ALT The artwork titled “Repentance” by Nicholas Roerich, created in 1917, is a Symbolist cityscape executed with tempera on canvas. It is currently housed in the Nicholas Roerich Museum in New York City, NY, US. In the artwork, Roerich has depicted a solemn, snow-covered cityscape, bounded by imposing architectural structures. The buildings, adorned with thick snow, stand under an ominous sky, capturing a somber and introspective atmosphere. The use of tempera on canvas brings a subdued texture that complements the subdued, almost contemplative mood. The presence of a solitary, cloaked figure adds to the narrative depth of repentance, emphasizing the theme of introspection and humility. The architectural elements are imbued with mysticism, characteristic of Roerich’s Symbolist approach, inviting viewers to delve into deeper layers of meaning within the serene yet austere cityscape.
ALT Clinical improvement after 4 months of oral roflumilast therapy.
ALT Histopathologic features of actinic granuloma. Low-power examination demonstrates a dermal granulomatous infiltrate within a background of solar elastosis (H&E, Ă—40).
ALT Histopathologic features of actinic granuloma. Colloidal iron stain highlights the absence of dermal mucin within areas of granuloma formation (colloidal iron, Ă—40).
ALT Histopathologic features of actinic granuloma. Higher-power examination reveals palisading lymphocytic inflammation with multinucleated giant cells in the dermis (H&E, Ă—100).
ALT Left axilla showing an active erythematous, hyperkeratotic, brown-scaly intertriginous plaque.
ALT Histopathology of the left axilla, shave biopsy (hematoxylin-eosin). Low-power view showing a markedly thickened, compact, lamellated stratum corneum w/ parakeratosis & retention of basophilic keratohyalin granules (arrow 2), overlying a papillomatous, mildly acanthotic epidermis; a plugged adnexal (follicular/acrosyringeal) ostium contains similar compact parakeratotic debris (arrow 1). The papillary and superficial reticular dermis show a dense, band-like lymphocytic infiltrate with congested vessels (arrow 3).
ALT Higher-power view of the same specimen better demonstrating the plugged adnexal ostium (arrow 1) and the compact, lamellated parakeratotic stratum corneum with retained basophilic granules (arrow 2).
ALT The clinical photograph highlights three scattered, well-circumscribed, dome-shaped papules on the right distal lateral thigh representative of the patient's lesion distribution at presentation. The biopsy site is circled while a separate representative pre-treatment lesion is indicated by an arrow.
ALT The low-power view (H&E, Ă—10) of the shave biopsy demonstrates a well-organized, cup-shaped (crateriform) lesion with an invaginated epidermis. Suprabasilar acantholysis produces clefts above an intact basal layer.
ALT The high-power view (H&E, Ă—20) shows cup-shaped epidermal invagination with a central keratin-filled crater. There is suprabasilar acantholysis with loss of keratinocyte cohesion and dyskeratotic acantholytic cells within the cleft space. A mild superficial perivascular lymphocytic infiltrate is present.
ALT Clinical progression of left-sided cutaneous Rosai-Dorfman disease lesions. Initial presentation of erythematous nodules involving the left malar cheek.
ALT Clinical progression of left-sided cutaneous Rosai-Dorfman disease lesions. Improvement after intralesional bleomycin injections.
ALT Clinical progression of left-sided cutaneous Rosai-Dorfman disease lesions. Near-complete resolution following intralesional bleomycin & subsequent fractional ablative CO2 laser.
ALT Cutaneous Rosai-Dorfman disease: Histopathological features and immunohistochemistry. Top Left (Hematoxylin & eosin, x40) Large histiocytes with abundant amphophilic cytoplasm and vesicular nuclei, admixed with numerous lymphocytes and plasma cells. Top Right (Hematoxylin & eosin, x40) The histiocytes demonstrate emperipolesis (inset, arrows), with intact lymphocytes, plasma cells, and polymorphonuclear cells present within their cytoplasm. Immunohistochemical studies show that the histiocytes are positive for CD68 (Bottom Left, x20) and S100 (Bottom Right, x20).
ALT Initial presentation demonstrating multiple firm pink-to-yellow nodular plaques with overlying telangiectasias and irregular surface change. There is focal central ulceration of select lesions on the right malar cheek.
ALT Initial presentation of erythematous nodules involving the left malar cheek.
ALT Solitary pink-red nodule on the left chest wall selected for punch biopsy to preserve facial cosmesis.
ALT To capture this deep-seated, existential fatigue, I've created an immersive oil painting. It depicts a figure who embodies your words, slumped at a table, illuminated by a warm lamp, yet surrounded by complex shadows. Outside, the "swift summers" are visually fading into twilight. The painting merges the specific Bukowski text with a universal feeling of time's passage and endurance. - Gemini
ALT Initial presentation of vulvar edema, erythema, and exudate.
ALT CT chest imaging with diffuse mediastinal & B/L hilar lymph node enlargement.
ALT Physical exam images showing edematous pink papules and blanchable erythematous plaques on the right posterior arm.
ALT Physical exam images showing edematous pink papules and blanchable erythematous plaques on the anterior chest.
ALT Physical exam images showing edematous pink papules and blanchable erythematous plaques on the left lateral torso.
ALT Physical exam images showing edematous pink papules and blanchable erythematous plaques on the posterior torso.
ALT Left upper chest showing erythematous scaly plaques evidence of linear post inflammatory hyperpigmented excoriations suggestive of intense itching.
ALT Right medial thigh with well demarcated, erythematous, and hyperpigmented, scaly plaques.
ALT Right inner thigh with well demarcated, erythematous, and hyperpigmented, scaly plaques. Lesions were pruritic and involved multiple body sites, including intertriginous areas, trunk, and extremities.
ALT Medial buttock with multiple well-demarcated polycyclic, erythematous, hyperpigmented, scaly plaques, somewhat sparing gluteal cleft.
ALT Left upper chest showing erythematous scaly plaques evidence of linear post inflammatory hyperpigmented excoriations suggestive of intense itching.
ALT Right medial thigh with well demarcated, erythematous, and hyperpigmented, scaly plaques.
ALT Right inner thigh with well demarcated, erythematous, and hyperpigmented, scaly plaques. Lesions were pruritic and involved multiple body sites, including intertriginous areas, trunk, and extremities.
ALT Medial buttock with multiple well-demarcated polycyclic, erythematous, hyperpigmented, scaly plaques, somewhat sparing gluteal cleft.
ALT Cutaneous findings at initial dermatology review.
ALT Histopathology of the skin biopsy, showing interface reaction with dermal mucin deposition (stained with colloidal iron), a superficial lymphocytic infiltrate, and the presence of eosinophils.
ALT Histopathology of the skin biopsy, showing interface reaction with dermal mucin deposition (stained with colloidal iron), a superficial lymphocytic infiltrate, and the presence of eosinophils.
ALT Multiple punctate keratotic projections involving the thumb.
ALT Diffuse punctate hyperkeratotic papules involving the palm with the selected punch biopsy site marked.
ALT Diffuse distribution of scattered hyperkeratotic papules across the palmar surface.
ALT Histopathologic examination demonstrating a column of parakeratotic hyperkeratosis arising from a depression in the epidermis with underlying hypogranulosis.
ALT Low-power histopathology of a punch biopsy of the lesion on the arm demonstrating thickened sclerotic hyalinized collagen and loss of periadnexal fat extending from the superficial to mid dermis.
ALT Higher power of the aforementioned punch biopsy on the arm highlighting the thickened sclerotic hyalinized collagen in the superficial dermis.
