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Browsing by Author "Alomari, Ahmed K."
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Item 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 MedicineItem 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 MedicineCutaneous 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.Item 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 MedicineThe 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.Item 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 MedicineKinase 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.Item 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 MedicineIntroduction: 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.Item 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 MedicineInfection 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.