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Intestinal metaplasia and high-grade dysplasia in abdominal skin
Interesting cases from Indiana University
Intestinal metaplasia and high-grade dysplasia in abdominal skin
(Poster reference number 4786)
(Poster reference number 5673)
Lori Jacquemin Sanford, MD, Indiana University, Indianapolis, IN, United States; Elizabeth Bryant, MD, Indiana University, Indianapolis, IN, United States We present 6 cases of interest from our clinics at Indiana University during the preceding year. Cases are all uncommon and of educational value. Clinical photographs are presented as well as histopathology when available. Each case includes a discussion of initial presentation, clinical data, and treatments. We also briefly review high yield facts and clinical pearls for each patient presented.
Aruni Ranasinghe, MBBS, MD, Addenbrooke’s Hospital, Cambridge, United Kingdom; Ed Rytina, MBBS, MD, Department of Dermatopathology, Addenbrooke’s Hospital, Cambridge, United Kingdom; Pamela Todd, MBChB, MD, Addenbrooke’s Hospital, Cambridge, United Kingdom
Commercial support: None identified.
Intestinal metaplasia is a premalignant condition where there is transformation of gut epithelium, usually the stomach and esophagus, to resemble the intestinal mucosa. It is Histologically characterized by the presence of goblet cells and is associated with the development of adenocarcinoma. A 49-year-old woman was referred to our department in May 2009 with an abdominal lesion adjacent to her urostomy. She was born with spina bifida and had a urostomy fashioned at 4 years of age for a neurogenic bladder. Several months before her presentation, she developed an asymptomatic area of florid erythema in the peristomal skin, extending several inches. She was on long-term immunosuppressants following a kidney transplant in 2002, for renal failure secondary to malignant hypertension. On examination she had an erythematous plaque adjacent to her stoma measuring 5 3 4 cm. The differential diagnosis included allergic contact dermatitis, extramammary Paget, or Bowen disease. A diagnostic biopsy taken very distant from the stoma in 2009 revealed a complex mixture of squamous epithelium and metaplastic, lower gastrointestinal glandular epithelium. The glandular areas showed multiple foci of nuclear enlargement, hyperchromasia, high nuclear:cytoplasmic ratio and prominent mitotic activity. These appearances were of intestinal metaplasia, exhibiting low-grade dysplasia. The colorectal surgeons opted for a conservative approach of monitoring only, due to numerous stoma revisions in the past and risk of poor healing due to immunosuppression. Despite topical corticosteroids, her lesion persisted. In December 2010, she had five further diagnostic biopsies from the very distant margins and center of the plaque. All biopsies showed the presence of intestinal epithelium with marked cytological atypia reaching the surface, coupled with uniform strong nuclear positivity for p53, confirming high-grade glandular dysplasia. Complete excision of the plaque of intestinal dysplasia is planned. Although intestinal metaplasia progressing to adenocarcinoma in the internal bladder mucosa of a patient with spina bifida has been described, there have been no previous reports of intestinal metaplasia or dysplasia occurring in the abdominal skin of patients with urostomies. We postulate that this cutaneous lesion maybe arising from an underlying bladder or intestinal pathology. This is a most unusual presentation and our patient’s prognosis and management remain a great concern. Commercial support: None identified.
Investigator-blinded study on the potential benefits of daily shaving with an advanced shave regimen compared to shaving 2 to 3 times per week with a standard shave regimen in the management of the symptoms of pseudofolliculitis barbae
(Poster reference number 5715)
Pamela Zupkosky, Procter and Gamble, Boston, MA, United States; Amy McMichael, MD, Wake Forest University, Winston-Salem, NC, United States; Anne Westbrook, Procter and Gamble, Cincinnati, OH, United States; Helen Kemp, PhD, Procter and Gamble, Cincinnati, OH, United States Background: Pseudofolliculitis barbae (PFB), also referred to as razor bumps, is an inflammatory condition with a clinical presentation of papules in the beard area with occasional pustules or hypertrophic scarring, which usually develops in response to hair removal. PFB occurs when hair grows back into the skin, causing an inflammatory response that can then be further traumatized during subsequent shaving. PFB can affect men and women who have naturally curly hair. While PFB refers to the beard region, the condition can occur in any region of the body where hair is removed. Objective: The primary purpose of this study is to evaluate the impact of daily shaving compared to the more frequently advised two to three times per week shaving regimen on number of lesions and clinical severity scores on the overall appearance in men with PFB. The secondary purpose is to compare standard and advanced shaving skin care products when used on a daily basis, and to measure facilitation of shaving and decreased post shave symptoms. Interesting cases from Stony Brook University Tara Kaufmann, MD, SUNY Stony Brook, East Setauket, NY, United States; Peter Klein, MD, SUNY Stony Brook, East Setauket, NY, United States
Methods: An investigator-blinded study of men with symptoms of PFB, divided into two treatment groups and a control group. Using a combination of dermatologist, self-assessment and instrumental measures, the impact of the regimens were evaluated for efficacy in reducing symptoms of PFB.
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. Some of the cases that we will present include metastatic Crohn disease, leprosy, cutaneous tuberculosis, leukemia cutis, and perifolliculitis capitis.
Results: A regimen with daily shaving reduced the severity of PFB. Results showed a decrease in lesions for the two test groups as compared to the control. Panelist selfassessment scores demonstrate improved skin look and feel for the daily shaving protocol.
Commercial support: None identified.
Commercial support: Procter and Gamble.
(Poster reference number 4886)
AB54
J AM ACAD DERMATOL
APRIL 2012
Intestinal metaplasia and high-grade dysplasia in abdominal skin
(Poster reference number 4786)
(Poster reference number 5673)
Lori Jacquemin Sanford, MD, Indiana University, Indianapolis, IN, United States; Elizabeth Bryant, MD, Indiana University, Indianapolis, IN, United States We present 6 cases of interest from our clinics at Indiana University during the preceding year. Cases are all uncommon and of educational value. Clinical photographs are presented as well as histopathology when available. Each case includes a discussion of initial presentation, clinical data, and treatments. We also briefly review high yield facts and clinical pearls for each patient presented.
Aruni Ranasinghe, MBBS, MD, Addenbrooke’s Hospital, Cambridge, United Kingdom; Ed Rytina, MBBS, MD, Department of Dermatopathology, Addenbrooke’s Hospital, Cambridge, United Kingdom; Pamela Todd, MBChB, MD, Addenbrooke’s Hospital, Cambridge, United Kingdom
Commercial support: None identified.
Intestinal metaplasia is a premalignant condition where there is transformation of gut epithelium, usually the stomach and esophagus, to resemble the intestinal mucosa. It is Histologically characterized by the presence of goblet cells and is associated with the development of adenocarcinoma. A 49-year-old woman was referred to our department in May 2009 with an abdominal lesion adjacent to her urostomy. She was born with spina bifida and had a urostomy fashioned at 4 years of age for a neurogenic bladder. Several months before her presentation, she developed an asymptomatic area of florid erythema in the peristomal skin, extending several inches. She was on long-term immunosuppressants following a kidney transplant in 2002, for renal failure secondary to malignant hypertension. On examination she had an erythematous plaque adjacent to her stoma measuring 5 3 4 cm. The differential diagnosis included allergic contact dermatitis, extramammary Paget, or Bowen disease. A diagnostic biopsy taken very distant from the stoma in 2009 revealed a complex mixture of squamous epithelium and metaplastic, lower gastrointestinal glandular epithelium. The glandular areas showed multiple foci of nuclear enlargement, hyperchromasia, high nuclear:cytoplasmic ratio and prominent mitotic activity. These appearances were of intestinal metaplasia, exhibiting low-grade dysplasia. The colorectal surgeons opted for a conservative approach of monitoring only, due to numerous stoma revisions in the past and risk of poor healing due to immunosuppression. Despite topical corticosteroids, her lesion persisted. In December 2010, she had five further diagnostic biopsies from the very distant margins and center of the plaque. All biopsies showed the presence of intestinal epithelium with marked cytological atypia reaching the surface, coupled with uniform strong nuclear positivity for p53, confirming high-grade glandular dysplasia. Complete excision of the plaque of intestinal dysplasia is planned. Although intestinal metaplasia progressing to adenocarcinoma in the internal bladder mucosa of a patient with spina bifida has been described, there have been no previous reports of intestinal metaplasia or dysplasia occurring in the abdominal skin of patients with urostomies. We postulate that this cutaneous lesion maybe arising from an underlying bladder or intestinal pathology. This is a most unusual presentation and our patient’s prognosis and management remain a great concern. Commercial support: None identified.
Investigator-blinded study on the potential benefits of daily shaving with an advanced shave regimen compared to shaving 2 to 3 times per week with a standard shave regimen in the management of the symptoms of pseudofolliculitis barbae
(Poster reference number 5715)
Pamela Zupkosky, Procter and Gamble, Boston, MA, United States; Amy McMichael, MD, Wake Forest University, Winston-Salem, NC, United States; Anne Westbrook, Procter and Gamble, Cincinnati, OH, United States; Helen Kemp, PhD, Procter and Gamble, Cincinnati, OH, United States Background: Pseudofolliculitis barbae (PFB), also referred to as razor bumps, is an inflammatory condition with a clinical presentation of papules in the beard area with occasional pustules or hypertrophic scarring, which usually develops in response to hair removal. PFB occurs when hair grows back into the skin, causing an inflammatory response that can then be further traumatized during subsequent shaving. PFB can affect men and women who have naturally curly hair. While PFB refers to the beard region, the condition can occur in any region of the body where hair is removed. Objective: The primary purpose of this study is to evaluate the impact of daily shaving compared to the more frequently advised two to three times per week shaving regimen on number of lesions and clinical severity scores on the overall appearance in men with PFB. The secondary purpose is to compare standard and advanced shaving skin care products when used on a daily basis, and to measure facilitation of shaving and decreased post shave symptoms. Interesting cases from Stony Brook University Tara Kaufmann, MD, SUNY Stony Brook, East Setauket, NY, United States; Peter Klein, MD, SUNY Stony Brook, East Setauket, NY, United States
Methods: An investigator-blinded study of men with symptoms of PFB, divided into two treatment groups and a control group. Using a combination of dermatologist, self-assessment and instrumental measures, the impact of the regimens were evaluated for efficacy in reducing symptoms of PFB.
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. Some of the cases that we will present include metastatic Crohn disease, leprosy, cutaneous tuberculosis, leukemia cutis, and perifolliculitis capitis.
Results: A regimen with daily shaving reduced the severity of PFB. Results showed a decrease in lesions for the two test groups as compared to the control. Panelist selfassessment scores demonstrate improved skin look and feel for the daily shaving protocol.
Commercial support: None identified.
Commercial support: Procter and Gamble.
(Poster reference number 4886)
AB54
J AM ACAD DERMATOL
APRIL 2012