Heinz Kutzner - Academia.edu (original) (raw)

Papers by Heinz Kutzner

The American Journal of Dermatopathology, 2007

The American Journal of dermatopathology, 2014

Journal of Cutaneous Pathology, 2014

A few series addressing the cutaneous side effects related to imatinib in the skin have been publ... more A few series addressing the cutaneous side effects related to imatinib in the skin have been published, but only one described scarce histopathologic information in seven patients. To characterize these lesions and compare the number of melanocytes between hypopigmented lesions and normal appearing skin. We retrieved clinical data of the patients and performed 24 skin biopsies (13 from hypopigmented skin and 11 from normal-appearing skin) within a cohort of 41 patients with chronic myeloid leukemia treated with imatinib. We classified the biopsies into three patterns. About 45% of patients presented with periocular hypopigmentation. Perifollicular fibrosis was observed in hypopigmented skin biopsies (76.9%) and in normal-appearing skin (45.5%). Epidermal melanin, as determined with Masson-Fontana staining, and melanocyte number, as evaluated with MiTF, Melan A and c-kit immunostains, were lower in hypopigmented skin. Histopathologic study of hypopigmented macules demonstrates the presence of melanin with a statistically significant decrease in the number of melanocytes. Therefore, these findings differ from vitiligo, as melanocytes are present. Three histopathological patterns may be found, namely (a) perifollicular fibrosis, (b) lichen planopilaris-like and (c) apparently normal skin. One of the most striking histopathologic finding consisted of the presence of perifollicular fibrosis in both hypopigmented lesions and apparently normal skin.

Histopathology, 2013

The family of perivascular epithelioid cell tumours (PEComas) comprises a related group of mesenc... more The family of perivascular epithelioid cell tumours (PEComas) comprises a related group of mesenchymal tumours of uncertain origin that show both smooth muscle and melanocytic differentiation markers. TFE3 nuclear immunoreactivity may be viewed as a supporting marker, as it has been found in a subset of visceral PEComas. We immunohistochemically analysed 17 cases of primary cutaneous PEComas for TFE3, and five of them also for SOX-10, and also analysed them by FISH for TFE3 rearrangement. PEComas presented as skin-coloured tumours, in 12 women and five men, with a median age of 49.5 years. Tumours showed either a mixed clear cell-epithelioid cell pattern or a monomorphous clear cell pattern. None of the primary cutaneous PEComas showed detectable TFE3 or SOX-10 positivity. FISH assay for TFE3 rearrangement yielded negative results in all of the tested tumours. Cutaneous PEComas are mostly composed of clear cells, and, unlike a subset of visceral and deep-seated PEComas, cutaneous PE...

Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG, 2015

The American Journal of Dermatopathology, 2015

Chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syn... more Chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syndrome is a newly characterized autoinflammatory disorder, caused by mutations in PSMB8. It is characterized by early-onset fevers, accompanied by a widespread, violaceous, and often annular cutaneous eruption. Although the exact pathogenesis of this syndrome is still obscure, it is postulated that the inflammatory disease manifestations stem from excess secretion of interferons. Based on preliminary blood cytokine and gene expression studies, the signature seems to come mostly from type I interferons, which are proposed to lead to the recruitment of immature myeloid cells into the dermis and subcutis. In this study, we systematically analyzed skin biopsies from 6 patients with CANDLE syndrome by routine histopathology and immunohistochemistry methods. Skin lesions showed the presence of extensive mixed dermal and subcutaneous inflammatory infiltrate, composed of mononuclear cells, atypical myeloid cells, neutrophils, eosinophils, and some mature lymphocytes. Positive LEDER and myeloperoxidase staining supported the presence of myeloid cells. Positive CD68/PMG1 and CD163 staining confirmed the existence of histiocytes and monocytic macrophages in the inflammatory infiltrate. CD123 staining was positive, demonstrating the presence of plasmacytoid dendritic cells. Uncovering the unique histopathological and immunohistochemical features of CANDLE syndrome provides tools for rapid and specific diagnosis of this disorder and further insight into the pathogenesis of this severe life-threatening condition.

Journal of Cutaneous Pathology, 2015

Atypical Spitz tumor with loss of BAP1 or Wiesner nevus is a peculiar variant of intradermal spit... more Atypical Spitz tumor with loss of BAP1 or Wiesner nevus is a peculiar variant of intradermal spitzoid melanocytic neoplasm composed of epithelioid melanocytes with a sheet-like growth pattern, abundant infiltrating lymphocytes, and rare or absent mitotic activity. This subset of atypical spitzoid tumors is characterized by the BRAF(V600E) mutation and loss of BAP1 expression. Recognition of these lesions is important because they can be a marker for a hereditary BAP1-associated cancer syndrome. We present an unusual case of sporadic Wiesner nevus that had typical histopathologic features and a BAP1 but not a BRAF mutation. The biological significance of Wiesner nevus is controversial, and little is known about prognosis, particularly in atypical cases like this one.

Journal of the American Academy of Dermatology, 2015

With the exception of erythema migrans, Borrelia infection of the skin manifests much more common... more With the exception of erythema migrans, Borrelia infection of the skin manifests much more commonly with B cell-rich infiltrates. T cell-rich lesions have rarely been described. We report a series of 6 patients with cutaneous borreliosis presenting with T cell-predominant skin infiltrates. We studied the clinicopathologic and molecular features of 6 patients with T cell-rich skin infiltrates. Half of the patients had erythematous patchy, partly annular lesions, and the other patients had features of acrodermatitis chronica atrophicans. Histopathology revealed a dense, band-like or diffuse dermal infiltrate. Apart from small, well differentiated lymphocytes, there were medium-sized lymphocytes with slight nuclear atypia and focal epidermotropism. An interstitial histiocytic component was found in 4 cases, including histiocytic pseudorosettes. Fibrosis was present in all cases but varied in severity and distribution. In 5 patients, borrelia DNA was detected in lesional tissue using po...

Journal of the American Academy of Dermatology, 2014

Ob der ursprünglich als pigmentierter Spindelzelltumor beschriebene Reed-Nävus tatsächlich eine p... more Ob der ursprünglich als pigmentierter Spindelzelltumor beschriebene Reed-Nävus tatsächlich eine pigmentierte Spindelzellvariante des Spitz-Nävus oder nicht doch eine eigenständige Entität ist , bleibt noch zu klären. Offenkundig aber ist, dass es sich um eine distinkte Melanozytenproliferation handelt , die klinisch und histopathologisch leicht mit spindelzelligen malignen Melanomen verwechselt werden kann.

American Journal of Surgical Pathology, 2006

Mitotic figure (MF) counting is important in the evaluation of many tumor types. Inadequate fixat... more Mitotic figure (MF) counting is important in the evaluation of many tumor types. Inadequate fixation, crush artefacts, the presence of many apoptoses, or the rarity of MFs in a given lesion can make the determination of the mitotic index a very time-consuming or even impossible task, especially for novices. We evaluated the potential of the two commercially available mitotic markers MPM-2 and Phospho-Histone H3 Ser28 (PHH3) for improving mitotic counting. Formalin-fixed tissue of 1 lymphoma, 19 epithelial, 25 mesenchymal, and 10 melanocytic tumors was immunohistochemically stained with both antibodies. Mitotic counts of each tumor sample were determined by a pathologist and three residents in the hematoxylin and eosin and in both immunohistochemical stainings. Because of the higher sensitivity of the immunohistochemical stainings for MFs, average mitotic counts per 10 HPF were higher with MPM-2 (11.0) and PHH3 (10.1) than with hematoxylin and eosin (5.9) staining. The precise distinction of MFs from apoptoses and the visualization of the distribution of MFs uncovering mitotic hotspots, even at low magnification, turned out to be major advantages of both mitotic markers. In addition, the average time needed to establish the mitotic count was reduced by 40.3% with MPM-2 and by 50.4% with PHH3. MPM-2 and PHH3 were subjectively rated by all pathologists involved in this study to be very helpful in mitotic counting, especially in melanocytic and mesenchymal lesions but less so in epithelial tumors. Both markers have hence been successfully introduced in our laboratory for the routine assessment of MFs in melanocytic and mesenchymal tumors.

Actas Dermo-Sifiliográficas (English Edition), 2008

Background. Selective immunostaining for calretinin labels the innermost layer of the outer root ... more Background. Selective immunostaining for calretinin labels the innermost layer of the outer root sheath of normal hair follicles, which is difficult to distinguish with hematoxylin-eosin staining.

Archives of dermatology, 2005

To describe a series of 41 patients with fresh lesions of Sweet syndrome in which the histopathol... more To describe a series of 41 patients with fresh lesions of Sweet syndrome in which the histopathologic study demonstrated an inflammatory infiltrate mostly composed of histiocytoid mononuclear cells. Histopathologic, immunohistochemical, and cytogenetic studies of the inflammatory infiltrate in a case series of histiocytoid Sweet syndrome. University departments of dermatology and a private laboratory of dermatopathology. Conventional histopathologic study as well as immunohistochemical investigations were performed using the alkaline phosphatase antialkaline phosphatase technique with a large panel of antibodies. In some cases, fluorescent in situ hybridization studies were performed to investigate the presence of the bcr/abl gene fusion. Immunohistochemical studies demonstrated that most cells of the infiltrate showed immunoreactivity for CD15, CD43, CD45, CD68, MAC-386, HAM56, and lysozyme, which is consistent with a monocytic-histiocytic immunoprofile. However, intense myeloperox...

Journal of the American Academy of Dermatology, 2014

The dermatologic hallmark of a recently described BAP1-associated cancer susceptibility syndrome ... more The dermatologic hallmark of a recently described BAP1-associated cancer susceptibility syndrome is a dome-shaped nevus with distinct clinicopathological features, first delineated by Wiesner and colleagues. Here we describe the leading histopathological criteria of Wiesner nevus. Wiesner nevus is composed of various nevomelanocytic populations all showing different degrees of atypia ranging from hyperchromatic nevus cell-like to large atypical epithelioid cells. Immunohistochemically, Wiesner nevus is BAP1 negative and VE1 positive.

Human Pathology, 2009

Human Pathology (2009) 40, 624-630 immunohistochemical pattern of T pallidum distribution may per... more Human Pathology (2009) 40, 624-630 immunohistochemical pattern of T pallidum distribution may permit the diagnostic differentiation of primary from secondary syphilis.

Design: We were particularly interested in the clinical course of patients with MM and cutaneous ... more Design: We were particularly interested in the clinical course of patients with MM and cutaneous metastases, includingsurvivaloncemetastasesweredetectedandthe possible influence of various forms of therapy. Our goal was also to identify the immunoglobulin and the light- chain type in these cases, with emphasis on any possible association between a particular immunoglobulin class and cutaneous involvement, as well as the histopatho- logic,immunohistochemical,andcytogeneticfeaturesof

Journal of Cutaneous Pathology, 2007

Cryoglobulins are detected in a wide variety of diseases, including malignancies, infections and ... more Cryoglobulins are detected in a wide variety of diseases, including malignancies, infections and systemic autoimmune diseases. Classically, monoclonal cryoglobulinemia is associated with hematologic malignancies, whereas mixed cryoglobulinemias are reported in association with hepatitis C virus infections or autoimmune diseases. We present a patient with generalized livedo reticularis as the first manifestation of monoclonal cryoglobulinemia and multiple myeloma. Histopathology demonstrated that nearly all small blood vessels of the upper and deep dermis, as well as the capillaries of the fat lobule, were filled with homogeneous, eosinophilic material that corresponded to monoclonal cryoglobulin deposits within the vascular lumina. Our case of livedo reticularis associated with monoclonal cryoglobulinemia and multiple myeloma was exceptional, because the mottled cyanotic discoloration of the skin with a reticular pattern was generalized, covering most of the skin surface. We have not found previous report of similar cases. Therefore, we recommend that dermatologists be made aware of the significance of this diagnosis.

Journal of The American Academy of Dermatology, 2009

Cribriform carcinoma is the histopathologic variant of cutaneous apocrine carcinoma characterized... more Cribriform carcinoma is the histopathologic variant of cutaneous apocrine carcinoma characterized by interconnected solid aggregations of neoplastic cells that are punctuated by small round spaces. To describe the histopathologic and immunohistochemical characteristics of this under-recognized cutaneous adnexal neoplasm. Twenty-six cases of primary cutaneous cribriform apocrine carcinoma were clinically, histopathologically, and immunohistochemically studied. Seven neoplasms arose in males and 19 in females. The median age of the patients was 47.8 years. The lower and upper limbs were the most frequent sites. Histopathologically, the neoplasms consisted of well-circumscribed dermal nodules composed of multiple, interconnected, solid aggregations of basophilic epithelial cells that were punctuated by small round spaces. Immunohistochemically, the neoplastic cells expressed immunoreactivity for MNF116, AE1/AE3, Cam 5.2, cytokeratin 7, carcinoembryonic antigen, and epithelial membrane antigen. All specimens came from dermatopathology laboratories, and some inherent selection bias may exist. Primary cutaneous cribriform apocrine carcinoma is a distinctive but little-known variant of cutaneous apocrine carcinoma.

The American Journal of Dermatopathology, 2007

The American Journal of dermatopathology, 2014

Journal of Cutaneous Pathology, 2014

A few series addressing the cutaneous side effects related to imatinib in the skin have been publ... more A few series addressing the cutaneous side effects related to imatinib in the skin have been published, but only one described scarce histopathologic information in seven patients. To characterize these lesions and compare the number of melanocytes between hypopigmented lesions and normal appearing skin. We retrieved clinical data of the patients and performed 24 skin biopsies (13 from hypopigmented skin and 11 from normal-appearing skin) within a cohort of 41 patients with chronic myeloid leukemia treated with imatinib. We classified the biopsies into three patterns. About 45% of patients presented with periocular hypopigmentation. Perifollicular fibrosis was observed in hypopigmented skin biopsies (76.9%) and in normal-appearing skin (45.5%). Epidermal melanin, as determined with Masson-Fontana staining, and melanocyte number, as evaluated with MiTF, Melan A and c-kit immunostains, were lower in hypopigmented skin. Histopathologic study of hypopigmented macules demonstrates the presence of melanin with a statistically significant decrease in the number of melanocytes. Therefore, these findings differ from vitiligo, as melanocytes are present. Three histopathological patterns may be found, namely (a) perifollicular fibrosis, (b) lichen planopilaris-like and (c) apparently normal skin. One of the most striking histopathologic finding consisted of the presence of perifollicular fibrosis in both hypopigmented lesions and apparently normal skin.

Histopathology, 2013

The family of perivascular epithelioid cell tumours (PEComas) comprises a related group of mesenc... more The family of perivascular epithelioid cell tumours (PEComas) comprises a related group of mesenchymal tumours of uncertain origin that show both smooth muscle and melanocytic differentiation markers. TFE3 nuclear immunoreactivity may be viewed as a supporting marker, as it has been found in a subset of visceral PEComas. We immunohistochemically analysed 17 cases of primary cutaneous PEComas for TFE3, and five of them also for SOX-10, and also analysed them by FISH for TFE3 rearrangement. PEComas presented as skin-coloured tumours, in 12 women and five men, with a median age of 49.5 years. Tumours showed either a mixed clear cell-epithelioid cell pattern or a monomorphous clear cell pattern. None of the primary cutaneous PEComas showed detectable TFE3 or SOX-10 positivity. FISH assay for TFE3 rearrangement yielded negative results in all of the tested tumours. Cutaneous PEComas are mostly composed of clear cells, and, unlike a subset of visceral and deep-seated PEComas, cutaneous PE...

Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG, 2015

The American Journal of Dermatopathology, 2015

Chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syn... more Chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syndrome is a newly characterized autoinflammatory disorder, caused by mutations in PSMB8. It is characterized by early-onset fevers, accompanied by a widespread, violaceous, and often annular cutaneous eruption. Although the exact pathogenesis of this syndrome is still obscure, it is postulated that the inflammatory disease manifestations stem from excess secretion of interferons. Based on preliminary blood cytokine and gene expression studies, the signature seems to come mostly from type I interferons, which are proposed to lead to the recruitment of immature myeloid cells into the dermis and subcutis. In this study, we systematically analyzed skin biopsies from 6 patients with CANDLE syndrome by routine histopathology and immunohistochemistry methods. Skin lesions showed the presence of extensive mixed dermal and subcutaneous inflammatory infiltrate, composed of mononuclear cells, atypical myeloid cells, neutrophils, eosinophils, and some mature lymphocytes. Positive LEDER and myeloperoxidase staining supported the presence of myeloid cells. Positive CD68/PMG1 and CD163 staining confirmed the existence of histiocytes and monocytic macrophages in the inflammatory infiltrate. CD123 staining was positive, demonstrating the presence of plasmacytoid dendritic cells. Uncovering the unique histopathological and immunohistochemical features of CANDLE syndrome provides tools for rapid and specific diagnosis of this disorder and further insight into the pathogenesis of this severe life-threatening condition.

Journal of Cutaneous Pathology, 2015

Atypical Spitz tumor with loss of BAP1 or Wiesner nevus is a peculiar variant of intradermal spit... more Atypical Spitz tumor with loss of BAP1 or Wiesner nevus is a peculiar variant of intradermal spitzoid melanocytic neoplasm composed of epithelioid melanocytes with a sheet-like growth pattern, abundant infiltrating lymphocytes, and rare or absent mitotic activity. This subset of atypical spitzoid tumors is characterized by the BRAF(V600E) mutation and loss of BAP1 expression. Recognition of these lesions is important because they can be a marker for a hereditary BAP1-associated cancer syndrome. We present an unusual case of sporadic Wiesner nevus that had typical histopathologic features and a BAP1 but not a BRAF mutation. The biological significance of Wiesner nevus is controversial, and little is known about prognosis, particularly in atypical cases like this one.

Journal of the American Academy of Dermatology, 2015

With the exception of erythema migrans, Borrelia infection of the skin manifests much more common... more With the exception of erythema migrans, Borrelia infection of the skin manifests much more commonly with B cell-rich infiltrates. T cell-rich lesions have rarely been described. We report a series of 6 patients with cutaneous borreliosis presenting with T cell-predominant skin infiltrates. We studied the clinicopathologic and molecular features of 6 patients with T cell-rich skin infiltrates. Half of the patients had erythematous patchy, partly annular lesions, and the other patients had features of acrodermatitis chronica atrophicans. Histopathology revealed a dense, band-like or diffuse dermal infiltrate. Apart from small, well differentiated lymphocytes, there were medium-sized lymphocytes with slight nuclear atypia and focal epidermotropism. An interstitial histiocytic component was found in 4 cases, including histiocytic pseudorosettes. Fibrosis was present in all cases but varied in severity and distribution. In 5 patients, borrelia DNA was detected in lesional tissue using po...

Journal of the American Academy of Dermatology, 2014

Ob der ursprünglich als pigmentierter Spindelzelltumor beschriebene Reed-Nävus tatsächlich eine p... more Ob der ursprünglich als pigmentierter Spindelzelltumor beschriebene Reed-Nävus tatsächlich eine pigmentierte Spindelzellvariante des Spitz-Nävus oder nicht doch eine eigenständige Entität ist , bleibt noch zu klären. Offenkundig aber ist, dass es sich um eine distinkte Melanozytenproliferation handelt , die klinisch und histopathologisch leicht mit spindelzelligen malignen Melanomen verwechselt werden kann.

American Journal of Surgical Pathology, 2006

Mitotic figure (MF) counting is important in the evaluation of many tumor types. Inadequate fixat... more Mitotic figure (MF) counting is important in the evaluation of many tumor types. Inadequate fixation, crush artefacts, the presence of many apoptoses, or the rarity of MFs in a given lesion can make the determination of the mitotic index a very time-consuming or even impossible task, especially for novices. We evaluated the potential of the two commercially available mitotic markers MPM-2 and Phospho-Histone H3 Ser28 (PHH3) for improving mitotic counting. Formalin-fixed tissue of 1 lymphoma, 19 epithelial, 25 mesenchymal, and 10 melanocytic tumors was immunohistochemically stained with both antibodies. Mitotic counts of each tumor sample were determined by a pathologist and three residents in the hematoxylin and eosin and in both immunohistochemical stainings. Because of the higher sensitivity of the immunohistochemical stainings for MFs, average mitotic counts per 10 HPF were higher with MPM-2 (11.0) and PHH3 (10.1) than with hematoxylin and eosin (5.9) staining. The precise distinction of MFs from apoptoses and the visualization of the distribution of MFs uncovering mitotic hotspots, even at low magnification, turned out to be major advantages of both mitotic markers. In addition, the average time needed to establish the mitotic count was reduced by 40.3% with MPM-2 and by 50.4% with PHH3. MPM-2 and PHH3 were subjectively rated by all pathologists involved in this study to be very helpful in mitotic counting, especially in melanocytic and mesenchymal lesions but less so in epithelial tumors. Both markers have hence been successfully introduced in our laboratory for the routine assessment of MFs in melanocytic and mesenchymal tumors.

Actas Dermo-Sifiliográficas (English Edition), 2008

Background. Selective immunostaining for calretinin labels the innermost layer of the outer root ... more Background. Selective immunostaining for calretinin labels the innermost layer of the outer root sheath of normal hair follicles, which is difficult to distinguish with hematoxylin-eosin staining.

Archives of dermatology, 2005

To describe a series of 41 patients with fresh lesions of Sweet syndrome in which the histopathol... more To describe a series of 41 patients with fresh lesions of Sweet syndrome in which the histopathologic study demonstrated an inflammatory infiltrate mostly composed of histiocytoid mononuclear cells. Histopathologic, immunohistochemical, and cytogenetic studies of the inflammatory infiltrate in a case series of histiocytoid Sweet syndrome. University departments of dermatology and a private laboratory of dermatopathology. Conventional histopathologic study as well as immunohistochemical investigations were performed using the alkaline phosphatase antialkaline phosphatase technique with a large panel of antibodies. In some cases, fluorescent in situ hybridization studies were performed to investigate the presence of the bcr/abl gene fusion. Immunohistochemical studies demonstrated that most cells of the infiltrate showed immunoreactivity for CD15, CD43, CD45, CD68, MAC-386, HAM56, and lysozyme, which is consistent with a monocytic-histiocytic immunoprofile. However, intense myeloperox...

Journal of the American Academy of Dermatology, 2014

The dermatologic hallmark of a recently described BAP1-associated cancer susceptibility syndrome ... more The dermatologic hallmark of a recently described BAP1-associated cancer susceptibility syndrome is a dome-shaped nevus with distinct clinicopathological features, first delineated by Wiesner and colleagues. Here we describe the leading histopathological criteria of Wiesner nevus. Wiesner nevus is composed of various nevomelanocytic populations all showing different degrees of atypia ranging from hyperchromatic nevus cell-like to large atypical epithelioid cells. Immunohistochemically, Wiesner nevus is BAP1 negative and VE1 positive.

Human Pathology, 2009

Human Pathology (2009) 40, 624-630 immunohistochemical pattern of T pallidum distribution may per... more Human Pathology (2009) 40, 624-630 immunohistochemical pattern of T pallidum distribution may permit the diagnostic differentiation of primary from secondary syphilis.

Design: We were particularly interested in the clinical course of patients with MM and cutaneous ... more Design: We were particularly interested in the clinical course of patients with MM and cutaneous metastases, includingsurvivaloncemetastasesweredetectedandthe possible influence of various forms of therapy. Our goal was also to identify the immunoglobulin and the light- chain type in these cases, with emphasis on any possible association between a particular immunoglobulin class and cutaneous involvement, as well as the histopatho- logic,immunohistochemical,andcytogeneticfeaturesof

Journal of Cutaneous Pathology, 2007

Cryoglobulins are detected in a wide variety of diseases, including malignancies, infections and ... more Cryoglobulins are detected in a wide variety of diseases, including malignancies, infections and systemic autoimmune diseases. Classically, monoclonal cryoglobulinemia is associated with hematologic malignancies, whereas mixed cryoglobulinemias are reported in association with hepatitis C virus infections or autoimmune diseases. We present a patient with generalized livedo reticularis as the first manifestation of monoclonal cryoglobulinemia and multiple myeloma. Histopathology demonstrated that nearly all small blood vessels of the upper and deep dermis, as well as the capillaries of the fat lobule, were filled with homogeneous, eosinophilic material that corresponded to monoclonal cryoglobulin deposits within the vascular lumina. Our case of livedo reticularis associated with monoclonal cryoglobulinemia and multiple myeloma was exceptional, because the mottled cyanotic discoloration of the skin with a reticular pattern was generalized, covering most of the skin surface. We have not found previous report of similar cases. Therefore, we recommend that dermatologists be made aware of the significance of this diagnosis.

Journal of The American Academy of Dermatology, 2009

Cribriform carcinoma is the histopathologic variant of cutaneous apocrine carcinoma characterized... more Cribriform carcinoma is the histopathologic variant of cutaneous apocrine carcinoma characterized by interconnected solid aggregations of neoplastic cells that are punctuated by small round spaces. To describe the histopathologic and immunohistochemical characteristics of this under-recognized cutaneous adnexal neoplasm. Twenty-six cases of primary cutaneous cribriform apocrine carcinoma were clinically, histopathologically, and immunohistochemically studied. Seven neoplasms arose in males and 19 in females. The median age of the patients was 47.8 years. The lower and upper limbs were the most frequent sites. Histopathologically, the neoplasms consisted of well-circumscribed dermal nodules composed of multiple, interconnected, solid aggregations of basophilic epithelial cells that were punctuated by small round spaces. Immunohistochemically, the neoplastic cells expressed immunoreactivity for MNF116, AE1/AE3, Cam 5.2, cytokeratin 7, carcinoembryonic antigen, and epithelial membrane antigen. All specimens came from dermatopathology laboratories, and some inherent selection bias may exist. Primary cutaneous cribriform apocrine carcinoma is a distinctive but little-known variant of cutaneous apocrine carcinoma.