Whitney A High MD,JD

Dermatologist/Dermatopathologist,
Opinions are my own.

[Whitney A High MD,JD @MileHighDpath]

@SkinMD13 🙂Answers C,C,A. Reticulohistiocytoma has "ground glass"/"muddy rose" cytoplasm. Can be solitary but multicentric reticulohistiocytosis (MRH) presents with lesions, often on hands, with a "coral bead" appearance. Non-Langherhans' origin = CD1a neg. Arthritis common with MRH.

[Whitney A High MD,JD @MileHighDpath]

40 y/o F. Finger papules.
BEST answers.
Dx:
A) giant cell tumor
B) granuloma annulare
C) reticulohistocytoma
D) xanthogranuloma

IHC + in cells of interest:
A) CD1a
B) CD3
C) CD68
D) Sox10

Important to ? pt about:
A) arthritis
B) DM
C) HTN
D) NHL

#Dermquiz #Dermpathquiz #Derm

[Whitney A High MD,JD @MileHighDpath]

My answers:
TRUE -pT criteria differ for conjunct MM, some in dermpaths own group unaware;
TRUE -subjectivity here, no fighting, but IMHO the utility is about same;
TRUE -reports of conjunctival MM confused with PG and vice/versa
Refs attached.
Hope that expands ur knowledge!🙂

[Whitney A High MD,JD @MileHighDpath]

Young man (<30 y/o). Noted lesion for several years. Dx as pyogenic granuloma at some point, but continued to grow. Bx performed.

The best dx is:
A) cavernous hemangioma
B) Kaposi sarcoma
C) melanoma
D) pyogenic granuloma

#Dermquiz, #Dermpathquiz, #ConjunctivalLesion

[Whitney A High MD,JD @MileHighDpath]

Things learned from case:

T/F - pT criteria for conjuctival MM differ from those of skin
T/F - evidence re: utility of PRAME for conjuctival melanoma is similar to skin MM
T/F - there are several case reports in idex med lit. of conjuctival MM being confused (clinically) with PG

[Whitney A High MD,JD @MileHighDpath]

@Dermpathl All evolved this week.
The morning specimen reached my desk, I heard (vaguely) NPR summary of the CDC announcment re: syphilis rates reaching all time highs during my commute!
Wish every provider, especially, non-dermatology related providers, could see case. Seems ominous!

[Whitney A High MD,JD @MileHighDpath]

Part 1. 39 y/o. Rash since 11/23. Also c/o joint/muscle pain. Chart states "saw derm last week, dx???" Derm did bx. FP APP did many blood tests.

You now want:
A. Want more blood tests
B. Want IHC
C. Want special stain
D. Want to see more skin
E. >/=3 of above.
#Dermpath #Derm

[Whitney A High MD,JD @MileHighDpath]

@Dermpathl Yes. I also wanted a RPR/VDRL and FTA-ABS, and asked for more detailed pictures (none exist) I had to call both the dermatology office, and the family practice office, before the blood tests were performed (pt difficult to reach) but they were both POSITIVE. Thanks reply.

[Whitney A High MD,JD @MileHighDpath]

@SkinMD13 That is a good idea, but ultimately it was secondary syphilis. Very importan thing to consider though.

[Whitney A High MD,JD @MileHighDpath]

Last week CDC stated syphilis infections at highest rate since 50's!
Here is what was done:
1) asked for pics of palms/soles - none
2) obtained IHC for spiros (Steiner is other option)
3) I recommended RPR/VDRL and FTA-ABS (+/+)
#syphilis,#dermpathquiz, #dermquiz

[Whitney A High MD,JD @MileHighDpath]

Hints:
(1) Fam Med focused on CTD, but in limited pics, there is not photodisribution and a "boiled ham" color to pap squamous rash.
(2) There are granulomatous elements (uncommon in CTD), but also tracking of inflammation down N/V bundles and curious number of plasma cells.

[Whitney A High MD,JD @MileHighDpath]

IMHO best theories on foam cell origin go something like this:
- unknown event damages keratinocytes, perturbations in repair mechanism(s) yield cytokines that attract histiocytes, histiocytes ingest lipids from degen keratinocytes, form foam.
(Hu Ja et al. 2005, among others)

[Whitney A High MD,JD @MileHighDpath]

34 y/o. Papule on scrotum. "R/O condyloma." No other history known. What is the best diagnosis?

A. Condyloma acuminatum
B. Condyloma lata
C. Epidermolytic hyperkeratosis of the genitalia
D. Verruciform xanthoma

#Dermpathquiz,#Dermquiz

[Whitney A High MD,JD @MileHighDpath]

Yes, verruciform xanthoma. Common on oral mucosa and genitalia. Histo features:
1) papillomatous architecture
2) "crypt-like" parakeratosis
3) neutrophils in parakeratosis
4) lipid laden foamy histiocytes in shallow dermis

Associated in literature with CHILD syndrome.

[Whitney A High MD,JD @MileHighDpath]

@anjuthevirgo I believe that is entirely correct (or at least it was the kind of thing I was asked about when I took boards!:)

[Whitney A High MD,JD @MileHighDpath]

For MCQ examination purposes:

Which of the following syndromes is most strongly associated with the presence of verruciform xanthomas?
A. CHILD syndrome
B. LAMB syndrome
C. PHACE syndrome
D. SAPHO syndrome

[Whitney A High MD,JD @MileHighDpath]

@SkinMD13 Great. I hope it is helpful to you.

[Whitney A High MD,JD @MileHighDpath]

IHC below represents "Adipu" stain (or combination of Pu.1 (brwn) - a histiocytic marker, and adipophilin (red) - a lipid marker). It highlights the lipid laden histiocytic cells in the shallow dermis.

There are 3 proposed mechanisms for lipid accumulation.