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- Presentation
Greatest Cases from the Dermatopathology Slide Club
Description
The presentation by Baalik Barak from Baylor Scott and White discusses several intriguing dermatopathology cases. The first case features a 23-year-old female with a three-year history of recurrent tender nodules, primarily affecting her proximal extremities. Biopsy results revealed significant changes in the deeper dermis and fat lobules, prompting considerations for lupus panniculitis versus subcutaneous paniculitis-like T-cell lymphoma. Following extensive immunostaining and clinical evaluations, the case was thought to align with atypical lymphocytic lobular panniculitis, now termed adipotropic lymphoproliferative disorders. Another case involved a 60-year-old male with a purpuric rash attributing to stranguliasis post-renal transplant, identified through larvae in the dermis and organs, treated with ivermectin and albendazole but ultimately leading to the patient's death. Lastly, a pediatric case involved a 21-month-old with an umbilical granuloma, uncovering colonic mucosa in the skin, indicative of an unfollow mesenteric duct remnant, a developmental remnant typically regressing in early gestation. Each case highlighted challenges in diagnosis and the importance of thorough investigation in dermatopathology.
View moreConclusions
- The patient presented with recurrent tender nodules has a complex diagnosis that could be at the intersection of lupus panniculitis and subcutaneous panniculitis-like T-cell lymphoma.
- Histological analysis indicated atypical lymphoid changes, prompting further investigation into the nature of the infiltrate.
- The diagnosis considered atypical lymphocytic lobular panniculitis may be more accurate based on observed features and clinical presentation.
- Longitudinal monitoring of patients with atypical lymphocytic lobular panniculitis is essential as there is a small risk for progression to subcutaneous panniculitis-like T-cell lymphoma.
- In the second case, a patient with acute purpuric rash post-renal transplant was diagnosed with strongyloidiasis, highlighting the importance of considering parasitic infections in immunocompromised patients.
- The last case discussed illustrates an omphalomesenteric duct remnant in a pediatric patient, emphasizing the need for clinical monitoring and potential surgical exploration for associated anomalies.
- Cynthia M. Magro X, A. Neil Crowson, John C. Byrd, A. David Soleymani, Igor Shendrik, 'Atypical lymphocytic lobular panniculitis', First published: 08 March 2004, https://doi.org/10.1111/j.0303-6987.2004.0165.x, Citations: 50
- Cynthia M. Magro, A. Neil Crowson, John C. Byrd, A. David Soleymani, Igor Shendrik. Atypical lymphocytic lobular panniculitis. First published: 08 March 2004 | https://doi.org/10.1111/j.0303-6987.2004.0165.x | Citations: 50
- Joan Guitart, MD; Aaron R. Mangold, MD; Maria Estela Martinez-Escala, MD, PhD; Christina J. Walker, MD; Nneka I. Comfere, MD; Mellissa Pulitzer, MD; Kerri E. Rieger, MD, PhD; Carlos A. Torres-Cabala, MD; Cynthia M. Magro, A. Neil Crowson, John C. Byrd, A. David Soleymani, Igor Shendrik. Clinical and Pathological Characteristics and Outcomes Among Patients With Subcutaneous Panniculitis-like T-Cell Lymphoma and Related Adipotropic Lymphoproliferative Disorders. JAMA Dermatol. 2022;158(10):1167-1174. doi:10.1001/jamadermatol.2022.3347. Published online August 24, 2022.