bluuebunny/crossref_metadata_2025 huggingface dataset:
Hidroacanthoma simplex: An ultrastructural and immunohistochemical study
Authors: Perniciaro Charles , Muller Sigfrid A. , Zelickson Brian D. , Snow John L.
Published: April 2006

A representative case of hidroacanthoma simplex was studied with routine light microscopy, immunohistochemistry, and electron microscopy. Staining with the periodic acid‐Schffi reagent and immunostaining with anti‐keratin antibodies were useful in demarcating the tumor cells from adjacent normal epithelium. However, antibodies to carcinoembryonic antigen and epithelial membrane antigen did not help us to segregate or identify the neoplastic cells. Electron microscopy revealed tumor cells markedly different in appearance from luminal cells of the acrosyringium. Hidroacanthoma simplex does not appear to be derived from luminal cells of the acrosyringium. We propose criteria for the histologic diagnosis of this benign neoplasm.
Immunohistochemical expression of BCL‐2 in melanomas and intradermal nevi
Authors: Carmen Saenz‐Santamaría M. , Reed Jon A. , Scott McNutt N. , Shea Christopher R.
Published: April 2006

The BCL‐2 gene is the prototype of a newly described family of oncogenes involved in tumorigenesis by blocking apoptosis, or programmed cell death. Overexpression of BCL‐2 protein was originally described in follicular B‐cell lymphomas bearing the 14;18 translocation. BCL‐2 overexpression has also been described in other lymphomas and more rarely in neoplasms outside the lymphoid tissue. The aim of this paper is to determine the immunohistochemical expression of BCL‐2 in intradermal nevi and primary invasive and metastatic melanoma. Formalin‐fixed and paraffin‐embedded tissues from 4 cutaneous melanoma metastases, 10 primary invasive melanomas, and 10 intradermal melanocytic nevi were immimolabeled with monoclonal antibodies directed against BCL‐2 protein (Dako, clone 124) and Ki‐67 antigen (Amac, clone MIB‐1), after antigen retrieval techniques. Morphologically normal epidermal melanocytes expressed BCL‐2, as did nevi and melanomas in virtually all cells. However, whereas the labeling in normal melanocytes and nevus cells showed a uniformly strong reactivity, melanoma cells showed a variable but mainly weak reactivity. Ki‐67 antigen expression was restricted to melanomas. The widespread expression of BCL‐2 suggests that this onco‐protein cannot be involved in the malignant transformation of melanocytic cells. It seems likely that the decreased BCL‐2 expression detected in melanomas may reflect one further step of tumor progression in melanocytic neoplasms.
Histopathology in erythroderma: review of a series of cases by multiple observers
Authors: Walsh Noreen M.G. , Prokopetz Robert , Tron Victor A. , Sawyer Douglas M. , Kevin Walters A. , Murray Scott , Zip Catherine
Published: April 2006

This study examines the utility of objective histopathological studies in the evaluation of adult patients with erythroderma. A series of 56 skin biopsies, from 40 erythrodermic patients, was reviewed sequentially by 4 Canadian dermatopathologists who were unaware of clinical details of the cases. The final diagnosis (gold standard), in each instance, had already been determined by others, based on clinicopathologic data and response to therapy. Direct comparison revealed that the mean accuracy of I he histopathological diagnoses was 53% (range: 48‐(i6%). a favorable result in view of the difficulty of the task at hand. Additional points of information which evolved from the study are as follows: (i) identification, by microscopy alone, of spongiolic dermatitis, cutaneous T‐cell lymphoma and psoriasis, as underlying causes of eryihroderma was more successful than that of drug eruptions and pilyriasis rulira pilaris; (ii) the1 epidermotropism which characterizes cutaneous T‐cell lymphoma may be mistaken for inflammatory interface changes seen in drug eruptions and vice versa, thus constituting a pitfall in diagnosis; (iii) finally, it appears dial submission of multiple simultaneous biopsies, rather than a single specimen, from patients with erythroderma would be likely to enhance the accuracy of histopathological diagnosis.
Cutaneous focal mucinosis – a histopathological an immunohistochemical analysis of 11 cases
Authors: Wilk Michael , Schmoeckel Christian
Published: April 2006

The histogenesis of cutaneous local mucinosis (CFM) is controversial. Eleven cases of CFM (5F, 6M; mean age 51 years) from our routine files between 1986 and the present time have, therefore, been examined histopathologically and immunohistochemically. Histology revealed an increased number of fibroblast‐like cells in early lesions, whereas they were diminished or predominantly at the margin in advanced ones. The myxomatous areas showed slight to absent reticulum formation. Similarly, elastic fibers were almost absent, and collagen fibers were fragmented and replaced by variable amounts of mucin. One specimen revealed an epithelial component within the lesion reminiscent of a poorly induced trichofolliculoma. Immunohistochemically, vimentin was consistently present and correlated with the number of fibroblast‐like cells. A few (<5%) CD34+ dermal dendritic cells (DDs) were locally seen within CFM. In contrast, FXIIIa+ DDs accounted for up to 30%. Fibroblasl‐like cells were negative for S‐100 protein, Leu7, desmin and α‐SMA. The epithelial component within one of our specimens seems to have been induced by CFM and is a feature also seen in (angio)‐myxomas. CFM appears to be a mesenchymally derived lesion composed predominantly of fibroblasts. DDs do not form the major cell component but rather seem passively incorporated.
A case of acantholytic dermatosis of the vulva with features of pemphigus vegetans
Authors: Wong K.T. , Wong K.K.
Published: April 2006

We report an unusual case of vulvar acantholytic dermatosis with features of pemphigus vegetans in a 22‐year‐old Indian girl who presented with a “warty” lesion in her left labium majus. Following excision of this lesion, she presented with 2 localized recurrent lesions on the left and right labia majora about 21/2 years later which were also excised. All 3 biopsies showed histological features typical of pemphigus which included extensive suprabasal acautholysis with bullae formation, prominent villus‐like processes at the base of the bullae, focal hyperkeratosis and papillomatosis, and the occasional mixed neutrophil and eosinophilic intraepidermal abscess. IgG and C3 immunofluorescence was positive in the intercellular spaces of the epidermis. These lesions, which probably represent a form of pemphigus vegetans, have not been previously reported as a cause of localized vulvar acantholytic dermatosis.
Hyperplastic pacinian corpuscles: an uncommonly encountered lesion of the hand
Authors: Fraitag Sylvi , Gherardi Remain , Wechsler Janine
Published: April 2006

The occurrence of hyperplastic pacinian corpuscles in the hand is rare, with only 13 cases reported in the literature. We describe such a case in a 70‐year‐old male who had worked as a locksmith for many years. A grape‐like cluster of firm, rice‐sized nodules was discovered in the subcutaneous tissue of the finger following a glass‐induced injury. Histopathological findings revealed pacinian corpuscles to be increased in size and number. Individual corpuscles consisted of a central nerve fiber surrounded by 35 to 60 concentric lamellae (normal controls from other specimens: 13–15 lamellae). The external corpuscular diameter ranged from 1.8 to 3.2 mm (normal controls from other specimens: 1.6 mm). Immunohistochemistry showed positive staining with Leu 7 antibody and anti‐glial fibrillary acidic protein in the small nerves situated in the vicinity of the pacinian corpuscles, but not in the corpuscles themselves. The lesion reported here clearly differed from both neurofibroma with occasional pacinian differentiation and the so‐called pacinian neurofibroma. There was no evidence of neurofibromatosis.
Multiple perifollicular fibromas: report of a case and analysis of the literature
Authors: Junkins‐Hopkins Jacqueline M. , Cooper Philip H.
Published: April 2006

Perifollicular fibroma is a cutaneous hamartomatous proliferation of the pilar connective tissue sheath. We describe a patient with multiple perifollicular fibromas and analyze the literature on this topic. Histologically, perifollicular fibroma is characterized by a concentric arrangement of collagen fibers surrounding a generally unaltered hair follicle. Clinically, it is usually multiple and occurs predominantly on the face and upper trunk. This clinical presentation is similar to that observed in patients with the Birt‐Hogg‐Dubé syndrome where, in addition to perifollicular fibromas, fibrofolliculomas, trichodiscomas, and acrochordons are found. Several reports of multiple perifollicular fibroma prior to the recognition of this syndrome may, in fact, represent cases of the Bin‐Hogg‐Dubé syndrome.
Value of skin biopsy
Authors: King Lloyd E.
Published: April 2006

In regard to the recent report, “The specificity of histopathology in erythrodernia” by Zip, Murray and Walsh (j cutaneous Pathology 1993: 20: 393) 1 would like to Comment on the conclusions drawn from our previous article (Ref. #8, Southern Medical J 1986: 79: 1210). We reported that 43% of skin biopsies were highly suggestive or truly diagnostic and did not “aver that it [skin biopsy] is of little or no value” (Discussion, p. 395). We do not agree that the diagnostic value ol skin biopsies in erythrodermic patients is in question as both positive and negative data are highly relevant. Skin biopsies are helpful and the results are accurate in the setting described, but the clinical population was very different from that likely to be evaluated by pathologists in a general hospital setting.
CD44 expression in Merkel cell carcinoma may correlate with risk of metastasis
Authors: Penneys Neal S. , Shapiro Steven
Published: April 2006

We retrospectively studied 25 cases of cutaneous primary, locally recurrent or metastatic Merkel cell carcinoma to see if expression of the cell surface marker CD44 correlated with metastatic potential. In 3 of 6 cases in which metastasis was documented, CD44 was found on membranes of tumor cells. Three cutaneous lesions associated with local metastasis did not express CD44. Three primary tumors expressed CD44 but had not disseminated at the time of this report; follow‐up after excision of the primary lesion in these cases was less than (5 months. None of the primary or locally recurrent Merkel cell carcinomas followed longer than 6 months (14 of 19 cases) expressed CD44. We conclude that expression of CD44 in Merkel cell carcinoma may eventually be of some value in the assessment of prognosis of cutaneous Merkel cell carcinoma.
Acantholytic dermatosis localized to genitalia and crural areas of male patients: A report of three cases
Authors: Wong Tai‐Yuen , Mihm Martin C.
Published: April 2006

A series of 3 cases of acantholytic dermatosis localized to the male genitalia and perineal area with distinct clinical and histological features is presented. These patients did not have a family history of similar disorders and had no evidence of rash elsewhere. Clinically, the eruption was characterized by multiple discrete papules or macerated patches involving the genitalia and the perineum. Histologically, the acantholytic dermatosis had features that resembled both Hailey‐Hailey disease and Darier's disease. Similar clinical and histological findings have been reported in females. To the best of our knowledge, this is the first report of these lesions described confined to the genital and perineal areas in male patients. We agree with other authors that this condition may represent a distinct acantholytic eruption in the perineal area that should be distinguished from other generalized blistering acantholytic dyskeratotic disorders dial may also involve the genitalia.
E‐selectin and vascular cell adhesion molecule‐1 as critical adhesion molecules for infiltration of T lymphocytes and eosinophils in atopic dermatitis
Authors: Wakita Hisashi , Sakamoto Taiko , Tokura Yoshiki , Takigawa Masahiro
Published: April 2006

To study the temporal and spatial relationship between infiltrating T‐cell subsets or eosinophils and cell adhesion molecules on endothelial cells in skin lesions of atopic dermatitis (AD), we undertook immunohistochemical analysis using monoclonal antibodies against surface markers of T cells, eosinophil granule proteins and cell adhesion molecules. Predominant mononuclear cells in acute and chronic skin lesions were CDS, CD4 and CD45RO positive helper‐inducer/memory T cells. Their number was significantly and strongly correlated with the intensity of E‐selectin expression. Eosinophils and deposition of eosinophil‐derived granule proteins such as eosinophil cationic protein (ECP), major basic protein (MBP) and eosinophil peroxidase (EPO) were found constantly in acute lesions and only occasionally in chronic lesions. The total number of immunoreactive eosinophils and deposits of MBP, EPO and ECP were significantly and strongly correlated with die staining intensity of VCAM‐1. In chronic lesions significant reduction of VCAM‐1 expression paralleled occasional infiltration of eosinophils. Our results demonstrate the possibility that E‐selectin and VCAM‐1 are the critical adhesion molecules for trafficking of memory T cells and eosinophils, respectively, into skin lesions of AD. Persistent expression of the adhesion molecules may be related to prolongation of the skin lesion in AD.
Giant cell lichenoid dermatitis: A possible manifestation of sarcoidosis
Authors: Goldberg Lynne J. , Goldberg Neil , Abrahams Irving , Silvers David N. , Szaniawski Wojciech , Halperin Alan J.
Published: April 2006

Giant cell lichenoid dermatitis is a recently described dermatosis thought to be an unusual lichenoid drug eruption. It is characterized by a generalized, pruritic, papulosquamous eruption sparing palms, soles, face and mucous membranes. Histopathologic findings include areas of epidermal hyperplasia and atrophy with focal vacuolar alteration of the basal layer, exocytosis and cytoid body formation. The dermis contains a band‐like, mononuclear cell infiltrate at the dermoepidermal junction with admixed cosinophils, plasma cells and large multinucleate cells. The histologic differential diagnosis includes infectious processes, sarcoidosis, lichen nitidus, lupus erythematosus and lichen planus. We report 3 patients with giant cell lichenoid dermatitis, one of whom was subsequently diagnosed as having sarcoidosis. Because giant cell lichenoid dermatitis may resemble sarcoidosis both clinically and histologically, and because cutaneous sarcoid is often associated with systemic involvement, the diagnosis of sarcoid should be strongly considered in patients with giant cell lichenoid dermatitis.
Hypertrophic lichen planus in positive patients: A histologic immunological study
Authors: Rippis George E. , Becker Brad , Scott Glynis
Published: April 2006

It is well known that several dermatoses, such as psoriasis vulgaris and seborrheic dermatitis, present with more extensive and severe disease in patients infected with the human immunodeficiency virus (HIV‐1). Except for one report, however, lichen planus (LP) has not been described in patients with HIV infection. In this report we describe the clinical and morphological features of 3 HIV‐positive patients who presented with extensive hypertrophic LP. To determine if alteration in the immune status in HIV‐positive hosts is reflected in the nature of the infiltrate in LP, we determined the proportion of T‐helper and T‐suppressor cells in the infiltrate in 1 case. The majority of the infiltrating lymphocytes in the dermis were of the T‐helper phenotype. Epidermal lymphocytes, however, were predominantly of the T‐suppressor phenotype. We conclude that LP in HIV‐positive hosts may present with more extensive disease than in immunocompetent hosts. Based on our immunohistochemical studies, we conclude that, similar to immuonocompetent hosts, T‐helper cells are the predominant cells in the dermal infiltrate of LP in HIV‐positive patients. However, in contrast with reports in the literature on LP in immunocompetent hosts, we found that, in the case studied, the epidermal lymphocytes were predominantly of the T‐suppressor phenotype.
Association of nevus sebaceus with an unusual type of “combined nevus”
Authors: Misago Noriyuki , Narisawa Yutaka , Nishi Takahisa , Kohda Hiromu
Published: April 2006

A case of nevus sebaceus with development of a basal cell epithelioma is described. This case of nevus sebaceus was characterized by an association with extensive nevoid growths of melanocytes in the same lesion. The nevoid growths of melanocytes showed features of an unusual “combined nevus”, representing a combination of speckled lentiginous nevus with blue nevi. We discuss the relationship between nevus sebaceus and nevoid growths of melanocytes.
Idiopathic plantar hidradenitis: a neutrophilic eccrine hidradenitis occurring children primarily in children
Authors: Stahr Benjamin J. , Cooper Philip H. , Caputo Raymond V.
Published: April 2006

Neutrophilic eccrine hidradenitis (NEH) has been described in a variety of clinical settings but is most often seen in leukemic patients receiving chemotherapy. We have recently encountered 6 healthy individuals, of whom 5 were children, who developed NKH localized to the feel. The patients were from 9 to 21 years of age. The presenting complaint was rapid development of tenderness of the feet with varying degrees of morbidity. At clinical evaluation, tender, erythematous papules and nodules were confined to the feet, primarily the plantar surfaces. The major differential diagnoses were erythema no‐dosum and vasculitis. Laboratory studies were non‐contributory. Histologically, the findings were generally similar to those of NEH with certain exceptions, most notably the absence of syringosquamons metaplasia and the presence, in most cases, of neutrophilic abscesses in eccrine coils. Inflammatory and dengenerative changes involved primarily the eccrine duct (coiled and dermal), and tended to spare the secretory apparatus. Stains for microorganisms were negative. There were brief recurrences in some of the patients, but those followed over time have remained well. We suggest the term idiopnthic plantar hidradenitis for this condition.
Melanocytes in human skin express bcl‐2 protein
Authors: Klein‐Parker Helga A. , Warshawski Larry , Tron Victor A.
Published: April 2006

The bcl‐2 gene was initially identified through its participation in the translocation 14:18 in B‐cell lymphomas of follicular center cell origin. This classic translocalion juxtaposes the transcriptionally active immunoglobulin heavy‐chain locus on chromosome 14 to the bcl‐2 gene on chromosome 18, resulting in overexpression of bcl‐2 protein. The oncogene bcl‐2 is thought to prolong cell survival through interference with programmed cell death. To date, bcl‐2 expression has been reported in normal lymphoid, hemopoietic, neural, breast and prostatic tissues. Since melanocytes are neural crest derivatives and have an extended life‐span, our objective was to determine whether the bcl‐2 protein is expressed in human melanocytes. We analyzed normal skin biopsies for bcl‐2 expression using standard immunohistochemistry. As hypothesized, dendritic cells in the basal epidermal layer stained strongly for bcl‐2. The distribution and morphology of these cells was typical for melanocytes. Additionally, eccrine sweat glands, lymphocytes and the dermal papilla of hair follicles demonstrated bcl‐2 positivity. We believe this to be the first report of bcl‐2 expression in normal melanocytes.
Characterization of the mononuclear infiltrate involved in regression of halo nevi
Authors: Akasu Reiko , From Lynn , Kahn Harriette J.
Published: April 2006

Halo nevi are characterized by progressive degeneration of nevus cells surrounded by a mononuclear cell infiltrate. We studied the morphological features of the nevus cells and the composition of the mononuclear cell infiltrate in 15 cases of halo nevi using immunohistochemical techniques and a battery of antibodies to different subsets of lymphocytes and histiocytes. Regression could be divided into four more or less identifiable stages, associated with different subsets of lymphocytes and monocyte‐macrophage lineage cells. Stage I (preregression): nests of unremarkable nevus cells were surrounded by a moderate number of T lymphocytes (relatively small percentage of helper/inducer T cells), occasional B cells and macrophages. Stage II (early regression): large number of T lymphocytes and FXIIIa‐positive cells were in close contact with nevus cell clusters which showed ragged edges. Lysozymepositive cells and epidermal Langerhans cells were mildly increased. Stage III (late regression): single nevomelanocytes showing mild atypia were present. Numerous T lymphocytes and macrophages positive for lysozyme, KP1 and/or FXIIIa were interspersed between the nevus cells. Increased numbers of epidermal Langerhans cells were present. Stage IV (complete regression): no nevus cells were observed and moderate numbers of T lymphocytes only remained. These results suggest that T cells, especially T‐suppressor cells, and different subsets of macrophages participate in the regression of the nevi.
Pseudoepitheliomatous hyperplasia in chronic cutaneous wounds
Authors: Gattuso P. , Candel A. G. , Castelli M. J. , Kowal‐Vern A. , Gamelli R. L. , Herman C.
Published: April 2006

Cutaneous squamous cell carcinomas (SCC) arising in a setting of chronic regeneration and repair tend to be highly aggressive lesions prognostically distinct from SCC arising in solar‐damaged skin. Full thickness thermal injury and chronic nonhealing ulcers are predisposing conditions in up to 2% of SCC. A significant association has been suggested to exist between pseudoepitheliomatous hyperplasia (PH) and SCC. Three‐hundred‐eighty‐six surgical cases of skin excised secondary to severe burns (n = 254) or chronic ulcers (n= 132) were reviewed, yielding 43 (11%) with PH. Flow cytometric DNA analysis was performed on paraffin‐embedded sections. Thirty cases without PH were studied in addition to the 43 cases with PH. The majority (39/43) of the PH cases showed a single diplod population with a mean S‐phase of 13.7%. Four cases (9.3%) showed an aneuploid peak. All cases without PH were diploid with a mean S‐phase of 9.0%. In this study, PH was present in 11% of cases reviewed, and showed a 50% mean higher S‐phase than comparable cases without PH. Aneuploidy was present in 9.3% of the PH cases studied. SCC may arise from a subgroup of PH in a background of rapidly proliferating keratinocytes.
Techniques in immuno‐electron microscopy
Authors: Schaumburg‐Lever G. , Fehrenbacher B. , Möller H. , Nau P.
Published: April 2006

Normal skin was cryoprotected by submerging it in a mixture of 30% dimethylformamide (DMF) in PBS or RPMI. Subsequently it was frozen in liquid propane gas. Cryosubstitution was carried out at −90°C by using methanol to which uranyl acetate or osmium tetroxide were added. The tissue was embedded in either Lowicryl K4M at −40°C or in Epon at +60°C. The‐ tissue was evaluated by its overall preservation of ultras‐tructural details and by its labeling intensity alter incubation with either anti‐clesmoglein or anti‐type VII collagen monoclonal antibodies. The mixture of DMF and PBS caused an electron‐dense precipitate within the cell. The overall morphology was better in Epon‐embedded material than in K4M‐embedclecl material. However, the labeling was best in K4M material. Regardless of whether the tissue was embedded in Epon or K4M, the addition of osmium tetroxide markedly reduced the degree of labeling.
Arteriovenous hemangioma: a clinicopathological and immunohistochemical study
Authors: Koutlas Ioannis G. , Jessurun Jose
Published: April 2006

The clinicopathological and immunohistochemical properties of 6 examples of arteriovenous hemangioma, including 2 intraoral lesions, were reviewed. This distinct benign, acquired vascular lesion, infrequently encountered in the literature, is characterized by multiple thick‐ and thin‐walled vascular spaces resembling arteries and veins, respectively. In our study, we performed elastic stains that revealed a prominent venular component, whereas the arterial aspect was inconspicuous to absent. Our aim was also lo elucidate the possible histogenesis of this lesion. Previous reports suggest as pathogenetic mechanisms hamartomatous proliferation either of the subpapillaiy vascular plexus or of the Suquet‐Hoyer canal of the true glomus. Our immunohistochemical studies failed to identify typical glooms cells. In addition, we investigated the mast cell count in all lesions and it was found increased. These findings, as well as recent evidence directly implicating mast cells in angiogenesis, can support the theory of hamartomatous proliferation of the subpapillary plexus. One should also not exclude the possibility of a reactive process resulting in the characteristic features of arteriovenous hemangioma.
Dermatomyofibroma: report of two cases
Authors: Colomé María I. , Sénchez Ramén L.
Published: April 2006

Dermatomyofibroma is a recently described, benign acquired cutaneous proliferation of fibroblasts and myofibroblasts. We report 2 additional cases, both in young women. The lesions measured 0.5 and 1.0 cm and were located on the breast and upper back. Follow‐up at 8 months and 3 years revealed no evidence of recurrence. Both lesions exhibited a uniform population of spindle cells forming intersecting long fascicles with a tendency to horizontal orientation in the reticular dermis. Cytologic atypia was absent and mitotic figures were minimal or absent. Collagen was present as thin fibers separating individual cells and as thicker bundles between the fascicles. A fine reticulin network surrounded the spindle cells. Elastic Fibers were mostly preserved and appeared thicker or even increased in number. The spindle cells were immunoreactive for vimentin and muscle actin and negative for desmin, S‐100 protein, factor XIIIa, and CD34. Electron microscopic studies confirmed the presence of myofibroblasts. The differential diagnosis was made with cellular and fibrous dermatofibroma, piloleiomyoma, hyperlrophic scar, and dermatofibrosarconia protuberans, both classic and plaque type. The data presented supports the histologic distinction of dermatomyofibroma from other fibroblastic proliferations of the skin.
Cutaneous Rosai‐Dorfman disease presenting as a suspicious breast mass
Authors: Mac‐Moune Lai Fernand , Lam Wing Yin , Chin Chu Wah , Ng Wing Ling
Published: April 2006

Cutaneous Rosai‐Dorfman disease in a male patient presented as a clinically malignant left breast mass. The intra‐operative frozen section indicated a benign inflammatory lesion and a simple excision was performed. The disease was apparently limited to the skin and subcutis of the left breast with no lymph nodes or other organs involvement. While the lesion demonstrated the characteristic morphology of Rosai‐Dorfman disease, the diagnosis of granulomatous mastitis, epithelioid sarcoma and other cutaneous xanthohistiocytic proliferations were considered. In the absence of lymphadenopathy, a high index of diagnostic awareness is required to recognize the uncommon, solitary cutaneous Rosai‐Dorfman disease.
Distinctive dendritic cell subsets expressing factor XIIIa, CD1a, CD1b and CD1c in mycosis fungoides and psoriasis
Authors: Fivenson David P. , Nickoloff Brian J.
Published: April 2006

The papillary dermis of psoriasis and mycosis fungoides (MF) lesions is characterized by prominent collections of cells with dendritic morphology. Immunophenotypically distinct populations of cutaneous dendritic cells have been identified as CD1a+, FXIIIa‐Langerhans cells (LC) and CD1a‐, FXIIIa+ dermal dendritic cells (DDC). In this study, antibodies against the human GDI cluster of antigens (i.e. CD1a, CD1b and CD1c) and the DDC) marker (FXIIIa) were used to further characterize the subsets of dendritic cells in normal skin as compared to neonatal foreskin, psoriasis and MF by both immunoperoxidase and double immunofluorescence techniques. Normal skin and foreskin epidermis and dermis contained few CD1b+ or CD1c+ cells along with normal numbers of CD1a+ LC and FXIIIa+ DDC. Both MF and psoriasis were characterized by CD1a+ cells in the epidermis and dermis. FXIIIa+ cells were greatly expanded in the upper dermis of MF lesions and to a lesser degree in psoriasis as has been previously described by our group. MF contained significantly increased epidermal and dermal CD1b+ (15.7/5 high power fields [HPF] and 59.7/5 HPF respectively) and CD1c+ dendritic cells (33.8/5 HPF and 95.9/5 HPF respectively), while in psoriasis these cells were not statistically different from normal skin. Double immunofluorescence studies revealed that some (<25%) FXIIIa+ cells co‐expressed CD1b and CD1c in MF>psoriasis> foreskin, while FXIIIa+ DDC never co‐expressed CD1a. Thus, in contrast to normal skin in which epidermal or dermal dendritic cells rarely express CD1b and CD1c antigens, these members of the CD1 family are upregulated on both LC and DDC in benign and malignant inflammatory states. Upregulation of CD1b and CD1c on MF epidermal and dermal dendritic cells, as compared to psoriasis, foreskin and normal skin, may be useful in the immunophenotypic recognition of MF, as well as in helping to understand its immunobiology.
Merkel cells are integral constituents of Desmoplastic trichoepithelioma: an immunohistochemical and electron microscopic study
Authors: Hartschuh Wolfgang , Schulz Tilman
Published: April 2006

The incidence of Merkel cells has previously been investigated in a number of inflammatory and tumorous lesions of the skin. Special attention was given to tumors with follicular differentiation. In the present study we examined the localization of Merkel cells in another adnexal tumor, the desmoplastic trichoepithelioma (n= 15), as well as in its main differential diagnosis, the morpheiform basal‐cell carcinoma (n=30). Using immunohistochemical methods, we found Merkel cells as a stable constituent in desmoplastic trichoepitheliomas, but failed to detect them in morpheiform basal‐cell carcinomas. These findings might therefore be an important tool in the sometimes very difficult but clinically imperative distinction between these two conditions. Furthermore, our study may be of interest in the discussion about the origin of desmoplastic trichoepitheliomas. High numbers of Merkel cells in desmoplastic trichoepitheliomas indicate a bulge‐derived origin of this adnexal tumor, since high numbers of Merkel cells, especially in the bulge, were recently discovered. Although the significance of Merkel cell hyperplasia in desmoplastic trichoepithelioma is not presently understood, a regulatory role of the Merkel cell in growth and development of this adnexal tumor is suggested.
Progesterone receptor positivity supports hormonal control of syringomas
Authors: Wallace M. L. , Smoller B. R.
Published: April 2006

Syringomas may be at least partially under estrogen and/or progesterone influence, as they are more common in women and are known to proliferate at puberty. During pregnancy and the premenstrual period an increase in tumor size has also been described. We examined nine syringomas using immunohistochemical markers for estrogen (ER) and progesterone (PR) receptors. Scattered tumor cells displaying nuclear and cytoplasmic staining for ER were noted in one of the nine cases. Intense nuclear and cytoplasmic staining for PR was noted in most (>80%) of the neoplastic cells in 8/9 syringoma cases. Current immunohistochemical evidence supports the theory that syringomas are under hormonal control.
Papillomatous melanocytic nevi: an estrogen related phenomenon
Authors: Morgan Michael B. , Raley Brian A. , Vannarath Rick L. , Lightfoot Stan L. , Everett Mark A.
Published: April 2006

A prospective two‐month epidemiologic and histologic study of all melanocytic nevi biopsied (n = 434) at the University of Oklahoma Health Center was undertaken. Melanocytic nevi with papillomatous features (PAP) (n=50) were found to occur predominantly in females (females = 44, males = 6; p < 0.01 adjusted for sex distribution of all melanocytic nevi). Immunohistochemical analysis of melanocytic nevi revealed concordance between PAP and intracytoplasmic nevocellular staining for estrogen‐inducible pS2 protein. Melanocytic nevi without papillomatous features failed to stain for pS2 protein. These results suggest a hormone responsivness exclusive of patient sex which may influence the pathogenesis of these distinctive melanocytic nevi.
Subcutaneous juvenile xanthogranuloma
Authors: Yus Evaristo Sánchez , Requena Luis , Villegas Cristina , Valle Pilar
Published: April 2006

A 1‐month‐old female infant was seen in consultation because of a congenital subcutaneous nodule, 2×3 cm in diameter, in the right retroauricular area. The nodule was surgically excised. Histologically, a large subcutaneous nodular mass was well delimited but not encapsulated. It consisted of a monomorphous sheet of foamy histiocytic cells with scattered eosinophils. Multinucleated giant cells were not found. The pure subcutaneous type of juvenile xanthogranuloma has been reported very rarely in the literature. The usual histological monomorphism of these cases, with only occasional eosinophils and lymphocytes and rare Touton giant cells, adds another diagnostic difficulty to their unusual clinical presentation.
Cutaneous eruption of lymphocyte recovery mimicking mycosis fungoides in a patient with acute myelocytic leukemia
Authors: Gibney Mary Davis , Penneys Neal S. , Nelson‐Adesokan Paula
Published: April 2006

Eruption of lymphocyte recovery (ELR) develops in the setting of leukocyte reconstitution after iatrogenic marrow aplasia and displays a superficial perivascular lymphocytic infiltrate composed of CD3+/CD4+ cells. Epidermal changes are usually minimal to absent. We report a case of an ELR mimicking mycosis fungoides with the formation of CD4+ Pautrier‐like microabscesses.
New applications of electron microscopy techniques in dermatopathology
Authors: Schaumburg‐Lever Gundula
Published: April 2006

The application of immunostaining techniques to electron microscopy specimens has led to a renewal of interest in electron microscopy in biological research in general, as well as in dermatopathology. Refinements in the preparative procedures have made easier the immunolocalization of antigens both in chemically‐fixed and frozen unfixed tissues, embedded in plastic and sectioned. Application of these methods has led to the demonstration of the bullous pemphigoid antigen inside basal keratinocytes. HMB‐45 antigen has been found to be present in premelanosomes. Recently, Factor XIIIa has been localized not only in dermal dendrocytes but also in endothelial cells and mast cells.
Nevoid malignant melanoma: morphologic patterns and immunohistochemical reactivity
Authors: McNutt N. Scott , Urmacher Carlos , Hakimian Jack , Hoss Diane M. , Lugo Jorge
Published: April 2006

The term “nevoid malignant melanoma” (nevoid MM) is used here to describe rare nodular malignant melanomas that may escape detection in routine histological sections due to the lack of a prominent intraepidermal component, sharp lateral circumscription and evidence of partial maturation with descent in the dermis. Nevoid MM mimic ordinary compound or intradermal melanocytic nevi when the melanoma cells are small, or Spitz's nevi when the cells are large.

The patterns of HMB‐45 staining in 12 nevoid MM were compared with those in 107 melanocytic nevi. HMB‐45 staining was strong in the dermal component of the nevoid MM, even in the absence of a junctional component. In common acquired and congenital nevi, the upper dermal component stained less than the junctional component of the lesion. The deepest components of these nevi were negative. Spitz nevi and cellular blue nevi had positive dermal cells, even without a junctional component. Additional staining for a proliferation marker, such as cyclin (PCNA) or Ki‐67 (with the antibody MIB‐1), can help further in distinguishing a nevoid MM from a Spitz's nevus. Melanoma has strong nuclear staining throughout the lesion. In contrast, Spitz's nevi have more staining at the top of the lesion than at the bottom. The patterns of HMB‐45 and MIB‐1 staining can be used along with standard histologic criteria for the diagnosis of nevoid MM. Clinicopathologic correlation is needed to distinguish some metastatic melanomas from primary nevoicl MM.
Distribution of CD44 variant isoforms in human skin: differential expression in components of benign and malignant epithelia
Authors: Hale Laura P. , Patel Dhavalkumar D. , Clark Robert E. , Haynes Barton F.
Published: April 2006

Expression of cell adhesion molecules regulates epithelial cell differentiation and organization of complex tissues such as skin. The CD44 family of adhesion molecules is generated by alternative splicing of up to 10 variant exons encoding inserts into the extracellular domain. Expression of CD44 variant exons has been correlated with metastatic potential of some epithelial malignancies. We studied the distribution of total and variant CD44 isoforms containing exons v4, v6, and v9 in normal skin, basal cell carcinoma, and in control tissues using immunohistologic assays. While normal epidermis and other stratified squamous epithelia reacted strongly with antibodies specific for standard CD44 (CD44S) and CD44 isoforms containing exons v4, v6, and v9, the epithelium of eccrine glands was reactive, often in a polarized distribution, only with antibodies specific for CD44S and isoforms containing exon v9. These studies suggest that differential expression of CD44 variant exons may be important in development and organization of epithelial structures within skin. Malignant cells in basal carcinoma tissues were found to have low reactivity with antibodies specific for CD44S or variant CD44 molecules. The low expression of CD44 molecules in basal cell carcinomas may play a role in the relatively low probability of metastasis of these neoplasms.
Cutaneous cysts of Gardner's syndrome are similar to follicular stem cells
Authors: Narisawa Yutaka , Kohda Hiromu
Published: April 2006

Cutaneous cysts from a patient with Gardner's syndrome were histopathologically studied in detail. The cysts were, by and large, indistinguishable from ordinary epidermal cysts. However, several distinctive features were found: 1) epidermal or trichilemmal keratinization, 2) mature sebaceous glands connected with the cyst wall, 3) hair matrix‐like structures associated with dermal papilla cells, 4) pilomatricoma‐like changes, 5) intraluminal masses or pericystic deposits of shadow cells variably accompanied with foreign body reaction, 6) foreign body reaction or masses of shadow cells lining completely eroded cysts, 7) the presumptive bulge area, and 8) epithelial islands adjacent to the cyst. Each cutaneous cyst showed a variable combination of the findings described above. Foci of the basal layer of some cyst walls or epithelial islands were immunohistochemically stained with CK19, where CK20‐reactive Merkel cells were also present. These Findings were consistent with those of the bulge area. Unexpectedly, desmin‐reactive muscle bundles, presumably indicating arrector pili muscle, were observed along the cyst wall. Our observations suggest that Gardner's cysts may be derived from putative follicular stem cells which reside in the bulge area.
Approach to diagnostic image analysis of melanocytic tumors*
Authors: Smolle J. , Hofmann‐Wellenhof R. , Soyer H.P.
Published: April 2006

Numerous attempts have been made to apply image analysis in dermatopathology. The technics used comprise measurement of nuclear size, shape, chromatin content, and texture, evaluation of immunohistological slides, assessment of proliferation, pattern analysis, and tumor volume estimation. For commonly accepted routine use, however, image analysis research has to be extended to large numbers of cases, using straightforward and reproducible measuring procedures, and to the development of ready‐to‐use equipment for specific tasks. In this way, image analysis in dermatopathology might supply useful diagnostic tools in addition to conventional microscopy, and may increase our understanding of morphology as a whole.
Expression of α subunit of guanine nucleotide‐binding protein Go in Merkel cell carcinoma
Authors: Uhara Hisashi , Wang Yu‐Lai , Matsumoto Sachiyo , Kawachi Shigeo , Saida Toshiaki
Published: April 2006

The α subunit of guanine nucleotide‐binding protein Go(Goα), which was initially isolated from bovine brain, interacts with muscarinic cholinergic receptors and regulates neuronal calcium channels. Goα is known to be localized in neural tissues, some endocrine cells, and neuroendocrine tumors. We have immunohistochemically investigated the expression of Goα in 4 cases of Merkel cell carcinoma using the method of microwave treatment. In all cases of Merkel cell carcinoma, Goα was consistently detected on the plasma membrane and cytoplasm of the tumor cells. Nerve fibers in the skin were also positive for Goα, but other epidermal or dermal components such as keratinocytes, melanocytes, fibroblasts, or lymphoid cells were negative. Tumor cells of squamous cell carcinoma, cutaneous lymphoma, sweat gland carcinoma, and malignant melanoma were negative for Go4aL. The present study indicates that Goα may be a useful immunohistochemical marker of Merkel cell carcinoma.
Acquired progressive lymphangioma of the skin following radiotherapy for breast carcinoma
Authors: Rosso R. , Gianelli U. , Carnevali L.
Published: April 2006

A case of a vascular tumor clinically and pathologically consistent with acquired progressive lymphangioma (benign lymphangioendothelioma) in a 48‐year‐old woman is reported. The lesion appeared in the skin close to a mastectomy scar 3 years after surgery and radiotherapy for invasive ductal carcinoma. On histologic examination, it mimicked an aggressive vascular neoplasm because of its infiltrative pattern. However, follow‐up studies confirmed the benign nature of the lesion, clinically and histologically. This case indicates that acquired progressive lymphangioma may follow radiotherapy and must be considered in the differential diagnosis of other vascular proliferations occurring in the skin of the breast, especially of low‐grade postradiation angiosarcoma, a recently described neoplastic entity.
Cystic clear cell acanthoma
Authors: Hamaguchi Taizo , Penneys Neal
Published: April 2006

An histologically typical clear cell acanthoma was identified forming a cystic structure. The finding of clear cell acanthoma within a cyst is histologically unique.
Comparison of p53 expression in dermatofibrosarcoma protuberans and dermatofibroma: Lack of correlation with proliferation rate
Authors: Díaz‐Cascajo Carlos , Bastida‐Iñarrea Jesús , Borrego Leopoldo , Carretero‐Hernández Gregorio
Published: April 2006

p53 protein plays an important role in control of cell proliferation by suppressing proliferation of cells with DNA damage. Mutations of the p53 gene increase the stability of the encoded nonfunctional protein which accumulates in the nuclei, allowing it to be detectable by immunohistochemistry. Mutant p53 protein has been observed in preneoplastic and neoplastic conditions supporting its role in the development of some human cancers. In this immunohistochemical study, we examined p53 expression in 12 Dermatofibrosarcoma Protuberans (DFSP) and 10 Dermatofibromas (DF). Results were compared with the cellular proliferation rate by using the monoclonal antibody Mib‐1 which detects Ki‐67 antigen expression. Nuclear accumulation of the p53 protein was observed in 11 DFSP. All DF were negative for p53. No statistical correlation could be established between p53 and Mib‐1 staining in our cases. We conclude that mutations of the p53 gene may be involved in the molecular pathogenesis of DFSP but not of DF. Mib‐1 index can not be successfully used to distinguish DFSP from DF.
A comparison of clinical, morphological and immunohistochemical features of lymphomatoid papulosis and primary cutaneous CD30(Ki‐1)‐positive anaplastic large cell lymphoma
Authors: Tomaszewski Maria‐Magdalena , Lupton George P. , Krishnan Jayashree , May Dennis L.
Published: April 2006

The advent of immunoperoxidase technique on paraffin embedded tissue has identified a number of shared immunologic markers present in various lymphoproliferative cutaneous disorders. Two such disorders are the recently described primary cutaneous CD30‐positive anaplastic large cell lymphoma (ALCL) and lymphomatoid papulosis; both entities are characterized by CD30‐positive large atypical cells predominantly of T cell origin. We have compared the clinical, morphological and immunohistochemical features of 50 patients with lymphomatoid papulosis to a group of 27 patients with cutaneous CD30‐positive ALCL. There are clear differences between the clinical presentation in these two diseases, and although both are characterized by similar atypical cells, the histologic pattern and distribution of atypical cells is sufficiently different to allow distinction and specific diagnosis based on hematoxylin and eosin stained sections supported by the immunohistochemical stains. In addition, both diseases are characterized by a long benign course, rarely complicated by development of lymphoreticular malignancy and invariably demonstrate CDSO(Ki‐I) antigen positive large atypical cells.
Proliferative activity in metastatic malignant melanoma: comparison of pre‐treatment and post‐treatment metastases
Authors: Barksdale S. K. , Stern J. B. , Haupt H.M. , Multhaupt H.
Published: April 2006

In this study, the proliferative activity of malignant melanoma metastases was assessed before and after isolated limb perfusion chemotherapy by quantitating AgNORs, mitoses and PCNA activity. No significant difference in either AgNOR count, mitotic activity or PCNA index was observed. We conclude that AgNOR count, mitotic activity and PCNA index were not significantly effected by isolated limb perfusion chemotherapy.
Choriocarcinoma presenting as a cutaneous metastasis
Authors: Chhieng David C. , Jennings Timothy A. , Slominski Andrzej , Jr. Mihm Martin C.
Published: April 2006

The rare presentation of choriocarcinoma as a cutaneous metastasis in a 23‐year‐old male is reported. Histological and immunohistochemical analysis of the biopsy material demonstrated two distinct cell populations, syncytiotrophoblasts and cytotrophoblasts, with syncytiotrophoblasts strongly positive for human chorionic gonadotropin antigen. Subsequent clinical evaluation revealed a testicular tumor with metastases to lungs, brain, liver and kidney and increased serum levels of human chorionic gonadotropin. The patient died shortly alter diagnosis due to complications of metastatic disease despite chemotherapy.