bluuebunny/crossref_metadata_2025 huggingface dataset:
Oral hyposensitization in patients with contact dermatitis from Parthenium hysterophorus
Authors: Handa Sanjeev , Sahoo Bijaylaxmi , Sharma* Vinod K.
Published: March 2003

Parthenium hysterophorus is the commonest cause of airborne contact dermatitis in northern India. Treatment is mostly palliative and consists of repeated courses of antihistamines and topical and/or systemic corticosteroids. We have evaluated the effect of oral hyposensitization as an alternative therapeutic modality. In 70% of those patients who completed the study, there was a gradual improvement in their clinical status, as evident from a fall in their clinical severity score for eczema. 30% of patients had an exacerbation during the course of the study and hence hyposensitization in them was stopped. Patients tolerated therapy well and no significant side‐effects were seen, except for abdominal pain, ‘heartburn’ and cheilitis.
Multicenter study of the frequency of contact allergy to gold
Authors: Lee Ai‐Young , Eun Hee‐Chul , Kim Hyung‐Ok , Moon Kee‐Chan , Lee Chul‐Hun , Kim Gye‐Jung , Kim Soo‐Chan , Ham Jung‐Hee
Published: March 2003

Gold sodium thiosulfate (GSTS) is reputed to be the most reliable gold antigen, but control studies are still required. Although Koreans have more varied sources of contact with gold, such as herbal medicines with gold coatings and indwelling gold acupuncture needles, no epidemiological studies have been performed. This study examined the frequency and sources of contact allergy to gold in South Korea by a multicenter study. Patch testing with 0.5% GSTS in pet. was conducted in 255 eczema patients and 58 control subjects. Results were observed at 21 days (D) to ensure there were no undetected late reactions in 54 observed patients and 47 controls. 8 (3.1%) of the 255 patients reacted positively to GSTS, including 1 with a late reaction. 1 of the 58 controls showed a positive reaction to GSTS on D4 with a negative reaction on D14. Clinical relevance was lacking in the patients with positive reactions. Unexpectedly, the above particular sources of gold contact gave rise to few allergic reactions in our patients.
Guidelines for performing skin tests withdrugs in the investigation of cutaneous adverse drug reactions
Authors: Barbaud Annick , Gonçalo Margarida , Bruynzeel Derk , Bircher Andreas
Published: March 2003

Skin testing with a suspected drug has been reported to be helpful in determining the cause of cutaneous adverse drug reactions (CADR). Many isolated reports of positive drug skin tests are published, but without detailed information concerning the clinical features of the CADR and the method used in performing drug skin tests, such data are not very informative. A working party of the European Society of Contact Dermatitis (ESCD) for the study of skin testing in investigating cutaneous adverse drug reactions, has proposed the herein‐reported guidelines for performing skin testing in CADR in order to standardize these procedures. In each reported case, the imputability of each drug taken at the onset of the CADR and a highly detailed description and characterization of the dermatitis need to be given. Drug skin tests are performed 6 weeks to 6 months after complete healing of the CADR. Drug patch tests are performed according to the methods used in patch testing in studying contact dermatitis. The commercialized form of the drug used by the patient is tested diluted at 30% pet. (pet.) and/or water (aq.). The pure drug is tested diluted at 10% in pet. or aq. In severe CADR, drug patch tests are performed at lower concentrations. It is also of value to test on the most affected site of the initial CADR. Drug prick tests are performed on the volar forearm skin with the commercialized form of the drug, but with sequential dilutions in cases of urticaria. Intradermal tests (IDT) are performed with sterile sequential dilutions (10–4, 10–3, 10–2, 10–1) of a pure sterile or an injectable form of the suspected drug with a small volume of 0.04 ml. Drug skin tests need to be read at 20 min and also later at D2 and D4 for patch tests, at D1 for prick tests and IDT. All these tests also need to be read at 1 week. The success of skin tests varies with the drug tested, with a high % of positive results, for example, with betalactam antibiotics, pristinamycin, carbamazepine and tetrazepam on patch testing, or with betalactam antibiotics and heparins on delayed readings of IDT. The results of drug skin tests also depend on the clinical features of the CADR. The use of appropriate control patients is necessary to avoid false‐positive results.
Surveillance scheme for occupational skin disease in the Saarland, FRG
Authors: Dickel H. , Bruckner T. , Bernhard‐Klimt C. , Koch T. , Scheidt R. , Diepgen T. L.
Published: March 2003

Occupational skin disease (OSD) is a significant public health concern. To keep OSDs under surveillance, a register of OSDs (BKH‐S) was implemented in 1999 in the Saarland, FRG. We conducted a population‐based register study to analyse all initial reports of OSDs reported to the BKH‐S. 336 cases were prospectively assessed from July 1999 to June 2001. In 78% (n = 263) of the cases an occupational cause for the skin disease was stated, 91% (n = 240) of which fell within 16 occupational groups. This is equivalent to 6.8 cases per 10,000 workers per year within these occupational groups. Notably, young age groups (median age 35 years) were affected with a female predominance. The most frequent final diagnosis was irritant contact dermatitis (75%) followed by allergic contact dermatitis (34%) and atopic dermatitis (19%). The overall prevalence of occupationally relevant delayed‐type reactors was 21% and of immediate‐type reactors 17%. Work‐related delayed‐type sensitizations to potassium dichromate (n = 8) and immediate‐type sensitizations to natural rubber latex (n = 11) were the most frequently observed. Questionnaire results showed frequent occupational skin contact with wet work (59%), detergents (48%), and disinfectants (38%). The second valid surveillance scheme for OSD in the FRG has been introduced and can be made available for further analysis.
The design of custom orthodontic mechanics
Authors: Fiorelli G. , Melsen B. , Modica C.
Published: March 2003

The straightwire appliance promises prescribed tooth positions within the arches. Unfortunately, such an outcome is not necessarily achieved, especially in the adult patient. Teeth do not always move according to a template. Continuous archwires do not allow for differentiation between active and reactive units; consequently, the correct force system is never developed. These shortcomings could be overcome by custom‐designed mechanics. Here we report on the use of Dental Movement Analysis (DMA) software supported by two clinical examples. On the computerized occlusogram, DMA stimulates the desired tooth movements and computes the force vectors and moments necessary to achieve the planned result. These images enable the clinician to fabricate a custom appliance for maximum efficiency. Maximum efficiency results in minimal treatment time.
Bodily tooth movement through the maxillary sinus with implant anchorage for single tooth replacement
Authors: Re S. , Cardaropoli D. , Corrente G. , Abundo R.
Published: March 2003

Movement of teeth through anatomic limitations, such as the maxillary sinus, can be a reliable therapeutic protocol if suitable force systems are used. We report here the outcome of a treatment based on this concept. The patient exhibited pneumatization of the maxillary sinus resulting from earlier extractions. She was treated using an endosseous implant inserted in the retromolar region to serve as orthodontic anchorage and a T‐loop appliance fabricated from TMA wire to bodily move an upper second premolar through the sinus. After 6 months, at the end of the displacement, a titanium implant was inserted in the alveolus of the moved tooth and a single crown restoration was placed. The premolar moved through the sinus maintaining its support apparatus and bone. At the end of treatment the implant used for anchorage was still osseointegrated.
Perspectives in dermatopathology: telomeres and telomerase in ageing and cancer; with emphasis on cutaneous disease
Authors: Smith Kathleen J. , Germain Marguerite , Skelton Henry
Published: March 2003

Shortening of telomeres occurs with cell proliferation and correlates well with ageing in humans. Telomerase is a ribonucleoprotein, and is the body's most widely studied mechanism for extension of telomeres to circumvent cellular ageing. Telomerase levels remain at low or unmeasurable levels in most somatic cell populations with only a few exceptions. However, in transformed cell populations, upregulation of telomerase or some other mechanism for telomere extension is required for immortality. The telomere‐telomerase system has been proposed to be an adaptation of organisms with prolonged lifespan to avoid malignant tumors, at the cost of the cellular dysfunctions associated with the aged phenotype. Therapies to modulate telomere length and telomerase levels hold promise for therapy of cancer and ageing as well as for genetic conditions that predispose to an aged phenotype.
Lipedematous alopecia: a clinicopathologic, histologic and ultrastructural study
Authors: Fair Kevaghn P. , Knoell Keith A. , Patterson James W. , Rudd Rebecca J. , Greer Kenneth E.
Published: March 2003

Lipedematous alopecia is a rare condition of unknown etiology characterized by a thick, boggy scalp with varying degrees of hair loss that occurs in adult black females, with no clearly associated medical or physiologic conditions. The fundamental pathologic finding consists of an approximate doubling in scalp thickness resulting from expansion of the subcutaneous fat layer in the absence of adipose tissue hypertrophy or hyperplasia. Observations by light and electron microscopy detailed in this report suggest that this alteration principally manifests by localized edema with disruption and degeneration of adipose tissue. Some diminution in the number of follicles as well as focal bulb atrophy is noted. Aberrant mucin deposition such as that seen in myxedema or other cutaneous mucinoses is not a feature. The histologic findings bear some resemblance to those seen in lipedema of the legs, a relatively common but infrequently diagnosed condition. We present a case of lipedematous alopecia with emphasis on histologic and ultrastructural features. The etiology is unknown.
Long‐term preservation of direct immunofluorescence staining in slides stored at room temperature
Authors: Grimwood Ronald E. , Proffer Liana H.
Published: March 2003

To determine whether reproducible results from direct immunofluorescent tissue staining could be obtained after storing the slides at room temperature. We examined the original slides of 22 cases noted to be positive for direct immunofluorescence. Diagnoses include pemphigus, pemphigoid, lupus, dermatitis herpetiformis, lichen planus, and vasculitis. These specimens, initially evaluated during the period January 1997 to September 1998, were prepared with a standard immunofluorescence staining technique, and then a permanent aqueous mounting medium was added. All specimens were stored at room temperature in vertical slide holding trays. We focused on the presence and relative intensity of the immunofluorescence staining, as well as the final diagnosis. We then compared our readings to that of the original reports. Twenty of the 22 cases studied (91%) were read as having the same diagnosis as the initial immunopathology report. Seventeen of the 22 cases (77%) were found to have the identical or slightly less fluorescence intensity. The original reports in 3 of the cases did not comment on the original intensity of fluorescence. Thus, a comparison of fluorescence preservation could not be made. In 2 of the cases, the quality of tissue preservation was poor, and though fluorescent staining was noted, we were unable to render a diagnosis. Our results suggest that direct immunofluorescent studies, using a permanent aqueous mounting medium, can be stored over long periods of time at room temperature without significant degradation of staining.
Lymphoepithelioma‐like carcinoma of the skin: a report of 3 Epstein‐Barr virus (EBV)‐negative additional cases. Immunohistochemical study of the stroma reaction
Authors: Ferlicot Sophie , Plantier Françoise , Rethers Luc , Bui Anh Dung , Wechsler Janine
Published: March 2003

Lymphoepithelial carcinoma is a relatively common malignancy in the nasopharynx, but it rarely occurs in other sites. We report 3 additional cases of cutaneous location. Histopathologically, the tumors consisted of multiple well‐circumscribed dermal‐hypodermal nodules composed of aggregates of undifferentiated malignant cells. These cells had moderate amounts of eosinophilic cytoplasm and vesicular nuclei with prominent nucleoli. There was no squamous or glandular differentiation. For each case, a heavy lymphoplasmacytic infiltrate was found. No dysplasia was noted in the epidermis. In one case, the tumoral component showed numerous Sternberg‐like cells scattered within a lymphocytic background. This case might be mistaken with a Hodgkin's lymphoma. Immunohistochemistry showed that the neoplastic cells were positive for cytokeratin and epithelial membrane antigen. In the present report, studying the stroma reaction cell components, we have stressed the presence of numerous factor XIIIa‐positive dendritic cells in 2 cases. Because of the role of these cells in the immune response of normal stroma, their presence herein might be in relation with the favorable prognosis of this type of primary skin carcinoma. No Epstein‐Barr viral genomic sequences were detected by in situ hybridization. This negativity for Epstein‐Barr virus may be a help in the differential diagnosis from metastatic undifferentiated nasopharyngeal carcinoma.
A rippled‐pattern trichoblastoma: an immunohistochemical study
Authors: Yamamoto Osamu , Hisaoka Masanori , Yasuda Hiroshi , Nishio Daisuke , Asahi Masakazu
Published: March 2003

Background: Since the first description by Hashimoto et al., there have been only a few case reports of rippled‐pattern tricogenic tumor. In addition, there are no reports on detailed immunohistochemical analyses of this rare neoplasm. We describe here an additional case of rippled‐pattern trichogenic tumor with a special reference to its immunohistochemical features.

Methods: A nodule arising on the occipital area of a 62‐year‐old Japanese woman was histologically and immunohistochemically investigated.

Results: Histopathologically, the lesion contained various‐sized lobular nests, which consisted of oval to elliptical shaped basaloid cells without any atypia and were embedded in the collagenous stroma. Some elongated basaloid cells were arranged in a palisading fashion forming parallel rows of epithelial ribbons in a rippled‐pattern. Cytokeratin (CK) immunohistochemistry showed constant expressions of CK1/5/10/14, CK5/8, CK14 and CK7, and focal expressions of CK17 and CK19 in the basaloid cells, suggesting a keratin phenotypical similarity to the cells in small nodular type trichoblastoma.

Conclusions: The present tumor is a variant of trichoblastoma, and considered to be in close association with the outer root sheath and/or follicular germinative cells.
Acantholysis and spongiosis are associated with loss of syndecan‐1 expression
Authors: Bayer‐Garner Ilene B. , Dilday Brad R. , Sanderson Ralph D. , Smoller Bruce R.
Published: March 2003

Background: Syndecan‐1, a heparan sulfate proteoglycan present on the membrane of keratinocytes, functions in intercellular adhesion. Acantholysis and spongiosis are both characterized by diminished intercellular adhesion that may lead to blister formation. In spongiotic conditions, desmosomal stretching occurs prior to cell separation while in acantholytic conditions, cell separation occurs without stretching. While many of the structural relationships have been described, the molecular interactions regulating keratinocyte to keratinocyte adhesion are not yet fully understood.

Methods: Sections from ten cases of Grover’s disease, two pemphigus vulgaris, one pemphigus foliaceus, one bullous pemphigoid, two herpes simplex, and ten spongiotic dermatitis were stained with BB‐4, a monoclonal anti‐syndecan‐1 antibody.

Results: Nine of ten Grover’s, all three pemphigus, and both herpes cases showed absent or markedly decreased syndecan‐1 expression by acantholytic keratinocytes, with a sharp delineation from adjacent unaffected skin. The remaining Grover’s case showed moderate loss of syndecan‐1 expression. The pemphigus foliaceus case showed retention of staining along the basal cell layer, but expression was lost in the mid stratum spinosum. All ten spongiotic cases showed a diffuse mild decrease in staining, with loss of syndecan‐1 expression surrounding microvesicles. Bullous pemphigoid, as expected, did not show loss of syndecan expression.

Conclusions: The loss of syndecan‐1 expression evident in acantholytic conditions and, to a lesser extent in spongiotic conditions, may contribute to the decreased intercellular adhesion characteristic of these lesions.
Histologic criteria for the diagnosis of mycosis fungoides: proposal for a grading system to standardize pathology reporting
Authors: Guitart Joan , Kennedy John , Ronan Salve , Chmiel Joan S. , Hsiegh Yi‐Ching , Variakojis Daina
Published: March 2003

Background: The histological diagnosis of early lesions of mycosis fungoides (MF) is often difficult for dermatopathologists and prior studies have shown a low agreement rate among pathologists. An important reason for such difficulty may be the lack of specific histological criteria.

Methods: We tested a new method to interpret and report biopsies suspicious for MF. The method is based on a grading system reflecting the pathologist’s degree of diagnostic certainty. A panel of four pathologists independently assessed a set of 50 biopsies suspicious for MF first without (Phase I) and subsequently with specific histological criteria (Phase II). A third Phase was carried out after a training session, using a new set of cases with corresponding immunophenotyping and gene rearrangement analysis. Weighted and unweighted kappa statistics were used to assess inter‐ and intra‐pathologist variation.

Results: The consensus rate among pathologists improved from 48% in Phase I to 76% in Phase III. Overall precision weighted kappas increased from 0.630 in Phase I to 0.854 in Phase III, indicating excellent inter‐pathologist agreement by Phase III. There was a significant association between the presence of an abnormal phenotype and/or T‐cell clonality and a higher diagnostic score.

Conclusions: The use of uniform criteria and training sessions can substantially improve the consensus rate among pathologists in the diagnosis of MF.
Expression of the human erythrocyte glucose transporter glut‐1 in areas of sclerotic collagen in necrobiosis lipoidica
Authors: Holland Cheryl , Givens Vicky , Smoller Bruce R.
Published: March 2003

Background: Glut‐1 is the human erythrocyte glucose transporter which mediates facilitative transport of glucose across epithelial and endothelial barrier tissues. A primary abnormality in glucose transport and Glut‐1 cell‐surface content has been observed in fibroblasts from NIDDM and obese individuals. With the strong correlation between necrobiosis lipoidica and diabetes mellitus, we investigated the expression of Glut‐1 in diabetic individuals with necrobiosis lipoidica (NL).

Methods: A polyclonal anti‐Glut‐1 antibody was used with a standard immunoperoxidase technique to determine Glut‐1 expression by fibroblasts in areas of sclerotic collagen from specimens taken from diabetic individuals with necrobiosis lipoidica,and non‐diabetic individuals with scars and granuloma annulare (GA).

Results: Our results showed Glut‐1 expression in the areas of sclerotic collagen in patients with NL, possibly contributing to insulin resistance in these tissues.

Conclusions: Our findings raises the question as to whether abnormalities in glucose transport by fibroblasts in individuals with necrobiosis lipoidica contribute to the histopathologic changes.
Volar melanotic macules in a Japanese man with histopathological postinflammatory pigmentation: the volar counterpart of mucosal melanotic macules
Authors: Kiyohara T. , Kumakiri M. , Kouraba S. , Lao L.‐M. , Sawai T.
Published: March 2003

Background: Volar melanotic macules are asymptomatic light‐brown or tannish‐grey macules usually found on the palms and/or soles of blacks, although they have also been reported on the volar surfaces of whites. Similar lesions have not been reported before in Japanese people. Since the cause is as yet unknown, it remains to be discussed whether they are a distinct entity.

Methods: In this report, a 52‐year‐old Japanese man with volar melanotic macules is reported with the clinical and histopathological findings.

Results: A 52‐year‐old Japanese man presented with many light‐brown macules on his bilateral soles. He had a 20‐year history of tinea pedis. Histopathological examination revealed melanophages and inflammatory infiltrates in the superficial dermis. There was a slight increase in melanin granules around the acrosyringium. Fontana‐Masson stain revealed a slight increase in melanin granules in the basal layer including the acrosyringium and superficial dermis. These changes corresponded with postinflammatory pigmentation.

Conclusions: This is the first report of volar melanotic macules in Japanese people. We suggest that volar melanotic macules is not an independent entity but a clinicopathological one that includes postinflammatory pigmentation, and that the condition is the volar counterpart of mucosal melanotic macules.
Disseminated acanthamoebiasis presenting as lobular panniculitis with necrotizing vasculitis in a patient with AIDS
Authors: Rosenberg Arlene Sylvia , Morgan Michael B.
Published: March 2003

Background: Disseminated acanthamoebiasis is a rare entity, almost exclusively occurring in the immunocompromised host.

Methods: We report an unusual case of a 35‐year‐old female with recurrent sinusitis and multiple skin nodules demonstrating a necrotizing panniculitis, shown to be due to disseminated acanthamoebiasis.

Results: Histologic sections showed a neutrophilic lobular panniculitis with 20‐ to 30‐μm trophozoites consistent with Acanthamoeba species.

Conclusions: A review the literature shows that the histopathological presentation of acanthamoebiasis often eludes initial diagnostic attempts and that central nervous system (CNS) involvement is frequent and ultimately fatal. When amoebiasis is suspected, knowledge of the trophozoite and cyst forms may be helpful in distinguishing Acanthamoeba species from Entamoeba histolytica.
Tumor‐infiltrating T cells in primary cutaneous B‐cell lympho‐proliferative disorders
Authors: Kamarashev Jivko , Schaerer Leo , Burg Günter , Hess Schmid Monika , Müller Beatrix , Kempf Werner
Published: March 2003

Background: Tumor‐infiltrating lymphocytes (TILs) are considered to play an important role in the antitumoral immune response. The presence and percentage of CD8‐positive tumor‐infiltrating T cells have been shown to correlate with differentiation and prognosis in various neoplasms. The aim of this study was to determine the number of CD8‐positive T cells in various primary cutaneous B‐cell lymphoproliferative disorders and to evaluate its correlation with the histological type of tumor.

Methods: Fifty‐three lesions were examined by immunohistochemistry with antibodies targeting CD3, CD4, CD8 and TIA‐1. Thirty‐two lesions had been diagnosed as primary cutaneous B‐cell lymphomas (CBCL) and 21 as B‐cell pseudolymphomas (B‐PSL). CBCLs included 15 follicular lymphomas (FL), 6 marginal zone lymphomas (MZL), and 11 diffuse large B‐cell lymphomas (LCL). The number of CD8‐positive cytotoxic T cells was determined by computer‐assisted morphometrical microscopy.

Results: No significant difference could be detected in the density of CD8‐positive T cells in B‐PSL (101/105μm2), FL (110/105μm2), and MZL (122/105μm2). In contrast, the number of CD8‐positive cells (55/105μm2) in LCL was significantly lower (p<0.01) compared to B‐PSL, FL and MZL.

Conclusions: In summary the number of CD8‐positive T cells in B‐cell lymphoproliferative disorders differs in regard to tumor type and differentiation with lowest numbers in diffuse large B‐cell lymphomas. However, due to an overlap of the number of TILs, this parameter cannot be employed as a diagnostic parameter for individual cases.
Creation of psoriatic plaques: the ultimate tumor suppressor pathway.
Authors: Nickoloff Brian J.
Published: March 2003

From an oncological and immunological perspective, the T‐cell‐mediated induction of psoriatic plaques should be prone to malignant transformation as the phenotype of psoriatic plaques includes: chronic inflammation, epidermal hyperplasia, prolonged survival and elevated telomerase levels in lesional keratinocytes, as well as angiogenesis, exposure to carcinogens and immunosuppressants. However, conversion of a psoriatic plaque to squamous cell carcinoma is exceedingly rare. This paper explores the possible molecular mechanism for the tumor suppressor pathway in psoriatic lesions, with an emphasis on a putative senescence‐switch involving p16.
The expression of syndecan‐1 is preferentially reduced compared with that of E‐cadherin in acantholytic squamous cell carcinoma
Authors: Bayer‐Garner Ilene B. , Smoller Bruce R.
Published: March 2003

Background: Syndecan‐1 and E‐cadherin are cell adhesion molecules which are expressed primarily on the surface of adult epithelial cells. They appear to be co‐regulated and may act in concert to stabilize the epithelium. Loss of expression of both E‐cadherin and syndecan‐1 is seen in malignant transformation and invasion.

Methods: Thirteen cutaneous biopsies of acantholytic squamous cell carcinoma (SCC) were examined for coexpression of E‐cadherin and syndecan‐1.

Results: Interestingly, immunoreactivity for E‐cadherin was increased in the in situ component while immunoreactivity for syndecan‐1 was similar to that seen in normal skin. Conversely, in invasive SCC the expression of these two adhesion molecules was very similar. Both diminished with decreasing cell differentiation, as well as in the acantholytic areas where both molecules exhibited increasing cytosolic staining rather than cell membrane staining.

Conclusions: Our results suggest that it is likely E‐cadherin and syndecan‐1 act in concert to stabilize the epithelium and that the loss or decreased expression of both of these adhesion molecules is associated with malignant transformation.
Giant cells in pyoderma gangrenosum
Authors: Sanders Scott , Tahan Steven R. , Kwan Theodore , Magro Cynthia M.
Published: March 2003

It has been claimed that pyoderma gangrenosum (PG) lesions may contain granulomatous foci when associated with Crohn’s disease. To test this assertion, we obtained clinical histories and archived cutaneous biopsies from 34 PG patients. Thirteen of these patients had inflammatory bowel disease (IBD). Immunostaining with PGM1, a macrophage marker, revealed well‐formed giant cells with three or more nuclei in biopsies from 6 of 13 patients with IBD. Five of the 6 biopsies came from patients with Crohn’s disease and one from a patient with ulcerative colitis. Two were peristomal. In the 21 patients who had PG without IBD, no giant cells were seen. Thus, PGM1+ histiocytic giant cells within a PG lesion may be indicative of associated IBD (p=0.006), particularly Crohn’s disease.
Comprehensive analysis of 112 melanocytic skin lesions demonstrates microsatellite instability in melanomas and dysplastic nevi, but not in benign nevi
Authors: Hussein Mahmoud R. , Sun Min , Tuthill Ralph J. , Roggero Eduardo , Monti Jorge A. , Sudilovsky Eulalia C. , Wood Gary S. , Sudilovsky Oscar
Published: March 2003

Introduction: Alterations in the length of DNA repetitive sequences (microsatellite instability (MSI)) represent distinct tumorigenic pathways associated with several familial and sporadic tumors.

Material and methods: To investigate the prevalence and frequency of MSI in melanocytic lesions, the polymerase chain reaction (PCR)‐based microsatellite assay was used to examine formalin‐fixed, paraffin‐embedded tissues of 30 benign melanocytic nevi, 60 melanocytic dysplastic nevi (MDN), and 22 primary vertical growth phase cutaneous malignant melanomas (CMM). Twenty‐four microsatellite markers at the 1p, 2p, 3p, 4q and 9p chromosomal regions were used.

Results: MSI was found at 1p and 9p in MDN and CMM but not in benign melanocytic nevi. The overall prevalence of MSI was17/60 (28%) in MDN and 7/22 (31%) in CMM. The frequency of MSI ranged from 2/24 (9%) to 4/24 (17%) and was most commonly found at D9S162. There was a statistically significant correlation between degree of atypia and frequency of MSI (p<0.001) in MDN. There were two MSI banding patterns: band shifts and additional bands.

Conclusions: The data presented revealed the presence of low‐frequency MSI (MSI‐L) at the 1p and 9p regions in both MDN and CMM. Whether the MSI‐L pattern reflects a defect in mismatch repair genes is still to be determined.
Interstitial mycosis fungoides, a variant of mycosis fungoides resembling granuloma annulare and inflammatory morphea*
Authors: Su Lyndon D. , Kim Youn H. , LeBoit Philip E. , Swetter Susan M. , Kohler Sabine
Published: March 2003

Background: Interstitial mycosis fungoides (IMF) is a rare variant of mycosis fungoides that resembles the interstitial form of granuloma annulare and inflammatory morphea. IMF has received little attention in the literature.

Methods:  Clinical, histological, immunophenotypical, and genotypical findings of five cases of IMF were reviewed. The histological and immunophenotypical findings were compared with those of eight cases of interstitial granuloma annulare and six cases of inflammatory morphea.

Results:  Five patients with IMF presented with non‐indurated, erythematous macules; ill‐defined erythematous plaques with slight scale; and nodules on the trunk and proximal limbs. Two of five patients had a prior diagnosis of mycosis fungoides. Skin biopsies revealed a striking dermal interstitial infiltrate of lymphocytes with rare histiocytes that resembled the interstitial form of granuloma annulare or inflammatory morphea. Epidermotropic lymphocytes were present at least focally in all cases. A band‐like lymphocytic infiltrate was observed in two of five cases. In contrast, many plasma cells and histiocytes were observed in cases of inflammatory morphea and interstitial granuloma annulare, respectively. With Movat‐pentachrome stains, increased dermal mucin deposition was observed in two of five IMF cases, in all cases of interstitial granuloma annulare, and in one of six cases of inflammatory morphea. There was focal loss of elastic fibers in all cases of inflammatory morphea. Immunohistochemical studies of IMF highlighted a dominant population of T cells (CD3+) in the dermis and epidermis. In contrast, moderate numbers of B cells (CD20+) were admixed with T cells and plasma cells in inflammatory morphea. Almost equal numbers of histiocytes (CD68+) and T cells comprised the infiltrate of interstitial granuloma annulare. In two of five IMF cases, a clonal T‐cell population was detected by PCR T‐cell gamma gene rearrangement analysis.

Conclusion:  Mycosis fungoides occasionally presents as an interstitial lymphocytic infiltrate that mimics granuloma annulare and inflammatory morphea. Hematoxylin & eosin (H&E) findings alone can sometimes distinguish the three disorders. Immunophenotyping and genotyping may be helpful in difficult cases.
Papular xanthoma: a clinicopathological study of 10 cases
Authors: Breier Friedrich , Zelger Bettina , Reiter Harald , Gschnait Friedrich , Zelger Bernhard W. H.
Published: March 2003

Background: Papular xanthoma (PX) is one of several clinicopathologic variants of normolipemic cutaneous non‐Langerhans cell histiocytoses (n‐LCH). PX represents a monomorphous reaction pattern of n‐LCH characterized by the presence of predominantly xanthomatized macrophages.

Objective: The purpose of this study was to identify the clinical, histological and immunohistochemical characteristics of PX.

Methods: A series of 10 cases of PX was identified and the results compared with the other histologic subtypes, namely the polymorphous and the remaining other monomorphous reaction patterns in n‐LCH.

Results: In this clinicopathologic study, papular xanthoma presented clinically mainly as solitary papule, with a male to female ratio of4 : 1, in an age range from 13 to 57 years and a biphasic occurrence: in the young adolescence and middle ages. It was predominantly located on the trunk, the extremities, and rarely on the head. Clinically, PX was described as xanthoma, ‘cutaneous tumor’, but also as atheroma, keloid, histiocytoma, Spitz's nevus or clear cell acanthoma. Histology showed moderately well circumscribed exoendophytic papules with a regular epidermis and a dense infiltration of xanthomatized macrophages interspersed by numerous Touton type giant cells. Immunohistochemically mono‐ and multinucleated macrophages were consistently positive with KiM1p; while only giant cells were labeled with KP1 (CD68), the reactivity with HAM 56 was much more variable. Up to 50% of the xanthomatized cells labeled positive for the lectin peanut agglutinin. In one case the xanthomatized cells stained positive for CD34. Staining for factor XIIIa and CD1a were negative.

Conclusions: This series confirms PX as a rare, but distinguished clinicopathologic entity in the spectrum of n‐LCH of the skin.
Rhabdomyomatous mesenchymal hamartoma: an unusual dermal entity with a report of two cases and a review of the literature
Authors: Rosenberg Arlene Sylvia , Kirk John , Morgan Michael B.
Published: March 2003

Background: Rhabdomyomatous mesenchymal hamartoma (RMH) is a rare congenital lesion of the dermis and soft tissues consisting of a disordered and varied collection of mature adipose tissue, skeletal muscle, adnexal elements and nerve bundles. This entity exists under various names including striated muscle hamartoma, congenital midline hamartoma, and hamartoma of cutaneous adnexa and mesenchyme. Several published cases report the occurrence of RMH within the setting of other uncommon congenital abnormalities.

Methods: We report the clinical and pathologic features of two cases of rhabdomyomatous mesenchymal hamartoma. Patient 1 is a 71‐year‐old man who presented for removal of a nodule located on his temple that had been traumatized during a recent haircut. Patient 2 is a 4‐month‐old infant with amnion rupture sequence and rare craniofacial abnormalities including facial clefts, microphthalmia, bilateral colobomas, and a mobile fingerlike projection above the left medial canthus.

Results: Histological examination in both cases showed a deep dermal and subcutaneous fat collection of disorganized skeletal muscle fibers, adipose and neural tissue, and adnexal structures. Characteristically, the skeletal muscle approximated folliculosebaceous structures in a haphazard manner.

Conclusions: RMH is a rare benign condition of the deep dermis and subcutaneous fat with only 22 cases existing in the English literature. To our knowledge, this is the first report of an elderly man presenting with RMH, presumptively present since birth. There was no evidence of cellular or malignant degeneration. While the etiology of RMH is unknown, possible explanations include aberrancy in the embryonic migration of mesodermally derived tissues or a genetic defect predisposing to the formation of hamartomas.
Primary cutaneous plasmacytoma: a clinicopathological study of two cases with a long‐term follow‐up and review of the literature
Authors: Kazakov Dmitry V. , Belousova Irena E. , Müller Beatrix , Palmedo Gabriele , Samtsov Alexey V. , Burg Günter , Kempf Werner
Published: March 2003

Background:  Primary cutaneous plasmacytoma (PCP) is a rare type of cutaneous B‐cell lymphoma arising primarily in the skin and derived from clonally expanded plasma cells with a various degrees of maturation and atypia. The disease is rare with only 30 cases reported so far.

Methods:  Two cases of PCP with long‐term follow‐up of 17 and 15 years are presented.

Results and conclusions:  Both patients were men with nodular lesions on the face. Histologically, the lesions were composed predominantly of variably maturated plasma cells with monotypic expression of immunoglobulin (Ig) lambda chains. Polymerase chain reaction for IgH genes did not reveal clonal rearrangement. Our cases are discussed in the context of previously reported cases of PCP with a long‐term follow‐up. We also include a review of all cases of PCP with known tumor progression earlier in the course of the disease (local relapse or visceral spread) to determine the clinical course of this primary cutaneous lymphoma.
Microsatellite instability and its relevance to cutaneous tumorigenesis
Authors: Hussein Mahmoud R. , Wood Gary S.
Published: March 2003

Increasing evidence suggests that human tumors sequentially accumulate multiple mutations that cannot be explained by the low rates of spontaneous mutations in normal cells (2–3 mutations/cell). The mathematical models estimate that for the solid tumors to develop, as many as 6–12 mutations are required in each tumor cell. Therefore, to account for such high mutation rates, it is proposed that tumor cells are genetically unstable, i.e. they have genome‐wide mutations at short repetitive DNA sequences called microsatellites. Microsatellite repeats are scattered throughout the human genome, primarily in the non‐coding regions, and can give rise to variants with increased or reduced lengths, i.e. microsatellite instability (MSI). This instability has been reported in an increasing number of cutaneous tumors including: melanocytic tumors, basal cell carcinomas and primary cutaneous T‐cell lymphomas. Moreover, MSI has been observed in skin tumors arising in the context of some hereditary disorders such as Muir–Torre syndrome, Von Recklinghausen's disease and disseminated superficial porokeratosis. While MSI in some of these disorders reflects underlying DNA replication errors, the mechanism of instability in others is still unknown. Thus far, MSI is considered to be a distinct tumorigenic pathway that reveals surprising versatility. The ramifications for cutaneous neoplasms warrant further investigation.
Microsatellite instability and immunostaining for MSH‐2 and MLH‐1 in cutaneous and internal tumors from patients with the Muir–Torre syndrome
Authors: Machin Pilar , Catasus Lluis , Pons Cristina , Muñoz Josefina , Conde‐Zurita Jose Maria , Balmaña Judith , Barnadas Maria , Martí Rosa M. , Prat Jaime , Matias‐Guiu Xavier
Published: March 2003

Background:  Muir‐Torre syndrome (MTS) is characterized by the co‐existence of sebaceous gland tumors of the skin and internal malignancies. Currently, MTS is regarded as a variant of the hereditary non‐polyposis colon cancer syndrome (HNPCC). Both MTS and HNPCC are secondary to germline mutations in DNA mismatch repair genes (mainly MSH‐2 and MLH‐1).

Methods:  Cutaneous (eight sebaceous adenomas, one sebaceous carcinoma and one keratoacanthoma) and internal tumors (four colonic adenocarcinomas, two endometrial carcinomas, two transitional cell carcinomas of renal pelvis and ureter, one adenocarcinoma of the small bowel, one ovarian carcinoma and one colonic tubular adenoma) were obtained from six patients with MTS and were subjected to microsatellite instability (MI) analysis, and to immunostaining for MLH‐1 and MSH‐2. MI was assessed by evaluating three (CA)n dinucleotide repeats (D2S123, D5S346, D17S250) and the mononucleotide tracts BAT 26 and BAT 25.

Results:  All cutaneous and internal tumors exhibited MI. An immunohistochemical concordance between all tumors within each single patient was obtained in five cases. In these five patients all tumors exhibited a lack of MSH‐2 staining, consistent with a germline abnormality in this gene. In the one remaining case, the immunohistochemical staining in the sebaceous adenoma was negative for MLH‐1 and positive for MSH‐2, consistent with a germline alteration in MLH‐1. However, the colonic adenocarcinoma in that patient showed positivity for MSH‐2 and an equivocal positivity for MLH‐1.

Conclusions: The results confirm that tumors from patients with MTS exhibit MI. Moreover, immunostaining for MLH‐1 and MSH‐2 may be useful to identify the most probable gene responsible for the disease in each family.
Immunoglobulin A‐associated lymphocytic vasculopathy: a clinicopathologic study of eight patients
Authors: Crowson A. Neil , Magro Cynthia M. , Usmani Arif , McNutt N. Scott
Published: March 2003

Introduction: Cutaneous IgA‐associated vasculitis can be a clue to Henoch–Schönlein purpura (HSP), which typically comprises renal and gastrointestinal tract disease and arthritis, whereby prominent and predominant IgA deposits within the cutaneous vasculature provoke a pustular leukocytoclastic vasculitis.

Design: We describe eight patients with a novel expression of a cutaneous IgA vascular injury syndrome, namely a lymphoid vasculopathy which clinically and light microscopically resembled a pigmentary purpura (PP) in six, and correlate direct immunofluorescence (DIF) and clinical features to light microscopy.

Results: Among associated diseases were prior viral infection, an HSP symptom complex, an undifferentiated connective tissue disease syndrome, lupus erythematosus profundus (LEP), Degos' disease and Berger's disease. Skin lesions comprised non‐palpable petechial lesions involving lower extremities in all cases and also the upper extremities in two. A superficial perivascular lymphocytic infiltrate unaccompanied by vascular fibrin deposits was associated with prominent erythrocyte extravasation including into the epidermis. Mural and extravascular fibrin deposition was seen in one biopsy from a PP‐like lesion and mural fibrinoid necrosis was seen in the cases of LEP and Degos' disease; in biopsies from these three cases, the presence of fibrin deposition warranted use of the appellation ‘lymphocytic vasculitis’. In all patients, DIF showed prominent and predominant IgA deposits.

Conclusions: A non‐necrotizing lymphocytic purpuric vascular reaction is one manifestation of vascular IgA deposition in the skin. A subpopulation of human lymphocytes bear surface Fc receptor and/or C3 receptors (‘complement receptor lymphocytes’) which can bind circulating immune complexes (ICs) or C3 generated via activation of the alternative complement cascade. Thus, circulating ICs are a potential pathogenic basis of this eruption, the histologic differential diagnosis of which is idiopathic PP and PP of drug or viral etiology.
Cutaneous sclerosing extramedullary hematopoietic tumor in chronic myelogenous leukemia
Authors: Lane Joshua E. , Walker Anna N. , Kulharya Anita , Marzec Tomasz
Published: March 2003

Background:  Extramedullary hematopoiesis is a well‐documented manifestation of chronic myeloproliferative disorders, most commonly seen in chronic idiopathic myelofibrosis (agnogenic myeloid metaplasia), but rarely in chronic myelogenous leukemia. It typically occurs in the spleen and liver, but has also been described in skin. Microscopically, foci of extramedullary hematopoiesis consist of erythroid and myeloid precursors intermixed with megakaryocytes. The megakaryocytes may elaborate fibrogenic cytokines, which induce proliferation of fibroblasts. The term ‘sclerosing extramedullary hematopoietic tumor’ has been applied to this latter entity and its resemblance to a fibrohistiocytic neoplasm has been noted.

Methods:  We report the case of a 66‐year‐old man, whose cutaneous sclerosing extramedullary hematopoietic tumor preceded the diagnosis of chronic myelogenous leukemia.
Fatty acid synthase expression in melanoma
Authors: Innocenzi D. , Alò P. L. , Balzani A. , Sebastiani V. , Silipo V. , La Torre G. , Ricciardi G. , Bosman C. , Calvieri S.
Published: March 2003

Background: Fatty acid synthase (FAS), the key enzyme responsible for the synthesis of fatty acids, is weakly expressed in some normal human tissues. Recently, FAS has been demonstrated to be overexpressed in many non‐neoplastic highly proliferative lesions and in aggressive carcinomas with poor outcome, including colon, breast and ovary carcinomas.

Methods: In order to evaluate the prognostic significance of FAS in human melanoma, we analysed by means of immunohistochemistry, using a monoclonal anti‐FAS antibody, 77 primary melanomas and 30 nodal and cutaneous metastasis. Thirty nevi (15 dermal and 15 junctional nevi) were used as controls. All patients were followed‐up for 5 years.

Results: Thirty‐four melanomas expressed strong FAS immunostaining; the remaining 43 cases showed weak expression or were negative. All cutaneous and nodal metastasis were strongly positive. All patients with metastases deceased during the follow up period. Control specimens expressed weak staining. None of these patients developed recurrence. Statistical analysis revealed significant association of FAS expression with Breslow thickness (p = 0.012). The intensity of FAS immunostaining was also predictive of prognosis (p = 0.049).

Conclusions: FAS is a reliable prognostic marker in human melanomas. FAS predictive strength is increased when associated with Breslow thickness. The observation of FAS in human melanomas may stratify patients for stricter follow‐ups and suggest different therapeutic approaches.
Multidisciplinary case‐based learning for undergraduate students
Authors: Garvey M. Thérèse , O'Sullivan Michael , Blake Marielle
Published: March 2003

This report describes the introduction of case‐based learning into the final‐year dental programme at the Dublin Dental School. Students attended a series of one‐hour sessions in groups of 8. Each group appointed a chairman for each session and a tutor facilitated the discussion. Case details were provided during the session with relevant diagnostic records. At weekly discussion sessions, the group findings and treatment options were considered. The diagnosis and treatment plans were then discussed by clinicians involved in the treatment of the case. Following the last session, the case‐based learning programme was evaluated by means of a questionnaire distributed to both tutors and students. Both students and tutors rated the sessions positively. Case‐based learning was found to be a worthwhile progression from problem‐based learning.
A study of videoconferencing for postgraduate continuing education in dentistry in the UK – the teachers’ view
Authors: Odell E. W. , Francis C. A. , Eaton K. A. , Reynolds P. A. , Mason R. D.
Published: March 2003

Videoconferencing is an established method for providing medical education over long distances. Our aims were to assess the feasibility of videoconferencing in dental postgraduate education, to evaluate its practicability, teacher satisfaction and evaluate equipment. Twenty‐seven teachers from the 4 London Dental Schools provided 41 postgraduate dental education sessions on a range of topics to regional postgraduate centres and dental practices as part of the Thames Health Region’s programme. Videoconferencing was carried out using a relatively inexpensive personal computer system link using ISDN2 telephone lines and Z350 protocol. Presenter views and assessment were obtained by questionnaire, interview and videotape.

Teachers felt that minimal additional preparation time was required for videoconferencing and 21/27 preferred it to in‐person teaching, most noting the saving in travel time. Only 3 of the teachers were dissatisfied with their ability to communicate, 4 were equivocal and 20 were either pleased or very pleased. The teachers largely enjoyed the experience and performed well in the new medium. However, sound quality proved inadequate in 5/41 links and most sessions included some periods of suboptimal sound. Only 4 teachers were satisfied with their ability to perform question and answer interaction with the audience. We conclude that experienced teachers adapt readily to videoconferencing and learn to communicate effectively very quickly. Teachers were positive about the medium despite its shortcomings and improvements in sound quality would allow a rapid expansion of postgraduate dental education by videoconference.