Cutaneous vasculitis encompasses a varied clinicopathologic spectrum, some of them with grave systemic consequences. A skin biopsy is often part of the first-line investigations done in the workup of such patients. A pathologist confronted with a biopsy for vasculitis has to be cognisant of the variations in morphology of these lesions with the course of the disease, overlaps in clinical and histologic features, use of ancillary tests like direct immunofluorescence (DIF), and its limitations. This review outlines a practical histopathologic approach to cutaneous vasculitis and emphasizes features that help in differential diagnosis.

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We present a rare case of subcutaneous granuloma annulare (SGA) of the palm in a 3-year-old girl disappearing on removal of a SGA of the dorsum of foot. Though GA is more common in children, subcutaneous type is rare and poses diagnostic difficulty. Very few cases of SGA over the palm have so far been reported. Disappearance of SGA of the palm following removal of a nodule from the foot represents remote reverse Koebner's phenomenon.

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Subungual melanoma is a rare type of skin cancer. It is an uncommon form of acral lentiginous melanoma. Approximately 85% of cases are misdiagnosed initially, and it is generally associated with a poor prognosis. Herein, we describe a case of metastatic subungal melanoma to the axillary lymph node in a 45-year-old male. Diagnosis of metastasis was made based on cytology, where the clinicians were guided to search for primary. This case report highlights the role of fine-needle aspiration cytology (FNAC) in the diagnosis of this entity to draw the attention of the reader to the possible underreporting of melanoma because of a variant that evades diagnosis and our reluctance to think about its existence.

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Background: The classical histological feature of porokeratosis (PK) is the cornoid lamella. The occurrence of the cornoid lamella within the follicular infundibulum and the acrosyringium is believed to be primarily associated with specific types of PK, for example, follicular PK, porokeratotic eccrine and hair follicle nevus. We looked for such occurrence in all cases of PK. Objective: We attempted to evaluate the incidence of follicular and acrosyringeal involvement in the various clinical types of PK in our population and describe the histological features of the same. Materials and Methods: Case records in 2011 were reviewed for patients diagnosed with PK based on clinicopathological correlation. The histology was reevaluated and follicular or acrosyringeal involvement was noted. Results: In total, biopsies from 28 lesions from 16 patients were reviewed. Nine (32%) lesions were found to have follicular involvement and 12 (42%) were found to have acrosyringeal involvement on histopathology. Of these, 61% of these patients were clinically diagnosed as PK of Mibelli (PM), 14% as disseminated superficial actinic PK (DSAP), 13% as linear PK (LP), 7% cases of follicular PK (FP), and 7% as genital PK. Conclusions: Follicular and acrosyringeal involvement in PK is more frequent than expected. Though follicular PK has been described as a distinct entity, there is no correlation between the clinical subtype and the involvement of the follicular infundibulum and acrosyringium. This involvement may occur as an incidental finding and hence, histological delineation of follicular or acrosyringeal PK as distinct entities without appropriate clinical correlation appears unjustified.

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Cutaneous lymphomas are heterogeneous and distinct entities which have been in controversy since the time of conception. WHO EORTC defined them as distinct pathological entity compared to the nodal counterpart. They are defined as lymphomas having primary cutaneous presentation without any systemic involvement. As such the diagnosis of cutaneous lymphomas is a diagnosis of exclusion. These lymphomas are distinct from the nodal lymphomas in their presentation, behaviour and prognosis. These lymphomas have been divided into B cell and T cell type based on the presence of predominance of atypical lymphocytes of B or T lineage. The most common cutaneous lymphomas are T cell immunophenotype, and Mycosis fungoides constitutes the majority of cutaneous lymphomas. Cutaneous lymphomas needs to be differentiated from pseudolymphomas which are benign proliferation of lymphoid cells mimicking lymphomas and mostly have a benign course

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Background: Immunobullous diseases are morphologically heterogeneous and the differentiation between various subtypes is essential for proper treatment and prognosis. Aim of our study was to analyze and correlate clinical, histopathological and immunofluorescence findings in autoimmune bullous diseases. Materials and Methods: A cross-sectional study was done over a period of two years (2010-2012) after approval of the ethics committee. Sixty patients, who met the inclusion criteria of immunobullous disease, were included in the study. Skin biopsy for histopathology and direct immunofluorescence (DIF) examination was taken. DIF using salt-split technique was done in few of the cases. The final diagnosis was based on clinical, histopathology and DIF findings. Pearson's coefficient of correlation (r) was calculated. Statistical Analysis was done using Epi info version. 7.0. Results: Fifty-three cases with clinical diagnosis of autoimmune bullous diseases were evaluated. In 88.6% of cases, histopathology diagnosis was consistent with clinical diagnosis and in 75.5% of cases, DIF findings were consistent with clinical diagnosis. A positive relation was seen between clinical and DIF findings with r = 0.65 and between histopathology and DIF findings with r = 0.75. DIF positivity was seen in 100% cases of bullous pemphigoid (BP) and pemphigus foliaceous and 94.7% cases of pemphigus vulgaris, which was statistically significant with p < 0.05. In DIF salt-split test, deposition was seen on roof of blister in BP whereas on floor in epidermolysis bullosa acquisita. Conclusion: Our study provides evidence-based guidance for the diagnosis and classification of various immunobullous disorders. DIF test should be done in conjunction with histopathology for definitive diagnosis and to minimize both: False-positive and false-negative results.

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A 21-year-old vegetarian lady presenting with migratory erythema and pain in her right hand subsequently developed a blister on the palm. A worm-like structure came out of the wound and was identified as Gnathostoma spp. adult male worm. It is a very rare cause of creeping eruptions and so far only one case of cutaneous gnathostomiasis caused by a larva has been reported from India. This is the first case of cutaneous gnathostomiasis due to an adult Gnathostoma spp. in India.

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Advent of virtual microscopy in the last decade has revolutionized medical education in many countries. Time has come when our country should also adopt this innovative technology to enrich medical education.

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A 26-year-old female patient presented with multiple, smooth, round to oval, well-defined, and skin-colored nodules, without central punctum, over both axillae since past 5 years. Few nodules were observed on chest, right upper arm, and left upper thigh. No other ectodermal abnormalities were observed in the patient. There was no family history of similar lesions. A clinical diagnosis of multiple neurofibromas was made, and largest of the lesion was excised. Histopathological examination showed features of steatocystoma multiplex. Steatocystoma multiplex is an extremely rare cystic disorder of pilosebaceous units. Although previously regarded as an inherited autosomal dominant disorder, sporadic cases have been reported.

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