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Acinic cell carcinoma on the lower lip
P903
P905
ACINIC CELL CARCINOMA ON THE LOWER LIP Eun Young Bae, MD, Jae Hoon Cho, MD, Jeong Deuk Lee, MD, Sang Hyun Cho, MD, Our Lady of Mercy Hospital, Seoul, Korea Acinic cell carcinoma is a rare tumor usually involving the parotid gland and, unusually, the minor salivary glands. The clinical feature of acinic cell carcinoma is an asymptomatic swelling, and the treatment is the surgical excision that includes a border of normal tissue. The tumor behaves in a malignant fashion with a propensity for local recurrence and metastatic spread. We report a case of acinic cell carcinoma presenting as an asymptomatic mucocele-like mass on an unusual site. A 64-year-old woman presented with an asymptomatic, subcutaneous mass on the lower lip of 2 weeks’ duration. The histopathological examination showed a well-circumscribed tumor composed of many lobules separated by thin, fibrous connective tissues. The individual lobule was composed of round or polyhedral tumor cells, which had a characteristic finely granular and vacuolated cytoplasm and eccentric hyperchromatic nucleus. The cytoplasmic granules were periodic acidSchiff and diastase resistant. Immunohistochemistry showed these cells to be reactive to cytokeratin, a1-antitrypsin, and S-100 protein. There were no mitoses, necrosis, cellular pleomorphism, or infiltration. After the clinical diagnosis of acinic cell carcinoma was made, surgical excision was performed, including a border of normal tissue. Given these findings, we suggest that acinic cell carcinoma should be considered in any mucocele-like mass on the lower lip.
CUTANEOUS SPLENIC ECTOPIA PRESENTING AS PIGMENTED LESION IN A MELANOMA PATIENT Tracy Kuykendall, MD, MS, Kelli Lovelace, MD, A. Neil Crowson, MD, Raashid Haque, MD, University of Oklahoma Health Science Center, Oklahoma City, OK, United States Cutaneous implantation of ectopic splenic tissue is a rare but well-recognized phenomenon that often reflects prior blunt or penetrating abdominal trauma. We report the case of a 66-year-old woman with a history of superficial spreading melanoma; she presented in June 2004, with a 1.5-cm pigmented nodule in her 30year-old splenectomy incisional scar. The melanoma had been excised from a different site, namely, the right side of the abdomen in 2002 and was a Clark level III, Breslow thickness 0.45-mm neoplasm with negative margins. The new lesion was a uniformly and darkly pigmented 1.5-cm subcutaneous nodule clinically suspect as a recurrent melanoma. Other considerations included splenic ectopia, endometriosis, vascular lesion, or other dermal tumor. After complete excision, the nodule was characterized histologically as an encapsulated structure with splenic cords of red pulp admixed with lymphoid follicles typical of splenic light pulp. There was no evidence of malignancy. The patient is currently being followed UP and has had recurrence of the melanoma or of the ectopic spleen. Nothing to disclose.
Nothing to disclose.
P906 DERMATOLOGISTS INTERPRET A LARGE PERCENTAGE OF DERMATOPATHOLOGY SPECIMENS
P904 ACTINIC KERATOSES: CLINICAL DIAGNOSIS VERSUS HISTOPATHOLOGIC ASSESSMENT Torsten Ehrig, MD, Clay Cockerell, MD, Cockerell and Associates Dermatopathology Laboratory, Dallas, TX, United States; Antoanella Bardan, MD, Daniel Piacquadio, MD, University of California, San Diego, Dermatology, San Diego, CA, United States The clinical diagnosis of actinic keratoses (AKs) is frequently taken for granted, given its simplicity and its ease of treatment. However, over the past decade, the increasing importance of the association of squamous cell carcinoma with this common clinical malady has focused a greater degree of attention on this disease. As part of a larger prospective AK treatment trial, we had the opportunity to assess the clinicohistopathologic correlation for this disease. One hundred ten subjects were enrolled in the study at 11 investigational sites. At the baseline visit, before any treatment, two clinically diagnosed AKs from each patient were randomly selected for 2-mm punch biopsy. All specimens (220 total) were processed by a central laboratory (Cockerell and Associates). Tissue samples were fixed in 10% buffered formalin and processed by routine histopathological techniques and stained by hematoxylin and eosin. Sections were evaluated by one of two dermatopathologists using the sample criteria and were classified as (A) actinic keratoses (macular actinic keratosis, actinic keratosis, or advanced actinic keratosis), (B) squamous cell carcinomas (in situ or with superficial invasion) or (C) ‘‘other.’’ Histopathology of lesions in question was confirmed by both pathologists. Ninety-one percent (200/220) of the lesions were diagnosed as Aks (AK/advanced, AK/macular, or AK). Squamous cell carcinomas were found in 4.5% (10/220) of the lesions (7 in-situ lesions, 3 with superficial invasion). The remaining lesions constituted 4.5% (10/220) and included one basal cell carcinoma and a variety of benign dermatoses. Details of the histopathologic findings will be presented and the clinical significance of the findings will be discussed. All authors received compensation to perform the clinical research work cited in this poster. Sponsored by an educational grant from DUSA Pharmaceuticals
MARCH 2005
John Hancox, MD, Julie Neville, MD, John Chen, MD, PhD, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, United States; Brett Coldiron, The Skin Cancer Center, Cincinnati, OH, United States Background: Recent legislation passed in California, Louisiana, Nevada, New Jersey, New York, and Rhode Island (and recently tabled in South Carolina and proposed in Ohio) prohibits medical providers from billing for pathological services provided by other physicians. Legislation introduced in Ohio states that only Board-certified pathologists can directly bill for anatomic pathology services. However, dermatologists have extensive training in dermatopathology and commonly bill for dermatopathological services. Objective: To analyze whether the category of cutaneous pathology can be considered within the standard of care for a dermatology practice. Methods: Part A and B claims data from the Medicare Current Beneficiary Survey, 1992 to 2000, were utilized to identify surgical pathology claims based on Current Procedural Terminology (CPT) code 88305. In addition, codes related to skin disease [according to the associated International Classification of Disease (ICD-9) code] were also utilized. Weights were applied to ensure nationally representative estimates. Data on the amount of physicians in each specialty were obtained from estimates posted by the American Medical Association (AMA) estimates. Results: Dermatologists submitted 13% of all claims, whereas independent laboratories and group practices submitted 26% and pathologists submitted 59%. However, for diagnoses related to the skin, dermatologists submitted 32.8% of all claims, while independent laboratories and group practices submitted 31.2%, and pathologists submitted 34.5%. Under the assumption that individuals at the independent laboratories and group practices were wholly pathologists, 1047 of all cases were submitted by dermatologists and 1154 of the cases were submitted by pathologists. Discussion: Dermatologists interpret a large percentage of all cutaneous specimens and have extensive training and experience in dermatopathology. Based on these presumptions, the interpretation of anatomic pathology, especially when related to skin and subcutaneous specimens, falls well within the scope of a dermatological standard of care. The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, LP.
J AM ACAD DERMATOL
P81
P905
ACINIC CELL CARCINOMA ON THE LOWER LIP Eun Young Bae, MD, Jae Hoon Cho, MD, Jeong Deuk Lee, MD, Sang Hyun Cho, MD, Our Lady of Mercy Hospital, Seoul, Korea Acinic cell carcinoma is a rare tumor usually involving the parotid gland and, unusually, the minor salivary glands. The clinical feature of acinic cell carcinoma is an asymptomatic swelling, and the treatment is the surgical excision that includes a border of normal tissue. The tumor behaves in a malignant fashion with a propensity for local recurrence and metastatic spread. We report a case of acinic cell carcinoma presenting as an asymptomatic mucocele-like mass on an unusual site. A 64-year-old woman presented with an asymptomatic, subcutaneous mass on the lower lip of 2 weeks’ duration. The histopathological examination showed a well-circumscribed tumor composed of many lobules separated by thin, fibrous connective tissues. The individual lobule was composed of round or polyhedral tumor cells, which had a characteristic finely granular and vacuolated cytoplasm and eccentric hyperchromatic nucleus. The cytoplasmic granules were periodic acidSchiff and diastase resistant. Immunohistochemistry showed these cells to be reactive to cytokeratin, a1-antitrypsin, and S-100 protein. There were no mitoses, necrosis, cellular pleomorphism, or infiltration. After the clinical diagnosis of acinic cell carcinoma was made, surgical excision was performed, including a border of normal tissue. Given these findings, we suggest that acinic cell carcinoma should be considered in any mucocele-like mass on the lower lip.
CUTANEOUS SPLENIC ECTOPIA PRESENTING AS PIGMENTED LESION IN A MELANOMA PATIENT Tracy Kuykendall, MD, MS, Kelli Lovelace, MD, A. Neil Crowson, MD, Raashid Haque, MD, University of Oklahoma Health Science Center, Oklahoma City, OK, United States Cutaneous implantation of ectopic splenic tissue is a rare but well-recognized phenomenon that often reflects prior blunt or penetrating abdominal trauma. We report the case of a 66-year-old woman with a history of superficial spreading melanoma; she presented in June 2004, with a 1.5-cm pigmented nodule in her 30year-old splenectomy incisional scar. The melanoma had been excised from a different site, namely, the right side of the abdomen in 2002 and was a Clark level III, Breslow thickness 0.45-mm neoplasm with negative margins. The new lesion was a uniformly and darkly pigmented 1.5-cm subcutaneous nodule clinically suspect as a recurrent melanoma. Other considerations included splenic ectopia, endometriosis, vascular lesion, or other dermal tumor. After complete excision, the nodule was characterized histologically as an encapsulated structure with splenic cords of red pulp admixed with lymphoid follicles typical of splenic light pulp. There was no evidence of malignancy. The patient is currently being followed UP and has had recurrence of the melanoma or of the ectopic spleen. Nothing to disclose.
Nothing to disclose.
P906 DERMATOLOGISTS INTERPRET A LARGE PERCENTAGE OF DERMATOPATHOLOGY SPECIMENS
P904 ACTINIC KERATOSES: CLINICAL DIAGNOSIS VERSUS HISTOPATHOLOGIC ASSESSMENT Torsten Ehrig, MD, Clay Cockerell, MD, Cockerell and Associates Dermatopathology Laboratory, Dallas, TX, United States; Antoanella Bardan, MD, Daniel Piacquadio, MD, University of California, San Diego, Dermatology, San Diego, CA, United States The clinical diagnosis of actinic keratoses (AKs) is frequently taken for granted, given its simplicity and its ease of treatment. However, over the past decade, the increasing importance of the association of squamous cell carcinoma with this common clinical malady has focused a greater degree of attention on this disease. As part of a larger prospective AK treatment trial, we had the opportunity to assess the clinicohistopathologic correlation for this disease. One hundred ten subjects were enrolled in the study at 11 investigational sites. At the baseline visit, before any treatment, two clinically diagnosed AKs from each patient were randomly selected for 2-mm punch biopsy. All specimens (220 total) were processed by a central laboratory (Cockerell and Associates). Tissue samples were fixed in 10% buffered formalin and processed by routine histopathological techniques and stained by hematoxylin and eosin. Sections were evaluated by one of two dermatopathologists using the sample criteria and were classified as (A) actinic keratoses (macular actinic keratosis, actinic keratosis, or advanced actinic keratosis), (B) squamous cell carcinomas (in situ or with superficial invasion) or (C) ‘‘other.’’ Histopathology of lesions in question was confirmed by both pathologists. Ninety-one percent (200/220) of the lesions were diagnosed as Aks (AK/advanced, AK/macular, or AK). Squamous cell carcinomas were found in 4.5% (10/220) of the lesions (7 in-situ lesions, 3 with superficial invasion). The remaining lesions constituted 4.5% (10/220) and included one basal cell carcinoma and a variety of benign dermatoses. Details of the histopathologic findings will be presented and the clinical significance of the findings will be discussed. All authors received compensation to perform the clinical research work cited in this poster. Sponsored by an educational grant from DUSA Pharmaceuticals
MARCH 2005
John Hancox, MD, Julie Neville, MD, John Chen, MD, PhD, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, United States; Brett Coldiron, The Skin Cancer Center, Cincinnati, OH, United States Background: Recent legislation passed in California, Louisiana, Nevada, New Jersey, New York, and Rhode Island (and recently tabled in South Carolina and proposed in Ohio) prohibits medical providers from billing for pathological services provided by other physicians. Legislation introduced in Ohio states that only Board-certified pathologists can directly bill for anatomic pathology services. However, dermatologists have extensive training in dermatopathology and commonly bill for dermatopathological services. Objective: To analyze whether the category of cutaneous pathology can be considered within the standard of care for a dermatology practice. Methods: Part A and B claims data from the Medicare Current Beneficiary Survey, 1992 to 2000, were utilized to identify surgical pathology claims based on Current Procedural Terminology (CPT) code 88305. In addition, codes related to skin disease [according to the associated International Classification of Disease (ICD-9) code] were also utilized. Weights were applied to ensure nationally representative estimates. Data on the amount of physicians in each specialty were obtained from estimates posted by the American Medical Association (AMA) estimates. Results: Dermatologists submitted 13% of all claims, whereas independent laboratories and group practices submitted 26% and pathologists submitted 59%. However, for diagnoses related to the skin, dermatologists submitted 32.8% of all claims, while independent laboratories and group practices submitted 31.2%, and pathologists submitted 34.5%. Under the assumption that individuals at the independent laboratories and group practices were wholly pathologists, 1047 of all cases were submitted by dermatologists and 1154 of the cases were submitted by pathologists. Discussion: Dermatologists interpret a large percentage of all cutaneous specimens and have extensive training and experience in dermatopathology. Based on these presumptions, the interpretation of anatomic pathology, especially when related to skin and subcutaneous specimens, falls well within the scope of a dermatological standard of care. The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, LP.
J AM ACAD DERMATOL
P81