Intralymphatic histiocytosis (IH) is a rare condition first reported in 1994 by O'Grady et al. Less than 40 cases have been reported, with the majority occurring in patients with rheumatoid arthritis. We present a case of a 72-year-old man who developed an asymptomatic rash on his left upper arm 3 years after placement of a metal implant to stabilize a fractured humerus. Examinations revealed a poorly demarcated erythematous to brown indurated plaque with a pebbly surface overlying the inferior portion of the surgical scar. Biopsy revealed a mixed dermal infiltrate with a complex glomeruloid intravascular accumulation of histiocytes and neutrophils. Histiocytes were identified with immunostaining for CD68. Immunostains for CD31 and D2-40 confirmed the intravascular location of the histiocytes. This reactive process is closely related to reactive angioendotheliomatosis, but is best classified as IH. This is the only case of IH reported in association with a metal implant of the upper arm and the fourth case reported in association with a metal implant. Although the pathogenesis of IH is unknown, a role for lymphatic stasis secondary to chronic inflammation or surgery has been suggested. This is a benign process with a chronic course, and there are no known efficacious treatments.
have indicated no significant interest with commercial supporters. Case ReportA 68-year-old gentleman presented to the Veterans Administration dermatology clinic with a severalweek history of a new growth on the left ear ( Figure 1). The lesion was asymptomatic and the patient denied previous treatment to the area. He was feeling constitutionally well. Physical examination revealed a 1.0-cm pink to brown shiny opalescent crusted nodule on the left ear, spanning the midhelix and antihelix. Adenopathy was not appreciated. The initial clinical differential diagnosis included basal cell carcinoma, amelanotic malignant melanoma, and Merkel cell carcinoma. A deep shave biopsy was performed.Histologic evaluation revealed an atypical spindle cell proliferation with pleomorphic nuclei and scattered atypical mitoses infiltrating the dermis (Figures 2 and 3). Immunohistochemistry showed strong positivity for smooth muscle actin and vimentin. Desmin was focally positive. Pankeratin, S100, and Mart-1 staining were negative.A histologic diagnosis of cutaneous leiomyosarcoma was made. Excision of the primary lesion was performed. Lateral surgical margins extended 5 mm beyond the clinical boundary of the lesion, and the deep margin extended to the posterior aspect of the auricular cartilage. Clear surgical margins were confirmed histologically. A porcine xenograft Figure 1. Clinical photograph.Figure 2. Low-power magnification demonstrates an atypical spindle cell proliferation infiltrating the entire dermis. H&E; original magnification, 4 Â .
Abstract. Cutaneous leishmaniasis is rarely seen in the United States. Four Cuban immigrants traveled along the same route at different times from Cuba to Ecuador, then northward, including through the Darié n Jungle in Panama. These patients had chronic ulcerative non-healing skin lesions and were given a diagnosis of leishmaniasis.Leishmaniasis is a vector-borne disease caused by the protozoan parasite of the genus Leishmania and is spread by the bite of sand flies from the sub-family Phlebotominae.
Assessment of a patient's disease severity is an essential component of formulating therapeutic strategies. However, disorders of the skin are often not amenable to strict classification criteria, and the dermatologist relies upon personal thresholds of severity when assessing the patient's overall condition. A number of grading systems have arisen, primarily from the need for standardized end points in clinical trials; in some circumstances, these severity assessments may assist the clinician in the evaluation and treatment of dermatologic disease. In this review, we will summarize the results of available severity scores of frequently encountered dermatologic disorders and discuss their utility in the management of disease in a clinician's office.
Simple lipomas of the eyelid are rare. We present a case of a 61-year-old man, who presented with 6 months of a slowly worsening blepharoptosis. On examination, that patient was noted to have a palpable, soft mass in the medial left upper eyelid. Histopathological examination of the mass revealed mature adipose tissue most consistent with lipoma. Simple lipomas of the eyelid are very unusual but should be considered in the differential diagnosis of patients presenting with mechanical ptosis.
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