Diagnostic Criteria for Kawasaki Syndrome

Morbilliform

Presence of fever for at least 5 days, 4 of the 5 criteria below, and lack of another known disease process to cause the illness 1. Bilateral conjunctival injection 2. Changes of the mucous membranes of the upper respiratory tract injected pharynx injected, fissured lips strawberry tongue 4. Changes of the extremities peripheral edema, peripheral erythema, periungual desquamation Strict use of these criteria will miss cases of Kawasaki disease, so-called atypical or incomplete Kawasaki disease....

Eruptive Xanthoma

Eruptive Xanthomas And Lipemia Retinalis

IHC repertoire Staging Prognosis Adverse variables Treatment Diabetic xanthoma, xanthoma diabetacorum Serum hypertriglyceridemia and or elevated VLDL Diabetes mellitus, oral estrogens, acute ethanol ingestion, lipoprotein lipase deficiency, Type IV V hyperlipoproteinemia, pregnancy, nephrotic syndrome, hypothyroidism, intravenous miconazole, oral 13-a's-retinoic acid Crops of red-yellow papules on buttocks and thighs Normal epithelium, early-perivascular lipid and neutrophils, later...

Calciphylaxis Calcific Uremic Arteriolopathy

Calciphylaxis Pictures

Calcifying panniculitis, subcutaneous calcific arteriolopathy, uremic small artery disease with medial calcification and intimal hyperplasia, metastatic calcinosis cutis Multifactorial, including hyperphosphatemia, hypercalcemia, hyperparathyroidism, hypoalbuminemia, rapid weight loss, obesity Chronic renal insufficiency Subcutaneous vascular calcification and epidermal necrosis Serum blood urea nitrogen, creatinine, calcium, phosphate, albumin, parathyroid hormone, quantitative and functional...

Pellagra Skin Photomicrograph Pathology

Clinical and metabolic aspects of glucagonoma. Medicine 1980 59 100. 2. Hashizume T, Kiryu H, Noda K, et al. Glucagonoma syndrome. J Am Acad Dermatol 1988 19 377. 3. Frankton S, Boom SR. Glucagonomas. Baillieres Clin Gastroenterol 1996 10 697. 4. Chastain MA. The glucagonoma syndrome A review of its features and discussion of new perspectives. Am J Med Sci 2001 321 326. 5. Boden G. Insulinoma and glucagonoma. Semin Oncol 1987 14 253. 6. Doll DC. Necrolytic migratory erythema....

Gram Positive Rods

Anthrax Disease Gastrointestinal

Woolsorter's disease inhalational anthrax Inoculation or inhalation of spores of Bacillus anthracis, a gram-positive bacillus None Cutaneous papule, followed by vesicle, then ulcer with eschar at the site of inoculation septicemia in approximately 20 Partial epidermal necrosis, dermal edema with fibrin, neutrophils, and abscess formation positive gram stain expected Notifying local health department and laboratory of clinical suspicion, gram stain and culture of vesicle fluid or eschar base,...

Multiple Cutaneous Leiomyomas

Cutaneous Leiomyomas Pictures

Multiple cutaneous and uterine leiomyomatosis MCUL Hereditary leiomyomatosis renal cell cancer HLRCC Mutation in fumarate hydratase gene, mapped to chromosome Uterine leiomyomas and rarely leiomyosarcomas, renal Red-brown indurated papules, sometimes clustered or in linear Reticular dermal fascicular tumor with cigar-shaped nuclei, amphophilic vacuolated cytoplasm, rare mitotic figures Renal, uterine ultrasound, possible evaluation for fumarate Surgical management of underlying tumors, excision...

Ecthyma Gangrenosum

Erythematous Papules With Eschar

Etiology Pseudomonas aeruginosa and other gram-negative bacteria, similar lesions caused by opportunistic fungi Associations Immunosuppression, premature infants Clinical Indurated plaques with black eschar and rim of erythema, favors axillae, inguinal folds, and perineum Histology Mixed infiltrate of lymphocytes, neutrophils, plasma cells special stains of affected skin usually demonstrate the organism Evaluation Blood cultures, skin biopsy with fresh tissue culture, special stains on touch...

Rocky Mountain Spotted Fever

Rocky Mountain Spotted Fever

Rocky Mountain Spotted Fever and the Rickettsioses Rickettsia rickettsii following Dermacentor sp. tick bite Fever headache followed by macules and petechial eruption of wrists ankles with subsequent generalization Lymphocytic vasculitis with vascular thrombosis, epidermal necrosis organisms with special stains seen in Organisms identified by immunohistochemical and Fatality rate of 20 -30 , worse in the elderly or with Renal failure, myocarditis, arrythmias, DIC and ARDS Intravenous...

Muir Torre Syndrome

Muir Torre Syndrome

Visceral malignancies mainly gastrointestinal Lobules of sebocytes surrounded by basaloid Sebaceous adenomas are benign adnexal tumors that have no malignant potential. They are of no clinical significance in isolation, but may be indicators of internal malignancy when occurring as part of the Muir-Torre syndrome. Sebaceous adenomas grow as exophytic, yellowish papules and nodules. In most cases, these lesions are less than 1 cm in diameter 1 . While they may occur at any body site, they are...

Thrombophlebitis Pictures

Acrodermatitis Enteropathica

Glucagon-secreting tumors, usually malignant and MEN I syndrome, Zollinger-Ellison syndrome Rash erythematous, scaly patches intertriginous and acral area angular chelitis, diabetes mellitus, diarrhea Mild epidermal acanthosis with confluent parakeratosis and vacuolar degeneration of the superficial epithelial Malignant pancreatic tumor, weight loss, metastases Necrolytic migratory erythema NME , referred to as the glucagonoma syndrome, is a rare paraneoplastic syndrome consisting of the...

Subcutaneous Panniculitislike Lymphoma

Lymphoma Panniculitis Like

Subcutaneous lymphoma, cytophagic histiocytic panniculitis Hemorrhagic plaques and nodules, abdomen and extremities Dense lymphoid infiltrate in subcutis with hemorrhage and necrosis Systemic workup required to assess extent Subcutaneous panniculitis-like lymphoma SPL occurs primarily in younger adults, but can arise in persons of any age. The usual presentation is that of an ulcerative and hemorrhagic panniculitis, presenting as multiple ery-thematous nodules often involving the lower...

Gardner Syndrome

Cd34 Gardner Fibroma

Synonyms Familial adenomatous polyposis FAP , adenomatous polyposis coli APC Etiology Mutation in adenomatous polyposis coli APC gene, chromosome 5q21 Associations Colonic tubular adenomas and carcinoma, cutaneous epidermoid cysts, fibromas, desmoids, osteomas Histology Epithelial cysts with pilomatrical differentiation, fibrous nodules Evaluation Ophthalmologic examination, panoramic dental radiographs, lower GI tract evaluation, possible APC gene mutation evaluation Treatment Prophylactic...

Erythema Gyratum Repens

Erythema Gyratum

Gyrate Erythemas Erythema Gyratum Repens and Erythema Chronicum Migrans ECM Infection with Borrelia burgdorferi EGR Internal malignancy, tuberculosis ECM Outdoor activities in endemic areas for Ixodes EGR Truncal arcuate erythematous bands with trailing ECM Expanding erythematous solid or annular patch EGR Mild spongiosis with superficial perivascular ECM Nonspecific superficial and deep lymphocytic ECM Early, early disseminated, chronic late ECM Good with appropriate antibiotic therapy, lt 5...

Necrobiotic Xanthogranuloma

Necrobiotic Xanthogranuloma

Lethal Non-Langerhans Cell Histiocytoses Necrobiotic Xanthogranuloma and Xanthoma Disseminatum NXG Necrobiotic xanthogranuloma with NXG Myeloma, Grave's disease, primary biliary XD Myeloma, Waldenstrom's macroglobulinemia, NXG Ulcerating red-orange plaques, particularly of the XD Disseminated red brown papules into plaques NXG Palisading granulomatous dermatitis with bizarre XD Diffuse epithelioid histiocytes, foam cells, and XD Cases associated with myeloma and Waldenstrom's NXG...

Metastatic Carcinoma

Prostate Nodule

Cutaneous metastatic neoplasm, Sister Mary Joseph Hematogenous or lymphatic spread of primary tumor to Primary malignancies most commonly gastrointestinal Nodule, occasionally ulcerated, scalp most common site Most commonly adenocarcinoma in dermis Cytokeratins 7, 20, carcinoembyronic antigen Implies widespread metastatic disease Less than 1-year survival in most cases None ovarian primary may be associated with slightly Cutaneous metastases occur in approximately 10 of all cancer patients. The...

Cowdens Syndrome

Cowden Syndrome

Multiple hamartomas, keratoacanthomas, neoplasms Hyperkeratotic folliculocentric papules Proliferations of pale staining keratinocytes from Trichilemmomas are benign epidermal neoplasms that may serve as an indicator of underlying malignancy. Trichilemmomas appear, largely on the head and neck, as exophytic, small, hyperkeratotic papules Figure 15.1 . There is no particular gender predilection and they usually arise during the second decade. When occurring as isolated lesions, these tumors are...

Epidermolytic Hyperkeratosis

Leser Trelat Sign

Acquired Ichthyosis, Acanthosis Nigricans, Palmar Hyperkeratosis PH Tylosis, Howel-Evans Syndrome, tripe palms, AI Hypogranulosis with hyperkeratosis PH Acanthosis with hyperkeratosis and hypergranulosis Generally poor, associated with advanced internal Dependent upon underlying malignancy type and stage of Serious systemic diseases, including visceral cancer, may be indirectly signaled by the development of distinctive cutaneous eruptions. Important aspects of these eruptions include...

Mast Cell Disease Urticaria Pigmentosa

Urticaria Pigmentosa Histopathology

IHC repertoire Staging Prognosis Adverse variables Treatment Urticaria pigmentosa, telangiectasia macularis eruptive Nausea, vomiting, diarrhea, syncope, mast cell leukemia, Papules or nodules with or without associated hyperpigmentation and telangiectasia positive Darier's Increased dermal mast cells perivascular or as tumor nodules, basilar hyperpigmentation, vascular ectasia CD117 c-kit and mast cell tryptase positive Bone marrow involvement conveys poor prognosis Varies with subtype of...

Langerhans Cell Histiocytosis

Multinucleated Macrophage

Synonyms Histiocytosis X, Langerhans cell granulomatosis, eosinophilic granuloma, Hand-Sch ller-Christian disease, Letterer-Siwe disease, self-healing reticulohistiocytosis, Hashimoto-Pritzker syndrome Etiology Unknown, a clonal or reactive expansion of Langerhans cells infiltrating various organs Associations May coexist, precede, or follow the development of various solid tumors and hematopoietic malignancies Clinical Polymorphous red-brown purpuric scaly papules, lichenoid papules, purpura,...

Granulomatous Slack Skin

Hyperchromatic Convoluted Nuclei

Cutaneous T-cell lymphoma, granulomatous mycosis Hodgkin's disease, mycosis fungoides, non-Hodgkin's lymphoma, leukemia, Langerhans cell histiocytosis Pendulous folds in axilla and inguinal regions Epidermotropic, hyperchromatic lymphocytes in epidermis with admixed granulomatous areas and Controversial possibly better than conventional mycosis Anaplasia of T cells, nodal involvement Electron beam irradiation, topical and systemic Granulomatous slack skin GSS is a subtle variant of mycosis...

Leukemia Cutis

Types Leukemia

Cutaneous leukemia, extramedullary myeloid tumor Erythematous patches, papules, nodules, hemorrhagic and purpuric lesions, blue-green nodules Malignant immature hematopoietic precursor cells in dermis, diffusely or in patchy distribution Lymphocyte surface markers and or markers of specific Histologic subtype of high-grade leukemias No local therapy systemic chemotherapy Leukemia cutis is an uncommon cutaneous eruption that may be difficult to diagnose. In the vast majority of patients, there...

Angiosarcoma

Angiosarcoma Intracytoplasmic Globules

Hemangiosarcoma, lymphangiosarcoma, malignant Ultraviolet light, radiotherapy, lymphedema Treves- Stewart syndrome , preexisting vascular malformations Rapidly expanding bruise-like patch, erythematous Ill-defined anastomosing dermal network of atypical endothelial-lined spaces most common or defined diffusely arranged aggregates of epithelioid or spindled CD-31 most sensitive and specific , CD-34, Ulex Size gt 5 cm, depth of invasion gt 3.0 mm, mitotic rate gt 3 HPF, positive surgical margins,...