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Presentation

Dermatopathology Case Challenge: Recognizing Mimics and Masqueraders

Description

Dr. Tammy Feringer, Director of Dermatopathology at Geisinger Medical Center, discusses case challenges in dermatopathology, focusing on conditions that can mimic each other. She presents a case of a 79-year-old man with a complicated medical history exhibiting rashes and nodular lesions, initially thought to be cryptococcosis based on histopathology but later diagnosed as histiocytoid sweet syndrome, demonstrating that neutrophilic dermatoses can mimic cryptococcosis. She emphasizes the importance of recognizing these mimics to prevent misdiagnosis. In a second case, a 25-year-old woman with cyclical nodular plaques was presumed to have lupus paniculitis based on her medical history and biopsy results. However, further inquiry revealed she worked in a cold environment, leading to the diagnosis of cold-associated pernio. Feringer highlights the histological overlap between conditions like lupus and pernio and the significance of patient history in reaching accurate diagnoses. She underscores the potential for misdiagnosis when presenting pathogens and the necessity for dermatopathologists to maintain awareness of various neoplastic and inflammatory conditions that can present similarly.

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Conclusions

Neutrophilic dermatoses, such as histiocytoid Sweet syndrome, can mimic conditions like cryptococcosis.
Histological analysis can reveal degenerated neutrophils that lead to misdiagnosis.
Stains such as PAS, GMS, and mucicarmine can be negative in some cases of neutrophilic dermatoses.
Clinical history and context are important in differentiating between similar dermatological conditions.
The association of iododerm with renal impairment points to the importance of considering recent medical interventions as a cause for skin manifestations.
Considering the patient's background is crucial in arriving at a correct diagnosis of pernio and differentiating it from other conditions like lupus.
Sweet syndrome is associated with various underlying diseases, necessitating thorough evaluation to confirm diagnosis.
Differential diagnoses must be comprehensive, including infections, inflammatory dermatoses, and neoplastic processes.

Luis Requena, MD; Heinz Kutzner, MD; Gabriele Palmedo, PhD; Marta Pascual, MD; Jesús Fernández-Herrera, MD; Javier Fraga, MD; Amaro Garcia-Diez, MD; Evaristo Sánchez Yus, MD (ArchDermatol.2005;141:834-84)
(Am J Dermatopathol 2014;36:264-269)
Francesca Bosisio, MD, Sebastiana Boi, MD, Valentina Caputo, MD, Concetta Chiarelli, MD, Fergus Oliver, MD, Roberto Ricci, MD, Lorenzo Cerroni, MD (J Cutan Pathol. 2023 Jan;50(1):29-34)
Joel Hua-Liang Lim MBBS, MRCP (UK), M.Med (S'pore), Joyce Siong-See Lee, MBBS, MRCP (UK), M.Med (Int. Med), FAMS (Dermatology), Dip. Dermatopathology (ICDP-UEMS) (J Cutan Pathol. 2023 Jan;50(1):29-34)