Moving forward to understand the alteration of physiological mechanism by seed priming with different halo-agents under salt stress.

Soil salinity hampers the survival and productivity of crops. To minimize salt-associated damages in plant, better salt management practices in agriculture have become a prerequisite. Seed priming with different halo-agents is a technique, which improves the primed plant's endurance to tackle sodium. Salt tolerance is achieved in tolerant plants through fundamental physiological mechanisms- ion-exclusion and tissue tolerance, and salt-tolerant plants may (Na+ accumulators) or may not (Na+ excluders) allow sodium movement to leaves. While Na+ excluders depend on ion exclusion in roots, Na+ accumulators are proficient Na+ managers that can compartmentalize Na+ in leaves and use them beneficially as inexpensive osmoticum. Salt-sensitive plants are Na+ accumulators, but their inherent tissue tolerance ability and ion-exclusion process are insufficient for tolerance. Seed priming with different halo-agents aids in 'rewiring' of the salt tolerance mechanisms of plants. The resetting of the salt tolerance mechanism is not universal for every halo-agent and might vary with halo-agents. Here, we review the physiological mechanisms that different halo-agents target to confer enhanced salt tolerance in primed plants. Calcium and potassium-specific halo-agents trigger Na+ exclusion in roots, thus ensuring a low amount of Na+ in leaves. In contrast, Na+-specific priming agents favour processes for Na+ inclusion in leaves, improve plant tissue tolerance or vacuolar sequestration, and provide the greatest benefit to salt-sensitive and sodium accumulating plants. Overall, this review will help to understand the underlying mechanism behind plant's inherent nature towards salt management and its amelioration with different halo-agents, which helps to optimize crop stress performance.

Seed priming with NaCl helps to improve tissue tolerance, potassium retention ability of plants, and protects the photosynthetic ability in two different legumes, chickpea and lentil, under salt stress.

MAIN CONCLUSION: Seed priming with NaCl mimicked the conditions of natural priming to improve the tissue tolerance nature of sensitive legumes, which helps to maintain survivability and yield in mildly saline areas. Seed priming with NaCl is a seed invigoration technique that helps to improve plant growth by altering Na+ and K+ content under salt stress. Legumes are overall sensitive to salt and salinity hampers their growth and yield. Therefore, a priming (50 mM NaCl) experiment was performed with two different legume members [Cicer arietinum cv. Anuradha and Lens culinaris cv. Ranjan] and different morpho-physiological, biochemical responses at 50 mM, 100 mM, and 150 mM NaCl and molecular responses at 150 mM NaCl were studied in hydroponically grown nonprimed and primed members. Similarly, a pot experiment was performed at 80 mM Na+, to check the yield. Tissue Na+ and K+ content suggested NaCl-priming did not significantly alter the accumulation of Na+ among nonprimed and primed members but retained more K+ in cells, thus maintaining a lower cellular Na+/K+ ratio. Low osmolyte content (e.g., proline) in primed members suggested priming could minimize their overall osmolytic requirement. Altogether, these implied tissue tolerance (TT) nature might have improved in case of NaCl-priming as was also reflected by a better TT score (LC50 value). An improved TT nature enabled the primed plants to maintain a significantly higher photosynthetic rate through better stomatal conductance. Along with this, a higher level of chlorophyll content and competent functioning of the photosynthetic subunits improved photosynthetic performance that ensured yield under stress. Overall, this study explores the potential of NaCl-priming and creates possibilities for considerably sensitive members; those in their nonprimed forms have no prospect in mildly saline agriculture.

Influence of arsenate imposition on modulation of antioxidative defense network and its implication on thiol metabolism in some contrasting rice (Oryza sativa L.) cultivars.

Globally, many people have been suffering from arsenic poisoning. Arsenate (AsV) exposure to twelve rice cultivars caused growth retardation, triggered production of As-chelatin biopeptides and altered activities of antioxidants along with increase in ascorbate (AsA)-glutathione (GSH) contents as a protective measure. The effects were more conspicuous in cvs. Swarnadhan, Tulaipanji, Pusa basmati, Badshabhog, Tulsibhog and IR-20 to attenuate oxidative-overload mediated adversities. Contrastingly, in cvs. Bhutmuri, Kumargore, Binni, Vijaya, TN-1 and IR-64, effects were less conspicuous in terms of alterations in the said variables due to reduced generation of oxidative stress. Under As(V) imposition, the protective role of phytochelatins (PCs) were recorded where peaks height and levels of PCs (PC2, PC3 and PC4) were elevated significantly in the test seedlings with an endeavour to detoxify cells by sequestering arsenic-phytochelatin (As-PC) complex into vacuole that resulted in reprogramming of antioxidants network. Additionally, scatter plot correlation matrices, color-coded heat map analysis and regression slopes demonstrated varied adaptive responses of test cultivars, where cvs. Bhutmuri, Kumargore, Binni, Vijaya, TN-1 and IR-64 found tolerant against As(V) toxicity. Results were further justified by hierarchical clustering. These findings could help to grow identified tolerant rice cultivars in As-prone soil with sustainable growth and productivity after proper agricultural execution.

Disseminated Mucocutaneous Histoplasmosis Diagnosed in the United Kingdom, Presumably as a Result of Recrudescence Decades After Primary Infection Following Immunosuppressive Treatment of Its Mimic, Sarcoidosis: A Multidisciplinary Cautionary Tale.

ABSTRACT: Histoplasmosis is a dimorphic fungal infection, which is rare outside endemic pockets in North, Central, and South America, Asia, and Africa. Herein, we describe a woman in her 80s living in the Scottish Borders region of the United Kingdom with a recent diagnosis of granulomatous rosacea, who on receiving escalating immunosuppression for suspected sarcoidosis, and long-standing rheumatoid arthritis developed a striking eruption involving her eyelids along with painful ulceration of the oral and nasal mucosa. Histopathologic examination of the skin and mucosal lesions demonstrated granulomatous inflammation with numerous yeast forms of fungal organisms with morphological characteristics of Histoplasma species. This was confirmed to be H. capsulatum on fungal culture and direct panfungal polymerase chain reaction assay. Although the patient had not left the United Kingdom for more than 20 years, she gave a travel history involving multiple trips to countries where histoplasmosis is known to occur, before that. This case exemplifies the challenges involved in making a diagnosis of histoplasmosis in nonendemic regions for both clinicians and pathologists alike. In this particular patient, the diagnostic difficulties were compounded by the clinicopathological overlap with other cutaneous and systemic granulomatous disorders like granulomatous rosacea and suspected sarcoidosis and also the exceptionally long latency period between the purported historical primary infection and recent recrudescence. We highlight this unusual case to increase an awareness of histoplasmosis, which is very rare in nonendemic regions like the United Kingdom and involves cases acquired during residence in or travel to endemic areas, to ensure its prompt recognition and treatment.

Comparative study on the influence of silicon and selenium to mitigate arsenic induced stress by modulating TCA cycle, GABA, and polyamine synthesis in rice seedlings.

Arsenic contamination of groundwater is a major concern for its usage in crop irrigation in many regions of the world. Arsenic is absorbed by rice plants mainly from arsenic contaminated water during irrigation. It hampers growth and agricultural productivity. The aim of the study was to mitigate the toxic effects of arsenate (As-V) [25 µM, 50 µM, and 75 µM] by silicon (Si) [2 mM] and selenium (Se) [5 µM] amendments on the activity of the TCA cycle, synthesis of γ-aminobutyric acid (GABA) and polyamines (PAs) in rice (Oryza sativa L. cv. MTU-1010) seedlings and to identify which chemical was more potential to combat this threat. As(V) application decreased the activities of tested respiratory enzymes and increased the levels of organic acids (OAs) in the test seedlings. Application of Si with As(V) and Se with As(V) increased the activities of respiratory enzymes and the levels of OAs. The effects were more pronounced during Si amendments. The activities of GABA synthesizing enzymes along with accumulation of GABA were increased under As(V) stress. During joint application of Si with As(V) and Se with As(V) the activity and the level of said parameters were decreased that indicating defensive role of these chemicals to resist As(V) toxicity in rice and Si amendments showed greater potential to reduce As(V) induced damages in the test seedlings. PAs trigger tolerance mechanism against As(V) in plants. PAs such as putrescine, spermidine and spermine were synthesized more during Si and Se amendments in As(V) contaminated rice seedlings to combat the toxic effects of As(V). Si amendments substantially modulated the toxic effects caused by As(V) over Se amendments in the As(V) challenged test seedlings. Thus, in future application of Si enriched fertilizer will be beneficial to grow rice plants with normal vigor in arsenic contaminated soil.

Selenium alleviates arsenic induced stress by modulating growth, oxidative stress, antioxidant defense and thiol metabolism in rice seedlings.

This study aims to investigate the potentiality of selenium in modulating arsenic stress in rice seedlings. Arsenate accumulation along with its transformation to arsenite was enhanced in arsenate exposed seedlings. Arsenite induced oxidative stress and severely affected the growth of the seedlings. Arsenate exposure caused an elevation in ascorbate and glutathione levels along with the activities of their metabolizing enzymes viz., ascorbate peroxidase, glutathione reductase, glutathione-S-transferase, and glutathione peroxidase. Phytochelatins content was increased under arsenic stress to subdue the toxic effects in the test seedlings. Co-application of arsenate and selenate in rice seedlings manifested pronounced alteration of oxidative stress, antioxidant defense, and thiol metabolism as compared to arsenate treatment only. ANOVA analysis (Tukey's HSD test) demonstrated the relevance of using selenate along with arsenate to maintain the normal growth and development of rice seedlings. Thus, exogenous supplementation of selenium will be a beneficial approach to cultivate rice seedlings in arsenic polluted soil.

Arsenic toxicity in the environment is a global concern, causes chronic signs of poisoning to plants and humans, leads to ecological imbalance. Selenium is known for its antagonistic characteristics and has been found to be effective in combating the adversities of arsenic at low concentrations (5 µM). The present study was performed to explore the comparative responses of rice seedlings during the joint application of selenium and arsenic in terms of growth, generation of oxidative stress, antioxidant defense, and thiol metabolism. Although the molecular basis of arsenic­selenium interaction is widely known a small number of reports were listed about the physio-chemical role of selenium against arsenic stress. Thus, we investigated the influence of selenium to alleviate arsenic-induced toxic effects by modulating the activities of antioxidant enzymes and reducing the levels of oxidative stress markers. It has been noted that selenium regulates thiol metabolism which is known to play a key role in growth preservation by restriction of arsenic translocation. The outcome from the study would be useful in field trials for sustainable agriculture in arsenic-contaminated soil.

Trichoblastic carcinosarcoma with panfollicular differentiation (panfollicular carcinosarcoma) and CTNNB1 (beta-catenin) mutation.

We present a case of trichoblastic carcinosarcoma with panfollicular differentiation. An 80-year-old man presented with a lesion on the left ear, which had been present for several months. Histopathology revealed a well-demarcated neoplasm in the dermis composed of intimately intermingled malignant epithelial and mesenchymal cells. The epithelial component showed multilineage follicular differentiation toward all of the elements of a normal hair follicle. Molecular analysis revealed identical molecular aberrations in both epithelial and mesenchymal components including CTNNB1 and SUFU mutations. To the best of our knowledge, this is the first report of panfollicular carcinosarcoma and of the presence of a CTNNB1 mutation in trichoblastic carcinosarcoma.

Desmoplastic stromal changes in cutaneous neural granular cell tumors: An under-recognized histopathologic feature of diagnostic and prognostic importance.

BACKGROUND: Granular cell tumors (GCTs) are uncommon mucocutaneous and soft tissue neoplasms with distinctive histopathologic appearance but controversial histogenesis. Herein, we report a variant of cutaneous GCT featuring extensive desmoplastic stroma which may result in diagnostic difficulties with mesenchymal proliferations, particularly a dermatofibroma. METHODS: Following a recent case of GCT with prominent stromal desmoplasia, we reviewed all cases diagnosed as GCT during the past 10 years accessioned at the dermatopathology unit in a tertiary university hospital. RESULTS: Three additional cases with a similar excessive connective tissue were identified out of a total of 49 GCTs. Cytoplasmic granularity was often subtle and focal, S100 expression was weak, and nuclei had a tendency to show spindling in tumor cells entrapped within the desmoplastic areas. Of note, nuclear spindling is one of the criteria used to diagnose an atypical/malignant GCT. CONCLUSION: We propose the term "desmoplastic GCT" for these tumors, which not only appropriately addresses the stromal changes but also raises an awareness of GCT being one of the cutaneous tumors which may show stromal desmoplasia. Differential diagnostic difficulties apart, awareness of this phenomenon is important so that desmoplasia and resultant spindling are not linked with potential aggressive behavior.

Spectrum of Melanocytic Proliferation/Differentiation in a Large Series of Cutaneous Neurofibromas: An Under-Recognized Histopathologic Phenomenon and Potential Clue for Neurofibromatosis Type 1.

AIMS: Neurofibromas (NFs) and melanocytic nevi share a common neuroectodermal origin and may occasionally show overlapping morphological features. The objective of this study was to assess the prevalence and spectrum of melanocytic proliferation/differentiation in NFs and also to test the hypothesis whether detection of this feature could be used as a potential clue for neurofibromatosis type 1 (NF-1). METHODS: This was a retrospective study of 229 syndromic and 239 sporadic cutaneous NFs. Each case was assessed for an associated melanocytic component, both within the tumor and the overlying epidermis. Melan A immunohistochemistry was used in selected cases to further characterize this feature, particularly in diffuse NFs. RESULTS: An associated melanocytic component was detected in 77/229 syndromic and 12/239 sporadic cases (P < 0.00001). This was in the form of a junctional proliferation (lentiginous melanocytic hyperplasia or junctional nevus) or dermal differentiation (diffuse spindle cell or dermal nests of pigmented epithelioid melanocytes). CONCLUSIONS: Our study affirms that the spectrum of melanocytic proliferation/differentiation in NFs is broad and probably under-recognized. Awareness of this phenomenon is critical to avoid misdiagnosis of some diffuse NFs as primary melanocytic tumors, for example, desmoplastic melanomas. Given the strong link between dermal melanocytic differentiation and syndromic NFs, its detection could potentially serve as a useful clue for NF-1 in an appropriate clinical context.

Differential responses of photosynthetic parameters and its influence on carbohydrate metabolism in some contrasting rice (Oryza sativa L.) genotypes under arsenate stress.

Influence of arsenic (As) in As tolerant and sensitive rice genotypes based chloroplastic pigments, leaf gas exchange attributes and their influence on carbohydrate metabolism were investigated in the present study. As retards growth of crop plants and increase several health ailments by contaminating food chain. Photosynthetic inhibition is known to be the prime target of As toxicity due to over-production of ROS. Hydroponically grown rice seedlings of twelve cultivars were exposed to 25, 50, and 75 µM arsenate (AsV) that exerted negative impact on plastidial pigments content and resulted into inhibition of Hill activity. Internal CO2 concentration lowered gradually due to interference of As with stomatal conductance and transpiration rate that subsequently led to drop in net photosynthesis. Twelve contrasting rice genotypes responded differentially to As(V) stress. Present study evaluated As tolerant and sensitive rice cultivars with respect to As(V) imposed alterations in pigments content, photosynthetic attributes along with sugar metabolism. Starch contents, the principle carbohydrate storage declined differentially among As(V) stressed test cultivars, being more pronounced in cvs. Swarnadhan, Tulaipanji, Pusa basmati, Badshabhog, Tulsibhog and IR-20 compared to cvs. Bhutmuri, Kumargore, Binni, Vijaya, TN-1 and IR-64. Therefore, the six former cultivars tried to adapt defensive mechanisms by accumulating higher levels of reducing and non-reducing sugars to carry out basal metabolism to withstand As(V) induced alterations in photosynthesis. This study could help to screen As tolerant and sensitive rice genotypes based on their photosynthetic efficiency in As polluted agricultural fields to reduce As contamination assisted ecotoxicological risk.

Evaluation of arsenic induced toxicity based on arsenic accumulation, translocation and its implications on physio-chemical changes and genomic instability in indica rice (Oryza sativa L.) cultivars.

Arsenic (As) accumulation in rice is a principal route of As exposure for rice based population. We have tested physiochemical and molecular parameters together to identify low As accumulating rice cultivars with normal growth and vigor. The present study examined potential toxicity caused by arsenate (AsV) among four rice cultivars tested that varied with respect to accumulation of total arsenic, arsenite (AsIII) and their differential translocation rate which had deleterious impact on growth and metabolism. Intracellular homeostasis of rice cultivars viz., TN-1, IR-64, IR-20 and Tulaipanji was hampered by 21 days long As(V) treatment due to generation of reactive oxygen species (ROS) and inadequate activity of catalase (CAT; EC 1.11.1.6). Upregulation of oxidative stress markers viz., H2O2, proline and MDA along with alteration in enzymatic antioxidants profile were conspicuously pronounced in cv. Tulaipanji while cv. TN-1 was least affected under As(V) challenged environment. In addition to that genomic template stability and band sharing indices were qualitatively measured by DNA profiling of all tested cultivars treated with 25 µM, 50 µM, and 75 µM As(V). In rice cv. Tulaipanji genetic polymorphism was significantly detected with the application of random amplified polymorphic DNA (RAPD) tool and characterized as susceptible cultivar of As compared to cvs. TN-1, IR-64 and IR-20 that is in correlation with data obtained from cluster analysis. Hence, identified As tolerant cultivars viz., TN-1, IR64 and IR-20 especially TN-1 could be used in As contaminated agricultural field after appropriate field trial. This study could help to gather information regarding cultivar-specific tolerance strategy to avoid pollutant induced toxicity.

Fibrous Papule: A Histopathologic Review.

Fibrous papule (FP) is a common benign lesion located primarily in the nose. Although its histogenesis has been marred with controversies in the past, the dermal dendrocyte is now largely accepted to be the putative cell of origin. Histopathologic diagnosis of an FP is straightforward in most cases, which shows characteristics of an angiofibroma. Several histologic variants have been described, recognition of which is important to avoid a misdiagnosis and inappropriate treatment. This review presents a historical perspective into the histogenesis, discusses the histopathologic features and potential diagnostic pitfalls of classic FP, and lists the various histologic variants and their differential diagnoses.

Hailey-Hailey Disease With Coexistent Herpes Virus Infection: Insights Into the Diagnostic Conundrum of Herpetic/Pseudoherpetic Features in Cutaneous Acantholytic Disorders.

The specific histopathologic diagnosis of a primary acantholytic disorder takes into account the distribution and extent of acantholysis, presence or absence of dyskeratosis, nature of the dermal inflammatory cell infiltrate, and immunofluorescence findings. Herpes virus infection is a common cause of secondary acantholysis where distinctive viral cytopathic changes aid in making it a clear-cut diagnosis in majority of cases. We present a case of coexistence of Hailey-Hailey disease and herpes simplex virus infection to compare and contrast their histopathologic features. This is imperative because acantholytic cells from primary acantholytic disorders may occasionally show cytological features traditionally associated with herpes virus infection (pseudoherpetic changes). The objective of this article is to create a greater awareness of pseudoherpetic changes and also to explore the clinical significance of coexistence of a primary acantholytic disorder and herpes virus infection, as in this case.

Nicolau Syndrome (Embolia Cutis Medicamentosa): A Rare and Poorly Recognized Iatrogenic Cause of Cutaneous Thrombotic Vasculopathy.

Nicolau syndrome is a rare form of iatrogenic cutaneous necrosis which affects injection sites. Although classically associated with intramuscular injections, it may develop after subcutaneous or other routes of parenteral drug administration. Clinically, it manifests as necrotic ulcers that often develop in a background of erythematous and livedoid reticular patches. The histopathologic characteristics of Nicolau syndrome are poorly documented in the dermatopathology literature and features only rarely as one of the obscure causes of cutaneous thrombotic vasculopathy. We report a case of Nicolau syndrome developing secondary to subcutaneous injection of cyclizine to familiarize the clinicians and pathologists to this unusual condition. Given that it is potentially avoidable, pathologists should alert the clinicians to the possibility of Nicolau syndrome when a skin biopsy from an injection site shows signs of extensive thrombotic vasculopathy.

Modulation of growth, ascorbate-glutathione cycle and thiol metabolism in rice (Oryza sativa L. cv. MTU-1010) seedlings by arsenic and silicon.

Arsenic is a carcinogenic metalloid, exists in two important oxidation states-arsenate (As-V) and arsenite (As-III). The influence of arsenate with or without silicate on the growth and thiol metabolism in rice (Oryza sativa L. cv. MTU-1010) seedlings were investigated. Arsenate was more toxic for root growth than shoot growth where the root lengths were short, characteristically fragile and root tips turned brown. The multiple comparison analysis using Tukey's HSD (honest significant difference) tests indicated that the rate of arsenate accumulation and its conversion to arsenite by arsenate reductase were significantly increased in all arsenate treated seedlings while in seedlings treated jointly with arsenate and silicate, arsenate accumulation and its conversion to arsenite decreased. Silicate content was detected in the seedlings treated with silicate alone and under co-application of arsenate with silicate. In the test seedlings arsenic toxicity increased ascorbate and glutathione contents along with the activities of their regulatory enzymes, viz., ascorbate peroxidase, glutathione reductase, glutathione peroxidase and glutathione-s-transferase to reduce the toxicity level induced by arsenic whereas ascorbate oxidase activity was decreased to maintain sufficient ascorbate pool under arsenate treatment. Phytochelatins production were increased in both root and shoot of the test seedlings under arsenate exposure to alter the detrimental effects of arsenic by chelation with arsenite and their subsequent sequestration into vacuole. Thus, joint application of silicate along with arsenate showed significant alterations on all the parameters tested compared to arsenate treatment alone due to less availability of arsenic in the tissue leading to better growth and metabolism in rice seedlings. Thus use of silicon in arsenic contaminated medium may help to grow rice with improved vigour.

Tumoral PD-L1 expression in desmoplastic melanoma is associated with depth of invasion, tumor-infiltrating CD8 cytotoxic lymphocytes and the mixed cytomorphological variant.

Recently, patients with metastatic desmoplastic melanoma (DM) have been shown to respond more favorably to anti-PD1/PD-L1 therapy than other melanoma subtypes. Given this, we evaluated PD-L1/2 expression in primary DM samples and correlated these with subtype, CD8+ lymphocyte status, histopathological prognosticators, and select genetic alterations. Eighty-six (36 mixed DM, 50 pure DM) archival annotated samples met inclusion criteria and were immunohistochemically semiquantitatively evaluated. Per established criteria, for PD-L1/L2, cases with ⩾5% tumoral expression, and for CD8, cases with a predominantly peri/intratumoral CD8+ infiltrate were scored positive. Univariate analysis (chi-square and Wilcoxon) identified potential confounders and a nested case-control study was accomplished using multiple logistic regression. For PD-L1, 49% of cases were positive and 71% of cases with thickness >4 mm were positive; PD-L1 expression differed by median depth (3.29 mm, interquartile range=3.58 mm for PD-L1 positives vs 1.75 mm, interquartile range=2.04 mm for PD-L1 negatives, P=0.0002) and was linearly associated with increasing depth of invasion (P=0.0003). PD-L1-positive cases were more likely to display CD8+ lymphocytes (60 vs 28% P=0.0047).The presence of CD8+ lymphocytes correlated significantly with depth of invasion >1 mm (P=0.022). On multivariate analysis, PD-L1 was 6.14 × more likely to be expressed in mixed DM than pure DM (P=0.0131), CD8+ staining was 6.22 × more likely in PD-L1 positive cases than in PD-L1 negative (P=0.0118), and tumor depth was associated with greater odds of PD-L1 expression (OR=1.61, P=0.0181). PD-L2 expression was observed in 48% of cases but did not correlate with any variables. Correlation of tumoral PD-L1 with increased depth and CD8+ lymphocytes implicates the tumoral immune microenvironment with advancing disease in DM. Enhanced tumoral PD-L1 expression in the mixed cytomorphological variant provides an insight into the differential pathogenesis of the subtypes and suggests that these patients are likely better candidates for anti-PD/PD-L1 therapy.

Pseudomembranous changes in the dermis: A novel observation and potential clue for evolving lipodermatosclerosis?

Lipodermatosclerosis (LDS) is a well-recognized form of fibrosing panniculitis. Although chronic cases are readily diagnosed, early and evolving lesions may be clinically mistaken for cellulitis and other forms of panniculitis. Most pathologists are familiar with a pseudomembranous type of fat necrosis as a useful feature of chronic LDS. Although nonspecific, this distinctive pattern of fat necrosis helps in supporting a diagnosis of LDS in the appropriate clinical context. The histopathologic features of early and evolving LDS and those involving the dermis are less well documented. We report a case of early LDS showing extensive pseudomembranous changes in the dermis on a superficial skin biopsy where progression to a classic established lesion was documented clinically. We suspect that this previously unreported and unusual finding may be a histopathologic clue for evolving lesions of LDS.

A Comparative Study of Immunohistochemical Myoepithelial Cell Markers in Cutaneous Benign Cystic Apocrine Lesions.

The use of immunohistochemical markers for myoepithelial cells (MEC) is a useful tool in the distinction of benign from malignant epithelial neoplasms. Although their use in breast tumors is well recognized, little is known concerning its application in comparable cutaneous lesions. Using benign cutaneous cystic apocrine lesions as a study model, the aim of this study was to compare 5 immunohistochemical markers [calponin, p63, smooth muscle actin (SMA), cytokeratin 14, and CD10] in their effectiveness to highlight MEC. Cases of apocrine hidrocystoma and cystadenoma (n = 44) were reviewed with a particular emphasis on proliferative features and apocrine change. The MEC staining pattern and the intensity and distribution scores in proliferative (n = 29) and nonproliferative (n = 15) lesions were assessed, and the differences between the 2 groups were statistically analyzed using Fisher exact test. Calponin and SMA stained MEC in the most consistent manner. Being a nuclear stain, p63 was easy to interpret but typically showed discontinuous staining. Cytokeratin 14 not only effectively highlighted MEC but also stained some luminal epithelial cells in an unpredictable manner. Because of prominent background dermal fibroblast staining, CD10 was often difficult to interpret. Only SMA and p63 showed a statistically significant difference in MEC staining intensity scores between the proliferative and nonproliferative groups. Our results show that immunohistological staining for MEC in benign cystic apocrine lesions of the skin is variable. The authors recommend that a panel of markers that includes calponin and p63 be used and highlight the need for awareness of specific caveats associated with individual markers.