CUMC Dermatopathology

publications,2006-

Deba P Sarma, MD
Professor of Pathology, Director of Dermatopathology
Creighton University Medical Center, Omaha
Man, 58, with a tumor mass in the leg amputation stump

Fig.2
Fig.1

Diagnosis: Verrucous carcinoma

Ref:
Deba P. Sarma, Thomas P. Hansen, Edward D. Adickes:
Carcinoma Arising In The Leg Amputation Stump. The Internet Journal of Dermatology.
2006. Volume 4 Number 1.
 Male, 41, presented with disseminated subcutaneous abscesses one month
after amputation for septic right leg and removal of Groshon vascular catheter
tip.

Fig.1 Fig.2

Fig,3, AFB stain

Diagnosis: Dermal abscess due to

Mycobacterium abscessus.

Ref.
Hansen TP, Sarma DP(2006): Multiple subcutaneous nodules associate with Mycobacterium
abscessus infection following removal of an infected Groshon vascular catheter tip. Dermatol
Online J 12(4):12. PMID:17083867 [PubMed - indexed for MEDLINE]
 Man, 29, with a painless slow-growing nodule of left forearm

for a year.
Fig.2
Fig.1

Diagnosis: Sinusoidal hemangioma.

Ref.

Wang B, Santos E, Sarma DP(2006).

Sinusoidal hemangioma in an adult male. The Internet J Dermatol
. 4(1):2006. Indexed by Google Scholar.
 Man, 59, phimosis, excised foreskin.
Fig.1 Fig.2

Diagnosis: Hemangioma.

Ref. Santos E, Sarma D(2006): Hemangioma of the prepuce. The InternetJ

  Dermatol.4(1). Indexed by Google Scholar.
 Man,74, 1-cm keratotic lesion of forehead
Fig.2
Fig.1

Diagnosis: Bullous actinic keratosis

Ref.


Sarma DP, Sharma P(2006) Bullous solar keratosis. The Internet J Dermatol, 4(1).     
Indexed by Google Scholar.
 Man,69, left cheek lesion, suspected of squamous cell carcinoma

Fig.1 Fig.2
The tumor cells were immunoreactive for EMA, BerEp-4, CK7, and, AE1/3 with variable positive stains of Androgen receptor,
CK8/18, and Vimentin, but were negative for immunostains of S100, HMB45, CK20, TTF-1, RCC, and PSA. The neoplastic cells
from the foci of apocrine differentiation were immunoreactive for GCDFP-15 and CK8/18. Immunostains for mismatch repair genes
includnig hMLH1, hMSH2, hMSH6, PMSH2 and RT-PCR for microsatellite instability studies including MSI (T) and MSI(C) were
negative.
Diagnosis: Sebaceous carcinoma with apocrine
differentiation
Ref.

Wang B, Sarma DP(2006). Sebaceous carcinoma with apocrine differentiation.  The Internet J Dermatol
, 4(2).       Indexed by Google Scholar.
 Woman, 51, 1-cm nodule, left arm

Diagnosis: Proliferating trichilemmal cyst

Ref.

Sharma P, Sarma DP(2006).

Proliferating trichilemmal cyst of the arm. The Internet J Dermatol,4(2), 2006.
Indexed by Google Scholar.
 A 73-year-old woman presented with a 0.4 cm lesion on the left cheek.

Diagnosis: Squamous cell carcinoma in situ associated with osteoma cutis.

Ref.

Poonam Sharma, Deba P. Sarma: Squamous Cell Carcinoma In Situ Associated With
Osteoma Cutis. The Internet Journal of Dermatology. 2006. Volume 4 Number
 An 80-year-old man presented with a long-standing skin lesion on his mid forehead.

Diagnosis: Seborrheic keratosis with in-situ squamous cell carcinoma changes

Ref.

Sharma P, Sarma DP, Adickes ED (2006). Seborrheic keratosis

with in-situ carcinoma changes. Dermatology Online J 12(7):19. PMID:
17459305 [PubMed - indexed for MEDLINE]
A few interesting memories from more than 30-year of dermatopathology practice

Deba P. Sarma: From The Diary Of A Dermatopathologist. The Internet

Journal of Dermatology. 2006. Volume 4 Number 2.
 A 63-year-old man with a 20-year history of diabetes mellitus,
peripheral vascular disease and hypertension presented with a non-

healing ulcer of left foot

Diagnosis: Verrucous carcinoma.

Ref.

Deba P. Sarma, Jeff F. Wang, Chhanda Bewtra, Lisa M. J. Lee: Verrucous Carcinoma
Arising In A Chronic Non-Healing Ulcer Of The Foot Of A Diabetic Patient. The
Internet Journal of Dermatology. 2007. Volume 5 Number 1.
A 69-year-old female presented a 0.5 cm flat, pigmented skin lesion on the right dorsal forearm.

Melan A stain S-100 stain

Diagnosis: Pigmented neurofibroma.

Ref.

Zenggang Pan, Deba P. Sarma: Pigmented Neurofibroma Of The Skin: A

Case Report And Review Of The Literature. The Internet Journal of
Dermatology. 2007. Volume 5 Number 1.
 A 34-year-old woman noticed multiple slow-growing painful and itchy nodules on
her face (1 lesion) and extremities(1 on arm and 5 on both legs).

Diagnosis: Dermatofibroma.

Ref.

Mingkui Chen, Deba Sarma: Multiple Dermatofibromas in an Adult Female. The

Internet Journal of Dermatology. 2007. Volume 5 Number 1.
 Abstract
We report a case of dermal malignant melanoma that stained negatively for commonly
done immunostains, HMB-45, and Melan-A. It stained weakly positive for S-100 protein,
a less specific marker for melanocytes. The diagnosis was established by strongly
positive immunostaining by MITF ( microphthlmia-associated transcription factor). A brief
review of the MITF and its usefulness in the diagnosis of melanoma are presented.

MITF

Ref.

Jeff F. Wang, Deba P. Sarma, Pamela Ulmer: Diagnostic dilemma: HMB-45 and
Melan-A negative tumor, can it be still a melanoma?: MITF (Microphthalmia-
associated transcription factor) stain may confirm the diagnosis. The Internet
Journal of Dermatology. 2007. Volume 5 Number 1.
 Abstract
A benign adnexal skin tumor showing sebaceous and hair differentiation occurring in an 84-
year-old man is reported. Such a tumor may be called a sebotrichoma.

Diagnosis: Sebotrichoma

Ref.

Sarma DP, Santos EE, Wang B (2007). Sebotrichoma. The Internet J Dermatol
5(1). Indexed by Google Scholar.
 Abstract
A skin biopsy from a nasal lesion showed a dermal infiltrating neoplasm composed of
polygonal cells with small nuclei and abundant coarsely granular eosinophilic cytoplasm.
Light microscopic features were that of a granular cell tumor. However, the results of the
immunohistologic studies and the observations of the electron microscopic studies did
not identify the nature of the cells nor did they confirm that it was a granular cell tumor.
We interpret the lesion as a pseudogranular cell tumor of the skin.

Ref.

Deba P. Sarma, Eric E. Santos, William J. Hunter, Zoran Gatalica:

Pseudogranular Cell Tumor Of The Skin. The Internet Journal of Dermatology.
2007. Volume 5 Number 1.
 A case of acquired perforating osteoma cutis occurring on the
finger of a 43-year-old man is reported. English literature on

the topic is briefly reviewed.

Diagnosis: Osteoma cutis

Ref.

Wang JF, Sarma DP (2007). Acquired perforating osteoma



cutis. The Internet J Dermatol 5(1). Indexed by Google Scholar.

 Abstract
We are reporting a case of cutaneous leiomyosarcoma
occurring on the face of a 98-year-old woman with a brief

review of the literature .

SMA stain
Diagnosis: Leiomyosarcoma cutis.

Ref.

Eric E. Santos, Deba P. Sarma: Cutaneous Leiomyosarcoma of the Face.

The Internet Journal of Dermatology. 2007. Volume 5 Number 1.
I find no good reason to separate keratoacanthoma from well differentiated
squamous cell carcinoma. I am now reporting crateriform squamous
epithelial lesions (that I used to report as keratoacanthoma) as ‘well
differentiated squamous cell carcinoma, keratoacanthoma type'. They may
then be treated as a well differentiated squamous cell carcinoma with a
superficial complete resection, and the patient is relieved of a fast-growing
lesion. A small scar is definitely acceptable!

Ref.
Deba P. Sarma: Keratoacanthoma Should Be Reported As 'Well
Differentiated Squamous Cell Carcinoma, Keratoacanthoma Type': A
Dermatopathologist's View. The Internet Journal of Dermatology. 2007.
Volume 5 Number 1.
 The picture is that of the palms of a 44-year old man of Chinese heritage who
had had red hands since birth. His 74-year-old mother and his 7-year-old
daughter also had bright red palms all their life.

Diagnosis: Erythema palmare hereditarium

Ref

Sarma DP, Wang B (2007). Erythema palmare hereditarium
(Red palms): Lane’s Disease. Dermatol Online J. 13(2). PMID: 17498447
[PubMed - indexed for MEDLINE
 Abstract
A case of a wooden splinter dermatitis occurring in the foot of a 69-year old female is
reported. The clinical features, pathology and treatment of this common injury are
briefly reviewed.

Ref.
Chen M, Sarma DP (2007).


Wooden splinter dermatitis. The Internet J Dermatol 5(2). Indexed by

Google Scholar.
 Abstract
Cutaneous ossification is as a primary event or secondary to
a wide variety of inflammatory, traumatic, or neoplastic
conditions. We describe a case of pilomatricoma with
extensive ossification

Ref.


Sharma P, Sarma DP (2007). Ossified pilomatricoma. The Internet  J
Dermatol 5(2). Indexed by Google Scholar.
 Abstract
We report a case of a Merkel cell carcinoma of the dermis with a Bowen's disease
of the overlying epidermis arising in the left thigh in an 88-year-old Caucasian
female. A brief review of the literature is presented.

CK20

Ref.

Deba P. Sarma, Bo Wang, James Shehan, Lisa Linder-Stephenson:

Concurrent Merkel cell carcinoma and Bowen's disease of the thigh. The
Internet Journal of Dermatology. 2007. Volume 5 Number 2.
 Abstract
We report a case of metatypical basal cell carcinoma on the
nose of a 79-year-old woman with a brief review of the
literature
bcl2 Ber-Ep4

Ref.

Eric E. Santos, Deba P. Sarma, Mingkui Chen, Bo Wang: Metatypical Basal

Cell Carcinoma of the Nose. The Internet Journal of Dermatology. 2007.
Volume 5 Number
 Abstract
Fibrofolliculoma is a very rare benign tumor of the skin that is derived from the
perifollicular sheath. Histologically, it shows a well-formed central hair follicle with a
dilated infundibulum containing laminated keratin with anastomosing epithelial strands
that radiate from the central hair follicle into the perifollicular fibrotic stroma. The
patients with multiple fibrofolliculomas have an association with Birt-Hogg-Dube
syndrome. We report a case of a solitary nasal fibrofolliculoma occurring in a 60-year-
old male and briefly review the literature.

Ref.

Zenggang Pan, Deba P. Sarma: Solitary Nasal Fibrofolliculoma. The Internet

Journal of Dermatology. 2007. Volume 5 Number 2.
 Abstract
A case of intramuscular angioma in the frontalis muscle of the forehead
is reported. The etiology, pathology and treatment of this rare tumor
are briefly reviewed.

Ref.

Mingkui Chen, Deba P. Sarma: Intramuscular Angioma of the

Frontalis Muscle. The Internet Journal of Dermatology. 2007.
Volume 5 Number 2.
Abstract
We report a rare case of a dermal nerve sheath myxoma of the left intranasal skin occurring in a
33-year-old female. A brief review of nerve sheath myxoma and a similar tumor, neurothekeoma, is
presented.

S-100

Ref.

Jeff F. Wang, Deba P. Sarma, Eric E. Santos, Bo Wang: Dermal Nerve Sheath
Myxoma. The Internet Journal of Dermatology. 2007. Volume 5 Number 2.
 Abstract
Medical students and the trainees in dermatology and pathology have a curiosity about the names, such as,
acne vulgaris or verruca vulgaris. The word “vulgaris” sounds like vulgar, commonly meaning crudely
indecent, coarse, or obscene. However, the word “vulgar” is derived from the Latin word “vulgaris”, meaning
“of or belonging to the common people”. In medical terminology, the word “vulgaris” means common or
ordinary.
A search through the indexes in Dermatology and Pathology text books revealed seven dermatologic
conditions with “vulgaris” in their names. These included very common diseases, such as, acne vulgaris and
verruca vulgaris as well as now rarely diagnosed disease, such as, lupus vulgaris. We are briefly reviewing
the seven “vulgaris” diseases of the skin.

Ref.

Mingkui Chen, Erin Bruno, Eric E. Santos, Deba P. Sarma: A brief review of
the “vulgaris” lesions of the skin. The Internet Journal of Dermatology.
2007. Volume 6 Number 1.
 Abstract
We present a case of an 81-year-old male with an
asymptomatic skin nodule on his left upper cheek

Ref

Bo Wang, Deba P. Sarma: Sebaceous Carcinoma and Mismatch Repair

Gene Expression. The Internet Journal of Dermatology. 2007. Volume 6
Number 1
 Case Report
This is a photomicrograph (Figure 1) of a biopsied asymptomatic skin nodule from the anterior neck of
a 45-year-old man. There was no history of trauma or previous surgical procedure in this location. The
epidermis is somewhat raised with hyperkeratosis and acanthosis. The upper dermis shows fibrosis. A
well-circumscribed dermal tumor nodule shows no extension into the subcutis. The tumor is composed
of mature hyaline cartilage with normal chondrocytes within a homogeneous basophilic stroma. The
chondrocytes show mostly single small nuclei without any significant atypia (Figure 2). There is no
necrosis or mitotic figures. Secondary ossification or calcification is not present. The periphery of the
tumor is free of any giant cell reaction, granulation tissue or any evidence of traumatic tissue reaction.
The lesion appears to be a true chondroma in the dermis.

Ref
Deba P. Sarma, Mingkui Chen, Bo Wang: Chondroma Cutis. The Internet
Journal of Dermatology. 2007. Volume 6 Number 1.
 Case presentation
We report a case of a 59-year-old woman with a cutaneous
leiomyosarcoma associated with osteoclast-like giant cells arising from the
subcutaneous artery of the leg. The nature of the giant cells is discussed in
light of the findings from the immunostaining as well as survey of the
literature.

Ref.


Sarma DP, Santos EE, Wang B (2007). Leiomyosarcoma
of the skin with osteoclast
-like giant cells: a case report. J Med Case Reports 1(1):108
.
PMID: 18081931 [PubMed - in process
 Abstract
Dermatomyofibroma is a rare, benign cutaneous tumor derived from
myofibroblasts. It is predominantly found in young women, and only a few
cases have been reported in males. This entity is not generally well known and
often misdiagnosed. We report such a case of dermatofibroma occurring in a
23-year-old male with a brief review of the English literature.

SMA

Ref.

Zenggang Pan, Edward D. Adickes, Deba P. Sarma: Dermatomyofibroma: A

Case Report And Review Of The Literature. The Internet Journal of
Dermatology. 2008. Volume 6 Number 2.
 Abstract
Mycobacterium mucogenicum is a recently characterized organism that rarely may cause human infections.
This rapidly growing mycobacterium is commonly identified in tap water. Both immunosuppressed and
immunocompetent patients may develop infections from Mycobacterium mucogenicum. Some patients have
experienced lethal disease, including sepsis. Infections occurring in the skin and soft tissues have been
described only after a preceding injury. We present the first case of infection with Mycobacterium
mucogenicum occurring in a patient on the TNF-α antagonist etanercept and without any prior soft tissue
injury.

AFB stain

Ref.


Shehan JM, Sarma DP. (2008). Mycobacteriun mucogenicum
: Report of a skin infection associated with the use of Etanercept
. Dermatology Online J. 14(1): 5. PMID: 18319022 [PubMed - indexed for
MEDLINE]
 Abstract
We report a case of a 50-year-old man who developed a possible implantation
carcinoma of the scalp within the craniotomy scar 19 months after a metastatic renal
cell tumor nodule was removed from the brain. The English literature on the
implantation carcinoma is briefly reviewed.

RCC immunostain

Ref.

Sarma DP, Wang JF, McAllister MV, Wang B, Shehan JM. (2008)
Possible implantation carcinoma of the scalp following craniotomy
for
metastatic renal cell carcinoma. Dermatology Online J 14(6):20.
PMID: 18713600 [PubMed - indexed for MEDLINE
 Abstract
A 58-year-old Caucasian woman presented with a cystic lump behind the right ear
that was clinically diagnosed as an infected sebaceous cyst. The lesion was
treated with incision and drainage followed by antibiotics for 3 months. Because
there was no resolution, a biopsy was performed that revealed a high grade
angiosarcoma. She expired 2 months later. Cutaneous angiosarcoma is an
extremely aggressive tumor. Therefore early diagnosis and management is crucial
in providing better patient care.

CD34

Ref. Factor VIII


Pan Z, Albertson D, Bhuller A, Wang B, Shehan JM,
Sarma DP. (2008)
Angiosarcoma of the scalp mimicking a sebaceous cyst.
Dermatolgy Online J 14 (6): 13. PMID: 18713594 [PubMed
- indexed for MEDLINE
 Abstract
We are reporting a rare case of an acantholytic seborrheic keratosis and briefly
reviewing the relevant literature.

Ref.


Wang JF, Wang W, Shehan JM, Sarma DP. (2008).
Acantholytic seborrheic keratosis. The Internet J Dermatol 6 (2).
Indexed by Google Scholar.
 Abstract
We are reporting a case of CD34-positive fibroma of the lip. English literature is briefly reviewed.

Case Report
A 56-year-old female presented with a slightly raised nodule on the lower lip measuring 0.7 x 0.7 cm. This lesion was noted by
the patient for about a month. There was no history of trauma or previous biopsy at this site. An excisional biopsy was performed.

CD34 Vimentin

Ref.

Wang JF, Sarma DP. (2008). CD34-positive fibroma

of the lip. The Internet J Dermatol 6 (2). Indexed by
Google Scholar.
 Abstract
We are reporting a case of desmoplastic malignant melanoma that was confirmed by
immunostaining for microphthalmia-associated transcription factor (MITF). A brief review
of utility of MITF for diagnosis of melanoma is presented.

S100 MITF
Ref.

Wang JF, Wang B, Shehan JM, Sarma DP. (2008). Use of MITF (
Microphthalmia-Associated Transcription Factor) immunostain
for diagnosis of desmoplastic melanoma. The Internet J Dermatol 6 (2).
Indexed by Google Scholar.
 Abstract
A rare case of a nodulocystic hidradenoma with intracystic carcinoma in-situ occurring
in the scalp of a 79-year-old man is reported.

Ref.

Wang B, Sarma DP, Javadzadeh BM, Shehan JM, (2008).



Solid and cystic clear cell hidradenoma with focal intracystic

carcinoma in-situ. The Internet J Dermatol 6(2). Indexed by Google Scholar.
 Abstract
Paraganglioma-like dermal melanocytic tumor is a rare subtype of benign dermal melanocytic tumors. Its
histopathologic features resemble those of paraganglioma, but the immunostaining characteristics are
those of melanocytic lesions.
We report a case of a 60-year-old male with a paraganglioma-like dermal melanocytic tumor of his left
cheek and briefly review the English literature.

S100

Ref.

Sarma DP, Teruya B, Wang B (2008). Paraganglioma-like dermal melanocytic



tumor: a case report. Cases Journal 1:48. PMID: 18638402 [PubMed - in process]
 Abstract
We are reporting two cases of glomus tumor of the cheek that we had recently encountered
during the last six months. English literature is briefly reviewed .
Case Reports
A 51-year-old male presented with an asymptomatic red right lower cheek lesion that was clinically diagnosed as
a “venous lake”.

Ref.
Wang B, Wang J, Shehan J, Sarma DP.(2008). Glomus


tumor of the cheek. The Internet J of Dermatology 6 (2). Indexed by Google

Scholar.
 Abstract
Fibroepithelioma of Pinkus (FEP) is a rare indolent variety of basal cell carcinoma that is typically polypoid and
located on the trunk of adult males aged 40–60 years. Basal cell carcinoma (including FEP) is very rare in the
pediatric population. We are reporting such a case occurring in a 9-year-old boy.
Case presentation
A 9-year-old boy presented with a 6.0-mm polypoid erythematous nodule with ulceration on his left chest. An
excisional biopsy was done. Histologically, the tumor revealed several foci of superficial basal cell carcinoma along
the epidermis. In the dermis, the tumor was composed of basaloid epithelial anastomosing cords that were
separated by fibrovascular stroma connected to the overlying epidermis (Figure 1). The histopathological features
were that of a fibroepithelioma of Pinkus. The lesion was completely removed with clear biopsy margin. The patient
is being followed for any possible local recurrence.

Ref.

Pan Z, Huynh N, Sarma DP. (2008). Fibroepithelioma of Pinkus
in a 9-year-old boy: a case report. Cases Journal 1:21. PMID: 18588684 [PubMed -
in process]
 Abstract
We are reporting two cases of perianal squamous cell carcinoma in-situ, negative for high-risk (HR) and
low-risk (LR) human papilloma viruses. A brief review of anal and perianal squamous cell carcinoma and
the role of HPV are presented.
Introduction
Squamous cell carcinoma, the second most common form of skin cancer, most often affects sun-exposed
surfaces. However, squamous cell carcinoma can involve skin surfaces not previously exposed to sunlight,
such as in the anal and perianal regions. Invasive perianal squamous cell carcinoma is a locally infiltrative
malignant skin tumor that exhibits destructive growth. It is a relatively uncommon tumor, which develops
from the precursor lesion anal intraepithelial neoplasia (AIN). Immunosuppression is felt to be a risk factor.

Ref.

Shehan J, Wang JF, Repertinger S, Sarma DP.(2008). Perianal
squamous cell carcinoma in-situ: a report of two human papilloma
virus-negative cases. Cases J 1(1):114. PMID: 18715505 [PubMed - in process]
An-86-year-old male with a history of multiple actinic keratoses and seborrheic
keratoses of the head and trunk presented with a mid-back skin lesion. The lesion
was poorly circumscribed, flat, and gray, with a pink-tan, well-circumscribed scaly
nodule within it. The biopsied lesion was composed of the usual features of
hyperkeratotic seborrheic keratosis, but with focal atypical melanocytic proliferation
with nesting along the dermal-epidermal junction. We interpreted this lesion as a
melanoma in-situ arising within a seborrheic keratosis.

MITF

Ref.
Repertinger S, Wang J, Adickes E, Sarma DP. (2008). Melanoma in-situ


arising in seborrheic keratosis: a case report. Cases J 1 (1):263. PMID:

18947402 [PubMed - in process]
 Abstract
Fibroepithelioma of Pinkus is a rare, indolent variant of basal cell carcinoma (BCC). The presence of pleomorphic
giant cells in such a tumor is extremely rare and to our knowledge, only one such case has been previously
reported in the literature. We report another case occurring as a pedunculated, gluteal lesion in an 82-year-old
man. The nodule was lightly pigmented, polypoid, and measured 1.0 cm in greatest dimension.
Immunohistochemical staining confirmed that the giant cells were of epithelial origin and that the proliferative rate
of these cells was low

CD68

p63

Ref.

Repertinger SK, Stevens T, Markin N, Klepacz H, Sarma DP.(2008).



Fibroepithelioma of Pinkus with pleomorphic epithelial giant cells. Dermatology Online

J 14(12):13. {Pubmed- in process].
 Abstract
Although 50%-65% of metastatic gallbladder tumors come form malignant
melanoma, clinically diagnosed cases are very rare. We are reporting such a
symptomatic case of metastatic melanoma in the gall bladder occurring in a 40-year-
old man.
Figure 1: Microscopic picture of metastatic melanoma in the gallbladder, H&E,
X20

  Ref.
                                                                 

Liu H, Wang J, Bewtra C, Sarma DP. (2009). Symptomatic gallbladder metastasis

from cutaneous melanoma. The Internet J Gastroenterol 7(2). Indexed by Google
Scholar