摘要:

Many patients with Behçet disease (BD) develop lesions that clinically resemble those of erythema nodosum (EN) but differ from that condition with regard to their microscopic features. We examined 11 sections of EN-like lesions in BD and compared them with 9 sections of classic EN using routine histopathology and immunohistochemistry so as to form a comprehensive picture of the pathologic findings in BD and to determine the role of vasculitis in the formation of lesions. Erythema nodosum–like lesions of BD are characterized by panniculitis, usually lobular or mixed septal and lobular in pattern, with variable numbers of neutrophils, lymphocytes, and histiocytes as well as variable numbers of necrotic adipocytes. Vasculitis was noted in most EN-like lesions in BD. Scattered vessels showing lymphocytic vasculitis were evident in 6 sections, and foci of leukocytoclastic vasculitis were obvious in 4 sections, sometimes with phlebitis or arteriolitis. In specimens with classic EN, we did not observe vasculitis. Only the percentages of CD3+ lymphocytes and chloroacetate esterase–positive neutrophils in the infiltrating cells showed statistically significant differences (P < 0.05) between EN-like lesions in BD and EN through immunohistochemical and enzyme cytochemical studies. Because vasculitis in the EN-like lesions in BD was extensive and not limited to areas of severe inflammation, we believe that it is primary vasculitis. We suggest that vasculitis is an important pathologic event in EN-like lesions in BD but cannot determine the extent to which other pathologic changes such as septal or lobular panniculitis, fat necrosis, neutrophilic infiltration, or microabscess formation are secondary features.

ISSN:0193-1091    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The atypical histologic features considered to be specific to dysplastic (atypical) nevi have been reported to occur in nevi that are common nevi by all other clinical and histologic features. The distribution and mutual relations among such features in nevi need to be further studied. Six histologic features (dimension > 5 mm, lentiginous proliferation, disordered nested pattern, melanocytic dyskaryosis, dermal lymphocytic infiltrate, suprabasal melanocytes) were analyzed in 253 melanocytic nevi with different clinical appearances. Atypical histologic features, found in 72% of nevi, occurred singly or formed numerous and highly variable combinations. Nevi formed a complex histologic spectrum comprising lesions showing a progressively increasing incidence of atypical features rather than two classes (common and dysplastic nevi). To divide the investigated lesions in objectively defined groups, we used a scoring system. In each nevus, a numeric value of 1 was assigned when each of the studied parameters was present and a value of 0 was assigned when each of these parameters was absent; on the basis of the final scores, nevi were divided in six different classes (classes 0–5). Diagnostic categories such as dysplastic nevi and common nevi seem to be inappropriate, as they do not reflect the real histologic complexity of such lesions.

ISSN:0193-1091    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

When cytomegalovirus (CMV) involves the skin, viral inclusions are typically present within mesenchymal cells, e.g., endothelial cells, fibrocytes, and sometimes within inflammatory cells, e.g., macrophages, in contrast to infection in other organs in which inclusions are usually present within ductal epithelial cells. Two cases of cutaneous CMV are presented, one showing prominent findings within eccrine ductal epithelium and the other revealing mostly endothelial cells affected by CMV. Due to the range of cytologic changes induced by CMV observed in these cases, there seem to be early, fully developed, and late cellular changes brought about by CMV analogous to how herpesvirus (varicella, zoster, simplex) induces different changes depending on its stage of infection.

ISSN:0193-1091    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Sarcoidosis is a multisystem disease of unknown etiology. The demonstration of polarizable foreign bodies in cutaneous granulomas is generally thought to exclude a diagnosis of sarcoidosis. Nevertheless, some investigators have reported systemic sarcoidosis with cutaneous manifestations in which polarizable particles were associated with granuloma formation in the skin. We searched the biopsy specimens of granulomatous lesions from 50 patients with cutaneous sarcoidosis using polarization microscopy to estimate the frequency of polarizable foreign bodies in cutaneous lesions of sarcoidosis. Using electron probe microanalysis, we sought to determine what elements compose these foreign bodies. Polarizable foreign bodies were found in the granulomatous skin lesions of 12 of 50 patients with cutaneous sarcoidosis. All 12 patients also had at least one other granulomatous systemic lesion, and 4 had biopsy specimens of a systemic lesion available for review. Polarizable foreign bodies were found in two cases. The elements identified were calcium, phosphorus, silicon, and aluminum. Polarizable foreign bodies were found in cutaneous sarcoidosis far more often than expected. Foreign bodies were also found in granulomatous systemic lesions. The foreign body may serve as an inciting stimulus for granuloma formation in selected cases of sarcoidosis.

ISSN:0193-1091    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Toxic epidermal necrolysis (TEN) is a rare drug-induced disease for which the pathomechanism remains poorly understood. The effector cells of epidermal injury in TEN were studied by taking skin biopsies of early lesions in 23 TEN patients and by performing immunohistochemical tests using antibodies to factor XIIIa (type I dendrocytes), L1-protein (mainly Mac 387+monocytes and macrophages), UCLH1 (mainly CD45R0+T-memory lymphocytes), interleukin-6 (IL-6), and tumor necrosis factor-&agr; (TNF&agr;). Computerized image analysis was used to evaluate the cell density relative to each immunolabeling. A statistical analysis of cellular counts revealed a numeric relation between the cell types in skin with TEN. Factor XIIIa+dendrocytes were abundant and plump in the dermis, although Mac 387+macrophages were the most numerous inflammatory cells in the epidermis. Their numbers greatly exceeded those of CD45R0+T lymphocytes and cells showing immunoreactivity for either IL-6 or TNF&agr;. In the epidermis, IL-6+cells were significantly less numerous than TNF&agr;+cells. No quantitative difference was found between IL-6+and CD45R0+cell populations. Correlations were observed between either the numbers of TNF&agr;+cells or Mac 387+macrophages and CD45R0+lymphocytes. In the dermis, a significant correlation was also present between the numbers of Mac 387+and factor XIIIa+cells. These findings highlight the complex interactions between the inflammatory cells that mediate epidermal damage in skin with TEN. The high density of factor XIIIa+dendrocytes and Mac 387+macrophages in lesional skin assigns these cellular populations a prominent role in the pathomechanism of TEN. Despite a lower cell density, CD45R0+T-memory lymphocytes likely participate in TNF&agr;- andagr;-and IL-6–regulated processes in the epidermis of TEN. TNF&agr; seems to be a major cytokine involved in TEN, although a less prominent role can be ascribed to IL-6.

ISSN:0193-1091    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Rare cases of angiosarcoma have been reported to arise in the setting of retained foreign material or in association with arteriovenous fistulae. No previous case of angiosarcoma, or any other malignancy, has been reported to arise with a gouty tophus. We present a case of an 86-year-old man with a high-grade angiosarcoma that arose within a long-standing tophus.

ISSN:0193-1091    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Primary cutaneous CD30+ large cell lymphoma is an unusual tumor most commonly seen in adults. Most of these lymphomas are of T-cell origin and carry a good prognosis. We present the case of a 4-year-old girl with stage IEA CD30+ large cell lymphoma with a CD56+ natural killer cell phenotype and the t(2;5)(p23;q35) translocation. After excision, the patient has been free of disease for 44 months. Primary cutaneous CD30+ large cell lymphoma is uncommon in children. To our knowledge, primary cutaneous CD30+ natural killer type lymphoma has not been reported previously. The indolent behavior of this tumor indicates its similarity to other primary cutaneous CD30+ large cell lymphomas and its difference from other CD56+ lymphomas involving the skin, which often exhibit an aggressive clinical course. Cases such as this one illustrate why the use of a single, or even a few, immunohistochemical stains can be misleading in regard to lymphoma classification and prognostication.

ISSN:0193-1091    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Sweet syndrome (SS) associated with myeloproliferative disorders has been considered an inflammatory process mediated by neutrophils in which immunologic mechanisms are operative. The authors report the case of a 68-year-old man suffering from a myelodysplastic syndrome, who presented with a relapsing skin eruption resembling SS. Histopathologically, the skin infiltrates showed prominent neutrophilic features masking the underlying malignant process. Extensive immunophenotypic studies of skin revealed the presence of a few immature myeloid cells intermingled with an overwhelming infiltrate of neutrophils. The atypical cells in the skin had a phenotype identical to that of leukemic cells in the peripheral blood and bone marrow. Whether or not immature myeloid cell precursors constitute a specific infiltrate of leukemia cutis or are a result of recruitment of circulating leukemic cells to this area of inflammation is discussed.

ISSN:0193-1091    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Extramedullary hematopoiesis is rare outside the setting of significant primary hematologic disease. We describe this phenomenon in an exuberant pyogenic granuloma in an otherwise healthy man. We postulate that this vascular lesion provided a suitable milieu for homing and proliferation of stem cells.

ISSN:0193-1091    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Extramammary Paget disease (EMPD) is a heterogenous entity representing either an intraepidermal adenocarcinoma in situ with apocrine differentiation or an expression of underlying malignancy of the skin or of the intestinal or genitourinary tract. The coexistence of EMPD with a benign underlying hidradenoma papilliferum (HP) is, however, exceptional. We present the case of a 79-year-old woman with diffuse and patchy gray-white lesions involving her left vulva as well as an underlying 0.7-cm asymptomatic firm nodule. Histologically, the epidermis and dermis showed features characteristic of EMPD and HP, respectively. Malignant transformation in HP giving rise to EMPD in the overlying epithelium has been reported. In our case, however, failure to demonstrate continuity between the two lesions together with the lack of cytologic atypia, mitoses, and necrosis in the HP lends additional support to the possibility that the HP is “innocent” and that its association with EMPD is thus coincidental. A common histogenetic derivation of these two lesions from the mammary-like glands or from related germinative cells in the epidermis is suggested to explain this rare presentation.

ISSN:0193-1091    

出版商:OVID    

年代:2000

数据来源: OVID