Oral Ulcer/diagnosis , Pharyngeal Diseases/diagnosis , Pyoderma Gangrenosum/diagnosis , Skin Ulcer/diagnosis , Vasculitis, Leukocytoclastic, Cutaneous/diagnosis , Adult , Biopsy , Diagnosis, Differential , Female , Humans , Oral Ulcer/pathology , Pharyngeal Diseases/pathology , Pyoderma Gangrenosum/pathology , Skin/pathology , Skin Ulcer/pathology , Vasculitis, Leukocytoclastic, Cutaneous/pathology
BACKGROUND AND OBJECTIVES: Cutaneous squamous cell carcinoma (SCC) is known for its capacity to metastasize via lymphatic vessels. In recent studies, the level of lymphangiogenesis has been reported as a potential prognostic factor for several skin tumors. The aim of this study was to quantify lymphangiogenesis in SCC using either computer-assisted image analysis or the Chalkley count technique. Vascular parameters were evaluated and compared with respect to their predictive power for tumor metastasis. PATIENT AND METHODS: In this case-control study, clinical and histological data of 15 metastatic and 15 nonmetastatic SCC patients were retrospectively analyzed. SCC samples were immunostained for the lymphatic endothelial marker D2-40 and the panvascular marker CD31, and analyzed using computer-assisted morphometric image analyses within hot spots as well as the digitalized Chalkley counting method. RESULTS: Lymphatic vessel density, relative lymphatic vessel area, and lymphatic Chalkley count were significantly elevated in metastatic SCC. Tumor thickness was significantly higher in metastatic SCC, and had the highest predictive power for metastatic disease. Tumor thickness was a significant predictor of lymphangiogenic parameters. CONCLUSIONS: Lymphangiogenesis is elevated in metastatic SCC but its extent is influenced by tumor thickness. Tumor thickness remains the most reliable predictive factor for metastatic disease.
Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/secondary , Densitometry/methods , Lymphangiogenesis , Lymphatic Metastasis/pathology , Lymphatic Vessels/pathology , Skin Neoplasms/pathology , Adult , Aged , Aged, 80 and over , Densitometry/statistics & numerical data , Female , Humans , Male , Middle Aged , Organ Size , Prognosis , Reproducibility of Results , Risk Factors , Sensitivity and Specificity
HINTERGRUND UND ZIELE: Kutane Plattenepithelkarzinome (SCC) sind bekannt für ihre Fähigkeit, über Lymphgefäße zu metastasieren. In neueren Studien wird das Ausmaß der Lymphangiogenese als möglicher prognostischer Faktor bei einigen Hauttumoren genannt. Ziel dieser Studie war die Quantifizierung der Lymphangiogenese bei SCC entweder durch computergestützte Bildanalyse oder mithilfe der Zählmethode nach Chalkley. Gefäßparameter wurden im Hinblick auf ihre Vorhersagekraft für die Bildung von Tumormetastasen beurteilt und verglichen. PATIENTEN UND METHODEN: In dieser Fallkontrollstudie wurden die klinischen und histologischen Daten von jeweils 15 SCC-Patienten mit bzw. ohne Metastasen retrospektiv analysiert. In den SCC-Proben wurde der für das Lymphendothel spezifische Marker D2-40 und der pan-vaskuläre Marker CD31 immunhistochemisch angefärbt und durch computergestützte morphometrische Bildanalyse in Hotspots sowie mithilfe der digitalisierten Zählmethode nach Chalkley analysiert. ERGEBNISSE: Die Dichte von Lymphgefäßen, die relative Lymphgefäßfläche und die mit der Chalkley-Methode ermittelte Zahl an Lymphgefäßen (Chalkley-Count) waren bei metastasierten SCC signifikant erhöht. Die Tumordicke war bei metastasierten SCC signifikant höher und besaß die höchste Vorhersagekraft für eine Metastasierung. Die Tumordicke war ein signifikanter Prädiktor für Lymphangiogeneseparameter. SCHLUSSFOLGERUNGEN: Die Lymphangiogenese ist bei metastasierten SCC erhöht, doch ihr Ausmaß wird von der Tumordicke beeinflusst. Die Tumordicke bildet weiterhin den zuverlässigsten prädiktiven Faktor für die Metastasierung.
Serum markers can be important tools for prognostic classification and treatment monitoring in cancer patients. The MAP-kinase pathway, which is upregulated in the majority of melanoma patients, can be activated by hepatocyte-growth factor (HGF) through the proto-oncogene c-MET. The aim of this study was to evaluate the predictive and prognostic value of circulating HGF in terms of treatment outcome and survival compared with a widely established serum marker, protein S-100B, in patients with advanced metastatic melanoma. HGF and S-100B were measured in serum samples of 101 patients with metastatic melanoma (American Joint Committee on Cancer stage IV) before and after treatment and 50 patients with stage I/II melanoma. HGF and S-100B correlated significantly with the stage of disease (P=0.032 and P<0.001, respectively). In stage IV melanoma patients, baseline serum levels of HGF and S-100B were significantly associated with treatment response (P=0.012 and 0.006, respectively). Furthermore, the Cox regression analysis confirmed that serum levels of HGF and S-100B proved to have a significant prognostic impact on progression-free survival (hazard ratio=1.39 and 1.29, respectively) and overall survival (hazard ratio=1.27 and 1.29, respectively) in advanced metastatic melanoma patients. In melanoma patients, serum levels of HGF and S-100B correlate significantly with the stage of disease. In stage IV melanoma, both markers are prognostic factors and correlate significantly with progression-free survival and overall survival. Measurement of serum HGF levels might be a useful additional tool in the management of melanoma patients.
Biomarkers, Tumor/blood , Hepatocyte Growth Factor/blood , Melanoma/blood , Skin Neoplasms/blood , Adult , Aged , Aged, 80 and over , Disease-Free Survival , Female , Humans , Male , Melanoma/pathology , Middle Aged , Prognosis , Proto-Oncogene Mas , Skin Neoplasms/diagnosis , Skin Neoplasms/pathology , Young Adult
Bone Diseases, Metabolic/diagnosis , Bone Diseases, Metabolic/surgery , Dermatologic Surgical Procedures/methods , Ossification, Heterotopic/diagnosis , Ossification, Heterotopic/surgery , Scalp Dermatoses/diagnosis , Scalp Dermatoses/pathology , Scalp Dermatoses/surgery , Skin Diseases, Genetic/diagnosis , Skin Diseases, Genetic/surgery , Aged , Diagnosis, Differential , Humans , Male , Treatment Outcome
A 40-year old prima para presented with multiple urticaria-like plaques and severe pruritus 2 weeks prior to giving birth by cesarean section. Three days after birth, the disease flared up and tense blisters appeared on hands, lower arms and feet. Based on the clinical presentation, direct immunofluorescence microscopy, complement binding test and detection of high levels of circulating anti-BP180 antibodies, the diagnosis of pemphigoid gestationis was established. Despite treatment with class IV topical corticosteroid and prednisolone p.o. up to 60 mg/day, both skin lesions and severe pruritus progressed accompanied by increasing anti-BP180 antibody serum levels. In order to continue breast feeding, the prednisolone dose could not be further increased and 10 immunoadsorptions over 4 weeks were performed. During this period, skin lesions cleared rapidly, pruritus subsided and BP180-specific serum autoantibodies decreased by 99.5% allowing the reduction of prednisolone to 7.5 mg/day. We conclude that immunoadsorption is an effective and safe adjuvant therapeutic option for severe pemphigoid gestationis.
Drug Resistance , Immunosorbent Techniques , Pemphigoid Gestationis/therapy , Adult , Autoantibodies/blood , Autoantigens/immunology , Female , Glucocorticoids/therapeutic use , HLA Antigens/immunology , Humans , Non-Fibrillar Collagens/immunology , Pemphigoid Gestationis/diagnosis , Pemphigoid Gestationis/drug therapy , Pemphigoid Gestationis/immunology , Prednisolone/therapeutic use , Pregnancy , Treatment Outcome , Collagen Type XVII
Photosensitivity is an important and distinguishing sign in various subtypes of cutaneous lupus erythematosus (CLE); however, it remains poorly defined. The purpose of this study was to evaluate whether standardized photoprovocation is a reproducible method to assess photosensitivity in subjects with CLE. A total of 47 subjects with CLE (subacute cutaneous lupus erythematosus (SCLE), n=14; discoid lupus erythematosus (DLE), n=20; lupus erythematosus tumidus (LET), n=13) and 13 healthy volunteers underwent photoprovocation at seven European sites. Of these, 22 (47%) subjects (57% SCLE, 35% DLE, and 54% LET) and none of the healthy volunteers developed photoprovoked lesions according to clinical analysis. Of these 22 subjects, 19 (86%) developed lesions that were histopathologically confirmed as specific for lupus erythematosus (LE). In CLE subjects who developed UV-induced lesions, 86% had Fitzpatrick's phototypes I or II, and the mean minimal erythema dose (MED) was significantly lower compared with subjects without UV-induced lesions (P=0.004). No significant differences in photoprovocation results were observed between study sites. Safety parameters showed no clinically meaningful differences between CLE subjects and healthy volunteers after photoprovocation. In conclusion, a standardized, safe, and reproducible protocol for photoprovocation using UVA and UVB radiation induced skin lesions in approximately half of all CLE subjects and showed comparable results across multiple sites. This method may therefore be used for future diagnostic testing and clinical trials.
Diagnostic Techniques and Procedures/standards , Lupus Erythematosus, Cutaneous/diagnosis , Lupus Erythematosus, Discoid/diagnosis , Photosensitivity Disorders/diagnosis , Ultraviolet Rays , Adolescent , Adult , Aged , Antimalarials/therapeutic use , Diagnostic Techniques and Procedures/adverse effects , Dose-Response Relationship, Radiation , Female , Humans , Male , Middle Aged , Reproducibility of Results , Smoking , Young Adult
