Biomedical subjects
Publications and source records attributed to B Giannotti.
We report a case of cutaneous myxoid melanoma in a 61-year-old man. Histologically, the tumor, which showed an adjacent intraepidermal proliferation of atypical melanocytes, was composed of spindle-shaped and epithelioid cells with atypical nuclei, arranged in lobules and embedded in a prominent myxoid stroma. Primary cutaneous myxoid melanoma is rare: we found only one other example in the literature.
We investigated antigenic features associated with different tumor progression steps in primary melanoma, interpreted as different patterns of growth (radial and vertical) in the same and in different lesions. Thirty-eight primary melanomas were examined: 18 superficial spreading malanomas, 13 superficial spreading melanomas with a nodular area and 7 nodular melanomas. 225.28,763.74, CL.203, VF19LL209, VF19LL217, Q5.13, W6.32 and anti-HLA-DR monoclonal antibodies were used. Phenotypic differences between radial and vertical growth areas were observed but no statistical significance could be found.
In this study the clinico-pathological and immuno-histological features, the methods of treatment and follow-up data of 11 patients with follicular centre-cell (B-cell) lymphoma primarily presenting in the skin are reported. All the patients had nodular, tumorous and/or papulonodular skin lesions on the trunk. In nine patients the disease was confined to a circumscribed area of the back. Small papulonodular or plaque-like lesions, as well as large nodules or tumours, were biopsied in six of 11 patients. No clear-cut correlation between the age and clinical morphology of the lesions and their histological growth pattern was found. Interestingly, however, a different immuno-architectural pattern was observed in large, late lesions compared to small, early lesions. Initial treatment consisted of orthovolt radiotherapy (in two patients associated with surgical excision), resulting in complete remission in all patients. Only one patient developed extracutaneous disease, which was limited to a single drainage lymph node appearing simultaneously with a cutaneous relapse. Five other patients had recurrent disease in the skin close to the initial site. The median disease-free period was 15.5 months. On relapse, radiotherapy alone or in combination with short courses of chemotherapy was performed. This resulted in a second complete remission. All the patients are still alive and in complete remission, with a median survival of 37 months. These results confirm the favourable prognosis of patients affected with primary cutaneous follicular centre-cell lymphoma limited to the trunk. Orthovolt radiotherapy proved to be the most suitable treatment for both initial lesions and relapses limited to the skin.
The differentiation of two types of T-lymphocyte accessory cells, i.e., interdigitating reticulum cells and Langerhans cells, was studied immunocytochemically and ultrastructurally on cutaneous lesions from patients with mycosis fungoides, a neoplasm of mature T-lymphocytes. In such a condition the lymphoid infiltrate creates, adjacent to the epidermis, a microenvironment in the dermis similar to that of T-cell areas of lymphoid organs. Immunocytochemistry revealed that CD11c+ CD1a- putative monocytic cells co-exist with CD11c+ CD1a+ putative mature accessory cells. By electron microscopy, large numbers of interdigitating reticulum cells in the dermal infiltrate and Langerhans cells in the epidermis were found. Furthermore, monocytes were frequently observed, at times with cells showing intermediate features between monocytes and interdigitating reticulum cells on the one hand and Langerhans cells on the other. In the absence of proliferative phenomena of the above cells, it is conceivable that both interdigitating reticulum cells and Langerhans cells originate from locally migrated monocytes. A possible role of the local tissue micro-environment--namely the T-lymphoid microenvironment for interdigitating reticulum cells and the epidermal microenvironment for Langerhans cells--in inducing the differentiation of monocytes into the two kinds of accessory cells is proposed.
20% azelaic acid cream was compared clinically with its vehicle in a 3-month double-blind study of 92 patients with moderate inflammatory acne. It was found that the azelaic acid treatment significantly reduced inflamed and non-inflamed lesions and yielded clinically relevant improvement rates. Its action was significantly more effective than its vehicle. In the study of comedo acne, 20% azelaic acid cream was equally effective as 0.05% tretinoin cream in reducing the number of comedones and with respect to overall response. However azelaic acid cream was better tolerated, causing fewer local side effects than the tretinoin.
In order to provide insight into the role of accessory cells in lymphoproliferative neoplasms, 7 cases of mycosis fungoides at various clinical stages--patches, plaques and nodules--were studied ultrastructurally and immunohistochemically. The aim was to establish whether interdigitating reticulum cells are a constant finding in the dermal infiltrate. Their possible relationships with mycosic cells were also investigated. This study revealed that interdigitating reticulum cells were present in all the skin lesions examined, were present in considerable number in the patches and plaques and became sparse in the nodules. Furthermore, in the lesions at various clinical stages these cells showed varying ultrastructural features, probably related to different developmental stages. The close contacts between interdigitating reticulum cells and mycosic cells, the expression of antigenic markers of activation by mycosic cells and the morphological and immunohistochemical signs of progressive de-differentiation of mycosic cells in the more advanced stages suggest that interdigitating reticulum cells are involved in stimulating proliferation and--possibly--neoplastic progression of mycosic cells. A role for the T-cell microenvironment created in the dermis by lymphoid infiltrate in inducing the differentiation of interdigitating reticulum cells from their precursors is proposed.
We have investigated the occurrence, immunohistochemical profile, ultrastructural features and relationships to lymphocytes of the non-lymphoid accessory cells in the dermal infiltrate of five patients affected by B cell lymphoma with secondary involvement of the skin. Typical non-lymphoid accessory cells were found in all cases. Most of these cells had ultrastructural features which resembled those of the poorly differentiated dendritic reticulum cells described in follicular lymphomas of the lymph nodes. The immunohistochemical findings of DRC-I+, C3b r+ dendritic cells often arranged in follicular-like structures with neoplastic B cells and only few, scattered OKMI+, OKM5+ mononuclear phagocytes support the hypothesis that the vast majority of the non-lymphoid cells observed in our cases were poorly differentiated dendritic reticulum cells. These results and previously published reports indicate that the organization of the dermal infiltrate of B cell lymphomas tends to reproduce the typical arrangement of the B zone of the lymphoid tissue, although with a lesser degree of differentiation, similar to that observed in lymph node follicular lymphomas.
The effectiveness of a topical corticosteroid is related to various factors which should be considered when planning treatment. The most relevant factor is the potency of the drug. Another important factor is the absorption through the skin, which is influenced by marked regional variations in percutaneous penetration, hydration and the degree of inflammation present, types of dressings, the solubility of the drug and the age of the patient. Multiple daily applications do not lead to better or faster resolution of the disease. Intermittent therapy with treatment-free intervals, when the vehicle alone is applied, can be as effective as continuous treatment. The choice of a topical corticosteroid depends not only on the severity or activity of the disease, but also on the age of the subject, the body site affected and the extent of the surface area to be treated. In addition, the choice of vehicle depends on the type of lesion and on the body region afflicted. Combinations of a corticosteroid with other agents can be useful, but they are recommended in only a few specific indications. Treatment guidelines for topical corticosteroids must therefore take into account a number of factors which will influence the clinician's ultimate decision in providing care for the patient with steroid-responsive dermatoses.
The evolutionary modifications of the clinical, histomorphologic, and immunopathologic features of both classic and immunodeficiency (ID)-associated Kaposi's sarcoma (KS) were investigated in relation to the immune status of the patients. The histologic picture was similar in the classic and ID-associated forms of the tumor. In classic KS, a variably dense reactive infiltrate was present, and its amount was inversely related to the age of the lesions; conversely, a scarce reactive infiltrate, with the absence of CD4+ cells, was always evidenced in ID-associated KS lesions, even when the immune status of the patient showed no abnormalities. This evidence supports the hypothesis that a specific impairment of skin-associated lymphoid tissue may be crucial to the development of ID-associated KS.
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Fifteen biopsies from contact allergic reactions in sensitized patients were taken at different time intervals after application of simple chemicals. Two different procedures for electron microscopy were done. No signs of damage were ever seen in Langerhans cells. The authors are therefore of the opinion that there is still no proof for a target role of Langerhans cells in contact allergic reactions in humans.
The dermal infiltrates of four patients with the Sézary syndrome were studied by electron microscopy and the data were evaluated quantitatively. The nuclear contour index of lymphocytes was calculated, and many tumour cells had an index greater than 6.5. Dendritic cells were found in all cases. The dendritic cells contained smooth and rough endoplasmic reticulum, moderately well-developed Golgi apparatus, scanty lysosomes and many thin and intermediate filaments; their surface was scalloped with numerous vesicles. Birbeck granules were not found in the cytoplasm of dendritic cells. Dendritic cells comprised 24% of infiltrating cells and were interspersed with lymphocytes; 75% of the lymphocytes were in contact with dendritic cells; 35% of the lymphocytes in contact with dendritic cells had a nuclear contour index higher than 6.5 and 76% had a nuclear contour index higher than 5. The data strongly suggest a functional relationship between lymphocytes and dendritic cells in the dermal infiltrate of Sézary syndrome. They are discussed in relation to the hypothesis that the disease is a consequence of chronic immune stimulation.
The histological and ultrastructural features of a sclerosing epithelial hamartoma are described. By electron microscopy, epithelial cords formed by basal-like cells and epithelial cysts with a pattern of keratinization similar to that of normal epidermis or of follicular infundibula were seen. By conventional light microscopy, continuities were found between the epithelial cords and the overlying epidermis. The stroma was found to be fibrous and contained some fibroblasts or possibly myofibroblasts with bundles of microfilaments. The data are interpreted with respect to the origin of the neoplasm, its line of differentiation, and its sclerosing behavior.
The phenotypic profile of atypical cells from a patient with cutaneous multilobated T-cell lymphoma was investigated using a multiparameter approach including evaluation of membrane markers, cytochemistry, and functional activity. Retroviral sequence restriction analysis was also used to investigate the presence of human T-cell leukaemia/lymphoma virus type I (HTLV-I) in atypical cells infiltrating the skin and in otherwise normal peripheral blood lymphocytes. The atypical cells appeared to belong to the T-lineage demonstrating OKT11 positivity, E-rosette formation, tartrate-sensitive acid phosphatase and beta-glucuronidase activity, and consistent negativity for cytoplasmic and/or surface monoclonal immunoglobulins. However, they failed to stain for other T-lymphocyte-associated antigens, such as those defined by OKT3, OKT4, OKT6, OKT8, OKT9, OKT10, Leu-2a and Leu-3a monoclonal antibodies, and did not express a definite alpha-naphthyl-acetate esterase pattern. Additional studies including phagocytosis tests and a series of monoclonal antibodies against phagocytic and natural killer cell associated antigens were all negative. No HTLV-I related sequences were found in either the cells infiltrating the skin or in circulating lymphocytes. To our knowledge, in previously reported cases of cutaneous multilobated cell lymphoma a clear T-lymphocyte phenotypic profile was demonstrated. Our present data indicate that this is not always necessarily the case. The peculiar phenotype we found might represent a transitional state between different T-cell subsets or an as yet unrecognized phenotype of a neoplastic T-lymphocyte which lacks a normal counterpart.
This paper reports the results of a series of light and electron microscopic, cytochemical, immunologic and cytogenetic investigations performed in a patient with Sézary syndrome. Fifty-two percent of the cerebriform cells were OKIa-1 positive and 55% were acid alpha-naphthyl-acetate esterase (ANAE) negative. Since activated T-lymphocytes are known to lose their peculiar ANAE activity while acquiring Ia-like antigens, it is conceivable that the ANAE-negative and OKIa-1-positive cells represent an in vivo activated subset. Thus, it appears that a typical Sézary cell population from a given individual can exhibit heterogeneous phenotypic profiles.
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