Merkel cell carcinoma with divergent differentiation

Merkel cell carcinoma (MCC) is a rare primary neuroendocrine carcinoma of the skin, usually occurring at sun-exposed sites in elderly people. Divergent differentiation in MCC, although rare, has been reported in previous case series. We describe two new cases of MCC with divergent differentiation. Patient 1 was a 96-year-old man with a scalp lesion; on biopsy, the morphology and immunoprofile suggested MCC with divergent squamous differentiation. Patient 2 was an 87-year-old woman with a lesion on her leg, originally reported as squamous cell carcinoma, later showing extensive local recurrence. On review, primary histology showed an MCC with divergent differentiation, most likely trichilemmal carcinoma; the recurrence showed only MCC. These cases illustrate that MCC is capable of divergent differentiation, including squamous and adnexal morphologies. Correct diagnosis is essential for appropriate prognosis and management, as later recurrence or metastases may only show the Merkel cell component.

Association of cytokine gene polymorphism with susceptibility and clinical types of leprosy

BACKGROUND

Both pro- and anti-inflammatory cytokines are implicated in development and prognosis of leprosy so the genetic regulation of such cytokines could play an important role.

OBJECTIVE

. This study was planned for testing the association of cytokine gene polymorphisms with susceptibility and clinical types of leprosy among Egyptian cases.

SUBJECTS

This study included 47 cases (29 men, 18 females, mean age = 46.3 years) with leprosy in addition to 98 healthy unrelated controls (52 males, 46 females, mean age = 44.9 years). Cases were recruited from Leprosy Clinics, Delta region of Egypt. Cases were classified into paucibacillary (PB) (n = 17; 10 males, 7 females; mean age 42.6 years) and multibacillary (MB) (n = 29; 19 males, 10 females; mean age 43.9 years).

METHODS

For all cases and controls, DNA was extracted and amplified using polymerase chain reaction with sequence specific primers (PCR-SSP) for detection of single nucleotide polymorphisms (SNPs) in the promoter regions of cytokine genes, TNF-α-308 (G/A), IL-10-1082(G/A), IL-6-174(G/C) as well as IL-1RaVNTR in intron 2 of the gene.

RESULTS

COMPARED TO CONTROLS, ALL CASES HAVE SHOWN INCREASED FREQUENCY OF HOMOZYGOUS GENOTYPES : IL-10-1082 (GG) (Odds ratio 6.6, P <0.05), homozygous TNF-α-308 (GG) (Odds ratio =3.23), and homozygous IL-1Ra (11) (Odds ratio = 3.6, P<0.05) with increased frequency of IL10 G and ILRa 1 alleles (P<0.05). BP subgroup showed increased frequency of homozygous IL-10-1082 (GG) (Odds ratio = 18.6, P<0.05) with increased frequency of IL10 G allele (P<0.05). On the other hand, MB subgroup showed increased frequency of homozygous TNF-α-308 (GG) (Odds ratio = 5.84, P<0.05) and homozygous IL-1Ra (11) (Odds ratio = 4, P<0.05) with increased frequency of IL-1Ra 1 allele (P<0.05). There is predominance for heterozygous IL-6-174 (G/C) polymorphism in all studies patient subgroups as well as controls with no significant difference among them.

CONCLUSION

Genetic polymorphisms related to TNF-α-308 and IL-10-1082 and IL-1Ra may be used as genetic markers for susceptibility and clinical outcome of leprosy among Egyptian cases from the Nile Delta.

Evaluation of penile revascularization for erectile dysfunction: a 10-year follow-up

The objective of this study was to report long-term success rates for penile revascularization (PR) and investigate factors responsible for failures. During the past 10 y, data were obtained on 52 patients who underwent PR. Surgical technique was selected according to preoperative arteriographic findings. The mean age was 28.5 y and the mean follow-up was 70.8 months. Success was defined as satisfactory intercourse without additional therapy. Overall success was 48%. Patients under 28 y showed a 73% success rate vs 23% in the older ones (P=0.0003). Nonsmokers had a 57% success compared to 29% in smokers (P=0.05). The presence of venous leak and type of procedure had an insignificant impact on success (P=0.33 and 0.23 respectively). To conclude, this curative treatment option is limited to a selective population with vasculogenic erectile dysfunction. We found that the cure rate of this procedure is maintained and long-term follow-up shows good results, especially in the young nonsmokers.

Deltamethrin-induced testicular apoptosis in rats: the protective effect of nitric oxide synthase inhibitor

This study is the first to examine and characterize the testicular apoptosis which might be induced due to exposure of male rats to deltamethrin. Furthermore, the role which might be played by nitric oxide (NO), as well as the other reactive oxygen species (ROS) in controlling this testicular apoptosis was assessed. Apoptosis was evaluated by DNA fragmentation detected by agarose gel electrophoresis and cellular morphology on testicular tissue sections. It was found that administration of deltamethrin (1 mg/kg daily for 21 days) to animals resulted in characteristic DNA migration patterns (laddering), thereby providing evidence that apoptosis is the major mechanism of cell death in the testicular tissues. In addition, histopathological examination of testicular tissue sections showed that apoptosis was confined to the basal germ cells, primary and secondary spermatocytes. These changes, in addition to the appearance of Sertoli cell vacuoles in deltamethrin-intoxicated animals, indicates the suppression of spermatogenesis. At the same time, the plasma levels of both NO and lipid peroxides measured as malondialdehyde (MDA) were found to be significantly increased in deltamethrin-treated animals. Administration of NO synthase (NOS) inhibitors such as N(G)-nitro monomethyl L-arginine hydrochloride (L-NMMA, 1 mg/kg) to rats 2 h before exposure to deltamethrin was effective in the reduction of the typically testicular apoptotic DNA fragmentation pattern and the associated histopathological changes. These findings may suggest that deltamethrin-induced testicular apoptosis is mediated by NO. Therefore, the pharmacological manipulation of apoptosis by selective NOS inhibitors such as L-NMMA may offer new possibilities for the control of deltamethrin-induced testicular dysfunction and infertility in the future.

Effect of diclofenac sodium (Voltaren) on spermatogenesis of infertile oligospermic patients

The effect of the prostaglandin synthesis inhibitor diclofenac sodium (Voltaren) on spermatogenesis in infertile oligospermic patients has been studied. Diclofenac sodium was given orally at a daily dose of 100 mg for 30 days. Seminal fluid parameters were evaluated. Group II with high levels of seminal prostaglandin showed a statistically significant increase in the number and motility of spermatozoa (p less than 0.01), whilst no significant variations were observed in patients of group I with normal values of seminal prostaglandin.

Spinal cord compression in neuroblastoma

Twelve of 80 patients suffering from neuroblastoma who were treated during a 21-year period had intraspinal involvement. Mediastinal tumors have a greater tendency to extend to the spinal canal; however, distant spread of the tumor is rare in patients presenting with intraspinal extension. Patients with intraspinal extension also survive longer than those without. Other factors affecting survival are age, stage of disease, duration of neurological symptoms, degree of histologic differentiation, and mode of therapy. In the absence of osseous metastasis, total excision of the primary lesion and its intraspinal components is usually followed by a favorable outcome; residual neurological deficits among survivors, however, are relatively common.

A study of the absorptive function of the small intestine in childhood malignant lymphomas

A study of the absorptive function of the small intestine in chidlhood malignant lymphomas was carried out at the Cancer Institute of Cairo University. The study comprised twenty-five children, with stage III or IV lymphoma. A complete lymphoma work-up was performed for each patient, comprising clinical, pathological, haematological, biochemical and roentgenological assessments. Evaluation of small intestinal function was done by means of mucosal biopsy, small bowel motor meal, xylose excretion test, and estimation of faecal fat excretion. These tests revealed evidence of malabsorption in 69% of the patients. The study provides a better understanding of childhood malignant lymphomas in Egypt, and shows that malabsorption may be more common in the disease than has been previously suspected.

The cortico-nigral fibre tract. An experimental Fink-Heimer study in cats

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Studies with 15N-labeled ammonia and urea in the malnourished child

Investigations using ammonium citrate-(15)N and urea-(15)N showed that children in the acute stage of kwashiorkor and marasmus receiving a diet of adequate protein content retained a considerable percentage of the label from both compounds. Excretion of both total (15)N and urea-(15)N was subnormal and elimination was virtually completed 36 hr after administration of the isotope. During recovery from kwashiorkor total (15)N excretion had approached normal a month after commencement of rehabilitation. Urea-(15)N excretion was still slightly subnormal after 3 months. In marasmus urea-(15)N formed a normal proportion of total (15)N excretion after 1 month, although total (15)N excretion then was still low. Ammonia nitrogen was retained to a greater extent than urea nitrogen in all cases. As it is known that a considerable amount of urea is degraded to ammonia in the gastrointestinal tract, it seems probable that urea nitrogen became available for use after this degradation. Examination of blood from one marasmic child after feeding ammonia-(15)N and from another after intravenous injection of urea-(15)N showed incorporation of the label into blood cells and plasma proteins. This did not occur in well nourished controls. It is concluded that ammonia and urea as sources of nonessential nitrogen may play an important part in protein metabolism in the malnourished child.