Jerad M Gardner

University of Arkansas at Little Rock, Little Rock, Arkansas, United States

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Publications (25)47.02 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Linear dermatoses are fascinating entities that likely reflect embryologically derived cutaneous mosaicism, even when they present outside of childhood. Adult blaschkitis is a rare, relapsing inflammatory dermatitis that most often presents in middle age. It presents clinically as a pruritic eruption of linear papules, vesicles, and plaques, and is most commonly found to have features of spongiotic dermatitis on pathology. However, the clinical and histopathologic presentation of lichen striatus in adults may be similar to adult blaschkitis. We present a case in which ‘blaschkitis’ was suspected clinically, but the biopsy was noted to have non-characteristic microscopic features resembling erythema multiforme—a finding rarely reported in the literature to date. We present this case and a brief review of the most common acquired linear eruptions following Blaschko lines with the goal of expanding the histopathologic findings that may be encountered in adult blaschkitis. Moreover, the clinical and histopathologic overlap between the entities of blaschkitis and lichen striatus is explored, with acknowledgement that these entities may exist on a clinicopathologic spectrum. In the diagnosis of linear eruptions, clinicopathologic correlation is important for arriving at an accurate final diagnosis.
    Journal of Cutaneous Pathology 10/2014; · 1.77 Impact Factor
  • Journal of Cutaneous Pathology 08/2014; 41(8). · 1.77 Impact Factor
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    ABSTRACT: Adenoid cystic carcinoma (ACC) is a rare carcinoma that typically arises in salivary glands but can also occur in other sites including skin. Primary salivary ACC is a locally aggressive tumor characterized by local recurrence and late metastasis. Primary cutaneous ACC is found predominately on the scalp and is more indolent than salivary ACC; and, despite a high incidence of local recurrence, metastases are exceedingly rare.
    The American Journal of dermatopathology. 07/2014;
  • The American Journal of dermatopathology. 07/2014;
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    ABSTRACT: Typical myofibromas are biphasic tumors composed of a central zone of immature spindled to rounded cells arranged in a pericytic pattern and a peripheral zone of myoid nodules. Central necrosis is occasionally seen. A small but undefined subset of myofibromas displays atypical features that may lead to a misdiagnosis of sarcoma. To more completely characterize these tumors and define their behavior, we analyzed our experience with myofibromas having 1 or more atypical features including hypercellularity, absent or inconspicuous, poorly demarcated myoid nodules, infiltrative growth pattern, and perineural invasion. Of 266 cases of myofibromas, 24 cases were retrieved on the basis of pathology reports in which atypical features were mentioned. The tumors presented in 16 male and 8 female individuals (mean age 17 y; range, 2 wk to 62 y) as masses of variable size (mean 3.0 cm; range, 1.5 to 6.5 cm). Fourteen cases arose on the head and neck and 10 cases on the limbs. The referring or suspected diagnosis was sarcoma in 8 cases. The tumors were typically more cellular than ordinary myofibroma with levels of cellularity similar to that expected in fibrosarcoma (22/24). In addition, they displayed inconspicuous, loosely cohesive (22/24) or absent myoid nodules (2/24), infiltrating borders (19/24), intravascular growth (5/24), and perineural invasion/nerve entrapment (6/24). The mean mitotic rate was 5 mitoses/10 high-power fields, but no tumor showed significant cytologic atypia. The tumors were positive for actins (11/11) and CD34 (2/8). Follow-up in 14 patients revealed no distant metastases. We conclude that a small subset of myofibromas shows atypical features that complicate the diagnosis but do not adversely affect outcome.
    The American journal of surgical pathology. 06/2014;
  • 17th Joint Meeting of The International Society of Dermatopathology; 03/2014
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    ABSTRACT: A 71-year-old woman presented with five scalp nodules that were clinically suspicious for pilar cysts. Histopathologic examination showed a proliferation of mitotically-active pleomorphic spindle cells arranged into intersecting fascicles in the dermis and subcutis. Tumor cells displayed deeply eosinophilic cytoplasm and expressed desmin but were negative for S100 protein by immunohistochemistry. Ten years previously, the patient was diagnosed with high-grade retroperitoneal leiomyosarcoma and underwent resection with intraoperative radiation. Metastatic disease involving the lungs, liver, and soft tissue developed, requiring treatment with resections, radiation, and chemotherapy. Due to the presentation of multiple scalp nodules with microscopic features of leiomyosarcoma in conjunction with the clinical history of retroperitoneal leiomyosarcoma, a diagnosis of metastatic leiomyosarcoma was made. Scalp metastasis from retroperitoneal leiomyosarcoma is extremely rare and portends a poor prognosis. To our knowledge, only two other cases have been reported in the English literature, and a further search discovered only nine additional cases of scalp metastasis from soft tissue leiomyosarcoma of any non-gynecologic anatomic site. This case highlights the striking microscopic similarity between primary cutaneous and metastatic leiomyosarcoma and illustrates the necessity of adequate clinical information and an appropriate index of suspicion in excluding the possibility of cutaneous metastases of leiomyosarcoma from somatic soft tissue.
    Journal of Cutaneous Pathology 03/2014; · 1.77 Impact Factor
  • Jesse L. Hart, Mark A. Edgar, Jerad M. Gardner
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    ABSTRACT: Vascular tumors of bone represent a variety of neoplasms, ranging from benign hemangiomas and epithelioid hemangiomas, to intermediate grade hemangioendotheliomas, to frankly malignant angiosarcomas. Over the years, there has been considerable debate concerning the aggressivity, nomenclature and mere existence of various nosologic entities, due to morphologic similarities and uncertainty regarding biologic behavior. Such debate has led to confusion among pathologists and clinicians, thus diminishing the prognostic implications in the diagnosis of these lesions. Here we review the current knowledge concerning the primary vascular neoplasms of bone, and correlate clinicopathologic features with tumor behavior.
    Seminars in Diagnostic Pathology 01/2014; · 1.62 Impact Factor
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    ABSTRACT: Classification of small round cell tumors of bone is often challenging due to overlapping clinicopathologic features. The purpose of this article is to review the clinical, radiological, histologic, and molecular features of Ewing sarcoma and to provide a discussion of the differential diagnosis of small round cell tumors of bone.
    Seminars in Diagnostic Pathology 01/2014; · 1.62 Impact Factor
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    ABSTRACT: Inflammatory myofibroblastic tumor (IMT) is a rare soft tissue neoplasm of uncertain malignant potential and unclear etiology. IMT involving the appendix is very rare. Herein, we report a case of IMT of the appendix in a gastric cancer patient who was treated with radical gastrectomy and adjuvant systemic chemotherapy. Rare cases of IMT associated with preceding events have been described in other organs/sites, but not in the appendix. A previous intra-abdominal operation for gastric cancer may contribute to the development of IMT in the appendix as seen in the present patient. To our knowledge, this is the first case of appendiceal IMT arising after a previous operation.
    Apmis 12/2013; · 2.07 Impact Factor
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    ABSTRACT: Since histopathologic assessment is subject to sampling error, some institutions 'pre-order' deeper sections on some or all cases (hereafter referred to as prospective deeper sections), while others order additional sections only when needed (hereafter referred to as retrospective deeper sections). We investigated how often additional sections changed a diagnosis and/or clinical management. Given the recent decrease in reimbursement for CPT-code 88305, we also considered the financial implications of ordering additional sections. Cases (n=204) were assigned a preliminary diagnosis, based on review of the initial slide, and a final-diagnosis, after reviewing additional sections. Cases with discordant diagnoses were assessed by 2 dermatologists, who indicated whether the change in diagnosis altered clinical management. Expenses were estimated for 3 scenarios: a) no additional sections, b) prospective deeper sections, c) retrospective deeper sections. Diagnoses were modified in 9% of cases, which changed clinical management in 56% of these cases. Lesions obtained by punch-biopsy and inflammatory lesions were disproportionately overrepresented amongst cases with changed diagnoses (p<0.001, p=0.12, respectively). The cost of prospective deeper sections and retrospective deeper sections represented a 56% and 115% increase over base-costs, respectively. Labor costs, particularly the cost of dermatopathologist evaluation, were the most significant cost-drivers. While additional sections improve diagnostic accuracy, they delay turn-around-time and increase expenditures. In our practice, prospective deeper sections are cost effective; however this may vary by institution.
    Journal of Cutaneous Pathology 11/2013; · 1.77 Impact Factor
  • Annie S Morrison, Jerad M Gardner
    Archives of pathology & laboratory medicine 11/2013; · 2.78 Impact Factor
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    ABSTRACT: Low-grade fibromyxoid sarcoma (LGFMS) represents a rare soft tissue tumor that was first characterized in 1987. LGFMS usually presents as a large, deeply situated mass in adults and is characterized by deceptively bland histopathologic features. LFGMS is less common in superficial soft tissue and in children. It is distinctly uncommon for LGFMS to exhibit nuclear pleomorphism. Herein, we present a case of a 10-year-old male who presented with a subcutaneous back mass that displayed features typical for LGFMS as well as scattered large, hyperchromatic and pleomorphic nuclei. The constellation of clinicopathologic features, including the young age of the patient, the small size and superficial location of the tumor and the presence of scattered nuclear pleomorphism are all unusual features for LGFMS. Fluorescent in situ hybridization (FISH) with a break-apart probe for FUS revealed the presence of a FUS gene rearrangement confirming the diagnosis of LGFMS. This case highlights the importance of maintaining a high index of suspicion for LGFMS even in the context of small, superficially-located tumors, pediatric patients or tumors with scattered nuclear pleomorphism.
    Journal of Cutaneous Pathology 10/2013; · 1.77 Impact Factor
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    ABSTRACT: Epithelioid sarcoma-like (pseudomyogenic) hemangioendothelioma (ESHE) represents a rare soft tissue and bone tumor that typically presents as nodule(s) in the distal extremities of young adults. The nodules traverse several tissue planes simultaneously and can involve the dermis, subcutis, skeletal muscle and bone. ESHE shares clinical and microscopic features with epithelioid sarcoma (ES), and, accordingly, is commonly misdiagnosed as ES. However, unlike ES, which has a poor prognosis, ESHE commonly follows an indolent course. Herein, we report a case of ESHE diagnosed by skin biopsy that clinically mimicked a dermatofibroma. We also provide clinical photographs of the lesions in various stages of development, representing information that has not been previously published, to our knowledge.
    Journal of Cutaneous Pathology 07/2013; · 1.77 Impact Factor
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    ABSTRACT: Soft tissue chordomas (STCs) have never been systematically studied because of their rarity and the difficulty in separating them from similar-appearing lesions. Using brachyury to confirm the diagnosis, we have analyzed our experience with 11 cases. Cases coded as "chordoma" or "parachordoma" were retrieved from institutional and consultation files (1989 to 2011) and were excluded from further analysis if they arose from the bone or in a patient with previous axial chordoma. Eleven of 27 cases met inclusion criteria. Patients (8 male; 3 female) ranged in age from 13 to 71 years (mean 44 y). Tumors were located on the buttock (n=2), wrist (n=2), leg (n=2), toe (n=1), thumb (n=1), ankle (n=1), shoulder (n=1), and chest wall (n=1), ranged in size from 0.5 to 10.9 cm (mean 5.3 cm), and consisted of cords and syncytia of spindled/epithelioid cells with vacuolated eosinophilic cytoplasm and a partially myxoid background. Tumors expressed brachyury (10/10), 1 or more cytokeratins (11/11), and S100 protein (10/11). Follow-up information was available for 10 patients (69 mo; range, 2 to 212 mo). Most (n=6) were alive without disease, 2 developed local recurrence and lung metastases, and 1 developed lung metastasis only. One died with unknown disease status. STCs are histologically identical to osseous ones, but differ in their greater tendency to occur in distal locations where small size and surgical resectability result in better disease control. The existence of STC implies that notochordal remnants are not a prerequisite for chordoma development.
    The American journal of surgical pathology 05/2013; 37(5):719-26. · 4.06 Impact Factor
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    ABSTRACT: Rhabdomyosarcoma is a malignant mesenchymal tumor with skeletal muscle differentiation. Primary cutaneous rhabdomyosarcoma is rare. We report a series of 11 cases of primary cutaneous rhabdomyosarcoma. Cases diagnosed as rhabdomyosarcoma arising in the dermis/subcutis with no identified primary tumor elsewhere were retrospectively reviewed. Follow-up was obtained. The tumors occurred in five children and six adults. The adult subset consisted of pleomorphic, epithelioid and not otherwise specified (NOS) subtypes while the pediatric subset showed alveolar and embryonal subtypes. All cases showed immunohistochemical staining consistent with the diagnosis of rhabdomyosarcoma. Three adult cases showed immunoreactivity for cytokeratins (one pleomorphic, one epithelioid and one NOS. Primary cutaneous rhabdomyosarcoma shows a bimodal age distribution and male predominance, correlating with rhabdomyosarcoma in deep soft tissue. Follow-up, available on all patients, showed aggressive behavior in both children and adults. Primary cutaneous rhabdomyosarcoma should be considered in the differential diagnosis of tumors with abundant eosinophilic cytoplasm and those with "small round blue cell" morphology. Desmin, myogenin and MYOD1 are a trio of markers with high sensitivity and specificity for primary cutaneous rhabdomyosarcoma. Cytokeratin immunoreactivity in primary cutaneous rhabdomyosarcoma represents a potential diagnostic pitfall in the differential diagnosis with sarcomatoid carcinoma.
    Journal of Cutaneous Pathology 09/2012; 39(11):987-95. · 1.77 Impact Factor
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    ABSTRACT: Pleomorphic liposarcoma (PL) is an uncommon form of liposarcoma that rarely occurs in the skin and subcutis. As its behavior in this setting is incompletely characterized, we undertook a study of a series of superficial PLs, defined as those arising or based primarily in the dermis and/or subcutis without involvement of deep structures. In addition, MDM2 gene amplification, a diagnostic signature of well-differentiated/dedifferentiated liposarcoma (WDL/DL), was evaluated to address the recent observation that this gene is amplified within PL-like areas in DL. PLs were obtained from institutional and consultation files (n=29). Cases were evaluated with respect to age, sex, location (dermis, dermis and subcutis, subcutis), size, predominant pattern (pleomorphic spindled or epithelioid), extent of lipogenic differentiation, and tumor necrosis. MDM2 amplification was analyzed using FISH on formalin-fixed, paraffin-embedded material in 26 cases. Patients ranged in age from 5 to 93 years (M:F=1.4:1). Tumors were located on the extremity (n=15), trunk (n=7), and head and neck (n=7) and involved the dermis (n=4), dermis and subcutis (n=10), and subcutis (n=15). Tumor size ranged from 0.8 to 15 cm (median=2 cm). All were mitotically active high-grade sarcomas [FNCLCC grade 2 (n=23) or 3 (n=6)] with either a pleomorphic spindled (n=24) or an epithelioid pattern (n=5) with variable extent of lipogenic differentiation [<25% (n=15), 25% to 50% (n=9), >50% (n=5)]. Necrosis was present in 3 cases. MDM2 gene amplification was present in 3 of 26 cases. Follow-up information in 24 cases (range=1 to 192 mo; median=48 mo; mean=59 mo) revealed local recurrences (4/24) but no metastasis or death from disease. We conclude that cutaneous and subcutaneous PLs, despite their high grade, have a much more favorable outcome compared with their deep-seated counterparts, most likely attributed to their small size and superficial location. The low incidence of MDM2 gene amplification in our series indicates that most superficial PLs are unrelated to WDL/DL. PL likely evolves by way of more than 1 molecular pathway.
    The American journal of surgical pathology 03/2012; 36(7):1047-51. · 4.06 Impact Factor
  • Journal of the American Academy of Dermatology 09/2011; 65(3):683-4. · 4.91 Impact Factor
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    Se Jin Jang, Jerad M Gardner, Jae Y Ro
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    ABSTRACT: When one follows a systematic approach to make a diagnosis of a malignant lesion, it is relatively easy to render a correct cancer diagnosis in most cases during routine daily practice. The first step is to recognize whether or not the specimen contains a lesion and then to determine whether the lesion is neoplastic or non-neoplastic. As a neoplasm is a clonal proliferation, neoplastic conditions are consisted of a single cell type, whereas non-neoplastic conditions consist of multiple different cell types. After determining that a lesion is neoplastic, the next step is to decide whether the neoplasm is of an epithelial origin or mesenchymal origin. The main differences between epithelial tumors and mesenchymal tumors include: (1) The tumor cells in epithelial tumors are oval-round to polygonal, but in mesenchymal tumors, the tumor cells are in general spindle-shaped; (2) Epithelial tumors generally form tumor cell nests, but mesenchymal tumors are arranged diffusely in sheets, without forming tumor cell nests; (3) In epithelial tumors, desmoplastic stroma is well formed in between tumor cell nests, but in mesenchymal tumors there is no desmoplastic stroma; and lastly, (4) feeding vessels open in the stroma in epithelial tumors but open directly between tumor cells in mesenchymal tumors. After this, we can decide whether the tumor is benign or malignant. The differences between benign and malignant tumors include; (1) differentiation, (2) growth rate, (3) growth pattern, and (4) metastasis. A benign tumor is well differentiated, grows slowly, shows expansile growth with encapsulation and does not metastasize. In contrast, a malignant tumor is often poorly differentiated, grows rapidly with many mitoses, shows invasive growth with no capsule and frequently metastasizes. In general, malignant tumors show high cellularity, tumor necrosis and nuclear alterations, which include nuclear enlargement with a high nuclear/cytoplasmic ratio, hyperchromatism, pleomorphism, prominent nucleoli, and frequent mitoses. The final step is to classify the type of tumor based on the cellular differentiation and gross and microscopic growth pattern based on the light microscopic examination of hematoxylin and eosin stained slides. For the correct identification of the tumor, immunostaining, molecular diagnostic tools, or possibly electron microscopic evaluation may be required. After making a diagnosis of malignancy, one should then consider the relevant prognostic factors. The 2 well-known prognostic factors (category I prognostic factors) important in almost all tumors include stage and grade. Therefore, information for regarding stage and grade should be included in the pathology report.
    Advances in anatomic pathology 03/2011; 18(2):165-72. · 3.22 Impact Factor
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    ABSTRACT: We report a case of ectopic prostate tissue with an associated prostatic adenocarcinoma occurring in the dome of the urinary bladder. A 62-year-old man presented with a 4-month history of persistent microscopic hematuria following a urinary tract infection. Other complaints included frequent urination, but there was neither dysuria nor gross hematuria. Digital rectal examination revealed a smooth prostate of normal size. Cystoscopic examination revealed a sessile lesion of the anterior bladder neck and multiple smaller papillary lesions throughout the bladder. Following a transurethral resection of the bladder tumor with a diagnosis of muscle-invasive transitional cell carcinoma grade 3, a radical cystoprostatectomy was performed. The diagnosis of transitional cell carcinoma was confirmed, but in addition, a different lesion was also incidentally found in the dome of the bladder. This incidental lesion showed a prostatic adenocarcinoma arising from ectopic prostatic tissue within the bladder submucosa. The prostate also showed prostatic adenocarcinoma, but this was minimal, low grade, and confined to the prostate gland, and thus it was felt to be unlikely to have metastasized to the bladder dome. Adenocarcinoma arising in ectopic prostatic tissue is a rare finding and to our knowledge only 1 case has been previously described, occurring in the soft tissue adjacent to the prostate. We report the first case of adenocarcinoma arising in ectopic prostatic tissue within the bladder.
    Archives of pathology & laboratory medicine 09/2010; 134(9):1271-5. · 2.78 Impact Factor

Publication Stats

46 Citations
47.02 Total Impact Points

Institutions

  • 2013–2014
    • University of Arkansas at Little Rock
      Little Rock, Arkansas, United States
    • University of Texas Medical Branch at Galveston
      • Department of Pathology
      Galveston, Texas, United States
  • 2012
    • Emory University
      • Department of Pathology and Laboratory Medicine
      Atlanta, GA, United States
  • 2010–2011
    • Ulsan University Hospital
      Urusan, Ulsan, South Korea
  • 2008–2010
    • Houston Methodist Hospital
      Houston, Texas, United States
  • 2009
    • Weill Cornell Medical College
      New York City, New York, United States