B-cell epidermotropism in lymphomas.
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B-Lymphocytes↗
Biomedical subjects
H Kerl
Publications and source records attributed to H Kerl.
Solitary skin lesions with histopathologic features of early mycosis fungoides.
Mycosis fungoides (MF) is a cutaneous T-cell lymphoma that usually begins with cutaneous patches that evolve into plaques and tumors. A few recent reports describe a solitary variant of MF distinct from localized pagetoid reticulosis, a disease in which solitary verrucous lesions occur on acral skin. Solitary skin lesions with some of the histopathologic features of MF rarely occur during treatment with several drugs, especially antidepressants or antihistamines. We analyzed the clinicopathologic features of 20 patients with solitary skin lesions showing histopathologic features of patch- or early plaque-stage MF. Eight men and 12 women (mean age 50.6, range 23-82, median 49) had solitary, small erythematous patches or plaques located on the trunk (16 cases, 6 of them on the breast), upper extremities (3 cases), and inguinal region (1 case). Ten patients were treated with one or more drugs; only two of them received antidepressants or antihistamines. Histopathologic examination revealed in all cases a band-like infiltrate in the upper dermis, frequently with epidermotropism of solitary lymphocytes. Atypical lymphocytes were present in a minority of cases. Immunohistology showed a predominance of CD3+ T lymphocytes, in most cases admixed with clusters of CD20+ B-cells. Only a small proportion of the infiltrate was CD8+. Molecular analysis of the rearrangement of the T-cell receptor genes was performed in 16 cases using the polymerase chain reaction (PCR) technique and revealed a monoclonal band in 8 of them. After surgical excision, 2/14 patients had a recurrence near the surgical scar. In 18 patients with complete follow-up data, no evidence of "classic" MF could be observed after a mean follow-up of 31.9 months. Solitary skin lesions with the histopathologic features of MF can be considered as a distinct clinicopathologic entity, probably representing a solitary variant of mycosis fungoides.
Adult↗
Trichoblastoma and sebaceoma in nevus sebaceus.
We report two cases of an unusual combined adnexal neoplasm arising in a nevus sebaceus (NS). Clinically, both neoplasms presented in two women (46 and 78 years) as single, partially ulcerated nodules within NS situated on the scalp. Histopathologically, each neoplasm showed distinctive aggregations of basaloid cells with features of trichoblastoma adjacent to aggregations of neoplastic cells exhibiting features of sebaceoma. In both cases, typical features of NS were present. To the best of our knowledge, this unusual combined adnexal neoplasm comprised of trichoblastoma and sebaceoma could not be assigned to any previously described histopathologic entity. This "complex" adnexal neoplasm should be distinguished histopathologically from basal cell carcinoma with sebaceous differentiation and trichoblastoma with sebaceous differentiation.
Aged↗
Foreign body granulomas due to injectable aesthetic microimplants.
We present two types of "new" foreign body granulomas caused by the injectable aesthetic microimplants Bioplastique and Artecoll. We report the clinical and histopathologic findings in five patients who had undergone treatment of mainly facial contour abnormalities with one of these implants. All patients were women, and the mean age was 45 years (age range 24-72 years). Two patients presented after treatment with Bioplastique; in three patients, augmentation was achieved by using Artecoll. Unsatisfactory cosmetic effects led to excision of the implants in four patients; in one patient, parts of the implant were excised during another cosmetic intervention. Subsequent histopathologic examination showed features of foreign body granulomas with distinctive cystic spaces. The clue to the diagnosis is the particular configuration of these cystic spaces and the characteristic shape of the foreign bodies. Bioplastique granuloma presents with irregularly shaped cystic spaces of varying size containing jagged, translucent, nonbirefringent foreign bodies whereas Artecoll granuloma shows numerous round vacuoles nearly identical in size and shape enclosing round and sharply circumscribed, translucent, nonbirefringent foreign bodies. These specific histopathologic findings unequivocally allow the correct diagnosis in spite of sparse clinical information.
Adult↗
Non-random spatial association of melanoma and naevi--a morphometric analysis.
Previous studies have shown that congenital as well as acquired melanocytic naevi indicate an increased risk for developing melanoma in individual patients. Most studies stress the importance of melanocytic naevi as melanoma markers, while in some studies they are considered to be direct melanoma precursors. The latter opinion is favoured by the common co-occurrence of melanoma and naevus within one biopsy. The present study examines the question of whether the co-occurrence of melanoma and naevus is a random event or whether melanomas significantly co-localize with pre-existent naevi, which would suggest a precursor role for these naevi. Seven hundred biopsies of primary melanoma were examined for the presence of congenital or acquired naevi according to standard histological criteria. A naevus was found in 143 of the 700 biopsies (20.4%), of which 90 were acquired (12.9%) and 53 were congenital (7.6%). Within each biopsy the exact location of the melanoma and the naevus was determined using an ocular micrometer at a final magnification of 20 x. From these data the frequency of finding a naevus with increasing distance from the melanoma margin was calculated. The frequency of finding a naevus decreased from 2.6% immediately at the melanoma border to 0.3% at a distance of 4.5 mm and 0% at a distance of 5.0 mm. This decrease was statistically highly significant (P<0.001). Similar results were obtained when congenital and acquired naevi were evaluated separately. These data strongly indicate that melanoma and naevi are non-randomly distributed and that both congenital and acquired naevi may be precursors of melanoma.
Adult↗
Subcutaneous trichoblastoma.
We have recently observed three examples of solitary trichoblastomas (TB) with unusual histopathologic features characterized mainly by numerous aggregations of basaloid cells limited to the subcutis. The three trichoblastomas with unusual features were identified from a large series of 38 solitary TB cases collected over a period of 20 years. Clinically, all three neoplasms presented in men (49, 52, and 62 years old) as solitary, 1- to 1.5-cm skin-colored nodules situated on the scalp, face, and lower arm, respectively. Histopathologically, they showed numerous, smooth-bordered aggregations of basaloid cells limited to the subcutis and surrounded by a sclerotic and partly hyalinized stroma. Multiple sections revealed no connections of basaloid aggregations to the overlying epidermis or pre-existing follicular structures. All three cases displayed rather unusual morphologic growth patterns, including areas of variously sized, nodular aggregations of basaloid cells and extensive foci of elongated, thin columns and branching cords of basaloid cells. A striking feature in the stromal component in two cases was the presence of large, prominent areas of hyalinization and sclerosis. Characteristically, all three neoplasms showed numerous foci with rudimentary follicular germs and papillae. Cytomorphologically, the basaloid cells exhibited dark staining nuclei with large prominent nucleoli and scanty, pale or eosinophilic cytoplasm. Variable number of mitotic figures (2-4 mitoses per high-power field) and single necrotic cells were noted. In one case, small, foci of necrosis en masse were observed. Follow-up data after total excision in all three cases (80, 69, and 6 months) revealed no local recurrences. In light of our observations, we suggest that subcutaneous TB represents a rare variant of solitary TB. Besides the exclusive subcutaneous location, this neoplasm also displays a constellation of particular histopathologic features, namely, rather complex epithelial growth patterns and stroma with prominent foci of sclerosis and hyalinization.
Adolescent↗
CD56+ blastic transformation of chronic myeloid leukemia involving the skin.
We report on two patients with chronic myeloid leukemia (CML) who presented blastic transformation involving the skin, with leukemic infiltrates showing unusual morphologic and immunohistologic characteristics. Both patients were elderly men with a 36-month and a 40-month history of CML, respectively. They presented with disseminated, reddish to violaceous papules and plaques (case 1), and with localized reddish nodules on the left temporal area (case 2). Concurrent features of blastic transformation in the bone marrow were observed in one patient (case 1). Histopathologic examination of skin lesions revealed similar features in both cases. There was a moderate to dense dermal infiltrate composed mainly of medium-sized atypical mononuclear myeloid precursor cells with only few relatively well-differentiated cells of the granulocytic series. Histochemical staining for naphthol-ASD-chloroacetate esterase revealed strong positivity (>50% of neoplastic cells) in case 2 and only scattered positivity (< 10% of neoplastic cells) in case 1. Immunohistologic analysis performed on paraffin-embedded sections showed in both cases variable reactivity of neoplastic cells for leucocyte common antigen (CD45), lysozyme, myeloperoxidase, CD11c, CD15, CD43, CD66, CD68, HLA-DR, and the neural cell adhesion molecule (NCAM) CD56. A negative reaction was observed for CD3, CD34, and TdT. The immunohistologic findings were remarkably similar to those reported for acute myeloid leukemia (AML) with monocytic differentiation (French-American-British [FAB] classification, subtype M4). Examination of blasts from the bone marrow performed in one patient (case 1) revealed a similar phenotype also with CD56 expression. In conclusion, our observations show that specific cutaneous infiltrates in CML may show morphologic and immunohistochemical characteristics similar to those observed in AML with monocytic differentiation. Moreover, specific cutaneous manifestations of CML may express CD56.
Aged↗
'Tubular' structures within melanocytic proliferations: a distinctive morphologic finding not restricted to Spitz nevi.
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Humans↗
Cutaneous involvement in lymphoblastic lymphoma.
Lymphoblastic leukemia/lymphoma (LBL) is a malignant neoplasm of precursor lymphocytes of B- or T-cell phenotype. Involvement of the skin is relatively uncommon. We examined retrospectively the clinicopathologic, immunophenotypic, and molecular genetic features of six patients with cutaneous involvement of LBL (B-LBL=5; T-LBL=1). Patients presented clinically with solitary, large tumors located on the head (3 cases) or the back (1 case), or with generalized tumors (2 cases). Ulceration was uncommon. In two patients the onset of skin lesions was concomitant to the diagnosis of lymphoblastic leukemia. Histopathologic examination showed in all cases a dense, diffuse, monomorphous infiltrate located in the entire dennis and subcutaneous fat. A typical "starry sky" pattern was observed in the majority of the lesions. In some areas neoplastic cells were aligned in a "mosaic-like" fashion. Cytomorphologically, medium sized lymphoid cells with round or convoluted nuclei, inconspicuous nucleoli and scant cytoplasm predominated. There were no significant differences in the histopathologic features of skin lesions in T- and B-LBL. In B-LBL, CD79a was more useful than CD20 in determining the phenotype of neoplastic cells (4/5 cases positive for CD79a as compared to 2/5 cases positive for CD20). TdT, CD10 and CD43 were positive in 4 cases, CD34 in 2. The case of T-LBL revealed positivity for CD1a, CD3, CD43 and TdT, and negativity for CD34 and for B-cell markers. All neoplasms were positive for CD99 and bcl-2, and showed a high proliferation rate. Molecular genetic analysis of J(H) and T-cell receptor (TCR) genes performed using a polymerase chain reaction technique revealed a monoclonal rearrangement of J(H) genes in all five B-LBLs. One of these cases showed also a concomitant TCR-gamma gene rearrangement. A monoclonal rearrangement of the TCR-gamma gene was detected in the case of T-LBL. Our study shows that skin lesions of LBL present characteristic clinicopathologic and molecular features allowing the differentiation from other cutaneous lymphomas, even in cases without clinical history of previous precursor lymphoblastic leukemia/lymphoma.
Adult↗
Hot-water-bottle rash: not only a sign of chronic pancreatitis.
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Aged↗
A double-blind, controlled clinical trial of homeopathy and an analysis of lunar phases and postoperative outcome.
OBJECTIVE: To use scientific methods to evaluate 2 claims made by practitioners of alternative medicine. DESIGN: A placebo-controlled, double-blind study of homeopathy in children with warts, and a cohort study of the influence of lunar phases on postoperative outcome in surgical patients. SETTING: Outpatients of a dermatology department (homeopathy study) and inpatients evaluated at an anesthesiology department (lunar phases). SUBJECTS: Sixty volunteers for the homeopathy study and 14,970 consecutive patients undergoing surgery under general anesthesia for the lunar phase study. INTERVENTIONS: Treatment of children with warts with individually selected homeopathic preparations (homeopathic study); surgical procedures including abdominal, vascular, cardiac, thoracic, plastic, and orthopedic operations and assessment of the lunar phase at the time of operation (lunar phase study). MAIN OUTCOME MEASURES: Reduction of area occupied by warts by at least 50% within 8 weeks; death from any cause within 30 days after surgery. RESULTS: Nine of 30 subjects in the homeopathy group and 7 of 30 subjects in the placebo group experienced at least 50% reduction in area occupied by warts (chi 2 = 0.34; P = .56); the mortality rate was 1.20% in patients operated on during waxing moon and 1.33% in patients operated on during waning moon (chi 2 = 0.49; P = .50). CONCLUSIONS: Statements and methods of alternative medicine--as far as they concern observable clinical phenomena--can be tested by scientific methods. When such tests yield negative results, as in the studies presented herein the particular method or statement should be abandoned. Otherwise one would run the risk of supporting superstition and quackery.
Double-Blind Method↗
Human herpesvirus 8-specific DNA sequences in primary cutaneous B-cell lymphomas.
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Base Composition↗
Long-term follow-up and histological changes of superficial nonmelanoma skin cancers treated with topical delta-aminolevulinic acid photodynamic therapy.
OBJECTIVE: To investigate the immediate and long-term effects of photodynamic therapy with delta-aminolevulinic acid (ALA-PDT) on superficial basal cell carcinomas (BCC) and superficial squamous cell carcinomas (SCC). DESIGN: Retrospective study with 60 months of maximal follow-up. SETTING: University-based hospital in Graz, Austria. PATIENTS: Forty-seven subjects with a total of 95 superficial BCC and 35 superficial SCC. INTERVENTIONS: A compound of 20% delta-aminolevulinic acid was topically applied under an occlusive and light-shielding dressing before exposure to either UV-A or different wave bands of polychromatic visible light (full-spectrum visible light, >515, >570, or >610 nm). MAIN OUTCOME MEASURES: Primary tumor responses and recurrence rates in the long-term follow-up, as well as histological changes associated with ALA-PDT, were studied. RESULTS: The complete primary response rate for all wave bands of light was 86% (82/95) for superficial BCC and 54% (19/35) for superficial SCC. There was no statistically significant difference among the response rates to the different wave bands of light. After a median follow-up of 19 months (range, 3-60 months) for BCC and 8 months (range, 3-47 months) for SCC, the overall recurrence rate was 44% (36/81) and 69% (11/16), respectively. At 36 months after therapy, the projected disease-free rate was 50% (95% confidence interval, 43%-57%) for BCC vs 8% (95% confidence interval, 7%-9%) for SCC (P<.001, log-rank test). Histopathologic studies revealed a significant increase of fibrosis in the dermis after ALA-PDT and appearance of a sharp border between fibrotic and nonfibrotic tissue. In 15 of 16 BCC examined, the border between fibrotic and nonfibrotic tissue was deeper in the dermis than the maximum tumor thickness before therapy (P<.001, Wilcoxon signed rank test). Similar histopathologic observations were made in SCC. CONCLUSIONS: Our study revealed poor long-term cure rates for superficial BCC and SCC treated with topical ALA-PDT and visible light. The histopathologic observations showing remarkable fibrosis in the dermis indicated that the effect of ALA-PDT reached deeper than the initial depth of invasiveness of the neoplastic tissue, suggesting in turn that the poor long-term results of ALA-PDT cannot be explained by insufficient penetration of the therapy effect.
Administration, Topical↗
Ultraviolet radiation of melanocytic nevi: a dermoscopic study.
BACKGROUND: UV radiation can lead to clinical, histological, and ultrastructural changes in melanocytic nevi. In this study, we investigated whether exposure to 2 minimal erythema doses of UV radiation induces changes in the dermoscopic image of acquired melanocytic nevi. OBSERVATIONS: Fifteen melanocytic nevi were exposed to 2 minimal erythema doses of UV radiation. Differences in dermoscopic parameters (asymmetry, border, erythema, and telangiectasias in the nevus; pigmentation; hypopigmented areas; presence, regularity, and sharpness of pigment network; and brown-black globules) in digital dermoscopic images taken before and 3, 7, 14, and 28 days after UV irradiation were scored. Three days after UV irradiation, the borders of nevi were more faded (P<.02), the nevi were darker brown (P<.02), the hypopigmented areas were smaller (P<.02), and the pigment network structures were more faded (P<.007) and less prominent (P<.02) than before UV irradiation. Seven days after UV irradiation, pigmented globules have also grown (P<.05). After 28 days, all parameters, except hypopigmented areas, were essentially the same as before UV irradiation. CONCLUSION: UV irradiation of melanocytic nevi with 2 minimal erythema doses induces transient changes in their dermoscopic appearance that are sometimes suggestive of malignant melanoma.
Adult↗
[Problems, responsibility and goals in dermatopathology].
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Diagnosis, Differential↗
[History of the University Clinic of Dermatology and Venereology in Graz. A review of 125 years (1873-1998)].
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Austria↗
Comparison of phototherapy with near vs. far erythemogenic doses of narrow-band ultraviolet B in patients with psoriasis.
The therapeutic effectiveness of radiation from a 311 nm ultraviolet B (UVB) lamp (Philips TL-01) in a near vs. far erythemogenic therapy regimen was investigated in 13 patients with widespread, symmetrically distributed psoriasis. The patients received UV therapy starting with 70% of the 311 nm minimal erythema dose (MED) on one randomly chosen half of the body and 35% of the 311 nm MED on the other half. Therapy was given three to five times a week, and the UVB dose in both regimens was increased simultaneously in the same relation. For the 11 patients completing the study, the mean psoriasis area and severity index (PASI) score for the near vs. far erythemogenic treatment side was 21.2 vs. 18.5 before therapy (Wilcoxon's test, not significant), 11.8 vs. 14.4 at week 1 (P = 0.003), 8.2 vs. 12.0 at week 2 (P = 0.004), and 6.6 vs. 15.6 at week 3 (P = 0.005). After 3 weeks, a satisfactory response (i.e. improvement of the initial PASI score by more than 75%) was observed in six of 11 patients on the near erythemogenic treatment side vs. three of 11 patients on the far erythemogenic side. However, the definitive median total number of treatments needed to achieve a satisfactory therapy response on the near vs. far erythemogenic sides was 12 vs. 16 (P = 0.022), whereas the definitive median cumulative UV dose was 14.0 vs. 9.1 J/cm2 (P = 0.088), respectively. These results suggest that near erythemogenic 311 nm UVB therapy may clear psoriasis faster than far erythemogenic therapy but that the latter regimen may be equally effective as it requires slightly more treatment sessions at a lower (and possibly less carcinogenic) cumulative UV dose.
Adult↗