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The article presents abstracts of medical research. They include "CD30 Expression on Mast Cells in Cutaneous Mastocytosis, a Potential Pitfall for a Lymphoproliferative Process,” by A. Agarwal, and colleagues, "Utilization of Double Immunostaining to Highlight Perineural Invasion of Recurrent Squamous Cell Carcinoma,” by L. Edsall and colleagues, and "Mycobacterium Tuberculosis Infection in a Patient with Erythema Induratum Confirmed by Interferon-Gamma Assay,” K. Kortuem and R. Weenig.

The article presents abstracts of medical research. They include "Merkel Cell Carcinoma: Evaluation of Kit (CD117) Expression and Mutations in the C-kit and PDGFR-A Genes Implications for Treatment with Imatinib Mesylate,” by B. Swick and colleagues, "Primary Dermal Melanoma: Distinct Prognostic and Immunohistochemical Features,” by E. Cabral and colleagues and "The Expression of CD23 in Cutaneous Neoplasms,” by J. Carvalho and colleagues.

Frozen sections are a useful pathologic tool, but variable image quality may impede the use of artificial intelligence and machine learning in their interpretation. We aimed to identify the current research on machine learning models trained or tested on frozen section images. We searched PubMed and Web of Science for articles presenting new machine learning models published in any year. Eighteen papers met all inclusion criteria. All papers presented at least one novel model trained or tested on frozen section images. Overall, convolutional neural networks tended to have the best performance. When physicians were able to view the output of the model, they tended to perform better than either the model or physicians alone at the tested task. Models trained on frozen sections performed well when tested on other slide preparations, but models trained on only formalin‐fixed tissue performed significantly worse across other modalities. This suggests not only that machine learning can be applied to frozen section image processing, but also use of frozen section images may increase model generalizability. Additionally, expert physicians working in concert with artificial intelligence may be the future of frozen section histopathology. [ABSTRACT FROM AUTHOR]

Presents abstracts of articles on dermapthology. "Merkel Cells are Seen in Association With Dermoplastic Trichoepithelioma, But not With Microcystic Adnexal Carcinoma, Basal Cell Carcinoma, or Syringoma," by E. E. Abesamis-Cubillan, L. El Shabrawi and P. E. LeBoit; "Kaposi's Sarcoma Arising in Chronic Post-Mastectomy Lymphedematous Arms is Found to Be HHV8 Positive by Polymerase Chain Reaction," by A. Allan, T. Shoji et al.; "Involutional Lipoatrophy: A Macrophage Induced Lipoatrophy," by Iftikhar Ahmed and Debra E. F. Ahmed; "Axillary and Umbilical Nevi: A Comparative Study," by C. Austin, A. Dumas et al.

This paper describes a solitary lesion of the hand thought to represent a variant of eccrine nevus composed solely of acrosyringeal elements. [ABSTRACT FROM AUTHOR]

It has been described that the etiology of epidermal cysts on acral skin is different from that on non-acral skin; however, no papers have been published regarding the detailed histological differences between acral and non-acral epidermal cysts. In this study, we compared the clinicopathologic findings of epidermal cysts of the sole with those of traditional epidermal cysts and trichilemmal cysts.The cases studied were 12 epidermal cysts of the sole, 35 traditional (non-acral) epidermal cysts, and 12 trichilemmal cysts. The age and sex of the patients and the site, size, and microscopic findings of the lesions were evaluated.The pattern of keratinization was specifically focused on the evaluation of microscopic findings.Microscopically, most of the epidermal cysts of the sole showed the presence of parakeratosis and focal lack of a granular layer at least at the upper portion of the cyst wall. The cyst content of the epidermal cysts of the sole was predominantly compact orthokeratotic material. These pathological findings could be explained by the pathogenesis of epidermal cysts of the sole, namely invagination of the surface epidermis.Our study indicates that most cases of the epidermal cyst of the sole are considered to be a true traumatic epidermal inclusion cyst.Shimizu Y, Sakita K, Arai E, Tsuchida T, Ogawa F, Ban S, Mitsuhashi T, Hirose T, Shimizu M. Clinicopathologic features of epidermal cysts of the sole: comparison with traditional epidermal cysts and trichilemmal cysts. [ABSTRACT FROM AUTHOR]

Cell carcinoma? Keywords: basal cell carcinoma; collision; myoepithelial carcinoma; sarcomatoid; tumor EN basal cell carcinoma collision myoepithelial carcinoma sarcomatoid tumor 576 578 3 05/21/20 20200601 NES 200601 ABSTRACT The tumor designated as "primary biphasic sarcomatoid basal cell carcinoma with myoepithelial differentiation" does not truly represent a new variant of sarcomatoid basal cell carcinoma but rather a collision tumor composed of a myoepithelial carcinoma and an incidental basal cell carcinoma and should therefore be classified appropriately. In summary, the tumor designated as "primary biphasic sarcomatoid basal cell carcinoma with myoepithelial differentiation" does not truly represent a new variant of sarcomatoid BCC but rather a collision tumor composed of a myoepithelial carcinoma and a BCC and should therefore be classified appropriately. [Extracted from the article]

Sebaceous carcinoma typically presents a diagnostic challenge because it mimics other more common, locally invasive carcinomas, including squamous cell carcinoma and basal cell carcinoma-particularly when one of these tumors exhibits concomitant clear-cell changes. Immunohistochemical studies offering high sensitivity and specificity are critical for accurate diagnosis. [ABSTRACT FROM AUTHOR]

Pilomatrix carcinoma is a rare, locally aggressive tumor with a tendency to recur. Distant metastases have been reported, with pulmonary lesions being the most frequent manifestation. Similar to pilomatrixoma, pilomatrix carcinoma typically presents as a nontender, firm dermal swelling and is found most commonly in the head and neck region. Although pilomatrixomas and pilomatrix carcinoma are well-recognized lesions, clinically they are frequently misdiagnosed as other skin conditions. By reviewing the literature over the past 10 years, the aims of this review are to analyze the cause, clinical presentation, histopathologic features, management and outcomes of pilomatrix carcinoma amongst children and adults. [ABSTRACT FROM AUTHOR]

The article presents abstracts presented at the 48th Annual Meeting of the American Society of Dermatopathology, on topics including positive melanomas, angiotropism, and trichilemmomas.

Malignant melanoma has been extensively studied concerning methods of predicting progression and clinical outcome. The maximum tumor thickness as measured by Breslow's method is the cornerstone prognostic criterion, but despite this, evolution of the disease in some patients remains unpredictable, confirming that new reliable prognostic factors are awaited. Cell kinetic evaluation has been shown to be a useful tool for assessing the prognosis of breast and gastrointestinal cancer patients. Indeed, in these fields, the mitotic index and MIB-1 expression index, which are indirect estimates of the growth fraction of tumor cell population, are commonly shown to correlate with tumor grade and patient survival and presented as prognostic factors. In melanoma, results of cell kinetic investigations are conflicting: some studies have established a link between high proliferative activity and a bad prognosis, whereas other reports suggest the opposite. The aim of this review is to discuss these findings. [ABSTRACT FROM AUTHOR]

Cutaneous squamous cell carcinoma (SCC) includes many subtypes with widely varying clinical behaviors, ranging from indolent to aggressive tumors with significant metastatic potential. However, the tendency for pathologists and clinicians alike is to refer to all squamoid neoplasms as generic SCC. No definitive, comprehensive clinicopathological system dividing cutaneous SCCs into categories based upon their aggressiveness has yet been promulgated. Therefore, we have proposed the following based upon the malignant potential of SCC variants, separating them into categories of low (≤2% metastatic rate), intermediate (3–10%), high (greater than 10%), and indeterminate behavior. Low-risk SCCs include SCC arising in actinic keratosis, HPV-associated SCC, tricholemmal carcinoma, and spindle cell SCC (unassociated with radiation). Intermediate-risk SCCs include adenoid (acantholytic) SCC, intraepidermal epithelioma with invasion, and lymphoepithelioma-like carcinoma of the skin. High-risk subtypes include de novo SCC, SCC arising in association with predisposing factors (radiation, burn scars, and immunosuppression), invasive Bowen's disease, adenosquamous carcinoma, and malignant proliferating pilar tumors. The indeterminate category includes signet ring cell SCC, follicular SCC, papillary SCC, SCC arising in adnexal cysts, squamoid eccrine ductal carcinoma, and clear-cell SCC. Subclassification of SCC into these risk-based categories, along with enumeration of other factors including tumor size, differentiation, depth of invasion, and perineural invasion will provide prognostically relevant information and facilitate the most optimal treatment for patients. [ABSTRACT FROM AUTHOR]

Adenocarcinoma of the rete testis (ACRT) is extremely rare and has only been the subject of sporadic case reports, in most of which the neoplasm manifested as a scrotal mass with diffuse enlargement of the testis. Only a few cases of scrotal infiltration by a contiguous ACRT have been described. To our knowledge, none have reported distant skin metastases. We report a case of ACRT presenting with suprapubic skin metastases. The diagnosis was based on clinical and histopathological findings and supported by the results of immunohistochemical and ultrastructural studies. We discuss the differential diagnosis to this rare entity, which include metastatic adenocarcinoma, serous tumor of the testis, and mesothelioma of the tunica vaginalis. [ABSTRACT FROM AUTHOR]

We report a rare case of mucinous carcinoma of the skin with mammary infiltrating carcinoma-like patterns. An 82-year-old Japanese male had a gourd-shaped tumor on his scalp. Histopathologically, the posterior portion of the tumor showed small lobules of cuboidal tumor cells with no atypia floating in mucinous lakes. In the anterior portion, there were solid lobules, cords, and strands of anaplastic tumor cells infiltrating into the surrounding stroma. Enzyme- and immunohistochemistry and electron microscopy confirmed the eccrine origin of this tumor. It is suggested that mucinous carcinoma of the skin can occur in association with diverse histological patterns, analogous to mucinous carcinoma of the breast. [ABSTRACT FROM AUTHOR]

Dermatofibrosarcoma protuberans (DFSP) is a not uncommon low-grade cutaneous sarcoma of uncertain histogenesis, which typically arises in early to middle adult life. Traditionally, it is regarded as extremely uncommon in infants and children, and this diagnosis may therefore easily be overlooked in young patients. Eight such cases (representing 5.9% of the available DFSPs on file) are presented of which two were congenital. Age range at presentation was 14 months to 12 years. Five arose on the trunk. Most had originally been mistaken for unclassified sarcoma, a fibromatosis, or diffuse neurofibroma. The histologic features were entirely comparable to the more usual adult cases except that all had a plaque-like, rather than nodular, growth pattern. Short-term follow up has revealed no recurrences. DFSP is not so rare in childhood and warrants wider recognition in order to ensure appropriate treatment. [ABSTRACT FROM AUTHOR]

A number of studies have failed to detect point mutations at codon 12 in the Ki-ras gene in melanocytic neoplasms. One recent study, however, has found a high percentage of Ki-ras codon 12 point mutations. In an effort to resolve this difference, the present study examined noncultured melanocytic lesions (i.e., 5 benign nevi, 10 dysplastic nevi, and 8 primary melanomas: 4 in situ and 4 invasive) for point mutations at codon 12 in the first exon of the Ki-ras proto-oncogene using polymerase chain reaction methodology with oligonucleotide hybridization and direct DNA sequencing. The results of this study indicates no detectable mutations in the 12th codon of the first exon of the Ki-ras gene in any premalignant or malignant melanocytic lesion examined. [ABSTRACT FROM AUTHOR]

Epidermotropic neuroendocrine carcinoma (NEC) is rare. Based on such a case in an 88-year-old woman with a facial NEC showing epidermotropism with a pagetoid growth pattern, we asked whether several similar tumors involving the epidermis could be easily differentiated by immunohistochemical methods. We constructed a panel of control cases (2 each) for NEC, clear cell Bowen's disease (CCBD), Paget's disease (PD), superficial basal cell carcinoma (SBCC), cutaneous T-cell lymphoma (CTTL), and superficial spreading malignant melanoma (SSMM) to compare with our patient. A panel of antibodies including epithelial membrane antigen (EMA), neuron specific enolase (NSE), AE1/3 cytokeratin (CK), carcinoembryonic antigen (CEA), leukocyte common antigen (LCA), S-100, and HMB-45 were applied. Cutaneous NEC controls and our patient's tumor were strongly positive for EMA and NSE and had paranuclear dot-like cytoplasmic positivity for CK. CCBD was moderate to strong for CK. PD was strong for CEA. SBCC was essentially negative for all. CTTL was strong for LCA. SSMM was strong for S-100 and HMB-45. Controls were either negative or weak for the antibodies not mentioned. We conclude that this antibody panel can reliably differentiate these epidermotropic or juxtaepidermal tumors in diagnostic dermatopathology and should be applied to lesions requiring separation beyond H&E capabilities, especially with superficial shave biopsies showing small cell "Pagetoid" growth patterns. [ABSTRACT FROM AUTHOR]

We report the case of a 67-year-old man with a granular, cauliflower-pink lesion on the skin of the thigh. Histopathological study showed a typical verrucous carcinoma associated with a syringadenoma papilliferum. To our knowledge this association has not been previously reported. [ABSTRACT FROM AUTHOR]

A case of mixed carcinoma in situ, of the skin, is presented. The lesion, located on the right temple of a 71-year-old man, showed histologic features of Bowen's disease and extramammary Paget's disease. This case suggests that Bowen's disease and extramammary Paget's disease may arise from pluripotential adnexal epithelium capable of keratinocytic and glandular differentiation. Utilization of the peroxidase-antiperoxidase technique for demonstrating carcino-embryonic antigen was performed in order to identify the component interpreted as extramammary Paget's disease. This procedure is apparently more sensitive than the commonly employed histochemical stains for demonstrating glandular differentiation. [ABSTRACT FROM AUTHOR]

In recent years, understanding of the immune system and its malignant disorders, the lymphomas has made great advances. Indeed, an entire branch of medical science known as hematopathology has developed, which, with input from clinicians, pathologists and immunologists, attempts to increase understanding of disease processes by correlation of clinical data with very careful analysis of tissues and cells removed from patients, so that make a more accurate and precise diagnosis and construct a more accurate and useful clinical prognosis.

Misonidazole, a hypoxic cell radiation-sensitizer, has been used in rho to analyze its effects on normal and x-irradiated epidermis. The drug action was evaluated 3 days after being implanted subcutaneously. The response of the epidermis and specially of the basal cells to the drug alone and in combination with x-radiation was studied. The ultramorphological analysis as well as quantitative data on epidermal thickness and keratinocyte volume showed that high doses of misonidazole impair the usual lost-irradiation epidermal reaction, thus enhancing the involutional effects of radiation and inhibiting radiation-damage repair, even under conditions of normal oxygenation. [ABSTRACT FROM AUTHOR]

Malignant melanoma is a disease characterized by clinical evidence of host defense, possibly immunologically mediated. It is a disease which tends to be refractory to both radiotherapy and chemotherapy. Immunotherapy has been used in three phases of the disease. 1. Intralesional immunotherapy with a nonspecific immune adjuvant in patients with local intradermal or soft tissue recurrence. This treatment produces approximately 15% regression of both injected and uninjected lesions, and about 60% regression of injected lesions only. Both clinical and laboratory evidence suggests that this regression is immunologically mediated. 2. Patients with surgical removal of all clinically demonstrable tumor, either primary disease alone or regional node recurrence, active nonspecific, and specific, immunotherapy has been used in an adjuvant setting. There is considerable controversy about the benefits accruing to such immunotherapy, but most large scale prospective and randomized studies have suggested that if benefit does result it is modest in degree and probably cannot be measured in terms of increase in cure rate. 3. Immunotherapy has also been used as a nonspecific active adjuvant to single drug or polychemotherapy in patients with disseminated melanoma. Whereas complete response rate may be slightly increased by this maneuver there is no convincing evidence that immunotherapy markedly increases the total objective response rate to polychemotherapy, and survival is only marginally superior when immunotherapy is added to chemotherapy in this setting. Further studies need to be done with active specific immunotherapy with tumor cell membrane extracts; as an adjuvant in patients with minimal body burden of tumor cells; and to study the inaction between chemotherapy and immunotherapy in this disease. [ABSTRACT FROM AUTHOR]

The incidence of metastasis in cutaneous melanoma is proportional to maximal tumor thickness. The relationship is linear for extremity melanoma but not for tumors from all body sites, probably due to intrinsic differences in tumors from different sites. The level of invasion of the tumor is an indirect measure of tumor thickness and is not as accurate in predicting metastases because of the marked variation in thickness within each level. The implications of these observations for the treatment of melanoma are discussed. [ABSTRACT FROM AUTHOR]

This case proves the possibility of a malignant transformation of seborrheic keratosis. This evidence is furnished by a biopsy specimen that shows not only a topical relationship between seborrheic keratosis and Bowen's disease, but also the progressive transition. An evident biopsy has to be made prior to clinical suspicion of malignant degeneration, that means prior to the destruction of the transitional zone by the tumor. [ABSTRACT FROM AUTHOR]

A 63-year-old white male presented with a nine-month history of a nontender ulcerated lesion on his ear. Light microscopy demonstrated a moderately well circumscribed lesion in the dermis which abutted upon epidermis. There was no evidence of continuity between the tumor and overlying epithelium. The tumor was very cellular with an admixture of cells - spindle, polyhedral and bizarre giant cells. Mitotic figures were abundant and frequently abnormal. We interpreted this lesion to have the clinical and pathologic features of an atypical fibroxanthoma (AFX). Ultrastructure, however, showed abundant tonofilaments and desmosomes indicative of an epithelial origin and therefore most consistent with a spindle cell squamous carcinoma (SCSC). It is urged that, when possible, electron microscopy he performed on problematic cases diagnosed either as an AFX or spindle cell squamous carcinoma since it is the most valid basis on which a correct diagnosis can be made. [ABSTRACT FROM AUTHOR]

The morphological variants of dermal fibrous histiocytomas have engendered a confusing terminology. One hundred and eighty-nine cases of fibrous histiocytomas were studied in order to define the morphological spectrum exhibited by these lesions. Based on the prevailing morphological components, fibrocollagenous, vascular, or histiocytic, an arbitrary division into three main categories was made. A fourth group was defined to include those cases in which a fully developed storiform pattern was the dominant morphological feature. The majority (15 cases) of the lesions were of the fibrocollagenous variety. Lesions with an angiomatous component (vascular variety) were the next most common (41 cases). Thirteen of the tumors were of the histiocytic variety. Twenty tumors were of the storiform variety and fulfilled many of the microscopic criteria of dermatofibrosareoma protuberans. This latter group often presents a diagnostic problem and may stimulate fibrosarcoma, aggressive fibromatosis or other connective tissue neoplasias. The combination of several clinical and pathological features are helpful in better separating this variety from the more benign forms. The present of different well-defined morphological components developing in the same tumors suggests a common origin. [ABSTRACT FROM AUTHOR]

A 50-year-old Hispanic man presented to the dermatology clinic with a 0.6-cm eroded, erythematous, scaly plaque on the left side of his neck. On shave biopsy, the lesion was composed of intra-epidermal and invasive dermal cells characterized by a signet-ring appearance. One area suggestive of topical squamous cell carcinoma prompted the inclusion of that entity in the differential diagnosis. Mucicarmine stains were negative, while the extra-vacuolar cytoplasm focally reacted with periodic acid-Schiff staining, the positive reaction for which was abolished by diastase, consistent with glycogen. Malignant cells expressed keratins by reacting to antibodies, Mak6, AE1/AE3, Ker 903, and CAM5.2. Additionally, weak reactivity occurred with antibodies to CEA and EMA. Tumor cells did not express S-100, HM-B45, Leu M1, or actin. By ultrastructural examination, the large vacuoles corresponded to markedly dilated endoplasmic reticulum. A diagnosis of signet-ring squamous cell carcinoma, a rare form of cutaneous squamous cell carcinoma which has been described in only one case report in the last 10 years, was made. Immunohistochemical staining provided information useful in differentiating this lesion from other clear cell and signet-ring cell tumors which involve the skin. [ABSTRACT FROM AUTHOR]

This unusual case is that of a middle-aged man exhibiting a tumor diathesis including a basal cell adenocarcinoma with features of adenoid cystic carcinoma arising in minor salivary gland of lip in association with multiple primary malignant cylindromas of skin. The labial lesion showed invasive tubules, solid epithelial sheets and cribriform structures. It did not exhibit PAS positive juxta-tubular basement membrane material. The skin lesions all showed features of a highly infiltrative cylindromatous carcinoma with two cell types, peripheral palisading and prominent PAS positive juxta-tubular basement membrane material. Immunocytochemical studies of the lip lesion and one of the skin lesions showed similarities, including positive staining for high and low molecular weight keratins and S-100 with negative staining for CEA. The previous descriptions of tumor diatheses involving dermal cylindromas and dermal analogue tumors of salivary glands and the distinctions with the present study are noted. If benign and even malignant cylindromas were described in the literature to be associated with basal cell adenocarcinoma of the major salivary glands, our case is unique by its association with this rare malignant tumor in a minor salivary gland. [ABSTRACT FROM AUTHOR]

Epidermotropic metastatic squamous cell carcinoma produced full-thickness cellular atypia of bowenoid carcinoma in situ or vulvar intraepithelial neoplasia, grade 3 (VIN 3), in a 73-year-old woman who had past history of uterine cervical carcinoma. The presence of intravascular tumor cell nests and areas showing smooth continuity of the malignant squamous cell nodules with the adjoining benign epidermis supported the possibility of the epidermotropic metastasis. To our knowledge, metastatic epidermotropic squamous carcinoma clinicopathologically simulating primary Bowen's disease has not been reported. [ABSTRACT FROM AUTHOR]

A slowly growing malignant tumor of the nail unit in a 74-year-old female is reported. At light microscopy, the tumor was composed of small keratinous cysts with abrupt central keratinization, and of solid nests and strands of atypical keratinocytes filling the dermis and penetrating the phalangeal bone. In our view, this can be regarded as the malignant analog of the keratin cysts arising from the nail bed epithelium, as first reported by Samman in 1959. Since, according to several authors, the nail bed epithelium is comparable to the outer root sheath of the follicle and since the reported tumor showed some analogies with malignant proliferative trichilemmal cyst, it is suggested that this new entity be designated as malignant proliferating onycholemmal cyst. [ABSTRACT FROM AUTHOR]

Given that nevi may grow in size, mitotic figures may be expected in melanocytic nevi. We reviewed the literature for studies addressing this issue. We sought to determine the number of mitotic figures we might discover upon review of a group of randomly collected, conventional nevi. We reviewed 157 nevi from patients and found seven nevi exhibiting mitotic figures, comprising 4% of our sample. We noted the location of the mitoses within the nevi, the presence of any congenital features, as well as other features such as signs of inflammation or irritation. Through this study we have shown that occasional mitoses occur within unremarkable, conventional nevi. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Endocrinemucin-producing sweat gland carcinoma occurring on extra-facial site: a case report" by J. H. Tsai and colleagues in the 2014 issue.

Metabolite β-Hydroxy β-Methylbutyrate Monohydrate (HMB)-45 is a murine monoclonal antibody that was developed by Allen Gown and colleagues at the University of Washington and which preferentially labels a subgroup of benign melanocytic lesions and the majority of malignant melanomas. The target antigen for this reagent is still under study, and its physiologic role has been unclear until recently. In any event, the current assessment by some researchers provides the grist for future research on the interplay between molecular modulators of cell biology, cellular growth factor receptors, and the HMB-45 antigen. It is more than possible that in the course of addressing this topic, important information will be uncovered on the clinical behavior of malignant melanomas.

Presents information on a series of events related to dermatopathology. Dermatopathology workshop in Saint Louis, Missouri; Meeting of the German Society of Dermatohistology and the Austrian Society of Dermatopathology; Dermatopathology self-assessment course; Alpine Melanoma Meeting in Davos, Switzerland.