A Rare Cutaneous Manifestation: Leukocytoclastic Vasculitis after Pfizer-BioNTech COVID-19 Vaccination.

There is growing evidence that vaccines against SARS-CoV-2 can cause various skin reactions, many of which have autoimmune origins. These specific vaccine-induced autoimmune conditions with cutaneous manifestations include lupus erythematosus, bullous pemphigoid, vitiligo, alopecia areata, and leukocytoclastic vasculitis (LCV). In particular, LCV, which is also called hypersensitivity vasculitis, is an inflammation of small blood vessels. We present a case of an 81-year-old male evaluated in the emergency department for a bilateral purpuric non-blanching rash that appeared ten days after receiving the Pfizer-BioNTech booster vaccine against SARS-CoV-2. Results of a skin biopsy indicated LCV, and the rash completely resolved three weeks after clinical presentation.

Peculiar vegetative tumor-like genital herpes simplex nodules with brisk tissue eosinophilia in patients with human immunodeficiency virus infection.

Genital herpes simplex virus (HSV) infection in a human immunodeficiency virus (HIV) patient can present as a vegetative nodule. Clinical differential diagnoses of the nodule include condyloma latum, condyloma acuminatum, viral or fungal infection, and cutaneous neoplasms. Histological examination of herpetic nodules has been reported to show thick pseudoepitheliomatous hyperplasia with dense dermal lymphoplasmacytic infiltrate and multifocal multinucleated cells with herpetic viral cytopathic changes. We report two patients with HIV presenting with vegetative tumor-like HSV nodules with distinctive histopathologic pattern of inflammation that has not been described in the literature before. All samples displayed slightly acanthotic epidermis with focal ulceration, dense dermal sclerosis, scattered plasma cells, and a brisk lymphoeosinophilic infiltrate found dissecting between dense collagen bundles. This pattern of inflammation is an important clue that can guide the pathologist to look for focal herpetic viral changes in the epidermis, as patients with HIV possibly tend to amount a predominantly eosinophilic immune response in inflammatory skin conditions.

A dynamic monitoring approach for the surface morphology evolution measurement of plasma facing components by means of speckle interferometry.

Plasma Facing Components (PFCs) in a magnetically confined fusion plasma device will be exposed to high heat load and particle fluxes, and it would cause PFCs' surface morphology to change due to material erosion and redeposition from plasma wall interactions. The state of PFCs' surface condition will seriously affect the performance of long-pulse or steady state plasma discharge in a tokamak; it will even constitute an enormous threat to the operation and the safety of fusion plasma devices. The PFCs' surface morphology evolution measurement could provide important information about PFCs' real-time status or damage situation and it would help to a better understanding of the plasma wall interaction process and mechanism. Meanwhile through monitoring the distribution of dust deposition in a tokamak and providing an upper limit on the amount of loose dust, the PFCs' surface morphology measurement could indirectly contribute to keep fusion operational limits and fusion device safety. Aiming at in situ dynamic monitoring PFCs' surface morphology evolution, a laboratory experimental platform DUT-SIEP (Dalian University of Technology-speckle interferometry experimental platform) based on the speckle interferometry technique has been constructed at Dalian University of Technology (DUT) in China. With directional specific designing and focusing on the real detection condition of EAST (Experimental Advanced Superconducting Tokamak), the DUT-SIEP could realize a variable measurement range, widely increased from 0.1 µm to 300 µm, with high spatial resolution (<1 mm) and ultra-high time resolution (<2 s for EAST measuring conditions). Three main components of the DUT-SIEP are all integrated and synchronized by a time schedule control and data acquisition terminal and coupled with a three-dimensional phase unwrapping algorithm, the surface morphology information of target samples can be obtained and reconstructed in real-time. A local surface morphology of the real divertor tiles adopted from EAST has been measured, and the feasibility and reliability of this new experimental platform have been demonstrated.

Increased expression of enhancer of Zeste Homolog 2 (EZH2) differentiates squamous cell carcinoma from normal skin and actinic keratosis.

BACKGROUND: Enhancer of Zeste Homolog 2 (EZH2) is a polycomb group protein that has been shown to be involved in the progression of multiple human cancers including melanoma. The expression of EZH2 in normal skin and in pre-malignant and malignant cutaneous squamous cell carcinoma (SCC) has not been studied. OBJECTIVES: We examined the expression of EZH2 in normal skin, actinic keratosis (AK), SCC in situ, well-differentiated (SCC-WD), moderately-differentiated (SCC-MD) and poorly-differentiated SCC (SCC-PD) to ascertain whether EZH2 expression differentiates these conditions. MATERIALS AND METHODS: Immunohistochemical staining for EZH2 was performed on formalin-fixed paraffin-embedded biopsies and a tissue microarray containing normal skin, AK, SCC in situ, and SCC of different grades. RESULTS: In comparison to the normal skin, EZH2 expression in actinic keratosis was increased (p=0.03). Similarly, EZH2 expression in all of the neoplastic conditions studied (SCC in situ, SCC-WD, SCC-MD and SCC-PD) was greatly increased in comparison to both the normal skin and actinic keratosis (p≤0.001). CONCLUSION: EZH2 expression increases incrementally from normal skin to AK and further to SCC, suggesting a role for EZH2 in the progression and differentiation of SCC. EZH2 expression may be used as a diagnostic marker for differentiating SCC from AK or normal skin.

The spectrin-based membrane skeleton stabilizes mouse megakaryocyte membrane systems and is essential for proplatelet and platelet formation.

Megakaryocytes generate platelets by remodeling their cytoplasm first into proplatelets and then into preplatelets, which undergo fission to generate platelets. Although the functions of microtubules and actin during platelet biogenesis have been defined, the role of the spectrin cytoskeleton is unknown. We investigated the function of the spectrin-based membrane skeleton in proplatelet and platelet production in murine megakaryocytes. Electron microscopy revealed that, like circulating platelets, proplatelets have a dense membrane skeleton, the main fibrous component of which is spectrin. Unlike other cells, megakaryocytes and their progeny express both erythroid and nonerythroid spectrins. Assembly of spectrin into tetramers is required for invaginated membrane system maturation and proplatelet extension, because expression of a spectrin tetramer-disrupting construct in megakaryocytes inhibits both processes. Incorporation of this spectrin-disrupting fragment into a novel permeabilized proplatelet system rapidly destabilizes proplatelets, causing blebbing and swelling. Spectrin tetramers also stabilize the "barbell shapes" of the penultimate stage in platelet production, because addition of the tetramer-disrupting construct converts these barbell shapes to spheres, demonstrating that membrane skeletal continuity maintains the elongated, pre-fission shape. The results of this study provide evidence for a role for spectrin in different steps of megakaryocyte development through its participation in the formation of invaginated membranes and in the maintenance of proplatelet structure.

Rate of renal cell carcinoma subtypes in different races.

PURPOSE: We sought to identify racial differences among histological subtypes of renal cell carcinoma (RCC) between black and non-black patients in an equal-access health care system. MATERIALS AND METHODS: We established a multi-institutional, prospective database of patients undergoing partial or radical nephrectomy between January 1, 2000 and Sept 31, 2009. For the purposes of this study, data captured included age at diagnosis, race, tumor size, presence of lymphovascular invasion, presence of capsular invasion, margin status, and tumor histology. RESULTS: 204 kidney tumors were identified (Table-1). Of these, 117 (57.4%) were in black patients and 87 (42.6%) were in non-black patients. Age at surgery ranged from 37 to 87 with a median of 62. Tumor size ranged from 1.0 to 22.0 cm with a median of 5.0 cm. Overall, tumors were composed of clear cell RCC in 97 cases (47.5%), papillary RCC in 65 cases (31.9%), chromophobe RCC in 13 cases (6.4%), collecting duct/medullary RCC in 2 cases (1.0%), RCC with multiple histological subtypes in 8 cases (3.9%), malignant tumors of other origin in 6 cases (2.9%), and benign histology in 13 cases (6.4%). Among black patients, papillary RCC was seen in 56 cases (47.9%), compared to 9 cases (10.3%) among non-black patients (p < 0.001) (Table-2). Clear cell RCC was present in 38 (32.5%) of black patients and in 59 (67.8%) of non-blacks (p < 0.001). CONCLUSIONS: In our study, papillary RCC had a much higher occurrence among black patients compared to non-black patients. This is the first study to document such a great racial disparity among RCC subtypes.

Rate of renal cell carcinoma subtypes in different races

PURPOSE: We sought to identify racial differences among histological subtypes of renal cell carcinoma (RCC) between black and non-black patients in an equal-access health care system. MATERIALS AND METHODS: We established a multi-institutional, prospective database of patients undergoing partial or radical nephrectomy between January 1, 2000 and Sept 31, 2009. For the purposes of this study, data captured included age at diagnosis, race, tumor size, presence of lymphovascular invasion, presence of capsular invasion, margin status, and tumor histology. RESULTS: 204 kidney tumors were identified (Table-1). Of these, 117 (57.4 percent) were in black patients and 87 (42.6 percent) were in non-black patients. Age at surgery ranged from 37 to 87 with a median of 62. Tumor size ranged from 1.0 to 22.0 cm with a median of 5.0 cm. Overall, tumors were composed of clear cell RCC in 97 cases (47.5 percent), papillary RCC in 65 cases (31.9 percent), chromophobe RCC in 13 cases (6.4 percent), collecting duct/medullary RCC in 2 cases (1.0 percent), RCC with multiple histological subtypes in 8 cases (3.9 percent), malignant tumors of other origin in 6 cases (2.9 percent), and benign histology in 13 cases (6.4 percent). Among black patients, papillary RCC was seen in 56 cases (47.9 percent), compared to 9 cases (10.3 percent) among non-black patients (p < 0.001) (Table-2). Clear cell RCC was present in 38 (32.5 percent) of black patients and in 59 (67.8 percent) of non-blacks (p < 0.001). CONCLUSIONS: In our study, papillary RCC had a much higher occurrence among black patients compared to non-black patients. This is the first study to document such a great racial disparity among RCC subtypes.

Carcinosarcoma of the oesophagus - a rare mixed type of tumor.

Oesophageal carcinosarcoma is a rare type of oesophageal cancer composed of both squamous cells and sarcomatous cells. We report a case of a 71 year old man presenting with dysphagia and weight loss. Oesophagogastroduodenoscopy revealed a bulky mass with a preliminary diagnosis of only oesophageal carcinoma, and the oesophageal mass was resected with a transhiatal oesophagectomy. On surgical pathology, it was discovered that the tumor had both squamous cell and sarcomatous cell components, and the final diagnosis was changed to oesophageal carcinosarcoma. We discuss the presentation, differential diagnosis, treatment, and prognosis of this unique entity.

Castleman's disease in the head of the pancreas: report of a rare clinical entity and current perspective on diagnosis, treatment, and outcome.

BACKGROUND: Castleman's disease of the pancreas is a very rare condition that may resemble more common disease entities as well as pancreatic cancer. CASE PRESENTATION: Here we report the case of a 58-year-old African American male with an incidentally discovered lesion in the head of the pancreas. The specimen from his pancreaticoduodectomy contained a protuberant, encapsulated mass, exhibiting microscopic features most consistent with localized/unicentric Castleman's disease. These included florid follicular hyperplasia with mantle/marginal zone hyperplasia along with focal progressive transformation of germinal centers admixed with involuted germinal centers. CONCLUSION: To date, eight cases of Castleman's disease associated with the pancreas have been described in the world literature. We report the first case of unicentric disease situated within the head of the pancreas. In addition, we discuss the diagnostic dilemma Castleman's disease may present to the pancreatic surgeon and review current data on pathogenesis, treatment, and outcome.