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Wang H, Zhong Z, Wang X, Zheng L, Wang Y, Wang S, Liu S, Li H, Guo Z, Gao M. Case Report: Amyloidosis Cutis Dyschromica: Dermoscopy and Reflectance Confocal Microscopy and Gene Mutation Analysis of a Chinese Pedigree. Front Med (Lausanne) 2021; 8:774266. [PMID: 34926516 PMCID: PMC8671158 DOI: 10.3389/fmed.2021.774266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Amyloidosis cutis dyschromica (ACD) is a rare type of primary localized cutaneous amyloidosis. Non-invasive techniques can provide important clues for early diagnosis. Objectives: To highlight the characteristic imaging changes of ACD under dermoscopy and reflectance confocal microscopy (RCM), investigate gene mutations in a Chinese Han pedigree of ACD, and analyze the genotype-phenotype correlation. Methods: Dermoscopy and RCM examinations were completed together for the pedigree, and the imaging characteristics were described. The diagnosis of ACD was confirmed by pathological examination. Sequencing was performed followed by bioinformatics and genotype-phenotype correlation. ACD-related articles published on PubMed between January 1970 and March 2021 were reviewed and summarized. Results: In ACD, dermoscopy showed patchy white hypopigmentation and brownish spots, stripes, or hyperpigmented blotches and patches. RCM showed a highly refractive substance with clumpy, dotted, and linear structures inside the papillary dermis. Sequencing identified glycoprotein non-metastatic melanoma protein B (GPNMB) missense mutations [c.393T>G (p.Y131X; NM_001005340.2)] and a frameshift deletion mutation [c.719_720delTG (p.V240fs; NM_001005340.2)]. The ANNOtate VARiation (ANNOVAR) software predicted that c.393T>G is a pathogenic mutation. The literature review found 14 mutations, namely, 5 (35.7%) frameshift mutations, 4 (28.6%) non-sense mutations, 4 (28.6%) missense mutations, and 1 (7.1%) splice site mutation. Blisters and epidermolysis were observed in several cases, but there was no significant association between clinical manifestations and mutations in ACD. Conclusions: This study was the first to combine dermoscopy and RCM to describe ACD. Two GPNMB gene mutations were reported in a Chinese ACD pedigree. The genotype-phenotype correlation was analyzed for the first time; however, there was no significant correlation.
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Affiliation(s)
- Hui Wang
- Department of Dermatology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui, China
| | - Zhenyu Zhong
- Department of Dermatology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui, China
| | - Xiuli Wang
- Department of Dermatology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui, China
| | - Liyun Zheng
- Department of Dermatology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui, China
| | - Yifan Wang
- Department of Dermatology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui, China
| | - Shan Wang
- Department of Dermatology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui, China
| | - Siqi Liu
- Department of Dermatology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui, China
| | - Hui Li
- Department of Dermatology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui, China
| | - Ze Guo
- Department of Dermatology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui, China
| | - Min Gao
- Department of Dermatology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui, China
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Chen J, Yang H, Xu Z, Lu P, Yuan L, Xue Y, Xue R, Yang B. Diagnosis of Primary Cutaneous Amyloidosis by Rapid 4,6-Diamidino-2-Phenylindole Staining. Dermatology 2021; 238:368-376. [PMID: 34515096 PMCID: PMC8985017 DOI: 10.1159/000518082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/18/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Quick and accurate diagnosis of primary cutaneous amyloidosis (PCA) may be difficult because its symptoms are often subtle and nonspecific. OBJECTIVE We sought to review the literature on the roles of various staining methods in the diagnosis of amyloidosis and demonstrate added benefits of using rapid 4,6-diamidino-2-phenylindole (DAPI) staining in the diagnosis of PCA. METHODS Three groups of cases, namely, PCA, neurodermatitis, and prurigo nodularis, were retrieved from a computerized pathology database for study, and their paraffin-embedded tissue blocks were cut following standard procedures. The tissue sections were stained with three stains: hematoxylin-eosin (HE), Congo red, and DAPI stains, and examined under the microscope to compare the staining patterns of these three methods. We also performed amyloid keratin and apolipoprotein E (APOE) staining on the sections of PCA in order to further support our conclusion. The PCA sections were read by junior and senior dermatopathologists for comparison. RESULTS The sensitivity of DAPI staining for PCA was significantly higher than that of Congo red staining and HE staining (p < 0.001). This statement holds true whether the experiment was grouped in one sample or was divided into groups of junior and senior dermatopathologists (p < 0.001). The DAPI-positive staining areas, except for the nuclei, were consistent with the amyloid deposition areas. In this study, DAPI staining had a sensitivity of 98.6% and a specificity of 100%. CONCLUSION DAPI staining could serve as a useful technique to establish the diagnosis of PCA, and its high efficacy in diagnosing PCA makes it less dependent on the experience levels of the evaluators. Additionally, the binding of DAPI to the A-T-rich sequence of double-stranded DNA suggests that amyloid may contain DNA or a similarly structured nucleic acid.
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Affiliation(s)
- Junchen Chen
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Huan Yang
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Zhijun Xu
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, China,
| | - Ping Lu
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Liyan Yuan
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Yaohua Xue
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Ruzeng Xue
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Bin Yang
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, China
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Wang X, Wang H, Zhong Z, Zheng L, Wang Y, Guo Z, Li H, Gao M. Case Report: Diagnosis of Primary Cutaneous Amyloidosis Using Dermoscopy and Reflectance Confocal Microscopy. Front Med (Lausanne) 2021; 7:619907. [PMID: 33553215 PMCID: PMC7859258 DOI: 10.3389/fmed.2020.619907] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/30/2020] [Indexed: 11/13/2022] Open
Abstract
The dermoscopy and reflectance confocal microscopy (RCM) can provide new insights for diagnosis disease as non-invasive and easy-to-use tool. We described the dermoscopy and RCM characteristics of two patients with primary cutaneous amyloidosis (PCA) respectively. The dermoscopy characteristics were as follows: brownish macules with brown or white centers surrounded by hyperpigmented blotches, and a whitish scar-like center encircled by irregular brownish hyperpigmented spots or patches. The RCM features were increased melanin deposition in the basal layer, highly refractive structures with various shapes in the enlarged papillary dermis, and the increased pleomorphic structure of the dermal papillary ring. This is the first report the dermoscopy and RCM characteristics of PCA. We hope the characteristic dermoscopy and RCM appearances would provide a basis for doctors to diagnose and intervene earlier.
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Affiliation(s)
- Xiuli Wang
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Hui Wang
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Zhenyu Zhong
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Liyun Zheng
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Yifan Wang
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Ze Guo
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Hui Li
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Min Gao
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
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