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Presentation

Three Dermatopathology Cases: Angiosarcoma, Metastatic Papillary Thyroid Carcinoma, and Microneedling-Related Skin Infection

Description

The speaker presented three dermatopathology cases with a superhero theme. The first was a 76-year-old man whose inflammatory-appearing facial and chest rash initially suggested eczema, CTCL, sarcoid, or infection, but biopsy and CD31 staining showed a vascular proliferation consistent with angiosarcoma; clinical correlation revealed widespread disease, including lung involvement and pleural effusions, and the patient ultimately transitioned to hospice after difficulty tolerating paclitaxel. The second case was a 27-year-old woman with a neck lesion initially labeled a neoplasm of uncertain behavior; histology showed infiltrative dermal nodules with papillary structures and psammoma bodies, and immunostains (CK7, TTF1, PAX8 positive; CK20 and CK5/6 negative) confirmed metastatic papillary thyroid carcinoma, a rare cutaneous metastasis with poor prognostic significance. The third case was a 27-year-old woman with a rash on the forearm that looked like a subepidermal blistering or autoimmune process on biopsy, but further history revealed recent microneedling and MRSA-positive cultures, making this a post-procedural skin infection, highlighting the importance of procedural history and considering infectious or hypersensitivity complications of microneedling.

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Conclusions

Cutaneous angiosarcoma can present as an apparently inflammatory rash and should be considered when a head-and-neck eruption is progressive or treatment-refractory.
Clinical history and immunostains such as CD31, CD34, and ERG are critical for recognizing subtle vascular proliferations that may otherwise be mistaken for dermatitis or other inflammatory dermatoses.
Papillary thyroid carcinoma can rarely metastasize to the skin and should be suspected in dermal nodules with papillae, psammoma bodies, and positivity for PAX8, TTF-1, CK7, and thyroglobulin.
Cutaneous metastasis from papillary thyroid carcinoma is uncommon but, when present, often involves the head and neck and signals a poor prognosis.
Superficial shaves can be misleading, so unexpected histology should prompt correlation with the clinical setting and prior procedures before committing to a diagnosis.
Microneedling can cause significant complications, including bacterial or fungal infection and hypersensitivity reactions, and these reactions may mimic autoimmune bullous disease histologically.
Recent cosmetic or procedural history is essential in dermatopathology because it can completely change the interpretation of a biopsy.
Overall, the presentation emphasizes that careful clinicopathologic correlation is the best defense against skin cancer and procedure-related mimics masquerading as benign inflammatory disease.

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