Concurrent Presentation of Mycosis Fungoides and Primary Cutaneous Marginal Zone LPD: Clinicopathological Study of 4 Cases and Literature Review.

BACKGROUND: Mycosis fungoides is rarely associated to B-cell malignancies, and the few reported cases are mainly internal lymphomas involving secondarily the skin (ie, chronic lymphocytic leukemia). OBJECTIVES: The aim of our study is to describe the clinical and histopathological features of 4 patients presenting with 2 concurrent primary cutaneous lymphomas and review the pertinent literature. METHODS: We identified 4 cases of concurrent primary cutaneous lymphomas in our institutions. An extracutaneous lymphoma was ruled out on the basis of a complete work out. We performed a PubMed search to identify reported cases of primary cutaneous composite or concurrent lymphomas. RESULTS: Eleven cases of primary cutaneous concurrent lymphomas have been described in the literature. Counting all together (our cases and the cases previously described in the literature), mycosis fungoides was the most frequent primary cutaneous T-cell lymphoma (TCL) (13/15), followed by 1 case of peripheral TCL-NOS and 1 case of subcutaneous panniculitis-like TCL. Regarding the associated primary cutaneous B-cell lymphomas, 8/15 cases consisted of low-grade B-cell lymphomas [that is, 5 marginal zone lymphoma (in the most recent classification reclassified as marginal zone lymphoproliferative disorder, MZLD, 2 follicular-center B-cell lymphoma (primary cutaneous follicle-center lymphoma) and 1 low-grade NOS B-cell lymphoma]; 4/15 were associated to Epstein-Barr virus; 1 case consisted of a methotrexate-associated lymphoproliferative disease, and 2 cases consisted of primary cutaneous diffuse large B-cell lymphoma-leg type. CONCLUSIONS: Primary cutaneous concurrent lymphomas are exceptional. Clinicopathological correlation and a complete workout to reach the correct diagnosis may guide the appropriate treatment in each case.

Acral lymphomatoid papulosis: Report of five cases, differential diagnosis, and review.

Acral lymphomatoid papulosis (a-LyP) is a rare clinical variant of LyP whose diagnosis may be challenging. A case series of a-LyP was studied clinically, histopathologically, immunohistochemically, and from molecular point of view. Including ours, 25 cases of a-LyP have so far been reported. Clinically, a-LyP may present as acral involvement exclusively, in combination with mucosal lesions, (in itself a rare presentation), or in association with conventional LyP. The age of presentation was slightly higher than that of conventional LyP (55 vs 45 years) and a male predominance has been observed, as usually reported. Histopathologically, no morphological differences exclusively from conventional LyP were observed. LyP types A and E were the main variants. We describe for the first time one case of type D a-LyP. Acral LyP is a rare entity and correct diagnosis can only be reached with clinical and histopathological correlation, to avoid aggressive treatment of this indolent lymphoproliferative disorder.

The endophyte Serendipita indica reduces the sodium content of Arabidopsis plants exposed to salt stress: fungal ENA ATPases are expressed and regulated at high pH and during plant co-cultivation in salinity.

Serendipita indica (formerly Piriformospora indica) is an endophytic fungus that colonizes plant roots producing a beneficial effect on plant growth and development under optimal and suboptimal conditions provoked by any biotic or abiotic stress, such as salt stress. Salinity induces osmotic and ionic imbalances in plants, mainly by altering the Na+ and K+ contents. However, the mechanism by which Serendipita improves plant growth has yet to be elucidated. Previous works suggest that this fungus improves the plant osmotic state but not much is known about whether it participates in readjustment of the ionic imbalance in plants. Here, we report that co-cultivation with Serendipita reduces the Na+ content of Arabidopsis plants under saline conditions. Additionally, we describe the functional characterization of the two Serendipita ENA ATPases, which are homologous to the main proteins involved in the salt tolerance of other fungi. Their heterologous expression in salt-sensitive yeast mutants shows that SiENA1 is involved in Na+ and K+ efflux, while SiENA5 seems to only be involved in Na+ detoxification. Both are induced and might have a relevant function at alkaline pH, condition in which there are few chlamydospores in the mycelium, as well as during co-cultivation with plants exposed to saline conditions.

The Role of Soil Fungi in K+ Plant Nutrition.

K+ is an essential cation and the most abundant in plant cells. After N, its corresponding element, K, is the nutrient required in the largest amounts by plants. Despite the numerous roles of K in crop production, improvements in the uptake and efficiency of use of K have not been major focuses in conventional or transgenic breeding studies in the past. In research on the mineral nutrition of plants in general, and K in particular, this nutrient has been shown to be essential to soil-dwelling-microorganisms (fungi, bacteria, protozoa, nematodes, etc.) that form mutualistic associations and that can influence the availability of mineral nutrients for plants. Therefore, this article aims to provide an overview of the role of soil microorganisms in supplying K+ to plants, considering both the potassium-solubilizing microorganisms and the potassium-facilitating microorganisms that are in close contact with the roots of plants. These microorganisms can influence the active transporter-mediated transfer of K+. Regarding the latter group of microorganisms, special focus is placed on the role of endophytic fungus. This review also includes a discussion on productivity through sustainable agriculture.

Salt intolerance in Arabidopsis: shoot and root sodium toxicity, and inhibition by sodium-plus-potassium overaccumulation.

MAIN CONCLUSION: Arabidopsis plants in NaCl suffering half growth inhibition do not suffer osmotic stress and seldom shoot Na (+) toxicity; overaccumulation of Na (+) plus K (+) might trigger the inhibition. It is widely assumed that salinity inhibits plant growth by osmotic stress and shoot Na(+) toxicity. This study aims to examine the growth inhibition of Arabidopsis thaliana by NaCl concentrations that allow the completion of the life cycle. Unaffected Col-0 wild-type plants were used to define nontoxic Na(+) contents; Na(+) toxicities in shoots and roots were analyzed in hkt1 and sos1 mutants, respectively. The growth inhibition of Col-0 plants at 40 mM Na(+) was mild and equivalent to that produced by 8 and 4 mM Na(+) in hkt1 and sos1 plants, respectively. Therefore, these mutants allowed to study the toxicity of Na(+) in the absence of an osmotic challenge. Col-0 and Ts-1 accessions showed very different Na(+) contents but similar growth inhibitions; Ts-1 plants showed very high leaf Na(+) contents but no symptoms of Na(+) toxicity. Ak-1, C24, and Fei-0 plants were highly affected by NaCl showing evident symptoms of shoot Na(+) toxicity. Increasing K(+) in isotonic NaCl/KCl combinations dramatically decreased the Na(+) content in all Arabidopsis accessions and eliminated the signs of Na(+) toxicity in most of them but did not relieve growth inhibition. This suggested that the dominant inhibition in these conditions was either osmotic or of an ionic nature unspecific for Na(+) or K(+). Col-0 and Ts-1 plants growing in sorbitol showed a clear osmotic stress characterized by a notable decrease of their water content, but this response did not occur in NaCl. Overaccumulation of Na(+) plus K(+) might trigger growth reduction in NaCl-treated plants.

Knockouts of Physcomitrella patens CHX1 and CHX2 transporters reveal high complexity of potassium homeostasis.

This study aims to increase our understanding of the functions of CHX transporters in plant cells using the model plant Physcomitrella patens, in which four CHX genes have been identified, PpCHX1-PpCHX4. Two of these genes, PpCHX1 and PpCHX2, are expressed at approximately the same level as the PpACT5 gene, but the other two genes show an extremely low expression. PpCHX1 and PpCHX2 restored growth of Escherichia coli mutants on low K(+)-containing media, suggesting that they mediated K+ uptake that may be energized by symport with H+. In contrast, these genes suppressed the defect associated with the kha1 mutation in Saccharomyces cerevisiae, which suggests that they might mediate K+/H+ antiport. PpCHX1-green fluorescent protein (GFP) fusion protein transiently expressed in P. patens protoplasts co-localized with a Golgi marker. In similar experiments, the PpCHX2-GFP protein appeared to localize to tonoplast and plasma membrane. We constructed the ΔPpchx1 and ΔPpchx2 single mutant lines, and the ΔPpchx2 ΔPphak1 double mutant. Single mutant plants grew normally under all the conditions tested and exhibited normal K+ and Rb+ influxes; the ΔPpchx2 mutation did not increase the defect of ΔPphak1 plants. In long-term experiments, ΔPpchx2 plants showed slightly higher Rb+ retention than wild-type plants, which suggests that PpCHX2 mediates the transfer of Rb+ either from the vacuole to the cytosol or from the cytosol to the external medium in parallel with other transporters. The distinction between these two possibilities is technically difficult. We suggest that K+ transporters of several families are involved in the pH homeostasis of organelles by mediating either K+/H+ antiport or K(+)-H(+) symport.

The potassium transporters HAK2 and HAK3 localize to endomembranes in Physcomitrella patens. HAK2 is required in some stress conditions.

The function of HAK transporters in high-affinity K+ uptake in plants is well established; this study aims to demonstrate that some transporters of the same family play important roles in endomembranes. The PpHAK2-PpHAK4 genes of Physcomitrella patens encode three transporters of high sequence similarity. Quantitative PCR showed that PpHAK2 and PpHAK3 transcripts are expressed at approximately the same level as the PpACT5 gene, while the expression of PpHAK4 seems to be restricted to specific conditions that have not been determined. KHA1 is an endomembrane K+/H+ antiporter of Saccharomyces cerevisiae, and the expression of the PpHAK2 cDNA, but not that of PpHAK3, suppressed the defect of a kha1 mutant. Transient expression of the PpHAK2-green fluorescent protein (GFP) and PpHAK3-GFP fusion proteins in P. patens protoplasts localized to the endoplasmic reticulum and Golgi complex, respectively. To determine the function of PpHAK2 and PpHAK3 in planta, we constructed ΔPphak2 and ΔPphak2 ΔPphak3 plants. ΔPphak2 plants were normal under all of the conditions tested except under K+ starvation or at acidic pH in the presence of acetic acid, whereupon they die. The defect observed under K+ starvation was suppressed by the presence of Na+. We propose that PpHAK2 may encode either a K(+)-H(+) symporter or a K+/H+ antiporter that mediates the transfer of H+ from the endoplasmic reticulum lumen to the cytosol. PpHAK2 may be a model of the second function of HAK transporters in plant cells. The disruption of the PpHAK3 gene in ΔPphak2 plants showed no effect.

Two closely linked tomato HKT coding genes are positional candidates for the major tomato QTL involved in Na+ /K+ homeostasis.

The location of major quantitative trait loci (QTL) contributing to stem and leaf [Na(+) ] and [K(+) ] was previously reported in chromosome 7 using two connected populations of recombinant inbred lines (RILs) of tomato. HKT1;1 and HKT1;2, two tomato Na(+) -selective class I-HKT transporters, were found to be closely linked, where the maximum logarithm of odds (LOD) score for these QTLs located. When a chromosome 7 linkage map based on 278 single-nucleotide polymorphisms (SNPs) was used, the maximum LOD score position was only 35 kb from HKT1;1 and HKT1;2. Their expression patterns and phenotypic effects were further investigated in two near-isogenic lines (NILs): 157-14 (double homozygote for the cheesmaniae alleles) and 157-17 (double homozygote for the lycopersicum alleles). The expression pattern for the HKT1;1 and HKT1;2 alleles was complex, possibly because of differences in their promoter sequences. High salinity had very little effect on root dry and fresh weight and consequently on the plant dry weight of NIL 157-14 in comparison with 157-17. A significant difference between NILs was also found for [K(+) ] and the [Na(+) ]/[K(+) ] ratio in leaf and stem but not for [Na(+) ] arising a disagreement with the corresponding RIL population. Their association with leaf [Na(+) ] and salt tolerance in tomato is also discussed.

Essential thrombocythemia presenting as localized livedo reticularis.

Essential thrombocythemia is a chronic myeloproliferative disorder characterized by a persistent and absolute increase in the peripheral platelet count (>600,000/mm) in the absence of another underlying disorder. From a clinical point of view, it is characterized by thrombotic manifestations that primarily involve the central nervous system as strokes and transient ischemic attacks and also affects other systems, causing gastrointestinal hemorrhages and arterial or venous thrombosis. Cutaneous manifestations may complicate essential thrombocythemia, but they may be a helpful guide to the diagnosis. These manifestations appear up to 22% of patients and may even be the presenting sign of the disease in up to 10% of them. We present a case of a previously healthy woman who was diagnosed with essential thrombocythemia after the onset of localized livedo reticularis. The case was immunohistochemically studied, supporting the role of the increased platelet number in the pathogenesis of the livedo reticularis lesions.

The transportome of the endophyte Serendipita indica in free life and symbiosis with Arabidopsis and its expression in moderate salinity.

Serendipita indica is an endophytic root symbiont fungus that enhances the growth of various plants under different stress conditions, including salinity. Here, the functional characterization of two fungal Na+/H+ antiporters, SiNHA1 and SiNHX1 has been carried out to study their putative role in saline tolerance. Although their gene expression does not respond specifically to saline conditions, they could contribute, together with the previously characterized Na+ efflux systems SiENA1 and SiENA5, to relieve Na+ from the S. indica cytosol under this stressed condition. In parallel, an in-silico study has been carried out to define its complete transportome. To further investigate the repertoire of transporters expressed in free-living cells of S. indica and during plant infection under saline conditions, a comprehensive RNA-seq approach was taken. Interestingly, SiENA5 was the only gene significantly induced under free-living conditions in response to moderate salinity at all the tested time points, revealing that it is one of the main salt-responsive genes of S. indica. In addition, the symbiosis with Arabidopsis thaliana also induced SiENA5 gene expression, but significant changes were only detected after long periods of infection, indicating that the association with the plant somehow buffers and protects the fungus against the external stress. Moreover, the significant and strongest induction of the homologous gene SiENA1 occurred during symbiosis, regardless the exposure to salinity. The obtained results suggest a novel and relevant role of these two proteins during the establishment and maintenance of fungus-plant interaction.

Nursing and Telemental Health during the COVID-19 Pandemic.

Measures taken to reduce the rate of contagion during the first months of the COVID-19 pandemic in Spain led to the interruption of nursing interventions for many patients with serious mental illness (SMI), while others stayed in touch with their nurses telematically. However, published research into the impact of mental telehealth and the outcome of the changes that took place in the pandemic is very limited. Aim: The aim of this study was to analyze the changes in nursing interventions received by severe mental illness (SMI) patients and to test whether telemental health (TH) has been effective in reducing relapses during the COVID-19 pandemic. Materials and methods: Information was gathered retrospectively from about 270 patients under treatment at 15 mental health day hospitals (MHDHs) in Spain during the year 2020. Results: Face-to-face nursing interventions were found to have decreased and TH interventions were found to have increased in the first few months of the pandemic. In the following months, TH interventions-especially those conducted by video call-helped reduce the number of relapses. Conclusions: TH helps provide news forms of effective telematic nursing interventions that reduce the number of relapses and admissions in patients with serious mental health disorders.

Diffuse lower limb lipoatrophy.

Lipoatrophic panniculitis is the term used to describe those panniculitides in which atrophy of the subcutaneous fat is the main residual lesion. They can be classified as primary or secondary. Primary lipoatrophic panniculitis is idiopathic, whereas secondary lipoatrophic panniculitides include those because of infection, malignancy, pancreatic disorders or connective tissue diseases. Usually, these entities are characterized by the appearance of tender, erythematous nodules or plaques that resolve leaving one or several localized areas with loss of subcutaneous fat. We report a 76-year-old female who developed diffuse and symmetric lipoatrophy of lower limbs after an extensive inflammatory process affecting both extremities from thighs to ankles. Histopathologic assessment revealed a lobular panniculitis with a lymphohistiocytic infiltrate, foamy macrophages and lipophagic granuloma formation. The most striking feature in our patient was the clinical presentation as a symmetrical diffuse inflammatory process resulting in lipoatrophy of the lower limbs.

Subcutaneous panniculitis-like T-cell lymphoma, lupus erythematosus profundus, and overlapping cases: molecular characterization through the study of 208 genes.

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare cytotoxic cutaneous lymphoma. Differential diagnosis with lupus erythematosus panniculitis (LEP) can be challenging and overlapping cases have been described. In this study, we investigate whether gene expression profiling may or not identify markers that can be used to improve our understanding of the disease and to make a precise differential diagnosis. SPTCL, LEP, and overlapping cases were analyzed using a customized NanoString platform including 208 genes related to T-cell differentiation, stromal signatures, oncogenes, and tumor suppressor genes. Gene expression unsupervised analysis of the samples differentiated SPTCL from LEP samples. Most overlapping cases were clustered with LEP cases. Differentially expressed genes were observed when comparing SPTCL with LEP cases; and overlapping with LEP cases. Gene set enrichment analysis recognized gene sets defining each group. In conclusion, SPTCL and LEP have distinctive molecular profiles and the molecular background of overlapping cases more closely resembles LEP.

High-affinity sodium uptake in land plants.

High-affinity Na(+) uptake in plants and its mediation by HKT transporters have been studied in very few species. This study expands the knowledge of high-affinity Na(+) uptake in land plants for both uptake characteristics and involvement of HKT transporters. In non-flowering plants, we analyzed the Na(+) content of wild mosses, carried out experiments on K(+) and Na(+) uptake in the micromolar range of concentrations with the moss Physcomitrella patens and the liverwort Riccia fluitans, studied a Deltahkt1 mutant of P. patens and identified the HKT genes of the lycopodiophyta (clubmoss) Selaginella moellendorffii. In flowering plants we studied Na(+) uptake in the micromolar range of concentrations in 16 crop plant species, identified the HKT transporters that could mediate high-affinity Na(+) uptake in several species of the Triticeae tribe, and described some characteristics of high-affinity Na(+) uptake in other species. Our results suggest that high-affinity Na(+) uptake occurs in most land plants. In very few of them, rice and species in the Triticeae and Aveneae tribes of the Poaceae family, it is probably mediated by HKT transporters. In other plants, high-affinity Na(+) uptake is mediated by one or several transporters whose responses to the presence of K(+) or Ba(2+) are fundamentally different from those of HKT transporters.

Superficial thrombophlebitis: A new clinical manifestation of the immune reconstitution inflammatory syndrome in a patient with HIV infection.

Skin manifestations of immune reconstitution inflammatory syndrome in response to highly active antiretroviral therapy may account for up to 50% of the clinical presentations in this syndrome. Viable or dying infective antigens, host antigens, tumoral antigens, and others may target immune reconstitution inflammatory syndrome, resulting in a wide spectrum of clinical manifestations. We describe a 26-year-old HIV-infected man who had started highly active antiretroviral therapy a few months earlier. He developed multiple linear nodules following the superficial veins in both legs. Histopathologic examination demonstrated a mostly septal panniculitis with features of superficial thrombophlebitis. We propose that superficial thrombophlebitis should be added to the list of clinical manifestations of this newly observed immune restoration disease.

Mask-like metastasis: report of 2 cases of 4 eyelid metastases and review of the literature.

Bilateral periorbital edema and swelling are frequent in clinical practice and are commonly attributed to orbital contact dermatitis due to different drugs and cosmetic products. However, when there is a background of a solid cancer, the possibility of eyelid metastasis should be also considered. Metastases to the eyelids are rare, and in most cases, these lesions are unilateral. Because only a few cases of bilateral involvement have been reported in the literature, clinical and morphological data of this variant are under recognized. We report the clinical and histopathological characteristics of 2 patients with 4 eyelid metastasis and review the previous cases reported in the literature.

Giant angiolymphoid hyperplasia with eosinophilia on the chest.

Angiolymphoid hyperplasia with eosinophilia is a rare vascular proliferation characterized by single or multiple purplish, brownish papules and subcutaneous nodules, sometimes associated with pain or pruritus. This rare benign process occurs with a female predominance. Approximately 85% of the lesions occur in the skin of the head and neck; most of them are around the ear or on the forehead or scalp. Whether angiolymphoid hyperplasia with eosinophilia represents a benign neoplasm or an unusual reaction to varied stimuli, including trauma, the etiology remains unclear. Histopathologically, the lesions consist of a proliferation of blood vessels of variable size lined by large epithelioid endothelial cells and a variable inflammatory infiltrate of lymphocytes and eosinophils, sometimes with lymphoid follicle formation. The lesion is benign but may be persistent and is difficult to eradicate. We report on a case of a 58-year-old Caucasian man who presented a purplish pink dome-shaped tumor of size up to 8 cm in diameter located on the chest. We emphasize this case considering the unusual dimensions of the lesion (8 cm diameter) and the atypical location on the chest.

Plaque-like osteoma cutis with transepidermal elimination.

Osteoma cutis is a rare lesion that consists of the presence of bone tissue within the dermis and/or hypodermis. It may be classified as primary osteoma cutis, when bone tissue develops in the skin without any pre-existing lesion and secondary osteoma cutis, which is more frequent and occurs when osseous tissue develops on a pre-existing lesion. We present a case of primary plaque-like osteoma cutis involving the scalp, left forehead and left cheek, which appeared in an adult male. Histopathological study showed several islands of mature osseous tissue involving the full thickness of the dermis. In some areas, there was also transepidermal elimination of bone spicules. We review the literature about previously reported similar cases.

Effects of polylinker uATGs on the function of grass HKT1 transporters expressed in yeast cells.

HvHKT1 mediates K(+) or Na(+) uniport in yeast cells if the expression promoter is joined directly to the HvHKT1 cDNA, and Na(+)-K(+) symport if a 59 nucleotide polylinker is inserted. Our results show that three ATG triplets in the polylinker decreased the synthesis of the transporter and that the lower amount of transporter caused the functional change. With the rice HKT1 cDNA, the 59 nt polylinker changed the mode of Na(+) uptake from K(+)-insensitive to K(+)-inhibitable. These two modes of Na(+) uptake also occurred in rice plants.