UPMC Dermatopathology "Case of the Month" Presentations
UPP - Department of Dermatology, Dermatopathology Unit
Case Authors: Justin J. Vujevich MD, Marion M. Vujevich MD and Drazen Jukic MD PhD
APRIL 2004 CASE OF THE MONTH
CLINICAL FINDINGS
CLINICAL HISTORY:35 year-old white male presents with two-month history of non-pruritic, rash on his arms, chest, back, and legs (Figure 1.1). Closer inspection of the lesions revealed blanching erythematous papules (Figures 1.2, 1.3). A firm rubbing of one of the lesions produced an urticarial wheal adjacent to the lesion. According to the patient, he occasionally has gastrointestinal cramping, diarrhea, flushing prior to the onset of new lesions. A 4 mm punch biopsy was performed on a left forearm lesion. Clinical differential diagnosis of the lesion at time of biopsy included lichen planus vs. psoriasis.
Hematoxylin-eosin (H&E) Staining:
H&E staining of a left forearm punch biopsy reveals a normal epidermis and a superficial perivascular and interstitial infiltrate (Figures 2.1, 2.2). Closer inspection of this infiltrate demonstrates perivascular and interstitial eosinophils, mast cells, and lymphocytes (Figures 2.3, 2.4, 2.5, 2.6). The arrow in Figure 2.7 points to a mast cell. .
Immunohistochemistry:
The following immunostains were performed:
A. Tryptase. Antibodies to the granule-associated
serine proteinase, tryptase, are detected within the cytoplasm of cells of the
perivascular and interstitial infiltrate (Figure 3.1, 3.2)
B. c-kit. Antibodies to the protein product of the proto-oncogene c-kit, a transmembrane
tyrosine kinase receptor, are detected on the cell membranes of the cells of
the perivascular and interstitial infiltrate (Figures 4.1, 4.2)
C. CD68. Antibodies to CD68, seen on histiocytes, was faintly positive in the
superficial dermis (Figure 5.1).
D. CD1a. Antibodies to CD1a stained positive for Langerhans cells within the
epidermis, but did not stain for cells of the perivascular and interstitial
infiltrate (Figure 6.1).
E. CD30. Antibodies to CD30 did not stain impressively for B-cells within the
perivascular and interstitial infiltrate (Figure 7.1)
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