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Brunner G, Roux MS, Falk T, Bresch M, Böhm V, Blödorn-Schlicht N, Meiners T. The Peripheral Lymphatic System Is Impaired by the Loss of Neuronal Control Associated with Chronic Spinal Cord Injury. Am J Pathol 2022; 192:1448-1457. [PMID: 35843264 DOI: 10.1016/j.ajpath.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 06/03/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
Spinal cord injury (SCI) is associated with venous vascular dysfunction below the level of injury, resulting in dysregulation of tissue fluid homeostasis in afflicted skin. The purpose of this study was to determine whether loss of neuronal control in chronic SCI also affects the skin lymphatic system. Morphology of lymphatics was characterized by immunohistochemistry and lymphatic gene expression profiles determined by DNA microarray analysis. In SCI, skin lymphatic function appeared to be impaired, because the ratio of functionally dilated versus collapsed lymphatic vessels was decreased 10-fold compared with control. Consequently, the average lumen area of lymphatic vessels was almost halved, possibly due to the known impaired connective tissue integrity of SCI skin. In fact, collagenases were found to be overexpressed in SCI skin, and dermal collagen structure was impaired. Molecular profiling also suggested an SCI-specific phenotype of increased connective tissue turnover and decreased lymphatic contractility. The total number of lymphatic vessels in SCI skin, however, was doubled, pointing to enhanced lymphangiogenesis. In conclusion, these data show, for the first time, that lymphatic function and development in human skin are under neuronal control. Because peripheral venous and lymphatic vascular defects are associated with disturbed fluid homeostasis, inappropriate wound healing reactions, and impaired skin immunity, they might contribute to the predisposition of afflicted individuals to pressure ulcer formation and wound healing disorders.
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Affiliation(s)
- Georg Brunner
- Center for Spinal Cord Injuries, Werner Wicker Hospital, Bad Wildungen, Germany; Department of Cancer Research, Fachklinik Hornheide, Münster, Germany.
| | - Meike S Roux
- Department of Cancer Research, Fachklinik Hornheide, Münster, Germany
| | - Thomas Falk
- Department of Dermatohistopathology, Dermatologikum Hamburg, Hamburg, Germany
| | - Martina Bresch
- Department of Dermatohistopathology, Dermatologikum Hamburg, Hamburg, Germany
| | - Volker Böhm
- Center for Spinal Cord Injuries, Werner Wicker Hospital, Bad Wildungen, Germany
| | | | - Thomas Meiners
- Center for Spinal Cord Injuries, Werner Wicker Hospital, Bad Wildungen, Germany
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Sunderkötter C, Becker K, Kutzner H, Meyer T, Blödorn-Schlicht N, Reischl U, Nenoff P, Geißdörfer W, Gräser Y, Herrmann M, Kühn J, Bogdan C. Molecular diagnosis of skin infections using paraffin-embedded tissue - review and interdisciplinary consensus. J Dtsch Dermatol Ges 2019; 16:139-147. [PMID: 29418086 DOI: 10.1111/ddg.13438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 08/21/2017] [Indexed: 01/18/2023]
Abstract
Nucleic acid amplification techniques (NATs), such as PCR, are highly sensitive and specific methods that have become valuable supplements to culture and serology in the diagnosis of infectious disorders. However, especially when using formalin-fixed and paraffin-embedded tissue, these techniques are associated with both false-negative and false-positive results, a pitfall that is frequently misjudged. Representatives of the German Society of Hygiene and Microbiology (DGHM) and the German Society of Dermatology (DDG) therefore set out to develop a consensus - in the form of a review article - on the appropriate indications for NATs using paraffin-embedded tissue, its contraindications, and the key points to be considered in the pre- and post-analytical phase. Given that fresh, naive tissue is preferably to be used in the workup of a suspected infection, PCR analysis on paraffin sections represents an exception. The latter may be considered if an infection is suspected at a later point in time and fresh tissue has not been preserved or can no longer be obtained. Potential indications include confirmation of histologically suspected infections with Leishmania spp., Bartonella spp., Rickettsia spp., or in case of ecthyma contagiosum. Infections with, for example, mycobacteria or RNA viruses, on the other hand, are not considered useful indications for NATs using paraffin sections. In order to avoid misinterpretation of test results, it is essential that laboratory reports on NATs using paraffin-embedded tissue contain information on the indication/diagnostic circumstances, the required and chosen pre-analytical steps, the limitations of the method, and on diagnostic alternatives.
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Affiliation(s)
- Cord Sunderkötter
- Department of Translational Dermatoinfectiology, Westphalian Wilhelms University, Münster, Germany, and Department of Dermatology and Venereology, University Medical Center, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Karsten Becker
- Institute of Medical Microbiology, University Medical Center, Münster, Germany
| | | | - Thomas Meyer
- Institute for Medical Microbiology, Virology, and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Udo Reischl
- Institute of Clinical Microbiology and Hygiene, University Medical Center, Regensburg, Germany
| | - Pietro Nenoff
- Laboratory of Medical Microbiology, Rötha OT Mölbis, Germany
| | - Walter Geißdörfer
- Microbiology Institute - Clinical Microbiology, Immunology, and Hygiene, University Medical Center, Erlangen, Germany
| | - Yvonne Gräser
- Institute of Microbiology and Hygiene, University Medicine Berlin - Charite, Berlin, Germany
| | - Mathias Herrmann
- Institute of Medical Microbiology and Hygiene Institute for Infectious Diseases, Saarland University Medical Center, now: Dean of the Medical Faculty, Westphalian Wilhelms University, Münster, Germany
| | - Joachim Kühn
- Institute of Virology, University Medical Center, Münster, Germany
| | - Christian Bogdan
- Institute of Microbiology - Clinical Microbiology, Immunology, and Hygiene, University Medical Center and Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Sunderkötter C, Becker K, Kutzner H, Meyer T, Blödorn-Schlicht N, Reischl U, Nenoff P, Geißdörfer W, Gräser Y, Herrmann M, Kühn J, Bogdan C. Molekulare Diagnostik von Hautinfektionen am Paraffinmaterial - Übersicht und interdisziplinärer Konsensus. J Dtsch Dermatol Ges 2019; 16:139-148. [PMID: 29418100 DOI: 10.1111/ddg.13438_g] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 08/21/2017] [Indexed: 12/20/2022]
Abstract
Nukleinsäure-Amplifikations-Techniken (NAT), wie die PCR, sind hochsensitiv sowie selektiv und stellen in der mikrobiologischen Diagnostik wertvolle Ergänzungen zur kulturellen Anzucht und Serologie dar. Sie bergen aber gerade bei formalinfixiertem und in Paraffin eingebettetem Gewebe ein Risiko für sowohl falsch negative als auch falsch positive Resultate, welches nicht immer richtig eingeschätzt wird. Daher haben Vertreter der Deutschen Gesellschaft für Hygiene und Mikrobiologie (DGHM) und der Deutschen Dermatologischen Gesellschaft (DDG) einen Konsensus in Form einer Übersichtsarbeit erarbeitet, wann eine NAT am Paraffinschnitt angezeigt und sinnvoll ist und welche Punkte dabei in der Präanalytik und Befundinterpretation beachtet werden müssen. Da bei Verdacht auf eine Infektion grundsätzlich Nativgewebe genutzt werden soll, ist die PCR am Paraffinschnitt ein Sonderfall, wenn beispielsweise bei erst nachträglichaufgekommenem Verdacht auf eine Infektion kein Nativmaterial zur Verfügung steht und nicht mehr gewonnen werden kann. Mögliche Indikationen sind der histologisch erhobene Verdacht auf eine Leishmaniose, eine Infektion durch Bartonellen oder Rickettsien, oder ein Ecthyma contagiosum. Nicht sinnvoll ist oder kritisch gesehen wird eine NAT am Paraffinschnitt zum Beispiel bei Infektionen mit Mykobakterien oder RNA-Viren. Die Konstellation für eine NAT aus Paraffingewebe sollte jeweils benannt werden, die erforderliche Prä-Analytik, die jeweiligen Grenzen des Verfahrens und die diagnostischen Alternativen bekannt sein. Der PCR-Befund sollte entsprechend kommentiert werden, um Fehleinschätzungen zu vermeiden.
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Affiliation(s)
- Cord Sunderkötter
- Abteilung für translationale Dermatoinfektiologie, Westfälische Wilhelms-Universität Münster und Universitätsklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg
| | - Karsten Becker
- Institut für Medizinische Mikrobiologie, Universitätsklinikum Münster
| | | | - Thomas Meyer
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf
| | | | - Udo Reischl
- Institut für Klinische Mikrobiologie und Hygiene, Universitätsklinik Regensburg
| | - Pietro Nenoff
- Labor für medizinische Mikrobiologie, Rötha OT Mölbis
| | - Walter Geißdörfer
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen
| | - Yvonne Gräser
- Institut für Mikrobiologie und Hygiene, Universitätsmedizin Berlin - Charité
| | - Mathias Herrmann
- Institut für Medizinische Mikrobiologie und Hygiene Institute für Infektionsmedizin, Universitätsklinikum des Saarlandes, jetzt Dekanat der Medizinischen Fakultät, Westfälische Wilhelms-Universität Münster
| | - Joachim Kühn
- Institut für Virologie, Universitätsklinikum Münster
| | - Christian Bogdan
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen und Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg
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Reich K, Reich JLK, Falk TM, Blödorn-Schlicht N, Mrowietz U, von Kiedrowski R, Pfeiffer C, Niesmann J, Frambach Y, Warren RB. Clinical response of psoriasis to subcutaneous methotrexate correlates with inhibition of cutaneous T helper 1 and 17 inflammatory pathways. Br J Dermatol 2019; 181:859-862. [PMID: 30972731 DOI: 10.1111/bjd.18001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- K Reich
- Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Germany.,Skinflammation Center, Hamburg, Germany, Dermatologikum Berlin, Berlin, Germany
| | - J L K Reich
- School of Medicine, Imperial College London, U.K
| | - T M Falk
- Dermatologikum Hamburg, Hamburg, Germany
| | | | - U Mrowietz
- Psoriasis-Centre, Department of Dermatology, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | | | - C Pfeiffer
- Department of Dermatology and Allergology, University of Ulm, Germany
| | - J Niesmann
- Hautzentrum im Jahrhundert Haus - Centre for Clinical Trials, Bochum, Germany
| | | | - R B Warren
- Dermatological Sciences, University of Manchester, Manchester, U.K
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Brunner G, Heinecke A, Falk TM, Ertas B, Blödorn-Schlicht N, Schulze HJ, Suter L, Atzpodien J, Berking C. A Prognostic Gene Signature Expressed in Primary Cutaneous Melanoma: Synergism With Conventional Staging. JNCI Cancer Spectr 2018; 2:pky032. [PMID: 31360859 PMCID: PMC6649804 DOI: 10.1093/jncics/pky032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/25/2018] [Accepted: 06/08/2018] [Indexed: 12/13/2022] Open
Abstract
Background Current clinico-pathological American Joint Committee on Cancer (AJCC) staging of primary cutaneous melanoma is limited in its ability to determine clinical outcome, and complementary biomarkers are not available for routine prognostic assessment. We therefore adapted a gene signature, previously identified in fresh-frozen (FF) melanomas and adjacent stroma, to formalin-fixed paraffin-embedded (FFPE) melanomas. The aim was to develop a gene expression profiling (GEP) score to define patient survival probability at the time of first diagnosis. Methods Expression of 11 FF melanoma signature genes was quantified by reverse transcription polymerase chain reaction in an FFPE melanoma training cohort (n = 125), corresponding to the combined FF melanoma training and validation cohorts. The resulting GEP score was validated technically and clinically in an independent FFPE melanoma cohort (n = 211). All statistical tests were two-sided. Results We identified a prognostic eight-gene signature in the tumor area (tumor and adjacent tissue) of AJCC stage I–III melanomas. A signature-based GEP score correlated with melanoma-specific survival (MSS; Kaplan-Meier analysis: P < .0001) was independent of tumor stage (multivariable regression analysis: P = .0032) and stroma content (<5%–90%) and complemented conventional AJCC staging (receiver operating characteristic curve analysis: area under the curve = 0.91). In the clinical validation cohort, the GEP score remained statistically significant (P = .0131) in a multivariable analysis accounting for conventional staging. The GEP score was technically robust (reproducibility: 93%; n = 84) and clinically useful, as a binary as well as a continuous score, in predicting stage-specific patient MSS. Conclusions The GEP score is a clinically significant prognostic tool, contributes additional information regarding the MSS of melanoma patients, and complements conventional staging.
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Affiliation(s)
| | - Achim Heinecke
- Department of Biometry and Clinical Research, Westphalian Wilhelms University, Muenster, Germany
| | | | | | | | | | | | - Jens Atzpodien
- Department of Medical Oncology, Niels Stensen Clinics, Osnabrück, Germany
| | - Carola Berking
- Department of Dermatology, University Hospital, Munich, Germany
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Garbe C, Eigentler TK, Bauer J, Blödorn-Schlicht N, Cerroni L, Fend F, Hantschke M, Kurschat P, Kutzner H, Metze D, Mielke V, Preßler H, Reusch M, Reusch U, Stadler R, Tronnier M, Yazdi A, Metzler G. Mitotic rate in primary melanoma: interobserver and intraobserver reliability, analyzed using H&E sections and immunohistochemistry. J Dtsch Dermatol Ges 2018; 14:910-5. [PMID: 27607033 DOI: 10.1111/ddg.12797] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In 2009, the AJCC issued a revised melanoma staging system. In addition to tumor thickness and ulceration, the mitotic rate was introduced as the third major prognostic parameter for the classification of primary cutaneous melanoma. Given that, according to the 2009 AJCC classification, the detection of one or more dermal tumor mitoses leads to an upstaging - from stage Ia to Ib - of melanomas with a tumor thickness of ≤ 1.0 mm, we set out to investigate the reproducibility of this new parameter. METHODS In order to assess interobserver reliability, 17 dermatopathologists und pathologists - all well versed in the diagnosis of cutaneous melanoma - analyzed the mitotic rate in 15 thin primary cutaneous melanomas (mean tumor thickness 0.91 mm) using identical slides. Mitotic rates were determined on H&E and phosphohistone H3 (Ser10)-stained samples. Without knowledge of their previous assessment, five of the aforementioned examiners reevaluated the samples after more than one year in order to ascertain intraobserver reliability. RESULTS Interobserver reliability of the mitotic rate in thin primary melanomas is disappointing and independent of whether H&E or immunohistochemically stained samples are used (kappa value: 0.088 [H&E], 0.154 [IH], respectively). Kappa values improved to 0.345 (H&E) and 0.403 (IH) when using a cutoff of 0/1 vs. 2+ mitoses. Similarly unsatisfactory, kappa values for intraobserver reliability ranged from 0.18 and 0.348, depending on the individual examiner. DISCUSSION Given the unsatisfactory reproducibility and large variations in assessing the mitotic rate, it remains a matter of debate whether this diagnostic parameter should play a role in therapeutic decisions.
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Affiliation(s)
- Claus Garbe
- Department of Dermatology, University Hospital, Tübingen, Germany.
| | | | - Jürgen Bauer
- Department of Dermatology, University Hospital, Tübingen, Germany
| | | | - Lorenzo Cerroni
- Department of Dermatology and Venereology, University Hospital, Graz, Austria
| | - Falko Fend
- Institute for Pathology, General Pathology, and Anatomic Pathology, Tübingen, Germany
| | - Markus Hantschke
- Dermatopathology Practice Friedrichshafen/Lake Constance, Friedrichshafen, Germany
| | - Peter Kurschat
- Department of Dermatology and Venereology, University Hospital, since 2014 HKS - Hautärzte Köln Süd, Dermatology Practice. Cologne, Cologne, Germany
| | - Heinz Kutzner
- Dermatopathology Practice Friedrichshafen/Lake Constance, Friedrichshafen, Germany
| | - Dieter Metze
- Department of Dermatology, University Hospital, Münster, Germany
| | | | - Harald Preßler
- Institute for Pathology, General Pathology, and Anatomic Pathology, Tübingen, Germany
| | | | | | - Rudolf Stadler
- Department of Dermatology, Venereology, Allergology, and Phlebology, Johannes Wesling Hospital, Minden, Germany
| | - Michael Tronnier
- Department of Dermatology, Venereology, and Allergolgy, HELIOS Hospital, Hildesheim, Germany
| | - Amir Yazdi
- Department of Dermatology, University Hospital, Tübingen, Germany
| | - Gisela Metzler
- Department of Dermatology, University Hospital, Tübingen, Germany
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Brunner G, Falk TM, Ertas B, Berking C, Schulze HJ, Blödorn-Schlicht N. Validation, in silico and in vitro, of a gene-signature based risk score in cutaneous melanoma. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.9560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9560 Background: Melanoma staging, as defined by the American Joint Committee on Cancer (AJCC), is limited in its ability to predict outcome. We have previously identified and validated a prognostic gene signature expressed in primary cutaneous melanoma and adjacent stroma. The signature comprises seven protective genes (down-regulated with tumor progression) and one risk-associated gene (up-regulated). A signature-based risk score independently predicts patient survival, across AJCC stages IA-IIIC, in formalin-fixed, paraffin-embedded (FFPE) melanomas (training cohort, n = 125; p = 0.0003, hazard ratio 1.85). The score has been validated in 206 melanomas, selected to be significantly mis-prognosticated by AJCC staging regarding patient survival (40.8% mis-prognostication). In this cohort, the score outperforms AJCC staging (p = 0.0005, hazard ratio 1.41 vs. p = n.s.), correcting 34.9% of AJCC-based mis-prognostications. Methods: Here, we report twofold external validation of the risk score, (i) prognostic performance in silico using the SurvExpress web tool (Aguirre-Gamboa et al., 2013), and (ii) technical performance in vitro(Dermatologikum Hamburg; IMGM Munich) . Results: (i) Kaplan Meier analysis and log-rank testing demonstrated that all signature genes combined predicted survival in four different cohorts of metastatic melanoma (from GEO Expression Omnibus or Cancer Genome Atlas; cohorts dichotomized at the median): see table. (ii) The risk score was re-analyzed in melanomas of the training cohort (n=69). The overall concordance of duplicate determinations was 90% (average scores of 1.12 ± 0.14 and 0.97 ± 0.14). Conclusions: In conclusion, we have validated a signature-based FFPE melanoma risk score, complementary to AJCC staging in predicting outcome: (i) Signature genes predicted patient survival in silico(n=449) (ii) The risk score proved to be reproducible and technically robust in vitro. The score improves risk stratification and decision making in melanoma, particularly regarding new adjuvant therapies. [Table: see text]
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Affiliation(s)
| | | | | | - Carola Berking
- Department of Dermatology, University of Munich, Munich, Germany
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Warren RB, Mrowietz U, von Kiedrowski R, Niesmann J, Wilsmann-Theis D, Ghoreschi K, Zschocke I, Falk TM, Blödorn-Schlicht N, Reich K. An intensified dosing schedule of subcutaneous methotrexate in patients with moderate to severe plaque-type psoriasis (METOP): a 52 week, multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2017; 389:528-537. [PMID: 28012564 DOI: 10.1016/s0140-6736(16)32127-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/18/2016] [Accepted: 09/27/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Methotrexate is one of the most commonly used systemic drugs for the treatment of moderate to severe psoriasis; however, high-quality evidence for its use is sparse and limited to use of oral dosing. We aimed to assess the effect of an intensified dosing schedule of subcutaneous methotrexate in patients with moderate to severe plaque-type psoriasis. METHODS We did this prospective, multicentre, randomised, double-blind, placebo-controlled, phase 3 trial (METOP) at 16 sites in Germany, France, the Netherlands, and the UK. Eligible patients were aged 18 years or older, had a diagnosis of chronic plaque psoriasis for at least 6 months before baseline, had currently moderate to severe disease, and were methotrexate treatment-naive. Participants were randomly assigned (3:1), via a computer-generated random number sequence integrated into an electronic data capture system, to receive either methotrexate at a starting dose of 17·5 mg/week or placebo for the first 16 weeks, followed by methotrexate treatment of all patients up to 52 weeks (methotrexate-methotrexate vs placebo-methotrexate groups). Dose escalation to 22·5 mg/week was allowed after 8 weeks of methotrexate treatment if patients had not achieved at least a 50% reduction in baseline Psoriasis Area and Severity Index score (PASI), with corresponding volume increases in placebo injections. Treatment was combined with folic acid 5 mg/week. Group allocation was concealed from participants and investigators from the time of randomisation until an interim database lock at week 16, and was open label from week 16 onwards, with no masking of participants or investigators. The primary efficacy endpoint was a 75% reduction in PASI score (PASI 75) from baseline to week 16. We did analysis by modified intention to treat, with non-responder imputation. This study is registered with EudraCT, number 2012-002716-10. FINDINGS Between Feb 22, 2013, and May 13, 2015, we randomly assigned 120 patients to receive methotrexate (n=91) or placebo (n=29). At week 16, a PASI 75 response was achieved in 37 (41%) patients in the methotrexate group compared with three (10%) patients in the placebo group (relative risk 3·93, 95% CI 1·31-11·81; p=0·0026). Subcutaneous methotrexate was generally well tolerated; no patients died or had serious infections, malignancies, or major adverse cardiovascular events. Serious adverse events were recorded in three (3%) patients who received methotrexate for the full 52 week treatment period. INTERPRETATION Our findings show a favourable 52 week risk-benefit profile of subcutaneous methotrexate in patients with psoriasis. The route of administration and the intensified dosing schedule should be considered when methotrexate is used in this patient group. FUNDING Medac.
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Affiliation(s)
- Richard B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
| | - Ulrich Mrowietz
- Psoriasis-Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | | | | | - Kamran Ghoreschi
- Department of Dermatology, University Medical Center, Eberhard Karls University Tübingen, Tübingen, Germany
| | | | | | | | - Kristian Reich
- SCIderm GmbH Hamburg, Hamburg, Germany; Dermatologikum Hamburg, Hamburg, Germany.
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Garbe C, Eigentler TK, Bauer J, Blödorn-Schlicht N, Cerroni L, Fend F, Hantschke M, Kurschat P, Kutzner H, Metze D, Mielke V, Preßler H, Reusch M, Reusch U, Stadler R, Tronnier M, Yazdi A, Metzler G. Mitoserate beim primären Melanom: Interobserver- und Intraobserver-Reproduzierbarkeit am HE-Schnitt und in der Immunhistologie. J Dtsch Dermatol Ges 2016; 14:910-6. [PMID: 27607034 DOI: 10.1111/ddg.12797_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
HINTERGRUND Die Melanomklassifikation wurde 2009 durch die AJCC revidiert. Für die Klassifizierung primärer Melanome wurde als dritte Größe neben Tumordicke und Ulzeration die Angabe der Mitoserate neu eingeführt. Gemäß der AJCC-2009-Klassifikation des Melanoms führt der Nachweis nur einer oder mehrerer dermaler Tumormitosen bei Melanomen ≤ 1,0 mm Tumordicke zu einer Umgruppierung des Tumors von T1a nach T1b. Dies erklärt, wie wichtig die Frage nach der Reproduzierbarkeit dieses neuen Parameters ist. METHODEN Zur Prüfung der Interobserver-Reproduzierbarkeit der Mitoserate haben 17 Dermatopathologen und Pathologen, die in der Befundung des kutanen Melanoms sehr erfahren sind, die Mitoserate in 15 dünnen Melanomen mit einer mittleren Tumordicke von 0,91 mm an demselben Tumorschnitt bestimmt. Die Mitoserate wurde am HE-Schnitt und immunhistologisch (IH) mittels des mitosespezifischen Antikörpers Phospho-Histon-H3 (Ser10) bestimmt. Fünf Befunder wiederholten die Bestimmung nach mehr als einem Jahr ohne Kenntnis ihres Vorbefundes zur Ermittlung der Intraobserver-Reproduzierbarkeit. ERGEBNISSE Die Interobserver-Reproduzierbarkeit der Mitoserate bei dünnen Melanomen ist unbefriedigend und unabhängig davon, ob die Mitoserate am HE-Schnitt oder am immungefärbten Schnitt bestimmt wird (κ-Werte: 0,088 [HE] bzw. 0,154 [IH]). Bei einer Diskriminationsschwelle von 0/1 vs. 2+ Mitosen verbesserte sich der κ-Wert auf 0,345 (HE) bzw. 0,403 (IH). Die Intraobserver-Reproduzierbarkeit lag mit κ-Werten zwischen 0,18 und 0,348 je nach Befunder ebenfalls im unbefriedigenden Bereich. DISKUSSION Wegen der unbefriedigenden Reproduzierbarkeit und der großen Variation der Befunde zur Mitoserate bleibt es zweifelhaft, ob dieser Befund als Grundlage für Therapieentscheidungen herangezogen werden kann.
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Affiliation(s)
| | | | | | | | - Lorenzo Cerroni
- Universitätsklinik für Dermatologie und Venerologie, Graz, Österreich
| | - Falko Fend
- Institut für Pathologie, Allgemeine Pathologie und Pathologische Anatomie, Tübingen
| | | | - Peter Kurschat
- Klinik für Dermatologie und Venerologie, Uniklinik Köln, seit 2014 HKS - Hautärzte Köln Süd, Köln
| | - Heinz Kutzner
- Dermatopathologie Friedrichshafen/Bodensee, Friedrichshafen
| | | | - Volker Mielke
- Dermatologische Gemeinschaftspraxis am Tibarg, Hamburg
| | - Harald Preßler
- Institut für Pathologie, Allgemeine Pathologie und Pathologische Anatomie, Tübingen
| | | | - Ursula Reusch
- Dermatologische Gemeinschaftspraxis am Tibarg, Hamburg
| | - Rudolf Stadler
- Klinik für Dermatologie, Venerologie, Allergologie und Phlebologie - Mühlenkreiskliniken, Johannes Wesling Klinikum Minden
| | - Michael Tronnier
- Klinik für Dermatologie, Venerologie und Allergologie, HELIOS Klinikum Hildesheim
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Herbert VG, Blödorn-Schlicht N, Böer-Auer A, Getova V, Steinkraus V, Reich K, Breuer K. [Cutaneous granulomatous reactions at botulinum neurotoxin A injection sites: First manifestation of systemic sarcoidosis]. Hautarzt 2016; 66:863-6. [PMID: 26129729 DOI: 10.1007/s00105-015-3651-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CASE REPORT We report a case of granulomatous skin reaction after injection of an unknown botulinum neurotoxin (BoNT) A preparation. Four years after occurrence of skin lesions, systemic sarcoidosis became manifest. CONCLUSION In addition to injection trauma, the BoNT A preparation may have acted as an immunogenic stimulus leading to cutaneous manifestation of sarcoidosis.
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Affiliation(s)
- V G Herbert
- Dermatologikum Hamburg, Stephansplatz 5, 20354, Hamburg, Deutschland.
| | | | - A Böer-Auer
- Dermatologikum Hamburg, Stephansplatz 5, 20354, Hamburg, Deutschland
| | - V Getova
- Dermatologikum Hamburg, Stephansplatz 5, 20354, Hamburg, Deutschland
| | - V Steinkraus
- Dermatologikum Hamburg, Stephansplatz 5, 20354, Hamburg, Deutschland
| | - K Reich
- Dermatologikum Hamburg, Stephansplatz 5, 20354, Hamburg, Deutschland
| | - K Breuer
- Dermatologikum Hamburg, Stephansplatz 5, 20354, Hamburg, Deutschland
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Gebhardt M, Ertas B, Falk T, Blödorn-Schlicht N, Metze D, Böer-Auer A. Fast, sensitive and specific diagnosis of infections withLeishmaniaspp. in formalin-fixed, paraffin-embedded skin biopsies by cytochrome b polymerase chain reaction. Br J Dermatol 2015; 173:1239-49. [DOI: 10.1111/bjd.14088] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 11/29/2022]
Affiliation(s)
- M. Gebhardt
- Dermatologikum Hamburg; Stephansplatz 5 20354 Hamburg Germany
| | - B. Ertas
- Dermatologikum Hamburg; Stephansplatz 5 20354 Hamburg Germany
| | - T.M. Falk
- Dermatologikum Hamburg; Stephansplatz 5 20354 Hamburg Germany
| | | | - D. Metze
- Department of Dermatology; Münster University; Von Esmarch Strasse 58 48149 Münster Germany
| | - A. Böer-Auer
- Dermatologikum Hamburg; Stephansplatz 5 20354 Hamburg Germany
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Brunner G, Heinecke A, Suter L, Blödorn-Schlicht N, Schulze HJ, Atzpodien J. Abstract 2861: Independent validation of a prognostic gene-signature based risk score in formalin-fixed paraffin-embedded melanomas. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-2861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Current staging of melanoma, as defined in 2009 by the American Joint Committee on Cancer (AJCC), is based mainly on histopathological criteria but is limited in predicting outcome. Complementary molecular markers are not available for routine prognostic assessment.
We have previously identified and validated a prognostic nine-gene signature expressed in fresh-frozen (FF) primary cutaneous melanomas (training cohort: n=91; validation cohort: n=44). A signature-based risk score predicts patient overall survival (OS) independently of AJCC staging (multivariate regression analysis: p = 0.0004; hazard ratio: 3.8). However, clinical application requires adaptation to formalin-fixed, paraffin-embedded (FFPE) melanomas.
Therefore, we have transfered signature expression analysis onto FFPE melanomas. From FFPE melanomas matching the training and validation cohorts of the above FF melanoma study (n=125), RNA was prepared and transcribed into cDNA. Following cDNA pre-amplification, expression of the 9 signature genes, 2 additional candidate genes, and 3 housekeeping genes was quantified by real-time PCR. Correlation of gene expression with OS was evaluated using Cox regression analysis. Expression of a signature of 8 out of 11 genes (risk gene: KBTBD10; protective genes: DCD, GBP4, COL6A6, PIP, SCGB1D2, SCGB2A2, KRT9) was associated with OS in univariate regression and Kaplan Meier analysis. A signature-based risk score predicted OS independently of AJCC staging (multivariate analysis: p=0.0059, hazard ratio 3.09). The misclassification rates were 20% overall, 13.8% for low risk, and 5.7% for double low-risk (combined with AJCC staging). The risk score complemented and refined conventional AJCC staging. Thus, the FF melanoma risk score was successfully transfered onto FFPE melanomas.
In order to validate the FFPE melanoma risk score, we analyzed signature expression in an independent cohort of 130 selected FFPE melanomas, which were particularly difficult to classify by AJCC staging (misclassification rate 40.8%), in order to stringently test the performance of the risk score. The misclassification rate of the FFPE melanoma risk score was comparable, even slightly better (39.2%) than that of AJCC staging, confirming its prognostic performance.
The FFPE melanoma risk score was also externally validated in a Molecular Diagnostics Lab (Dermatologikum Hamburg). The concordance of melanoma classification exceeded 85%, demonstrating technical robustness of the risk score.
We have established and independently as well as externally validated a quantitative, robust prognostic FFPE melanoma risk score that is complementary to AJCC staging in predicting outcome. This demonstrates clinical applicability and allows retrospective risk assessment of melanomas. The score identifies patients at low risk, not identified by AJCC staging, and defines high-risk patients in need of adjuvant therapy.
Citation Format: Georg Brunner, Achim Heinecke, Ludwig Suter, Norbert Blödorn-Schlicht, Hans-Joachim Schulze, Jens Atzpodien. Independent validation of a prognostic gene-signature based risk score in formalin-fixed paraffin-embedded melanomas. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2861. doi:10.1158/1538-7445.AM2014-2861
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Affiliation(s)
- Georg Brunner
- 1Skin Cancer Center Hornheide-Muenster, Muenster, Germany
| | | | - Ludwig Suter
- 1Skin Cancer Center Hornheide-Muenster, Muenster, Germany
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Reich K, Blödorn-Schlicht N, Falk TM. Genetic diagnostics in inflammatory dermatoses - from insights into pathophysiology to individualized patient management. J Dtsch Dermatol Ges 2013; 11 Suppl 4:59-67. [DOI: 10.1111/ddg.12071_supp] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Reich K, Blödorn-Schlicht N, Falk TM. Genetische Diagnostik bei entzündlichen Dermatosen - vom Einblick in die Pathophysiologie zur Möglichkeit eines individualisierten Managements. J Dtsch Dermatol Ges 2013. [DOI: 10.1111/ddg.12071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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]
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Blonski KM, Blödorn-Schlicht N, Falk TM, Faye RS, Clausen OPF. Increased detection of cutaneous leishmaniasis in Norway by use of polymerase chain reaction. APMIS 2012; 120:591-6. [DOI: 10.1111/j.1600-0463.2012.02875.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 12/28/2011] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | - Ragnar S. Faye
- Department of Dermatology; Oslo University Hospital-Rikshospitalet; Oslo; Norway
| | - Ole P. F. Clausen
- Department of Pathology; Oslo University Hospital-Rikshospitalet; Oslo; Norway
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Garbe C, Eigentler TK, Bauer J, Blödorn-Schlicht N, Fend F, Hantschke M, Kurschat P, Kutzner H, Metze D, Preßler H, Reusch M, Röcken M, Stadler R, Tronnier M, Yazdi A, Metzler G. Histopathologische Befundung maligner Melanome in Übereinstimmung mit der AJCC-Klassifikation 2009: Literaturübersicht und Empfehlungen zum praktischen Vorgehen. J Dtsch Dermatol Ges 2011. [DOI: 10.1111/j.1610-0387.2011.07714_suppl.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Garbe C, Eigentler TK, Bauer J, Blödorn-Schlicht N, Fend F, Hantschke M, Kurschat P, Kutzner H, Metze D, Pressler H, Reusch M, Röcken M, Stadler R, Tronnier M, Yazdi A, Metzler G. Histopathological diagnostics of malignant melanoma in accordance with the recent AJCC classification 2009: Review of the literature and recommendations for general practice. J Dtsch Dermatol Ges 2011; 9:690-9. [PMID: 21651721 DOI: 10.1111/j.1610-0387.2011.07714.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND TNM classifications are the basis for diagnostic and therapeutic procedures in oncology. Histopathological reports have to enable a proper indexing of tumor specific findings into recent classifications. METHODS A systematic review of the literature was performed to identify reports dealing with the assessment of mitotic rate and the processing and evaluation of sentinel node biopsies in malignant melanoma. On the basis of this review an expert panel of dermatopathologists and general pathologists discussed and agreed recommendations for general practice. RESULTS Following recommendations were agreed with a broad consensus (93-100 % agreement): The determination of the mitotic rate in primary melanoma is performed on HE slides. The evaluation of an area of 1 mm(2) is sufficient. Only dermal mitoses are considered. The counted number of mitoses is provided as an integer value. The mitotic rate shall be determined in primary melanomas of ≤1.00 mm vertical tumor thickness according to the hot-spot method and provided as an integer value in relation to an area of 1 mm(2) . The determination of the mitotic rate in the case of thicker primary melanomas is desirable. In general, for the evaluation of each sentinel lymph node, 4 slides should be prepared. For diagnostic purposes, immunohistochemistry (preferably with antibodies against S100ß, Melan A and HMB-45) should be performed in addition to HE staining. The pathology report should provide information about micro-metastases and their longest extension (one-tenth of a millimeter). CONCLUSIONS These recommendations are suitable for standardizing the histopathological diagnosis of malignant melanoma and for providing a common basis for clinical decisions and scientific research.
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Affiliation(s)
- Claus Garbe
- Department of Dermatology, Tübingen University Hospital, Germany.
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Jung JE, Matias JEF, Blödorn-Schlicht N, Falk TM, Böer A. Correlation of histopathological patterns in cutaneous melanoma with BRAF mutations. J Bras Patol Med Lab 2010. [DOI: 10.1590/s1676-24442010000600011] [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: 11/22/2022] Open
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Kauer F, Paasch U, Böer A, Blödorn-Schlicht N, Simon JC. Halbkugeliger, zentral eingesunkener Tumor mit Teleangiektasien. J Dtsch Dermatol Ges 2007; 5:621-2. [PMID: 17610613 DOI: 10.1111/j.1610-0387.2007.06305.x] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Friederike Kauer
- Klinik für Dermatologie, Venerologie und Allergologie Universität Leipzig, Germany.
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Böer A, Blödorn-Schlicht N, Wiebels D, Steinkraus V, Falk TM. Unusual histopathological features of cutaneous leishmaniasis identified by polymerase chain reaction specific for Leishmania
on paraffin-embedded skin biopsies. Br J Dermatol 2006; 155:815-9. [PMID: 16965433 DOI: 10.1111/j.1365-2133.2006.07365.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) is rare in Northern Europe and may be overlooked because colleagues have little experience with it. OBJECTIVES To identify manifestations of CL that may escape diagnosis. METHODS Correlation of clinical diagnosis and histopathological findings in 28 biopsy specimens taken from 19 patients with CL confirmed by polymerase chain reaction (PCR) specific for Leishmania. RESULTS In only one patient was the clinical diagnosis CL; other diagnoses included: malignant epithelial neoplasms (5), follicular cyst (2), atypical mycobacteriosis (1), sarcoidosis (2) and lymphoma (1). Lesions were single (15) or few (4) nodules predominantly situated on the extremities or face (16). Histopathological findings were diagnostic of CL in only 10 cases. In nine cases Leishmania was not identified microscopically; histopathological diagnoses were: granulomatous dermatitis (6), lupoid rosacea (1), foreign body granuloma (1) and granuloma annulare (1). Unaltered epidermis (9), nodular infiltrates (5), numerous multinucleated histiocytes (3), palisaded granulomas with fibrinoid centres (2), sarcoidal granulomas (4) and elastophagocytosis (1) misled the histopathologists in these cases. CONCLUSIONS CL seems often to be misdiagnosed clinically in countries where it is not endemic. Histopathologically, CL may be misinterpreted as sarcoidosis, foreign body granuloma, lupoid rosacea and granuloma annulare, especially when Leishmania is not seen microscopically. We suggest that in Northern Europe, PCR for Leishmania-specific DNA should be performed routinely in any granulomatous dermatitis presenting as a single or few nodules on the extremities or face, even when a diagnosis of CL was not considered by the referring clinician.
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Affiliation(s)
- A Böer
- Dermatologikum Hamburg, Stephansplatz 5, 20354 Hamburg, Germany.
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Abstract
Infections of the skin by herpesviruses do not always present themselves in typical fashion. Conventional microscopy is used routinely to confirm infection by herpesviruses, but sometimes typical signs such as multinucleated epithelial cells or "ghosts" of them are not encountered in a specimen (so-called herpes incognito). We studied 35 patients in whom infection with herpesviruses was differentially diagnosed clinically but in whom a biopsy specimen had been taken for confirmation. Only those patients in whom histopathologic findings had been interpreted as being "not diagnostic" of herpesvirus infection by 2 independent dermatopathologists were included. Clinical and histopathologic findings were correlated with results from polymerase chain reaction studies on formalin-fixed paraffin-embedded tissue. Polymerase chain reaction revealed herpesvirus-specific DNA in 12 of 35 specimens, 10 being varicella zoster virus (VZV) positive, 1 herpes simplex virus (HSV)-2 positive, and 1 HSV-1 positive. Ten of these 12 cases presented themselves in very similar fashion (8 VZV, 1 HSV-1, 1 HSV-2). All lesions were macular or papular and typified mostly by dense perivascular and sparse interstitial superficial and deep infiltrates of lymphocytes, sometimes assuming a patchy lichenoid pattern. Infiltrates were prominent in and around adnexal structures, often peppering follicles, sebaceous glands, and eccrine glands. Lymphocytes were also found in the lower part of the epidermis accompanied by a combination of spongiosis and vacuolar alteration. The papillary dermis was often edematous; extravasated erythrocytes in variable numbers were a common finding. Lymphocytes sometimes had large and polygonal nuclei. Neutrophils and nuclear dust were present occasionally; eosinophils were rare. We conclude that herpes incognito most commonly is herpes zoster and its histopathologic pattern is distinctive.
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Affiliation(s)
- Almut Böer
- Dermatologikum Hamburg, Stephansplatz 5, 20354 Hamburg, Germany.
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Böer A, Herder N, Blödorn-Schlicht N, Steinkraus V, Falk TM. Refining criteria for diagnosis of cutaneous infections caused by herpes viruses through correlation of morphology with molecular pathology. Indian J Dermatol Venereol Leprol 2006; 72:270-5. [PMID: 16880572 DOI: 10.4103/0378-6323.26717] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Infections of the skin by herpes viruses do not always present themselves in typical fashion. Early diagnosis, however, is crucial for appropriate treatment. Polymerase chain reaction (PCR) allows diagnosis and differential diagnosis of herpes virus infections, but the method is not yet available in large parts of the world, where diagnosis is made based on morphology alone. AIM To refine criteria for the diagnosis of herpes virus infections of the skin by way of correlation of clinical and histopathologic findings with results of PCR studies. METHODS We studied 75 clinically diagnosed patients of "zoster," "varicella," and "herpes simplex", to correlate clinical and histopathological findings with results of PCR studies on paraffin embedded biopsy specimens. RESULTS Clinical suspicion of infection by herpes viruses was confirmed by histopathology in 37% of the cases and by PCR studies in 65% of the cases. Zoster was frequently misdiagnosed as infection with herpes simplex viruses (30%). When diagnostic signs of herpes virus infection were encountered histopathologically, PCR confirmed the diagnosis in 94%. By way of correlation with results of PCR studies, initial lesions of herpes virus infections could be identified to have a distinctive histopathological pattern. Herpetic folliculitis appeared to be a rather common finding in zoster, it occurring in 28% of the cases. CONCLUSION We conclude that correlation of clinical and histopathological features with results of PCR studies on one and the same paraffin embedded specimen permits identification of characteristic morphologic patterns and helps to refine criteria for diagnosis both clinically and histopathologically.
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Affiliation(s)
- Almut Böer
- Division of Dermatopathology, Dermatologikum, Hamburg, Germany.
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Gyulay A, Kahl T, Böer A, Blödorn-Schlicht N, Steinkraus V. Lymphomatoide Papulose: Ist Imiquimod eine therapeutische Alternative? Akt Dermatol 2004. [DOI: 10.1055/s-2004-832552] [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: 10/19/2022]
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Blödorn-Schlicht N, Böer A. Intraepitheliales Talgdrüsenkarzinom – Ein Simulator des Morbus Bowen. Akt Dermatol 2004. [DOI: 10.1055/s-2004-832551] [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: 10/19/2022]
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Wagner G, Tholl U, Blödorn-Schlicht N, Steinkraus V. Mikroskopische Polyangiitis. Akt Dermatol 2002. [DOI: 10.1055/s-2002-35209] [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: 10/27/2022]
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Distelrath K, Neuber K, Blödorn-Schlicht N, Altenhoff J, Dührsen U, Düring J, Steinkraus V. [Painful ischemia of the extremities with T-cell lymphoma]. Hautarzt 1999; 50:284-7. [PMID: 10354922 DOI: 10.1007/s001050050903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Two years after the diagnosis of Sézary syndrome, a 50-year old female patient experienced attacks of painful ischemia of both hands and feet, leading to acral necrosis. Another 59-year old patient presented with severe pain in his feet, secondary to ischemia. This was the first symptom of a T-cell-chronic lymphocytic leukemia. Similar cases have only occasionally been described. The relationship between acral ischemia and T-cell-lymphoma is not clear but is discussed in this article.
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Neuber K, tom Dieck A, Blödorn-Schlicht N, Itschert G, Karnbach C. Treosulfan is an effective alkylating cytostatic for malignant melanoma in vitro and in vivo. Melanoma Res 1999; 9:125-32. [PMID: 10380934 DOI: 10.1097/00008390-199904000-00003] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [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: 11/26/2022]
Abstract
The therapy of metastatic malignant melanoma is limited by poor responses and short overall survival. Thus it remains an important issue to identify and test potential new drugs in this disease. This study was performed to examine the effects of the bifunctional alkylating cytostatic treosulfan in vitro. Using an in vitro microplate ATP bioluminescence tumour chemosensitivity assay (ATP-TCA) five highly chemoresistant melanoma cell lines and melanoma cells freshly isolated from metastases surgically resected from stage IV melanoma patients (n = 10) were incubated with treosulfan. Three cell lines and eight of the 10 tested tumour cells isolated from melanoma metasteses showed tumour growth inhibition >50% after incubation with treosulfan. Therefore, 14 patients with rapidly progressing stage IV malignant melanoma who had been pretreated with at least one standard chemotherapy regimen received treosulfan. In this population of patients with highly refractory advanced melanoma, one complete remission (7.1%), two partial remissions (14.3%) and three cases of stable disease (21.4%) were observed. The median survival time for all the patients measured from the beginning of treosulfan treatment was 9 months, and the median overall survival was 17 months. Except for two patients who developed grade 3 leucopenia, only moderate side effects were observed. Therefore, we conclude that treosulfan was well tolerated in this small series of patients and seems to be a promising alkylating cytostatic for the treatment of metastatic melanoma. Further studies are warranted to test these findings.
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Affiliation(s)
- K Neuber
- Department of Dermatology, University Hospital Eppendorf, Hamburg, Germany
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