nevus in a 47-year-old female patient who presented with a dome-shaped red papule on the superior crus of the right antihelix. Histology revealed intradermal melanocytic proliferation with biphenotypic morphology. There was a proliferation of atypical melanocytes showing epithelioid features in the background of nevus. Mitotic figures were identified in the cytologically atypical component of the lesion. Mart-1/Ki67 dual stain demonstrated a higher proliferation index in the larger epithelioid atypical cells, supporting the diagnosis of melanoma. Nuclear BAP-1 expression was lost in the larger atypical cells and associated nevoid cells. Preferentially expressed antigen in melanoma stain demonstrated focal positive staining in 20%-30% of the melanocytes. Immunostaining for B-Raf proto-oncogene, serine/threonine kinase V600E was diffusely positive and ALK demonstrated patchy immunoreactivity in the melanocytic proliferation. Interphase fluorescence in situ hybridization studies showed gains at chromosome 6p25 (Ras responsive element binding protein 1) in the tumor cells. The comprehensive next-generation sequencing revealed B-Raf proto-oncogene, serine/threonine kinase V600E mutation, TP53 mutation, ALK fusion, BAP1 loss (copy number variation = 0.0, potentially germline), and loss of MAP2K7, Von Hippel-Lindau tumor suppressor, FGFR3, CDKN2A , 19q, and telomerase reverse transcriptase . The tumor was microsatellite stable with a low tumor mutational burden (5.76 mutations/Mb). The tumor was completely excised with negative margins. The patient is doing well at 17 months follow-up with no signs of recurrence.</p>","PeriodicalId":50967,"journal":{"name":"American Journal of Dermatopathology","volume":" ","pages":"264-268"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257248","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":"Thiotepa-Induced Toxicity: A Clinical Mimic of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Featuring Severe Mucositis, Diffuse Dusky Discoloration, and Skin Sloughing.","authors":"Nada Shaker, Robert Phelps, George Niedt, Ruwaida Ben Musa, Rituja Bhowmik, Omar P Sangueza, Dinesh Pradhan","doi":"10.1097/DAD.0000000000002923","DOIUrl":"10.1097/DAD.0000000000002923","url":null,"abstract":"<p><strong>Background: </strong>Thiotepa, an alkylating agent commonly used in chemotherapy, is increasingly recognized to induce cutaneous reactions resembling toxic erythema of chemotherapy (TEC). This condition is characterized by erythema, hyperpigmentation, and mucositis, often affecting intertriginous areas, and can mimic the early stages of Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN).</p><p><strong>Case description: </strong>A 31-year-old woman with a history of systemic lupus erythematosus, antiphospholipid antibody syndrome, seizures, and chronic kidney disease was admitted for the management of central nervous system (CNS) lymphoma. Seven days after receiving thiotepa during an autologous stem cell transplant, she developed severe mucositis, requiring intubation for airway protection, followed by a dusky, gray, full-body rash with sloughing in the groin, axillae, and buttocks. A skin biopsy from the back revealed vacuolar interface changes, eccrine gland necrosis, and occasional necrotic keratinocytes at the dermal-epidermal junction, with no evidence of full-thickness necrosis or significant eosinophilic infiltration. The differential diagnosis included thiotepa-induced toxicity, SJS/TEN, and drug eruption. Based on the patient's clinical presentation and the biopsy findings, thiotepa-induced TEC was favored over SJS/TEN.</p><p><strong>Discussion: </strong>Thiotepa is a potent lipophilic alkylating agent widely used in chemotherapy for pediatric and adult patients with various solid tumors and hematologic malignancies. Its anticancer mechanism involves DNA alkylation, leading to DNA strand cross-linking that disrupts replication and transcription, ultimately inhibiting cancer cell proliferation and survival. While thiotepa is primarily utilized in high-dose preparative regimens for stem cell transplantation in pediatric patients, its use in the adult population remains comparatively limited.This case emphasizes the importance of differentiating thiotepa-induced TEC from severe cutaneous adverse reactions such as SJS/TEN. While these conditions share clinical and histologic features, the absence of extensive epidermal necrosis, satellite cell necrosis, and systemic involvement, along with recent thiotepa exposure, supported a diagnosis of TEC.</p><p><strong>Conclusions: </strong>This case highlights the diagnostic challenge of distinguishing thiotepa-induced TEC from SJS/TEN in post-transplant patients. Recognizing the characteristic involvement of intertriginous areas and eccrine gland necrosis in TEC is critical for accurate diagnosis and management. Awareness of this potential complication in patients receiving thiotepa is essential to avoid misdiagnosis and inappropriate treatment.</p>","PeriodicalId":50967,"journal":{"name":"American Journal of Dermatopathology","volume":" ","pages":"269-273"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257310","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":"Unusual Nodule on the Left Leg of an Elderly Woman-A Case Report: Challenge.","authors":"Gerardo Cazzato, Giuseppe Ingravallo, Paola Vitiello, Francesca Pagliuca, Renato Franco, Andrea Ronchi","doi":"10.1097/DAD.0000000000002961","DOIUrl":"https://doi.org/10.1097/DAD.0000000000002961","url":null,"abstract":"<p><strong>Abstract: </strong>We present the case of a 71-year-old woman with no significant medical history who developed a nodular, ulcerated lesion on her left leg, alongside bruise-like lesions on her extremities. Histologic examination revealed basal cell carcinoma with adenoid-cystic features colliding with blastic plasmacytoid dendritic cell neoplasm (BPDCN), a rare and aggressive hematologic malignancy. Immunohistochemical analysis confirmed BPDCN, with markers such as CD123, CD4, CD56, and TCL1, and a high proliferation index (Ki67 >90%). This represents the first reported case of a collision lesion comprising adenoid-cystic basal cell carcinoma and BPDCN. The findings highlight the need for comprehensive histopathologic evaluation in atypical cases to achieve an accurate diagnosis.</p>","PeriodicalId":50967,"journal":{"name":"American Journal of Dermatopathology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765733","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":"P16-Negative, High-Risk Human Papilloma Virus-Associated Penile Squamous Cell Carcinomas.","authors":"Burak Tekin, John C Cheville, Elizabeth Ann L Enninga, Andrew P Norgan, Emma F Johnson, Rumeal D Whaley, Loren P Herrera Hernandez, Rafael E Jimenez, Lori A Erickson, Ruifeng Guo, Sounak Gupta","doi":"10.1097/DAD.0000000000002960","DOIUrl":"https://doi.org/10.1097/DAD.0000000000002960","url":null,"abstract":"","PeriodicalId":50967,"journal":{"name":"American Journal of Dermatopathology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659715","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":"Elastosis Amyloidosis as a Histologic Pattern in Cutaneous Amyloidosis.","authors":"Eva Sánchez-Martínez, Jörg Schaller","doi":"10.1097/DAD.0000000000002952","DOIUrl":"https://doi.org/10.1097/DAD.0000000000002952","url":null,"abstract":"<p><strong>Abstract: </strong>Elastosis amyloidosis is an exceptionally rare form of cutaneous amyloidosis characterized by amyloid deposition around dermal elastic fibers. To date, only 11 cases have been documented in the literature, some of them with associated systemic involvement. We report a case of a 60-year-old man presenting with an asymptomatic umbilical nodule. Histopathological analysis revealed amyloid deposits in the upper reticular dermis with characteristic distribution around the elastic fibers, confirmed by positive staining with PAS and Congo red. Immunohistochemical staining was positive for cytokeratins but negative for light chains and other systemic amyloid markers, leading to a diagnosis of elastosis amyloidosis with deposit of amyloid-AK, a finding previously unreported. We consider this an incidental discovery that may provide new insights into the etiopathogenesis of amyloidosis in both localized and systemic processes.</p>","PeriodicalId":50967,"journal":{"name":"American Journal of Dermatopathology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659705","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":"Monkeypox and Malignant Syphilis Coinfection in an HIV Patient.","authors":"Rafael Fayos-Gregori, Miguel Mansilla-Polo, Fernando Navarro-Blanco, Rodolfo David Palacios-Díaz, Javier López-Davia, Vicent Martínez-Cozar, Rafael Botella-Estrada","doi":"10.1097/DAD.0000000000002955","DOIUrl":"https://doi.org/10.1097/DAD.0000000000002955","url":null,"abstract":"","PeriodicalId":50967,"journal":{"name":"American Journal of Dermatopathology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659707","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":"Multicentric Reticulohistiocytosis-Histopathologic Spectrum in Indian Patients.","authors":"Lavanya Murugesu, Rajalakshmi Tirumalae","doi":"10.1097/DAD.0000000000002944","DOIUrl":"https://doi.org/10.1097/DAD.0000000000002944","url":null,"abstract":"<p><strong>Abstract: </strong>Multicentric reticulohistiocytosis (MRH) is a rare histiocytosis, characterized by polyarthritis and multiple papulonodular lesions in the skin, mucosa, and visceral organs. It has a robust association with autoimmune diseases and malignancies. We studied histopathological features of 4 cases of MRH over a period of 11 years (2012-2023). The mean age was 48 years with no gender predilection. All patients had papulonodular skin lesions distributed over dorsum of finger, scalp, pinna, hands, elbows, and back. Associated conditions include arthritis in 2 cases and malignancy in 2 cases. All biopsies showed sheets of histiocytes, the morphology of which varied from having dense eosinophilic glassy appearing cytoplasm to abundant vacuolated cytoplasm. Good clinicopathologic correlation is necessary to make a diagnosis; however, it is not always possible to establish diagnosis at the time of biopsy. Follow-up diagnosis of malignancy led to the diagnosis in 2 cases. This small, yet insightful, case series emphasizes the need for good clinicopathologic correlation regardless of histiocyte morphology when MRH is suspected.</p>","PeriodicalId":50967,"journal":{"name":"American Journal of Dermatopathology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659710","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":"Artificial Intelligence and Convolutional Neural Networks-Driven Detection of Micro and Macro Metastasis of Cutaneous Melanoma to the Lymph Nodes.","authors":"Nada Shaker, Sean Niu, Heath Blankenship, Nuha Shaker, Hossam Arafat, Raed Sbenaty, Ahmed Yones, Mohammad Shaker, Noor Shaker, Omar P Sangueza","doi":"10.1097/DAD.0000000000002954","DOIUrl":"https://doi.org/10.1097/DAD.0000000000002954","url":null,"abstract":"<p><strong>Background: </strong>Lymph node (LN) assessment is a critical component in the staging and management of cutaneous melanoma. Traditional histopathological evaluation, supported by immunohistochemical staining, is the gold standard for detecting LN metastases. However, the process is labor-intensive, requiring the analysis of multiple tissue levels, which increases both time and cost. With the growing integration of artificial intelligence (AI) into clinical workflows, there is potential to streamline this process, enhancing efficiency and accuracy.</p><p><strong>Method: </strong>This study analyzed 53 WSIs (12 negative samples). Images are all derived from hematoxylin-eosin (H&E) stains and were uploaded to the Orca AI cloud-based platform (SpatialX Diagnostics, Inc.), a commercially available platform specifically designed for AI pathology. An AI-driven model was developed and trained to detect melanoma metastases directly from H&E histopathological images, bypassing additional immunohistochemical staining. The algorithm was designed to identify the presence of metastases and classify tumor deposits based on size, specifically distinguishing deposits greater than 0.1 mm and less than 1.0 mm in diameter, which are critical thresholds for prognostic evaluation. The model was validated on 9 WSIs (2 negative) that were not seen by the model. For every WSI in the validation set, one of the following 4 classes was assigned: normal, metastasis (<0.1 mm), metastasis (0.1-1 mm), and metastasis (>1 mm). The class corresponding to the highest metastasis size range was assigned to the whole sample. The results were then examined by a board-certified pathologist.</p><p><strong>Results: </strong>The AI algorithm demonstrated high accuracy in detecting LN metastases in patients with melanoma. It effectively identified and classified tumor deposits with a specificity of 0.91 and a sensitivity of 0.74. The model also distinguishes between smaller deposits (>0.1 mm) and larger deposits (>1.0 mm). This stratification is essential for accurate staging, prognosis determination, and treatment planning, highlighting the algorithm's potential clinical value. When evaluating the model performance in the WSI classification tasks, the model showed high agreement with the pathologist's classification, correctly identifying 7 WSIs as metastasis (>1 mm) and labeling 1 normal WSI as metastasis (0.7 mm).</p><p><strong>Conclusion: </strong>The study's findings underscore the potential of AI in revolutionizing the detection of melanoma metastasis in lymph nodes. By significantly reducing the reliance on time-consuming and costly immunohistochemical staining, AI-driven tools can streamline diagnostic workflows, improve accuracy, and potentially enhance patient outcomes. As AI technology continues to evolve, its application in melanoma management could become a cornerstone of modern pathology, offering a powerful adjunct to traditional diagnostic methods.</p>","PeriodicalId":50967,"journal":{"name":"American Journal of Dermatopathology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659703","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}