bluuebunny/crossref_metadata_2025 huggingface dataset:
Immunelectron microscopic localization of cathepsin B in human exocrine glands
Authors: Fröhlich E. , Schaumburg‐Lever G. , Klessen C.
Published: April 2006

The distribution of the lysosomal enzymes cathepsin B, lysozyme, ehymotrypsin, and neutrophil elastase was examined in eccrine, apocrine, and sebaceous glands using a postembedding immunogold labeling procedure. Various amounts of cathepsin B were detected in all glands. Lysozyme, however, was detected in apocrine glands only. The other two lysosomal enzymes Were not detectable immunologically. In apocrine and eccrine glands, anti‐cathepsin B antibody labeled all secretory granules. In sebaceous glands, only the peripheral layer of cells showed immunological activity for cathepsin B. In apocrine glands, granules containing remnants of cristae were more intensively labeled than those lacking cristae which supports the assumption that both granules are derived from mitochondria by acquiring lysosomal enzymes. The enzymes convert mitochondria to granules with cristae and finally to granules without cristae. Thus the difference in morphology is part of a spectrum of the degradation of mitochondria to granules.
Eccrine squamous syringometaplasia
Authors: Serrano Teresa , Saez Amparo , Moreno Abelardo
Published: April 2006

Squamous syringometaplasia (SS) is defined as a mature squamous metaplasia of the eccrine ducts. We prospectively evaluated its frequency and clinical and pathological features in a series of 21 patients. SS was found in association with several diseases, chiefly chronic ulcers. The patients'ages ranged between 20 and 80 years and there was no sex predominance. The involved eccrine ducts were usually located in the superficial and mid dermis and displayed inner keratinization. The stimulus required for SS is unknown. Differential diagnosis between SS and well‐differentiated squamous cell carcinoma (SCC) depends on the preservation of a lobular configuration and the absence of epithelial dysplasia or invasion.
Intravascular immunoglobulin crystalloids in monoclonal cryoglubulinemia‐associated dermatitis: ultrastructural findings
Authors: Armin A. R. , Rosenbaum L. , Chapman‐Winokur R. , Hawkins E. T.
Published: April 2006

A 46‐year‐old women developed polyarthritis, purpurie skin rashes, nasal septal perforation and marginal furrowing of corneas in 1980. Monoclonal IgG, kappa cryoglobulinemia was found in the patient's serum. No underlying lymphoproliferative disorder has been found in ten years since her original diagnosis. In 1991, she developed palpable purpura on both lower extremeties with subsequent necrosis and ulceration. A skin biopsy revealed fibrin thrombi within capillaries in the papillary dermis, and immunoflourescence studies showed IgG and light chain kappa within the fibrin thrombi. An electron microscopy study showed intravascular immunoglobulin crystalloid structures with a mean diameter of 80.3A° (8.03 nm), mixed with fibrin and red blood cells. The exclusive vascular location of these crystalloids may have implication in the pathogenesis of skin lesions.
Myxoid change in decidualized scar endometriosis mimicking malignancy
Authors: Nogales Francisco F. , Martin Felix , Linares Juan , Naranjo Ramon , Concha Angel
Published: April 2006

A case of cesarean scar endometriosis with massive decidualization is presented. The 25‐year‐old patient had an extensive, ulcerated lesion that mimicked malignancy microscopically due to myxoid change with alveolar patterns reminiscent of some soft tissue sarcomas, signet ring‐like cells similar to mucin‐producing carcinoma, and pseudoinfiltration of the fascia. The myxoid tissue was positive for acid mucopolysaccarides but negative with PAS. Decidual cells were vimentin positive and keratin negative. No atypia or mitoses were seen. The pseudoinfiltrative aspect was due to abundant extracellular matrix that separated the fascicles of the fascial tissue. There was a metaplastic decidual “proximity effect” in the surrounding, unaffected dermis, which may be responsible for the expansile features of the lesion. This case exemplifies the differential diagnosis of myxoid endometriosis with malignant conditions of the skin.
Subcutaneous T‐cell lymphoma: A clinical, histopathologic, and immunohistochemical study of six cases
Authors: Mehregan David A. , Su W. P. Daniel , Kurtin Paul J.
Published: April 2006

Recently, T‐cell lymphoma localized to the subcutaneous tissue has been reported. We report the clinical, histolpgic, immunohistochemical, and molecular genetic findings in 6 patients who we believe had this peculiar T‐cell lymphoma with its unique morphologic and clinical features. All patients presented with deep‐seated nodules, most frequently on the extremities, and with systemic complaints of low‐grade fever, fatigue, myalgias, and weight loss. In all cases, the neoplastic lymphocytic infiltrate was confined to the subcutaneous tissue, predominantly in a lobular pattern. Hemorrhage, necrosis, and rare erythrophagocytosis were also seen. Immunohistochemical staining was predominantly T‐cell reactive (CD43, CD3, and CD45RO). Clonal rearrangements of the β and γ chains of the T‐cell antigen receptor genes were found in 1 case. Three of the 6 patients died within 22 months of the diagnosis of lymphoma. We believe that subcutaneous T‐cell lymphomas are a distinctive group of peripheral T‐cell lymphomas with unusual clinical and morphologic features and that they should be distinguished from other types of lymphoma.
Immunofluorescent analysis of the basement membrane zone in lichen planus suggests destruction of the lamina lucida in bullous lesions
Authors: Smoller Bruce R. , Glusac Earl J.
Published: April 2006

Lichen planus is an inflammatory dermatosis which is characterized histologically by an intense lymphocytic infiltrate at the dermal epidermal junction. This frequently results in disruption of the basement membrane zone, occasionally causing clinical blisters. In order to better understand the specific portion of the basement membrane zone which is disrupted by the lymphocytic infiltrate, we examined 7 cases of lichen planus with antibodies directed against anchoring filaments (GB3), the bullous pemphigoid antigen, anchoring fibrils (type VII collagen) and type IV collagen. In lesions without separation at the BMZ, all antibodies were strongly expressed, as in normal skin. In lesions with early separation, there was a focal decrease in GB3 staining, but types VII and IV collagen labelled normally. In lesions resulting in blisters, GB3 staining was essentially absent, and anti‐types IV and VII collagen remained, but stained in a disrupted, less discrete pattern. The bullous pemphigoid antigen showed only slight deviation from the normal staining pattern. These findings suggest that the basement membrane zone in lichen planus is disrupted in the lamina lucida region. The lamina densa and sub‐lamina clensa zones remain intact even in bullous lesions of lichen planus.
Granuloma annulare: An immunohistochemical study
Authors: Mullans Elizabeth , Helm Klaus F.
Published: April 2006

The monocyte/histiocytic response in granuloma annulare has not been extensively studied. We studied the immunohistochemical staining pattern in granuloma annulare by using a panel of markers for “histiocytic” cells including Ham 56, KP1, factor XIIIa, Mac 387, vimentin, and lysozyme. The infiltrate failed to stain with the histiocytic markers, except with antibodies against vimentin and lysozyme. Commonly used histiocytic markers for infectious, immunogenic, and foreign body granulomas fail to stain the infiltrate in granuloma annulare. We hypothesize that a locally derived, immunologically distinct population of histiocytes produces the reaction pattern of granuloma annulare.
Coexpression of cytokeratin and vimentin intermediate filaments in benign and malignant sweat gland tumors
Authors: Eckert Fritjof , de Viragh Pierre A. , Schmid Ulrico
Published: April 2006

The coexpression of cytokeratin and vimentin intermediate filaments has been immunohistochemically evaluated in 124 benign and malignant sweat gland tumors of various types in comparison to normal sweat glands. In addition, all neoplasms have been stained by an antibody to alpha‐smooth muscle actin. Epithelial cells reacted with the pan‐cytokeratin antibody lu‐5. In normal sweat glands, vimentin immunoreactivity was restricted to myoepithelial cells and to some cells of the coiled duct. In benign sweat gland tumors (n=88), coexpression of vimentin and alpha‐smooth muscle actin was frequently found in basal cells of neoplasms considered to differentiate towards the secretory coil of the eccrine or apocrine gland. These included eccrine spiradenoma, apocrine cystadenoma, hidradenoma papilliferum, syringocystadenoma papilliferum, and cylindroma. Thus, in these tumors, vimentin‐reactive cells corresponded to myoepithelial cells. Vimentin‐positive cells were also found in 14 of 36 sweat gland carcinomas, including 1 case of sclerosing sweat duct carcinoma, 1 case of porocarcinoma, 4 cases of eccrine adenocarcinoma, 1 case of mucinous eccrine carcinoma, and 5 cases of apocrine adenocarcinoma. Co‐expression of vimentin and alpha‐smooth muscle actin was observed in some cells of eccrine and apocrine adenocarcino‐mas. Therefore, in these neoplasms, some vimentin‐positive cells appear to represent myoepithelial cells. In contrast, vimentin‐positive cells in all other malignant tumors did not express alpha‐smooth muscle actin. Our results indicate that coexpression of cytokeratin and vimentin may be frequently found in a variety of benign and malignant sweat gland tumors. In the majority of these neoplasms, vimentin‐positive cells correspond to myoepithelial cells. Because vimentin is not specific for myoepithelial cells, additional stains for alpha‐smooth muscle actin should be performed to prove the myoepithelial nature of vimentin‐positive cells.
Adenocarcinoma of the mammary‐like glands of the vulva:
Authors: van der Putte S. C. J. , van Gorp L. H. M.
Published: April 2006

An unusual case of primary adenocarcinoma of the vulva is described. It combined features of the three different types of adenocarcinoma of the skin of the vulva which are currently recognized, i.e. sweat gland carcinoma, adenocarcinoma derived from supernumerary mammary glands, and extramammary Pagel's disease (EMPD). Central in this tumor was a recently recognized type of cutaneous gland which appeared special for the anogenital region and was distinguished because it combined morphological features of eccrine, apocrine and mammary glands. As it most resembles mammary glands, it is named “mammary‐like gland”. On the basis of the case presented and of a critical review of the literature, it was concluded that, with the exception of a few sweat gland carcinomas similar to those elsewhere in the skin, adenocarcinomas of the skin of the vulva form a single category of neoplasms with a variable expression of features reminiscent of eccrine, apocrine and mammary gland carcinomas. The data strongly suggested a common derivation from the mammary‐like gland or, in cases of EMPD, its related germinative cells in the epidermis.
Giant folliculosebaceous cystic hamartoma
Authors: Yamamoto Osamu , Suenaga Yoshinori , Bhawan Jag
Published: April 2006

We report a case of a giant cystic cutaneous adnexal hamartoma which showed fibrofollicular units embedded in the stroma with aberrant fat tissue. There were many sebaaeous lobules in the fibrofollicular units, and its histologic features were consistent with conventional folliculosebaceous cystic hamartoma. Given the unique clinical history and appearance, this lesion is considered to be a congenital variant.
Granulocytic sarcoma: An immunohistologic comparison with peripheral T‐cell lymphoma in paraffin sections
Authors: Ritter Jon H. , Goldstein Neal S. , Argenyi Zsolt , Wick Mark R.
Published: April 2006

In evaluating histologically malignant infiltrates in the skin, it is often challenging to distinguish granulocytic sarcoma (GS) from selected cases of peripheral T‐cell lymphoma (PTCL). These lesions have clinical features in common, in addition to shared histologic attributes. These include similarity in dermal distribution and growth pattern, nuclear characteristics, propensity to recruit other inflammatory cell types, and production of matrical sclerosis. In order to determine if immunohistology could contribute to differential diagnosis in this setting, we analyzed 15 cases of mucocutaneous GS, and compared them with 11 cases of well‐documented PTCL. Antibodies in the CD15, CD20, CD34, CD43, GD45, CD45RO, and CD68 groups were used, as well as antimyeloperoxidase (anti‐MPX), anti‐lysozyme (anti‐LYSO), Mac387, and MB2. Anti‐LYSO and anti‐MPX were sensitive and specific markers of GS, labeling 93% and 80% of GS cases, respectively, and no cases of PTCL. Anti‐CD 15 and MB2 were also specific for GS, but each labeled only (50% of GS cases. CD34, CD68, and Mac 387 were specific but insensitive markers of GS. CD43 and CD45 were not particularly useful discriminants, with each being seen in 93% of GS cases, but also 64% and 100% of cases of PTCL, respectively. CD45RO was specific for PTCL; it was present in 82% of PTCL cases and no GS cases. Thus, conjoint reactivity for CD43, CD45, MPX, and LYSO characterizes GS, and differs from the pattern of PTCL, which is characterized by reactivity for CD45 and CD45RO, occasional reactivity for CD43, and lack of other specified markets.
CD44 expression in alopecia areata and androgenetic alopecia
Authors: Sawaya Marty E. , Bakshandeh Haleh , Hordinsky Maria K. , Penneys Neal S.
Published: April 2006

CD44 is a widely distributed cell surface protein thought to be involved in multiple steps of normal immune cell function, including T‐cell activation, and in cellular adhesion where it mediates cell attachment to hyaluronate. In normal skin, CD44 is found by immunohistochemical means to be primarily in eccrine coil cells. In this study, we have looked at the expression of CD44 in normal scalp and in two different hair disorders, androgenetic alopecia and alopecia areata. In normal scalp and androgenetic alopecia, CD44 was found in its normal distribution in eccrine coil cells. In scalp of 30 patients with alopecia areata, there was no expression of this glycoprotein. Patients were also assessed pre and post treatment for their alopecia areata, and even though they had no significant hair regrowth, 2 patients regained expression of CD44, indicating a variable expression of this protein in the alopecia areata disease process. The absence of CD44 expression in alopecia areata‐affected scalp may give further information regarding the pathogenesis of this disease.
Mast cells in angiolipomas and hemangiomas of human skin: are they important for angiogenesis?
Authors: Shea Christopher R. , Prieto Victor G.
Published: April 2006

To characterize the potential role of mast cells (MC) in angiogenesis, this study tests the hypothesis that MC may be more abundant in angiolipomas than in classic lipomas. MC counts were compared in 13 subcutaneous angiolipomas and 15 subcutaneous classic lipomas stained with Giemsa. Angiolipomas had ten times as many MC as did classic lipomas (25.34 ± 2.83 versus 2.41 ± 0.37 per mm2, mean ±SE). To clarify whether this difference was primary (angiogenic activity) or secondary to the increased vascularity, MC were counted in 8 longstanding cutaneous capillary hemangiomas versus 13 cutaneous capillary hemangiomas of recent onset (pyogenic granulomas). If MC were mediating primary angiogenesis, one would expect them to be present in greater numbers in early than in late hemangiomas. To the contrary, however, long‐standing hemangiomas were found to have significantly more MC than had those of recent onset (52.48 ± 14.99 versus 6.59 ± 3.37 per mn2, mean ±SE). These results suggest that MC may not play an essential, early role in the proliferation of blood vessels in angiolipomas and hemangiomas, but rather may be related to maturation of blood vessels in these tumors.
Malignant granular cell tumor
Authors: Gokaslan Sefik T. , Terzakis John A. , Santagada Eugene A.
Published: April 2006

We report a case of malignant granular cell tumor present in the left medial mid‐thigh of a 69‐year‐old black male. The lesion was grossly fungating, partially ulcerated and measured 14 cm in largest diameter. Light microscopy, electron microscopy and immunohistochemistry techniques were used to confirm the preliminary cytologic diagnosis of malignant granular cell tumor. Diagnostic criteria of malignancy for such lesions are reviewed. Immunohistochemical and ultrastructural analyses support a neural or Schwann cell origin for the tumor. Clinical outcome for such lesions is discussed.
Eruptive clear cell hamartoma of sweat duct
Authors: Izaki S. , Kono E. , Hirai A. , Kitamura K.
Published: April 2006

A histologically unique condition of the sweat duct was found in a miliaria‐like papular eruption on the extensor surfaces of extremities of a 41‐year‐old female patient. The hypertrophic epithelium of the sweat duct wall consisted of extensively vacuolated clear cells. There was mild hyperkeratosis around the sweat duct orifice. The eccrine gland cells showed only partial vacuolization. Since this condition is not related to any of the other known benign changes of the eccrine duct, we report it with a presumptive descriptive diagnosis of eruptive clear cell hamartoma of sweat duct.
Metastatic prostatic carcinoma histologically mimicking malignant melanoma
Authors: Segal Robert , Penneys Neal S. , Nahass George
Published: April 2006

Prostatic carcinoma rarely metastasizes to the skin. We describe a case in which inguinal metastasis occurred. Histologically, the tumor was composed of pale‐staining cells which had pronounced epidermotropism, producing a pagetoid pattern mimicking that seen in malignant melanoma. The diagnosis was confirmed by demonstrating prostatic specific antigen in tumor cells.
Paget's disease in an adolescent arising in a supernumerary nipple
Authors: Martin Victorino G. , Pellettiere Edmund V. , Gress Damion , Miller Alexander W.
Published: April 2006

Paget's disease of the breast generally affects middle‐aged and older females. In the majority of cases, it is considered to be the result of epidermal spread from a contiguous mammary duct carcinoma. We report the first case in an adolescent female with an accessoiy nipple. The histomorphology and immunophenotypic findings support the hypothesis of in situ transformation and suggest a histologic spectrum exists in terms of cytologic atypia.
Acute cutaneous eruptions after marrow ablation: Roses by other names?
Authors: Horn Thomas D.
Published: April 2006

This review will cover acute cutaneous eruptions following marrow ablation in the treatment of various malignant neoplasms. The clinical and histopathological features of 1. the eruption of lymphocyte recovery, 2. acute allogeneic graft‐vs‐host reaction, 3. acute autologous (spontaneous) graft‐vs‐host reaction, 4. eruptions associated with the administration of cyclosporin A, and 5. eruptions associated with the administration of human recombinant cytokines in pharmacologic doses will be considered. The idea is put forth that the second, third, and fourth cutaneous eruptions listed above represent variations on the theme of the eruption of lymphocyte recovery. The final common pathway in the development of all these diffuse erythematous eruptions probably relates to the elaboration of cytokines by infiltrating lymphocytes or to the administration of cytokines in pharmacologic doses.
Aberrant bcl‐2 protein expression provides a possible mechanism of neoplastic cell growth in cutaneous basal‐cell carcinoma
Authors: Cerroni Lorenzo , Kerl Helmut
Published: April 2006

The bcl‐2 proto‐oncogene encodes a protein that protects cells from programmed cell death (apoptosis). High levels of this protein confer a growth advantage to neoplastic cells even in the absence of a high mi to tic rate. This gene is involved in the interchromosomal 14;18 translocation, an abnormality present in more than two‐thirds of follicular lymphomas and in about 25% of other non‐Hodgkin's lymphomas of the lymph nodes. A recent study also demonstrated the presence of high levels of bcl‐2 protein in solid tumors such as squamous cell carcinomas of the lung and related it to a better prognosis. We analyzed bcl‐2 protein expression in 20 cases each of basal‐ and squamous‐cell carcinoma and in 5 biopsy specimens of normal skin, using a monoclonal anti‐bcl‐2 protein antibody with a standard 3‐step immunoperoxidase technique on routinely fixed, paraffin‐embedded tissue sections. Normal skin showed positive staining of the majority of keratinocytes in the epidermal basal layer. bcl‐2 positivity was also observed within the outer root sheath and the mesenchymal cells of the follicular papillae', the clear cells of the eccrine glands, and in some melanocytes at the dermo‐epidermal junction. Neoplastic cells in all cases of basal‐cell carcinoma showed a positive cytoplasmic reaction for bcl‐2 All biopsy specimens of squamous‐cell carcinoma were negative. Expression of bcl‐2 protein could also be observed in the majority of peri‐ and intratumoral lymphocytes in both basal‐cell carcinoma and squamous‐cell carcinoma. Our results indicate that protection from apoptosis mediated by bcl‐2 protein may be involved in the neoplastic growth mechanism of basal‐cell carcinoma. Further studies are required to detect the molecular basis of bcl‐2 protein over‐expression in these tumors.
Aneuploidy in atypical fibroxanthoma: DNA content quantification of 10 cases by image analysis
Authors: Michie B.A. , Reid R.P. , Fallowfield M.E
Published: April 2006

It has recently been reported that atypical fibroxanthoma (AFX) is a predominantly diploid lesion in contrast to malignant fibrous hystiocytoma (MFH) which is usually aneuploid. To test this hypothesis, DNA content quantification was undertaken on Feulgen‐stained cytology and tissue section preparations from 10 cases of AFX by image analysis. The large‐atypical cells which characterize AFX were aneuploid in each case. Smaller spindle‐shaped cells found in this lesion were diploid. The results suggest that AFX is indistinguishable from MFH by DNA content estimation and highlight an advantage of image analysis over (low cytometry.
Examination of non‐involved skin, previously involved skin, and peripheral blood for herpes simplex virus DNA in patients with recurrent herpes‐associated erythema multiforme
Authors: Brice Sylvia L , Leahy Maureen A. , Ong Lani , Krecji Sonja , Stockert Stephen S. , Clark Huff J. , Weston William L.
Published: April 2006

The association between infection with HSV and the subsequent, development of erythema multiforme is well established, although the role that the virus plays in the pathogenesis of this disorder is not known. HSV DNA has been detected in cutaneous lesions of herpes‐associated erythema multiforme (HAEM), and it has been suggested that the tissue damage seen in these lesions is virus‐specific. In the current, prospective study, we examined biopsies of lesional, non‐involved, and previously involved but healed skin, in addition lo specimens of peripheral blood, from patients with HAEM, for HSV DNA by using the polymerase chain reaction. HSV DNA was detected in lesional skin of 10 of 11 patients compared to 2 of 11 non‐involved skin biopsies obtained at the same time. I ISV was present in 4 of 6 blood specimens obtained during the acute episode. Five patients returned 3 months after the acute episode resolved for biopsies of previously involved skin. HSV was detected in 4 of these 5 biopsies. Thus, the presence of HSV DNA in the skin of pal inns with HAEM appears lo be predominantly in areas of clinical involvement; the virus remains in those cutaneous sites for up to 3 months without evidence of clinical disease; and HSV DNA may be detected in the peripheral blood cells during acute HAEM. Based on these findings, we suggest that the virus plays a role in lesion development, that the skin may function as a site of viral persistence, and that hemalogenous spread of viral DNA may bean important factor in the development of HAEM.
T lymphocytes bearing the γ/δ T‐cell receptor in cutaneous lesions of dermatitis herpetiformis
Authors: Kell Donna L. , Glusac Earl J. , Smoller Bruce R.
Published: April 2006

T lymphocytes bearing the γ/δ T‐cell receptor are a rare component of normal human GI epithelium and skin. Recently, however, an unusually high percentage of T lymphocytes with γ/δ receptors has been described in gastrointestinal biopsies from patients with dermatitis herpetiformis, implicating the γ/δ T cell subset in the pathogenesis of this disease. We investigated a possible role for this subset of lymphocytes in the pathogenesis of the cutaneous lesions of dermatitis herpetiformis. Using a standard immunoperoxidase technique, we labelled perilesional skin biopsies from patients with dermatitis herpetiformis and other inflammatory dermatoses with monoclonal antibodies to CDS, CD4, CDS, α/β T cell receptor, γ/δ T cell receptor, and IL‐2 receptor. We found no differences in the percentage of γ/δ positive T lymphocytes in skin lesions of dermatitis herpetiformis as compared to other selected in‐flammatory conditions. These findings suggest that die pathogenesis of the cutaneous lesions of dermatitis herpetiformis is not mediated through γ/δ T cells, and that the cutaneous lesions may develop through mechanisms different from those operative in the gastrointestinal tract.
Increased tenascin expression in melanocytic tumors
Authors: Tuominen Hannu , Kallioinen Matti
Published: April 2006

Tenascin is a large extracellular matrix glycoprotein which is widely distributed in normal, hyperplastic and neoplastic tissues. Its function is unknown but it has been associated with the epithelial‐stromal interactions, such as cell adhesion and movement which take place, e.g. in morphogenesis, cellular proliferation and neoplasia. In this study, we investigated tenascin expression in 70 benign, dysplastic and malignant melanocytic tumors by using immunohistochemistry and monoclonal anti‐tenascin L43DB7C8 antibody on paraffin sections. In all types of benign nevi, both intradermal, compound and functional, there was a moderate expression of tenascin at the dermoepidermal junction and in the papillary dermis. In dysplastic nevi, the fibrotic areas in the papillary clermis also showed a moderate staining for tenascin. Invasive malignant melanomas showed the strongest expression of tenascin. In addition to the staining at the dermo‐epidermal junction and in the papillary clermis, there was a variable expression of tenascin in the reticular dermis. Intracyloplasmic tenascin was detected both in primary melanomas and melanoma metastases. In conclusion, we have shown that tenascin expression is moderately increased in benign and dysplastic melanocytic tumors and greatly increased in malignant melanomas and melanoma metastases. The function of tenascin may be related to the cellular‐stromal interactions and it is possibly associated with the proliferation and spread of the melanocytic tumors.
The spectrum of cutaneous granulomatous vasculitis: histopathologic report of eight cases with clinical correlation
Authors: Gibson Lawrence E. , El‐Azhary Rokea A. , Smith Thomas F. , Reda Ashraf M.
Published: April 2006

Cutaneous granulomatous vasculitis is an uncommon histopathologic finding that has been associated with lymphoproliferative disorders, systemic vasculitis, autoimmune inflammatory diseases, and infection. To define further the concept of cutaneous granulomatous vasculitis and to emphasize its clinical importance, we reviewed biopsy material from 8 patients seen from 1985 through 1992. All biopsies showed evidence of blood vessel damage with fibrinoid change or hemorrhage (or both) and granulomatous inflammation in and around vessel walls. Special stains for microorganisms were negative in all cases. Associated medical disorders included neuropathy (2 patients), sarcoid‐like disease (2), systemic vasculitis (1), lymphoma and suspected lymphoma (1 each), and associated herpes simplex virus (1). T‐cell gene‐rearrangement studies were negative in a patient with suspected lymphoma. Granulomatous cutaneous vasculitis is most commonly associated with lymphoma and systemic vasculitis. In selected cases, infection should be considered as an underlying cause.
Determining the processing cost of a skin biopsy specimen
Authors: Penneys Neal S.
Published: April 2006

An integral part of directing a pathology laboratory is to understand the nature and behavior of relevant costs. Until recently, pathologists did not need to accurately know the specific costs assigned to various steps in the processing of tissue specimens. With the advent of a more competitive approach to the delivery of health care, laboratory directors must accurately cost their product in order to use competitive pricing strategies. In this article, I review the principles that are used to analyze costs that are identified in a typical dermatopathology laboratory.
Interphase cytogenetics of melanocytic neoplasms: numerical aberrations of chromosomes can be detected in interphase nuclei using centromeric DNA probes
Authors: Matsuta M. , Matsuta M. , Kon S. , Thompson C. , LeBoit P. E. , Weier H.‐U. , Gray J. W.
Published: April 2006

This study shows that fluorescence in situ hybridization (FISH) to thin sections cut from paraffin‐embedded material can lie used to distinguish between groups of melanocytic neoplasms and thus may be useful as an investigational and diagnostic tool. FISH with a probe for a repealed, alpha satellite sequence specific to chromosome 17 was used to investigate the chromosomal composition of dysplastic (or Clark's nevus) and Spitz's nevi and malignant melanomas. Hybridization was to thin (∼6 μm) sections cut from paraffin blocks. The number of signals per nucleus in normal diploid cells is expected to be less than 2 since the sections are thinner than one nuclear diameter. Keratinocytes and lymphocytes m these same sections showed 1–2 signals per nucleus with a mean of 1.2. Dysplastic nevi showed 1–4 hybridization signals per nucleus with a mean of 1.5. Spitz's nevi showed 1–2 signals per nucleus with a mean of 1.3. Melanomas showed 1–6 signals per nucleus with a mean of 2.1. We were thus able to use FISH to demonstrate differences in chromosome numbers between groups of benign and malignant melanocytic neoplasms. Technical improvements in the near future can be expected lo result in more precise estimates of chromosomal number.
Differentiation between malignant melanomas and benign melanocytic nevi by computerized DNA cytometry of imprint specimens*
Authors: Stolz Wilhelm , Vogt Thomas , Landthaler Michael , Hempfer Siegfried , Bingler Paul , Abmayr Wolfgang
Published: April 2006

Recently image analysis (IA) and DNA‐cytophotometry (CP) have proved to be useful for the differentiation between benign and malignant melanocytic lesions on paraffin sections. Since, on sections, these procedures are very time‐consuming, we tested in the present study whether LA of imprint specimens, which can be evaluated in less than 30 minutes, might also be sufficient. In 39 malignant melanomas (MM), 18 melanocytic nevi (MN), and 6 dysplastic nevi (ON), 12 different morphometric and DNA cytometric features were determined in 100 randomly selected nuclei. In univariate analysis, 5 features were found to be significantly different between the benign and malignant groups (p<0.0001): mean value (MAREA) and standard deviation (SAREA) of nuclear area and the 80th, 90th, and 95th percentiles of DNA distribution. Using SARKA, the best univariate feature, 82.5% of the cases could be correctly separated. In multivariate analysis with a combination of three features–standard deviation of nuclear area (SAREA), mean DNA value (MDNA), and 95th percentile of DNA distribution (PERC95) ‐ a coned diagnosis was achieved in 89.5% of the cases. Results obtained in the cases of ON indicated an increased proliferation, but did not allow the separation of DN from MM and MN. Since our technique allows a rapid analysis without loss of tissue, which might be important for histological analysis, and the classification rates are equal or still higher than reported in studies on sections, imprints of melanocytic lesions seem to be most appropriate for the calculation of DNA cytometric features as helpful diagnostic criteria in equivocal melanocytic lesions.
Histologic correlates of metastasis in primary invasive squamous cell carcinoma of the lip
Authors: Stein Amy L. , Tahan Steven R.
Published: April 2006

Clinical and histologic features of 44 invasive squamous cell carcinomas of the lip treated by surgical excsion were correlated with metastases and survival. Age, diameter, ulceration, grade, depth of invasion, muscle invasion, mitotic rate, lymphatic‐vascular invasion, and tumor infiltrating lymphocytes were evaluated. Two (4.5%) patients had local recurrence, 10 (23%) had metastases to cervical lymph nodes, and 2 (4.5%) died from complications of extensive spread in the neck. One patient with local recurrence had regional node metastases. Regional metastases were discovered at the lime of (3 patients) or up to 21 (median 8) months after initial diagnosis, correlating with ulceration (P − 0.003), depth of invasion (P − 0.0001), and mitotic rate (P − 0.05) of the primary tumor. Depth exceeding 2.0 mm. was associated with metastasis (P − 0.028), and all carcinomas deeper than 6.0 mm. metastasized. Eight of the 10 patients with regional metastases had no farther disease after treatment through the follow‐up period (median 64 months). Both fatalities were older (median 81 years) men. These results underscore the metastatic potential of invasive squamous cell carcinoma of the lip. Histologic analysis of the primary lesion can be used to identify individuals at risk.
Alopecia neoplastica simulating alopecia areata and antedating the detection of primary breast carcinoma
Authors: Carson Henry J. , Pellettiere Edmund V. , Lack Edward
Published: April 2006

A woman with no previous history of breast carcinoma presented with focal hair loss, which was presumptively diagnosed as alopecia areata. After treatment failures, a scalp biopsy was performed, which subsequently led to the diagnosis of breast carcinoma. This case illustrates the subtle course which breast cancer can take and the insidious manner in which it may present. It alerts clinicians and pathologists to the possibility of secondary causes, including malignancy, in the differential diagnosis of alopecia refractory to usual treatments.
Eccrine angiomatous hamartoma (nevus):
Authors: Sulica R. Lucien , Kao Grace F. , Sulica Virginia I. , Penneys Neal S.
Published: April 2006

Eccrine angiomatous hamartoma (nevus) is a rare form of congenital tumorous malformation with proliferation of eccrine secretory coils and duels, surrounding capillary angiomatous channels and occasionally oilier minor elements. To date, there have been only about 24 cases reported in the literature. We report an additional case with more detailed description of the microscopic Endings, including immunohistochemical observations. The patient was a 28‐year‐old female who presented with painless, flesh to reddish brown‐colored, violaceous or bluish subcutaneous nodules on the extremities and trunk. The tumors did not show sweating following exertion. The histologic features were comparable lo the previously reported cases. The hamartomatous eccrine sweat glands and duels and a few apocrine glands demonstrated qualitatively diminished antigens commonly found in the eccrine sweat apparatuses, such as carcinoembryonic antigen (CEA) and S–100 protein. The. findings of CD34, CD44, human nerve growth factor receptor and Ulex europacus antigens have not been previously reported. The histologic features suggested a “hamartomatous” growth rather than a true neoplastic process.
Sclerotic fibroma: A fossil no longer
Authors: McCalmont Timothy H.
Published: April 2006

We report on a patient with a sclerotic Fibroma that recurred 30 months after initial removal. The histologic features were characteristic, and immunoperoxidase stains using primary antibodies directed against cell proliferation markers were positive in a significant proportion of the neoplastic nuclei. A review of the literature identified one other sclerotic fibroma that persisted. These clinical and light microscopic features support the interpretation that sclerotic fibroma is a proliferating neoplasm with an unusual histologic pattern, rather than the end‐stage of a process that was formerly more cellular. We advocate use of sclerotic fibroma as the preferred diagnostic term.
Altered p53 expression and epidermal cell proliferation is seen in vulval lichen sclerosus
Authors: Tan Suat‐Hoon , Derrick Elizabeth , McKee Phillip H. , Hobbs Carl , Ridley Marjorie , Neill Sallie
Published: April 2006

Aberrant p53 immunoreactivity has been found in skin premalignancies and dysplasias such as Bowen's disease and actinic keratoses. Vulval lichen sclerosus (LS) has been reported to be pre‐malignant, with an association of vulval carcinoma in 3% to 6% of patients. In contrast, non‐genital LS appears to have no malignant potential. In this immunocytochemical study, we investigated p53 expression in 10 cases of histologically proven vulval LS and 9 cases of non‐genital LS using the murine monoclonal antibody Do‐1 raised against recombinant human p53 which reacts with both wild‐type and mutant p53. None of the vulval specimens had epithelial dysplasia or malignancy. Normal vulval (7 cases) and non‐genital skin (5 cases) were used as tissue controls, respectively. The cell proliferation index was also studied using the MIB 1 monoclonal antibody which detects the cell‐cycle associated Ki‐67 antigen. The technique of microwave irradiation for antigen unmasking was employed on Formalin‐fixed and paraffin‐embedded tissues. There was a significant increase in p53 immunoreactivity in vulval LS (32.13 ± 15.11 epidermal cells per 100 basal cells) compared to normal vulval skin (7.52 ± 5.04 epidermal cells per 100 basal cells) (p < 0.001), whereas the MIB 1 labelling index was lower in vulval LS (39.45 ± 15.88 epidermal cells per 100 basal cells) than in normal controls (86.26 ± 32.31 epidermal cells per 100 basal cells) (0.001 < p < 0.01). In contrast, there was no significant difference in p53 immunoreactivity or MIB 1 labelling index between non‐genital LS and normal controls. Vulval LS, when compared to non‐genital LS (8.76 ± 6.61 epidermal cells per 100 basal cells), also demonstrated a significant increase in P53 immunoreactivity (p < 0.001). The reduced proliferative index in vulval LS may be directly related to its increase in p53 expression and is in keeping with the role ol p53 in the negative regulation of cell proliferation. We propose that the difference in p53 expression may represent a difference in biological behavior between vulval LS and non‐genital LS. What role it plays in the evolution of vulval carcinoma in a setting of long standing LS is uncertain.
CD34 immunoreactivity distinguishes between scar tissue and residual tumor in re‐excisional specimens of dermatofibrosarcoma protuberans
Authors: Prieto Victor G. , Reed Jon A. , Shea Christopher R.
Published: April 2006

Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive tumor that often recurs after simple excision, and therefore usually requires wide surgical re‐excision. It is sometimes difficult to distinguish histologically between residual tumor and scar tissue formed in response to the original biopsy. In an effort to solve this diagnostic problem, we have examined CD34 immunoreactivity in 10 primary biopsies of DFSP, 12 scars, and 7 re‐excisional DFSP specimens containing residual tumor adjacent to scar tissue. In all 10 primary biopsies of DFSP, the tumor cells strongly and uniformly expressed CD34. In the 12 scars, only periaclnexal cells, enclothclial cells, and rare, scattered dendritic cells in the clermis were immunolabeled for CD34. In the 7 re‐excisions of DFSP, the foci of residual DFSP were strongly immunolabeled, while the surrounding scar tissue was not. The pattern of CD34 immunoreactivity distinguishes DFSP from scar tissue, and thereby may permit more accurate assessment of surgical margins in re‐excisional specimens of DFSP.
Eruptive xanthomata with urate‐like crystals
Authors: Walsh Noreen M.G. , Murray Scott , D'Intino Yolanda
Published: April 2006

The microscopic manifestations of eruptive xanthomata are variable and although they are most frquently characterized by aggregations of foamy macrophages in the dermis, they can, on occasion, simulate granuloma annulare. We have recently encountered a further unusual histopathological variant of eruptive xanthomata in 3 skin biopsies from 2 patients with hypertriglyceridemia. The lesions had a granuloma annularelike pattern at low magnification, the exceptional feature being their content of polarizable, needle‐shaped crystals. These bore a strong resemblance to monosodium urate mono‐hydrate and displayed negative birefringence under polarized light. In the case of each patient, an initial pathological diagnosis of gout was rendered, and the true nature of the lesions came to light only after clinicopathologic correlation. While it is clear that the chemical composition of these crystals requires further study, recognition of this microscopic variant of eruptive xanthomata should help to reduce errors in diagnosis.
Low‐grade fibromyxoid sarcoma: case report and immunohistochemical study
Authors: Nichols Guy E. , Cooper Philip H.
Published: April 2006

A case is presented of low‐grade fibromyxoid sarcoma involving the arm of a 52‐year‐olcl man. Low‐grade fibromyxoid sarcoma is a recently described neoplasm of the deep and subcutaneous soft tissue which demonstrates a spectrum of histologic images. The current case demonstrated the typical patterns of intermixed, sweeping bands of fibrous and myxoid tissue, homogeneous foci of fibrous and myxoid tissue, focal areas of storiforming, and concentric perivascular cuffs of slender spindle cells, all lacking the nuclear anaplasia, mitotic activity, and necrosis generally associated with sarcomas. Immunohistochemical analysis performed on paraffin‐embedded sections demonstrated strong labeling of the tumor cells by anti‐CD34 antibody, moderate labeling for vimientin, and rare, focal positivity for muscle‐specific actin. Tumor cells were negative for markers of epithelial, muscular, neural, histiocytic, melanocytic, and vascular differentiation. The constellation of histopathologic features described in this arid previous reports is characteristic of low‐grade fibromyxoid sarcoma. Based on this case, it appears that the immunohistochemical features of low‐grade fibromyxoid sarcoma can help to exclude many cutaneous and deep soft tissue tumors from the differential diagnosis. The findings support the interpretation that the neoplasm is essentially fibroblastic in nature.
Diffuse dermal angiomatosis: a variant of reactive cutaneous angioendotheliomatosis
Authors: Krell James M. , Sanchez Ramon L. , Solomon Alvin R.
Published: April 2006

Reactive angioendotheliomatosis (RA) is a rare, benign disease. Affected patients present with self‐limited, erythematous to violaceous plaques. The clinical lesions are due to intravascular hyperplasia of cytologically banal endothelial cells in the dermis. We report 2 patients who presented with ulcerated, violaceous plaques on the lower extremities. Both had severe peripheral vascular atherosclerotic disease requiring bypass grafts. Unlike previously described cases of RA, our patient's lesions were due to a diffuse proliferation of endothelial cells in the reticular dermis with only minimal, focal intravascular proliferation of these cells. Positive immunostaining with antibodies to Factor VIII‐related and CD34 antigens adds evidence that the proliferated cells in the dermis were endothelial cells.
Use of CD34 in assessing the relationship between stroma and tumor in desmoplastic keratinocytic neoplasms
Authors: Kirchmann Tin Tin T. , Prieto Victor G. , Smoller Bruce R.
Published: April 2006

It has been hypothesized that the ability for neoplastic growth of epithelial‐derived neoplasms depends upon the stroma. There are currently some studies which show that the stroma surrounding basal cell carcinomas (BCC) is derived from the tumor. In contrast, other studies provide evidence that the stroma is a host‐derived response to the tumor. In order to further examine the nature of stroma enveloping cutaneous epithelial neoplasms, we examined a series of tumors which contain abundant stroma, including morpheic type BCC (MBCC), desmoplastic trichoepitheliomas (DTE), and microcystic adnexal carcinomas (MAC). The spindle‐shaped cells surrounding the epithelial islands of the two malignant tumors, MBCCs and MACs, were negative in 70% and 100% of cases, respectively, for CD34. In contrast, the spindle‐shaped cells surrounding the islands of the benign DTEs were positive for CD34 in 80% of cases. The results suggest that whereas stromal cells surrounding DTEs resemble the CD34‐positive perifollicular cells, the spindle‐shaped stromal cells surrounding MBCC and MAC are CD34 negative, and may be derived from sources other than the normal mesenchymal tissue surrounding cutaneous appendages.
Cyclin D and retinoblastoma gene product expression in actinic keratosis and cutaneous squamous cell carcinoma in relation to p53 expression
Authors: Bito Toshinori , Ueda Masato , Ahmed Nazim U. , Nagano Tohru , Ichihashi Masamitsu
Published: April 2006

Masato Ueda, Abnormality of the molecules regulating the cell cycle has been shown to lead cells to transformation. Recently, overexpression of cyclin D protein, one of the G1 cyclins, and the abnormality of the retinoblastoma gene have been found in various human cancers. We analyzed the expression of cyclin D, retinoblastoma gene product (pRB) and p53 in actinic keratoses (AKs) and cutaneous squamous cell carcinomas (SCCs) by immunohistochemistry to elucidate the role of these molecules in keratinocyte carcinogenesis. In the normal epidermis, a few cyclin D positive cells were seen mainly at die basal layer. In 11 seborrheic keratoses, no overexpression of cyclin D was observed. Twelve of 26 AKs (4.5%) and 27 of 45 SCCs (60%) showed cyclin D overexpression. A few pRB positive cells were seen in the basal layer and in the supra‐basal spinous layer of the normal epidermis. An abnormality of pRB, loss of expression, was seen in 2 of 26 AKs (8%) and 7 of 45 SCCs (16%). p53 protein was positive in 12 of 26 AKs (46%) and 24 of 45 SCCs (53%). Forty‐five SCCs examined were divided into 22 ultraviolet (UV)‐related SCCs and 23 UV‐unrelated SCCs. Though UV‐related SCCs showed a significantly higher incidence of p53 positivity, as previously reported by us, no significant difference in cyclin D overexpression and loss of the pRB expression was observed between UV‐related and UV‐unrelated SCCs. These results suggest that cyclin D overexpression is frequently involved in keratinocyte carcinogenesis and that this is an early event, as well as p53 abnormality. In addition, abnormality of the retinoblastoma gene is also related to epidermal cell carcinogenesis, though die frequency is relatively low.