'

/

SruiNA..'t 0!1 TlruORS Of THE SKIN

SOUTH CEJITiiAL REGION COT! FGE OF Al[E!UCAN PATHOL..GISTS

HISSOURI PATHOLOGICAL SOCIETY

S1' . LOU IS. ?ATHOLOGl C,\1. SOCIETY

conduct-ed at

ST . :.OUIS u~;_v£.".51TY SCJ:OOi. OF . ::::OlCil:E

>!.~RCH 25, 1950

JP. . :z-sor i3 . !IE!:·r.:-;

AR!.!ED FOilC,ES !NSTITUTB OF PATHOLOGY

VIASH!!!GTON, 0 . C.

CASE l

SEBORRI!EIC KERATOSIS (VeRRUCA SENILIS)

usuall-· sessile an<i ver1·ucous - occas ionally pedunculated .

Cl:!t.racterisUcaU,· located above t;eneral level of epidcr-.:ds - "stuck on" (note .;r ossly on slide.} .

t!a:/ or ma;,• nat be covered with ker:!t.ln and parar:t:rat.in .

Comprised ·Of acanthotic epithelium which surrounds suppor t:.ns cores of connecLive t-issue . Ep:.thelium snO"~s !lO a;>preeiable d7sKerntosia .

Epit.heliu.tn oa,y show none or heavy molanin pigmentati on .

Scatter ed keratin cysts mostly represent-ing invaginat!.on o!' epiderc:is .

Dennal-epideroal junction sharp.

vascularit'' and inflatr.matory cell infiltration in s ubj acent. corium associated with trauma and irri~~on .

~p!lhelial whorls may be L,ereased with irrit-ation.

Practicall~/ never a ";a·ecaneerous" lesion .

Not to be confused with senile keratosis, a distinctly different and entirel y unrelated conoition .

Not to be c:~nfused ~'ith pit.:t:ler.ted basal cell carcinoma, pi{,l!l<!nted nevi nor malignant ~elan~~a .

Dermatosis Jl<lpulosa ni:ra o;:currin:; in neo·oes histole>eieally sim.llar t.> sebor rheic keratosis but. clinical manifest.a~ion ~s diff srent..

Refcr;onces

!!c!'lt.;CCller;~ , H:...Uton: Vorruca Senilis a"ld Kera~oma Senile . Mi.:mgsota !~cd . 18: 735-733, 19J5 ~

Castellani and D~val: Dcm.at.osis Pa;>ulosa 1/i ,;ra . ·\rch . Derm. and Syrh. 18: 39) , 1928.

CASE 2

OO'iEt:•s JIS!!ASE (SQUA!<OUS CELL CI.RCTI<O!L\ IN SITU)

usually an armular or ser pi:;inous solitar., plnque C;r o•tth slow 5 - 35 ;•ears) ..

SurfaCe scales of few o r n-.an;• para!<eratotic ce!.ls and diminished t;r anular layer .

Acanthosis with e~arcenent of rote pe~s .

Disorientation of cells with loss ~r nor=al pro&ressive layers of Cl.aturat.ion.

Scattered at:norma.l individual cell keratinization.

Mit.otic fi,;ures numerous and at. a.l,l depths .

l!ultinucleated cells with •cluq>ine" of nuclei.

Scatter ed vacoolateri epithe:!al cells.

Dilated capillaries and inflammator;· cell infiltration, chiefly 1!11lpnoeyt,ic of upper corium.

PrecnncerJus , often aventuall; developing into 3qanmPas cell car­ci.n:lela . (T!.is •tiew;oint not unanimous . See Acl<erman and Rc.;ato : Cancer , Eel 1 , 1947, 11.3 pp . , c. V. Uosb; Co . , St. Lcuis . )

Chan.;es indistir<euishable from Bowan 1 s disease may be duplicated by senile keratosis, arsenical keratosis and radiation keratosis .

Clinical!!', 8o:"~eo 1 s disease ~· be conf11sed with pooriasis and super­ficial epitheliooatosis ( . ..lllticentrie bnsal cell carcinDllla) .

References

Bowen, J . T . : Prscaneerous Der1"at.osos , J . c .. t . Di~ . 30: 2-.i- 255, !912.

St out , A. P.: Mill0 <:ant !Jooifestat.i~ns of Bowen1 s Disease, rlew Yor k State J . Ucd. 39: 601-809, 19)9.

CASE J

LY!!PHCSARCO!!A (REiiCULU'..! C£1 L S.L'lCO!JA)

Epider~s wit~uL ap~reciable chan~e is elevated over the under ­lyin!) cor lum wnich is infiltrated .. ith t.Uill(>r cells.

A relativel"· noroal thi."i la;;e r of corilll:l is present between the epidermis and tumor .

The tU<llOr cell infiltrate forms a poor l,!' outl ined mass with peripheral extensions .

s atellite twr~r foci pr~minent about adnexa and blood vessels .

T~r cells arc o~nonuciear wi~h oval nuclei and a variable ~~unt of cytoplasm t hat tends to continue into short processes, ~he enti~e pic­ture auggest in& reticullllll cell tYPe•

A1thou0h tho tumer cells s~~w varia•ion among oach other the entire picture i s ~"iiform .

There is liLUe or no fixed tissue reactbn in the vicinity of the tumor cell infiltrate .

Must be differe~tiated from Spie&Ler-fendt sarcoid.

All of the l.¥mrhoblastOJ:Jas may fot·m plaques , nodules and l ocalized diffuse thickening so that. the configuration of tbe infiltr ate in t.he present sect i on is nolo specific for rcticulu.:n CPU sarcCCM or any ot.her l.ype.

With the exce~ion of P.o:Jokin1s d~sease nnd "'.7Cosis fun.:oides , there is us uall;; no appr eciable fixed tissue re:tction in the vicinity of t.he tut:'!or cells . In benl:;n focal ~-:nphoid hyperplasia f ollow inc insect bite, vaccin.1tion , etc . there is usually s~me degree of f ixed tissue react ion.

References

Gates , o.: Cutaneous Tut!lors in Leul:emia and I.,;;::~phonla , Ar ch. Dera . & 5~~~ - 37: 1015, 1938.

Warren, s·. , and Picena, J . P.: Reticulum C.;ll Snreo.:~a of L,ya;:h aodes , A.... J . Path. , 17: J$5-394, 1941.

Lewis , C. M. : Is Spiegler-Pendt Sarcoid a Clinical or Histolo&ic Entitr? Arch . oer'-1 • & S;;;:h., 31: 67 , 1935.

CASE 4

The epkenni s .:s elevated over a n;ass of t.uoor c ells witr.in the co:--iu:.

At. =r,;b of nodule aricerois shows n~·perke:-atosis, aea.~~!-.csis and elongation of rete p<!(;S a."ld cent !'ally at.roph;t, hyperker a•osis and -parake=-atvsis .

!::filtrat.bn of t.w::or cells aboct blood vessels a.'ld ad..,e.:m.

!~r cells oenerally free~ an~clated cr ~.d, larba , W:..th Cist.,net.!;., outlined pale cytoplas~ and moderateLy large ro~nd or oval so~et.imes indented nc.ciei. !.!itcses coro.,.:m.

E;" .. t.:.rs t...t::Or infilt.rat.e decidedly constant ( .... suallJ t;;.iea- of l eukeoia) .

T;, pe of leu.'<e.-:oia depe:1ds on identification of cells and tD<tcl\ smears of lesions Dbtained by biopsy are of value.

Ai!.t:o-J,&.~ pleomorphisll of i.ucor ce:!.ls is r:-resent t.he cve~ill picture i'l 11niform and in c;>nt.rast to the ~.ide va:riet.;1 of cells seen in benign focal l.:,..::iph.~id nyper11lasia associate<i ~it.h .L"'lSect bites, e!.c .

~cos:S fur~oides csuall; shows Pa~tr~e~•s nnscesses {co_lecticns of monoc;"t:oid cells in upr.er epiderods) e.s well ns a pleooo r;Jhic cell .:.ni'ilt.rate.

~.;n focal lyephoid h!'l'8rrlnsi.a osua:~ sh.:nos :>.lt.l'! ret:c~ar ac.d J.yophocytic cells and cccasiciUlly pri::Jar~: and secondary nodules of lynpJ:oid 1.issue.

Rc.l' e.:-ences

17:0er, t . H. : ll:icosis F.!l'-<:.oides, Arch. Dora . & Syph. )6: 1.80-495, 19!.2 ..

!l./~cr , 11. R. ar.d Nctr.erton., E. r.. : C.;tr:r.eoas 1!:..-..:.!"esta·~o,:; c: !&:>~•~~ C;tt..:c LcJ. .. eda. ~~"<:h. [)m-_.. & S;;,:h . 56: ?0--8? , 191.7 •

Sc.n.e~r,, F. s. ood CG.I·o, !.!. :t.: Ulcerative 1iodol~in 's Dls~ase r f the Skin. hl"C!t. 0\ll"- · & S;;,.ll. J5: L;.- l2B , :..9J7.

,

CASE 6

KAP0SI ' S DISEASE

u.,.-.i.fests itsel f .nest often in the skin,

Red ~o ;:urple nodules IU!d ;Uaques, ~•uaUs multiple and e,.-oo:ped.

p,~ference r~r u; per ~~d espec~ l~~er a~ramities ~ith greatest manifest ation near joints.

~icroscorically small nodules poorly outlined and lar:er nodules sometkes circwnscr ibed .

T .. co' features of we:l developed :~odule . ;. . S~oi• :;le shaped cells pr obabl•· fibr oblasts often arr.an.:;ed parallel and ~o<:eti<::es in in"Ler­l aciJie bundles . B. Sl il!i l:a s inuses often .filled wit h blood lyiJie between the spindle shaped cells .

S..~l l esions inclcfi.~ite and marked .b"' capillar .;- ond()th~;~lial prolif­erat..ion and 1.,;-mphoc~oid cells.

Mus~ be differentiated f r om sclerosin,; hemaneioa:a ( c!crmntofibro.~a) , o,ranw.cma ~:.·o~enicv.m., nor::- spec-i fie ..;ranU:o::a ., hetna!\';ioperic;"toaa and heman.e i o-endot:teliamn.

Vi scera, especially t.he :;as~ro-i!'ltestinal tract , ma;- show il!voh.,.,ent. .

Pr~ess sometimes inv~lves con~unctiva .

References

1-.r ch . P:.th . ;2: 764- 786, 1941.

C!:oisser, R. L{, nod R=sey, E. &!. : :~-:.;!.oreticuloendothelioma ( Kaposi•s Di sease ) of the lleart. . A ..•• J . P::th . 155-177, 1939.

I

•

CASE 7

D::::RI!.'JOF:BRll!A (SCI.ER'IS2<C HE>l4llGIO!(.\ . l<O!"iJL!Jl SUB­

EP!DEFI!{.'J. F!Bi!OSIS . H!ST!OC!'l'OliAS

!los t co:n.non on lm-rer extre=~it.ies but ma;· occur on a.'!? part of skin stirface , Involve chief!; · the cor ium bur- may extend into subcut.aneoos f at .

At first sma.ll but ma;r become a centimeter or more in di:;:oet.er and re­~in stationary and non~qcapsulated .

All shades of color clinicall;· and gNssly.

surr,.ce usun.Uy fl3t or he;:rl.spher ical and rarel y pedunculated .

Histolo~icilll; picture~; var;• fr~ rela'ivaly avascular fibrcblas•ic tissue which is sometimes arranged in ln~ e rlacing bands or radically about a central point to a cisorcerly tt.arkedly vascular lesi~n comp1·ised of curly shaped i!'!ldotnolial like cells a r r DJJged nbout occult. or ob;·ious lua~ns Mong "hich G>ay be nw::erous hist:.:>cyt;,s f iliad with lipoid , hemosiderin and a brown pisment , proo-•bl y '' lipochron:e .

Les ion l!I!IY ~b"w multinucl ent. ed ,::innt cells but t hese do not indicat-e mali~:nant chanee .

Los lon.often mistaken clinically and :!Or.lll~imes path:>lo(;ically f or mal!gnnnt <!Gla."lOll'.a .

Wet to be confused with fibr~sarcom~ or Ka~osi' s disease.

Le~ ions ca.;· rec<Jr and locally inf il \.rate .

Pr obabl;r closel:· r elated :..1) dermatofibros•rcar.m prot uber ans .

Uust b~ differentL,~ed fr~ neurofibr ooa and ri&1~1ted nevus ,

Ref er ences

Reat 'iers , P. L. and Hontgomery , i! .: !Joddar s .. be,-idermal Fi br,sis . (Dor=to~ibr"'-"" Versus Hi st.iocrt,aa) .<rch. ~r:. . & S;;;:.h. 59: 568-58), 1949 • Gross, R. E. Md i/Olbach, S . S. : Sclerosing Hc=n,:;ix.as : Their F..ela~iD"­ship to Oe:-.cato!'ibrcm..~ , lii!:t.ioc,:,-tor.ta , Y..a.nthcmn P...nd to Cart a in Pio,..crrt.ed l.,oslons of ~he g ,;.:.n . A:J, . ,J . ?:.th . 19,: 533- 551, 191,).

""! .-,b,,., •. r... 1"1' ne rtoat.of:._br!)sarcctna Prot.ubera.'ls ; Hepo:-t of six Cc~es .

OJ\SE 8

DER:L\L GLC!'US TlruOR

Derived f ro.n the nourotr;ya-.artc rial Jlomus .

Located mainl :· in the t·et ic ular zone of the der;:rls .

us~ill:.- thin but occasional!:· thick connectcive tissue capsules .

Histolocic pattern shows mar ked variation in dif fer ent l esions .

;. . V~sels may be small , t hick , SUITounded b;• masses of &].o.:!us cells and soruetimes separated b;· s::-cma sho·r;.inz str~ing cucoid degeneration.

-a. Vess els Ilia!' be lnrge, ane.iomat ous nnd surrounded by a fe-.• or mult i ple layers of clo:!<IS cell s . (T •• cse tueors S!>r.tet:..Ces Called ;;l<>'!!<"lllgiOClas . )

C. \'es-s~ls , disorderly a.rr~t;:ed , o.ay hove VP.rious sized lume:1:1 sw-­r ounded by smooth .. .uocle llke ~ells which o.re c.>ntlnu~us with sicil'll' cells of t !le tumor. (,'lleso lesions have been called cutaneous l eiomyoma and anzio:ny<lc.a . )

Vessel s usually lined b;• sint:h ondotneliAl la;>er .

Gl!l.:lus cells char acterized bs distinc~ outlines, pale nmrttoptltii.c sooe­tim~s vac~ola~ed c;~opldsm and central!~ s ituated r ound chromatic nuclei .

Kcr:-.:~:,·o1inated nerves particubrl;• in peri ph.,r ;· of tuo:or evident by specific s ilver pr.?P<>.rat.ions .

Tf.e s~ so~ tuoor s are most frequent in the digits nnd ere Lhe m~st painful .

1he ~lomaneiomas a~e mosc frequen~ on the extr~iiies and oecasionall7 are of painful character.

!he ;-,l:>:~ar>sio=>yo=s show a scattered distribution and aro tho l easlo often pninflll .

References

Stout , 1\ .r. : T ..aors of the II eurom.;·o-arter ial Glo.::us . i-. J . C;-.ncer , 24: 255-272, 19)5 . ~sson, P. : Los QlQnuS Cut aneS de l'hn~e, 9~1 . Soc . Fr~c de dercat­et s;-;Jl . 42: ~171.-12!.5, 1935. Popoff, !1 .''1 .: The Digit al V.::.scular Sy~tem . Arch . P<.tl: . 18: 2J5, 19)... . s t out . A . P. : Solitary CutaneDUS anct Sut~eutane!>US te.:.oc~·oma . ...... J ' Cancer. 29: 4)5-1..69, 1937. Bai.l.ey, o-. T . : The Cutaneous G. omus and its 'l't~.t.ors - GlOO!llr.,;iomas . W:... J . l'cth . ll: )!5-935, 19J5.

CASE 9

R'.Sl.L CELL CA!tCINOM1\

A distorted and a t rophic epi dormis •i s eleva~~d over a ~wr.or loc~ted in th~ upper cQrium,

The tucor is c~mposed of irrtercommunicatL~g masses of basel-like cell s wh~ch centrall y s how en irregu.hr but sor.~et.imes parallel pattern a.~d per~pherally usually a palisaded st ructt.tre .

Seve ral of the mor e isoloted masses of t~or show a central cystic focus p>...r< ially filled with pink and blue stnining cellular debris. . Else>~here ther e are small ••horled foci of cells, sooeti.Gies contAining melanin ;>igcent, with one or mor e centr L r ed s t aining pa:-ak&r atoti<: cells . 111 a few arc.'ls the t.u::or cells a~e la~g"r a11d have clear cyto­pla.so. This organoid appearanc e is int-erpreted as probably mimicking th<> hir folliclil a.'ld possibly the sebaceous gland.

Parakere~otic f oci may be sean in most basal eel! carcinomas and soma­times it i• a pro~L~~nt f~ature . I~ is not indic3tiva of basal-sq~o~~cs cell carcinoma and thes& lesions d o not motastas ize.

Not to be conf used wltJ , ~he clini cal ar.d pathologic ont.ity of "Epithe­li"ma Adcnoides Cyst icwn" described by Prooka.

R~;forences

Br ooke , H. C. : Epi•heli~ma Adenoldes Cystic~. B~it . • • Dero. , 4: 269-2S6, 1392.

Krompeckar , E. : oer Bnsalzel lcnkr cbs . C. Fisher , Jena, 1903.

Foot, N. c. : Adnexal Csrcioo~a ?f t.he Skin. l9b.7 ,

1~ . ~ . Path. 23: 1- 27,

flontgome.ry, H. : Hi stogF..nesis of Basal -cell Epithelioma . Radiology, 25: 8-23, 1935.

Lever , W. : Pathogenosis of Benign Tumors of Cutaneous Appondagas and of Basal C~ll Epitheli oma. Arch . Darm. ~ Syph. 57: 679-72£, 19~8 .

Teloh, !! . A. and t.heeloc><, M.c .: Histl gcnesis of Basal C~ll Carcinom.n, ,\rch , Path . 48: 1.4?-461 , 19W . '

CASE 10

? DlAG!IOSIS

ror~-~~~ ~th atropn] and desenaration oi fa• a~d reactiv~ ectasia of c,pillarics and thronbosis .

7he c;:iderc!s shows cllrl ncanthosi$ and h;•perttera.tosisJ ehant:e:s which ars non-5pecific • •

. ~ ic>< 1;-.::;:h:x:;t.es surro.l!\a the bl~d vessels in the upper cerium ~d botb tho arterioles and venules of the cnt.ire c:>riu:; ara dilated.

Accom;mn~ed b; swilllin;; cf th., perivascular cells (? !JOricyt.es ).

Tne =est str~~ cbansa is ~-JSast L~ the subcuti~ where the fat and blood vessels are great.ly altrrerl .

In the absence of a specific st~ for fat it is ass~ed that the clear spaces are fat cells . l.!<.r.~· fat. cills have underso:1e at:-op..,;· or dege!'!era:.i.l!'l accO<Dpanied !:>;r di.latat~n c.f the capllle.ry boo, some fixed tissue r~action a.'ld iniiltrati:m ef scattered piiogocyt.ic histh'<:yt..s , l!srv· of the bl:):>d ,·essels sholl thr"c.bos:.s .

On U:e basis <>f speculation it is su._.c;ested that 1-hr- cM:\;;es i."t the !a~ a-'"'E seco:tdary t.:> tb:: thr:>cl>oses . The t.f\.rcr.boses in the small vessel s may be secon<lary to ve~us throt;bcsis ot larc,er drainlng veins ><hieh ll!ls bee.-. induced by the r::-cc;nan:::y . !nc : ..... ~on a;Jpears benign.

C,\SE ll

DER!!AL f!JUWl'fOMA (EPill'!lELIJll. NEVUS )

Hyper plasia of the epithelial cells of the e~cermis and der~\1 appendages .

Lesi on mny be pr~sent at birth or appear later in life and of ten show a her editary fac~or •

Lesi on may be a localized pat.cb or: i."lvoh'e a particular anatocJ.c part such as t;he antire l ength of an elCt. r enlity.

Hisvlogically a verrucous or papi.Uar y proliferation of tbo epi der mi s , irr eguJ.ar acanthos i s and f r equently an incr ease i.d t he s kin appendages, particularl y t he sebaceous glands .

Les i on ~ay be as sociated ~ith increased vascularity and increased st.romn.

Lesion may show extensive hypc~keratosis ar~ c~ed,ne for¢ation .

Part. icularly 1f lesion i s bcalize<i as in the scatp may be irritated and show evidence of inf~ation, folli culi tis and pseudo-epithdliomatous hyperplasia. '!'he pseudo~pitheliomatous h,r~rplllsia a.ust he di!'f~•·M­t.iat ed fr01:1 squamous cell carcinoma.

l!ust be di~fere:ttiatcd froo senile keratosis, seborr heic keratosis and verruca. vulgar is .

I Lesion rarely if ever devel~ps into c~~cinamA.

Varia~ions r efer red to by dermatologists :1s nevus unius .laterali s, novl!S anilatol'alis comedonicus, nevus l inearis , ha1·d ne\'ue (Unna ) and epider·modysplasia ·1er ruciformis •

• References

i'iais lllbll, J.l , and Hontgor.>el-y; H.: V ~t-ruca Pl..na and Epi~helial Nevus ; Including a study of ;,;pi der aooysplasia Verruciformis . ~.reb . Oer JL. & Syph. 45: 259, 1942,

JUV::lrrtE liEVUS

Ei=ti<!er.::i.s c~\reri-<tG :l nt"tw~ c;:,..herie£-2. tu,.lt:>r nodul.e snjws bot.h at.rcph;"' a:td. c.arked aca.:1t~osis with clof\.,at.ed r-et.e pe&s deep am.on..; tho twnor .

T:.e ~~icer;.:~ 3;."U! ;::::.r!..!.-c\..!c.r :1 lne el~nc;:.t. ed r et c pe;;.s oft. en show interruption of the basal cell !;·e b;· :1est;S :>f ~=~r cells k.~;-;!S

.:~!..:.::) (.}...r.c.t:e:: c~·::..s ~r C.er...zl-cpi~er~;al nevus) .

T.-or cells ~end t.o b.:: dist.!.r.z:. :.nt! !#D ••. £t.!;es s;;>.:lriJ:;. ~,;ti !rx: c;;!.Ce::-­cal cells .

i"-cr c6..-!.s ~!:er. ..::::-:.t:c,e:i .:..n .:rrf.;~-u.J.ar clu!ttcrs , t.er.d t::> be !.~rGe , spindle shaped or plucp with ~_;enerally lar;o:e round or oval nuclei ld ~h O!stinct nacleoii .

T~..or ce!ls ;:..;:;.;; or ;.::,.:; :-.ot be d:ste:'lced .li:h fine brown pi.;:ont. .

G~oss calor v~r~~ e.

Jow~.re,c.;!.,l~ r. ... v~ ~~ .. tJ- De c:Jr..:.~t:Sed 'dith jav<..,.: le Y.:L."'lthcn'.a (oc ;.:J;:Gr.~ •• o­andothe!io~~)~~d ~:caria pi~en~~:a .

Tt.e p:eSW\t:t; ef' .;::::t ce.:1ls is re~rC'..:d by Spitz .:.s an inc!l~ot..l.on the leslon is b~~ioC.

Rei ercr.ces

We~~~, J . P.; s~~vcnsor. , T. W. ; ~n~ SLaut, ~ . P . : The Sur&icul 1re.::.~er.t. of Uuli~ }t-..l.Jl.)~S of t.t.e S"~.n . s. ~~. ::o:-~t.~. , ~: 3·~-J~) , :9-- ·

Ser.~, F. X.>r.tho::!.l .

3. ~rl c.ro, U.R.: t;cvo#-:~th~-~-~ciotnc...!~c. . .:l :)r J~ . u.llc A.l·c!. , o.,r_, & Sy,_.·. . ~: .:.95-206, 19;3!> .

FiMu--.. :! , c. - .: Ur:.i=io Pi,..~r.t.os'- (l\od<.~l::r T,po) ·.li~h A Su.-~r;; of thu L.i.t.cr .... t.~.o.rc . ~xc!i . Dcr- . !t S;,~.. 8 :- >-, .:.<;:J.

NEURONEVUS

£f..ider mio elevated over ttlt.lor nodule located chiefly :.n tho coriwn. so.~e lesions of this type !!l'a fl.:>t .

E;..iC.e:-.:is over tu__:>r sf:.V\JS :!cant.hos is , h;rperker:"ltosis , o.nd patchy pnrakeratos is . T·'"~o cJ:o.c.r..,;e. r.::t c,..cci£ !.c end not co:~stant .

r .... or coopo3ed of ~pin<!le sh:.ped cells wit h f usi.t'orm nuclei, ill de.t'ined coli outlines a."Id a variabl e amount o.t' ~olnni.n P'-&mont .

C<l.ll s sooot:.Oes •u::.v~·, sonet~-nes llrranccd in pz:.ralle l f ashion and somet:iJ!les whorled but this t !'PO of lodon practically alwa;'s shows some areos in which individual cells or zr oups of cells are separated by r ichly colla&enous str oma.

!,cs i on i:UJ.;! extend into the s ubcutis .

l\ few nests of r~.1t1d a.r..d poly0 tJna.l nevus cells t:}!J,;.. be present but junction nevus cel.l.s are absent 01' min ir.uU. .

M.Uti :wclo:;.tcd ce...l~ .:.tJ.3 be present but these do not indicate "'"lignMt change .

$.Jae ~esiD~ .::e Censcls pid=e:ttaC and others practical2.~· without pl.&ment. .

R00 <ordleSG of s i ze (l!lC. ~:\.~tiSion into the subcutiS t.he l esion is benign.

l~G.;;· ccc-J.r ~.n:.:lJhcrc on skin su,rf cc c but. :.s co~on and scoet.imes l arge in the sacr~~ area .

Not to Od confused w.:..~h C:!.li.;r=t cel.:>.!ll>ca, ce::-r.:alof~br:>ma, and n~ro.t' ibr :lela .

t!~ntgc.:.er~~, H. uoc! Koh:cr • J .E.: -The Blue t1vxus (Je.~ss~hn-Ti~ehe) . ~·· J . Cnnc~r, 36: 527-539, l9J9.

Acl:er.n:;n , L . <l:ld Rus-.t.o, J . dol. : Cc.11ccr Dil:;,nosls , Tr ectt.Jont and Prosnosis . Eel . l , St . L<>Uis. l 947. C. V . l~os~;, Co., p . 170 .

CASE: lJ..

~idermis contaL~s einzl~ and eroups of mel~~~~~ cell~ wh~ch L~ proo~unccd ;'J.I'C3S are associated wi~h opiden-..al ai.r oph;;, ac,nthosis and papillar)• 9rolongatbn of r~te pegs , llfid parakeratotic pLaques witb oe lanin .

J!elanoma calls are l a r (;e , var iable i n shape wit.h l :?.rge nuclei and nucleoli .

I n ma1~ areas oelanoaa cells show l oss of cohesiveness nnd are separated fr:>r- each i)ther , Tt~s is :L'l iTo!)~rtant. ohser vat ion.

~:~...;:n~::la cells heavll;- l'i&•ented but this chan&e is not related t o d% ree of malignancy. .

so,lle cells appear within lymphatics but. even lfit.h~ut this observation t his l esion s hould be call~d ~~lignant. .

Some cells show mito~ie Ii~ure:s . 1~it..:>tic f isTJr es are r:'\re in beni£=1 nevi , particularly in the absence of t r;aur-.a or infection.

Must be diffClrent i ated from piwnented multi.cen~ric basal cell carcino::~a, heavily pigr.:entad seborrheic kerat.osis , DD\-:en' ~ disoc1a,se ~ ?~t:t 1 s d.l.seaSE dermatofibroma, i ntra-opidormal epithelioma of J~d-1ssohn and nearonevus .

uost ·,.llgnant. melanomas show dPru.al-epiderr.al or junction ch'Ul_!;e but this change without plaooor phism jf cells, ~i.totic figur~s and loss of cohesiveness of cells does no~ ~~ke a maligr.ant tw=or .

References

Aek~r:oan , L. V. : ' \ali;;na:11. Uelanccm of the SfiL'1 . 18: 602-624 , 1948.

J • Clln. P:lth .

All~, A. C.: A Reorientation on the Histo~enosis and Cl inical Si 0-niiicance o f Cutaneous Nevi and l!el!lnomas , C...ncer , 2.: 28-56, 1949.

lo!ont;:;omer·y, 11 . end Kernohan , J . 1/1 . : P~.,.:>ented Nevi with Special Studies Reoardine a P:>ssihle Neuro-e~ ith,litll Ori;;in of t:cwus Cells . J . Ihvest . Dormat. . J : 1.65-~91, 1940 .

TraQb , E. F. ~d Kui! , H. : Relations and ~;he Q.1est icn s,~h· 41: 214-252, 194o~

The nccc.-:ton t!o.lc" l ts Cl ir.icopa~holocic of Mn.lignant Dc,;etH:!l·ation.. ,\.1·ch. Derm. &

CASB 15

BUSTOi.!YCOSIS l;:rt'H

PSSIDOEl'ITHELIOUA'fOUS I!YPLRPL/.Sif.

The "¢cer .:lis sh:>ws profound acanth.>s is with r.he interpaplllary peus exte.nc!in:; d~eply and irr egular ly into the corium nnd ::.iaicking ca1·clnoma .

The surf' ace epider.:U.s also shOi-IS ulceration anti parakcrat;:,sis , ~~ang"s which sr~ non-specific .

The diaenosis of bhs~""*'cosis in t his case is ooviou.s because ol' the budding blastomcvcetic cells .

As a t;eneral nlle .in t.he m;rcjt ic granu..Lomas., even if the oreanisms are so scar<:c as to escnpe dctect.ion ., t..ho pl"·esence of suppt.;.rnt i·1~ or grruul010.1tous infla;r.mation and cpi<!or,'tlal hyperpl<!sla f a,·ors a .nycotic infection rather than carcino~ .

Poreil:'l body ~;iant cells in rdalion to oquar.Jous 9pitholiu:o favor a benign diagnosis in t he ab5ence of radia~ion therapy .

Pseudoep~theliooatous hyperplasia always arpears as squ~~ou~ hyper­p:~sia' exc~pt occasijnally abouL hntr fol licles where ~he appearance is cot·e basal in t.yp<~ .

Fseudoe;:i.Lhelio::vttous h; per ;:lasill m~· be produced t>~· .-.any different proc-esses . Qt,o _ust al·•ays bo :>n the alert for th~-::.. ;:;..;u::pleJS are m!rCet.ic eranulrr!.aS. granu.loma L~ale, bro,nide :;ranulontlS J chronic draining s inuses and epid.;rc;al inclusion c;·sts .

References

Vlu•er, 1., . h .: Pseudoe,.i~helioa.atous Hy;.crplasia, ;.rch. Dc.r.:n . & Syph. 42: 856-867, - 91.2 .

B...ker , R. D.: Tissue R~ct.ions ln Hu..~"'l ~l....st.c .. ;rc~is, A- . J . ? .. 1..h . 18 : - 79, 1942.

Ct.SE .16

;. circur.scribcd but non-encapsulated <O.ass of tw::or cells which sh~K many variati~ns .

Basically vascular tumors but somet:Unes lumens only ~~ential .

Al"ays each capillary surrounddd by a connective tissue sheath, ~ut­side of which a r e the tumor cells (sheath best dcmonsua.ted by a s U ,•er coru:ec•ive tissue stain) . (This is the one co:~stant f eatur e or the tumor . )

Tumor calls vvy i n she and shape .

T=or cells fill ent ire space bet.t<e(lll capillnry sheaths .

Differentiated f r om h~~ioendothelioma in which the tuoor calls occur in~ice the capillary shtath.

!.!ust be diff erentiatcd fr"" enbcr ine t w.ors .

Le,.ion is not lid. ted to the skin o.nd ::my he primar;r i.n other organs .

Ref erenccs

St out, A. P. and !lul'l'n;r, U. R. : He. . .an,,ioper ic~·t~ma . An!h Sur;; . 116: 26-33, 1942.

St out. , A. P . : flc:n;muioper lcyt.o.:m. A Study of Tv11mty-five rr~w C<oses , ~cer, 2: 10:<!7-10;1,, 1949.