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Defining the histopathologic features of high-risk squamous cell carcinoma
DERMATOPATHOLOGY P1500 Neutrophilic urticaria: Descriptive study of 32 patients Mar Llamas-Velasco, Hospital Universitario De La Princesa, Dermatology Department, Madrid, Spain; Amaro Garcıa-Diez, Hospital Universitario de la Princesa, Department of Dermatology, Madrid, Spain; Enrique Ovejero, Hospital Universitario De La Princesa, Madrid, Spain; Javier Fraga, Hospital Universitario De La Princesa, Pathology Department, Madrid, Spain; Javier Sanchez-Perez, Hospital Universitario de la Princesa, Department of Dermatology, Madrid, Spain Background: Neutrophilic urticaria (NU) was defined as a neutrophilic venulitis without fibrinoid necrosis, hemorrhage, or leukocytoclasia in its original description by Winkelmann in 1985. In any case, it has not been completely defined and differentiated from other urticarial lesions where neutrophils can be present. Objective: To study the epidemiologic, clinical, and analytical characteristics of histologically probed NU found in our hospital. Methods: We undertook the histologic review of all cases codified as ‘‘urticaria’’ in our pathologist’s database between January 1, 1999 and June 28, 2009. Two hundred and five single reports were reviewed. In 45 biopsy specimens, neutrophils were the predominant cell type. All clinical records, as well as biopsies, were reviewed in detail. Results: There were 45 biopsy specimens from 32 patients (7 men [14 biopsies], 25 women [31 biopsies]) with a mean age of 47.19 years (range, 14-79 years). Clinically, most lesions were described as itchy (77.5%); most reported lesions were wheals (34.8%), with a variable duration (55% \24 hours). Biopsies were taken from affected limbs (21 cases) and trunk (12 cases). Histologic review let us classify different patterns. Interstitial neutrophilic urticaria was the most frequent pattern (29.4%). Some patients were biopsied several times, and only a single patient showed changes in the histologic pattern. We have also statistically compared associated diseases, drug intake, and other variables, without finding any statistically relevant difference. In three of four patients with perivascular and interstitial pattern, Still disease was suspected. Discussion: NU accounts for 21% of biopsied urticaria in our hospital compared with 50% of acute urticaria founded by Toppe et al, for example. We have not found a remarkable percentage of systemic diseases associated with this histologic pattern, and in this way our results differ from the cases reported by Kieffer et al.
P1502 Defining the histopathologic features of high-risk squamous cell carcinoma Antonio Martorell-Calatayud, MD, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain; Carlos Guillen, MD, Fundaci on Instituto Valenciano de Oncologia, Valencia, Spain; Onofre Sanmartın, MD, Fundaci on Instituto Valenciano de Oncologia, Valencia, Spain Background: Cutaneous squamous cell carcinoma (cSCC) is the second most common malignant tumor, preceded only by basal cell carcinoma. Up to 3% of cSCC cases develop metastasis to regional nodes, and this tumor is considered an important cause of death. The features that define the risk of nodal involvement in cSCC are not well defined. Knowledge of both clinical and histopathologic characteristics of those cSCC who associate high risk of node involvement could improve the management of these patients. Objective: To establish the clinical and histologic characteristics of nodal cSCC. Methods: Retrospective data were collected from 18 consecutive patients with cSCC who developed nodal invasion and who attended an oncology center between January 1999 and December 2009. Conclusion: The most relevant features observed in our analysis included the following items. (1) The presence of personal history of cSCC and actinic keratoses. (2) A short time of evolution (6 months to 1 year). (3) A short interval of time between tumor excision and nodal involvement (up to 9 months). (4) Most tumors were included in the stage III of Broders classification. (5) Median depth index was 7.3 mm. (6) Median number of mitosis in 10 areas was 31, being located mainly in the growth’s margins. (7) Invasion of vascular and neural structures was very common. (8) The inflammatory peritumoral component was mostly compounded by lymphocytes and plasmatic cells. Commercial support: None identified.
Commercial support: None identified.
P1501 Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL): The importance of the cutaneous biopsy in the diagnosis Pedro Valer on-Almazan, MD, Universitary Hospital of Gran Canaria Dr. Negrın, Service of Dermatology, Las Palmas de Gran Canaria, Spain; Carolina Medina, MD, Universitary Hospital of Gran Canaria Dr. Negrın, Service of Dermatology, Las Palmas de Gran Canaria, Spain; Gregorio Carretero, MD, Universitary Hospital of Gran Canaria Dr. Negrın, Service of Dermatology, Las Palmas de Gran Canaria, Spain; N estor Santana, MD, Universitary Hospital of Gran Canaria Dr. Negrın, Service of Dermatology, Las Palmas de Gran Canaria, Spain; Rafael Camacho, MD, Universitary Hospital of Gran Canaria Dr. Negrın, Service of Pathology, Las Palmas de Gran Canaria, Spain
P1503 Atypical angiolymphoid hyperplasia with eosinophilia mimicking cutaneous lymphoma Kevin Boyd, MD, University of Alabama at Birmingham, Birmingham, AL, United States; Aleodor Andea, MD, University of Alabama at Birmingham, Birmingham, AL, United States; Matthew Woods, MD, University of Alabama at Birmingham, Birmingham, AL, United States; Vlada Groysman, MD, University of Alabama at Birmingham, Birmingham, AL, United States
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a familiar cerebrovascular disease characterized by migraines, recurrent ischemic strokes, and early-onset dementia. Mutations of the Notch3 gen located on chromosome 19q12 are responsible for the disease. Histopathologic pathognomonic changes in small vessels have been identified not only in biopsy specimens of the brain but also in arteries of various other organs, such as skeletal muscle, nerve vessels, and the skin. Cutaneous biopsy is probably an ideal method for obtaining the diagnosis, because it is related to fewer complications. The histopathologic alterations consist of degeneration of smooth muscle cells within the small arteries, showing a granular osmiophilic material (GOM) deposition surrounding the vascular smooth muscle cells in the electron microscopy study. The specificity of GOM in the dermal arteries for the diagnosis of CADASIL is nearly 100% in several studies. Although cutaneous biopsy has been proposed as a useful technique with specific electronmicroscopic changes, dermatologists have not been familiarized with the diagnosis of this entity. We report 10 cases of CADASIL that were diagnosed in our hospital within the period 2002-2010. The typical granular osmiophilic material attached to vascular smooth muscle cells was evidenced in the cutaneous biopsy in all patients. We review the histopathologic and ultrastructural features of these cases, correlating them with the clinical picture.
We present a 65-year-old man with a 6-month history of a multifocal rash that erupted 3 weeks after an accidental electrocution. The physical examination revealed erythematous scaly papules and subcutaneous nodules scattered over his forehead, back, and legs, and a large plaque within a background of edema on the right lower leg. There was no lymphadenopathy; absolute blood eosinophilia was 998. Clinical diagnosis included a cutaneous lymphoma. A biopsy specimen from the left calf showed a subcutaneous nodular infiltrate of lymphocytes admixed with numerous eosinophils in association with increased numbers of arborizing vessels focally with plump endothelial cells suggesting angiolymphoid hyperplasia with eosinophilia (ALHE). However, some of the lymphocytic nodules were composed of small to intermediate, monomorphic lymphocytes with pale cytoplasm and distinct cell membranes. Scattered large atypical Hodgkin-like cells were seen, the overall pattern resembling angioimmunoblastic T-cell lymphoma. Immunohistochemical stains revealed a population of both T- and B-cell lymphocytes and plasma cells and rare small follicles. In situ hybridization for EBV-encoded RNA was also negative. The clinical and histopathologic characteristics were most consistent with angiolymphoid hyperplasia with eosinophilia (ALHE). The patient had complete resolution of his lesions with both oral and intralesional corticosteroids. This case illustrates an unusual presentation of ALHE showing clinical and histologic features mimicking a lymphoma. Awareness of this phenomenon is important for a correct diagnosis.
Commercial support: None identified.
Commercial support: None identified.
FEBRUARY 2011
J AM ACAD DERMATOL
AB65
P1502 Defining the histopathologic features of high-risk squamous cell carcinoma Antonio Martorell-Calatayud, MD, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain; Carlos Guillen, MD, Fundaci on Instituto Valenciano de Oncologia, Valencia, Spain; Onofre Sanmartın, MD, Fundaci on Instituto Valenciano de Oncologia, Valencia, Spain Background: Cutaneous squamous cell carcinoma (cSCC) is the second most common malignant tumor, preceded only by basal cell carcinoma. Up to 3% of cSCC cases develop metastasis to regional nodes, and this tumor is considered an important cause of death. The features that define the risk of nodal involvement in cSCC are not well defined. Knowledge of both clinical and histopathologic characteristics of those cSCC who associate high risk of node involvement could improve the management of these patients. Objective: To establish the clinical and histologic characteristics of nodal cSCC. Methods: Retrospective data were collected from 18 consecutive patients with cSCC who developed nodal invasion and who attended an oncology center between January 1999 and December 2009. Conclusion: The most relevant features observed in our analysis included the following items. (1) The presence of personal history of cSCC and actinic keratoses. (2) A short time of evolution (6 months to 1 year). (3) A short interval of time between tumor excision and nodal involvement (up to 9 months). (4) Most tumors were included in the stage III of Broders classification. (5) Median depth index was 7.3 mm. (6) Median number of mitosis in 10 areas was 31, being located mainly in the growth’s margins. (7) Invasion of vascular and neural structures was very common. (8) The inflammatory peritumoral component was mostly compounded by lymphocytes and plasmatic cells. Commercial support: None identified.
Commercial support: None identified.
P1501 Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL): The importance of the cutaneous biopsy in the diagnosis Pedro Valer on-Almazan, MD, Universitary Hospital of Gran Canaria Dr. Negrın, Service of Dermatology, Las Palmas de Gran Canaria, Spain; Carolina Medina, MD, Universitary Hospital of Gran Canaria Dr. Negrın, Service of Dermatology, Las Palmas de Gran Canaria, Spain; Gregorio Carretero, MD, Universitary Hospital of Gran Canaria Dr. Negrın, Service of Dermatology, Las Palmas de Gran Canaria, Spain; N estor Santana, MD, Universitary Hospital of Gran Canaria Dr. Negrın, Service of Dermatology, Las Palmas de Gran Canaria, Spain; Rafael Camacho, MD, Universitary Hospital of Gran Canaria Dr. Negrın, Service of Pathology, Las Palmas de Gran Canaria, Spain
P1503 Atypical angiolymphoid hyperplasia with eosinophilia mimicking cutaneous lymphoma Kevin Boyd, MD, University of Alabama at Birmingham, Birmingham, AL, United States; Aleodor Andea, MD, University of Alabama at Birmingham, Birmingham, AL, United States; Matthew Woods, MD, University of Alabama at Birmingham, Birmingham, AL, United States; Vlada Groysman, MD, University of Alabama at Birmingham, Birmingham, AL, United States
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a familiar cerebrovascular disease characterized by migraines, recurrent ischemic strokes, and early-onset dementia. Mutations of the Notch3 gen located on chromosome 19q12 are responsible for the disease. Histopathologic pathognomonic changes in small vessels have been identified not only in biopsy specimens of the brain but also in arteries of various other organs, such as skeletal muscle, nerve vessels, and the skin. Cutaneous biopsy is probably an ideal method for obtaining the diagnosis, because it is related to fewer complications. The histopathologic alterations consist of degeneration of smooth muscle cells within the small arteries, showing a granular osmiophilic material (GOM) deposition surrounding the vascular smooth muscle cells in the electron microscopy study. The specificity of GOM in the dermal arteries for the diagnosis of CADASIL is nearly 100% in several studies. Although cutaneous biopsy has been proposed as a useful technique with specific electronmicroscopic changes, dermatologists have not been familiarized with the diagnosis of this entity. We report 10 cases of CADASIL that were diagnosed in our hospital within the period 2002-2010. The typical granular osmiophilic material attached to vascular smooth muscle cells was evidenced in the cutaneous biopsy in all patients. We review the histopathologic and ultrastructural features of these cases, correlating them with the clinical picture.
We present a 65-year-old man with a 6-month history of a multifocal rash that erupted 3 weeks after an accidental electrocution. The physical examination revealed erythematous scaly papules and subcutaneous nodules scattered over his forehead, back, and legs, and a large plaque within a background of edema on the right lower leg. There was no lymphadenopathy; absolute blood eosinophilia was 998. Clinical diagnosis included a cutaneous lymphoma. A biopsy specimen from the left calf showed a subcutaneous nodular infiltrate of lymphocytes admixed with numerous eosinophils in association with increased numbers of arborizing vessels focally with plump endothelial cells suggesting angiolymphoid hyperplasia with eosinophilia (ALHE). However, some of the lymphocytic nodules were composed of small to intermediate, monomorphic lymphocytes with pale cytoplasm and distinct cell membranes. Scattered large atypical Hodgkin-like cells were seen, the overall pattern resembling angioimmunoblastic T-cell lymphoma. Immunohistochemical stains revealed a population of both T- and B-cell lymphocytes and plasma cells and rare small follicles. In situ hybridization for EBV-encoded RNA was also negative. The clinical and histopathologic characteristics were most consistent with angiolymphoid hyperplasia with eosinophilia (ALHE). The patient had complete resolution of his lesions with both oral and intralesional corticosteroids. This case illustrates an unusual presentation of ALHE showing clinical and histologic features mimicking a lymphoma. Awareness of this phenomenon is important for a correct diagnosis.
Commercial support: None identified.
Commercial support: None identified.
FEBRUARY 2011
J AM ACAD DERMATOL
AB65