Lymphangiogenesis: implications for diagnosis, treatment, and prognosis in patients with melanoma.

Disease course in melanoma often cannot be accurately predicted by means of the prognostic factors usually considered in patients with melanoma; therefore, new factors are clearly needed. Increasingly robust scientific evidence shows that tumor lymph vessels play a key role in melanoma that metastasizes by lymphatic and hematogenous pathways. We review current knowledge and examine the implications of lymphangiogenesis in the diagnosis, treatment, and prognosis of patients with melanoma.

Mechanisms of tumour vascularization in cutaneous malignant melanoma: clinical implications.

Malignant melanoma represents < 10% of all skin cancers but is responsible for the majority of skin-cancer-related deaths. Metastatic melanoma has historically been considered as one of the most therapeutically challenging malignancies. Fortunately, for the first time after decades of basic research and clinical investigation, new drugs have produced major clinical responses. Angiogenesis has been considered an important target for cancer treatment. Initial efforts have focused primarily on targeting endothelial and tumour-related vascular endothelial growth factor signalling. Here, we review different mechanisms of tumour vascularization described in melanoma and discuss the potential clinical implications.

Blood microvessel density, lymphatic microvessel density and lymphatic invasion in predicting melanoma metastases: systematic review and meta-analysis.

In malignant melanoma (MM) there is an urgent need to identify new markers with predictive value superior to the traditional clinical and histological parameters. Angiogenesis and lymphangiogenesis have been recognized as critical processes in tumour growth and metastasis development, and numerous studies have evaluated the significance of these parameters in predicting the prognosis in solid tumours, including MM. We set out to determine whether angiogenesis, lymphangiogenesis and lymphatic invasion (LI) are valuable prognostic markers in MM. We systematically reviewed the available literature and subsequently performed a meta-analysis on the compiled data. To be eligible for the systematic review, a study had to provide the microvessel density (MVD), the lymphatic vessel density (LVD) or information about LI, assessed by immunohistochemistry on the primary site in patients with MM. To be evaluable for the meta-analysis, a study also had to provide information on clinical outcome. We approached selected studies with the Reporting recommendations for tumour marker (REMARK) criteria, verifying whether they had followed the recommendations. In total, nine angiogenesis, seven lymphangiogenesis and 10 LI studies were included in our meta-analysis, representing 419, 474 and 802 patients, respectively. Using meta-analysis, we showed that peritumoral LVD and the presence of LI have prognostic value for patients with MM. In contrast, MVD and intratumoral LVD did not have prognostic value in these patients. LVD and LI seem to have prognostic value for patients with MM.

[Solar elastosis in cutaneous squamous cell carcinoma]. / Elastosis solar en carcinomas espinocelulares cutáneos.

INTRODUCTION: Solar elastosis, or basophilic degeneration of collagen, may be a histologic sign of chronic sun damage. MATERIAL AND METHODS: We reviewed 222 cases of squamous cell carcinoma (SCC) to identify the presence of solar elastosis and its possible invasion of the upper, middle, or deep reticular dermis. We also analyzed clinical variables such as SCC location, location in exposed areas of the skin, age, sex, and immunosuppression. Patients included had undergone surgical excision of an SCC. RESULTS: Severe solar elastosis was found in most cases (182 patients, 82%): 87 extended to the middle reticular dermis and 95 had reached the deep reticular dermis. Only 6 (2.7%) patients had no solar elastosis. In some cases elastosis was so severe that it had affected the subcutaneous cellular tissue or venous or arteriolar walls. Deeper solar elastosis was significantly associated with older age and female sex. CONCLUSIONS: Solar elastosis was found in most patients with SCC and seems to indicate chronic severe solar damage. Exposure to ultraviolet radiation would be the main cause of SCC, although other factors might also be implicated, particularly in patients who did not have severe solar elastosis. Systemic or localized immunosuppression was associated with nearly all the SCC cases studied, consistent with the marked immunosuppressant effects of sun exposure, the aging process, or both.

'Bowenoid wart': wart with bowenoid histological changes? Report of 9 cases.

INTRODUCTION: Cases of lesions that simulate Bowen's disease have been previously described in the literature. CASE REPORT: Nine exophytic verruca-like lesions with histological findings of Bowen's disease (BD) are described. All cases had a rapid growth, and were located on the face and neck of elderly patients with chronic solar skin damage. We carried out p16 immunohistochemical staining using the immunoperoxidase technique, which was negative in all cases. DISCUSSION: We think that these 9 lesions are only histologically mimicking BD, and could be a subtype of verruca ('bowenoid wart'). These lesions could be provoked by nononcogenic human papillomavirus (HPV), as in other cases previously described. The p16 staining was negative in all cases, in contrast with most BD cases. It would be interesting to study whether positive p16 staining is related to oncogenic HPV, whereas negative p16 staining could be associated with low or nononcogenic HPV; thus, more studies are needed.

T and B lymphocytes in contact and atopic dermatitis.

The pattern of distribution of T and B lymphocytes was investigated in a group of patients with contact, atopic, and mixed dermatitis by means of immunofluorescence and T-cell rosette tests. A significant increase (P less than .001) in B lymphocytes with surface IgD but without changes in the lymphocytes bearing other immunoglobulins or C3 and T cells was noted in patients with contact dermatitis when compared with a control group. A significant increase (P less than .001) in B lymphocytes carrying IgE and a significant decrease (P less than .001) in the total numbers of T cells were noted in patients with atopic dermatitis, and a significant increase in B lymphocytes positive for IgD (P less than .001) and IgE (P less than .003) with a decrease in the number of lymphocytes bearing IgG were the most important changes observed in patients with mixed contact and atopic dermatitis.

Schnitzler's syndrome: report of a case with bone osteolysis.

A case of chronic urticaria with macroglobulinemia (Schnitzler's syndrome) is described. To our knowledge, this is only the second case reported in the literature with osteolysis and the presence of cryoglobulins in sera. The characteristics of the previous 21 cases of this syndrome are reviewed. The pathogenesis of this peculiar entity is discussed.

[Multiple trichoepithelioma with variable evolution of its lesions (malignancy and spontaneous remission)]. / Tricoepitelioma múltiple con variable evolución de sus lesiones. (Malignización y regresión espontánea).

A case of Multiple Trichoepithelioma with extensive skin involvement without familial history is reported. Some of the lesions showed spontaneous remission over the years, and in two, the microscopcal examination, demonstrated malignant changes (Basal cell Epithelioma).

[Ehlers-Danlos syndrome (1 case)]. / Sindrome de Ehlers-Danlos.

A male patient is presented is clinical and histopathological characteristics are typical of Ehlers-Danlos Syndrome (cutaneous and articular hyperelasticity and cutaneous fragility with the presence of atrophic scars). Looking into the family history we think that other relatives had the same disease and they had died during their childhood due to internal hemorrhages. The patient we present did not have significant hemorrhages in any moment. The elastic fibers in the dermal papilla are reduced giving rise to the appearance of being increased in the middle and deep dermis.

[A case of lichen nitidus]. / Un caso de liquen nítido.

A case of Lichen Nitidus exclusively localized on the arms and palms of an 8 year old girl with ten years of evolution and a good response to treatment, is described.

[Juvenile xanthogranuloma]. / Xantogranuloma juvenil.

The clinical and histopathological picture of a case of Juvenile Xanthogranuloma present in a new-born, in which all the investigations and analytic results were normal, is commented upon. The patient presents a case of exclusive skin affectation.

[Diffuse normolipemic xanthoma planum]. / Xantoma plano difuso normolipémico.

We comment on the case of a 75-year-old woman whose dermatologic process had started 15 years before with the onset of xanthelasma on the lower eyelids which were surgically removed, recurring on the scar areas two months later. At the same time new lesions involved the forehead as well as the periorbital and malar regions. Some months later new yellow papular lesions appeared involving the neck, thorax, pelvis and extremities which grew eccentrically covering large areas. Five years later the lesions localized on the face and showed a progressive tendency to atrophy in their centers while those localized on the trunk showed an evolution to sclerosis of their central area. There was no mucosal involvement or ulceration in any of the xanthomatous lesions. The microscopic study revealed the existence of a dermal infiltrate formed by histiocyte foamy frothy cells and Touton cells, among which there were some lymphocytes, which occasionally adopted a perianexial, perineural and perivascular pattern but there were no signs of thrombosis or degenerative changes in the perilesional connective tissue. The study by chromatography of the lipid composition of the pathologic skin revealed an increase in cholesterol esters. The laboratory exams as well as the general physical examination performed every six months for a period of 15 years' time were always normal except for a moderate elevation of ESR which persisted throughout the process.(ABSTRACT TRUNCATED AT 250 WORDS)

[Generalized urticaria due to food allergy (codfish)]. / Urticaria generalizada por contacto a alimentos (bacalao).

A case of generalized urticaria after ingesta of raw cod in a patient who had any previous episodes of atopy or other findings of interest is presented. One month after the manipulation of this same food she presented another episode of generalized urticaria, this time more severe and persistent. Skin patches to cod provoked a contact urticaria probably produced by an immunologic mechanism. A sensitization via the digestive tract is presumed on the basis of the clinical course and the symptoms of the patient.

[Cutaneous mycobacteriosis caused by Mycobacterium chelonei var. abscessus]. / Micobacteriosis cutánea por Mycobacterium chelonei variedad abscessus.

We are commenting on a case of cutaneous mycobacteriosis (M. chelonei) in an asthmatic 60-year-old patient under continuous steroid treatment, who months after an accidental trauma on his hand, developed painful papular lesions, located over the trauma scar, and on the dorsal lateral side of the forearm. The lesions on the forearm were accompanied by epitrochlear adenopathies and a general reaction in the form of fever. Histologically the lesions showed a subacute inflammatory reaction with lymphocytes, histiocytes, polynuclear neutrophils and areas of necrosis. The staining of the exudate with Ziehl-Neelsen and the histological samples were negative, but the culture was identified as M. chelonei, of the abscessus variety. The process was cured with continuous therapy with cefotaxime and procodazol.

[Fixed cutaneous sporotrichosis localized on the face, with an infrequently seen clinical picture]. / Esporotricosis cutánea fija de localización facial, con morfología clínica poco frecuente.

A case of fixed cutaneous sporotrichosis in an urban patient in whom the contagious trauma could not be proved is commented on. Remarkable is the location of the lesions involving the face, which is extremely rare, as well as the morphology of the lesions, adopting the pattern of congestive erythema on which there were crusty-erythematous papules causing an intense itching which also preceded their onset.

[Dermatomycosis in plaques caused by Botryomyces caespitosus. A new causative agent]. / Dermatomicosis en placa por Botryomyces caespitosus. Nuevo agente causal.

The clinical and histological features of a dermomycosis caused by a new dematiaceum fungus are described. The mycological characteristics of this fungus individualize and differentiate it from other demiataceum hyphomycetes, proposing the name of Botryomyces caespitosus for it. The submicroscopic features are commented, as well.

[Toxic epidermal necrolysis (Lyell's syndrome) caused by piroxicam, with fatal outcome from disseminated aspergillosis]. / Necrolisis epidérmica tóxica (síndrome de Lyell) por piroxican, con evolución fatal por aspergilosis diseminada.

A case of Lyell Syndrome provoked by ingestion of an antirheumatic drug (Piroxicam) is commented. The evolution under treatment with steroids and broad spectrum antibiotics was excellent but once recovered from this, the patient died subsequently to a systemic infectious process caused by an Aspergillosis with pulmonary involvement and secondary affectation of the kidneys, brain liver, and heart. The hepatic involvement during the acute stage is discussed and evaluated (increase of transaminases), amylasemia, amylasuria, anemia and thrombopenia which persisted throughout the process and presumably conditioned the evolution of the disease.