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
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
Early squamous cell carcinomas of penis and vulva, the so-called precancerous lesions of genital region, have similarities in morphology and pathogenesis, but they also have, unfortunately, similarities in their classification and nomenclature that are quite confusing. Archaic terminologies lacking epidemiologic value and good reproducibility are still in use and, armed with their historical importance, compete for space in medical publications against modern terms which were coined on solid sci
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
Some months ago, our admirable colleague Dra. Marcia Lanzoni de Alvarenga Lira warned me that clinicians were starting to request dysplasia grading in cases of actinic cheilosis with the aim of predict malignant transformation and guide a more suitable therapeutic decision for an individual patient. At that time, I still hadn't received such a request. However, things changed somewhat in the last few weeks. Nowadays in my routine practice, clinicians not only started to request dysplasia grading
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
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
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
It's not uncommon a tumor appearing in the form of a histological subtype or a microscopic variant, in such a way that makes more difficult the correct diagnosis. There's no remaining alternative for practitioner pathologists but to be aware, as much as possible, about subtypes and variants of tumors, thereby reducing the chances of rare features be misconstrued as evidence of another tumor, or even of no tumor at all. For example, adenoid melanoma can be misconstrued as adenocarcinoma, and desm
It is a well-known fact that trainees in Dermatology & Dermatopathology are overawed by the hundreds and thousands of entities in our field, particularly with a new entity being named on a weekly basis!
For a novice in the field, the prospect of getting to terms with these entities is daunting and is probably one of the reasons most dermatologists are happy to outsource pathology to someone else. How many of these entities are actually truly unique and how many of these can be 'lumped' to
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
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
Melanocytic lesions always represent diagnostic challenge. Some nevi might display features disquieting enough to be unskillfully misdiagnosed as melanoma. And some melanomas have too subtle malignant characteristics that can pass unnoticed if a careful scrutiny is not accomplished. Not surprisingly, some melanocytic lesions are so difficult to be rendered as benign or malignant that even worldwide recognized experts in the field fail in achieve a reproducible diagnosis.
During a recent pract
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
[center]"There is nothing new to be discovered in physics now.â€[/center]
[center] - Lord Kelvin, 1900[/center]
In the 1990’s I was interviewed for a university position in pathology. The Chair, a Professor & Cambridge alumnus, informed me that we have “reached the limits of morphology†in pathology, and the era of molecular biology would revolutionise medicine. It was the first time I had heard such a view but by no means the last; indeed, the same claim was made by a derm
In the same way as for any occupational group, numerous potential health hazards are associated with the routine work of pathologists.
Empirical evidence gathered from close observation of work colleagues' complaints and of their own suggests to pathologists that their most common health problems are intolerance reactions to formalin, musculoskeletal disorders due to non-ergonomically optimized office chair and microscope, and cutting injuries during macroscopic organ dissection and autopsy.
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
All that glitters is not gold – the importance of context in the evaluation of atypia
“It’s too atypical to be malignant.â€
“It’s too atypical and so it has to be malignant.â€
These are too variations on the theme of atypia, and lead the thinker to two contradictory conclusions. I am sure you have either heard or spoken at least one of these two statements. Obviously, atypia doesn’t mean the same in every situation and to every person. Or, as Shakespeare wrote (in his T
It is now virtually routine in most centers around the world to consider SLN biopsy for all patients with melanoma's of stage 1b and above.
Current evidence suggests that this is only a prognostic exercise and has no influence on long-term outcome for patients. However, patients still do end up having SLN biopsy and lymphadenectomy (when SLN +ve), depending on the individual surgeon's enthusiasm regarding the procedure and the ability to sway the patient either way through 'informed consent'!
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?
I came across a nice study in the Journal of Cutaneous Pathology* in which the authors compared diagnostic accuracy between virtual microscopy and traditional glass slide microscopy among dermatology residents. According to this study, the overall diagnostic accuracy was better with glass slides than virtual slides.
I remember in Graz in the Summer Academy of Dermatopathology 2011, I have attended several lectures prepared by the virtual microscope in which scanned slides were presented.
Inflammatory dermatopathology is challenging to dermatopathologists as many diseases usually share one pattern. One should follow meticulously certain algorithms to limit the differential diagnosis to few diseases and also should pay attention to proper clinicopathological correlations to establish a definite diagnosis.
The psoriasiform pattern is one of those difficult patterns. I came across a nice article* which provides some clues to the diagnosis of this pattern and interestingly enough,
There are many books of Dermatopathology available for physicians who are interested or committed to this field of the diagnostic medicine. Written in different formats, depth and methods, they came to meet any kind of taste and requirement, except to the language.
Of course English is the usual language of the most famous Dermatopathology books. It wouldn't be a hassle for dermatopathologists with sufficient English proficiency if they had not to use another language to prepare reports and t
