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Arjun Ramaiya Profile picture
@ArjunRamaiya1
Apr 19, 2023 • 5 tweets • 6 min read • Read on X
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15yr Female, long standing slow growing pigmented lesion on buttock. DBN?
What of diffuse strong nuclear cyclin D1?
#dermpath
@DiegoMoralesN @melanopath @mccalmo @et565 @JacobSmalberger @alegru18 @CarlosMonteag20 @atman_ci @PIorfino @HENRYY_MD @kis_lorand @AlomariDermpath ImageImageImageImage
Immunos ImageImageImageImage
And in case Henry asks if i STILL did a p16 the answer is … Image
Er..just to clarify by DBN I mean “deep blue / cellular blue” not deep penetrating naevus (DPN) ….I really ought to stop thinking of the “deep blue”sea 😬 🤣
So heres a paper which made me do it heres the Cyclin D1 …make of it what you will …

pubmed.ncbi.nlm.nih.gov/26766120/#:~:t…. Image

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More from @ArjunRamaiya1

Arjun Ramaiya Profile picture
May 12, 2023
40+ Female, “large pigmented patch on back over inner scapula, ?Dx.”

Histology of Notalgia Paresthetica

#dermpath #dermtwitter #pathtwitter #pathresident #dermatologia #dermatology #dermatologist #pathologist #histopathology #surgpath #dermatopathologia #dermatopathology





NP is thought to be due to sensory neuropathy involving cutaneous branch of the posterior divisions of spinal sensory nerves.
The histological hallmark is of scattered single cell apoptosis in epidermis with secondary epidermal dyspigmentation and pigment incontinence. Crucially there is no primary dermal inflammatory, degenerative or neoplastic cause for dyspigmentation.
Read 6 tweets
Arjun Ramaiya Profile picture
May 11, 2023
Comparing the structure of a normal eyelid and one with a sebaceous “trichofolliculoma” of the eye lash.

#dermpath #dermtwitter #pathtwitter #pathresident #dermatologia #dermatology #dermatologist #pathologist #histopathology #surgpath #dermatopathologia #dermatopathology

Notice although a normal lid has a large sebaceous gland it is actually beautifully elongated and compact to not distort the surface of the eyelid, so that the conjuntiva remains closely opposed to the eyeball. By contrast the eye las has relatively small sebaceous glands.
This small sebaceous trichofolliculoma was large enough to cause persistent irritation / conjunctivitis and clinical concern of a tumour (?BCC) resulting in a formal excision.
Read 10 tweets
Arjun Ramaiya Profile picture
May 8, 2023
FINALLY clinician’s have figured that the PSEUDOSCIENTIFIC term “squamoproliferative lesion” means nothing more than a proliferating squamous lesion 🤣
#dermpath #dermtwitter #pathtwitter #dermatologia #dermatology #dermatologist #histopathology #dermatopathology Image
Squamoproliferative lesion was invented by some hotshot pathologist pretending its a diagnostic entity, but it actually means nothing more than an unspecified and unqualified proliferating squamous “lesion”.

#dermpath #dermtwitter #pathtwitter #dermatology #dermatopathology
Viral warts, seborrhoeic keratosis, actinic keratosis, keratoacanthomas, in situ and invasive squamous carcinomas are ALL either benign, atypical or malignant “squamoproliferative lesions”
🤣🤣🤣
#dermpath #dermtwitter #pathtwitter #dermatologia #dermatology #histopathology
Read 4 tweets
Arjun Ramaiya Profile picture
May 5, 2023
70+ female, ulcerated nodule on chest.
#dermpath #dermtwitter #pathtwitter #pathresident #dermatologia #dermatology #dermatologist #pathologist #histopathology #surgpath #dermatopathologia #dermatopathology





@Cristina_VargAP @alegru18 @CarlosMonteag20 @atman_ci @JacobSmalberger @PIorfino @DrGeeONE @et565 @TristanRutland7 @HENRYY_MD @kis_lorand @melanopath @AlomariDermpath @gonzadetoro @kriyer68




Read 6 tweets
Arjun Ramaiya Profile picture
May 2, 2023
Clinical was “70+ Female 4 benign scalp lesions” 😣

Brooke Spiegler subtype of CYLD cutaneous syndrome.

#dermpath #dermtwitter #pathtwitter #dermatologia #dermatology #dermatologist #pathologist #histopathology #surgpath #dermatopathologia #dermatopathology





CLYD cutaneous syndrome was first proposed by Rajan et al in 2009 (Arch Dermatol. 2009 Nov; 145(11): 1277–1284.). This brought together three syndromes caused by a mutation in the CYLD gene on the long arm of Chromosome 16.
CYLD Cutaneous syndrome includes:

1. Multiple familial Trichoepitheliomas. (Trichoepithelioma)

2. Familial Cylindromatosis (Cylindroma and spiradenoma) 

3. Brooke Spiegler syndrome (Trichoepitheliomas, Cylindroma and spiradenoma).
Read 17 tweets
Arjun Ramaiya Profile picture
Apr 28, 2023
A great example of the importance and efficacy of a vertical plane of dissection to the deep margin.

Note the impact the angle of the plane of cleavage on tumour clearance between the two sides.

#dermpath #dermatologia #dermatology #surgpath #surgery #dermatopathology
@javiperezhisto @pembeoltulu So whats is my approach. Well I estimate the average curvature of flat epidermis (see the blue lines) ignoring any focal large deviations. This to the best of my estimation is the “average” level of flat skin ignoring physiological and tumour related undulations
@javiperezhisto @pembeoltulu Ignoring the focal abnormally large undulations / deviations, you can see that on average the epidermis maintains its level along the drawn lines with less than 0.5 mm of deviation. So thats my best guess for the “estimated deepest vertical cross section of tumour” in sampled sec
Read 7 tweets

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