Reflectance confocal microscopy in the diagnosis of vesicobullous disorders: case series with pathologic and cytologic correlation and literature review.

Background: Vesicobullous disorders are characterized by intraepidermal or subepidermal blistering resulting from different pathogenetic mechanisms. The diagnosis is generally based on clinical examination and semi-invasive/invasive procedures such as cytology and histopathology. In vivo reflectance confocal microscopy (RCM) is a non-invasive technique for real-time, en face imaging of the epidermis and upper dermis with high resolution close to conventional histopathology.

Identification of granzyme B-expressing CD-8-positive T cells in lymphocytic inflammatory infiltrate in cutaneous lupus erythematosus and in dermatomyositis.

Background: Lupus erythematosus (LE) and dermatomyositis (DM) are interface dermatitis, histologically characterized by formation of colloid bodies and a CD4+ CD8+ lymphocyte infiltrate. Colloid bodies are examples of intraepidermal apoptosis. Granzyme (Gr)B, synthesized by activated cytotoxic lymphocytes, is a serine protease able to prime apoptosis.

Acquired cutaneous lymphangiectasia with mesothelial cells reflux in a patient with cirrhotic ascites.

A previously undescribed case of acquired cutaneous lymphangiectasias on the abdomen in a patient with cirrhotic ascites where peritoneal mesothelial cells refluxed in the skin is discussed. A 56-year-old man previously submitted to liver transplantation presented with vesiculobullous lesions on the developed as his cirrhotic ascites progressed. Histology showed dilated lymphatic channels in the upper dermis lined by a single, discontinuous layer of flattened, monomorphous endothelial cells with endoluminal papillary projections.

Infantile erythema elevatum diutinum: report of a vesiculo-bullous case.

Erythema elevatum diutinum (EED) is a localized, low-grade form of leukocytoclastic vasculitis mainly affecting adults, with only a few pediatric cases reported in the literature. The pathogenesis of this dermatosis is unknown, although an Arthus-type reaction to bacterial and viral antigens seems involved. We describe a case of EED in a 9 year-old child suffering from recurrent pharyngotonsillitis induced by Streptococcus pyogenes.

Interobserver reproducibility of histological features in cutaneous malignant melanoma.

Aims: To assess the interobserver reproducibility of certain histological features proposed for the diagnosis of melanoma.

Methods: In a series of melanomas, 13 histological parameters were analysed: dimension > 6 mm, asymmetry, poor circumscription, irregular confluent nests, single melanocytes predominating, absence of maturation, suprabasal melanocytes, asymmetrical melanin, melanin in deep cells, cytological atypia, mitoses, dermal lymphocytic infiltrate, and necrosis.

Results: The agreement (reproducibility) between the nine observers was excellent (kappa > 0.

Histological features used in the diagnosis of melanoma are frequently found in benign melanocytic naevi.

Aims: The histological features used in the diagnosis of melanoma may be present in benign naevi, but quantitative data are not available. The aim of this study was to establish the real prevalence of such features in naevi.

Methods: Ten dermatopathologists, from nine Italian institutions, studied a series of naevi.

Targetoid hemosiderotic nevus. A trauma-induced simulator of malignant melanoma.

Background: Simulators of malignant melanoma comprise a heterogenous group of melanocytic and nonmelanocytic lesions of the skin. Among frequent clinical mimickers of melanoma are injured melanocytic nevi. Any change in the clinical appearance of a pre-existing nevus should alert the clinician to exclude the possibility of malignant transformation in order to early identify a lesion at a stage when complete cure can still be achieved.

Cutaneous angiosarcoma arising in an irradiated breast. Case report and review of the literature.

Angiosarcoma (AS) is a rare, aggressive tumour of endothelial origin occurring in various clinical settings, including idiopathic AS on the head and neck in elderly people, lymphoedema-associated AS, post-irradiation AS, soft-tissue AS, and various others. Despite the widespread use of radiation therapy in the treatment of breast carcinoma, AS developing in the wake of a radiation therapy is extremely infrequent. Although there is little doubt that radiation in therapeutic doses can induce sarcomas, quantification of that risk is complicated by many variables, among them chronic lymphoedema.

Cutaneous intravascular lymphoma following extravascular lymphoma of the lung.

Intravascular lymphoma (IL) is a rare aggressive disease characterized by exclusive or predominant accumulation of malignant lymphoid cells within the lumina of small arteries, veins and capillaries. We describe a 74-year-old woman with IL presenting in the skin as asymptomatic teleangiectatic plaques on the thighs. The cutaneous neoplasm developed 18 months after an extravascular large B cell lymphoma of the lung and heralded its relapse.

Melanocytic nevi of the breast: a histologic case-control study.

Background: Melanocytic nevi in the genital, acral, and flexural sites often display clinical and histologic features that may simulate melanoma. We verified whether this is the case also for nevi of the breast.

Methods: Eleven dermatopathologists, from nine Italian Institutions, collected the specimens of melanocytic lesions from the breast and other body sites, excluding the acral, genital, and flexural areas, as controls.

Eyelid swelling: think of metastasis of histiocytoid breast carcinoma.

Metastatic breast carcinoma may assume many clinicopathological patterns. We here describe a case of histiocytoid breast carcinoma metastasis in the eyelids of a 73-year-old woman. Clinically, the patient presented painless swelling and nodular infiltration of the lateral and medial portions of the eyelids recalling a xanthomatous process or cystic lesions.

Interstitial granulomatous dermatitis with plaques.

Background: Interstitial granulomatous dermatitis is a histopathologic pattern with variable clinical appearance associated with autoimmune systemic diseases. The frequency of its different cutaneous expressions and its association with autoimmune diseases are not known.

Objective: We describe the clinical, serologic, and histologic features in 17 patients with interstitial granulomatous dermatitis with a clinical presentation consisting of large erythematous plaques.

Reproducibility of histopathologic diagnosis and classification of non-melanocytic skin cancer: a panel exercise in the framework of the multicenter southern European study HELIOS.

Aims And Background: The reproducibility of histologic diagnoses, and in particular of the distinction between basal and squamous cell forms, has been evaluated in the framework of a multicenter case-control study (in Italy, France, Spain and Switzerland) aimed to assess the causes of non-melanocytic skin cancers.

Methods: A panel composed of 10 pathologists from the collaborating centers was appointed. A total of 1,774 slides of routine diagnoses were blindly reviewed by a second panelist; discordant diagnoses underwent a third examination.

Immature myeloid precursors in chronic neutrophilic dermatosis associated with myelodysplastic syndrome.

Sweet syndrome (SS) associated with myeloproliferative disorders has been considered an inflammatory process mediated by neutrophils in which immunologic mechanisms are operative. The authors report the case of a 68-year-old man suffering from a myelodysplastic syndrome, who presented with a relapsing skin eruption resembling SS. Histopathologically, the skin infiltrates showed prominent neutrophilic features masking the underlying malignant process.

Angioendotheliomatosis in a woman with rheumatoid arthritis.

Reactive angioendotheliomatosis (RA) is a rare self-limited skin condition characterized histopathologically by a proliferation of endothelial cells within vascular lumina, usually as a result of different stimuli such as systemic infections, cryoproteinemias, monoclonal gammopathies, allergic conditions, severe peripheral vascular atherosclerotic disease, and iatrogenic arteriovenous fistulas. We report on a 67-year-old woman with a 20-year history of seropositive rheumatoid arthritis who presented with violaceous swelling of her left forearm. A skin biopsy revealed the histopathologic finding of RA with focal glomeruloid features and deposition of periodic acid-Schiff-positive material.

[Estimate of the proportion of skin tumors attributable to sun exposure in 3 Italian populations].

Translation of recommendations on skin cancer prevention formulated by many national and international institutions into efficient steps requires measuring the potential impact in terms of preventable cases. This study analyses the proportion of skin cancers attributable to sun exposure in Turin, Trento and Ragusa. Estimates have been reached by applying the risk models calculated from the case-control study on melanoma in Turin and the Helios multi-centric study on skin carcinomas.

The clinicopathologic spectrum of rhinophyma.

We report the results of a clinicopathologic study of 17 patients with rhinophyma in different stages of evolution, with particular attention paid to the severe form of this disease. On the basis of clinical features, we identified 2 groups of patients: the first group (12/17 patients) included patients with the common form of rhinophyma, whereas the second one (5/17 patients) included patients with the severe form of the disease. There was no link between the clinical aspect and the duration of the disease.

Dermatofibroma with granular cells: a report of two cases.

We describe two examples of an unusual variant of dermatofibroma (DF) in which areas of granular cells were a prominent feature. The diagnosis of DF was confirmed by immunohistochemistry and by ultrastructural studies. Granular cell changes can be observed in numerous benign and malignant cutaneous tumors of different cellular lineage.

Interstitial granulomatous dermatitis with plaques.

We report on the clinical and histopathologic findings of four patients who had asymptomatic, erythematous to violaceous plaques symmetrically distributed on the upper aspect of the thighs, lateral chest, and in two cases also on the abdomen and flexor surface of the elbows. All of the patients were women; two of them had arthritis, which in one case was associated with an autoimmune disorder, and another had autoimmune thyroiditis. Histopathologically, all cases showed similar changes consisting of an interstitial granulomatous dermatitis involving mostly the lower reticular dermis.

Parallel risk assessment of melanoma and basal cell carcinoma: skin characteristics and sun exposure.

In this study we compared the strength of the association of constitutional factors and sun exposure with cutaneous malignant melanoma (CMM) and basal cell carcinoma (BCC). We analysed 260 incident cases of CMM, 425 incident cases of BCC and two sets of population controls from previous case-control studies conducted in Turin, Italy. Simultaneous comparison was accomplished by comparing separate simple logistic and polytomous logistic regressions.

Multinucleate cell angiohistiocytoma: a report of two cases.

We report the clinical, histological and immunological features of two cases of multinucleate cell angiohistiocytoma (MCAH) in women of 32 and 53 years of age, respectively. Clinically, MCAH occurs mostly in middle-aged women and consists of crops of reddish-purple, dome-shaped papules especially on the limbs. Histologically, the reticular dermis presents an increased number of small vascular channels with plump endothelial cells embedded in a fibrohistiocitic stroma with numerous bizarre multinucleate cells.

Vulvodynia and HIV: causal or casual association?

Background: No study exists on HIV and vulvodynia.

Objective: To evaluate vulvodynia in HIV infected women and its possible association with HIV.

Design: Cross sectional study.