ECP 2022 Abstract Book

Virchows Archiv (2022) 481 (Suppl 1):S1–S364 13 Background & objectives: Melanomas can oftentimes be difficult to diagnose because of the various ways they present themselves clinically and microscopically. Diagnosing the melanoma subtype is often very challenging, but the main issue must always be that the patient receives the right treatment. Methods: 60-year-old woman initially presents with a progres- sively enlarging cervical lymphnode, which showed positivity for melanoma markers, without knowing the primary melanoma site. One month later, surgical excision of a scalp lesion was performed, showing nodules located in the dermis and subcutis, without any epidermal connections, with some heavily pigmented areas, con- sisting in both epithelioid and fusiform malignant cells. Results: Histological examination could not differentiate between a primary melanoma with blue nevus-like features/a melanoma arising in a blue nevus and a cutaneous metastasis of a melanoma originating elsewhere. The fact that no other significant melanocytic lesion was found made it reasonable to consider this a primary lesion. The BRAF mutation was then assessed and it’s absence might also be a clue that the tumour might have developed from a blue nevus, as these usually lack the BRAF mutation. Conclusion: Establishing whether the lesion truly belongs to the ”blue line” would have required molecular tests for the GNA11 or Gnaq alterations, but what matters is that she received treatment in time, the only one available in country protocols being INFα – which has been shown to improve overall survival and recurrence-free survival in patients with high-risk melanoma. We come across pathology pitfalls daily, but it is always important to only focus on the details that could really help the patient. E-PS-05-015 Rare association of Leishmaniasis with purpura: a case report S. Hincapié*, E. Loayza, C. Pozo, M.E. Cruz, A. Orellana, S. Eguez, J.C. Garcés *Instituto Oncológico Nacional Dr. Juan Tanca Marengo, Ecuador Background & objectives: Leishmaniasis is a chronic disease caused by an intracellular parasite. We report an uncommon cutaneous leish- maniasis associated with lymphocytic vasculitis, clinically manifested with purpura without ulceration. This hasn’t been reported in Ecuador before, although there are 1000 cases per year. Methods: A 75-year-old female presented drug-induced vasculitis with multiple purpuric lesions on both lower extremities, treated with prednisone 60mg during 2 weeks and 20mg per day as main- tenance. Two months later after resolution of skin lesions, the patient presented a single cutaneous purpuric lesion on left lower extremity. Results: Laboratory findings presented negative antinuclear anti- bodies, negative anti-DNA and C3–C4 protein levels within normal range. Biopsies of this lesion were taken and showed lymphop- lasmocytic inflammatory infiltrate with diffuse and perivascular distribution, fibrin deposits on arterial walls and amastigotes forms of Leishmania inside histiocyte vacuoles. Conclusion: This infectious disease presented a wide range of dif- ferential diagnosis due to its atypical presentation. Lymphocytic vasculitis has been associated with systemic lupus erythematosus, lymphoproliferative disorders such as angiocentric lymphoma or lymphomatoid papulosis, arachnidism and borrelia burdorferi infec- tion due to erythema migrans similar appearance. The diagnosis of leishmaniasis in this patient was made by the identification of intra- cellular amastigotes. This uncommon manifestation of leishmaniasis can easily be mistaken with other diseases, which should have special considerations mainly in endemic areas. E-PS-05-016 Calciphylaxis – histopathological feeling of impending doom. A case report A. Dumitru*, A.M. Ciongariu, D. Tapoi, I. Mergeanu, M. Sajin, M. Costache, C. Aliu ș *Carol Davila University of Medicine, Romania Background & objectives: Calciphylaxis is a poorly understood and highly morbid syndrome of vascular calcification, thrombosis and skin necrosis prevalent in patients with uremia. The mortality rate is high, due to sepsis and internal organ failure. Methods: We present the case of a 33-year-old female patient, smoker, obese, admitted in the hospital for intense pain on right foot, muscle weakness, necrotic lesions on the skin with a history of important comorbidities (arterial hypertension, diabetes, dyslipidemia, hyperuricemia, obliterating artery disease of the lower limbs, ESRD and COVID-19). Results: The patient rapidly developed extensive necrotic lesions of the right food, intense pain and worsening of the general condition despite treatment. The patient underwent a transmetatarsal amputation of the forefoot. The surgical sam- ple was sent the the Pathology Department for histopathologi- cal assessment. Despite intensive care and multiple therapeu- tic attempts, the evolution was unfavourable, and the patient died 3 days after surgery. Microscopically, in addition to the tissue lesions characteristic of wet gangrene, typical features of calciphylaxis were observed. There were variable stippled calcification within adipose tissue and associated fat necrosis. Thick ring-shaped calcification of arteriole and capillaries were identified. Capillary thrombosis was extensive. Also a lymphohistiocytic infiltrate was noted Conclusion: Calciphylaxis is a rare, critical condition, sometimes difficult to diagnose. The differential diagnosis might be challenging especially in patients with multiple comorbidities. The prognosis of calciphylaxis is often unfavourable despite aggressive treatment. Histopathological features suggestive for calciphylaxis found on post-amputation resection specimens should alarm both the pathologist and the medical team caring for the patient. Despite maximal medical and surgical therapies, calciphylaxis typically results in a 60% to 80% mortality rate with sepsis being the leading cause of death. E-PS-05-017 Pilomatrical carcinoma, a case report S. Kartal*, E. Tuncer, O.F. Goze *Sivas Cumhuriyet University, Turkey Background & objectives: Pilomatrical carcinoma is an uncommon adnexal carcinoma with matrical differentiation. In the literature, less than 150 cases have been described. We aimed to contribute to the literature re-evaluating a rare case of pilomatrical carcinoma with the new immunohistochemical methods investigated. Methods: We reported the case of a 86-year-old male with a 3 cm ulcerated nodule on the left temporal skin. The lesion was excised in Plastic Surgery department and we stained the excision speci- men with LEF-1, CDX2 and SATB2 immunohistochemical stains which were related to the SATB2/β-catenin/TCF-LEF pathway that is discussed as an important pathway in pathogenesis of randomly selected pilomatricoma. Results: As a result of the immunohistochemical analysis we performed, although pilomatrical carcinoma and pilomatrixoma showed expression with LEF-1 and CDX-2, SATB2 showed positivity only for pilomatrical carcinoma. When we re-evaluated the case with our previous findings, we obtained findings S210