UPMC Dermatopathology "Case of the Month" Presentations
UPP - Department of Dermatology, Dermatopathology Unit
Case Authors: Jason G. Whalen, MD, Jau-Shyong Deng, MD, Drazen Jukic MD PhD
MAY 2004 CASE OF THE MONTH
CLINICAL FINDINGS
CLINICAL HISTORY:An 82 year old white male with a past medical history of hypertension, benign prostate hyperplasia, and dementia presented for consultation to the VA hospital for a "rash" on his head. It has been present for approximately 6 weeks. It started around the forehead, and has been progressing to the rest of his face, scalp, and neck. He states his head becomes occasionally swollen and tender, and there are no other lesions on his body. He has not tried any treatments for this, and is not on aspirin/ NSAID's or other anticoagulants. A review of systems was otherwise unremarkable..
Physical Examination: On physical examination, the patient was a frail-appearing, elderly white male in no acute distress. One his forehead (Figure 1), anterior scalp, and upper neck (Figure 2), there were large, ill-defined purple patches. Some of these were indurated and mildly tender to palpation. No nodules, tumors, or ulceration was present. There were no other skin or mucous membrane lesions.
Pathology :
A punch biopsy of the forehead was performed. H&E (Figure 3 & 4) revealed infiltration of the dermis by pleomorphic cells, forming irregular and slit-like vascular spaces. The vascular spaces were seen to split around collagen bundles and papillary processes into the lumen were seen. The cells exhibited large nuclei with hyperchromatism and occasional mitoses. CD31 immunohistochemistry (Figure 5) was performed and showed positive staining of these irregular vascular spaces .
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