CD56 and smooth muscle actin immunoreactivity in basal cell carcinomas: Are they indicators of differentiation or do they hold a diagnostic use?

BACKGROUND: Basal cell carcinoma (BCC) is the most common cutaneous malignancy and may show various differentiations. The possible pluripotent stem cell lineage of BCCs, whose origins are controversial today, is thought to be the main reason for the different morphologies. The aim of the study is to evaluate the expression of some neuroendocrine and smooth muscle markers of differentiation in BCCs and investigate the relationship between histopathologic subtypes and recurrence. METHODS: A total of 128 cases diagnosed as BCC in our center were included. Immunohistochemical studies of CD56, synaptophysin, chromogranin-A, smooth muscle actin (SMA), desmin, caldesmon, and Ki67 were applied. RESULTS: CD56, chromogranin-A, and synaptophysin immunoreactivity were detected in 77.3%, 13.3%, and 0.8% of the cases, respectively. 78.1% showed SMA positivity while no tumor expressed desmin or caldesmon. A correlation between histopathologic recurrence risk groups and CD56 expression was found (p < 0.05). CONCLUSIONS: CD56 and SMA immunoreactivity is present in the majority of BCCs. However, the available findings do not support neuroendocrine or smooth muscle differentiation. CD56 antigen can be used for prognostic purposes in detecting high recurrence risk tumors. After the investigation of the expression rates of these two antigens in different cutaneous tumors, it may be appropriate to use them for diagnostic purposes in BCCs.

A Comparative Study of CD56 and Smooth Muscle Actin Expression in Basal and Squamous Cell Carcinomas.

ABSTRACT: Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the 2 most common types of nonmelanoma skin tumors. Clinical or histopathological diagnostic challenges are encountered on occasion. CD56 and smooth muscle actin (SMA) are highly expressed in BCCs. We aimed to investigate the frequency of these markers, along with B-cell lymphoma 2 (Bcl-2) and Ki67. This study was conducted to propose a method that could possibly be of diagnostic value. One hundred twenty-eight BCC and 39 SCC cases were included in this study. CD56, SMA, Bcl-2, and Ki67 immunohistochemical stains were applied. Ninety-nine (77.3%) BCC and 6 (15.4%) SCC cases showed CD56 immunoreactivity. SMA expression was detected in 78.1% of BCC and 5.1% of SCC cases. CD56, SMA, and Bcl-2 expressions were significantly higher in BCC cases. The Ki67 proliferation index was found significantly higher in SCC cases. When basosquamous carcinoma cases were compared with SCC cases, a significant correlation between tumors and expression of CD56, SMA, and Bcl-2 were obtained. CD56 and SMA, in addition to Bcl-2, favor BCC. Ki67 should also be included in the panel to demonstrate the proliferative activity.

Retrospective Analysis of 91 Kaposi's Sarcoma Cases: A Single-Center Experience and Review of the Literature.

BACKGROUND: Kaposi's sarcoma (KS) is a multifocal angioproliferative tumor involving primarily the skin. OBJECTIVE: The aim of this study was to describe the clinical, demographic, histopathological characteristics, treatment modalities, and outcome of 91 KS patients, and compare them with other contemporary research. METHODS: Medical records of 91 KS patients followed between January 2005 and September 2017 were evaluated retrospectively. RESULTS: Most of our patients were male (male-to-female ratio was 4.05). The median age at diagnosis was 69 years (range, 6-93 years). The duration of the lesions varied between 3 and 25 years. The lower extremities were the most commonly involved area (51.6%). Of the 91 patients, classic type KS was seen in 75 patients. Radiotherapy was used successfully in approximately half of our patients. Recurrence was observed in approximately one third of the patients. All KS patients in this study except 1 were classic KS. CONCLUSION: The clinical and demographic characteristics of our patients were compatible with the previous literature suggesting that KS is a tumor that tends to be limited to the skin. Close follow-up of patients is important to monitor for recurrence. This is the largest report from Turkey to date.

Choroidal ganglioneuroma in a patient with orbitopalpebral neurofibromatosis.

Ganglioneuroma is a rare, benign tumor originating from the sympathetic ganglion cells. Choroidal ganglioneuroma in association with neurofibromatosis type 1 (NF-1) has been reported in a few cases. This study describes a 21-year-old woman with orbitopalpebral NF, who underwent evisceration for pseudophakic bullous keratopathy, intractable glaucoma, and absolute painful eyes and who was found to have choroidal ganglioneuroma and retrobulbar plexiform neurofibroma on histologic examination. This case, together with the previously described cases, suggests that eyes with choroidal ganglioneuromas may have some common clinical and prognostic characteristics, although this condition cannot be diagnosed preoperatively. In patients with NF-1 who may undergo eye removal surgery, the possibility of choroidal tumors should be kept in mind.

Birt-Hogg-Dubé Syndrome: Diagnostic Journey of Three Cases from Skin to Gene.

Birt-Hogg-Dube syndrome (BHDS) is a rare disorder characterized by the triad of cutaneous lesions, renal tumors, lung cysts and inactivation of the gene folliculin (FLCN). Here, we present three female patients diagnosed with BHDS. First case a 55-year-old female had flesh moles histopathology compatible with angiofibroma, multiple cysts in the lung and kidneys, FLCN gene mutations ('c.1285dupC [p.His429Profs*]' 11th exon and 'c.653G>A [p.Arg258His]' 7th exon). The second case a 76-year-old female had trichodiscoma on her skin, multiple cysts in the lung, spontaneous pneumothorax, FLCN gene mutation 'c.1285dupC (p.His429Profs*27) 11th exon' and, her son had renal carcinoma history under 50 years of age. Our third case, also the daughter of case 2, had dermal papules histopathology compatible with trichodiscoma, spontaneous pneumothorax, FLCN gene mutation 'c.1285dupC (p.His429Profs*27) 11th exon' and, parotid oncocytoma. Through our cases, we document the first case of two mutations ('c.1285dupC [p.His429Profs*]' 11th exon and 'c.653G>A [p.Arg258His]' 7th exon) in the same FLCN gene and the 11th known case of parotid oncocytoma associated with BHDS in the light of the literature.

Cavernous hemangioma of the conjunctiva: case report.

Cavernous hemangioma of the conjunctiva is rare and has been reported previously in only a few cases. In this report, the authors describe a 17-year-old boy with an isolated conjunctival cavernous hemangioma. The tumor was located in the caruncular region over the bulbar conjunctiva. The lesion had appeared as a red mark in early childhood, grown in the last 2 years, and was causing bloody tears occasionally. No associated vascular lesion was noted within the eye and orbit. After removal of the tumor, no recurrence or complication developed during the follow-up period.

Maspin expression in gastrointestinal stromal tumors.

BACKGROUND: To investigate the role of maspin expression in the progression of gastrointestinal stromal tumors, and its value as a prognostic indicator. METHODS: In the study 54 patients with GIST diagnosis were included in Uludag University of Faculty of Medicine, Department of Pathology between 1997-2007. The expression of maspin in 54 cases of gastrointestinal stromal tumor was detected by immunohistochemistry and compared with the clinicopathologic tumor parameters. RESULTS: The positive expression rates for maspin in the GISTs were 66.6% (36 of 54 cases). Maspin overexpression was detected in 9 of 29 high risk tumors (31%) and was significantly higher in very low/low (78.6%) and intermediate-risk tumors (63.6%) than high-risk tumors. CONCLUSIONS: Maspin expression might be an important factor in tumor progression and patient prognosis in GIST. In the future, larger series may be studied to examine the prognostic significance of maspin in GISTs and, of course, maspin expression may be studied in different mesenchymal tumors.

Cutaneous heterotopic bronchogenic tissue in the scapular area.

Cutaneous bronchogenic anomalies are very rare lesions, and most of them present as cysts and/or sinus tracts in the subcutaneous layer. We report a 15-year-old boy who presented with a crusted and papillomatous plaque over the right scapular region. Histopathological examination of this plaque revealed pseudostratified ciliated columnar epithelium with papillary invaginations that included mucinous material. The lesion had no cyst or sinus formation and was bordered with smooth muscle bundles in stroma.

Leukocytoclastic vasculitis in patients with severe congenital neutropenia.

Leukocytoclastic vasculitis is a rare complication of the use of granulocyte colony-stimulating factor (G-CSF). We present two cases of severe congenital neutropenia (SCN) associated with GCSF use. It is reported that skin rashes and biopsy findings of leukocytoclastic vasculitis following the use of G-CSF.

The effect of nicotine on distraction osteogenesis: an experimental study on rabbits.

BACKGROUND: Tobacco smoke contains more than 4,000 constituents, but not all of them are reported to have adverse effects on bone healing after distraction osteogenesis. No research on the systemic administration of nicotine has been done on distraction osteogenesis of the weight-bearing long bones of the lower extremity. METHODS: Fourteen New Zealand white male rabbits underwent distraction osteogenesis on the right tibia and lengthening by 1 cm. Transdermal nicotine bands were applied onto the dorsal skin of the rabbits in the study group. Mineral density of the distraction zone was measured at weekly intervals using quantitative computerized tomography. Mechanical properties were assessed by torsional loading, and the regenerated bone tissue was subjected to histopathological examination. RESULTS: Comparisons of weekly measurements in both groups showed that while the increase in bone density in the nicotine group was higher, relative to the initial values, it was still far behind the average density obtained in the control group at the end of the experiment. Statistical analysis of mechanical data showed significant differences in the gradient of the regression lines and maximum torsional angles between the two groups. The histopathological assessments showed noticeable neovascularization in the study group, which was concluded to be a compensatory mechanism for the negative delaying effect of nicotine on bone healing. CONCLUSION: Systemic administration of nicotine can cause delays in the process of healing in distraction osteogenesis by its negative effect on the mineralization of the regenerate. Patients should be made aware of this negative impact of nicotine before the limb-lengthening surgery.

Palpebral Tarsal Solitary Neurofibroma

Solitary neurofibroma is a rare, benign tumor of the peripheral nerve sheath, and is often associated with neurofibromatosis type 1. Herein, a case of palpebral tarsal solitary neurofibroma in a patient without neurofibromatosis is presented, with a review of the literature. A 68-year-old man presented with a subcutaneous mass in the right upper eyelid of 6 months' duration. Eversion of the eyelid revealed a round, reddish mass on the lateral part of the tarsal plate which measured 12x8 mm in size. The lesion was excised with its tarsal base, diagnosed histologically, and did not recur during a follow-up of 34 months. Isolated, solitary neurofibroma of the eyelid has been reported in a total of 7 cases, including the case presented herein. The tumors arose from the eyelid margin in 4 cases, from the tarsal plate in 2 cases, and from the supratarsal conjunctiva in 1 case. The tumor did not recur after surgical excision in 5 cases for which follow-up data were available.

A Report of 13 Cases of Merkel Cell Carcinoma: Single-Center Experience and Review of the Literature.

BACKGROUND: There is limited data knowledge of Merkel cell carcinoma (MCC) in Turkey aside from a few case reports. OBJECTIVE: The aim of this study was to describe the clinical characteristics, demographic features, therapeutic parameters, and outcome of primary cutaneous MCC cases from Turkey. METHODS: Digital medical records of the 13 MCC patients who were followed-up at a tertiary referral center were retrospectively analyzed. Clinic, demographic, tumor characteristics, and survival of the patients were retrieved. RESULTS: Most of our patients were elderly. Female predominance was noticed. The most common primary site of the tumors was the lower extremities. The overall survival was 42 months, 68% at first year, 68% at third years, and 29% at fifth years. CONCLUSION: This is the first largest report from Turkish population with female predominance, and lower extremity tendency.

Miliary osteoma cutis of the face: treatment with the needle microincision-extirpation method.

Multiple miliary osteoma cutis of the face represents primary extra-skeletal bone formation that arises within the skin of the face. Multiple miliary osteoma cutis of the face is a rare complication of chronic inflammatory acne vulgaris and has invasive and non-invasive treatment alternatives different from acne vulgaris. Invasive techniques should be simple, easy, and inexpensive, with minimal risk of scarring and pigmentation. We used a needle microincision-extirpation technique in a patient with multiple miliary osteoma cutis unresponsive to non-invasive treatment modalities. Skin overlying the papules was incised with a needle and then the calcificated papules were extirpated by using a small curettage device. Lesions were left to secondary healing. Results were quite good and cosmetically acceptable.

Periampullary carcinomas.

BACKGROUND/AIMS: The purpose of this study was to determine predictors of survival after resection for periampullary neoplasms. METHODOLOGY: In this study, we reevaluated our 17 cases of this type tumor which we had reported as periampullar site tumors, in advanced stages with undetermined localization, in our pathology department of the Uludag University faculty of medicine. RESULTS: Six of our cases were female, and 11 were male with a mean age of 60.6 years (range 31-77). Their main complaints were loss of weight, anorexia, jaundice and fatigue. Physical and endoscopic examination of these patients revealed periampullary mass and Whipple operations were performed on all of them. Histopathologic examinations of these tumors revealed adenocarcinoma in 15, small cell (neuroendocrin) carcinoma in two. All were in the advanced stages. Eight of them were alive and free of disease after 1.5- to 20-month follow-ups, while ten died because of disease. CONCLUSIONS: Periampullary carcinoma is a problem with increasing clinical significance. Tumor size, tumor type and differentiation, lymph node status appears to be prognostic markers.

A Mimicker of Gallbladder Carcinoma: Cystic Gastric Heterotopia with Intestinal Metaplasia.

Heterotopic gastric mucosa in the gallbladder is an unusual entity and is usually clinically silent. We report a 75-year-old female patient who presented with intermittent upper abdomial pain radiating to the back. Abdominal imaging studies showed a sessile polypoid lesion and a gallstone in the gallbladder. Gallbladder carcinoma was suspected and cholecystectomy performed. Intraoperative frozen section examination suggested mucinous tumor, suspicious for malignancy. However, the permanent sections revealed aberrant gastric tissue consisted of gastric pyloric and fundic glands of heterotopic gastric mucosa with intestinal metaplasia in the gallbladder.

The biochemical and histological analysis of subcutaneous calcitonin and intramedullary methylprednisolone on bone repair after bone marrow ablation: an experimental comparative study in rats.

BACKGROUND: Although, glucocorticoid (GC) and calcitonin-induced changes in bone repair have been studied previously, the exact effects of these on fracture healing remain controversial. Hence, the purpose of this experimental study is to determine biochemical and histological effects of locally administrated GC and systemically administrated calcitonin on the kinetics of healing response after bone marrow ablation in rats. METHODS: After having undergone marrow ablation, a steroid-treated group of rats (n = 24) received a single dose of intramedullary methylprednisolone (2 mg/kg), a calcitonin-treated group (n = 24) received intermittently administrated subcutaneous salmon calcitonin (16 IU/kg), and a control group (n = 24) received intramedullary saline (25 µl). RESULTS: Blood samples taken on days 1, 3, 7, 9, and 15 after ablation showed an increase in serum calcium, alkaline phosphatase (ALP), and phosphate levels in the Calcitonin and Control groups. Levels of calcium and ALP peaked on day 7 after ablation. However, an increase in phosphate levels indicated a biphasic reaction that peaked on the third and ninth day after ablation. Hypercalcemia was not observed in Steroid group because of the inhibition of osteoclastic bone resorption. In that group, the serum levels of ALP and phosphate were lower than baseline levels. The levels of urinary calcium excretion peaked 3 to 7 days after marrow ablation in the control group and 7 to 9 days after that procedure in the steroid group. Histologic evaluation showed that the rats in the control group demonstrated the expected healing period according to the histological grades and that a delay in healing occurred in the calcitonin group after day 9 because of the inhibition of osteoclastic bone resorption. All rats in the steroid group exhibited a decrease and delayed healing response. CONCLUSION: Total serum calcium, phosphate, and ALP levels increased after bilateral tibial bone marrow ablation and urine calcium and hydroxyproline excretion also increased as a factor of bone resorption. Subcutaneously administrated salmon calcitonin did not affect biochemical changes after marrow ablation. Single-dose intramedullary methylprednisolone inhibited extra-tibial bone resorption induced by cytokines after bone marrow ablation.