To determine whether tissue eosinophilia is a reliable indicator of a drug-induced etiology in biopsy samples demonstrating leukocytoclastic vasculitis.Design: Retrospective medical record review with concurrent histopathologic analysis.Setting: University-affiliated dermatology practice.Patients: Sixty-three patients with cutaneous smallvessel vasculitis meeting specific inclusion criteria were divided into drug-induced (n = 16) and non-druginduced (n=47) groups.Main Outcome Measures: Corresponding histopathologic material was reviewed by a dermatopathologist masked to the etiologic associations. An eosinophil ratio was calculated for each patient, derived from the mean eosinophil score (averaging eosinophil counts from 10 high-power histologic fields), and expressed in relation to the intensity of inflammation in the histopathologic slides examined. Eosinophilia ratios were compared for both groups using the Mann-Whitney test.

Prototheca species are an achlorophyllic algae that cause infections primarily in immunocompromised individuals. At least one-half of infectious cases are cutaneous. Because protothecosis is seldom suspected clinically, patients may be subjected to various treatment modalities for extended periods without satisfactory results. Cutaneous protothecosis shares similar clinical and pathologic findings with deep tissue fungal mycoses. The typical presentation occurs most commonly on the face and extremities as erythematous plaques, nodules, or superficial ulcers. Prototheca spp are spherical, unicellular, nonbudding organisms that are sometimes noted on routine hematoxylin-eosin staining but are best visualized with periodic acid–Schiff and Gomori methenamine-silver histochemical stains. Although protothecosis can be diagnosed on biopsy, culture of the organism on a medium such as Sabouraud dextrose agar is required for definitive diagnosis. Treatment may require a combination of surgical excision and antifungal agents. Therefore, cutaneous protothecosis should be considered in a lesion that appears suspicious for the more-common fungal infections.

MiTF is as effective as MART-1/Azure blue in identifying melanocytes in the context of solar lentigo or MIS. On the basis of our results, we favor expanding the use of MiTF as an immunohistochemical marker, as it provides an efficient alternative to MART-1 with Azure blue counterstaining in the evaluation of cutaneous pigmented lesions.

cl obe tas ol , h and de rm atos e s , foot de rm atos e s , l ich e n pl anus , path ol ogy J D e rm atol Case Re p 2008 1, pp 08-10 Abs tractBack grou nd: L ich e n pl anus (L P) is a ch ronic infl am m atory s k in dis e as e comm onl y s e e n by de rm atol ogis ts .M ain O b se rvations: Th e curre nt cas e de s cribe s pal m opl antar l ich e n pl anus , a rare variant of th is dis e as e th at can e as il y be m is diagnos e d. Th is cas e de s cribe s a patie nt th at pre s e nte d w ith m ul tipl e papul e s on h is h ands and pl antar fe e t th at h ad pre vious l y be e n diagnos e d as tine a m anum and ps orias is . A biops y from th e patie nt, h ow e ve r, w as diagnos tic of l ich e n pl anus . Th e patie nt w as s ubs e q ue ntl y tre ate d s ucce s s ful l y w ith topical cl obe tas ol propionate 0.05% ointm e nt appl ie d tw ice dail y.Concl u sions: Pal m opl antar l ich e n pl anus is a rare dis e as e th at can be e as il y m is diagnos e d. Th is cas e re port e m ph as ize s th e rol e of th e biops y w h e n pre s e nte d w ith s uch patie nts . Pal m opl antar IntroductionL ich e n pl anus (L P) is an infl am m atory s k in dis e as e w h ich produce s a ch aracte ris tic pol ygonal , viol ace ous papul e . Its s l igh tl y s cal y s urface cons is ts of fine w h ite l ine s cal l e d W ick h am 's s triae , and th e l e s ions are h igh l y pruritic. 1 Th e re are a num be r of l ich e n pl anus varie tie s incl uding actinic, annul ar, atroph ic, bul l ous , h ype rtroph ic, fol l icul ar, l ine ar, nail , oral , and ul ce rative L P. Anoth e r type of L P th at h as be e n m uch l e s s fre q ue ntl y de s cribe d is pal m opl antar L P. W e pre s e nt a cas e of a pal m opl antar L P th at h ad be e n diagnos e d as tine a m anum and ps orias is for ove r five ye ars prior to pre s e ntation to our outpatie nt cl inic. Cas e Re portA 59 ye ar-ol d m an pre s e nte d w ith a 5 ye ar h is tory of pruritic papul e s th at w e re initial l y pre s e nt e xcl us ive l y on h is pal m s and s ol e s . Pre vious diagnos e s of pal m opal m ar ps orias is and tine a m anum w e re m ade on cl inical appearance . H e h ad be e n tre ate d w ith topical k e toconazol e 2% cre am , a varie ty of topical s te roids , and cal cipotrie ne w ith out re l ie f. Th e patie nt h ad num e rous com orbid conditions , incl uding poorl y-control l e d diabe te s m e l l itus , h ype rte ns ion, an uns pe cifie d s e izure dis orde r, ch ronic obs tructive pul m onary dis e as e , de pre s s ion, and a h is tory of al coh ol abus e . H is ph ys ical e xam on pre s e ntation s h ow e d m ul tipl e 2-3m m k e ratotic papul e s , s om e w ith ce ntral de l l s (Figure 1). A num be r of th e s e papul e s h ad coal e s ce d into pl aq ue s , e s pe cial l y on th e l ate ral as pe cts of th e h ands . Th e dors i of th e h ands w e re not invol ve d. Th e pl antar as pe cts of th e fe e t s h ow e d ye l l ow papul e s and pl aq ue s w ith k e ratotic s cal e . M ore proxim al l e s ions on th e ank l e s and...

Loss of heterozygosity (LOH) has previously been demonstrated at multiple chromosome microsatellites in primary and metastatic melanomas. Epidermotropic metastases of melanoma are unique in their varied histopathologic appearance, which can mimic a primary lesion. Our objective was to compare LOH profiles in primary and epidermotropic metastatic melanoma to delineate their clonal relationship. We examined the pattern of allelic loss in the primary melanomas of nine patients in addition to the 21 corresponding epidermotropic metastatic melanomas (average 2.3 metastases per patient). DNA samples were prepared from formalin-fixed, paraffin-embedded tissue sections using laser capture microdissection. Eight DNA microsatellite markers on six different chromosomes were analyzed: D1S214 (1p), D6S305 (6q), D9S171 (9p), D9S157 (9p), IFNA (9p), D10S212 (10q), D11S258 (11q), D18S70 (18q). In addition, X-chromosome inactivation analysis was performed in tumors from four women. LOH was seen in 67% (6/9) of primary melanomas and 81% (17/21) of epidermotropic metastatic melanomas. The most frequent allelic losses in informative cases occurred at 10q (33%), 9p (22%), and 11q (22%) in primary melanomas, and at 10q (50%), 1p (44%), and 6q (39%) in epidermotropic metastatic melanomas. Primary lesions demonstrating LOH had concordant allelic loss in at least one locus in a corresponding epidermotropic metastatic melanoma in 83% (5/6) of cases. X-chromosome analysis showed nonrandom inactivation in 75% (3/4) and 71% (5/7) of primary melanoma and epidermotropic metastatic melanoma cases, respectively. Our LOH and X-chromosome inactivation analysis data suggest that epidermotropically metastatic melanomas are clonally related to their primary lesion in many cases. Our data also indicated that some cases diagnosed as epidermotropic metastatic melanoma might be divergent clones or new primaries rather than metastatic disease.