DermAtlas: Online Dermatology Image Library dermatology image,germ cell aplasia,Del Castillo syndrome,foreign body reaction,café au lait spot,macromelanosomes,rheumatoid neutrophilic dermatosis,rheumatoid arthritis,embolus, cholesterol,botryomycosis,Splendore-Hoeppli phenomenon,mycetoma,medial calcific sclerosis (Monckeberg)

© 2001-2009, DermAtlas	*Image Name:*	Del_Castillo_Syndrome_1_081210	*File Type:*	jpg
	*Diagnosis:*	GERM CELL APLASIA / DEL CASTILLO SYNDROME	*Category:*	histologic finding / infertility
	*Body Site:*	genital	*Age:*	40 years
	*Contributor:*	Amr Gohar, MRCPS Glasgow
	*Description:*	Germ cell aplasia does not represent a diagnosis but it is rather a characteristic histopathologic finding first described by Del Castillo et al. in 1947 which is sometimes referred to by his name. No germ cells are present in the seminiferous tubules but Sertoli cells are present (hence the name Sertoli-cell-only syndrome).
	*Comments:*	A 40-year old man was unable to impregnate his 30-year old wife for five years. His past medical history was unremarkable. Clinical examination was unrevealing and the testicular volume on both sides was 20 ml (measured by orchidometer). Semen analyses on 4 occasions over 2 years have all showed azoospermia and were fructose positive. Total testosterone, FSH and LH serum levels have all been within reference range on 4 repeated estimations over 2 years. Mature Sertoli cells with their apical aspects displaced to one side “wind swept tree tops” are seen. This patient’s condition represents atypical germ cell aplasia and without bilateral testicular biopsies could have been misdiagnosed as obstructive azoospermia.

© 2001-2009, DermAtlas	*Image Name:*	foreign_body_1_080801	*File Type:*	jpg
	*Diagnosis:*	FOREIGN BODY REACTION	*Category:*	environmental injury / histologic finding
	*Body Site:*	forearm	*Age:*	75 years
	*Contributor:*	Greg Hosler, MD, PhD
	*Description:*	There is a yellow-brown foreign body lodged within the superficial dermis with an associated epidermal defect. A mixed inflammatory infiltrate is present.
	*Comments:*	This biopsy from a 75 year old woman was submitted to rule out a basal cell carcinoma. The concentric complex polarization pattern is most consistent with organic material, such as plant matter or splinter. Fungal infections (e.g. dematiaceous organisms) may occur at these sites.
	*Related Images:*	foreign_body_2_080801

© 2001-2009, DermAtlas	*Image Name:*	foreign_body_2_080801	*File Type:*	jpg
	*Diagnosis:*	FOREIGN BODY REACTION	*Category:*	environmental injury / histologic finding
	*Body Site:*	forearm	*Age:*	75 years
	*Contributor:*	Greg Hosler, MD, PhD
	*Description:*	The object polarizes, highlighting the concentric rings.
	*Comments:*	This biopsy from a 75 year old woman was submitted to rule out a basal cell carcinoma. The concentric complex polarization pattern is most consistent with organic material, such as plant matter or splinter. Fungal infections (e.g. dematiaceous organisms) may occur at these sites.
	*Related Images:*	foreign_body_1_080801

© 2001-2009, DermAtlas	*Image Name:*	macromelanosomes_1_071101	*File Type:*	jpg
	*Diagnosis:*	CAFé AU LAIT SPOT / MACROMELANOSOMES	*Category:*	histologic finding / neoplasm, melanocytic / neoplasm, benign
	*Body Site:*	thigh	*Age:*	32 years
	*Contributor:*	Greg Hosler, MD, PhD
	*Description:*	There is a nevomelanocytic lesion, confined to the epidermis. There are nevomelanocytes present both singly and in nests along the dermoepidermal junction. Varibly-sized melanosomes, some macro forms, are evident in the junctional melanocytes, There is no cytologic atypia.
	*Comments:*	This café au lait spot shows typical histology. Macromelanosomes were thought to be specific for this entity but is not as pathognomonic as originally believed. There is likely some abnormality in melanin or melanosome production, leading to the size variability.

© 2001-2009, DermAtlas	*Image Name:*	rheumatoid_neut_derm_2_070201	*File Type:*	jpg
	*Diagnosis:*	RHEUMATOID NEUTROPHILIC DERMATOSIS / RHEUMATOID ARTHRITIS	*Category:*	cutaneous sign of systemic disease / vesiculobullous eruptions / histologic finding
	*Body Site:*	forearm	*Age:*	49 years
	*Contributor:*	Greg Hosler, MD, PhD
	*Description:*	The infiltrate consists almost exclusively of neutrophils. There is no evidence of vasculitis.
	*Comments:*	This is a great example of a rare case of rheumatoid neutrophilic dermatosis. This patient had severe rheumatoid arthritis and developed plaques and bulla over the forearms. Rheumatoid neutrophilic dermatosis is a rare manifestation of severe joint disease, as in this case. Histologically, this is one of the neutrophilic dermatoses along with Sweet syndrome, cellulitis, pyoderma gangrenosum and others. The bulla are often secondary, and not always seen. Distinction between these entities is virtually impossible without clinical history.
	*Related Images:*	rheumatoid_neut_derm_1_070201

© 2001-2009, DermAtlas	*Image Name:*	rheumatoid_neut_derm_1_070201	*File Type:*	jpg
	*Diagnosis:*	RHEUMATOID NEUTROPHILIC DERMATOSIS / RHEUMATOID ARTHRITIS	*Category:*	cutaneous sign of systemic disease / vesiculobullous eruptions / histologic finding
	*Body Site:*	forearm	*Age:*	49 years
	*Contributor:*	Greg Hosler, MD, PhD
	*Description:*	There is separation of the epidermis from the dermis in a subepidermal plane. The papillary dermis is filled with neutrophils. The infiltrate extends to the mid demis.
	*Comments:*	This is a great example of a rare case of rheumatoid neutrophilic dermatosis. This patient had severe rheumatoid arthritis and developed plaques and bulla over the forearms. Rheumatoid neutrophilic dermatosis is a rare manifestation of severe joint disease, as in this case. Histologically, this is one of the neutrophilic dermatoses along with Sweet syndrome, cellulitis, pyoderma gangrenosum and others. The bulla are often secondary, and not always seen. Distinction between these entities is virtually impossible without clinical history.
	*Related Images:*	rheumatoid_neut_derm_2_070201

© 2001-2009, DermAtlas	*Image Name:*	cholesterol_embolus_1_070201	*File Type:*	jpg
	*Diagnosis:*	EMBOLUS, CHOLESTEROL	*Category:*	ulcer / histologic finding
	*Body Site:*	leg	*Age:*	67 years
	*Contributor:*	Greg Hosler, MD, PhD
	*Description:*	Within the vessels of the deep dermis and subcutis, there are unusual angulated clefts. These are cholesterol clefts and are lodged in the lumen of medium sized vessels. Not shown in this field is the large overlying zone of necrosis.
	*Comments:*	This patient develped an ulcer on his lower extremity. The clinical differential diagnosis was infectious, vasculitis, calciphylaxis, etc. After identifiying the cholesterol emboli, the patient was found to have a large abdominal aortic aneurysm.

© 2001-2009, DermAtlas	*Image Name:*	botryomycosis_1_060410	*File Type:*	jpg
	*Diagnosis:*	BOTRYOMYCOSIS / SPLENDORE-HOEPPLI PHENOMENON / MYCETOMA	*Category:*	infections and infestations / histologic finding
	*Body Site:*	leg	*Age:*	51 years
	*Contributor:*	Greg Hosler, MD, PhD
	*Description:*	Histologic sections of skin show a mixed inflammatory infiltrate, extending from an ulcerated epidermis to the subcutaneous tissue. There are zones of necrosis and abundant neutrophils. Scattered within the infiltrate are basophilic concretions with a brightly eosinophilic rim.
	*Comments:*	This 51-year-old woman had chronic ulcers of her lower extremities. Botryomycosis is an unusual finding in skin biopsies. The lesions are similar to mycetoma, but the the central areas are bacterial colonies (often Staphylococcus aureus) and not filamentous fungi. Immunoglobulin is abundant within the concretions. These structures have a characteristic brightly eosinophilic peripheral band, the Splendore-Hoeppli phenomenon.
	*Related Images:*	botryomycosis_2_060410

© 2001-2009, DermAtlas	*Image Name:*	botryomycosis_2_060410	*File Type:*	jpg
	*Diagnosis:*	BOTRYOMYCOSIS / SPLENDORE-HOEPPLI PHENOMENON / MYCETOMA	*Category:*	infections and infestations / histologic finding
	*Body Site:*	leg	*Age:*	51 years
	*Contributor:*	Greg Hosler, MD, PhD
	*Description:*	At high power, the center of the concretion consists of basophilic granular material. A brightly eosinophilic band encases the bacteria.
	*Comments:*	This 51-year-old woman had chronic ulcers of her lower extremities. Botryomycosis is an unusual finding in skin biopsies. The lesions are similar to mycetoma, but the the central areas are bacterial colonies (often Staphylococcus aureus) and not filamentous fungi. Immunoglobulin is abundant within the concretions. These structures have a characteristic brightly eosinophilic peripheral band, the Splendore-Hoeppli phenomenon.
	*Related Images:*	botryomycosis_1_060410

© 2001-2009, DermAtlas	*Image Name:*	medial_calcific_sclerosis_1_060327	*File Type:*	jpg
	*Diagnosis:*	MEDIAL CALCIFIC SCLEROSIS (MONCKEBERG)	*Category:*	histologic finding / deposition disorders
	*Body Site:*	leg	*Age:*	79 years
	*Contributor:*	Greg Hosler, MD, PhD
	*Description:*	Histologic sections of skin show extensive calcification of an artery. The calcium lies within the media.
	*Comments:*	This 79-year-old man had a surgical excision for an unrelated purpose. Monckeberg medial calcific sclerosis is often an incidental finding of calcium within the media of arteriole vessel walls. When this builds, the vessels lose their distensibility. Atherosclerosis may also be seen.

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© DermAtlas, Johns Hopkins University; 2000-2009
Bernard A. Cohen, MD, Christoph U. Lehmann, MD
DermAtlas was last updated: Oct-28-2009
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