This education series for dermatologists is presented by the Weill Cornell Comprehensive Dermatopathology Service.
Case 1. A 55-year-old woman with breast carcinoma presenting for breast lumpectomy and sentinel node biopsy (Figures A-C).
a. Traumatic neuroma
b. Schwannoma
c. Neurofibroma
d. Perineurioma
Case 2. A 75-year-old man with a history of seborrheic keratosis of the thigh s/p excision, now the area has changed by becoming darker peripherally (Figures A-C).
a. Melanoma
b. Postinflammatory pigment alteration
c. Monsel solution reaction
d. Minocycline pigmentation
Case 3. A 70-year-old woman with a 1.6-cm lesion of her left foot (Figures A-D).
a. Seborrheic keratosis
b. Basal cell carcinoma
c. Squamous cell carcinoma in situ
d. Poroma
Case 4. A 79-year-old man presented with a scalp nodule (Figures A-H).
a. Spindle cell squamous cell carcinoma
b. Spindle cell melanoma
c. Leiomyosarcoma
d. Atypical fibroxanthoma
To learn the answers, go to page 2.
CASE ANSWERS
Case 1
Answer: A. Traumatic Neuroma
Traumatic neuroma results from disruption in a nerve either in the setting of trauma or postsurgically. The proximal end of the nerve regenerates in a haphazard fashion resulting in a tangled mass of axons, Schwann cells, and perineurial cells set in a fibrous or myxoid stroma. The growth is frequently painful. It is regarded as a non-neoplastic/reactive proliferation.
Case 2
Answer: C. Monsel Solution Reaction
Monsel solution (20% ferric subsulfate) is used for hemostasis to wounds caused by excisions of skin. Monsel solution produces artifacts which can be troublesome if re-biopsy of a lesion is necessary. Histologically it is associated with ferrugination of fibrin, dermal collagen, and striated muscle fibers. Siderophages can be present in these areas and can form sheets of large polygonal cells and multinucleated histiocytic giant cells containing granules and clumps of dark brown and black pigment. This pigment can stain strongly for iron (Perl’s method). The tattoo produced can distort or obscure the underlying pathology. It may lead an unwary pathologist into the false interpretation of the depth of a melanoma, as such the use of Monsel solution for hemostasis should be discouraged following biopsies of pigmented lesions or tumors which may prove to be diagnostic problems.
Case 3
Answer: D. Poroma
Poromas are benign tumors most commonly arising in the palms and soles as red-pink papules or nodules. Poromas generally occur in middle-aged adults with an equal predilection for men and women. Several conditions can be associated with the development of multiple lesions including radiation therapy, chemotherapy, pregnancy, and posttransplant. Histologically, they are nodular, well circumscribed, and feature sheets and trabeculae of monomorphic cuboidal bland keratinocytes containing scattered duct-like structures.
Case 4
Answer: B. Spindle Cell Melanoma
This is a very interesting example of an invasive melanoma showing a hybrid conventional invasive vertical growth phase with spindle and epithelioid cell features.
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 55-year-old woman with breast carcinoma presenting for breast lumpectomy and sentinel node biopsy (Figures A-C).
a. Traumatic neuroma
b. Schwannoma
c. Neurofibroma
d. Perineurioma
Case 2. A 75-year-old man with a history of seborrheic keratosis of the thigh s/p excision, now the area has changed by becoming darker peripherally (Figures A-C).
a. Melanoma
b. Postinflammatory pigment alteration
c. Monsel solution reaction
d. Minocycline pigmentation
Case 3. A 70-year-old woman with a 1.6-cm lesion of her left foot (Figures A-D).
a. Seborrheic keratosis
b. Basal cell carcinoma
c. Squamous cell carcinoma in situ
d. Poroma
Case 4. A 79-year-old man presented with a scalp nodule (Figures A-H).
a. Spindle cell squamous cell carcinoma
b. Spindle cell melanoma
c. Leiomyosarcoma
d. Atypical fibroxanthoma
To learn the answers, go to page 2.
CASE ANSWERS
Case 1
Answer: A. Traumatic Neuroma
Traumatic neuroma results from disruption in a nerve either in the setting of trauma or postsurgically. The proximal end of the nerve regenerates in a haphazard fashion resulting in a tangled mass of axons, Schwann cells, and perineurial cells set in a fibrous or myxoid stroma. The growth is frequently painful. It is regarded as a non-neoplastic/reactive proliferation.
Case 2
Answer: C. Monsel Solution Reaction
Monsel solution (20% ferric subsulfate) is used for hemostasis to wounds caused by excisions of skin. Monsel solution produces artifacts which can be troublesome if re-biopsy of a lesion is necessary. Histologically it is associated with ferrugination of fibrin, dermal collagen, and striated muscle fibers. Siderophages can be present in these areas and can form sheets of large polygonal cells and multinucleated histiocytic giant cells containing granules and clumps of dark brown and black pigment. This pigment can stain strongly for iron (Perl’s method). The tattoo produced can distort or obscure the underlying pathology. It may lead an unwary pathologist into the false interpretation of the depth of a melanoma, as such the use of Monsel solution for hemostasis should be discouraged following biopsies of pigmented lesions or tumors which may prove to be diagnostic problems.
Case 3
Answer: D. Poroma
Poromas are benign tumors most commonly arising in the palms and soles as red-pink papules or nodules. Poromas generally occur in middle-aged adults with an equal predilection for men and women. Several conditions can be associated with the development of multiple lesions including radiation therapy, chemotherapy, pregnancy, and posttransplant. Histologically, they are nodular, well circumscribed, and feature sheets and trabeculae of monomorphic cuboidal bland keratinocytes containing scattered duct-like structures.
Case 4
Answer: B. Spindle Cell Melanoma
This is a very interesting example of an invasive melanoma showing a hybrid conventional invasive vertical growth phase with spindle and epithelioid cell features.
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 55-year-old woman with breast carcinoma presenting for breast lumpectomy and sentinel node biopsy (Figures A-C).
a. Traumatic neuroma
b. Schwannoma
c. Neurofibroma
d. Perineurioma
Case 2. A 75-year-old man with a history of seborrheic keratosis of the thigh s/p excision, now the area has changed by becoming darker peripherally (Figures A-C).
a. Melanoma
b. Postinflammatory pigment alteration
c. Monsel solution reaction
d. Minocycline pigmentation
Case 3. A 70-year-old woman with a 1.6-cm lesion of her left foot (Figures A-D).
a. Seborrheic keratosis
b. Basal cell carcinoma
c. Squamous cell carcinoma in situ
d. Poroma
Case 4. A 79-year-old man presented with a scalp nodule (Figures A-H).
a. Spindle cell squamous cell carcinoma
b. Spindle cell melanoma
c. Leiomyosarcoma
d. Atypical fibroxanthoma
To learn the answers, go to page 2.
CASE ANSWERS
Case 1
Answer: A. Traumatic Neuroma
Traumatic neuroma results from disruption in a nerve either in the setting of trauma or postsurgically. The proximal end of the nerve regenerates in a haphazard fashion resulting in a tangled mass of axons, Schwann cells, and perineurial cells set in a fibrous or myxoid stroma. The growth is frequently painful. It is regarded as a non-neoplastic/reactive proliferation.
Case 2
Answer: C. Monsel Solution Reaction
Monsel solution (20% ferric subsulfate) is used for hemostasis to wounds caused by excisions of skin. Monsel solution produces artifacts which can be troublesome if re-biopsy of a lesion is necessary. Histologically it is associated with ferrugination of fibrin, dermal collagen, and striated muscle fibers. Siderophages can be present in these areas and can form sheets of large polygonal cells and multinucleated histiocytic giant cells containing granules and clumps of dark brown and black pigment. This pigment can stain strongly for iron (Perl’s method). The tattoo produced can distort or obscure the underlying pathology. It may lead an unwary pathologist into the false interpretation of the depth of a melanoma, as such the use of Monsel solution for hemostasis should be discouraged following biopsies of pigmented lesions or tumors which may prove to be diagnostic problems.
Case 3
Answer: D. Poroma
Poromas are benign tumors most commonly arising in the palms and soles as red-pink papules or nodules. Poromas generally occur in middle-aged adults with an equal predilection for men and women. Several conditions can be associated with the development of multiple lesions including radiation therapy, chemotherapy, pregnancy, and posttransplant. Histologically, they are nodular, well circumscribed, and feature sheets and trabeculae of monomorphic cuboidal bland keratinocytes containing scattered duct-like structures.
Case 4
Answer: B. Spindle Cell Melanoma
This is a very interesting example of an invasive melanoma showing a hybrid conventional invasive vertical growth phase with spindle and epithelioid cell features.
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.
