Adult rhabdomyoma: report of two cases of rhabdomyoma of the lip and of the eyelid

We describe two cases of adult rhabdomyoma. One was located in the lip of a 66-year-old woman and was removed because it was clinically suspicious for infiltrating carcinoma. The other arose in the eyelid of a 60-year-old woman with a glass eye and was initially interpreted as a reactive process due to the prosthesis. Both lesions were composed of cells with oval nuclei and deeply eosinophilic cytoplasms with occasional cross striations. Immunoreactivity for desmin and myoglobin excluded the diagnosis of other tumors with similar morphology. The unusual association of the eyelid tumor with the prosthesis suggests a role for chronic irritation in the pathogenesis of rhabdomyoma.

Papillary hidradenoma: immunohistochemical analysis of steroid receptor profile with a focus on apocrine differentiation

AIM

To make a quantitative evaluation by image analysis of oestrogen receptors, progesterone receptors, and androgen receptors in papillary hidradenomas and anogenital sweat glands.

METHODS

20 papillary hidradenomas and the anogenital sweat glands detected in surgical specimens selected from 10 vulvectomies for squamous carcinoma, eight haemorrhoidectomies, and one anal polypectomy, all from female patients, were investigated by the avidinstreptavidin peroxidase testing system.

RESULTS

90% of papillary hidradenomas and almost all the anogenital sweat glands showed immunoreactivity for oestrogen receptor and, more weakly, for progesterone receptor, with immunolabelled nuclear area ranging from 10% to 90%. Conversely conventional sweat glands did not show any nuclear staining. Overexpression of androgen receptors occurred in 20% of papillary hidradenomas, with nuclear staining strictly bordering papillary epithelium with apocrine differentiation. There was no immunoreactivity for androgen receptors in anogenital sweat glands.

CONCLUSIONS

Oestrogen and progesterone receptors seem to represent reliable markers for differentiating between anogenital sweat glands and conventional sweat glands, and a further link to explain why papillary hidradenomas occur almost exclusively in the female anogenital region. Positivity for oestrogen/progesterone receptors suggests that epithelia either of anogenital sweat glands or of papillary hidradenomas are controlled by ovarian steroid hormones. Androgen receptor nuclear staining of the epithelium with apocrine differentiation in vulvar papillary hidradenoma strengthens its homology with breast duct papilloma.

Low dose interferon-alpha2b combined with PUVA is an effective treatment of early stage mycosis fungoides: results of a multicenter study. Cutaneous-T Cell Lymphoma Multicenter Study Group

BACKGROUND AND OBJECTIVE

The early stages of mycosis fungoides (MF) can be treated but not cured by photochemotherapy (PUVA) alone; some recent studies of the effect of a combination of human interferon-alpha (IFN(alpha)) and PUVA reported a high degree of response. The aim of our study was to evaluate the activity of a low dose of IFN-alpha2b combined with PUVA.

DESIGN AND METHODS

Twenty-five patients were included: 16 men and 9 women aged between 23-80 years; 19 patients ahd stage I and 6 stage II disease. In the induction phase, the dose of IFNalpha was gradually raised over 6-8 weeks to the target dose of 18 MU/week; in the maintenance phase, the combination with PUVA allowed IFNalpha to be reduced to a maximum dose of 6 MU/week; in this way the cumulative administration of IFNalpha and PUVA was considerably lower than in similar combination protocols. Treatment success was analyzed in terms of freedom from treatment failure (FFTF).

RESULTS

After the induction phase 9/25 patients (36%) achieved complete remission (CR) and 15/25 (56%) achieved partial remission (PR). One to five months from the beginning of the maintenance phase, a CR was recorded in 19/25 patients (76%) and a PR in 5/25 patients (20%) accounting for an overall response rate of 96%. The median of FFTF was not reached; probability of FFTF was 82% at 12 months and 62% at 24 months. Disease free survival projected to 48 months was 75%.

INTERPRETATION AND CONCLUSIONS

Even with low doses of IFNalpha plus PUVA it is possible to achieve excellent clinical responses,many of which are long-lasting, in patients with early MF.

Treatment of scabies with ivermectin

The authors report six new cases of patients suffering from severe infestation with the mite sarcoptes scabiei, treated with ivermectin, currently the only oral therapy available for this disease. Each patient received 200 mug/kg of ivermectin, taken as single dose. No topical therapy was undertaken, except for topical treatment with emollient, as needed. The drug was very effective in all cases, easy to use, safe, and particularly useful in those patients with secondary eczematisation and escoriations, for whom the topical treatments are irritant and less well tolerated.

Subclinical joint involvement in psoriasis: magnetic resonance imaging and X-ray findings

Previous studies have shown that magnetic resonance imaging is more sensitive in assessing soft tissue and bone involvement in inflammatory arthritis than conventional radiography. Therefore the main objects of this study were to evaluate the frequency of hand involvement in psoriatic patients free from arthritic symptoms, and to compare the results with those of a healthy control population (age- and sex-matched). Twenty-five patients suffering from active nummular and/or plaque psoriasis with no arthritic signs or symptoms were studied together with 12 healthy control subjects. The articular structures of both hands in all patients were screened using both traditional radiological techniques and magnetic resonance imaging. Specifically, we examined: soft tissue swelling, periarticular effusion, joint effusion-synovial pannus, tendon sheath effusion, bone erosion, luxation, sub-luxation, bone cysts and subchondral signal intensity abnormalities. Sixty-eight percent of our psoriatic patients were found to be positive with at least one arthritic sign using magnetic resonance imaging, while with the standard X-ray procedure, only 32% of the same group of patients were found to be positive. Specifically, abnormal signal intensity in the subchondral focal areas were seen in 9 patients using the magnetic resonance imaging technique, while in the control group, no significant abnormalities were detected. A high percentage of psoriatic patients without apparent arthritic signs and symptoms were shown to have hand articular involvement, in particular in the distension of the capsular and periarticular oedema when examined with magnetic resonance imaging. In our experience, the use of magnetic resonance imaging allows a clear and adequate evaluation of the cartilage, bone and soft tissue material, and is diagnostically superior to X-ray in demonstrating clinically silent and radiologically invisible articular lesions. Moreover, the subchondral changes detected by magnetic resonance imaging were unexpected findings which could imply an ischaemic origin.

Tinea capitis due to Microsporum gypseum in an adult

A case of tinea capitis due to Microsporum gypseum in an adult is described. An otherwise healthy 69-year-old woman presented two large patches of slightly erythematous scaling alopecia localized on the vertex and on the left parietal region of the scalp. The only subjective sign was itching. A mycological culture was positive for Microsporum gypseum. Tinea capitis is uncommon in adults; furthermore, isolation of Microsporum gypseum from this type of lesion is rare.

Advances in the understanding of malignant transformation of keratinocytes: an immunohistochemical study

AIM

We set out to investigate the interactions between malignant transformation of keratinocytes, presence of oncoproteins and immunosurveillance in squamous cell carcinoma (SCC) and in a preneoplastic lesion, actinic keratosis (AK).

METHODS

Samples of SCC, AK and normal skin (NS) were subjected to quantitative analysis using the following antibodies: anti-p53, Ki67, OKT6, OK-DR, B7/BB1, anti-CD54, anti-CD11, OKT3, OKT4, OKT8; positivity for ras-p21, EGFr and bcl-2 was evaluated by semiquantitative analysis.

RESULTS

Oncoprotein alterations and increased keratinocyte proliferative activity were observed both in AK and SCC. The number of Langerhans cells (CD1a+ cells) was similar in the two lesions but lower in SCC compared to AK. The proportion of CD1a(+)-B7/BB1+ cells was slightly higher in AK and SCC than in NS. The Langerhans cells expressed the HLA-DR antigen in all groups. Values were highest in AK and NS, and quite low in SCC. Cytotoxic T lymphocytes were more numerous in SCC than in AK and NS. Interestingly, the total CD4/CD8 ratio was much lower in SCC than in AK and NS, which indicates an increase in the CD8+ subpopulation in samples of SCC. In the epithelia of SCC samples there were a considerable number of B7/BB1+ keratinocytes.

CONCLUSIONS

We suggest that alterations in the immunodefence mechanisms have an important role in the transformation of AK into SCC, and that these changes affect not only lymphocytes, but also professional (i.e., Langerhans cells) and non-professional (i.e., keratinocytes) antigen presenting cells.

Hypomelanosis of Ito: a case report with clinical and ultrastructural data

Hypomelanosis of Ito (HI) is an uncommon skin disorder characterized by the presence of hypochromic areas associated with visceral abnormalities, the most common being neurological, muscular, skeletal and ocular. The authors describe a typical case of hypomelanosis of Ito in a 7-year-old child. The patient was obese, suffered from scoliosis, flat feet and had a bilateral genu valgus. No neurological, ophthalmological or dental malformations were noted. An electron microscopic study of a hypomelanotic area showed decreased functional activity in the melanocytes, which contained only a few rudimentary cytoplasmatic projections and poorly developed organelles. In addition, there was a reduction in the number of mature melanosomes.

Skin metastases from prostate cancer associated with malignant melanoma

A 66-year-old man, admitted to the hospital for prostatic carcinoma, presented with a nodular lesion located on the presternal region and a small nodule (0.5 cm in diameter) simulating a scalp sebaceous cyst located on the scalp. Moreover, an irregular darkbrown lesion was observed on the left side of the abdomen, and a brownish macula was also present on the presternal region. Histologic examination of the two nodular lesions revealed cutaneous metastases from prostatic carcinoma. The pigmented lesion, localized on the abdomen, proved to be a superficial spreading melanoma with a maximal depth of 1.36 mm. Histologic examination of the brownish lesion on the presternal region revealed nevus cell nests within the epidermis and in the dermis. We discuss the propensity of developing a secondary cancer in a patient with a primary malignancy.

An epidemiological study on cutaneous diseases of agricultural workers authorized to use pesticides

BACKGROUND

There is an increased risk for agricultural workers to acquire skin problems, but data so far published are still very scarce.

OBJECTIVE

To individualize skin disorders that involved this class of workers.

METHODS

Between 1990 and 1992, 426 agricultural workers, authorized to use pesticides, were examined. The control group consisted of 100 nonagriculture workers, who were age and sex matched.

RESULTS

Some common dermatological diseases, such as vitiligo, psoriasis and seborrheic dermatitis, had an incidence overlapping with that found in the controls. Irritant plant dermatoses (2.5%), episodes of acute systemic intoxication from pesticides (6.8%), onychopathies due to chronic trauma (16%), contact dermatitis of the hands (12%), chilblains (7%) and Favre-Racouchot syndrome (2.5%) showed a higher prevalence in the study group.

CONCLUSION

Farmers were affected mainly by diseases caused by the direct action of chemical agents, either natural or industrial, in addition to climatic and physical agents.

Chordoma with multiple skin metastases

We report a case of sacral chordoma with numerous skin metastases. Histologically they show the typical 'physaliform cells' expressing simultaneously cytokeratin, S-100 protein, epithelial membrane antigen and vimentin immunoreactivity.

Familial supernumerary nipples and breasts

We report 3 cases of supernumerary breasts in the same family. The presence of glandular tissue (polymastia) was demonstrated by ultrasound examination. No associated kidney lesions were found.