A congenital smooth muscle hamartoma masquerading as a reticulate vascular naevus

Smooth muscle hamartoma (SMH) is a benign congenital or acquired hamartomatous lesion comprising a dermal proliferation of smooth muscle bundles. We report a case of congenital SMH with an unusual clinical appearance. A 3‐year‐old girl presented with an asymptomatic atrophic linear lesion on the posterior surface of her right thigh, which had been present since birth. The striking resemblance to a vascular lesion initially led to the erroneous clinical diagnosis of atrophic reticulate vascular naevus. However, a skin biopsy showed typical features of SMH. To our knowledge, SMH with linear configuration has only been described in two previous cases, and there are no previous reports of SMH with such a marked resemblance to a vascular lesion.     

Congenital Spitz nevus clinically mimicking melanoma

The differentiation between atypical variants of Spitz nevus and melanoma is often difficult given the many clinical and histopathologic similarities between the two. We report a case of an infant with a congenital scalp lesion exhibiting clinical features of melanoma, including variegation and regression of pigmentation and a rapidly changing appearance. Histologic examination of the excised lesion revealed a benign congenital Spitz nevus. This case emphasizes the need for clinical and histologic correlation in determining the benign or malignant nature of atypical pigmented lesions in infants.     

Chronic bullous dermatosis of childhood.

The clinical features, laboratory studies, and therapeutic responses of two boys with chronic bullous dermatosis of childhood are described. Direct immunofluorescent preparations of sections from a lesion, skin adjacent to a lesion, and uninvolved skin demonstrated linear deposition of IgA at the dermoepidermal junction in all three biopsy specimens from one patient. Similar preparations from the second child were negative for staining. No circulating antibodies to skin components were detected in either child by means of multiple substrates. Neither child had clinical manifestations nor laboratory findings suggestive of an associated gastrointestinal lesion; therefore, small bowel biopsies were not performed. Immunologic studies failed to demonstrate any of the abnormalities frequently described in dermatitis herpetiformis. Both boys responded dramatically to sulfapyridine therapy.     

电针围刺治疗斑块型银屑病疗效观察

目的通过皮损的临床症状改变及检测表皮厚度、乳头密度、血管直径的变化,观察电针围刺对银屑病局限性斑块型皮损的临床疗效。方法分为空白对照组和电针围刺治疗组,通过临床疗效及CLSM（皮肤CT）检测局部皮损治疗前后表皮厚度、乳头密度、血管直径的变化,探讨治疗斑块型银屑病的机制。结果临床观察电针围刺治疗第1、2疗程后,较治疗前硬厚斑块分解、皮损颜色变淡、鳞屑变薄;CLSM检测局部皮损,电针围刺组治疗第1、2疗程后各项数值均明显低于空白对照组,差异有统计学意义（P〈0．05）。结论经电针围刺治疗后斑块型银屑病皮损明显改善,表皮厚度、乳头密度、血管直径有明显改善。电针围刺是治疗银屑病的有效方法。     

Pyoderma gangrenosum in a thoracotomy wound associated with a pulmonary cavitating lesion

We present a patient with both pyoderma gangrenosum in a thoracotomy wound and a pulmonary cavitating lesion with the histological features of Wegener's granulomatosis. An ulcer with blue undermined edges developed in our patient's thoracotomy scar after a lobectomy was carried out for the cavitating lung lesion and c Antineutrophil Cytoplasmic Antibodies (cANCA), which is highly specific for active Wegener's granulomatosis but was negative at the time of her skin lesion. This suggests that our patient had cutaneous pyoderma gangrenosum rather than cutaneous Wegener's granulomatosis, although the two conditions may occasionally have similar clinical and histological features.     

Pigmented spindle cell tumor

The pigmented spindle cell tumor first described by Reed et al. is a benign melanocytic lesion of the skin that frequently remains unrecognized. The tumor is a heavily pigmented macule or plaque that usually appears on the extremities of young patients. The clinical and histological features and the differential diagnosis of pigmented spindle-cell tumor are described with reference to two clinical cases.     

Ulcerated dermatofibroma with osteoclast-like giant cells

Background: Ulceration and osteoclast-like giant cells are two pathological features uncommonly seen in dermatofibromas. To our knowledge, the presence of these features has not been previously described within the same lesion.
Methods: We report the clinical, histopathological and immunohistochemical findings of a 38-year-old man with an ulcerated dermatofibroma (DF) on the sole containing OLGC.
Comments: DF, or cutaneous fibrous histiocytoma, is a frequent dermatological lesion with many clinicopathological variants. Therefore, a correct diagnosis is not always straightforward, especially when two rare features co-exist in the same lesion. Differential diagnosis was performed with cutaneous and even non-cutaneous lesions. An explanation for the clinicopathological findings is also described.     

Vitiligo Coexistent with Nevus Depigmentosus: This Was Treated with Narrow-Band UVB and These Lesions Were Followed Using the Mexameter?, a Pigment-Measuring Device

Nevus depigmentosus (ND) is a congenital, non-progressive, hypopigmented lesion that is usually stable throughout an affected individual''s lifetime. The clinical features of vitiligo are similar to those of ND, but the two diseases have different treatment responses and prognoses. We report here on a rare case of vitiligo that was coexistent with ND. Both conditions were treated with narrow-band UVB. An 11-year-old boy presented with two distinct types of hypopigmented lesions, one on the forehead and the other on his back. The first was a hypopigmented patch with leukotrichia, and it was incidentally discovered 3 months before the child was examined at our clinic and it had rapidly increased in size. The second hypopigmented patch was detected at birth and it had slowly been increasing in size. The hypopigmented lesion on the child''s forehead was diagnosed as vitiligo, and the one on his back as ND. Once- or twice-weekly narrow-band UVB treatment was initiated. Improvements in the two lesions were assessed with clinical photography and using a Mexameter® (Courage-Khazaka Electronic, Germany), which is a pigment-measuring device.     

The spirochetal etiology of lymphadenosis benigna cutis solitaria

Ten patients with a clinical diagnosis of lymphadenosis benigna cutis (LABC) solitaria were investigated. Four of the patients knew that they had received a tick bite during the year prior to the appearance of the LABC lesion. Five patients had had a migrating erythema, indicating a previous erythema chronicum migrans Afzelius, near the site where the LABC lesion had developed. In one patient meningitis and a facial palsy occurred. Elevated titers of antibodies against Borrelia spirochetes were found in sera from six of nine patients. Spirochetes were cultivated from one out of two biopsies from LABC lesions. The clinical findings, the results of the serologic tests and the successful cultivation of spirochetes show that Ixodes ricinus-transmitted Borrelia spirochetes can cause LABC solitaria.     

Association of Syringoma and Intradermal Nevus

A 73-year-old man presented with a skin-colored, asymptomatic, 3-mm papule on the right infraorbital region of the face. The duration of the lesion was not known. A clinical diagnosis of papilloma was made. The patient did not have any other skin lesions. Past and family history were noncontributory. A simple excision of the lesion was performed. Histologic examination of the papule revealed two lesions next to each other: the first one consisted of an intradermal nevus, the second, of a typical syringoma (Fig. 1).     

Solitary and multifocal oral melanoacanthoma

BACKGROUND: Oral melanoacanthoma is a rare pigmented lesion characterized by sudden appearance and rapid radial growth, mimicking malignant melanoma. Oral melanoacanthoma may present as a solitary or multifocal lesion; however, the characteristics of these two clinical variants have never been addressed. In this study, we present an unusual case of multifocal oral melanoacanthoma and analyze cases of oral melanoacanthoma reported in the literature, with special emphasis on multifocal lesions. METHODS: A thorough MEDLINE search of the literature for cases of oral melanoacanthoma was performed. The demographic and clinical data, histologic features, and immunohistochemical findings were extracted from the full-text articles. RESULTS: The literature search yielded 52 patients with 67 lesions. The addition of our case increased this number to 53 patients with 72 lesions, 43 of whom had solitary lesions and 10 of whom had multifocal lesions. There was a female predominance amongst the patients with solitary oral melanoacanthoma (3 : 1), whereas multifocal oral melanoacanthoma showed an equal gender distribution (1 : 1). Multifocal lesions tended to occur more frequently on the palate, and solitary lesions on the buccal mucosa. CONCLUSIONS: Multifocal oral melanoacanthoma appears to demonstrate some demographic and clinical variations from the solitary type of lesion.     

Bowen's disease of the glans penis (erythroplasia of Queyrat) in plasma cell balanitis

We report a case of a persistent penile plaque on the glans penis of allegedly more than 20 years' duration, which was refractory to circumcision and local treatment. Over the years, the patient repeatedly presented with a circumscribed inflammatory lesion of the glans penis, diagnosed as Zoon's balanitis on the basis of clinical aspects and two biopsies. Because of unresponsiveness of the lesion to circumcision and focal steroid infiltration, repeated biopsies were performed in an attempt to rule out malignancy. Two further biopsies were carried out. One again showed the features of a plasmacellular inflammation, while the other finally revealed the histopathologic features of erythroplasia of Queyrat (carcinoma in situ or Bowen's disease of the glans penis). We assume that either the former biopsy specimens were taken from a plasma cell-rich reactive infiltrate around the neoplastic lesion, or that carcinoma in situ may have arisen due to the chronic inflammation of Zoon's balanitis plasmacellularis. Radiotherapy was performed with good clinical response and subsequent histopathologic proof of complete remission of the lesion.     

应用刮除法处理眼睑部白癜风皮损进行白体表皮移植治疗的临床研究

目的研究和观察应用括除术处理眼睑部白癜风皮损进行自体表皮移植治疗的临床疗效与安全性。方法选择眼睑部和额、颊部的稳定期白癜风患者,分别应用括除术法和磨削法处理受皮区,常规进行负压加温吸疱自体表皮移植治疗,移植后对比分析临床疗效和安全性。结果11例眼睑部和10例面颊部、额部白癜风皮损,分别移植疱壁53、48片,移植后2组总成活率分别为94．34％、95．83％;2组3级以上的复色率分别为86．79％,89．58％,2组差异无统计学意义（P〉0．05）。移植过程和移植后均无不良反应。结论应用括除术处理受皮区进行自体表皮移植治疗眼睑部白癜风,具有临床疗效好与安全性可靠的优势,值得临床上推广和应用。     

BRAF V599E Mutation is Not Age Dependent: It is Present in Common Melanocytic Nevi in Both Children and Adults

Pigmented dermatofibrosarcoma protuberans (Bednar tumor) constitute 5–10% of all cases of dermatofibrosarcoma protuberans, and are usually considered mimics of melanocytic proliferations rather than fibrous lesions. We report two cases of pigmented fibrous proliferations that demonstrate features of both dermatofibromas and DFSP. The first case is a 19‐year‐old man with a three year history of a slowly growing pigmented lesion on the right arm. On clinical exam the lesion was a 7 mm firm pigmented papulonodular lesion. The second case is a 31‐year‐old woman with a 4–5 year history of a slowly enlarging, asymptomatic 'dark area' on the right buttock. On clinical exam the lesion is a 2 cm darkly pigmented flat nodule. Morphologically both lesions are primarily dermal proliferations of spindled cells admixed with pigmented dendritic melanocytes. The lesional cells trap collagen fibers at the periphery and there is basal cell hyperpigmentation. Adnexal structures are effaced but significant trapping of subcutaneous fat is not present. By immunohistochemistry both lesions show focal CD34 positivity but are negative for Factor XIIIa and melanocytic markers. Although overlap between dermatofibromas and DFSP is well documented in the literature, pigmented fibrous lesions with features of both entities are not well described.     

Dermoscopy is useful for the recognition of benign-malignant compound tumours

The association of two different neoplasms in the same lesion is uncommon and has been reported as collision or compound tumours in the medical literature. In cases where a malignant neoplasm exists in association with a benign lesion it is important to make an accurate diagnosis in order to treat the lesions correctly. Dermoscopy is an in vivo, noninvasive technique that improves the clinical accuracy in diagnosing melanoma and other pigmented skin lesions. We describe the dermoscopic characteristics of various collision or compound tumours that were composed of benign and malignant neoplasms: two cases of seborrhoeic keratosis associated with basal cell carcinoma, two cases of melanocytic naevus and basal cell carcinoma and one case of dermatofibroma associated with basal cell carcinoma. We conclude that dermoscopy is a useful tool for improving the recognition of these kinds of tumours.     

Annular lichen planus showing a change in metallothionein expression on immunohistochemistry

The immunohistochemical localization of metallothioneins (MTs), low-molecular-weight metal-binding proteins, was investigated in a case of annular lichen planus (LP) that enlarged centrifugally with healing in the centre after a month. The annular lesion was found to exhibit the early, developed and late stages of LP, as judged by the clinical and histopathological findings. Immunostaining for MTs was increased around the lesion, discontinuous around the rim of the erythema and undetectable in the centre of the lesion. MT expression was examined in eight specimens of idiopathic LP. Discontinuous immunostaining for MTs was observed in six specimens and increased staining around the lesion was observed in two specimens. These results suggest that MT expression changes depending on the inflammatory stage of LP. Although the role of MTs in dermatological disease is still unknown, their expression might be related to the pathological process of LP.     

A variant of junctional naevus of epithelioid and spindle cell type rich in melanophages

We describe a form of junctional melanocytic neoplasm with a massive production of melanin accumulated in the dermis. The pigment is stored in macrophages, which are by far the most numerous cellular component of the lesion. Another peculiar aspect is the occasional presence of a few melanocytes scattered in a pagetoid pattern above the dermo-epidermal junction in the spinous layer. The histological picture of this lesion is similar to a form of "tumoral melanosis" induced by a regressed malignant melanoma. The lesion had a worrisome clinical picture, its dark colour constituting a clinico-pathological diagnostic problem. The main clinical clues to the benign nature of this entity are the small lateral diameter, the uniform distribution of the pigment and the stability of the lesion over time; moreover, the patients are alive and well after a considerable length of time. Although a regressed dysplastic or malignant lesion cannot be totally excluded from a scientific point of view, we conclude that there is no sound morphological or clinical evidence that the lesion is other than biologically benign. The lesion is most likely another peculiar variant of epithelioid and spindle cell naevus.     

Hybrid cyst: case reports and review of 15 cases in Japan

Hybrid cyst is a rare cystic lesion that includes more than two components of the pilosebaceous units. To clarify the clinical and pathological features of hybrid cysts, we report two cases and review 15 cases of hybrid cyst in Japan. On the whole, the age range was 12-73 years with a 2.95:1 female predominance and predilection for the scalp and face (46.7%). Most of the tumours presented as a solitary lesion and the size range was 2-45 mm. The most frequent histological type was the combination of infundibular and trichilemmal cysts (60.0%). Studying the clinicopathological features of hybrid cysts helps us in understanding the pathogenesis of diseases arising from pilosebaceous units.     

ELECTRON MICROSCOPIC FINDINGS IN ICHTHYOSIS SECONDARY TO SARCOIDOSIS

Acquired ichthyosis has been associated with a number of benign and malignant infiltrative lesions. However, the mechanisms responsible for this clinical lesion remain unknown. We report electron microscopic changes in two patients, which may help to clarify this subject.     

A case of Bowen's disease showing a clinical tendency toward spontaneous regression

We present a case of Bowen's disease showing a clinical tendency toward spontaneous regression. The patient, a healthy 86-year-old woman, complained that erythema had appeared on her left forearm two years earlier and had gradually enlarged. At the first examination, we observed a well-demarcated, 4 x 3 cm, erythematous plaque, partically covered with crusting and erosions near the wrist. Diagnosis of Bowen's disease was confirmed by a biopsy. Since the patient refused surgery and also discontinued hyperthermic treatment with disposable chemical pocket warmers after a brief trial, we decided to continue the observation of disease progression without any treatment. Two years after the initial visit, the lesion showed a clinical tendency toward spontaneous regression, with a fine erythematous plaque that showed the obscurely demarcated border of the lesion. After three years, although the patient exhibited a similar symptomatic improvement, a skin biopsy showed a few residual tumor cells. At the patient's request, we chose to observe the progress of the lesion. We review the literature of cases of Bowen's disease that have shown a similar tendency toward spontaneous regression, which have been rare.