Introduction to the Field of Pediatric Dermatopathology



Introduction to the Field of Pediatric Dermatopathology


Barrett J. Zlotoff

Alejandro A. Gru



It is true that Pediatric Dermatology has existed since the dawn of medicine. Hippocrates described multiple pediatric dermatologic conditions in his Corpus Hippocraticum. But it was not until 1827 that the first book exclusively devoted to pediatric dermatology, Cutaneous Diseases Incidental to Childhood, by Walter Dendy was published in London.1,2 The global establishment of Pediatric Dermatology as a recognized subspecialty did not gain momentum until the first international symposium on and founding of the International Society of Pediatric Dermatology in 1972. Before 1983, the dermatologic literature was made up of only 15% articles related specifically to children, and the pediatric literature had only 4% of articles devoted to skin disease. Since the launch of the journal Pediatric Dermatology in 1982, and particularly after the recognition of the subspecialty by the Accreditation Council for Graduate Medical Education in 2000, research in and the description of dermatologic disease specific to the pediatric population has blossomed.2,3

If the field of Pediatric Dermatology can be said to be in its infancy, Pediatric Dermatopathology may still be in the gestation process.4 We are delighted to include Dr Louis P. Dehner, a pioneer and developer of this discipline, as one of the senior editors and contributor to our book. “Pepper” has been one of the most influential surgical pathologists of the last century. Authoring more than 450 publications, he is the premier modern pediatric pathologist. Perhaps less recognized is his role as creator of the art of pediatric dermatopathology.

Dehner has written at least 50 major publications describing, discovering, and orienting the discipline in the fields of fibrohistiocytic disorders of childhood, vascular tumors, and histiocytosis, among others. He gave birth to the theory that, although there are many similarities between adult and pediatric surgical pathology, “children get different diseases.” Dehner has been one of the primary investigators who helped separate histiocytosis into two main categories in accordance with the cell which they morphologically and immunophenotypically resemble: the mature macrophage and the dendritic cells. Originally classified as histiocytosis X, nonhistiocytosis X, and malignant histiocytosis, significant reordering and reclassifications have emerged.5,6 The largest, most eloquent and comprehensive article documenting the natural history, clinical presentation, and histopathologic findings of juvenile xanthogranulomas, the most common histiocytic disorder in children, was written by Dehner in 2003 and published in the American Journal of Surgical Pathology.7 An article crucial to understanding reactive and neoplastic fibrous tumors in children was published by Dehner and Askin in Cancer in 1976.8 Dehner also was one of the first to publish a large series of adnexal neoplasms in patients aged 20 or younger.9 His mindful analysis and correlations between the clinicopathologic and biologic aspects of specific entities certainly qualify him as a pioneer in the field of pediatric dermatopathology.


WHY ARE CHILDREN DIFFERENT?

Skin diseases occur in both pediatric and adult individuals, but we know that skin conditions in children differ from adults.10,11 In fact, certain conditions are limited to the pediatric age group, and some neoplasms, such as
lipoblastoma, occur only in children. Many present in the context of inflammatory dermatoses and genodermatoses that clinicians, and particularly pathologists, may not be entirely familiar with. Careful histopathologic studies of many entities are limited to small series or case reports, making histologic recognition challenging. Dermatopathologists in community practice, without a significant volume of cases from pediatric hospitals, may never get to witness some conditions. We have heard many colleagues describe pediatric dermatopathology as a “no-man’s land.”

Most cases in adult dermatopathology practice are derived from benign tumors (particularly keratoses and epidermal tumors), malignant tumors, drug-induced hypersensitivity reactions, melanocytic proliferations, infectious processes, papulosquamous disorders (eg, psoriasis), connective tissue disorders, vasculitis, bullous dermatoses, and folliculitis. This pattern does not reflect the pediatric practice, with the exception of melanocytic lesions, which are probably some of the most common biopsies seen in the routine histopathologic examination. In contrast, in the pediatric setting, Henoch-Schonlein purpura, pityriasis lichenoides, pityriasis rubra pilaris, atopic dermatitis, erythema multiforme, granuloma annulare, and pigmented purpuras are frequent inflammatory conditions that are biopsied.

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May 8, 2019 | Posted by in Dermatology | Comments Off on Introduction to the Field of Pediatric Dermatopathology

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