Browsing by Author "Alomari, Ahmed K."

Now showing 1 - 9 of 9
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    A Case of Hybrid Cellular Neurothekeoma and Perineurioma With a Folliculin Gene Mutation
    (Wiley, 2025) Prechtel, Taylor J.; Brashear, Emma; Dehner, Carina A.; Alomari, Ahmed K.; Pathology and Laboratory Medicine, School of Medicine
    Hybrid peripheral nerve sheath tumors (PNSTs) are benign tumors that show features of more than one type of PNST. Benign cutaneous plexiform hybrid tumor of perineurioma and cellular neurothekeoma (BCPHTPCN) is a rare, recently described entity that shows various combinations of histomorphologic and immunophenotypic features of the PNSTs perineurioma and cellular neurothekeoma. Our case describes a middle-aged man initially presenting with an acute papulopustular rosacea flare. Rosacea treatment unmasked a prominent erythematous papule on the forehead. A biopsy was taken, and histopathological examination showed a proliferation of epithelioid, ovoid, and spindled cells arranged in a compact nested and intersecting fascicular growth. Immunohistochemical stains were positive for NKI/C3, CD10, PGP9.5, MITF, and GLUT-1. There was weak reactivity with EMA and minimal reactivity with Claudin-1. Tumor cells were negative for SOX10, CD163, CD68, CD34, ALK, and Pan-TRK. The patient was diagnosed with BCPHTPCN. DNA and RNA sequencing showed a folliculin (FLCN) gene mutation, which is most commonly associated with Birt-Hogg-Dubé syndrome. The patient underwent excision and has remained without recurrence or complications several months post-diagnosis. We hope to expand the clinical and histopathologic characteristics of this peculiar neoplasm, as well as provide additional insight that might improve our understanding of BCPHTPCN tumorigenesis.
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    Cutaneous Metastases in a Patient With Muir–Torre Syndrome
    (Wolters Kluwer, 2019-09) Kunz, Michael; Bari, Omar; Alomari, Ahmed K.; Somani, Ally-Khan; Dermatology, School of Medicine
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    Cutaneous Syncytial Myoepithelioma: A Recently Described Neoplasm Which May Mimic Nevoid Melanoma and Epithelioid Sarcoma
    (Wiley, 2017) Alomari, Ahmed K.; Brown, Noah; Andea, Aleodor; Betz, Bryan L.; Patel, Rajiv M.; Department of Pathology and Laboratory Medicine, School of Medicine
    Cutaneous syncytial myoepithelioma is a recently described rare tumor of the dermis. It is derived and composed purely of myoepithelial cells and shows a characteristic syncytial growth pattern of neoplastic cells with little intervening stroma and no recognizable ductal structures. It represents a diagnostic challenge to dermatopathologists given its rarity and unusual immunophenotype. Molecular testing for rearrangement of the EWSR1 gene plays a significant role in confirming the diagnosis in most cases. Herein, we present 2 cases with mundane clinical presentations and challenging histopathological findings. In both cases, the lesion was composed of relatively well-circumscribed proliferation of epithelioid and spindle cells in the superficial dermis growing in a syncytial fashion and showing focal adipocytic metaplasia. The 2 cases had slightly different immunohistochemical profiles, but shared focal positivity for S100, EMA and pan-keratin or p63. Break-apart FISH demonstrated the presence of an EWSR1 gene rearrangement confirming the diagnosis in both cases. We discuss the most important differential diagnoses, particularly melanocytic lesions and epithelioid sarcoma and the original diagnostic considerations that the cases were referred to us with. We also review the molecular features and spectrum of immunohistochemical findings in these lesions and their role in excluding entities in the differential diagnosis.
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    Diet-induced Pigmented Purpuric Dermatosis Confirmed with a Rechallenge Response
    (Cureus, Inc., 2019-07-29) Li, Wendy; Reedy, Matthew; Alomari, Ahmed K.; Rahnama-Moghadam, Sahand; Medicine, School of Medicine
    The pigmented purpuric dermatoses (PPDs) are a group of chronic cutaneous eruptions characterized by non-blanching and non-palpable purpuric lesions. Their etiology is not completely understood, although dietary exposures have been implicated in a few case reports. We describe a recurring case of diet-induced PPD in a 73-year-old Caucasian male following the ingestion of tomato-based products on two separate occasions, one year apart. On physical examination, he demonstrated numerous 1-2 mm red/brown, non-blanching, petechial macules scattered on the bilateral anterior lower legs, thighs, trunk, arms, hands, and feet with facial sparing. Histopathologic examination revealed the classic perivascular lymphocytic infiltrate with red blood cell extravasation seen in PPD. Mirroring his first episode, the patient saw a complete resolution of his rashes with careful avoidance of tomato-based products and required no other interventions. This represents a rare case of diet-induced PPD confirmed with a rechallenge response and suggests that acute or recurrent cases of PPD may be a result of a hypersensitivity reaction.
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    Drug Reaction With Eosinophilia and Systemic Symptoms to Vancomycin-Laden Cement Space: A Case Report
    (Springer Nature, 2025-01-03) Chalasani, Sai; Mannam, Harshita; Alomari, Ahmed K.; Rahnama-Moghadam, Sahand; Dermatology, School of Medicine
    Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adverse drug reaction mediated by a complex immune response. Vancomycin is a known cause of DRESS, and cases are often attributed to intravenous exposure. Vancomycin-laden bone cements deliver high concentrations of the drug locally with low to undetectable systemic levels. Despite trace systemic concentrations, cement spacers have been reported to cause systemic reactions ranging from organ failure to diffuse cutaneous eruptions. A patient receiving intravenous (IV) and local vancomycin, via bone cement, experienced symptom resolution only after the vancomycin-eluting bone cement was removed, which was done after the IV vancomycin had been stopped. This suggests that the vancomycin eluted from the local bone cement may be sufficient to maintain the immune response mediating DRESS syndrome. In patients who experience persistent symptoms despite discontinuing systemic drug exposure, clinicians should consider eliminating all sources of the causative drug.
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    Extranodal NK/T-cell lymphoma primarily presenting as two adjacent slowly growing skin nodules with prominent epidermotropism and CD30 expression, a case report and review of literature
    (University of California, 2021-12-15) Mohammed, Arooj; Dave, Utpal; Rahnama-Moghadam, Sahand; Alomari, Ahmed K.; Dermatology, School of Medicine
    Extranodal NK/T-cell lymphoma (NKTCL) is a rarely occurring non-Hodgkin lymphoma with predilection for the nasal cavity. Cutaneous involvement, rarely occurring and often aggressive in behavior, may present as nodular mass-forming lesions with or without ulceration. Histologically, lesions are characterized by an atypical dermal lymphoid infiltrate with angioinvasion and associated necrosis. Fortuitously, Epstein-Barr virus (EBV) infection, implicated in the pathogenesis of this entity, serves as a useful diagnostic marker (i.e. EBER in situ hybridization). We present a 54-year-old-man who initially presented with two ulcerations on the right lower leg which progressed despite antibiotic therapy. Histologic examination demonstrated dense lymphoid infiltrates exhibiting epidermotropism, angiocentricity and angioinvasion extending into the deep dermis. Immunohistochemical staining demonstrated expression of CD2, CD3, CD8, TIA-1, perforin, and granzyme-B, consistent with a cytotoxic T-cell phenotype. Additionally, CD56 was positive, confirming the presence of a coexistent NK cell phenotype. Testing also demonstrated significant CD30 expression, and molecular analysis was positive for TCR gene rearrangement. These findings, in conjunction with EBER in situ hybridization positivity, confirmed a diagnosis of extranodal NKTCL. We aim to increase awareness of this rarely occurring lymphoma with cutaneous involvement. CD30 expression in NKTCL raises the possibility of targeted treatment with brentuximab.
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    Fatal melanoma with a novel MYO5A-BRAF fusion and small associated conventional nevus: A case report and review of literature
    (Wiley, 2022) Clark, Hannah E.; Huang, Yuan Yu Michael; Vance, Gail H.; Alomari, Ahmed K.; Dermatology, School of Medicine
    Kinase fusions play an important role in the pathogenesis of Spitz neoplasms and occasionally non-Spitz neoplasms. We report a case of a 19-year-old woman with a growing nodule on the scalp, morphologically consistent with a diagnosis of melanoma with epithelioid features arising in association with small nevus. This tumor aggressively metastasized and failed to respond to immunotherapy. Next-generation sequencing of a metastatic focus revealed an MYO5A-BRAF kinase fusion with a low mutational burden and fluorescence in situ hybridization (FISH) of the primary melanoma showed similar results. FISH testing of the associated nevus failed because of technical reasons. MYO5A has rarely been reported as the fusion partner with BRAF-rearranged melanocytic tumors. Moreover, this case raises speculations and contributes to the growing literature on the pathogenesis, nomenclature, and tumorigenic pathways in kinase-fusion melanomas. The patient succumbed to disease, which is in concordance with some literature suggesting aggressive behavior of BRAF fusion melanomas with TERT promoter mutations.
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    Predicting melanoma survival and metastasis with interpretable histopathological features and machine learning models
    (Frontiers Media, 2023-01-06) Couetil, Justin; Liu, Ziyu; Huang, Kun; Zhang, Jie; Alomari, Ahmed K.; Medical and Molecular Genetics, School of Medicine
    Introduction: Melanoma is the fifth most common cancer in US, and the incidence is increasing 1.4% annually. The overall survival rate for early-stage disease is 99.4%. However, melanoma can recur years later (in the same region of the body or as distant metastasis), and results in a dramatically lower survival rate. Currently there is no reliable method to predict tumor recurrence and metastasis on early primary tumor histological images. Methods: To identify rapid, accurate, and cost-effective predictors of metastasis and survival, in this work, we applied various interpretable machine learning approaches to analyze melanoma histopathological H&E images. The result is a set of image features that can help clinicians identify high-risk-of-metastasis patients for increased clinical follow-up and precision treatment. We use simple models (i.e., logarithmic classification and KNN) and "human-interpretable" measures of cell morphology and tissue architecture (e.g., cell size, staining intensity, and cell density) to predict the melanoma survival on public and local Stage I-III cohorts as well as the metastasis risk on a local cohort. Results: We use penalized survival regression to limit features available to downstream classifiers and investigate the utility of convolutional neural networks in isolating tumor regions to focus morphology extraction on only the tumor region. This approach allows us to predict survival and metastasis with a maximum F1 score of 0.72 and 0.73, respectively, and to visualize several high-risk cell morphologies. Discussion: This lays the foundation for future work, which will focus on using our interpretable pipeline to predict metastasis in Stage I & II melanoma.
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    An unusual presentation of cutaneous histoplasmosis as a recurrent solitary and spontaneously healing lesion in an immunocompetent patient
    (Microbiology Society, 2020) Muldoon, Jessica L.; Wysozan, Timothy R.; Toubin, Yulianna; Relich, Ryan F.; Davis, Thomas E.; Zhang, Chen; Alomari, Ahmed K.; Dermatology, School of Medicine
    Infection with Histoplasma capsulatum typically manifests as a self-limiting pulmonary disease in immunocompetent patients. Systemic symptoms such as cutaneous lesions are associated with immunodeficient states. Our patient was an immunocompetent 68-year-old male who presented with a plaque on his left infraorbital area that was concerning for malignancy. Histological examination of the lesion revealed granulomatous inflammation and small yeast forms suggestive of H. capsulatum. The lesion resolved spontaneously and recurred 1 year later. On recurrence, histological examination again revealed yeast forms consistent with H. capsulatum. Serum and urine testing for H. capsulatum antigen were negative. Next-generation sequencing detected H. capsulatum, which supported the diagnosis of a cutaneous infection. The patient was prescribed and started treatment with itraconazole for 1 year after recurrence of the lesion, and he has not reported further disease recurrence to date. This case is unique because of the presentation of a primary cutaneous recurrent H. capsulatum lesion, and it demonstrated the utility of laboratory testing in its diagnosis.