bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative analysis of histologicai and immunohistological features in mycosis fungoides and Sézary syndrome
Authors: Kamarashev J. , Burg G. , Kempf W. , Schmid M. Hess , Dummer R.
Published: August 2006

Mycosis fungoides (MF) and Sezary syndrome (SS) are closely related cutaneous T‐cell lymphotmas, which differ in several clinical aspects. We compared histological and immunophenotypical features of these two entities, which could be implicated in the dermotropism and epidermotropism, characteristic for both of them. Thirteen biopsy specimens from patients with established plaque‐stage MF and 13 from SS patients were examined retrospectively, and 21 histological criteria were assessed. Further, 9 cryosections from MF lesions and 9 from SS lesions were stained for LFA, ICAM1, CD40, CD40‐ligand, CD28, CD80, CTLA‐4, CD86, FAS, FAS‐ligand, CLA and CD 15s. The only histological criteria that showed persistent differences were acanthosis (in 12 of 13 SS and in 7 of 13 MF specimens) and Pautrier collections (detected in 6 SS and 11 MF biopsies). Patterns of staining with the antibodies mentioned above were found to be similar. Our results indicate that these interaction molecules seem to be involved in the pathogenesis of MF and SS, but their immunohistochemical distribution does not contribute to the differentiation between the two entities.
Infiltrative basal cell carcinoma occurring in sites of biopsy‐proven nodular basal cell carcinoma
Authors: Swetter Susan M. , Yaghmai Dina , Egbert Barbara M.
Published: August 2006

Over 200 basal cell carcinomas (BCCs) are biopsied and subsequently excised each year at the Veterans Affairs Palo Alto Health Care System (VAPAHCS). A focal infiltrative pattern developed in the region of the biopsy scar in the re‐excision specimens of 20 cases out of approximately 400 BCCs (< 5%) examined histopathologically over a 2‐year period. The patient population included predominantly male, elderly Caucasians (mean age 71), and all tumors fulfilled clinical and histologic criteria for nodular BCC at the time of initial punch or shave biopsy. No patient showed recurrence of tumor following simple re‐excision with 2–3 mm surgical margins, with a mean follow up of 25.4 months after excisional surgery. These neoplasms had a more benign clinical course, possibly related to scar formation in healing sites of previously biopsied nodular BCC, rather than true aggressive‐growth BCC. The authors conclude that a focal infiltrative pattern in a re‐excision specimen may occur histologically as a scar‐induced pattern which mimics an aggressive‐growth BCC, but does not appear to have the same prognosis. We believe this is an important histologic observation, as recognition of biopsy scar changes in an excisional specimen of BCC may help to distinguish it from true aggressive‐growth BCC.
Dermal dendrocytes participate in the cellular pathology of experimental acute graft‐versus‐host disease
Authors: Yoo Young H. , Park Bong S. , Whitaker‐Menezes Diana , Korngold Robert , Murphy George F.
Published: August 2006

In a well established murine model relevant to human disease, graft‐versus‐host disease results from recognition of recipient minor histocompatibility antigens by donor bone marrow‐derived T lymphocytes. Previous studies suggest that factor XIIIa‐positive dermal dondrocytes may be involved in the pathogenesis of disorders involving antigen presentation to T cells and dermal fibrosis. This study was undertaken to determine (i) whether normal murine skin contains factor XIIIa‐positive dermal dendrocytes, and (ii) whether such cells participate in the pathophysiology of acute graft‐versus‐host disease. Graft‐versus‐host disease was produced using B10.BR CD8+ donor T cells administered to CBA recipients. Skin samples were collected weekly for a 5‐week period and evaluated by immunohistochemistry and electron microscopy. Our data indicate that normal murine dermis contains factor XIIIa‐positive cells localized primarily around deep dermal microvessels. Ultrastructural analyses reveal these cells to have long processes, pinocytotic vesicles, fibronexuses, and intimate associations with mast cells. During graft‐versus‐host disease, factor XIIIa‐positive dendrocytes appeared within the superficial dermis. By ultrastructure, the dendrocytes were hypertrophic and highly branched, and demonstrated an intimate relationship with neighboring cells. In conclusion, factor XIIIa‐positive dendrocytes comprise a normal component of the murine dermis and undergo alterations in experimental acute graft‐versus‐host disease consistent with participation in disease pathophysiology.
Sclerosing dermatofibrosarcoma protuberans
Authors: Diaz‐Cascajo Carlos , Weyers Wolfgang , Borghi Susanna
Published: August 2006

Dermatofibrosarcoma protuberans is a low‐grade sarcoma of the skin with well characterized clinical and histopathological features. The lesion frequently appears as a plaque on the trunk or on the extremities of middle‐aged adults. Microscopically, the tumor is composed of monomorphous spindle cells arranged in storiform pattern and embedded in a sparse to moderately dense fibrous stroma. We report on two unusual cases of dermatofibrosarcoma protuberans in which neoplastic cells were diffusely replaced by sclerotic tissue in more than 50% of the entire tumor. In both cases, no external trauma or radiotherapy were recorded. Since tumor regression has been defined as a loss of tumor mass in the absence of any treatment (or trauma) we believe that sclerosis in DFSP may represent a manifestation of regression and not, as previously suggested, a new variant of the neoplasm.
Expression of bcl‐2, p53 and Ki‐67 in arsenical skin cancers
Authors: Chang Chung‐Hsing , Tsai Rong‐Kung , Chen Gwo‐Shin , Yu Hsin‐Su , Chai Chee‐Yin
Published: August 2006

To investigate the regulation of apoptosis and proliferation in arsenic‐induced skin cancers, we examined the expression of bcl‐2. p53, and Ki‐67 using immunohistochemical staining. Thirty patients with Bowen's disease (BD), ten with basal cell carcinoma (BCC), eight with squamous cell carcinoma (SCC) and eleven of perilesional normal skin (PLN) of the non‐sun exposure sites from endemic area were examined. The results showed that: 1) bcl‐2 was expressed in all of the BCC homogeneously, in none of the SCC, and in 12/30 of the BD focally or homogeneously; 2) p53 was expressed in all of the arsenical skin cancers with a labelling index of 75±14% of BD, 50±17% of BCC. 61±15% of SCC, and also in all of the perilesional normal skin with a labelling index of 55±24%; 3) Ki‐67 was expressed in all of the skin cancers with labelling index of 58±17% of BD. 12±7% of BCC, 47±21% of SCC, and in 9/11 of PLN with a labelling index of 41±24%. Expression of bcl‐2 in BCC or BD is related to the phenotype of germinative basal cell. The constant expression of bcl‐2 i early dysplastic cells of BD and the earliest expression of P53 in the basal cells of perilesional normal skin indicate that the initial step of arsenic‐induced carcinogenesis is from the basal germinative cells. There is no mutual relationship between bcl‐2, p53 or Ki‐67 expression in any type of the arsenical skin cancers, but there is a positive correlation between p53 and Ki‐67 expression identified in perilesional normal skin. BD had the highest labelling index of p53 and Ki‐67.
S100⊕ cell response to squamous cell carcinoma of the lip: inverse correlation with metastasis
Authors: Wei Naimin , Tahan Steven R.
Published: August 2006

Previous work has suggested a key role of dendritic cells in anti‐neoplastic immunity. The course of mycosis fungoides and cancers of the lung, colon, thyroid and stomach has been associated with dendtitic cell response to the primary tumor. However, this has not been reported for cutaneous or mucosal squamous cell carcinoma (SCC).

Thirty‐six cases of primary SCC of the lip mucosa or vermillion border, including nine cases with regional metastasis, were stitdied to investigate the relationship of dendritic cell density with age, tumor grade, mitotic rate, diameter, ulceration, depth of invasion, muscle invasion, tumor‐infiltrating lymphocytes (TILs) and metastasis. Dendritic cells were identified using S100 immunohistochemistry, and their peritumor and intratumor density (peri‐S100D and intra‐S100D) were determined.

The mean peri‐S100D was 314 ± 50/mm2. High peri‐S100D was associated with lower rate of metastasis (P = 0.03), and no case with peri‐S100D > 311/mm2 metastasized. Peri‐S100D inversely correlated with depth of invasion (P = 0.04) and ulceration (P = 0.02), and positively associated with TILs (P = 0.02). The mean intra‐S100D was 317 ± 42/mm2. Intra‐S100D did not quantitatively correlate with metastasis; however, no metastasis occurred when intra‐S100D exceeded 515/mm2. Intra‐S100D correlated with brisk TILs (P = 0.04).

These results suggest a functional role of dendritic cells in the immune response to SCC. Peri‐S100D may be a prognostic indicator.
‘Tubular’ epithelioid cell nevus: a new variant of Spitz's nevus
Authors: Burg Guenter , Kempf Werner , Höchli Matthias , Huwyler Toni , Panizzon Renato G.
Published: August 2006

The term Spitz's nevus refers to a large spectrum of nevi composed of spindle and/or epithelioid cells. We report on a hitherto undescribed tubular variant of a dermal epithelioid nevus, characterized by aggregates composed exclusively of cuboidal cells with the prominent feature of tubular or microcystic structures, Immunohistochemically, the epithelioid cells expressed melanocytic markers (S‐100, NKI/C3) lacking markers for cytokeratin or carcinoembryonic antigen. The three‐dimensional analysis of the lesions by confocal laser scanning microscopy revealed the structural configuration of tubular or microcystic empty spaces bordered by cuboidal nevus cells. This rare variant of epithelioid nevus is another example for the remarkable diversity of Spitz's nevi.
Mainly unmutated VH genes rearranged in B cells forming germinal centers in a cutaneous pleomorphic T‐cell lymphoma
Authors: Golembowski Sven , Gellrich Sylke , Lorenz Pamela , Rutz Sascha , Audring Heike , Sterry Wolfram , Jahn Sigbert
Published: August 2006

B Cells in skin lesions of a pleomorphic cutaneous T‐cell lymphoma with reactive germinal center hyperplasia were analyzed for their immunoglobulin VHDJH gene rearrangements by micromanipulation and single cell polymerase chain reaction (PCR) analysis. In B lymphocytes located in germinal center‐like structures, we found in 11/16 different VHDJH rearrangements completely Unmutaied VH genes, suggesting that those cells did not undergo antigen‐driven selection. Two VH genes showed more than 98% germ‐line identity. In only three cells VH segments were somatically mutated to a higher extent, but two of these rearrangements were non‐productive. These results diller markedly from what we have previously detected in B cells present in mycosis fungoides, another entity of cutaneous T‐cell lymphomas where the Ig gene repertoire resembles the situation in peripheral blood with a significantly higher proportion of mutated VH genes. When investigating the large atypical B cells strongly expressing CD30 which were detected within the T‐cell zone outside the germinal centers. we found again, in most cases, that the rearranged VH genes were completely unmutated. The B cells were of polyclonal origin. Due to this comparable Ig gene repertoire and mutational pattern, we suggest that these cells descend from the germinal center centroblasts, which migrated into the T‐cell zone and obviously became stimulated to express the CD30 marker. The mieromanipulation technique and molecular analysis on the single cell level may provide an important Input into our understanding of the mechanisms of immune regulation in cutaneous lymphomas.
Quantitative study of mast cells in Kimura's disease
Authors: Wong K. T. , Shamsol S.
Published: August 2006

The association of mast cells with typical lesions of Kimura's disease was investigated by quantitative melhods after immunohistochemical staining for Factor VIII‐related antigen and counterstaining with toluidine blue. Formalin‐fixed, paraffin‐embedded, tissue sections from 9 confirmed cases of Kimura's disease were examined after staining to estimate mast cell and blood vessel densities by counting 100 random fields under oil immersion. There was a statistically significant increase of both mast cells and blood vessels in Kimura's disease (p<0.01) compared with normal skin and reactive lymph node controls. However, as far as the individual Kimura's disease lesion is concerned, there was generally no correlation between areas with mast cell increase and the degree of vascularity. Moreover, when lesions of less than 1 year's duration were compared with older lesions, there appeared to be a relative decrease in mast cells and a concomitant increase in vascularity in the latter. These results confirmed that mast cells are associated with Kimura's disease, and suggest that they may be involved in its early pathogenesis, although its possible role in angiogenesis may not be direct.
Spiny keratoderma ‐ a demonstration of hair keratin and hair type keratinization
Authors: Hashimoto Ken , Toi Yoichiro , Horton Sharon , Sun Tung‐Tien
Published: August 2006

Six cases of spiny keratoderma were analyzed with hair specific antikeratin antibodies (AE13, AE14) and by electron microscopy. The keratotic column exhibited a different keratin birefringence and the underlying viable epidermis was less eoinophilic than the surrounding epidermis. AE13, which is specific for hair cortex, was positive in the lower column and variably positive in the viable epidermis, often beyond the columnar lesion. AE14 was negative in the lesion. Electron microscopy demonstrated features of keratinization of normal hair cortex, i.e. by the accretion of keratin filaments without production of keratohyalin or trichohyalin granules. Cementsomes (lamellar granules) and marginal bands were not produced as they are not formed in normal cortical keratinization. It was suggested that spiny keratoderma represents an ectopic hair formation of palms and soles.
Neural spectrum: palisaded encapsulated neuroma and verocay body poor dermal schwannoma
Authors: Kossard Steven , Kumar Ajay , Wilkinson Barbara
Published: August 2006

We examined 25 palisaded encapsulated neuromas (PEN) of the skin and used peripherin antibody as an immunohistochemical label for axons. Quantitative analysis of the axon to schwann cell nuclear ratio for each PEN was determined by examining cross‐sectioned neuroid fascicles. This revealed that 120 of the 253 cross‐sectioned fascicles in PEN lacked axon and only 5% of the fascicles had an axon to schwann cell nuclear ratio greater than 1:2. In contrast, all fascicles in 40 dermal nerves adjacent to PENs as well as 35 traumatic neuromas in surgical scars had an axon to schwann cell nuclear ratio of at least 1:2 and die majority a ratio of 1:1 or higher. These results suggest that there is a spectrum between PENs which arc axon rich to a form of schwannoma with an identical histopathology which lacks significant axonal content and that not all PENs are true neuromas.
In vivo abnormal keratinization in Darier‐White's disease as viewed by real‐time confocal imaging
Authors: González Salvador , Rubinstein Gennady , Mordovtseva Veronica , Rajadhyaksha Milind , Anderson R. Rox
Published: August 2006

Darier‐White's disease is a rare autosomal‐dominant disorder of keratinization. The underlying pathology for the clinical presentation is acantholysis, and various types of dyskeralosis and acanthosis. In this study, we utilized a non‐invasive optical imaging modality, confocal reflectance microscopy, to identify specific histologic features of Darier‐White's disease in vivo. Micro graphic findings in the confocal images were corps ronds, suprabasal clefts, acantholytic suprabasal keratinocytes, and villi. Real‐time confocal images are illustrative and can be well correlated with known light microscopic phenomena, particularly in the case of keratinization abnormalities in Darier‐White's disease.
Ultrastructural and immunohistochemical studies of the periendothelial matrix in human melanoma: evidence for an amorphous matrix containing laminin
Authors: Lugassy C. , Dickersin G. R. , Christensen L. , Karaoli T. , LeCharpentier M. , Escande J. P. , Barnhill R. L.
Published: August 2006

Angiogenesis and the extracellular matrix are fundamental to tumor progression from in situ to invasive and metastatic disease. Laminin, a major glycoprotein integrated into basement membranes, is observed in angiogenesis and tumorigenesis. A recent study described an association between melanoma cells and endothelial cells via an amorphous matrix containing laminin. In the current study, we have examined 45 cases of human primary and metastatic melanomas by electron microscopy for the presence of an amorphous matrix. We observed an amorphous matrix without a clearly delineated lamina or basement membrane in 41 of the 45 melanomas studied. 28 cases with tissue blocks available for study were examinated by immunohistochemistry for the expression of laminin and type IV collagen. We observed die presence of an angiocentric matrix containing laminin in 24 of the 28 melanomas studied. Since laminin is involved in tumor migration, the presence of laminin between melanoma cells and small vessels suggests a role for this material in periendothelial tumor migration. However, further study is required to characterize the nature of this material and the mechanisms involved.
Dysplastic changes in different types of melanocytic nevi. A unifying concept
Authors: Toussaint Sonia , Kamino Hideko
Published: August 2006

We observed histopathologic changes previously described in dysplastic melanocytic nevi in association with a dermal component characteristic of other types of melanocytic nevi or overlapping with features of other varieties of nevi. In order to determine the frequency of these changes, we studied 2,164 cases of compound melanocytic nevi that fulfilled the histopathologic criteria for the diagnosis of compound dysplastic nevus, including architectural pattern, cytologic features, and mesenchymal changes. Of the 2,164 compound dysplastic melanocytic nevi,. 1,895 (87.6%) had the histopathologic characteristics previously described for dysplastic nevus, 179 (8.3%) showed a dermal component with a congenital pattern, 67 (3.1%) demonstrated epidermal and dermal characteristics of Spitz's nevus, 8 (0.3%) had features of a combined blue nevus, 13 (0.6%) had a halo phenomenon and 2 (0.1%) showed dermal neuronevus. By considering these nevi as variants of dysplastic nevi, one may apply a unified conceptual basis for their nomenclature. In order to completely describe the appearance of the nevus, we named them by adding the term “dysplastic”, to their main histopathologic subtype. Accordingly, six different varieties of dysplastic nevi were identified: 1) dysplastic nevus (original); 2) dysplastic nevus with a congenital pattern; 3) dysplastic Spitz's nevus; 4) dysplastic combined blue nevus; 5) dysplastic halo nevus; and 6) dysplastic neuronevus. In summary, we conclude that the histopathologic criteria previously reported for the diagnosis of dysplastic nevi may be found in association with a dermal component characteristic of other types of melanocytic nevi or may have overlapping features with other variants of nevi.
Lichenoid and subacute cutaneous lupus erythematosus‐like dermatitis associated with antihistamine therapy
Authors: Crowson A. N. , Magro C. M.
Published: August 2006

The authors report the occurrence of lichenoid and/or subacute lupus erythematosus‐like eruptions in a group of patients receiving agents with antihistaminic properties. In 1 of the patients the eruption clinically resembled lichen planus, while in 5 patients the eruption resembled subacute cutaneous lupus crythematosus (SCLE). At a light microscopic level all cases showed a lichenoid dermatitis and in 4 cases the lesions were interpreted as representing subacute lupus‐like eruptions by virtue of the presence of alternating cell poor and lichenoid interface dermatitis, suprabasilar lymphocytosis around degenerating keratinocytes, and dermal mucinosis. Despite the resemblance at a clinical and light microscopic level to SCLE, anti‐Ro seropositivity could not be established in any of the cases. One case, however, did demonstrate antihistone antibodies in concert with a high antinuclear antibody titer. A causal association was implicated by virtue of lesional resolution following drug withdrawal. The association of cutaneous eruptions resembling SCLE with antihistamine intake is seemingly a novel one. The possible pathogenetic basis of the eruptions is discussed.
Histopathology of an adverse reaction to a eutectic mixture of the local anesthetics lidocaine and prilocaine
Authors: Hoss Diane M. , Gross Earl G. , Grant‐Kels Jane M.
Published: August 2006

A unique hislopathologic reaction to the topical application of a eutectic mixture of the local anesthetics lidocaine and prilocaine (EMLA), used for topical anesthesia prior to biopsy in two children is described. Standard application of EMLA cream under occlusion for 1 h was given to both patients. The biopsies in both cases demonstrate focal vacuolization of the upper spinous and granular layers. The epidermis was locally separated from the dermis in areas of basal vacuolar alteration. Electron microscopy performed in one case demonstrated the dermal‐epidermal cleft to be secondary to alteration of the basal cells with condensation of the cytoplasm and cytologic degeneration similar to that seen in epidermolysis bullosa simplex.
Immunohistochemical comparison of cutaneous lymphadenoma, trichoblastoma, and basal cell carcinoma: support for classification of lymphadenoma as a variant of trichoblastoma
Authors: McNiff Jennifer M. , Eisen Richard N. , Glusac Earl J.
Published: August 2006

Cutaneous lymphadenoma is an uncommon basaloid epithelial tumor of uncertain histogenesis, most recently classified as a variant of trichoblastoma. Because characteristic immunohistochemical findings have been reported in trichoblastomas, we evaluated the staining patterns of five cutaneous lymphadenomas and compared the results to those of ten trichoblastomas and ten nodular basal cell carcinomas (BCCs), using antibodies to cytokeratin 20 (CK20), bcl‐2, and CD34. In addition, because lymphadenomas contain intraepithelial S100‐positive putative Langerhans cells, we compared staining of all tumor groups for S100 protein and CD1a. We also attempted to corroborate recent reports of CD30‐positive activated lymphocytes in lymphadenomas. We identified GK20‐positive Merkel cells in 3/5 lymphadenomas, 7/10 trichoblastomas, and none of the BCCs. Staining for bcl‐2 accentuated the peripheral epithelial layer in all lymphadenomas and in 3/10 trichoblastomas, while the remaining trichoblastomas and all BCCs stained diffusely. There was stromal staining with CD34 in two lymphadenoma, 4 trichoblastomas, and 3 BCCs. All lymphadenomas featured numerous intraepithelial S100‐positive cells which were also positive for CD1a in three cases tested. In addition, 8/10 trichoblastomas and 2/10 BCCs contained modest numbers of cells labelling for S100 and CD1a. Two of three lymphadenomas contained rare single cells resembling histiocytes faintly positive For CD30, and similar cells labelled for CD68. We conclude that the similar staining patterns of lymphadenomas and trichoblastomas support the classification of lymphadenoma as a variant of trichoblastoma. Staining with CD34 does not reliably distinguish between these tumors and BCCs. Lymphadenomas, trichoblastomas, and BCCs may all contain Langerhans’cells. The relationship between these cells and the striking lymphoid infiltrates seen in lymphadenomas is not clear. In our cases, the CD30‐positive cells in lymphadenomas appear to represent histiocytes rather than activated lymphocytes.
Immunohistochemistry to identify Leishmania parasites in fixed tissues
Authors: Kenner Julie R. , Aronson Naomi E. , Bratthauer Gary L. , Turnicky Ronald P. , Jackson Joan E. , Tang Douglas B. , Sau Purnima
Published: August 2006

The definitive diagnosis of leishmaniasis currently depends on the identification of characteristic amastigote morphology in tissue, or isolation of promastigotes by culture. Histapathological identification can be difficult, and is variably sensitive; culture is considered “the gold standard”, but is not uniformly diagnostic or available. In this study, we compared light microscopic immunohistochemistry (IHC) using a monoclonal anti‐Leishmania antibody (G2D10) to standard hematoxylin and eosin (H&E) stain in the diagnosis of Leishmania on skin. Sixty‐one archived specimens from patients suspected of being infected with Leishmania were used; 41 of these had leishmaniasis confirmed by culture. Although not statistically significant, both sensitivity and specificity were higher for IHC compared to H&E: 51% (95% CI: 35‐67%) compared to 42% (CI: 26‐58%; 2p=0.29) for sensitivity, and 100% (CI: 83‐100%) compared to 85% (CI: 62‐97%, 2p=0.25) for specificity, respectively. Furthermore, because organisms could be diagnosed by IHC at low power (X20‐40), this assay was more rapid than H&E, in which parasite morphology could best be identified at oil immersion power. The G2D10 antibody has broad Leishmania species recognition, and offers promise as a simple, rapid diagnostic screen for leishmaniasis. Further study is underway to better characterize this antibody.
Melanotic pigmentation in excision scars of melanocytic and non‐melanocytic skin tumors
Authors: Botella‐Estrada Rafael , Sanmartin Onofre , Sevila Amparo , Escudero Angel , Guillén Carlos
Published: August 2006

The appearance of pigmented lesions in melanoma surgical scars is a frequent finding that in some instances may cause confusion with a melanoma persistence. Nevertheless, only a few papers have dealt with this subject in the dermatologic literature. The melanoma surgical scars of 60 consecutive patients were reviewed with special attention to the presence of pigmentation and its clinical characteristics. Simultaneously, the scars of 60 consecutive patients who had been subjected to excision of a non‐melanoma skin tumor were also studied died. Biopsies were performed in representative clinical cases of pigmented lesions arising on the scars of both groups, as well as in non‐pigmented scars, and processed for hematoxylin‐eosin and immunohistochemistry. Pigmented lesions were present in a similar percentage in both groups (30% in melanoma scars (18/60) and 25% in non‐melanoma scars (15/60)). Clinically, three types of clinical pigmentation were observed: lentigine‐like lesions; pigmented streaks in scars after direct closure: and diffuse pigmentation in grafts. Histologically, two patterns emerged: one with lentiginous epidermal hyperplasia, hyperpigmentation, and a normal or moderately increased number of melanocytes; and a second one characterized by melanocytic hyperplasia of a variable degree. The scar process itself, irrespective of the tumor excised, seems to be responsible for the pigmentation. We suggest the existence of an induction process of scar tissue acting on melanocytes of the overlying epidermis.
Pigmented hidrocystoma of the eccrine secretory coil in the vulva: clinicopathologic, immunohistochemical and ultrastructural studies
Authors: Kamishima Tomoko , Igarashi Seiji , Takeuchi Yoshio , Ito Masatoshi , Fukuda Takeaki
Published: August 2006

A case of pigmented hidrocystoma of eccrine secretory coil is presented. A 47‐year‐old woman had developed a bluish black small nodule in the anterior portion of the labium minor a few years before entry. Microscopically, the cyst was lined by eosinophilic columnar epithelium with abundant brownish granules. There was a vague suggestion of decapitation secretion focally in the epithelial layer of cuboidal cells. This layer expressed distinct reactivity against CA19‐9 with no reactivity Tor human milk fat globule‐1 (HMFG‐1). These features demonstrated that the cyst was not of apocrine nature but of eccrine derivation. In addition, positive immunoreaction for cytokeratin (CK)7, CK8 and CK19 defined the cyst as originating from the secretory coil of the sweat gland. Ullrastructurally, melanosomes in various stages were identified in most of the epithelial cells. These findings suggest that the present case was a hidrocystoma of eccrine secretory coil with abnormal melanin accumulation.
Acquired vulvar lymphangioma mimicking genital warts. A case report and review of the literature
Authors: Mu Xiao C. , Tran Tien‐Anh N. , Dupree Marsha , Carlson J. Andrew
Published: August 2006

A 44‐year‐old female developed confluent, dusky red, pruritic labial papules clinically suspected to be genital warts. She had a long‐standing history of Crohn's disease with vulvar fistulae. The papular eruption developed after several bouts of cellulitis in a region of valvar lymphedema. Shave biopsy of a papule exhibited papillated epidermal hyperplasia overlying a dermis with a “Swiss‐cheese’appearance secondary to lymphedema and superficial eciatic thin‐walled vascular spaces characteristic of lymphangiectasias. Review of published cases reveals that acquired lymphangiomas often affect the vulva compared to other cutaneous sites and can be associated with surgery, radiation therapy. infection (e.g., erysipelas, tuberculosis), Crohn's disease, congenital dysplastic angiopathy and congenital lymphedema. Rather than translucent vesicles (‘frog spawn’) typical of extragenital cutaneous lymphangiomas, vulvar lymphangiomas often present as verrucous papules that can be mistaken for genital warts. In this case, we believe that the combination of vulvar Crohn's disease and recurrent cellulitis resulted in local lymphatic destruction, lymphedema and ultimately symptomatic lymphangiectasias that mimicked genital warts.
Pilonidal sinus of the penis. A report of two cases, one of them associated with actinomycosis
Authors: Val‐Bernal J. Fernando , Azcarretazábal Teresa , Garijo M. Francisca
Published: August 2006

Pilonidal sinus is a long‐standing chronic inflammatory condition which occurs most commonly in the sacrococcygeal area and it is rare in the penis. Two cases of penile pilonidal sinus in patients aged 25 and 28 years are reported and the literature is reviewed. The lesion is acquired and has to be distinguished from balanoposthitis, epidermal cyst and carcinoma. For pilonidal sinus to occur at this site, it is hypothesized that the coronal sulcus acts as a cleft where hair may accumulate and be driven into the shaft and prepuce by the natural movement between these two surfaces. One of our cases was associated with actinomycosis. Actinomycosis associated with pilonidal sinus of the penis is extremely rare and there are only two previous reports. It is suggested that pilonidal sinus may have been predisposed to the infection with the actinomyces organisms. Information stating that penile pilonidal sinus and actinomycosis may occur simultaneously is necessary to accomplish an early diagnosis.
Three‐dimensional reconstruction in dermatopathology – A personal computer‐based system
Authors: Matsumura Tetsuri , Sato‐Matsumura Kazuko C. , Yokota Tazuko , Kobayashi Hitoshi , Nagashima Kazuo , Ohkawara Akira
Published: August 2006

The purpose of the present study was to build a system for three‐dimensional (3D) reconstruction of dermalopathological specimens using an easily available personal computer and graphic programs. A stereogram was generated by projecting thirty serial sections transferred into a Macintosh computer. The quality of the 3D images obtained by this method were high enough to show the net‐like structure of rete ridges in normal epidermis, the antler‐like branching of dermal papillae in seborrheic keratosis, and the bulge‐like proliferation of tumor nests in basal cell carcinoma. This method was also helpful to assess oblique sectioning of the specimens, which sometimes produces a strange appearance in dermatopathological sections. The method presented here would not only help to better understand the 3D structures of dermatopathological specimens, but could also be used to examine 3D patterns of tumor invasion, which may contribute to the differential diagnosis of malignant tumors.
Angiomatosis of skin with local intravascular immunoglobulin deposits, associated with monoclonal gammopathy. A potential cutaneous marker for B‐chronic lymphocytic leukemia
Authors: Salama Samih S. , Jenkin Peter
Published: August 2006

Reactive cutaneous vascular proliferation or angiomatosis is associated with various conditions, but is rarely seen secondary to vascular occlusion. We report an unusual case of a 79‐year‐old female who presented with 8 month history of purpuric facial plaques, with painful crusted ulceration of the nose, later developing similar eruptions on hands, thighs and trunk. Biopsies showed marked angioproliferation, with intravascular (IV) hyaline deposits (PAS +, fibrin ±: IgM +, fibrinogen+, and C3+), associated with endothelial hyperplasia (Factor VIII+ Vimentin+). Immunofluorescenee showed IV IgM, fibrinogen, and granular C3 deposits within vessel walls. Initially, extensive investigations only showed minimal monoclonal gammopathy of undetermined significance (MGUS) and repeatedly negative cryoglobulins. After a 3‐year follow‐up, the patient developed chronic lymphocytic leukemia (B‐CLL). This case illustrates a difficult diagnostic challenge. Although this condition resembles other forms of reactive angiomatosis, it shows distinct features and should be considered in the differential diagnosis of unusual vascular proliferations of the skin. The cutaneous lesions are also considered a potential marker for an underlying systemic condition, which may require prolonged clinical follow‐up. We believe this condition to be related to other rare cutaneous vascular proliferations associated with plasma cell and lymphoproliferative disorders. Furthermore, we suggest a common pathogenetic pathway resulting from the IV immunoglobulin deposits causing vascular injury, finally leading to the angiomatosis.
Tumor microvessels in melanoma express the beta‐2 chain of laminin. Implications for melanoma metastasis
Authors: Lugassy Claire , Shahsafaei Ali , Bonitz Paula , Busam Klaus J. , Barnhill Raymond L.
Published: August 2006

The ultrastructural localization of an amorphous matrix to the interface between microvessel endothelium and tumor cells has been recently reported in a series of melanomas. Laminin expression as documented by immunohistochemistry was localized to microvessels in melanomas showing the amorphous matrix. In order to identify more precisely the type of laminin present in this amorphous material, immunostaining was carried out on cryostat sections from 16 human melanoma specimens. Four murine monoclonal antibodies directed against the alpha‐3, beta‐2, beta‐3 and gamma‐2 laminin chains were employed. In the melanomas studied, α3, β3 and γ2 laminin chains showed only minimal focal vascular positivity. In contrast, the β2 (16/16 cases) laminin chain exhibited a consistent positivity in an angiocentric pattern about tumor microvessels. In all melanomas, some tumor cells seemed to spread along the abluminal surface of the small vessels, exhibiting a pericytic location, particularly along the intratumoral projections formed by the β2 laminin chain. Given the role of laminin in migration and tumor progression, the results suggest a role of the β2 laminin chain in melanoma spread, promoting tumor migration along the abluminal surface of vessel, a phenomenon which has been termed extra‐vascular migratory metastasis.
Epstein Barr virus‐associated lymphoproliferative‐disorders primarily involving the skin
Authors: Chai Chiling , White Wain L. , Shea Christopher R. , Prieto Victor G.
Published: August 2006

In cases of solid organ or bone marrow transplantation, up to 2 to 10% of patients may develop lymphoproliferative disorders (LPD), often induced by Epstein‐Barr virus (EBV). Despite a morphology mimicking malignant lymphoma, in some cases the lesions will disappear completely after the degree of immunosuppression is lowered. Lately, similar processes have been described in non‐transplant, immunosuppressed patients. A SNOMED search was performed on the database of three hospitals between 1990 and 1997, to identify patients with immunosuppression‐relaied lymphoproliferative disorders (IR‐EPD) involving primarily the skin. Two patients were identified. One was 2 years after kidney transplantation, and the other was being treated with methotrexate for dermatomyositis. In both biopsies, there was a diffuse perivascular proliferation of large lymphocytes with ample cytoplasm and pleomorphic nuclei, associated with extensive dermal and subcutaneous necrosis. Immunohistochemical studies revealed expression of CD20, CD45RO, CD43, CD30, EBV‐LMP1, and EBV‐NA2 by the atypical lymphocytes in both cases and, in one case, of the EBV‐transcriptional replication activation protein. In both cases the lesions completely disappeared and have not recurred. Primary involvement of the skin by IR‐LPD is very rare. Based on our results, it is possible that some of these cases in the skin contain EBV and co‐express CD30 and T‐ and B‐ccll markers. The diagnosis of IR‐LPD should be considered in cutaneous lymphoid proliferations in immunosuppressed patients. Belore rendering an unequivocal diagnosis of malignant lymphoma, reduction of immunosuppression and follow‐up of 4‐8 weeks should be considered.
Conjunctival melanocytic nevi of childhood
Authors: Kabukçuoğlu S. , McNutt N. S.
Published: August 2006

Two young patients with conjunctival compound nevi are presented to illustrate two types of abnormalities that lead to difficulty in distinction of these nevi from invasive melanomas. In Case 1, inflammation is associated with disruption of the nevus cell architecture and cytologic atypia. In Case 2, the occurrence of a combined nevus (compound and blue nevus types) in the conjunctiva leads to diagnostic problems. Circumscription of the lesions, lack of mitoses in the sub‐stantia propria, and lack of pagetoid spread of atypical cells in the adjacent conjunctival epithelium support benign diagnoses in both cases.
Congenital CD34‐positive granular cell dendrocytosis
Authors: Chang Sung Eun , Choi Jee Ho , Sung Kyung Jeh , Moon Kee Chan , Koh Jai Kyoung , Lim So Dug , Huh Jooryung , Shwayder Tor , Lee Min Woo
Published: August 2006

Granular cell tumors involving the skin are mostly acquired lesions. The Schwann cell origin of these lesions is supported by positive Immunostaining for S‐100 protein and myelin basic protein. S‐100–granular cell lesions rarely have been described in association with fibrous papules or dermatofibromas. The congenital variety of S‐100‐granular cell tumors occurs almost exclusively in the gingiva. The cell origin of these lesions is not well delineated. We report a hitherto undescribed case of a congenital cutaneous lesion which is histologically characterized by diffuse dermal infiltrates of S‐100‐ but CD34+ granular dermal dendrocytes. The granular appearance of these CD34+ dendrocytes is attributed to an abundance of phagolysosomes. The pathogenetic mechanism of this unusual lesion remains to be elucidated.
Sialadenoma papilliferum of the palate: case report and literature review
Authors: Argyres Michael I. , Golitz Loren E.
Published: August 2006

Sialadenoma papilliferum (SP) is a rare tumor of salivary gland ducts which bears a strong histologic resemblance to the more common syringocystadenoma papilliferym (SCAP). We report a case occurring on the palate of a 50‐year‐old man, and review the clinical and histologic features of this tumor. Because of the histologic similarities between these two tumors and squamous papilliomas, polymerase chain reaction (PCR) for human papilloma virus (HPV) DNA was performed on this tumor and on two cases of SCAP, with negative results. To our knowledge, this is the first case report of SP in the dermatopathology literature.
Hobnail hemangioma (“targetoid hemosiderotic hemangioma”): clinicopathologic and immunohistochemical analysis of 62 cases
Authors: Mentzel Thomas , Partanen Taina A. , Kutzner Heinz
Published: August 2006

Hobnail hemangioma, also known as “targetoid hemosiderotic hemangioma”, represents a distinctive, benign vascular tumor, characterized histologically by a biphasic growth pattern of dilated vascular structures in the superficial dermis lined by prominent hobnail endothelial cells, and collagen dissecting, rather narrow neoplastic vessels in deeper parts of the lesion. We analyzed the clinicopathologic and immunohistochemical features in a series of 62 cases. Patient age range was 6‐72 years (median: 32 years); 34 patients were male and 25 female. Clinically, a broad variation of diagnoses ranging from hemangioma to dermal melanocytic nevus and fibrous histiocytoma was suggested. Nineteen tumors arose in the lower and 13 in the upper extremities, 12 on the back, 8 in the buttock and hip region, and one case on the chest wall. Follow‐up information on 35 patients (range from 1 to 4 years; mean: 1.5 years) revealed no local recurrence nor systemic metastasis. All neoplasms were located in the dermis and showed a broad morphologic spectrum in dependence of the age of the lesions. In addition to lesions resembling cavernous lymphangioma or lymphangioma circumscriptum, neoplasms were seen widi morphologic features reminiscent to retiform hemangioendothelioma, progressive lymphangioma and so‐called Dabska's tumor. Immunohistochemistry performed in 28 cases showed positive staining of tumor cells for CD31 in all cases tested, whereas only 3 out of 28 cases stained completely positive for CD34. In addition 4 out of 8 cases stained positively for vascular endothelial growth factor receptor‐3 (VEGFR‐3). Neoplastic endothelial cells were surrounded by actin‐positive pericytes in only 7 out of 27 cases tested. Hobnail hemangioma occurs more frequently in male patients and arises commonly in the extremities and the trunk. Histologic and immunohistochemcial features suggest a lymphatic line of differentiation for this distinctive vascular neoplasm.
Immunohistochemical analysis of cytokeratin expression in apocrine cystadenoma or hidrocystoma
Authors: Ohnishi Takamitsu , Watanabe Shinichi
Published: August 2006

Apocrine cystadenoma is a benign sweat gland tumor which consists of various histologic types of epithelium: epithelium with decapitation secretion, pseudostratified epithelium, and flattened epithelium. Immunophenotypes, especially the expression of cytokeratins, in 8 cases of this tumor were examined immunohistochemically, because the nature or differentiation of each epithelium is not well known. The following antibodies were used as primary antibodies: those against involucrin, smooth muscle actin, and human milk fat globulin respectively, and 15 kinds of monoclonal anti‐cytokeratin antibodies. Although the staining pattern varied from case to case according to the proportion of each epithelium, these epithelia, except for the flattened epithelium, revealed invariable staining patterns. The staining pattern in the epithelium with decapitation secretion and the pseudostratified epithelium was similar to that in the secretory portion including myoepithelial cells and the junction of the excretory ductal portion with the secretory portion, respectively. However, the flattened epithelium, probably due to intraluminal pressure, showed various staining patterns similar to that in each portion of the apocrine gland. Based on the above observations, we confirmed that apocrine cystadeuoma was a complex tumor differentiating into each portion of the apocrine gland, i.e. the dermal duct, the junction of the excretory ductal portion with the secretory portion, and the secretory portion.
The extracellular matrix in skin tumor development – a morphological study
Authors: Stenbäck Frej , Mäkinen Markus J. , Jussila Tommi , Kauppila Saila , Risteli Juha , Talve Lauri , Risteli Leila
Published: August 2006

The development of cancer involves epithelial‐stromal interactions. Alterations in the synthesis and deposition of type I and III collagens are related to the tumor morphology. Skin carcinogencsis in experimental animals provides a reliable model for the development of neoplasia. Ultraviolet (UV) irradiation is the main etiological factor for epidermal dysplasia and malignant tumors in man, but also for dermal degeneration. Non‐neoplastic dermal changes and skin tumors induced by ultraviolet irradiation and 7,12‐dimethylbenz(a)anthra‐cene were investigated in various mouse strains with different susceptibilities to tumor formation. UVB irradiation resulted in an increased immunoreactivity of collagens in the dermis, in comparison with 7,12‐dimethylbenz(a)anthxacene. Increased synthesis and deposition of type I and III collagens were found in the stroma adjacent to benign alterations. In well‐differentiated squamous cell carcinomas, a similar induction of collagen synthesis and deposition was observed. The destruction of fibrillary structures was more pronounced during the decrease of differentiation from moderately to poorly differentiated squamous cell carcinomas. Anaplastic carcinomas with spindle cell morphology displayed a delicate meshwork of reticular fibers and collagen III, and abnormal expression of mRNA for collagens in some malignant cells with epithelial characteristics. The underlying stroma reacts to the development of epithelial tumors in a reproducible way, which is related to the carcinogenic agent involved.
Granular parakeratosis – a unique acquired disorder of keratinization
Authors: Metze D. , Rütten A.
Published: August 2006

Axillary granular parakeratosis is a recently described condition presenting with erythematous hyperkeratouc papules and plaques. We report on nine women and one man with eruptions not only localized to the axillae. Biopsy specimens were investigated by histology, immunohistochemistry, electron microscopy, immuno‐electron microscopy, and in situ hybridization. In general, the epidermis was hyperplastic and showed a well preserved stratum granulosum. In the upper dermis a discrete perivascular CD4+ T‐cell infiltrate was found, CD1 + dendritic cells were absent from the epidermis. The distribution pattern of the epidermal keratins (keratin 5/14, 1/10) and the expression of involucrin was regular. The horny layer was excessively thickened and parakeratotic. The nuclear remnants showed marginal chromatin condensation and were reactive for the nick‐end labeling technique using TdT‐mediated dUTP‐biotin. The eorneocytes were characteristically replete with basophilic granules which showed both ultrastructural features of keratohyalin granules and immunoreactivity for filaggrin. Loricrin was expressed irregularly in small L‐granules. Granular parakeratotic cells revealed regular development of a cornified envelope while cell membranes and desmosomes remained undegraded. In conclusion, our studies on granular parakeratosis suggest a basic defect in processing of profilaggrin to filaggrin that results in a failure to degrade keratohyalin granules and to aggregate keratin filaments during cornification. Associated abnormalities of the cell surface structures and dysregulation of cornified envelope components may account for the retention hyperkeratosis. Further studies are necessary to clarify the etiology of this unique, acquired disorder of keratinization that localizes to intertriginous areas and body folds.