bluuebunny/crossref_metadata_2025 huggingface dataset:
Repeated exposures to cobalt or chromate on the hands of patients with hand eczema and contact allergy to that metal
Authors: Nielsen N. H. , Kristiansen J. , Borg L. , Christensen J. M. , Poulsen L. K. , Menné T.
Published: March 2003

The present study aimed at evaluating the effects of daily repeated exposures to low cobalt or chromate concentrations on the hands of patients with hand eczema and cobalt or chromate allergy. For 2 weeks, the patients immersed a finger for 10 min daily into the appropriate metal salt solution in water. During the 1st week, this was a 10 or 50 mg/l cobalt concentration or a 10 mg/l chromate concentration, and, during the 2nd week, a 100 or 200 mg/l cobalt concentration or a 100 mg/l chromate concentration. This regimen elicited a flare of hand eczema only in the chromate‐exposed chromate‐sensitive patients. During the exposure period, accumulation of cobalt or chromate in the nail was demonstrated. Standardization of chemical methods of quantification of skin exposure to allergens, combined with experimental exposure studies in patients with specific contact allergy, will increase the possibility of providing evidence‐based medicine in the area of allergic contact dermatitis in the future.
An overview of the efficacy of topical corticosteroids in experimental human nickel contact dermatitis
Authors: Levin Cheryl , Maibach Howard I.
Published: March 2003

We review controlled trials of corticosteroid effect in experimentally elicited acute nickel contact dermatitis in man, in the hope of clarifying optimal efficacy for clinical use. To maximize discrimination and objectivity, we focus on data with 1 well‐characterized allergen, nickel, in studies utilizing bioengineering documentation. Higher potency corticosteroids are effective (unlike in experimental irritant contact dermatitis), but optimum schedules still require definition.
Exposure to metallic gold in patients with contact allergy to gold sodium thiosulfate
Authors: Ahnlide Ingela , Björkner Bert , Bruze Magnus , Möller Halvor
Published: March 2003

Gold allergy is common, with approximately 10% of patients patch tested because of eczematous disease being positive to gold sodium thiosulfate (GSTS). However, clinical relevance seems to be rare. The aim of this prospective double‐blind study was to demonstrate the effects of exposure to metallic gold, in this case earrings, in gold‐positive patients. 60 female patients with pierced earlobes test‐positive to GSTS were included in the study. The patients were randomized into 2 groups, 30 patients receiving earrings with a surface layer consisting of 24‐carat gold and 30 patients earrings with a surface layer of titanium nitride, virtually indistinguishable from gold. The patients wore the earrings for 8 weeks. During the study, any dermatitis on the earlobes, as well as on other body sites, was registered. The skin reactions observed were weak but, in total, 17 of the 60 patients had a skin reaction (local or remote) during the study, 12 of whom had received gold earrings and 5 titanium (p<0.05). 11 patients had a reaction on the earlobes, 7 of whom had received gold earrings and 4 titanium (NS). With these facts it is hard to exclude that exposure to gold jewelry can be clinically relevant in persons hypersensitive to gold.
Occupational contact dermatitis has an appreciable impact on quality of life
Authors: Hutchings Clare V. , Shum Kid Wan , Gawkrodger David J.
Published: March 2003

In this study, we examined the impact of occupational contact dermatitis on quality of life. 181 patients, diagnosed with occupational contact dermatitis over a period of 3 years (1996–1999 inclusive), were sent a questionnaire based on the Dermatology Life Quality Index (DLQI) and the Short Form‐36 (SF‐36). 60 (32%) patients were in industrial occupations and 27 (14%) in health care. An overall response rate of 39% (n=70) was obtained. The median DLQI score was 5, with a mean score 6.6 (SD 6.4), which is similar to that seen in Behçet’s syndrome and urticaria. There was no statistically‐significant difference between male and female median scores (p=0.98) and no significant correlation between age and DLQI score nor between DLQI score and time from diagnosis. The most problematic quality of life areas were symptoms and feelings. Males scored highest in problems associated with work, relationships and treatment, whereas females scored highest in problems associated with symptoms and feelings, daily activities and leisure. The SF‐36 scores showed an association between physical problems and emotional problems affecting work. From this study, it can be seen that occupational contact dermatitis has an appreciable impact on quality of life.
Diluted Compositae mix versus sesquiterpene lactone mix as a screening agent for Compositae dermatitis: a multicentre study
Authors: Bong J. L. , English J. S. C. , Wilkinson S. M.
Published: March 2003

The objective of this study was to compare diluted Compositae mix with sesquiterpene lactone mix as a marker for Compositae dermatitis. Patients undergoing diagnostic patch testing in 8 British Isles patch test centres were also patch tested to sesquiterpene lactone mix (0.1% pet.) and Compositae mix (3% pet. or 0.6% pet.). Of a total of 5574 patients tested, 71 (1.3%) reacted to Compositae mix, 57 (1.0%) reacted to sesquiterpene lactone mix, and 45 to both. Diluted Compositae mix remained a more sensitive screening marker for Compositae allergy. We recommend that patients are patch tested to both agents.
An 8‐year experience with routine SL mix patch testing supplemented with Compositae mix in Denmark
Authors: Paulsen E. , Andersen K. E. , Hausen B. M.
Published: March 2003

Routine patch testing with sesquiterpene lactone (SL) mix, supplemented with Compositae mix (CM) and other Compositae extracts and allergens where appropriate, was evaluated over an 8‐year period. 190 of 4386 patients tested (4.3%) were Compositae‐sensitive, 143 females (mean age 51.5 years) and 47 males (mean age 55 years), and 83% of reactions considered clinically relevant. 22% were suspected of occupational sensitization/dermatitis. 62% had a contact allergy to 2 or more compounds, most often to nickel, fragrance and colophonium. SL mix detected 65%, CM 87% of Compositae‐allergic patients, and the overall detection rate with both mixes was 93%. Few irritant reactions and no cases of clear‐cut active sensitization were recorded with the mixes, but our results emphasize the importance of differentiating late‐appearing reactivation reactions from patch test sensitization. The weakly positive CM reactions could reflect some irritancy, but as they were associated with fragrance and/or colophonium allergy to a higher degree than weakly positive SL mix reactions, they probably represented cross‐reactions. In conclusion, the detection rate with SL mix was high enough to support its continued use as a screening mix and it was very well and rather safely supplemented by aimed testing with CM.
Investigation of the threshold for allergic reactivity to chromium
Authors: Basketter David , Horev Liran , Slodovnik Dany , Merimes Sharon , Trattner Akiva , Ingber Arieh
Published: March 2003

Allergy to chromium is relatively common, often in association with exposure to cement or in leather manufacture. However, in certain locations, there appears to be a relatively large cohort of chromium‐sensitive individuals whose allergy cannot be explained by these common sources. In particular, this group include Israeli housewives with persistent hand eczema and concomitant patch test positivity to chromium. The causation of their allergy has been linked with relatively high levels of chromium contamination in household products. To provide further information in respect of the definition of safe levels for such products, we examined 17 chromium‐allergic individuals to determine their threshold for reaction under closed patch test and repeated open application test (ROAT) conditions. The data derived indicated that, on normal skin, the patch test threshold was 10 ppm chromium; in the presence of an irritant (sodium lauryl sulfate) the threshold was closer to 1 ppm, 2/17 subjects giving 1+ reactions at this concentration. In the more realistic exposure conditions of the ROAT, 8/14 individuals failed to react to 50 ppm, whilst 3/15 reacted to 5 ppm. Interestingly, there was very poor correlation between patch test sensitivity and ROAT sensitivity. To ensure the large majority of chromium‐allergic individuals do not suffer elicitation of their allergy, as well as to limit the development of new chromium‐sensitive subjects, it is recommended that household products adhere to a previously published standard of a maximum limit of 5 ppm, with an ultimate target of 1 ppm contamination by chromium.
Allergic contact dermatitis from 3‐iodo‐2‐propynyl‐butylcarbamate (IPBC) – an update
Authors: Bryld Lars Erik , Agner Tove , Menné Torkil
Published: March 2003

Results from 3 1/2 years of routine patch testing with 3‐iodo‐2‐propynyl‐butylcarbamate (IPBC) are presented. From 1996 to 1999, a total of 3168 persons (2093 women and 1075 men) were patch tested with IPBC, and 7 cases were found to be positive. In 2 cases, sensitization could be attributed to cosmetics, and in a further 2 cases cosmetics were the most likely cause of sensitisation. It is concluded that the use of IPBC in cosmetic products can lead to contact sensitization and allergic contact dermatitis. 2 of the 7 reported cases with IPBC allergy were also found positive to thiuram, and possible cross‐reactivity between IPBC and thiuram is discussed.
Prevention of work‐related skin problems in student auxiliary nurses
Authors: Held Elisabeth , Wolff Christine , Gyntelberg Finn , Agner Tove
Published: March 2003

The present study was designed as an intervention study to investigate whether an educational programme was efficient in preventing work‐related skin problems on the hands. 107 student auxiliary nurses (61 in the intervention group and 46 in the control group) were followed during the first 10 weeks of their initial practical training in county hospitals. The intervention group was given an educational programme before the practical training started. For evaluation the participants had questionnaires, clinical examination of the hands, measurement of transepidermal water loss (TEWL) and patch testing. The use of hand disinfectants, which was discouraged in the educational programme, was significantly lower in the intervention group as compared to the control group (p=0.002). 48% of the intervention group and 58% of the control group had aggravation of skin problems during practical training (p>0.05). Use of hand disinfectant agents was significantly associated with aggravation of skin problems (p=0.016). A significant increase in TEWL for the control group (p<0.005), but not for the intervention group, was seen after 10 weeks of practical training. In conclusion, the present intervention study shows promising results from the use of an educational programme.
Preservation of products with MCI/MI in Switzerland
Authors: Reinhard E. , Waeber R. , Niederer M. , Maurer T. , Maly P. , Scherer S.
Published: March 2003

Preservation of products with the combination of 5‐chloro‐2‐methyl‐4‐isothiazolinone (methylchloroisothiazolinone, MCI) and 2‐methyl‐4‐isothiazolinone (methylisothiazolinone, MI), commercialized as Kathon CG or WT, is widely used. Allergic contact dermatitis reactions to the preservative have been described in many publications of epidemiological studies. In addition, a number of allergic, airborne reactions to MCI/MI were observed in recent years. The aim of the presented study was: (i) to compare epidemiological data of MCI/MI with data of other preservatives; (ii) to estimate the possible exposure to MCI/MI from commercial products and the distribution of MCI/MI in chemical products based on a product evaluation of the chemical product register of the Swiss Federal Office of Public Health; (iii) to estimate the exposure to MCI/MI, volatile organic chemicals (VOC) and glycols from freshly painted walls; (iv) to compare the contact allergenic potential of MCI/MI with other preservatives. It was found that the number of registered chemical products, unambiguously identifiable as containing MCI increased from 3644 products in July 1999 to 4843 products in April 2001 in Switzerland. It is estimated that today, the total number of chemical products preserved with MCI/MI on the Swiss market is about 6000. A further increase is to be expected. The contact allergenic potential of MCI/MI seems to be higher than for other preservatives. Measurements of MCI/MI concentrations in air samples of freshly painted rooms have shown that the concentration of MCI/MI in the air a few days after painting may be high enough to elicit airborne reactions in already‐sensitized patients. In a single case, reactions to MCI/MI were observed over months after wall painting. In this case, both wall paint and plaster contained MCI (40 and 46 ppm). Volatile organic chemicals (VOC) may also be relevant for the elicitation of airborne reactions. In 1/3 of the measurements, the VOC concentrations measured within 14 days after painting were in a range within which sensory irritation and discomfort may be induced. Declaration of MCI/MI‐containing products, replacement of MCI/MI by alternative preservatives or the separate use of preservatives in industrial products and in cosmetics might reduce the risk of airborne reactions.
Evaluation of biophysical and clinical parameters of skin barrier function among hospital workers
Authors: Hachem Jean Pierre , De Paepe Kristien , Sterckx Guy , Kaufman Leonard , Rogiers Vera , Roseeuw Diane
Published: March 2003

The goal of this study was to evaluate biophysically and clinically the hand skin of nurses working in the operating room in comparison with the hand skin of a control group of female administrative employees. 19 nurses and 14 employees were included in this trial. Transepidermal water loss (TEWL) and stratum corneum (SC) hydration were evaluated on 4 different test sites − dominant and non‐dominant pulse, and dominant and non‐dominant hand dorsum. The clinical score Dermatology Life Quality Index (DLQI) and subjective evaluation of skin sensitivity were also recorded. In comparison with the control group, TEWL values among nurses were significantly higher on all test sites, while SC hydration was significantly lower on 3 of the 4 test sites. In addition, clinical score showed the presence of irritant contact dermatitis (ICD). DLQI reported a higher level of disability among the nurses group, while the subjective evaluation of skin sensitivity was identical in both groups. The results suggest the presence of skin barrier alterations and clinical signs of chronic ICD on the hands of nurses working in operating room units.
Multicentre study of fragrance allergy in Hungary
Authors: Temesvári Erzsébet , Németh Ilona , Baló‐Banga Mátyás J. , Husz Sándor , Kohánka Valéria , Somos Zsuzsa , Judák Rita , Remenyik É. V. A. , Szegedi Andrea , Nebenführer László , Mészáros Csilla , Horváth Attila
Published: March 2003

The authors followed the frequency of fragrance contact sensitization in Hungary in a multicentre study in the years 1998 and 1999. A total of 3604 patients were tested with fragrance mix (FM), and positive reactions were observed in 294 (8.2%). In 160 FM hypersensitive patients, the study was continued with patch testing of the mix constituents (cinnamic alcohol, cinnamic aldehyde, eugenol, amyl cinnamic aldehyde, hydroxycitronellal, geraniol, isoeugenol, oak moss absolute). Of the patients tested, 70.6% produced positive reactions to the constituents. FM contact sensitization was mainly observed in female patients (74.4%). The incidence of contact urticaria in FM hypersensitive patients was 6.1%. Simultaneous patch test trials of other environmental contact allergens, in both early and late evaluations, mainly confirmed hypersensitivity reactions to balsams. Female dominance of hypersensitivity reactions observed during testing the individual components of the mix was striking (82.4%). In positive skin reactions, cinnamic alcohol, isoeugenol and oak moss provoked skin symptoms most frequently. We also tested the 104 patients who produced negative reactions to FM with the constituent individual allergens, with 11.9% positive incidence. The clinical symptoms of the patients were above all manifest in the form of contact eczema, located on the hands, face, eyelids and axillae. With this study, the authors, members of the Hungarian Contact Dermatitis Research Group, call attention to one of the most frequent allergens in the environment.
Combined effects of irritants and allergens
Authors: Agner Tove , Johansen Jeanne Duus , Overgaard Lene , Vølund Aage , Basketter David , Menné Torkil
Published: March 2003

Knowledge of the combined effects of irritants and allergens is of interest with respect to accurate risk assessment. The threshold for elicitation of allergic contact dermatitis in previously sensitized individuals may theoretically be markedly influenced by the simultaneous presence of irritants and allergens. Combined exposures have, however, only been studied infrequently. In the present study, the combined effect of an irritant and an allergen was evaluated in a dose–response designed experimental study. 20 nickel‐sensitized subjects were exposed to patch testing with varying concentrations of NiCl2 (nickel chloride) and sodium lauryl sulfate (SLS) alone and in combination. Evaluation of skin reactions was performed by colorimetry, measurement of transepidermal water loss and clinical evaluation, and the data were analyzed by logistic dose–response models. A synergistic effect was found of combined exposure to NiCl2 and SLS, as compared to each of the substances applied separately, as evaluated by colorimetry and clinical scoring. This means that the effect produced by the combined exposure was substantially greater than the effect produced by either of the substances alone. A synergistic effect of combined exposure on skin barrier impairment was not found, since the barrier function is significantly influenced by SLS‐exposure only and not by NiCl2. Concentration limits are used by industry and government agencies to protect consumers. The present results clearly illustrate that elicitation thresholds and concentration limits may be influenced considerably by combined exposure to allergens and irritants.
Dental gold alloys and contact allergy
Authors: Möller Halvor
Published: March 2003

Contact allergy to gold as demonstrated by patch testing is very common among patients with eczematous disease and seems to be even more frequent among patients with complaints from the oral cavity. There is a positive correlation between gold allergy and the presence of dental gold. Gold allergy is often found in patients with non‐specific stomatitides as well as in those with lichenoid reactions or with only subjective symptoms from the oral cavity. The therapeutic effect of substituting other dental materials for gold alloys is conspicuous in casuistic reports but less impressive in larger patient materials. The amount of dental gold is correlated qualitatively and quantitatively to the blood level of gold and the effects if any of circulating blood gold are unknown. There is clearly a need for prospective studies in the field and gold sodium thiosulfate is considered an important item in the dental series for patch testing.
Topical immunotherapy with contact sensitizers: a model to study the natural history of delayed hypersensitivity
Authors: Mastrolonardo M. , Lopalco P. L. , Diaferio A.
Published: March 2003

So‐called ‘topical immunotherapy’ (TI) is a well‐established treatment modality based on the use of potent contact sensitizers, such as squaric acid dibutylester (SADBE), that are not found in the general or occupational environment of man, and do not induce cross‐sensitization to other substances. Thus, unlike patients with sensitivity to other more or less commonplace allergens, subjects submitted to this treatment modality might provide useful data for the study of the natural course of contact sensitivity. On the basis of these premises, we have retrospectively reviewed 40 patients who had consecutively received TI with SADBE for severe alopecia areata and viral warts in the period 1993–2001, and returned to visit after a 1–7‐year period since the last therapeutic challenge with the sensitizer. The chronological profile of loss of contact sensitization of this case cohort has been evaluated and compared to that of other series available in the literature. Provided more standardized TI application procedures are established, aim‐oriented studies of the outcome of this treatment modality may bring useful data to be employed in construction of predictive models of decay of contact sensitization under conditions of antigen avoidance.
Ethnicity as a possible endogenous factor in irritant contact dermatitis: comparing the irritant response among Caucasians, blacks, and Asians
Authors: Modjtahedi S. P. , Maibach H. I.
Published: March 2003

Irritant contact dermatitis (ICD) is a common dermatological diagnosis in which endogenous and exogenous factors have been implicated. This review explores ethnicity as a possible endogenous factor. While there is a clinical consensus that blacks are less reactive and Asians are more reactive than Caucasians, the data supporting this hypothesis rarely reaches statistical significance. The studies reviewed do not provide sufficient evidence to determine that race is a predisposing factor to the degree of irritation in ICD. We conclude that race could be a factor in ICD, which has practical consequences regarding topical product testing requirements, an ever‐expanding global market, occupational risk assessment, and the clinical thinking about ICD. Pitfalls in defining differences are discussed.
Evaluation of metal allergies in patients with coronary stents
Authors: Hillen U. , Haude M. , Erbel R. , Goos M.
Published: March 2003

In‐stent restenosis is a complication which impairs the success of coronary stenting. Recently, it was supposed that a delayed hypersensitivity reaction to nickel and molybdenum might be one of the triggering factors in in‐stent restenosis. We have analyzed the data collected in our centre with respect to this hypothesis. Altogether, 34 patients were investigated (24 male, 10 female). Patch tests were performed with the standard series of the German Contact Dermatitis Research Group and a metal series containing the metal components of 316 L stainless steel. A positive patch test reaction to nickel was observed in 4 (11.8%) patients. None of the patients showed sensitization to the other metals. Retrospective analysis was performed in 20 patients: 2 of these patients had a positive patch test reaction to nickel, one of whom had an in‐stent restenosis, and the other not. Restenoses were predominantly observed in patients with negative patch test reactions to nickel (6/18 patients). Out of the patients who were investigated prospectively only one showed sensitization to nickel. Restenosis was observed in 2 patients: neither patient had nickel allergy. Although it still cannot be excluded that metal allergy may play a role in the restenosis process in coronary stenting, there is at present little evidence for it.
Temporomandibular joint sound evaluation with an electronic device and clinical evaluation
Authors: Tanzilli R. A. , Tallents R. H. , Katzberg R. W. , Kyrkanides S. , Moss M. E.
Published: March 2003

Sound analysis to diagnose internal derangement has received much attention as an alternative to radiographic examination. The purpose of this study was to compare findings with an electronic device (sonography) and clinical examination to magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ).   Twenty‐three symptomatic patients (46 joints) were evaluated for this study. All patients had jaw joint pain and one or more of the following findings; limitation of jaw opening, painful mandibular movement with or without clicking or crepitation. The presence or absence of joint sounds was evaluated clinically by palpation and auscultation and with sonography. If sounds were present (clicking or crepitation) on either examination the patient was considered positive for disc displacement for that examination.   Two by two tables were constructed comparing sonography and clinical examination with MRI findings. The sensitivity of the sonogram was 84% and the specificity was 33% when compared with MRI findings. The sensitivity of the clinical examination was 70% and the specificity was 40% when compared with MRI findings.   This study suggests that clinical and sonographic examination has a high sensitivity (low false negative examinations) but low specificity (high false positive examinations).
The nature of human craniofacial growth studied with finite element analytical approach
Authors: Takeshita Satoshi , Sasaki Akiko , Tanne Kazuo , Publico Andre S. , Moss Melvin L.
Published: March 2003

The purpose of this study was to elucidate the nature of human craniofacial growth by means of finite element method (FEM), and to compare the results with the current concept derived from morphometric studies with roentgenographic cephalometry (RCM). Lateral cephalograms were taken of 20 males and 20 females, and traced on acetate paper. On the tracing, the craniofacial complex was divided into seven areas or elements. Growth analysis was executed with FEM for changes in the size and shape of each area during six developmental periods from 4 to 18 years old. The size change in the male group exhibited a peak from 10 to 12 years old for the cranial base and upper facial skeleton, from 8 to 10 years old for the maxillary complex, and from 12 to 14 years old for the mandible. On the other hand, in the females, the size change was almost invariable from 4 to 12 years old and completed suddenly at 12 years old, which was earlier by a few years than in the males. An interesting finding is that changes in the size and shape were the most substantial in the maxillary complex, followed by those in the mandible, and the smallest in the cranial base and upper facial skeleton. It is shown that growth of the cranial base lasted up to 14 years old and the maxillary complex exhibited the greatest growth changes in the size among various anatomic structures. These findings may provide a new concept of human craniofacial growth, somewhat different from the previously established principles by RCM.
Cutaneous collagenous vasculopathy with generalized telangiectasia: an immunohistochemical and ultrastructural study
Authors: Salama Samih , Rosenthal Donald
Published: March 2003

We report a 54‐year‐old male, with a 5‐year history of spreading asymptomatic generalized cutaneous telangiectases. The patient had no mucosal or nail involvement, no positive family history and no clinical evidence of systemic disease or bleeding diathesis. Histologically, the superficial small dermal blood vessels were dilated and showed thickened walls with hyaline perivascular material, staining as collagen. The vessel walls were PAS and colloidal iron stain positive, and immuno‐histochemically lacked actin staining. Collagen IV, fibronectin and laminin antibodies showed the material deposited around the basement membrane zone. Ultrastructurally, the vessels were post‐capillary venules (PCV) and showed marked collagen deposition around the basal lamina. There were many abnormally banded widely spaced fibres with 100–150 nm periodicity (Luse bodies), in addition to regular banded collagen. Pericytes were sparse and lacked intracytoplasmic filaments, and few veil or fibroblastic cells were seen embedded within the collagen. We believe this is a form of cutaneous microangiopathy not previously described, with distinct morphology and unique ultrastructural features. It may be due to a genetic defect with erroneous production of disorganized collagen in the cutaneous microvasculature. Dermatologists and Dermatopathologists should be aware of this unusual cutaneous vasculopathy. *
Analysis of thyroid transcription factor‐1 and cytokeratin 20 separates merkel cell carcinoma from small cell carcinoma of lung
Authors: Hanly Andrew J. , Elgart George W. , Jorda Merce , Smith Jon , Nadji Mehrdad
Published: March 2003

Merkel cell carcinoma needs to be separated from small cell carcinoma metastatic from visceral sites to skin. Pulmonary small cell carcinoma is the most common primary site of small cell carcinoma. We evaluated the immunophenotypic characteristics of 21 Merkel cell carcinomas and 33 small cell carcinomas of lung using thyroid transcription factor‐1 and cytokeratin 20. Thyroid transcription factor‐1 was 100% specific for the diagnosis of small cell carcinoma of lung associated with a diagnostic sensitivity of 85%. Cytokeratin 20 was present in 95% of Merkel cell carcinomas; however, 33% of small cell carcinoma of lung were also positive. Both antibodies typically demonstrate diffuse and intense staining of their respective tumor cells. We conclude that thyroid transcription factor‐1 is a sensitive and specific marker for small cell carcinomas of lung and that a combination of thyroid transcription factor‐1 and cytokeratin 20 is indicated to assist in the differentiation of metastatic small cell carcinoma of lung from merkel cell carcinoma.
Giant‐sized condyloma of the breast with focal acantholytic changes
Authors: Googe Paul B. , Chung Sung J. , Simmons John , King Roy
Published: March 2003

Background/Aims:

A healthy 26‐year‐old pregnant woman presented with a 6.0‐cm exophytic mass in her left inframammary fold. The lesion was surgically excised.

Methods: Histopathologic sections of the skin lesion were reviewed in hematoxylin and eosin‐stained slides. Additional sections were studied by an in situ hybridization method for human papillomavirus DNA (HPV) types 6 and 11.

Results: The histopathologic examination demonstrated a benign exophytic, verrucous and papillary epidermal proliferation with features of condyloma acuminatum. Reactivity to HPV DNA types 6 and 11 was demonstrated by in situ hybridization method. The epidermis adjacent to, and focally within, the neoplasm showed multiple areas of suprabasilar and intraepidermal acantholysis without dyskeratosis.

Conclusions: Condylomas related to HPV 6 and 11 may be found in extragenital locations including conjunctiva, oral and nasal mucosa. To our knowledge, however, the extragenital condylomas described in the literature have not included the giant‐sized variant. We describe an example of a benign, giant‐sized condyloma acuminatum of the breast with nearby acantholytic alterations similar to Hailey‐Hailey disease.
Solitary fibrous tumors are immunophenotypically distinct from mesothelioma(s)
Authors: Morgan Michael B. , Smoller Bruce R.
Published: March 2003

Introduction:

Solitary fibrous tumor is a soft tissue tissue tumor of unknown histogenesis. Based upon histologic similarities and CD‐34 expression, it has been suggested that these neoplasms bear some relationship to mesothelioma, and may represent its extra‐pleural equivalent.

Methods: In order to further investigate this possible relationship, we examined a series of five dermal and five extra‐cutaneous solitary fibrous tumors with antibodies directed against the mesothelial markers calretinin and HBME‐1.

Results: All the lesions failed to stain with the antibodies tested. This suggests that despite some similar histologic and immunophenotypic features, these lesions are not immunophenotypically identical. Mesotheliomas are CD‐34(+), calretinin(+), HBME‐1(+), while solitary fibrous tumors are CD‐34(+), calretinin(−), HBME‐1(−).

Conclusions: The histogenesis of solitary fibrous tumor remains elusive. It is unlikely that tumor location or tumor de‐differentiation accounts for the dichotomous staining properties, as these neoplasms show a similarly benign histologic appearance regardless of location.
Quantitation of human herpes virus 8 DNA in paraffin‐embedded biopsies of HIV‐associated and classical Kaposi’s sarcoma by PCR
Authors: Bezold Guntram , Messer Gerald , Peter Ralf Uwe , Flaig Michael J. , Sander Christian A.
Published: March 2003

Background: Kaposi’s sarcoma occurs in patients seropositive and seronegative for the human immunodeficiency virus (HIV) and has been associated with human herpes virus 8 (HHV8). The purpose of this study was to determine and to compare the amount of HHV8 DNA in formalin‐fixed tissue sections of Kaposi’s sarcoma.

Methods: From 27 biopsies of Kaposi’s sarcoma patients, tissue sections were taken and deparaffinized. Four patients were HIV seronegative and 13 were HIV seropositive. After extraction of DNA copy numbers of HHV8 and β‐globin were determined in every sample by quantitative PCR ELISA using an internal quantitation standard. Results were expressed as HHV8 per β‐globin.

Results: No significant differences were found between biopsies from HIV‐positive and HIV‐negative patients (14.8±19.6 HHV8 per 1000 β‐globin in HIV‐positive versus 18.0±23.5 in HIV‐negative patients).

Conclusions: These data suggest that HHV8 viral load in Kaposi’s sarcoma is relatively low and does not differ in HIV‐positive and HIV‐negative samples. The importance of viral load determination for prognosis or treatment monitoring remains to be elucidated.
Quantitative histopathologic findings of erythromelanosis follicularis faciei et colli
Authors: Kim Min Gi , Hong Seok Jin , Son Sook Ja , Song Hae‐Jun , Kim Il Hwan , Oh Chil Hwan , Moon Jong Sub
Published: March 2003

Background: Even though only 33 cases of Erythromelanosis follicularis faciei et colli (EFFC) have been reported around the world, there have been no quantitative clinicopathological studies yet.The purpose of this study is to examine quantitatively clinical and histopathological evaluations of EFFC using image analysis system.

Method: Clinical grading of its severity was assessed. Many parameters of the horny layer, granular layer, epidermis and the dermal components were measured and compared to controls by image analysis. The correlation between the histological findings and clinical grading was assessed.

Result: Thickness and compactness of the horny layer was significantly increased in EFFC. There were no significant differences in the number of melanocytes and severity of pigmentation between EFFC and controls; however, melanization was slightly increased in EFFC. The percent area of the superficial blood vessels was significantly increased and correlated with visual grading of erythema. Diameters of hair shafts and outer root sheaths, and thickness of inner root sheaths were decreased. Basal layer pigmentation was correlated with the clinical features of pigmentation.

Conclusion: This study supported the findings of hyperkeratosis and dilatation of superficial dermal blood vessels in EFFC. The pigmentation of the basal layer and the percent area of the inner spaces of the superficial dermal blood vessels may reflect the clinical severity more than the other parameters. Although follicular plugging is a characteristic clinical feature of EFFC, enlargement of hair follicles and hair shafts were not characteristic pathologic changes EFFC in our study.
Follicular mycosis fungoides: a case report and review of the literature
Authors: DeBloom James , Severson Jessica , Gaspari Anthony , Scott Glynis
Published: March 2003

Background:Follicular mycosis fungoides is an unusual variant of mycosis fungoides (MF). Unlike classic MF where atypical lymphocytes show a predilection for the epidermis (epidermotropism), follicular MF displays a malignant lymphocytic infiltrate tropic for hair follicles (folliculotropism). This malignant lymphocytic infiltrate results in follicular disruption typically manifesting clinically as plaques, comedones and follicular papules.

Methods:This report describes a 40‐year‐old patient with follicular MF presenting as nodules on the face and chest. Histologic examination of the patient’s biopsy revealed a folliculocentric infiltrate of atypical lymphocytes with sparing of the epidermis.

Results and Conclusions:Our case is discussed in the context of previously reported cases of follicular MF; we also include a review of all cases of follicular MF published to date that meet the strict criterion for this diagnosis.
Subcutaneous malignant epithelioid schwannoma with cartilaginous differentiation
Authors: Yamamoto Tetsuji , Minami Rieko , Ohbayashi Chiho
Published: March 2003

Background: Malignant epithelioid schwannoma is a rare tumor. The aim of this study is to describe a case of subcutaneous malignant epithelioid schwannoma with cartilaginous differentiation.

Methods: Histological, immunohistochemical, and ultrastructural examinations were performed on a tumor that arose on the back of a 37‐year‐old woman.

Results: Histologically, the tumor predominantly consisted of small, round or polygonal cells arranged in cords or nests. Immunohistochemical study revealed that the tumors cells were positive for vimentin, S‐100 protein, glial fibrillary acidic protein and neuron specific enolase. The cells were negative for HMB‐45, keratin, epithelial membrane antigen, and CAM5.2. Electron microscopic study showed closely associated cells with undifferentiated features. The cells were devoid of external laminae and cellular junctions.

Conclusion: Malignant epithelioid schwannoma should be pathologically differentiated from other epithelioid tumors with cartilaginous elements.
Granulomatous slack skin: an ultrastructural study
Authors: Tsuruta Daisuke , Kono Takeshi , Kutsuna Haruo , Yashiro Noriko , Ishii Masamitsu
Published: March 2003

Background:

Granulomatous slack skin is a rare lymphoproliferative disorder characterized clinically by gradual development of pendulous folds of lax erythematous skin in flexural areas, and histologically by non‐necrotizing granuloma, with numerous multinucleated giant cells, mononuclear histiocytes, and atypical lymphocytes associated with loss of elastic fibers. Although there are many reports describing the histological and immunophenotypic features of this disease, only a few have described the ultrastructural features.

Methods: Here we report a case of granulomatous slack skin and describe the ultrastructural findings.

Results and conclusion:

We could detect some previously not noted abnormal findings in multinucleated giant cells, histiocytes, and atypical lymphocytes.
Trichoepithelioma with “monster” stromal cells
Authors: Rivet Jacqueline , Rogez Corinne , Wechsler Janine
Published: March 2003

Trichoepithelioma is a benign tumor of trichogenic origin which appears predominantly in childhood or in young adults. Different forms have been described according to clinical and histological features. The authors report a unique variant of trichoepithelioma arising on the limb of a 27‐year‐old man. The tumor was characterized by the mixture of an atypical fibroxanthomatous proliferation and basaloid epithelial strands of trichoepithelioma. Such histological features have not been previously reported. It raises the question of an additional variant of hair follicle tumor with a mixed epithelial and mesenchymal proliferation.
Cutaneous indeterminate cell histiocytosis: a new spindle cell variant resembling dendritic cell sarcoma
Authors: Rosenberg Arlene Sylvia , Morgan Michael B.
Published: March 2003

Background: Cutaneous indeterminate cell histiocytosis is a rare neoplastic disorder. Its varied histological presentation and rarity have limited efforts to determine its pathogenic relationship with other histiocytic lesions and possibly, its recognition.

Methods: We report on an unusual histologic pattern of indeterminate cell histiocytosis that resembled follicular dendritic sarcoma. A battery of immunohistochemical stains and electron microscopy were performed to elucidate the phenotype of the “histiocytic” cells. Based on a review of the literature, reported cases of indeterminate cell histiocytosis are presented and the diagnostic differential of spindle‐cell lesions is discussed.

Results: Spindling histiocytes were positive for S‐100 and CD1a. The monocytic/macrophage marker, CD68, and the dendritic cell marker, CD21, were negative. Electron microscopy failed to reveal Birbeck granules.

Conclusions: Relatively few reports of indeterminate cell histiocytosis exist, some of which include discussion of potential overlaps with the non‐X histiocytoses. Although the presence of prominent spindling in our case expanded the differential to include non‐histiocytic disorders, the identified histiocytes unequivocally fulfilled the criteria of S‐100 and CD1a positivity without demonstrable Birbeck granules.
Spindle cell angiosarcoma following irradiation therapy for cervical carcinoma
Authors: Kiyohara Takahiro , Kumakiri Masanobu , Kobayashi Hitoshi , Itoh Kei , Lao Li‐Min , Ohkawara Akira , Nakamura Hideki
Published: March 2003

Background:  Angiosarcomas arise in the scalp and face in the elderly, in association with chronic lymphedema (Stewart–Treves syndrome), and in irradiated areas. Rarely in these settings, angiosarcomas exhibit pure spindle cell phenotype.

Methods:  Herein, the clinicopathologic features of a 72‐year‐old‐woman with spindle cell angiosarcoma are described.

Results:  A 72‐year‐old woman presented with numerous nodules and diffuse induration from the lower abdomen to the right buttock, corresponding to the area exposed to 60Co‐irradiation during treatment for cervical carcinoma 10 years earlier. Histopathological examination revealed inflitrative, atypical, spindle cells that labeled with antibodies to CD31, CD34, and factor VIII‐related antigen. Ultrastructurally, these malignant spindle cells contained Weibel–Palade bodies. No features suggesting radiation dermatitis (sclerosis or bizarre, large fibroblasts) were identified, but lymphangiectases and widely spaced collagen bundles(lymphedema) were prominent in the skin surrounding the angiosarcoma. Computed tomographic scan of the abdomen highlighted this histologic finding by demonstrating tumor masses limited to areas of lymphedema. Treatment with intravenous and local injections of recombinant interleukin 2 (rIL 2) followed by electron beam irradiation were initially effective with tumor remission for 2 months. However, the recurrent tumor did not respond to a second course of one‐shot injection of rIL 2 through the abdominal aorta and the patient succumbed to her angiosarcoma 19 months after diagnosis.

Conclusions:  Radiation‐induced lymphedema may be a factor in angiosarcoma associated with radiotherapy.
Fibroepithelioma‐like changes occurring in perianal Paget's disease with rectal mucinous carcinoma: case report and review of 49 cases of extramammary Paget's disease
Authors: Ishida‐Yamamoto Akemi , Sato Katsuhiko , Wada Takashi , Takahashi Hidetoshi , Toyota Noriaki , Shibaki Taiichiro , Yamazaki Kousuke , Tokusashi Yoshihiko , Miyokawa Naoyuki , Iizuka Hajime
Published: March 2003

Background:  Anogenital Paget's disease (PD) may be accompanied by varying degrees of epidermal hyperplasia. The histological changes can be reminiscent of fibroepithelioma of Pinkus.

Methods:  We present a case of perianal PD associated with fibroepitheliomatous epidermal hyperplasia in a 76‐year‐old‐man with an underlying rectal mucinous carcinoma. We also carried out a retrospective analysis of 51 biopsies from 49 cases of extramammary PD to see whether particular epidermal changes occur in association with PD in different anatomic locations.

Results:  A tumor, 3 cm in diameter, was noted in the patient's perianal skin. Histologically, it was composed of anastomosing thin epithelial strands with follicular differentiation. Paget's cells were distributed in the epithelial strands of this tumor as well as in the surrounding epidermis and anal epithelia. In our series of extramammary PD, epidermis was hyperplastic in two of two perianal cases, 26 of 43 genital skin samples, and one of six axillary PD biopsies. The stroma beneath the hyperplastic epidermis tended to be rich in thin collagen fibers and fibroblasts.

Conclusions:  Anogenital PD was more frequently associated with epidermal hyperplasia than axillary PD. Fibroepitheliomatous hyperplasia may be induced by the altered stroma associated with PD.
Clinical and pathological spectrum of CD8‐positive cutaneous T‐cell lymphomas
Authors: Lu Di , Patel Kaushali A. , Duvic Madeleine , Jones Dan
Published: March 2003

CD8+ T‐cell lymphomas presenting in the skin are rare. We describe the clinical and histological features of 18 patients with CD8+ cutaneous T‐cell tumors, which have been divided into four groups. Seven patients had precedent long histories of rashes, which progressively spread in a presentation similar to that of CD4+ mycosis fungoides (MF). Three patients had long‐standing localized plaques consistent with a pagetoid reticulosis (PR) pattern. Two patients presented with erythroderma and had peripheral blood involvement consistent with a Sezary syndrome (SS) pattern and had rapidly progressive clinical courses. Six patients presented with cutaneous nodules of varying sizes and had variable outcomes, with two having rapidly progressive disease, two with indolent recurrences and a further two with complete responses to treatment. Histologically, 12 of the 18 cases showed an epidermotropic tumor infiltrate that was most marked in the three PR cases. Prominent periadnexal infiltration was seen in 11 cases. Similar to CD4+ MF, the skin‐homing antigen, (cutaneous lymphocyte antigen: CLA), was strongly expressed in 13 of 16 tested cases. Expression of the cytotoxic granule protein granzyme B was noted in a majority of tumor cells in only three of 16 tested cases. We conclude that approximately half of CD8+ cutaneous T‐cell lymphomas clinically and histologically resemble CD4+ MF/SS, whereas presentation as discrete nodular lesions are more common in CD8+ tumors as compared to those that express CD4.
Melanoma associated with pseudoepitheliomatous hyperplasia: a case series and investigation into the role of epidermal growth factor receptor
Authors: Mott Ryan T. , Rosenberg Arlene , Livingston Sandra , Morgan Michael B.
Published: March 2003

Background:  Pseudoepitheliomatous hyperplasia (PEH) is a reactive epithelial proliferation that occurs in response to underlying infectious, inflammatory, and neoplastic conditions. The histologic features of PEH may simulate squamous cell carcinoma and may obscure an underlying malignant process. The association of PEH with benign melanocytic nevi is well described in the literature. However, reports documenting the association of PEH with melanoma are rare.

Methods:  We examined the demographic and histologic features in 13 cases of melanoma in association with PEH. In addition, we evaluated the possible pathogenic role of epidermal growth factor receptor (EGFR) using immunohistochemical methods.

Results:  In each case, histologic examination revealed epidermal hyperplasia with irregular cords of well‐differentiated epithelial cells extending into the dermis and infiltrating the melanoma. Although overlap existed, two patterns of epidermal hyperplasia were noted. The majority of cases (69%) exhibited acanthosis, hyperkeratosis, papillomatosis, and irregular infiltrating epithelial cords with squamous eddies. The remaining cases demonstrated basaloid acanthosis, laminated orthokeratosis, and horn cysts. EGFR immunohistochemical studies revealed strong staining within the basal layer of the epithelium, with no discernible difference between the hyperplastic epithelium overlying the melanoma cells and adjacent normal skin. Immunostaining among the melanoma cells was absent to weak in each of the cases. All cases exhibited intense EGFR immunoreactivity in macrophages underlying the epidermal lesions.

Conclusions:  Melanoma is capable of presenting in a variety of histologic guises, including a pattern with PEH. The etiology of PEH, as rarely seen in conjunction with melanoma, unlikely involves EGFR and remains to be elucidated.