Digital Dermatopathology Digest: Identifying Hair Follicle Tumors

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There are a number of different hair follicle tumors, each with its own distinguishing features. In the Digital Dermatopathology Digest series, Rajni Mandal, MD, clinical research associate in dermatopathology for PathologyWatch, discusses these different variants in greater detail.

Trichilemmal cells come from the outer root sheath of the hair follicle. The cells show abrupt keratinization and pink to clear cytoplasm with a lack of keratohyalin granules.

Trichilemmoma cells have a lobular proliferation of cells that can push into the dermis. They can also present as pink to clear due to glycogen, and there can be peripheral palisading at the periphery of the islands as well as a thick pink basement membrane deposition. Multiple trichilemmomas are associated with Cowden syndrome.

Trichoadenoma cells can have multiple epithelial islands of keratin-filled cysts in the dermis. These cysts can frequently rupture, shoring a foreign body giant cell reaction to keratin fibers. Cyst islands are lined by epithelium, and the majority of the squamous epithelium lacks keratohyalin granules.

Trichoblastoma cells typically have multiple blue islands with fibrotic stroma and are associated with nevus sebaceous.

Cells on the trichofolliculoma, fibrofolliculoma, and trichodiscoma spectrum are all different stages of the same tumor. They can present with branches of anastomosing epithelium originating out of the hair follicle and often occur in small antigen hair follicles.

  • In a fibrofolliculoma, there can be a proliferation of fibrous cells or fibrous stroma, which can have a concentric pattern around the tumor.
  • Fibrous proliferations are most prominent in a trichodiscoma.
  • Cells can show peripheral palisading, but there is no retraction artifact or myxoid stroma surrounding them, which would be seen in basal cell carcinoma.
  • Multiple fibrofolliculomas and trichodiscomas are commonly associated with Birt-Hogg-Dubé syndrome.

The Digital Dermatopathology Digest series provides educational information for both students and professionals on a number of topics. To view the complete series, click here.

Digital Dermatopathology Digest: Identifying Sebaceous Neoplasms 

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Sebaceous neoplasms are abnormal growths of cells originating in the oil glands of the skin. As part of the ongoing Digital Dermatopathology Digest series, Rajni Mandal, MD, a clinical research associate in dermatopathology for PathologyWatch, discusses the characteristics of sebaceous differentiation, up to and including sebaceous carcinoma.

Sebaceous glands found in the dermis are formed by mature sebocytes and immature sebaceous cells. Mature sebocytes show evacuated cytoplasm, which can indent the nucleus in contrast to the immature cells that show increased nuclear-cytoplasmic ratio, sometimes with foamy cytoplasm.

“Neva sebaceous has an increased risk of basal cell carcinoma, trichoblastoma, and syringocystadenoma papilliferum,” says Rajni.

Sebaceous adenoma is defined as having greater than 50 percent mature sebaceous cells as compared to basaloid cells, in contrast to a sebaceoma. It can present as multiple nests in the dermis, with a predominance of the immature basaloid cells, as compared to the mature sebocytes.

The malignant counterpart of a sebaceous neoplasm is sebaceous carcinoma. It is most common in the eyelid, originating from the Meibomian gland. It can include the dermis as a proliferation of predominantly immature cells. In the epidermis, sebaceous cells—which are predominantly immature—can infiltrate in a pagetoid manner, which can mimic squamous cell carcinoma.

To learn more about sebaceous neoplasms, check the Digital Dermatopathology Digest video series, which provides detailed information and examples on a number of skin conditions, click here.

Digital Dermatology Digest: Identifying Syringomas

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If you happen across a small cluster of brown, yellow, or pink bumps (or papules), around the eyes or on the neck, it may be a case of syringomas. In this episode of Digital Dermatopathology Digest, Rajni Mandal, MD, clinical research associate in dermatopathology for PathologyWatch, briefly discusses the distinct characteristics of this benign growth of the sweat gland. 

According to Rajni, syringomas are common in the periorbital and genital regions. Growths can be associated with Down’s syndrome, and disseminated, solitary, or eruptive types sometimes indicate Nicolau-Balus syndrome. 

“Note that the eccrine ducts have an eccentric lumen and can have a tadpole shape,” says Rajni, referring to a common variant of syringomas. “And a clear cell syringoma is often associated with diabetes.” 

Another type of syringomas, a mixed tumor called chondroid syringoma, is common in elderly males and appears on the head and neck. It’s characterized by a circumscribed dermal tumor, and it also appears as an apocrine/eccrine proliferation in fibrous, myxoid, or chondroid stroma. 

“Women, especially of Japanese heritage, are affected more than men,” explains the American Osteopathic College of Dermatology. “Syringomas tend to first erupt in adolescence, but could start at any age.” The AOCD adds that young people may be predisposed to “eruptive syringomas,” wherein the growths occur suddenly.  

Whether you’re in residency, studying for board exams, or a practicing dermatologist looking to stay sharp, the Digital Dermatopathology Digest video series is your informational and convenient source for dermatopathology review. Find the full series here.

PathologyWatch Ranked Top MedTech Innovator of the Year

PathologyWatch was recently ranked by MedTech Innovator as one of the top 50 most transformative device, diagnostic, and digital health technologies from around the globe. PathologyWatch will participate in a flagship, four-month Showcase and Accelerator program that offers unparalleled visibility and access to some of the medtech industry’s leading manufacturers, providers, investors, and other industry stakeholders. 

“Our goal at MedTech Innovator is to find the most promising medical innovations and make sure they actually reach the patients who need them,” said Paul Grand, CEO of MedTech Innovator. “We are thrilled with the caliber of the startups participating in this year’s cohort and we look forward to providing them with the resources and mentorship they need to succeed.”

Since 2017, PathologyWatch has been an innovative leader in intuitive, easy-to-implement digital dermatopathology solutions that aim to streamline the diagnostic process while improving patient care models. 

Compared to its competitors, PathologyWatch focuses on enhancing services available in outpatient clinics by offering a fully interfaced EMR reporting process, access to top dermatopathologists with the option to interpret and bill for their cases, and provide their clients 24/7 access to digital slides. 

“I believe PathologyWatch is the future of dermatopathology for dermatologists. The group combines academic expertise with the efficiency of a private lab. It is a huge timesaver for me and my staff,” said April Larson, a certified dermatologist, and VP of client experience and advisory board at PathologyWatch. “By reviewing my own cases, I am able to make better clinical decisions for my patients. It’s a win-win for everybody.”

With PathologyWatch, clinics can significantly reduce the time it takes from completing the patient examination to diagnosis with high-quality reads that lead to improved patient-provider relationships in shared medical decisions. What typically takes two weeks to receive a diagnosis can now potentially take two days through the efficient workflow that PathologyWatch has developed.

The 50 companies selected by MedTech Innovator will compete in the final competition at The MedTech Conference in September 2021. 

To read the full list of the medtech companies honored, click here

Looking for a Medical Courier Service? Here Are 4 Questions to Ask

Medical courier services play an integral role across the healthcare industry. This expanding, $54.8 billion industry quickly responds to meet the specialized demands of today’s pathology clinics, with no signs of slowing down.  

A recent Market Analysis Report suggests that the popularity of medical couriers is impacted by an emphasis to improve the healthcare system by streamlining the growing need for quick transportation of samples and specimens for testing while reducing the cost of logistics. 

“As a dermatologist, I ultimately answer to my patient for the biopsy procedure as well as the pathology result,” explains April Larson, MD, VP of client experience and Advisory Board at PathologyWatch. “My work at PathologyWatch has taught me the importance of appropriate specimen labeling, handling, and chain of custody. It’s important to ask questions and make sure your courier has clear guidelines around the handling of medical specimens.”

As the desire for a quick turnaround time on lab work increases, you need a courier service you can count on. 

“A quality medical courier service is knowledgeable in the laws and customs of every product they transport. They’ll be able to handle the legal matters for you, giving you more time to focus on your business,” say experts at Mobile One Courier. “A medical courier service should also have the necessary equipment to keep your medical equipment, prescriptions, and specimens safe. Whether that involves a refrigerated car or just careful watching, they ensure that every package arrives undamaged.”

Factors like experience, property protection, and tracking tools are essential. If you are moving toward a medical courier service, here are four questions to ask.

1. Are they insured?

As the saying goes, always expect the unexpected. In unforeseen weather conditions or significant delays, even an accident, it’s important that your precious cargo is protected. Be sure to clarify whether or not the collateral and the driver are both insured.

2. Do they have experience handling specimens or other sensitive materials?

Medical couriers should be experienced with the intricacies of medical equipment and biological samples and understand the special conditions required for successful delivery. 

“Many specialty medications and medical tests must be maintained within a specific temperature range during shipment,” explains Benjamin Meskin, owner of Meslee Insurance Services, Inc. “To keep those items at the manufactured recommended temperature, they require special handling and storage during transport from shipper to recipient.” 

Be sure to ask how many years of experience the courier company has in healthcare. Studies show that 34 percent of medical couriers only work in the industry for one to two years before moving onto something else. In addition, inquire if the courier company requires that drivers complete specific training to ensure they understand the unique conditions for transporting specimens.

3. How do they track deliveries? 

An internal study from the University of Minnesota Medical Center laboratory found their facility could not account for about six to seven specimens per week, totaling around 30 specimens per month. That rate of error isn’t acceptable if you want to run a successful pathology practice. 

Every patient sample matters. This isn’t just a specimen—it’s your patient’s peace of mind. You need to work with a courier who shares that commitment to safeguarding your packages. Most courier services offer a real-time GPS tracking system to monitor their deliveries. This feature lets you check real-time locations to ensure your packages are moving in the right direction and will arrive when you expect them to.

4. Are the delivery drivers HIPAA compliant? 

Courier services are essential to patient care, but they are not part of the health care sector. However, courier companies still need to adhere to HIPAA standards. This is under the omnibus rule mandating compliance to the HIPAA privacy rule by business associates or entities engaged by individuals and businesses in the healthcare industry that help them complete industry-related activities and functions.

Larger courier companies are quick to advertise their HIPAA compliance, but if you prefer to use a local service, be sure to ask about it. 

Your practice relies on trusting doctor-patient relationships. Working with a medical courier service that supports a quick turnaround time on test results is essential to building and maintaining those relationships. You will find a great long-term partnership that provides quick results by asking about a courier’s specialized experience, tracking tools, and other support services.

Identifying Sweat Gland Tumors

Images shown are not intended to be used for the diagnosis or treatment of a disease or condition.

In this episode of Digital Dermatology Digest, things are starting to heat up as dermatopathologist Rajni Mandal, MD, at PathologyWatch discusses sweat gland tumors.

What is a sweat gland tumor?

These skin tumors are often benign and derive from cells related to sweat glands. “Normal sweat glands have ducts and secretory components,” explains Dr. Mandal, noting the different appearance, which shows clear apocrine and eccrine cells.

Here are highlights of the four common types of sweat gland tumors.

  1. Hidradenoma papilliferum, which is common in the vulvar area. The distinct appearance of this dermal tumor includes papillary folds and the apocrine gland’s decapitation secretion.
  2. Papillary adenoma often appears in the axilla, the patient’s scalp, and other sites. This is a tumor of the skin, also known as eccrine papillary adenoma, where the tumor forms tubular and tubulopapillary structures.
  3. Apocrine hidrocystoma is common in the patient’s head and neck as well as the Moll’s gland in the eyelid. It’s a multiloculated cyst with apocrine cells and is often associated with Schöpf–Schulz–Passarge syndrome.
  4. Poroma is common on the patient’s palms, soles of their feet, and scalp. This benign adnexal neoplasm is composed of epithelial cells that show tubular (usually distal ductal) differentiation.

What is the treatment for sweat gland tumors?

Sweat gland tumors are often benign. However, some patients may prefer to have them removed surgically.

To learn more about this skin condition and other common diseases, join us for each episode of Digital Dermpath Digest right here on pathologywatch.com.