Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.
- Presentation
Dermatopathology Case Challenge: Recognizing Mimics and Masqueraders
Description
In this presentation by Dr. Ron Rapini, he discusses various dermatopathology cases, highlighting conditions that may mimic or obscure specific diagnoses. He begins with lymphomatoid papulosis, emphasizing the challenges posed by its potential misdiagnosis as squamous cell carcinoma due to its histological features like pseudocarcinomatous hyperplasia. He notes the prevalence of CD30 positivity in affected lesions and the complications that arise from misclassifying this condition, sometimes leading to unnecessary surgeries. Dr. Rapini then describes eccentric basaloid proliferation, often seen in Mohs surgical margins, which can confuse pathologists due to its resemblance to basal cell carcinoma. A patient case featuring porokeratosis tikotropica illustrates another diagnostic challenge, as this condition can be mistaken for psoriasis. With a mix of humor and clinical anecdotes, he conveys the importance of careful diagnosis in dermatopathology, admitting the trials of distinguishing between similar lesions, and reinforcing the idea that experience, even with a limited number of cases, can lead to greater understanding.
View moreConclusions
- Lymphomatoid papulosis can mimic squamous cell carcinoma, but diagnosis can be complicated by pseudocarcinomatous hyperplasia.
- Patients with lymphomatoid papulosis may develop true lymphomas, with a risk of large cell anaplastic lymphoma.
- There are various subtypes of lymphomatoid papulosis, but they often present similarly and can exhibit variability in the same patient.
- Folliculocentric basaloid proliferation (FBP) can resemble basal cell carcinoma, complicating diagnosis for Mohs surgeons.
- The bulge activation hypothesis suggests a role for follicular stem cells in FBP, although the validity of this hypothesis is debated.
- Porokeratosis ptychotropica is a rare variant that primarily affects flexural skin folds and can be mistaken for ichthyosis, requiring accurate diagnosis for appropriate treatment.
- Treatment options for porokeratosis ptychotropica may include systemic therapies like acitretin, which may lead to modest improvement.
- Scarisbrick, J. et al. (2001). Lymphomatoid papulosis with pseudocarcinomatous hyperplasia. JAAD, 44:239-247.
- Leshin, B., White, W.L. (1990). The Bulge (der Wulst) revisited. Arch Dermatol, 126:900.
- Sun, T., et al. (1990). Cell differentiation in the bulge of hair follicles. Cell, 61:1329.
- Holacek, J., Ackerman, A. B. (1993). Bulge activation hypothesis: is it valid? Am J Dermatopathol, 15:235.
- Lucker, GPH, Happle, R, Steijlen, PM. (1995). An unusual case of porokeratosis involving the natal cleft: porokeratosis ptychotropica? Br J Dermatol, 132:150.