RESUMEN
Melanoma arising in blue nevus, also known as melanoma ex blue nevus, is a specific form of melanoma whose genetic profile is different to that of other cutaneous melanomas and surprisingly similar to that of uveal melanoma. Although melanoma ex blue nevus can appear de novo, it usually arises in a preexisting blue nevus or dermal melanocytosis. Not all nodular lesions arising in association with blue nevus or dermal melanocytosis are melanomas, however, and because clinical and histologic findings may be insufficient for a definitive diagnosis, additional studies such as comparative genomic hybridization are important. Detection of chromosomal aberrations supports a diagnosis of malignancy. Studies of the BAP1 gene are particularly useful in this setting because loss of expression is indicative of melanoma. We present 3 cases on the spectrum of blue nevus to melanoma ex blue nevus that were studied using molecular biology techniques.
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Melanoma , Nevo Azul , Neoplasias Cutáneas , Humanos , Nevo Azul/diagnóstico , Nevo Azul/genética , Nevo Azul/patología , Pronóstico , Hibridación Genómica Comparativa , Melanoma/diagnóstico , Melanoma/genética , Melanoma/patología , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/genética , Neoplasias Cutáneas/patología , Proteínas Supresoras de Tumor/genética , Ubiquitina Tiolesterasa/genéticaAsunto(s)
COVID-19 , SARS-CoV-2 , Vacuna nCoV-2019 mRNA-1273 , Vacunas contra la COVID-19 , Mano , HumanosRESUMEN
This series of 2 articles on dermatopathologic diagnoses reviews conditions in which granulomas form. Part 1 clarifies concepts, discusses the presentation of different types of granulomas and giant cells, and considers a large variety of noninfectious diseases. Some granulomatous diseases have a metabolic origin, as in necrobiosis lipoidica. Others, such as granulomatous mycosis fungoides, are related to lymphomas. Still others, such as rosacea, are so common that dermatologists see them nearly daily in clinical practice.
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Part 2 of this series on granulomatous diseases focuses on skin biopsy findings. Whereas the first part treated noninfectious conditions (metabolic disorders and tumors, among other conditions), this part mainly deals with various types of infectious disease along with other conditions seen fairly often by clinical dermatologists.
RESUMEN
Vascular occlusion has multiple, diverse clinical manifestations, some of which can have grave consequences for patients. It also has a wide variety of causes, including thrombi, which we recently addressed in partI of this review. In this second part, we look at additional causes of vascular occlusion.
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Trastornos de la Coagulación Sanguínea/complicaciones , Embolia/complicaciones , Enfermedades Cutáneas Vasculares/etiología , Anticoagulantes/efectos adversos , Síndrome Antifosfolípido/complicaciones , Síndrome Antifosfolípido/patología , Calcifilaxia/complicaciones , Calcifilaxia/patología , Cocaína/efectos adversos , Femenino , Cuerpos Extraños/complicaciones , Cuerpos Extraños/patología , Humanos , Isquemia/etiología , Isquemia/patología , Levamisol/efectos adversos , Livedo Reticularis/etiología , Livedo Reticularis/patología , Masculino , Papulosis Atrófica Maligna/patología , Necrosis , Neoplasias/complicaciones , Neoplasias/patología , Paraproteinemias/complicaciones , Paraproteinemias/patología , Piel/irrigación sanguínea , Enfermedades Cutáneas Vasculares/inducido químicamente , Enfermedades Cutáneas Vasculares/patología , Úlcera Cutánea/etiología , Úlcera Cutánea/patología , Síndrome de Sneddon/patologíaRESUMEN
Reticular telangiectatic erythema is a benign dermatosis which has been described on patients with pacemakers, implantable devices or materials inserted in their body. Etiology of this entity hasn't been clarified since the first description in 1981 but it is suggested that physical or mechanical factors have to be involved. We present the second case of bilateral reticular telangiectatic erythema by breast implants described in the literature.
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This article describes a proposed protocol for the histologic diagnosis of cutaneous melanoma developed for the National Cutaneous Melanoma Registry managed by the Spanish Academy of Dermatology and Venereology (AEDV). Following a review of the literature, 36 variables relating to primary tumors, sentinel lymph nodes, and lymph node dissection were evaluated using the modified Delphi method by a panel of 8 specialists (including 7 pathologists). Consensus was reached on the 30 variables that should be included in all pathology reports for cutaneous melanoma and submitted to the Melanoma Registry. This list can also serve as a model to guide routine reporting in pathology departments.
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Dermatología , Melanoma , Neoplasias Cutáneas , Venereología , Consenso , Humanos , Melanoma/diagnóstico , Sistema de Registros , Literatura de Revisión como Asunto , Neoplasias Cutáneas/diagnósticoRESUMEN
Vascular occlusion has multiple, diverse clinical manifestations, some of which can have grave consequences for patients. The causes of vascular occlusion are also highly variable, ranging from thrombi triggered by the uncontrolled activation of coagulation mechanisms, on the one hand, to endothelial dysfunction or occlusion by material extrinsic to the coagulation system on the other. In a 2-part review, we look at the main causes of vascular occlusion and the key clinical and histopathologic findings. In this first part, we focus on vascular occlusion involving thrombi.
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Trombosis , Coagulación Sanguínea , Humanos , Trombosis/etiologíaRESUMEN
BACKGROUND: Panniculitis occurring in dermatomyositis is uncommon, with only a few cases described in the literature, most of them as case reports. OBJECTIVE: This report describes the clinicopathological and immunohistochemical findings in a series of 18 patients with panniculitis associated with dermatomyositis. METHODS: In each patient, we collected the clinical data of the cutaneous lesions as well as the characteristic clinical and laboratory findings. A series of histopathologic findings was recorded in the biopsy of each patient. A panel of antibodies was used in some cases to investigate the immunophenotype of the infiltrate. Data of treatment and follow-up were also collected. RESULTS: Of the 18 patients, 13 were female and 5 were male, ranging in age from 13 to 74 years (median, 46.4 years). In addition to panniculitis, all patients presented pathognomonic cutaneous findings of DM and reported proximal muscle weakness prior to the diagnosis of panniculitis. Muscle biopsy was performed in 17 patients and MRI in one, all with the diagnosis of inflammatory myopathy. None of the patients presented any associated neoplasia. Panniculitis lesions were located in the upper or lower limbs. Histopathology showed a mostly lobular panniculitis with lymphocytes as the main component of the infiltrate. Most cases showed also numerous plasma cells and lymphocytes surrounding necrotic adipocytes (rimming) were frequently seen. Lymphocytic vasculitis and abundant mucin interstitially deposited between collagen bundles of the dermis were also frequent findings. Late-stage lesions showed hyaline necrosis of the fat lobule and calcification. Immunohistochemistry demonstrated that most lymphocytes of the infiltrate were T-helper lymphocytes, with some B lymphocytes in the lymphoid aggregates and small clusters of CD-123-positive plasmacytoid dendritic cells in the involved fat lobule. CONCLUSION: Panniculitis in dermatomyositis is rare. Histopathologic findings of panniculitis dermatomyositis are identical to those of lupus panniculitis. Therefore, the final diagnosis requires clinic-pathologic correlation.
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Dermatomiositis/metabolismo , Dermatomiositis/patología , Paniculitis/metabolismo , Paniculitis/patología , Adolescente , Adulto , Anciano , Linfocitos B/patología , Biopsia , Células Dendríticas/metabolismo , Células Dendríticas/patología , Dermatomiositis/complicaciones , Femenino , Humanos , Subunidad alfa del Receptor de Interleucina-3/metabolismo , Masculino , Persona de Mediana Edad , Músculo Esquelético/patología , Paniculitis/complicaciones , Linfocitos T Colaboradores-Inductores/patología , Adulto JovenRESUMEN
The occurrence of Pacinian corpuscles associated to lymph nodes is an anatomical rarity and very scarce information exists in this regard. Here we examined immunohistochemically four Pacinian corpuscles found in the close vicinity of the hiliar blood vessels of lymph nodes (2 cervical, 1 axillary, and 1 inguinal) during routine surgical pathology. Pacinian corpuscles were normally arranged and displayed a pattern of protein distribution as follows: the axon was positive for neurofilament proteins and neuron specific enolase, the inner core cells showed intense S100 protein and vimentin immunostaining while they were negative for glial fibrillary acidic protein, type IV collagen and glucose transporter 1; vimentin, type IV collagen, and glucose transporter 1 were also observed also in the outer-core and the capsule. These results are in agreement with those reported for cutaneous Pacinian corpuscles, demonstrating that the immunohistochemical profile of these corpuscles is independent of its anatomical localization. The possible functional significance of Pacinian corpuscles in lymph nodes is discussed. Anat Rec, 300:2233-2238, 2017. © 2017 Wiley Periodicals, Inc.
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Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Corpúsculos de Pacini/patología , Corpúsculos de Pacini/cirugía , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/cirugía , Anciano , Anciano de 80 o más Años , Hernia Inguinal/diagnóstico , Hernia Inguinal/cirugía , Humanos , Persona de Mediana Edad , Neoplasias/diagnóstico , Neoplasias/cirugíaRESUMEN
The identification of B-Raf proto-oncongene (BRAF) mutation and the emergence of targeted therapy marked a turning point in the treatment of melanoma. The study of mutation status concordance between primary tumors and metastases in this cancer has major treatment implications as it facilitates the selection of candidates for targeted therapy. This review analyzes the evidence on the level of mutation status concordance between primary tumors and different types of metastases in cutaneous melanoma and provides an overview of the advantages and disadvantages of the various methods used to detect BRAF mutations.
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Melanoma/secundario , Mutación , Proteínas de Neoplasias/genética , Oncogenes , Proteínas Proto-Oncogénicas B-raf/genética , Neoplasias Cutáneas/genética , Anticuerpos Monoclonales/inmunología , Anticuerpos Monoclonales/uso terapéutico , Células Clonales , Análisis Mutacional de ADN , Activación Enzimática , Evolución Molecular , Humanos , Sistema de Señalización de MAP Quinasas/genética , Melanoma/genética , Terapia Molecular Dirigida , Mutación Missense , Proteínas de Neoplasias/inmunología , Células Neoplásicas Circulantes , Células Madre Neoplásicas , Reacción en Cadena de la Polimerasa/métodos , Proteínas Proto-Oncogénicas B-raf/inmunología , Análisis de Secuencia de ADN/métodos , Melanoma Cutáneo MalignoRESUMEN
BACKGROUND: Human parvovirus B19 (B19V) has been associated with a number of dermatological and systemic conditions, including myocarditis and autoimmune syndromes. OBJECTIVES: To determine the frequency of B19V DNA detection in a large dermatopathology practice, and to characterize the histopathological patterns involved. METHODS: We selected for polymerase chain reaction (PCR) detection of B19V a total of 1815 skin biopsies pertaining to entities allegedly related to B19V, as well as cases suspected clinically of representing paraviral exanthemas. Immunohistochemical detection of B19V viral protein 2 (VP2) was performed in 92 PCR-positive cases. RESULTS: B19V DNA was found by PCR in 402 out of 1825 biopsy specimens (22%). VP2 protein was identified by immunohistochemistry in only three instances of papular purpuric 'gloves-and-socks' syndrome. CONCLUSIONS: As the virus has the capacity to persist in different tissues (including the skin) for long periods, it could represent merely an innocent bystander, so no pathogenetic significance can be inferred from the PCR positivity for B19V in the vast majority of dermatological conditions studied.
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ADN Viral/aislamiento & purificación , Infecciones por Parvoviridae/diagnóstico , Parvovirus B19 Humano/genética , Enfermedades Cutáneas Infecciosas/diagnóstico , Piel/virología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Adulto JovenRESUMEN
BACKGROUND: Cutaneous squamous cell carcinoma (CSCC) is the second most frequent cancer in humans after basal cell carcinoma, and its incidence is dramatically rising. CSCC is rarely problematic, but given its high frequency, the absolute number of complicated cases is also high. It is necessary to identify molecular markers in order to recognize those CSCCs with poor prognosis. There is controversy concerning the role of epidermal growth factor receptor (EGFR) as a marker of prognosis in CSCC. In addition, EGFR-targeted therapies have emerged in recent years and a better understanding of the role of EGFR in CSCC may be of help for some patients in predicting prognosis and guiding curative management. OBJECTIVES: To evaluate the role of EGFR as a prognostic factor in CSCC. METHODS: We evaluated clinical and histopathological features, including events of poor clinical evolution, in a series of 94 cases of CSCC. We also analysed EGFR expression by immunohistochemistry, fluorescent in situ hybridization and quantitative polymerase chain reaction. RESULTS: We detected EGFR in 85 cases (90%), with overexpression in 33 cases (35%), and aberrant EGFR expression in the cytoplasm in 50 cases (53%). EGFR overexpression in the primary tumours was associated with lymph node progression, tumour-nodes-metastasis stage progression and proliferation (Ki-67 staining) in CSCC. EGFR overexpression and poor grade of differentiation were the strongest independent variables defining lymph node metastasis and progression in CSCC in a logistic regression model. CONCLUSIONS: We demonstrate that EGFR overexpression has prognostic implications associated with lymph node metastasis and progression in CSCC.
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Biomarcadores de Tumor/metabolismo , Carcinoma de Células Escamosas/diagnóstico , Receptores ErbB/metabolismo , Neoplasias Cutáneas/diagnóstico , Anciano de 80 o más Años , Carcinoma de Células Escamosas/genética , Progresión de la Enfermedad , Receptores ErbB/genética , Femenino , Humanos , Inmunohistoquímica , Metástasis Linfática , Masculino , Pronóstico , Factores de Riesgo , Neoplasias Cutáneas/genéticaAsunto(s)
Anteojos/efectos adversos , Granuloma/diagnóstico , Enfermedades Nasales/diagnóstico , Enfermedades de la Piel/diagnóstico , Femenino , Granuloma/etiología , Granuloma/patología , Humanos , Persona de Mediana Edad , Enfermedades Nasales/etiología , Enfermedades Nasales/patología , Enfermedades de la Piel/etiología , Enfermedades de la Piel/patologíaRESUMEN
Cutaneous graft-versus-host disease (GVHD) is a frequent complication of allogeneic bone marrow transplant and haematopoietic cell transplantation, but it is rarely presented as a Wolf's isotopic response. We report a patient who developed chronic lichenoid GVHD following the dermatomes previously affected by varicella zoster virus (VZV) infection. Nineteen months later, the same patient suffered from reactivation of GVHD at the injection site of an influenza vaccination. We review the literature concerning GVHD appearing after VZV infection and discuss the possible implications of this case and the pathogenic hypotheses.