bluuebunny/crossref_metadata_2025 huggingface dataset:
Fibrous mastocytoma in a patient with generalized cutaneous mastocytosis
Authors: Wood C. , Sina B. , Webster C. G. , Kurgansky D. , Drachenberg C. B. , Reedy E. A.
Published: April 2006

A 57‐year‐old woman with cutaneous mastocytosis of 23 years duration developed a hyperpigmented abdominal plaque composed of confluent indurated papules that enlarged for a period of 1 year to 12×8 cm. Biopsy showed dermal infiltration by closely packed spindle‐shaped mast cells, fibroblasts, collagen, and scattered lymphocytes, predominately T‐suppressor cells/ Electron microscopy showed close contact between mast cells, fibroblasts, and lymphocytes Piecemeal mast cell degranulation and extrusion of mast cell granules was seen, with rare mast cell granules in fibroblasts, and collagen fibers in peripheral and perinuclear endoplasmic reticulum of mast cells. The term Fibrous mastocytoma is suggested for this tumor‐like dermal fibrosis, possibly induced by lymphokines.
Neurotropic malignant melanoma occurring in a stable burn scar
Authors: Lee Julia Y.‐Y. , Kapadia Silloo B. , Musgrave Ross H. , Futrell William J.
Published: April 2006

Malignant melanoma occurring in burn scars is extremely rare. Nine cases are reported in the literature. We report a case of a small malignant melanoma arising in a stable thermal burn scar after a long latent period of 58 years. The case was unique in that it was of the de novo neurotropic variant. Fascicles of amelanotic, S100 protein‐positive atypical spindle cells with neuroid appearance infiltrated deeply in the scarred dermis and perineural spaces. The pigmentation of the lesion was due to solar lentigo instead of atypical melanocytic proliferation in the overlying epidermis.
Verruciform xanthoma in association with discoid lupus erythematosus
Authors: Meyers Dawn C. , Woosley John T. , Reddick Robert L
Published: April 2006

Verruciform xanthoma (VX) is an uncommon lesion occuring primarily in the oral cavity. Cutaneous lesions are much less common and they preferentially arise on anogenital skin. They are not necessarily associated with a pre‐existing inflammatory process. We report a VX in association with a long‐standing lesion of discoid lupus erythematosus (DLE) on the scalp of a 34‐year‐old black woman. This association, which to our knowledge has not been previously reported, is consistent with the proposed pathogenetic mechanism of entrapment and subsequent degeneration of epithelial cells in the papillary dermis of VX. Histological distinction of VX from squamous cell carcinoma, with which this lesion may be clinically confused, is straightforward.
T‐cell receptor variable region gene expression in cutaneous T‐cell lymphomas
Authors: Gilks C.B. , Ho V.C. , Gascoyne R.D. , Ellison D.J.
Published: April 2006

The cutaneus T‐cell lymphomas (CTCL) arc a group of diseases characterized by malignant proliferations of CD4 positive T‐cells having monoclonally rearranged T‐cell receptor (TCR) genes. A recent study using monoclonal antibodies to two TCR β‐chain variable (V) region gene products showed preferential expression of the Vβ8 gene product in these tumors. The finding of predominant usage of a single Vβ gene would imply that selection by antigen is important in the etiology of these tumors. We have studied eight cases of cutaneous T‐cell lymphoma and one cell line derived from a patient with mycosis fungoides/Sezary syndrome, using an extended panel of antibodies to V region gene products. Contrary to the previous report, in our study expression of the Vβ8 gene product by tumor cells was not observed in any of the cases of CTCL or in the tumor cell line studied; preferential use of any of the variable region genes recognized by the antibodies in the panel was not observed.
Poorly differentiated squamous cell carcinomas of the skin can express vimentin
Authors: Iyer Prema V. , Leong Anthony S.‐Y.
Published: April 2006

Thirty cases of poorly differentiated carcinomas of the skin were examined for the expression of vimentin. All cases expressed cytokeratins; in addition, 12 cases were positive for vimentin. These were all non‐reactive with antibodies to S100 protein, HMB45 and desmin. The finding of vimentin in poorly differentiated squamous cell carcinomas underscores the need for caution in the use of immunohistochemical stains for tumor typing. Cutaneous squamous cell carcinomas are an addition to the list of epithelial tumors which are known to coexpress vimentin intermediate filaments. Other carcinomas which consistently express vimentin include those of renal, endometrial, thyroid, pulmonary, ovarian, salivary gland, adrenal and more recently, those of breast and prostatic orgin.
Histologic and immunofluorescence study of cutaneous porphyrias
Authors: Maynard B. , Peters M. S.
Published: April 2006

We reviewed the histologic and direct immunofluorescence findings in skin biopsy specimens from 24 patients with cutaneous porphyrias. The histopathologic changes were characterized by cell‐poor subepidermal bullae, festooning of dermal papillae, thickening and hyalinization of dermal blood vessel walls, dermal sclerosis, and a mild perivascular infiltration of mono‐nuclear cells in the upper dermis. The characteristic pattern on direct immunofluorescence testing was fluorescence of thickened doughnut‐like blood vessels in the upper dermis, reflecting deposition of immunoglobulins and C3, and deposition of immunoglobulins or C3 or both at the dermal‐epidermal junction in most cases. These findings are characteristic but not specific for the porphyrias; they may also be observed in the pseudoporphyria syndromes and in other clinical settings. However, the immunopathologic findings are distinctive enough to be useful in differentiating the porphyrias and pseudoporphyria syndromes from other subepidermal bullous diseases such as epidermolysis bullosa acquisita and bullous pemphigoid. The most important diagnostic test in the evaluation of the cutaneous porphyrias still is measurement of porphyrins in urine, stool, and blood.
Abnormal expression of epidermal growth factor receptor in cutaneous epithelial tumours
Authors: Groves R.W. , Allen M.H. , MacDonald D.M.
Published: April 2006

Epidermal growth factor (EGF) and transforming growth factor alpha (TGFα) are important keratinocyte mitogens. Their effects are mediated by a cell membrane receptor (EGFR), quantitative and qualitative abnormalities of which may be responsible for deranged keratinocyte proliferation and differentiation. We have therefore examined EGFR expression immunohistochemically in a variety of benign and malignant epithelial neoplasms using monoclonal antibodies to the extracellular and intracellular receptor domains. In benign tumours (virus wart, seborrhoeic keratosis, keratoacanthoma), there was an ordered pattern of EGFR expression. In malignant tumours (basal and squamous cell carcinoma), there was loss of membrane labelling and cytoplasmic accumulation of the receptor. In premalignant proliferations, there was loss of membrane receptor with either absent cytoplasmic EGFR (actinic keratosis) or cytoplasmic receptor accumulation (Bowen's disease). Evidence of truncated receptors was not found. We suggest that dysregulation of the EGFR may be important in the development of cutaneous epithelial malignancies but that grossly abnormal forms of the receptor do not occur.
Keratin expression in normal skin and epidermal neoplasms demonstrated by a panel of monoclonal antibodies
Authors: Perkins W. , Campbell I. , Leigh I. M. , MacKie R. M.
Published: April 2006

The tissue labelling of a panel of monoclonal antikeratin antibodies (LL001, LL002, LL003, LP2K, BA17, LP34, CAM 5.2, and LH1) recognising keratins 1, 5, 8, 10, 14, 18, and 19 were investigated in frozen and formalin‐fixed normal skin. Antibodies LL001, LL003, BA17, LP34, CAM 5.2, and LH1 were found to be reactive in formalin‐fixed material and were used to study 23 basal cell carcinomas, 8 squamous cell carcinomas, 5 keratoacanthomas, 5 Bowen's disease, and 6 clear cell acanthomas. All these tumours demonstrated a loss of keratin 10 expression as demonstrated by loss of labelling with LH1. Keratin 14 expression, as demonstrated by LL001, was reduced but present in all the tumours except squamous cell carcinomas and keratoacanthomas where increased labelling was observed in the more differentiated areas of these tumours. Simple epithelial keratin expression was demonstrated by positive labelling with CAM 5.2 and keratin 19 by BA17 in a third of basal cell carcinomas and squamous cell carcinomas. Three of the five keratoacanthomas labelled with BA17, indicating the presence of keratin 19 in these lesions. These results support the concept that keratin expression is a phenotypic marker of the state of differentiation or malignant transformation and that patterns of keratin expression are not specific to any particular premalignant or malignant disorder.
Distant cutaneous metastasis of pleural malignant mesothelioma
Authors: Dutt P.L. , Baxter J.W. , O'Malley F. P. , Glick A. D. , Page D. L.
Published: April 2006

We report a facial tumor that was proven to be a metastatic: mesothelioma. The diagnosis was not established pre‐mortem. The patient died shortly after the facial biopsy, and an autopsy revealed a large pleural‐based mass which had the gross appearance typical of a mesothelioma. Electron microscopic examination of tissue from the pleural tumor was diagnostic for mesothelioma. The patient had extensive visceral metastatic disease. Inclusion of this entity in the differential diagnosis of certain cutaneous tumors is important, in part because this lesion may be confused with angiosarcoma, particularly when it occurs in the skin of the face or head in older patients.
Beningn lymphangioendothelioma: report of 2 cases
Authors: Mehregan D. R. , Mehregan A. H. , Mehregan D. A.
Published: April 2006

Benign lymphangioendothelioma is an acquired vascular proliferation clinically appearing as well‐demarcated, pink to red‐brown macules or plaques. Histologically, numerous endothelial‐lined channels are found infiltrating throughout the dermis. Recognition and differentiation from malignant vascular tumors is essential. We report 2 cases of benign lymphangioendothelioma. One of these lesions is unique in its presentation as a subcutanous nodule. The Other is also unusual, as it resolved spontaneously.
In vitro acantholysis induced by D‐penicillamine, captopril, and piroxicam on dead de‐epidermized dermis
Authors: De Dobbeleer Gilbert , Godfrine Sylvie , Gourdain Jean‐Marie , De Graef Chantal , Heenen Michel
Published: April 2006

Drug‐induced pemphigus has been recognized for 20 years, hui the mechanisms leading to acantholysis are still unclear. It has recently been demonstrated that penicillamine, captopril, and thiopronin may produce acantholytic lesions, cither by direct toxic or biochemical died, in human skin explains. Our work confirms that penicillamine and captopril may induce acantholysis on the model of keralinocyte culture on dead, de‐epidermized dermis. Moreover, it demonstrates that piroxicam, a new non‐steroidal anti‐inflammatory drug, of which one side effect is a pemphigus vulgaris‐like eruption, is also able to produce in vitro acantholysis.
Epidermal Langerhans cells after allogeneic bone marrow transplantation: depletion by chemotherapy conditioning regimen alone
Authors: Zambruno G. , Girolomoni G. , Manca V. , Andreani M. , Galimberti M. , Lucarelli G. , Giannetti A.
Published: April 2006

Depletion of Langerhans colls (LC) is known lo follow bone marrow transplantation (BMT) and is thought to be mainly related lo prelransplanl radiation and chemotherapy conditioning regimens. We studied sequential biopsies of clinically normal skin of 22 thalasscmic and leukemie palienls undergoing allogeneic BMT who had received only chemotherapy (busulfan and cyclophosphamide) as conditioning regimen. LC were identified immunohistochemically using antibodies against CD1a and HLA‐DR antigens, and their number expressed per square mm of epidermal vertical section, the latter measured by computerized image analysis. Afler the preparatory regimen, the number of LC decreased progressively in both leukemie and thalassemic patients. CD1a+ and HLA‐DR+ epidermal cells were reduced, respectively, to 68.5% and 64.5% of their original number around Day 2, and to 23.1% and to 18.2% around Day 17. By this time, electron microscopic examination of selected biopsies confirmed the depletion of LC. Variable depopulation was observed between Days 40 and 60. Our results indicate that a conditioning regimen based exclusively on high dose chemotherapy depletes epidermal LC early after BMT, and that such depletion is not related to the development of acute graft‐versus‐host disease.
Value of immunohistochemistry in the diagnosis of leukemia cutis: study of 54 cases using paraffin‐section markers
Authors: Ratnam Kavipurapu V. , Daniel Su W. P. , Ziesmer Steven C. , Li Chin‐Yang
Published: April 2006

A grave prognosis is usually associated with leukemic skin infiltrates (leukemia culis). However, some leukemia skin infiltrates are clinically similar to reactive non‐leukemic infiltrates in paetients with leukemia; thus it is of great importance to distinguish them. Fifty‐four cases which were thought clinically to be leukemia cutis underwent immunophenotyping with a panel of nine T, B, monocytic, and macrophagc markers using paraffin sections. Immunohistochemistry helped identify 44 cases with leukemia cutis and 10 with reactive infiltrates. In all cases of leukemia culis, the staining patterns of skin infiltrates were concordant with cell type in the bone marrow. Furthermore, the panel of markers was usually helpful in distinguishing reactive from leukemic infiltrates, especially in cases with chronic lymphatic leukemia. Immunohistochemistry is a valuable adjunct in histopathologic differentiation of skin infiltrates in most cases of leukemia. With formalin‐fixed, paraffin‐embedded biopsies, we recommend that CD45 (LCA), CD45RO (UCHL‐1), CDS, CD20 (L‐26), CD43 (Leu‐22), CD68 (KIM), lysozyme, and chloroacetate estcrase be considered in cases of systemic leukemia with cutaneous papules and nodules that prove difficult to interpret with routine section.
Swollen keratinocytes: a histologic marker of unusual human papillomavirus‐type infection and immunosuppression
Authors: Penneys N. S. , Friend A. , Zhu W.‐Y. , Leonardi C.
Published: April 2006

Cutaneous papillomavirus infection is common in patients who are immunosupprcsscd. We describe swollen keratinocytes in the granular layer in lesions from four patients who had human immunodeficiency virus infection. These cells were similar to those described in skin lesions of epidermodysplasia verruciformis. Amplification of DNA from the lesions revealed an amplimer for human papillomavirus using a consensus primer for a highly conserved region of the LI open reading frame: however, specific binding was not noted when radiolabelled probes for human papillomavirus types 6, 11, 16, 18, and 33 were used. We conclude that the presence of these distinctive swollen cells strongly suggests immunosuppression and quite possibly infection by a less common papillomavirus type.
Cutaneous myelofibrosis
Authors: Hoss Diane M. , McNutt N. Scott
Published: April 2006

Cutaneous extramedullary hematopoiesis is rare, usually occurring in ueonates following intrauterine viral infections, hereditary spherocytosis or the twin transfusion syndrome. Only 20 cases of cutaneous extramedullary hematopoiesis have been reported in adults, all with myelofibrosis. The cutaneous inliltrates may be atypical and difficult to distinguish from leukemia cutis. We have studied a 65‐year‐old woman with myelofibrosis and approximately 40 violaceous, firm, non‐tender cutaneous nodules measuring 1 to 4 cm in diameter, located on her abdomen near a splenectomy scar. Histologically, the lesions had a dense infiltrate of myeloid cells in all stages of maturation, atypical large cells with multilobate nuclei or multiple nuclei, resembling atypical megakaryocytes, and fibroblasts. Although the patient received erythropoietin therapy prior to the development of the nodules, erythroid progenitors were not seen. Reticulin was increased particularly surrounding the atypical megakaryocytes. The myeloid cells stained for chloracetate esterase and with the polyclonal antibody MAC 387. Atypical megakaryocytes stained for Factor Xllla and Factor Vlll‐related antigen. Dendritic Factor XIIla positive cells were also increased. The skin lesions remain unchanged grossly one year after their development.

Hoss DM, McNutt NS. Cutaneous myelofibrosis.
Plate‐like sebaceous hyperplasia overlying dermatofibroma
Authors: Requena Luis , Roó Elia , Yus Evaristo Sánchez
Published: April 2006

Epidermal hyperplasia, sometimes with primitive hair folliclelike differentiation, is a characteristic finding overlying dermatofibroma. We here report plate‐like sebaceous hyperplasia overlying a dermatofibroma. Such changes are interpreted as a result of inductive epithelial died by the dermatofibroma on the overlying epidermis.
Common acquired melanocytic nevi, dysplastic melanocytic nevi and malignant melanomas: an image analysis cytometric study
Authors: Bruijn Jan A. , Berwick Marianne , Mihm Martin C. , Barnhill Raymond L.
Published: April 2006

We used computerized image analysis cytometry in analyze 10 melanocytic lesions from each of the following categories: common acquired nevi, melanocytic nevi with architectural features of dysplasia, dysplastic melanocytic nevi (DMN) with slight atypia, DMN with moderate atypia, DMN with severe atypia, and superficial spreading melanomas. The nuclei of at least 50 consecutive nevomelanocytes in the most atypical zones were digitized at ×1000 under oil immersion, without knowledge of diagnosis by one observer. Grading of atypia was based on current practices as described in the literature. The results showed significant differences (p < 0.05) in nuclear area and standard deviation of nuclear area between melanoma and DMN with severe atypia, and between DMN with severe atypia and all other categories of nevi. There were no differences among any lesions with respect to nuclear shape. No differences in nuclear area were found among DMN with moderate, or slight atypia, nevi with features of dysplasia, and typical nevi. These results show for the first time objective distinction of low‐grade (slight‐moderate atypia), and high‐grade or severe atypia in pre‐malignant nevomelanocytic lesions of the skin.
Immunohistochemistry detects differences between lichen planus‐like keratosis, lichen planus, and lichenoid actinic keratosis
Authors: Prieto Victor G. , Casal Miriam , McNutt N. Scott
Published: April 2006

Lichen planus‐like keratosis (LPLK) (benign lichenoid keratosis) is a common skin lesion that shows some morphologic features of lichen planus (LP) and lichenoid actinic keratosis (LAK). To try to detect differences among these three entities, immunohistochemical staining for S100 protein and HLA‐DR (with the antibody LN3) was performed in 31 cases of LPLK, 26 of LAK, and 25 of LP. Langerhans cells (LC) were counted per linear mm of epidermis in the S100 and LN3 slides. With anti‐S100 staining, LP cases showed higher numbers of LC (mean = 25.3, SE = 2.84, median = 21.2) than did LPLK (mean = 17.3, SE = 2.26, median = 14.5) and LAK (mean = 9.7, SE = 1.5, median = 5.4). With LN3 stains, LP cases also showed higher numbers of LC than did LPLK and LAK. These results suggest that the involvement of LC in the production of lesions may be different in these three entities. However, due to the overlap in distribution of values observed, the use of these stains does not allow a definite diagnosis to be made exclusively based on the number of LC.
Differential expression of factor XIIIa and CD34 in cutaneous mesenchymal tumors
Authors: Altman David A. , Nickoloff Brian J. , Fivenson David P.
Published: April 2006

The histogenetic relationship amongst various dendritic cells of the dermis which may express markers including factor XIIIa (FXIIIa) or CD34 remains unclear. In this study we utilized a sensitive indirect immunoperoxidase staining technique to identify CD34 and FXIIIa, as well the monocyte/macrophage markers KP‐1 and MAC 387 expression in a variety of cutaneous dermal tumors of mesenchymal origin to see if differentia] expression of CD34 vs FXIIIa exists. Tumors studied included dermatofibroma (DF) (N = 10), keloid (N=9), atypical fibroxanthoma (AFX) (N = 3), and dermatofibrosarcoma protuberans (DFSP) (N = 7). DF were all composed of FXIIIa + spindle‐shaped and stellate tumor cells (mean score = 4.9 or ≥ 75% FXIIIa +) as previously reported, but these cells rarely (< 10%) expressed CD34. Six of 7 DFSP were found to be > 75% CD34+ and FXIIIa negative, while one DFSP was negative for both CD34 and FXIIIa. In all DFSP, there were trapped FXIIIa+ cells which were distinct from the spindle‐shaped tumor cells. AFX showed sparse populations of FXIIIa + cells in the stroma (mean score = 1.33 or 10–25% positive), which were distinct from the atypical giant cells characteristic of these tumors. Keloid similarly contained trapped FXIIIa+ cells (mean score = 0.44 or < 5% positive) that were distinct from the spindle‐shaped fibroblasts of the tumor mass. Dendritic and spindle‐shaped cells within these tumors were consistently both KP‐1 and Mac‐387 negative, while all lesions studied were characterized by scattered round, histiocytic cells which were KP‐1 + and/or Mac‐387 + irrespective of tumor cell type. We suggest that these tumors can be delineated by their relative degrees of FXIIIa and CD34 expression and that these neoplasms may be a useful link with which to study the relationship between CD34+ cells and dermal dendrocytes.
Clinicopathological significance of cutaneous epidermal nuclear staining by direct immunofluorescence
Authors: Burrows N. P. , Bhogal B. S. , Jones R. Russell , Black M. M.
Published: April 2006

Epidermal antinuclear antibody (ANA) staining was noted during routine direct immunofluorescence (DIF) of skin biopsies from 22 cases at St John's Dermatology Centre over a 2‐year period. We have reviewed the clinical, serological and immunopathological features of these patients. They comprised 13 cases of lupus erythematosus (LE), 3 dermatomyositis, 1 morphoea, 1 systemic sclerosis, 1 CREST syndrome, 1 mixed connective tissue disorder and 1 probable cutaneous sarcoidosis. Five (38.4%) patients with LE had moderate to severe oral mucosal involvement. Epidermal nuclear staining (ENS) was seen following IgG deposition in 21 cases and IgA in only 1 case. Complement C3 staining was an additional feature in 1 patient. Circulating ANA was absent in 7 cases at the time of biopsy, confirming that this pattern of staining does not occur as a result of tissue con‐lamination during processing. The presence of ENS by IMF corroborates a diagnosis of a connective tissue disorder, and our results suggest that it may also be associated with oral involvement in E.E.
Study of the DNA content of basal and suprabasal keratinocytes in psoriatic patients
Authors: González S. , Díaz F. , Parrado C. , de Vargas I. Pérez
Published: April 2006

We carried out a cytophotometric study of the DNA content of basal and suprabasal keratinocytes using involved and univolved histological sections of epidermis from psoriatic patients using the Feulgen technique. The reference 2C value of the DNA content was obtained from lymphocyte nuclei in a sub‐epidermal infiltrate from normal skin. According to the DNA content profiles obtained for the keratinocytes of psoriatic patients, individuals were classified into three groups: Group 1, composed of individuals with a monomodal diploid profile and preferential keratinocytes with a 2C DNA content and, hence, a low proliferation activity; Group 2, consisting of patients with significantly increased 2C–4C and 4C populations; and Group 3, made up of individuals with high proportions of 4C and hyperdiploid (6C, 8C, and > 8C) keratinocytes. The results obtained in this work and the observed changes in the proliferative activity of the keratinocytes in the three groups of patients led us to suggest that the cytophotometric determination of the DNA content of basal and suprabasal keratinocytes may be useful as a prognostic criterion for the classification of psoriatic patients in terms of the extent of alteration of their proliferative epidermal activity.
Neutrophilic tuberculous panniculitis in a patient with polymyositis
Authors: Langenberg Andria , Egbert Barbara
Published: April 2006

The clinical spectrum of cutaneous M. tuberculosis infections is varied and atypical. Once a major cause of death, with the advent of antimicrobial drugs it had, until recently, been an uncommon consideration in the differential diagnosis of cutaneous disorders. Panniculitis can be caused by a variety of etiologic agents; however, only rarely has it been reported caused by tuberculosis. Herein, we describe a patient with an unusual case of neutrophilic panniculitis caused by M. tuberculosis that arose following corticosteroid therapy for presumptive polymyositis. This case illustrates the need to include mycobacterial infection in the differential diagnosis of panniculitis in immunocompromised patients, and the importance of early detection via microbiologic culture and histopathologic examination.
Alopecia universalis in an HIV–positive patient: possible insight into pathogenesis
Authors: Stewart Margaret I. , Smoller Bruce R.
Published: April 2006

Alopecia universalis, a variant of alopecia areata, is a disease of unknown etiology, though evidence for an autoimmune etiology continues to mount. We report an HIV–positive patient with altered T‐lymphocyte subsets in whom alopecia universalis developed. A skin biopsy of the patient's scalp demonstrated a classic perifollicular lymphocytic infiltrate, and immunophenotyping of the same specimen revealed that the majority of the cells were CD4+ lymphocytes. During the active loss of hair, the patient's CD4/CD8 ratio was decreased. This ratio normalized during the period of regrowth. Our data suggest that systemic immune dysfunction, as seen in HIV infection, may be more important in mediating alopecia areata than localized immune responses. Given the proposed mechanism of alopecia areata developing in this patient, i.e. influx of CD4+ lymphocytes to the perifollicular regions of skin when the CD4/CD8 ratio is low, it is surprising that alopecia areata is not seen more commonly in patients with HIV infection.
Mitotic Langerhans cell as a possible sign of activation in ichthyosis
Authors: Kanerva Lasse , Niemi Kirsti‐Maria
Published: April 2006

The fine structure of Lagerhans cells (LC) in four rare types of ichthyosis, namely recessive ichthyosis congenita type II, III and IV and ichthyosis hystrix Curth‐Macklin was examined. Signs of LC activation were observed in eight of 21 patients. In IC type IV, the rare occurrence of a mitotic LC was observed. It is possible that LCs are secondarily activated in keratinization disorders.
Primary cutaneous CD30‐positive anaplastic large cell lymphoma. Report of 27 cases
Authors: Krishnan Jayashree , Tomaszewski Maria‐Magdalena , Kao Grace F.
Published: April 2006

The clinical, morphological and immunohistochemical features of 27 patients with anaplastic large cell lymphoma (ALCL) of CD30‐positivc type, with cutaneous lesions as the sole initial clinical manifestation, were analyzed. The neoplasm presented as solitary or multiple, usually ulcerated skin lesions, affecting predominantly elderly patients (median age: 67 years) with a male preponderance (male to female ratio of 6:1). In most patients, there was an excellent response to chemotherapy. The cardinal histological features included diffuse dermal and sub‐cutaneous infiltration by large, anaplastic tumor cells, all or nearly all of which showed diffuse, strong membrane staining and frequently a paranuclear, dot‐like reaction with the CD30 marker (Ber‐H2). Epidermal ulceration, pseudo‐epitheliomatous hyperplasia and dermal vascular proliferation were also ob‐served.
DNA ploidy of basal cell carcinoma determined by image cytometry of fresh smears
Authors: Herzberg Arlene J. , Garcia Julian A. , Kerns B. J. , Jordan Patrick A. , Pence Jeffrey C. , Rotter Steven M. , Dzubow Leonard M.
Published: April 2006

Image analysis of nuclear DNA content (DNA ploidy) was performed on smears of basal cell carcinoma (BCC) obtained during Mohs microscopically‐controlled surgery from 51 tumors. DNA ploidy was compared with histologic growth pattern and the contour of the invading edge. There was a statistically significantly increased frequency of DNA aneuploidy in smears from BCC exhibiting partial or total diffuse (infiltrative and superficial multicentric) growth patterns (80%; 32 of 40) as compared to solely circumscribed growth patterns (0%; 0 of 11) (p< 0.001).
Primary cutaneous phaeohyphomycosis: report of seven cases
Authors: Ronan S. G. , Uzoaru I. , Nadimpalli V. , Guitart J. , Manaligod J. R.
Published: April 2006

We report seven cases of primary cutaneous phaeohyphomycosis. There were five males and two females, ranging in age from 42–65 years (mean 57.7 years). Two patients were otherwise healthy, but five were immunocompromised. One patient had rheumatoid arthritis and was on oral prednisone; two were renal transplant recipients, one was a heart transplant recipient, and the fifth had dermatomyositis. No history of trauma was elicited from any of the patients, but in two cases, foreign material was seen in the tissue sections. All lesions were oil the extremities. In two cases, tissues were cultured, and these grew Exophiala jean‐selmei. The others were not cultured because fungal infection was not clinically suspected. No systemic disease developed in any of the cases, and all were cured by the simple, complete excision of the lesions.
Comparison of proliferative activity as assessed by proliferating cell nuclear antigen (PCNA) and Ki‐67 monoclonal antibodies in melanocytic skin lesions
Authors: Rieger Edgar , Hofmann‐Wellnhof Rainer , Soyer H. Peter , Kofler Regina , Cerroni Lorenzo , Smolle Josef , Kerl Helmut
Published: April 2006

Immunostaining with the monoclonal antibodies PCNA and Ki‐67 provides a simple method for the assessment of growth fractions of tumors. Contrary to Ki‐67, PCNA antibody can be applied on aldehyde‐ or alcohol‐fixed and paraffin‐embedded tissues, thus allowing studies on archival material. For 77 melanocytic skin lesions, we compared PCNA immunostaining on formalin‐fixed tissue with Ki‐67 immunostaining on frozen material of the same lesion. 16 benign melanocytic nevi (BMN, from 16 patients), 43 primary malignant melanomas (PMM, 42 patients), and 18 skin mclastases of malignant melanoma (MMM, 12 patients) were included in the study. Maximum nuclear density (NDmax) of PCNA‐ and Ki‐67‐positivc nuclei was assessed using interactive image analysis. NDmax values for both PCNA and Ki‐67 differed significantly between the three diagnostic groups (Kruskal‐Wallis H‐test: p ≪ 0.001). Mean values (given as 1000 nuclei/mm1 tissue) increased considerably from benign lo malignant lesions (PCNA: BMN: 23.8 ± 28.4 [mean ± standard deviation], PMM: 48.1 ± 41.0, MMM: 117.0 ± 64.6; Ki‐67: BMN: 6.4 ± 3.3, PMM 25.0 ± 31.1, MMM: 95.2 ± 47.2). Correlation between NDmax values of PCNA‐ and Ki‐67‐positive nuclei was significant (Linear regression analysis: r = 0.51, p ≪ 0.001). Furthermore, for PMM a significant correlation between histologic parameters related to prognosis (Breslow index and mitotic rate) and PCNA as well as Ki‐67 expression was found (PCNA – Breslow index: r = 0.42, p < 0.01; Ki‐67 – Breslow index: r = 0.60, p ≪ 0.001; PCNA – mitotic rale: r = 0.40, p <.0.01; Ki‐67 – milotic rale: r = 0.50, p < 0.001). Concerning patients' survival, NDmax values of PCNA – and Ki‐67‐posilive nuclei as a single prognostic parameter were not superior to Breslow index. We conclude that PCNA and Ki‐67 expression as assessed by interactive image analysis may be suitable for tumor grading in melanocytic skin lesions. The relevance of these parameters for prognosis remains to be determined by long‐term follow‐up studies.
Carcinosarcoma of the skin: Immunohistochemical and electron microscopic observations
Authors: Izaki S. , Hirai A. , Yoshizawa Y. , Kitamura K. , Inoue T. , Hatoko M. , Itoyama S. , Inazu M.
Published: April 2006

A rapidly growing, hemorrhagic, exophytic tumor on the upper back of a 44‐year‐old male patient was investigated. Histological, immunohistochemical, and electron microscopic studies revealed both basal cell carcinoma‐like and spindle cell sarcoma‐like structures intermingled in the same tumor. Clinical consequences to this patient were mainly dependent on the sarcomatous element.
Molecular detection of Borrelia burgdorferi in formalin‐fixed, paraffin‐embedded lesions of Lyme disease
Authors: Wienecke R. , Neubert U. , Volkenandt M.
Published: April 2006

A system for the detection of a Borrelia burgdorferi (Bb)‐specific gene segment in formalin‐fixed, paraffin‐embedded skin lesions is described. A nested polymerase chain reaction technique is used to selectively amplify in vitro a short segment of a Bb‐specific gene recently described by Rosa et al. (J Infect Dis 1989: 160: 1018). The design of oligonucleotide primers for the amplification of a relatively short gene segment allows the successful analysis of DNA which has been altered by fixation in formalin. Using this technique, Bb‐specific DNA was clearly identified in 8 of 12 specimens of erythema chronicum migrans and in 1 case of lymphadenosis benigua cutis. These skin lesions are known to represent cutaneous manifestations of Lyme disease. Negative control reactions, using DNA from borrelial strains not related to Lyme disease, were negative. The system enables the dermatopathologist to identify Bb in routinely fixed clinical specimens and allows the rapid analysis of various skin diseases for which an association with Bb so far has only been hypothesized.
Expression of platelet‐endothelial cell adhesion molecule‐1 (PECAM‐1) during melanoma‐induced angiogenesis in vivo
Authors: Berger Randy , Albelda Steven M. , Berd David , Ioffreda Michael , Whitaker Diana , Murphy George F.
Published: April 2006

Recent ultrastructural data indicate that tumor‐induced angiogenesis involves polarized outgrowth of endothelial cells from established vessels into tumor parenchyma and interstitium. Efforts to define the cytoarchitecture of the angiogenic response and to ascertain molecular determinants of polarized endothelial migration have been impeded by lack of sensitive and specific immunologic markers for endothelium and vessel wall components. In this study, we utilized monoclonal antibody to platelet‐endothelial cell adhesion molecule‐1 (PECAM‐1), a cell‐cell adhesion molecule belonging to the immunoglobulin superfamily, to determine extent and patterns of angiogenesis in metastatic melanomas before (N = 7) and after (N = 3) induction of tumor‐infiltrating lymphocyte responses provoked by administration of experimental melanoma vaccine. PECAM‐1 proved to be a more reliable marker for angiogenesis than antibodies to von Willebrand Factor. Although both normal and tumor vessels exhibited prominent staining for PECAM‐1, different patterns of endothelial reactivity were observed. Formation of new vessels was associated with i) PECAM‐1 redistribution from a constitutive circumferential membrane pattern to a pattern restricted to cell‐cell junctions; ii) formation of endothelial cords formed by cell‐cell interactions; and iii) eventual development of open lumens. Vessels within inflamed (vaccine‐treated) and non‐inflamed melanomas did not differ with regard to patterns of PECAM‐1 expression. Forming vessels of inflamed melanomas failed to express the cytokine‐inducible activation marker, E‐selectin. Although normal microvessels and reactive vessels of healing wounds demonstrated prominent staining for α6; laminin receptor, vessels within melanomas showed apparently diminished expression. These data establish PECAM‐1 as a sensitive and specific marker for experimental angiogenesis, and further support the possibility that cell‐cell adhesion mediated by PECAM‐1 may contribute to directed endothelial migration typical of tumor‐induced formation of new vessels.
The spectrum of cutaneous disease in leukemias
Authors: Desch Julie K. , Smoller Bruce R.
Published: April 2006

Cutaneous eruptions are frequent complications in the clinical course of patients with leukemia. Leukemia cutis is occasionally the cause of the eruption, but in many cases the lesions are non‐leukemic. We have retrospectively selected all skin biopsies from patients with a computer‐coded diagnosis of leukemia seen in the Stanford University Department of Pathology in the last 7 years, and separated these cases into the broad categories of acute myelogenous leukemia (AML), acute lymphocytic leukemia (ALL), chronic myelogenous leukemia (CML), and chronic lymphocytic leukemia (CLL). We also analyzed separately those cases seen in patients treated with bone marrow transplantation from those treated with standard chemotherapy regimens. We found that leukemia cutis was seen frequently as the cause of lesions in patients with CML and CLL. In contrast, a wide variety of lesions were seen in patients with AML, including a greater number of infectious lesions, drug reactions, vasculitis, and lesions secondary to a hemorrhagic diathesis. In the bone marrow transplantation patients, graft vs host disease was usually the cause of skin lesions in those transplanted for CML and ALL, but again those patients with an underlying diagnosis of AML showed a wide variety of lesions including drug reactions, fungal infections and leukemia cutis. Finally, 6% of cases from patients with AML showed intraepidermal blistering disorders of various types, an association that has not been previously reported.
Incidental acantholysis
Authors: Sánchez Yus Evaristo , Requena Luis , Simón Pilar , de Hijas Carmen Martín
Published: April 2006

The incidental finding of microscopic foci of acantholytic dyskeratosis, reproducing the histological pattern of Darier's disease, has been the subject of a number of papers in the last few years. In contrast, the incidental finding of other types of acantholysis has not been mentioned in the literature. In the last 5 years, we have noticed such a microscopic finding in 14 biopsy specimens (0.15% of our cutaneous specimens). They were from 13 patients (7 men and 6 women); their ages ranged from 37 to 79 years (mean, 63). Three lesions were located on the head, 7 on the trunk, and 4 on the limbs. The histological diagnoses were basal cell carcinoma (6 cases), keratoacanthoma (2 cases), psoriasis (2 cases), elastolytic granuloma, acral arteriovenous angioma, tinea corporis, and leukocytoclastic vasculitis (1 case each). The histological patterns of the acantholytic foci simulated pemphigus vulgaris (9 cases), superficial pemphigus (1 case), Hailey‐Hailey disease (3 cases), and unclassifiable acantholysis (1 case). None of the patients had familial or personal history of acantholytic disorders. We propose a classification of the primary acantholytic disorders based on both their acantholytic pattern and their clinical extent.
p53 immunoreactivity in cutaneous PUVA tumors is similar to that in other non‐melanoma skin neoplasms
Authors: Proby Charlotte M. , du Peloux Menage Hélène , McGregor Jane M. , Hobbs Carl , Norris Paul G. , Smith Neil , Hawk John L. M. , McKee Phillip H.
Published: April 2006

Expression of the p53 tumor suppressor gene product was determined in keratoses and skin cancers associated with psoralen photochemotherapy (PUVA). An immunocytochemical study was employed using CM‐1 (polyclonal) and Do‐1 (monoclonal) antibodies to human wild‐type p53. Thirty‐two cutaneous lesions and 20 perilesional PUVA‐irradiated skin biopsies were examined from 7 patients, all of whom had received more than 200 PUVA treatments and/or a cumulative UVA dose of greater than 1000J/cm2 as treatment for widespread plaque psoriasis. p53 immunoreactivily was seen in 7 of 15 squamous cell carcinomas (46.7%), 5 of 8 dysplastic keratoses (62.5%) and in no basal cell carcinomas or benign keratoses. The overall prevalence of p53 immunoreactivity in 46.2% of malignant or dysplastic PUVA‐associated skin tumors is similar to that previously found by our group in comparable skin tumors from the general population. Most patients with lesions showing positive p53 immunoreactivity had, however, been exposed to additional risk factors before receiving PUVA therapy. p53 gene sequencing of PUVA‐associated non‐melanoma skin cancer (NMSC) may clarify whether p53 mutation contributes to the development of these tumors and whether this relates to PUVA therapy or prior carcinogen exposure.
Immunophenotypic analysis suggests that granuloma faciale is a γ‐interferon‐mediated process
Authors: Smoller Bruce R. , Bortz Jeff
Published: April 2006

Granuloma faciale (GF) is an uncommon inflammatory dermatosis with characteristic clinical and histologic features. Very little is known about its pathogenesis. We used a battery of immunoperoxidase lymphocyte markers to study the population of hematopoetic cells present in a case of GF. The majority of non‐myelocytic hematopoetic cells present were T‐helper lymphocytes, The cells stained strongly with antibodies against the interleukin‐2 receptor and with anti‐lymphocyte functional antigen (LFA 1α) antibodies. Overlying keratinocytes did not stain with ICAM‐1 or HLA‐DR, which may account for the presence of the Grenz zone in granuloma faciale. These findings suggest that a γ‐interferon‐mediated process may play some role in the pathogenesis of this disorder.
Giant cell fibroblastoma with dermatofibrosarcoma protuberans‐like transformation
Authors: Perry Deborah A. , Schultz Loyd R. , Dehner Louis P.
Published: April 2006

A giant cell fibroblasloma (GCF) presented in the subcutis of the breast in a 13‐month‐old girl which recurred 6 years later as a dermal and subcutaneous neoplasm whose patterns were in part GCF and spindle cells with a storiform configuration resembling dermatofibrosarcoma protuberans (DFSP). The issue remains unsettled as to whether GCF is the juvenile variant of DFSP, but an argument about this relationship is supported circumstantially by a case such as ours.
Expression of the human hematopoietic progenitor cell antigen CD34 in vascular and spindle cell tumors
Authors: Cohen Philip R. , Rapini Ronald P. , Farhood Anwar I.
Published: April 2006

The human hematopoietic progenitor cell antigen is known as CD34. This antigen is present on normal bone marrow progenitor cells and vaseular endothelial cells. We used the monoclonal antibody auti‐CD34 and immunoperoxidase staining techniques to evaluate the expression of CD34 in benign and malignant vascular and spindle cell tumors. All of the 42 vascular lesions, except two of three lesions of intravascular papillary endothelial hyperplasia, demonstrated diffuse membraneous staining of moderate lo strong intensity of their endothelial cells. Also, normal placentas (five) showed similar staining. All neurofibromas (12), three of five neuromas, and one of four neurilemmomas revealed moderate to strong, diffuse, membraneous staining. Five of eight piloleiomyomas, two of seven angiolciomyomas, and one of five uterine leiomyomas showed focal to dilluse, and weak to moderate, membraneous staining in the smooth muscle component. Six dermatofibrosarcoma protuberans were studied: generalized, strongly positive membraneous staining was present in four. All specimens showed staining of the normal endothelial cells and the cells surrounding the hair follicles (bulge area), sebaceous glands, and eccrine glands. No staining was demonstrated in any of the following fibrohistiocytic tumors: atypical fibroxanthomas (two), fibrous dermatofibromas (23), giant cell tumor of tendon sheath (one), and hemosiderotic dermatofibromas (18). Melanocytic tumors (Spitz nevi (three) and spindle cell superficial spreading malignant melanoma (one)], Merkel cell carcinomas (six), and spindle cell squamous cell carcinomas (two) did not stain with anti‐CD34. Glomus tumors (two) and a hemangiopericytoma were also negative except for their vascular channels. This study demonstates that reactivity with anti‐CD34 is not limited to normal vascular endothelial cells and their neoplasms.
Cylindroma expresses immunohistochemical markers linking it to eccrine coil
Authors: Penneys Neal S. , Kaiser Mark
Published: April 2006

Nerve growth factor, S‐100 protein, CD44, and CD34 have unique expressions in or surrounding eccrine coil hut are not found in eccrine duct or apoerine gland. We studied 15 cases of cutaneous cylindroma to see if these antigens are found in this neoplasm. All were found in cylindroma to varying degrees. These results link the histogenesis of cylindroma to the eccrine coil. A unique feature of cylindroma is the large number of prominent dendritic cells most likely representing Langerhans cells that permeate the tumor aggregates.
Trichilemmal carcinoma: review of 8 cases
Authors: Reis J. P. , Tellechea O. , Cunha M. F. , Baptista A. Poiares
Published: April 2006

Clinical and hislological data from 8 trichilemmal carcinomas are reviewed. The tumors occurred mainly on sun‐exposed skin of the face of elderly people as small solitary, frequently ulcerated nodules. Histologically, they consisted of multilobulate, infiltrative growths, connected to the epidermis and piloscbaceous structures and showing features reminiscent of the outer root sheath of the hair follicle. The presence of lobules of clear, glycogen‐rich cells with peripheral palisading, hyaline basement membranes, trichilemmal keratinization, and abortive follicular sheaths and the absence of ductal or acinar differentiation allow distinction from other clear cell tumors of the skin. Although the histological picture suggests a high‐grade malignant neoplasm, trichilemmal carcinoma has an indolent course. No recurrence or metastases have been observed.
Further validation of the prognostic model for stage I malignant melanoma based on tumor progression
Authors: Szymik Bonnie , Woosley John T.
Published: April 2006

Prediction of long‐term survival for clinical stage I malignant melanoma and guidance of therapy has long relied upon assessment of tumor thickness. This parameter is a strong, but not infallible predictor of prognosis. Clark et al. have developed a prognostic model based upon the concept of tumor progression and the evaluation of six readily assessable clinical and histologic attributes. They report the most accurate prediction of long‐term survival of any prognostic method available for melanoma (100% accurate for radial‐growth‐phase and 84.1% accurate for vertical‐growth‐phase melanomas). This model was developed and validated via study of a patient population which largely resided in the northeastern portion of the United States. We report additional validation of this model using a data base of 55 patients from a different geographic location (North Carolina) and have observed virtual identity in the accuracy of predicting 8‐year survival for radial‐growth‐phase (100%) and vertical‐growth‐phase (85.1%) melanomas. Twenty per cent of these cases were randomly selected and subjected to re‐evaluation for prognosis with extremely good precision obtained in the prognostic prediction.