Browse Health
Pathologist, Dermatologist (skin)
17 years of experience
Accepting new patients


Education ?

Medical School Score Rankings
New York University (1995)
Top 25%

Awards & Distinctions ?

Henry Ford
American Board of Pathology

Affiliations ?

Dr. Pui is affiliated with 9 hospitals.

Hospital Affiliations



  • Mount Clemens Regional Medical Center
    1000 Harrington St, Mount Clemens, MI 48043
    Top 25%
  • Garden City Hospital
    6245 Inkster Rd, Garden City, MI 48135
    Top 25%
  • Henry Ford Hospital
    2799 W Grand Blvd, Detroit, MI 48202
    Top 25%
  • Doctors Hospital of Michigan
    461 W Huron St, Pontiac, MI 48341
  • Botsford Hospital
    28050 Grand River Ave, Farmington Hills, MI 48336
  • POH Medical Center
    50 N Perry St, Pontiac, MI 48342
  • Hilbrich Dermatopathology Laboratory
  • Ashe Memorial Hospital
  • POH Regional Medical Center
  • Publications & Research

    Dr. Pui has contributed to 15 publications.
    Title Brooke-spiegler Syndrome with Associated Pegged Teeth.
    Date January 2009
    Journal Cutis; Cutaneous Medicine for the Practitioner

    The occurrence of cylindromas, trichoepitheliomas, and spiradenomas completes the triad for Brooke-Spiegler syndrome (BSS). This combination represents a rare genetic syndrome with tumors expressing adnexal differentiation. Malignant transformation is rare but reported, and surgical excision is warranted to prevent turban tumor formation of the scalp. Genetic testing is encouraged, with mutations present on the cylindromatosis gene, CYLD, locus. The occurrence of pegged teeth in our patient was most interesting, as it has not been reported in the literature in patients with BSS.

    Title The Diagnostic Concordance of Actinic Keratosis and Squamous Cell Carcinoma.
    Date November 2006
    Journal Journal of Cutaneous Pathology
    Title Distinguishing Pseudoepitheliomatous Hyperplasia from Squamous Cell Carcinoma in Mucosal Biopsy Specimens from the Head and Neck.
    Date June 2006
    Journal Archives of Pathology & Laboratory Medicine
    Title Postirradiation Morphea and Subcutaneous Polyarteritis Nodosa: Case Report and Literature Review.
    Date August 2005
    Journal Seminars in Arthritis and Rheumatism

    OBJECTIVE: To describe a case of postirradiation morphea and subcutaneous polyarteritis nodosa occurring simultaneously in a patient and to review the literature on postirradiation autoimmune phenomenon and the potential pathogenesis of such changes. METHODS: A 75-year-old woman with breast cancer treated with chemotherapy and radiation who developed postirradiation morphea and subcutaneous polyarteritis nodosa, both inside and outside of the field of radiation, is described. Literature searches were performed on postirradiation morphea and other radiation-related inflammatory cutaneous conditions and the potential pathogenic mechanisms involved. RESULTS: Twenty-five cases of postirradiation morphea and 8 cases of postirradiation panniculitis were reported in the literature. Only 3 cases of morphea with distant vasculitis occurring in the same patient have been reported and each of these patients had features suggestive of an underlying connective tissue disease. This is the first case of morphea and subcutaneous polyarteritis nodosa occurring in the same location both inside and outside the field of radiation. CONCLUSIONS: Postirradiation morphea is an uncommon condition but is being increasingly recognized. Related phenomena following radiation include postirradiation panniculitis and now postirradiation subcutaneous polyarteritis nodosa. Radiation may be responsible for inducing some of the pathogenic changes seen in scleroderma and other autoimmune diseases. Rheumatologists should be aware of these potential complications of radiation treatment.

    Title Rickettsialpox: Report of Three Cases and a Review.
    Date March 2005
    Journal Journal of the American Academy of Dermatology

    Rickettsialpox is a rare mite-borne rickettsiosis that is encountered in urban populations in the eastern United States and throughout the world. It is characterized clinically by an eschar, fever, and a papulovesicular eruption. Both of these cutaneous manifestations may be mimicked by infectious diseases that have been designated as bioterrorist agents by the United States Centers for Diseases Control and Prevention: the former by anthrax, and the latter by smallpox. It is thus important for clinicians to be familiar with rickettsialpox. We report 3 cases and review the epidemiology, clinical and laboratory findings, differential diagnosis, and management of this disease.

    Title Linear Focal Elastosis: Histopathologic Diagnosis of an Uncommon Dermal Elastosis.
    Date August 2003
    Journal Journal of Drugs in Dermatology : Jdd

    BACKGROUND: Linear focal elastosis is an uncommon dermal elastosis that occurs predominantly on the back. Although first described in the lumbar region of elderly white men, more recent reports note similar findings on the trunk and limbs of adolescent Asian men. METHODS: We present a typical case of an eighty-three year old white man with a one-year history of asymptomatic linear yellow and erythematous plaques on his lumbar region. RESULTS: Light microscopic examination revealed skin with an unremarkable epidermis with coarsely clumped elastic fibers in the reticular dermis, which were highlighted by an elastic tissue stain. CONCLUSION: The histopathologic differential diagnosis includes pseudoxanthoma elasticum, connective tissue nevus, elastofibroma, and solar elastosis. Although some of these diagnoses can be excluded by histologic examination, correlation with the clinical findings is necessary to arrive at the correct diagnosis of linear focal elastosis. Linear focal elastosis is an uncommon dermal elastosis that was originally described as asymptomatic linear yellow plaques in the lumbar region in elderly white males 1. Recent reports have extended the spectrum of this entity to include red-yellow linear atrophic to raised plaques on the trunks and limbs of adolescent males, predominantly of Asian descent. Twenty-one cases of linear focal elastosis have been reported in the literature. We report an additional case of linear focal elastosis in an elderly male and review the literature.

    Title Capecitabine Induced Cutaneous Hyperpigmentation: Report of a Case.
    Date July 2003
    Journal Journal of Drugs in Dermatology : Jdd

    We report an unusual case of cutaneous and mucosal hyperpigmentation in a thirty-six year old African American woman who was receiving capecitabine chemotherapy for Stage IV breast carcinoma. Possible etiologies for the hyperpigmentation are discussed. To our knowledge, this is the first reported case of capecitabine associated cutaneous hyperpigmentation.

    Title Separation of Notch1 Promoted Lineage Commitment and Expansion/transformation in Developing T Cells.
    Date August 2001
    Journal The Journal of Experimental Medicine

    Notch1 signaling is required for T cell development. We have previously demonstrated that expression of a dominant active Notch1 (ICN1) transgene in hematopoietic stem cells (HSCs) leads to thymic-independent development of CD4(+)CD8(+) double-positive (DP) T cells in the bone marrow (BM). To understand the function of Notch1 in early stages of T cell development, we assessed the ability of ICN1 to induce extrathymic T lineage commitment in BM progenitors from mice that varied in their capacity to form a functional pre-T cell receptor (TCR). Whereas mice repopulated with ICN1 transduced HSCs from either recombinase deficient (Rag-2(-/)-) or Src homology 2 domain--containing leukocyte protein of 76 kD (SLP-76)(-/)- mice failed to develop DP BM cells, recipients of ICN1-transduced Rag-2(-/)- progenitors contained two novel BM cell populations indicative of pre-DP T cell development. These novel BM populations are characterized by their expression of CD3 epsilon and pre-T alpha mRNA and the surface proteins CD44 and CD25. In contrast, complementation of Rag-2(-/)- mice with a TCR beta transgene restored ICN1-induced DP development in the BM within 3 wk after BM transfer (BMT). At later time points, this population selectively and consistently gave rise to T cell leukemia. These findings demonstrate that Notch signaling directs T lineage commitment from multipotent progenitor cells; however, both expansion and leukemic transformation of this population are dependent on T cell-specific signals associated with development of DP thymocytes.

    Title Demonstration of Varicella-zoster Virus Infection in the Muscularis Propria and Myenteric Plexi of the Colon in an Hiv-positive Patient with Herpes Zoster and Small Bowel Pseudo-obstruction (ogilvie's Syndrome).
    Date June 2001
    Journal The American Journal of Gastroenterology

    Gastrointestinal symptomatology as a complication of herpes zoster (HZ) is extremely rare, with the majority of reported cases showing only temporal or radiological evidence of GI tract involvement by varicella zoster virus (VZV) infection. We present the first case of documented direct VZV infection in the muscularis propria of the gut presenting as intestinal pseudo-obstruction (Ogilvie's syndrome). The patient was a 34-yr-old HIV+ man who developed small bowel pseudo-obstruction in association with disseminated cutaneous HZ. A partial ileocolectomy specimen demonstrated a focal ulcer in the terminal ileum. Immunohistochemistry against VZV gpI demonstrated diffuse staining of the muscularis propria and myenteric plexi throughout the length of the specimen. Viral particles consistent with Herpesviridae were shown to be present ultrastructurally. We postulate that the viral infection in the neuronal plexi and muscularis propria caused muscle injury leading to pseudo-obstruction.

    Title Notch1 Regulates Maturation of Cd4+ and Cd8+ Thymocytes by Modulating Tcr Signal Strength.
    Date April 2001
    Journal Immunity

    Notch signaling regulates cell fate decisions in multiple lineages. We demonstrate in this report that retroviral expression of activated Notch1 in mouse thymocytes abrogates differentiation of immature CD4+CD8+ thymocytes into both CD4 and CD8 mature single-positive T cells. The ability of Notch1 to inhibit T cell development was observed in vitro and in vivo with both normal and TCR transgenic thymocytes. Notch1-mediated developmental arrest was dose dependent and was associated with impaired thymocyte responses to TCR stimulation. Notch1 also inhibited TCR-mediated signaling in Jurkat T cells. These data indicate that constitutively active Notch1 abrogates CD4+ and CD8+ maturation by interfering with TCR signal strength and provide an explanation for the physiological regulation of Notch expression during thymocyte development.

    Title Effect of Lupus Anticoagulants on Inr with Different Thromboplastins.
    Date March 2001
    Journal Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis
    Title Essential Roles for Ankyrin Repeat and Transactivation Domains in Induction of T-cell Leukemia by Notch1.
    Date October 2000
    Journal Molecular and Cellular Biology

    Notch receptors participate in a conserved signaling pathway that controls the development of diverse tissues and cell types, including lymphoid cells. Signaling is normally initiated through one or more ligand-mediated proteolytic cleavages that permit nuclear translocation of the intracellular portion of the Notch receptor (ICN), which then binds and activates transcription factors of the Su(H)/CBF1 family. Several mammalian Notch receptors are oncogenic when constitutively active, including Notch1, a gene initially identified based on its involvement in a (7;9) chromosomal translocation found in sporadic T-cell lymphoblastic leukemias and lymphomas (T-ALL). To investigate which portions of ICN1 contribute to transformation, we performed a structure-transformation analysis using a robust murine bone marrow reconstitution assay. Both the ankyrin repeat and C-terminal transactivation domains were required for T-cell leukemogenesis, whereas the N-terminal RAM domain and a C-terminal domain that includes a PEST sequence were nonessential. Induction of T-ALL correlated with the transactivation activity of each Notch1 polypeptide when fused to the DNA-binding domain of GAL4, with the exception of polypeptides deleted of the ankyrin repeats, which lacked transforming activity while retaining strong transactivation activity. Transforming polypeptides also demonstrated moderate to strong activation of the Su(H)/CBF1-sensitive HES-1 promoter, while polypeptides with weak or absent activity on this promoter failed to cause leukemia. These experiments define a minimal transforming region for Notch1 in T-cell progenitors and suggest that leukemogenic signaling involves recruitment of transcriptional coactivators to ICN1 nuclear complexes.

    Title Notch1 Expression in Early Lymphopoiesis Influences B Versus T Lineage Determination.
    Date October 1999
    Journal Immunity

    Notch receptors regulate fate decisions in many cells. One outcome of Notch signaling is differentiation of bipotential precursors into one cell type versus another. To investigate consequences of Notch1 expression in hematolymphoid progenitors, mice were reconstituted with bone marrow (BM) transduced with retroviruses encoding a constitutively active form of Notch1. Although neither granulocyte or monocyte differentiation were appreciably affected, lymphopoiesis was dramatically altered. As early as 3 weeks following transplantation, mice receiving activated Notch1-transduced BM contained immature CD4+ CD8+ T cells in the BM and exhibited a simultaneous block in early B cell lymphopoiesis. These results suggest that Notch1 provides a key regulatory signal in determining T lymphoid versus B lymphoid lineage decisions, possibly by influencing lineage commitment from a common lymphoid progenitor cell.

    Title Efficient and Rapid Induction of a Chronic Myelogenous Leukemia-like Myeloproliferative Disease in Mice Receiving P210 Bcr/abl-transduced Bone Marrow.
    Date December 1998
    Journal Blood

    Expression of the 210-kD bcr/abl fusion oncoprotein can cause a chronic myelogenous leukemia (CML)-like disease in mice receiving bone marrow cells transduced by bcr/abl-encoding retroviruses. However, previous methods failed to yield this disease at a frequency sufficient enough to allow for its use in the study of CML pathogenesis. To overcome this limitation, we have developed an efficient and reproducible method for inducing a CML-like disease in mice receiving P210 bcr/abl-transduced bone marrow cells. All mice receiving P210 bcr/abl-transduced bone marrow cells succumb to a myeloproliferative disease between 3 and 5 weeks after bone marrow transplantation. The myeloproliferative disease recapitulates many of the hallmarks of human CML and is characterized by high white blood cell counts and extensive extramedullary hematopoiesis in the spleen, liver, bone marrow, and lungs. Use of a retroviral vector coexpressing P210 bcr/abl and green fluorescent protein shows that the vast majority of bcr/abl-expressing cells are myeloid. Analysis of the proviral integration pattern shows that, in some mice, the myeloproliferative disease is clonal. In multiple mice, the CML-like disease has been transplantable, inducing a similar myeloproliferative syndrome within 1 month of transfer to sublethally irradiated syngeneic recipients. The disease in many of these mice has progressed to the development of acute lymphoma/leukemia resembling blast crisis. These results demonstrate that murine CML recapitulates important features of human CML. As such, it should be an excellent model for addressing specific issues relating to the pathogenesis and treatment of this disease.

    Title Myofibroblastoma Associated with Bilateral Gynecomastia: a Case Report and Literature Review.
    Date April 1998
    Journal Oncology Reports

    Myofibroblastoma of the breast is a recently recognized benign mesenchymal mammary tumor that typically occurs as a unilateral, solitary lesion. Myofibroblastomas are well-circumscribed, unencapsulated tumors characterized by spindle cells in fascicles which exhibit varying degrees of myogenic and fibroblastic differentiation. Our case reports a mammary myofibroblastoma occurring in an 82-year-old male with gynecomastia and reviews the reported incidence of this benign spindle cell tumor in the world literature.

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