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author:("Sarma, dba P")
1.  Clear Cell Basal Cell Carcinoma 
Introduction. Clear cell basal cell carcinoma (BCC) is an uncommon and unusual variant of BCC, which is characterized by a variable component of clear cells. The pathogenesis of this histological variant and its clinical significance has not been clarified. Differentiation of this uncommon variant of BCC from other clear cell tumors is important for the treatment. Case Presentation. A 65-year-old male presented with a 0.9 cm dome-shaped lesion on his upper chest. A shave biopsy revealed a dermal basaloid tumor that comprised nests with a peripheral palisading pattern, retraction artifacts, and striking clear cell changes. Histopathologic examination, along with findings from immunohistochemical studies and special staining of the clear cells, supports the diagnosis of clear cell basal cell carcinoma. Conclusion. Clear cell BCC is a rare and unusual variant of BCC. The underlying pathogenesis of this subtype is unclear; however, accurate identification may affect treatment and prognosis.
PMCID: PMC3090100  PMID: 21559201
2.  A Woman with a Lower Lip Nodule: What Is Your Diagnosis? 
Angiolymphoid hyperplasia with eosinophilia (ALHE), also known as epitheliod hemangioma is an uncommon benign vascular tumor of the skin. It usually presents as nodules and erythema over the ears, forehead, or scalp. Histologically, the lesion is composed of a combination of immature blood vessels, endothelial cells with distinct epitheliod appearance and chronic inflammatory cell infiltration with numerous eosinophils. Such a case occurring on the lower lip of a 55-year-old woman is presented. The lesion was completely excised with clear margins. Surgical resection is the preferred mode of treatment and is curative.
PMCID: PMC3090186  PMID: 21559206
3.  Poorly Differentiated Squamous Cell Carcinoma Arising in Tattooed Skin 
Case Reports in Medicine  2011;2010:431813.
Introduction. Tattoos have increasingly become accepted by mainstream Western society. As a result, the incidence of tattoo-associated dermatoses is on the rise. The presence of a poorly differentiated squamous cell carcinoma in an old tattooed skin is of interest as it has not been previously documented. Case Presentation. A 79-year-old white homeless man of European descent presented to the dermatology clinic with a painless raised nodule on his left forearm arising in a tattooed area. A biopsy of the lesion revealed a poorly differentiated squamous cell carcinoma infiltrating into a tattoo. The lesion was completely excised and the patient remains disease-free one year later. Conclusion. All previous reports of squamous cell carcinomas arising in tattoos have been well-differentiated low-grade type or keratoacanthoma-type and are considered to be coincidental rather than related to any carcinogenic effect of the tattoo pigments. Tattoo-associated poorly differentiated invasive carcinoma appears to be extremely rare.
PMCID: PMC3027001  PMID: 21274289
4.  A Man with an Umbilicated Papule of the Hand: What Is Your Diagnosis? 
Case Reports in Medicine  2010;2010:524021.
Introduction. Ecthyma contagiosum is a zoonotic disease caused by the parapoxvirus that causes “sore mouth” in sheep and goats and orf in human. Case Presentation. A 61-year-old sheep farmer presented with a painful non-pruritic lesion on the left hand that had been present for approximately 5 weeks. Physical examination demonstrated a 1 cm pearly, umbilicated papule with raised borders. A biopsy showed an asymmetrical nodule with parakeratotic crust and acanthosis with thin epidermal strands extending deeply in the underlying dermis. Marked edema, capillary proliferation and extensive lymphocytic infiltration was also present. One red intranuclear inclusion was identified in an epidermal keratinocyte. A diagnosis of human orf (ecthyma contagiosum) was made. Conclusion. Infected sheep and freshly vaccinated sheep or goats are the reservoir for human infection. After an incubation period of 3–7 days, parapoxvirus infections produce 1–3 painful lesions measuring 1-2 cm in diameter. The natural history of the disease is complete resolution and no treatment is indicated. Prevention of echthyma contagiosum in ruminants through vaccination is thought to be the best way to control infection.
PMCID: PMC2878684  PMID: 20585366
5.  An Unusual Clinical Presentation of Merkel Cell Carcinoma: A Case Report 
Case Reports in Medicine  2010;2010:905414.
Introduction. Merkel cell carcinoma is a rare, aggressive neuroendocrine cell carcinoma arising in the sun-exposed skin of elderly patients. Most of these tumors are located in the dermis. An unusual clinical presentation of such a tumor in the subcutis, if not biopsied, may be easily mistaken as a benign lesion. Case Presentation. An 83-year-old white woman presented with a several-month history of a painless 7 mm subcutaneous mass that was initially thought to be a lipoma. A conservative follow-up was planned. At the insistence of the patient, an excisional biopsy of the mass was performed revealing a subcutaneous Merkel cell carcinoma. The tumor cells stained positively for CK 20, chromogranin, and synaptophysin. No other primary or metastatic tumors found after a thorough work-up. The patient was treated with local irradiation. She remains disease free at her six-month follow-up visit. Conclusion. When a new growth is encountered in the sun-exposed skin of elderly patients, a biopsy is warranted even if the lesion clinically appears benign.
PMCID: PMC2840409  PMID: 20300432
6.  Photoletter to the editor: An erythematous folliculocentric papular lesion on the chest of a 60-year-old man: What is your diagnosis? 
Folliculitis has many etiologies including bacterial, fungal, viral and parasitic. Therefore, an accurate determination of the cause is necessary to direct treatment. This is a case of a 60-year-old man who presented with an erythematous papule on his chest. Biopsy showed granulomatous inflammation, abscess formation, and the causative agent was Demodex.
PMCID: PMC3184778  PMID: 22187582
demodex; folliculitis; histopathology
7.  Acquired trichostasis in postoperative site: a case report 
Cases Journal  2009;2:9310.
Usual causes of a papule or nodule in a post-operative site after resection of a skin tumor are residual or recurrent tumor, proliferative scar, or suture granuloma with inflammation and granulation tissue. Inverted or trapped hair, an acquired trichostasis, has not been implicated as a cause in such cases, this is probably the first case reported in literature.
Case presentation
A 31-year-old woman underwent an excision of a ruptured epidermal cyst of the left axilla. One month later, the previous excision site was re-excised secondary to a non-healing, inflamed papule in order to exclude recurrent epidermal cyst formation. Microscopic examination revealed that the cause of the papular lesion was acquired trichostasis, rather than a recurrent epidermal cyst.
A papular or nodular lesion at a postoperative site may rarely be caused by acquired trichostasis and should be considered as one of the differential diagnosis.
PMCID: PMC2803973  PMID: 20062633
8.  Infiltrating syringomatous eccrine adenoma of the nipple: a case report 
Cases Journal  2009;2:9118.
Differential diagnosis for a nodule in the nipple or subareolar area of woman includes both primary neoplasms of breast as well as those from skin and adnexae.
Case Presentation
A 32-year-old woman presented with a painless 0.5 cm subareolar nodule of her left nipple that she had noticed for several months, with no associated nipple discharge. A biopsy revealed an infiltrating adnexal neoplasm with features similar to those seen in syringomas commonly occurring in locations such as upper face and pubis. The infiltrating syringomatous adenoma of the nipple occurs almost exclusively in women of all ages and is cured by simple excision. Microscopic appearance of such a rare benign infiltrating neoplasm of eccrine duct origin occurring in woman's breast should not be misinterpreted as more common infiltrating primary breast carcinoma.
Infiltrating eccrine syringomatous adenoma should be included in the differential diagnosis of a nipple or subareolar nodule occurring in woman.
PMCID: PMC2803915  PMID: 20062695
9.  ‘Lint ball’ omphalitis, a rare cause of umbilical discharge in an adult woman: a case report 
Cases Journal  2009;2:7785.
Umbilical discharge in adult is rare and is usually induced by foreign material, most commonly hair. Rarely, it may be due to embryonal anomalies. We are reporting an unusual case of umbilical discharge in adult secondary to an impacted lint ball.
Case presentation
A 55-year-old obese woman presented with a 4-month history of hemorrhagic discharge from the umbilicus. Deep from the base of the umbilicus, a 0.8 cm gray-tan mass was removed that on microscopic examination revealed a lint ball.
An impacted lint ball may be a rare cause of umbilical discharge in adult.
PMCID: PMC2740229  PMID: 19830013
10.  Melanoma in-situ arising in seborrheic keratosis: a case report 
Cases Journal  2008;1:263.
Seborrheic keratosis is a very common benign skin tumor in man. Melanoma is rare but is the most dreaded of all malignant skin tumors. A melanoma arising in a seborrheic keratosis is distinctly rare. We are reporting such a case occurring in an 86-year-old man.
Case presentation
An-86-year-old male with a history of multiple actinic keratoses and seborrheic keratoses of the head and trunk presented with a mid-back skin lesion. The lesion was poorly circumscribed, flat, and gray, with a pink-tan, well-circumscribed scaly nodule within it. The biopsied lesion was composed of the usual features of hyperkeratotic seborrheic keratosis, but with focal atypical melanocytic proliferation with nesting along the dermal-epidermal junction. We interpreted this lesion as a melanoma in-situ arising within a seborrheic keratosis.
It is not uncommon for many physicians to remove a typical seborrheic keratosis without a confirmatory microscopic confirmation. We urge that all such lesions be examined by the pathologist to avoid missing another concomitant malignant lesion such as melanoma which needs adequate resection and close follow-up.
PMCID: PMC2577645  PMID: 18947402
11.  Primary squamous cell carcinoma of lung in a 13-year-old boy: a case report 
Cases Journal  2008;1:123.
We are reporting a very rare case of primary bronchogenic squamous cell carcinoma (SCC) with bone metastasis in a 13-year-old boy. A brief review of the English literature on this rare neoplasm in childhood is presented.
PMCID: PMC2529260  PMID: 18721462
12.  Perianal squamous cell carcinoma in-situ: a report of two human papilloma virus-negative cases 
Cases Journal  2008;1:114.
We are reporting two cases of perianal squamous cell carcinoma in-situ, negative for high-risk (HR) and low-risk (LR) human papilloma viruses. A brief review of anal and perianal squamous cell carcinoma and the role of HPV are presented.
PMCID: PMC2527493  PMID: 18715505
13.  Paraganglioma-like dermal melanocytic tumor: a case report 
Cases Journal  2008;1:48.
Paraganglioma-like dermal melanocytic tumor is a rare subtype of benign dermal melanocytic tumors. Its histopathologic features resemble those of paraganglioma, but the immunostaining characteristics are those of melanocytic lesions.
We report a case of a 60-year-old male with a paraganglioma-like dermal melanocytic tumor of his left cheek and briefly review the English literature.
PMCID: PMC2488318  PMID: 18638402
14.  Fibroepithelioma of pinkus in a 9-year-old boy: a case report 
Cases Journal  2008;1:21.
Fibroepithelioma of Pinkus (FEP) is a rare indolent variety of basal cell carcinoma that is typically polypoid and located on the trunk of adult males aged 40–60 years. Basal cell carcinoma (including FEP) is very rare in the pediatric population. We are reporting such a case occurring in a 9-year-old boy.
PMCID: PMC2474574  PMID: 18588684
15.  Leiomyosarcoma of the skin with osteoclast-like giant cells: a case report 
Osteoclast-like giant cells have been noted in various malignant tumors, such as, carcinomas of pancreas and liver and leiomyosarcomas of non-cutaneous locations, such as, uterus and rectum. We were unable to find any reported case of a leiomyosarcoma of the skin where osteoclast-like giant cells were present in the tumor.
Case presentation
We report a case of a 59-year-old woman with a cutaneous leiomyosarcoma associated with osteoclast-like giant cells arising from the subcutaneous artery of the leg. The nature of the giant cells is discussed in light of the findings from the immunostaining as well as survey of the literature.
A rare case of cutaneous leiomyosarcoma with osteoclast-like giant cells is reported. The giant cells in the tumor appear to be reactive histiocytic cells.
PMCID: PMC2245960  PMID: 18081931

Results 1-15 (15)