Sampling of interesting Dermatopathology cases from CUMC-1

Deba P Sarma, MD Director of Dermatopathology Creighton University Medical Center Dept of Pathology, Omaha

Case 1

F 55, obese

4-month history of hemorrhagic discharge from the umbilicus

8-mm dark mass from base of the umbilicus

Diagnosis: Lint ball omphalitis

Ref: Sarma DP, Teruya B (2009). Lint ball omhphalitis, a rare cause of umbilical discharge in an adult woman: a case report. Cases J 2: 7785.PMID 19830013 Steinhauser G (2009). The nature of navel fluff. Med Hypotheses. 72(6):623-5.

Case 2

M 50 Possible pilar cyst removed from scalp.

RCC Immunostain

Diagnosis:
Implantation carcinoma of the scalp from renal cell carcinoma

Ref: Sarma DP, Wang JF, McAllister MV, Wang B, Shehan JM. (2008) Possible implantation carcinoma of the scalp following craniotomy for metastatic renal cell carcinoma. Dermatology Online J 14(6):20.

Case 3

M 44, of Chinese heritage had red palms since birth

Mother (74 yrs) and daughter(7 yrs) had bright red palms all their life

Diagnosis

Erythema palmare hereditarium (Red palm disease, Lanes disease)

Ref: Sarma DP, Wang B (2007). Erythema palmare hereditarium (Red palms): Lanes Disease. Dermatol Online J. 13(2). Lane JE.(1929). Erythema palmare hereditarium. Arch Derm Syph. 20:445-448.

Case 4

M 58, left knee dislocation with neurovascular injury, 1968.

Left below the knee amputation, fitted with an artificial leg. 36 years later (2004), pain at the amputation site, mass, foul discharge.

Diagnosis

Verrucous carcinoma in the amputation stump Ref: Sarma DP, Hansen TP, Adickes ED(2006): Carcinoma arising in the leg amputation stump. The Internet J Dermatol 4(1).

 Sarma DP, Weilbaecher TG.(1985)) Carcinoma arising in burn scar. J Surg Oncol. 29(2):89-90.
M 60, left BK amputation 30 years ago after a dynamite explosion injury. Artificial leg since then. Developed squamous cell carcinoma on the amputation stump 30 years later.

Case 5

F 32 5 mm, painless subareolar nodule, left breast

Diagnosis: Infiltrating syringomatous eccrine adenoma of the nipple Ref: Sarma D, Stevens T (2009). Infiltrating syringomatous eccrine adenoma of the nipple: a case report. Cases J 2:0118.

Case 6

F 83, 7-mm painless soft papule, left cheek, present for few months Clinical: Lipoma

CK 20

Chromogranin

Synaptophysin

 Diagnosis: Subcutaneous Merkel cell carcinoma

Case 7 F 81 Raised hyperkeratotic lesion, left temple, clinical sk

Diagnosis: Malignant seborrheic keratosis Ref: Sharma P, Sarma DP, Adickes ED (2006). Seborrheic keratosis with in-situ carcinoma changes. Dermatology Online J 12(7):19

Case 8

M 86, back, clinical seborrheic keratosis

MITF

Diagnosis: Melanoma in-situ arising in seborrheic keratosis

Ref: Repertinger S, Wang J, Adickes E, Sarma DP. (2008). Melanoma in-situ arising in seborrheic keratosis: a case report. Cases J 1 (1):263.

Case 9

M 72, farmer, sheep handler, left wrist crusted nodule, 0.9 cm.

Diagnosis: Human orf ( Ecthyma contagiosum, Contagious pustular dermatosis)

Case 10

Three skin biopsies from the face of three men (age: 55-67yrs)

Ref

Winer L H.(1954). The dilated pore, a trichoepithelioma. J Invest Dermatol 23(3):181188.

Sarma Deba P.(2009): Dilated Pore of Winer, Dr. Louis H Winer and Wine Glass. The Internet Journal of Dermatology Vol 7(2).