Subungual melanoma with pigmentation beneath the nail that extends to involve the proximal nail fold is referred to as Hutchinson’s sign. Black or brown subungual discoloration involving the proximal nail fold secondary to other etiologies has been referred to as pseudo-Hutchinson’s sign. Three patients with nail discoloration and concurrent dyschromia of the proximal nail fold are described: a female with a chronic subungual hematoma and pseudo-Hutchinson’s sign, a male with culture-confirmed Pseudomonas aeruginosa (P. aeruginosa) of the nail with green discoloration involving the proximal nail fold, and a male with an acute subungual hematoma with red-purple subungual discoloration affecting the proximal nail fold. PubMed was searched for the following: black, brown, chloronychia, discoloration, dyschromia, green, hematoma, Hutchinson’s sign, nail, nail fold, proximal, pseudo-Hutchinson’s sign, red, subungual melanoma, syndrome. The papers were reviewed and appropriate references evaluated. In conclusion, melanoma-associated black proximal nail fold pigmentation is referred to as Hutchinson’s sign, and non-melanoma-associated black pigmentation has been designated as pseudo-Hutchinson’s sign. Subungual nail plate discoloration extending to involve the proximal nail fold may be black, green, or red-purple in patients with melanocytic and non-melanocytic lesions, bacterial infection (Pseudomonas), and acute subungual hematoma, respectively. Instead of creating a new terminology, we suggest that non-black subungual discoloration (green or red-purple) extending to involve the proximal nail fold be referred to as pseudo pseudo-Hutchinson’s sign.
Plasma cell leukemia is an uncommon, aggressive variant of leukemia that may occur de novo or in association with multiple myeloma. Leukemia cutis is the cutaneous manifestation of leukemia, and indicates an infiltration of the skin by malignant leukocytes or their precursors. Plasma cell leukemia cutis is a rare clinical presentation of leukemia. We present a man who developed plasma cell leukemia cutis in association with multiple myeloma. Cutaneous nodules developed on his arms and legs 50 days following an autologous stem cell transplant. Histopathologic examination showed CD138-positive nodular aggregates of atypical plasma cells with kappa light chain restriction, similar to the phenotype of his myeloma. In spite of systemic treatment of his underlying disease, he died 25 days after the presentation of leukemia cutis. Pub-Med was searched for the following terms: cutaneous plasmacytomas, leukemia cutis, plasma cell leukemia nodules, plasma cell leukemia cutis, and secondary cutaneous plasmacytoma. Papers were reviewed and appropriate references evaluated. Leukemia cutis in plasma cell leukemia patients is an infrequent occurrence. New skin lesions in patients with plasma cell leukemia should be biopsied for pathology and for tissue cultures to evaluate for cancer or infection, respectively. The diagnosis plasma cell leukemia cutis is associated with a very poor prognosis.
Purpose: Traditionally, medical school pathology educators have used formalin-fixed specimens to demonstrate effects of diseases on target organs, despite the handling of these "wet" tissues having distinct disadvantages, such as the need for gloves, protective clothing, and appropriate facilities to limit potential fixative moisture and fumes. Paper-mounted sections of solid organs have significant potential as an aid for teaching gross pathology and eliminate the disadvantages of handling formalin-fixed specimens. However, published techniques for preparing giant organ sections include the use of the highly toxic ethylene glycol monoethyl ether (EGEE; 2-ethoxyethanol). We investigated whether replacing EGEE with a less toxic dehydrating and clearing agent, Histo-Clear™, would allow production of high-quality sections. Materials and methods: Whimster's procedure for preparing rapid paper sections of lungs and other organs was modified to incorporate the xylene substitute Histo-Clear in place of EGEE. Results: Giant paper sections of various organs were prepared. In addition to lungs, excellent pathology teaching specimens were prepared from other organs, including the brain, heart, kidney, liver, and colon. Side-by-side comparisons of paper-mounted organ sections prepared using EGEE and Histo-Clear were indistinguishable. The sections prepared using Histo-Clear showed fine anatomical and pathological details. Conclusion:The Gough-Wentworth technique of preparing rapid giant paper sections of organs was made less toxic without sacrificing quality by using Histo-Clear as an alternative to EGEE. Paper-mounted sections offer a safe and portable way for studying macroscopic pathology, and have great potential for use in the anatomy and pathology classroom, as well as in postgraduate pathology training.
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