This education series for dermatologists is presented by the Weill Cornell Comprehensive Dermatopathology Service.
Case 1.
A 60-year-old man presented with a chest nodule. The biopsy showed a spindle cell proliferation that is of moderate to high cellularity assuming an intersecting vesicular growth pattern within the dermis. There was a grenz zone that separates the proliferation from the overlying epidermis (Figures A-D).
a. Spindle cell squamous cell carcinoma
b. Leiomyosarcoma
c. Atypical fibroxanthoma
d. Leiomyoma
Case 2.
A 70-year-old man presented with an upper arm lesion (Figures A-D).
a. Hemangioma
b. Kaposi sarcoma
c. Aneurysmal fibrous histiocytoma
d. Angiosarcoma
Case 3.
A 78-year-old man presented with a right big toe painful nodule (Figures A-C).
a. Calcium pyrophosphate crystal deposition disease
b. Methyl methacrylate
c. Talc
d. Gouty tophus
To learn the answers, go to page 2.
Quiz Answers
Case 1 - B
Leiomyosarcoma
The findings are diagnostic of a well-differentiated atypical leiomyomatous tumor. Based on the extent of cytologic atypia, mitotic activity, and Ki-67 proliferation index, this lesion is best treated and categorized as a leiomyosarcoma. This would be a probable superficial variant of presumptive origin from the arrector pili muscle. Some authors have argued that these lesions should perhaps be designated as atypical leiomatous tumors because their biological course is one associated only with local disease without metastatic potential. It is well known that these lesions do have a cognate morphology to their benign counterparts; however, it is the pleomorphism and mitotic activity that would separate this lesion from a leiomyoma. The differential diagnosis would encompass a symplastic leiomyoma; however, the overall degree of cellularity and mitotic activity would not support this particular designation.
Case 2 - B
Kaposi Sarcoma
Kaposi sarcoma is an human herpesvirus 8 driven angioproliferative disease. Four types are described and include classic form, endemic, iatrogenic (typically arising in the setting of immunosuppressive drug therapy), and AIDS-associated. Clinically, the lesions can appear red/blue or brown and assume the form of a macule, plaque, or nodule. The microscopic appearance is variable and can range from irregular, dissecting vascular channels to sheets of epithelioid or spindled cells with slit-like spaces, attendant red blood cell (RBC) extravasation, and occasional vascular lumens. Periodic acid–Schiff positive hyaline globules (representing RBC degradation products) and a lymphoplasmacytic infiltrate are also commonly seen.
Case 3 - D
Gouty Tophus
Monosodium urate deposition disease/gout is characterized by extracellular fluid deposits that range from tiny to massive, typically assuming a dermal or subcutaneous location. The clinical presentation can include tophaceous deposits, uric acid kidney stones, recurrent inflammatory arthritis, chronic arthritis, or chronic nephropathy. Fixation in alcohol preserves the sodium urate monohydrate crystals. The crystals appear needle-shaped and demonstrate negative birefringence when polarized. Formalin fixation is avoided if one wishes to see the crystals because formalin dissolves them and the deposits appear as amorphous pink areas. While not seen in this case, gouty tophi are frequently associated with a foreign body type giant cell.
Dr Magro is the director of dermatopathology at Weill Cornell Medicine in New York, NY. For more information, please visit www.weillcornelldermpath.com.
Disclosure: The author reports no relevant financial relationships
This education series for dermatologists is presented by the Weill Cornell Comprehensive Dermatopathology Service.
Case 1.
A 60-year-old man presented with a chest nodule. The biopsy showed a spindle cell proliferation that is of moderate to high cellularity assuming an intersecting vesicular growth pattern within the dermis. There was a grenz zone that separates the proliferation from the overlying epidermis (Figures A-D).
a. Spindle cell squamous cell carcinoma
b. Leiomyosarcoma
c. Atypical fibroxanthoma
d. Leiomyoma
Case 2.
A 70-year-old man presented with an upper arm lesion (Figures A-D).
a. Hemangioma
b. Kaposi sarcoma
c. Aneurysmal fibrous histiocytoma
d. Angiosarcoma
Case 3.
A 78-year-old man presented with a right big toe painful nodule (Figures A-C).
a. Calcium pyrophosphate crystal deposition disease
b. Methyl methacrylate
c. Talc
d. Gouty tophus
Quiz Answers
Case 1 - B
Leiomyosarcoma
The findings are diagnostic of a well-differentiated atypical leiomyomatous tumor. Based on the extent of cytologic atypia, mitotic activity, and Ki-67 proliferation index, this lesion is best treated and categorized as a leiomyosarcoma. This would be a probable superficial variant of presumptive origin from the arrector pili muscle. Some authors have argued that these lesions should perhaps be designated as atypical leiomatous tumors because their biological course is one associated only with local disease without metastatic potential. It is well known that these lesions do have a cognate morphology to their benign counterparts; however, it is the pleomorphism and mitotic activity that would separate this lesion from a leiomyoma. The differential diagnosis would encompass a symplastic leiomyoma; however, the overall degree of cellularity and mitotic activity would not support this particular designation.
Case 2 - B
Kaposi Sarcoma
Kaposi sarcoma is an human herpesvirus 8 driven angioproliferative disease. Four types are described and include classic form, endemic, iatrogenic (typically arising in the setting of immunosuppressive drug therapy), and AIDS-associated. Clinically, the lesions can appear red/blue or brown and assume the form of a macule, plaque, or nodule. The microscopic appearance is variable and can range from irregular, dissecting vascular channels to sheets of epithelioid or spindled cells with slit-like spaces, attendant red blood cell (RBC) extravasation, and occasional vascular lumens. Periodic acid–Schiff positive hyaline globules (representing RBC degradation products) and a lymphoplasmacytic infiltrate are also commonly seen.
Case 3 - D
Gouty Tophus
Monosodium urate deposition disease/gout is characterized by extracellular fluid deposits that range from tiny to massive, typically assuming a dermal or subcutaneous location. The clinical presentation can include tophaceous deposits, uric acid kidney stones, recurrent inflammatory arthritis, chronic arthritis, or chronic nephropathy. Fixation in alcohol preserves the sodium urate monohydrate crystals. The crystals appear needle-shaped and demonstrate negative birefringence when polarized. Formalin fixation is avoided if one wishes to see the crystals because formalin dissolves them and the deposits appear as amorphous pink areas. While not seen in this case, gouty tophi are frequently associated with a foreign body type giant cell.
Dr Magro is the director of dermatopathology at Weill Cornell Medicine in New York, NY. For more information, please visit www.weillcornelldermpath.com.
Disclosure: The author reports no relevant financial relationships
This education series for dermatologists is presented by the Weill Cornell Comprehensive Dermatopathology Service.
Case 1.
A 60-year-old man presented with a chest nodule. The biopsy showed a spindle cell proliferation that is of moderate to high cellularity assuming an intersecting vesicular growth pattern within the dermis. There was a grenz zone that separates the proliferation from the overlying epidermis (Figures A-D).
a. Spindle cell squamous cell carcinoma
b. Leiomyosarcoma
c. Atypical fibroxanthoma
d. Leiomyoma
Case 2.
A 70-year-old man presented with an upper arm lesion (Figures A-D).
a. Hemangioma
b. Kaposi sarcoma
c. Aneurysmal fibrous histiocytoma
d. Angiosarcoma
Case 3.
A 78-year-old man presented with a right big toe painful nodule (Figures A-C).
a. Calcium pyrophosphate crystal deposition disease
b. Methyl methacrylate
c. Talc
d. Gouty tophus
,
This education series for dermatologists is presented by the Weill Cornell Comprehensive Dermatopathology Service.
Case 1.
A 60-year-old man presented with a chest nodule. The biopsy showed a spindle cell proliferation that is of moderate to high cellularity assuming an intersecting vesicular growth pattern within the dermis. There was a grenz zone that separates the proliferation from the overlying epidermis (Figures A-D).
a. Spindle cell squamous cell carcinoma
b. Leiomyosarcoma
c. Atypical fibroxanthoma
d. Leiomyoma
Case 2.
A 70-year-old man presented with an upper arm lesion (Figures A-D).
a. Hemangioma
b. Kaposi sarcoma
c. Aneurysmal fibrous histiocytoma
d. Angiosarcoma
Case 3.
A 78-year-old man presented with a right big toe painful nodule (Figures A-C).
a. Calcium pyrophosphate crystal deposition disease
b. Methyl methacrylate
c. Talc
d. Gouty tophus
To learn the answers, go to page 2.
Quiz Answers
Case 1 - B
Leiomyosarcoma
The findings are diagnostic of a well-differentiated atypical leiomyomatous tumor. Based on the extent of cytologic atypia, mitotic activity, and Ki-67 proliferation index, this lesion is best treated and categorized as a leiomyosarcoma. This would be a probable superficial variant of presumptive origin from the arrector pili muscle. Some authors have argued that these lesions should perhaps be designated as atypical leiomatous tumors because their biological course is one associated only with local disease without metastatic potential. It is well known that these lesions do have a cognate morphology to their benign counterparts; however, it is the pleomorphism and mitotic activity that would separate this lesion from a leiomyoma. The differential diagnosis would encompass a symplastic leiomyoma; however, the overall degree of cellularity and mitotic activity would not support this particular designation.
Case 2 - B
Kaposi Sarcoma
Kaposi sarcoma is an human herpesvirus 8 driven angioproliferative disease. Four types are described and include classic form, endemic, iatrogenic (typically arising in the setting of immunosuppressive drug therapy), and AIDS-associated. Clinically, the lesions can appear red/blue or brown and assume the form of a macule, plaque, or nodule. The microscopic appearance is variable and can range from irregular, dissecting vascular channels to sheets of epithelioid or spindled cells with slit-like spaces, attendant red blood cell (RBC) extravasation, and occasional vascular lumens. Periodic acid–Schiff positive hyaline globules (representing RBC degradation products) and a lymphoplasmacytic infiltrate are also commonly seen.
Case 3 - D
Gouty Tophus
Monosodium urate deposition disease/gout is characterized by extracellular fluid deposits that range from tiny to massive, typically assuming a dermal or subcutaneous location. The clinical presentation can include tophaceous deposits, uric acid kidney stones, recurrent inflammatory arthritis, chronic arthritis, or chronic nephropathy. Fixation in alcohol preserves the sodium urate monohydrate crystals. The crystals appear needle-shaped and demonstrate negative birefringence when polarized. Formalin fixation is avoided if one wishes to see the crystals because formalin dissolves them and the deposits appear as amorphous pink areas. While not seen in this case, gouty tophi are frequently associated with a foreign body type giant cell.
Dr Magro is the director of dermatopathology at Weill Cornell Medicine in New York, NY. For more information, please visit www.weillcornelldermpath.com.
Disclosure: The author reports no relevant financial relationships
This education series for dermatologists is presented by the Weill Cornell Comprehensive Dermatopathology Service.
Case 1.
A 60-year-old man presented with a chest nodule. The biopsy showed a spindle cell proliferation that is of moderate to high cellularity assuming an intersecting vesicular growth pattern within the dermis. There was a grenz zone that separates the proliferation from the overlying epidermis (Figures A-D).
a. Spindle cell squamous cell carcinoma
b. Leiomyosarcoma
c. Atypical fibroxanthoma
d. Leiomyoma
Case 2.
A 70-year-old man presented with an upper arm lesion (Figures A-D).
a. Hemangioma
b. Kaposi sarcoma
c. Aneurysmal fibrous histiocytoma
d. Angiosarcoma
Case 3.
A 78-year-old man presented with a right big toe painful nodule (Figures A-C).
a. Calcium pyrophosphate crystal deposition disease
b. Methyl methacrylate
c. Talc
d. Gouty tophus
Quiz Answers
Case 1 - B
Leiomyosarcoma
The findings are diagnostic of a well-differentiated atypical leiomyomatous tumor. Based on the extent of cytologic atypia, mitotic activity, and Ki-67 proliferation index, this lesion is best treated and categorized as a leiomyosarcoma. This would be a probable superficial variant of presumptive origin from the arrector pili muscle. Some authors have argued that these lesions should perhaps be designated as atypical leiomatous tumors because their biological course is one associated only with local disease without metastatic potential. It is well known that these lesions do have a cognate morphology to their benign counterparts; however, it is the pleomorphism and mitotic activity that would separate this lesion from a leiomyoma. The differential diagnosis would encompass a symplastic leiomyoma; however, the overall degree of cellularity and mitotic activity would not support this particular designation.
Case 2 - B
Kaposi Sarcoma
Kaposi sarcoma is an human herpesvirus 8 driven angioproliferative disease. Four types are described and include classic form, endemic, iatrogenic (typically arising in the setting of immunosuppressive drug therapy), and AIDS-associated. Clinically, the lesions can appear red/blue or brown and assume the form of a macule, plaque, or nodule. The microscopic appearance is variable and can range from irregular, dissecting vascular channels to sheets of epithelioid or spindled cells with slit-like spaces, attendant red blood cell (RBC) extravasation, and occasional vascular lumens. Periodic acid–Schiff positive hyaline globules (representing RBC degradation products) and a lymphoplasmacytic infiltrate are also commonly seen.
Case 3 - D
Gouty Tophus
Monosodium urate deposition disease/gout is characterized by extracellular fluid deposits that range from tiny to massive, typically assuming a dermal or subcutaneous location. The clinical presentation can include tophaceous deposits, uric acid kidney stones, recurrent inflammatory arthritis, chronic arthritis, or chronic nephropathy. Fixation in alcohol preserves the sodium urate monohydrate crystals. The crystals appear needle-shaped and demonstrate negative birefringence when polarized. Formalin fixation is avoided if one wishes to see the crystals because formalin dissolves them and the deposits appear as amorphous pink areas. While not seen in this case, gouty tophi are frequently associated with a foreign body type giant cell.
Dr Magro is the director of dermatopathology at Weill Cornell Medicine in New York, NY. For more information, please visit www.weillcornelldermpath.com.
Disclosure: The author reports no relevant financial relationships
Quiz Answers
Case 1 - B
Leiomyosarcoma
The findings are diagnostic of a well-differentiated atypical leiomyomatous tumor. Based on the extent of cytologic atypia, mitotic activity, and Ki-67 proliferation index, this lesion is best treated and categorized as a leiomyosarcoma. This would be a probable superficial variant of presumptive origin from the arrector pili muscle. Some authors have argued that these lesions should perhaps be designated as atypical leiomatous tumors because their biological course is one associated only with local disease without metastatic potential. It is well known that these lesions do have a cognate morphology to their benign counterparts; however, it is the pleomorphism and mitotic activity that would separate this lesion from a leiomyoma. The differential diagnosis would encompass a symplastic leiomyoma; however, the overall degree of cellularity and mitotic activity would not support this particular designation.
Case 2 - B
Kaposi Sarcoma
Kaposi sarcoma is an human herpesvirus 8 driven angioproliferative disease. Four types are described and include classic form, endemic, iatrogenic (typically arising in the setting of immunosuppressive drug therapy), and AIDS-associated. Clinically, the lesions can appear red/blue or brown and assume the form of a macule, plaque, or nodule. The microscopic appearance is variable and can range from irregular, dissecting vascular channels to sheets of epithelioid or spindled cells with slit-like spaces, attendant red blood cell (RBC) extravasation, and occasional vascular lumens. Periodic acid–Schiff positive hyaline globules (representing RBC degradation products) and a lymphoplasmacytic infiltrate are also commonly seen.
Case 3 - D
Gouty Tophus
Monosodium urate deposition disease/gout is characterized by extracellular fluid deposits that range from tiny to massive, typically assuming a dermal or subcutaneous location. The clinical presentation can include tophaceous deposits, uric acid kidney stones, recurrent inflammatory arthritis, chronic arthritis, or chronic nephropathy. Fixation in alcohol preserves the sodium urate monohydrate crystals. The crystals appear needle-shaped and demonstrate negative birefringence when polarized. Formalin fixation is avoided if one wishes to see the crystals because formalin dissolves them and the deposits appear as amorphous pink areas. While not seen in this case, gouty tophi are frequently associated with a foreign body type giant cell.
Dr Magro is the director of dermatopathology at Weill Cornell Medicine in New York, NY. For more information, please visit www.weillcornelldermpath.com.
Disclosure: The author reports no relevant financial relationships
