bluuebunny/crossref_metadata_2025 huggingface dataset:
Lysozyme in abnormal dermal elastic fibers of cutaneous aging, solar elastosis and pseudoxanthoma elasticum
Authors: Albrecht S. , From L. , Kahn H. J.
Published: April 2006

Staining of elastic fibres with antilysozyme antibodies has been noted previously. In this study, we examined the staining pattern of dermal elastic fibres in aging, solar elastosis, and lesional skin of pseudoxanthoma elasticum (PXE) using an antibody to lysozyme and the indirect‐peroxidase technique. To assess the effects of aging, sun‐protected skin (buttock) from a younger and an older group of patients was used. Sun damage was studied in skin specimens from varying sun‐exposed body regions (trunk; head and neck). No staining was seen in sun‐protected skin from younger individuals, whereas sun‐protected skin from older persons had scattered positive fibres. Solar elastotic material was intensely positive and the number of positive fibres appeared to correlate with the amount of sun damage. Abnormal elastic fibres in PXE also stained positively, but less intensely, than fibres in solar elastosis. This study shows that changes in the elastic fibres due to degenerative processes or genetic factors results in altered antigenic expression of the fibres. This may be an epiphenomenon secondary to changes in proteoglyeans, which are known to occur with solar elastosis and PXE, or may represent an adaptive phenomenon to maintain the elastic properties of the altered fibres or to decrease their antigenicity.
Alopecia syphilitica, a simulator of alopecia areata: histopathology and differential diagnosis
Authors: Lee J. Yu‐Yun , Hsu Ming‐Long
Published: April 2006

Alopecia syphilitica (AS) may be “moth‐eaten” or diffuse, clinically, and be confused with alopecia areata (AA) or other alopecias. The English language literature contains scant information regarding the histopathology of AS, and the resemblance between AS and AA has not been given adequate recognition. We report the histopathological findings of AS from nine patients with secondary syphilis and acute hair loss. The alopecia was moth‐eaten in four patients and diffuse, but slightly moth‐eaten, in five. Microscopically, the dermoepidermal interface was not involved. The numbers of hair follicles were diminished, with increased numbers of catagens and telogens. Lymphocytic infiltration was present around the hair bulbs and fibrous tracts in eight cases. Plasma cells were present in four biopsies. Other less common findings included lymphocytes in the isthmus, parabulbal lymphoid aggregates, and granulomatous infiltrate in the upper dermis. The findings, save for the follicular changes, resembled those of macular/maculopapular syphilides outside the scalp. With the follicular changes, the overall patterns resembled AA closely. The modified Steiner stain did not reveal spirochetes in any of our cases and failed to differentiate between AS and AA. Comparing the AS cases to 13 cases of AA, we found only a few differentiating features. The presence of peribulbal eosinophils strongly suggests AA. Without peribulbal eosinophils, the presence of plasma cells, abundant lymphocytes in the isthmus, or parabulbal lymphoid aggregates suggests AS.
Lymphoepithelioma‐like carcinoma of the skin with adnexal differentiation
Authors: Wick Mark R. , Swanson Paul E. , LeBoit Philip E. , Strickler John G. , Cooper Philip H.
Published: April 2006

Lymphoepithelioma‐like carcinoma of the skin (LELCS) is a recently‐described tumor entity with a microscopic resemblance to undifferentiated carcinoma of the nasopharynx. Only five cases of this lesion have been reported heretofore. We document three additional examples of LELCS that were composed of clustered dermal arrays of cytologically malignant, mitotically active polygonal cells, without connections to the overlying epidermis or skin appendages. Chronic inflammatory cells were interspersed throughout each of the tumors. Two of them demonstrated multiple foci of trichilemmal‐type keratinization among the neoplastic cells, whereas the other exhibited focal eccrine ductal or glandular differentiation. None of the neoplasms was found to contain nucleic acid of Epstein‐Barr virus by in situ hybridization. It is postulated that LELCS represents a primitive cutaneous appendage tumor. Based on the results of a prior publication and those of the current assessment, this neoplasm is thought to have the potential for both sweat glandular and follicular differentiation.
Epidermolytic acanthoma does not contain human papillomavirus DNA
Authors: Leonardi C. , Zhu W. , Kinsey W. , Penneys N.S.
Published: April 2006

The histologic changes of epidermolytic acanthoma can mimic those of human papillomavirus infection. Sections from paraffin‐embedded tissues identified histologically as epidermolytic acanthoma were examined for the presence of human papillomavirus (HPV) types 6, 11, 16, 18, and 33 using the polymerase chain reaction followed by dot‐blot analysis with specific radiolabelled detecting probes. Although present in appropriate controls, human papillomavirus DNA was not detected in epidermolytic acanthoma. We conclude that epidermolytic acanthoma is not a skin lesion that is associated with human papillomavirus infection.
Hyalohyphomycosis masquerading as squamous cell carcinoma
Authors: Griffin T. D. , McFarland J. P. , Johnson W. C.
Published: April 2006

A case of primary cutaneous hyalohyphomycosis in a healthy individual is presented. The initial clinial impression was kerato‐acanthoma or squamous cell carcinoma. Upon excision, the lesion proved to be an example of cutaneous hyalohyphomycosis due to an unidentified, non‐pigmented fungal organism. The lesion was completely excised, and the patient was treated with saturated solution of potassium iodide. To date, there has been no evidence of recurrence. The clinical, histologic and mycologic aspects of hyalophyphomycosis are discussed.
Epidermotropic neuroendocrine carcinoma
Authors: Gillham S. L. , Morrison R. G. , Hurt M. A.
Published: April 2006

Epidermotropic neuroendocrine carcinoma (NEC) is rare. Based on such a case in an 88‐year‐old woman with a facial NEC showing epidermotropism with a pagetoid growth pattern, we asked whether several similar tumors involving the epidermis could be easily differentiated by immunohistochemical methods. We constructed a panel of control cases (2 each) for NEC, clear cell Bowen's disease (CCBD), Paget's disease (PD), superficial basal cell carcinoma (SBCC), cutaneous T‐cell lymphoma (CTTL), and superficial spreading malignant melanoma (SSMM) to compare with our patient. A panel of antibodies including epithelial membrane antigen (EMA), neuron specific enolase (NSE), AE1/3 cytokeratin (CK), carcinoembryonic antigen (CEA), leukocyte common antigen (LCA), S‐100, and HMB‐45 were applied. Cutaneous NEC controls and our patient's tumor were strongly positive for EMA and NSE and had paranuclear dot‐like cytoplasmic positivity for CK. CCBD was moderate to strong for CK. PD was strong for CEA. SBCC was essentially negative for all. CTTL was strong for LCA. SSMM was strong for S‐100 and HMB‐45. Controls were either negative or weak for the antibodies not mentioned. We conclude that this antibody panel can reliably differentiate these epidermotropic or juxtaepidermal tumors in diagnostic dermatopatholpgy and should be applied to lesions requiring separation beyond H&E capabilities, especially with superficial shave biopsies showing small cell “Pagetoid” growth patterns.
Proliferating trichilemmal cyst with apocrine‐acrosyringeal and sebaceous differentiation
Authors: Sakamoto F. , Ito M. , Nakamura A. , Sato Y.
Published: April 2006

An adnexal tumor on the scalp of a 74‐year‐old woman is described. Histologically, the tumor was composed of cystic structures showing typical trichilemmal keratinization. The tumor cells in the cyst walls often formed duct‐like or squamous eddy‐like structures and occasionally showed vacuolation or poromalike change. Ultrastructurally, some tumor cells showed differentiation either toward the acrosyringium or sebaceous cells. From these findings, the present tumor is considered to differentiate toward various parts of the hair follicle including infundibulo‐isthmus epithelium, apocrine acrosyringium, and sebaceous cells.
Rudimentary meningocele of the skin
Authors: Marrogi A. J. , Swanson Paul E. , Kyriakos Michael , Wick Mark R.
Published: April 2006

Although “rudimentary meningocele” (RM) or “meningothelial hamartoma” of the skin is a seemingly recently described entity, it has been included in past reports as a variant of primary cutaneous meningioma. We document our experience with four such lesions and compare the histologic and immunohistochemical features of these cases with those of seven classic meningoceles (CM) and four giant cell fibroblastomas (GCF). Although all of these entities share significant points of microscopic similarity, RM and CM are lesions composed of meningothelial cells, whereas GCF is probably of myofibroblastic origin. Rudimentary and classic meningoceles demonstrate cellular immunoreactivity for vimentin and epithelial membrane antigen, whereas the cells of GCF lack the latter determinant and may express muscle‐specific actin. Our observations suggest that RM and CM represent closely related developmental malformations; however, RM becomes clinically apparent in a somewhat older patient population than CM and is not associated with major skeletal anomalies as may be found with CM. The distinction between various cutaneous meningothelial proliferations has prognostic importance, as does their separation from GCF. RM and CM are adequately treated by simple excision, whereas GCF, a probable form of fibromatosis, has the potential for local recurrence.
Trichilemmomas are not associated with human papillomavirus DNA
Authors: Leonardi C. L. , Zhu W. Y. , Kinsey W. H. , Penneys N. S.
Published: April 2006

Trichilemmoma is considered a benign neoplasm derived from the outer root sheath of the hair follicle. Although the histogenesis of the lesion is unknown, a relationship between human papillomavirus (HPV) infection and development of these tumors has been suggested on morphologic observations. In order to determine whether HPV is, in fact, present in these lesions, we have analyzed sections from 25 formalin‐fixed, paraffin‐embedded trichilemmomas for the presence of occult HPV DNA using ultrasensitive DNA amplification technology. Under carefully controlled conditions normally effective in detecting HPV from condyloma or verrucae, we were unable to detect an HPV‐induced amplimer in agarose gels or their corresponding Southern blots using radiolabeled probes. Our results do not support the hypothesis that trichilemmomas arise from HPV infection.
Keratinocyte expression of CD36 antigen in benign and malignant epidermal cell‐derived tumours
Authors: Allen M. H. , Barker J. N. W. N. , MacDonald D. M.
Published: April 2006

Keratinocytes express the macrophage/monocyte antigen CD36 in a variety of inflammatory cutaneous diseases characterised by a T lymphocyte rich infiltrate. Since cell‐mediated immune mechanisms also play a role in host responses to skin tumours, we investigated the presence of CD36 antigen on keratinocytes in a range of epidermal cell‐derived benign and malignant tumours characterised by a peritumoural, dermal lymphocytic infiltrate. Frozen tissue sections of lesional tissue from a range of epidermally derived tumours were labelled with antibodies to CD1a, CD11b, CD36, and HLA‐DR antigens. Benign and malignant squamoproliferative tumour cells exhibited a spectrum of CD36 expression, whereas those of basal cell origin were consistently CD36−. Suprabasal expression of CD36 was present in the normal perilesional epidermis of all tumours studied including basal cell carcinoma. Keratinocyte CD11b expression was not observed. The widespread presence of keratinocyte CD36 positivity in squamoproliferative, but not basal epidermal, tumours suggests its expression may be linked to the degree of keratinocyte differentiation. The stimulus for expression is unknown, but the fact that suprabasal perilesional epidermis expressed CD36 strongly in the absence of infiltrate suggests it may represent a non‐specific response by keratinocytes to various stimuli
Sequence analysis of DNA from formalin‐fixed, paraffin‐embedded human malignant melanoma
Authors: Volkenandt M. , McNutt N. Scott , Albino A. P.
Published: April 2006

Direct sequence analysis of in vitro amplified DNA from paraffin‐embedded tissue is a promising new technique useful for detailed molecular analyses of material stored in dermatopathological archives. As only minute amounts of highly damaged DNA can be recovered from paraffin‐embedded sections, sequence analysis of DNA from formalin‐fixed and embedded tissue can result in less clear and readable data. We report here useful modifications that result in clear and readable sequence data. As an example, we detail the detection of a point mutation at codon 61 of the human N‐ras gene in DNA from a formalin‐fixed paraffin‐embedded malignant melanoma specimen. This technique will be of value in many areas of molecular dermatopathology.
Immunohistochemical studies on the localization of fetal antigen 2 (FA2), laminin, and collagen type 4 in basal cell carcinoma
Authors: Rasmussen H. Boje , Teisner B. , Andersen J. A. , Brandrup F. , Purkis T. , Leigh I.
Published: April 2006

The localization of fetal antigen 2 (FA2), a recently described basement membrane (BM) associated antigen, was studied by immunohistochemical techniques in 21 basal cell carcinomas (BCC). In both superficial and infiltrating BCC, FA2 was located in a broad diffuse band around the tumor elements and in close contact with the BM. Compared to normal skin, a more extensive distribution of FA2 was seen in BCC. In the infiltrating BCC, FA2 staining was also present in the interstitial stroma between the tumor islands. FA2 was absent in areas with inflammatory cell infiltrates and elastoid degeneration. Epithelial and tumor cells were FA2 negative. The distribution of FA2 was clearly different from that of laminin and collagen type 4. Collagen type 4 and laminin were present as a continuous linear band corresponding to the BM surrounding the tumors. The close contact to the BM and the increased content of FA2 in the reactive stroma around BCC suggest that FA2 is involved in the matrix and/or BM changes taking place during tumor growth and invasion.
An ultrastructural comparison of dermo‐epidermal separation techniques
Authors: Willsteed E. M. , Bhogal B. S. , Das A. , Bekir S. S. , Wojnarowska F. , Black M. M. , Mckee P. H.
Published: April 2006

Dermo‐epidermal separation through the lamina lucida is an essential technique for immunoblotting studies and for the diagnostic immunofluorescence of autoimmune bullous diseases. The most widely used methods of producing skin separation in the laboratory are suction blister induction and incubation in 1 molar sodium chloride. More recently the use of a proteolytic enzyme, thermolysin, has been described for this purpose. We examined the electron microscopic appearance of five suction blisters, five skin specimens separated by 1 M NaCl, and five treated with thermolysin. Both suction blister formation and treatment with 1 M NaCl resulted in a clean separation through the lamina lucida in all specimens examined. However specimens treated with thermolysin developed intra‐epidermal separation in four cases without any lamina lucida separation in three. Suction blister formation was associated with hemidesmosome disruption. Incubation in 1 M NaCl remains the most reproducible, convenient, and reliable method of producing dermo‐epidermal separation in the laboratory.

Willsteed EM, Bhogal BS, Das A, Bekir SS, Wojnarowska F, Black MM, Mckee PH. An ultrastructural comparison of dermo‐epidermal separation techniques.
Fixed drug eruptions: evidence for a cytokine‐mediated process
Authors: Smoller Bruce R. , Luster Andrew D. , Krane Jeff F. , Krueger James , Gray Mark H. , McNutt N. Scott , Hsu Amy , Gottlieb Alice B.
Published: April 2006

Fixed drug eruptions (FDE) are immunologic reactions to drugs which produce erythematous plaques or blisters that characteristically recur at the same cutaneous sites with repeated anti‐genie challenges. While a detailed pathogenesis of these lesions remains obscure, T‐lymphocyte infiltration has been documented repeatedly. In this study, we tried to determine if FDE were mediated, at least in part, by cytokines, such as gamma‐interferon. We examined biopsies from 6 cases of clinically well‐documented FDE with an HLA‐DR antibody, LN3, and an antibody to gamma IP‐10 (IP‐10), a protein expressed by keratinocytes, monocytes, lymphocytes and endothelial cells following exposure to gamma‐interferon. We found staining of the dermal lymphocytes with anti‐HLA‐DR antibody in all 6 cases examined. Keratinocytes and endothelial cells showed only focal staining at the antibody concentrations used. In addition, there was keratinocyte staining with the IP‐10 antibody at all levels of the epidermis, with accentuation in areas of blister formation. There was more intense staining of keratinocytes with the IP‐10 antibody in cases with accumulations of HLA‐DR positive lymphocytes in the dermis. We believe that these findings are consistent with the hypothesis that FDE represent cell‐mediated immunologic responses to a variety of antigens, and further, that the histologic alterations can be explained, at least in part, by a cytokine‐mediated process.
Majocchi's granuloma
Authors: Smith K. J. , Neafie R. C. , Skelton H. G. , Barrett T. L. , Graham J. H. , Lupton G. P.
Published: April 2006

Majocchi's granuloma (nodular granulomatous perifolliculitis) is a well recognized but uncommon infection of dermal and subcutaneous tissue by fungal organisms (dermatophytes) usually limited to the superficial epidermis. The organism usually associated with Majocchi's granuloma is Trichophylon rubrum; however, other dermatophytes including T. mentagrophytes (variety granulosum), T. epilans, T. violaceum, M. audouinii, M. gypseum, M. ferrugineum, and M. canis may be the causative agent. A review of 17 cases revealed not only the variety of possible organisms but also a marked variation from the usual hyphal forms. The morphologic variations including yeast forms, bizarre hyphae, mucinous coatings, and the Splendore‐Hoeppeli phenomenon may be factors which allow the dermatophytes to persist and grow in an abnormal location. Also, there is evidence that Majocchi's granuloma may occur in two distinct groups of patients.
Endothelial expression of intercellular adhesion molecule (ICAM‐1) is unaffected by marrow aplasia‐inducing chemotherapy
Authors: Horn Thomas D. , Kerker Barbara J. , Karp Judith E. , Burke Philip J. , Hood Antoinette F.
Published: April 2006

Sequential skin biopsies were obtained from five patients receiving chemotherapy for acute myelocytic leukemia. The first specimen was taken on the fourth day of initial chemotherapy and subsequent specimens were obtained at weekly intervals thereafter, until discharge. In all cases, clinically normal skin was selected as the biopsy site. A panel of monoclonal antibodies was applied to frozen tissue sections, including anti‐intercellular adhesion molecule‐1 (ICAM‐1), anti‐lymphocyte function‐associated antigen‐1 (LFA‐l), and anti‐HLA‐DR. Bound antibody was detected using the avidin‐biotin complex method. Endothelial cell expression of ICAM‐1 and lymphocyte expression of LFA‐1 were unaffected over the course of the ensuing, profound marrow aplasia. This finding suggests that this mechanism of lymphocyte trafficking in the skin remains operational despite the administration of antileukemic agents.
Ultrastructural effects of UVB radiation and subsequent retinoic acid treatment on the skin of hairless mice
Authors: Feldman Dorothy , Bryce Graeme F. , Shapiro Stanley S.
Published: April 2006

The infrastructure of hairless mouse skin exposed to UVB radiation and followed by retinoic acid treatment was studied to identify alterations induced in both epidermis and dermis. Female mice were irradiated 3 times weekly for 5–6 months; a group of these mice was then treated topically 3 times weekly for 10 weeks with either 25 μg all‐trans‐retinoic acid dissolved in acetone or with acetone alone. Age‐matched, unexposed, untreated mice served as controls. Cutaneous changes induced by UVB radiation included keratinocyte mitochondrial inclusions often accompanied by damaged cristae, duplication of basement membrane, increased number of dermal fibroblasts, inflammatory cells and elastic fibers, and abnormal elastic fibers. Subsequent retinoic acid treatment resulted in more prominent mitochondrial inclusions which sometimes coalesced to form irregular contoured bodies. Also observed were lipid droplets in the stratum corneum, glycogen deposits in keratinocytes and granular material in dilated keratinocyte endoplasmic reticulum. Poorly differentiated epidermis with necrotic or apoptotic cells was present in some specimens. Elastic fibers were fewer and usually morphologically normal. Skin exposed to UVB and treated with vehicle appeared similar to control except for the presence of excess basement membrane and occasional small mitochondrial inclusions. Because of the heightened concern regarding UV radiation‐induced damage to the human skin and the current topical use of retinoids, the cutaneous changes described are considered worthy of attention.

Feldman D, Bryce GF, Shapiro SS. Ultrastructural effects of UVB radiation and subsequent retinoic acid treatment on the skin of hairless mice.
Dermatofibrosarcoma protuberans presenting in infancy and childhood
Authors: McKee P. H. , Fletcher C. D. M.
Published: April 2006

Dermatofibrosarcoma protuberans (DFSP) is a not uncommon low‐grade cutaneous sarcoma of uncertain histogenesis, which typically arises in early to middle adult life. Traditionally, it is regarded as extremely uncommon in infants and children, and this diagnosis may therefore easily be overlooked in young patients. Eight such cases (representing 5.9% of the available DFSPs on file) are presented of which two were congenital. Age range at presentation was 14 months to 12 years. Five arose on the trunk. Most had originally been mistaken for unclassified sarcoma, a fibromatosis, or diffuse neurofibroma. The histologic features were entirely comparable to the more usual adult cases except that all had a plaque‐like, rather than nodular, growth pattern. Short‐term follow up has revealed no recurrences. DFSP is not so rare in childhood and warrants wider recognition in order to ensure appropriate treatment.
Morphogenesis of the cornoid lamella: histochemical, immunohistochemical, and ultrastructural study of porokeratosis
Authors: Ito M. , Fujiwara H. , Maruyama T. , Oguro K. , Ishihara O. , Sato Y.
Published: April 2006

To elucidate the morphogenesis of cornoid lamellae (CL) in porokeratosis, skin lesions of three cases of disseminated superficial actinic porokeratosis and a case of linear porokeratosis were examined. By N‐(7‐dimethylamino‐4‐methyl‐3‐coumarinyl)maleimide staining, SH groups were present in the living layer of the epidermis beneath CL and irregularly disappeared at the bottom of CL, whereas SS linkages appeared in dyskeratotic cells in the living layer and in the irregularly shaped cell membranes of the horny cells. Epidermis beneath CL showed an increased and irregular involucrin expression. Ultrastructurally, the living keratinocytes contained many cytoplasmic vacuoles and had a smaller number of lamellar bodies than normal. Intercellular lamellar sheets were incompletely formed. The dyskeratotic cells and the lower horny cells contained many small vacuoles but formed a marginal band. The horny cells of CL also formed a marginal band and, further, a keratin pattern. CL may be formed by hyperproliferative atypical kertatinocytes which keratinize rapidly and irregularly and show defective desquamation due to the paucity of intercellular lamellar sheets.
Analysis of HMB‐45 immunoreactivity in common and cellular blue nevi
Authors: Wood W. S. , Tron V. A.
Published: April 2006

HMB‐45 is generally thought of as a melanoma specific antibody; however, there are certain exepdons. It is known that most dermal nevi show no reactivity; however, the dermal nevus component within dysplastic nevi and certain Spitz nevi show positive reactivity. In order to further examine this observation, we undertook a study to examine blue nevi, both common and cellular, for the expression of HMB‐45. Cases were stained with antibodies directed at both HMB‐45 and SI00 protein. Of 16 common blue nevi studied, 14 were positive with HMB‐45, as were 6 of 6 cellular blue nevi. Staining for HMB‐45 was quite variable in intensity amongst cases labelled common blue nevi. In contrast, cellular blue nevi were uniformly strongly positive. It is therefore concluded that blue nevi, including cellular blue nevi, exhibit an activated phenotype as demonstrated by HMB‐45 reactivity.
Keratoacanthoma within a superficial spreading malignant melanoma in situ
Authors: Yus E. Sánchez , Requena L.
Published: April 2006

A case of a keratoacanthoma arising from the center of a superficial spreading malignant melanoma in situ is presented. The keratoacanthoma already showed regressive changes in its central area, and the superficial spreading malignant melanoma had partially disappeared at the site in which the keratoacanthoma had arisen. The possible mechanisms of these interactions are discussed.
Pigmented purpuric eruptions: immunopathologic studies supportive of a common immunophenotype
Authors: Smoller Bruce R. , Kamel Onsi W.
Published: April 2006

Traditionally, the pigmented purpuric eruptions (PPE) have been subdivided into four histologic categories, based upon variations in histologic pattern and clinical morphologies. In recent years, it has become apparent that the lesions behave similarly, and this family of eruptions has become grouped under the term PPE. The pathogenesis of these eruptions is largely unknown. In this study, we examined 13 examples of the histologic and clinical subtypes of the PPE with a panel of hematolymphoid immunophenotypic markers, in hopes of better understanding the pathogenesis of these curious eruptions. All lesions examined showed a predominantly T cell infiltrate composed of a mixture of OPD4 (CD4) positive and OPD4 negative cells. B cells were rare. Macrophages did not comprise a significant component of the infiltrate. The staining pattern was relatively constant, independent of the histologic pattern (i.e., Schamberg's vs. Gougerot‐Blum, etc) of the PPE. Our results suggest that PPE are a group of related eruptions which may have a common pathogenesis. It seems likely that the vascular damage and erythrocyte extravasation are secondary to a localized cell‐mediated immunologic event.
Necrotizing eccrine squamous syringometaplasia presenting as acral erythema
Authors: Rongioletti F. , Ballestrero A. , Bogliolo F. , Rebora A.
Published: April 2006

Acral erythema (AE) and eccrine squamous syringometaplasia (ESS) are distinctive clinico‐pathological entities described in patients receiving chemotherapy for malignancies, mainly myelogenous leukemia. In no case of chemotherapy‐induced AE have histopathologic changes of ESS been described. We report a patient with acute myelogenous leukemia who had typical AE due to cytarabine with histopathologic ESS. The latter findings in a case of AE may be a useful diagnostic clue for distinguishing chemotherapy‐induced AE from palmo‐plantar erythema of graft‐vs‐host reaction.
A new type of connective tissue nevus: isolated exophytic elastoma
Authors: Fork Heather E. , Sanchez Ramon L. , Wagner Richard F. , Raimer Sharon S.
Published: April 2006

An unusual case of isolated exophytic elastic tissue nevi in the scrotal region of a 64‐year‐old man is described. The histological and ultrastructural findings were those of abundant abnormal elastic fibers and increased reticulin in the dermis. This hamartomatous lesion possesses clinical and histological features previously undescribed in connective tissue nevi.
Juxta‐clavicular beaded lines: a subepidermal proliferation of sebaceous gland elements
Authors: Finan Marian C. , Apgar J. Thomas
Published: April 2006

Juxta‐clavicular beaded lines typical arise at puberty as an asymptomatic, linear papular eruption involving the neck and supraclavicular areas. This entity appears to be more common in blacks than Caucasians, and a female predominance has been noted. Microscopically, the papules noted clinically appear secondary to sebaceous gland hyperplasia, which is particularly prominent in the immediate subepidermal zone. Mild papillated epidermal hyperplasia may be observed. Whereas many regard this entity as an anatomic variant of normal, it may be confused clinically and histologically with a number of pathologic processes. A case of juxtaclavicular beaded lines in a 14‐year‐old Caucasian girl is presented.
Cutaneous lesions of listeriosis in a newborn
Authors: Smith Kathleen J. , Skelton Henry G. , Angritt Peter , James William D. , Yeager Josef , Wagner Kenneth
Published: April 2006

Although HIV‐infected patients are commonly infected by organisms that require an intact T cell immune system for control or eradication, there are some exceptions. The intracellular pathogen Listeria monocytogenes is one such organism. Listeriosis occurs primarily in neonates, elderly patients, patients on immune suppressive medications, cancer patients, and during pregnancy. However, listeriosis is an uncommon opportunistic infection in HIV‐infected patients. We report a case of listeriosis with cutaneous lesions in a neonate born to an HIV‐infected woman.
HMB‐45 monoclonal antibody recognizes an inducible and reversible melanocyte cytoplasmic protein
Authors: Smoller B. R. , Hsu A. , Krueger J.
Published: April 2006

HMB‐45 is a monoclonal antibody directed against human melanoma cells and which stains epidermal and dermal melanoma cells, the junctional components of common and dysplastic mel‐anocytic nevi, and melanocytes in fetal skin. In addition, melan‐ocytes in a variety of reactive conditions have been shown to label with HMB‐45, as have dermal melanocytes within Spitz and dysplastic nevi. No melanocytes in normal adult epidermis or in the dermis of common nevi have stained with HMB‐45. In order to better understand the properties of this antibody, and of the melanocytes that react with it, we stained cultured human melanocytes grown in a variety of conditions. Melanocytes from human foreskins were grown for 2–3 weeks in MCDB 153 medium supplemented with insulin, epidermal growth factor, and bovine pituitary extract as a mixed population of keratinocytes and melanocytes. Some cells were transferred to basal medium MCDB 153 (unsupplemented) for periods ranging from 3–5 days, and a subset of these were returned to growth‐factor supplemented medium. In all cases, SI00 staining was used to confirm the presence of melanocytes. Melanocytes grown in complete medium showed strong granular cytoplasmic staining with HMB‐45. Cells transferred to basal medium showed a markedly diminished staining intensity which was reversible within 3 days upon return of the cells to complete medium. The findings suggest that expression of the protein recognized by HMB‐45 may be related to a growth factor present in complete medium, but missing from basal MCDB 153. Additional studies, supplementing medium with phorbol esters, markedly enhanced HMB‐45 staining and essentially removed keratinocytes from cell cultures. As determined by measurement of melanocyte proliferation, staining of HMB‐45 did not correlate with mitogenic activation but may correlate with biochemical activation by specific growth factors.
Neonatal lupus erythematosus syndrome
Authors: Maynard B. , Leiferman K. M. , Peters M.S.
Published: April 2006

Three cases of neonatal lupus erythematosus (NLE) syndrome are described. The key diagnostic sign is the erythematous and annular clinical appearance of lesions. The histopathologic findings may be subtle in NLE syndrome compared with discoid or subacute cutaneous lupus erythematosus. Direct immunofluo‐rescence testing may be useful in supplementing the histopathologic evaluation. Detection of immunoglobulins, complement, or both at the basement membrane zone in lesional skin by immunofluorescence occurs in approximately half of cases; a negative study does not preclude the diagnosis of NLE syndrome. Clinical and serologic evaluation of both the infant and the mother are important in establishing a diagnosis of NLE syndrome, particularly when histopathologic findings are subtle.
Cell cycle analysis by flow cytometry of non‐exposed, sun‐exposed, and tretinoin‐treated skin
Authors: Nedorost Susan T. , Bergfeld Wilma F. , Valenzuela Rafael , Guitart Joan , Fleming Matthew G.
Published: April 2006

The percentage of keratinocytes in the proliferative phase of the cell cycle (S + G2+ M) was measured by DNA How cytometry in sun‐exposed, non‐exposed, and tretinoin‐treated skin. Before tretinoin treatment, the percentage of keratinocytes actively cycling was higher in sun‐exposed than in non‐sun‐exposed skin (p = .002) and was correlated with clinically assessed photo‐damage (p = .007). Subsequently, tretinoin‐treated sun‐exposed skin was compared to the pre‐treatment sun‐exposed skin. Overall, there was no statistically significant change. However, there was a trend toward a decrease1 in the percentage of keratinocytes in the S + G2+ M phases immediately after four months of tretinoin us that was limited to the most severely damaged patients. This effect was no longer evident two months after discontinuing treatment. This is the first study, to our knowledge, utilizing flow cytometry to investigate the effects of tretinoin in patients with varying degress of photodamage.
Alpha‐6 (CD 49f) integrin expression in genetic and acquired bullous skin diseases
Authors: Kanitakis J. , Zambruno G. , Vassileva S. , Giannetti A. , Thivolet J.
Published: April 2006

Bullous pemphigoid (BP) antigen and α6 integrin are hemidesmosome‐associated glycoproteins of basal keratinocytes. In this work, the immunoreactivity of antibodies to BP and to α6 in salt‐ or dispase‐split human skin, and in 46 biopsy specimens of various genetic and autoimmune bullous dermatoses taken from various body sites, was studied by double‐labeling immunofluorescence. In all specimens, both antigens localized at the same side of the blisters observed, i.e. the roof of the bulla in cases with a junctional or hemolytic cleavage, or the floor of the blister in those with intraepidermal cleavage. Immunostaining for α6 was strong and present in all specimens studied, whereas the one obtained with the BP serum was absent from some specimens. These results show that the BP antigen and the α6 integrin colocalize at the level of cleavage in bullous diseases; however, the more consistent and reproducible reactivity obtained with the anti‐α6 antibody suggests that this should be preferentially used in the immunohistochemical investigation of bullous dermatoses.
Mitten deformity in severe generalized recessive dystrophic epidermolysis bullosa: histological, immunofluorescence, and ultrastructural study
Authors: McGrath J. A. , O'Grady A. , Mayou B. J. , Eady R. A. J.
Published: April 2006

Light and electron microscopy and indirect immunofluorescence techniques were used to study the nature of the mitten deformity in live adult patients with severe generalized recessive dystrophic epidermolysis bullosa undergoing release of hand and finger contractures. Although the mitten appeared largely to be clinically separated from the underlying fixed digits, histology showed mostly normal keratinocytes beneath a thickened stratum corneum. The lower margin of the milieu was formed just below the lamina densa of the basement membrane, at a level similar lo dial of the usual blister formation in this condition. No anchoring fibrils and only a few distinct dermal structures were noted. A substantial portion of the mitten, however, consisted of necrotic keratinocytes without an intact basement membrane. This finding suggests that the mitten is not suitable for use as an epidermal autograft and confirms the rationale for taking split thickness skin grafts to close skin defects in patients with recessive dystrophic epidermolysis bullosa undergoing plastic surgery.
Image analysis of Stage 1 melanoma (1.00–2.50 mm): lymphocytic infiltrates related to metastasis and survival
Authors: Pastorfide G. C. , Kibbi A.‐G. , de Roa A. L. , Barnhill R. L. , Sober A. J. , Mihm M. C. , Byers H. R.
Published: April 2006

Image analysis of histologic sections of II patients with clinical Stage 1 melanoma, 1.00 mm – 2.50 mm, who developed metastasis, was done to determine the significance of lymphocytic infiltrates relative to metastasis and survival. An ago, sex, site, and thickness matched control group of non‐metastasizing clinical Stage 1 melanoma revealed no significant difference in the lymphocytic infiltrate parameters from the metastasizing group with the exception of the ratio of lymphocyte infiltrate width lo the tumor width (p = 0.003). Increased lymphocytic infiltrates within the tumor and subjacent lo its base significantly correlated with delayed lime to metastasis (p = 0.014 and p < 0.001, respectively) and longer survival period (p = 0.045 and p < 0.001, respectively). Lymphocytic infiltrate area at the tumor base in relation to tumor area was of prognostic value: the larger the ratio, the greater the time interval from metastasis to death (p = 0.008).
Oral submucosal dendrocytes: factor XIIIa+ and CD34+ dendritic cell populations in normal tissue and fibrovascular lesions
Authors: Regezi Joseph A. , Nickoloff Brian J. , Headington John T.
Published: April 2006

Factor XIIIa+ and CD34+ dendritic cells, believed to be subsets of monocyte/macrophages, have been identified in dermis and in dermal tumors. The purpose of this study was to determine the presence and distribution of analogous cell types in oral sub‐mucosa and oral fibro‐vascular lesions. Antibodies to XIIIa, CD34, S‐100 protein, and macrophage antigen (MAC 387) were tested on formalin‐fixed, paraffin‐embedded tissue sections from normal mucosa, peripheral fibroma (PF), peripheral ossifying fibroma (POP), peripheral giant cell granuloma (PGCG), pyogenic granuloma (PG), lymphangioma (La), benign fibrous histiocytoma (BFH), idiopathic histiocytosis (IH), angiofibroma (Af) using an ABG immunoperoxidase technique. Numbers of positively stained cells were compared to unstained cells in the tumors. XII la positive submucosal dendrocytes (GD34‐, S‐100‐, MAC 387‐) were found in abundance in normal tissue in characteristic distributions: collagen‐associated, vessel‐associated, and lymphoid‐associated. The percentage of XIIIa+ cells in the oral tumors was as follows: PF: 10–30%, POF: 5–10%, PGCG: 0–5%, PG: 5–20%, La: 0%, BPH: 5–25%, IH: 0%, and Af: 10–20%. CD34+ dendrocytes (XIIIa‐, S‐100‐, MAC 387‐) were few in number and were found in deeper submucosa, especially around skeletal muscle. Other than blood vascular endothehum, CD34+ cells were not generally seen in the oral tumors studied. It is concluded that two previously unrecognized dendrocyte populations reside in normal submucosa. XIIIa+ cells participate in the formation of some oral reactive and neoplastic lesions.
Monoclonal antibody analysis of keratin expression in carcinomas of sweat glands
Authors: Tazawa T. , Ito M. , Fujiwara H. , Imai S. , Akai S. , Niizuma K.
Published: April 2006

Characteristics of keratins of live carcinomas of sweat gland origin were immunohistochemically investigated with several antikeratin monoclonal antibodies with differing specificities. Specimens were obtained from two cases of mucinous carcinoma of the skin, two cases of classic type of eccrine adenocarcinoma, and a case of eccrine porocarcinoma. The tumor cells of mucinous carcinoma expressed only simple epithelial keratins. In a case of eccrine adenocarcinoma, simple epithelial keratin 19 was diffusely expressed. The expression of the other simple epithelial keratins was confined to the luminal cells, whereas the remaining tumor cells further expressed stratified epithelial keratins. Eccrine porocarcinoma and a second case of eccrine adenocarcinoma did not express simple epithelial keratins, although stratified epithelial keratins were diffusely expressed. These data suggest that carcinomas of sweat glands express various combinations of simple and stratified epithelial keratins. Development of additional data along these lines may help to further define their classification.
Simple epithelial cytokeratin‐expression in seborrheic keratosis
Authors: Nindl M. , Nakagawa H. , Furue M. , Ishibashi Y.
Published: April 2006

The cytokeratin expression of seborrheic keratosis was studied by means of immunohistochemistry and compared with that of normal human skin. The following findings were obtained in seborrheic keratosis: (1) a partial lack of high molecular weight cytokeratin (#1/68 kD, # 10/56.6 kD) in all ten cases examined; (2) the detection of cytokeratin typical for simple epithelia (#8/52.5 kD, # 18/45 kD, # 19/40 kD) in eight often cases; and (3) the detection of cytokeratin #5/58 kD in supra‐basal cells in 5 of 10 cases. An immunoelectron‐microscopic investigation, using an anti‐keratin antibody against cytokeratin #19/40 kD, revealed a whirl‐like arrangement of keratin filaments within immunoreactive cells, in contrast to a linear, parallel arrangement in non‐immunoreactive cells. Cells known to express cytokeratin typical for simple epithelia, such as sweat gland cells or Merkel cells, were not observed. The altered cytokeratin gene‐expression in seborrheic keratosis may be attributable to de‐differentiation of tumor cells or potential re‐differentiation towards embryonic keratinocytes.
Cutaneous lymphadenoma with ductal differentiation
Authors: Requena L. , Yus E. Sánchez
Published: April 2006

Cutaneous lymphadenoma (CL) is a recently described neoplasm of unknown histogenesis. Histologically, these tumors typically present as well‐circumscribed nodules with scant or no epidermal connections. They tire composed of multiple rounded lobules of basaloid cells with some degree of peripheral palisading. These epithelial lobules characteristically show a dense lymphoid infiltrate within them. In cases of CL previously described, there was no obvious adnexal differentiation except for isolated cells showing apparent sebaceous differentiation or hints of follicular differentiation. We report two typical cases of CL that were studied histologically and immunohistochemically. In some of the tumor lobules, there were foci of ductal differentiation, with luminal positivity for CEA and EMA. We postulate that some CL represent a form of immature sweat gland tumor with ductal differentiation.
Juvenile colloid milium: clinical, histological and ultrastructural features
Authors: Handfield‐Jones S. E. , Atherton D. J. , Black M. M. , Hashimoto K. , McKee P. H.
Published: April 2006

We report the clinical, histological and ultrastructural features of juvenile colloid milium affecting a brother and sister. In this rare condition, translucent papules develop on sun‐exposed areas of skin, with onset in childhood. Histologically and ultrastructurally, the papules consist of amyloid‐like material derived from epidermal keratonocytes. A review of the literature suggests a possible genetic abnormality that leads to sun‐induced degeneration of keratinocytes.
Vertically growing ectopic nail
Authors: Kato Naoko
Published: April 2006

A 64‐year‐old Japanese woman with an ectopic nail al the palmar lip of the led middle linger is reported. Interestingly, the nail grew vertically to a line horizontal to the surface epidermis. Atypically, it appeared at 60 years of age with no prior injury or trauma to explain inoculation of a nail matrix into the regional skin. Roentgenographically, there were no abnormal findings such as Y‐shaped bifurcation of the distal phalanx of the affected finger. There arc conflicting opinions concerning whether or not a proximal nail fold is critical for the nail lo grow outward instead of upward. Although the present case had a wide proximal nail fold, it did not seem to play its role of compressing and assisting the nail plate to grow outward. Hence, it may be that the absence of a proper nail bed, rather than the absence of a proximal nail fold, promotes upward growth of a nail plate in‐stead of outward growth.
Tricholemmal carcinoma:
Authors: Swanson P.E. , Marrogi A.J. , Williams D.J. , Cherwitz D.L. , Wick M.R.
Published: April 2006

Trieliolemmal carcinoma (TLC) is a cutaneous adnexal tumor with presumed external hair sheath differentiation. In order to better understand the salient features of this neoplasm, we analyzed the histologic and clinical findings in 10 cases of TLC. Eight patients were males, and two were female; they ranged in age from 55–88 years. Each tumor occured in hair bearing, sun‐exposed. skin, and involved the scalp, face, trunk, or upper extremities. The lesions were usually slightly raised, pale tan or reddish, and keratotic; were usually present for less than I year; and measured 0.4–2.0 cm. All of them were treated by wide local excision; neither recurrence nor metastasis was reported after II to 92 months of clinical followup. Histologically, each I LC was composed of a lobular proliferation centered on the pilar apparatus. Cells with glycogen‐rich, mucin‐negative, clear or pale eosinophillic cytoplasm predominated. Brisk mitotic activity (4–39 mitoses per 10 high power fields) was typical. Involvement of the interfollicular epidermis was invariably noted, with superficial alteration in seven tumors. Transitional ones between TLC and the adjacent epidermis were not seen, although pagetoid spread occurred in two examples. Invasion of reticular dermis was present in eight cases, with infiltration to mid‐dermis in live TLC. All tumors exhibited areas of tricholemmal type keratinization; dyskeratotic cells were noted in six examples. Hyperkeratosis and parakeratosis were variably present as well. Actinic damage was a constant feature. Despite local invasion at diagnosis, the clinical course of TLC was indolent in all cases.
Scabietic nodules: a dermatopathologic and immunofluorescent study
Authors: Liu Han‐Nan , Sheu Wen‐Jong , Chu Tel‐Lu
Published: April 2006

Mites and their eggs were thought to be rarely Found in nodular lesions of scabies. However, serial sections from 27 scabietic scrotal papules or nodules revealed mile parts in 22% (6/27). This supports the contention that scabietic nodules may result from persisting antigens of mile parts. In contrast lo previous studies, vasculitis with fibrinoid degeneration was uncommon (3/27) in our series. This discrepancy may be due lo the timing of the biopsies: 2 of 3 eases with vasculitis were associated with diffuse dense infiltration, and vasculitis may be a late event in the development of scabietic nodules. The specificity of immunoreactant deposits along the epidermodermal junction (EDJ) in scabies is controversial. In our study, direct immunofluorescence (DIF) was performed on 13 scabietic nodules. Four (31%) showed immunoreactants at the EDJ and two on blood vessels. Because of the relatively low positive rate, the low intensity of fluorescence, and 3 of 4 cases with positive immunoreactants having only a single class of immunoglobulin, the deposition may only be secondary lo inflammation instead of a specific type II immunologic reaction lo scabies.