Sebaceous adenoma with a cutaneous horn

Cutaneous horns are common lesions that: usually represent actinic keratoses, verrucae, seborrheic keratoses, and squamous cell carcinomas. We present a remarkable example of a sebaceous adenoma with cutaneous horn formation. The solitary lesion occurred over the left clavicle of a 71-year-old man without evidence of the Muir-Torre syndrome. There have been only three previous reports of sebaceous tumors (one sebaceous adenoma and two sebaceous carcinomas) producing cutaneous horns, the latter of which are actually pseudohorns, exophytic extensions of tumor without hyperkeratosis.     

Cutaneous manifestations of internal malignancy

Background:

Many malignancies affecting the internal organs display cutaneous manifestations which may be either specific (tumor metastases) or nonspecific lesions.

Aims:

The study is aimed at determining the frequency and significance of cutaneous manifestations among patients with internal malignancy.

Materials and Methods:

750 cases of proven internal malignancy, who attended a cancer chemotherapy center in South India, were studied. Specific infiltrates were confirmed by histopathology, fine needle aspiration cytology (FNAC) and marker studies.

Results:

Out of the 750 patients with internal malignancy, skin changes were seen in a total of 52 (6.93%) patients.

Conclusion:

Cutaneous metastases (specific lesions) were seen in 20 patients (2.66%): contiguous in 6 (0.8%), and non-contiguous in 14 (1.86%). Nonspecific skin changes were seen in 32 patients (4.26%). None of our patients presented with more than one type of skin lesions. Herpes zoster was the most common nonspecific lesion noticed in our patients, followed by generalized pruritus, multiple eruptive seborrheic keratoses, bullous disorder, erythroderma, flushing, purpura, pyoderma gangrenosum, insect bite allergy and lichenoid dermatitis.     

Seborrheic keratoses in five elderly patients: an appearance of raindrops and streams

Five Chinese patients were found to have a linear, splayed, vertical pattern of lesions on their back, chest and abdomen. These lesions were clinically and pathologically diagnosed as seborrheic keratosis. The mean age of our patients was 77.6 years. During the follow-up period of 12-20 years, the lesions appeared to increase with age, and no malignant changes were observed on these sites. These patients had no serious underlying medical problems or malignant neoplasm, except for one patient with duodenal ulcer. While we are uncertain as to the cause of this patterning of seborrheic keratoses, we believe that it is distinct from previously reported patterns; this will contribute to research on the pathogenesis of seborrheic keratosis.     

MALIGNANT TRANSFORMATION OF ACTINIC KERATOSES TO SQUAMOUS CELL CARCINOMA IN AN ALBINO

A 25-year-old male, who was a known case of oculocutaneous albinism presented to us with right inguinal swellings of six months'' duration. He gave a preceding history of a similar lump in the right thigh, which was excised at the Chennai Government Hospital. He was diagnosed to have oculocutaneous albinism with actinic keratoses, with multiple squamous cell carcinomas (with metastatic deposits in the right inguinal region) and cutaneous horns. The case is reported to highlight preventive aspects in the management of albinos.     

Lymphocytoma cutis following excision arthroplasty

Cutaneous pseudolymphomas are a group of benign reactive T or B cell lymphoproliferative processes of diverse etiology that simulate cutaneous lymphomas clinically and histologically. We report one such case of pseudolymphoma occurring in the groin of an elderly lady with a history of excision arthroplasty and cementing done at the same site decades ago.     

Approach to Cutaneous Lymphoid Infiltrates: When to Consider Lymphoma?

Cutaneous lymphoid infiltrates (CLIs) are common in routine dermatopathology. However, differentiating a reactive CLI from a malignant lymphocytic infiltrate is often a significant challenge since many inflammatory dermatoses can clinically and/or histopathologically mimic cutaneous lymphomas, coined pseudolymphomas. We conducted a literature review from 1966 to July 1, 2015, at PubMed.gov using the search terms: Cutaneous lymphoma, cutaneous pseudolymphoma, cutaneous lymphoid hyperplasia, simulants/mimics/imitators of cutaneous lymphomas, and cutaneous lymphoid infiltrates. The diagnostic approach to CLIs and the most common differential imitators of lymphoma is discussed herein based on six predominant morphologic and immunophenotypic, histopathologic patterns: (1) Superficial dermal T-cell infiltrates (2) superficial and deep dermal perivascular and/or nodular natural killer/T-cell infiltrates (3) pan-dermal diffuse T-cell infiltrates (4) panniculitic T-cell infiltrates (5) small cell predominant B-cell infiltrates, and (6) large-cell predominant B-cell infiltrates. Since no single histopathological feature is sufficient to discern between a benign and a malignant CLI, the overall balance of clinical, histopathological, immunophenotypic, and molecular features should be considered carefully to establish a diagnosis. Despite advances in ancillary studies such as immunohistochemistry and molecular clonality, these studies often display specificity and sensitivity limitations. Therefore, proper clinicopathological correlation still remains the gold standard for the precise diagnosis of CLIs.     

Concurrent Hand-Foot Skin Reaction and Hair Depigmentation With Sunitinib: Report of a Case and Literature Review of Kinase Inhibitors and Blocking Antibodies

Kinase inhibitors have revolutionized cancer therapy by becoming the first-line agents for advanced solid malignancies replacing the traditional chemotherapeutic agents. Cutaneous side-effects with these drugs are common, but owing to their infrequent use in Indian patients, our current knowledge of toxicity is scanty and primarily based on the western literature. Cutaneous reactions can adversely affect patients’ quality of life (QoL) and can lead to dose modifications and treatment interruptions. The report discusses concurrent hand-foot skin reaction (HFSR) and hair depigmentation in an Indian patient being treated with sunitinib for advanced renal cell carcinoma. The pathogenesis and treatment strategies for this characteristic phenomenon and other cutaneous toxicities of kinase inhibitors have also been reviewed.     

DERMATOLOGICAL MANIFESTATIONS IN HIV-INFECTED PATIENTS AT A TERTIARY CARE HOSPITAL IN A TRIBAL (BASTAR) REGION OF CHHATTISGARH, INDIA

Background:

Cutaneous disorders during HIV infection are numerous and skin is often the first and only organ affected during most of the course of HIV disease. Some Cutaneous disorders reflect the progression of HIV disease; though the relation is still controversial.

Aims:

The objective of this study, conducted at a tertiary care centre in Bastar, Jagdalpur, is to estimate the status of cutaneous manifestation in HIV-infected patients and its relationship with CD4 cell counts.

Methods:

We enrolled 137 HIV positive subjects. Demographic information such as age, gender, weight, height, socioeconomic status, and educational status were recorded. Laboratory parameter (CD4 counts) and treatment regimen were noted. Patients were examined for skin disorders by a dermatologist. Data were analyzed using chi-square test for categorical variables.

Results:

Majority of the patients were from rural area (65.69%) and belonged to a low socioeconomic and educational status. 30.65% of the patients were housewives, 23.35% drivers, and 16.78% labourers. Predominant mode of transmission was heterosexual contact (94.16%). Most common HIV-related dermatological manifestations were seborrheic dermatitis (74.16%), xerosis (52.5%), generalized skin hyperpigmentation 56 (46.67%), onychomycosis 53 (44.16%), pruritic papular eruption 27 (22.5%), oral candidiasis 21 (17.5%), photo dermatitis 21 (17.5%), and scabies 4 (3.33%). Significant correlation with low CD4+ cell counts was found for oral candidiasis (P < 0.0001) and Kaposi''s sarcoma (P = 0.03), while other disorders such as seborrheic dermatitis (P = 0.22), xerosis (P = 0.25), and onychomycosis (P = 0.08) were not statistically significant.

Conclusion:

This study showed high prevalence of dermatological manifestations in HIV-infected subjects, and they occur more frequently with progression of HIV and decline in immune functions. Therefore, early diagnosis and management of skin disorders can improve the quality of life of HIV-infected subjects.     

A clinical and histopathological profile of patients with cutaneous tuberculosis

Extrapulmonary tuberculosis constitutes about 10% of all cases of tuberculosis, and cutaneous tuberculosis makes up only a small proportion of these cases. Despite prevention programs, tuberculosis is still progressing endemically in developing countries. Commonest clinical variant of cutaneous tuberculosis in our study was lupus vulgaris seen in 55% patients followed by scrufuloderma seen in 25% patients followed by orificial tuberculosis, tuberculosis verrucosa cutis, papulonecrotic tuberculid, and erythema induratum seen in 5% each. The commonest site of involvement was limbs seen in 50% patients followed by neck seen in 25% patients, face in 15%, and trunk in 10% patients. Maximum percentage of patients (55%) had duration of cutaneous tuberculosis between 6-12 months followed by 35% between 13-24 months, 5% had duration of cutaneous tuberculosis less than 6 months, and the rest 5% had duration more than 24 months. The commonest histopathological feature in our study was tuberculoid granuloma with epitheloid cell and Langhans giant cells seen in 70% patients, hyperkeratosis was seen in 15% patients and AFB bacilli were seen in 5% patients.     

T-Cell Rich Angiomatoid Polypoid Pseudolymphoma: A Novel Cutaneous Pseudolymphoma

Cutaneous pseudolymphomas refer to a group of benign reactive T or B cell lymphoproliferative processes that simulate cutaneous lymphomas. T cell rich angiomatoid polypoid pseudo lymphoma (TRAPP) of the skin is a unique form of T cell rich cutaneous pseudolymphoma. A 13-year-girl presented with an asymptomatic skin colored papule on the right elbow, the biopsy of which revealed features consistent with TRAPP. The dermis showed an infiltrate of lymphocytes, plasma cells, and histiocytes along with prominent vascular channels lined by plump endothelium. An immunohistochemical study showed a predominance of T cells over B cells. The morphological and immunohistochemical features pointed towards the diagnosis of TRAPP. We report this rare entity, only 17 cases of which have been described so far in literature. The differential diagnoses have also been discussed.     

Seborrheic keratoses and cancer

BACKGROUND: The eruptive appearance of numerous seborrheic keratoses, the sign of Leser-Trélat, has been regarded as a reliable cutaneous marker of internal malignancy. OBJECTIVE: We have evaluated the possible association of malignant disease and the sign in 1752 consecutive cases of seborrheic keratoses. METHODS: First, the Swedish Cancer Registry was searched for records of malignancies in the study population (1958 to 1984), and the expected number of malignancies was calculated. Second, records of persons with malignancy within 1 year before or after the diagnosis of seborrheic keratosis were checked for the sign of Leser-Trélat. Third, a case control study was performed to evaluate the possibility of eruptive seborrheic keratoses among the noncancer patients in the study population. RESULTS: The results showed a slight increased risk of cancer in the study population (relative risk = 1.2; 95% confidence interval = 1.0 to 1.3), mainly because of an increased risk of cutaneous squamous cell carcinoma. In 62 patients with seborrheic keratoses, a malignancy (excluding skin) was diagnosed within 1 year before or after the diagnosis of seborrheic keratosis. Of these 62 patients, 6 were regarded as possibly having presented with the sign of Leser-Trélat. For every one of the 62 cases with seborrheic keratosis and malignancy within one year, an age- and sex-matched control patient without cancer was selected from the study population and the records were checked for sudden and eruptive seborrheic keratoses. Among the control patients, five were regarded as possibly having presented with the sign of Leser-Trélat. CONCLUSION: This study gives no evidence to support the opinion that eruptive seborrheic keratoses are related to internal cancer risk.     

Cutaneous B cell lymphomas: Report of two interesting cases

Cutaneous B cell lymphomas can arise primarily from the skin or may occur due to secondary spread from nodal lymphomas. Primary lymphomas are confined to the skin without systemic spread and they differ from secondary lymphomas in their clinical behavior, treatment and prognosis. Cutaneous lymphomas being relatively rare, lack of precise definition and understanding of their clinical behavior diseases leads to pitfalls in the diagnosis. We report two cases of cutaneous B cell lymphomas who presented with fever of unknown origin initially and later found to have skin lesions. Hence, skin can be a potential diagnostic clue in the evaluation of patients with fever of unknown origin. The distinctions between the primary and the secondary lymphomas become important in choosing the treatment and assessing the prognosis.     

Bilateral Multisegmental Zosteriform Leiomyoma Cutis: A Rare Entity

Cutaneous leiomyomas are benign tumors derived from the smooth muscles of the skin. They are firm, skin-colored to brownish, frequently painful papules and nodules presenting either as a solitary tumor or multiple clustered lesions. Uncommon patterns of multiple leiomyoma cutis include linear, zosteriform, or dermatomal-like arrangement of lesions. We saw a 32-year-old man who presented with clusters of skin colored to reddish brown, occasionally painful papules and nodules distributed segmentally over C6 to T8 dermatomes on left side and T11 to L1 dermatomes on right side. Histopathology confirmed the diagnosis of cutaneous leiomyoma. The case is reported here for the occurrence of this benign cutaneous neoplasm in an extremely rare bilateral multisegmental distribution.     

Metastatic Fungating Ulcerative Growth on Vulva as a Presenting Feature of Carcinoma Cervix: A Rare Case Report

Carcinoma of the cervix is the second to fourth most common malignancy in women. It metastasizes most often to the lungs, bones, and liver. Skin involvement originating from cervical cancer is rare, even in the terminal stages of the disease. Cutaneous metastasis of cervical cancer usually presents as cutaneous nodules, papules/plaques, maculopapular rash, and diffuse inflammatory rash. We report a rare case (only the second reported case to the best of our knowledge) of a 50-year-old woman with cutaneous metastasis in form of fungating ulcerative growth on mons pubis as presenting feature of carcinoma cervix.     

CUTANEOUS PANCREATIC METASTASIS: A CASE REPORT AND REVIEW OF LITERATURE

Pancreatic cancer is one of the most dangerous human cancers and will continue to be a major unsolved health problem as we enter the 21^st century. This is the case despite advances in imaging technology and surgical management. Indeed, 80% to 90% of pancreatic cancers are diagnosed either at the locally advanced or metastatic stage. Cutaneous metastases originating from pancreatic cancer are relatively rare. The most common site of cutaneous metastasis is the umbilicus, and this is known as the Sister Joseph''s nodule. Very few patients have been reported with cutaneous lesions disclosing a pancreatic carcinoma at sites other than the umbilical area. To the best of our knowledge, there have been no previous reports on cutaneous pancreatic metastasis in Egypt. This is a report on a patient with cutaneous pancreatic metastases at the neck and review of reported non-umbilical cutaneous metastases from pancreatic carcinoma in the literatures.     

Solitary Pilar Leiomyoma of the Nasal Dorsum: Case Report and Literature Review

Cutaneous leiomyoma is an infrequently occurring benign tumor that arises from smooth muscle in the skin. Pilar leiomyoma, a subtype of cutaneous leiomyoma, arises from the arrector pili muscle associated with hair follicles. Pilar leiomyoma, particularly in the head and neck region, is rare and frequently misdiagnosed. We report one patient who developed pilar leiomyoma of the nasal dorsum, explore the differential diagnosis and review the characteristics of previously reported individuals with pilar leiomyoma of the nasal dorsum.     

Palmoplantar keratoderma and oral leucoplakia with cutaneous horn of the lips

The inherited palmoplantar keratodermas (PPK) may be associated with a wide variety of other ectodermal abnormalities. The coexistence of PPK and leucoplakia may indicate the increased risk of oesophageal carcinoma in adult life. Cutaneous horn may develop over benign, precancerous, as well as malignant lesions, and frequently may be associated with actinic keratoses and Bowen's disease. On the other hand, the relationship of cutaneous horn and leucoplakia has been the subject of only a single case report. We present a case of PPK and diffuse oral leucokeratosis associated with relapsing cutaneous horn of the lips.     

Hemorrhagic Skin Nodules and Plaques: A Diagnostic Clue to Underlying Primary Plasma Cell Leukemia

Plasma cell leukemia (PCL) is a rare lymphoproliferative disorder characterized by a malignant proliferation of plasma cells (PC) in blood and marrow. Cutaneous involvement is very rare in PCL. We present the case of a 45-year-old lady who presented with multiple hemorrhagic nodules and plaques in the skin. Her total leucocyte count was 2,00,200/cmm with 85% abnormal plasmacytoid cells in peripheral smear. Biopsy of the skin lesions revealed diffuse infiltration by plasma cells with ‘choked’ blood vessels. A diagnosis of plasma cell leukemia with cutaneous involvement was made. On the second day of admission, the patient expired probably because of intracranial bleed due to thrombocytopenia. Post-mortem bone marrow and liver biopsy also showed diffuse infiltration by plasma cells. Monoclonality of the cells was proven by demonstrating the production of only kappa light chains.