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Wright WA, Kamp E, Musbahi E, Martin B, Farrant P. Focal alopecia associated with a plaque. Clin Exp Dermatol 2023; 48:272-275. [PMID: 36763693 DOI: 10.1093/ced/llac030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/04/2022] [Accepted: 10/16/2022] [Indexed: 01/09/2023]
Abstract
We report the case of a 65-year-old woman presenting with a 15-month history of recurrent episodes of focal alopecia at the site of a bluish plaque on the vertex of her scalp. Histopathological examination revealed an admixture of focally nested oval, dendritic or epithelioid melanocytes together with slender spindle cells and occasional melanocytes. The spindle cells were positive for S100 and focally positive for epidermal membrane antigen, while the melanocytes were positive for S100 and Melan A.
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Affiliation(s)
- William A Wright
- Department of Dermatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Erin Kamp
- Department of Dermatology, Brighton General Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Esra Musbahi
- Department of Dermatology, Brighton General Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | - Paul Farrant
- Department of Dermatology, Brighton General Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
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2
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Clements SA, Kelley BF, Rivera L, Greenway HT. Neurotropic melanoma arising from a neurocristic hamartoma. J Cutan Pathol 2023; 50:197-200. [PMID: 36515639 DOI: 10.1111/cup.14378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/30/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022]
Abstract
Neurotropic melanoma is a rare type of malignant melanoma with nerve invasion or neural differentiation. Neurocristic cutaneous hamartoma is a rare, benign tumor of the skin and superficial soft tissue that arises from aberrant migration of neural crest cells. We report a rare case of a 74-year-old man with a clinically diagnosed giant congenital nevus of the right mid-back, histopathologically confirmed to be a neurocristic cutaneous hamartoma, who developed neurotropic spindle cell melanoma within the lesion. The patient was treated with serial re-excisions until clear margins were achieved.
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3
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Peter D, Kuryan P, Gupta AK, Thomas M. Dermoscopy of Cutaneous Neurocristic Hamartoma and Report of its Rare Clinical Presentation. Dermatol Pract Concept 2022; 12:e2022138. [PMID: 36159146 PMCID: PMC9464567 DOI: 10.5826/dpc.1203a138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Dincy Peter
- Department of Dermatology, Venereology and Leprosy, Christian Medical College, Vellore, Tamil Nadu, India
| | - Priya Kuryan
- Department of Dermatology, Venereology and Leprosy, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ashish Kumar Gupta
- Department of Plastic Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Meera Thomas
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
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4
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Finberg A, Martin S, Gradecki S, Zlotoff B, Raghavan SS. Cutaneous Neurocristic Hamartoma Mimicking Basal Cell Carcinoma in a Patient With Xeroderma Pigmentosum. Am J Dermatopathol 2022; 44:e54-e56. [PMID: 35170472 DOI: 10.1097/dad.0000000000002133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Neurocristic hamartomas (NCH) of cutaneous origin are especially rare congenital or acquired neoplasms that often arise through aberrant embryologic development of pluripotent neural crest cells. Clinically, they often present as pigmented macules or papules on the scalp with associated alopecia. NCHs are characterized histopathologically by dermal melanocytic, fibroblastic, and neurosustentacular components. Correct identification of this etiology is critical because of potential for malignant transformation, particularly in acquired NCHs. Our patient was a 6-year-old girl with xeroderma pigmentosum and confirmed XPC mutation followed in our dermatology clinic since the age of 3. She had a history of multiple actinic keratoses but no prior skin cancers. A 4-mm homogenous pink papule on the left frontal scalp concerning for basal cell carcinoma was noted during routine skin examination. After a 3-month course of 3 times weekly topical imiquimod, the lesion had grown to a 6 mm diameter. The patient was then referred to plastic surgery for definitive excision. Histologically, the lesion showed a well-circumscribed proliferation of spindle cells with a trabecular and nested growth pattern. Perivascular pseudorosettes were identified, as were areas that resembled well-differentiated neural tissue. The spindle cells diffusely expressed S100 protein, SOX10, and CD34, with patchy expression of Melan-A and HMB-45. PRAME was negative, and p16 was retained. Array comparative genomic hybridization was performed, and no clinically significant copy number or single nucleotide variants were detected. To the best of our knowledge, this is the first documented case in the literature of a cutaneous neurocristic hamartoma arising in a patient with xeroderma pigmentosum.
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Affiliation(s)
- Ariel Finberg
- University of Virginia School of Medicine, Charlottesville, VA
| | - Seth Martin
- Department of Dermatology, University of Virginia, Charlottesville, VA; and
| | - Sarah Gradecki
- Department of Dermatopathology, University of Virginia, Charlottesville, VA
| | - Barrett Zlotoff
- Department of Dermatology, University of Virginia, Charlottesville, VA; and
| | - Shyam S Raghavan
- Department of Dermatopathology, University of Virginia, Charlottesville, VA
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Wong J, Roy SF, Kokta V. Neurocristic Cutaneous Hamartoma With Perineuriomatous Differentiation: Can It Be Distinguished From Perineuriomatous Melanocytic Nevi? Am J Dermatopathol 2021; 43:757-758. [PMID: 33767071 DOI: 10.1097/dad.0000000000001934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jahg Wong
- Division of Pathology, University of Montréal, Montréal, Québec, Canada
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Kabbur G, Ravishankar A, Maguiness S. Hypertrichotic Plaque in a 17-Month-Old Boy. JAMA Dermatol 2021; 157:342-343. [PMID: 33566075 DOI: 10.1001/jamadermatol.2020.5665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Gowri Kabbur
- Department of Dermatology, University of Minnesota Medical Center, Minneapolis
| | | | - Sheilagh Maguiness
- Department of Dermatology, University of Minnesota Medical Center, Minneapolis.,Division of Pediatric Dermatology, Department of Dermatology, University of Minnesota Medical Center, Minneapolis
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7
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Liao C, Yang C, Chen Y. Cutaneous neurocristic hamartoma of the scalp: a rare case. Int J Dermatol 2019; 59:e60-e62. [DOI: 10.1111/ijd.14715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/29/2019] [Accepted: 10/20/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Chao‐Yu Liao
- Department of Dermatology Taichung Veterans General Hospital Taichung Taiwan
| | - Chi‐Shun Yang
- Department of Pathology and Laboratory Medicine Taichung Veterans General Hospital Taichung Taiwan
- Central Taiwan University of Science and Technology Taichung Taiwan
| | - Yi‐Ju Chen
- Department of Dermatology Taichung Veterans General Hospital Taichung Taiwan
- Department of Dermatology National Yang‐Ming University Taipei Taiwan
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Proliferating Neurocristic Hamartoma Arising in a Giant Congenital Nevus: Comparative Genomic Hybridization Findings. Am J Dermatopathol 2019; 41:438-442. [DOI: 10.1097/dad.0000000000001319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Hamartomas are benign lesions composed of aberrant disorganized growth of mature tissues. Choristomas are similar, except that they are composed of tissues not normally found at the anatomic site in which the lesion is arising. A wide range of hamartomas and choristomas can arise in the skin and soft tissue. Some of these may cause diagnostic difficulty and potentially be mistaken for neoplasms. Some neoplasms may resemble hamaratomas. Here we review the current clinical and pathologic features of these lesions, both common and rare, and discuss how to distinguish them from other entities in the differential diagnosis.
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Affiliation(s)
- B Joel Tjarks
- Departments of Laboratory Medicine and Dermatology, Geisinger Health System, Danville, PA, United States
| | - Jerad M Gardner
- Departments of Pathology and Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Nicole D Riddle
- Department of Pathology and Cell Biology - USF Health, Ruffolo, Hooper, and Associates, Tampa, FL, United States.
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Wilson LM, Beasley KJ, Sorrells TC, Johnson VV. Congenital neurocristic cutaneous hamartoma with poliosis: A case report. J Cutan Pathol 2017; 44:974-977. [DOI: 10.1111/cup.13027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/05/2017] [Accepted: 08/07/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | - Knox J. Beasley
- Department of Dermatology; McDonald Army Health Center; Ft. Eustis Virginia
| | - Timothy C. Sorrells
- Departments of Dermatology and Pathology; Naval Medical Center Portsmouth; Portsmouth Virginia
| | - Viviana V. Johnson
- Departments of Dermatology and Pathology; Naval Medical Center Portsmouth; Portsmouth Virginia
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Singh AD, Schoenfield LA, Bastian BC, Aziz HA, Marino MJ, Biscotti CV. Congenital uveal melanoma? Surv Ophthalmol 2015; 61:59-64. [PMID: 26277063 DOI: 10.1016/j.survophthal.2015.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 07/29/2015] [Accepted: 07/31/2015] [Indexed: 10/23/2022]
Abstract
A 3-month-old infant with a white mother and Asian father presented with discoloration and prominence of the left eye since birth. Examination revealed a normal right eye. The left eye had hyperchromic heterochromia and an enlarged cornea (diameter, 13.0 mm) with intraocular pressure of 26 mm Hg. There were multiple areas of subconjunctival nodular pigmentation that extended posteriorly into the superior fornix. Fundus examination showed a large ciliochoroidal pigmented mass extending from 10:30 to 3:00 o'clock position involving the superior half of the choroid and adjacent ciliary body. The eye was enucleated, confirming the diagnosis of diffuse uveal melanoma with extraocular extension. Systemic surveillance (hepatic panel and ultrasonography of the liver) performed every 6 months for 5 years was has been negative for metastases. The tumor was investigated intensively for the panel of genes (BAP1, BRAF, NRAS12, NRAS61, GNAQ, Kit 9,11,13,17,18) implicated in pathogenesis of blue nevus, cutaneous melanoma, and mucosal melanomas with negative results. Moreover, germline BAP1 mutation could not be identified. This case possibly represents as yet unidentified uveal melanocytic proliferation rather than a true variant of uveal melanoma.
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Affiliation(s)
- Arun D Singh
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland, Ohio, USA.
| | - Lynn A Schoenfield
- Department of Pathology, Wexner Medical Center, Ohio State University, Columbus, Ohio, USA
| | - Boris C Bastian
- Department of Dermatology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA; Department of Pathology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | - Hassan A Aziz
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland, Ohio, USA
| | - Meghan J Marino
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland, Ohio, USA
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A deep penetrating facial congenital melanocytic tumor with bone involvement and ipsilateral eye blindness. Am J Dermatopathol 2015; 37:e5-e11. [PMID: 25222197 DOI: 10.1097/dad.0000000000000048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Bone involvement has been described in tumors with melanocytic differentiation such as melanotic neuroectodermal tumor of infancy, and very rarely in cellular blue nevi and neurocristic cutaneous hamartoma. We present an unusual case of facial congenital melanocytic tumor that involved the underlying bones and maxillary sinus and led to unilateral blindness. A newborn with a large red bluish patch with peripheral brown and black macules overlying marked swelling on the left side of his face was presented. The tumor was shown by magnetic resonance imaging, scintigraphy, and histopathology to invade the underlying bones and maxillary sinus and to compress the left eyeball resulting in blindness. Histopathology, immunohistochemistry, morphometric computerized microscopy, molecular genetic mutation analysis, and fluorescent in situ hybridization studies were more congruent with a melanocytic nevus. An 8.5-year follow-up was uneventful, with spontaneous partial shrinkage of the tumor.
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Hadley C, Mohila CA, Luerssen TG, Lam S. Congenital neurocristic tumor presenting as an isolated calvarial defect in an infant: case report. J Neurosurg Pediatr 2015; 16:46-9. [PMID: 25837885 DOI: 10.3171/2014.12.peds14497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In infants, the presence of a cranial defect may be due to a variety of traumatic, inflammatory, neoplastic, and congenital abnormalities. Differentiation between these possible etiologies is facilitated by clinical presentation, patient history, and physical examination. Congenital cutaneous neural crest-derived lesions are unlikely to be considered in a patient presenting with an asymptomatic cranial defect without overlying mass or skin pigmentation. The authors present an unusual case of a 2-month-old infant with an asymptomatic calvarial defect with normal overlying skin. Pathology of the excised tissue showed features consistent with a congenital neurocristic tumor: a pigmented, neural crest-derived hamartomatous tumor that typically presents as a melanotic skin lesion.
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Affiliation(s)
| | - Carrie A Mohila
- Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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Goyal S, Arora VK, Gupta L, Singal A, Kaur N. Neurocristic Hamartoma With Lymph Node Involvement: A Diagnostic Dilemma. Am J Dermatopathol 2015; 37:e87-92. [PMID: 26091517 DOI: 10.1097/dad.0000000000000155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Neurocristic hamartoma (NH) is a rare dermal melanocytic lesion that is formed due to the aberrant development of neural crest-derived melanocytes during their course of migration through the dermis at the time of embryogenesis. Here, we describe a case of NH in a 6-year-old boy who clinically presented with diffuse plaque-type blue nevus on his scalp with a contiguous extension into the cervical region and lymph node involvement. A subcutaneous nodule displaying a marked histological heterogeneity with lymph node involvement is a very unusual and diagnostically challenging presentation of NH. The importance of an accurate diagnosis of NH lies in the fact that malignant transformation can rarely occur within these lesions over an unpredictable time course and remain undetected, rendering clinical management difficult. Although our child had a benign course after a follow-up of 5 years despite lymph node involvement, the possible risk of development of malignant melanoma in such a lesion warrants long-term surveillance. This case report highlights the unusual clinical presentation and histopathological features of this rare entity along with a relevant review of the literature. The present case also underscores the concept that sentinel lymph node involvement in certain melanocytic lesions in children must not be mistaken for malignant melanoma.
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Lee CC, Wu NL, Wu YH. Cutaneous neurocristic hamartoma on the scalp. DERMATOL SIN 2015. [DOI: 10.1016/j.dsi.2014.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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16
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El Hachem M, Diociaiuti A, Latella E, Zama M, Lambiase C, Giraldi L, Surrenti T, Callea F. Congenital myxoid and pigmented dermatofibrosarcoma protuberans: a case report. Pediatr Dermatol 2013; 30:e74-7. [PMID: 23534369 DOI: 10.1111/pde.12131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a low-grade, mesenchymal, spindle cell tumor. In addition to the classical form characterized by a storiform pattern of tumor cells, pigmented (Bednar's tumor) and myxoid variants can be observed. Classical DFSP and Bednar's tumor are easily diagnosed. The myxoid variant represents a diagnostic challenge. Pigmented and myxoid variants are rare and thus far have never been reported in association in congenital DFSP. We came across a unique DFSP that was, at the same time, congenital, pigmented, and myxoid. The tumor was surgically excised with broad free margins and no recurrence. The differential diagnosis with other entities such as giant cell fibroblastoma, CD34-positive plaque-like dermal fibroma, superficial plaque-like CD34 DFSP, and neurocristic hamartoma is discussed. The recognition of this hybrid variant of congenital DFSP is important to avoid under- or overtreatment.
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Affiliation(s)
- May El Hachem
- Department of Dermatology, Bambino Gesù Children's Hospital Istituto Di Ricovero e Cura a Carattere Scientifico, Rome, Italy
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Melanocytic Differentiation Is Present in a Significant Proportion of Nonpigmented Diffuse Neurofibromas. Am J Surg Pathol 2013; 37:1182-91. [DOI: 10.1097/pas.0b013e31828950a3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
We report a case of a 20-year-old Chinese man with an alopecic congenital combined compound and blue melanocytic nevus of the scalp, associated with alopecia areata. The diagnosis of a combined melanocytic nevus was confirmed by histopathological examination and immunohistochemical stains, with exclusion of neurocristic hamartoma, which can have a similar clinical and histopathological appearance but different prognosis. In addition, we explore the association of this large melanocytic lesion with alopecia areata.
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