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Drugs causing cutaneous necrosis
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
A properly done skin biopsy almost always yields diagnostic information. The site and technique of biopsy have to be chosen carefully. Histopathology sections may reveal evidence of vasculitis, intravascular thrombosis, or signs of arteritis as in drug-induced polyarteritis nodosa. The characteristic finding in WISN is diffuse microthrombi within dermal and subcutaneous capillaries, venules, and deep veins, with endothelial cell damage resulting in ischemic skin necrosis and marked extravasation of red blood cells. Vascular inflammation and arterial involvement can differentiate a primary vasculitic process from WISN [71,72]. Calcium deposits in dermis and subcutaneous vessels highlighted by von Kossa stain point to the possibility of calciphylaxis. Intravascular cholesterol clefts are characteristic of cholesterol microemboli [71]. Multiple swabs for culture of bacteria and fungi have to be obtained from appropriate sites and antibiotic therapy modified accordingly. A purulent, culture-positive, rapidly progressive ulcer is characteristic of necrotizing fasciitis [73].
Respiratory System
Published in Pritam S. Sahota, James A. Popp, Jerry F. Hardisty, Chirukandath Gopinath, Page R. Bouchard, Toxicologic Pathology, 2018
Tom P. McKevitt, David J. Lewis
Interstitial mineralization is characterized by the linear deposition of slightly basophilic material within collagen, elastin, or the basement membranes and can be demonstrated by the Von Kossa stain (Renne et al. 2009). The presence of mineral often results in poor section quality as decalcification is not performed when the lesion is unsuspected. This can be alleviated to a considerable degree by decalcification of the paraffin block surface.
Intracellular and Extracellular Structures
Published in Philip T. Cagle, Timothy C. Allen, Mary Beth Beasley, Diagnostic Pulmonary Pathology, 2008
Rose C. Anton, Philip T. Cagle
Calcospherites and psammoma bodies are calcified basophilic concretions with a laminated appearance and may be seen in papillary malignancies (psammoma bodies) or in benign conditions such as tuberculosis or pulmonary alveolar microlithiasis (multiple calcospherites ranging from 0.1–0.3 mm present in 25–80% of alveoli) The central portion of the calcospherite may be PAS-positive, with the surrounding layers staining with the von Kossa stain. Occasionally, the calcospherites are birefringent and may be demonstrated under a polarizing microscope by a "Maltese cross" pattern.
Leg ulceration with histological features of pseudoxanthoma elasticum
Published in Baylor University Medical Center Proceedings, 2021
Usman Asad, Sheevam Shah, Palak Parekh
To rule out the possibility of calciphylaxis and further identify the etiology of the ulceration, she underwent a skin and soft tissue wedge biopsy with tissue cultures 2 days after admission. At that time, her parathyroid hormone level was 162 pg/mL (reference range 14–65), phosphorus level was 2.2 mg/dL (reference range 2.4–4.5), and calcium was within normal limits. Tissue cultures revealed a polymicrobial infection. Histology demonstrated ulceration with mixed inflammation, bacterial colonies within the surface crust, and nonspecific reactive vascular changes subjacent to the ulcer bed (Figure 2a, 2b). Foci of dystrophic calcification were noted. Von Kossa stain showed elastic tissue abnormalities with calcification (Figure 2c, 2d). There were no diagnostic features of calciphylaxis. Given the nonspecific changes and the clinical appearance of surrounding induration and stasis-type changes, lipodermatosclerosis and ulceration in the background of venous insufficiency were favored. Although she was on antibiotics, her necrotic wound worsened, with black eschar formation, appearance of a dusky rim around the wound, and wet gangrene of the soft tissue. She underwent successful debridement of the wound and was instructed to follow-up with general surgery.
Multifactorial aetiology for non-uremic calciphylaxis: a case report
Published in Journal of Community Hospital Internal Medicine Perspectives, 2018
Sijan Basnet, Niranjan Tachamo, Rashmi Dhital, Biswaraj Tharu
The patient again presented to the ED a week later with substernal exertional chest pain. Workup for acute coronary syndrome was negative but a significant drop in haemoglobin from 12.3 to 8.4 g/dl was noted since prior admission. The patient underwent upper gastrointestinal endoscopy which showed a sessile 7 mm nodule on the anterior wall of the bulb of the duodenum which was biopsied using cold forceps. Biopsy of the nodule in duodenum showed nests of tumour cells which were positive for chromogranin, synaptophysin, CD56 and pankeratin, consistent with a neuroendocrine tumour. With plasma metanephrines and MIBG whole body scan being normal, there was low suspicion that it was a functional paraganglioma. By this time, the ulcerations were necrotic and had progressed to the left medial leg (Figure 1). Punch biopsies were again taken. Hematoxylin and eosin stained sections reveal an epidermal ulceration, areas of necrosis, neutrophilic inflammatory infiltrate with karyorrhexis in the dermis and subcutaneous tissue. Focal areas of lipomembranous, fibrinized vessels and focal basophilic stippling of the subcutaneous vessels were noted (Figure 2). Paraganglioma as aetiology of calciphylaxis was thought to be unlikely as it was nonfunctional. A von Kossa stain showed calcium deposition in the small vessels of the subcutaneous tissue consistent with a diagnosis of calciphylaxis. A Gram stain, GMS stain, AFB-Fite stain and cultures failed to show an infection.
Treatment of pseudoxanthoma elasticum-like papillary dermal elastolysis with nonablative fractional resurfacing laser resulting in clinical and histologic improvement in elastin and collagen
Published in Journal of Cosmetic and Laser Therapy, 2018
Kristen Foering, Richard Lawrence Torbeck, Michael P Frank, Nazanin Saedi
Punch biopsies of the unaffected skin on the left neck and the affected skin on the right neck were performed. On hematoxylin and eosin (H&E) stain, the affected skin showed a relative expansion of the epidermis compared to the unaffected skin. Elastin stain of the right neck revealed increased fragmentation of elastic fibers in the papillary and reticular dermis compared to unaffected skin (Figure 3). A Von Kossa stain did not reveal calcified elastic fibers. The patient underwent ophthalmology evaluation that did not elicit any pertinent findings (e.g., angioid streaks).