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Dr. Mona Abdel Halim's Blog

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Sebaceoma or Sebaceous Carcinoma?

[b][i][size=4]Mona R.E. Abdel Halim[/size][/i][/b] [center][b][i][size=4]MD Dermatology, Diploma of Dermatopathology (ICDP-UEMS)[/size][/i][/b][/center]   [size=4] I have followed with great attention a spot diagnosis case in this excellent website that was posted by Dr Mark Hurt in December 2015. A split of opinions has happened in this case between a sebaceoma and a sebaceous carcinoma, with Dr Mark giving the final diagnosis as a moderately differentiated sebaceous carcinoma. [/siz

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

Drug Reactions

[center][b][i]Mona R.E. Abdel Halim[/i][/b][/center] [center][b][i]MD Dermatology, Diploma of Dermatopathology (ICDP-UEMS)[/i][/b][/center] Drug reactions are one of the most common encounters in routine dermatopathology practice. In most of the cases, they are straight forward and represent distinct clinicopathological entities such as erythema multiforme, exanthematous drug eruptions, lichenoid drug eruptions, lymphomatoid drug eruptions and photosensitive drug eruptions. However, in some

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

The importance of dermatopathology meetings

[center][b][i]Mona R.E. Abdel Halim[/i][/b][/center] [center][b][i]MD Dermatology, Diploma of Dermatopathology (ICDP-UEMS)[/i][/b][/center] Attending dermatopathology meetings is an important tool for upgrading the knowledge of any dermatopathologist especially international meetings. Skin diseases have different distributions around the world. For example, whereas melanoma and non melanoma skin cancer are prevalent in the west, other skin diseases are more prevalent in the Middle East an

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

Appearances in dermatopathology

[center][b]Mona R.E. Abdel Halim[/b][/center] [center][b]MD Dermatology, Diploma of Dermatopathology (ICDP-UEMS)[/b][/center] I just came across this interesting article published in the Indian Journal of Dermatology, Venereology and Leprology about appearances in Dermatopathology. Dermatopathologists give different terms to describe various morphological appearances of different lesions so as to help them identify them. Although most of the terms I read were known to me, I came across new t

Pediatric Dermatopathology

[b]Mona R.E. Abdel Halim[/b] [b]MD Dermatology, Diploma of Dermatopathology (ICDP-UEMS)[/b] The pediatric age group which extends from birth till the age of 18 is a very rich age group when it comes to skin diseases. In this age group, we see congenital malformations, nevoid/hamartomatous lesions, and cutaneous manifestations of various syndromes in addition to other categories of medical disorders peculiar to this age group. Many skin diseases affect the pediatric age group more than the

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

A step in making a change

[b]Mona R.E. Abdel Halim MD Dermatology, Diploma of Dermatopathology (ICDP-UEMS)[/b] Two weeks ago was our annual meeting of the Dermatology Department, Cairo University. Alongside the meeting several workshops were carried out. This was the second time we have organized a Dermatopathology workshop. Last year the workshop was designed to cover major tissue reaction patterns and this year we covered epidermal tumors, adnexal tumors and cutaneous cysts (basic level). The interest for dermat

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

Hypopigmented MF or hypopigmented interface T cell dyscrasia?

One of the difficult areas in dermatopathology is the diagnosis of hypopigmented MF (HMF). Most of the cases affect children and young aged individuals. Constellation of clinical, histopathological and gene re-arrangement studies are needed to reach a definite diagnosis. In areas of the world like Egypt where resources are limited, TCR gene rearrangement studies are a luxurious kind of investigation that is not available on routine basis. Besides, it is known that TCR in HMF might be unreliable

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

Why is it important to carefully examine the stratum corneum?

I have seen a case that presented with a history of psoriasis for which she received topical steroids. The patient used to improve on topical steroids so she kept re-using them again and again. Since 1 year she claimed that the lesions started to progress to involve larger areas of her body and became resistant to treatment. I saw the skin biopsy in a routine signing out session before seeing the patient clinically. The findings were totally that of nonspecific spongiotic dermatitis with foci of

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

The sometimes challenging lichenoid reaction pattern

The lichenoid reaction pattern is commonly encountered in our daily signing out routine. it comprises a wide range of diseases from benign simple conditions like lichen planus to malignant serious conditions like lichenoid MF. A common mistake, that many beginners in dermatopathology can fall in, is the misinterpretation of interface lymphocytes as epidermotropic cells of MF especially in the context of lichenoid drug reactions for example where lymphocytes may become activated and appea

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

Longitudinal melanonychia

It was last week when I accidentally discovered a longitudinal band of melanonychia in my left little toe. Surprisingly, this was in the evening of a long day at work that included a signing out of a case of in transit metastasis of acral lentiginous melanoma!!!! Needless to say that my first decision was to arrange with my colleague, who is excellent in nail biopsies, to do a nail biopsy immediately. With the image of a metastatic acral lentiginous melanoma, I could not think of somethi

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

Have we missed any of them?

The interesting case of Dr Richard Carr posted in the Spot diagnosis section of this website on Friday 19/9 of Bowen's disease arising in a seborrheic keratosis has provoked my concern. I performed some Pubmed search and found several published reports of a variety of malignant tumors arising within seborrheic keratosis including BCC, SCC, trichilemmal carcinoma, porocarcinoma and Bowen's disease. It seems that these cases represent a mere random collision of two tumors within a single l

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

How to deal with difficult cases?

When you encounter a difficult case in your signing out routine, a case that you are unable to settle its diagnosis, which scenario you go through? 1. Refer the case to a colleague from the start. 2. Write down your findings, your provisional interpretation, suggest a differential diagnosis and ask for further work up, if not available in your lab. 3. Leave the case for a while, may be few days, have a second look on it later. Actually, each of the above scenarios can be used accordi

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

Ramadan Inspirations !!

It has been our holy month of Ramadan since the 29th of June! The month during which we fast from dawn till sunset every day. This month represents a great opportunity for our souls and bodies to undergo spiritual and physical re-shaping. It is part of our culture and tradition during this month to gather as families and friends at the "Iftar" meal at sunset to break our fasting. This meal is very important and although it should be nutritious, it still should be light and healthy especi

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

Lymphoma in disguise

The case of Dr Richard Carr which was posted in the spot diagnosis section of this wonderful website on Friday was really an amazing case of anaplastic large cell lymphoma (ALCL) rich in esinophils. The esinophils were so abundant that I missed the case as an infectious process !!!! This raised my attention to the possible disguised presentations of lymphomas. Primary cutaneous T cell lymphoma can be disguised clinically as eczematous or inflammatory skin conditions for long time before a p

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

Demodex folliculorum, the mite that lives inside your hair follicles!!

Unless I have studied dermatology and dermatopathology, if anyone would have told me that a mite lives inside my hair follicles and crawls over my face at night to eat and mate, I wouldn't have believed!!!!! Demodex folliculorum, this tiny mite living in symbiotic manner with us, has been implicated in the pathogenesis of rosacea and can cause resistant papulopustular eruptions in immunocompromized individuals (demodicosis). Together with my colleague Dr. Eman El-Nabarawy, we h

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

Limitations of immunohistochemistry in Egypt

In all the meetings that I have attended abroad, I have been always fascinated by the feasibility of applying different panels of markers for diagnosis of tumors. This is definitely a good tool in the hands of the dermatopathologist. However, in countries like Egypt, different panels may not be available and if available they are very expensive. Moreover, we do not have a National Health Service (NHS) that cover such expenses. In private practice, patients will have to pay for all these marke

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

A scientific day by the Thames !!

As part of upgrading my dermatopathology skills, I have planned to attend a meeting every year where I meet dermatopathologists from around the world, see interesting cases and know about updates in the field. This year, The Annual Updates in Dermatopathology Meeting, at St. Thomas Hospital arranged by Dr Eduardo Calonje, was my target. Thanks God, London was sunny!! It was an excellent day where I have attended interesting presentations and have seen cases related to many topics such as swe

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

Putting everything in context

Diagnosis in medicine is all about gathering symptoms and information from history, signs from examination, findings from labs and investigations and putting them all in a proper context to reach a meaningful diagnosis. In dermatopathology, it is very important to interpret histopathological findings in their proper context. Spongiosis in the epidermis does not necessarily mean that the diagnosis is eczema. Lymphocytes within the epidermis does not necessarily mean mycosis fungoides. Putting

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

Bullous pemphigoid in disguise!!

Bullous pemphigoid (BP) is a common cause of pruritus in the elderly population. I came across three cases in the last 3 months with my colleague Dr Eman El Nabarawy, in which the disease did not present with the classic tense bullae that we are all used to. All three cases were elderly who presented with intense itching of long durations associated with erythematous plaques, some are edematous, erythematous papules and crusted lesions. Bullous pemphigoid was not necessarily present in the g

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

Reaching a consensus about diagnosis and management of melanocytic proliferations, is it feasible?

The diagnosis of melanocytic lesions can be very difficult. Not all cases fall in the clear ends of the spectrum from a benign straightforward nevus to a frank invasive melanoma. The problem always lie in the lesions falling in between, in the grey zone. The problem is not only in the diagnosis but in the implications of this diagnosis on the management and prognosis. If we wrote in our report: atypical site nevus, or dysplastic nevus, moderate dysplasia, what is the message transferred

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

When clinicians make me irritated !!!!

It happened a couple of times this month that I have received insufficient specimens from clinicians!! A keratotic lesion on the forehead was referred to me and my colleague ,Dr Eman El-Nabarawy, as a lesion suspicious to be BCC. The specimen was a punch biopsy that revealed only masses of keratin!!!!! We signed out the report as insufficient specimen, excisional biopsy is required. The excisional biopsy revealed bowenoid actinic keratosis. A punch biopsy was referred to us from a lesion d

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

Spongiosis and Spongiform

Understanding dermatopathology related terminology is the basic step in learning dermatopathology. Sometimes residents get confused in these two words;" spongiosis" and "spongiform[b]"[/b] From the medical dictionary (www.medical-dictionary.com), spongiosis was defined as an inflammatory intercellular edema of the epidermis, while spongiform was given 3 descriptions: 1) Soft, and full of cavities; of an open, loose, pliable texture as, a spongy excrescence; spongy earth; spongy cake; spongy b

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

Ethical aspects in dermatopathology

Like any branch in medicine, dermatopathology has its ethical aspects. I was thinking about some issues: 1. Dermatologists doing dermatopathology might fall in unethical behavior when they take biopsies for their cases irrespective to their real need, just for running their business and increasing their profits. 2. Dermatologists doing dermatopathology may automatically interfere with the management plans of patients referred to them for biopsy taking. This may cause conflicts with origina

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

The cell that is bothering everyone!!

The fat cell, this lovely looking cell that constitute the bulk of the subcutaneous fat is a very annoying cell to many people nowadays!! With the stressful hectic life styles that most of us are living nowadays and with the increased availability of fast food shops, selling junk food, the incidence of obesity is increasing. With the increased awareness of comorbidities associated with obesity, many people are seeking obesity clinics. Many techniques are evolving to get rid of excess fa

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

Why is it important to publish cases with unusual findings?

We all know that LSEA commonly affects the vulva but we have been taught that it does not affect the vagina. I came across an interesting article in The JAMA Dermatol* issue of October 2013 about two cases of vulvar LSEA involving the vagina and this was confirmed by finding typical features of LSEA in vaginal biopsies. It appears that may be we are underestimating vaginal involvement in LSEA, maybe it is present while we do not know as we have been taught that it does not affect the vagina?

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

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