1
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Kessler AJ, Para A, Niedt GW, Klein P. Anti-transcriptional intermediary factor-1γ antibody-positive dermatomyositis in a patient with triple-negative breast cancer treated with adjuvant capecitabine. JAAD Case Rep 2023; 35:122-125. [PMID: 37188285 PMCID: PMC10176165 DOI: 10.1016/j.jdcr.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Affiliation(s)
- Alaina J. Kessler
- Division of Hematology and Medical Oncology, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- Correspondence to: Alaina J. Kessler, MD, MPH, 1 Gustave L. Levy Place, New York, NY 10029. @alainajkessler
| | - Andrew Para
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - George W. Niedt
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Paula Klein
- Division of Hematology and Medical Oncology, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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2
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Johnson JM, Takebe Y, Zhang G, Ober R, McLuckie A, Niedt GW, Johnson LL. Blocking RAGE improves wound healing in diabetic pigs. Int Wound J 2023; 20:678-686. [PMID: 35945908 PMCID: PMC9927915 DOI: 10.1111/iwj.13909] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/16/2022] [Indexed: 11/29/2022] Open
Abstract
Receptor for Advanced Glycated End-products (RAGE) is highly expressed in diabetes and impairs wound healing. We proposed that administering an antibody that blocks RAGE will hasten the healing of dorsal wounds in diabetic pigs compared with a non-immune IgG. Two purpose-bred diabetic (D) Yucatan minipigs (Sinclair, Auxvasse MO) each underwent 12 2 × 2 cm full thickness dorsal wounds: four wounds received decellularized porcine skin patches (Xylyx Bio, Bklyn NY): four anti-RAGE Ab (CR-3) infused patches, four saline infused patches and four wounds were left open. One pig received anti-RAGE Ab (CR-3) 1 mg/kg IM q 10 days and other received non-immune IgG. Wounds were measured at 2 and 4 weeks followed by euthanasia and wound harvesting. At 2 weeks few of the patches appeared to be incorporated into the wound. By 4 weeks all patches in pigs treated systemically with CR-3 were detached and the wounds almost healed. For all 24 wounds for both pigs regardless of presence of patch or type of patch, the average IgG treated pig wound size at 4 weeks was 69.2 ± 14.6% of initial size and the average CR-3 treated pig wound size was 40.9 ± 11.3% of initial size (P = 0.0002). Quantitative immunohistology showed greater staining for collagen in the CR-3 treated wounds compared with IgG treated. Staining was positive for RAGE, Mac, and IL-6 in the IgG treated wounds and negative in the CR-3 treated wounds. From these pilot experiments, we conclude that a RAGE blocking antibody given parenterally improved wound healing in a diabetic pig while patches were not effective.
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Affiliation(s)
- Jordan M Johnson
- Departments of Medicine, Pathology, and Veterinary MedicineColumbia UniversityNew York CityNYUSA
| | - Yared Takebe
- Departments of Medicine, Pathology, and Veterinary MedicineColumbia UniversityNew York CityNYUSA
| | - Geping Zhang
- Departments of Medicine, Pathology, and Veterinary MedicineColumbia UniversityNew York CityNYUSA
| | - Rebecca Ober
- Departments of Medicine, Pathology, and Veterinary MedicineColumbia UniversityNew York CityNYUSA
| | - Alicia McLuckie
- Departments of Medicine, Pathology, and Veterinary MedicineColumbia UniversityNew York CityNYUSA
| | - George W Niedt
- Departments of Medicine, Pathology, and Veterinary MedicineColumbia UniversityNew York CityNYUSA
| | - Lynne L Johnson
- Departments of Medicine, Pathology, and Veterinary MedicineColumbia UniversityNew York CityNYUSA
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3
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Stonesifer CJ, Yilmaz MM, Niedt GW. Assessment of Clinical Interruptions During the COVID-19 Pandemic on the Diagnosis of Melanoma: A 30-Month Retrospective Review. JAAD Int 2022; 10:25-27. [PMID: 35937549 PMCID: PMC9339103 DOI: 10.1016/j.jdin.2022.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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4
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Scollan ME, Yamashiro DJ, Niedt GW, Garzon MC. Novel CD63-PRKCB fusion in a case of pigmented epithelioid melanocytoma. Pediatr Dermatol 2022; 39:322-323. [PMID: 35028971 DOI: 10.1111/pde.14915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/09/2021] [Accepted: 12/26/2021] [Indexed: 11/28/2022]
Abstract
Pigmented epithelioid melanocytoma (PEM) is an intermediate-grade melanocytic tumor with considerable histologic overlap with other melanocytic neoplasms such as epithelioid blue nevus (EBN), which is associated with the neoplastic syndrome Carney complex (CC). Next-generation sequencing is a valuable tool for identifying the primary drivers of melanocytic neoplasms and differentiating them from one another. While germline variants in the protein kinase cAMP-dependent regulatory type 1 alpha (PRKAR1A) gene have been associated with EBN and CC, fusions in protein kinase C-alpha (PRKCA) have been shown as sporadic drivers of PEM. Herein, we report the diagnosis and workup of a case of pigmented epithelioid melanocytoma with a novel protein kinase C-beta (PRKCB) fusion.
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Affiliation(s)
- Margaret E Scollan
- Columbia University, Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Darrell J Yamashiro
- Department of Pediatrics, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - George W Niedt
- Department of Dermatology, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Maria C Garzon
- Department of Pediatrics, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Department of Dermatology, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York, USA
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5
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Kinariwalla N, London AO, Soliman YS, Niedt GW, Husain S, Gallitano SM. A case of generalized Sweet syndrome with vasculitis triggered by recent COVID-19 vaccination. JAAD Case Rep 2021; 19:64-67. [PMID: 34849386 PMCID: PMC8612751 DOI: 10.1016/j.jdcr.2021.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Neha Kinariwalla
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Ashley O London
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Yssra S Soliman
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - George W Niedt
- Kimberly and Eric J. Waldman Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sameera Husain
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Stephanie M Gallitano
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
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6
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Affiliation(s)
- Connor J. Stonesifer
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Syed A. Husain
- Department of Nephrology, Columbia University Irving Medical Center, New York, New York
| | - George W. Niedt
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Stephanie M. Gallitano
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
- Correspondence to: Stephanie M. Gallitano, MD, Department of Dermatology, Herbert Irving Pavilion, 12th Floor, 161 Fort Washington Avenue, New York, NY 10032.
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7
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Stonesifer CJ, Grimes JM, Garcia-Saleem TJ, Niedt GW, Kadin ME, Geskin LJ. Stenotrophomonas maltophilia-associated primary cutaneous anaplastic large-cell lymphoma. JAAD Case Rep 2021; 16:77-81. [PMID: 34541271 PMCID: PMC8435984 DOI: 10.1016/j.jdcr.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Connor J Stonesifer
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Joseph M Grimes
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | | | - George W Niedt
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Marshall E Kadin
- Department of Pathology and Laboratory Medicine, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island.,Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Larisa J Geskin
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
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8
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Maniar R, Anderson M, Taback B, Khan S, McDonnell D, Saqi A, Niedt GW, Carvajal R. Case of Merkel cell carcinoma in a patient with pre-existing ILD. J Immunother Cancer 2020; 8:jitc-2020-001672. [PMID: 33203666 PMCID: PMC7674100 DOI: 10.1136/jitc-2020-001672] [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] [Accepted: 10/25/2020] [Indexed: 11/17/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare neuroendocrine tumor of the skin with high rates of local recurrence and distant metastases despite treatment with traditional cytotoxic chemotherapies. The recent advances in immunotherapy, including the use of immune checkpoint blockade (ICB) has revolutionized treatment for this disease and resulted in durable responses for some patients. However, many patients, due to underlying conditions, have been insufficiently evaluated for potential use of immunotherapy. Here we present a case of ICB treatment with Programmed cell death protein 1 (PD-1) inhibition in a patient with underlying interstitial lung disease (ILD) and a new diagnosis of MCC. Through a multidisciplinary approach, we were able to maintain close monitoring with serial clinical and radiographical follow-up. The patient achieved a complete response though unrelated medical issues resulting in a treatment hold. At the last follow-up, the patient continued to experience a durable response without evidence of recurrence. This case describes the use of pembrolizumab, a PD-1 inhibitor, for the treatment of MCC in a patient with underlying ILD. The use of active surveillance with a multidisciplinary approach resulted in successful treatment of MCC without exacerbation of the underlying ILD.
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Affiliation(s)
- Rohan Maniar
- Department of Medicine, Division of Hematology/Oncology, Columbia University Irving Medical Center, New York, New York, USA
| | - Michaela Anderson
- Department of Medicine, Division of Pulmonology and Critical Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Bret Taback
- Department of Surgery, Division of Breast Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Shaheer Khan
- Department of Medicine, Division of Hematology/Oncology, Columbia University Irving Medical Center, New York, New York, USA
| | - Diana McDonnell
- Department of Medicine, Division of Hematology/Oncology, Columbia University Irving Medical Center, New York, New York, USA
| | - Anjali Saqi
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - George W Niedt
- Department of Dermatology, Division of Dermatopathology, Columbia University Irving Medical Center, New York, New York, USA
| | - Richard Carvajal
- Department of Medicine, Division of Hematology/Oncology, Columbia University Irving Medical Center, New York, New York, USA
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9
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Strom MA, Trager MH, Timerman D, Coromilas AJ, Burris K, Belsito DV, Eber A, Greenberg S, Husain S, Lewin JM, Naka F, Patrone CC, Coulon A, Cooper C, Bartholomew FB, Beck M, Dowd ML, Ensslin C, Gallitano SM, Loesch E, Malajian DM, Melnick L, Niedt GW, Uwakwe LN, Vu HL, Walther RR, Samie FH, Geskin LJ. Cutaneous findings in hospitalized and critically ill patients with COVID-19: A case series of 15 patients. J Am Acad Dermatol 2020; 84:510-511. [PMID: 33068643 PMCID: PMC7554488 DOI: 10.1016/j.jaad.2020.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/26/2020] [Accepted: 10/06/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Mark A Strom
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Megan H Trager
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Dmitriy Timerman
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Alexandra J Coromilas
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Katy Burris
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Ariel Eber
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Sophie Greenberg
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Sameera Husain
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Jesse M Lewin
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Fludiona Naka
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Christina C Patrone
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Aaron Coulon
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Chelsea Cooper
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | | | - Melissa Beck
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Margaret L Dowd
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Courtney Ensslin
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Stephanie M Gallitano
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Eric Loesch
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Dana M Malajian
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Laura Melnick
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - George W Niedt
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Laura N Uwakwe
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Ha Linh Vu
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Robert R Walther
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Faramarz H Samie
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Larisa J Geskin
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York.
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10
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Queen D, Shen Y, Trager MH, Lopez AT, Samie FH, Lewin JM, Niedt GW, Geskin LJ, Liu L. UV biomarker genes for classification and risk stratification of cutaneous actinic keratoses and squamous cell carcinoma subtypes. FASEB J 2020; 34:13022-13032. [PMID: 32776588 DOI: 10.1096/fj.202001412r] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/04/2020] [Revised: 07/08/2020] [Accepted: 07/27/2020] [Indexed: 11/11/2022]
Abstract
Currently, there is no sensitive molecular test for identifying transformation-prone actinic keratoses (AKs) and aggressive squamous cell carcinoma (SCC) subtypes. Biomarker-based molecular testing represents a promising tool for risk stratifying these lesions. We evaluated the utility of a panel of ultraviolet (UV) radiation-biomarker genes in distinguishing between benign and transformation-prone AKs and SCCs. The expression of the UV-biomarker genes in 31 SCC and normal skin (NS) pairs and 10 AK/NS pairs was quantified using the NanoString nCounter system. Biomarker testing models were built using logistic regression models with leave-one-out cross validation in the training set. The best model to classify AKs versus SCCs (area under curve (AUC) 0.814, precision score 0.833, recall 0.714) was constructed using a top-ranked set of 13 UV-biomarker genes. Another model based on a 15-gene panel was developed to differentiate histologically concerning from less concerning SCCs (AUC 1, precision score 1, recall 0.714). Finally, 12 of the UV-biomarker genes were differentially expressed between AKs and SCCs, while 10 genes were uniquely expressed in the more concerning SCCs. UV-biomarker gene subsets demonstrate dynamic utility as molecular tools to classify and risk stratify AK and SCC lesions, which will complement histopathologic diagnosis to guide treatment of high-risk patients.
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Affiliation(s)
- Dawn Queen
- Department of Medicine, Lankenau Medical Center, Philadelphia, PA, USA
| | - Yao Shen
- Department of Systems Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Megan H Trager
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Adriana T Lopez
- Department of Dermatology, New York University, New York, NY, USA
| | - Faramarz H Samie
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jesse M Lewin
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - George W Niedt
- Department of Pathology, Columbia University Irving Medical Center, New York, NY, USA
| | - Larisa J Geskin
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Liang Liu
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA.,The Hormel Institute, University of Minnesota, Austin, MN, USA
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11
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Abbott-Frey AM, Coromilas AJ, Niedt GW, Lewin JM. Recurrent Squamous Cell Carcinoma Arising Within a Linear Porokeratosis. J Drugs Dermatol 2020; 19:205-206. [PMID: 32155019 DOI: 10.36849/jdd.2020.4640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Here we report a case of linear porokeratosis with recurrent malignant degeneration to squamous cell carcinoma (SCC) recurring six years after excision of initial SCC. A 79-year-old woman presented with a friable tumor located within a longstanding lesion on her posterior thigh. Six years prior, she was diagnosed with SCC arising within the same lesion, which had been surgically excised with negative margins. Physical examination revealed a 3.5 x 2.7 cm friable tumor on the left proximal posterior thigh. The tumor was located within a hyperpigmented and erythematous scaly linear plaque within a line of Blaschko, extending from the left buttock to the left distal posterior thigh. Two 4 mm punch biopsies were performed: one of the erythematous plaque on the left buttock and one from the friable tumor on the left posteromedial thigh. Histology from the left buttock revealed a cornoid lamella consistent with porokeratosis and the left posteromedial thigh revealed SCC. The patient underwent Mohs micrographic surgery with negative margins, followed by a linear repair. Porokeratosis is a disorder of epidermal keratinization that has been associated with malignant degeneration, although such cases are rare. The risk of recurrence of SCC arising within a porokeratosis is unknown. This case emphasizes the importance of ongoing monitoring for malignant degeneration within these lesions.
J Drugs Dermatol. 2020;19(2)205-206. doi:10.36849/JDD.2020.4640
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12
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Stefanko NS, Davies OMT, Beato MJ, Blei F, Drolet BA, Fairley J, Frieden IJ, Galligan ER, Goddard D, Howard R, Husain S, Lauren CT, Lopez-Gutierrez JC, MacArthur C, Metry DW, Morel KD, Niedt GW, Garzon MC, Sokumbi O, Siegel DH. Hamartomas and midline anomalies in association with infantile hemangiomas, PHACE, and LUMBAR syndromes. Pediatr Dermatol 2020; 37:78-85. [PMID: 31631401 DOI: 10.1111/pde.14006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVE The pathogenesis of infantile hemangiomas (IH), PHACE, and LUMBAR syndromes remains unknown. We aim to describe histopathologic features of midline anomalies associated with IH, including patients with PHACE and LUMBAR syndromes. METHODS A multicenter retrospective chart review was performed to identify patients with IH, PHACE, and LUMBAR syndrome with histopathologic specimens from sternal or midline anomalies. A total of 18 midline lesions from 13 patients were included. Out of 18, 14 midline lesions underwent both histopathologic and clinical review. Three hamartoma-like chin plaques and one supraumbilical raphe underwent only clinical review. RESULTS All 13 patients had midline lesions and IH. Histopathologic diagnoses were as follows: rhabdomyomatous mesenchymal hamartoma (3), folliculosebaceous cystic hamartoma (1), fibroepithelial polyp (1), verrucous epidermal hyperplasia with vascular proliferation and fibroplasia (1), congenital midline cervical cleft (1), pericardium with fibrosis (1), fibrous components with increased collagen (1), atrophic skin/membrane (3), angiolipomatous mass with neural components (1), and lipomatous mass (1). Due to the retrospective nature of this study, it was not possible to obtain pathology slides for all midline lesions that had previously been biopsied or resected. We show clinically and histopathologically a new association between PHACE syndrome and rhabdomyomatous mesenchymal hamartoma (RMH), in addition to demonstrating the association between PHACE syndrome and chin hamartomas. We also display histopathologic findings seen in midline lesions resected from LUMBAR patients. CONCLUSION Rhabdomyomatous mesenchymal hamartoma is thought to be related to aberrations of mesenchymal cells during development; therefore, this may provide clues to the pathogenesis of IH and related syndromes.
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Affiliation(s)
| | | | - Maria Jose Beato
- Vascular Anomalies Center, La Paz Children's Hospital, Madrid, Spain
| | - Francine Blei
- Lennox Hill Hospital of Northwell Health, New York, New York
| | - Beth A Drolet
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | | | | | | | | | - Renee Howard
- University of California, San Francisco, California
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13
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Queen D, Fisher J, Husain S, Linos K, Niedt GW, Samie FH. Cutaneous metastasis of hepatocellular carcinoma following liver transplantation. J Cutan Pathol 2019; 47:47-51. [PMID: 31381162 DOI: 10.1111/cup.13555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 03/31/2019] [Revised: 06/09/2019] [Accepted: 07/29/2019] [Indexed: 11/28/2022]
Abstract
Cutaneous metastases from hepatocellular carcinoma (HCC) are extremely rare and can represent a sign of an underlying malignancy or relapse/progression from an existing tumor. We report a case of a cutaneous metastasis arising in a patient with metastatic HCC following orthotopic liver transplantation. Diagnosis is a multistep process as cutaneous HCC metastases must be differentiated from primary cutaneous malignancies as well as other cutaneous metastases. Making this even more challenging, HCC metastases have heterogeneous clinical and histologic appearances. Therefore, the use of immunohistochemical stains, including hepatocyte paraffin-1, arginase-1, and glypican-3, and correlation with the clinical context are essential for a correct diagnosis.
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Affiliation(s)
- Dawn Queen
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Juliya Fisher
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Sameera Husain
- Department of Pathology, Columbia University Irving Medical Center, New York, New York
| | - Konstantinos Linos
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - George W Niedt
- Department of Pathology, Columbia University Irving Medical Center, New York, New York
| | - Faramarz H Samie
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
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14
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Anderson ME, Rodic N, Subtil A, Queen D, Arcasoy S, Niedt GW, Heald PW, Geskin LJ. Multifocal pleomorphic dermal sarcoma and the role of inflammation and immunosuppression in a lung transplant patient: a case report. J Med Case Rep 2019; 13:169. [PMID: 31142349 PMCID: PMC6542061 DOI: 10.1186/s13256-019-2093-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 09/07/2018] [Accepted: 04/22/2019] [Indexed: 02/07/2023] Open
Abstract
Background Pleomorphic dermal sarcoma is the cutaneous variant of undifferentiated pleomorphic sarcoma. It is a rare malignancy of unclear histogenesis; it is a diagnosis of exclusion that requires extensive use of immunohistochemistry to rule out other malignancies. Pleomorphic dermal sarcoma typically presents as a solitary tumor in sun-exposed areas and may have unpredictable clinical behavior, with some tumors associated with metastasis and death. Case presentation We present an unusual case of multifocal pleomorphic dermal sarcoma arising in the areas of alpha-1-antitrypsin deficiency panniculitis in a lung transplant patient. Our patient was a 58-year-old white woman whose initial presentation was consistent with alpha-1-antitrypsin deficiency panniculitis. She then developed extensive multifocal, bleeding, and ulcerated nodules in the areas of the panniculitis. A skin biopsy was consistent with a diagnosis of pleomorphic dermal sarcoma. Her immunosuppressive regimen was decreased, and she was treated with liposomal doxorubicin 40 mg/m2 every 3 weeks with some initial improvement in the size of her tumors. However, soon after beginning therapy, she developed pneumonia and septic shock and ultimately died from multi-organ failure. Conclusions We hypothesize that chronic, multifocal inflammation in the skin in the setting of immunosuppression led to simultaneous, malignant transformation in numerous skin lesions. We discuss the challenges of diagnosing pleomorphic dermal sarcoma, therapeutic options, and stress the need for multidisciplinary management of these cases.
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Affiliation(s)
- Mary E Anderson
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nemanja Rodic
- Department of Dermatology, Yale-New Haven Hospital, New Haven, CT, USA
| | - Antonio Subtil
- Department of Dermatology, Yale-New Haven Hospital, New Haven, CT, USA
| | - Dawn Queen
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Selim Arcasoy
- Department of Dermatology, Columbia University Irving Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 12th floor, New York, NY, 10032, USA
| | - George W Niedt
- Department of Dermatology, Columbia University Irving Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 12th floor, New York, NY, 10032, USA
| | - Peter W Heald
- Department of Dermatology, Yale-New Haven Hospital, New Haven, CT, USA
| | - Larisa J Geskin
- Department of Dermatology, Columbia University Irving Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 12th floor, New York, NY, 10032, USA.
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15
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Rigo RS, Finnin CY, Schneiderman PI, Niedt GW. A case of bullous eruptive disseminated porokeratosis. J Cutan Pathol 2018; 45:968-969. [PMID: 30187499 DOI: 10.1111/cup.13353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/10/2018] [Accepted: 08/13/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Rachel S Rigo
- College of Physicians & Surgeons, Columbia University, New York, New York
| | - Christine Y Finnin
- Department of Dermatology, Columbia University Medical Center, New York, New York
| | - Paul I Schneiderman
- Department of Dermatology, Columbia University Medical Center, New York, New York
| | - George W Niedt
- Department of Dermatology, Columbia University Medical Center, New York, New York
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16
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Abstract
Malignant melanoma may exhibit morphologic characteristics of nonmelanocytic cell or tissue components, a phenomenon termed divergent differentiation. Melanoma with rhabdomyosarcomatous differentiation is rare, with 6 definite cases in adults reported in the literature. The authors describe a 75-year-old man with a cutaneous lesion of the right ear initially diagnosed as malignant melanoma. Three months later, biopsy of a right cervical lymph node showed changes suggestive of rhabdomyosarcoma. Reexamination of the initial skin biopsy with muscle markers confirmed a diagnosis of malignant melanoma with rhabdomyosarcomatous differentiation. This case serves to highlight the diagnostic challenges associated with this rare subtype of melanoma.
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Affiliation(s)
- Nina K Antonov
- *Department of Dermatology, Columbia University Medical Center, New York, NY; and †Department of Dermatology, Division of Dermatopathology, Columbia University Medical Center, New York, NY
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17
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O’Bryan K, Sherman W, Niedt GW, Taback B, Manolidis S, Wang A, Ratner D. An evolving paradigm for the workup and management of high-risk cutaneous squamous cell carcinoma. J Am Acad Dermatol 2013; 69:595-602.e1. [DOI: 10.1016/j.jaad.2013.05.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 04/26/2013] [Accepted: 05/16/2013] [Indexed: 10/26/2022]
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18
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Sagerman PM, Choi YJ, Hu Y, Niedt GW. Human papilloma virus, vulvar dystrophy, and vulvar carcinoma: differential expression of human papillomavirus and vulvar dystrophy in the presence and absence of squamous cell carcinoma of the vulva. Gynecol Oncol 1996; 61:328-32. [PMID: 8641610 DOI: 10.1006/gyno.1996.0151] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In situ hybridization (ISH) and polymerase chain reaction (PCR) for several common HPV types were performed on 41 cases of vulvar dystrophy, 19 of which were associated with previous or simultaneous invasive squamous cell carcinoma of the vulva. Three of the 19 cases (16%) of dystrophy associated with cancer were found to contain HPV-16/18 by PCR. In contrast, 12 of the 22 cases (55%) of dystrophy not associated with carcinoma contained HPV-16/18 by PCR (P < 0.01). A control group of 10 vulvar specimens without dystrophy or carcinoma was negative for all HPV types tested. ISH was negative for all HPV types in all 41 cases. The data confirm the association between vulvar carcinoma and hypertrophic/mixed dystrophy, and provide evidence for an association between HPV-16/18 and some cases of vulvar dystrophy. Cases of vulvar dystrophy not associated with HPV-16/18 may be at increased risk for the development of vulvar carcinoma.
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Affiliation(s)
- P M Sagerman
- Department of Pathology, Winthrop-University Hospital, Mineola, New York 11501, USA
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19
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Abstract
We report a case of a 12-year-old boy with a large perianal condyloma. The lesion was found to contain both spirochetes (Warthin-Starry stain) and human papillomavirus types 6 or 11 (in situ hybridization). Because of persistent negative serologies for syphilis and lack of other clinical stigmata of syphilis, the lesion was diagnosed as condyloma acuminatum with secondary involvement by spirochetes of probable intestinal origin. The case demonstrates the potential histologic similarities between condyloma latum and condyloma acuminatum, as well as the pitfalls of using the Warthin-Starry stain to establish the diagnosis of secondary syphilis.
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Affiliation(s)
- P M Sagerman
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York
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20
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Niedt GW, Myskowski PL, Urmacher C, Niedzwiecki D, Chapman D, Krown SE, Safai B. Histologic predictors of survival in acquired immunodeficiency syndrome-associated Kaposi's sarcoma. Hum Pathol 1992; 23:1419-26. [PMID: 1468779 DOI: 10.1016/0046-8177(92)90063-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The relationship between 22 histologic variables and survival was investigated in 93 patients with acquired immunodeficiency syndrome (AIDS)-associated Kaposi's sarcoma (KS). All the patients were homosexual men in whom KS was the initial manifestation of AIDS. All patients were followed for at least 12 months or until death. Histologic specimens of the initial KS biopsy were reviewed in a blind manner by two of the authors and were evaluated for the presence of a number of histologic features. In a univariate analysis nodular lesions of KS (upsilon patch or plaque lesions), the absence of hemosiderin, the absence of irregular vascular spaces, and the presence of spindle cell nodules were all significantly associated with increased length of survival. Two variables previously shown to be related to survival (CD4:CD8 cell ratio, initial lesion on lower extremities) were included in a multivariate analysis (Cox model) in addition to the histologic variables. Complete data were available from 85 patients. In the multivariate analysis a higher helper to suppressor T-cell ratio, initial lesion on lower extremities, presence of spindle cell nodules, and nodular histology (upsilon patch or plaque histology) were all significantly associated with increased length of survival. These data suggest that in AIDS-associated KS, as in reticuloendothelial neoplasms, histologic features may be useful in identifying prognostically different subgroups of patients.
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Affiliation(s)
- G W Niedt
- Department of Pathology, New York Hospital-Cornell Medical Center, NY
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21
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Sagerman PM, Relman DA, Niroomand F, Niedt GW. Localization of Mycobacterium avium-intracellulare within a skin lesion of bacillary angiomatosis in a patient with AIDS. Diagn Mol Pathol 1992; 1:212-6. [PMID: 1285277] [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: 12/26/2022]
Abstract
We report a 39-year-old man who had AIDS and who presented with an unusual cutaneous vascular lesion, which was clinically thought to be Kaposi's sarcoma. Histologically, the lesion was characterized by capillary proliferation and a mixed inflammatory infiltrate that included numerous histiocytes. The lesion was found to contain slender intracellular acid-fast bacilli, as well as plump extracellular Warthin-Starry-positive bacilli. The acid-fast bacilli were confirmed to be Mycobacterium avium-intracellulare by subsequent positive blood cultures for this organism. To further investigate the lesion, polymerase chain reaction DNA amplification and sequencing was performed, and the lesion was found to contain DNA sequences identical to those previously established for the agent of bacillary angiomatosis. The lesion is thought to represent a lesion of bacillary angiomatosis with secondary involvement by M. avium-intracellulare.
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Affiliation(s)
- P M Sagerman
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021
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22
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Abstract
There is an association of some vascular tumors with estrogen receptors and an association of vascular telangiectasias with high levels of circulating estrogen. Because of this, a study of patients with lower extremity starburst telangiectasias and predisposing factors associated with hyperestrogenemic and hyperprogesteronemic states was undertaken in order to look for estrogen and progesterone receptors in biopsy specimens of lower extremity telangiectasias noted to arise in this setting. Contrary to expected results, using immunocytochemical techniques, no patient in this study was found to have estrogen or progesterone receptors present in their lower extremity telangiectasias. Possible explanations for these results are discussed.
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Affiliation(s)
- N S Sadick
- Division of Dermatology, Cornell University Medical College, Ithaca, New York
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23
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Niedt GW, Myskowski PL, Urmacher C, Niedzwiecki D, Chapman D, Safai B. Histology of early lesions of AIDS-associated Kaposi's sarcoma. Mod Pathol 1990; 3:64-70. [PMID: 2308922] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The original cutaneous biopsy specimens of 93 patients who presented themselves to the Memorial Sloan-Kettering Cancer Center with acquired immunodeficiency syndrome (AIDS)-related Kaposi's sarcoma (KS) were systematically reviewed for 23 histologic variables. KS was the initial manifestation of AIDS in all of the patients. The vast majority of patients presented with plaque histology of KS. Early lesions of KS were characterized by the presence of dilated vascular spaces haphazardly arranged in the biopsy specimen, a sparse inflammatory cell infiltrate composed of lymphocytes (usually without plasma cells), and aggregates of cuboidal cells with the appearance of epithelioid cells. Individually necrotic tumor cells were present in nearly every case. Spindle cells arranged in fascicles or nodules were seen in a minority of cases. These data provide an overview of the different histologic patterns seen in initial lesions of AIDS-associated KS and may lead to better understanding of the pathogenesis of this tumor.
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Affiliation(s)
- G W Niedt
- Department of Pathology, New York Hospital-Cornell Medical Center, New York
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24
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Abstract
We describe two children with vascular neoplasms that resembled Kaposi's sarcoma in places. Both presented with intraabdominal masses and severe thrombocytopenia. At autopsy the tumors extensively infiltrated the peritoneum and retroperitoneum and surrounded or invaded numerous organs including the kidneys, pancreas, adrenal glands, gastrointestinal tract, mesentery, and lymph nodes in both cases, and spleen or bone marrow in one case each. The neoplasms were histologically identical and displayed two patterns: dilated vascular spaces (angiomatous areas) lined by flat endothelial-like cells and areas of spindle cells forming slitlike vascular spaces similar to those described in Kaposi's sarcoma. Tumor cells in both cases expressed markers for endothelial cells. The clinical and histologic character of these neoplasms differentiates them from Kaposi's sarcoma, hemangioendothelioma, and from conventional juvenile hemangioma.
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Affiliation(s)
- G W Niedt
- Department of Pathology, New York University School of Medicine, New York 10016
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25
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Abstract
A 31-year-old black man with a history of intravenous drug abuse developed a mass in his neck, a biopsy of which revealed Kaposi's sarcoma. The patient underwent radiation therapy, and the mass diminished in size. Approximately 2 months later the patient developed a herpes zoster infection in the left T3 distribution. The vesicular eruption resolved, but postherpetic neuralgia remained. Two months after the herpes zoster infection, the patient developed many small nodules in the area of the prior vesicular eruption. Biopsy revealed these nodules to be Kaposi's sarcoma. At this time no other cutaneous lesions were present. We believe that these nodules represent the occurrence of the Koebner phenomenon in a patient with Kaposi's sarcoma and the acquired immunodeficiency syndrome.
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Affiliation(s)
- G W Niedt
- Department of Pathology, New York Hospital-Cornell Medical Center, NY 10021
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26
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Niedt GW, Schinella RA. Acquired immunodeficiency syndrome. Clinicopathologic study of 56 autopsies. Arch Pathol Lab Med 1985; 109:727-34. [PMID: 2990378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We studied 56 patients with acquired immunodeficiency syndrome who underwent autopsy at the New York University Medical Center. We uncovered several entities that were not previously described or emphasized in prior series. These were as follows: (1) three cases of necrotizing arteritis with cytomegalovirus inclusions; (2) dissemination in 95% of cases of Kaposi's sarcoma; (3) unusual clinical and histologic presentations of Kaposi's sarcoma presenting diagnostic difficulties for both clinicians and pathologists; and (4) a very high incidence of serious nonmycobacterial infections. In addition, previous autopsy studies have disagreed over such matters as the incidence of disseminated candidiasis, hemophagocytosis, and severe adrenal necrosis in acquired immunodeficiency syndrome. All of these studies, except one, involved ten to 12 cases each. Our study of 56 cases helps to resolve these disagreements.
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27
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Nash GS, Niedt GW, MacDermott RP. Ionophore-A23187-induced cellular cytotoxicity: a cell fragment mediated process. Immunology 1980; 40:265-72. [PMID: 6773881 PMCID: PMC1458004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Calcium ionophore A23187 was found to induce human white blood cells to kill human red blood cells. Optimal conditions for ionophore-induced cellular cytotoxicity (IICC) included an 18 h time period, an incubation temperature of 25 degrees, a 25:1 or 50:1 killer:target cell ratio,and a final ionophore concentration of 2 . 5 microgram/ml. WBC or granulocytes which were either frozen and thawed three times or sonicated were capable of mediating IICC. As intact cells, granulocytes (67 . 2% cytotoxicity), monocytes (34 . 8%), B cells (22 . 0%) and Null cells (19 . 3%) were effector cells but T cells (7 . 4%) were not. After fragmenting these cells, all cell types including T cells were able to mediate IICC. When cell lines (K562, Chang, and NCTC) were used as effectors, none would mediate IICC when intact. After freezing and thawing, Chang and NCTC would not mediate IICC, whereas K562 cells did. These studies may be indicative of a calcium-dependent, membrane-localized mechanism in cellular cytotoxic processes, and may provide a useful indicator system for isolation of the enzyme systems involved in cellular cytotoxicity.
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