Neoplastic cells parasitized by Mycobacterium leprae: report of two cases of melanocytic nevus and one of basal cell carcinoma

Background: Leprosy is a major public health concern in many developing countries. Mycobacterium leprae (M. leprae), the causative agent of leprosy, has the ability to parasitize different types of human cells and tissues. In this article, the uncommon parasitism of nevus and neoplastic and epithelial cells by M. leprae are described using histological sections doubly stained by Fite-Faraco (FF) and immunohistochemistry (IHC), respectively. Case presentation: Three patients with borderline-lepromatous and lepromatous leprosy underwent excision of melanocytic nevi (cases 1­2) and basal cell carcinoma (case 3). Histological sections confirmed the clinical diagnosis of melanocytic nevus and basal cell carcinoma, but leprosy lesions were evident in adjacent tissues. FF staining and IHC (CD68, Melan A, and 34ßE12) demonstrated the presence of bacilli within the nevus cells and also in the epithelial cells of the basal cell carcinoma. Conclusions: M. leprae has the ability to parasitize different types of cells, including neoplastic cells. Pathologists working in settings where leprosy is endemic should be aware that some cutaneous biopsy specimens may also present with leprosy findings.

Laser-assisted photodynamic therapy for superficial basal cell carcinoma and Bowen's disease: a randomized intrapatient comparison between a continuous and a fractional ablative CO2 laser mode.

BACKGROUND: Laser-assisted photodynamic therapy is being explored as a method to enhance efficacy of photodynamic therapy (PDT). OBJECTIVE: To compare a continuous (CL) and a fractional (FL) ablative CO2 laser-assisted methyl aminolevulinate (MAL) PDT in the management of superficial basal cell carcinoma (sBCC) and Bowen's disease (BD). METHODS: Thirty treatment areas in fifteen patients with inoperable, histologically verified sBCC or BD received CL or FL after intrapatient randomization. Laser treatment was followed by MAL application and illumination occurred 3 h later. This treatment was repeated after 2 weeks. An equivalence analysis was performed on the primary endpoint efficacy, while secondary endpoints pain, side-effects and aesthetics were evaluated using paired samples tests. Patients were also asked for their preferred treatment. RESULTS: An excellent efficacy of 92.9% (sBCC, 100%; BD, 80%) was found in both CL + PDT and FL + PDT after 12 months. Equivalence could not be established. Little pain was perceived in most patients during PDT illumination. PDT treatment in FL + PDT was less painful, significantly during the second treatment (P = 0.026). Side-effects were mild to moderate with erythema being the most frequent immediate side-effect, followed by oedema, crusting and burning sensation. Pigmentary changes occurred in 21% (CL + PDT) to 29% (FL + PDT), and aesthetics were good to excellent in all patients. CL + PDT and FL + PDT did not significantly differ in side-effects (P = 0.219-1.000) or aesthetics (P = 0.157-1.000). CONCLUSIONS: Results in this pilot study support the promising role of laser-assisted PDT. Both treatment arms demonstrated the same efficacy as well as comparable side-effects and aesthetics. PDT illumination was significantly less painful in the FL + PDT group, suggesting a preference for FL + PDT. The authors recommend further investigation with a larger sample size, a subgroup analysis between sBCC and BD and comparison of different treatment protocols before one technique could be preferred to another.

Trendy Tattoos-Maybe a Serious Health Risk?

BACKGROUND: The literature reports many cases of cutaneous malignancy in the setting of skin tattoos. In this study, we review the reported incidence of and risk factors for tattoo-associated skin cancer. METHODS: A PubMed literature review was performed for all cases of tattoo-associated skin cancer, including squamous cell carcinoma, basal cell carcinoma, malignant melanoma, keratoacanthoma, and other rare skin malignancies (source: PubMed/until June 2017). RESULTS: The authors identified 51 publications and 63 total cases of tattoo-associated skin cancer. We also report on a single new case of tattoo-associated skin cancer observed at one of our co-authors' institutions. Among these 64 total cases, 58% were associated with black and blue inks and 34% were associated with red ink. CONCLUSIONS: Overall, while the strength of association remains unclear, the literature reports many cases of tattoo-associated skin cancer. Among these cases, black, blue, and red inks were particularly worrisome for their carcinogenic potential. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

[Development of a PCR for the detection and quantification of parasitism by Demodex folliculorum infestation in biopsies of skin neoplasms periocular area]. / Desarrollo de una PCR para la detección y cuantificación de la parasitación por Demodex folliculorum en biopsias de neoplasias cutáneas del área periocula.

OBJECTIVE: To standardize the relative quantification by mass of tissue parasitism by Demodex folliculorum infestation from neoplastic skin biopsies periocular using molecular amplification to study the possible relationship of the appearance of eyelid basal cell carcinoma with the presence and density of the mite in later works. METHODS: A quantitative PCR was developed real-time probes TaqMan. PCR was tested in a pilot 46 actual biopsy samples nodular basal cell carcinoma series. RESULTS: The sensitivity was placed with a detection limit of between 1 and 10 copies / µl. 50% (23/46) of the biopsies were positive for D. folliculorum. The specificity was 100% confirmed by sequencing. CONCLUSIONS: The technique shows good results for sensitivity and specificity that can make it useful as a tool for studies of cause and effect D. folliculorum and basal cell carcinoma.

Ocular myiasis in a glioma: a case report.

BACKGROUND: Ocular myiasis though rare, is usually found in association with basal cell carcinoma. It is rarer still in tumors other than basal cell carcinoma. We report a case of ocular myiasis in a glioma which is hitherto unreported to the best of our knowledge. CASE: A 50 year old male presented with bleeding and maggots emanating from a tumourous outgrowth which had replaced his right eye. He complained of swelling and pain in his right eye for the last 2 years. Manual removal of maggots was carried out following which he underwent total excision of the mass and local debridement. Biopsy of the mass was consistent with astrocytoma. CONCLUSION: Myiasis though rare should be suspected in long standing neglected lesions with suggestive history. Infection, ischemic necrosis and malignancy coupled with overcrowding, poor living conditions, presence of excessive arthropods in the locality and low levels of hygiene drastically increase the risk of myiasis.

Trichomonas vaginalis induces cytopathic effect on human lung alveolar basal carcinoma epithelial cell line A549.

Trichomonas vaginalis, the causative agent of trichomoniasis is generally known to inhabit the genitourinary tract. However, several case reports with supporting molecular and immunological identifications have documented its occurrence in the respiratory tract of neonates and adults. In addition, the reports have documented that its occurrence is associated with respiratory failures. The medical significance or consequence of this association is unclear. Thus, to establish the possible outcome from the interaction of T. vaginalis with lung cells, the cytopathic effects of the parasites were evaluated using monolayer cultures of the human lung alveolar basal carcinoma epithelial cell line A549. The possible effect of association of T. vaginalis with A549 epithelial cells was analyzed using phase-contrast, scanning electron microscopy and fluorescence microscopy. MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide), crystal-violet and TUNEL (terminal deoxynucleotidyltransferase-mediated dUTP nick-end labelling) assays were conducted for cytotoxicity testing. The results demonstrate that T. vaginalis: (1) adheres to A549 epithelial cells, suggesting a density-dependent parasite-cell association; (2) adherence on A549 is through flagella, membrane and axostyle; (3) causes cell detachment and cytotoxicity (50-72.4%) to A549 and this effect is a function of parasite density; and (4) induces apoptosis in A549 about 20% after 6 h of incubation. These observations indicate that T. vaginalis causes cytopathic effects on A549 cell. To date, this is the first report showing a possible interaction of T. vaginalis with the lung cells using A549 monolayer cultures. Further studies are recommended to completely elucidate this association.

Concurrent primary and secondary myiasis on basal cell carcinoma.

Myiasis is a disease caused by infestation of fly larvae in human and other vertebrate tissues. It is a skin condition common in tropical and subtropical countries and its predisposing factors are: chronic diseases, immunodeficiency, poor hygiene, senility, psychiatric disorders, skin cancers and ulcerated mucosae. We report the case of a healthy patient who after traumatic injury of a preexisting lesion showed a tumor on the dorsal region parasitized by fly larvae. The histopathological examination performed for the diagnosis of skin neoplasm surprisingly revealed the presence of a partially degenerated larva with characteristics of Dermatobia hominis, suggesting an association of primary and secondary myiasis on basal cell carcinoma.

Concurrent primary and secondary myiasis on basal cell carcinoma / Concomitância de miíase primária e secundária em lesão de carcinoma basocelular

Myiasis is a disease caused by infestation of fly larvae in human and other vertebrate tissues. It is a skin condition common in tropical and subtropical countries and its predisposing factors are: chronic diseases, immunodeficiency, poor hygiene, senility, psychiatric disorders, skin cancers and ulcerated mucosae. We report the case of a healthy patient who after traumatic injury of a preexisting lesion showed a tumor on the dorsal region parasitized by fly larvae. The histopathological examination performed for the diagnosis of skin neoplasm surprisingly revealed the presence of a partially degenerated larva with characteristics of Dermatobia hominis, suggesting an association of primary and secondary myiasis on basal cell carcinoma.

A miíase é uma doença causada por infestação de larvas de moscas nos tecidos humanos ou de outros animais vertebrados. É dermatose comum em países tropicais e subtropicais e tem como fatores predisponentes: doenças crônicas, imunodeficiência, má higiene, senilidade, doenças psiquiátricas, cânceres cutâneos e de mucosas ulcerados. Relata-se caso de paciente hígido que após trauma sobre lesão pré-existente, apresentou tumoração na região dorsal parasitada por larvas de moscas. O exame histopatológico realizado para o diagnóstico da neoplasia, de modo surpreendente, evidenciou a presença de uma larva parcialmente degenerada com características de Dermatobia hominis, sugerindo associação de miíase primária e secundária em carcinoma basocelular.

Acute burn scar basal cell carcinoma.

Basal cell carcinomas are rarely associated with long-standing burn wounds and even when so, take many years to develop. In this case report, we illustrate an acute variety of burn scar carcinoma, a very rare entity, and follow the evolution of current thoughts on this subject.

High incidence of demodicidosis in eyelid basal cell carcinomas.

BACKGROUND: Although UV radiation is the major cause of basal cell carcinoma (BCC), local factors, such as chronic trauma, irritation, or inflammation, may also have some role in its etiopathogenesis. The pilosebaceous follicle mites, Demodex folliculorum and D. brevis, inhabit most commonly and densely certain facial skin areas, including the nose and periorbital regions, where BCC also develops most frequently. AIM: To investigate, in a retrospective histopathologic study, whether a possible etiopathogenetic relationship exists between demodicidosis and eyelid BCCs. METHODS: We examined 32 eyelid BCC specimens that contained at least five eyelashes or five hair follicles with respect to the presence and density of Demodex mites. As controls, we evaluated 34 matched specimens consisting of benign eyelid skin lesions. RESULTS: Twenty-one of 32 BCC cases (65.6%) and eight of 34 control cases (23.33%) had demodicidosis. Mean mite counts were 1.31 +/- 1.57 and 0.47 +/- 0.99 in BCC cases and controls, respectively. The differences were significant for both prevalence (P < 0.001) and density (P = 0.0052). Although there was a significant positive correlation between increasing mite number and patient age in the control group (r = 0.47, P < 0.05), no significant correlation was found between these two factors in BCC cases (r = -0.102, P > 0.05). CONCLUSIONS: Demodicidosis may be one of the triggering factors of carcinogenesis in eyelid BCCs in otherwise predisposed people due to its traumatic/irritating effect or chronic inflammation.