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Traumatic ulcerative granuloma

TUG is an interesting lesion that is often under-recognized by pathologists (other than oral pathologists). It presents clinically as an ulcer most often on the lateral or ventral tongue that usually has been present for several weeks, and measures such as filing down sharp teeth in the area has not resolved the lesion, raising the suspicion for cancer. It even feels indurated on palpation. However, trauma to the site is reported in less than 50% of cases. Histologically, depending on when th

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“Submucosa� in the oral cavity

Maybe someone out there can help me with the concept of “submucosa” in the oral cavity. Although I was trained, as most oral pathologists were, to use that term, I have moved away from it altogether. Where does the mucosa end and the submucosa begin? In the small and large intestines, the submucosa is separated from the mucosa by the muscularis mucosa, a clearly discernible band of smooth muscle. There is no such band of muscle in the mouth and the lamina propria looks different depending o

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Epidermotropism, not only a lymphocytic phenomenon

For junior dermatopathologists, the word epidermotropism represents the synonym of MF. However, epidermotropism is not only a lymphocytic phenomenon. The word epidermotropism in medical dictionary means: movement towards the epidermis. It applies to the spread of different types of cells into the epidermis from an underlying dermal or subcutaneous pathology. A very interesting review article is the one written by Abbas and Bhawan entitled: Epidermotropic lesions, a review*. They discussed all

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

Dermatopathology has reached the App Store!!!

The world today is advancing so rapidly in the field of communication technology. Both Apple and Samsung companies are competing vigorously and great advances in the smart phone technologies emerge so fast that one cannot keep up with. Nowadays, you can instantly download a wide range of applications on your phone that really can help you in many aspects of your life. One day I wondered about dermatopathology related applications, are they available?!! Interestingly, I found an application c

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

Horn cysts, Horn pearls, Squamous Eddies, and Squamous Morules, What is the difference?

Understanding various dermatopathology terms is mandatory for proper interpretation of findings and hence reaching a proper diagnosis. Sometimes residents and trainers find it difficult to discriminate between various terms. A common area of confusion is the concept of horn cysts, horn pearls, squamous eddies and squamous morules. Horn cysts represent foci of abrupt complete keratinization (with only a very thin surrounding granular cell layer and without retained nuclei). It may be pse

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

It must be evident to the patient and to the non-dermatologist clinician! Or: how I learned to stop worrying and no longer spurn the word 'eczema'.

When I still was a medical student, I undertook a practical training program in Internal Medicine at Allgemeines Krankenhaus der Stadt Wien, the legendary AKH, in Vienna. One of the admitted patients suddenly developed pruritic clear vesicles along the sides of his fingers, and Prof. K. wanted to know a diagnostic hypothesis from me. Trying to demonstrate some confidence, I quickly answered: “It’s a kind of eczema.” But he gave me back this reply: “You’re right and you're wrong. You’re right bec

Robledo F. Rocha

Robledo F. Rocha

What to do when you see nothing?

Sometimes in our practice as dermatopathologists we face routine H&E sections that appear to show no abnormality on initial examination. The situation gets complicated when we do not have enough clinical data. The first impression that would come to mind in such conditions is that the biopsy site might have been missed and maybe we are looking at normal skin!!!! However, this is not usually the case. There are dermatological conditions that only show subtle histopathological features that c

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

Melanotic macules

Melanotic lesions of the mucosa are extremely common and most of these are referred to as melanotic macules both clinically and on histopathology. The most common sites are lips (wet surface or vermilion), palatal mucosa and gingiva. Little change has occurred since this term was coined decades ago. I have often wondered: are these post-inflammatory hypermelanosis (PIH)? It is hard to say. Once the biopsy is done and a diagnosis of melanotic macule made, the patient is discharged and we never kn

Guest

Guest

Esinophils: The elegant clue of an upcoming monster!!

Since my early training in Dermatopathology I used to love esinophils! Their characteristic esinophilic granules give them this typical elegant red color making them look so beautiful under the microscope especially when they are conspicuous in the tissue. Conspicuous esinophils are encountered in many dermatologic conditions that include vesiculobullous disorders, disorders of blood vessels, infections and infestations in addition to many miscellaneous conditions and several tumors suc

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

When arthropods cause challenge to dermatopathologists

Insect bite reactions are frequently encountered in our signing out practice especially in lesions referred from pediatric cases. In such cases one usually see epidermal changes in the form of spongiosis with exocytosis of inflammatory cells. Also spongiotic vesicles can be seen, usually large and multilocular. Edema of the papillary dermis can occur and in some cases this may lead to subepidermal separation. The dermis typically shows a superficial and deep perivascular infiltrate rich in esin

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

Architectural evidence of dysplasia

I often hear the term “low threshold” when it comes to diagnosis of oral dysplasias. Oral dysplasias are tricky especially if you don’t have a clinical image to guide you. We are all familiar with the usual cytologic features of dysplasia such as pleomorphic cells, pleomorphic nuclei, hyperchromatic nuclei, abnormal mitoses and so forth. In the oral mucosa, it is just as important to evaluate architectural features of dysplasia. The most common of this is atypical verrucous or papillar

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Guest

Hypopigmented MF and Vitiligo: Conflicts in diagnosis

Hypopigmented MF is a rare type of MF that is typically observed in dark skinned individuals of Asian or African origin and is mostly encountered in children. The phenotype is predominantely CD8+ve and TCR gene rearrangement studies usually show clonal T cell population. From my limited experience, I came across two problems in the diagnosis of hypopigmented MF; both of them have something to do with vitiligo!!! The first problem is a pitfall when you don’t have enough clinical data and di

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

Skin resident memory and resident regulatory T cells

Regulatory T cells (Treg) play an important role in controlling ongoing immune responses and silencing exacerbated immune responses. Various subsets of regulatory T cell populations have been identified and are subdivided based on their surrounding microenvironment, expression of activation molecules, production of cytokines, and mechanisms of action. Briefly, naturally occurring thymic-derived CD4+CD25+ Treg are characterized by their constitutive expression of the transcription factor FOXP3, w

Guest Felix J. Tapia

Guest Felix J. Tapia

My experience in the 1st Dermatopathology Course in El Bierzo, Ponferrada, Spain, July 19-20, 2012

My experience in the 1st Dermatopathology Course in El Bierzo, Ponferrada, Spain, July 19-20, 2012 Mona R.E. Abdel Halim MD Dermatology, Diploma of Dermatopathology (ICDP-UEMS) Since establishing my career as a dermatopathologist I found it of utmost importance to keep improving my diagnostic skills. In addition to regular practice and reading, attending specialized courses held by eminent dermatopathologists is a vital skill developing experience. It allows you to share others’ exp

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

SCRATCH principles for diagnosis of insect bites

Insect bite reactions (papular urticaria) are the most commonly encountered skin eruptions in pediatric population. However, in many cases, these eruptions are frequently misdiagnosed and parents usually keep going from one dermatologist to another seeking a correct diagnosis. An interesting article by Hernandez and Cohen was published in “Pediatrics”, the official journal of the American Academy of Pediatrics has discussed certain clinical features that represent principles for di

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

The guardians of the skin immune system

It has been well established that the epithelia are major components of the immune system. Together with secondary lymphoid organs (ig. lymph nodes, Payer´s patch, etc.), they comprise the activation sites of the Skin and Mucosal Immune Systems, also known as Peripheral or Tegumentary Immune System. Therefore, the epidermis is an essential place for immunemodulation. Base on a series of articles by [b]Ralf Paus[/b] and collaborators from the University of Hamburg in Germany, in relation t

Guest Felix J. Tapia

Guest Felix J. Tapia

“Biphasic� in dermatopathology, what does it mean?

“Biphasic” in medical terminology means: having two phases, parts, aspects, or stages. In dermatopathology, many conditions are described as having a biphasic pattern. However, this term represents three different categories. The first category of lesions described as having a biphasic pattern represents certain tumors showing two distinct morphological areas. For example, one area shows a hemangiopericytomatous morphology with ramifying vascular spaces with stag horn appearance sur

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

Dysplasia with lymphocytic band – the so-called “lichenoid dysplasia�

The term “lichenoid” is used by many [i]pathologists[/i] to denote a lymphocytic band, sparse or dense, that hugs the epithelial-connective tissue interface. This term is also used by [i]clinicians[/i] to mean a red and white area, that may or may not be reticulated. If you add the fact that oral lichen planus is considered by some to be premalignant, and the scene is set for confusion. [u]Clinical and Histopathologic Findings [/u] Here is an example of how things get confus

Guest

Guest

Dysplastic nevi: to re-excise or not

Dysplastic nevi are often graded as showing mild, moderate or severe atypia. They may be associated with an increased risk of melanoma particularly in a familial setting but also one not uncommonly sees a dysplastic nevus adjacent to a melanoma suggesting progression. Although it is assumed by many that there is a progression through the varying degrees of atypia to [i]in situ[/i] and eventually invasive melanoma, this matter has not been fully resolved. With this as a background, the dermato

Dr. Phillip McKee

Dr. Phillip McKee

Dermal Hypersensitivity Reaction

In my practice, it is often that I come across slides showing only dermal hypersensitivity reaction. In such cases one encounter a mild superficial perivascular lymphocytic infiltrate with no or minimal deep dermal extension, associated with some perivascular and interstitial esinophils and mild dermal edema. Usually the epidermis is normal or only mildly spongiotic. Sometimes, lymphocytic vasculitis is associated. In such cases, going back to the clinical presentation will be of no hel

Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim

The Texas Sharpshooter Fallacy and Dermatopathologists - you don’t have to be in Texas to suffer from it

Although I am in Houston, Texas, I cannot make any exclusive claims to the Texas Sharpshooter Fallacy. This fallacy is one which I believe we dermatopathologists (as well as others) should be aware of. What exactly is this fallacy? Where do sharpshooters come into this, and why specifically in Texas? The name, if Wikipedia is to be believed, comes from the story of a Texan who shot holes in the side of a barn and then painted a bull’s eye around a group of them, giving rise to the mistak

Dr. Hafeez Diwan

Dr. Hafeez Diwan

Nevoid melanoma

Nevoid melanoma is one of the most important and difficult variants of melanoma. When lecturing, I define it as “a melanoma that you diagnosed as a nevus and wish you hadn’t”! Very commonly, it is a diagnosis of retrospect when a previously diagnosed nevus recurs and the correct diagnosis comes out. I had a mantra when I started my signout reminding myself of conditions I always should bear in mind when looking at the cases- don’t forget nevoid and desmoplastic melanoma (never report

Dr. Phillip McKee

Dr. Phillip McKee

Overseas experience

After I left Brigham and Women’s Hospital in Boston, I spent 3 months reporting all of the dermatopathology in the Department of Pathology at the Wits University Hospital in Johannesburg, South Africa as a guest of Wayne Grayson. What an amazing experience. Having left the Ivory Tower of Boston where melanocytic pathology and cutaneous T-cell lymphoma were my bread and butter, I entered a whole new world. I was reminded very quickly as to why I had embarked on a career in dermatopathology a

Dr. Phillip McKee

Dr. Phillip McKee

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