[Show abstract][Hide abstract] ABSTRACT: An abnormal neutrophil subset has been identified in the PBMC fractions from lupus patients. We have proposed that these low-density granulocytes (LDGs) play an important role in lupus pathogenesis by damaging endothelial cells and synthesizing increased levels of proinflammatory cytokines and type I IFNs. To directly establish LDGs as a distinct neutrophil subset, their gene array profiles were compared with those of autologous normal-density neutrophils and control neutrophils. LDGs significantly overexpress mRNA of various immunostimulatory bactericidal proteins and alarmins, relative to lupus and control neutrophils. In contrast, gene profiles of lupus normal-density neutrophils do not differ from those of controls. LDGs have heightened capacity to synthesize neutrophils extracellular traps (NETs), which display increased externalization of bactericidal, immunostimulatory proteins, and autoantigens, including LL-37, IL-17, and dsDNA. Through NETosis, LDGs have increased capacity to kill endothelial cells and to stimulate IFN-α synthesis by plasmacytoid dendritic cells. Affected skin and kidneys from lupus patients are infiltrated by netting neutrophils, which expose LL-37 and dsDNA. Tissue NETosis is associated with increased anti-dsDNA in sera. These results expand the potential pathogenic roles of aberrant lupus neutrophils and suggest that dysregulation of NET formation and its subsequent responses may play a prominent deleterious role.
The Journal of Immunology 07/2011; 187(1):538-52. DOI:10.4049/jimmunol.1100450 · 4.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To identify significant clinical and pathological predictors of survival in mucosal melanoma of the head and neck.
Retrospective case series. We reviewed cases of mucosal melanoma of the head and neck from a prospectively collected database after institutional review board approval.
A single academic institution.
Fifty-two patients with mucosal melanoma of the head and neck.
With a median follow-up of 97 months, the median overall survival was 52 months, with a 5-year overall survival of 38%. The median disease-free survival was 15 months, with a 5-year disease-free survival of 22%. Younger age (P = .02), lower T status (P = .003), and lower American Joint Committee on Cancer stage (P < .001) were associated with better overall survival. Positive surgical margins predicted poorer overall survival (P = .01), but patients who required reexcision to achieve negative margins had outcomes that were not significantly different from those with initially negative surgical margins (P = .71). Sex, smoking history, and primary site did not affect disease-free or overall survival. Adjuvant radiotherapy and/or chemotherapy did not predict improved outcomes. Fewer mitoses (P = .02) and the absence of ulceration (P = .01) predicted improved overall survival.
Our experience confirms the utility of current staging systems in predicting outcomes of mucosal melanoma of the head and neck and stresses the importance of achieving negative surgical margins. Pathologically, fewer mitoses and the absence of ulceration predict better outcomes and should be reported as part of routine histological profiles of mucosal melanoma. Further studies are necessary to change the paradigm of care for this rare and deadly disease.
Archives of otolaryngology--head & neck surgery 04/2011; 137(4):331-7. DOI:10.1001/archoto.2011.46 · 2.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Spitz nevus was first described in 1948 by Dr Sophie Spitz, who termed it juvenile melanoma based on its striking cytologic resemblance to melanoma, being composed of large epithelioid and spindle cells, and its prevalence among children. Several changes in terminology have since occurred with increased knowledge and experience, particularly regarding its occurrence in adult populations and rather indolent clinical behavior. Nevertheless, the distinction of Spitz nevus from melanoma still remains a significant problem in dermatopathology. Most classic examples of Spitz nevi can be easily distinguished histopathologically from melanoma, although lesions with unusual or atypical features still pose diagnostic difficulties, particularly in small or partial samples. In general, poor interobserver diagnostic concordance is not uncommon. Herein, we review the histopathological features of Spitz nevi, including common and recently reported variants, and spitzoid melanoma, and discuss recent advances in ancillary studies that may prove useful in their diagnosis.
Expert Review of Dermatology 09/2010; 5(5):549-560. DOI:10.1586/edm.10.47
[Show abstract][Hide abstract] ABSTRACT: Paraneoplastic pemphigus is a rare cause of acute diffuse blistering in the adult patient. It commonly presents with subepidermal blistering, epidermal necrosis, and symptoms of mucosal irritation, such as conjunctivitis and vaginal ulceration. Because of its rarity, it is frequently misdiagnosed as Stevens-Johnson syndrome or toxic epidermal necrolysis. In this study, the authors will describe clinical and histologic manifestations of paraneoplastic pemphigus. This case report describes a 45-year-old woman with paraneoplastic pemphigus who was admitted and treated in a burn intensive care unit. Although initially diagnosed with Stevens-Johnson syndrome, the patient had progression of desquamation when potentially offending medications were discontinued. Diffuse adenopathy was noted on examination, and biopsy confirmed a low-grade lymphoma. Paraneoplastic pemphigus is a rare but important cause of acute diffuse blistering in adults. This disorder should be considered in the differential diagnosis of patients with diffuse blistering.
Journal of burn care & research: official publication of the American Burn Association 08/2010; 31(5):826-9. DOI:10.1097/BCR.0b013e3181eed4b4 · 1.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cutaneous adnexal differentiation is well-recognized in benign mixed tumors occurring in cutaneous sites. The incidence of this histologic finding in salivary gland sites is not known. We sought to describe the incidence of cutaneous adnexal differentiation in benign mixed tumors of the palate, lip, and parotid gland. Benign mixed tumors of the palate (n=30), lip (n=13), and parotid gland (n=37) resected between 1980 and 2009 at a single academic medical institution were reviewed. All hematoxylin and eosin-stained sections containing neoplasm were reviewed by all authors including one dermatopathologist (S.H.O.). After confirming the diagnosis of benign mixed tumor, we evaluated for morphologic evidence of cutaneous adnexal differentiation and metaplastic epithelial and stromal changes. Chart review was conducted to obtain pertinent clinical information. Cutaneous adnexal differentiation was seen in 20% of palate and 39% of lip benign mixed tumors but in no parotid tumors. The most frequent features of cutaneous adnexal differentiation were tricholemmal differentiation (20% of palate and 39% of lip tumors), infundibulocystic structures (17% and 31%), and trichohyalin granules (13% and 31%). Sebaceous differentiation was seen in only one palate tumor. Varying amounts of stromal adipose were seen in 62, 37, and 22% of lip, palate, and parotid tumors. Osseous metaplasia was seen in one tumor from each site. When cutaneous adnexal differentiation occurs in salivary gland pleomorphic adenomas, it can present a diagnostic pitfall that must not be misinterpreted as carcinoma at biopsy, fine needle aspiration, or frozen section.
The American journal of surgical pathology 08/2010; 34(8):1205-10. DOI:10.1097/PAS.0b013e3181e658a5 · 5.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A case is presented of white plaques occurring predominantly on the vulvar mucosa of a 28-year-old female diagnosed as white sponge nevus (WSN). WSN is a rare, autosomal dominant disorder involving mucous membranes. It predominantly affects the oral mucosa; however, it has been reported to rarely involve extraoral mucosal sites. In this case, histology and family history were key features leading to the correct diagnosis. WSN is an extremely rare cause of vulvar leukoplakia, yet it is important to recognize to allow for appropriate genetic counseling of this autosomal dominant disorder and to avoid misdiagnosis and the potential for subsequent exposure to ineffective treatment modalities.
Cutlan JE, Saunders N, Olsen SH and Fullen DR. White sponge nevus presenting as genital lesions in a 28-year-old female.
[Show abstract][Hide abstract] ABSTRACT: Eccrine porocarcinoma (EP), although rare, is widely recognized as the most common malignant sweat gland tumor. EP typically grows slowly and usually is cured by surgical excision with clear margins. An elevated mortality rate, however, is observed when regional lymph nodes are involved. We herein describe cytohistologic findings in a case of metastatic EP. An 86-year-old man with a history of EP of the left lateral ankle and squamous cell carcinoma in situ (Bowen's disease) of the penis presented with enlarged left inguinal lymph nodes. A superficial fine-needle aspiration (FNA) was performed and demonstrated a hypercellular sample with discohesive clusters and/or individual tumor cells. The tumor cells were round or oval with most of the cells showing dense, refractile cytoplasm. Intracytoplasmic vacuoles were readily appreciated in some of the cells. Nuclear enlargement, high N/C ratio, nuclear hyperchromasia, bi- and multinucleation, and prominent nucleoli were seen. A diagnosis of metastatic eccrine porocarcinoma was rendered. Enlarged retroperitoneal lymph nodes were detected and CT-guided left retroperitoneal core biopsy was performed 1 week later. The biopsy revealed features consistent with metastatic eccrine porocarcinoma.
[Show abstract][Hide abstract] ABSTRACT: Clusterin is a ubiquitous 80 kDa heterodimeric glycoprotein previously shown to be expressed on tumor cells of systemic and, to a lesser extent, primary cutaneous anaplastic large cell lymphoma (PC-ALCL). Lymphomatoid papulosis (LyP), an important differential diagnosis of ALCL, has been studied for clusterin expression in only a small number of cases. The aim of this study was to compare clusterin immunostaining patterns in LyP and other cutaneous histologic simulants with those of PC-ALCL.
Formalin-fixed, paraffin-embedded sections of PC-ALCL (6), LyP (20), mycosis fungoides with large cell transformation (MF-LCT, 12), pityriasis lichenoides et varioliformis acuta (PLEVA, 12), arthropod bite reaction (ABR, 12) and lymphomatoid reactions (LR, 9) were immunostained for clusterin and evaluated for staining pattern and distribution. All diagnoses were made with clinicopathologic correlation.
Characteristic dot-like Golgi staining was identified in 10/20 LyP (50%), 4/6 PC-ALCL (67%) and 9/12 MF-LCT (75%). Two of 12 PLEVA (17%), 1 of 12 ABR (8%) and 2 of 8 LR (25%) had lymphocytes (< 25%) with diffuse cytoplasmic staining. Dermal dendritic cells stained strongly for clusterin. High background staining occurred in some cases.
Clusterin immunostaining does not reliably distinguish between LyP, PC-ALCL or MF-LCT, but could distinguish LyP from its reactive histologic simulants.
[Show abstract][Hide abstract] ABSTRACT: The histologic diagnosis of atypical fibroxanthoma (AFX) can sometimes be challenging. No specific marker exists to confirm the diagnosis other than excluding other entities. CD163 has been shown to have great specificity for tumors of monocyte/histiocyte lineage. In this study, we evaluated the diagnostic utility of CD163 in diagnosing AFX and in identifying skin lesions with histiocytic/dendritic derivation.
A total of 157 cases, including 14 AFXs, 5 spindle cell squamous cell carcinomas (SCCs), and 7 spindle cell/desmoplastic melanomas, along with other cutaneous spindle cell and histiocytic/fibrohistiocytic lesions, were stained with CD163.
CD163 was expressed in 11 of 14 (79%) AFXs, with moderate to strong intensity. No staining was observed in cases of spindle cell SCC (0/5) and dermatofibrosarcoma protuberans (0/10). Rare spindle cell/desmoplastic melanomas (2/7) and cutaneous leiomyosarcomas (1/5) demonstrated positive staining. CD163 reactivity was seen in 24 of 29 of benign fibrous histiocytomas (BFHs), including 8 of 8 cellular fibrous histiocytomas and 6 of 9 epithelioid cell histiocytomas. The majority of cutaneous histiocytic lesions, including juvenile xanthogranuloma, Langerhans cell histiocytosis and Rosai-Dorfman disease, were positive for CD163.
CD163 is a useful adjunct in distinguishing AFX from other malignant cutaneous spindle cell tumors and offers improved specificity in identifying cutaneous histiocytic/dendritic lesions.
[Show abstract][Hide abstract] ABSTRACT: Recent studies have demonstrated telomerase expression in ophthalmologic sebaceous carcinoma and have suggested possible diagnostic utility in distinguishing these neoplasms from sebaceous adenomas. The aim of this study was to evaluate telomerase expression via human telomerase reverse transcriptase (hTERT) immunohistochemical staining in a spectrum of sebaceous lesions of the skin.
Paraffin-embedded sections from sebaceous hyperplasia (11), nevus sebaceus (22), sebaceous adenoma (19), sebaceoma (11), and sebaceous carcinoma (14) were evaluated for intensity (0 to 3+) and pattern of anti-hTERT staining.
Strong (2 to 3+) hTERT staining was observed in nucleoli of germinative cells and immature sebocytes in all sebaceous lesions, whereas mature sebocytes were negative. The distribution pattern paralleled features seen by routine haematoxylin and eosin-stained sections.
All hyperplastic and neoplastic sebaceous skin lesions expressed hTERT in this immunohistochemical study. The pattern of staining was predictive of the histologic pattern of the process but does not significantly add to our diagnostic armamentarium of sebaceous lesions.
[Show abstract][Hide abstract] ABSTRACT: As a result of overlapping morphologic and immunohistochemical features, it can be difficult to distinguish synovial sarcoma, malignant peripheral nerve sheath tumor, and Ewing sarcoma/primitive neuroectodermal tumor in core biopsies. To analyze and compare immunohistochemical profiles, we stained tissue microarrays of 23 synovial sarcomas, 23 malignant peripheral nerve sheath tumors, and 27 Ewing sarcomas with 22 antibodies potentially useful in the differential diagnosis, and analyzed the data with cluster analysis. Stain intensity was scored as none, weak, or strong. For CD99, tumors with membranous accentuation were independently categorized. Cluster analysis sorted five groups, with like tumors clustering together. Synovial sarcoma clustered into two groups: one cytokeratin and EMA positive (n = 11), the other mostly cytokeratin negative, EMA positive, bcl-2 positive and mostly CD56 positive (n = 9). Malignant peripheral nerve sheath tumor clustered into two groups: one S100 positive, with nestin and NGFR positivity in most (n = 10), the other mostly S100 negative, and variably but mostly weakly positive for nestin and NGFR (n = 11). Ewing sarcomas clustered into a single group driven by membranous CD99 staining. Thirteen cases failed to cluster (outliers), while three Ewing sarcomas clustered into groups of other tumor types. Paired antibodies for each tumor type determined by visual assessment of cluster analysis data and statistical calculations of specificity, sensitivity, and predictive values showed that EMA/CK7 for synovial sarcoma, nestin/S100 for malignant peripheral nerve sheath tumor, and membranous CD99/Fli-1 for Ewing sarcoma yielded high specificity and positive predictive values. Cluster analysis also highlighted aberrant staining reactions and diagnostic pitfalls in these tumors. Hierarchical cluster analysis is an effective method for analyzing high-volume immunohistochemical data.
Modern Pathology 06/2006; 19(5):659-68. DOI:10.1038/modpathol.3800569 · 6.19 Impact Factor