17-18 MAY 2018 London Dermatopathology Symposium 2018 Self assesment Case 21 MARC HASPESLAGH
CASE 21 1802-50585 48 year old lady with eczematous lesions at ear helix and red patch on nose bridge since 3 years Discoid Lupus? Sarcoidosis? TBC?
CD123 L K
Diagnosis Lupus Discoid lupus Hypertrophic discoid lupus Discoid lupus with amyloidosis Hyperthrophic discoid lupus with secondary amyloidosis
Localised Amyloid in Skin Primary as in lichen or macular amyloidosis and secondary as clinically unapparent phenomenon Secundary associated with tumors of epithelial origin or inflammatory diseases often linked to chronic UV exposition Amyloid K from epidermal origin
Amyloid in skin Described rarely in lupus, mainly hypertrophic lupus, Probably chronic UV exposure pathogenic role Keratin origin with CK+ Papillary dermis along basement membrane
34be12 AE1AE3 CK5
Case 21 : meaning of perivascular presence and keratin negativity? Secondary systemic in chronic inflammatory disease?
Self assesment Case 22
CASE 22 1406-50027 59 year old lady with six flat papules on vulva since many months Viral? Condylomas? Bowenoid papulosis? Lichen?
1406-50027
Diagnosis Acanthoma Condyloma Acantholytic acanthoma Multiple epidermolytic acanthoma Acantholytic dyskeratoma
Epidermolytic hyperkeratosis Histologic phenomenon : hyperkeratosis, hypergranulisis, perinuclear vacuolisation, reticular degeneration in granular and spinous layer Formation of amorphous, eosinophilic trichohyaline granules From generalised genetic disease in bullous ichtyosiform erythrodermia to acquired and localised aberration Keratin 1 and 10 mutations
Epidermolytic Acanthoma Epidermolytic acanthoma : benign tumor usually presenting as solitary, asymptomatic papule Multiple Epidermolytic Acantomas : very rare, genitocrural areas Mimicker of condylomas : older population, labia majora (scrotum in males) No HPV association
Lesson learned The same morfological pattern can occur in totally different diseases To classify correctly these patterns clinicopathological correlation is indespensable
Self assesment Case 23
CASE 23 1803-50218 12 year old girl with hyperkeratotic naevoid lesion in sacral region since birth
1803-50218
1708-50830 f 50y onderbeen re 1708-50642 M 87 onderb dsapk 1508-50486 1405-50163 F 60 y arm voor re 1803-50218 1710-50322 male 70y dsap + lich ker 1403-50624 1611-50717 F 53 arm naevus en pk
1508-50486
Diagnosis Neurodermatitis Psoriasis Verrucous hyperplasia Bowen s disease Verrucous plaque type porokeratosis
Lessons learned Blind sectioning and cutting can fool the pathologist EVD can save time, money and mental and emotional energy from the pathologist and technicians
Self assesment Case 24
CASE 24 1707-50662 Male of 78 years old with purpuric lesion on actinic damaged scalp. Takes anti-thrombotic medication
Keratin S100 CD34 CD31
Histology Anaplastic sarcomatous proliferation Fibrotic spindled, cellular cuboidal and acantholytic split like or sinusoidal areas CK- not pseudosarcomatous squamous, S100- not melanoma, angio sarcoma? : CD34 also CD31- CD10 + Similar to previous biopsy and immuno findings : again compatible with fragment from AFX?
24/9/2017 Telefone call from referring dermatologist : recidivating and progressive circular purpuric lesions around scars of previous lesions Clinical story is not compatible with AFX!!!!! Revision and additional stains
D2-40
ERG C-MYC
Diagnosis AFX Sarcoma NOS Angiosarcoma Malignant Fibrous Histiocytoma Pseudosarcomatous Squamous Cell Carcinoma
Poorly differentiated angiosarcoma of the face and scalp in elderly patients DD with Melanoma and AFX can be difficult in solid areas! Vacuoles are clue Misleading immunos : CD34 - CD31-20 % of cases CD10 + Differential : D2-40 +, ERG +, C-myc + 40% of cases
lessons Clinical story! Erythematous maculae resembling hematoma in face or scalp elderly : Pannel of antibodies When a lesion recurs be cautious with previous interpretations
Self assesment Case 25
CASE 25 1712-50568 Lady of 25 years old with erythematous infiltrated macula on central lumbar region since one month. Pseudolymphoma? Dermatofibroma? Malignant?
1712-50568
SMA D2-40 CD 31 CD 34
Diagnosis Angiomatosis Tufted angioma Hemangioma Microvenular angioma angiosarcoma
Microvenular Angioma Slow growing solitary asymptomatic plaque-like lesion Upper extremities, forearm, face, neck, trunk, lower extremities D2-40 neg CD31 +,CD34+ Pseudoinfiltrative growth DD Kaposi
Lesson learned Rare tumors do occur Not all what infiltrates is malignant!
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