UPMC Dermatopathology "Case of the Month" Presentations
UPP - Department of Dermatology, Dermatopathology Unit
Justin Vujevich, M.D., Joseph English, M.D. Drazen Jukic, M.D.
NOVEMBER 2005 CASE OF THE MONTH
CLINICAL FINDINGS
A 45 y/o Caucasian female presented to the dermatology clinic with a 6-month history of tender dusky-erythematous firm nodules and tumors on her trunk and extremities.
Past medical history was significant for multiple sclerosis, previously treated with chemotherapy. She had neither personal history nor family history of skin cancer. She was not on any medications. .
Review of systems included fevers, fatigue, loss of appetite, and a 10-pound weight loss.
Physical exam revealed multiple firm, tender, dusky 2-4 centimeter nodules and tumors on her chest, back, arms, and axillae (Figures 1 and 2). There were no oral lesions or nail changes. There was no appreciable hepatosplenomegaly.
An excisional biopsy was performed on one of the tumors on her upper scapular back. Hematoxylin and eosin staining demonstrated a deep nodular infiltrate (Figure 3). The blue-staining cells were pleomorphic with hyperchromatic nuclei (Figures 4, 5). Several mitotic figures were noted.
The atypical cells in the nodules stained positive for S100, HMB-45, Melan-A, vimentin, Ki-67 and tyrosinase (Figures 6, 7, 8, 9, 10, 11). The atypical cells did not stain for leukocyte common antigen (LCA), CD68, or pan-keratin (Figures 12, 13, 14).
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