Greatest Cases from the Dermatopathology Slide Club

Kara Bradas presents a series of complex dermatopathology cases from the University of Missouri, highlighting critical diagnostic challenges. The first case involves a patient with a history of squamous cell carcinoma (SCC), which was believed to have metastasized to the bone, though it raised concerns about the rarity of such occurrences. Subsequent biopsies revealed a poorly differentiated neoplasm. After extensive immunohistochemical analysis and next-generation sequencing, the diagnosis shifted to SMART B1 deficient malignant neoplasm, underscoring the importance of re-evaluation in perplexing cases.

The second case illustrates cutaneous collagenous vasculopathy, a rare condition impacting microvasculature, presenting as telangiectasia, emphasizing the need for heightened awareness among pathologists for this subtle diagnosis. Finally, Bradas discusses nodular secondary syphilis in an HIV-positive patient, which mimicked other dermatological conditions but was identified through specific staining for Treponema pallidum. Each case emphasizes the significance of thorough clinical investigation and the role of advanced diagnostic tools in understanding atypical presentations, especially in immunocompromised patients. The overarching lesson is to maintain a high index of suspicion for uncommon conditions and to continue exploring diagnostic options when faced with seemingly incongruous clinical information.