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Pálla S, Kuroli E, Tóth EA, Hidvégi B, Holló P, Medvecz M. Primary Localized Cutaneous Amyloidosis in Central Europe: A Retrospective Monocentric Study on Epidemiology and Therapy. J Clin Med 2023; 12:7672. [PMID: 38137741 PMCID: PMC10743860 DOI: 10.3390/jcm12247672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Amyloid deposits can be the cause of many chronic diseases. Primary localized cutaneous amyloidosis (PLCA) is a chronic dermatologic condition with amyloid deposits in the papillary dermis. The most common types of the keratinocyte-derived form of PLCA include macular (MA), lichen (LA), and biphasic (BA) amyloidosis. The estimated prevalence of PLCA in the Asian population is 0.98/10,000, which is higher than in the European population; thus, epidemiologic data on PLCA in the Caucasian population are limited. We performed a retrospective single-center study analyzing epidemiologic characteristics of a Central European PLCA population. Epidemiologic data regarding age, sex, skin phototype (Fitzpatrick scale I-VI), disease duration, comorbidities, history of atopy, and family history of PLCA were collected. Clinical characteristics, localization of PLCA lesions, applied therapies and treatment outcomes were also analyzed. Dermoscopic characteristics were also evaluated. A total of 41 patients diagnosed with PLCA were included, with 22 presenting with macular, 18 with lichen, and 1 with biphasic amyloidosis. The male/female ratio was 16/25, and mean age at diagnosis was 54.6 ± 15.2 years (range 27-87 years). The mean age at the onset of PLCA was 53 ± 16.1 years (range 19-79 years) in MA, 46.7 ± 18.2 years (range 14-73 years) in LA, and 26 years in BA. The interscapular region in MA and the extensor surface of the lower extremities in LA proved to be localization-related areas. In our center, a wide range of therapeutic options was applied, with the most prescribed being topical corticosteroids in all types of PLCA. We presented a retrospective, monocentric study on the epidemiology of PLCA in the Central European region. By examining the medical data of a significant number of PLCA patients, we compared our epidemiologic data with that of the Asian PLCA population. Due to the rarity of the condition, further randomized controlled trials and guidelines are needed to improve therapeutic outcomes.
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Affiliation(s)
- Sára Pálla
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary
| | - Enikő Kuroli
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary
- Department of Pathology and Experimental Cancer Research, Semmelweis University, 1085 Budapest, Hungary
| | - Eszter Alexa Tóth
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary
| | - Bernadett Hidvégi
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary
| | - Péter Holló
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary
| | - Márta Medvecz
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary
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Bozsányi S, Boostani M, Farkas K, Hamilton-Meikle P, Varga NN, Szabó B, Vasanits F, Kuroli E, Meznerics FA, Lőrincz K, Holló P, Bánvölgyi A, Wikonkál NM, Paragh G, Kiss N. Optically Guided High-Frequency Ultrasound to Differentiate High-Risk Basal Cell Carcinoma Subtypes: A Single-Centre Prospective Study. J Clin Med 2023; 12:6910. [PMID: 37959375 PMCID: PMC10648659 DOI: 10.3390/jcm12216910] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 10/24/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most common type of skin cancer in the Caucasian population. Currently, invasive biopsy is the only way of establishing the histological subtype (HST) that determines the treatment options. Our study aimed to evaluate whether optically guided high-frequency ultrasound (OG-HFUS) imaging could differentiate aggressive HST BCCs from low-risk tumors. METHODS We conducted prospective clinical and dermoscopic examinations of BCCs, followed by 33 MHz OG-HFUS imaging, surgical excision, and a histological analysis. We enrolled 75 patients with 78 BCCs. In total, 63 BCCs were utilized to establish a novel OG-HFUS risk classification algorithm, while 15 were employed for the validation of this algorithm. The mean age of the patients was 72.9 ± 11.2 years. Histology identified 16 lesions as aggressive HST (infiltrative or micronodular subtypes) and 47 as low-risk HST (superficial or nodular subtypes). To assess the data, we used a one-sided Fisher's exact test for a categorical analysis and a Receiver Operating Characteristic (ROC) curve analysis to evaluate the diagnostic accuracy. RESULTS OG-HFUS distinguished aggressive BCC HSTs by their irregular shape (p < 0.0001), ill-defined margins (p < 0.0001), and non-homogeneous internal echoes (p = 0.004). We developed a risk-categorizing algorithm that differentiated aggressive HSTs from low-risk HSTs with a higher sensitivity (82.4%) and specificity (91.3%) than a combined macroscopic and dermoscopic evaluation (sensitivity: 40.1% and specificity: 73.1%). The positive and negative predictive values (PPV and NPV, respectively) for dermoscopy were 30.2% and 76.8%, respectively. In comparison, the OG-HFUS-based algorithm demonstrated a PPV of 94.7% and an NPV of 78.6%. We verified the algorithm using an independent image set, n = 15, including 12 low-risk and 3 high-risk (high-risk) with two blinded evaluators, where we found a sensitivity of 83.33% and specificity of 91.66%. CONCLUSIONS Our study shows that OG-HFUS can identify aggressive BCC HSTs based on easily identifiable morphological parameters, supporting early therapeutic decision making.
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Affiliation(s)
- Szabolcs Bozsányi
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA;
| | - Mehdi Boostani
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
| | - Klára Farkas
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
| | - Phyllida Hamilton-Meikle
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
| | - Noémi Nóra Varga
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
| | - Boglárka Szabó
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
| | - Flóra Vasanits
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
| | - Enikő Kuroli
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
| | - Fanni Adél Meznerics
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
| | - Kende Lőrincz
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
| | - Péter Holló
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
| | - András Bánvölgyi
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
| | - Norbert M. Wikonkál
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
| | - Gyorgy Paragh
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA;
| | - Norbert Kiss
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
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Pálla S, Tőke J, Bozsik A, Butz H, Papp J, Likó I, Kuroli E, Bánvölgyi A, Hamar M, Bertherat J, Medvecz M, Patócs A. Publisher Correction: Whole genome sequencing resolves 10 years diagnostic odyssey in familiar myxoma. Sci Rep 2023; 13:16339. [PMID: 37770543 PMCID: PMC10539426 DOI: 10.1038/s41598-023-43188-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Affiliation(s)
- Sára Pálla
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Judit Tőke
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
- ENDO-ERN HCP Semmelweis University, Budapest, Hungary
| | - Anikó Bozsik
- Department of Molecular Genetics, National Institute of Oncology, Ráth György U. 7-9, 1122, Budapest, Hungary
- Hereditary Cancers Research Group, Eötvös Loránd Research Network, Semmelweis University, Budapest, Hungary
- National Tumorbiology Laboratory, Budapest, Hungary
| | - Henriett Butz
- Department of Molecular Genetics, National Institute of Oncology, Ráth György U. 7-9, 1122, Budapest, Hungary
- Hereditary Cancers Research Group, Eötvös Loránd Research Network, Semmelweis University, Budapest, Hungary
- National Tumorbiology Laboratory, Budapest, Hungary
| | - János Papp
- Department of Molecular Genetics, National Institute of Oncology, Ráth György U. 7-9, 1122, Budapest, Hungary
- Hereditary Cancers Research Group, Eötvös Loránd Research Network, Semmelweis University, Budapest, Hungary
| | - István Likó
- Hereditary Cancers Research Group, Eötvös Loránd Research Network, Semmelweis University, Budapest, Hungary
| | - Enikő Kuroli
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - András Bánvölgyi
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Mátyás Hamar
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Jerome Bertherat
- Université Paris Cité, Institut Cochin, Inserm U1016, Paris, France
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Márta Medvecz
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
- ERN-Skin Semmelweis University, Budapest, Hungary
| | - Attila Patócs
- ENDO-ERN HCP Semmelweis University, Budapest, Hungary.
- Department of Molecular Genetics, National Institute of Oncology, Ráth György U. 7-9, 1122, Budapest, Hungary.
- Hereditary Cancers Research Group, Eötvös Loránd Research Network, Semmelweis University, Budapest, Hungary.
- National Tumorbiology Laboratory, Budapest, Hungary.
- National Institute of Oncology, Oncology Biobank Center, Budapest, Hungary.
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary.
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Kuzmanovszki D, Kiss N, Tóth B, Tóth V, Szakonyi J, Lőrincz K, Hársing J, Kuroli E, Imrédi E, Kerner T, Patyánik M, Wikonkál NM, Szabó Á, Brodszky V, Rencz F, Holló P. Real-World Experience with Cemiplimab Treatment for Advanced Cutaneous Squamous Cell Carcinoma-A Retrospective Single-Center Study. J Clin Med 2023; 12:5966. [PMID: 37762907 PMCID: PMC10531652 DOI: 10.3390/jcm12185966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The systemic treatment of advanced cutaneous squamous cell carcinoma (cSCC) has seen significant developments in recent years. The anti-PD1 inhibitor cemiplimab has demonstrated efficacy in clinical trials, but real-world data are still limited. Here, we aimed to evaluate the efficacy and the safety of cemiplimab in a real-world clinical setting. METHODS A retrospective analysis was carried out for all patients who received at least two doses of cemiplimab at our department between February 2020 and January 2023. Progression-free survival (PFS), overall survival (OS), the objective response rate (ORR), the disease control rate (DCR) and adverse events (AEs) were evaluated. RESULTS Twenty-five patients were included with a median age of 78 (65-82) years. The median treatment duration was 48 (16-72) weeks. Five (20%) patients were immunocompromised. Sixteen patients (64%) developed AEs, including 36% serious AEs (SAEs) of grade ≥ 3. Six patients (24%) were withdrawn from treatment due to the occurrence of AEs. Among the 25 patients, 52% showed an objective response (3 complete and 10 partial responses), 76% had controlled disease and 24% experienced progression. Among the five immunocompromised patients, the ORR was 60%, while the DCR was 80%. CONCLUSIONS This retrospective real-world study revealed that locally advanced or metastatic cSCC could be effectively treated with cemiplimab even in elderly, polymorbid and immunocompromised patients.
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Affiliation(s)
- Daniella Kuzmanovszki
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, H-1085 Budapest, Hungary; (N.K.); (B.T.); (V.T.); (J.S.); (K.L.); (J.H.); (E.K.); (E.I.); (T.K.); (N.M.W.); (P.H.)
| | - Norbert Kiss
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, H-1085 Budapest, Hungary; (N.K.); (B.T.); (V.T.); (J.S.); (K.L.); (J.H.); (E.K.); (E.I.); (T.K.); (N.M.W.); (P.H.)
| | - Béla Tóth
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, H-1085 Budapest, Hungary; (N.K.); (B.T.); (V.T.); (J.S.); (K.L.); (J.H.); (E.K.); (E.I.); (T.K.); (N.M.W.); (P.H.)
| | - Veronika Tóth
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, H-1085 Budapest, Hungary; (N.K.); (B.T.); (V.T.); (J.S.); (K.L.); (J.H.); (E.K.); (E.I.); (T.K.); (N.M.W.); (P.H.)
| | - József Szakonyi
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, H-1085 Budapest, Hungary; (N.K.); (B.T.); (V.T.); (J.S.); (K.L.); (J.H.); (E.K.); (E.I.); (T.K.); (N.M.W.); (P.H.)
| | - Kende Lőrincz
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, H-1085 Budapest, Hungary; (N.K.); (B.T.); (V.T.); (J.S.); (K.L.); (J.H.); (E.K.); (E.I.); (T.K.); (N.M.W.); (P.H.)
| | - Judit Hársing
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, H-1085 Budapest, Hungary; (N.K.); (B.T.); (V.T.); (J.S.); (K.L.); (J.H.); (E.K.); (E.I.); (T.K.); (N.M.W.); (P.H.)
| | - Enikő Kuroli
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, H-1085 Budapest, Hungary; (N.K.); (B.T.); (V.T.); (J.S.); (K.L.); (J.H.); (E.K.); (E.I.); (T.K.); (N.M.W.); (P.H.)
| | - Eleonóra Imrédi
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, H-1085 Budapest, Hungary; (N.K.); (B.T.); (V.T.); (J.S.); (K.L.); (J.H.); (E.K.); (E.I.); (T.K.); (N.M.W.); (P.H.)
| | - Tünde Kerner
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, H-1085 Budapest, Hungary; (N.K.); (B.T.); (V.T.); (J.S.); (K.L.); (J.H.); (E.K.); (E.I.); (T.K.); (N.M.W.); (P.H.)
| | - Mihály Patyánik
- Uzsoki Street Hospital, Practice Hospital of the Faculty of General Medicine, Semmelweis University, H-1145 Budapest, Hungary;
| | - Norbert M. Wikonkál
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, H-1085 Budapest, Hungary; (N.K.); (B.T.); (V.T.); (J.S.); (K.L.); (J.H.); (E.K.); (E.I.); (T.K.); (N.M.W.); (P.H.)
- Central Hospital of Northern Pest-Military Hospital, H-1139 Budapest, Hungary
| | - Ákos Szabó
- Department of Health Policy, Corvinus University of Budapest, H-1093 Budapest, Hungary; (Á.S.); (V.B.); (F.R.)
- Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, H-1085 Budapest, Hungary
| | - Valentin Brodszky
- Department of Health Policy, Corvinus University of Budapest, H-1093 Budapest, Hungary; (Á.S.); (V.B.); (F.R.)
| | - Fanni Rencz
- Department of Health Policy, Corvinus University of Budapest, H-1093 Budapest, Hungary; (Á.S.); (V.B.); (F.R.)
| | - Péter Holló
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, H-1085 Budapest, Hungary; (N.K.); (B.T.); (V.T.); (J.S.); (K.L.); (J.H.); (E.K.); (E.I.); (T.K.); (N.M.W.); (P.H.)
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Pálla S, Tőke J, Bozsik A, Butz H, Papp J, Likó I, Kuroli E, Bánvölgyi A, Hamar M, Bertherat J, Medvecz M, Patócs A. Whole genome sequencing resolves 10 years diagnostic odyssey in familiar myxoma. Sci Rep 2023; 13:14658. [PMID: 37670105 PMCID: PMC10480295 DOI: 10.1038/s41598-023-41878-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 09/01/2023] [Indexed: 09/07/2023] Open
Abstract
Carney complex (CNC) is an ultrarare disorder causing cutaneous and cardiac myxomas, primary pigmented nodular adrenocortical disease, hypophyseal adenoma, and gonadal tumours. Genetic alterations are often missed under routine genetic testing. Pathogenic variants in PRKAR1A are identified in most cases, while large exonic or chromosomal deletions have only been reported in a few cases. Our aim was to identify the causal genetic alteration in our kindred with a clinical diagnosis of CNC and prove its pathogenic role by functional investigation. Targeted testing of PRKAR1A gene, whole exome and whole genome sequencing (WGS) were performed in the proband, one clinically affected and one unaffected relative. WGS identified a novel, large, 10,662 bp (10.6 kbp; LRG_514t1:c.-10403_-7 + 265del; hg19, chr17:g.66498293_66508954del) deletion in the promoter of PRKAR1A in heterozygous form in the affected family members. The exact breakpoints and the increased enzyme activity in deletion carriers compared to wild type carrier were proved. Segregation analysis and functional evaluation of PKA activity confirmed the pathogenic role of this alteration. A novel deletion upstream of the PRKAR1A gene was proved to be the cause of CNC. Our study underlines the need for WGS in molecular genetic testing of patients with monogenic disorders where conventional genetic analysis fails.
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Affiliation(s)
- Sára Pálla
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Judit Tőke
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
- ENDO-ERN HCP Semmelweis University, Budapest, Hungary
| | - Anikó Bozsik
- Department of Molecular Genetics, National Institute of Oncology, Ráth György U. 7-9, 1122, Budapest, Hungary
- Hereditary Cancers Research Group, Eötvös Loránd Research Network, Semmelweis University, Budapest, Hungary
- National Tumorbiology Laboratory, Budapest, Hungary
| | - Henriett Butz
- Department of Molecular Genetics, National Institute of Oncology, Ráth György U. 7-9, 1122, Budapest, Hungary
- Hereditary Cancers Research Group, Eötvös Loránd Research Network, Semmelweis University, Budapest, Hungary
- National Tumorbiology Laboratory, Budapest, Hungary
| | - János Papp
- Department of Molecular Genetics, National Institute of Oncology, Ráth György U. 7-9, 1122, Budapest, Hungary
- Hereditary Cancers Research Group, Eötvös Loránd Research Network, Semmelweis University, Budapest, Hungary
| | - István Likó
- Hereditary Cancers Research Group, Eötvös Loránd Research Network, Semmelweis University, Budapest, Hungary
| | - Enikő Kuroli
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - András Bánvölgyi
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Mátyás Hamar
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Jerome Bertherat
- Université Paris Cité, Institut Cochin, Inserm U1016, Paris, France
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Márta Medvecz
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
- ERN-Skin Semmelweis University, Budapest, Hungary
| | - Attila Patócs
- ENDO-ERN HCP Semmelweis University, Budapest, Hungary.
- Department of Molecular Genetics, National Institute of Oncology, Ráth György U. 7-9, 1122, Budapest, Hungary.
- Hereditary Cancers Research Group, Eötvös Loránd Research Network, Semmelweis University, Budapest, Hungary.
- National Tumorbiology Laboratory, Budapest, Hungary.
- National Institute of Oncology, Oncology Biobank Center, Budapest, Hungary.
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary.
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Tóth V, Diakoumakou SC, Kuroli E, Tóth B, Kuzmanovszki D, Szakonyi J, Lőrincz KK, Somlai B, Kárpáti S, Holló P. Cutaneous malignancies in patients with Parkinson's disease at a dermato-oncological university centre in Hungary. Front Oncol 2023; 13:1142170. [PMID: 37274278 PMCID: PMC10235680 DOI: 10.3389/fonc.2023.1142170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/03/2023] [Indexed: 06/06/2023] Open
Abstract
Background The possible correlation between melanoma and Parkinson's disease (PD) has been intensively studied. In this work, we aimed to assess the coincidence of skin malignancies and PD at a dermato-oncological university centre in Central-Eastern Europe, Hungary. Methods From 2004 to 2017, a retrospective analysis of the centre's database was performed based on International Statistical Classification of Diseases-10 codes. Results Out of the patients who visited the clinic during the study period, 20,658 were treated for malignant skin tumours. Over the 14 years, 205 dermatological patients had PD simultaneously, 111 (54%) of whom had at least one type of skin malignancy: melanoma (n=22), basal cell carcinoma (BCC) (n=82), or squamous cell carcinoma (SCC) (n=36) (in some patients, multiple skin tumours were identified). Compared to the age- and sex-matched control group, patients with PD had a significantly lower risk for basal cell carcinoma (OR, 0.65; 95% CI, 0.47-0.89, p=0.0076) and for all skin tumours (OR, 0.74; 95% CI, 0.56-0.98, p=0.0392) but not for melanoma. Conclusions We found a decreased risk of all skin tumours and basal cell carcinoma and an unchanged risk of melanoma among patients with PD. However, it should be kept in mind that some large-scale meta-analyses suggest a higher incidence of melanoma after a diagnosis of PD, indicating the importance of skin examination in this vulnerable population.
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Affiliation(s)
- Veronika Tóth
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | | | - Enikő Kuroli
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Béla Tóth
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Daniella Kuzmanovszki
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - József Szakonyi
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Kende Kálmán Lőrincz
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Beáta Somlai
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Sarolta Kárpáti
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Péter Holló
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
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Bánvölgyi A, Avci P, Kiss N, Meznerics FA, Jobbágy A, Fésűs L, Hársing J, Kuroli E, Szepesi Á, Marschalkó M. Scrofuloderma and granuloma annulare-like lesions: Challenges of diagnosing cutaneous tuberculosis in developed countries. J Clin Tuberc Other Mycobact Dis 2023; 31:100370. [PMID: 37122612 PMCID: PMC10130622 DOI: 10.1016/j.jctube.2023.100370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Tuberculosis remains a global health concern, as the increasing levels of urban poverty, higher number of immunodeficient patients and the development of drug resistance threaten the overall efforts made to induce a downward trend for the disease. Scrofuloderma, also known as tuberculosis cutis colliquativa is a subtype of cutaneous tuberculosis. Here we detail a case of a 70-year-old female patient presented with unilateral, left-sided, multiple palpable, painful, ulcerated and purulent cervical nodules, accompanied by persistent generalized erythematous popular granuloma annulare-like skin lesions on the upper extremities. Based on the result of the PCR assay, culture, imaging and histopathological findings, the diagnosis of scrofuloderma was established. To achieve prompt diagnosis and early treatment, it is crucial to include scrofuloderma in the differential diagnosis of ulcerated lesions in developed countries as well, and also be aware of the additional clinical symptoms, such as granuloma annulare-like lesions, possibly accompanying cutaneous tuberculosis.
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Affiliation(s)
- András Bánvölgyi
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
- Corresponding author at: Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, 41 Mária utca, Budapest H-1085, Hungary.
| | - Pinar Avci
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
| | - Norbert Kiss
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
| | - Fanni Adél Meznerics
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
| | - Antal Jobbágy
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
| | - Luca Fésűs
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
| | - Judit Hársing
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
| | - Enikő Kuroli
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
- First Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Ágota Szepesi
- First Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Márta Marschalkó
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
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Király Z, Kovács A, Medvecz M, Róbert L, Bokor L, Kuroli E, Szepesi Á, Marschalkó M, Hidvégi B. [Characteristics of the course of lupus erythematosus panniculitis in a retrospective analysis of 17 patients]. Orv Hetil 2023; 164:172-178. [PMID: 36739549 DOI: 10.1556/650.2023.32692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/27/2022] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Lupus erythematous panniculitis (LEP) is a rare type of chronic cutaneous lupus erythematous. Clinical characteristics are tender, subcutaneous nodules, erythematous plaques. Disfigurement of face and body might develop which affects the patient's quality of life. LEP can be the first sign of systemic lupus erythematous (SLE). OBJECTIVE Our aim was to review the clinicopathological characteristics and the course of LEP through our own patients. METHODS We retrospectively analyzed the clinical records of 17 LEP patients at Semmelweis University's Department of Dermatology, Venerology and Dermatooncology between 2000 and 2022. RESULTS The male : female ratio was 1 : 16, average age was 37.8 years. Lesion localisations were proximal lower (8/17) and upper extremities (7/17), face (4/17), breast (3/17), chest (2/17), buttocks (2/17), back (1/17) and distal lower extremity (1/17). Lesion morphologies were nodules (11/17), plaques (7/17), lipoatrophy (4/17), ulceration (3/17), calcification (1/17). Discoid changes covered in 6 cases. In 10 cases, systemic symptoms were observed (arthritis (4/17), haematological (5/17), renal (2/17), anti-phospholipid syndrome (2/17). 7 patients fulfilled the EULAR/ACR criteria for SLE. Histology showed mixed type panniculitis in 8, lobular in 3 cases. Average time until diagnosis was 24.3 months. Among all our SLE patients, skin symptoms regressed following systemic immunosuppressive treatment. LEP patients with only skin manifestation were often resistant for the therapy of cutaneous lupus erythematous. CONCLUSION The diagnosis of LEP often takes months or years. Wider knowledge of LEP would shorten the time to diagnosis, preventing disfigurement and possible damage of internal organs. Based on our observations, LEP without SLE might be treated with early immunosuppression. Orv Hetil. 2023; 164(5): 172-178.
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Affiliation(s)
- Zsófia Király
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest, Mária u. 41., 1085 Magyarország
| | - Anikó Kovács
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest, Mária u. 41., 1085 Magyarország
| | - Márta Medvecz
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest, Mária u. 41., 1085 Magyarország
| | - Lili Róbert
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest, Mária u. 41., 1085 Magyarország
| | - Laura Bokor
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest, Mária u. 41., 1085 Magyarország
| | - Enikő Kuroli
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest, Mária u. 41., 1085 Magyarország.,2 Semmelweis Egyetem, Általános Orvostudományi Kar, Patológiai és Kísérleti Rákkutató Intézet Budapest Magyarország
| | - Ágota Szepesi
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Patológiai és Kísérleti Rákkutató Intézet Budapest Magyarország
| | - Márta Marschalkó
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest, Mária u. 41., 1085 Magyarország
| | - Bernadett Hidvégi
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest, Mária u. 41., 1085 Magyarország
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Király Z, Szepesi Á, Sebestyén A, Kuroli E, Rencz F, Tóth B, Bokor L, Szakonyi J, Medvecz M, Hidvégi B. Immunohistochemical Study of the PD-1/PD-L1 Pathway in Cutaneous Lupus Erythematosus. Pathol Oncol Res 2022; 28:1610521. [PMID: 35979531 PMCID: PMC9377145 DOI: 10.3389/pore.2022.1610521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/10/2022] [Indexed: 11/19/2022]
Abstract
The pathomechanism of various autoimmune diseases is known to be associated with the altered function of programmed cell death 1/programmed cell death ligand 1 (PD-1/PD-L1) axis. We aimed to investigate the role of this pathway and inflammatory cell markers in subtypes of cutaneous lupus erythematosus (CLE): discoid lupus erythematosus (DLE), subacute CLE (SCLE) and toxic epidermal necrolysis (TEN)-like lupus, a hyperacute form of acute CLE (ACLE). Ten skin biopsy samples from 9 patients were analyzed with immunohistochemistry regarding the following markers: CD3, CD4, CD8, Granzyme B, CD123, CD163, PD-1, PD-L1. Our group consisted of 4 SCLE (2 idiopathic (I-SCLE) and 2 PD-1 inhibitor-induced (DI-SCLE)), 4 DLE and 1 TEN-like lupus cases. From the latter patient two consecutive biopsies were obtained 1 week apart. Marker expression patterns were compared through descriptive analysis. Higher median keratinocyte (KC) PD-L1 expression was observed in the SCLE group compared to the DLE group (65% and 5%, respectively). Medians of dermal CD4, Granzyme B (GB), PD-1 positive cell numbers and GB+/CD8+ ratio were higher in the DLE group than in the SCLE group. The I-SCLE and DI-SCLE cases showed many similarities, however KC PD-L1 expression and dermal GB positive cell number was higher in the former. The consecutive samples of the TEN-like lupus patient showed an increase by time within the number of infiltrating GB+ cytotoxic T-cells and KC PD-L1 expression (from 22 to 43 and 30%–70%, respectively). Alterations of the PD-1/PD-L1 axis seems to play a role in the pathogenesis of CLE.
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Affiliation(s)
- Zsófia Király
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
- *Correspondence: Zsófia Király,
| | - Ágota Szepesi
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Anna Sebestyén
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Enikő Kuroli
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Béla Tóth
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Laura Bokor
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - József Szakonyi
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Márta Medvecz
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Bernadett Hidvégi
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
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Bozsányi S, Varga NN, Farkas K, Bánvölgyi A, Lőrincz K, Lihacova I, Lihachev A, Plorina EV, Bartha Á, Jobbágy A, Kuroli E, Paragh G, Holló P, Medvecz M, Kiss N, Wikonkál NM. Multispectral Imaging Algorithm Predicts Breslow Thickness of Melanoma. J Clin Med 2021; 11:jcm11010189. [PMID: 35011930 PMCID: PMC8745435 DOI: 10.3390/jcm11010189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 12/21/2021] [Accepted: 12/26/2021] [Indexed: 12/20/2022] Open
Abstract
Breslow thickness is a major prognostic factor for melanoma. It is based on histopathological evaluation, and thus it is not available to aid clinical decision making at the time of the initial melanoma diagnosis. In this work, we assessed the efficacy of multispectral imaging (MSI) to predict Breslow thickness and developed a classification algorithm to determine optimal safety margins of the melanoma excision. First, we excluded nevi from the analysis with a novel quantitative parameter. Parameter s’ could differentiate nevi from melanomas with a sensitivity of 89.60% and specificity of 88.11%. Following this step, we have categorized melanomas into three different subgroups based on Breslow thickness (≤1 mm, 1–2 mm and >2 mm) with a sensitivity of 78.00% and specificity of 89.00% and a substantial agreement (κ = 0.67; 95% CI, 0.58–0.76). We compared our results to the performance of dermatologists and dermatology residents who assessed dermoscopic and clinical images of these melanomas, and reached a sensitivity of 60.38% and specificity of 80.86% with a moderate agreement (κ = 0.41; 95% CI, 0.39–0.43). Based on our findings, this novel method may help predict the appropriate safety margins for curative melanoma excision.
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Affiliation(s)
- Szabolcs Bozsányi
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (N.N.V.); (K.F.); (A.B.); (K.L.); (A.J.); (E.K.); (P.H.); (M.M.); (N.K.)
- Selye János Doctoral College for Advanced Studies, Clinical Sciences Research Group, 1085 Budapest, Hungary
| | - Noémi Nóra Varga
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (N.N.V.); (K.F.); (A.B.); (K.L.); (A.J.); (E.K.); (P.H.); (M.M.); (N.K.)
| | - Klára Farkas
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (N.N.V.); (K.F.); (A.B.); (K.L.); (A.J.); (E.K.); (P.H.); (M.M.); (N.K.)
| | - András Bánvölgyi
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (N.N.V.); (K.F.); (A.B.); (K.L.); (A.J.); (E.K.); (P.H.); (M.M.); (N.K.)
| | - Kende Lőrincz
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (N.N.V.); (K.F.); (A.B.); (K.L.); (A.J.); (E.K.); (P.H.); (M.M.); (N.K.)
| | - Ilze Lihacova
- Biophotonics Laboratory, Institute of Atomic Physics and Spectroscopy, University of Latvia, 1004 Riga, Latvia; (I.L.); (A.L.); (E.V.P.)
| | - Alexey Lihachev
- Biophotonics Laboratory, Institute of Atomic Physics and Spectroscopy, University of Latvia, 1004 Riga, Latvia; (I.L.); (A.L.); (E.V.P.)
| | - Emilija Vija Plorina
- Biophotonics Laboratory, Institute of Atomic Physics and Spectroscopy, University of Latvia, 1004 Riga, Latvia; (I.L.); (A.L.); (E.V.P.)
| | - Áron Bartha
- Department of Bioinformatics, Semmelweis University, 1085 Budapest, Hungary;
- 2nd Department of Pediatrics, Semmelweis University, 1085 Budapest, Hungary
| | - Antal Jobbágy
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (N.N.V.); (K.F.); (A.B.); (K.L.); (A.J.); (E.K.); (P.H.); (M.M.); (N.K.)
| | - Enikő Kuroli
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (N.N.V.); (K.F.); (A.B.); (K.L.); (A.J.); (E.K.); (P.H.); (M.M.); (N.K.)
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, 1085 Budapest, Hungary
| | - György Paragh
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA;
- Department of Cell Stress Biology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
| | - Péter Holló
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (N.N.V.); (K.F.); (A.B.); (K.L.); (A.J.); (E.K.); (P.H.); (M.M.); (N.K.)
| | - Márta Medvecz
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (N.N.V.); (K.F.); (A.B.); (K.L.); (A.J.); (E.K.); (P.H.); (M.M.); (N.K.)
| | - Norbert Kiss
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (N.N.V.); (K.F.); (A.B.); (K.L.); (A.J.); (E.K.); (P.H.); (M.M.); (N.K.)
| | - Norbert M. Wikonkál
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (N.N.V.); (K.F.); (A.B.); (K.L.); (A.J.); (E.K.); (P.H.); (M.M.); (N.K.)
- Correspondence:
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11
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Haász C, Kuroli E, Anker P, Márton DF, Szigeti Á, Nagy Z, Demeter J, Sárdy M, Medvecz M. Case report of amyloid light-chain amyloidosis with periocular cutaneous involvement. Orv Hetil 2021; 162:1303-1308. [PMID: 34370685 DOI: 10.1556/650.2021.32137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 01/29/2021] [Indexed: 11/19/2022]
Abstract
Összefoglaló. A könnyűlánc-amyloidosis ritka, multidiszciplináris jelentőségű kórkép, melynek hátterében az esetek döntő hányadában egy amyloidogen fehérje, a csontvelő kóros plazmasejtjeiben termelődő monoklonálisimmunglobulin-molekula lambda típusú könnyűláncának felszaporodása áll. A klinikai tünetek az érintett szervek függvényében igen változatosak és gyakran nem specifikusak, ezért a betegség sok esetben későn kerül felismerésre. A diagnózis felállításának alapfeltétele a szövettani vizsgálat elvégzése és a kóros fehérjelánc kimutatása. A betegség jellegzetes alarmírozó bőrtüneteinek helyes értékelése fontos szereppel bír a korai diagnózisalkotásban. A jelen közlemény egy myeloma multiplexhez társult könnyűlánc-amyloidosis esetét mutatja be. A betegnél a pathognomicus, típusos bőrgyógyászati tünetek (periorbitalis, axillaris és inguinalis lokalizációjú petechiák, purpurák, ecchymosisok, suffusiók és viaszsárga papulák) mellett szív- és veseérintettség is igazolódott. Az alkalmazott ciklofoszfamid-, bortezomib- és dexametazonkezelési séma hatására a csontvelőben komplett morfológiai remisszió következett be, a beteg a jelenleg legjobb túlélést biztosító autológőssejt-transzplantáció előtt áll. Orv Hetil. 2021; 162(32): 1303-1308. Summary. Amyloid light-chain amyloidosis is a rare disease with diverse signs and symptoms according to the affected organs. The signs are often aspecific which can lead to delayed diagnosis. Considering the characteristic cutaneous manifestations of the disease, dermatologists have an important role in early identification. Additionally, histopathological examination is required for diagnosis. Here we present a rare case of light-chain amyloidosis in association with multiple myeloma. The patient presented with characteristic periocular, axillar and inguinal petechiae, purpurae, ecchymoses, suffusions, yellowish-brown waxy papules and plaques besides cardiovascular and renal involvement. In this case, the amyloidogenic proteins are the lambda-chains of monoclonal immunoglobulins secreted by the clonally expanded plasma cells of the bone marrow. The applied cyclophosphamide, bortezomib and dexamethason treatment induced complete morphological remission in the bone marrow and the patient currently awaits autologous stem cell transplantation which yields the longest possible survival. Orv Hetil. 2021; 162(32): 1303-1308.
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Affiliation(s)
- Csilla Haász
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Bőr-, Nemikórtani és Bőronkológiai Klinika, Budapest, Mária u. 41., 1085
| | - Enikő Kuroli
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Bőr-, Nemikórtani és Bőronkológiai Klinika, Budapest, Mária u. 41., 1085.,2 Semmelweis Egyetem, Általános Orvostudományi Kar, I. Patológiai és Kísérleti Rákkutató Intézet, Budapest
| | - Pálma Anker
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Bőr-, Nemikórtani és Bőronkológiai Klinika, Budapest, Mária u. 41., 1085
| | - Dalma Fanni Márton
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Bőr-, Nemikórtani és Bőronkológiai Klinika, Budapest, Mária u. 41., 1085
| | - Ágnes Szigeti
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Bőr-, Nemikórtani és Bőronkológiai Klinika, Budapest, Mária u. 41., 1085
| | - Zsolt Nagy
- 3 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Onkológiai Klinika, Budapest
| | - Judit Demeter
- 3 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Onkológiai Klinika, Budapest
| | - Miklós Sárdy
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Bőr-, Nemikórtani és Bőronkológiai Klinika, Budapest, Mária u. 41., 1085
| | - Márta Medvecz
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Bőr-, Nemikórtani és Bőronkológiai Klinika, Budapest, Mária u. 41., 1085
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Abstract
Background: Calcinosis cutis is a rare condition associated with different diseases, which is difficult to manage. Aims and Objectives: In this retrospective study, the epidemiology of calcinosis cutis and the effectiveness of various treatment regimens in its management were assessed in a single center. Materials and Methods: The data of 34 patients suffering from calcinosis cutis (male:female = 12:22; mean age = 48.6 ± 18.6 years) treated at our department between 2003 and 2016 were analyzed retrospectively. Results: Dystrophic, idiopathic, metastatic subtype, and calciphylaxis occurred in 70.6%, 11.8%, 5.9%, and 11.8% of the cases, respectively. Underlying diseases of dystrophic calcinosis included autoimmune connective tissue disease, skin trauma, cutaneous neoplasm, and inherited disorder in 58.3%, 20.8%, 12.5%, and 8.3% of the cases, respectively. Extremities were most frequently affected (n = 18). In the management, diltiazem was most frequently used in monotherapy with partial response in five of eight cases. Other drugs in monotherapy or in combination were administered in single cases. Surgical treatment resulted in least partial response in all of the cases followed (n = 7). Conclusion: Dystrophic was the most common subtype and autoimmune connective tissue disease was the most frequent underlying disease. We conclude that lower doses of diltiazem have only partial efficiency, and surgical therapy is at least partially effective in localized calcinosis.
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Affiliation(s)
- Lili Róbert
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Norbert Kiss
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Márta Medvecz
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Enikő Kuroli
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Miklós Sárdy
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Bernadett Hidvégi
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
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13
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Medvecz M, Kiss N, Hársing J, Kuroli E, Hegede G, Csomor J, Kárpáti S, Marschalkó M. Lymphomatoid Papulosis Type B in a Patient with Crohn's Disease Treated with TNF-Alpha Inhibitors Infliximab and Adalimumab. Acta Dermatovenerol Croat 2019; 27:202-204. [PMID: 31542070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Dear Editor, Lymphomatoid papulosis (LP) is a chronic, recurrent, usually self-limited papulonecrotic or papulonodular skin disease, which belongs to the group of primary cutaneous CD30+ lymphoproliferative disorders (1). Three main histological subtypes of LP have been recognized: type A (histiocytic), type B (mycosis fungoides-like), and type C (anaplastic large cell lymphoma-like). Recently, new histologic LP variants classified as type D (CD8-positive, cytotoxic form) and type E (angioinvasive form) have also been described. The etiology of LP has not been determined to date (2-4). Herein we report a case of LP type B evolving in a patient with Crohn's disease after treatment with infliximab and adalimumab. A 38-year-old man suffering from terminal ileitis form of luminar Crohn's disease for 10 years presented at our department. During the last 10 years, the patient had been treated with a number of conventional disease-modifying anti-inflammatory drugs including non-steroid anti-inflammatory drugs, mesalazine, and immunomodulatory agents such as corticosteroids and azathioprine. As the disease was not sufficiently controlled, TNF-α inhibitor therapy was initiated. Infliximab was administered in standard dosage (5 mg/kg body weight every 8 weeks after the induction period) for one year. Concomitant therapy with azathioprine was established to reduce the risk of adverse immunological reactions. Since the patient showed only partial clinical response, infliximab was switched to adalimumab (40 mg biweekly), resulting in notable improvement. 18 months after the initiation of adalimumab treatment, asymptomatic, small, red to brown papules developed on the extremities. Multiple lesions were observed, initially on the legs, but the symptoms rapidly progressed to the arms and trunk (Figure 1). An acquired ichthyosis further complicated the disease course by extended, extremely xerotic, scaling skin lesions. Neither systemic symptoms nor significant lymphadenopathy was observed. The clinical picture suggested either ichthyosiform mycosis fungoides or a coincidence of LP and acquired ichthyosis. The histology of a typical papule showed perivascular and periadnexal lymphoid infiltration with massive hemorrhage in the dermis. The infiltration was dense, composed of small-to-medium-sized lymphoid cells showing focal significant epidermotropism (Figure 2). Most observed epidermal lymphocytes were CD3+, CD4+, and CD30+, while the dermal infiltration had higher CD4 and lower CD30 expression (10-15%). Polymerase chain reaction (PCR) analysis of skin and peripheral blood samples did not show clonal rearrangement of T-cell receptor gamma (TcRgamma) genes. Normal phenotypes of lymphocyte subsets were detected by flow cytometry of peripheral blood. Ichthyosiform mycosis fungoides was excluded since histology of ichthyosiform skin lesions showed only hyperkeratosis with a reduced granular layer. While the cutaneous CD4+ epidermotropic infiltrate was suspicious of either mycosis fungoides or LP type B, the complexity of clinicopathological data confirmed the diagnosis of LP type B. The peripheral blood counts, serum biochemical tests, and urinalysis were within normal range, while the elevated serum anti-Saccharomyces cerevisiae antibodies (ASCA) of IgG and IgA subclasses indicated the activity of Crohn's disease. Adalimumab and azathioprine were discontinued, and oral budesonide therapy was started in combination with topical corticosteroids and PUVA phototherapy. The skin lesions resolved with hyperpigmentation, and there was no relapse during the twelve-month follow-up. Recent data suggest that LP occurs more commonly in immunocompromised patients, especially in those with solid organ or bone marrow transplants (3). Though TNF-α inhibitors have dramatically advanced the treatment of various diseases, the risk of lymphoma associated with their use remains controversial (5). Several cases of cutaneous lymphoproliferative disorders associated with TNF-α inhibitor treatment have been reported, including two patients with LP (6). One of the two patients with LP received infliximab for Crohn's disease (7), while the other one had juvenile rheumatoid arthritis and received adalimumab (8). Our case is the third report on LP developing under TNF-α inhibitor therapy and the first LP type B in a patient with Crohn's disease treated with infliximab and later with adalimumab. A further interesting aspect of our case is that it also represents an example of the known association of acquired ichthyosis with inflammatory bowel disease (9). Multidisciplinary management was needed to provide optimal care and disease outcome for our patient. Since it is usually difficult to prove causality in most of such cases, it is important to collect similar clinical observations. Acknowledgments: The authors are grateful to Dr. László Bene, Dr. József Szakonyi, and Dr. Fruzsina Kovács for additional medical care of the patient and to Tamás Szaák for the clinical photos. The authors thank Prof. Miklós Sárdy for his critical review of the paper.
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Affiliation(s)
- Márta Medvecz
- Márta Medvecz, MD, PhD, Department of Dermatology, Venerology and Dermatooncology, Semmelweis University, Mária utca 41, 1085 Budapest, Hungary;
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14
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Kiss N, Haluszka D, Lőrincz K, Kuroli E, Hársing J, Mayer B, Kárpáti S, Fekete G, Szipőcs R, Wikonkál N, Medvecz M. Ex vivo nonlinear microscopy imaging of Ehlers-Danlos syndrome-affected skin. Arch Dermatol Res 2018; 310:463-473. [PMID: 29725758 DOI: 10.1007/s00403-018-1835-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 04/19/2018] [Accepted: 04/25/2018] [Indexed: 10/17/2022]
Abstract
Ehlers-Danlos syndrome (EDS) is the name for a heterogenous group of rare genetic connective tissue disorders with an overall incidence of 1 in 5000. The histological characteristics of EDS have been previously described in detail in the late 1970s and early 1980s. Since that time, the classification of EDS has undergone significant changes, yet the description of the histological features of collagen morphology in different EDS subtypes has endured the test of time. Nonlinear microscopy techniques can be utilized for non-invasive in vivo label-free imaging of the skin. Among these techniques, two-photon absorption fluorescence (TPF) microscopy can visualize endogenous fluorophores, such as elastin, while the morphology of collagen fibers can be assessed by second-harmonic generation (SHG) microscopy. In our present work, we performed TPF and SHG microscopy imaging on ex vivo skin samples of one patient with classical EDS and two patients with vascular EDS and two healthy controls. We detected irregular, loosely dispersed collagen fibers in a non-parallel arrangement in the dermis of the EDS patients, while as expected, there was no noticeable impairment in the elastin content. Based on further studies on a larger number of patients, in vivo nonlinear microscopic imaging could be utilized for the assessment of the skin status of EDS patients in the future.
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Affiliation(s)
- Norbert Kiss
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 41 Mária Street, Budapest, 1085, Hungary.,Institute for Solid State Physics and Optics, Wigner RCP, Budapest, Hungary
| | - Dóra Haluszka
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 41 Mária Street, Budapest, 1085, Hungary.,Institute for Solid State Physics and Optics, Wigner RCP, Budapest, Hungary
| | - Kende Lőrincz
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 41 Mária Street, Budapest, 1085, Hungary
| | - Enikő Kuroli
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 41 Mária Street, Budapest, 1085, Hungary
| | - Judit Hársing
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 41 Mária Street, Budapest, 1085, Hungary
| | - Balázs Mayer
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 41 Mária Street, Budapest, 1085, Hungary
| | - Sarolta Kárpáti
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 41 Mária Street, Budapest, 1085, Hungary
| | - György Fekete
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Róbert Szipőcs
- Institute for Solid State Physics and Optics, Wigner RCP, Budapest, Hungary.,R&D Ultrafast Lasers Ltd, P.O. Box 622, Budapest, 1539, Hungary
| | - Norbert Wikonkál
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 41 Mária Street, Budapest, 1085, Hungary
| | - Márta Medvecz
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 41 Mária Street, Budapest, 1085, Hungary.
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15
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Nemeth K, Gorog A, Mezey E, Pinter D, Kuroli E, Harsing J, Kovacs L, Fischer M, Rady P, Sillo P, Tyring S, Karpati S. Cover Image: Detection of hair follicle-associated Merkel cell polyomavirus in an immunocompromised host with follicular spicules and alopecia. Br J Dermatol 2017; 175:1409. [PMID: 27996135 DOI: 10.1111/bjd.15039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- K Nemeth
- Department of Dermatology, Semmelweis University, Budapest, Hungary.,Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, U.S.A
| | - A Gorog
- Department of Dermatology, Semmelweis University, Budapest, Hungary
| | - E Mezey
- Adult Stem Cell Section, NIDCR, CSDB, National Institutes of Health, Bethesda, MD, U.S.A
| | - D Pinter
- Department of Dermatology, Semmelweis University, Budapest, Hungary
| | - E Kuroli
- Department of Dermatology, Semmelweis University, Budapest, Hungary
| | - J Harsing
- Department of Dermatology, Semmelweis University, Budapest, Hungary
| | - L Kovacs
- First Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - M Fischer
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, MD, U.S.A
| | - P Rady
- Department of Dermatology, University of Texas Medical School of Houston, TX, U.S.A
| | - P Sillo
- Department of Dermatology, Semmelweis University, Budapest, Hungary
| | - S Tyring
- Department of Dermatology, University of Texas Medical School of Houston, TX, U.S.A
| | - S Karpati
- Department of Dermatology, Semmelweis University, Budapest, Hungary
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16
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Haluszka D, Lőrincz K, Kiss N, Szipőcs R, Kuroli E, Gyöngyösi N, Wikonkál NM. Diet-induced obesity skin changes monitored by in vivo SHG and ex vivo CARS microscopy. Biomed Opt Express 2016; 7:4480-4489. [PMID: 27895989 PMCID: PMC5119589 DOI: 10.1364/boe.7.004480] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 09/26/2016] [Accepted: 09/26/2016] [Indexed: 05/21/2023]
Abstract
Obesity related metabolic syndrome and type 2 diabetes have severe consequences on our skin. Latest developments in nonlinear microscopy allow the use of noninvasive, label free imaging methods, such as second harmonic generation (SHG) and coherent anti-Stokes Raman scattering (CARS), for early diagnosis of metabolic syndrome-related skin complications by 3D imaging of the skin and the connective tissue. Our aim was to study effects of various types of diet-induced obesity in mice using these methods. We examined mice on different diets for 32 weeks. The collagen morphology was evaluated four times in vivo by SHG microscopy, and adipocytes were examined once at the end of experiment by ex vivo CARS method. A strong correlation was found between the body weight and the adipocyte size, while we found that the SHG intensity of dermal collagen reduces considerably with increasing body weight. Obese mice on high-fat diet showed worse results than those on high-fat - high-fructose diet. Animals on high-fructose diet did not gain more weight than those on ordinary diet despite of the increased calorie intake, but their collagen damage was nonetheless significant. Obesity and high sugar intake damages the skin, mainly the dermal connective tissue and subcutaneous adipose tissue, which efficiently can be monitored by in vivo SHG and ex vivo CARS microscopy.
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Affiliation(s)
- Dóra Haluszka
- Semmelweis University, Department of Dermatology, Venereology and Dermatooncology, Budapest, Hungary
- Institute for Solid State Physics and Optics of Wigner RCP, Budapest, Hungary
| | - Kende Lőrincz
- Semmelweis University, Department of Dermatology, Venereology and Dermatooncology, Budapest, Hungary
| | - Norbert Kiss
- Semmelweis University, Department of Dermatology, Venereology and Dermatooncology, Budapest, Hungary
- Institute for Solid State Physics and Optics of Wigner RCP, Budapest, Hungary
| | - Róbert Szipőcs
- Institute for Solid State Physics and Optics of Wigner RCP, Budapest, Hungary
- R&D Ultrafast Lasers Ltd, Budapest, Hungary
| | - Enikő Kuroli
- Semmelweis University, Department of Dermatology, Venereology and Dermatooncology, Budapest, Hungary
| | - Nóra Gyöngyösi
- Semmelweis University, Department of Dermatology, Venereology and Dermatooncology, Budapest, Hungary
| | - Norbert M. Wikonkál
- Semmelweis University, Department of Dermatology, Venereology and Dermatooncology, Budapest, Hungary
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17
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Marschalkó M, Gyöngyösi N, Noll J, Károlyi Z, Wikonkál N, Hársing J, Kuroli E, Csomor J, Matolcsy A, Sarolta K, Szepesi Á. Histopathological aspects and differential diagnosis of CD8 positive lymphomatoid papulosis. J Cutan Pathol 2016; 43:963-973. [DOI: 10.1111/cup.12779] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 07/07/2016] [Accepted: 07/22/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Márta Marschalkó
- Department of Dermatology Venereology and Dermatooncology; Semmelweis University; Budapest Hungary
| | - Nóra Gyöngyösi
- Department of Dermatology Venereology and Dermatooncology; Semmelweis University; Budapest Hungary
| | - Judit Noll
- Department of Dermatology; Heim Pál Childrens Hospital; Budapest Hungary
| | | | - Norbert Wikonkál
- Department of Dermatology Venereology and Dermatooncology; Semmelweis University; Budapest Hungary
| | - Judit Hársing
- Department of Dermatology Venereology and Dermatooncology; Semmelweis University; Budapest Hungary
| | - Enikő Kuroli
- Department of Dermatology Venereology and Dermatooncology; Semmelweis University; Budapest Hungary
| | - Judit Csomor
- 1st Department of Pathology and Experimental Cancer Research Institute; Semmelweis University; Budapest Hungary
| | - András Matolcsy
- 1st Department of Pathology and Experimental Cancer Research Institute; Semmelweis University; Budapest Hungary
| | - Kárpáti Sarolta
- Department of Dermatology Venereology and Dermatooncology; Semmelweis University; Budapest Hungary
| | - Ágota Szepesi
- 1st Department of Pathology and Experimental Cancer Research Institute; Semmelweis University; Budapest Hungary
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18
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Nemeth K, Gorog A, Mezey E, Harsing J, Kuroli E, Rady P, Fischer M, Kovacs L, Sillo P, Tyring S, Karpati S. LB807 Detection of hair follicle-associated Merkel Cell Polyomavirus in an immunocompromised host with follicular spicules and alopecia and successful treatment with valganciclovir. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.05.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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