Hematidrosis: a case report and review of the literature

The authors report the case of a 9 year-old female who had bleeding episodes around the mouth after strenuous exercise or prolonged exposure to heat. Characteristically, bleeding occurred right after sweat drops started appearing on the surface of the skin around the mouth. The bleeding episodes ceased spontaneously.     

Hematidrosis: a pathologic process or stigmata. A case report with comprehensive histopathologic and immunoperoxidase studies

Cases of hematidrosis (bloody sweat) are extremely rare. This disease has been described in various terms and has been often tied to religious belief as stigmatization. We report a typical patient with hematidrosis in a 14-year-old girl who frequently bled from her scalp and palms, and, occasionally, from trunk, soles, and legs. The bloody sweat from her scalp contained all blood elements. Immediate biopsy after there was bleeding on her scalp showed multiple blood-filled spaces that opened directly into the follicular canals or on to the skin surface. Immunoperoxidase studies failed to demonstrate vascular nature of these spaces. Our study explained how and why there was bleeding in our patient and in patients with related conditions as described in earlier literatures. We also explained why this phenomenon was intermittent because the spaces indicated above will disappear after exuding their content but then reoccurred after the blood flow was reestablished.     

A Case of Hematidrosis Successfully Treated with Propranolol

We report a typical case of hematidrosis in a Chinese girl who had experienced frequent bleeding episodes for more than 3 years. During hospitalization, spontaneous bleeding from her intact skin was witnessed by our staff on more than 20 occasions. Characteristically, bloody droplets from the intact skin contained all blood components. Histopathologic examination showed some inconspicuous abnormalities, with normal sweat gland structure containing no blood, and bloody exudate also came from some areas that do not contain sweat glands.Webelieve that the blood was mixed with a sweat-like fluid, rather than real sweat. The patient’s bleeding problem was dramatically resolved by treatment with propranolol. We suggest that sympathetic nerve activation might play a role in these events, and that β-adrenoceptor antagonists might be an effective treatment for this disorder.     

Hermansky-Pudlak syndrome: report of a case with histological, immunohistochemical and ultrastructural findings

We report a 38-year-old female of Puerto Rican descent with Hermansky-Pudlak syndrome and decreased levels of von Wille-brand factor. Histologic and ultrastuctural findings of non-sun-exposed skin showed melanocytes with short dendritic processes and decreased numbers of melanosomes. Ultrastructutal examination of platelets revealed greatly reduced numbers of delta granules. Recognition of this syndrome is important because skin neoplasms, ceroid deposition and hemorrhagic manifestations can be causes of morbidity and of potential death in patients affected with this syndrome.     

Biophysical, histological and biochemical changes after non-ablative treatments with the 595 and 1320 nm lasers: a comparative study

BACKGROUND/PURPOSE: The objective was to compare the efficiencies of the 595 nm pulsed dye and the 1320 nm Nd : YAG laser non-ablative rejuvenation. METHODS: KM mice were irradiated with the 595 nm pulsed dye and the 1320 nm Nd : YAG lasers. Histological changes were evaluated immediately, 1, 7, 21, 30 and 60 days after the two laser treatments. Skin hydration and hydroxyproline content were measured to quantify the degree of improvement of the skin's water-holding capacity and the rate of hydroxyproline synthesis. RESULTS: Although not statistically significant, the 1320 nm Nd : YAG laser treatment induced 9.7% greater improvement of skin hydration than the 595 nm laser while the 595 nm pulsed dye laser treatment led to a thicker dermis and 8.7% greater increase of hydroxyproline than the 1320 nm laser. More than 50% increase of collagen type I was observed in 75% of 595 nm laser-treated sites and 42% of 1320 nm laser-treated sites, and more than 25% increase of collagen type III was observed in 75% of 595 nm laser-treated sites and 50% of 1320 nm laser-treated sites. The 595 nm laser treatment was better in increasing the amount of collagen fibers, especially collagen type I (P < 0.05). CONCLUSION: Our results demonstrated that the 595 nm laser appeared to be more effective in increasing new collagen formation, while the 1320 nm laser was superior to the 595 nm laser in improving the skin's water-holding capacity.     

Fibroblastic rheumatism: clinical, histological, immunohistological, ultrastructural and biochemical study of a case

We report a case of fibroblastic rheumatism (FR). Only eight other cases of this recently described entity have been reported previously. FR is characterized hy polyarthralgia and joint stiffness without joint destruction, associated with cutaneous nodules and sclerodactyly. Histology shows an increase in the number of fihroblasts and marked dermal fibrosis, Rheumatological and skin manifestations may improve with corticosteroid therapy.
In our patient, immunohistochemical studies of involved and uninvolved skin showed an increase in fibronectin and tenascin deposition. In the dermis, the hyperplastic cells had phenotypic features of muscle, suggesting myofihrohlastic differentiation. Ultrastructural study showed an increase in active fibroblastic cells with features of myofibroblasts. A hyperproliferative capacity was observed in fibroblasts cultured from involved skin. Biochemical studies of the production of collagen and non-collagen proteins were performed on these cultured cells, and showed a reduction in collagen and non-collagen protein synthesis hy FR fihrohlasts. Thus, FR appears to differ from other fibrotic skin diseases such as scleroderma, in that dermal fihrosis may be due predominantly to fibroblast proliferation with myofihrohlastic differentiation, without any increase in collagen synthesis.     

Fox-Fordyce disease: report of two cases with perifollicular xanthomatosis on histological image

Fox-Fordyce disease is a relatively infrequent pathology of the apocrine glands that affects almost exclusively young women. The disease is characterized by the presence of pruritic follicular papules mainly in the armpits that respond poorly to treatment and severely affect the patient’s quality of life. We report two cases with clinical diagnosis and histopathological confirmation, presenting perifollicular xanthomatosis on histological examination, recently described as a distinctive, consistent, and specific feature of this disease.     

Malignant hidradenoma—a case report demonstrating insidious histological and clinical progression

A histologically benign hidradenoma, occurring in a 15-year-old female inadequately excised at first procedure, recurred locally over the course of 11 years and exhibited first local and subsequently regional metastatic spread. The insidious progression was associated with increasing cytological atypia and alteration of epithelial antigenic expression. In view of the rarity of malignant sweat-gland tumours and consequent lack of a specific treatment protocol, this case serves to emphasize the importance of adequate primary local excision, with histological confirmation of clearance, in the management of sweat-gland tumours.     

Clinical and histological features of'mechanic's hands' in a patient with antibodies to Jo-1—a case report

The clinical and histological features of‘mechanic's hands' are described in a patient with polymyositis characterized serologically b6y antibodies to histidyl t RNA synthetase (Jo-1). Although distinctive cutaneous lesions have only recently been associated with the ‘anti-synthetase syndrome’. It is becoming apparent that recognition of subsets within the spectrum of polymyositis/dermatomyositis characterized by certain clinical and serological features not only have prognostic significance, but also may provide insights into mechanisms of disease.     

Hidradenocarcinoma: a histological and immunohistochemical study

The diagnosis of hidradenocarcinoma is difficult due to a combination of factors including inconsistent nomenclature/ classification, rarity of the neoplasm, and variable morphology of cells composing the neoplasm. Immunohistochemistry has not been previously performed on a series of hidradenocarcinomas. We evaluated six cases of hidradenocarcinoma histologically and immunohistochemically using antibodies to gross cystic disease fluid protein-15 (GCDFP-15), carcino-embryonic antigen (CEA), epithelial membrane antigen (EMA), S-100 protein, keratin AE1/3, cytokeratin 5/6, p53, bcl-1, bcl-2, and Ki67. Histology suggested concurrent eccrine and apocrine differentiation of the cases. Ki67 and p53 staining was strongly positive in five of six tumors. The neoplasms stained with antibodies to CEA, S-100 protein, GCDFP-15, EMA, bcl-1, and bcl-2 in no consistent pattern. All tumors studied stained positively for keratin AE1/3 and cytokeratin 5/6. In making the diagnosis of hidradenocarcinoma, it may be unnecessary to separate hidradenocarcinoma into eccrine and apocrine categories, and although Ki67 and p53 may be helpful, histological parameters remain paramount.     

Effect of UV irradiation on cutaneous cicatrices: a randomized, controlled trial with clinical, skin reflectance, histological, immunohistochemical and biochemical evaluations

The aim of this study was to examine the effect of ultraviolet (UV) irradiation on human cutaneous cicatrices. In this randomized, controlled study, dermal punch biopsy wounds served as a wound healing model. Wounds healed by primary or second intention and were randomized to postoperative solar UV irradiation or to no UV exposure. Evaluations after 5 and 12 weeks included blinded clinical assessments, skin reflectance measurements, histology, immunohistochemistry, and biochemical analyses of the N-terminal propeptide from procollagen-1, hydroxyproline, hydroxylysine, and proline. Twelve weeks postoperatively, UV-irradiated cicatrices healing by second intention: (i) were significantly pointed out as the most disfiguring; (ii) obtained significantly higher scores of colour, infiltration and cicatrix area; and (iii) showed significantly higher increase in skin-reflectance measurements of skin-pigmentation vs. non-irradiated cicatrices. No histological, immunohistochemical or biochemical differences were found. In conclusion, postoperative UV exposure aggravates the clinical appearance of cicatrices in humans.     

Alpha-interferon secreting blastic plasmacytoid dendritic cells neoplasm: a case report with histological, molecular genetics and long-term tumor cells culture studies

We report a new case of blastic plasmacytoid dendritic cell neoplasm (BPDCN) with extensive immunophenoptyping, genotyping (karyotype, array-comparative genomic hybridization, and fluorescent in situ hybridization), and long-term tumor cells culture. BPDCN is a very rare and aggressive disease clinically characterized by a skin revealing localization more or less rapidly disseminating to the bone marrow and other organs with or without and leukemia. The disease was initially phenotypically characterized by the expression of both CD4 and CD56 antigens, whereas lymphoid and myeloid lineage antigens were negative. A phenotypic link with alpha-interferon (IFN-I)-producing plasmacytoid dendritic cells was demonstrated. The data collected in this case report provide additional biological and genotypical data on tumor cells of BPDCN. This study confirms the capability of tumor cells to secrete IFN-I, demonstrated by biological IFN-I activity of cultured cells and immunohistochemical expression of Mx-1 protein. Although a common genetic profile involving chromosomes 5, 6, 9, 12, 13, and 15 has been identified, no specific genetic marker has been demonstrated that is specific to BPDCN. The demonstration of ETV6 gene deletion in this case deserves further investigations as a putative BPDCN marker.     

Bowen's disease: a clinical and histological re-evaluation

Brief reference is made to the original papers of Bowen and of Darier, and the later significant developments in our understanding of Bowen's Disease. The wide variation in clinical appearance is emphasized. The involvement of pilosebaceous follicles in the process, and the importance of this factor in planning treatment are emphasized.