Congenital myofibroma of the skin mimicking a piloleiomyoma

Myofibroma is an uncommon benign soft tissue disorder, which is usually congenital or present in early infancy. Myofibroma usually manifests as a single mass. When there are multiple lesions, the term myofibromatosis is used. The characteristic histopathological feature of the myofibroma is the coexistence of two distinct areas. One area mainly contains plump spindle cells with thin blunt‐ended nuclei and eosinophilic cytoplasm, thus indicating myoid characteristics. The other area contains either round or polygonal cells with slightly pleomorphic, hyperchromatic nuclei or small spindle cells typically arranged around a distinct hemangiopericytoma‐like vascular pattern. In the present case, the majority of the tumor was composed of the plump myoid spindle cells. This led to an initial diagnosis of a piloleiomyoma. However, the tumor cells were not immunohistochemically positive for desmin. Moreover, careful examination revealed a hemangiopericytoma‐like vascular pattern characterized by the presence of high cellular areas with irregular vascular spaces. These features led to the final diagnosis of the myofibroma. It is therefore important to recognize the leiomyoma‐like variants of myofibromas. Inoue T, Sada A, Mori T, Misago N, Narisawa Y. Congenital myofibroma of the skin mimicking a piloleiomyoma.     

Multiple familial cutaneous leiomyoma

INTRODUCTION: Cutaneous leiomyoma is a benign tumor, the discovery of which may suggest a hereditary form. We report a family in which 5 generations developed cutaneous and uterine leiomyomas. The originality of this report lies in the large number of generations developing the disease and the association with chronic myeloid leukemia. OBSERVATIONS: We have studied 16 members of a family with cutaneous and uterine leiomyomas spanning five generations. Eight members of the family (6 women and 2 men) presented with cutaneous leiomyomas. All 6 women also had uterine myomas with complications (menometrorrhagia, miscarriage, premature delivery and hysterectomy). Pathological association was also confirmed: polycythemia (1 case), papillary renal carcinoma (1 case) and chronic myeloid leukemia (1 case). DISCUSSION: Piloleiomyoma can develop sporadically or can be transmitted genetically. To our knowledge, we report the fifth case of a family of more than 2 generations presenting with piloleiomyoma. By studying the family tree, we were able to confirm the dominant autosomal nature of the mode of transmission found by other authors. The association of piloleiomyoma and uterine myoma is classified as Reed's syndrome. In such cases, the uterine myoma requires particularly careful monitoring since it is associated with significant risk of gynecological complications (menometrorrhagia, miscarriage, premature delivery and postpartum hemorrhage). Moreover, in our observations we describe diseases associated with piloleiomyoma: polycythemia (1 case), papillary renal carcinoma (1 case), but also the association of piloleiomyoma with chronic myeloid leukemia (1 case). A previous report described the same genetic deletion in uterine myoma as in chronic myeloid leukemia, which gives further weight to this association.     

CHONDROID SYRINGOMA

The characteristic features of chondroid syringoma are reviewed and three cases are presented. The first one showed typical localization and clinical features. The second one was remarkable because of the unusual size of the growth. The third patient had an unusual localization of the tumor on the tip of the nose.     

Atypical cellular neurothekeoma: A potential diagnostic pitfall for benign and malignant spindle cell lesions in skin

Cellular neurothekeomas (CNTs) are rare, benign cutaneous tumors that arise primarily on the head and neck, with a slight female predominance. CNTs with atypical features have been described, including those with an infiltrative growth pattern. Although CNTs with atypical features are benign, recognition of this entity can pose diagnostic challenges. Here, we report a case of CNT with an unusual clinical presentation on the left second digit, and with atypical histological features including an infiltrative growth pattern, which could have been mistaken for features of malignancy.     

Sporotrichosis masquerading as pyoderma gangrenosum

A 46-year-old man was diagnosed as having pyoderma gangrenosum after special stains and cultures from a skin biopsy specimen were reported as negative. Cutaneous sporotrichosis is usually diagnosed with relative ease on the basis of clinicopathologic features and prompt growth of the fungus in culture, although organisms are difficult to detect in tissue even with special stains. Identification of Sporothrix schenckii was delayed for three months in this patient because of unusual growth characteristics noted in the culture. The report of this patient's clinical course illustrates both the need to frequently reassess the diagnosis of pyoderma gangrenosum in treatment-resistant patients and the fact that S schenckii may be difficult to diagnose clinically and mycologically if the growth characteristics of the fungus are unusual.     

Piloleiomyoma

Histopathology Cutaneous piloleiomyoma(PLM),angioleiomyoma,and genital leiomyoma are variants of superficial cutaneous leiomyoma(CL).The classic appearance of a...     

Two cases of desmoplastic trichoepithelioma

Desmoplastic trichoepithelioma is a rare tumor that usually exhibits the distinct clinical features of a solitary granuloma annulare-like growth on the face. We experienced two cases of desmoplastic trichoepithelioma, one of which showed unusual clinical features and the other of which was a typical case. The first case was a 20-year-old female who presented with a five year history of a solitary yellowish nodule, 5 mm in diameter, centrally between the eyebrows. There was no central dimple or elevated border. The other case was a 40-year-old female who presented with a ten year history of a solitary nodule, 6 mm in diameter on her left cheek. The latter lesion had a typical depressed area in the center of the nodule with elevated borders and could be clinically diagnosed as desmoplastic trichoepithelioma. The histopathological examination revealed that both of them were desmoplastic trichoepithelioma. Histopathological comparison of the two specimens suggested that the clinical dimple in the center of the first tumor might be the result of stromal dystrophic changes induced by the tumor.     

Cutaneous leiomyosarcoma with myxoid alteration arising in a setting of multiple cutaneous smooth muscle neoplasms

Background:  Cutaneous leiomyomas and leiomyosarcomas are rare tumors that originate from the arrector muscle of hair follicles or the smooth muscle of blood vessels.
Case report:  A 74-year-old male presented with a single, erythematous nodule on the left upper arm. This lesion developed within the excision scar of a piloleiomyoma that had been excised 3 years ago. Additionally, physical examination revealed a tender nodule on the right ear.
Results:  Histological examination showed a cutaneous leiomyosarcoma with myxoid alteration on the upper arm and an angioleiomyoma on the right ear.
Conclusion:  Myxoid leiomyosarcomas have exclusively been reported in the uterus and gastrointestinal tract, but not in the skin. Here, we describe a case of cutaneous leiomyosarcoma with myxoid alteration that developed in the excision scar of a piloleiomyoma and was accompanied by a cutaneous angioleiomyoma in a different location.     

Unusual presentation of a salivary pleomorphic adenoma: a case report and review of the literature

Although pleomorphic adenomas are the most common neoplasms of salivary gland origin, our knowledge of the etiology, growth, and recurrence patterns, and significance of the varying histologic features of these tumors, remains limited. We present the case of a 66-year-old man with an unusual presentation of a pleomorphic adenoma, and review the important clinical and pathologic features of this entity.     

Piloleiomyoma mistaken for postacne scarring

Piloleiomyomas are benign, smooth muscle neoplasms arising from the arrectores pilorum muscles in the skin. They differ in size and number and are often cold and painful or sensitive to touch. Piloleiomyomas, though not exceedingly rare, may not be expected in the differential diagnosis for multiple skin nodules. We present a case of a piloleiomyoma that was initially diagnosed as postacne scarring.     

Peyronie's disease: clinical and sonographic evaluation of a case

We report a case of Peyronie's Disease, for which sonography proved to be a valuable, non-invasive diagnostic procedure. The sonographic findings and some unusual clinical features of our case are discussed.     

Dermatomyositis with tuberculous fasciitis

A case of dermatomyositis with tuberculous fasciitis is described. A 69-year-old Japanese man treated with prednisolone for dermatomyositis developed erythema and bilateral swelling of arms and forearms. A diagnosis of tuberculous fasciitis was confirmed by the presence of acid-fast bacilli in a biopsy specimen and the growth of Mycobacterium tuberculosis from tissue cultures. The unusual presenting clinical features resulted in delayed diagnosis. We emphasize that tuberculous fasciitis should be considered in an immunocompromised patient who is treated with steroids, especially if the results of initial treatment are not satisfactory.     

Granuloma annulare-like eruption due to chronic Epstein-Barr virus infection

A 32-year-old woman afflicted with a severe, chronic Epstein-Barr virus (CEBV) infection of 12 months' duration developed an unusual, granuloma annulare-like eruption. The cutaneous disorder, which paralleled the clinical course of her disease, was characterized by slightly raised, erythematous, annular lesions predominantly involving the face and arms, with sporadic involvement elsewhere. Histopathologic examination of biopsy material obtained from affected skin disclosed a granulomatous dermatitis. The patient's symptoms and cutaneous eruption resolved after systemic corticosteroid therapy. This eruption may represent a distinct cutaneous component of CEBV infection with clinically granuloma annulare-like features or the mere serendipitous association of CEBV infection and an unusual granulomatous dermatitis. Because of the unusual clinical appearance of the eruption and its clear correlation with disease activity, we speculate that it likely represents a distinct cutaneous condition, heretofore unreported, caused by CEBV infection.     

Extensive multiple piloleiomyoma in the submental region treated successfully by surgery and reconstruction with a submental perforator flap

Piloleiomyoma is a benign tumour originating in the smooth muscles of the arrector pili muscle in the skin. The lesions are often sensitive to touch, cold and emotional disturbance. We present a patient with multiple piloleiomyoma (MPL) of the submentum who underwent reconstructive surgery using a submental perforator flap. The result was excellent and there were no postoperative complications. MPL of the submental region is relatively rare; to our knowledge, ours is the first report of MPL treated successfully with a submental perforator flap.     

Halo balloon cell nevus

We report an unusual case occurring in a 25-year-old male of a balloon cell nevus which also showed clinical and pathological features of a halo nevus.     

Aggressive amelanotic lentigo maligna

A 66-year-old woman had a long-standing, scaly erythematous lesion on her left temple which histologically showed features of amelanotic lentigo maligna. It had recurred on numerous occasions over a period of 17 years, in spite of multiple attempts at curative surgery. There were also recurrences within a skin graft which, to our knowledge, has not been documented previously with lentigo maligna. In spite of the prolonged course, and extensive intraepidermal melanocytic proliferation amounting to melanoma in situ, there has been no evidence of dermal invasion. The lack of pigmentation in such lesions means that clinical definition of margins is highly inaccurate. In view of the aggressive horizontal growth phase of this lesion, with rapid recurrence following surgery, it was treated with electron beam therapy, and this has resulted in complete clinical remission. This most unusual case illustrates the potential difficulties in diagnosis and management of amelanotic lentigo maligna.     

Tumoral calcinosis

Tumoral calcinosis is an unusual clinical disorder in which large masses of calcium are deposited in the periarticular tissues of the body. The characteristic clinical, radiological and histopathological features of this disorder occurring in three middle aged female patients are reported.     

Diagnostic Pitfalls of Merkel Cell Carcinoma and Dramatic Response to Chemotherapy

Merkel cell carcinoma (MCC) is an unusual malignant tumor that arises from neuroendocrine cells with features of epithelial differentiation. We describe a MCC patient with unusual clinical, histopathological, and immunohistochemical features. Although the microscopic, immunohistochemical, and ultrastructural characteristics of MCC have been well defined, diagnostic difficulties remain, particularly in distinguishing it from lymphoma involving the skin, as suggested by our case. This is an unusual case in which dense lymphoid infiltration masked the true tumor. All the immunohistochemical markers of MCC except neuron-specific enolase (NSE) were negative. The dramatic response to primary chemotherapy was also very noteworthy.     

Rhinoentomophthoromycosis with mutilation

Rhinoentomophthoromycosis is a rare subcutaneous zygomycosis. We report a case of rhinoentomophthoromycosis with mutilation, which is an even more unusual phenomenon, and discuss the clinical features and management of this rare dermatosis.     

曲安奈德局封治疗多发性皮肤平滑肌瘤1例

患者男,42岁。左小腿多发性丘疹、结节16年,加重伴疼痛5年。皮损组织病理诊断:皮肤平滑肌瘤。疼痛经多种方法治疗不能缓解。疼痛性结节内注射曲安奈德注射液每周1次,共3次,结节变小,疼痛消失。随访1年,疼痛未复发,结节未增大。