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Michael B. Morgan, M.D. Professor Pathology, USFCOM

DERMPATH DIAGNOSTICS 2010 BOARD REVIEW. Spongiotic Dermatitis, Nutritional Disorders & Miscellaneous Deadly Epidermal Neoplasms. Michael B. Morgan, M.D. Professor Pathology, USFCOM. Case #1. An 89 y/o ♂ Presents with a Rapidly Growing Erythematous Papule. And the Diagnosis is….

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Michael B. Morgan, M.D. Professor Pathology, USFCOM

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  1. DERMPATH DIAGNOSTICS 2010 BOARD REVIEW Spongiotic Dermatitis, Nutritional Disorders & Miscellaneous Deadly Epidermal Neoplasms Michael B. Morgan, M.D. Professor Pathology, USFCOM

  2. Case #1 An 89 y/o ♂ Presents with a Rapidly Growing Erythematous Papule

  3. And the Diagnosis is… MERKEL CELL CARCINOMA

  4. MERKEL CELL CARCINOMA • Prevalence = 0.2 / 100,000, ♂= ♀, 1:1500 BCCS • Average age of presentation = 68 yrs. • Association = UV exposure, immunosuppression, IGF-1 Polyoma Virus (continues)

  5. MERKEL CELL CARCINOMA • Histogenesis - ?, Merkel Cell • Clinical • H + N ~ 60%, Exts ~ 30%, Uncommon trunk & Genitalia • Papule usually Erythematous and rapid growing

  6. Papilloma Viruses BK-Cystitis JC-PML KI-Respiratory PAPOVA Polyoma Viruses WU-Respiratory MK- Merkel Cell ? Vacuolating Agents (Koilocytes)

  7. MERKEL CELL CARCINOMA • Histology – Diffuse, trabecular, nested • Cells – Small (~7 mm) closely apposed, molded nuclei, scant cytoplasm, speckled nuclear chromatin • Look for crush artifact, ↑mitotic / apopotic rate • Immunostaining - CK-20 dot-like, synaptophysin (+), TTF (-)

  8. Merkel Cell Carcinoma

  9. Merkel Cell Carcinoma

  10. Merkel Cell Carcinoma

  11. Merkel Cell Carcinoma

  12. Merkel Cell Carcinoma

  13. Merkel Cell Carcinoma

  14. Synaptophysin

  15. CK -20

  16. Prognosis – • Ulceration, mitosis, depth of invasion • Treatment • WLE, XRT (palliative), CTX Dubious • Differential diagnosis • BCC, Lymphoma

  17. BCC in Lung

  18. BCC in Lung

  19. B-cell Lymphoma

  20. B-cell Lymphoma

  21. B-cell Lymphoma

  22. Case #2 70 y/o ♀ with Scaly Nipple

  23. And the Diagnosis is… PAGET’S DISEASE

  24. Paget’s Disease • Synonyms: Extramammary Paget’s disease, mammary Paget’s disease • Etiology: Ductular extension of carcinoma from breast genitourinary, gastrointestinal, or apocrine glands • Associations: Underlying adenocarcinoma of breast (mammary) or genitourinary or gastrointestinal carcinoma (extramammary) or primary appendagael adenocarcinoma • Clinical: Scaly, erythematous patch on nipple (mammary) or anogenital region (extramammary Paget’s)

  25. Paget’s Disease • Histology: Large, atypical cells at all levels of epidermis • IHC repertoire: Cytokeratins 7, CEA, EMA • Staging: Essential to workup for underlying adenocarcinoma • Prognosis: Excellent if no underlying carcinoma; poor if internal carcinoma present • Adverse variables: Dermal invasion by neoplastic cells, association with underlying malignancy • Treatment: Surgery, (topical chemotherapy, radiation)

  26. Case #3 29 Year Old Female Textile Worker with Itchy Vesicles

  27. And the Diagnosis is… Eczematous Dermatitis (Purpuric) Associated with Textile Dyes

  28. Definition/Pathogenesis Local Type IV Hypersensitivity reaction to textile dyes

  29. Special Variants of Allergic Contact Dermatitis Pustular - Cement

  30. Differential Diagnosis Dermal contact – neomycin, nickel, zinc

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