American Journal of Dermatopathology最新文献

{"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}

{"title":"Use of Albumin In Situ Hybridization to Diagnose Cutaneous Metastatic Hepatocellular Carcinoma With Poorly Differentiated Features: A Case Report and Review of the Literature.","authors":"Andrew J Gauger, Aofei Li, Mike Fritz, Terrence M Katona, Ahmed K Alomari","doi":"10.1097/DAD.0000000000002854","DOIUrl":"10.1097/DAD.0000000000002854","url":null,"abstract":"<p><strong>Abstract: </strong>Hepatocellular carcinoma (HCC) rarely metastasizes to the skin. When it occurs, it is often poorly differentiated making the diagnosis challenging. There exists a male predominance, and clinical presentation usually includes papules or nodules resembling pyogenic granulomas or dermal deposits. Histopathology shows malignant dermal cells. Hepatoid features including nests or cords of cells arranged in a trabecular or pseudoglandular pattern, sinusoidal formation, or the presence of bile exist in less than 50% of cases. Limitations exist with immunohistochemical staining, particularly in poorly differentiated neoplasms. Albumin in situ hybridization is more sensitive for detecting poorly differentiated HCC. Immunostaining in conjugation with albumin in situ hybridization enhances the detection of metastatic hepatocellular carcinoma. We report the case of a 74-year-old man with a history of HCC and a stable lung metastasis who presented with painful, growing bumps on his nose for 2 months. Examination revealed multiple, pink to white, shiny dermal-based papules with telangiectasias involving the right nasal tip and naris. Alpha-fetoprotein level was markedly elevated. Computed tomography showed expanding right lower lobe lung nodules. Histopathology of the cutaneous biopsy revealed features of a poorly differentiated basaloid carcinoma. Immunohistochemical staining was diffusely positive for glypican-3, focally positive for arginase-1, and negative for hepatocyte paraffin 1. Albumin in situ hybridization was diffusely positive, clinching the diagnosis of HCC. Metastatic HCC is a rare encounter for dermatopathologists. We aim to increase awareness of its occurrence in patients with advanced HCC and highlight the importance of clinical correlation when faced with poorly differentiated or unusual-looking basaloid neoplasms.</p>","PeriodicalId":50967,"journal":{"name":"American Journal of Dermatopathology","volume":" ","pages":"211-216"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559344","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 Comparison Among Drug Eruptions Induced by Enfortumab Vedotin, Brentuximab Vedotin, and Taxanes.","authors":"Yoshifumi Iwahashi, Keisuke Goto, Shuichi Ohe, Shota Bun, Kansuke Kido, Takahiro Matsui, Eiichi Morii, Keiichiro Honma","doi":"10.1097/DAD.0000000000002911","DOIUrl":"10.1097/DAD.0000000000002911","url":null,"abstract":"<p><strong>Abstract: </strong>Microtubule-stabilizing agents (enfortumab vedotin and brentuximab vedotin) and microtubule-disrupting agents (docetaxel and paclitaxel) are used as anticancer agents but can also induce drug eruptions. Recently, mitotic arrest figures have been reported in various non-neoplastic cells as the histopathologic side effect of these drug eruptions. Therefore, we performed a comparative analysis of drug eruptions associated with these microtubule-targeting agents. Enfortumab vedotin-, brentuximab vedotin-, docetaxel-, and paclitaxel-associated drug eruptions were retrieved from 4 hospitals in 5, 5, 5, and 7 patients, respectively. Ring mitotic and other mitotic arrest figures were observed in the epidermis in all types of drug eruption but were most frequently (100%) observed in enfortumab vedotin-induced eruptions. Such a finding was also occasionally observed in the sweat ductoglandular units but not in the follicular epithelium. Keratinocyte multinucleation and apoptotic keratinocytes distributed predominantly in the upper part of the epidermis were also observed in these eruptions, particularly in enfortumab vedotin-induced eruptions (4/5, 80%). In conclusion, drug eruptions associated with microtubule-targeting agents, particularly enfortumab vedotin, can often exhibit mitotic arrest figures, keratinocyte multinucleation, and apoptotic keratinocytes predominantly observed in the upper part of the epidermis. These characteristic histopathologic features can be the diagnostic clues of drug eruptions induced by microtubule-targeting agents.</p>","PeriodicalId":50967,"journal":{"name":"American Journal of Dermatopathology","volume":" ","pages":"191-196"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958160","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":"Rare Cutaneous Primary Presentation of Extracavitary Primary Effusion Lymphoma.","authors":"Apoorva Mehta, Sophia Luyten, Tiago Vencato da Silva, Carlos Bacchi, Alejandro Gru","doi":"10.1097/DAD.0000000000002913","DOIUrl":"10.1097/DAD.0000000000002913","url":null,"abstract":"<p><strong>Abstract: </strong>Primary effusion lymphoma (PEL) is a rare and aggressive B-cell lymphoma typically associated with human herpesvirus 8 (HHV-8) and Epstein-Barr virus infections. It classically presents as a malignant effusion in body cavities, but rarely presents with an extracavitary variant characterized by solid tumors in lymph nodes or extranodal sites such as the gastrointestinal tract, skin, lungs, and nervous system. This case report describes an unusual presentation of primary cutaneous extracavitary PEL in an HIV-positive patient that has only been reported in 8 cases previously. The patient presented with a skin nodule in the right supraclavicular area. Histopathologic examination showed a malignant infiltrate in the dermis composed of sheets of plasmablasts. The immunophenotype of the cells shows the characteristic coinfection with HHV-8 and Epstein-Barr virus. The case presented herein contributes to expand the reported literature on primary cutaneous extracavitary PEL and performs a comprehensive review of this entity, which most dermatopathologists are unfamiliar with.</p>","PeriodicalId":50967,"journal":{"name":"American Journal of Dermatopathology","volume":" ","pages":"233-237"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928587","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":"Evaluating CD1a Immunohistochemistry for Tegumentary Leishmaniasis Diagnosis in the New World: A Focus on Colombia.","authors":"Lucero Katherine Aristizábal-Parra, Juan Pablo Ospina-Gómez, Lina Restrepo-Rivera, Juan David Ramírez, Carlos Mario Ospina-Varón, Juan David González, Héctor Serrano-Coll","doi":"10.1097/DAD.0000000000002867","DOIUrl":"10.1097/DAD.0000000000002867","url":null,"abstract":"<p><strong>Introduction: </strong>Leishmaniasis, a chronic vector-borne disease caused by parasites of the genus Leishmania , presents diagnostic challenges. Conventional diagnostic methods struggle with accurate visualization of these parasites. Immunostaining with CD1a has demonstrated effectiveness in visualizing Leishmania parasites, particularly in the Old World. However, the application of CD1a immunostaining in Colombian leishmaniasis remains unexplored.</p><p><strong>Objective: </strong>To determine the utility of CD1a as an immunomarker in detecting chronic forms of tegumentary leishmaniasis.</p><p><strong>Materials and methods: </strong>This proof-of-concept study involved 48 paraffin-embedded samples categorized into 3 groups: moderate-to-high parasite load (n = 15), low load (n = 15), and chronic granulomatous inflammation (n = 13); 5 samples diagnosed with cutaneous histoplasmosis. These samples were stained with the immunomarker CD1a clone EP3622 for comparative analysis. In addition, CD1a immunohistochemistry was compared with 18S rDNA qPCR and hematoxylin-eosin staining to evaluate its performance in relation to these established methods.</p><p><strong>Results: </strong>CD1a immunohistochemistry was positive in 46.51% of the samples evaluated. This immunomarker showed lower sensitivity and negative predictive value than 18S rDNA qPCR and hematoxylin-eosin staining; specificity and negative predictive value were consistent. ROC indicated inferior discrimination for leishmaniasis compared with 18 s rDNA qPCR and hematoxylin-eosin staining.</p><p><strong>Conclusions: </strong>Immunohistochemistry for CD1a could be a diagnostic support in the detection of chronic forms of tegumentary leishmaniasis.</p>","PeriodicalId":50967,"journal":{"name":"American Journal of Dermatopathology","volume":" ","pages":"197-205"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480040","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":"Concepts in Cutaneous Vasculitis.","authors":"Angel Fernandez-Flores","doi":"10.1097/DAD.0000000000002807","DOIUrl":"https://doi.org/10.1097/DAD.0000000000002807","url":null,"abstract":"<p><strong>Abstract: </strong>Skin biopsy plays a fundamental role in the diagnosis of vasculitis. However, the general pathologist or dermatopathologist who encounters these diagnostic findings in their early stages often faces the paradox that the clinician requests the exclusion of various systemic diseases, when the biopsy only shows leukocytoclastic vasculitis. In other cases, even though the affected vessels are small, some of them seem deep within the biopsy, raising differential diagnosis with several entities of systemic repercussion. Lastly, although the dermatopathologist has a histological picture before them, they are often required to correlate it with laboratory data such as the presence of antineutrophil antibodies, for example. Therefore, the objective of this article is conceptual, emphasizing those basic aspects that can contribute to a better understanding and diagnosis of skin biopsy in vasculitis.</p>","PeriodicalId":50967,"journal":{"name":"American Journal of Dermatopathology","volume":"47 3","pages":"165-177"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416207","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":"Histopathology of Linear Lichen Planus.","authors":"Nikhil Mehta, M Ramam, Binod K Khaitan","doi":"10.1097/DAD.0000000000002886","DOIUrl":"https://doi.org/10.1097/DAD.0000000000002886","url":null,"abstract":"","PeriodicalId":50967,"journal":{"name":"American Journal of Dermatopathology","volume":"47 3","pages":"249-250"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416182","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}