Upregulation of TGF-ß1 and basic FGF in elastofibroma: an immunohistochemical analysis.

Elastofibroma is a rare tumour that occurs in the subscapular space, and it typically presents in middle-aged and older individuals. The aetiology of elastofibroma remains unknown. Recent, sporadic reports have shown, immunohistologically, that fibroblasts in elastofibroma may produce abnormal elastic and collagen fibres through the action of transforming growth factor-beta (TGF-ß), a factor that promotes fibroblast proliferation. However, that finding lacked quantitative measurements and controls. Therefore, in this study, we performed quantitative, immunohistochemical analyses of TGF-ß1 and basic fibroblast growth factor (bFGF) in three elastofibromas, and we compared them to ten dermatofibromas and keloids, and five normal skin. In elastofibroma specimens, 16-59 % fibroblasts were positive for TGF-ß1 in the cytoplasm, compared to 96 % in dermatofibroma, 93 % in keloid and 2 % in normal dermis specimens. Also, in elastofibroma specimens, 26-67 % of fibroblasts were positive for bFGF in the cytoplasm, compared to 97 % in dermatofibroma, 97 % in keloid, and 22 % in normal dermis specimens. Intriguingly, the tumour size and growth rate were proportional to the percentage of cells positive for bFGF. Finally, greater levels of bFGF expressions in fibroblasts were associated with larger sized elastofibromas. These results suggested that elastofibroma development depended on high expression of TGF-ß1 and bFGF.

Chondrolipoma of the toe.

Chondrolipoma is a rare benign mesenchymoma composed of mature cartilage and adipose tissue. We present a 71-year-old man with a chondrolipoma of the great toe. On histological examination, the tumor contained both mature fat cells and chondrocytes. To our knowledge, this is the first report of a chondrolipoma on the toe. This case contributes to better awareness of an extremely rare lesion of the distal lower limb.

Erythrodermic lymphomatoid granulomatosis: a case report.

A 70-year-old man was admitted to our hospital for evaluation of a rapidly progressive erythrodermia. He had superficial lymph node swelling and gluteal/inguinal nodosum-like lesions. A skin biopsy of the erythrodermia showed dense mixed infiltrates distributed throughout the whole dermis, predominantly consisting of small lymphocytes and histiocytes with multinucleated giant cells presenting with a granulomatous appearance. The dense infiltrates showed a characteristic angiocentric pattern surrounding the upward vasculature interconnecting the subcutaneous/subpapillary plexus in the dermis. Some infiltrating lymphocytes showed mild atypia with somewhat irregularly shaped nuclei. Their immunologic staining profiles supported the diagnosis of lymphomatoid granulomatosis. Despite the dense angiocentric infiltration in the dermis, typical angiodestructive infiltration with necrotic changes was not seen on pathological examination. In this case, in situ hybridization yielded negative findings for Epstein-Barr virus-encoded RNAs. Three months after the onset of erythrodermia, the patient developed pulmonary lymphomatoid granulomatosis. Corticosteroid pulse therapy was effective for the treatment of severe pulmonary infiltrations and erythrodermia. However, there had been mild recurrence of the condition or hypereosinophilia during the 4 years of follow-up. Low maintenance doses of cyclophosphamide and corticosteroid provided the patient symptomatic relief to date.

Hard palate mucoperiosteal graft for posterior lamellar reconstruction of the upper eyelid: histologic rationale.

Reconstruction of full-thickness upper eyelid defects often requires repair of both the anterior lamella (skin and orbicularis oculis muscle) and the posterior lamella (tarsus and conjunctiva). Various autogenous grafts have been used for posterior lamellar reconstruction, but it is still unclear which material is most suitable for repairing the posterior lamella. We report a patient in whom a subtotal defect of upper eyelid was reconstructed with a bipedicled myocutaneous flap lined by hard palate mucoperiosteum. We also examined tarsoconjunctiva, labial mucosa, hard palate mucoperiosteum, and auricular cartilage histologically and assessed the histologic features of these tissues as substitutes for the posterior lamella. An even and stable upper eyelid was formed by our method of reconstruction. A mucoperiosteal graft from the hard palate bears a close resemblance to the tarsoconjunctiva histologically because it contains both fibrous connective tissue and a mucous membrane. The graft took completely and there was no donor site morbidity or postoperative complications. A hard palate mucoperiosteal graft may be an optimal substitute for the posterior lamella of the upper eyelid.