RESUMEN
A 75 years old patient presented with a papular easily bleeding lesion of the lower lip that had been growing for two months. He was known for alcoholic cirrhosis complicated with hepatocellular carcinoma treated since one year. A working diagnostic hypothesis of benign vascular lesion was proposed. Microscopic examination showed a neoplastic dermal proliferation that had been fully excised, made of lobules segregated by thin fibrous septae. The neoplastic architecture was trabecular and delineating spaces forming pseudo-rosettes. Tumour cells were monomorphic, cuboidal or cylindric with abundant eosinophilic and granulous cytoplasm and centered by a lone nucleus that often contained a prominent nucleolus. Some spaces were filled with a brownish-greenish pigmented material. Immunohistochemical study showed that tumour cells were positive with the hepatocyte paraffin 1 antibody as well as cytokeratin 8 antibody. Chromogranin A and synaptophysin stainings were negative. Thus we concluded to a lip metastasis from the previously known hepatocellular carcinoma. Skin metastasis arise in around 3% of cases of hepatocellular carcinoma. They account for less than 1% of all cutaneous metastasis. Overall appearance of cutaneous metastasis of hepatocellular carcinoma is associated with a poor prognosis and an aggravated risk of metastasis to other locations and organs and a median overall survival of less than 5 months. Since incidence of hepatocellular carcinoma is rising pathologists might face more frequently in years to come to cutaneous metastasis whose varied clinical presentations make a diagnostic challenge.
Asunto(s)
Carcinoma Hepatocelular , Neoplasias Hepáticas , Neoplasias Cutáneas , Masculino , Humanos , Anciano , Carcinoma Hepatocelular/patología , Neoplasias Cutáneas/patología , Inmunohistoquímica , Anticuerpos , Neoplasias Hepáticas/patologíaRESUMEN
is missing (Short communication).
Asunto(s)
Enfermedad de Hodgkin , Lupus Eritematoso Cutáneo , Lupus Eritematoso Discoide , Linfoma de Células B de la Zona Marginal , Neoplasias Cutáneas , Humanos , Lupus Eritematoso Cutáneo/diagnóstico , Lupus Eritematoso Cutáneo/tratamiento farmacológico , Linfoma de Células B de la Zona Marginal/diagnóstico , Neoplasias Cutáneas/diagnósticoAsunto(s)
Síndrome de Bronquiolitis Obliterante , Enfermedad Injerto contra Huésped , Trasplante de Células Madre Hematopoyéticas , Linfoma Cutáneo de Células T , Humanos , Recurrencia Local de Neoplasia , Nitrilos , Linfoma Cutáneo de Células T/tratamiento farmacológico , Enfermedad Injerto contra Huésped/tratamiento farmacológico , Enfermedad Injerto contra Huésped/etiología , Estudios Retrospectivos , Enfermedad CrónicaAsunto(s)
Linfoma Cutáneo de Células T , Micosis Fungoide , Neoplasias Cutáneas , Humanos , Linfoma Cutáneo de Células T/diagnóstico , Linfoma Cutáneo de Células T/terapia , Linfoma Cutáneo de Células T/patología , Micosis Fungoide/patología , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/terapia , Neoplasias Cutáneas/patología , Piel/patología , PronósticoAsunto(s)
Mieloma Múltiple , Urticaria , Humanos , Inmunoglobulina A , Inflamación/diagnóstico , Mieloma Múltiple/complicaciones , Mieloma Múltiple/diagnóstico , Mieloma Múltiple/tratamiento farmacológico , Neutrófilos , Urticaria/diagnóstico , Urticaria/tratamiento farmacológico , Urticaria/etiologíaRESUMEN
The treatment of advanced stage primary cutaneous T-cell lymphomas remains challenging. In particular, large-cell transformation of mycosis fungoides is associated with a median overall survival of two years for all stages taken together. Little is known regarding allogeneic hematopoietic stem cell transplantation in this context. We performed a multicenter retrospective analysis of 37 cases of advanced stage primary cutaneous T-cell lymphomas treated with allogeneic stem cell transplantation, including 20 (54%) transformed mycosis fungoides. Twenty-four patients (65%) had stage IV disease (for mycosis fungoides and Sézary syndrome) or disseminated nodal or visceral involvement (for non-epidermotropic primary cutaneous T-cell lymphomas). After a median follow up of 29 months, 19 patients experienced a relapse, leading to a 2-year cumulative incidence of relapse of 56% (95%CI: 0.38-0.74). Estimated 2-year overall survival was 57% (95%CI: 0.41-0.77) and progression-free survival 31% (95%CI: 0.19-0.53). Six of 19 patients with a post-transplant relapse achieved a subsequent complete remission after salvage therapy, with a median duration of 41 months. A weak residual tumor burden before transplantation was associated with increased progression-free survival (HR=0.3, 95%CI: 0.1-0.8; P=0.01). The use of antithymocyte globulin significantly reduced progression-free survival (HR=2.9, 95%CI: 1.3-6.2; P=0.01) but also transplant-related mortality (HR=10(-7), 95%CI: 4.10(-8)-2.10(-7); P<0.001) in univariate analysis. In multivariate analysis, the use of antithymocyte globulin was the only factor significantly associated with decreased progression-free survival (P=0.04). Allogeneic stem cell transplantation should be considered in advanced stage primary cutaneous T-cell lymphomas, including transformed mycosis fungoides.
Asunto(s)
Trasplante de Células Madre Hematopoyéticas , Linfoma Cutáneo de Células T/patología , Linfoma Cutáneo de Células T/terapia , Adolescente , Adulto , Trasplante de Médula Ósea/efectos adversos , Niño , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Francia , Supervivencia de Injerto , Enfermedad Injerto contra Huésped/etiología , Enfermedad Injerto contra Huésped/prevención & control , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Linfoma Cutáneo de Células T/mortalidad , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Recurrencia , Donantes de Tejidos , Acondicionamiento Pretrasplante , Trasplante Homólogo , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: A rare variant of mycosis fungoides (MF), syringotropic MF (STMF) is characterized by a particular tropism of the lymphocytic infiltrate for the eccrine structures, and included in the follicular subtype of MF in the World Health Organization-European Organization for Research and Treatment of Cancer classification of cutaneous lymphomas. OBJECTIVE: We sought to determine the clinicopathologic features and disease course of patients with STMF. METHODS: A retrospective study was conducted to identify patients with STMF from 1998 to 2013. RESULTS: Nineteen patients were included: 15 men and 4 women, mean age 55 years (range, 24-86). Most had multiple lesions (n=16, 84%) with associated alopecia (n=12, 63%) and/or punctuated aspect (n=12, 63%). Palms or soles were involved in 10 cases (53%). Folliculotropism was found in 13 cases (68%). After a median follow-up of 70 months (range, 2-140), 3 patients died, 1 from disease-related death. The 5-year overall and disease-specific survival were 100%. The disease-specific survival was significantly higher than in 54 patients with folliculotropic MF without syringotropism (5-year disease-specific survival, 74%; 95% confidence interval, 58%-94%, P=.02). LIMITATIONS: Retrospective setting is a limitation. CONCLUSIONS: In the spectrum of adnexotropic MF, STMF appears as a distinct entity from follicular MF, with peculiar clinical characteristics and natural history.
Asunto(s)
Alopecia/etiología , Micosis Fungoide/patología , Neoplasias Cutáneas/patología , Adulto , Anciano , Anciano de 80 o más Años , Glándulas Ecrinas , Femenino , Folículo Piloso , Humanos , Linfocitos/fisiología , Masculino , Persona de Mediana Edad , Micosis Fungoide/complicaciones , Micosis Fungoide/tratamiento farmacológico , Estudios Retrospectivos , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/tratamiento farmacológico , Tasa de Supervivencia , Resultado del Tratamiento , Tropismo , Adulto JovenRESUMEN
Eccrine porocarcinoma is a rare malignant sweat gland tumor, representing less than 0.01% of all cutaneous neoplasms, with eccrin differentiation. Its acrosynringeal origin and physiopathology still remain discussed. The prognosis of this carcinoma is held to be poor with a significant risk of lymph node metastasis and local recurrence. Also, this not specific tumor can be a challenging histological diagnosis, in particular, in Bowenoid variant. We report a case of Bowenoid and keratinizing variant of eccrine porocarcinoma of the left ring finger with pejorative evolution and initial diagnosis of infiltrating squamous cell carcinoma arising in Bowen's disease. The knowledge of these patterns and identification of eccrine differentiation of the tumor are essential for the diagnosis and for adapted therapeutic care.
Asunto(s)
Enfermedad de Bowen/patología , Porocarcinoma Ecrino/patología , Neoplasias Cutáneas/patología , Neoplasias de las Glándulas Sudoríparas/patología , Anciano de 80 o más Años , Biomarcadores de Tumor/análisis , Femenino , Dedos , Humanos , Inmunohistoquímica , Metástasis Linfática , Recurrencia Local de Neoplasia , PronósticoAsunto(s)
Enfermedad Injerto contra Huésped/inmunología , Interleucina-17/metabolismo , Psoriasis/metabolismo , Células TH1/citología , Células Th17/citología , Linfocitos T CD4-Positivos/citología , Linfocitos T CD8-positivos/citología , Enfermedad Injerto contra Huésped/terapia , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Interferón gamma/metabolismo , Interleucina-10/metabolismo , Queratinocitos/citología , Pulmón/inmunología , Linfocitos/citología , Masculino , Persona de Mediana Edad , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Inducción de Remisión , Piel/inmunología , Piel/patologíaRESUMEN
BACKGROUND: A CD8 cutaneous lymphoinfiltrative disease has been described in human immunodeficiency virus (HIV)-infected patients presenting with a severe erythroderma. The true nature of this severe skin infiltrative disorder is still elusive. Although some clinical features of this syndrome have raised the hypothesis of its malignant nature in initial observations, several studies have provided stronger support to the hypothesis that it is a reactive pseudotumoral process. METHODS: From 1995 through 2008, 8 HIV type 1 (HIV-1)-infected patients presenting with a chronic skin eruption, diagnosed as CD8 T cell infiltration of the skin, were studied. RESULTS: All patients showed diffuse infiltrated skin with superficial lymphadenopathy. A profound CD4(+) lymphocytopenia and eosinophilia were other major features. Histological and immunostaining analysis revealed a predominant dermal and epidermal infiltration by CD8(+) T cells belonging to the cytotoxic lineage, without evidence for a monoclonal status by polymerase chain reaction-based molecular analysis of lesional skin. A remission of skin symptoms occurred in all cases following highly active antiretroviral therapy, which paralleled the decrease of HIV-1 RNA load and the increase of CD4(+) peripheral blood absolute count. CONCLUSIONS: Altogether, these results emphasize the reactive, nonmalignant nature of this syndrome and strongly support the coupling between HIV-induced immune deficiency and uncontrolled CD8 activation.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa , Linfocitos T CD8-positivos/inmunología , Dermatitis Exfoliativa/tratamiento farmacológico , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Linfocitos T Citotóxicos/inmunología , Adulto , Dermatitis Exfoliativa/inmunología , Dermatitis Exfoliativa/patología , Histocitoquímica , Humanos , Inmunohistoquímica , Masculino , Microscopía , Persona de Mediana Edad , Inducción de Remisión , Piel/patologíaRESUMEN
Prurigo nodularis is a pruritic dermatosis of unknown origin. Human T-cell lymphotropic virus type 1 (HTLV-1) causes adult T-cell leukaemia/lymphoma. HTLV-1 is not considered to be a cause of prurigo nodularis. A 52-year-old black man, from the French West Indies, who had had prurigo nodularis for 12 years, presented with a distinct micropapular eruption with the typical pathological picture of epidermotropic T-cell lymphoma. Based on HTLV-1-positive serology and monoclonal integration of HTLV-1 we diagnosed smouldering adult T-cell leukaemia/lymphoma. Re-examination of previous skin biopsies revealed that the disease had been evolving for 12 years. Treatment with alpha-interferon, 3 x 106 units three times a week, associated with zidovudine, 1 g daily, resulted in complete remission within 4 months. When investigating a prurigo nodularis, we therefore recommend: (i) performing HTLV-1 serology if the patient comes from an endemic area; (ii) if positive, performing CD25 staining and looking for a HTLV-1 clonal integration; and (iii) if positive, using a treatment targeting HTLV-1.
Asunto(s)
Anemia Refractaria con Exceso de Blastos/virología , Virus Linfotrópico T Tipo 1 Humano/patogenicidad , Leucemia-Linfoma de Células T del Adulto/diagnóstico , Prurigo/virología , Piel/virología , Anemia Refractaria con Exceso de Blastos/tratamiento farmacológico , Anemia Refractaria con Exceso de Blastos/patología , Antineoplásicos/uso terapéutico , Antivirales/uso terapéutico , Biopsia , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD4-Positivos/virología , Virus Linfotrópico T Tipo 1 Humano/genética , Virus Linfotrópico T Tipo 1 Humano/inmunología , Humanos , Interferón alfa-2 , Interferón-alfa/uso terapéutico , Subunidad alfa del Receptor de Interleucina-2/análisis , Leucemia-Linfoma de Células T del Adulto/complicaciones , Leucemia-Linfoma de Células T del Adulto/tratamiento farmacológico , Leucemia-Linfoma de Células T del Adulto/inmunología , Masculino , Persona de Mediana Edad , Prurigo/tratamiento farmacológico , Prurigo/inmunología , Prurigo/patología , Proteínas Recombinantes , Piel/inmunología , Piel/patología , Factores de Tiempo , Resultado del Tratamiento , Zidovudina/uso terapéuticoRESUMEN
Digital microscopy enables several observers to look at any field of one microscopical section, at any magnification, through an Internet connexion. An overview of the systems used to digitize microscopy slides and to put them on line is presented. This technique is already used in many fields of pathology, for teaching, research and, to a lesser extent, diagnostic purposes. Several examples are given in this review, some of them with a true evaluation process, and strong points and weaker points are addressed. While conventional microscopy remains the keystone method in 2007 and for the coming years, it is also obvious that digital microscopy will be playing an increasing role. It is our task to make it evolve according to our needs.