490 results on '"Cynthia M. Magro"'
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2. Plasma cell and neutrophil enriched neovascularization with granulomatous lymphangitis in POEMS syndrome
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Oluwaseyi Adeuyan, BS, Cynthia M. Magro, MD, Megan H. Trager, MD, Emily R. Gordon, BA, Brigit A. Lapolla, BS, Celine M. Schreidah, BS, Lauren M. Fahmy, BS, and Larisa J. Geskin, MD
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cutaneous T-cell lymphoma ,kappa light chain restriction ,POEMS syndrome ,Dermatology ,RL1-803 - Published
- 2024
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3. Expanding the Differential Diagnosis of the Painful Nail: A Case of an Onychopapilloma with Neuroma
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Jade Conway, Cynthia M. Magro, and Shari R. Lipner
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onychopapilloma ,neuroma ,nail ,pain ,Dermatology ,RL1-803 - Abstract
Introduction: Onychopapilloma most commonly presents as longitudinal erythronychia, but diagnosis may be challenging in some cases due to varied clinical presentations. Most patients with onychopapillomas do not report associated pain but instead more commonly report functional interference. Case Report: We present a case of a 74-year-old female with a 5-year history of splitting and lifting of the right thumbnail, accompanied by nail sensitivity and intermittent painful throbbing. Clinical examination was significant for a less than 1 mm red line with distal onycholysis. Love’s test and a cold test performed with ice pack were negative. X-ray of the right thumb was negative for erosion or exostosis. Nail biopsy was performed, and dermatopathology was consistent with onychopapilloma with a concomitant traumatic neuroma. Conclusion: We report a case of onychopapilloma with a concomitant traumatic neuroma. Subungual neuromas are extremely rare and have not previously been associated with onychopapilloma. Our case supports the expansion of the differential diagnosis for a painful nail and demonstrates the importance of diagnostic confirmation with biopsy and histopathology.
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- 2024
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4. Horrifying Basal Cell Carcinoma Presenting as Progressive Pyoderma Gangrenosum: Case Report
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Jason S. Hoellwarth, Taylor J. Reif, Shoko Mori, Rachel Kang, and Cynthia M. Magro
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basal cell carcinoma ,pyoderma gangrenosum ,amputation ,crohn’s disease ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Introduction: Skin ulcers can be challenging to diagnose and manage, particularly with comorbid autoimmune and gastrointestinal diseases. Occam’s razor encourages the simplest explanation to guide care, but reconsideration must occur when intervention proves futile. Case Presentation: We report the case of a 70-year-old male, with a 17-year history of expanding pretibial skin ulcer, presumed by prior care providers to be pyoderma gangrenosum related to Crohn’s disease. A surgical biopsy performed upon presentation to our institution revealed basal cell carcinoma of the skin, invasive to the proximal tibia with associated deep infection, prompting transfemoral amputation. Conclusion: This report is written as a reminder to reconsider a diagnosis and consider seeking additional expertise when a patient’s condition progressively worsens despite intervention. Earlier diagnosis likely would have facilitated therapeutic limb salvage care.
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- 2024
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5. Exploring cutaneous lymphoproliferative disorders in the wake of COVID‐19 vaccination
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Emily R. Gordon, Oluwaseyi Adeuyan, Bradley D. Kwinta, Celine M. Schreidah, Lauren M. Fahmy, Dawn Queen, Megan H. Trager, Cynthia M. Magro, and Larisa J. Geskin
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Dermatology ,RL1-803 - Abstract
Abstract Background Individual reports have described lymphoproliferative disorders (LPDs) and cutaneous lymphomas emerging after administration of the COVID‐19 vaccine; however, the relationship between reactions and vaccine types has not yet been examined. Objective Determine if there are cases of cutaneous LPDs associated with certain COVID‐19 vaccines and their outcomes. Methods We analysed PubMed, the Vaccine Adverse Events Reporting System (VAERS), and our database for instances of biopsy‐proven LPDs following COVID‐19 vaccines. Results Fifty cases of biopsy‐proven LPDs arising after COVID‐19 vaccination were found: 37 from medical literature, 11 from VAERS and two from our institution. Geographical distribution revealed the most cases in the United States, Italy, and Greece, with single cases in Spain, Colombia, Canada, Japan, and Romania. The average age of patients was 53; with a slight male predominance (male‐to‐female ratio of 1.5:1). The Pfizer‐BioNTech vaccine was associated with LPDs in 36/50 (72%) cases, aligning with its 70% share of the global vaccine market. Histopathology revealed CD30+ in 80% of cases. The most prevalent form of LPD was lymphomatoid papulosis (LyP, 30%). All reported cases produced favourable outcomes (either complete or near‐complete remission). Therapeutic approaches ranged from observation to treatment with steroids, methotrexate, or excision. Conclusion LPDs after COVID‐19 vaccination appear in the context of the same vaccines (proportionally to their global market shares), share clinical and pathological findings, and have indolent, self‐limited character.
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- 2024
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6. Mycosis fungoides diagnosed after exposure to risankizumab for psoriasis
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Lauren M. Fahmy, BS, Celine M. Schreidah, BS, Brigit A. Lapolla, BS, Cynthia M. Magro, MD, and Larisa J. Geskin, MD
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biologic ,cytokine blocker ,interleukin-23 ,mycosis fungoides ,psoriasis ,risankizumab ,Dermatology ,RL1-803 - Published
- 2023
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7. Bullous Lichen Planus of the Nails: A Case Report and Review of the Literature
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Jonathan K. Hwang, Cynthia M. Magro, and Shari R. Lipner
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nail ,nail disease ,nail disorder ,nail inflammatory disease ,nail pathology ,Dermatology ,RL1-803 - Abstract
Lichen planus is a chronic inflammatory disorder that may affect the skin, nails, and/or oral mucosa. Bullous lichen planus is a rare variant of lichen planus, which is even less common in the nails. We present a case of nail bullous lichen planus, in a 48-year-old male presenting with a 10-month history of onychodystrophy of all ten fingernails. A longitudinal excision of the left thumbnail was performed, with histopathology consistent with lichen planus with focal transition to bullous lichen planus. He was treated with intralesional triamcinolone injections to the fingernails monthly, with improvements noted after three treatments. Our patient’s nail bullous lichen planus manifested with longitudinal ridging, white-yellow discoloration, onycholysis, subungual hyperkeratosis, and v-shaped nicking. Histopathological findings included classical lichen planus changes, as well as formation of subepidermal bullae, colloid bodies, and extensive inflammatory infiltrate. Increased awareness and high index of suspicion for this condition are necessary, given the often late diagnosis reported in previously published cases.
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- 2023
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8. VEXAS syndrome presenting as refractory cutaneous Kikuchi disease-like inflammatory pattern responding to tofacitinib
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Lauren M. Fahmy, BS, Celine M. Schreidah, BS, Brigit A. Lapolla, BS, Cynthia M. Magro, MD, and Larisa J. Geskin, MD
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cutaneous Kikuchi disease ,janus kinase inhibitor ,Kikuchi disease ,Kikuchi disease-like inflammatory pattern ,MxA staining ,tofacitinib ,Dermatology ,RL1-803 - Published
- 2023
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9. Acral Fibrochondromyxoid Tumor Presenting as Enlarging Nodule Involving the Distal Fingertip and Hyponychium: A Case Report
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Rhiannon C. Miller, Cynthia M. Magro, Laura E Melnick, and Shari R. Lipner
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fingernail ,hyponychium ,acral fibrochondromyxoid tumor ,nail tumor ,acral skin ,glomus tumor ,immunohistochemistry ,chondroma ,myxoid ,verruca vulgaris ,Dermatology ,RL1-803 - Abstract
An acral fibrochondromyxoid tumor is a newly described type of benign soft tissue neoplasm that presents as a single nodular lesion on a finger or toe. There has only been one previous report on this tumor, a case series that described the initial pathologic and clinical findings; however, details on clinical history, physical examination, and outcome are unknown. In this report, we describe a case of a 39-year-old male who presented with a painful enlarging mass involving the distal right 3rd finger and hyponychium. Punch biopsy was performed and the lesion was identified as an acral fibrochondromyxoid tumor on microscopic examination. X-ray showed no bony involvement. The tumor was successfully excised with complete resolution of pain symptoms. We discuss the clinical features and immunohistochemistry findings of our case in the context of the current limited knowledge about this very rare tumor.
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- 2023
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10. Gastrointestinal Kohlmeier–Degos disease: a narrative review
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Samantha S. Sattler, Cynthia M. Magro, Lee Shapiro, Jamie F. Merves, Rebecca Levy, Jesse Veenstra, and Puraj Patel
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Kohlmeier–Degos disease ,Degos disease ,Gastrointestinal ,Perforation ,Laparoscopy ,C5b-9 ,Medicine - Abstract
Abstract Introduction Kohlmeier-Degos (K-D) disease is a rare obliterative vasculopathy that can present as a benign cutaneous form or with potentially malignant systemic involvement. The gastrointestinal tract is most frequently involved in systemic disease and mortality is often related to bowel perforations. Herein, we provide information to providers and patients regarding gastrointestinal K-D symptomology, pathology, treatment, and diagnosis, with a focus on the importance of timely diagnostic laparoscopy. We present three new cases of gastrointestinal K-D to highlight varying disease presentations and outcomes. Body Based on reviewed reports, perforation is preceded by at least one gastrointestinal symptom: abdominal pain/cramping, anorexia/weight loss, vomiting, diarrhea, nausea, gastrointestinal bleeding, obstipation, constipation, and abdominal fullness. Perforation most commonly occurs in the small intestine and often results in sepsis and death. Although underutilized, laparoscopy is the most sensitive and specific diagnostic technique, demonstrating serosal porcelain plaques similar to those on the skin and characteristic for K–D. The combination of eculizumab and treprostinil is presently the most effective treatment option for gastrointestinal K–D. The pathology of gastrointestinal K-D is characterized by an obliterative intimal arteriopathy eventuating in occlusive acellular deposits of mucin and collagen along with an extravascular pauci-cellular sclerosing process resembling scleroderma confined to the subserosal fat. C5b-9 and interferon-alpha are both expressed in all caliber of vessels in the affected intestine. While C5b-9 blockade does not prevent the intimal expansion, enhanced type I interferon signaling is likely a key determinant to intimal expansion by, causing an influx of monocytes which transdifferentiate into procollagen-producing myofibroblast-like cells. Conclusion Prompt laparoscopic evaluation is necessary in any K–D patient with an abdominal symptom to facilitate diagnosis and treatment initiation, as well as to hopefully decrease mortality. Those with gastrointestinal K–D should start on eculizumab as soon as possible, as onset of action is immediate.
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- 2022
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11. Isolation of Terbinafine-Resistant Trichophyton rubrum from Onychomycosis Patients Who Failed Treatment at an Academic Center in New York, United States
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Jonathan K. Hwang, Wayne L. Bakotic, Jeremy A. W. Gold, Cynthia M. Magro, and Shari R. Lipner
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nails ,nail diseases ,antifungal resistance ,antimicrobials ,antimicrobial resistance ,Biology (General) ,QH301-705.5 - Abstract
Onychomycosis is a common nail infection. Terbinafine-resistant dermatophyte infections pose an emerging global public health concern, but few cases have been described in the United States. We retrospectively reviewed and characterized clinical, histopathological, and mycological features of patients with mycologically confirmed onychomycosis who failed oral terbinafine treatment for onychomycosis at a U.S. academic nail referral center and ascertained for terbinafine-resistant isolates. During 1 June 2022–31 January 2023 at Weill Cornell Medicine in New York City, USA, 96 patients with mycologically confirmed onychomycosis were treated with oral terbinafine. Among 64 patients with adequate follow-up, 36 had clinical or complete cure. Of 28 patients who failed treatment, 17 underwent terbinafine resistance testing. Trichophyton rubrum with terbinafine resistance-conferring mutations was isolated from two patients. Overall, terbinafine failures for onychomycosis were relatively common, with some cases associated with terbinafine-resistant T. rubrum infections. These findings underscore the need for a clinical awareness of this emerging problem and public health efforts to monitor and prevent spread. We highlight the importance of diagnostic testing and species identification for onychomycosis patients and the increasingly important role of fungal identification and susceptibility testing to guide therapy.
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- 2023
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12. Intralesional overlap syndrome: Sclerodermic lupus panniculitis and sclerodermic discoid lupus erythematosus
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Ziv Schwartz, MHA and Cynthia M. Magro, MD
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discoid lupus erythematosus ,localized scleroderma ,morphea ,overlap syndrome ,sclerodermiform linear lupus erythematosus ,sclerodermic lupus erythematosus profundus ,Dermatology ,RL1-803 - Published
- 2020
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13. Linear scleroderma 'en coup de sabre' with extensive brain involvement—Clinicopathologic correlations and response to anti-Interleukin-6 therapy
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Cynthia M. Magro, Pierre Halteh, Luke C. Olson, Ilya Kister, and Lee Shapiro
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Linear scleroderma ,“en coupe de sabre,” vasculitis ,Autoimmune endotheliopathy ,Medicine - Abstract
Abstract Linear scleroderma “en coup de sabre” (LSES) variant is a cephalic subtype of localized scleroderma that can be associated with extracutaneous stigmata, such as epilepsy, dementia syndromes, as well as focal central nervous system neurologic deficits. While the pathophysiology of cutaneous linear scleroderma includes endothelial cell injury and up regulation of pro-fibrogenic pathways, the basis of LSES-associated neurologic complications is largely unknown. We report a patient with a history of LSES who developed intractable epilepsy and cognitive decline. Magnetic resonance imaging (MRI) of the brain exhibited numerous persistently enhancing brain lesions. Due to progressive neurologic deterioration over a period of 7 years, despite interventional therapy, a brain biopsy was performed. Neuropathologic analysis exhibited acute and chronic cortical ischemia associated with a small vessel lymphocytic vasculitis. Direct immunofluorescent studies showed C5b-9 and IgG deposition on endothelium while indirect immunofluorescent studies demonstrated reactivity of the patient’s serum with the microvasculature of the patient’s own brain tissue and generic human umbilical vein endothelial cells indicative of anti-endothelial cell antibodies. Therapy focusing on damaged endothelium was implemented. The interleukin-6 (IL-6) receptor inhibitor tocilizumab was used and the patient improved dramatically, likely reflecting the drug’s effect on the replenishment of endothelial progenitor cells.
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- 2019
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14. Treatment of Kimura disease with mycophenolate mofetil monotherapy
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Kalee Shah, MD, Anh N. Tran, MD, Cynthia M. Magro, MD, and Julie B. Zang, MD, PhD
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angiolymphoid hyperplasia with eosinophilia ,IgG4-related skin ,disease ,Kimura disease ,leflunomide ,lymphoproliferative condition ,mycophenolate mofetil ,peripheral eosinophilia ,Dermatology ,RL1-803 - Published
- 2017
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15. Epidermotropic marginal zone lymphoma: An uncommon cutaneous B-cell lymphoma responsive to rituximab
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Cynthia M. Magro, MD, Tracy L. Davis, MD, PhD, and Drew J.B. Kurtzman, MD
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Dermatology ,RL1-803 - Published
- 2017
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16. Giant variant of acquired perforating dermatosis in a renal dialysis patient
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Lauren Metterle, BS, Cynthia M. Magro, MD, and Julie B. Zang, MD, PhD
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acquired perforating dermatosis ,elastosis perforans serpiginosa ,end-stage renal disease ,generalized eruption ,giant variant ,perforating dermatosis ,Dermatology ,RL1-803 - Published
- 2017
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17. Nail Unit Squamous Cell Carcinoma with Onycholemmal Features: Case Report and Review of the Literature
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Kelita Waterton, Cynthia M. Magro, and Shari R. Lipner
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Dermatology - Abstract
Introduction: Onycholemmal carcinoma (OC) is a rare subtype of squamous cell carcinoma (SCC) that originates from the epithelium of the nail bed. It is characterized by distinct histopathologic features including small clusters of atypical squamous epithelium devoid of a granular layer, with abrupt onycholemmal keratinization. Case Presentation: We present a case of a 75-year-old male with right thumbnail onycholysis, yellow-green nail plate discoloration, as well as bleeding and purulence of the lateral nail fold. Histopathologic evaluation revealed high-grade squamous dysplasia, small clusters of severely atypical epithelial cells, and a pattern of abrupt keratinization consistent with the diagnosis of SCC carcinoma with onycholemmal features. GMS and PAS staining indicated concomitant onychomycosis. Pathologic analysis also disclosed residual SCC and concomitant amyloidosis, possibly light chain related and hence reflective of his underlying multi-organ lymphoplasmacytic lymphoma. The patient subsequently underwent Mohs micrographic surgery. Conclusion: Clinical presentation of nail unit SCC with onycholemmal features is highly variable, making differentiating between similarly presenting benign and malignant nail disorders particularly challenging. This case report demonstrates clinical and histopathological features of nail unit SCC with onycholemmal features to improve diagnosis and management.
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- 2023
18. Localized lymphomatoid papulosis: Unilesional lymphomatoid papulosis, regional lymphomatoid papulosis, and persistent agmination of lymphomatoid papulosis
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Cynthia M, Magro, Joshua H, Mo, and Gladys, Telang
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Dermatology - Abstract
Lymphomatoid papulosis (LYP), the most common primary cutaneous CD30-positive lymphoproliferative disorder, is heralded by multiple papular and nodular lesions at anatomically discontiguous cutaneous sites. The histologic patterns are protean. An uncommon form of LYP is one that is anatomically confined. Cases of unilesional LYP, regional LYP, and persistent agmination of LYP were encountered in the routine and consultative practices of Weill Cornell Medicine, Division of Dermatopathology. The clinical presentation, outcomes, light microscopic findings, and phenotypic profile are reviewed. There were 10 cases of LYP presenting as solitary plaques or nodules primarily occurring in older patients and without a relevant medical history in most. Most cases occurred at an acral site with many localized to the foot; the morphology was one of a necrotizing angiocentric type E pattern and borderline type C morphology. Two of the unilesional patients in our series went on to develop mycosis fungoides, one at the initial site of unilesional type A LYP, and the other at a discontiguous site. Excluding one case, the solitary lesions underwent complete regression; after the lesions regressed, some cases had no apparent recurrence. The second anatomically confined variant of LYP in our series was regional LYP exhibiting a type E morphology in two cases and a hybrid type A and granulomatous eccrinotropic morphology in one case. There was no subsequent development of lymphoma, nor was there any spread to additional anatomic sites. The final category was persistent agmination of LYP, whereby the agminated papules of LYP were superimposed on a plaque of cutaneous T-cell lymphoma represented by mycosis fungoides in two and follicular helper T-cell lymphoma in one. In conclusion, anatomically confined LYP defines an uncommon form of LYP, but it is an important one to recognize because the histology can be worrisome despite an indolent clinical course. The clinical presentation, the infrequent association with lymphoma/leukemia, and histology are similar to conventional LYP, although there appears to be a greater tendency for complete regression without recurrence, excluding cases of persistent agmination of LYP whereby the clinical course warrants categorization as a form of cutaneous T cell lymphoma cutaneous T cell lymphoma (CTCL).
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- 2022
19. Linear <scp>IgA</scp> bullous dermatosis in the setting of angioimmunoblastic T‐cell lymphoma
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Tyler M. Andriano, Rachel Tannenbaum, Haoming Xu, and Cynthia M. Magro
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Histology ,Dermatology ,Pathology and Forensic Medicine - Published
- 2022
20. Cutaneous collagenous vasculopathy: A report of three cases
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Marc E. Grossman, Marc Cohen, Margaret Ravits, Ralph Blume, and Cynthia M. Magro
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Histology ,Dermatology ,Pathology and Forensic Medicine - Published
- 2022
21. A Standardization Protocol for the In Situ Detection of SARS-CoV2 RNA and Proteins
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Gerard J. Nuovo, David Suster, Cynthia M. Magro, Esmerina Tili, and Hamdy Awad
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Adult ,Aged, 80 and over ,Male ,In situ ,Protocol (science) ,Histology ,Standardization ,SARS-CoV-2 ,Chemistry ,COVID-19 ,RNA ,Computational biology ,Middle Aged ,Reference Standards ,Immunohistochemistry ,Pathology and Forensic Medicine ,Medical Laboratory Technology ,Humans ,Female ,Aged - Abstract
This manuscript details a stringent protocol for the in situ detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) RNA and 4 different viral proteins: envelope, spike, membrane, and nucleocapsid. Key aspects of the protocol are: (1) analysis of adjacent (serial) sections for viral RNA and at least 2 viral proteins; (2) cytologic alterations in the cells scored as virus positive based on an hematoxylin and eosin stain; (3) in situ demonstration of a host response in the cells scored as virus positive; (4) co-labeling experiments that show that the viral RNA and/or proteins co-localize with each other and the angiotensin converting enzyme 2 (ACE2) receptor; and (5) lack of signal in equivalent tissues obtained before the pandemic. Optimization conditions for the four viral proteins as well as the ACE2 receptor were each antigen retrieval in an EDTA solution which facilitates co-expression analyses. It is recommended not to use either electron microscopy or qRTPCR as methods to corroborate in situ SARS-CoV2 detection. This stringent protocol, that relies on sequentially labeled serial sections and can be completed in one working day, demonstrated the following: (1) infectious SARS-CoV2 is abundant in the lung in fatal coronavirus disease-2019 and is seen primarily in macrophages and endothelial cells; (2) circulating viral capsid proteins (spike, envelope, membrane without RNA) are evident in multiple organs including the skin and brain where it is endocytosed by ACE2+ cells and induce an endothelialitis; (3) both the infectious virus and circulating spike protein induce complement activation and cytologic changes in the viral positive cells.
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- 2021
22. The histologic and molecular correlates of COVID-19 vaccine-induced changes in the skin
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Patrick Whelan, Gerard J. Nuovo, A. Neil Crowson, Panta Rouhani Schaffer, Linda Franks, and Cynthia M. Magro
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medicine.medical_specialty ,COVID-19 Vaccines ,Urticaria ,SARS-CoV-2 ,business.industry ,medicine.medical_treatment ,Eczema ,COVID-19 ,Dermatology ,Atopic dermatitis ,medicine.disease ,Article ,Immune complex ,Psoriasis ,Pityriasis rosea ,medicine ,Humans ,Pityriasis rubra pilaris ,Urticarial vasculitis ,business ,Adjuvant ,Guttate psoriasis - Abstract
A total of 22 patients who had developed an adverse cutaneous reaction to the Moderna or Pfizer vaccine underwent biopsies. Each patient was assessed light microscopically, and, in select biopsies, spike glycoprotein and cytokine assessment were also conducted. The patients developed self-limited cutaneous reactions often described clinically as urticarial or eczematous within 1 day to 4 weeks after receiving the first or second dose of the Pfizer or Moderna vaccine. Classic clinical and morphologic depictions of type IV cutaneous hypersensitivity with features of eczematous dermatitis, interface dermatitis, granulomatous inflammation, and/or lymphocytic vasculitic component were observed. Clinical and/or histologic features of perniosis, pityriasis rosea, pityriasis rubra pilaris, and guttate psoriasis were seen in select cases. In 2 cases the dominant picture was urticarial vasculitis, possibly reflective of an Arthus type III immune complex action. The biopsy specimens of normal skin post vaccine and of skin affected by the post-vaccine eruption showed rare deep microvessels positive for spike glycoprotein with no complement deposition contrasting with greater vascular deposition of spike protein and complement in skin biopsies from patients experiencing severe coronavirus disease 2019 (COVID-19). It is concluded that self-limited hypersensitivity reactions to the vaccine occur possibly owing to a substance found in the vaccine vehicle (eg, polyethylene glycol). An immune response that is directed against human-manufactured spike has to be considered because some of the reactions clinically and or histologically closely resemble mild COVID-19. Finally, vaccine-associated immune enhancement largely attributable to the adjuvant properties of the vaccine may unmask certain inflammatory milieus operational in psoriasis, atopic dermatitis, and subclinical hypersensitivity.
- Published
- 2021
23. Dermatoscopy of Onychomatricoma: Tortuous Hairpin Vessels
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Solomon, Geizhals, Cynthia M, Magro, and Shari R, Lipner
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- 2022
24. Acquired epidermodysplasia verruciformis (AEV) in three children after cardiac transplantation: A case series and review of the literature
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Laura E. Levin, Alexandra J Coromilas, Neha Kinariwalla, Maria C. Garzon, Cynthia M. Magro, and Christine T. Lauren
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medicine.medical_specialty ,animal structures ,business.industry ,Human immunodeficiency virus (HIV) ,Treatment options ,Dermatology ,Epidermodysplasia verruciformis ,medicine.disease_cause ,medicine.disease ,Transplantation ,embryonic structures ,Pediatrics, Perinatology and Child Health ,medicine ,business ,Pediatric population - Abstract
Acquired epidermodysplasia verruciformis (AEV) describes epidermodysplasia verruciformis developing in an immunocompromised host. There is limited information in the literature regarding AEV in the pediatric population; of the patients reported, most patients described had HIV, with only two reported cases of children who developed AEV post-transplantation. This case series describes three pediatric patients who developed AEV on immunosuppressant therapy following cardiac transplantation. We review risk factors, treatment options, and prognosis of AEV in the pediatric population.
- Published
- 2021
25. Use of eculizumab in autologous hematopoietic stem cell transplantation-associated thrombotic microangiopathy in two adults
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Aquino Williams, Koen van Besien, David H. Vesole, Mohammad Alhomoud, Cynthia M. Magro, and Jeffrey Laurence
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Hemolytic anemia ,Cancer Research ,Thrombotic microangiopathy ,business.industry ,medicine.medical_treatment ,Hematology ,Hematopoietic stem cell transplantation ,Eculizumab ,medicine.disease ,Oncology ,hemic and lymphatic diseases ,Immunology ,medicine ,Thrombotic Microangiopathies ,business ,medicine.drug - Abstract
Transplant-associated thrombotic microangiopathies (TA-TMAs) are inflammatory and thrombotic disorders of the microvasculature characterized by hemolytic anemia, thrombocytopenia, and organ dysfunc...
- Published
- 2021
26. CD8+ Lymphogranulomatous Dermatitis as a Manifestation of Malignancy-Associated Immunodeficiency: Rethinking Paraneoplastic Granulomas
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Larisa J. Geskin, Cynthia M. Magro, Connor J. Stonesifer, and Megan H. Trager
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Male ,Pathology ,medicine.medical_specialty ,Paraneoplastic Syndromes ,Chronic lymphocytic leukemia ,Dermatitis ,Dermatology ,CD8-Positive T-Lymphocytes ,Malignancy ,Pathology and Forensic Medicine ,Hypogammaglobulinemia ,Immunocompromised Host ,hemic and lymphatic diseases ,Humans ,Medicine ,Immunodeficiency ,Aged ,Granuloma ,business.industry ,Common variable immunodeficiency ,General Medicine ,medicine.disease ,Leukemia, Lymphocytic, Chronic, B-Cell ,Lymphoma ,Sarcoidosis ,business ,Granulomatous Dermatitis - Abstract
Paraneoplastic granulomatous disease occurs in approximately 7.3% of patients with non-Hodgkin lymphoma, most commonly among patients with chronic lymphocytic leukemia (CLL). These lesions are often reported to appear similar to sarcoidosis in clinical presentation and under light microscopy. However, comprehensive descriptions of the cytomorphologic characteristics of these paraneoplastic granulomas are lacking, and the mechanisms involved in their formation remain ill-defined. Noninfectious dermal granulomatous reactions have also been reported in many primary immunodeficiencies, including common variable immune deficiency and ataxia-telangiectasia. We present a case of noninfectious CD8+ predominant granulomatous dermatitis with ocular involvement occurring in the setting of CLL and marked hypogammaglobulinemia. Based on the analysis of shared factors in patients with primary immunodeficiencies and CLL, we conclude that the presence of pan-humoral immunodeficiency could itself be a risk factor for developing a CD8+ lymphogranulomatous reaction. This report and associated discussion evince that CD8+ predominant granulomatous reactions, distinct from sarcoidosis, may represent a previously unappreciated segment of the paraneoplastic granulomas observed in hematologic malignancies.
- Published
- 2021
27. The Cutaneous Lymphoid Proliferations: A Comprehensive Textbook of Lymphocytic Infiltrates of the Skin
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Cynthia M. Magro, A. Neil Crowson, Martin C. Mihm and Cynthia M. Magro, A. Neil Crowson, Martin C. Mihm
- Published
- 2015
28. Leukocytoclastic vasculitis in association with linear epidermal basement membrane zone immunoglobulin deposition: Linear vasculitis
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Cynthia M. Magro, Joshua H. Mo, and Mary Jo Kerns
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Dermatology - Abstract
Cutaneous leukocytoclastic vasculitis (LCV) has a distinctive clinical and light microscopic presentation; however, the etiologic basis of LCV is varied. Most cases are attributable to immune complex deposition within a vessel wall and represent an Arthus type III immune complex reaction. The prototypic immunoreactant profile is characterized by granular deposits of components of complement activation in concert with immunoglobulin within the cutaneous vasculature. We encountered nine patients with vasculitic and/or vesiculobullous clinical presentations exhibiting an LCV in association with an immunoreactant profile characterized by homogeneous linear deposits of immunoglobulin along the dermal epidermal junction in a fashion resembling an autoimmune vesiculobullous disease. Among the clinical presentations were palpable purpura, urticarial vasculitis, and vesiculobullous eruptions with supervening purpura. Two patients with Crohn disease presented with classic palpable purpura with biopsy-proven LCV, and direct immunofluorescence (DIF) studies demonstrated linear immunoglobulin G (IgG) with floor localization on the salt-split skin assay. Four patients with systemic lupus erythematosus (SLE) showed purpuric vesiculobullous lesions, with evidence of a neutrophilic interface dermatitis and LCV in three of the four. The remaining patient had urticarial nonbullous lesions showing small-vessel vasculitiswith a neutrophilic interface dermatitis. In all of the patients with SLE, DIF studies showed linear immunoglobulin deposits within the basement membrane zone (BMZ). These constellation of findings clinically, light microscopically, and by immunofluorescence were those of a vasculitic presentation of bullous systemic lupus erythematosus. Two patients had linear IgA disease, which was drug induced in one and paraneoplastic in the other, and the dominant morphology on biopsy in both cases was an LCV. One patient microscopically demonstrated drug-associated and eosinophilic enriched LCV with DIF studies showing striking linear deposits of IgG suggestive of bullous pemphigoid, which was consistent with a vasculitic presentation of drug-induced bullous pemphigoid. In all cases, typical granular vascular immunoglobulin and complement deposition compatible with immune complex mediated vasculitis was observed. It is likely that local immune complexes derived from BMZ antigen bound to antibody are pathogenically relevant. We propose the designation of linear vasculitis for this unique scenario of LCV and linear immunoglobulin epidermal BMZ staining, which in some cases represents a vasculitic presentation of conventional autoimmune vesiculobullous disease.
- Published
- 2022
29. Primary cutaneous blastic marginal zone lymphoma: A comprehensive clinical, light microscopic, phenotypic and cytogenetic appraisal
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Cynthia M. Magro, Taylor Kalomeris, and Alice Roberts
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General Medicine ,Pathology and Forensic Medicine - Published
- 2023
30. The Melanocytic Proliferations: A Comprehensive Textbook of Pigmented Lesions
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A. Neil Crowson, Cynthia M. Magro, Martin C. Mihm and A. Neil Crowson, Cynthia M. Magro, Martin C. Mihm
- Published
- 2014
31. Docked severe acute respiratory syndrome coronavirus 2 proteins within the cutaneous and subcutaneous microvasculature and their role in the pathogenesis of severe coronavirus disease 2019
- Author
-
A. Neil Crowson, J. Justin Mulvey, Steven P. Salvatore, Cynthia M. Magro, Jeffrey Laurence, Andrew J. Dannenberg, Gerard J. Nuovo, Surya V. Seshan, and Joanna Harp
- Subjects
Adult ,Male ,0301 basic medicine ,skin ,Pathology ,medicine.medical_specialty ,Viral protein ,viruses ,ACE2 ,Peptidyl-Dipeptidase A ,medicine.disease_cause ,Pathology and Forensic Medicine ,Pathogenesis ,03 medical and health sciences ,0302 clinical medicine ,Atypical hemolytic uremic syndrome ,medicine ,Humans ,complement ,Receptor ,Complement Activation ,Aged ,deltoid biopsy ,medicine.diagnostic_test ,SARS-CoV-2 ,business.industry ,COVID-19 ,Endothelial Cells ,Original Contribution ,Middle Aged ,medicine.disease ,Complement system ,Endothelial stem cell ,030104 developmental biology ,Viral Receptor ,030220 oncology & carcinogenesis ,Microvessels ,Skin biopsy ,RNA, Viral ,Female ,Angiotensin-Converting Enzyme 2 ,business - Abstract
The purpose of this study was to examine the deltoid skin biopsy in twenty-three patients with coronavirus disease 2019 (COVID-19), most severely ill, for vascular complement deposition and correlate this with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral RNA and protein localization and ACE2 expression. Deltoid skin microvascular complement screening has been applied to patients with various systemic complement-mediated microvascular syndromes, best exemplified by atypical hemolytic uremic syndrome. In 21 of 23 cases, substantial microvascular deposition of complement components was identified. The two patients without significant complement deposition included one patient with moderate disease and a severely ill patient who although on a ventilator for a day was discharged after 3 days. The dominant microvascular complement immunoreactant identified was the terminal membranolytic attack complex C5b-9. Microvascular complement deposition strongly colocalized in situ with the SARS-CoV-2 viral proteins including spike glycoproteins in the endothelial cells as well as the viral receptor ACE2 in lesional and nonlesional skin; viral RNA was not evident. Microvascular SARS-CoV-2 viral protein, complement, and ACE2 expression was most conspicuous in the subcutaneous fat. Although the samples from severely ill patients with COVID-19 were from grossly normal skin, light microscopically focal microvascular abnormalities were evident that included endothelial cell denudement, basement membrane zone reduplication, and small thrombi. It is concluded that complement activation is common in grossly normal skin, especially in the subcutaneous fat which may provide a link between severe disease and obesity, in people with severe COVID-19, and the strong colocalization with the ACE2 receptor and viral capsid proteins without viral RNA suggests that circulating viral proteins (ie, pseudovirions) may dock onto the endothelial of these microvessels and induce complement activation.
- Published
- 2020
32. Concomitant calciphylaxis and COVID-19 associated thrombotic retiform purpura
- Author
-
Kathryn E. Dean, Gerard J. Nuovo, Jessica A. Rotman, Cynthia M. Magro, and Roger J. Bartolotta
- Subjects
medicine.medical_specialty ,Panniculitis ,Coronavirus disease 2019 (COVID-19) ,Computed Tomography Angiography ,Pneumonia, Viral ,Case Report ,Polymerase Chain Reaction ,030218 nuclear medicine & medical imaging ,Angiopathy ,Diagnosis, Differential ,03 medical and health sciences ,Betacoronavirus ,0302 clinical medicine ,Fatal Outcome ,Ultrasound ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Pandemics ,Purpura ,Ultrasonography ,030203 arthritis & rheumatology ,Calciphylaxis ,business.industry ,SARS-CoV-2 ,COVID-19 ,Middle Aged ,medicine.disease ,Dermatology ,Lower Extremity ,Radiology Nuclear Medicine and imaging ,Concomitant ,Etiology ,Female ,Differential diagnosis ,medicine.symptom ,business ,Coronavirus Infections ,CT - Abstract
While initial reports regarding coronavirus disease 2019 (COVID-19) focused on its pulmonary manifestations, more recent literature describes multisystem abnormalities related to its associated microvascular angiopathy. Calciphylaxis is a rare systemic condition characterized by tissue necrosis in the setting of systemic microvascular calcifications. Both COVID-19 and calciphylaxis are procoagulant diagnoses associated with vascular-mediated cutaneous findings. To our knowledge, this is the first report to document the coexistence of COVID-19 associated retiform thrombotic purpura and calciphylaxis in a single patient, to link the pathologic etiologies of the two entities, and to describe the concomitant diagnoses' associated radiologic findings.
- Published
- 2020
33. Collisional variant of CD8+ mycosis fungoides and indolent CD8+ lymphoid proliferation
- Author
-
Cynthia M. Magro, Larisa J. Geskin, Megan H. Trager, and Adriana T. Lopez
- Subjects
Pathology ,medicine.medical_specialty ,Clone (cell biology) ,Case Report ,Dermatology ,Lesion ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,CD8+ cutaneous T-cell lymphoma ,Biopsy ,medicine ,lcsh:Dermatology ,fungoides ,cutaneous T-cell lymphoma ,Mycosis ,Mycosis fungoides ,medicine.diagnostic_test ,business.industry ,Cutaneous T-cell lymphoma ,mycosis ,lcsh:RL1-803 ,medicine.disease ,030220 oncology & carcinogenesis ,Immunohistochemistry ,MF, mycosis fungoides ,medicine.symptom ,business ,CD8 - Abstract
CD8+ lymphoid infiltrates of the skin are classified into different subtypes with variable prognoses and treatment options. Here, we present a patient with CD8+ mycosis fungoides who developed CD8+ indolent lymphoid proliferation in a background of conventional plaque stage CD8+ mycosis fungoides. The patient is a 42-year-old man who had long standing hypopigmented patches on the buttocks, back, and lower extremities that were compatible with CD8+ mycosis fungoides. He then developed a solitary indurated raised lesion on the thigh that was clinically disparate to those elsewhere on the skin. The biopsy showed a collision of CD8+ patch stage mycosis fungoides and indolent CD8+ lymphoid proliferation. Clonality studies on each atypical CD8+ component were not performed to prove or disprove a common T-cell clone. A common clone would indicate plasticity of a neoplastic CD8+ T-cell clone to eventuate into these two divergent patterns, a phenomenon that has been observed in other hematologic malignancies. We highlight the unique aspects of this case by analyzing histopathologic features in conjunction with comprehensive immunohistochemical staining.
- Published
- 2020
34. Juvenile dermatomyositis resembling late-stage Degos disease with gastrointestinal perforations successfully treated with combination of cyclophosphamide and rituximab: case-based review
- Author
-
William Day, Laura Gifford, Christos A Gabriel, Sameer P. Lapsia, Cynthia M. Magro, Robert E. Kelly, Judith V. Williams, Alice L. Werner, and Cassyanne L. Aguiar
- Subjects
030203 arthritis & rheumatology ,medicine.medical_specialty ,Cyclophosphamide ,business.industry ,Immunology ,Perforation (oil well) ,Degos disease ,Dermatomyositis ,medicine.disease ,Dermatology ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Gastrointestinal perforation ,Immunology and Allergy ,Medicine ,Rituximab ,030212 general & internal medicine ,medicine.symptom ,business ,Pneumatosis intestinalis ,Juvenile dermatomyositis ,medicine.drug - Abstract
Dermatomyositis (DM) is a multi-system disease that results in chronic inflammation principally of the skin and striated muscle. Small blood vessel injury in the GI tract has been described in dermatomyositis, manifesting as bleeding, ulceration, pneumatosis intestinalis, and ultimately perforation. Recent histopathological studies have shown deposits in the capillaries of the skin, gastrointestinal tract, and brain of patients with dermatomyositis similar to that found in patients with Degos disease, suggesting these disease processes are closely related or represent varying degrees of severity on the same pathologic spectrum. We report a case of juvenile dermatomyositis (JDM) resembling late-stage Degos disease with gastrointestinal perforations successfully treated with combination rituximab and cyclophosphamide therapy. We systematically reviewed the literature detailing the medical and surgical treatments for gastrointestinal perforation in dermatomyositis, Degos-like dermatomyositis, and Degos disease. In addition to our case, as of October 2019, we identified 36 cases describing gastrointestinal perforation in patients with underlying dermatomyositis, 5 cases of Degos-like dermatomyositis and 17 cases of idiopathic Degos disease. Corticosteroid therapy was used widely for dermatomyositis and Degos-like dermatomyositis, while antiplatelet and anticoagulant medications were chiefly used for patients with idiopathic Degos disease. However, there were no cases that detailed the successful treatment of dermatomyositis or Degos disease with gastrointestinal perforation with rituximab alone or combined with cyclophosphamide. We report that rituximab, in combination with cyclophosphamide, can be used as a novel adjunctive therapy to successfully treat dermatomyositis with Degos-like gastrointestinal perforation.
- Published
- 2020
35. Amyloid-Associated Alopecia: A Reappraisal Including Its Pathophysiology
- Author
-
Mary Jo J Kendrick, Garron J. Solomon, Cynthia M. Magro, and Shabnam Momtahen
- Subjects
Pathology ,medicine.medical_specialty ,Amyloid ,Plasma cell dyscrasia ,Dermatology ,Pathology and Forensic Medicine ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Hair cycle ,medicine ,Humans ,skin and connective tissue diseases ,Multiple myeloma ,integumentary system ,business.industry ,Amyloidosis ,Alopecia ,General Medicine ,Middle Aged ,Alopecia areata ,medicine.disease ,Hair follicle ,stomatognathic diseases ,medicine.anatomical_structure ,Female ,business ,Primary systemic amyloidosis - Abstract
Primary systemic amyloidosis has a varied clinical presentation, making it one of the great masqueraders of other disease entities in clinical medicine. The association of amyloidosis with alopecia is uncommon with at least 22 cases reported in the literature mostly in the setting of systemic amyloidosis. Alopecia in these patients occurs either as the initial presentation of the systemic amyloidosis or it happens during the disease course. The occurrence of amyloid alopecia associated with light chain (LC) restricted plasmacytic infiltrates in the absence of systemic amyloidosis, however, it is not well known. We report 3 cases of LC-associated amyloidosis presenting with alopecia, whereby there was evidence of a systemic plasma cell dyscrasia in 2 of the patients, one of whom developed multiple myeloma. None of the patients had systemic amyloidosis. Skin presentation in the patient with multiple myeloma was characterized by a diffuse form of alopecia affecting the entire scalp, eyebrow, and axillary and pubic hair in contrast to the localized form of alopecia noted in the other 2 patients. The mechanism by which LC-associated amyloidosis eventuates in this pattern of nonscarring alopecia potentially reflects the affinity of this form of amyloid for dermatan sulfate. Dermatan sulfate is found at highest concentrations within the adventitial dermis of the superficial to mid isthmic portions of the anagen hair follicles likely interfering with the hair cycle and induces early hair follicle involution. The result is a pattern of alopecia that can clinically and to some extent pathologically resemble either androgenetic alopecia or alopecia areata.
- Published
- 2019
36. Bilateral tennis toe
- Author
-
Julianne M. Falotico, Cynthia M. Magro, and Shari R. Lipner
- Subjects
Infectious Diseases ,Dermatology - Published
- 2022
37. Idiopathic systemic capillary leak syndrome, a unique complement and interferon mediated endotheliopathy syndrome: The role of the normal skin biopsy in establishing the diagnosis and elucidating pathogenetic mechanisms
- Author
-
Cynthia M, Magro, Joshua H, Mo, and Mark S, Pecker
- Subjects
Male ,Biopsy ,Interferon Type I ,Paraproteinemias ,Humans ,Female ,Complement Membrane Attack Complex ,General Medicine ,Middle Aged ,Capillary Leak Syndrome ,Aged ,Pathology and Forensic Medicine - Abstract
Idiopathic Systemic Capillary Leak Syndrome (ISCLS), also known as Clarkson's Syndrome, is due to primary fluid and protein leak across capillaries that leads to an accumulation of interstitial fluids and cardiovascular collapse from intravascular hypovolemia. Viral infections are a putative trigger of these episodes. ISCLS is typically associated with a monoclonal gammopathy. Here we present four patients with idiopathic systemic capillary leak syndrome. The cohort consists of three men and one woman who range in age from 55 to 72 years old. All of the patients had a monoclonal gammopathy. Two patients had viral triggers. Biopsies of normal skin were examined throughout all phases of the disease. During an acute attack, we identified perivascular mixed CD4+ and CD8+ T cell lymphocytic infiltrates in the superficial dermis. We observed significant microvascular deposits of C5b-9 and upregulation of type I interferon signaling in endothelium along with reduced serum levels of complement during very active disease. We also identified deposits of immunoglobulin along the dermal epidermal junction mirroring the monoclonal immunoglobulin isotype implicated in each patient. During a post treatment recovery or mild disease phase there was reduced inflammation and decreased amounts of C5b-9 and type I interferon expression. Sudden onset capillary leak syndrome reflects enhanced endothelial cell permeability as a unique form of endothelial injury mediated by the combined effects of complement pathway activation and upregulation of type I interferon signaling on endothelium.
- Published
- 2022
38. Potential Masquerader of Malignancy: Tophaceous Gout Causing Nail Dystrophy
- Author
-
Cynthia M. Magro, Kira Minkis, and Haoming Xu
- Subjects
Male ,medicine.medical_specialty ,Skin Neoplasms ,Gout ,business.industry ,Biopsy ,Nails, Malformed ,Dermatology ,General Medicine ,Malignancy ,medicine.disease ,Tophaceous gout ,Diagnosis, Differential ,Keratoacanthoma ,Nail Diseases ,Nails ,medicine ,Carcinoma, Squamous Cell ,Humans ,Surgery ,business ,NAIL DYSTROPHY ,Aged ,Skin - Published
- 2021
39. A newly described cutaneous reaction at sites of insulin pump use in a child with Type 1 diabetes
- Author
-
Mark A. Strom, Sameera Husain, Kristen M. Williams, Laura E. Levin, Victoria A. Perez, and Cynthia M. Magro
- Subjects
Insulin pump ,medicine.medical_specialty ,Type 1 diabetes ,Standard of care ,Continuous glucose monitoring ,business.industry ,Insulin ,medicine.medical_treatment ,Dermatology ,medicine.disease ,Subcutaneous insulin ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Skin reaction ,0302 clinical medicine ,Endocrinology ,030220 oncology & carcinogenesis ,Internal medicine ,Pediatrics, Perinatology and Child Health ,medicine ,Adverse effect ,business - Abstract
Continuous subcutaneous insulin infusion (CSII), or insulin pumps, with or without continuous glucose monitoring (CGM) devices have become the standard of care for patients with type 1 diabetes. While increasingly popular, a wide range of reported skin reactions to CSII and CGM devices was found. We present this case of a pyogenic granuloma-like neutrophilic and granulomatous response to an insulin pump to increase awareness of a previously uncharacterized cutaneous adverse reaction at insulin pump infusion sites.
- Published
- 2020
40. The Skin as a critical window in unveiling the pathophysiologic principles of COVID-19
- Author
-
Gerard J. Nuovo, Cynthia M. Magro, Jeffrey Laurence, Joanna Harp, J. Justin Mulvey, and A. Neil Crowson
- Subjects
COVID-19 Vaccines ,business.industry ,T cell ,COVID-19 ,Dermatology ,Skin Diseases ,Virus ,Immune complex ,Article ,Complement system ,Immune system ,medicine.anatomical_structure ,Antigen ,Interferon ,Immunology ,Spike Glycoprotein, Coronavirus ,medicine ,Cytokines ,Humans ,business ,B cell ,medicine.drug - Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiologic agent of coronavirus disease 2019 (COVID-19), is a single-stranded RNA virus whose sequence is known. COVID-19 is associated with a heterogeneous clinical phenotype ranging from asymptomatic to fatal disease. It appears that access to nasopharyngeal respiratory epithelia expressing angiotensin-converting enzyme (ACE) 2, the receptor for SARS-CoV-2, is followed by viral replication in the pulmonary alveolar septal capillary bed. We have demonstrated in earlier studies that incomplete viral particles, termed pseudovirions, dock to deep subcutaneous and other vascular beds, potentially contributing to the prothrombotic state and systemic complement activation that characterizes severe and critical COVID-19. A variety of skin eruptions have been described in the setting of SARS-CoV-2 infection and more recently, after COVID-19 vaccination. The vaccines deliver a laboratory-synthesized mRNA that encodes a protein that is identical to the spike glycoprotein of SARS-CoV-2, allowing the production of immunogenic spike glycoprotein that will then elicit T cell and B cell adaptive immune responses. In this contribution, we review an array of cutaneous manifestations of COVID-19 that provide an opportunity to study critical pathophysiologic mechanisms that underlie all clinical facets of COVID-19, ranging from asymptomatic/mild to severe and critical COVID-19. We classify cutaneous COVID-19 according to underlying pathophysiologic principles. In this regard we propose three main pathways: (1) complement mediated thrombotic vascular injury syndromes deploying the alternative and mannan binding lectin pathways and resulting in the elaboration of cytokines like interleukin 6 from endothelium in the setting of severe and critical COVID-19 and (2) the robust T cell and type I interferon-driven inflammatory and (3) humoral-driven immune complex mediated vasculitic cutaneous reactions observed with mild and moderate COVID-19. Presented are novel data on cutaneous vaccine reactions that manifest a clinical and morphologic parallel with similar eruptions observed in patients with mild and moderate COVID-19 and in some cases represent systemic eczematoid hypersensitivity reactions to a putative vaccine-based antigen versus unmasking subclinical hypersensitivity due to immune enhancing effects of the vaccine. Finally, we demonstrate for the first time the localization of human synthesized spike glycoprotein after the COVID-19 vaccine to the cutaneous and subcutaneous vasculature confirming the ability of SARS-CoV-2 spike glycoprotein to bind endothelium in the absence of intact virus.
- Published
- 2021
41. Atrophic papulosis: the wedge‐shaped skin necrosis overlays an active lesion
- Author
-
Christos C. Zouboulis, Cynthia M. Magro, and Lee Shapiro
- Subjects
Pathology ,medicine.medical_specialty ,Necrosis ,business.product_category ,Kohlmeier-Degos Disease ,business.industry ,Degos disease ,Dermatology ,medicine.disease ,Skin Diseases ,Wedge (mechanical device) ,Malignant Atrophic Papulosis ,Lesion ,Infectious Diseases ,medicine ,Humans ,Atrophy ,medicine.symptom ,business ,Skin ,Rare disease - Published
- 2021
42. Intralesional overlap syndrome: Sclerodermic lupus panniculitis and sclerodermic discoid lupus erythematosus
- Author
-
Cynthia M. Magro and Ziv Schwartz
- Subjects
medicine.medical_specialty ,Discoid lupus erythematosus ,morphea ,Case Report ,Dermatology ,overlap syndrome ,SLE, systemic lupus erythematosus ,LEP, lupus erythematosus panniculitis ,sclerodermic lupus panniculitis ,discoid lupus erythematosus ,lcsh:Dermatology ,medicine ,Localized Scleroderma ,LE - Lupus erythematosus ,sclerodermic lupus erythematosus profundus ,Lupus erythematosus ,business.industry ,sclerodermiform linear lupus erythematosus ,Overlap syndrome ,DLE, discoid lupus erythematosus ,lcsh:RL1-803 ,medicine.disease ,Lupus Panniculitis ,LE, lupus erythematosus ,business ,Morphea ,Lupus erythematosus panniculitis ,localized scleroderma ,SLEP, sclerodermic lupus erythematosus panniculitis - Published
- 2020
43. Spontaneous Hair Repigmentation in an 80-Year-Old Man: A Case of Melanoma-Associated Hair Repigmentation and Review of the Literature
- Author
-
Shaofeng Yan, Shabnam Momtahen, Dorothea T. Barton, Nicole C Pace, Cynthia M. Magro, Anh Khoa Pham, M. Shane Chapman, Cynthia X Chan, and Robert E. LeBlanc
- Subjects
Male ,medicine.medical_specialty ,Skin Neoplasms ,Dermatology ,Lentigo maligna ,Outer root sheath ,Risk Assessment ,Pathology and Forensic Medicine ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Rare Diseases ,0302 clinical medicine ,Black hair ,Hyperpigmentation ,Biopsy ,medicine ,Humans ,Hair Color ,Melanoma ,Aged, 80 and over ,Scalp ,integumentary system ,medicine.diagnostic_test ,business.industry ,Biopsy, Needle ,General Medicine ,medicine.disease ,Immunohistochemistry ,Treatment Outcome ,medicine.anatomical_structure ,Pagetoid ,sense organs ,business ,Hair Follicle ,Pigmentation Disorders - Abstract
Spontaneous hair repigmentation of physiologically white or gray hair is a rare occurrence that may be associated with melanoma in elderly individuals. We present the first case of this phenomenon in a man. A gray-haired, 80-year-old man presented to dermatology clinic with a 3-cm lock of black hair on his vertex scalp that developed over 1 year. Punch biopsies showed an increase in junctional dendritic melanocytes with rare pagetoid cells and extension along the follicular outer root sheath epithelium and interfollicular epidermis, associated with prominent dendritic melanocytic hyperplasia and pigment-containing melanocytes within the hair bulbs. Although the findings on the biopsies were not diagnostic of melanoma in situ, an irregular interfollicular distribution of melanocytes was concerning for an adjacent atypical process. A complete excision was performed and revealed melanoma in situ, lentigo maligna type. Rare reports describe spontaneous hair repigmentation as a harbinger of lentigo maligna in women. Repigmentation can occur in the setting of proliferation of malignant pigment-producing melanocytes or by paracrine stimulation of benign bulbar melanocytes through receptor tyrosine kinase KIT activation. Presence of prominent dendritic melanocytic hyperplasia and pigment-containing melanocytes within the hair bulbs in our patient's biopsies was suggestive of paracrine or physiologic stimulation of bulbar melanocytes. Given the importance of early melanoma detection and the low visibility of the scalp, this report raises awareness of an extraordinary presentation of lentigo maligna and exemplifies the importance of close clinicopathologic correlation to ensure optimal clinical management and patient outcome.
- Published
- 2019
44. Lacrimal tissue resection in Fasanella Servat operation and the correlation to dry eye
- Author
-
Hency H. Patel, Benjamin Levine, Gary J. Lelli, Cynthia M. Magro, Shulamit Pinchover, Filippos Vingopoulos, Luke C. Olson, and Shani Golan
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Accessory Lacrimal Gland ,Resection ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Ptosis ,medicine ,Blepharoptosis ,Humans ,Child ,030223 otorhinolaryngology ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Lacrimal Apparatus ,Dry eyes ,Middle Aged ,medicine.disease ,eye diseases ,Surgery ,Ophthalmology ,medicine.anatomical_structure ,Eye dryness ,030221 ophthalmology & optometry ,Dry Eye Syndromes ,Female ,Histopathology ,Eyelid ,medicine.symptom ,business - Abstract
Purpose: Fasanella-Servat operation (FSO) was previously reported to be associated with post-operative dry eyes due to accessory lacrimal gland resection during the surgery.We performed a retrospective, cohort study to determine the frequency of lacrimal tissue resection during FSO and its correlation with post-operative eye dryness and keratopathy.Methods: Review of all patients who underwent FSO at New York-Presbyterian Weill Cornell Hospital over a two-year period (2013-2015). Patients were included only if they had adequate histopathological specimens of the resected tissue obtained during surgery. Outcomes included the study of the pathological specimen for the presence of lacrimal tissue; Post-operative dry eye symptoms and pre- and post-operative corneal epitheliopathy.Results: 46 patients with a total of 58 eyelid resections were studied.Eight eyelids (13.7%) were found to have lacrimal tissue present in the pathology specimens.Postoperatively, nine patients reported some symptoms of dry eye and new-onset keratopathy was noted in four eyes (6.8%), only one of which had lacrimal tissue present in histopathology specimen obtained from surgery.Discussion: Previous studies found lacrimal tissue present in up to 43% of specimens resected during FSO. Our data found a lower rate of lacrimal tissue resection during FSO, and did not find an association between lacrimal tissue resection and post-operative dryness or epitheliopathy.Conclusion: Our study is one of few to examine histopathological resections from the FSO.We found that lacrimal tissue is not frequently resected during FSO, and when it is resected, there is no increased incidence of post-operative dryness or keratopathy.
- Published
- 2019
45. A comparison of the detection of biomarkers in infections due to low risk versus high-risk human papillomavirus types
- Author
-
Cynthia M. Magro, Gerard J. Nuovo, and Ziv Schwartz
- Subjects
Adult ,Male ,0301 basic medicine ,Pathology ,medicine.medical_specialty ,L1 ,Uterine Cervical Neoplasms ,In situ hybridization ,Pathology and Forensic Medicine ,Variable Expression ,Lesion ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,MCL1 ,Aged ,business.industry ,Papillomavirus Infections ,HPV infection ,virus diseases ,General Medicine ,Middle Aged ,Uterine Cervical Dysplasia ,medicine.disease ,female genital diseases and pregnancy complications ,030104 developmental biology ,Capsid ,Condylomata Acuminata ,030220 oncology & carcinogenesis ,Immunology ,Immunohistochemistry ,Female ,Warts ,medicine.symptom ,business ,Biomarkers - Abstract
Adjunctive immunohistochemistry tests for human papillomavirus (HPV) infection include p16 and Ki67 as well as the more recently discovered biomarkers importin-β, exportin-5, Mcl1, and PDL1. The purpose of this study was to compare the expression of these biomarkers in HPV infection due to the high-risk types such as HPVs 16, 18, 31, 33, 35, and 51 versus lesions that contain the low risk types HPV 2, 6 or 11. We studied 35 lesions with low risk HPV types (verruca vulgaris = 10 cases, condyloma acuminatum = 15 cases, CIN 1 with HPV 6/11 = 10 cases) and 25 CIN 1 or 2 lesions with a high-risk HPV type. The 25 high-risk positive CIN 1–2 cases had strong expression of the panel p16, Ki67, importin-β, exportin-5, Mcl1, and PDL1 where each protein localized to the cells in the parabasal aspect of the lesion. In comparison, neither p16, importin-β, exportin-5, Mcl1, nor PDL1 were increased in the epithelia of the lesions with the low risk HPV types; Ki67 showed variable expression. HPV viral capsid L1 protein and viral DNA were excellent markers of infection in the lesions with low risk types. Thus, p16, importin-β, exportin-5, Mcl1, and PDL1 are not only biomarkers of high-risk HPV infection but can also differentiate such lesions from those that contain low risk HPV types. Low risk HPV infections can be best differentiated from their mimics by viral L1 capsid detection and/or HPV DNA by in situ hybridization.
- Published
- 2019
46. An unusual cause of bilateral orbital swelling: Immunoglobulin G4–related orbital disease arising in a patient with ulcerative colitis
- Author
-
Amin A. Hedayat, Cynthia M. Magro, Dawn Queen, and Larisa J. Geskin
- Subjects
Pathology ,medicine.medical_specialty ,medicine.medical_treatment ,Treg, regulatory T cell ,Case Report ,Inflammation ,Dermatology ,Inflammatory bowel disease ,030207 dermatology & venereal diseases ,03 medical and health sciences ,ULN, upper limit of normal ,0302 clinical medicine ,Immune system ,inflammatory bowel disease ,parasitic diseases ,medicine ,IgG4-related disease ,Th1, T helper ,ulcerative colitis ,immunosuppression ,biology ,business.industry ,fungi ,IgG4-ROD, IgG4-related orbital disease ,Immunosuppression ,medicine.disease ,Ulcerative colitis ,IL, interleukin ,UC, ulcerative colitis ,medicine.anatomical_structure ,inflammation ,030220 oncology & carcinogenesis ,IgG4-related orbital disease ,biology.protein ,IgG4-RD, immunoglobulin G4–related disease ,Antibody ,medicine.symptom ,Pancreas ,business - Abstract
Immunoglobulin G4–related diseases (IgG4-RD) are a group of immune-mediated disorders characterized by organ infiltration with lymphocytes and IgG4+ plasma cells. IgG4-RD has multiple clinical manifestations, affecting distant organs ranging from the orbit to the pancreas. Ulcerative colitis (UC) is an inflammatory bowel disease that causes chronic colonic mucosal inflammation, most likely due to a damaged epithelial barrier, an abnormal reaction to intestinal bacteria, and a dysregulated immune response.1 UC is also associated with extraintestinal manifestations including ocular complications. Here we present an unusual case of IgG4-related orbital disease (IgG4-ROD) arising in a patient with ulcerative colitis.
- Published
- 2019
47. A comprehensive assessment of cutaneous Rosai-Dorfman disease
- Author
-
Aadil Ahmed, Cynthia M. Magro, and Neil Crowson
- Subjects
Adult ,Male ,0301 basic medicine ,Pathology ,medicine.medical_specialty ,Adolescent ,Disease ,Skin Diseases ,Immunophenotyping ,Pathology and Forensic Medicine ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Vascularity ,Langerhans cell histiocytosis ,medicine ,Humans ,Child ,Rosai–Dorfman disease ,Aged ,Skin ,Aged, 80 and over ,CD68 ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Lymphoma ,Emperipolesis ,Histiocytosis, Langerhans-Cell ,030104 developmental biology ,Child, Preschool ,030220 oncology & carcinogenesis ,Female ,Histiocytosis, Sinus ,medicine.symptom ,business - Abstract
Background Cutaneous Rosai-Dorfman (CRD) disease is a rare entity that is characterized by histiocytic proliferation in the skin. The disease has been reported to exhibit different clinical profiles and occasionally confounding histologic features that may be challenging for a correct diagnosis. The purpose of this study was to assess the pathobiology and highlight the variance in clinical and histologic spectrum of the disease based on published literature. Methods A PUBMED search was performed to retrieve cases of cutaneous Rosai-Dorfman disease published in the literature. A PRISMA-guided review of the included articles was performed. Three interesting case reports from our institution are also described. Results A total of 263 patients, of which 220 with purely cutaneous disease were identified in 152 studies. The mean age at presentation was 45.2 years with a slight female preponderance, and East-Asian, Caucasian and African populations being largely affected. Majority of the patients presented with multiple lesions, predominantly on limbs and comprising of nodules, plaques and papules that were occasionally pigmented. The classis histologic findings included large foamy histiocytes, exhibiting emperipolesis and a specific immunophenotype (S100+, CD68+, CD1a-). Inconspicuous emperipolesis, fibrosis, increased vascularity, neutrophilic microabscesses and concurrent langerhans cell histiocytosis and lymphoma in few cases highlighted the importance of immunohistochemistry for a definitive diagnosis. The disease shows an indolent and benign course with excision and chemotherapy being most effective for extensive and refractory cases. Conclusions This review of largest cohort of CRD patients provides an updated insight into the clinicopathologic features with possible diagnostic pitfalls and effective therapeutic options that should be useful in diagnosis, management and future research opportunities.
- Published
- 2019
48. Post-thymic CD4 positive cytotoxic T cell infiltrates of the skin: A clinical and histomorphologic spectrum of the unique CD4 positive T cell of immunosenescence
- Author
-
Shabnam Momtahen, Luke C. Olson, and Cynthia M. Magro
- Subjects
CD4-Positive T-Lymphocytes ,Male ,0301 basic medicine ,Pathology ,medicine.medical_specialty ,Skin Neoplasms ,CD30 ,Naive T cell ,Immunosenescence ,T cell ,Pathology and Forensic Medicine ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,T-cell lymphoma ,Cytotoxic T cell ,Aged ,Mycosis fungoides ,business.industry ,Large cell ,Cutaneous T-cell lymphoma ,General Medicine ,Middle Aged ,medicine.disease ,Lymphoma, T-Cell, Cutaneous ,030104 developmental biology ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Female ,business ,T-Lymphocytes, Cytotoxic - Abstract
T cell lymphoproliferative disorders that arise in the skin are mainly derived from post thymic T cells most commonly of CD4 subset. Human CD4 positive T cells are dynamic exhibiting phenotypic and functional malleability. For example, with repetitive antigen exposure most commonly associated with age, CD4 positive T cells acquire a cytotoxic phenotype. The authors present four cases characterized by cutaneous infiltrates of cytotoxic CD30 negative CD4 positive T cells in the skin; three cases were forms of malignant lymphoma other than mycosis fungoides and one case was a reactive lymphomatoid photodermatosis associated with underlying collagen vascular disease. The three patients with lymphoma were adult men, two above 50 years of age and all with disseminated cutaneous disease. One of these patients whose biopsy showed a large cell morphology succumbed to the disease while one patient with localized disease responded to local radiation. In all three cases there was a nodular and diffuse pan-dermal infiltrate which was predominated by non-cerebriform atypical lymphocytes ranging from small to intermediate sized cells in two cases to a large cell dominant morphology in one case. The biopsies showed some degree of epidermotropism, and in one case it was striking. Neoplastic cells were positive for CD4, and at least one cytotoxic protein (i.e. granzyme and/or TIA). CD56, CD57 or CD30 were negative. In addition, CD28, the naive T cell marker, was negative. Based on the few cases reported herein, one might suggest that the prognosis mirrors that seen in other forms of cutaneous T cell lymphoma with mature small cell dominant infiltrates exhibiting an indolent pattern while a CD30 negative large cell T cell lymphoma would be expected to demonstrate an aggressive clinical course.
- Published
- 2019
49. Pediatric oral Epstein-Barr virus associated self-remitting CD30+ lymphoproliferative disorder: A distinct entity
- Author
-
Robert B. Bowe, Morton Coleman, Cynthia M. Magro, and Ziv Schwartz
- Subjects
Epstein-Barr Virus Infections ,Pathology ,medicine.medical_specialty ,Lymphomatoid granulomatosis ,Adolescent ,CD30 ,Ki-1 Antigen ,Lymphoproliferative disorders ,Aggressive lymphoma ,Pathology and Forensic Medicine ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Type C Lymphomatoid Papulosis ,Lymphomatoid Papulosis ,immune system diseases ,hemic and lymphatic diseases ,Humans ,Medicine ,Diagnostic Errors ,Lymphomatoid papulosis ,B-cell lymphoma ,Anaplastic large-cell lymphoma ,business.industry ,General Medicine ,medicine.disease ,Lymphoma, Extranodal NK-T-Cell ,030220 oncology & carcinogenesis ,Female ,Mouth Neoplasms ,business - Abstract
Epstein-Barr virus (EBV) has a well-known association with lymphoproliferative disorders of B and T cell origin. EBV-related B cell lymphoproliferative disorders include Hodgkin and Burkitt lymphomas, lymphomatoid granulomatosis, EBV positive diffuse large cell B cell lymphoma of the elderly, as well as B cell lymphomas associated with solid organ transplantation and methotrexate use. EBV-related T cell disorders are primarily represented by NK/T- cell lymphoma. In a subset of patients, EBV has been implicated in CD30 positive B cell lymphoproliferative disorders of the oral mucosa falling under the rubric of the mucocutaneous ulcer of the oral cavity. We previously reported on an index series of endogenous CD30 positive T cell lymphoproliferative disorder of the oral cavity resembling borderline type C lymphomatoid papulosis. The clinical manifestation of type C oral lymphomatoid papulosis is that of a recurrent self-remitting ulcer of the oral mucosa, which histologically resembles anaplastic large cell lymphoma. Such cases can be misdiagnosed as aggressive lymphoma leading to unnecessary treatment with aggressive chemotherapeutic regimens. Whereas none of the patients in our index series exhibited EBV positivity, here we discuss a very unique example of a 14-year-old girl diagnosed with EBV positive CD30 positive lymphoproliferative disorder strongly resembling the cases of intra-oral type C lymphomatoid papulosis. The patient was initially diagnosed by a senior hematopathology consultant as having EBV positive aggressive NK/T-cell lymphoma. The significance of raising physician awareness regarding pediatric oral EBV associated CD30 positive lymphoproliferative disease of the oral cavity lies in preventing inadvertent exposure to toxic chemotherapeutic agents intended for treatment of aggressive look-alikes, namely anaplastic large cell lymphoma. Additionally, we include a literature review of similar reports of pediatric intra-oral EBV positive CD30 positive T cell lymphoproliferative disease.
- Published
- 2018
50. Case 33. Primary cutaneous aggressive epidermotropic CD8-positive T-cell lymphoma with initial protracted course
- Author
-
Larisa J. Geskin, Megan H. Trager, and Cynthia M. Magro
- Subjects
Pathology ,medicine.medical_specialty ,Protracted course ,business.industry ,hemic and lymphatic diseases ,Medicine ,T-cell lymphoma ,Cytotoxic T cell ,Differential diagnosis ,business ,medicine.disease ,CD8 ,Lymphoma - Abstract
CD8 marker is not unique to primary cutaneous aggressive epidermotropic CD8+ cytotoxic T-cell lymphoma (pc CD8+ AECTCL). Moreover, it occurs in seven other entities presented in the following table. There is a certain clinical and morphological overlap of γδ-positive and CD8-positive cases. Due to various aberrant expression of CD56, TCRγ, and CD8 markers, it was suggested that the term “primary cutaneous aggressive epidermotropic cytotoxic T-cell lymphoma” without specification may be better suited for those lymphomas. There is a range of CD8+ pseudolymphomas and CD8+ non-lymphomatous proliferations should be kept on a list of differential diagnosis such as actinic reticuloid, CD8+ drug-associated eruptions, and HIV-associated CD8+ LPD.
- Published
- 2021
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