Characterization of Sentinel Lymph Node Immune Signatures and Implications for Risk Stratification for Adjuvant Therapy in Melanoma.

BACKGROUND: Although sentinel lymph node (SLN) biopsy is a standard procedure used to identify patients at risk for melanoma recurrence, it fails to risk-stratify certain patients accurately. Because processes in SLNs regulate anti-tumor immune responses, the authors hypothesized that SLN gene expression may be used for risk stratification. METHODS: The Nanostring nCounter PanCancer Immune Profiling Panel was used to quantify expression of 730 immune-related genes in 60 SLN specimens (31 positive [pSLNs], 29 negative [nSLNs]) from a retrospective melanoma cohort. A multivariate prediction model for recurrence-free survival (RFS) was created by applying stepwise variable selection to Cox regression models. Risk scores calculated on the basis of the model were used to stratify patients into low- and high-risk groups. The predictive power of the model was assessed using the Kaplan-Meier and log-rank tests. RESULTS: During a median follow-up period of 6.3 years, 20 patients (33.3%) experienced recurrence (pSLN, 45.2% [14/31] vs nSLN, 20.7% [6/29]; p = 0.0445). A fitted Cox regression model incorporating 12 genes accurately predicted RFS (C-index, 0.9919). Improved RFS was associated with increased expression of TIGIT (p = 0.0326), an immune checkpoint, and decreased expression of CXCL16 (p = 0.0273), a cytokine important in promoting dendritic and T cell interactions. Independent of SLN status, the model in this study was able to stratify patients into cohorts at high and low risk for recurrence (p < 0.001, log-rank). CONCLUSIONS: Expression profiles of the SLN gene are associated with melanoma recurrence and may be able to identify patients as high or low risk regardless of SLN status, potentially enhancing patient selection for adjuvant therapy.

Receptors for Treponema pallidum attachment to the surface and matrix proteins of cultured human dermal microvascular endothelial cells.

Pathogenicity of Treponema pallidum may depend upon the binding of Treponema pallidum to matrix proteins, especially to fibronectin. Infectious organism or cell to matrix interactions are mediated by a family of adhesion molecule receptors known as integrins. Once in the host, the pathogenic Treponema pallidumdum adheres to the vascular endothelium and readily penetrates surrounding tissues. Fibronectin plays an important role in the mediation of the attachment of Treponema pallidum to host cells, including endothelial cells. We found that the binding of Treponema pallidum to human dermal microvascular endothelial cells and to a glass surface coated with fibronectin is inhibited by the presence of arginine-glycine- aspartic acid (RGD), and analysis of the surface receptor revealed an antigenic similarity to an integrin molecule, namely alpha5. This ability to adhere to host endothelium and fibronectin is quite unique to T. pallidum among the treponemes, and may be a key pathogenic factor.

Do patients with acne need cognitive behavioral therapy? An analysis of patient knowledge and behavior.

BACKGROUND: Acne is a common skin condition that affects adolescents as well as young adults, and numerous treatment modalities have been introduced with various success. However, most of the therapeutic measures have failed to show a long-lasting effect because acne is a multi-factorial disease. Some of the factors can be effectively modified by patients themselves. We hereby present an analysis of patients' cognition of the disease and behavioral patterns that can influence patient compliance and the efficacy of the adjacent therapy. METHODS: The survey was conducted on 136 Korean patients at a private cosmetic clinic, using a questionnaire form on their cognition and everyday habitual care. RESULTS: The results showed that the patients neither possess the proper knowledge nor behave appropriately when taking care of acne-prone skin. CONCLUSIONS: For a successful therapeutic alliance, it seems useful to provide knowledge and introduce a cognitive-behavioral therapy to the field of acne treatment.

Recalcitrant adverse reaction to vitamin K: response to pulsed dye laser.

BACKGROUND: Adverse cutaneous reaction to vitamin K manifests in sclerodermatous or erythematous plaque-like reactions. Most of the cases with erythematous plaque-like dermatitis arising at the site of intramuscular vitamin K injection were recalcitrant and did not respond to various attempts with topical and intralesional corticosteroid. OBJECTIVE: The objective was to describe a 25-year-old woman with recalcitrant adverse reaction owing to vitamin K who was successfully treated with pulsed dye laser. METHODS: Two consecutive pulsed dye laser treatments were performed 3 weeks apart with 450-microec pulse duration, 585-nm pulse width, and fluence of 5 and 7 J/cm(2), respectively, using a 7-mm handpiece. RESULTS: One week after the second treatment, her skin lesion was cleared and she was followed without recurrence for 7 months. CONCLUSION: Although the precise mechanism remains yet to be proven, we have demonstrated successful treatment of localized adverse cutaneous reaction to vitamin K in one patient with the pulsed dye laser.

Neurofibromatosis type 2 with multiple plexiform schwannomas.

Multiple plexiform schwannomas (PS) or neurilemmomas are very rare nerve sheath tumors, showing multiple schwannomas of the skin and other soft tissues, brain, or spinal cord with histopathologic characteristic of interwoven Antonio-A type tissues(1) but without other signs of neurofibromatosis type 2 (NF2). Neurofibromatosis type 2 is much less common than neurofibromatosis type 1 (NF1), with a symptomatic prevalence of 1 in 210,000,(2) and, to the authors' knowledge, only six cases of NF2 with multiple plexiform schwannomas have been reported in the literature.(3-5) We report a rare case of multiple cutaneous plexiform schwannomas associated with characteristic features of NF2 including bilateral acoustic neurilemomas and intracranial meningioma.

Metastatic malignant proliferating trichilemmal tumor detected by positron emission tomography.

BACKGROUND: Whole-body 18F-fluorodeoxyglucose-positron emission tomography (18F-FDG-PET) was introduced in 1990s, and its efficacy for cerebral mapping and for selective detection of various malignancies is now being recognized. OBJECTIVE: To report on the usefulness of whole-body 18F-FDG-PET for detecting a metastatic lesion in a rare case of malignant proliferating trichilemmal tumor. METHODS: A malignant proliferating trichilemmal tumor on the occipital scalp of a 69-year-old female recurred on the margin of the surgical scar after an initial wide excision, and it was removed by Mohs micrographic surgery. 18F-FDG-PET was done to detect any remaining tumor tissue, and it showed a hot uptake on the lower left occipital area, where a pea-sized nodule formed 2 months later. Dissection and wide excision of the nodule showed metastatic malignant proliferating trichilemmal tumor cells in the lymph nodes. RESULTS: We were able to take advantage of the high resolution of the 18F-FDG-PET in detecting a metastatic lesion despite its proximity to the central nervous system. CONCLUSION: The 18F-FDG-PET can be used in future malignant proliferating trichilemmal tumor cases to study the metastatic characteristics of this rare tumor.

Clinical features of patients with Behçet's disease and epididymitis.

PURPOSE: Epididymitis is a rare manifestation of Behçet's disease but its clinical significance is still not fully understood. We evaluated the clinical significance of epididymitis in patients with Behçet's disease. MATERIALS AND METHODS: Of 780 male patients attending our clinics between 1985 and 2002 who were diagnosed with Behçet's disease by international criteria or who had the complete or incomplete type of Behçet's disease by Japanese criteria 36 were identified with epididymitis. Clinical data on these patients were reviewed. RESULTS: The 36 patients were categorized into the complete (13 or 36.1%) and incomplete (23 or 63.9%) types of Behçet's disease with an average age at onset of 27.4 years. The frequency of individual symptoms were oral ulcers and cutaneous involvement in all 36 cases (100%), genital ulcers in 32 (88.9%), arthritis in 18 (50.0%), ocular involvement in 17 (47.2%), central nervous system involvement in 2 (5.6%), gastrointestinal ulcer in 1 (2.8%) and a positive pathergy test in 4 (11.1%). A significantly higher number of patients with epididymitis had genital ulcers (p <0.05), cutaneous involvement (p <0.001), arthritis (p <0.05), central nervous system involvement (p <0.05) and a positive pathergy test (p <0.05) compared with the other 744 with Behçet's disease without epididymitis who served as controls. CONCLUSIONS: To our knowledge there has been no controlled study of the clinical significance of epididymitis in Behçet's disease. Our results suggest a tendency toward severe Behçet's disease manifestations in patients with epididymitis, prompting physicians to evaluate closely and meticulously treat such patients.