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Llamas-Velasco M, Pérez-Muñoz N, Rozas-Muñoz E, Ballester R, Posada R, Figueras MF. Approach to the so-called "Invisible Dermatosis": When Subtle Histopathological Findings Guide Diagnosis. Am J Dermatopathol 2023; 45:801-811. [PMID: 37982463 DOI: 10.1097/dad.0000000000002563] [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: 11/21/2023]
Abstract
ABSTRACT Invisible dermatosis is a concept that can be applied either to clinical or histopathological findings. We will focus on the dermatopathological aspect of this invisible dermatosis that can be seen as dermatosis with subtle histopathological findings that are mandatory to known to stablish the diagnosis. With a proper approach facing in depth the different skin layers from stratum corneum to subcutaneous tissue combined with some especial stains, special investigations and mostly a proper clinicopathological correlation, the problem of missing out a diagnosis can be decreased. We will review the general aspects for diagnosis and the peculiar findings of an in-depth review of them because it is important to note that minor changes on a skin biopsy do not mean it is disease free. We will review classic clues, we will add some new useful ones, and we will also provide a guide on the special stains helpful, such as periodic acid-Schiff when facing fungi, orcein-Giemsa and van Gieson when altered elastic fibers are suspected, or Pearl and Masson Fontana when an altered skin pigmentation is suspected.
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Affiliation(s)
- Mar Llamas-Velasco
- Faculty, Department of Dermatology, Hospital Universitario de La Princesa, Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
| | - Noelia Pérez-Muñoz
- Faculty, Department of Pathology, Hospital Universitari General de Catalunya-Quirónsalud, Sant Cugat del Vallès, Barcelona, Spain
- Universitat International de Catalunya, Sant Cugat del Vallès, Barcelona, Spain; and
| | | | - Rosa Ballester
- Faculty, Department of Pathology, Hospital Universitari General de Catalunya-Quirónsalud, Sant Cugat del Vallès, Barcelona, Spain
| | - Rodolfo Posada
- Faculty, Department of Pathology, Hospital Universitari General de Catalunya-Quirónsalud, Sant Cugat del Vallès, Barcelona, Spain
| | - Maite Fernández Figueras
- Faculty, Department of Pathology, Hospital Universitari General de Catalunya-Quirónsalud, Sant Cugat del Vallès, Barcelona, Spain
- Universitat International de Catalunya, Sant Cugat del Vallès, Barcelona, Spain; and
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Silveira HA, Javaroni JB, da Silva ATF, Reyes MRT, Hashimoto JM, Cuadra-Zelaya FJM, Dominguete MHL, Mesquita ATM, Brunaldi MO, Bufalino A, León JE. Lipometaplasia in fibrous hyperplasia and inflammatory fibrous hyperplasia of the oral cavity. J Cutan Pathol 2023; 50:787-792. [PMID: 37394822 DOI: 10.1111/cup.14485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/22/2023] [Accepted: 05/29/2023] [Indexed: 07/04/2023]
Affiliation(s)
- Heitor Albergoni Silveira
- Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto Dental School (FORP/USP), University of São Paulo, Ribeirão Preto, Brazil
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental School, Sao Paulo State University (UNESP), Araraquara, Brazil
| | - Julia Biliato Javaroni
- Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto Dental School (FORP/USP), University of São Paulo, Ribeirão Preto, Brazil
| | | | - Magdalena Raquel Torres Reyes
- Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto Dental School (FORP/USP), University of São Paulo, Ribeirão Preto, Brazil
| | - Jennifer Mayumi Hashimoto
- Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto Dental School (FORP/USP), University of São Paulo, Ribeirão Preto, Brazil
| | | | | | - Ana Terezinha Marques Mesquita
- Department of Dentistry, Clinical Stomatology, Federal University of the Jequitinhonha and Mucuri Valleys, Diamantina, Brazil
| | - Mariângela Ottoboni Brunaldi
- Department of Pathology and Forensic Medicine, Ribeirão Preto Medical School (FMRP/USP), University of São Paulo, Ribeirão Preto, Brazil
| | - Andreia Bufalino
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental School, Sao Paulo State University (UNESP), Araraquara, Brazil
| | - Jorge Esquiche León
- Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto Dental School (FORP/USP), University of São Paulo, Ribeirão Preto, Brazil
- Department of Pathology and Forensic Medicine, Ribeirão Preto Medical School (FMRP/USP), University of São Paulo, Ribeirão Preto, Brazil
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Llamas-Velasco M, Muñoz-Aceituno E, Sánchez-Pérez J, Camarero-Mulas C, Fraga J, Aragüés M. Graft-versus-host disease-associated angiomatosis with striking lipomatous metaplasia. J Cutan Pathol 2021; 49:373-376. [PMID: 34743349 DOI: 10.1111/cup.14162] [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: 05/09/2021] [Revised: 10/30/2021] [Accepted: 10/31/2021] [Indexed: 11/30/2022]
Abstract
Sclerodermatous graft-versus-host disease (GvHD) is one of the many clinicopathological variants of chronic GvHD. One of the rarest forms of this variant is GvHD-associated angiomatosis (GvHD-AA). We describe the case of a 62-year-old male with sclerodermatous GvHD who presented, in consecutive years, two different lesions that showed characteristics of GvHD-AA. The first lesion fitted perfectly with the previously known features of this rare entity. However, the second lesion was more interesting, as the angiomatoid lesion was surrounded by newly appeared adipocytes, something not previously described. The appearance of this peculiar adipose tissue may be explained as related to an important dermal atrophy, as a concomitant appearance of a lipomatous nevus and GvHD-AA, or, finally, as mature adipose tissue related to a previous inflammatory process, that is, lipomatous metaplasia. Both lesions were diagnosed as GvHD-AA, and the second one was considered to be associated with dermal lipomatous metaplasia. We also considered whether hypoxia could be related to both lesions. In the present report, we review previously published cases of GvHD-AA and discuss the different hypotheses that could explain the appearance of metaplasia associated with the second lesion.
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Affiliation(s)
- Mar Llamas-Velasco
- Department of Dermatology, Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de la Princesa, Madrid, Spain
| | - Ester Muñoz-Aceituno
- Department of Dermatology, Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de la Princesa, Madrid, Spain
| | - Javier Sánchez-Pérez
- Department of Dermatology, Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de la Princesa, Madrid, Spain
| | - Celia Camarero-Mulas
- Department of Dermatology, Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de la Princesa, Madrid, Spain
| | - Javier Fraga
- Department of Pathology, Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de la Princesa, Madrid, Spain
| | - Maximiliano Aragüés
- Department of Dermatology, Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de la Princesa, Madrid, Spain
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Takai T, Murata Y, Goto K. Intradermal Band-like Lipomatous Metaplasia Can Be Associated With the Regression of Overlying Skin Neoplasms: A Clinicopathologic Study of 20 Cases. Am J Dermatopathol 2021; 43:477-484. [PMID: 34140440 DOI: 10.1097/dad.0000000000001813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
ABSTRACT Lipomatous metaplasia has been rarely reported in both neoplastic and inflammatory dermatological disorders. Most neoplastic cases show the lipomatous change within the tumor silhouette, but band-like lipomatous metaplasia in the dermis under tumors has not been well-described. The aim of this study was to reveal the characteristics and relationship of intradermal band-like lipomatous metaplasia and coexisting skin tumors. A total of 20 cases with intradermal band-like lipomatous metaplasia were retrieved from 10,992 archive cases between April 1997 and March 2020 at Hyogo Cancer Center, and subjected to a detailed clinicopathologic analysis. Nine (45%) patients had superficial variant basal cell carcinoma as a coexisting neoplasm. Eight (40%) patients had squamous cell carcinoma, 5 of which were in situ. The remaining 3 (15%) cases were invasive extramammary Paget disease. All 20 cases showed at least one of 3 signs of tumor regression, namely, partial loss of overlying neoplasia, significant inflammatory infiltrate under the tumor, and fibrosis around the tumor. We concluded that intradermal band-like lipomatous metaplasia could be seen in association with the regressing process of cutaneous superficially-spreading neoplasms.
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Affiliation(s)
- Toshihiro Takai
- Chief, Department of Dermatology, Hyogo Cancer Center, Akashi, Japan
| | - Yozo Murata
- Senior Adviser, Department of Dermatology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Keisuke Goto
- Chief, Department of Dermatology, Hyogo Cancer Center, Akashi, Japan
- Consultant Dermatopathologist, Department of Dermatology, Hyogo Cancer Center, Akashi, Japan
- Consultant Dermatopathologist, Department of Pathology, Itabashi Central Clinical Laboratory, Tokyo, Japan
- Consultant Dermatopathologist, Department of Diagnostic Pathology, Shizuoka Cancer Center Hospital, Nagaizumi, Japan ; and
- Consultant Dermatopathologist, Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
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Sahel H, Bellaifa S, Baba-Ahmed R. Lésions jaunâtres de psoriasis révélant une métaplasie lipomateuse dermique. Ann Dermatol Venereol 2020; 147:46-49. [DOI: 10.1016/j.annder.2019.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 05/25/2019] [Accepted: 09/04/2019] [Indexed: 10/25/2022]
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Band-like Lipomatous Metaplasia of the Superficial Dermis and Nonseptate Subcutaneous Tissue: A Rare Histopathological Phenomenon With Ultrasonographic Correlation. Am J Dermatopathol 2019; 42:526-529. [DOI: 10.1097/dad.0000000000001576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Mettman D, Fraga GR. Adipocytes in fibroepithelial polyps are not related to diabetes mellitus or obesity. J Am Acad Dermatol 2018; 79:1154-1155. [DOI: 10.1016/j.jaad.2018.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 06/12/2018] [Indexed: 10/14/2022]
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