Glomus-like bodies within a neurofibroma: a novel neoplasm arising in neurofibromatosis type 1 or a coincidence?

Neurofibromatosis type 1 is a relatively common genetic disorder with variable phenotypes. Tumors with features of both glomus tumors and neurofibromas are exceedingly rare in literature. Herein, we report a not yet described neoplasm with features of both a glomangioma/glomus tumor and a neurofibroma arising in a patient with segmental neurofibromatosis. Our case report supports the theory of a common lineage/ancestor cell between neurofibromas and glomus tumors and adds it to the spectrum of neoplasms that may arise in the setting of Von Recklinghausen's disease.

Analysis of tumor mitotic rate in thin metastatic melanomas compared with thin melanomas without metastasis using both the hematoxylin and eosin and anti-phosphohistone 3 IHC stain.

Studies have suggested that elevated tumor mitotic rate (MR) is linked to overall survival in thin melanoma. Recently, promising data regarding anti-phosphohistone 3 (pHH3) immunohistochemistry and its ability to aid in calculation of MR have emerged. The authors retrospectively analyzed original biopsies from 13 thin melanomas with positive sentinel node (SN) status and 16 thin melanomas with negative SN status. Both anti-pHH3 immunohistochemistry and the hematoxylin and eosin (H&E) stain were used to evaluate MR by 2 dermatopathologists blinded to SN status using the "hot spot" method. Intraclass coefficient values were attained to measure interobserver concordance and reliability of the pHH3 stain. By generating a receiver operating characteristic curve and analyzing the overall area under the curve, pHH3 was found to have good interobserver reliability. The relationship between MR and SN involvement was also evaluated, but this correlation was not statistically significant.

Disseminated histoplasmosis in a renal transplant patient.

Histoplasma capsulatum is a common endemic mycosis. Infection typically goes unnoticed by an individual, but in immunosuppressed patients, it may become disseminated. We report a case of disseminated histoplasmosis occurring 6 weeks after a kidney transplant. We discuss disseminated histoplasmosis and review its characteristic clinical, laboratory, and histologic manifestations, as well as current treatment modalities.

Distinction of melanoma in situ from solar lentigo on sun-damaged skin using morphometrics and MITF immunohistochemistry.

Distinction between melanoma in situ (MIS) and solar lentigo (SL) on chronically sun-damaged skin (CSDS) by hematoxylin and eosin (H&E) criteria alone can be difficult and in frozen section (FS) material, may be virtually impossible without immunohistochemistry (IHC). In this study, we used microphthalmia-associated transcription factor (MITF) IHC-directed image analysis to compare melanocyte nuclear morphometrics of MIS, SL, and sections of sun-damaged skin from redundant tissue acquired during Mohs micrographic surgery. The mean nuclear diameter and melanocytic density figures for MIS were greater than those for SL and CSDS by both independent t-test and analysis of variance statistics. No significant differences in these parameters were found between SL and sun-damaged skin. Cutoff values that favored MIS over SL included melanocyte density ≥10 nuclei per 200 µm, nuclear diameter ≥9 µm, and a product of density and diameter of 80 or more, as each of these values was associated with 100% specificity of MIS diagnosis. Our results suggest that image analysis of melanocytes labeled with MITF IHC can be used to produce morphometric data that distinguish MIS from SL and CSDS. The study was conducted using permanent sections, but previous studies with FSs indicate that the findings would apply to FSs as well. Quantitative assessment of melanocytic parameters using image analysis will likely become increasingly important as an adjunct to conventional histopathology for the diagnosis and surgical management of MIS on sun-damaged skin.

Merkel cell carcinoma: clinical characteristics, markers, staging and treatment.

Merkel cell carcinoma (MCC) is a highly aggressive neoplasm affecting primarily the elderly Caucasian population. Earlier detection of this neoplasm may achieve a better prognosis and an improved outcome. Here, the authors review the typical clinical features of MCC to serve as a reference tool for clinicians in determining when a biopsy may be warranted. An array of immunohistochemical markers may be utilized to differentiate MCC from other neuroendocrine tumors. The staging and concomitant treatment options of MCC are discussed. In addition, the authors review therapeutic advances for treatment of MCC utilizing an array of target proteins.

Oral therapy for nonmelanoma skin cancer in patients with advanced disease and large tumor burden: a review of the literature with focus on a new generation of targeted therapies.

Nonmelanoma skin cancer (NMSC) is the most common cancer in patients and includes basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Treatments useful for SCC and BCC include surgical, topical, and in advanced cases systemic chemo-radiation. This review of the literature aims to describe previous and current treatment options for oral therapy in locally advanced and metastatic NMSC otherwise unamenable to standard treatment. Oral Smoothened (Smo) inhibitors Vismodegib, Sonidegib, and Taladegib have shown to be effective in several trials. Oral tyrosine kinase inhibitors Erlotinib and Gefitinib, which target epidermal growth factor receptor (EGFR), have early supporting data and are currently undergoing large multicenter trials. Other less studied oral therapies which have shown at least partial efficacy include 5-Fluorouracil, capecitabine, and picropodophyllin. In vitro studies have elucidated new targets for dual combination oral therapy targeting both EGFR and insulin-like growth factor 1 receptor (IGF-1R). It is important to stratify treatment options based on patient risk of advanced disease, failure of conservative treatment, and ill-tolerated intravenous chemotherapy adverse events. Oral therapy in NMSC is useful in high risk patients with recurrent and aggressive disease who may not tolerate other systemic therapies.

Reticular erythematous mucinosis--a review.

Reticular erythematous mucinosis (REM) is a rare cutaneous condition often referred to as plaque-like mucinosis and midline mucinosis. Although the exact etiology remains undefined, efforts to elucidate pathogenesis, disease associations, and prospective treatment modalities have been encouraging. Induction of the disease has been associated with viral processes, solar irradiation, specific cell lines, and cytokines such as Interleukin (IL)-1ß. Clinically, patients typically develop erythematous macules and papules that coalesce into reticulated patterns on the midline of the chest or back. The lesions have a tendency to respond to systemic antimalarial therapy, but novel therapeutic approaches with ultraviolet A1 light (UVA1) and pulse dye laser (PDL) have been promising. Histologically, REM is associated with a mild, predominantly lymphocytic infiltrate with variable deep perivascular extension. Mucin may be seen in the upper and mid dermis and is prominent around the infiltrate and appendages. IgM deposits may be visualized under direct immunoflourescence along the basal layer. Because of the similarities between REM and tumid lupus, the two disease processes have often been grouped together. The remarkable overlap between the two diseases suggests that the two conditions may actually be the same disease.