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2015 Annual Meeting
Evening Specialty Conference - Dermatopathology
Monday, March 23, 2015 - 7:30pm to 9:30pm
CC 302
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Case title: 27 year old male with pilonidal cyst
Clinical Summary:

27 year old male with clinical history of pilonidal cyst. Excision of skin and subcutaneous tissue was performed (multiple fragments measuring 4.5x3x1 cm in aggregate).  H&E-stained section and immunohistochemical studies were submitted to our department from an outside hospital for consultation (a metastatic germ cell tumor was considered by the provider).  The virtual slide is from the skin excision.  The provided immunohistochemical studies for cytokeratin AE1/AE3, CK20, S-100 protein, pan-melanoma, CD3 and CD20 were negative.  Immunohistochemical studies for CD45, CD30 and C-KIT are shown below.





CD45
CD45
CD30
CD30
C-KIT
C-KIT
Case title: 55 year-old female with right upper quadrant mass
Clinical Summary:

A 55 year-old female with a history of subcutaneous soft tissue mass in the right upper quadrant. A core needle biopsy was performed to evaluate for a metastasis (no know primary site).  Immunohistochemical studies show that the tumor cells are negative for CD5, CD7, CD4, CD8, perforin, CD56, TdT, CD34, CD20, CD79a, OCT2, CD10, BCL6, CKIT, cytokeratin AE1/AE3, S-100 protein and SMA. In situ hybridization study for EBV-encoded RNA (EBER) is also negative.  The virtual slide is from the H&E-stained section and the immunohistochemical studies for CD45, CD30, ALK1, CD3 and UCHL1 are shown below.  



CD45
CD45
CD30
CD30
ALK1
ALK1
CD3
CD3
UCHL1
UCHL1
Clinical Summary:

A 66-year-old man presented with an enlarged left inguinal lymph node

Clinical Summary:

A 52-year-old man with a history of many atypical nevi presented with a 6 x 6 mm brown-pink papule on his left forearm.

Case title: Erythematous plaque on the right nasolabial crease
Clinical Summary:

A 46-year-old woman presented with a 8 mm keratotic nodule on the right naso-labial crease.  Over a period of two months after the initial presentation a 3-cm erythematous plaque studded with multiple 1-2 mm milia-like cysts formed in the area of the right nasolabial fold. 

A 1-cm elevated keratotic papule on the right nasolabial crease
A 1-cm elevated keratotic papule on the right nasolabial crease
A biopsy showed an exo-endophytic, crateriform proliferation of keratinocytes with abundant eosinophilic cytoplasm. There was an epithelial lipping and a central keratotic plug.
A biopsy showed an exo-endophytic, crateriform proliferation of keratinocytes with abundant eosinophilic cytoplasm. There was an epithelial lipping and a central keratotic plug.
Well-differentiated squamous proliferation with no significant atypia.
Well-differentiated squamous proliferation with no significant atypia.
Case title: Non-healing ulcer on the right temple of an 83-year-old man
Clinical Summary:

An 83-year-old Caucasian man with extensive history of cardiovascular disease presented for non-healing ulcers for over 1 year on the right temple, right post-auricular neck, and central chest (Figure 1B). Each lesion evolved after a surgical procedure as slowly growing ulcerative plaques for which multiple therapies were attempted but unsuccessful.

Fragments of superficial skin with cystic spaces in the dermis lined by well-differentiated squamous epithelium.
Fragments of superficial skin with cystic spaces in the dermis lined by well-differentiated squamous epithelium.

There are areas of suppuration containing numerous neutrophils. In other foci granulomatous inflammation with multinucleated giant cells and plasma cells are present.
There are areas of suppuration containing numerous neutrophils. In other foci granulomatous inflammation with multinucleated giant cells and plasma cells are present.
Case title: 47 year old male with generalized papulonodular lesions
Clinical Summary:

Case # 1

47 year old male presents to the dermatology clinic with generalized papolunodular lesion on his chest, arms and legs. Some of these papules had spontaneous resolution. The patient was otherwise healthy and with no systemic symptoms. The clinical differential diagnosis was guttate psoriasis versus viral dermatitis.

Case 1
Case 1
Case 1
Case 1
Case 1
Case 1
Case 1
Case 1
Case 1
Case 1
Case 1
Case 1
Case title: 60 year old female with a vulvar mass
Clinical Summary:

A 60 year old female presents to the clinic complaining of vaginal bleeding. On inspection, a vulvar ulcerated mass was found. The mass measured 3 cm. The patient does not have a prior history of malignancy. The clinical differential diagnosis was squamous cell carcinoma versus melanoma.







Clinical Summary:

60 year old male presenting with multiple, rapidly progressing skin plaques on his head, arms, torso, buttocks, and legs.

Low magnification (4x)
Low magnification (4x)
H&E (10x)
H&E (10x)
MiTF-1 IHC
MiTF-1 IHC
CD3 IHC
CD3 IHC
CD8 IHC
CD8 IHC
CD56 IHC
CD56 IHC
CD4 IHC
CD4 IHC
Clinical Summary:

60 year-old Caucasian male who presents with fatigue, extreme weight loss, and a coin size red patch on upper arm. His local physician started treatment with antibiotics without any response. A CT scan revealed hepatosplenomegaly. New lesions developed on his trunk, buttocks, and legs. Skin and liver biopsies were taken.

Case 10 - 4x
Case 10 - 4x
Case 10 - 10x
Case 10 - 10x
Case 10 - 20x
Case 10 - 20x
Case 10 CD3
Case 10 CD3
Case 10 CD20
Case 10 CD20
Case 10 CD4
Case 10 CD4
Case 10 CD8
Case 10 CD8