Branched cells in the epidermis: an overview

Current considerations about Merkel cells

Since the discovery of Merkel cells by Friedrich S. Merkel in 1875, knowledge of their structure has increased with the progression of new technologies such as electron and laser microscopy, and immunohistochemical techniques. For most vertebrates, Merkel cells are located in the basal layer of the epidermis and characterized by dense-core granules that contain a variety of neuropeptides, plasma membrane spines and cytoskeletal filaments consisting of cytokeratins and desmosomes. The presence of the two latter structures would suggest that Merkel cells originate from the epidermis rather than from the neural crest, even though such a hypothesis is not unanimously accepted. The function of the Merkel cell is also very controversial. For a long time, it has been accepted that Merkel cells with associated nerve terminals act as mechanoreceptors although the transduction mechanism has not yet been elucidated. Merkel cells that do not make contact with nerve terminals have an endocrine function. The present review aims to shed new and comparative light on this field with an attempt to investigate the stimuli that Merkel cells are able to perceive.

Evidence for autonomic responses to pungent chemical stimuli applied to the skin vs inhaled via the nasal cavity

AIM OF THE STUDY

Chemical stimuli can produce different sensations from tingling to pain. Responses to chemical stimuli differ in relation to many factors. This study aims at examining two factors, i.e. the localization of their application and the implied sensory modality.

METHODS

Twenty volunteer students participated in the experiment. Skin conductance responses (SCRs) were recorded to compare the autonomic nervous activation to maximal stimulation with the same irritant stimulus (mustard oil (MO) diluted at 25%) applied to the skin or delivered into the nasal cavity.

RESULTS

The SCRs obtained following maximal nasal stimulation with MO were significantly different from those obtained following maximal skin stimulation. Application of MO on skin elicited higher SCR amplitude as well as a longer rising time and latency when compared to nasal stimulation.

CONCLUSIONS

These findings indicate that the autonomic nervous activation following maximal chemical irritation differ in temporal, amplitude and shape response characteristics. These results are discussed in terms of cutaneous and nasal innervation's.

Distribution of Langerhans cells in human hair follicle

Using immunohistochemical techniques, we mapped and quantified the distribution of Langerhans cells (LCs) within the follicular epithelium of normal human skin in serial horizontal sections. Ten skin biopsies from disparate, disease-free sites from individuals of various skin types were stained with antibody to CD1a. LCs concentrated in the infundibular epithelium (x=16.16 cells), including the follicular bulge, and extended into the germinative sebaceous epithelium (x=8.84). In contrast, rare LCs (x=1.06) were observed in the follicular epithelium below the entry of sebaceous glands into the follicle. LCs were absent in bulbar epithelium. This infundibulocentric distribution of LCs corresponds to the pattern of follicular inflammation in the scarring folliculitides of lupus erythematosus and lichen planopilaris, as well as allogeneic graft versus host reaction and infundibulofolliculitis of atopy. Follicular LCs may act as the trigger and/or target for these T cell-mediated inflammatory processes.

Turnover and kinetics of epidermal Langerhans cells and their dendritic precursor cells in experimental contact dermatitis. A correlated ultrastructural-morphometric and immunohistochemical evaluation

The numerical density of epidermal Langerhans cells (LCs) in contact sensitivity and toxic contact dermatitis is still a matter of controversy, mainly due to changes in the phenotypic markers of this antigen-presenting cell during the skin reactions. Since the electron microscopic detection of Birbeck granules is the most reliable marker for the identification of normal and pathologically altered LCs, we performed an ultrastructural-morphometric time-course analysis to evaluate their epidermal turnover in the earskin of BALB/c mice after painting the ears with the hapten 2,4-dinitrofluorobenzene and the irritant croton oil. The counts revealed degeneration and depletion of epidermal LCs in both allergic and toxic dermatitis. In contrast, a slightly increased number of activated epidermal LCs was found during contact sensitization. All experimental procedures resulted in an enhanced immigration of so-called indeterminate dendritic cells which also became ultrastructurally activated and often showed Birbeck granule-like formations at their cell membrane. Immunohistochemistry with the monoclonal antibody 4F7, a new marker for dendritic precursor cells of LCs, demonstrated a significant increase in these accessory cells in the epidermis. Our results indicate that contact sensitivity and toxic skin reactions are characterized by complex but distinct changes in the turnover, kinetics and cellular properties of epidermal LCs and their dendritic precursor cells.

Merkel cell carcinoma. Diagnosis and treatment

BACKGROUND

Merkel cell carcinoma is an uncommon malignancy of the skin that often portends a poor prognosis. Since its first description by Toker in 1972, a plethora of case reports and articles regarding the etiopathogenesis and treatment have been published spanning multiple medical and surgical disciplines. Much confusion still exists regarding the diagnosis and treatment of this ominous tumor.

OBJECT

Through extensive review of the medical, surgical, and pathological literature, to collate the observations of multiple investigators and summarize these findings.

METHODS

Articles from journals of multiple subspecialties were carefully reviewed with particular emphasis placed on epidemiology, prognosis, histology, immunohistochemistry, electron microscopy, tumor origin, treatment, and work-up of Merkel cell carcinoma.

RESULTS

Merkel cell carcinoma is an aggressive malignant neoplasm. Local recurrence develops in 26-44% of patients despite therapy. Up to three-fourths of patients eventually develop regional nodal metastases with distant metastases occurring in one-third of all patients. Reported overall 5-year survival rates range from 30% to 64%.

CONCLUSION

Treatment recommendations unfortunately are based more on anecdotal than scientific data because of the rarity of the tumor and its recognized high risk. Most authors recommend wide local excision of the primary lesion and regional lymph node resection if lymph nodes are palpable followed by x-irradiation of both the postsurgical bed and lymph node basin. The role of elective lymph node resection in the absence of clinically positive nodes remains controversial.

Early infection of interdigitating dendritic cells in the pig lymph node with African swine fever viruses of high and low virulence: immunohistochemical and ultrastructural studies

The role of interdigitating dendritic cells (IDCs) in the early pathogenesis of African swine fever (ASF) was investigated using mandibular lymphoid tissue from normal pigs and pigs inoculated oronasally with highly virulent Lisbon 60 (L-60) and moderately virulent Dominican Republic 1979 (DR-2) ASF virus (ASFV) isolates. Paraffin-embedded tissue sections were immunostained for ASFV antigen and S-100 protein, a marker of IDCs, using an avidin-biotin alkaline phosphatase procedure. Swine IDCs were identified morphologically by light microscopy, electron microscopy, and S-100 immunostaining. Infection with ASFV caused a marked reduction in S-100 staining by 3 days postinfection (DPI) that persisted through 14 DPI. Early ASFV infection of IDCs was demonstrated at 3 DPI by double immunohistochemical staining of cryosections and by transmission electron microscopy. These results support the hypothesis that the failure of a humoral immune response to virulent ASFV may be due to a primary infection of IDCs and the inability of IDCs to initiate an immune response. Infection of IDCs has also been demonstrated with human immunodeficiency virus (HIV-1), and these infections have some aspects in common.

Epidermal dendritic cell populations in the flaky skin mutant mouse

Flaky skin (gene symbol: fsn) is an autosomal recessive mouse mutation that causes pathologic changes in the skin yielding a papulosquamous disease resembling human psoriasis. Preliminary studies of epidermal sheets from foot pads of fsn/fsn mice stained for Ia+ Langerhans cells (LC) or Thy-1+ dendritic epidermal cells (Thy-1+ DEC) indicated a rise in LC numbers at the time of weaning, when the skin lesion becomes clinically evident. To further investigate this observation, epidermal sheets were obtained from the ear, dorsal skin, and foot pads from replicates of 6 female mice (both mutants and normal littermates) on weekly intervals from birth to 8 weeks of age. Dorsal skin epidermal thickness was quantitated by computer assisted image analysis and found to be significantly thickened from one week onward in the mutant mice. Using immunofluorescence microscopy, epidermal dendritic cell numbers were determined following staining with antibodies for the following markers: Ia, NLDC-145, and S-100 (for LC) or Thy 1.2 and asialo-GM1 (for Thy-1+ DEC). Use of all 5 markers to evaluate skin from 3 different locations yielded a subtle but significant increase in LC and Thy-1+ DEC in flaky skin mice. Of the three sites evaluated, the dorsal skin and ear epidermal sheets were most informative, which corresponded to the degree of pathological involvement. Mice doubly homozygous for fsn and for the severe combined immunodeficiency (scid) mutation developed the psoriasiform dermatitis. Bone marrow grafts from fsn/fsn homozygotes to homozygous scid/scid mice reproduce the skin lesion. These studies suggest that the psoriasiform dermatitis in the flaky skin mouse mutation is associated with abnormalities at the level of hematopoietic progenitor cells.

Birbeck granules or Birbeck junctions? Intercellular "zipperlike" lattice junctions in eosinophilic granuloma of bone

Three cases of eosinophilic granuloma of bone exhibited intercellular attachments between histiocytes, with a pentalaminar structure identical to that seen in nearby intracellular Birbeck granules (BG). It is proposed that the term "lattice junction" be coined to describe this organelle, which seems to be expressed only by cells of monocytic-histiocytic lineage. While this finding confirms the ability of the surface membrane to form such structures, it does not necessarily preclude other intracytoplasmic sites of origin for some BG. The previously suggested role of BG in membrane storage and regulation is reiterated as a supportable model for their function.

The differentiation of the skin and its appendages. I. Normal development of papillary ridges

In the present study, the normal development of papillary ridges was studied in the volar pads of both fore and hindpaws of the opossum, Monodelphis domesticus. At birth, the developmental state of the opossum's paws is equivalent to that of a six-week human embryo. The development of papillary ridges in the opossum occurs entirely postnatally and the hindpaw lags behind the forepaw by at least four days in most developmental parameters. Papillary ridge formation is preceded by four events: skin innervation, Merkel cell differentiation, mesenchymal condensation, and epidermal proliferation. The apical pads at the tips of the digits and the interdigital pads between the heads of the metacarpals (or metatarsals) have a unique pattern of innervation and mesenchymal content as compared to the non-pad skin. Each pad is innervated by a prominent nerve trunk and axons ascend towards the epidermis providing a density of innervation that exceeds that in the non-pad epidermis. Merkel cells are absent in non-pad epidermis but present in the pads prior to the onset of formation of papillary ridges. A loose aggregation of mesenchyme forms the core of the pads and the superficial dermis is more cellular in the pads as compared to the equivalent dermis in surrounding non-pad skin. Developing papillary ridges always contained Merkel cell-axon complexes. Merkel cell axon complexes serve as the anatomical substrate of slowly adapting (SA) mechanoreceptors. The presence of these complexes during early skin differentiation is consistent with the use of the opossum's forepaw in climbing to the nipple, but also suggests other possible functions. We hypothesize that the nervous system might play a role in the timing or patterning of the formation of papillary ridges.

Regional development of Langerhans cells and formation of Birbeck granules in human embryonic and fetal skin

The regional development of Langerhans cells (LC) and the formation of Birbeck granules (BG) were examined in human embryonic and fetal skin. Samples were obtained from multiple anatomic sites and stained with anti-CD36, anti-CD1a, and anti-HLA-DR antibody as well as Lag antibody specifically reactive to BG and some vacuoles of human LC. In the first trimester, CD36+ dendritic epidermal cells were identified before the appearance of CD1a+ cells and Lag+ cells. Some of the former co-expressed HLA-DR antigens but not CD1a antigens. In the second trimester, regional variations in LC development were observed. Epidermal LC of palms and soles reached a peak in number in the first trimester but were rarely detected after 18 weeks estimated gestation age (EGA), whereas, in other regions, their number increased with age. In the second trimester, CD1a+ cells and Lag+ cells were also identified in the epidermis, although Lag+ cells appeared later than CD1a+ cells. The Lag+ cells until 17 weeks EGA showed a variety of staining intensities and immunoelectron microscopy revealed that they contained various amounts of Lag-reactive BG. Flow cytometric analysis showed that relative amounts of Lag antigens in LC increased during the second trimester and that fetal LC of 18 weeks EGA expressed the same amounts of HLA-DR, CD1a, and Lag antigens as did adult human LC. In the dermis, in the second trimester, numerous CD36+ cells and HLA-DR+ cells were found, whereas CD1a+ cells and Lag+ cells were rarely detected. Taken together, it is suggested that HLA-DR+ dendritic cells acquire CD1a+ antigens first and then form BG after migration to the epidermis and that fetal LC are phenotypically mature in the second trimester.

Ultrastructure of melanocytes in chronically sun-exposed skin of elderly subjects

Chronically sun-exposed facial skin of three females aged 68, 71, and 78 years, and of a male aged 78, was examined by electron microscopy in order to study the condition of the epidermal melanocytes. Considerable heterogeneity of morphological and functional characteristics of the cells was observed. The majority of melanocytes were large, active, with occasionally lobulated or double nuclei, an appearance indicative of hyperstimulation. Some cells exhibited an appearance of having reached the end of an active life cycle and were labelled "aged." Others, in the upper end of the outer root sheath of hair follicles and adjacent interfollicular epidermis, presented a typically inactive appearance, indistinguishable from that of fetal melanocytes, or of those in unexposed skin of younger subjects. A cell with indented nucleus, fully melanised melanosomes, and hypertrophic Golgi apparatus was sporadically seen. Minute foci of dissociation of keratocytes were present, and melanocytes included in these were frequently disrupted. Swelling of mitochondria and cytoplasmic lipid droplets occurred sporadically within all the above variants of melanocytes. It proved difficult to establish criteria of specific sun damage of melanocytes. It is suggested that either the melanocytes exhibiting stimulation or the relatively inactive ones could be the precursors of the proliferating cells of lentigo maligna.

Non-epithelial cellular components in eccrine spiradenoma: a histological and immunohistochemical study of 20 cases

In this study, 20 cases of eccrine spiradenoma have been examined using monoclonal antibodies to identify the nature of the epithelial, as well as the non-epithelial, cellular components of this tumour. The results indicate that there is striking similarity between the epithelial cells of eccrine spiradenoma and the normal cells lining eccrine apparatus. An interesting finding was the presence of abundant T-lymphocytes and Langerhans' cells within the tumour lobules. Additionally, endothelial-lined vascular channels and neurofibrils were prominent in larger lesions.

The Merkel cell and associated neoplasms in the eyelids and periocular region

Merkel cells are clear oval cells in the epidermis and outer root sheaths of hair follicles, which are probably of epithelial origin, share ultrastructural features with neuroendocrine cells, and are found in association with touch receptors. In the eyelid, they occur singly in the epidermis and external root sheaths of hairs and eyelashes, and in specialized touch spots alternating with eyelashes. Their typical electron microscopical and antigenic features include dense-core granules, intranuclear rodlets, spinous processes, and a positive reaction for specific cytokeratins, epithelial membrane antigen, neuron-specific enolase, chromogranin and synaptophysin. Merkel cell carcinoma probably develops from precursor cells which give rise to keratinocytes and Merkel cells, and nearly one out of ten Merkel cell carcinomas occur in the eyelid and periocular region. They tend to be bulging lesions near the lid margin of elderly patients, reddish in color, and erythematous with telangiectatic vessels. The diagnosis is based on the frequent presence of neurofilaments and paranuclear aggregates of intermediate filaments in addition to features typical of normal Merkel cells. The tumor often mimics lymphoma or undifferentiated carcinoma and frequently invades lymphatic vessels. One third of Merkel cell carcinomas recur, almost two thirds give rise to regional node metastases, and up to one half metastasize widely and result in death. Initial treatment should be prompt and aggressive, with wide resection and routine postoperative irradiation. Although metastatic lesions often respond to radiation therapy and cytostatic drugs, these treatments are mainly of palliative value.

Localization of serotonin-like immunoreactivity in the Merkel cells of pig snout skin

The presence of serotonin in the Merkel cells of pig snout epidermis was investigated by the peroxidase-antiperoxidase immunohistochemical technique. Serotonin-like immunoreactive Merkel cells were found in groups located at the base of epidermal rete pegs and in the external root sheath of sinus hair follicles (vibrissae). Immunoreactivity was stronger on the basal side of the Merkel cells, where dense-cored granules are most numerous. Neither the nerve terminal associated with the Merkel cell nor the neighbouring epidermal cells were immunostained. These results are the first evidence of serotonin-like immunoreactivity in mammalian Merkel cells. The fact that immunoreactivity is strongest in those parts of the Merkel cells with the highest granule density suggests that in these cells serotonin is probably localized in the dense-cored granules.

Appearance of Birbeck granule-like structures in anti-T6 antibody-treated human epidermal Langerhans cells

We have previously demonstrated by immunogold labeling techniques that the T6 surface antigen of living human Langerhans cells (LC) of the skin is internalized by a process of receptor-mediated endocytosis (RME). Receptor-mediated endocytosis induced by the binding of the monoclonal anti-T6 antibody BL6 involves coated pits, coated vesicles, endosomes, the smooth endoplasmic reticulum, and lysosomes. After RME, gold-labeled Birbeck granules (BGs) appear in the cell center. In the present study, by modifying the experimental conditions but retaining the presence of gold-labeled BL6, we have observed (in addition to the above-mentioned gold-labeled organelles) images that appear to correspond to BG-like structures. These structures, like the intracytoplasmic BGs, are pentalaminar and gold-labeled, but they differ from the intracytoplasmic BGs by their attachment to the cell membrane, their length, the frequent presence of a coat, and by prolongation by one or more coated pits. Birbeck granule-like structures seem to result, at the ultrastructural level, from receptor ligand interactions and from modifications of the LC shape.

Langerhans cell histiocytosis: an unusual case illustrating the value of immunohistochemistry in diagnosis

The morphological features of Langerhans cell histiocytosis (histiocytosis X) are characteristic but the diagnosis can on occasion be difficult. A case is presented that illustrates the diagnostic value of immunohistochemistry in the differential diagnosis of this condition. The cells of Langerhans cell histiocytosis were found to express CD1, CD4, CD11b and CD11c. They also reacted with EBM11, UCHM1, KB61 and HLA-DR. Occasional cells showed nuclear staining with Ki67, but no other lymphoid antigens were detected. Immunoreactivity of the cells of Langerhans cell histiocytosis with antibodies that recognize antigens present on macrophages provides further evidence for immunological similarities between these cell types.

Morphometric characterization of the human neuroendocrine Merkel cells

In this study, the neuroendocrine Merkel cells (NEMCs) from adult human epidermis are defined morphometrically, using the MOP 20 image analyzer to measure 21 parameters of either the cell as a whole, or particular cellular structures. Maximum diameter (8.09 microns), perimeter (26.51 microns), area (36.87 microns2) and form factor (0.626) for the cell as a whole, and maximum diameter (5.08 microns), perimeter (18.74 microns), area (12.54 microns2) and form factor (0.452) for the nucleus were determined. Also measured were nuclear-cytoplasmic ratio (0.5595), filament thickness (10 nm), and granular numerical density (7.02 granules/micron2). Maximum diameter, area, and form factor of neurosecretory granules were 94.23 nm, 5020.05 nm2, and 0.93, respectively. Length of desmosomes linking NEMCs to keratinocytes was determined (286.9 nm) and compared with that of interkeratinocytic desmosomes (385 nm). In addition, length and diameter of cellular processes (spine-like processes (1.58 micron X 0.26 micron), interstitial processes (1.39 micron X 0.25 micron), and microvilli (0.35 micron X 0.25 micron) were measured after separation and classification according to the particular morphologic characteristics of each.

Ultrastructural and phenotypic changes in Langerhans cells induced in vitro by contact allergens

Ultrastructural changes of murine Langerhans cells (LC) were examined following exposure of crude epidermal cell suspensions to the contact allergens dinitrochlorobenzene, nickel sulphate and lead nitrate at various concentrations and for various incubation times. An immunogold labelling technique was employed to study changes in surface expression of MHC Class II (Ia) molecules. In all cases, activation of LC was evident after as little as 15 min exposure and was characterized by a marked increase in surface expression of Ia molecules, prominent rough endoplasmic reticulum and numerous ribosomes and lysosomes. Degenerative changes in LC were apparent to varying degrees depending on the allergen, its concentration and the time of incubation. Degenerative changes included swollen mitochondria, membrane disruption or rupture, loss of density of the cytoplasm (cytolysis), loss of dendritic processes and decreased expression of Ia molecules. In the case of dinitrochlorobenzene, degenerative changes were present and usually severe at concentrations greater than 10 micrograms/ml, while exposure to nickel sulphate and lead nitrate was associated with only mild degenerative changes. These observations indicate that contact allergens have a variety of direct effects on LC, including activation and degeneration, which are dose- and time-dependent. Since these alterations of LC were observed in the absence of other immunologically active cells, peripolesis cannot be involved in these events.

Epidermal Langerhans' cells and dermal dendritic cells in human fetal and neonatal skin: an immunohistochemical study

The dendritic cells in skin biopsies from 36 fetuses (from 16 weeks' gestational age on) and neonatal infants of different ages were investigated using a number of markers for various cells of the immune system and immunohistochemistry. Epidermal Langerhans' cells were found in all cases in a predominantly basal localization. The number of OKT6-positive Langerhans' cells and the development of their dendritic processes gradually increased with age. Dermal dendritic cells were present as well. Both HLA-DR-positive and Leu-10-positive dermal dendritic cells were found in the superficial and deep dermis, often in a perivascular distribution. The OKT6-positive dermal dendritic cells were few in number and occurred only in the upper dermis.

Merkle cell carcinoma report of a case and possible role for adjuvant radiotherapy

A case of neuroendocrine (Merkle cell) carcinoma of the skin is described. This uncommon tumor occurred in a 76-year-old female and presented as a small exophytic nodule on the right anterior chest wall. Following primary excision, it was thought to be a basal cell carcinoma. The diagnosis of Merkle cell carcinoma was established only after the tumor had recurred locally and involved ipsilateral axillary lymph nodes. Although local control was achieved with surgery and radiotherapy, the patient died of probable hepatic metastases 18 months after presentation. The Merkle cell tumor is an undifferentiated small cell carcinoma originating in the skin and has distinct ultrastructural characteristics that help to differentiate it from other small cell tumors. The clinicopathologic characteristics of these potentially aggressive neoplasms are reviewed, and treatment is briefly discussed.

Extramammary Paget's cells: further evidence of sweat gland derivation

Tissue from a 66-year-old male patient with extramammary Paget's disease of the right side of the scrotum and the right groin was studied for the presence of several antigens with the immunoperoxidase technic. Adenokeratin (cytokeratin No. 18) and carcinoembryonic antigens were positive in Paget's cells, whereas squamokeratin (cytokeratin No. 10) was expressed only in normal epidermal cells. Langerhans cells were decreased in the region of the tumor. Many transferrin receptors were present on the tumor cells, indicating a high cellular proliferation rate. Enzyme histochemical studies of the extramammary Paget's cells showed positive reactions for several enzymes typical of sweat glands, except for leucine aminopeptidase, which was negative. A comparison with three other cases showed that these enzyme reactions varied greatly from case to case. Both immunohistochemical and enzyme histochemical findings provide further evidence that extramammary Paget's cells are related to sweat gland epithelial cells, with variable expression of cellular characteristics.

Merkel cell carcinoma of the eyelid

The clinical and pathological features of two Merkel cell carcinomas of the eyelid skin are reported. Both tumours occurred in the upper lid in elderly women and enlarged rapidly to form smooth, round nodules which projected from the lid surface anterior to the grey line. In one case the primary excision biopsy was followed by a wider excision in 1982, and the patient has been free from recurrence or metastases in the intervening period. In the second more recent case, the tumour was inadequately excised in 1984 and the lid was treated by radiotherapy: this patient is at present free from recurrence. Histological examination of each tumour revealed an identical morphology - characterised by the presence of uniform polyhedral cells with multiple nucleoli lying in nests and lobules within the dermis: mitotic figures were prominent. Immunohistochemical studies showed the cells to react positively with antisera against neurone-specific enolase, epithelial membrane antigen and met-enkephalin. Electron microscopy revealed only rare neuroendocrine granules in one tumour, and numerous granules in the other. Intranuclear rodlets were not identified and there was paucity of cell membrane attachment modifications.

The skin immune system Its cellular constituents and their interactions

The term immunodermatology describes the systematic investigation of the complex mechanisms of the 'skin immune system' in health and disease. In this review Jan Bos and Martien Kapsenberg discuss the skin's vascular and lymphatic systems and the various cells which participate in the immune response. These include Langerhans' cells, indeterminate cells, veiled cells, endothelial cells, mast cells, tissue macrophages and 'homing' T lymphocytes, which are all present in skin under physiological conditions.

Ontogeny of Langerhans cells in human embryonic and fetal skin: expression of HLA-DR and OKT-6 determinants

Langerhans cells (LCs) have been identified in human skin by 10 weeks estimated gestational age (EGA), but it was not known when they first enter the epidermis or acquire HLA-DR, OKT-6, and ATPase reactivity. We assayed for LCs in human embryonic and fetal skin by using immunolabeling and histochemical techniques on epidermal sheets. HLA-DR+ and ATPase+ LCs were present in the epidermis by 6-7 weeks EGA, the youngest tissue examined. Most LCs were OKT-6- until about 12 weeks EGA when they underwent a dramatic increase in OKT-6 reactivity. Although LC densities between 50-100 days were statistically similar (100 cells/mm2 of epidermis), LCs early in development were smaller, less dendritic, and phenotypically heterogeneous. We conclude that LCs migrate into the epidermis during the first trimester and resemble the adult phenotype by the second trimester, long before the immune system is fully activated.

Fluorescence microscopic and flow cytometric analysis of bone marrow-derived cells in human epidermis: a search for the human analogue of the murine dendritic Thy-1+ epidermal cell

Lymphoid cells with an affinity for the epidermis (epidermotropic lymphocytes) have been proposed to play a role in the immune functions of the epidermis. However, antigen-presenting Langerhans cells (LC) and indeterminate cells are presently the only cells in the human epidermis which have been demonstrated to originate in the bone marrow. Recent studies of murine epidermis have identified a population of bone marrow-derived cells which express Thy-1 antigen and which are present in a similar density to, but distinct from, LC. We therefore sought to identify the potential human analogue of the murine Thy-1+ epidermal cell utilizing a battery of antileukocyte reagents in immunohistochemical, flow cytometric, and cell sorting studies. A panel of antibodies failed to detect significant numbers of human Thy-1 antigen-bearing cells, T cells, B cells, monocytes/macrophages (other than LC), and natural killer cells in tissue sections, epidermal sheets, and epidermal cell (EC) suspensions. This was the case using EC suspensions either unfractionated or fractionated on Ficoll-Hypaque to enrich for leukocyte subpopulations. Since the nature of the murine Thy-1+ EC is uncertain, it is possible that antibodies directed against well-defined leukocyte subpopulations may not be of value in the detection of a potential human analogue. We therefore utilized double fluorescence staining with anti-HLe-1, an antibody which identifies all human leukocytes, and anti-HLA-Dr (Dr), which identifies epidermal LC, in order to demonstrate a potential population of HLe-1+ Dr- non-LC, bone marrow-derived cells. The vast majority of HLe-1+ cells were HLA-Dr+ LC; these were present at a density of 608 cells/mm2 in epidermal sheets. A minor population of HLe-1+ cells which did not express HLA-Dr (HLe-1+ Dr-) was observed in tissue sections, epidermal sheets, and EC suspensions. The nondendritic morphology and low density of these HLe-1+ Dr- EC in epidermal sheets (mean density of 4.2 +/- 1.6 cells/mm2) precluded their representing a strict human analogue of the murine Thy-1+ EC, since murine Thy-1+ EC are dendritic and are present in a density similar to that of LC. Purified preparations of the minor HLe-1+ Dr- EC population obtained by electronic cell sorting or panning and examined ultrastructurally were not enriched for any bone marrow-derived cell population. Thus, using currently available markers and sorting technology, we have been unable to identify a human analogue of the murine dendritic Thy-1+ epidermal cell.

Morphological and phenotypical characterization of bone marrow-derived dendritic Thy-1-positive epidermal cells of the mouse

Increasing evidence exists that the spectrum of dendritic cells within the epidermis is more complex than previously thought. In addition to Langerhans cells, Merkel cells, and melanocytes, the murine epidermis contains a dendritic cell population whose most prominent phenotypic feature is the Thy-1 antigen. These cells are now generally referred to as dendritic Thy-1+ epidermal cells (dThy-1+EC). The ultrastructural features of these cells do not resemble those of other resident epidermal cells (EC). In particular, their cytoplasm contains abundant intermediate-sized filaments of the vimentin type as well as membrane-limited organelles with a central granular core. The bone marrow derivation of dThy-1+EC is now well established: dThy-1+EC carry Ly-5 determinants whose expression is restricted to cells of the hemopoietic differentiation pathway, and studies using Thy-1-disparate radiation bone marrow chimeras have revealed the presence of donor-type Thy-1+ cells within the epidermis; by immunoelectron microscopy, these cells represent dThy-1+EC. dThy-1+EC repopulate the epidermis at a slower rate than Langerhans cells as evidenced by a direct comparison of the repopulation kinetics of both cell systems in radiation bone marrow chimeras, and by experiments studying the emergence of either Ia+- or dThy-1+EC in an epidermis which had been previously depleted of either Langerhans cells (glucocorticosteroids) or of dThy-1+EC (PUVA). The phenotypical features of dThy-1+EC differ from those of thymus-derived lymphocytes, B cells, dendritic cells, and mononuclear phagocytes. The surface marker repertoire of dThy-1+EC (Thy-1, Ly-5, asialo-GM1) resembles certain members of the rather heterogeneous natural killer (NK) cell system but functional studies are needed to ascertain this contention.

Intermediate filaments in Merkel cell tumors

A series of ten Merkel cell tumors is described, with special emphasis on intermediate filament expression. The presence of cytoskeletal proteins was studied with a polyclonal antiserum directed against cytokeratin and with monoclonal antibodies against cytokeratin, neurofilament, and vimentin by the immunoperoxidase technique. Cytokeratin was demonstrated in nine of ten tumors. Neurofilament was observed in the two snap-frozen tissues tested and in three of the eight formalin-fixed, paraffin-embedded tissues. No reactivity for vimentin was found. By electron microscopy desmosomes were found to be present in all cases, while tonofilaments were found in only a few cases. neurosecretory granules, although seen in all tumors, were generally present in low numbers. The results of this study indicate that the Merkel cell tumor is a poorly differentiated small cell carcinoma that has the ability to express some neuroendocrine features.

Quantitative analysis of immunocompetent cells in human normal oral and uterine cervical mucosa, oral papillomas and leukoplakias

Using monoclonal antibodies reacting with T-cell subpopulations, Langerhans cells and macrophages, the number and distribution of cells of the immune system in normal oral and cervical mucosa was determined and statistically compared with that in oral papillomas and oral leukoplakias. Increased numbers of labelled cells were found in oral leukoplakias and particularly in oral papillomas. In the epithelium of all specimens, Langerhans cells and T-lymphocytes of the suppressor/cytotoxic phenotype as well as of the helper phenotype were seen. Suppressor/cytotoxic and helper T-lymphocytes were in equal numbers in the epithelium of oral papillomas, but were about 2:1 in all other lesions. In normal oral epithelium, macrophages were rare but were in greater numbers in leukoplakias and papillomas. In the connective tissue of all lesions, more labelled cells were present than in epithelium with T-lymphocytes predominant. Although Langerhans cells were rare in connective tissue, many were seen in oral papillomas.

The intermediate filament proteins of rabbit normal epidermal Merkel cells are cytokeratins

Four hundred Merkel cells (MC) have been studied by double-label immunofluorescence using: (1) a monoclonal antibody which has been previously demonstrated to react with MC and (2) antisera and monoclonal antibodies against the 5 types of intermediate filaments. It was demonstrated that MC did not react with vimentin, desmin, glial acidic fibrillary protein, or neurofilament antisera. A strong staining of MC was observed with 2 antisera and 2 monoclonal antibodies against keratin. The cytokeratin polypeptide pattern of MC is probably similar to that of simple epithelia. These findings attest to the epithelial nature of MC.

Thy-1+ dendritic cells in murine epidermis are bone marrow-derived

Thy-1+, Ly-5+ dendritic cells have recently been described as a resident cell population in murine epidermis, but their ontogeny and function are unknown. We therefore investigated the origin and turnover of epidermal Thy-1+ cells utilizing chimeric mice. Lethally x-irradiated AKR/J (Thy-1.1+) and AKR/Cum (Thy-1.2+) mice were reconstituted with allogeneic bone marrow cells with or without thymocytes from congenic AKR/Cum or AKR/J mice, respectively. The density of residual indigenous Thy-1.1+ cells in AKR/J chimeras and Thy-1.2+ cells in AKR/Cum chimeras was substantially reduced following x-irradiation, as determined by immunofluorescence staining of epidermal sheets. Epidermal repopulation by allogeneic Thy-1+ dendritic epidermal cells was first observed at 5 weeks in AKR/J chimeras and at 7 weeks in AKR/Cum chimeras and progressed slowly. Repopulation was not enhanced by increasing the number of allogeneic bone marrow cells injected from 2 X 10(7) to 10(8) cells or by the addition of 8 X 10(7) allogeneic thymocytes to the donor inoculate. Epidermal repopulation by allogeneic Thy-1.2+ cells was not seen in AKR/J mice reconstituted with syngeneic bone marrow cells and allogeneic Thy-1.2+ AKR/Cum thymocytes. Taken together, these results indicate that Thy-1+ dendritic epidermal cells are derived from the bone marrow and suggest that they are not related to conventional peripheral T-lymphocytes.

Migration of lymphocytes through the cutaneous basal lamina in normal skin: an ultrastructural study

Incubation of skin in 2 N sodium bromide allows separation of dermal and epidermal layers leaving an intact basal lamina covering the dermal portion. Examination of the surface of the dermis by SEM shows cells migrating through the basal lamina. By scanning and transmission electron microscopy, these cells have the characteristics of lymphocytes. The migrating lymphocytes produce a sequence of basal lamina deformations including dome formation, effacement of corrugations, and central fenestrations with hole formation allowing lymphocyte passage. Following passage there is reestablishment of a relatively smooth basal lamina in the crater base, effacement of the crater rim, and finally reformation of basal lamina corrugations. This deformability of the basal lamina supports the hypothesis that basal lamina is thixotropic. This study is the first demonstration in three dimensions of lymphocyte traffic across the basal lamina, an important component of skin-associated lymphoid tissue (SALT).

Langerhans' cells and T cells in human skin tumours: an immunohistological study

In this study normal skin and a range of skin tumours, both benign and malignant, have been examined using monoclonal antibodies to identify the distribution and morphology of Langerhans' cells and T cells, the distribution of T lymphocytes and their subsets have been analysed using monoclonal anti-T cell antibodies. The results indicated that Langerhans' cells can be reliably identified in both normal and malignant skin biopsies using monoclonal antibodies. A striking finding to emerge was that in benign skin lesions Langerhans' cells were increased, whereas in malignant tumours they were not only markedly depleted or absent but also grossly stunted and deformed in outline. The majority of lymphocytes surrounding these skin tumours were shown to be T cells with helper cells outnumbering suppressor cells by a ratio from 2 to 5:1. This study shows the usefulness of immunohistological techniques using monoclonal antibodies for examining the morphology and distribution of Langerhans' cells in skin pathology. In addition they are particularly appropriate for identifying their topographical relationships with other immunologically important cells such as T cells.

A quantitative study of the time course of the reduction in Merkel cell number within denervated rat touch domes

By using the fluorescent dye quinacrine as a marker for the Merkel cells in rat touch domes we have shown that denervation results in a progressive reduction in the number of these cells to a level that remains relatively constant at about 40% of that present at the time of denervation. The time-course of quinacrine fluorescent cell changes after denervation could be described by assuming that (i) there are two populations of quinacrine fluorescent cells, one labile and the other stable, and (ii) the labile population is the one most sensitive to denervation and disappears exponentially with a half-time of ca 10 days. It appeared that this time-course of decay of the labile quinacrine fluorescent cells was the same whether the denervation was performed during the period of postnatal development studied (at 7 and 14 days), when normally Merkel cells are rapidly added to the dome, or later (at 35 and 60 days) when the adult population is virtually established. Correlative electron microscopic studies confirmed that quinacrine fluorescent cell counts reflect fairly accurately the Merkel cell population in denervated domes. These quantitative findings based on the use of quinacrine to visualize the entire Merkel cell population of touch domes show that the normal development and maintenance of these cells are trophically dependent on sensory nerves, although a subpopulation may persist even in long-term denervated domes. In addition, the similarity of the first order rate constant for the decay of quinacrine fluorescent cells after denervation and for the normal generation of quinacrine fluorescent cells suggests that the labile Merkel cell population is one that turns over continuously in the normally innervated touch dome.

Merkel cell carcinoma: a malignant neuroendocrine tumour of the eyelid

Merkel cell carcinoma is a recently described tumour which may occur on the face of the elderly. We report such a lesion which presented as a cyst on the eyelid of an 88-year-old woman. This tumour differs from other tumours of the eyelids in its propensity for local and distant spread.

Merkel cells and Merkel cell tumors. Ultrastructure, immunocytochemistry and review of the literature

Certain monomorphic cellular tumors that occur in the dermis have been called trabecular carcinomas or Merkel cell tumors. Forty-six cases have been reported to date and the literature on these is reviewed here, with six additional cases reported. Cytologic features include sparse cytoplasm, dispersed chromatin with inconspicuous nucleoli in round nuclei and many mitoses. Trabeculae and pseudorosettes may be identified. Electron microscopy is required for definitive diagnosis. Like normal Merkel cells, tumor cells contain electron-dense granules (80-200 nm), 10 mm filaments and desmosomes. Filament-rich cytoplasmic spikes were found in four tumors. These resemble corresponding protrusions of normal Merkel cells and have not been described in other APUDomas.

Langerhans cells in skin from patients with psoriasis: quantitative and qualitative study of T6 and HLA-DR antigen-expressing cells and changes with aromatic retinoid administration

Using a monoclonal antibody against human HLA-DR antigens and OKT6, we investigated by indirect immunofluorescence the distribution of Langerhans cells in normal human skin and involved and uninvolved skin from patients with psoriasis before, during, and after systemic aromatic retinoid administration. In parallel, enumeration of HLA-DR and of OKT6+ cells was also performed. In involved psoriatic epidermis the distribution of positive cells was disturbed; OKT6+ cells were reduced in number, as were HLA-DR+ cells which were seen in clusters. In control skin sections, a regular pattern of fluorescent dendritic epidermal cells was noted. In normal-appearing human skin, in nonlesional psoriatic skin, but not in diseased psoriatic skin, the number of OKT6+ cells per epidermal section surface unit was higher than that of HLA-DR expressing cells. Changes in the number and distribution of OKT6 and HLA-DR+ cells in psoriatic involved epidermis were corrected by oral retinoid treatment.

In situ identification of T6-positive cells in normal human dermis by immunoelectron microscopy

Monoclonal anti-T6 antibody, which reacts with the majority of cortical thymocytes but not peripheral T cells, also reacts with human epidermal Langerhans cells, as shown by a four-step immunoperoxidase method and immunoelectron microscopy. To define whether T6-positive cells are also present in normal human dermis, we used these techniques to demonstrate two immunologically distinct populations of histiocyte-like cells in normal human dermis. The first population contains cells devoid of phagolysosomes or Birbeck granules. These cells react with anti-T6 antibody, but not with monoclonal anti-T3 antibody which defines peripheral T cells, and are found predominantly in and around dermal lymphatic vessels. The second is composed of phagolysosome-containing cells which do not react with anti-T6 antibody or anti-T3 antibody. Because to date, Langerhans cells are the only cells in normal human epidermis that react with anti-T6 antibody, these data provide immunological evidence for a specific link between Langerhans cells and a T6-positive dermal mononuclear cell, possibly the so-called indeterminate cell. In addition, application of these techniques should, for the first time, permit the immunological distinction of these T6-positive mononuclear cells from other cells bearing Ia antigens, such as dermal histiocytes and certain lymphocytes, in normal and diseased skin.

Merkel cell carcinoma: a report of three cases with neurone-specific enolase activity

Three cases are described of a primary cutaneous neoplasm occurring in elderly patients, histological and immunohistochemical features of which support an origin from Merkel cells. Microscopically sheets of uniform small cells filled the dermis, often with a prominent trabecular pattern. Ultrastructurally the cells showed neurosecretory granules, tangles of microfilaments, scattered mitochondria and occasional intranuclear rodlets. Immunohistochemical staining for neurone-specific enolase was positive and for prekeratin was negative in each case. The definitive diagnosis of Merkel cell tumour can be made with a combination of electron microscopy and immunohistochemistry.

Intermediate filaments in malignant melanomas. Identification and use as marker in surgical pathology

Intermediate-sized filaments have been studied in human malignant melanomas and in normal melanocytes by immunofluorescence microscopy with antibodies directed against keratin, vimentin, desmin, neurofilament protein, and glial filament protein. Both human melanotic and amelanotic tumor cells and tumor metastases as well as normal melanocytes in human skin and in the rat eye contain exclusively intermediate filaments of the vimentin type. No reaction was seen with antibodies to keratin, desmin, neurofilaments, or glial filaments. These latter four antisera, however, gave strong reactions in epidermis and other epithelial tissues, muscle, or neural tissues, respectively. The results favor a mesenchymal character of melanocytes, although a neuroectodermal origin in an early developmental stage is possible. The finding that melanomas contain exclusively vimentin intermediate filaments may prove useful in differential diagnosis of melanomas from other tumor types.

Functional and phenotypic analysis of isolated human Langerhans cells and indeterminate cells

In the mixed skin cell lymphocyte culture reaction (MSLR), epidermal cells induce the proliferation in vitro of peripheral blood lymphocytes. Using monoclonal antibodies (MCAB) OKT6 specific for Langerhans cells among epidermal cells and an anti HLA-Dr, we analysed which epidermal cells are necessary in MSLR in man. Inhibition and reduction of the proliferative responses in MSLR conducted respectively with 'anti HLA-Dr and complement' and 'OKT6 and complement'-pretreated epidermal cells suggested that not only Langerhans cells but also other HLA-Dr bearing cells play a major role. Immuno-electron microscopic studies of either HLA-Dr (+) or OKT6 (+) enriched and depleted epidermal cells suspensions: (I) were well correlated with results in MSLR; (2) indicated that Langerhans cells express both T6 and HLA-Dr determinants while indeterminate cells express only the HLA-Dr. No other epidermal cells were found to be either OKT6 or HLA-Dr (+). The data strongly suggest that not only Langerhans cells but also OKT6 (-) HLA-Dr (+) indeterminate cells play a major role in lympho-epidermal interactions.

Identification of inflammatory cell phenotypes in human oral carcinomas by means of monoclonal antibodies

Monoclonal antibodies reacting with human T cell sub-populations, Langerhans cells and macrophages were used to examine the quantitative distribution of immune-competent cells in normal oral mucosa and invasive oral carcinomas. Both immunofluorescent and immunoperoxidase procedures were applied. In normal oral epithelia, the dominant immune-reactive cell was the Langerhans cell, positive for OKT 6 and expressing HLA-DR gene products (OKIa1+). Many intra-epithelial non-epithelial cells (non-keratinocytes), belonged to the lymphocyte system carrying the suppressor/cytotoxic phenotype (OKT 8+). This lymphocyte sub-population was also the most prominent cell type in the normal mucosal stroma. The quantitative evaluation of immune-competent cells in squamous cell carcinomas revealed elevated numbers of all the inflammatory cell sub-populations investigated (suppressor/cytotoxic lymphocytes, helper/inducer lymphocytes, Langerhans cells, macrophages) compared with the normal oral mucosa. There was a striking increase in suppressor/cytotoxic lymphocytes (OKT 8+) and in cells of the macrophage system, including Langerhans cells (OKIa1+, OKM 1+, OKT 6+). In the stroma distant to the tumour complexes, many helper/inducer lymphocytes (OKT 4+) were also observed.

Reduction of Langerhans cells in human epidermis during PUVA therapy: a morphometric study

Skin biopsies were obtained before and after PUVA therapy from the normal skin of 5 psoriatic patients. By electron microscopic morphometric techniques the pretreatment volume density of Langerhans cells within the epidermis was estimated to be approximately 1%. This density was reduced in all 5 patients after therapy. The volume density of Langerhans cell granules per Langerhans cell cytoplasm was on an average 0.8% and this density was reduced in 4 of the patients after therapy, while in one patient there was an increase. There was a reduced volume density of Langerhans cell granules per unit volume of epidermis in all 5 patients after therapy. The mean length of the Langerhans cell disc was 260 +/- 120, nm the mean thickness 40 nm and the mean diameter of the Langerhans cell vesicle 120 +/- 30 nm. None of these parameters changed after PUVA therapy. The reduced volume density of Langerhans cells is discussed in the context of possible implications for immune reactions in the skin.