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Tumorous infiltration of the corium



5  Non-tumorous skin diseases

5.13  Tumorous infiltration of the corium

Introduction:

Some cases of tumorous dermal infiltrations are included here, because it is necessary to differenciate them from inflammatory conditions.

5.13.1  Urticaria pigmentosa

Introduction:

This process is caused by accumulation of mastocytes within the dermis. There are 5 different types of this disease, some of them malignant. The amount of mastocytes is increased, but in some cases the increase is not conspicuous and cannot be deected without using special stainings.

Etiology, pathogenesis:

  • increased amount of mastocytes intradermally

Clinical signs:

  • generalized process, mostly on the trunk and extremities
  • small macules and papules
  • red or red-brown color (increased epidermal melanin after histamin stimulation)
  • Darier's sign: papules reacts on mechanic irritation by urtica and erythema
  • pruritus, sometimes systemic symptoms: migraine, nausea, GIT spasms, hypo- and hypertension
  • hepatosplenomegaly rarely, infiltration of the bone marrow, (mastocytic) leukemia
  • some cases self-limited, some malignant

Histology:

Typical papular urticaria pigmentosa is characterized by dense aggregates of monomorphous mastocytes intradermally (can be diagnosed using HE staining). Other cases require special staings and clinical data. Scattered eosinophils are often present.

Special staings: Giemsa, kresyl violet, toluidin blue, naphtol-ASD chloracetate esterase.

Pictures

Urticaria pigmentosa:
Urticaria pigmentosa, HE 10x (430)

Urticaria pigmentosa, Giemsa 10x (429)

Urticaria pigmentosa, kresyl violet 100x (428)

Urticaria pigmentosa, Giemsa 100x (427)

Next case:
Urticaria pigmentosa, HE 10x (433)

Urticaria pigmentosa, HE 40x (437)

Urticaria pigmentosa, Giemsa 10x (432)

Urticaria pigmentosa, Giemsa 40x (436)

Urticaria pigmentosa, Giemsa 100x (431)

Urticaria pigmentosa, kresyl violet 10x (434)

Urticaria pigmentosa, kresyl violet 20x (435)

Next case, with dense accumulation of mastocytes:
Urticaria pigmentosa, HE 20x (423)

Urticaria pigmentosa, HE 40x (424)

Urticaria pigmentosa, kresyl violet 40x (425)

Urticaria pigmentosa, kresyl violet 100x (422)

Urticaria pigmentosa, Darier's sign
Urticaria pigmentosa, Darier's sign, HE 40x (1438)

Urticaria pigmentosa, Darier's sign, HE 20x (1439)

Mastocytoma, chloracetatesterase:
Urticaria pigmentosa, CHAE 20x (1436)

Mastocytoma, c-kit:
Urticaria pigmentosa, c-kit 20x (1437)

Another case, semithin section:
Urticaria pigmentosa (semi-thin section), toluidin blue 100x (426)

Electron microscopic pictures:
Urticaria pigmentosa, electron microscope (625)

Urticaria pigmentosa, electron microscope (626)

Urticaria pigmentosa, electron microscope (627)

Urticaria pigmentosa, electron microscope (628)

Next case, less conspicuous form with small number of irregular, spindle shaped mastocytes:
Teleangiectasia macularis eruptiva perstans, HE 20x (414)

Teleangiectasia macularis eruptiva perstans, HE 40x (417)

Teleangiectasia macularis eruptiva perstans, Giemsa 20x (415)

Teleangiectasia macularis eruptiva perstans, Giemsa 40x (416)

Macular urticaria pigmentosa, inconspicuous if stained with HE:
Urticaria pigmentosa, papular, HE 40x (3566)

Urticaria pigmentosa, macular, kresyl violet 40x (3531)

Case of generalized mastocytosis, which was diagnosed from a skin biopsy as teleangiectasia macularis eruptiva perstans; skin biopsy and biopsy of the bone marrow:
Teleangiectasia macularis eruptiva perstans, HE 40x (4109)

Teleangiectasia macularis eruptiva perstans, kresyl violet 40x (4110)

Teleangiectasia macularis eruptiva perstans, kresyl violet 100x (4108)

Bone marrow in mastocytosis, previously diagnosed as teleangiectasia macularis eruptiva perstans, HE 100x (4102)

Teleangiectasia macularis eruptiva perstans, kresyl violet 100x (4103)

Teleangiectasia macularis eruptiva perstans, kresyl violet 100x (4104)

Urticaria pigmentosa, papular:
Mastocytoma, HE 40x (4781)

Urticaria pigmentosa, HE a CHAE:
Urticaria pigmentosa papular nonbullous, HE 40x (5013)
  [zoomify]
Urticaria pigmentosa papular nonbullous, CHAE 40x (5014)
  [zoomify]

Mastocytoma:
Urticaria pigmentosa, HE 40x (6214)

Mastocytoma:
Mastocytoma, HE 40x (6215)

Teleangiectasia macularis eruptiva perstans:
Teleangiectasia macularis eruptiva perstans, HE 60x (6216)

Teleangiectasia macularis eruptiva perstans, kresyl violet 60x (6217)

Mastocytoma:
Mastocytoma, HE 60x (12293)

Mastocytoma, Giemsa 60x (12469)

Mastocytosis:
Macular mastocytosis, urticaria pigmentosa, HE 60x (10688)

Mastocytoma:
Mastocytoma, HE 60x (12827)

Mastocytoma, CHAE 60x (12828)

Urticaria pigmentosa, HE and Giemsa:
Urticaria pigmentosa, HE 60x (12252)

Urticaria pigmentosa, HE 60x (12253)

Urticaria pigmentosa, Giemsa 60x (12305)

Urticaria pigmentosa, Giemsa 60x (12306)

5.13.2  Histiocytosis X

Introduction:

Occurs in several forms (malignant Letterer-Siwe, Hand-Schüller-Christian with storing and eosinophilic granuloma). Affects various organs, including the skin.

Histology:

Malignant form is characterized by dense tumorous infiltration of the epidermis, sometimes infiltrating the epidermis as well. The cells have kidney-shaped, sometimes polymorphic nuclei and eosinohilic cytoplasm. Are S100 protein and CD1a antigens positive, electron microscopy detects Bierbeck granules.

5.13.3  Metastatic infiltration of the dermis

Introduction:

Occurs in some cases of carcinomas (stomach, breast), renal carcinoma (Grawitz) and others. Infiltrating cells often contain mucin (PAS positive cytoplasmatic vacuoles, signet ring cells). Tumorous cells can be inconspicuous, therefore imunohistochemistry (anticytokeratins) is often useful.

Clinical signs:

  • atypical nodules and plaques
  • special types of metastatic dissemination in breast carcinoma: erysipeloid, en cuirasse
  • carcinoma of the kidney (Grawitz): metastases in the scalp
  • GIT carcinomas: Sister Joseph's nodule: metastasis in the umbilicus

Pictures

Skin metastases of uterine adenocarcinoma:
Metastasis, CLINIC (817)

Metaststases of the breast adenocarcinoma (knee):
Metastasis, CLINIC (818)

Skin metastases of breast adenocarcinoma:
Ca mammae, CLINIC (980)

Skin metastases of adenocarcinoma:
Infiltration of the skin by adenocarcinoma, CLINIC (1972)

Skin infiltration and metastases, adenocarcinoma of the breast:
Metastasis, carcinoma of the breast, CLINIC (5754)

Metastasis, carcinoma of the breast, CLINIC (5755)

Metastasis, carcinoma of the breast, CLINIC (5756)

Metastasis, carcinoma of the breast, CLINIC (5757)

Metastasis, carcinoma of the breast, CLINIC (5758)

Metastasis, carcinoma of the breast, CLINIC (5759)

Another examples of metastatic infiltration of the skin:

Histology:

Metastasis, usually showing some features of the primary tumor.

Pictures

Adenocarcinoma, breast:
Breast carcinoma, dermal infiltration, HE 10x (181)

Breast carcinoma, dermal infiltration, HE 20x (182)

Breast carcinoma, dermal infiltration, HE 40x (183)

Breast carcinoma, dermal infiltration, CK19 40x (180)

Another metastasing ductal carcinoma of the breast:
Carcinomatosis, ductal carcinoma of the breast, HE 20x (4438)
  [zoomify]

Infiltration of the dermis, breast adenocarcinoma, male:
Ductal adenocarcinoma, male breast, HE 60x (13987)

Another metastasing carcinoma of the breast:
Skin metastasis, breast adenocarcinoma, HE 60x (12390)

Scar and metastatic infiltration of the corium by adenocarcinoma:
Skin adenocarcinoma metastasis, scar, HE 40x (12678)

Another case, metastasis of low differentiated ductal carcinoma of the breast:
Metastasis of ductal carcinoma of the breast, HE 100x (6121)

Sclerosing metastatic infiltration of the corium, breast carcinoma:
Sclerosing metastasis of the breast carcinoma, HE 20x (12475)

Sclerosing metastasis of the breast carcinoma, HE 40x (12476)

Adenocarcinoma, stomach, PAS, anticytokeratins AE1/AE3:
Adenocarcinoma, stomach, dermal infiltration, PAS 10x (184)

Adenocarcinoma, stomach, dermal infiltration, PAS 20x (186)

Adenocarcinoma, stomach, dermal infiltration, PAS 40x (189)

Adenocarcinoma, stomach, dermal infiltration, AE13 20x (185)

Adenocarcinoma, stomach, dermal infiltration, AE13 40x (187)

Adenocarcinoma, stomach, dermal infiltration of subcutaenous fat, AE13 40x (188)

Large metastasis of the adenocarcinoma of the colon:
Adenocarcinoma of the colon, metastasis to the skin, HE 40x (4048)

Metastatic infiltration of the skin in adenocarcinoma of the sigmoid:
Metastasis, adenocarcinoma of the sigmoid, HE 20x (4346)
  [zoomify]

Adenocarcinoma of the lung, skin metastases
Adenocarcinoma, lung, metastasis, HE 10x (1162)

Adenocarcinoma, lung, metastasis, HE 40x (1163)

Skin metastasis of renal carcinoma (Grawitz):
Metastasis, Grawitz carcinoma, HE 10x (1938)

Metastasis, Grawitz carcinoma, HE 40x (1939)

Skin metastasis of renal carcinoma (Grawitz):
Grawitz carcinoma, metastasis, HE 40x (13018)

Skin metastasis of clear cell renal carcinoma (Grawitz):
Renal cell carcinoma, skin metastasis, HE 20x (13740)

Renal cell carcinoma, skin metastasis, HE 60x (13741)

Skin metastasis of renal carcinoma (Grawitz):
Grawitz carcinoma, metastasis, HE 60x (13999)

Metastasis of high grade (pale cell) renal carcinoma to the skin:
Metastasis of clear cell renal carcinoma to the skin, HE 60x (10074)

Metastasis of clear cell renal carcinoma to the skin, vimentin 40x (10454)

Renal cell carcinoma of Grawitz, AE13 40x (10450)

Metastasis of clear cell renal carcinoma to the skin, Ki67 40x (10452)

Metastasis of clear cell renal carcinoma to the skin, CD31 40x (10448)

Metastasis of clear cell renal carcinoma to the skin, CD34 40x (10449)

Metastasis of clear cell renal carcinoma to the skin, HMB45 40x (10451)

Metastasis of clear cell renal carcinoma to the skin, S100 40x (10453)

Metastasis of squamous cell carcinoma, HE, AE1/AE3:
Metastasis, spinalioma, HE 40x (4831)
  [zoomify]
Squamous cell carcinoma, metastasis, AE13 40x (4830)

Adenocarcinoma metastasis:
Mucinous adenocarcinoma, metastasis, HE 40x (5158)

Mucinous adenocarcinoma, metastasis, PAS 40x (5163)

Mucinous adenocarcinoma, metastasis, AE13 40x (5157)

Lymphangiitis carcinomatosa:
Lymphangiitis carcinomatosa, HE 20x (5200)

Metastasis, CEA 20x (5199)

Carcinosis of the skin (breast carcinoma):
Carcinosis cutis, breast carcinoma, HE 60x (12869)

Carcinosis cutis, breast carcinoma, PAS 60x (12870)

Metastasis of carcinoid to the skin (HE, chromogranin):
Carcinoid, metastasis to the skin, HE 40x (13380)

Carcinoid, metastasis to the skin, chromogranin 40x (13379)

Erysipelas carcinomatosa, metastatic infiltration of the corium with adenocarcinoma:
Carcinomatous infiltration of the skin, HE 40x (12676)

Malignant phyllodes tumor, skin metastasis:
Cystosarcoma phyllodes, metastasis to the skin, HE 60x (13899)

Cystosarcoma phyllodes, metastasis to the skin, vimentin 20x (13898)

Cystosarcoma phyllodes, metastasis to the skin, SMA 20x (13897)

Cystosarcoma phyllodes, metastasis to the skin, S100 20x (13896)

Cystosarcoma phyllodes, metastasis to the skin, AE13 20x (13893)

Cystosarcoma phyllodes, metastasis to the skin, Melan A 20x (13895)

Cystosarcoma phyllodes, metastasis to the skin, CD34 20x (13894)

5.13.4  Paget's carcinoma of the breast

Clinical signs:

  • localization: areola mammae
  • intraepidermal spread of ductal breast carcinoma

Pictures

Morbus Paget:
Ca mammae, CLINIC (981)

Another examples of Paget's disease:

Histology:

Paget's disease is a special form of breast carcinoma, where malignant epithelial cells spread from the duct to the epidermis of the mamilla, areola and ev. further. The cells contain only small amounts of mucin (no signet ring cells are present).

5.13.5  Extramammary Paget's disease

Clinical signs:

  • intraepidermal tumorous proliferation
  • PAS positive tumorous cells
  • affects perigenital and genital regions, rarely somewhere else (axilla)
  • reddish patches with exudation and crusts
  • sharp, irregular borders
  • pruritic

Histology:

PAS positive tumorous cells within all layers of the epidermis and within follicular epithelium.

5.13.6  Epidermal spread of colonic adenocarcinoma

Clinical signs:

  • often perianal
  • adenocarcinoma of the colon (rectum) is present

Histology:

Signet ring cells with mucin, focal formation of adenoid formations.



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