bluuebunny/crossref_metadata_2025_split huggingface dataset:
Subcutaneous nodules in Whipple’s disease
Authors: Tarroch X. , Vives P. , Salas A. , Moré J. 
Published: March 2003

Background: Cutaneous findings other than hyperpigmentation are rare in Whipple’s disease.Case report: We present the case of a 59‐year‐old man previously diagnosed with Whipple’s disease by duodenal biopsy, who developed red‐brown, painful, subcutaneous nodules on the buttocks, thighs, arms and legs. Biopsy of these nodules showed a septal panniculitis and foamy macrophages containing PAS‐positive, diastase resistant intracytoplasmic material, characteristic of Whipple’s disease and similar to that observed in the duodenal biopsy. Ultrastructurally, this material in the histiocytes corresponded to degenerated bacilli.Conclusions: This is the fourth documented case of subcutaneous involvement by Whipple’s disease. One should consider the possibility of Whipple’s disease in any patient who presents with symptoms compatible with that condition who demonstrates septal panniculitis with a large amount of foamy histiocytes.
Malignant peripheral nerve sheath tumor with perineurial differentiation: ‘malignant perineurioma’
Authors: Rosenberg Arlene Sylvia , Langee Christena Lynn , Stevens G. Lex , Morgan Michael B. 
Published: March 2003

Background:  Although benign tumors derived from the nerve sheath perineurial cell have been described from a variety of anatomic sites and are known to be a component of a number of benign neoplasms, malignant nerve sheath tumors of perineurial origin are exceedingly uncommon.Methods: We report an unusual case of a 70‐year‐old male who presented with a rapidly growing mass of the left arm, subsequently shown to be a malignant nerve sheath tumor with perineurial differentiation. A brief microscopic differential diagnosis and review of the literature are discussed.Results:  Histologic sections show a partially circumscribed tumor of atypical spindle cells arranged in sweeping fascicles embedded in a myxoid matrix with focal whorling. Nuclear pleomorphism was evident among scattered typical and atypical mitotic figures (mean mitotic index of 7/10 high‐power fields). The immunophenotypic profile consisted of only vimentin and epithelial membrane antigen (EMA) positivity, while antibodies to S‐100, CD34, smooth muscle actin, and pankeratins were negative. Ultrastructural features included spindle cells with long cytoplasmic processes invested by interrupted basal lamina and pinocytotic vesicles, consistent with perineurial differentiation.Conclusions:  While the histogenic source of the benign perineurioma, the perineurial cell has only rarely been described in conjunction with malignant tumors. All cases to date have shown EMA‐positive and S‐100‐negative atypical spindled cells arranged in fascicles embedded in a myxoid matrix. In addition to immunohistochemistry, ultrastructural examination may be necessary to support the diagnosis. The diagnostic differential includes melanoma, spindle cell squamous cell carcinoma, atypical fibroxanthoma, leiomyosarcoma, and conventional malignant peripheral nerve sheath tumor, most commonly of Schwannian differentiation. Recognizing perineurial differentiation is important since few cases have been reported to date and the biological potential of these neoplasms is not known.
The histopathology of folliculitis in HIV‐infected patients
Authors: Holmes Rona Beth , Martins Ciro , Horn Thomas 
Published: March 2003

Background:  Cutaneous disease referable to human immunodeficiency virus (HIV) infection has become less common with the advent of widespread administration of antiretroviral medications, particularly the protease inhibitors. Pruritic eruptions that fall into the general categorization of folliculitis continue to be problematic.Methods: In this report, we describe 33 skin biopsy samples prospectively obtained of follicular papules and pustules from 33 HIV‐infected individuals with the clinical diagnosis of HIV‐related folliculitis.Results:  The histopathologic findings were stratified as follows: (i) acute folliculitis with bacteria and/or yeast (n = 9); (ii) lymphocytic perifolliculitis (n = 7); (iii) eosinophilic folliculitis (n = 5); (iv) perifolliculitis with mixed inflammation (n = 11); (v) follicular rupture with predominant granulomatous inflammation (n = 1). Demodex organisms were found in 10 specimens scattered among these categories.Conclusions:  The histopathology of folliculitis in HIV‐infected patients is protean. No single factor could be identified as the cause, making targeted antibacterial or antifungal therapy unlikely to be successful across a wide range of patients.
Disseminated cutaneous histoplasmosis in patients infected with human immunodeficiency virus
Authors: K. Ramdial Pratistadevi , Mosam Anisa , Dlova Ncoza C. , B. Satar Nasreen , Aboobaker Jamilla , Singh Shivon M. 
Published: March 2003

Background: In the pre‐AIDS era disseminated histoplasmosis was rare and the cutaneous manifestations thereof were reported infrequently. A range of unusual clinical manifestations of disseminated cutaneous histoplasmosis (DCH) in AIDS patients has been documented, but the cutaneous histopathological descriptions are short and incomplete. In addition, the histopathological spectrum of AIDS‐associated DCH is poorly recognized. Methods: This is a prospective 32‐month study of all HIV positive patients diagnosed with histoplasmosis in the Departments of Anatomical Pathology and Dermatology, Nelson R. Mandela School of Medicine and King Edward VIII Hospital, Durban, South Africa. Clinical distribution and morphology of the individual skin lesions and CD4+ lymphocyte counts in the peripheral blood were analysed in relation to the histopathological features of biopsied lesional tissue. Ultrastructural examination of tissue retrieved from the wax blocks of three cases that exhibited dermal karyorrhexis and collagen necrosis was undertaken. Fungal culture of lesional skin tissue was undertaken in all patients. Results: Twenty‐one biopsies of papules (7), nodules (4), plaques (5), erythema multiforme‐like lesions (2), vasculitic lesions (2) and exfoliative dermatitis (1) from 14 patients were examined. Of four biopsies (CD4 range: 120–128 cells/mm3) one and three demonstrated necrotizing and non‐necrotizing granulomatous inflammation with a paucity of intrahistiocytic microorganisms. Seven biopsies (CD4 range: 2–56 cells/mm3) demonstrated diffuse dermal and intravascular accumulation of histiocytes densely parasitized by Histoplasma capsulatum var. capsulatum. Vasculitis, karyorrhexis or collagen necrosis was not present. Ten biopsies (CD4 range: 2–72 cells/mm3) demonstrated diffuse dermal karyorrhexis, collagen necrosis and interstitial, extracellular H. capsulatum var. capsulatum. Histiocytic disintegration and nuclear fragmentation and release of intact microorganisms and intact and ruptured lysosomes were identified ultrastructurally. Leucocytoclastic vasculitis was present in two biopsies of vasculitic clinical morphology. Microbiological culture confirmed histoplasmosis in all cases. Three patients died before treatment was commenced. Two patients died within the first two days of induction of therapy. Nine patients demonstrated dramatic healing of the cutaneous lesions. Conclusions: Despite the clinicopathological spectrum of DCH and the attendant host immunocompromise, timely and appropriate treatment of DCH may be lifesaving and allows rapid healing of skin lesions. A high index of clinical suspicion and skin biopsies and culture are crucial for accurate diagnosis.
Acral pseudolymphomatous angiokeratoma of children: immunohistochemical and clonal analyses of the infiltrating cells
Authors: Hagari Yoshitaka , Hagari Shinobu , Kambe Naoto , Kawaguchi Toshio , Nakamoto Shu , Mihara Motoyuki 
Published: March 2003

Background:  Acral pseudolymphomatous angiokeratoma of children (APACHE) is a disorder characterized clinically by red nodules and histopathologically by a massive subepidermal lymphohistiocytic infiltrate. Although it was initially thought to be a vascular nevus, it has never been regarded as a pseudolymphoma. Case report: We report a 7‐year‐old‐girl with small red nodules on the dorsum of the right foot and a 73‐year‐old man with asymptomatic brown‐red nodules on the lower extremities.Results:  Histopathologic examination revealed a massive lymphohistiocytic infiltrate with plasma cells, some eosinophils, or a multinucleated giant cell immediately beneath the epidermis. Thick‐walled vessels were observed in the infiltrate. These characteristics are identical to those of acral pseudolymphomatous angiokeratoma of children. The infiltrate was composed mainly of equal numbers of CD4+ or CD8+ T cells and equal numbers of B cells stained for κ or λ light chains. PCR amplification of rearranged immunoglobulin heavy chain genes or T‐cell receptor γ genes showed no evidence of clonality, suggesting that these infiltrates were polyclonal both for B and T cells.Conclusions:  Our data support the idea that this disorder represents a reactive process. The modified term ‘papular angiolymphoid hyperplasia’ would define this disorder more appropriately.
CD34‐positive glomus tumor: clinicopathologic and immunohistochemical analysis of six cases with myxoid stromal changes
Authors: Mentzel Thomas , Hügel Heino , Kutzner Heinz 
Published: March 2003

Background: Glomus tumors are benign, mainly superficially located perivascular neoplasms, composed of cytologically characteristic neoplastic cells staining immunohistochemically positive for vimentin and muscle actin, closely associated with often branching blood vessels.Methods:  Six cases of glomus tumor were analysed histologically and immunohistochemically.Results:  We report six cases of glomus tumor (three solid glomus tumors, two glomangiomas, one glomangiomyoma) arising on the fingers of adult patients (five female and one male patient; age range 35–65 years) that showed prominent myxoid stromal changes and immunohistochemically a coexpression of alpha‐smooth muscle actin and CD34 by neoplastic cells.Conclusions: Neoplastic cells in glomus tumor may show a coexpression of alpha‐smooth muscle actin and CD34, an important finding regarding the differential diagnosis of these lesions and the relationship of perivascular neoplasms.
Cytomegalovirus neuritis in perineal ulcers
Authors: Ramdial Pratistadevi K. , Dlova Ncoza Cordelia , Sydney Clive 
Published: March 2003

Background:  Although a range of cytomegalovirus (CMV)‐induced cutaneous manifestations is described in AIDS patients, skin involvement in immunocompromised patients is rare, and intraneural CMV inclusions or CMV neuritis has not been documented in skin biopsies.Methods and results:  Cutaneous biopsies of CMV lesions were collected prospectively for 12 months. The morphology, sites and symptomatology of the individual lesions, associated systemic illnesses, treatment schedules and disease outcome were recorded. A total of nine biopsies were obtained from three females who presented with extensive painful perineal ulceration and disseminated cutaneous ulcers, nodules and plaques. Clinically, herpes simplex virus (HSV) ulceration was diagnosed and treatment with acyclovir was initiated after biopsies from the natal cleft, perineum and neck were obtained. All were superficial and demonstrated HSV infection. Only the natal cleft biopsy demonstrated coexistent CMV inclusions. Suboptimal healing necessitated two further biopsies from each patient, none of which demonstrated HSV inclusions. Three of four deep perineal biopsies demonstrated CMV inclusions within nerves attended by a lymphocytic infiltrate and architectural disturbances. Two deep cutaneous biopsies of the trunk and abdominal wall confirmed CMV in extraneural locations only. One superficial perineal biopsy did not demonstrate any viral inclusion.Conclusions:  In documenting CMV neuritis in painful perineal ulcers, the histopathological spectrum of perineal CMV ulcers is expanded, a cutaneous neurotropic characteristic of CMV is presented and a direct role for CMV in the pathogenesis of pain is suggested. CMV latency within perineal nerves is also revisited as another potential site of CMV reactivation in immunocompromised patients, and another potential site for possible venereal transmission of CMV infection. The exclusive presence of HSV in initial superficial biopsies highlights the need for optimally biopsied tissue to confirm the coexistence of CMV infection.
p63 expression in normal skin and usual cutaneous carcinomas
Authors: Reis‐Filho Jorge S. , Torio Beatriz , Albergaria André , Schmitt Fernando C. 
Published: March 2003

Background:  p63 is a p53 homologue that is mapped to chromosome 3q27. This gene encodes six different isoforms, which have either transactivating or dominant negative effects on p53‐reporter genes. It has been described that in contrast to p53, p63 seems not to be associated with tumor predisposition, as neither p63 knockout mouse models nor germline p63 mutations are related to an increased risk of tumorigenesis. It has been demonstrated that p63 is a reliable keratinocyte stem cell marker and that it is involved in the maintenance of the stem cell population. Scant data on p63 expression in normal skin, basal cell carcinomas (BCCs), keratoacanthomas and squamous cell carcinomas (SCCs) have been reported. We herein evaluated p63 expression in 16 BCCs, one keratoacanthoma and 13 SCCs.Methods:  Immunohistochemistry according to the streptavidin‐biotin‐peroxidase technique, using the antibody 4A4 raised against all p63 isoforms, was performed. p63 expression was evaluated in epidermal cells and skin appendages. Semi‐quantitative evaluation (–, +, ++, +++) of p63 expression in BCCs, keratoacanthoma and SCCs was carried out. Only nuclear expression was considered as specific.Results:  p63 was expressed in the nuclei of epidermal basal and suprabasal cells, in the cells of the germinative hair matrix and the external root sheath of hair follicles, in the basal cells of the sebaceous gland and in the myoepithelial/basal cells of the sweat glands. All terminally differentiated cells were negative for p63. All BCCs showed ++ to +++ immunoreactivity. At variance, keratoacanthomas and grade I and II SCCs showed variable p63 reactivity in a basal layer‐like distribution, whereas undifferentiated cells of grade III SCCs showed ++ to +++ positivity. A grade IV spindle SCC showed + immunoreactivity. The SCCs in situ showed remarkable expression of p63 in all cell layers. Terminally differentiated squamous cells were either negative or showed only focal immunoreactivity in the carcinomas.Conclusions:  p63 is consistently expressed in the basal cells of epidermis and cutaneous appendages, including the basal/myoepithelial cells of sweat glands. Based on our findings, the balance of probabilities favors that p63 might play a role in the pattern of differentiation and in the oncogenesis of usual carcinomas of the skin.
Abundance of interstitial heparan sulfate in granuloma annulare but not in other mucinous skin diseases
Authors: Bandel Christopher , DePrisco Gregorio , Cockerell Clay J. , Ehrig Torsten 
Published: March 2003

Background:  Heparan sulfate (HS), unlike other glycosaminoglycans, is mainly located on cell surfaces but can be shed into the interstitium by a regulated process. It has been found in interstitial fluid drained from cutaneous wounds, but otherwise the conditions under which the release of HS from the cell surface occurs are unknown. To better characterize this process, we have investigated the presence of interstitial HS in various skin diseases with glycosaminoglycan accumulation.Methods:  Histologic routine material was stained immunohistochemically using an antibody recognizing HS.Results:  Heparan sulfate immunoreactivity is present in the interstitium of young cutaneous scars and in the interstitium of the inflammatory infiltrate of granuloma annulare. No reactivity was found in a number of non‐inflammatory skin diseases with mucin deposition.Conclusions:  The selective presence of interstitial HS in only two of the investigated skin conditions supports the existence of a regulated mechanism to release HS from the surface of cells into the interstitium. It is suggested that HS modulates the biologic actions of growth factors and cytokines not only during wound repair but possibly also in inflammatory skin diseases such as granuloma annulare.
Desmoplastic and spindle cell melanomas express protein markers of the neural crest but not of later committed stages of Schwann cell differentiation
Authors: Huttenbach Yve , Prieto Victor G. , Reed Jon A. 
Published: March 2003

Background:  The rare desmoplastic and spindle cell variants of malignant melanoma exhibit histological and biochemical features suggestive of early Schwann cell differentiation. These features include a spindle‐shaped morphology, neurotropism, and the expression of the low affinity nerve growth factor receptor (p75NGFR).Methods: We evaluated by immunohistochemistry (using formalin‐fixed, paraffin‐embedded tissues) nine desmoplastic and three spindle cell melanomas for the expression of peripherin, p75NGFR, neural cell adhesion molecule (CD56/N‐CAM), and growth‐associated phosphoprotein‐43 (GAP‐43). Peripherin is expressed in the neural crest and in neurons, but not in cells committed to the Schwann cell lineage. p75NGFR and CD56/N‐CAM also are expressed in early neural crest cells, but persist in unmyelinated and early premyelinating Schwann cells. GAP‐43 is expressed in unmyelinated Schwann cells, but is downregulated in the later premyelinating to promyelinating stages of cells committed to the Schwann cell lineage.Results: Peripherin was expressed in 7/12 (58%), p75NGFR in 4/12 (33%), and CD56/N‐CAM in 6/12 (50%) of the desmoplastic and spindle cell melanomas. GAP‐43 was not expressed (0%) in any of the 12 melanomas (χ2, p = 0.05).Conclusions: Desmoplastic and spindle cell melanomas express protein markers common to cells of the neural crest and to neurons similar to the immunophenotype previously reported for epithelioid cell melanomas. The expression of peripherin and the lack of expression of GAP‐43 further define that these rare subtypes of melanoma do not recapitulate the later committed stages of Schwann cell differentiation.
Merkel cell (primary neuroendocrine) carcinoma of the skin with nodal metastasis showing rhabdomyosarcomatous differentiation
Authors: Fernández‐Figueras María‐Teresa , Puig Lluís , Gilaberte Montserrat , Del Carmen Gómez‐Plaza María , Rex Jordi , Ferrándiz Carlos , Ariza Aurelio 
Published: March 2003

Background:  We describe a unique case of Merkel cell (primary neuroendocrine) carcinoma of the skin with a lymph node metastasis showing rhabdomyosarcomatous differentiation. Skeletal muscle differentiation has occasionally been described in primary small cell neuroendocrine carcinomas and considered a form of dual differentiation rather than a collision tumor. In the present case, capacity for divergent differentiation appeared late in the course of the tumor, which suggests a clonal origin for both components of the neoplasm.Conclusions:  The coexistence of neural and rhabdomyoblastic types of differentiation, best epitomized by the Triton tumor, has been construed as the product of dual differentiation of cells originated from neural crest‐derived ectomesenchyme. Since Merkel cells seem to originate from a pluripotential primitive keratinocyte and not from the neural crest, rhabdomyoblastic differentiation in a metastasis of primary neuroendocrine carcinoma of the skin probably reflects the close proximity between the programs of neural and skeletal muscle differentiation, which would have been sequentially activated in the case we are reporting.
Initial Practice Locations of International Medical Graduates
Authors: Polsky Daniel , Kletke Philip R. , Wozniak Gregory D. , Escarce José J. 
Published: March 2003

Objective. To examine the influence of place of graduate medical education (GME), state licensure requirements, presence of established international medical graduates (IMGs), and ethnic communities on the initial practice location choices of new IMGs.Data Sources. The annual Graduate Medical Education (GME) Survey of the American Medical Association (AMA) and the AMA Physician Masterfile.Study Design. We identified 19,940 IMGs who completed GME in the United States between 1989 and 1994 and who were in patient care practice 4.5 years later. We used conditional logit regression analysis to assess the effect of market area characteristics on the choice of practice location. The key explanatory variables in the regression models were whether the market area was in the state of GME, the years of GME required for state licensure, the proportion of IMGs among established physicians, and the ethnic composition of the market area.Principal Findings. The IMGs tended to locate in the same state as their GME training. Foreign‐born IMGs were less likely to locate in markets with more stringent licensure requirements, and were more likely to locate in markets with higher proportions of established IMG physicians. The IMGs born in Hispanic or Asian countries were more likely to locate in markets with higher proportions of the corresponding ethnic group.Conclusions. Policymakers may influence the flow of new IMGs into states by changing the availability of GME positions. IMGs tend to favor the same markets over time, suggesting that networks among established IMGs play a role in attracting new IMGs. Further, IMGs choose their practice locations based on ethnic matching.
Effects of CAHPS Health Plan Performance Information on Plan Choices by New Jersey Medicaid Beneficiaries
Authors: Farley Donna O. , Short Pamela Farley , Elliott Marc N. , Kanouse David E. , Brown Julie A. , Hays Ron D. 
Published: March 2003

Objective. To assess the effects of CAHPS health plan performance information on plan choices and decision processes by New Jersey Medicaid beneficiaries.Data Sources/Study Setting. The study sample was a statewide sample of all new Medicaid cases that chose Medicaid health plans during April 1998. The study used state data on health maintenance organization (HMO) enrollments and survey data for a subset of these cases.Study Design. An experimental design was used, with new Medicaid cases randomly assigned to experimental or control groups. The experimental group received a CAHPS report along with the standard enrollment materials, and the control group did not.Data Collection. The HMO enrollment data were obtained from the state in June 1998, and evaluation survey data were collected from July to October 1998.Principal Findings. No effects of CAHPS information on HMO choices were found for the total sample. Further examination revealed that only about half the Medicaid cases said they received and read the plan report and there was an HMO with dominant Medicaid market share but low CAHPS performance scores. The subset of cases who read the report and did not choose this dominant HMO chose HMOs with higher CAHPS scores, on average, than did those in an equivalent control group.Conclusions. Health plan performance information can influence plan choices by Medicaid beneficiaries, but will do so only if they actually read it. These findings suggest a need for enhancing dissemination of the information as well as further education to encourage informed choices.