Pathology Inc. Consensus Conference
June 28th, 2006

Fascinoma #1

An interesting case of follicular mucinosis was presented by Dr. Shitabata. This 40 year old male patient presented with numerous flesh colored papules on the bilateral cheeks. Figures 1-4 on the left column document the diffuse expansion of the hair follicles by predominately extra-cellular collections of mucin. Follicular mucinosis is usually a secondary histopathologic finding and has been associated with diseases as diverse as acne vulgaris, photo-allergic dermatosis, and melanocytic nevi. However, in a small percentage of cases, this disease may represent a forme fruste of mycosis fungoides. The actual incidence is controversial with some researchers contending that all cases represent mycosis fungoides while others acknowledge that while the majority of cases may exhibit clonal rearrangements of the T-cell receptors, these cases follow an indolent course. The most important task for the pathologist is to alert the clinician of the potential risk for developing or concomitant mycosis fungoides.

Fascinoma #2

Dr. Mary Beth Shwayder presented an intriguing case of gastric endocrine cell hyperplasia (Figures 5-8). This entity is known by a variety of names including micronests, microcarcinoids, ECL cell hyperplasia (enterochromaffinlike cell), and even carcinoidosis!

These histopathologic changes are usually multiple in patients with atrophic gastritis and may present with the endoscopic appearance of multiple polypoid nodules. Recently, there has been an association with proton pump inhibitors. There does not appear to be any sinister prognosis with these hyperplasias and many cases resolve.

The Doctor's Doctor-Follicular Mucinosis/Alopecia Mucinosa