1
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Tchernev G, Patterson JW, Chokoeva AA. Global dermatology: challenges and changes? Wien Med Wochenschr 2016; 167:49-50. [PMID: 27557597 DOI: 10.1007/s10354-016-0504-8] [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: 11/30/2022]
Affiliation(s)
- G Tchernev
- Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior (MVR), General Skobelev blvd. 79, 1606, Sofia, Bulgaria.
| | - J W Patterson
- Department of Pathology, University of Virginia Health System, 1215 Lee Street, Box 800214,, Charlottesville, VA, 22908, USA
| | - A A Chokoeva
- Onkoderma-Policlinic for Dermatology and Dermatologic Surgery, General Skobelev 26 blvd., Sofia, Bulgaria.,Department of Dermatology and Venereology, Medical University of Plovdiv, Medical Faculty, Plovdiv, Bulgaria
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2
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Maximov GK, Maximov KG, Chokoeva AA, Lotti T, Wollina U, Patterson JW, Guarneri C, Tana C, Fioranelli M, Roccia MG, Kanazawa N, Tchernev G. 5-hydroxytryptamine and Lyme disease. Opportunity for a novel therapy to reduce the cerebellar tremor? J BIOL REG HOMEOS AG 2016; 30:7-12. [PMID: 27373127] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Lyme boreliosis is caused by the spirochete Borrelia burdorferi, which is transmitted by ticks. A 59 year-old woman developed pyrexia, strong headaches, ataxia, dysarthria and tremor of the limbs after a tick bite. She was unable to work and eat on her own. She was hospitalized three times and diagnosed with cerebellar intention tremor, cerebellar ataxia, dysarthria, bilateral horizontal gaze paralysis and a central lesion of the left facial nerve. There were no pyramidal, sensory or psychiatric disturbances. The brain MRI showed multifocal leucoencephalopathy with many hyperintense areas in both hemispheres, as well as in the left superior pedunculus cerebellaris. Diagnosis was confirmed by serologic examination. Treatment with cephtriaxone, doxycycline, methylprednisolone, cephixime and ciprofloxacine was administered without effect on the tremor, ataxia and horizontal gaze paralysis. Treatment was then administered with 5-hydroxytriptamine (5-HT) in increased doses. The result of the three-month treatment with 5-HT was a gradual diminution of the tremor and the ataxia and an increase in the ability to eat, walk and work independently.
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Affiliation(s)
- G K Maximov
- Department Medicinal Information and Non-interventional studies, Bulgarian Drug Agency, Sofia, Bulgaria
| | - K G Maximov
- Neuromed Center for Neurology and Neurosurgery, Military Medical Academy, Sofia, Bulgaria
| | - A A Chokoeva
- Onkoderma- Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria; Department of Dermatology and Venereology, Medical University of Plovdiv, Medical Faculty, Plovdiv, Bulgaria
| | - T Lotti
- Department of Dermatology, University of Rome G. Marconi Rome, Italy
| | - U Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - J W Patterson
- University of Virginia Health System, Department of Pathology, Charlottesville, VA USA
| | - C Guarneri
- Department of Clinical and Experimental Medicine, Section of Dermatology, University Hospital of Messina, Messina, Italy
| | - C Tana
- Internal Medicine Unit, Guastalla Hospital, AUSL Reggio Emilia, Reggio Emilia, Italy
| | - M Fioranelli
- History Department, G.Marconi University, Rome, Italy
| | - M G Roccia
- University B.I.S. Group of Institutions, Punjab Technical University, Punjab, India
| | - N Kanazawa
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - G Tchernev
- Medical Institute of Ministry of Interior (MVR-Sofia), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
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3
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Tchernev G, Sheta M, Rahoui M, Chokoeva AA, Wollina U, Maximov GK, Patterson JW, Fioranelli M, Roccia MG, Ananiev J, Lotti T. Biofibre hair implant: what is new, what is true? J BIOL REG HOMEOS AG 2016; 30:27-34. [PMID: 27373131] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Ensuring the safety of hair implant fibers is essential. At the same time, good aesthetic quality and durability should also be considered in order to maintain expected result over the years. The main features required are biocompatibility, resistance to traction, absence of capillarity, resistance to physical-chemical stress, and low tissue trauma, in addition to good aesthetics. Biofibre® medical hair prosthetic fibers meet all the biocompatibility and safety requirements established by international standards for medical devices. They are available in 13 colors, with different lengths (15, 30 or 45 cm) and various shapes (straight, wavy, curly and afro). Biofibre® hair implants are indicated for diffuse hair loss or hair thinning in cases where an immediate aesthetic result is required, when patients request minor surgery without hospitalization, both for male and female patients, in combination with other hair restoration techniques to improve the final aesthetic result, to correct scars or scalp burns and in cases of poor donor areas. Biofibre® Hair Implant is in fact a minor surgery technique, performed under local anesthesia by either a manual implanter or an automatic machine which enables an immediate aesthetic result and the desired quantity of hair without pain or hospitalization. Clinical and histological studies have demonstrated that Biofibre® hair Implants are safe and well tolerated by patients and can be totally reversible if the need arises. This technique requires good after-care, periodical check-ups and yearly implant re-touches to maintain the best cosmetic result.
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Affiliation(s)
- G Tchernev
- Medical Institute of Ministry of Interior (MVR-Sofia), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - M Sheta
- Al Mansour Dermatologic Clinic, Kuwait City, Kuwait
| | - M Rahoui
- Clinique Cheveux et Lifting, Tunis, Tunisia
| | - A A Chokoeva
- Onkoderma-Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria; Department of Dermatology and Venereology, Medical University of Plovdiv, Medical faculty, Plovdiv, Bulgaria
| | - U Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - G K Maximov
- Department Medicinal Information and Non-interventional studies, Bulgarian Drug Agency, Sofia, Bulgaria
| | - J W Patterson
- University of Virginia Health System, Department of Pathology, Charlottesville, VA USA
| | - M Fioranelli
- History Department, G. Marconi University, Rome, Italy
| | - M G Roccia
- University B.I.S. Group of Institutions, Punjab Technical University, Punjab, India
| | - J Ananiev
- Department of General and Clinical Pathology, Forensic Medicine and Deontology, Trakia University, Armeiska str.11, Stara Zagora, Bulgaria
| | - T Lotti
- Department of Dermatology, University of Rome G. Marconi Rome, Italy
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4
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Stowman AM, Griffin MM, Kanner WA, Tchernev G, Chokoeva AA, Wollina U, Lotti T, Fioranelli M, Roccia MG, Maximov GK, Patterson JW. Coexistent trichilemmoma and trichoblastoma without associated nevus sebaceus. J BIOL REG HOMEOS AG 2016; 30:17-20. [PMID: 27373129] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Trichilemmoma and trichoblastoma are benign adnexal neoplasms derived from the hair follicle unit. While trichilemmomas are closely associated with the epidermis, trichoblastomas are found within the dermis and subcutaneous tissue. Both tumors have been reported to arise within nevus sebaceus of Jadassohn (NSJ). We present a 42-year-old white male with a 5 mm crusted, erythematous papule on the right occipital scalp that had been present for years. A shave biopsy was performed and read as trichilemmoma involving the biopsy base. The patient returned for follow-up 2 months later with recurrence of a crusted papule, measuring 9 mm in greatest diameter at the site of the previous biopsy. The lesion was excised for complete histologic evaluation, diagnosed as trichilemmoma with verrucoid features and associated basaloid proliferation with adnexal differentiation, again involving the biopsy base. The lesion recurred 2 months later in the form of an 8 mm multilobulated pink nodule. It was again excised and diagnosed as trichoblastoma with overlying trichilemmoma. The significance of this finding is that coexistent lesions do not necessarily necessitate a preexisting nevus sebaceous. Rather, this finding supports the notion of a common stem cell capable of differentiating toward the various portions of the hair follicle unit and adnexal structures. The idea is that any portion of the skin adnexal structure may develop out of a pluripotential germ cell and develop into a tumor.
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Affiliation(s)
- A M Stowman
- Department of Medical 1Department of Pathology, Division of Dermatopathology, University of Virginia Health System, Charlottesville, Virginia
| | - M M Griffin
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina
| | - W A Kanner
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina; Pathology Consultants, Greenville, South Carolina
| | - G Tchernev
- Medical Institute of Ministry of Interior (MVR-Sofia), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - A A Chokoeva
- Onkoderma- Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria; Department of Dermatology and Venereology, Medical University of Plovdiv, Medical Faculty, Plovdiv, Bulgaria
| | - U Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - T Lotti
- Department of Dermatology, University of Rome G. Marconi Rome, Italy
| | - M Fioranelli
- History Department, G. Marconi University, Rome, Italy
| | - M G Roccia
- University B.I.S. Group of Institutions, Punjab Technical University, Punjab, India
| | - G K Maximov
- Department Medicinal Information and Non-Interventional Studies, Bulgarian Drug Agency, Sofia, Bulgaria
| | - J W Patterson
- Department of Medical 1Department of Pathology, Division of Dermatopathology, University of Virginia Health System, Charlottesville, Virginia
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5
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Kanazawa N, Tchernev G, Chokoeva AA, Maximov GK, Wollina U, Lotti T, Patterson JW, Guarneri C, Tana C, Furukawa F. Interstitial granulomatous dermatitis demonstrating small, discrete skin-colored papules. J BIOL REG HOMEOS AG 2016; 30:49-52. [PMID: 27373135] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We report the case of a 67-year-old female with a rare variant of interstitial granulomatous dermatitis showing multiple skin-colored papules. Clinically, numerous skin-colored or reddish papules were distributed on her back and posterior thighs with itchy scaly erythema on the upper back. After topical steroid application, skin-colored papules still remained after the disappearance of itchy scaly erythema. Histopathologically, perivascular and interstitial infiltration of lymphocytes and histiocytes with occasional multinucleated giant cells were observed in the superficial and mid reticular dermis, accompanied by mild mucin deposition. Interstitial granulomatous dermatitis is similar to interstitial granuloma annulare, but can be differentiated from it by lesser degrees of collagen degeneration with mucin deposition and frequent association with arthritis or rheumatic diseases. As previously reported, multiple asymptomatic skin-colored papules are considered a rare but distinct variant of interstitial granulomatous dermatitis. Although no apparent underlying disorder has developed in the presented case, careful follow-up needs to be continued.
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Affiliation(s)
- N Kanazawa
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - G Tchernev
- Medical Institute of Ministry of Interior (MVR-Sofia), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - A A Chokoeva
- Onkoderma- Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria; Department of Dermatology and Venereology, Medical University of Plovdiv, Medical Faculty, Plovdiv, Bulgaria
| | - G K Maximov
- Department Medicinal Information and Non-Interventional studies, Bulgarian Drug Agency, Sofia, Bulgaria
| | - U Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - T Lotti
- Department of Dermatology, University of Rome G. Marconi Rome, Italy
| | - J W Patterson
- University of Virginia Health System, Department of Pathology, Charlottesville, VA USA
| | - C Guarneri
- Department of Clinical and Experimental Medicine, Unit of Dermatology University Hospital of Messina, Messina, Italy
| | - C Tana
- Internal Medicine Unit, Guastalla Hospital, AUSL Reggio Emilia, Italy
| | - F Furukawa
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
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6
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Fama' F, Ieni A, Tchernev G, Chokoeva AA, Maximov GK, Wollina U, Lotti T, Patterson JW, Fioranelli M, Roccia MG, Guarneri C, Gioffre-Florio M. Pilomatrixoma of the breast in a patient with type 1 myotonic dystrophy: successful surgical approach. J BIOL REG HOMEOS AG 2016; 30:1-6. [PMID: 27373126] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Malherbes calcifying epithelioma is an uncommon cutaneous tumour that originates from the matrix cells of hair follicle. It was initially described by Malherbe as a benign calcifying epithelioma. Several ultra-structural and electron-microscopic studies later demonstrated its origin from matrix cells and the term pilomatrixoma was introduced. The treatment of this tumour remains mainly surgical. Malignant cases with post-surgical recurrences have been described in literature and recurrences have been related to an incomplete surgical treatment or tumour aggressiveness. We present the case of 31-year-old female patient with pilomatrixoma of the breast, which was very similar to fibroadenoma, in terms of size and other clinical features. We successfully treated this patient surgically, and the aesthetic results were good, despite the proximity of the tumour to the areola-nipple complex. Fifteen months later, the patient is doing well, free of any clinical local recurrence.
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Affiliation(s)
- F Fama'
- Department of Human Pathology; University Hospital of Messina, Messina, Italy
| | - A Ieni
- Department of Human Pathology; University Hospital of Messina, Messina, Italy
| | - G Tchernev
- Medical Institute of Ministry of Interior (MVR-Sofia), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - A A Chokoeva
- "Onkoderma"- Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria; Department of Dermatology and Venereology, Medical University of Plovdiv, Medical Faculty, Plovdiv, Bulgaria
| | - G K Maximov
- Department Medicinal Information and Non-Interventional studies, Bulgarian Drug Agency, Sofia, Bulgaria
| | - U Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - T Lotti
- Department of Dermatology, University of Rome G. Marconi Rome, Italy
| | - J W Patterson
- University of Virginia Health System, Department of Pathology, Charlottesville, VA USA
| | - M Fioranelli
- History Department, G. Marconi University, Rome, Italy
| | - M G Roccia
- University B.I.S. Group of Institutions, Punjab Technical University, Punjab, India
| | - C Guarneri
- Department of Clinical and Experimental Medicine, Unit of Dermatology University Hospital of Messina, Messina, Italy
| | - M Gioffre-Florio
- Department of Human Pathology; University Hospital of Messina, Messina, Italy
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7
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Ramos O, Tchernev G, Chokoeva AA, Wollina U, Maximov GK, Patterson JW, Fioranelli M, Roccia MG, Ananiev J, Lotti T. Biofibre hair implant impact on the quality of life. J BIOL REG HOMEOS AG 2016; 30:21-25. [PMID: 27373130] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Body image refers to how we feel about our bodies. It does not refer to what we actually look like, but rather to our perceptions, opinions and ways of thinking about our appearance. How we feel about our appearance is part of our body image and self-image. The hair is a significant part of this image. The problem of alopecia affects both sexes and all ages with significant sequelae. Along with androgenetic alopecia, there are forms of alopecia of various origins: traumatic, surgical, pharmacological and others. Polyamide artificial hair implant (Biofibre®) is one of the current techniques used to treat this problem.
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Affiliation(s)
- O Ramos
- Clinica Dermatologica Tavizon y Torres, Coyoacan, Distrito Federal, Mexico
| | - G Tchernev
- Medical Institute of Ministry of Interior (MVR), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - A A Chokoeva
- Onkoderma-Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria; Department of Dermatology and Venereology, Medical University of Plovdiv, Medical faculty, Plovdiv, Bulgaria
| | - U Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - G K Maximov
- Department Medicinal Information and Non-interventional studies, Bulgarian Drug Agency, Sofia, Bulgaria
| | - J W Patterson
- University of Virginia Health System, Department of Pathology, Charlottesville, VA USA
| | - M Fioranelli
- History Department, G. Marconi University, Rome, Italy
| | - M G Roccia
- University B.I.S. Group of Institutions, Punjab Technical University, Punjab, India
| | - J Ananiev
- Department of General and Clinical Pathology, Forensic Medicine and Deontology, Trakia University, Armeiska str.11, Stara Zagora, Bulgaria
| | - T Lotti
- Department of Dermatology, University of Rome G. Marconi Rome, Italy
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8
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Klug DJ, Darling MD, Kaley JR, Tchernev G, Chokoeva AA, Wollina U, Lotti T, Fioranelli M, Roccia MG, Maximov GK, Gagnon AL, Patterson JW. Isolated CMV infection causing perianal and sacral ulceration in a patient with aids. J BIOL REG HOMEOS AG 2016; 30:13-15. [PMID: 27373128] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Cytomegalovirus (CMV) is a DNA virus estimated to infect 70-90% of the worlds population, producing minimal symptoms in immunocompetent hosts. In the immunocompromised host, CMV infection can be potentially fatal, producing systemic or localized forms. We report the case of a 52-year-old female with acquired immunodeficiency virus (AIDS) who presented multiple sacral and perineal ulcers clinically and histopathologically consistent with CMV ulcerations. We discuss the patients clinical presentation and histologic findings to remind physicians to consider CMV as a cause for cutaneous and systemic infection in the immunocompromised host.
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Affiliation(s)
- D J Klug
- University of Nebraska Medical Center College of Medicine, Omaha, Nebraska
| | - M D Darling
- Departments of Pathology, University of Virginia Health System, Charlottesville, Virginia
| | - J R Kaley
- Departments of Pathology, University of Virginia Health System, Charlottesville, Virginia
| | - G Tchernev
- Medical Institute of Ministry of Interior (MVR-Sofia), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - A A Chokoeva
- "Onkoderma"- Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria; Department of Dermatology and Venereology, Medical University of Plovdiv, Medical Faculty, Plovdiv, Bulgaria
| | - U Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - T Lotti
- Department of Dermatology, University of Rome G. Marconi Rome, Italy
| | - M Fioranelli
- History Department, G. Marconi University, Rome, Italy
| | - M G Roccia
- University B.I.S. Group of Institutions, Punjab Technical University, Punjab, India
| | - G K Maximov
- Department Medicinal Information and Non-Interventional Studies, Bulgarian Drug Agency, Sofia, Bulgaria
| | - A L Gagnon
- Department of dermatology, University of Virginia Health System, Charlottesville, Virginia
| | - J W Patterson
- Departments of Pathology, University of Virginia Health System, Charlottesville, Virginia
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9
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Gagnon AL, Daniel S, Greer K, Patterson JW, Tchernev G, Chokoeva AA, Wollina U, Lotti T, Fioranelli M, Roccia MG, Guarneri C, Aguilera N. Langerhans cell sarcoma: an unusual microscopic presentation. J BIOL REG HOMEOS AG 2016; 30:39-43. [PMID: 27373133] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 70-year-old Caucasian male presented to our clinic for a pruritic eruption progressing over several months. He complained of fatigue with a 20-pound weight loss over the past year. On presentation, the patient had browny-yellow to violaceous, purpuric, macular and papular lesions on the legs, arms, lower abdomen and back. Initial biopsy showed an angiocentric infiltrate with a suggestion of intraluminal proliferation; CD31 and Fli-1 positivity suggested either reactive angioendotheliomatosis or an unusual intravascular histiocytosis. Further excisional biopsies demonstrated perivascular collections of cells with ample cytoplasm, prominent nuclear pleomorphism and mitotic activity. The nuclei demonstrated nuclear folding, grooves and indentations. The atypical cells were S100, CD1a and CD56 positive with immunohistochemistry. A diagnosis of Langerhans cell sarcoma (LCS) was made. LCS is a rare, aggressive malignancy that can involve multiple organs including the skin, lymph nodes, lung, bone marrow, spleen, heart, and brain. The skin and lymph nodes are commonly involved, and the cutaneous presentation varies greatly. Immunohistochemistry characteristically shows CD1a and S100 positivity. CD56 expression is uncommon and often portends a poor prognosis. There is no established treatment of LCS due to its rarity. Surgery, radiation, and chemotherapy have been used with varied outcomes. Our patient was treated with prednisone with improvement of cutaneous disease. He did not develop systemic involvement, but died 1.5 years later from complications associated with heart failure. Langerhans cell sarcoma should be considered when faced with an unusual angiocentric infiltrate in which initial immunohistochemical staining results may be misleading.
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Affiliation(s)
- A L Gagnon
- Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - S Daniel
- Departments of Pathology and Dermatology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - K Greer
- Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - J W Patterson
- Departments of Pathology and Dermatology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - G Tchernev
- Medical Institute of Ministry of Interior (MVR-Sofia), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - A A Chokoeva
- Onkoderma- Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria; Department of Dermatology and Venereology, Medical University of Plovdiv, Medical Faculty, Plovdiv, Bulgaria
| | - U Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - T Lotti
- Department of Dermatology, University of Rome G. Marconi Rome, Italy
| | - M Fioranelli
- History Department, G. Marconi University, Rome, Italy
| | - M G Roccia
- University B.I.S. Group of Institutions, Punjab Technical University, Punjab, India
| | - C Guarneri
- Department of Clinical and Experimental Medicine, Unit of Dermatology University Hospital of Messina, Messina, Italy
| | - N Aguilera
- Department of Pathology, University of Virginia Health System, Charlottesville, Virginia, USA
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10
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Fama F, Sindoni A, Tchernev G, Chokoeva AA, Wollina U, Lotti T, Maximov GK, Patterson JW, Fioranelli M, Roccia MG, Ieni A, Cascio A, Gioffre-Florio M, Guarneri C. Uncommon clinical presentation of Kimuras disease as bilateral retroauricular masses in a young Malian male: successful surgical approach. J BIOL REG HOMEOS AG 2016; 30:35-38. [PMID: 27373132] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We present a case of a 27 year-old Malian male referred to our hospital for two large, painless retroauricolar masses that had appeared two years earlier. Bilateral cervical painless lymphadenopathy was present at physical examination, without any other systemic symptoms. His history was relevant for bilateral Kimuras disease lesions resected 5 years earlier in the same locations. Lymphocytosis and a mild hypereosinophilia were found in routine blood tests, together with increased total IgE levels. After surgery, histology showed lymphoid infiltrates with reactive prominent germinal centres containing eosinophils, suggesting relapse of Kimuras disease, in the context of nonencapsulated fibrous proliferation with discontinuous collagen fibers, consistent with keloid. Three months after removal of retroauricular masses, abnormal laboratory findings reverted to normal. To the best our knowledge, this is the first case in literature of bilateral keloid lesions developed after surgery for Kimura Disease and harbouring its histopathologic features. Clinicians should be aware of these unusual reactive phenomena and their possible simulators.
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Affiliation(s)
- F Fama
- Department of Human Pathology, University Hospital of Messina, Messina, Italy
| | - A Sindoni
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University Hospital of Messina, Messina, Italy
| | - G Tchernev
- Medical Institute of Ministry of Interior (MVR-Sofia), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - A A Chokoeva
- Onkoderma- Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria; Department of Dermatology and Venereology, Medical University of Plovdiv, Medical Faculty, Plovdiv, Bulgaria
| | - U Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - T Lotti
- Department of Dermatology, University of Rome G. Marconi Rome, Italy
| | - G K Maximov
- Department Medicinal Information and Non-Interventional Studies, Bulgarian Drug Agency, Sofia, Bulgaria
| | - J W Patterson
- University of Virginia Health System, Department of Pathology, Charlottesville, VA USA
| | - M Fioranelli
- History Department, G.Marconi University, Rome, Italy
| | - M G Roccia
- University B.I.S. Group of Institutions, Punjab Technical University, Punjab, India
| | - A Ieni
- Department of Human Pathology, University Hospital of Messina, Messina, Italy
| | - A Cascio
- Department of Human Pathology, University Hospital of Messina, Messina, Italy
| | - M Gioffre-Florio
- Department of Human Pathology, University Hospital of Messina, Messina, Italy
| | - C Guarneri
- Department of Clinical and Experimental Medicine - Section of Dermatology, University Hospital of Messina, Messina, Italy
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11
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Chokoeva AA, Tchernev G, Cardoso JC, Patterson JW, Dechev I, Valkanov S, Zanardelli M, Lotti T, Wollina U. Vulvar sarcomas: Short guideline for histopathological recognition and clinical management. Part 2. Int J Immunopathol Pharmacol 2015; 28:178-186. [DOI: 10.1177/0394632015575977] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Malignant tumors of the female reproductive system are a serious health and social problem, as they are the second most common cause of death among women, after breast cancer. Vulvar tumors represent only 4% of all gynecological neoplasms, and they are fourth in frequency after tumors of the cervix, uterus, and ovary. Ninety-eight percent of all vulvar tumors are benign and only 2% are malignant. Sarcomas of the vulva comprise approximately 1–3% of all vulvar cancers. They are characterized by rapid growth, high metastatic potential, frequent recurrences, aggressive behavior, and high mortality rate. In Part 1 of this paper, we presented the most common forms of sarcoma of the vulva: leiomyosarcoma, epithelioid sarcoma, malignant rhabdoid tumor, and rhabdomyosarcoma. The second part of this review will focus mainly on the rarest variants of vulvar sarcoma: low-grade fibromyxoid sarcoma, synovial sarcoma, monophasic synovial sarcoma, carcinosarcoma, Ewing sarcoma, myeloid sarcoma, dermatofibrosarcoma protuberans, malignant fibrous histiocytoma, angiomatoid fibrous histiocytoma, liposarcoma, malignant peripheral nerve sheath tumor, and malignant mesothelioma.
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Affiliation(s)
- AA Chokoeva
- Onkoderma-Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
| | - G Tchernev
- Policlinic for Dermatology and Venereology, University Hospital Lozenetz, Sofia, Bulgaria
| | - JC Cardoso
- Department of Dermatology, University Hospital of Coimbra, Coimbra, Portugal
| | - JW Patterson
- Department of Dermatology, University of Virginia Health System, Charlottesville, VA, USA
- Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
| | - I Dechev
- Department of Urology, Medical University of Plovdiv, Bulgaria; University Clinic of Urology, University Hospital “St. George”, Plovdiv, Bulgaria
| | - S Valkanov
- Department of Urology, Medical University of Plovdiv, Bulgaria; University Clinic of Urology, University Hospital “St. George”, Plovdiv, Bulgaria
| | - M Zanardelli
- Department of Neuroscience, Psychology, Drug Research and Child Health - Neurofarba - Pharmacology and Toxicology Section, University of Florence, Florence, Italy
| | - T Lotti
- University of Rome “G.Marconi”, Rome, Italy
| | - U Wollina
- Department of Dermatology and Allergology, Hospital Dresden-Friedrichstadt, Dresden, Germany
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12
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Chokoeva AA, Tchernev G, Cardoso JC, Patterson JW, Dechev I, Valkanov S, Zanardelli M, Lotti T, Wollina U. Vulvar sarcomas: Short guideline for histopathological recognition and clinical management. Part 1. Int J Immunopathol Pharmacol 2015; 28:168-77. [PMID: 25816394 DOI: 10.1177/0394632015576029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 01/14/2015] [Accepted: 02/13/2015] [Indexed: 11/16/2022] Open
Abstract
Malignant tumors of the female reproductive system are a serious health and social problem, as they are the second most common cause of death among women, after breast cancer. Their incidence has increased dramatically during recent years, probably due to the different sexual habits and changes in the prevalence of HIV/ AIDS and HPV virus carriers, among other factors. Vulvar tumors represent only 4% of all gynecological neoplasms, and they are fourth in frequency after tumors of the cervix, uterus, and ovary. Ninety eight percent of all vulvar tumors are benign and only 2% are malignant. The overall incidence of tumors with vulvar location is between two and seven cases per 100,000 women, and it increases with age, while the death rate is estimated at 0.7 per 100,000 women. Sarcomas of the vulva comprise approximately 1-3% of all vulvar cancers, with leiomyosarcomas, epithelioid sarcomas, and rhabdomyosarcomas being the most common among them. They are characterized by rapid growth, high metastatic potential, frequent recurrences, aggressive behavior, and high mortality rate. In this paper, we present the most common forms of sarcomas of the vulva (leiomyosarcoma, epithelioid sarcoma, malignant rhabdoid tumor, rhabdomyosarcoma) in order to emphasize the broad differential diagnosis, rare appearance, non-specific clinical picture, aggressive course, and high mortality.
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Affiliation(s)
- A A Chokoeva
- Onkoderma-Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
| | - G Tchernev
- Policlinic for Dermatology and Venereology, University Hospital Lozenetz, Sofia, Bulgaria
| | - J C Cardoso
- Department of Dermatology, University Hospital of Coimbra, Coimbra, Portugal
| | - J W Patterson
- Department of Dermatology, University of Virginia Health System, Charlottesville, VA, USA Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
| | - I Dechev
- Department of Urology, Medical University of Plovdiv, Bulgaria, University Clinic of Urology, University Hospital "St. George", Plovdiv, Bulgaria
| | - S Valkanov
- Department of Neuroscience, Psychology, Drug Research and Child Health - Neurofarba - Pharmacology and Toxicology Section University of Florence, Florence, Italy
| | - M Zanardelli
- Department of Neuroscience, Psychology, Drug Research and Child Health - Neurofarba - Pharmacology and Toxicology Section University of Florence, Florence, Italy
| | - T Lotti
- University of Rome "G.Marconi", Rome, Italy
| | - U Wollina
- Department of Dermatology & Allergology, Hospital Dresden-Friedrichstadt, Dresden, Germany
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13
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Chokoeva AA, Tchernev G, Trayanova E, Patterson JW, Lotti T, Wollina U. Giant congenital melanocytic nevus localized in the axillary area: serial excisions as optimal treatment option. J BIOL REG HOMEOS AG 2015; 29:123-128. [PMID: 26016980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Congenital melanocytic nevi are relatively rare lesions (1-6%). Their size and location can cause cosmetic and functional disorders of varying degrees of severity, but in addition they can also undergo transformation to malignant melanoma. Different types of treatments have been described as being effective for these lesions, the choice of the most appropriate method depending on the size and the location of the nevi as well as the patients age. While locally destructive methods for superficial treatment could successfully reduce the pigmentation, recurrences are not rare and incomplete elimination of the melanocytic nevus would not exclude the possible development of subsequent malignancy. Surgical excision is the only reliable method allowing for complete removal of the lesion and the provision of material for subsequent histological examination. Complete surgical excision is a good option for prevention of future malignant transformation, but it is not always possible to carry out, especially in the case of large melanocytic nevi. In such cases, serial or staged surgical excisions represent an optimal therapeutic approach with the greatest assurance of total removal of the lesion, even large. We present the case of a female patient with a congenital melanocytic nevus located in the axillary area that had increased significantly in size during her pregnancy. The lesion was successfully treated through a series of surgical excisions with excellent aesthetic results in Onkoderma-Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria.
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Affiliation(s)
- A A Chokoeva
- Onkoderma- Policlinic for Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - G Tchernev
- Onkoderma- Policlinic for Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - E Trayanova
- Onkoderma- Policlinic for Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - J W Patterson
- Department of Pathology and Dermatology, University of Virginia Health System, Charlottesville, VA, USA
| | - T Lotti
- Professor and Chair of Dermatology, University of Rome "G. Marconi", Rome, Italy
| | - U Wollina
- Department of Dermatology and Allergology Hospital Dresden-Friedrichstadt, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
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14
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Trayanova E, Chokoeva AA, Tchernev G, Patterson JW, Wollina U, Lotti T. Dysplastic nevi, melanoma and pregnancy- where is the relationship? J BIOL REG HOMEOS AG 2015; 29:87-90. [PMID: 26016974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Dysplastic nevus is a precursor and a risk factor for the development of malignant melanoma, which explains the scientific interest in this field. Its etiology includes various of endogenous and exogenous factors, as we are considering the influence of hormonal status on the possible malignancy of congenital nevi in particular. The occurrence of some typical melanocytic lesions such as chloasma during pregnancy, where the hormone effect is demonstrated, as well as the more frequent changes of the dysplastic nevi namely within the pregnancy, leads to the idea for the endocrine dependence of the malignant transformation of some melanocytic lesions. We present a case of 37-year-old female patient whom consulted with the dermatologist due to occurrence of pigmented lesions on her left breast. The lesion changed significantly during both her pregnancies with a pause in growth between them and without any signs of regression after the births. During pregnancy, all pigmented skin lesions should be observed with caution because of the increased risk of malignant transformation. Lesions with any suspected changes are required to be immediately removed surgically with appropriate anaesthesia, without waiting to give birth.
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Affiliation(s)
- E Trayanova
- Onkoderma-Policlinic for Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - A A Chokoeva
- Onkoderma-Policlinic for Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - G Tchernev
- Onkoderma-Policlinic for Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - J W Patterson
- University of Virginia Health System, Department of Pathology, Charlottesville, VA USA
| | - U Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - T Lotti
- Professor and Chair of Dermatology, University of Rome "G. Marconi", Rome, Italy
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15
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Chokoeva AA, Tchernev G, Patterson JW, Wollina U, Lotti T. Nonsyndromic aplasia cutis congenita: a case report. J BIOL REG HOMEOS AG 2015; 29:129-131. [PMID: 26016981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Aplasia cutis congenita (ACC) is a rare disorder, which is defined by the localized, or less commonly widespread absence of skin involving the epidermis, dermis and subcutaneous tissue with an incidence of 1/10.000 newborns. The underlying bone and dura mater can be also affected, and muscle and bone involvement occur in approximately 20 to 30% of the cases. Aplasia cutis congenita most often occurs in isolated form, but it has also been reported as part of a heterogeneous group of syndromes. Conservative treatment, surgery, or a combination of these has been described as possible treatment options. In the neonatal period, conservative treatment is more appropriate as a management strategy. We present a rare case of a 2-month old female patient with isolated aplasia cutis congenita, localized on the vertex of the scalp, treated conservatively since birth with good results.
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Affiliation(s)
- A A Chokoeva
- Onkoderma-Policlinic for Dermatology and Dermatologic Surgery, Sofia Bulgaria
| | - G Tchernev
- Onkoderma-Policlinic for Dermatology and Dermatologic Surgery, Sofia Bulgaria
| | - J W Patterson
- Department of General and Clinical Pathology, Department of Dermatology, University of Virginia Health System, Virginia, USA
| | - U Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - T Lotti
- Professor and Chair of Dermatology, University of Rome "G. Marconi", Rome, Italy
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16
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Shaw KC, Kaley JR, Darling MD, Patterson JW, Chokoeva AA, Lotti T, Wollina U, Tchernev G. A case of perforating folliculitis in association with antisynthetase syndrome. J BIOL REG HOMEOS AG 2015; 29:95-98. [PMID: 26016976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Perforating folliculitis (PF) describes the process by which altered dermal material is eliminated from the epidermis through a follicular unit resulting in keratotic, follicular papules that favor hair-bearing regions of the forearms, arms, buttocks, and thighs. Diabetes mellitus (DM) and chronic renal failure (CRF) are commonly associated with PF. The more general term, acquired perforating dermatosis, has been applied to PF as well as Kyrles disease and the non-inherited form of perforating collagenosis. In this report, we describe an instance of PF that arose in the setting of preexisting antisynthetase syndrome.
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Affiliation(s)
- K C Shaw
- University of Maryland School of Medicine, Baltimore, MD USA
| | - J R Kaley
- University of Virginia Health System, Department of Pathology, Charlottesville, VA, USA
| | - M D Darling
- University of Virginia Health System, Department of Pathology, Charlottesville, VA, USA
| | - J W Patterson
- University of Virginia Health System, Departments of Pathology and Dermatology, Charlottesville, VA USA
| | - A A Chokoeva
- Onkoderma-Clinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
| | - T Lotti
- Department of Dermatology, University of Rome G. Marconi Rome, Italy
| | - U Wollina
- Department of Dermatology and Allergology, Academic Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - G Tchernev
- Onkoderma-Clinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
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17
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Tchernev G, Chokoeva AA, Wollina U, Patterson JW, Lotti T. Melanoma imitators- how to prevent the aggressive approach? J BIOL REG HOMEOS AG 2015; 29:75-80. [PMID: 26016972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Melanoma imitators could be lesions of different genres; vascular, infectious (granulomatous) and non-melanocytic tumors in addition to various skin artifacts. Their early recognition is essential for the subsequent and sometimes invasive diagnostic and therapeutic approach by the clinician. This paper focuses on several unique cases involving patients with clinical signs of advanced stage melanoma that actually had either benign lesions or circumstances where surgical excision could be avoided. We also analyze the means through which an early aggressive approach to these lesions could be avoided. The performance of confocal microscopy in dermatologic oncology units is one of the most modern trends in dermatology. Thanks to this method, the differentiation between melanocytic and non melanocytic lesions as well as between vascular lesions and lesions with granulomatous genesis, is substantially facilitated. The use of this methodology in the field of dermatologic oncology can be essential in improving the efficiency of medical services and reducing the number of unjustified surgical excisions.
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Affiliation(s)
- G Tchernev
- Onkoderma- Policlinic for Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - A A Chokoeva
- Onkoderma- Policlinic for Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - U Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - J W Patterson
- Department of Pathology, UVA Health System, Charlottesville, Virginia, USA
| | - T Lotti
- Professor and Chair of Dermatology, University of Rome "G. Marconi", Rome, Italy
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18
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Chokoeva AA, Tchernev G, Gianfaldoni S, Patterson JW, Wollina U, Lotti T. Heel melanoma: the final result of wrong diagnostic and therapeutic approach in another bulgarian patient. First documented case from the board of the adcrstr-association for dermatohistopathologic control, reevaluation and subsequent therapeutic recomme. J BIOL REG HOMEOS AG 2015; 29:111-115. [PMID: 26016978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Difficulties with frequent misdiagnoses and incorrectly defined tumor thicknesses applied to the same histopathological preparation occurring among Bulgarian patients, has led to the creation of national and/or international associations or boards for control in problematic circumstances, particularly for patients with melanocytic and non melanocytic cutaneous tumors. Once again we report a problematic case of a patient with acral lentiginous melanomа, localized in the heel area of the right foot, in an otherwise healthy 69-year old woman. A pigmented lesion gradually developed in her heel area, where the patient had been previously treated several times with invasive therapeutic methods (cryosurgery, shave curettage) due to misdiagnosis as a verrucous lesion or as a viral wart in the absence of any prior histopathology report. Years later, the lesion progressed and changed in color, leading to surgical removal, followed by several histopathological evaluations that produced very different results on three separate occasions. The first result described the lesion as melanocytic nevus, and removed with tumor-free margins. The second report from the Department of Dermatology and Venereology, Military Academy in Sofia , Bulgaria, stated no data for Verrucous carcinoma. Only on the third assessment the correct diagnosis of malignant melanoma was given. A relapse of the melanoma occurred as only at the time of the last histopathologic evaluation, (following surgical resection of the lesion with adequate margins, performed in the Onkoderma- Policlinic for Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria) were criteria followed for appropriate pathological evaluation consistent with the recommendations of the AJCC for reporting of melanomas. Tumor thickness at that time was 1.31 mm. Removal of the draining lymph node, followed by inguinal lymphadenectomy was performed in the National Oncological Hospital in accordance with the recommendations of the AJCC. Unfortunately disease progression was observed with loco-regional lymph node involvement. Systemic therapy with interferon was planned. The incorrect therapeutic approach in this patient, as well as the several subsequent misdiagnoses that were made in the leading pathology departments of the capital, undoubtedly helped lead to the creation of a national board with international participation in order to minimize errors in the diagnostic and therapeutic approach in dermatology, surgery and histopathology. The already-created Association for Dermatohistopathologic Control, Reevaluation and Subsequent Therapeutic Recommendations-ADCRSTR, aims to take control of histopathological preparations with wrong diagnoses and subsequent therapy in patients with cutaneous tumors, as well as their documentation. Another task of the Institution is to focus on the preservation and protection of the rights and interests of affected patients.
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Affiliation(s)
- A A Chokoeva
- Onkoderma-Policlinic for Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - G Tchernev
- Onkoderma-Policlinic for Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - S Gianfaldoni
- Dermatological Department University of Pisa, Pisa, Italy
| | - J W Patterson
- University of Virginia Health System, Department of Pathology, Charlottesville, VA USA
| | - U Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt
| | - T Lotti
- Professor and Chair of Dermatology, University of Rome "G. Marconi", Rome, Italy
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19
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Tchernev G, Chokoeva AA, Schiavone C, D Erme AM, Tana C, Darling M, Kaley J, Gianfaldoni S, Wollina U, Lotti T, Patterson JW. Sarcoidosis exclusion criteria: the simple truth for a complicated diagnosis. J BIOL REG HOMEOS AG 2015; 29:5-9. [PMID: 26016958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The differentiation between sarcoidosis and sarcoid-type reactions remains a clinical and histopathologic diagnostic dilemma. A definitive distinction is yet to be determined according to the current literature data. Sarcoid-like tissue reactions with identifiable infectious or other immunogenic antigens, should be classified as non-specific clinical manifestations of a specific disease. The current assignment of this type of reaction under the generic umbrella of sarcoidosis is incorrect and may result in the subsequent misinterpretation of the definition of the disease in general. On the other hand, this may lead to clinical studies with incorrectly selected inclusion criteria and, therefore, contradictory statements regarding the epidemiology and pathogenesis of the disease. Thus we propose the introduction of new criteria for exclusion of sarcoidosis as an autonomous disease. Recent trials on patients with probable sarcoidosis have focused on ideal criteria, or have provided information about the genetic and immunological profile of patients with specific infections or other diseases, which manifest themself as sarcoidal granulomas. This could explain the heterogeneous clinical and/or genetic profiles of the reported patients, who in fact were not affected by the autonomous disease sarcoidosis. The simplification of the current available data regarding this issue will be of fundamental importance for the correct direction of future studies, whose aim is to unravel the pathogenesis of the immunological cascade in patients with sarcoidosis and sarcoid-like type of reaction. It is expected that the introduction of exclusion criteria will inevitably lead to a change in the approach to diagnosis as well as the fundamental understanding of this mysterious disease, known as sarcoidosis.
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Affiliation(s)
- G Tchernev
- "Onkoderma"-Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
| | - A A Chokoeva
- "Onkoderma"-Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
| | - C Schiavone
- Department of Medicine and Science of Aging, G. dAnnunzio University, Chieti, Italy
| | - A M D Erme
- Division of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Anna Meyer Childrens University Hospital Florence, Italy
| | - C Tana
- Internal Medicine Unit, Guastalla Hospital, AUSL Reggio Emilia, Italy
| | - M Darling
- Department of Pathology, University of Virginia Health System, Charlottesville Virginia, USA
| | - J Kaley
- Department of Pathology, University of Virginia Health System, Charlottesville Virginia, USA
| | - S Gianfaldoni
- Division of Dermatology, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - U Wollina
- Department of Dermatology & Allergology, Hospital Dresden-Friedrichstadt, Academic Teaching Hospital of the Technical University of Dresden, Germany
| | - T Lotti
- Professor and Chair of Dermatology, University of Rome "G. Marconi", Rome, Italy
| | - J W Patterson
- Department of Pathology, University of Virginia Health System, Charlottesville Virginia, USA
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20
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Chokoeva AA, Tchernev G, Patterson JW, Lotti T, Wollina U. Acute overnight painful swelling of a finger. J BIOL REG HOMEOS AG 2015; 29:1-3. [PMID: 26016957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Gouty tophus represents а specific clinical substrate of а specific metabolic disease which requires specific treatment in order to reduce the levels of serum urate. Although curable, the painful tophi enlarge slowly and the time-depending response to the standard anti-gout therapy is longer, which significantly worsens the quality of life of those patients. We present the case of a patient with painful gouty tophus, which was eradicated by a micro invasive surgical technique, leading to an immediate positive effect on the pain symptoms. The performance of surgical techniques for excision of gouty tophus should be considered in all patients with strongly pronounced painful symptoms as well as those who show functional disorders caused by the painful swellings. Although not specific for this disease, the application of this therapeutic option produces substantial and immediate improvement of the painful symptoms and the quality of life of these patients.
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Affiliation(s)
- A A Chokoeva
- Onkoderma Policlinic for Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - G Tchernev
- Policlinic for Dermatology and Venereology, University Hospital Lozenetz, Sofia, Bulgaria
| | - J W Patterson
- Department of Pathology and Dermatology, University of Virginia Health System, Charlottesville, VA, USA
| | - T Lotti
- Professor and Chair of Dermatology, University of Rome "G. Marconi", Rome, Italy
| | - U Wollina
- Department of Dermatology and Allergology Hospital Dresden-Friedrichstadt, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
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21
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Tchernev G, Chokoeva AA, Tana C, Patterson JW, Wollina U, Lotti T. Sarcoid sine sarcoidosis? A classificative, semantic and therapeutic dilemma. J BIOL REG HOMEOS AG 2015; 29:33-34. [PMID: 26016965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Differentiation between sarcoidosis and sarcoid type reactions at the present time remains problematic, if not impossible. Criteria for clinical behavior and/or a systematic diagnostic approach in cases of proven epithelioid cell granulomas in lesional tissue do not currently exist. This is probably the main reason for chronicity of the sarcoid-type reactions within a specific disease or for their progression with the application of incorrect therapy. The refinement of the diagnostic criteria and the classification of both conditions remain objects of further consideration. We present a model for recommendations for an optimal diagnostic approach in patients with epitheloid cell granulomas, aiming to facilitate the differentiation between sarcoidosis and sarcoid type reactions, hopefully leading to optimization of subsequent therapy.
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Affiliation(s)
- G Tchernev
- Policlinic for Dermatology and Venerology, University Hospital Lozenetz, Sofia, Bulgaria
| | - A A Chokoeva
- Onkoderma-Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
| | - C Tana
- Unit of Internistic Ultrasound, Department of Medicine and Science of Aging, University G. dAnnunzio, Chieti, Italy
| | - J W Patterson
- Department of Pathology and Dermatology, University of Virginia Health System, Charlottesville, VA, USA
| | - U Wollina
- Department of Dermatology and Allergology Hospital Dresden-Friedrichstadt Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| | - T Lotti
- Professor and Chair of Dermatology, University of Rome "G. Marconi", Rome, Italy
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22
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Tchernev G, Chokoeva AA, Patterson JW, Wollina U, Lotti T. Sarcoid type reaction: medical hypotheses. J BIOL REG HOMEOS AG 2015; 29:35-38. [PMID: 26016966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Sarcoid-type reactions could not always be clearly distinct from the independent disease sarcoidosis. Particular attention should be paid to paraneoplastic type of sarcoid reaction which until recent literature was characterized as 1) sarcoidosis associated with tumor disease or 2) sarcoidosis classified and presented as paraneoplastic disease. The analogy between sarcoidosis and paraneoplastic type of sarcoid reaction are the pure epithelioid cell granulomas. The role of molecular mimicry in paraneoplastic type of reaction is probably significant but not yet fully proven and understood. Future studies on this issue should be directed to identify the genetic defects (regarding the inflammasome and those recently established at EOS and Blau Syndrome) as well as screening programs for early detection of cancers, with a view to optimization of the subsequent therapy.
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Affiliation(s)
- G Tchernev
- Onkoderma- Policlinic for Dermatology, Venereology and Dermatologic Surgery, General Skobelev 26, Sofia, Bulgaria
| | - A A Chokoeva
- Onkoderma- Policlinic for Dermatology, Venereology and Dermatologic Surgery, General Skobelev 26, Sofia, Bulgaria
| | - J W Patterson
- Department of Pathology and Dermatology, University of Virginia Health System, Charlottesville, VA, USA
| | - U Wollina
- Department of Dermatology and Allergology, Hospital Dresden-Friedrichstadt, Academic Teaching Hospital, Technical University of Dresden, Dresden, Germany
| | - T Lotti
- Professor and Chair of Dermatology, University of Rome "G. Marconi", Rome, Italy
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23
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Trayanova E, Chokoeva AA, Patterson JW, Wollina U, Lotti T, Tchernev G. Desmoplastic malignant melanoma associated with pigmented ocular tumor: second documented problematic case from the board of adcrstr-association for dermatohistopathologic control, re-evaluation and subsequent therapeutic recommendations. J BIOL REG HOMEOS AG 2015; 29:59-64. [PMID: 26016969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Malignant melanoma is the most malignant skin tumor, whose incidence is rising gradually. It usually occurs in pre-existing lesions in photo-exposed areas of the skin, and, despite its occurrence across a broad age range, its appearance prevails among the elderly. It has a tendency to metastasize rapidly. Secondary lesions are often located on mucous membranes including the conjunctiva, which in turn leads to higher mortality. Despite significant achievements in tumor diagnostics, explicit verification of a possible malignant melanoma is achieved by surgical removal of the lesion and its subsequent detailed histopathology. The prognosis for patients is determined by the stage of the primary tumor, tumor thickness and the presence or absence of additional risk factors, respectively. We present the case of a 39-year old female patient who was diagnosed with malignant melanoma of the left shoulder with a tumor thickness of 1 mm. No further microscopic prognostic criteria were described in the histological report. The lack of additional histopathological criteria in the pathologists report, such as mitotic activity and angio-lymphatic invasion from a lesion with this sort of tumor thickness, is followed almost always by risky or inadequate diagnostic and therapeutic decisions that may have fatal consequences for patients. The newly created Association for Dermatohistopathologic Control, Reevaluation and Subsequent Therapeutic Reccomendation in Sofia, Bulgaria aims to focus attention on these errors, in order to promote a unified histopathologic assessment of skin tumors in accordance with generally accepted European and World standards. This should ultimately help the clinician by increasing the efficiency of subsequent diagnostic and therapeutic decisions.
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Affiliation(s)
- E Trayanova
- Onkoderma-Policlinic for Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - A A Chokoeva
- Onkoderma-Policlinic for Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - J W Patterson
- University of Virginia Health System, Department of Pathology and Dermatology, Charlottesville, VA USA
| | - U Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - T Lotti
- Professor and Chair of Dermatology, University of Rome "G. Marconi", Rome, Italy
| | - G Tchernev
- Onkoderma-Policlinic for Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
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24
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Kaley JR, Fullen DR, Gardner JM, Patterson JW, Chokoeva AA, Lotti T, Wollina U, Tchernev G, Patel RM. Vascular neoplasm or pseudovascular nevus? Potential pitfalls in diagnosis. J BIOL REG HOMEOS AG 2015; 29:91-94. [PMID: 26016975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Melanocytic nevi, on histopathologic evaluation, occasionally contain slit-like clefts or spaces that may resemble vascular or lymphatic spaces. The spaces may contain blood or, perhaps more concerning, nests of melanocytes that could suggest lymphatic invasion of melanoma. When lined by melanocytes rather than true endothelium, these pseudovascular spaces within melanocytic nevi are generally attributable to tissue processing artifact. When the space in question is pronounced, a proper diagnostic work-up is prudent in order to exclude a true vascular neoplasm or melanoma. In this case series we present several melanocytic lesions with prominent vascular-appearing spaces that warranted further investigation.
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Affiliation(s)
- J R Kaley
- University of Virginia Health System, Department of Pathology, Charlottesville, VA, USA
| | - D R Fullen
- University of Michigan, Department of Dermatology, Ann Arbor, MI, USA
| | - J M Gardner
- University of Arkansas for Medical Sciences, Department of Pathology, Little Rock, AR, USA
| | - J W Patterson
- University of Virginia Health System, Departments of Pathology and Dermatology, Charlottesville, VA, USA
| | - A A Chokoeva
- Onkoderma-Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
| | - T Lotti
- Department of Dermatology, University of Rome G. Marconi Rome, Italy
| | - U Wollina
- Department of Dermatology & Allergology, Academic Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - G Tchernev
- Onkoderma-Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
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25
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Kaley J, Patterson JW, Chokoeva AA, Lotti T, Wollina U, Tchernev G. Are microscopic satellites in melanoma indicative of lymphovascular invasion? A preliminary case study. J BIOL REG HOMEOS AG 2015; 29:65-68. [PMID: 26016970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Microscopic satellites (microsatellites) in primary melanoma are defined as one or more discontinuous nests of neoplastic melanocytes measuring more than 0.05 mm in diameter that are clearly separated by normal dermis (i.e., no fibrosis or inflammation) from the main invasive component of the melanoma by a distance of at least 0.3 mm. Long considered an adverse prognostic variable, there has been debate about whether these satellites in fact represent lymphovascular invasion. In this preliminary study, 6 cases of primary cutaneous melanoma containing microsatellites were stained immunohistochemically for endothelial cells, using the markers CD31 and D2-40 (podoplanin, a marker of lymphatic endothelium). In none of the cases was positive staining found to surround the tumor deposits. In one case that also showed independent lymphovascular and perineural invasion, a small CD31 positive vessel within the microsatellite was found to contain tumor cells. The possible significance of these findings is discussed.
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Affiliation(s)
- J Kaley
- Department of Pathology, University of Virginia Health System, Charlottesville Virginia, USA
| | - J W Patterson
- Department of Pathology, University of Virginia Health System, Charlottesville Virginia, USA
| | - A A Chokoeva
- Onkoderma-Policlinic for Dermatology, Venereology and Dermatologic Surgery Sofia, Bulgaria
| | - T Lotti
- Professor & Chair of Dermatology University of Rome G.Marconi Rome, Italy
| | - U Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - G Tchernev
- Onkoderma-Policlinic for Dermatology, Venereology and Dermatologic Surgery Sofia, Bulgaria
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26
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Darling MD, Akin R, Tarbox MB, Stetson CL, Patterson JW, Tchernev G, Chokoeva AA, Lotti T, Wollina U. Intralymphatic histiocytosis overlying hip implantation treated with pentoxifilline. J BIOL REG HOMEOS AG 2015; 29:117-121. [PMID: 26016979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Intralymphatic histiocytosis (IH) is a rare condition that presents with livedoid, erythematous to violaceous patches and plaques near affected joints most commonly in patients with rheumatoid arthritis and in at least 8 reports overlying metal implants. We report the case of a 58 year-old Caucasian woman who developed an indurated violaceous reticulated plaque overlying her right hip after placement of a metal hip implant 6 years prior for treatment of osteoarthritis. Histopathology revealed a proliferation of D2-40-positive dilated lymphatic spaces in the dermis and intralymphatic proliferation of CD68-positive histiocytes. Lab results included negative serology for rheumatoid factor and negative leukocyte function testing for metal allergies. The patient was treated with pentoxifylline, which resulted in decreased induration and erythema of the lesion with almost complete resolution of the plaque. This case highlights the diagnostic and therapeutic challenges of cutaneous reactive angiomatoses, which are rare skin conditions that can present with similar clinical and histologic findings and can be differentiated on the basis of immunostains that highlight vascular and lymphatic endothelium and histiocytes. Pentoxifylline may be considered as a therapeutic option because of its anti-inflammatory and antiplatelet activity.
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Affiliation(s)
- M D Darling
- Department of Pathology, UVA Health System, Charlottesville, Virginia, USA
| | - R Akin
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - M B Tarbox
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - C L Stetson
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - J W Patterson
- Department of Pathology, UVA Health System, Charlottesville, Virginia, USA
| | - G Tchernev
- Policlinic for Dermatology and Venereology, Saint Kliment Ohridski University, Medical Faculty, University Hospital Lozenetz, Sofia, Bulgaria
| | - A A Chokoeva
- Onkoderma-Policlinic for Dermatology and Dermatologic Surgery, General Skobelev 26, Sofia, Bulgaria
| | - T Lotti
- Professor and Chair of Dermatology University of Rome G. Marconi Rome, Italy
| | - U Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
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27
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Chokoeva AA, Tchernev G, Patterson JW, Lotti T, Wollina U. Life-threatening onychomycosis imitator. J BIOL REG HOMEOS AG 2015; 29:31-32. [PMID: 26016964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Although onychomycosis is one of the most common dermatological conditions, the exact diagnosis should be carefully confirmed, especially in therapy-resistant cases. Considering the potential for development of various nail disorders that could resemble the clinical picture of typical onychomycosis, the performing of a diagnostic biopsy is sometimes of paramount importance, in order to exclude the possibility of a life threatening onychomycosis imitators. Here, we present a case of subungual malignant melanoma, diagnosed by histological examination in a patient who had received long term, ineffective treatment for onychomycosis.
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Affiliation(s)
- A A Chokoeva
- Onkoderma-Policlinic for Dermatology and Dermatologic Surgery, Sofia Bulgaria
| | - G Tchernev
- Policlinic for Dermatology and Venereology, Saint Kliment Ohridski University, Medical Faculty, University Hospital Lozenetz, Sofia, Bulgaria
| | - J W Patterson
- Department of Pathology and Dermatology, University of Virginia Health System, Charlottesville, VA, USA
| | - T Lotti
- Professor and Chair of Dermatology, University of Rome "G. Marconi", Rome, Italy
| | - U Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
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28
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Edsall LC, Patterson JW. Cutaneous T-cell lymphoma: important diagnostic tools. GIORN ITAL DERMAT V 2010; 145:323-344. [PMID: 20461042] [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: 05/29/2023]
Abstract
Cutaneous T-cell lymphomas comprise a complex group of disorders with heterogeneous clinical and genotypic features. Of these, mycosis fungoides represents the most common subtype. The diagnosis of these entities remains a challenging process due to their diverse clinical presentations and subtle microscopic features. Evaluation currently relies upon clinical criteria, in combination with histochemical, immunological and molecular studies. Recent algorithms have been proposed using criteria that incorporate each of these approaches. This review will focus on tools and techniques utilized for the diagnosis of cutaneous T-cell lymphomas classified within the most recent World Health Organization/European organization for Research and Treatment of Cancer (WHO/EORTC) consensus criteria. Particular emphasis will be placed on mycosis fungoides and Sézary syndrome. Key features facilitating the clinical and microscopic interpretations will be outlined, as well as a synopsis of the advances made in the use of techniques such as immunohistochemistry, flow cytometry and gene rearrangement. We will also consider some recently reported novel approaches that explore these complex diseases at the molecular and genetic levels.
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Affiliation(s)
- L C Edsall
- Department of Pathology, Division of Dermatopathology, University of Virginia, Charlottesville, VA, USA.
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29
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Kaiser CC, Perry DJ, Zimmer AS, Patterson JW, Swain SM. A phase I study of ixabepilone combined with dasatinib in patients with solid tumors. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e13514] [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: 11/20/2022] Open
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30
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Tchernev G, Nenoff P, Patterson JW, Horn LC. Sarcoidosis and sarcoid-like pathologies of the skin: result of a common pathological (immunodeficiency) process? - Authors’ reply to the comment of Dr Luis Ignacio Gonzalez-Granado. J Eur Acad Dermatol Venereol 2010. [DOI: 10.1111/j.1468-3083.2009.03502.x] [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: 11/28/2022]
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31
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Tchernev G, Patterson JW, Nenoff P, Horn LC. Sarcoidosis of the skin â A dermatological puzzle: important differential diagnostic aspects and guidelines for clinical and histopathological recognition. J Eur Acad Dermatol Venereol 2010; 24:125-37. [DOI: 10.1111/j.1468-3083.2009.03396.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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32
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Affiliation(s)
- J W Patterson
- The Department of Therapeutics, University of Edinburgh
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33
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Patterson JW. Be a good neighbor. Water Environ Res 2001; 73:643-644. [PMID: 11833756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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34
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Abstract
PURPOSE To determine the relationship of participation in organized and nonorganized physical activity with fundamental movement skills among adolescents. METHODS Male and female children in Grade 8 (mean age, 13.3 yr) and Grade 10 (mean age, 15.3 yr) were assessed on six fundamental movement skills (run, vertical jump, catch, overhand throw, forehand strike, and kick). Physical activity was assessed using a self-report recall measure where students reported the type, duration, and frequency of participation in organized physical activity and nonorganized physical activity during a usual week. RESULTS Multiple regression analysis indicated that fundamental movement skills significantly predicted time in organized physical activity, although the percentage of variance it could explain was small. This prediction was stronger for girls than for boys. Multiple regression analysis showed no relationship between time in nonorganized physical activity and fundamental movement skills. CONCLUSION Fundamental movement skills are significantly associated with adolescents' participation in organized physical activity, but predict only a small portion of it.
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Affiliation(s)
- A D Okely
- Faculty of Education, University of Wollongong, Wollongong, NSW, Australia.
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35
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Slingluff CL, Yamshchikov G, Neese P, Galavotti H, Eastham S, Engelhard VH, Kittlesen D, Deacon D, Hibbitts S, Grosh WW, Petroni G, Cohen R, Wiernasz C, Patterson JW, Conway BP, Ross WG. Phase I trial of a melanoma vaccine with gp100(280-288) peptide and tetanus helper peptide in adjuvant: immunologic and clinical outcomes. Clin Cancer Res 2001; 7:3012-24. [PMID: 11595689] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
A melanoma vaccine composed of HLA-A2-restricted peptide YLEPGPVTA (gp100(280)), with or without a modified T-helper epitope from tetanus toxoid AQYIKANSKFIGITEL, has been evaluated in a Phase I trial to assess safety and immunological response. The vaccines were administered s.c. in either of two adjuvants, Montanide ISA-51 or QS-21, to 22 patients with high-risk resected melanoma (stage IIB-IV). Local and systemic toxicities were mild and transient. We detected CTL responses to the gp100(280) peptide in peripheral blood in 14% of patients. Helper T-cell responses to the tetanus helper peptide were detected in 79% of patients and had a Th1 cytokine profile. One patient with a CTL response to gp100 had a recurrence in a lymph node 2 years later; her nodes contained CD8+ cells reactive to gp100(280) (0.24%), which proliferated in response to peptide. The overall survival of patients is 75% (95% confidence interval, 57-94%) at 4.7 years follow-up, which compares favorably with expected survival. Four of 14 patients who completed at least six vaccines subsequently developed metastases, all of which were solitary and surgically resectable. They remain alive and clinically free of disease at last follow-up. Data from this trial demonstrate immunogenicity of the gp100(280) peptide and suggest that immune responses may persist long-term in some patients. The frequency and magnitude of the CTL response may be improved with more aggressive vaccination regimens. Although this Phase I study was not intended to evaluate clinical benefit, the excellent survival of patients on this protocol suggests the possibility of a benefit that should be assessed in future studies.
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Affiliation(s)
- C L Slingluff
- Department of Surgery, University of Virginia, Charlottesville, 22908, USA.
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36
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Abstract
Syringocystadenoma papilliferum usually arises in the head and neck region. Linear lesions occurring in other locations are rare. We report such a case occurring on the thigh, documented by multiple biopsy specimens. The case is discussed in the context of other adnexal tumors that may form linear arrangements.
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Affiliation(s)
- J W Patterson
- Department of Dermatology, University of Virginia Medical Center, Charlottesville, USA.
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37
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Abstract
We review the literature on Merkel cell carcinoma (MCC; primary neuroendocrine carcinoma of the skin) and add 36 cases to the over 800 already described in the literature. Though generally considered a tumor of the elderly, MCC can also occur in young patients. Microscopically, there are dermal proliferations of small cells possessing nuclei with finely dispersed chromatin. The occasional presence of squamous or eccrine differentiation suggests a pluripotential stem cell origin. Immunohistochemistry is of great help in distinguishing these tumors from potential mimics such as malignant melanoma, lymphoma, or metastatic small cell (neuroendocrine) carcinomas. Recent chromosomal studies have enhanced our understanding of the biology of these tumors. Despite the high metastatic rate associated with Merkel cell carcinoma, spontaneous regression has been reported, and there have been some therapeutic successes. The high survival rate for stage I lesions indicates the importance of early recognition and treatment of these tumors.
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Affiliation(s)
- P D Smith
- Department of Pathology, University of Virginia Medical Center, Charlottesville 22908, USA
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38
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Yamshchikov GV, Barnd DL, Eastham S, Galavotti H, Patterson JW, Deacon DH, Teates D, Neese P, Grosh WW, Petroni G, Engelhard VH, Slingluff CL. Evaluation of peptide vaccine immunogenicity in draining lymph nodes and peripheral blood of melanoma patients. Int J Cancer 2001; 92:703-11. [PMID: 11340576 DOI: 10.1002/1097-0215(20010601)92:5<703::aid-ijc1250>3.0.co;2-5] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Many peptide epitopes for cytotoxic T lymphocytes (CTLs) have been identified from melanocytic differentiation proteins. Vaccine trials with these peptides have been limited mostly to those associated with HLA-A2, and immune responses have been detected inconsistently. Cases of clinical regression have been observed after peptide vaccination in some trials, but melanoma regressions have not correlated well with T-cell responses measured in peripheral blood lymphocytes (PBLs). We vaccinated stage IV melanoma patients with a mixture of gp100 and tyrosinase peptides restricted by HLA-A1 (DAEKSDICTDEY), HLA-A2 (YLEPGPVTA and YMDGTMSQV) and HLA-A3 (ALLAVGATK) in an emulsion with GM-CSF and Montanide ISA-51 adjuvant. CTL responses were assessed in PBLs and in a lymph node draining a vaccine site (sentinel immunized node, SIN). We found CTL responses to vaccinating peptides in the SIN in 5/5 patients (100%). Equivalent assays detected peptide-reactive CTLs in PBLs of 2 of these 5 patients (40%). CTLs expanded from the SIN lysed melanoma cells naturally expressing tyrosinase or gp100. We demonstrated immunogenicity for peptides restricted by HLA-A1 and -A3 and for 1 HLA-A2 restricted peptide, YMDGTMSQV. Immune monitoring of clinical trials by evaluation of PBLs alone may under-estimate immunogenicity; evaluation of SIN provides a new and sensitive approach for defining responses to tumor vaccines and correlating these responses with clinical outcomes. This combination of an immunogenic vaccine strategy with a sensitive analysis of CTL responses demonstrates the potential for inducing and detecting anti-tumor immune responses in the majority of melanoma patients.
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Affiliation(s)
- G V Yamshchikov
- Division of Surgical Oncology, Department of Surgery, University of Virginia HSC, Charlottesville, VA 22908, USA
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39
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Lin KY, Patterson JW, Simmons J, Long MD, Schultz RO, Amiss LR, Molloy JA, Kelly MD. Effects of External Beam Irradiation on the TRAM Flap: An Experimental Model. Plast Reconstr Surg 2001; 107:1190-7; discussion 1198-200. [PMID: 11373560 DOI: 10.1097/00006534-200104150-00014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 11/25/2022]
Abstract
The rat model of the transverse rectus abdominis musculocutaneous (TRAM) flap was used in the present study to determine the effects of external beam radiation on myocutaneous flap histology and pathophysiology. A total of 57 adult Sprague-Dawley rats underwent a TRAM procedure. A pilot study with 17 animals was first performed to determine proper radiation dosages, and the remaining 40 rats were then used in the definitive study. In half of the definitive study group, the flaps were subjected to fractionated doses of external beam radiation, whereas the other half served as controls. Six weeks after the last radiation dose, all animals were killed and the flaps were harvested for mechanical assessment and histopathologic evaluation. All TRAM flaps survived in both groups. The irradiated and nonirradiated flaps were minimally distinguishable in viscoelastic properties, as well as by histopathologic examination. Growth of the flap in the irradiated animals was significantly diminished (48 percent average surface area increase in irradiated flaps, versus 92 percent increase in nonirradiated flaps, p < 0.05). These findings suggest that the myocutaneous flap is relatively resistant to some of the known adverse affects of radiation on living tissues.
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Affiliation(s)
- K Y Lin
- Department of Plastic Surgery, Box 800376, University of Virginia Health Sciences Center, Charlottesville, VA 22908, USA.
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40
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Yamshchikov G, Thompson L, Ross WG, Galavotti H, Aquila W, Deacon D, Caldwell J, Patterson JW, Hunt DF, Slingluff CL. Analysis of a natural immune response against tumor antigens in a melanoma survivor: lessons applicable to clinical trial evaluations. Clin Cancer Res 2001; 7:909s-916s. [PMID: 11300491] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The long-term survival of some patients with metastatic melanoma may be attributable in part to cellular immune responses to melanoma antigens. However, little is known about the level of CTL reactivity in vivo that is required for immunological control of tumor progression. In the present report, T-cell responses were evaluated with lymphocytes obtained from tumor-involved nodes and peripheral blood of a long-term melanoma survivor. Using an ELISPOT assay, naturally occurring functional T cells, which recognize the peptide ALLAVGATK (gp100(17-25)) plus two other HLA-A3 restricted peptides, were detected in a tumor-involved lymph node. The ALLAVGATK-reactive T cells were also evaluated by MHC-tetramers staining and were found to be CD8+ CD45RO+ L-selectin(-) CD11a+, suggesting that they are antigen experienced and have a memory phenotype. Unstimulated peripheral blood lymphocytes from the same patient demonstrated no detectable T-cell responses; however, a single stimulation with ALLAVGATK peptide in vitro resulted in a dramatic expansion of peptide-reactive CTLs. This patient, with evidence of tumor-reactive CTLs targeted to several tumor antigens in a tumor-involved lymph node and with evidence of a circulating memory T-cell response, has remained disease-free for 6 years, despite prior bulky nodal metastasis. In contrast, three HLA-A3+ patients with rapidly progressive metastatic melanoma had no detectable T-cell response in tumor-involved nodes or peripheral blood lymphocytes, even after peptide stimulation ex vivo. The presented data are consistent with a systemic polyvalent immune response against tumor in this long-term survivor. These data provide an estimate of the level of CTL response that may be associated with protection from tumor recurrence.
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Affiliation(s)
- G Yamshchikov
- Department of Surgery, University of Virginia Health Sciences Center and Cancer Center, Charlottesville 22908, USA
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41
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Abstract
Onychomatricoma was first described in 1992 by Baran and Kint. Twenty cases have been reported to date, all of which are from Europe. This tumor has characteristic clinical, light microscopic, and ultrastructural features which have recently been refined andjustify its categorization as a novel tumor of the nail matrix. We examined a specimen sent in consultation by a large reference laboratory; despite improper orientation and absence of the involved nail plate, it had microscopic characteristics consistent with onychomatricoma. Soon thereafter, a second patient presented with a tumor arising in the nailbed that bore a superficial resemblance to onychomatricoma but showed the microscopic features of fibrokeratoma. We discuss the differentiation between these two lesions and point out that a distinction can be made even when incomplete material is submitted for review. To our knowledge, this is the first example of onychomatricoma to be reported from North America.
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Affiliation(s)
- G R Fraga
- Department of Pathology, University of Virginia Medical Center, Charlottesville 22908, USA
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42
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Affiliation(s)
- J C English
- Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia, USA.
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43
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Dittrich LB, English JC, Hendrix JD, Patterson JW. Friable scalp nodule in an elderly man. Arch Dermatol 2000; 136:1409-14. [PMID: 11074708 DOI: 10.1001/archderm.136.11.1409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- L B Dittrich
- University of Virginia, Charlottesville, VA, USA
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44
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Abstract
Aortic angiosarcoma is a rare malignancy. Clinical diagnosis is difficult, as the presenting symptoms mimic more common aortic lesions, particularly atherosclerosis. Dermatologists and dermatopathologists play a critical role in recognizing cutaneous metastases as a manifestation of this life-threatening tumor. We describe the fourth case of aortic angiosarcoma in the literature with initial presentation in the skin.
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Affiliation(s)
- R J Rudd
- Department of Dermatology, University of Virginia, Charlottesville, VA, USA
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45
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Abstract
Hailey-Hailey disease is a recurrent, autosomal dominant vesiculobullous dermatotis with a predilection for intertrigenous areas. We report what we believe to be the first case of squamous cell carcinoma arising de novo in a skin lesion of Hailey-Hailey disease. The occurrence of malignant neoplasms arising in the skin lesions of Hailey-Hailey disease and other acantholytic dermatoses is reviewed.
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Affiliation(s)
- V A Holst
- Departments of Pathology and Dermatology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908-0214, USA
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46
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Abstract
Cutaneous deciduosis is an exceedingly rare manifestation of endometriosis potentially mistaken for malignancy and thus far documented solely within surgical scars. We describe two additional cases, one occurring in a pregnant 21-year-old woman as a solitary flat erythematous vulvar papule, an extraordinary location not previously recorded. Histologic examination in that case revealed a subepithelial nodular aggregate of atypical large dyscohesive cells with accompanying edema and inflammation. An immunohistochemical panel showed positivity of the cells for vimentin and Ki-1 (CD30). Intracellular sulfated mucin and glycogen were also demonstrated. In a second case, a 27-year-old woman had a nodule at the umbilicus, removed incidentally during the course of cesarean section. Microscopically there were several circumscribed, multilobulated, intradermal nodules with variably sized lumens formed by crowded large epithelioid cells. The disparate histologic appearance of these examples highlights an essential challenge in their diagnosis. Clinical recognition is difficult unless suggested by more characteristic history or location.
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Affiliation(s)
- K P Fair
- Departments of Pathology and Dermatology, University of Virginia Health Science Center, Charlottesville 22908-0214, USA
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47
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Affiliation(s)
- M R Wick
- Fechner Laboratory of Surgical Pathology, University of Virginia Medical Center, PO Box 800214, Jefferson Park Avenue, Charlottesville, VA 22908, USA
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48
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Affiliation(s)
- T M Colonna
- University of Virginia, Charlottesville, USA
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49
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Kavanagh BD, Campbell RL, Patterson JW, O'Neill RL, Cardinale RM, Kaugars GE. Desmoplastic malignant melanoma of the palatal alveolar mucosa: sustained disease-free survival after surgery and postoperative radiotherapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 89:465-70. [PMID: 10760728 DOI: 10.1016/s1079-2104(00)70126-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aggressive surgical and radiotherapeutic management of a patient with desmoplastic malignant melanoma arising from the mucosa of the oral cavity has resulted in disease-free survival of more than 2(1/2) years after diagnosis. This case represents only the tenth reported instance of desmoplastic malignant melanoma arising from the oral cavity and only the third for which survival has exceeded 2 years. Details of the clinical, histopathologic, and therapeutic features of the case are provided to augment the paucity of literature available to clinicians managing this rare disease.
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Affiliation(s)
- B D Kavanagh
- Department of Radiation Oncology, Medical College of Virginia Hospital Campus, Virginia Commonwealth University, Richmond, VA 23298-0058, USA.
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50
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Abstract
Lipedematous alopecia is a rare condition of unknown etiology characterized by a thick, boggy scalp with varying degrees of hair loss that occurs in adult black females, with no clearly associated medical or physiologic conditions. The fundamental pathologic finding consists of an approximate doubling in scalp thickness resulting from expansion of the subcutaneous fat layer in the absence of adipose tissue hypertrophy or hyperplasia. Observations by light and electron microscopy detailed in this report suggest that this alteration principally manifests by localized edema with disruption and degeneration of adipose tissue. Some diminution in the number of follicles as well as focal bulb atrophy is noted. Aberrant mucin deposition such as that seen in myxedema or other cutaneous mucinoses is not a feature. The histologic findings bear some resemblance to those seen in lipedema of the legs, a relatively common but infrequently diagnosed condition. We present a case of lipedematous alopecia with emphasis on histologic and ultrastructural features. The etiology is unknown.
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Affiliation(s)
- K P Fair
- Department of Pathology, University of Virginia Health Science Center, Charlottesville 22908-0214, USA
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