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Polypoid dermatofibroma
P1176
P1178
Long-lasting discoid lupus erythematosus leading to basal cell carcinoma in a Haitian patient Shesly Jean Louis, MD, State University of Haiti, Port-au-Prince, Haiti; Babar K. Rao, MD, UMDNJ-Robert Wood Johnson Medical School Department of Dermatology, Somerset, NJ, United States; Ghislaine August, MD, State University of Haiti, Port-auPrince, Haiti; Hamza Bhatti, Touro College of Osteopathic Medicine, New York, NY, United States; Yolaine P. Bijou, MD, State University of Haiti, Port-au-Prince, Haiti Discoid lupus erythematosus (DLE) is the most common form of cutaneous chronic lupus erythematosus (CCLE). Early DLE lesions typically expand with erythema and hyperpigmentation at the periphery, leaving atrophic central scarring, telangiectasia, and hypopigmentation that can form large, confluent, disfiguring plaques. DLE lesions are most currently encountered on sun-exposed areas (face, scalp, ear, V area of the neck, and extensor aspect of the arm). Localized DLE lesions are confined to the face and neck, whereas in generalized DLE, lesions occur elsewhere on the body. Histopathologically it is characterized by vacuolar degeneration of basal cell layer of epidermis follicular hyperkeratosis, and patchy dermal perivascular and periadnexal lymphocytic infiltrate. Rarely, basal cell carcinoma and squamous cell carcinoma has been noted to develop on DLE lesions. We present a case of a Haitian female who presented with long-standing DLE associated with basal cell carcinoma. A 38-yearold Haitian woman presented with multiple, confluent erythematous and atrophic patches on her face. Dermatologic examination revealed well defined and geographic patterned of atrophic, depigmented plaques with irregular hyperpigmented margins, distributed all over the face, helix, and concha of ears. One of the atrophic plaques on root of nose has elevated border, which was suspicious for neoplasm. Histology of this lesion revealed a basal cell carcinoma in association with DLE. Other routine laboratory examinations were unremarkable other than mild anemia. ANA serologies were negative. The patient was started on oral hydroxychloroquine and topical steroids, was advised to avoid sun exposure, and was referred to a surgeon for the management of her condition.
Multiple eccrine hidrocystomas of uncommon presentation Jatziri Mireille Itze Chavez Bernal, MD, Centro Dermatologico ‘‘Dr. Ladislao de la Pascua,’’ Mexico DF, Mexico; Carlos Lizarraga Garcia, MD, Centro Dermatologico ‘‘Dr. Ladislao de la Pascua,’’ Mexico DF, Mexico Introduction: Eccrine hidrocystomas are cystic lesions of the sweat gland ducts.They affect most frequently women of 20 to 70 years of age and can be multiple (Robinson type) or unique (Smith type). Case report: A 20-year-old woman presented to our department with multiple asymptomatic skin-colored mobile subcutaneous nodules, with normal appearing overlying skin affecting the neck and armpits since 8 years of age. An excisional biopsy specimen of a left axillary nodule revealed cysts in the dermis lined by a double layer of cuboidal epithelium with low content of amorphous eosinophilic material. Discussion: We report this case because of the uncommon presentation of eccrine hidrocystomas both in age of onset and location. This condition represents a therapeutic challenge with disappointing results. Commercial support: None identified.
Commercial support: None identified.
P1179 Polypoid dermatofibroma Maria Jose Espi~ neira-Carmona, MD, San Cecilio University Hospital, Deparment of Dermatology, Granada, Spain; Jose Aneiros-Cachaza, MD, PhD, San Cecilio University Hospital, Department of Pathology, Granada, Spain; Jose AneirosFernandez, MD, San Cecilio University Hospital, Department of Pathology, Granada, Spain; Maria Antonia Fernandez-Pugnaire, MD, San Cecilio University Hospital, Department of Dermatology, Granada, Spain; Salvador Arias-Santiago, MD, San Cecilio University Hospital, Department of Dermatology, Granada, Spain Introduction: Dermatofibroma (DF) is a fibrohistiocytic tumor of usual observation in dermatology practice and one of the clinical forms of DF characterized by its low frequency and clinical diagnosis is difficult polypoid DF. We report the case of a man with a polypoid DF located on inside of right leg 1 year of evolution. Case report: A 34-year-old man without a medical history who had a tumor or a year of development located on inside of right leg. He had been undergoing steady growth and causing discomfort. The patient did not recall a history of trauma or injury in the area. On examination, there was an exophytic tumor of 2 cm 3 3 cm in diameter, joined by a pedicle skin. The tumor had a smooth surface and was surrounded by a pinkish-brown patch, with a crusted ulceration on its surface. He was scheduled for surgery under local anesthesia, and the histologic diagnosis was DF.
Stony Brook University Hospital is the only tertiary care medical center in Suffolk County, NY. We amass interesting cases from our inpatient service and outpatient clinics. We will present the best of these cases, including a case of massive stellate purpura associated with antiphospholipid antibodies and cocaine use.
Discussion: DF is a frequent skin lesion that has different clinical varieties. The polypoid DF is an uncommon variant, characterized by exophytic and pedunculated appearance of benign biologic behavior and histopathologic features similar to conventional DF. Our case highlights focal positivity for CD68 antigen common fibrohistiocytic and CD34, an antigen that appears in soft tissue tumors, such as dermatofibrosarcoma protuberans. Its clinical diagnosis of suspicion is difficult because it is often confused with benign lesions, such as keratoacanthoma, or malignant lesions, such as dermatofibrosarcoma protuberans, squamous cell carcinoma, sarcoma, and melanoma amelanotic. There is currently controversy over the nature of DF. Some authors believe it is a reactive condition of the dermal connective tissue with different stages of evolution and involution. Others say it is a benign neoplastic proliferation with differentiation of the fibrohistiocytic skin. With respect to its evolution and prognosis the DF is a benign lesion, although it should be noted that there are variations in the presence of atypical cells, which may recur and even metastasize, so it is important to complete excision and close monitoring of the patient.
Commercial support: None identified.
Commercial support: None identified.
P1177 Interesting cases from Stony Brook University Tara Kaufmann, MD, SUNY Stony Brook, East Setauket, NY, United States; Sandy Bost, MD, SUNY Stony Brook, East Setauket, NY, United States
FEBRUARY 2011
J AM ACAD DERMATOL
AB51
P1178
Long-lasting discoid lupus erythematosus leading to basal cell carcinoma in a Haitian patient Shesly Jean Louis, MD, State University of Haiti, Port-au-Prince, Haiti; Babar K. Rao, MD, UMDNJ-Robert Wood Johnson Medical School Department of Dermatology, Somerset, NJ, United States; Ghislaine August, MD, State University of Haiti, Port-auPrince, Haiti; Hamza Bhatti, Touro College of Osteopathic Medicine, New York, NY, United States; Yolaine P. Bijou, MD, State University of Haiti, Port-au-Prince, Haiti Discoid lupus erythematosus (DLE) is the most common form of cutaneous chronic lupus erythematosus (CCLE). Early DLE lesions typically expand with erythema and hyperpigmentation at the periphery, leaving atrophic central scarring, telangiectasia, and hypopigmentation that can form large, confluent, disfiguring plaques. DLE lesions are most currently encountered on sun-exposed areas (face, scalp, ear, V area of the neck, and extensor aspect of the arm). Localized DLE lesions are confined to the face and neck, whereas in generalized DLE, lesions occur elsewhere on the body. Histopathologically it is characterized by vacuolar degeneration of basal cell layer of epidermis follicular hyperkeratosis, and patchy dermal perivascular and periadnexal lymphocytic infiltrate. Rarely, basal cell carcinoma and squamous cell carcinoma has been noted to develop on DLE lesions. We present a case of a Haitian female who presented with long-standing DLE associated with basal cell carcinoma. A 38-yearold Haitian woman presented with multiple, confluent erythematous and atrophic patches on her face. Dermatologic examination revealed well defined and geographic patterned of atrophic, depigmented plaques with irregular hyperpigmented margins, distributed all over the face, helix, and concha of ears. One of the atrophic plaques on root of nose has elevated border, which was suspicious for neoplasm. Histology of this lesion revealed a basal cell carcinoma in association with DLE. Other routine laboratory examinations were unremarkable other than mild anemia. ANA serologies were negative. The patient was started on oral hydroxychloroquine and topical steroids, was advised to avoid sun exposure, and was referred to a surgeon for the management of her condition.
Multiple eccrine hidrocystomas of uncommon presentation Jatziri Mireille Itze Chavez Bernal, MD, Centro Dermatologico ‘‘Dr. Ladislao de la Pascua,’’ Mexico DF, Mexico; Carlos Lizarraga Garcia, MD, Centro Dermatologico ‘‘Dr. Ladislao de la Pascua,’’ Mexico DF, Mexico Introduction: Eccrine hidrocystomas are cystic lesions of the sweat gland ducts.They affect most frequently women of 20 to 70 years of age and can be multiple (Robinson type) or unique (Smith type). Case report: A 20-year-old woman presented to our department with multiple asymptomatic skin-colored mobile subcutaneous nodules, with normal appearing overlying skin affecting the neck and armpits since 8 years of age. An excisional biopsy specimen of a left axillary nodule revealed cysts in the dermis lined by a double layer of cuboidal epithelium with low content of amorphous eosinophilic material. Discussion: We report this case because of the uncommon presentation of eccrine hidrocystomas both in age of onset and location. This condition represents a therapeutic challenge with disappointing results. Commercial support: None identified.
Commercial support: None identified.
P1179 Polypoid dermatofibroma Maria Jose Espi~ neira-Carmona, MD, San Cecilio University Hospital, Deparment of Dermatology, Granada, Spain; Jose Aneiros-Cachaza, MD, PhD, San Cecilio University Hospital, Department of Pathology, Granada, Spain; Jose AneirosFernandez, MD, San Cecilio University Hospital, Department of Pathology, Granada, Spain; Maria Antonia Fernandez-Pugnaire, MD, San Cecilio University Hospital, Department of Dermatology, Granada, Spain; Salvador Arias-Santiago, MD, San Cecilio University Hospital, Department of Dermatology, Granada, Spain Introduction: Dermatofibroma (DF) is a fibrohistiocytic tumor of usual observation in dermatology practice and one of the clinical forms of DF characterized by its low frequency and clinical diagnosis is difficult polypoid DF. We report the case of a man with a polypoid DF located on inside of right leg 1 year of evolution. Case report: A 34-year-old man without a medical history who had a tumor or a year of development located on inside of right leg. He had been undergoing steady growth and causing discomfort. The patient did not recall a history of trauma or injury in the area. On examination, there was an exophytic tumor of 2 cm 3 3 cm in diameter, joined by a pedicle skin. The tumor had a smooth surface and was surrounded by a pinkish-brown patch, with a crusted ulceration on its surface. He was scheduled for surgery under local anesthesia, and the histologic diagnosis was DF.
Stony Brook University Hospital is the only tertiary care medical center in Suffolk County, NY. We amass interesting cases from our inpatient service and outpatient clinics. We will present the best of these cases, including a case of massive stellate purpura associated with antiphospholipid antibodies and cocaine use.
Discussion: DF is a frequent skin lesion that has different clinical varieties. The polypoid DF is an uncommon variant, characterized by exophytic and pedunculated appearance of benign biologic behavior and histopathologic features similar to conventional DF. Our case highlights focal positivity for CD68 antigen common fibrohistiocytic and CD34, an antigen that appears in soft tissue tumors, such as dermatofibrosarcoma protuberans. Its clinical diagnosis of suspicion is difficult because it is often confused with benign lesions, such as keratoacanthoma, or malignant lesions, such as dermatofibrosarcoma protuberans, squamous cell carcinoma, sarcoma, and melanoma amelanotic. There is currently controversy over the nature of DF. Some authors believe it is a reactive condition of the dermal connective tissue with different stages of evolution and involution. Others say it is a benign neoplastic proliferation with differentiation of the fibrohistiocytic skin. With respect to its evolution and prognosis the DF is a benign lesion, although it should be noted that there are variations in the presence of atypical cells, which may recur and even metastasize, so it is important to complete excision and close monitoring of the patient.
Commercial support: None identified.
Commercial support: None identified.
P1177 Interesting cases from Stony Brook University Tara Kaufmann, MD, SUNY Stony Brook, East Setauket, NY, United States; Sandy Bost, MD, SUNY Stony Brook, East Setauket, NY, United States
FEBRUARY 2011
J AM ACAD DERMATOL
AB51