A Case of Papulonodular Mucinosis in a Patient With Systemic Lupus Erythematosus.

Papulonodular mucinosis is a distinctive lupus erythematosus cutaneous variant that generally occurs in patients with systemic lupus erythematosus. Despite a higher incidence of SLE in women, lupus cutaneous mucinosis occurs more frequently in men. Typically, papulonodular mucinosis appears as asymptomatic, flesh-colored papules and nodules with a propensity for the trunk and upper extremities. Herein, we report a case of papulonodular mucinosis associated with systemic lupus erythematosus in a middle-aged woman. On presentation, patient had multiple flesh-colored papules coalescing into plaques on the trunk and upper extremities. Histological findings of the lesions demonstrated a pale dermis secondary to profuse mucin deposition. Immunofluorescent staining revealed a 'lupus band' with granular deposition of immunoglobulins/complement proteins at the dermal-epidermal junction.

Validation and implementation of an algorithm for reporting the automated absolute neutrophil count from selected flagged specimens.

Samples that are flagged by automated cell counters and, therefore, require a time-consuming microscopic review cause unacceptable wait times for patients in hematology/oncology clinics. We used a set of 518 samples to validate that 5 flags on Sysmex XE/XT instruments (Sysmex, Kobe, Japan) could safely be ignored when the absolute neutrophil count (ANC) was the primary clinical question. The R(2) between automated and manual ANCs was 96.9% for samples triggering non-ANC flags, with 1 clinically significant discrepant sample out of 296 (0.3%). A new test code allowing clinicians to specify "ANC-only" was implemented, and these non-ANC specific flags were disregarded. The new order set was used in 16.3% of patients. Automated reporting of the ANC in selected flagged samples reduced the review rate by 60% and decreased the turnaround time by 100 minutes. This approach to automatically report the ANC in selected flagged specimens in which the ANC is the primary clinical interest safely decreases the turnaround time for many ANC samples.

Islet grafting and imaging in a bioengineered intramuscular space.

BACKGROUND: Because the hepatic portal system may not be the optimal site for islet transplantation, several extrahepatic sites have been studied. Here, we examine an intramuscular transplantation site, bioengineered to better support islet neovascularization, engraftment, and survival, and we demonstrate that at this novel site, grafted beta cell mass may be quantitated in a real-time noninvasive manner by positron emission tomography (PET) imaging. METHODS: Streptozotocin-induced rats were pretreated intramuscularly with a biocompatible angiogenic scaffold received syngeneic islet transplants 2 weeks later. The recipients were monitored serially by blood glucose and glucose tolerance measurements and by PET imaging of the transplant site with [11C] dihydrotetrabenazine. Parallel histopathologic evaluation of the grafts was performed using insulin staining and evaluation of microvasularity. RESULTS: Reversal of hyperglycemia by islet transplantation was most successful in recipients pretreated with bioscaffolds containing angiogenic factors when compared with those who received no bioscaffolds or bioscaffolds not treated with angiogenic factors. PET imaging with [11C] dihydrotetrabenazine, insulin staining, and microvascular density patterns were consistent with islet survival, increased levels of angiogenesis, and with reversal of hyperglycemia. CONCLUSIONS: Induction of increased neovascularization at an intramuscular site significantly improves islet transplant engraftment and survival compared with controls. The use of a nonhepatic transplant site may avoid intrahepatic complications and permit the use of PET imaging to measure and follow transplanted beta cell mass in real time. These findings have important implications for effective islet implantation outside of the liver and offer promising possibilities for improving islet survival, monitoring, and even prevention of islet loss.

GAB2 amplifications refine molecular classification of melanoma.

PURPOSE: Gain-of-function mutations in BRAF, NRAS, or KIT are associated with distinct melanoma subtypes with KIT mutations and/or copy number changes frequently observed among melanomas arising from sun-protected sites, such as acral skin (palms, soles, and nail bed) and mucous membranes. GAB2 has recently been implicated in melanoma pathogenesis, and increased copy numbers are found in a subset of melanomas. We sought to determine the association of increased copy numbers of GAB2 among melanoma subtypes in the context of genetic alterations in BRAF, NRAS, and KIT. EXPERIMENTAL DESIGN: A total of 85 melanomas arising from sun-protected (n = 23) and sun-exposed sites (n = 62) were analyzed for copy number changes using array-based comparative genomic hybridization and for gain-of-function mutations in BRAF, NRAS, and KIT. RESULTS: GAB2 amplifications were found in 9% of the cases and were associated with melanomas arising from acral and mucosal sites (P = 0.005). Increased copy numbers of the KIT locus were observed in 6% of the cases. The overall mutation frequencies for BRAF and NRAS were 43.5% and 14%, respectively, and were mutually exclusive. Among the acral and mucosal melanomas studied, the genetic alteration frequency was 26% for GAB2, 13% for KIT, 30% for BRAF, and 4% for NRAS. Importantly, the majority of GAB2 amplifications occurred independent from genetic events in BRAF, NRAS, and KIT. CONCLUSIONS: GAB2 amplification is critical for melanomas arising from sun-protected sites. Genetic alterations in GAB2 will help refine the molecular classification of melanomas.