Granular cell tumor (Abrikossoff tumor) of the clitoris

A 60-year-old woman presented to the Department of Dermatology of the ABC Medical Center in Mexico City with a 2-month history of a progressive growth in the region of the clitoris that had been increasing rapidly. Examination revealed a firm growth measuring 3 cm in diameter; the overlying surface was smooth and free of ulceration. Vaginal speculum examination showed no mucosal irregularities or displacement. Rectal examination was normal. Inguinal lymph nodes were clinically negative. A wide excisional biopsy was performed with ample skin margins.
The specimen consisted of a mass measuring 3.5 × 1.2 × 0.5 cm that was pale tan, homogeneous, and firm. Prepared sections showed a cellular tumor composed of compact irregular strands and nodules of polyhedral cells containing centrally located, round to oval vesicular nuclei with no significant atypia of mitosis. These cells had granular eosinophilic cytoplasm with distinct cell borders (Fig. 1). The cytoplasmic granules were diastase-resistant periodic acid-Schiff (PAS) positive. The tumor cells were positive for S–100 protein and for neuron-specific enolase (NSE), and were negative for actin, desmin, and cytokeratin. The tumor showed compression and obliteration of the cavernous sinuses (Fig. 2) outlined by the S–100 immunostain and actin. (Figs 3 and 4).     

Vertical tumor thickness as an estimate of actual tumor volume

According to Cavalieri, the volume of any body-irrespective of its shape-can easily be estimated on the basis of the area of slabs of known thickness. We made use of this old principle in order to determine the correlation between the volume of skin tumors and their maximal vertical thickness. Investigations of a total of 30 benign and malignant tumors of the skin of various shapes showed a correlation coefficient of r = 0.77. Therefore, the widely used determination of the vertical thickness of malignant melanomas can be regarded as a good estimator of the tumor volume and seems to be appropriate for histological tumor staging. Together with high frequency ultrasound, Cavalieri's method allows a simple and rapid pretherapeutical in-vivo determination of the tumor volume. However, only prospective studies can reveal whether the determination of the tumor volume is of superior prognostic significance to the established techniques.     

肿瘤浸润淋巴细胞在人黑色素瘤组织中的形态学观察

目的探讨人黑色素瘤组织中肿瘤浸润淋巴细胞（tumor infiltrating lymphocyte，TIL）的形态学特征。方法采用光镜、透射电镜和免疫组化方法观察9例人皮肤黑色素瘤组织中TIL的分布及形态变化。结果肿瘤浸润淋巴细胞主要分布在癌周区，病变早期，TIL数量多、集中分布；病变晚期，TIL数量少、散在分布。病变早期TIL数量明显高于病变晚期（P〈0．01）。电镜下，可见肿瘤浸润淋巴细胞核大，胞质少，核较圆。TIL与肿瘤细胞有接触。结论本试验提示黑色素瘤组织中TIL数量多少与肿瘤的进展有关。TIL与肿瘤细胞关系密切。     

恶性肿瘤皮肤转移20例临床分析

报告了20例恶性肿瘤伴发皮肤转移性肿瘤,并对其进行临床分析,皮损为无痛性结节多见,组织病理以腺癌多见。在女性乳腺癌发生率高,男性肺癌发生率高。临床上出现皮肤转移性肿瘤,则提示了病情进展程度,应引起重视。     

Coexistence of tumor of the follicular infundibulum with an unusual trichilemmal tumor

Tumor of the follicular infundibulum (TFI) is a rare epithelial tumor, and its histogenesis is still somewhat debatable. The diagnosis of TFI cannot currently be made before biopsy, and it is most often misdiagnosed as basal cell carcinoma (BCC). A 78-year-old woman presented to the dermatology clinic with a slightly erythematous nodule surrounded by fine telangiectasia on her right temple. Histopathologic examination of the lesion revealed an epithelial tumor with a plate-like growth pattern as is typical of TFI. In the same specimen, an unusual trichilemmal tumor with multiple epidermal connections was observed adjacent to the foci of TFI. The lobular tumor was composed of a large mass of keratinocytes with pale cytoplasm arranged as sheets and interconnecting ribbons. Several cells with hyperchromatic nuclei and small foci of compact cornification were also noted within the bulk of the tumor. The histopathologic features of the unusual tumor were reminiscent of BCC with trichilemmal differentiation or desmoplastic trichilemmoma.     

Malignant giant cell tumor of soft parts presenting as a skin tumor

Malignant giant cell tumor of soft parts is a rare neoplasm that histologically resembles a giant cell tumor of bone. It has a distinctive multinodular growth pattern and is composed of numerous osteoclast-like giant cells, histiocytes, and fibroblasts. Although this tumor is usually found in deep soft tissues, a superficial form has been described in the subcutaneous tissue and fascia. The authors report two patients, aged 75 and 78, with malignant giant cell tumors presenting as ulcerating skin nodules of the arm and foot. The tumors were relatively small, measuring less than 3.5 cm in greatest dimension, and involved the entire dermis and subcutaneous tissue. The clinical differential diagnoses included Kaposi's sarcoma, melanoma, and hematoma. Dermatopathologists and dermatologists should be aware of this entity to avoid confusion with other benign and malignant neoplasms that may contain multinucleated giant cells. The distinguishing histologic and immunohistochemical features of this tumor are discussed.     

Plexiform fibrohistiocytic tumor

We report the case of a 6-year-old Japanese boy with a plexiform fibrohistiocytic tumor on the right perioral region. Clinically, the tumor, 5 mm in diameter, was a solitary, hard, erythematous, slowly growing, painless nodule. There was no preceding trauma. Histology revealed a well-circumscribed plexiform lesion with a biphasic appearance. Immuno-histochemistry demonstrated CD68 positivity in many of mononuclear macrophages. The lesion was negative for S-100 protein, lysozyme, CD57 and factor XIIIa. Interestingly, the tumor showed an intradermal location from superficial to deep dermis, and lacked osteoclast-like giant cells. During the follow-up for 9 months after the resection, there was no recurrence or metastasis.     

Merkel cell tumor

A case of a rapidly growing Merkel cell tumor occurring on the lower extremity in an 83-year-old woman is reported. A brief review of the clinical characteristics of this tumor as well as its immunohistochemical and ultrastructural features are presented.     

实体型血管球瘤

患者女,32岁。主诉:左大腿后内侧出现紫红色结节半年。现病史:患者半年前在洗澡时无意中发现左大腿后内侧有一粟粒大红色丘疹,伴有轻微疼痛,当时未就诊。此后丘疹逐渐增大,当穿衣或坐板凳不慎碰触时,有剧烈的疼痛。疼痛与寒冷、进食刺激性食物(如辣椒、醋、蒜等)无关。起病前局部无明确外伤史。患者既往体健,无皮肤及内脏肿瘤病史。为明确诊断,于2004年6月3日来我科门诊就诊。体格检查:一般情况好,各系统检查无异常,全身浅表淋巴结未扪及增大。皮肤科检查:左大腿后内侧可见一黄豆大紫红色结节,周边有淡红晕(图1A),质软,有明显触痛。组织病…     

Extraparotid Warthin's tumor

Warthin's tumor (papillary cystadenoma lymphomatosum) is a well-known benign tumor of the parotid gland. Extraparotid tumors occasionally arise in the cervical region, where they may well be seen by the dermatologist. The following is a case report of an extraparotid Warthin's tumor encountered in a dermatology practice, with a review of the important clinical and histopathologic features of this tumor.     

Apocrine mixed tumor

We report on an apocrine mixed tumor. There are two essential elements that are characteristic of well-circumscribed, benign tumor: 1. Nests of epithelial cells, 2. Variously structured glandular pattern of the apocrine type embedded in a chondroid or mucoid. matrix.