4. Philipp S, Kokolakis G, Hund M, et al. Immunological changes in psoriasis patients under long-term treatment with fumaric acid esters: risk of Kaposi sarcoma occurrence? Eur J Dermatol 2013; 23: 339-43. doi:10.1684/ejd.2013.2037
Residents’ corner May 2013. sQUIZ your knowledge! Kristina BUDER, Henning HAMM Department of Dermatology, Venereology and Allergology, University Hospital Wuerzburg, Josef-Schneider-Str. 2, 97080 Wuerzburg, Germany e-mail: [email protected]
What is your diagnosis (figure 1)? The answer is on the next page.
432
Figure 1. A 19-year-old female patient presented with a 4 × 1 cm linear lesion on the left side of her neck. It had been present since birth and had increased in thickness during puberty.
EJD, vol. 23, n◦ 3, May-June 2013
The answer to sQuiz: Nevus comedonicus A clinical diagnosis of nevus comedonicus was made. The lesion was noted at birth in an otherwise healthy newborn and enlarged in size in proportion to body growth. During puberty the patient noticed an increase in the thickness of the lesion. Excision was performed at the patient’s demand for cosmetic reasons. Histology showed dilated, comedo-like invaginations filled with keratin. Nevus comedonicus is a rare congenital organoid nevus. The typical clinical picture includes a unilateral linear plaque with large follicular ostia filled with brownish-black keratin. It is typically located on the face, neck or upper trunk and arranged along the lines of Blaschko. Nevus comedonicus can undergo inflammatory changes with pustules, fistules and scarring. Larger lesions should prompt physicians to rule out associated ocular, skeletal or neurological abnormalities within the scope of nevus comedonicus syndrome. None of these were present in our patient. doi:10.1684/ejd.2013.2038
A
Residents’ corner May 2013. DeRmpath & Clinic: Differential diagnosis between non-melanoma large-cell neoplasms on the epidermis Ana Rita TRAVASSOS1 , Luís SOARES-DE-ALMEIDA1,2 1 Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal e-mail: [email protected] 2 Faculty of Medicine, University of Lisboa, Lisboa, Portugal
Case 1: An 82-year-old female presented a 3-year, slow growing, slightly elevated, erythematous plaque on the right buttock. Case 2: A 67-year-old female presented a 2-year, pruritic, erythematous macule on the labia majora (vulva). Both these tumors present abnormal cells with abundant pale-staining cytoplasm, arranged either as solitary units or as nests within a thicked epidermis. In the first case (figures 1A and 2A) the following findings are observed in the epidermis: – parakeratosis; – epithelial cells with abnormal nuclei (many in mitosis) and pale cytoplasm arranged as solitary units at all
B
Figure 1. A) Bowen’s disease in scanning magnification: irregular epidermal hyperplasia with atypical pleomorphic keratinocytes throughout the entire epidermis (H&E). B) EMPD in scanning magnification: intraepithelial tumor composed of nests of plump epithelial cells (H&E).
Diskeratosis
A Mitosis
B
Mitosis
Mitosis
Pagetoid cells
Figure 2. A) Bowen’s disease at high power: dyskeratotic cells and many mitotic epithelial cells (H&E). B) EMPD at high power: plump epithelial cells with abnormal nuclei and pale cytoplasm (H&E).
EJD, vol. 23, n◦ 3, May-June 2013
433
Residents’ corner May 2013. sQUIZ your knowledge! Kristina BUDER, Henning HAMM Department of Dermatology, Venereology and Allergology, University Hospital Wuerzburg, Josef-Schneider-Str. 2, 97080 Wuerzburg, Germany e-mail: [email protected]
What is your diagnosis (figure 1)? The answer is on the next page.
432
Figure 1. A 19-year-old female patient presented with a 4 × 1 cm linear lesion on the left side of her neck. It had been present since birth and had increased in thickness during puberty.
EJD, vol. 23, n◦ 3, May-June 2013
The answer to sQuiz: Nevus comedonicus A clinical diagnosis of nevus comedonicus was made. The lesion was noted at birth in an otherwise healthy newborn and enlarged in size in proportion to body growth. During puberty the patient noticed an increase in the thickness of the lesion. Excision was performed at the patient’s demand for cosmetic reasons. Histology showed dilated, comedo-like invaginations filled with keratin. Nevus comedonicus is a rare congenital organoid nevus. The typical clinical picture includes a unilateral linear plaque with large follicular ostia filled with brownish-black keratin. It is typically located on the face, neck or upper trunk and arranged along the lines of Blaschko. Nevus comedonicus can undergo inflammatory changes with pustules, fistules and scarring. Larger lesions should prompt physicians to rule out associated ocular, skeletal or neurological abnormalities within the scope of nevus comedonicus syndrome. None of these were present in our patient. doi:10.1684/ejd.2013.2038
A
Residents’ corner May 2013. DeRmpath & Clinic: Differential diagnosis between non-melanoma large-cell neoplasms on the epidermis Ana Rita TRAVASSOS1 , Luís SOARES-DE-ALMEIDA1,2 1 Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal e-mail: [email protected] 2 Faculty of Medicine, University of Lisboa, Lisboa, Portugal
Case 1: An 82-year-old female presented a 3-year, slow growing, slightly elevated, erythematous plaque on the right buttock. Case 2: A 67-year-old female presented a 2-year, pruritic, erythematous macule on the labia majora (vulva). Both these tumors present abnormal cells with abundant pale-staining cytoplasm, arranged either as solitary units or as nests within a thicked epidermis. In the first case (figures 1A and 2A) the following findings are observed in the epidermis: – parakeratosis; – epithelial cells with abnormal nuclei (many in mitosis) and pale cytoplasm arranged as solitary units at all
B
Figure 1. A) Bowen’s disease in scanning magnification: irregular epidermal hyperplasia with atypical pleomorphic keratinocytes throughout the entire epidermis (H&E). B) EMPD in scanning magnification: intraepithelial tumor composed of nests of plump epithelial cells (H&E).
Diskeratosis
A Mitosis
B
Mitosis
Mitosis
Pagetoid cells
Figure 2. A) Bowen’s disease at high power: dyskeratotic cells and many mitotic epithelial cells (H&E). B) EMPD at high power: plump epithelial cells with abnormal nuclei and pale cytoplasm (H&E).
EJD, vol. 23, n◦ 3, May-June 2013
433
