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Sampling of interestingSampling of interesting

dermatopathology cases from CUMCdermatopathology cases from CUMC

Deba P Sarma, MDDeba P Sarma, MD

Director of DermatopathologyDirector of Dermatopathology

CUMC PathologyCUMC Pathology

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Dermatopathology published reportsDermatopathology published reportsfrom CUMC Pathology,from CUMC Pathology,

2006 to 20102006 to 2010

Total: 71Total: 71

Pubmed indexed: 22Pubmed indexed: 22

NonNon--Pubmed indexed: 49Pubmed indexed: 49

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Case 1Case 1

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Case PresentationCase Presentation

F 55, obese.F 55, obese.

44--month history of hemorrhagic dischargemonth history of hemorrhagic discharge

from the umbilicus.from the umbilicus. Deep from the base of the umbilicus, a 0.8Deep from the base of the umbilicus, a 0.8

cm graycm gray--tan mass was removed.tan mass was removed.

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MicroscopicMicroscopic

H&E: Refractile bean-shaped and elongated colorless

structures (lint), keratin material, granular red debris,

hair fragments and neutrophils

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Under polarized light, lint particles show brilliant blue-

green birefringence

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DiagnosisDiagnosis

Lint ball omphalitis

Ref:Sarma DP, Teruya B (2009). Lint ball omphalitis, a rare cause ofumbilical discharge in an adult woman: a case report. Cases J 2:7785 PMID:19830013. [Pubmed- indexed for MEDLINE].

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Umbilical dischargeUmbilical discharge

Congenital:Congenital: Patent urachus, urachal cyst or sinus,Patent urachus, urachal cyst or sinus,

patent vitelline duct, vitelline cystpatent vitelline duct, vitelline cyst

Acquired:Acquired: Pilonidal sinus disease, infection due to hairPilonidal sinus disease, infection due to hair

tufts and foreign bodies, nontufts and foreign bodies, non--specific inflammation and veryspecific inflammation and veryrarely endometriosis and metastatic carcinoma.rarely endometriosis and metastatic carcinoma.

Most common:Most common:

Foreign bodyForeign body--induced omphalitisinduced omphalitis

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Foreign bodyForeign body--induced omphalitisinduced omphalitis

Hair ball omphalitis:Hair ball omphalitis: Most common.Most common.

Mostly in young, hairy male with deep umbilicusMostly in young, hairy male with deep umbilicuswith poor personal hygiene.with poor personal hygiene.

Old toilet paper omphalitisOld toilet paper omphalitis in a 47in a 47--yearyear--oldoldobese female.(One case)obese female.(One case)

My addition:My addition:

Lint ball omphalitisLint ball omphalitis

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Lint ball omphalitisLint ball omphalitis

BellyBelly--button lint or Navel fuzz is quitebutton lint or Navel fuzz is quitecommon among hairy man.common among hairy man.

Washed off during bathing or shower.Washed off during bathing or shower.

Rarely does it cause any inflammation.Rarely does it cause any inflammation.

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How does the lint get into theHow does the lint get into theumbilicus?umbilicus?

Steinhausers hypothesis:Steinhausers hypothesis:Abdominal hair is responsible for directing the fibersAbdominal hair is responsible for directing the fibersfrom clothes into the navel.from clothes into the navel.

Shaving abdominal hair can prevent lint accumulationShaving abdominal hair can prevent lint accumulationin the umbilicus.in the umbilicus.

Ref:Ref:

Steinhauser G: The nature of navelSteinhauser G: The nature of navelfluff. Med Hypotheses. 2009,fluff. Med Hypotheses. 2009,72(6):62372(6):623--5. PMID: 192310875. PMID: 19231087[PubMed[PubMed -- indexed for MEDLINE]indexed for MEDLINE]

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Case 2Case 2

5050--yearyear--old manold man

Clinical cyst removed from scalpClinical cyst removed from scalp

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RCC immunostainRCC immunostain

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DiagnosisDiagnosis

Implantation carcinoma of the scalpImplantation carcinoma of the scalpfrom renal cell carcinomafrom renal cell carcinoma

Ref:Ref:

Sarma DP, Wang JF, McAllister MV, Wang B, Shehan JM.Sarma DP, Wang JF, McAllister MV, Wang B, Shehan JM.(2008)(2008) Possible implantation carcinoma of the scalpPossible implantation carcinoma of the scalpfollowing craniotomy for metastatic renal cell carcinoma.following craniotomy for metastatic renal cell carcinoma.Dermatology Online J 14(6):20.Dermatology Online J 14(6):20. PMID: 18713600PMID: 18713600[PubMed[PubMed -- indexed for MEDLINE]indexed for MEDLINE]

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CommentComment

Renal cell carcinoma (L) resected five yearsRenal cell carcinoma (L) resected five yearsearlier.earlier.

Craniotomy for resection of a singleCraniotomy for resection of a single

metastatic tumor nodule, 19 months earlier.metastatic tumor nodule, 19 months earlier. No other systemic metastasis.No other systemic metastasis.

Partially cystic nodule in the craniotomy scarPartially cystic nodule in the craniotomy scar

at presentation.at presentation.

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Renal cell carcinoma may metastasize to theRenal cell carcinoma may metastasize to theskin in 3skin in 3--11 percent of cases, mostly in the11 percent of cases, mostly in thehead and neck.head and neck.

Clinical: Dermal nodule, cyst or pyogenicClinical: Dermal nodule, cyst or pyogenicgranuloma.granuloma.

Implantation carcinoma may arise withinImplantation carcinoma may arise withinscars, incision sites, and hand portscars, incision sites, and hand port--sites usedsites usedfor laparoscopic nephrectomy for renal cellfor laparoscopic nephrectomy for renal cellcarcinoma.carcinoma.

Preferential localization of metastasizingPreferential localization of metastasizingcancer cells to a scar is also possible.cancer cells to a scar is also possible.

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M 44 of Chinese heritage who had red handsM 44 of Chinese heritage who had red handssince birth.since birth.

His 74His 74--yearyear--old mother and 7old mother and 7--yearyear--oldold

daughter also had bright red palms all theirdaughter also had bright red palms all theirlife.life.

Case 3

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Diagnosis:Diagnosis:

Erythema palmare hereditariumErythema palmare hereditarium

(Red palm disease)(Red palm disease)

(Lanes disease)(Lanes disease)

Ref:Ref: Sarma DP, Wang B (2007).Sarma DP, Wang B (2007). Erythema palmareErythema palmare

hereditarium (Red palms): Lanes Disease.hereditarium (Red palms): Lanes Disease.Dermatol Online J. 13(2).Dermatol Online J. 13(2). PMID: 17498447PMID: 17498447[PubMed[PubMed -- indexed for MEDLINE]indexed for MEDLINE]

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CommentComment

1929: Dr. John E Lane gave the name 'Erythema1929: Dr. John E Lane gave the name 'ErythemaPalmare Hereditarium (Red

Palms).

Palmare Hereditarium (Red

Palms).

The first patient, M 51 and one of his two sistersThe first patient, M 51 and one of his two sistershad red palms all their life.had red palms all their life.

Second patient, M 69 and one of his sisters, and hisSecond patient, M 69 and one of his sisters, and his

father had the same condition.father had the same condition. Autosomal dominant pattern.Autosomal dominant pattern.

A PubMed search for English literature: 0 article.A PubMed search for English literature: 0 article.

Several articles written in French, Italian, andSeveral articles written in French, Italian, andGerman.German.

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5858--yearyear--old man with left kneeold man with left kneedislocation with neurovascular injurydislocation with neurovascular injury

in 1968.in 1968.

Left below the knee amputation, fittedLeft below the knee amputation, fittedwith an artificial leg.with an artificial leg.

36 years later in 2004, pain at the36 years later in 2004, pain at theamputation site, mass, foul discharge.amputation site, mass, foul discharge.

Case 4

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Dilated poreDilated pore

Dr WinerDr Winer

Red wine glassRed wine glass

Case 5

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Ref:

The Internet Journal of Dermatology 2009 : Volume 7

Number 2

Dilated Pore of Winer, Dr. Louis H Winer and Wine Glass

Deba P. Sarma M.D.Department of Pathology Creighton University Medical

Center Omaha, NE, USA

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Case 6Case 6