Systemic lupus erythematosus, following prodromal idiopathic thrombocytopenic purpura, presenting with skin lesions resembling malignant atrophic papulosis.

Systemic lupus erythematosus (SLE) is an autoimmune disease. Its incidence in the UK is approximately 1 per 10 000. Cutaneous involvement, encompassing acute, subacute and chronic disease, occurs in over two-thirds of cases, and can often be the first clue to diagnosis. We describe a highly unusual case of SLE occurring after prodromal idiopathic thrombocytopenic purpura (ITP) and presenting with skin lesions more typical of malignant atrophic papulosis, a rare and often fatal vasculopathy. Such a combination of rare features emphasizes the potential for complexity in this multisystem disease.

Periocular pseudo-rheumatoid nodules commonly affect the orbital rim.

PURPOSE: To describe the typical presenting clinical characteristics and histopathology for periocular pseudo-rheumatoid nodules. METHODS: Clinical case-note and histopathological review for patients presenting to the Orbital Clinic at Moorfields Eye Hospital between 1994 and 2002. RESULTS: Four females with biopsy-proven periocular pseudo-rheumatoid nodules presented between the ages of 22 and 33 years (mean 26.8 years), having a 4-month to 3-year history of newly formed (or recurrent) subcutaneous nodules-these overlying the superotemporal orbital rim and rarely tender. One patient had insulin-dependent diabetes for 22 years and one patient had bilateral disease. The masses were excised in all patients, with a minor recurrence in one, not requiring further treatment; one patient defaulted from follow-up. CONCLUSIONS: Periocular pseudo-rheumatoid nodules appear to typically present in young females, possibly more commonly with type I diabetes mellitus, and form a rather characteristic slowly growing, firm, occasionally slightly tender, subdermal nodule overlying the superolateral rim of the orbit. Surgical excision improves the condition in many cases, although spontaneous regression might also occur.

hTERT protein expression is independent of clinicopathological parameters and c-Myc protein expression in human breast cancer.

BACKGROUND: Telomerase is a ribonucleoprotein enzyme that synthesises telomeres after cell division and maintains chromosomal length and stability thus leading to cellular immortalisation. The hTERT (human telomerase reverse transcriptase) subunit seems to be the rate-limiting determinant of telomerase and knowledge of factors controlling hTERT transcription may be useful in therapeutic strategies. The hTERT promoter contains binding sites for c-Myc and there is some experimental and in vitro evidence that c-Myc may increase hTERT expression. We previously reported no correlation between c-Myc mRNA expression and hTERT mRNA or telomerase activity in human breast cancer. This study aims to examine the correlation between hTERT expression as determined by immunohistochemistry and c-Myc expression, lymph node status, and tumour size and grade in human breast cancer. MATERIALS AND METHODS: The immunohistochemical expression of hTERT and c-Myc was investigated in 38 malignant breast tumours. The expression of hTERT was then correlated with the lymph node status, c-Myc expression and other clinicopathological parameters of the tumours. RESULTS: hTERT expression was positive in 27 (71%) of the 38 tumours. 15 (79%) of 19 node positive tumours were hTERT positive compared with 11 (63%) of 19 node negative tumours. The expression was higher in node positive tumours but this failed to reach statistical significance (p = 0.388). There was no significant association with tumour size, tumour grade or c-Myc expression. However, hTERT expression correlated positively with patients' age (correlation coefficient = 0.415, p = 0.0097). CONCLUSION: hTERT protein expression is independent of lymph node status, tumour size and grade and c-Myc protein expression in human breast cancer.