bluuebunny/crossref_metadata_2025 huggingface dataset:
Histologic features of cutaneous sinus histiocytosis (Rosai‐Dorfman disease): study of cases both with and without systemic involvement
Authors: Chu Paul , LeBoit Philip E.
Published: April 2006

Sinus histiocytosis with massive lymphadenopathy (Rosai‐Dorfnian disease) is a systemic proliferation of cells that resemble‐ the sinus histiocytes of lymph nodes. Whereas initial reports high‐lighted the often striking cervical adenopathy, more than 40% of patients have extranodal involvement. Cutaneous lesions are (Inmost common form of extranodal disease, but cases that present as cutaneous disease without lymph node involvement are rare. We examined biopsies from three patients with cutaneous lesions of sinus histocytosis, none of whom had detectable systemic involvement, and compared them to those of two patients whose lymph nodes were involved by the disease. The histology of skin lesions in all live cases showed dense nodular or diffuse infiltrates of “hisliocytes,” emperipolesis of lymphocytes, neutro‐phils, and plasma cells. “Histiocytes” were present in lumens of dilated lymphatics. At the peripheries of the lesions were lymphoid aggregates and thick‐walled vessels surrounded by plasma cells. Staining with anti‐S‐100 protein antibody showed marked cytoplasmic positively in the “hisliocytes” in each case. The only features that differed among the two groups were the presence ol pseudoepitheliomalous hyperplasia and infiltrates of eosinophils in one case in which the disease was limited to the skin. We believe that cutaneous sinus histiocytosis can be specifically diagnosed by skin biopsy. Because cutaneous sinus histiocytosis may be unfamiliar to general palhologists, dermatopathologists, and dermatologists, cases limited to the skin may be under‐recognized.
L‐tryptophan syndrome: histologic features of scleroderma‐like skin changes
Authors: Guerin S. B. , Schmidt J.J. , Kulik J. E. , Golitz L. E.
Published: April 2006

The eosinophilia‐myalgia syndrome (EMS) associated with the ingestion of L‐tryptophan (IT) containing products has recently been recognized in the United States. We report the histologic features of the cutaneous scleroclerma‐like changes in four patients. All of the patients met the Center for Disease Control criteria for EMS and had a history of LT ingestion. Skin biopsies showed increased dermal mucin and dermal sclerosis, with trapping of adnexal structures. There are clinical and histologic similarities between EMS, seleroderma, the toxic oil syndrome, and fascilitis with eosinophils.
Unusual variants of pemphigoid: from pruritus to pemphigoid nodularis
Authors: Ross J. S. , McKee P. H. , Smith N. P. , Shimizu H. , Griffiths W. A. D. , Bhogal B. S. , Black M. M.
Published: April 2006

We report three patients with pemphigoid nodularis. Patients were females aged 76, 71 and 50 years, and all had features of billions pemphigoid together with prurigo‐like lesions at some stage of their illness. In two eases, nodular lesions preceded the onset of blistering by some months. Blisters arose on normal skin and in one patient also at sites of prurigo lesions. Routine histology of bullous lesions revealed the presence of subepidermal blisters. Electron microscopy perlormed in two eases confirmed the level of split to be through the lamina lucicla. Direct immunoflourenscence in all eases was positive, with linear basement membrane zone deposition of IgG and G3. Circulating IgG anti‐basement membrane antibody was also detected in all patients, and in two, immunoblotting revealed a single antigen of 220 kD.
Eccrine syringofibroadenoma (Mascaro): an ultrastructural study
Authors: Sueki Hirohiko , Miller Stanley J. , Dzubow Leonard M. , Murphy George F.
Published: April 2006

To confirm the eccrine acrosyringeal differentiation of eccrine syringofibroadenoma (ESFA) and to elucidate the histogenesis of its angiofibrotic stroma, a case of ESFA from a 45‐year‐old man was examined by light and electron microscopy. Histologically, the parenchyma featured anastomosing, slender epithelial cords containing small cuboidal cells and occasional duct‐like structures. The stroma had increased numbers of mast cells, increased capillaries with swollen endothelial cells, and prominent fibrosis. Ultrastructurally, the following findings were characteristic of ESFA: a) abundant glycogen particles in epithelial cells, b) numerous intracytoplasmic and extracellular spaces lined with microvilli, c) intraepithelial duct formation, consisting of microvilli, vesicles, rod‐shaped dense bodies, multivesicular dense bodies, and peripheral network of tonofilaments, and d) large numbers of mast cells, closely associated with fibroblasts, surrounding increased numbers of capillaries containing swollen endothelial cells. These ultrastructural features support the acrosyringeal differentiation of ESFA. We hypothesize that mast cell hyperplasia and degranulation may play an important role in the formation of the angiofibrolic stroma.
Harlequin fetus with abnormal lamellar granules and giant mitochondria
Authors: Hashimoto Ken , Khan Shahida
Published: April 2006

A case of harlequin ichthyosis was studied with electron microscopy From the basal cell to granular cell layers, keratinocytes contained giant mitochondria (860 nm) which exhibited vesicular cristae. Typical lamellar granules were absent; instead, numerous dense cored granules (DCG) and particles containing cored granules (PGG) were produced. Some of these were discharged into the intercellular spaces of granular cells, but the majority failed to be released from the cytoplasm. These retained DCG and PGG coalesced to form large vacuoles and cavities in the stratum corneum. In the hair follicle, keratinized cells failed to loosen and desquamate into the hair canal; instead, they formed concentric keratin rings surrounding hair, a diagnostic feature of this disease. It is suggested that the abnormal lamellar granule underlies the pathogenesis of this disease and that giant mitochondria may be related to an abnormal lipid metabolism of keratinocytes which may ailed lipid composition of lamellar grannies.
Histologic regression in malignant melanoma: an interobserver concordance study
Authors: Kang Sewon , Barnhill Raymond L. , Mihm Martin C. , Sober Arthur J.
Published: April 2006

Histologic evidence for regression as a prognostic indicator in melanoma has shown conflicting results. To assess if melanoma regression is a consistently identifiable histologic feature, an interobserver concordance study was undertaken. Fifty histologic slides of melanoma with Breslow thickness of I mm or less were non‐randomly selected from the Massachusetts General Hospital Melanoma Registry. The selection was in favor of those with regression present in 44 of 50 slides (88%). Two dermatopathologists working independently evaluated a 2 mm wide bracketed area in each tissue section and then the remainder of the non‐bracketed tissue section for regression. Before and after each slide review, the evaluators were required to read criteria for early, intermediate, and late regression explicitly outlined. The overall concordance rate for the presence and absence of regression was 96% (48/50) in the bracketed area and 90% for the outside area. When the group with regression was subdivided into three stages, interobserver agreement fell to 86% for the bracketed, and 66% for the outside area. In at least 30% of cases where regression was detected in the bracketed area, both reviewers observed two or more stages of regression in the remainder of tissue section. Therefore, subdividing the process is impractical and unrealistic. Consistent histologic identification of regression in melanoma requires a simple and systematic approach which should be applied to future studies that include melanoma regression as a prognostic factor.
Cytoskeleton and motility: an immunohistological and computer simulation analysis of melanocytic skin tumors
Authors: Fink‐Puches Regina , Smolle Josef
Published: April 2006

Tumor cell motility and tumor cell proliferation are supposed to be essential for tumor invasion. The cytoskeleton, which consists of different components, is considered to be important for maintaining cell shape and facilitating cell movement. Numerous data are available about tumor cell motility in vitro, but the behavior of tumor cells in vivo is as yet poorly understood. In the present study, estimates of tumor cell motility and proliferation were statistically derived from morphological tumor patterns in human melanocytic skin tumors, and their relationship to expression of certain cytoskeletal components was evaluated. Over‐expression of vimentin within tumor cells correlated with low actual tumor cell motility and proliferation, indicating a structurally stabilizing function of these filaments. An overexpression of actin was found within tumor cells of high motility and proliferation, suggesting the contribution of cytocontractile elements to active tumor cell locomotion in situ. Concerning the cytoskeleton of the stromal cells, expression of actin, myosin and tubulin correlated with a high number of motile tumor cells and high mitotic counts. Thus increased tumor cell motility seems to be associated with cytoskeletal changes not only of the tumor cells themselves but also of the surrounding stromal cells.

Fink‐Puches R, Smolle J. Cytoskeleton and motility: an immunohistological and computer simulation analysis of melanocytic skin tumors.
Histologic features predictive of basal cell carcinoma recurrence: results of a multivariate analysis
Authors: Dixon Anita Y. , Lee Saing H. , McGregor Douglas H.
Published: April 2006

Previous univariate analysis of 30 recurrent and 74 non‐recurrent basal cell carcinomas identified 6 histologic parameters predictive of recurrence: distance to the closest resection margin, growth pattern, shape of cell groups, contour of invading edge, degree of peripheral palisading, and nuclear pleomorphism. Re‐analysis of the data by multivariate analysis to select the few most important independent prognostic variables identified two parameters in each of two final models: resection margin distance and growth pattern (Model 1), and resection margin distance and shape of cell groups (Model 2). Based on these variables, a logistic regression equation could be derived for each model to calculate the predicted probability of recurrence or non‐recurrence.
Degenerative (“ancient”) changes in benign cutaneous schwannoma. A light microscopic, histochemical and immunohistochemical study
Authors: Argenyi Zsolt B. , Balogh Karoly , Abraham Andrew A.
Published: April 2006

We studied the degenerative “ancient” changes in 19 cases of benign cutaneous schwannoma (BCS). Using conventional and immunohistochemical stains, we found (a) degenerative changes in 15 of 19 BCS; (b) prominent vascular abnormalities in 11 of 15 BCS; and (c) cytologic atypia in 15 of 19 BCS, without mitotic figures. We concluded that (1) degenerative, i.e., “ancient” changes are common in BCS and are qualitatively similar to those described in cellular schwannoma; (2) vascular abnormalities may be related to these degenerative changes; (3) cytologic atypia is commonly associated with “ancient” changes in BCS, but BCS is less cellular and has few if any mitotic figures as opposed to cellular schwannomas; and (4) the changes in “ancient” schwannoma do not indicate a “cellular” schwannoma.
Human cell adhesion molecule uvomorulin is differentially expressed in various skin tumors
Authors: Czech W. , Krutmann J. , Herrenknecht K. , Schöpf E. , Kapp A.
Published: April 2006

The cell adhesion molecule uvomorulin is important in cell recognition processes, both during tissue formation in embryonic development and in the maintenance of adult epithelia. In addition, uvomorulin appears to play a crucial role in carcinogenesis. Therefore, in the present study, the expression of uvomorulin in normal human skin and several benign and malignant proliferative skin lesions was evaluated by immunofluorescence microscopy using affinity purified antibodies. In normal human epidermis, basal and suprabasal keratinocytes showed a strong and homogeneous staining of the cell membrane. In contrast, uvomorulin expression was decreased in squamous cell, as well as in solid basal cell, carcinoma. Interestingly, solid basal cell carcinoma showed a dimorphic staining pattern with a reduced fluorescence of the inner cell layers and normal staining of the peripheral basal cells. In contrast, no such dimorphic staining pattern could be observed in squamous cell carcinoma, in which uvomorulin expression was homogeneously reduced. Decreased expression of uvomorulin was not specific for malignant skin lesions, since it could also be observed in condylomata acuminata. These studies demonstrate that human uvomorulin is differentially expressed in proliferative skin disorders, which may account at least in part for the differences observed in the clinical course between squamous cell and basal cell carcinoma.
A combined occurrence of neuroendocrine carcinoma of the skin and a benign appendageal neoplasm
Authors: Yamamoto Osamu , Tanimoto Akihide , Yasuda Hiroshi , Suenaga Yoshinori , Asahi Masakazu
Published: April 2006

A 76‐year‐old Japanese male presented with a subcutaneous nodule in the dorsal cubital region of the right arm. The center of the nodule showed typical features of neuroendocrine carcinoma of the skin. The peripheral portion showed epithelial islands of squamoid cells with horn cysts suggestive of benign appendageal tumor with pilar differentiation. The coexistence of two skin neoplasms in the same lesion would suggest that both tumors developed from common pluripotential stem cell.
Epidermoid cyst of the scalp containing human papillomavirus
Authors: Elston Dirk M. , Parker Lydia U. , Tuthill Ralph J.
Published: April 2006

We report an epidermoid cyst of the scalp with light microscopic and immunohistochemical evidence of human papillomavirus (HPV) infection. Light microscopic features suggesting HPV infection included papillomatosis and hypergranulosis of the cyst lining with the presence of koilocytes. Much of the keratin within the cyst demonstrated parakeratosis. Immunoperoxidase labeling for HPV antigen was noted within koilocytes. Papillomavirus infection has been reported in plantar epidermoid cysts. To our knowledge, this is the first report of a papillomavirus‐infected epidermoid cyst in a site other than plantar skin. Light microscopic features of our cases differed from those of the plantar cysts. Epidermoid cysts may be induced by the papillomavirus or the virus may merely infect pre‐existing cysts.
Paraneoplastic pemphigus: a subset of patients with pemphigus and neoplasia
Authors: Mehregan Darius R. , Oursler Judith R. , Leiferman Kristin M. , Muller Sigfrid A. , Anhalt Grant J. , Peters Margot S.
Published: April 2006

We reviewed the clinical, histologic, and immunofluorescence features of 20 patients with pemphigus and neoplasia and compared them will a control group of 17 patients with pemphigus without neoplasia. Patients with neoplasia were divided according to clinical, histologic, and immunofluorescence findings into those with paraneoplastic pemphigus syndrome (12 patients) and those with classic pemphigus vulgaris or pemphigus foliaceus with neoplasia (8 patients). The histologic findings in patients with paraneoplastic pemphigus included acantholysis, interface dermatitis, spongiosis, and satellite keratinocyte necrosis. Histologic findings in the 8 patients with classic pemphigus and neoplasia included acantholysis and spongiosis. Direct immunofluorescence in both paraneoplastic pemphigus and pemphigus with neoplasia showed IgG staining of cell‐surface proteins (intercellular substance) and deposition of immunoglobulin at the basement membrane one. Indirect immunofluorescence with rat bladder substrate was used to differentiate paraneoplastic pemphigus from classic pemphigus. Circulating IgG anti‐cell‐surface protein antibodies were detected in 4 patients with paraneoplastic pemphigus syndrome; they were absent in 2 patients with pemphigus and neoplasia. Immunoprecipitation of sera from the 4 patients with epithelial staining showed the complex of bands identified in studies of paraneoplastic pemphigus syndrome. We conclude that paraneoplastic pemphigus syndrome has distinct clinical, histologic, and immunologic features that differentiate it from classic pemphigus with underlying neoplasia.
Seborrheic keratosis‐like lesions in epidermodysplasia verruciformis
Authors: Tomasini C. , Aloi F. , Pippione M.
Published: April 2006

A light microscopic study of 6 verrucous lesions with clinical features of seborrheic keratoses (SK) occurring on sun‐exposed skin of 4 patients with epidermodysplasia verruciformis (EV) was performed. We observed the typical histological findings of SK in all cases. In addition, koilocytotic effects suggestive of EV were observed in the upper prickle layer and stratum granulosum. In 2 lesions, we also noted bowenoid changes suggesting possible early malignant transformation. Immunohistochemical study confirmed the presence of HPV in these lesions.
CD44 expression in normal and inflamed skin
Authors: Penneys Neal S.
Published: April 2006

CD44 is the principal cell surface receptor for hyaluronate. In non‐inflamed skin, CD44 expression is limited to the cell membrane of eccrine coil cells. The distribution on these cells is assymetric, with intense staining on the dermal side and little staining on the luminal side of the coil cell. In skin containing a pathologic process, either inflammatory or neoplastic, CD44 expression can be widespread on the membranes of keratinocytes and on infiltrating lymphocytes in the vicinity of the process. Diverse roles have been proposed for CD44 and largely involve aspects of cellular adhesion in one setting or another. CD44 may identify a more mobile, proliferating keratinocyte that is responding to local injury. In eccrine coil, the stable presence of CD44 on the non‐luminal surface of secretory cells indicates an undefined function for CD44 in the generation of eccrine sweat.
Schwannoma with sweat duct differentiation
Authors: Elston Dirk M. , Bergfeld Wilma F. , Biscotti Charles V. , McMahon James T.
Published: April 2006

We report a schwannoma with well differentiated ducts resembling cutaneous sweat ducts. The tumor presented as a painless mass near the left knee of a 41‐year‐old female. The mass had been present for many years. Some increase in size had been noticed over the previous 2 to 3 yr. The bulk of the tumor was composed of spindle cells with the appearance of Antoni A and Antoni B tissue. Rare mitotic figures were noted. In several areas of the tumor, numerous well‐differentiated ducts were present. Most resembled normal cutaneous sweat ducts. In some areas, cystic dilatation of the ducts was present. Focal areas demonstrated poorly formed ducts and single cells with prominent nuclei and ample cytoplasm. Well formed ducts, poorly formed ducts, and single cells marked with AE 1/3 (keratin) and epithelial membrane antigen. The spindle cell proliferation marked for S 100 protein and vimentin. Sweat duct differentiation has not been reported previously in either benign or malignant schwannoma. Light and electron microscopic features of this tumor are presented.
Localization of MGSA/GRO protein in cutaneous lesions
Authors: Tettelbach William , Nanney Lillian , Ellis Darrel , King Lloyd , Richmond Ann
Published: April 2006

Melanoma growth stimulatory activity (MGSA/GRO), a cyto‐kine originally characterized as an autocrine growth factor for melanoma cells, is highly chemotactic for neutrophils and releases neutrophil elastase as well as other matrix‐degrading enzymes. Previous work has demonstrated the presence of MGSA/GRO in melanocytic lesions and in the epidermal keratinocytes of non‐lesional skin and psoriatic scale. Herein, MGSA/GRO localization was examined in a variety of human skin lesions exhibiting proliferative and/or differentiative disorders using immunohistochemical methods. Most lesions showed greater MGSA/GRO immunoreactivity in the more differentiated supra‐basal keratinocytes of the stratum spinosum and stratum granulosum than in the stratum basalis, where the dividing basal cells are found. Hair follicles, sebaceous glands, and sweat glands were also frequently positive for MGSA/GRO. The highest level of immunoreactive MGSA/GRO in diseased epidermis was detected in verruca vulgaris, followed by psoriasis, keratoacanthoma, and squamous cell carcinoma. Detection of MGSA/GRO in basal cell carcinoma was variable, being present in the sclerosing variant and absent in the more common nodular variant. Melanocytic lesions stained less intensely for MGSA/GRO than keratinocytic lesions, where the levels of MGSA/GRO expression correlated with the inflammatory response and degree of keratinocyte differentiation.
Human subcutaneous pythiosis
Authors: Triscott Joseph A. , Weedon David , Cabana Esmeraldo
Published: April 2006

Two cases of subcutaneous infection caused by the primitive aquatic hyphal organism Pythium are described. Pythium is an important pathogen of horses in the U.S.A. and Australia. Cases of human subcutaneous pythiosis have been cited in the literature, but clinical and histopathological features have not been described previously. Both cases occurred in young immunocompetent males in the periorbital region and showed rapid growth, clinically mimicking a tumor and requiring operative biopsy. In both cases there was a history of exposure to either swampy water or horses. The tissue reaction was distinctive, closely resembling that seen in equine pythiosis, comprising well‐defined granular eosinophilic islands bordered by macrophages, multi‐nucleate giant cells, fibrosis and numerous eosinophils. Hyphae were well demonstrated with the Grocott stain but only poorlsy with the PAS method. Identity of the organisms was confirmed with an immunoperoxidase technique employing a polyclonal antiserum to Pythium. Both patients responded well to ampho‐lericin B.
Verrucous cysts: histopathologic characterization and molecular detection of human papillomavirus‐specific DNA
Authors: Peter Soyer H. , Schadendorf Dirk , Cerroni Lorenzo , Kerl Helmut
Published: April 2006

Verrucous cyst is an uncommon newly described benign epithelial cyst which may be associated with human papillomavirus infection. The purpose of this project was to study the clinico‐pathological features of verrucous cysts and to demonstrate human papillomavirus (HPV) by polymerase chain reaction (PCR) in these lesions. We have analyzed 5 examples of verrucous cysts: the age range of the patients was between 37–82 years and the most common locations were face and extremities. Clinically the lesions were interpreted as cyst (2), dermatofibroma (2) and basal‐cell carcinoma (1). Histopathologic examination of the biopsy specimens showed in all cases an intradermal infundibular cyst lined by a papillated and/or digitated epithelium with focal prominent hypergranulosis and irregular keratohyalin granules. Furthermore, numerous whorls of keratinocytes (so‐called squamous eddies) were present within the squamous areas of the hyperplastic epithelium of the cyst, morphologically reminiscent of inverted follicular keratosis. Architectural and cytological features of malignancy were not present. Sections of paraffin‐embedded tissue of the 5 verrucous cysts and of 5 “conventional” follicular cysts, infundibular type, were investigated for the presence of HPV DNA sequences by PCR using consensus primers. In all 5 cases of verrucous cysts, HPV‐specific DNA sequences were detected, whereas all follicular cysts, infundibular type, were negative. These results support the concept that verrucous cysts can be added to the large spectrum of HPV‐induced cutaneous neoplasms. Further studies are needed to identify the specific HPV‐type in these distinctive benign cystic proliferations.
p53 protein in aggressive and non‐aggressive basal cell carcinoma
Authors: De Rosa G. , Staibano S. , Barra E. , Donofrio V. , Salvatore G. , Vessecchia G. , Boscaino A.
Published: April 2006

Basal cell carcinoma (BCC) is the most frequent cutaneous neoplasm, with a generally favorable clinical behavior. Sometimes, indeed, it recurs after therapy and/or metastasizes. As point mutations in the coding sequence of the p53 tumor suppressor gene have been implicated in the progression of many human tumors, we studied the expression of p53 protein on this neoplasia. We tested immunohistochemically the positivity for p53 protein (NCL‐p53‐CM1, YLEM) on 19 cases of morphologically “non aggressive” BCC (BCC1) and on 19 “aggressive” BCC (BCC2), all with one or more relapses and 3 with distant meta‐stases also. Results were related to clinicopathological and follow‐up data. All but one BCC2 were found positive for p53 protein. Conversely, only 2 cases of BCC1 exhibited low immunoreactivity for p53 protein, with high statistical differences between the two groups. No correlation was found between the immunoreactivity, age of patients, and site of the lesions. The availability of immunohistochemistry and the relatively easy interpretation of the results make screening for p53 protein a possibly useful tool in the prognostic evaluation of BCC.
Human papillomavirus DNA in the dermis of condyloma acuminatum
Authors: Zhu Wen‐Yuan , Leonardi Craig , Blauvelt Andrew , Serfling Ulrike , Penneys Neal S.
Published: April 2006

Condyloma acuminatum (CA) has high recurrence rates after local treatments. Why this lesion is difficult to eradicate is unclear. One possible explanation for recurrence after superficial destructive therapy is the presence of residual human papillomavirus (HPV) in the superficial dermis beneath the treated epidermis. Thirteen samples of CA were excised from 13 patients. Thirteen samples of basal cell carcinoma (BCC) were studied for purposes of control. Epidermis was separated from dermis by treatment with sodium bromide. DNA was extracted from both tissues and used sodium bromide solution and amplified for the presence of HPV DNA using the polymerase chain reaction. HPV DNA was detected in the epidermis of 11 samples of CA. HPV type 6 was seen in 7 specimens; HPV type 11, in 4. HPV DNA was found in the dermis of 3 specimens of CA; type 6 in 2 and type 11 in 1. Two samples were excluded because of contamination of the sodium bromide solution by HPV. HPV DNA was not detected in tissue samples from BCC. The presence of HPV DNA in the dermis of some condylomata may explain recurrence in sporadic cases.
Cutaneous metastasis of neuroendocrine carcinoma of uterine origin
Authors: Fogaca Marcelo F. , Fedorciw Boris J. , Tahan Steven R. , Johnson Richard , Federman Micheline
Published: April 2006

We report a case of a 33‐year‐old woman who presented with the rapid development of multiple dermal and subcutaneous nodules on the chest, back, abdomen, axilla, neck, and scalp. These nodules were firm, tender, and non‐ulcerated and measured from 0.2 to 1.2 cm in diameter. A punch biopsy of one of the subcutaneous nodules in the scalp showed a poorly differentiated carcinoma in the reticular dermis with light microscopic, immunohistochemical, and ultrastructural features supporting neuroendocrine differentiation. The past medical history was significant for a recent total abdominal hysterectomy for carcinoma of the cervix at another hospital, originally characterized as a poorly differentiated adenocarcinoma of the cervix and lower uterine segment. Review of the microscopic slides of the uterine neoplasm revealed features suggesting a more appropriate classification as a primary neuroendocrine carcinoma; this was subsequently confirmed by immunophenotyping and ultrastructural evaluation. This is the first reported case of a uterine neuroendocrine carcinoma metastasizing exclusively to the skin. It further illustrates the important contribution of dermatopathology to the understanding of a systemic pathologic process.
Malignant melanoma arising in a blue nevus with features of pilar neurocristic hamartoma
Authors: Pathy Arun L. , Helm Thomas N. , Elston Dirk , Bergfeld Wilma F. , Tuthill Ralph J.
Published: April 2006

A 65‐year‐old man presented with a history of a giant blue plaque of the parietal scalp since childhood. Biopsy revealed a cellular blue nevus. The blue nevus was observed for 10 years and thought to be unchanged until a new adjacent lesion was noted. Biopsy of the new lesion revealed metastatic malignant melanoma. A wide excision was performed of the original lesion which revealed malignant melanoma arising in a blue nevus. Areas within the blue nevus were consistent with a pilar neurocristic hamartoma, whereas other areas were consistent with a common blue nevus. Subsequent satellite metastases developed, with early metastases resembling blue nevi except for the absence of a stromal component and the presence of hyperchromatic nuclei. Later metastases were typical of metastatic melanoma. This case illustrates the uncommon evolution of malignant melanoma from a blue nevus. The histological features and relationship between melanoma, blue nevus, and pilar neurocristic hamartoma are reviewed.
Prognostic significance of PCNA grade in malignant melanoma
Authors: Woosley John T. , Detrich Daniel R.
Published: April 2006

Proliferating cell nuclear antigen (PCNA) grade (a semi‐quantitative assessment of the entire tumor profile) and estimation whether PCNA grade is low (0–50% positive cells) or high (51–100% positive cells) has been demonstrated to be of prognostic significance in gastric carcinoma. Sixteen vertical growth phase melanomas with 8 or more years of clinical follow‐up were reacted with antibody to PCNA. PCNA grade was independently evaluated by both authors without knowledge of clinical outcome. PCNA grade was subsequently correlated with clinical outcome and other prognostic indicators. Agreement in assigning PCNA grade was noted between the two observers in 13/16 cases. However, PCNA grade failed to accurately predict patient survival or death. Additionally, PCNA grade was not significantly correlated with other recognized prognostic attributes. While interpretation of the prognostic significance of PCNA grade based upon this small series of cases should be conservative, a semi‐quantitative estimate of PCNA‐positive cells appears to have little utility in predicting the clinical outcome in malignant melanoma.
Dermal dendrocytes are decreased in collagenomas
Authors: Stewart Margaret I. , Smoller Bruce R.
Published: April 2006

Dermal dendrocytes comprise a subset of spindle‐shaped cells which normally reside in the dermis. While they appear to play some role in the reticuloendothelial system, their exact functions have not been completely elucidated. In addition to their purported immunologic functions, it has been suggested that dermal dendrocytes may play an inhibitory role in the regulation of dermal collagen synthesis. We examined 7 collagenomas with antibodies directed against factor XIIIa (FXIIIa) in order to test the hypothesis that dermal dendrocytes were focally diminished in these hamartomatous overgrowths of collagen. In all cases, there was a marked diminution in the number of FXIIIa‐positive cells in the lesional dermis when compared to the surrounding dermis. Our data support the hypothesis that dermal dendrocytes may be involved in regulation of collagen synthesis.
Differential induction of intercellular adhesion molecule‐1 in human skin by recombinant cytokines
Authors: Buchsbaum Marion E. , Kupper Thomas S. , Murphy George F.
Published: April 2006

We examine the effects of the recombinant epidermal cytokines interleukin 1α (IL‐1α), interleukin 1β (IL‐1β), interleukin 3 (IL‐3), interleukin 6 (IL‐6), granulocyte‐macrophage colony stimulating factor (GM‐CSF), macrophage colony stimulating factor (M‐CSF), tumor necrosis factor alpha (TNF), and the effect of the lymphokine gamma interferon (γ‐IFN) on the expression of ICAM‐1 in short term organ cultures of newborn human foreskins. In normal skin, ICAM‐1 was detected immunohistochemically exclusively on endothelial cells. In addition to enhanced ICAM‐1 expression by endothelial cells (at 1 h) and keratinocytes (by 6 h) exposed to γ‐IFN, increased endothelial cell expression also resulted at 24 h after exposure to IL‐6 and GM‐CSF and at 48 h to M‐CSF. Dermal dendritic cell reactivity for ICAM‐1 was observed at 24 h after supplementation with IL‐1α, IL‐1β and IL‐6, and at 48 h with GM‐CSF and M‐CSF. Incubation with culture medium alone or with IL‐3 resulted in no change in baseline ICAM‐1 expression on any cell type, and incubation with TNF resulted in enhanced ICAM‐1 expression only by endothelial cells. Thus, in skin explains (as opposed to isolated cell in culture), ICAM‐1 is induced on various cell types by a wide range of epidermal cytokines, including IL‐6, GM‐CSF, M‐CSF, IL‐1α and IL‐1β Endogenous production and release of these cytokines which may stimulate adhesion molecule expression directly or indirectly may govern lymphoid adhesion to specific dermal as well as epidermal types of skin cells under physiologic and pathologic conditions.
Apocrine nevus: light microscopic, immunohistochemical and ultrastructural studies of a case
Authors: Neill J. S. A. , Park H. Kim
Published: April 2006

The apocrine nevus (AN) is a rare tumor occurring in the upper chest and the axilla. We report a case of a AN in a 33‐year‐old female occurring unilaterally. The presenting complaint related to tenderness and swelling in the right axilla. The initial impression was hidradenitis suppurativa. The gross specimen revealed the presence of irregular thickening just beneath the dermal subcutaneous interface. Microscopically the lesion was composed of mature apocrine glands with apical snouts. The glands were arranged in lobules divided by thin fibrous septa. immunohistochemical studies revealed the following profile in the glandular epithelium: positive low molecular weight cytokeratin, epithelial membrane antigen, and gross cystic disease fluid protein reactivity and negative high molecular cytokeratin and S‐100 protein reactivity. Carcinoembryonic antigen reactivity was found in the duet epithelium. Ultrastructural studies revealed cells lining the lumen of the glands with a concentration of granules in the apical region and light and dark granules. These findings support the previously described light microscopic observations and provide unreported ultrastructural studies in this rare tumor.
Verruciform xanthoma in an immunocompromised patient: a case report and immunohistochemical study
Authors: Helm K. F. , Höpfl R. M. , Kreider J. W. , Lookingbill D. P.
Published: April 2006

The etiology of verruciform xanthoma, a rare lesion that usually occurs in the oral mucosa, is unknown. A viral etiology has been speculated since extraoral lesions usually occur in the genitalia. We present, to the best of our knowledge, the first reported case of verruciform xanthoma in an immunocompromised patient with chronic graft versus host disease. Immunohistochemical studies showed a few ham 56 (a macrophage marker) positive foam cells, both in the dermis and within the epidermis, supporting a role for an epidermal process in production of the foam cells. Staining for human papillomavirus protein (HPV) showed reactivity of some of the nuclei in the dermal Histiocytes, but in situ hybridization for HPV types 6/11, 16/18, and 31, 33 was negative. These results support an eopidermal process as the stimulus for the foam cell formation but fail to demonstrate HPV as the cause.
Intravenous glomus tumor of the forearm
Authors: Googe Paul B. , Griffin William C.
Published: April 2006

An intravenous glomus tumor occurring in a forearm vein is reported. The patient had a painful subcutaneous mass which was completely excised. This mass was a neoplasm which expanded the lumen of a vein and extended throughout its wall into the surrounding subcutaneous fat. The neoplasm consisted of sheets of rounded cells with a capillary stroma. The neoplastic cells were closely apposed to the capillary vessels and were positive for vimentin, smooth muscle actin and muscle specific actin. The cells were negative for desmin, factor VIII‐related antigen, epithelial membrane antigen, cytokeratins, S‐100 protein and chromogranin. This is the 2nd reported case of intravenous glomus tumor of the forearm. This unusual presentation may be due to intravascular extension by a cutaneous glomus tumor. The potential for intravascular growth by glomus tumor should be recognized by surgeons, dermatologists and pathologists.
Sinus histiocytosis (Rosai‐Dorfman disease) clinically limited to the skin
Authors: Perrin C. , Michiels J. F. , Lacour J. P. , Chagnon A. , Fuzibet J. G.
Published: April 2006

A case study of sinus histiocytosis of Rosai‐Dorfman (SH) clinically limited to the skin is presented with immunohistochemical study of the infiltrate, in both paraffin and cryostal sections. Factor XIIIa, a dendrocyte marker, was demonstrated in the cytoplasm of histiocytes. This feature had not been previously reported in this disease. In addition, the cells expressed S100 protein, CD4, CD la, GD68, and GD11c. This immunophenotyping study suggests that SH could affect the antigen‐presenting activity of Factor XIIIa cells, i.e., the skin dermal dendrocyte.
Mycosis fungoides skin lesions contain CD8+ tumor‐infiltrating lymphocytes expressing an activated, MHC‐restricted cytotoxic T‐lymphocyte phenotype
Authors: Wood Gary S. , Edinger Abby , Hoppe Richard T. , Warnke Roger A.
Published: April 2006

In prior studies, we showed that most CD8+ cells infiltrating skin lesions of CD3+CD4+ mycosis fungoides were CD3+ T‐line‐age tumor‐infiltrating lymphocytes (TIL) whose overall phenotype was suggestive of MHC‐restricted cytotoxic T lymphocytes (CTL). However, their lack of cytotoxic‐associated granzyme A mRNA suggested that they might be inactivated CTL precursors. In this study, we used single‐ and double‐label immunohistologic techniques to assess the expression of TlA‐1‐reactive protein and HLA‐DR by these CD8+TIL. Monoclonal antibody TIA‐1 recognises a novel family of proteins expressed preferentially by cytotoxic cells, including some that lack grauzyme A. HLA‐DR is a marker of T‐cell activation. Single‐label studies of 32 cases showed that CD8+TIL and TIA‐1+ cells constituted a variable minority of the total cellular infiltrate and had a similar distribution. Double‐label studies of 14 cases showed that in most instances the aggregate phenotype of the majority of CD8+TIL was CD3+TIA‐1+HLA‐DR+CD56−CD57−. These findings suggest that many of the CD8+TIL within skin lesions of CD3+CD4+ mycosis fungoides are activated, MHC‐restricted CTL.
Atypical melanocytic lesions in epidermolysis bullosa
Authors: Hoss D.M. , McNutt N.S. , Carter D.M. , Rothaus K.O. , Kenet B.J. , Lin A.N.
Published: April 2006

We report a 6‐year‐old female with recessive dystrophic epidermolysis bullosa (RDEB) who presented with a very large acquired melanocytic lesion. The lesion demonstrated many features both clinically and histologically that made the distinction from malignant melanoma difficult. The pathogenesis of this lesion and other unusual melanocytic lesions seen in the setting of acute and chronic blistering disorders seems related to repeated episodes of disruption of the dermal‐epidermal junction.
Necrobiosis in solitary mastocytoma: Coincidence or pathogenesis?
Authors: Kamysz Jeffery J. , Fretzin David F.
Published: April 2006

The coexistence of solitary mastocytoma and necrobiotic changes resembling granuloma annulare in the same lesion has not been reported to our knowledge. A 3½‐year‐old child with a plaque on the arm clinically and histologically consistent with solitary mastocytoma showed characteristic necrobiotic foci indistinguishable from granuloma annulare. We speculate that mast cell degranulation may be involved in the pathogenesis of necrobiosis by altering fibroblast enzyme activity and/or producing prolonged inflammaloiy reactions.
Malignant proliferating onycholemmal cyst
Authors: Alessi Elvio , Zorzi Fabio , Gianotti Raffaele , Parafioriti Antonina
Published: April 2006

A slowly growing malignant minor of the nail unit in a 74‐year‐old female is reported, At light microscopy, the tumor was composed of small keratinous cysts with abrupt central keratinization, and of solid nests and strands of atypical keratinocytes filling the dermis and penetrating the phalangeal bone. In our view, this can be regarded as the malignant analog of the keratin cysts arising from the nail bed epithelium, as first reported by Samman in 1959. Since, according to several authors, the nail bed epithelium is comparable to the outer root sheath of the follicle and since the reported tumor showed some analogies with malignant proliferative trichilemmal cyst, it is suggested that this new entity be designated as malignant proliferating onycholemmal cyst.
Occurrence of positive immunofluorescence in the dermo‐epidermal junction of sun‐exposed skin of normal adults
Authors: Leibold Ann M. , Bennion Scott , David‐Bajar Kathleen , Schleve Milton J.
Published: April 2006

A bright, continuous, granular deposition of immunoreactants at the dermo‐epidermal junction (DEJ) of lesional skin is highly suggestive of cutaneous lupus erythematosus (LE). A recent study of the direct immunofluorescence (IF) of sun‐exposed skin in normal adults has demonstrated findings similar to the bright, continuous granular pattern found in cutaneous LE. This data suggests that positive IF from sun‐exposed cutaneous lupus lesions is nonspecific. Forty‐one healthy adults, without a history of dermatoses or photosensitivity, presenting to the dermatology clinic for the excision of skin cancers were studied. Excess non‐lesional tissue, removed from Moh's excision sites (sun‐exposed face and neck) in order to obtain appropriate cosmetic closure, was examined for the deposition of immunoreactants. The specimens were incubated with iluoresceinated monovalent anti‐human immunoglobulin specific for IgG, IgA, IgM, C3, Clq, and fibrinogen and examined independently by 2 immunodennatologists without prior knowledge of patient or site. None of the samples demonstrated immunoreactant deposition consistent with cutaneous LE. IF of several specimens (21/41) had a weak(1+ or 2+), interrupted pattern of fibrinogen at the DEJ, – a common, non‐specific finding. Weak, interrupted, linear and granular patterns were seen with IgM (10/41), Clq (9/41), IgG (2/41), IgA (2/41), and C3 (1/41). Fibrinogen was the only immunoreactant demonstrating a bright (3+), continuous, granular pattern (4/41). This data suggests that sun‐exposure alone does not induce the deposition of immunoreactants at the DEJ in a pattern similar to that found in cutaneous LE.
QBEND/10 (anti‐CD34 antibody) in external root sheath cells and follicular tumors
Authors: Poblet Enrique , Jimenez‐Acosta Francisco , Rocamora Antonio
Published: April 2006

The human hematopoietic progenitor cell antigen (CD34) is a cell surface protein expressed by human hematopoietic progenitor cells, vascular endothelium, and many mesenchymal tumors. Sections from six samples of normal skin and from 41 epithelial tumors of the skin were studied. Immunostaining of epithelial cells from the external root sheath below the attachment of the arrector pili muscle and above the matrix cells was noted in normal samples. Tumors derived from or differentiated toward cells of the outer sheath, especially trichilemmomas, were immunostained with QBEND/10 (anti‐CD34 antibody), whereas other epithelial tumors studied were negative. CD34 could serve as a marker of outer sheath cell derivation and may well be of value in the distinction between trichilemmomas and other lesions with similar histopathological features.
Ultrastructural evaluation of mid‐dermal elastolysis
Authors: Harmon C. B. , Su W. P. D. , Gagne E. J. , Fransway A. F. , Zelickson B. D.
Published: April 2006

Mid‐dermal elastolysis is a well‐defined clinical and histopathologic entity manifested by fine wrinkling of the skin and a mid‐dermal loss of elastic fibers. Ulfrastructural and hislologic studies were performed in an attempt to better define the cause of the elastolytic process. Biopsy specimens from the lesions of 3 patients with mid‐dermal elasiolysis were studied at light and electron microscopic levels. Ultrastructural evidence of normal elastic fiber engulfment by activated macrophages was observed; however, some fields also demonstrated envelopment of abnormally degenerated elastic tissue. Although there are many potential causes of this degeneration, photodistribution of the lesions suggests that ultraviolet damage is a primary inciting factor.
Electron microscopic examination of cutaneous lesions by the quick re‐embedding method from paraffin‐embedded blocks
Authors: Ogiyama Yukiko , Ohashi Masaru
Published: April 2006

We attempted to evaluate whether Widéhn's quick re‐embedding method from paraffin blocks is useful for dermatopathological diagnosis. Regarding fine preservation of nuclei, tonofibrils and desmosomes of keratinocytes in normal skin, we could recognize no difference between the quick re‐embedding method and traditional re‐embedding methods. However, preservation of mitochondria and Birbeck granules in Langerhans cells was poor regardless of the method used. Furthermore, we studied the ultrastructural features of some viral skin diseases including mollscum contagiosnm, herpes simplex, varicella‐zoster and verruca vulgaris, and some skin tumors, including angioleiomyoma, angiosarcoma, Merkel cell carcinoma and amelanotic melanoma using the quick re‐embedding method. We determined that all viral structures were sufficiently preserved by the quick method to observe the virions and developement of the virus. Myolilaments and dense bodies of angioleiomyoma, Wcibel‐Palacle bodies of angiosarcoma, neurosecretory granules of Merkel cell carcinoma and melanosomes of amelanotic melanoma were recognized by the quick method. From these results, we concluded that the quick re‐embedding method is useful for the diagnosis of skin diseases, especially viral skin diseases and some skin tumors.
Pseudoxanthoma elasticum‐like papillary dermal elastolysis: A report of two cases
Authors: El‐Charif Maria A. , Mousawi Ali M. , Rubeiz Nelly G. , Kibbi Abdul‐Ghani
Published: April 2006

We report 2 women, aged 83 and 63 years, who presented with multiple asymptomatic, slowly progressive, coalescing, skin‐colored papules affecting the sides of the neck and lower abdomen. Incisional biopsies obtained from both patients revealed elastolysis in the papillary dermis. These 2 cases represent pseudoxanthoma elasticum‐like papillary dermal elastolysis, a recently described entity, the etiology of which remains unclear.
Cutaneous granular cell angiosarcoma
Authors: Hitchcock Michael G. , Hurt Mark A. , Santa Cruz Daniel J.
Published: April 2006

The majority of cutaneous angiosarcomas display typical architectural features of irregular anastomosing vascular channels in the dermis and subcutis. Nuclei are usually hyperchromatic and pleomorphic but die volume of cytoplasm of the neoplastic cells is often small. Diagnosis can be made readily on an adequate biopsy. We recently experienced difficulty diagnosing an angiosarcoma composed predominantly of cells with abundant granular cytoplasm. We were able to compare the present case with sections obtained from the only other reported example. The architectural expression of an anastomosing vascular pattern in areas of tumor, combined with the positive staining for Factor VIII‐related antigen (FVIIIRAg) and Ulex europaeus agglutinin‐1 (UEA1) enabled us to make a diagnosis of angiosarcoma. The tumor failed to stain for the other endothelial markers (CD31 and CD34) which were positive in the original case. A marker for lysosomes (CD68) stained the granules in both cases. The granular cell variant of cutaneous angiosarcoma is very rare. Diagnosis is possible by recognizing the typical anastomosing neoplastic vascular channels at the periphery of the lesion, and by use of a combination of lectin (UEA1) and immunohistochemical (FVIIIRAg, CD34 and CD31) endothelial markers.