Podoplanin is a highly sensitive and specific marker to distinguish primary skin adnexal carcinomas from adenocarcinomas metastatic to skin.

Distinction of primary skin adnexal carcinomas from cutaneous metastasis of adenocarcinomas is challenging. In this study, we evaluated podoplanin immunoreactivity in a series of primary skin adnexal tumors and adenocarcinomas metastatic to skin using a D2-40 antibody. The initial test series were composed of a total of 93 cases including 32 primary skin adnexal carcinomas, 46 benign primary adnexal tumors, and 15 cutaneous metastatic adenocarcinomas. We found that variable D2-40 reactivity was seen in all of the primary cutaneous carcinomas including sebaceous carcinomas (10/10), squamous cell carcinomas (10/10), porocarcinomas (4/4), trichilemmal carcinomas (4/4), skin adnexal carcinomas not otherwise specified (4/4), and in the majority of benign skin adnexal tumors. In contrast, no podoplanin immunoreactivity was seen in any of the 15 (0/15) cutaneous metastases. To confirm the initial findings and to further explore the utility of podoplanin reactivity in the distinction of these tumors, we also examined a test set of 35 unknown cases, including 21 adenocarcinomas metastatic to skin and 14 primary adnexal tumors, in a blinded fashion. In this test set of cases, podoplanin was negative in 22 cases and positive in 13 cases. Of the 22 podoplanin negative cases, 20 were proven to be metastatic adenocarcinoma. Of the 13 D2-40 positive cases, 12 were proven to be primary adnexal tumors. Our results suggest that podoplanin can be a useful tool to distinguish primary skin adnexal carcinomas form adenocarcinomas metastatic to skin with high sensitivity (94.5%) and specificity (97.2%).

Clinicopathologic correlation of cutaneous metastases: experience from a cancer center.

OBJECTIVE: To analyze the clinical, histopathologic, and immunohistochemical characteristics of skin metastases. DESIGN: Retrospective analysis (January 1, 1990, to December 31, 2005). SETTING: Comprehensive cancer center. PATIENTS: Fifty-one patients (21 men and 30 women) with biopsy-proven skin metastases and correlative clinical data. INTERVENTIONS: Four dermatopathologists reviewed a random mixture of metastases and primary skin tumors. Immunohistochemical studies for 12 markers were performed on the metastases, with skin adnexal tumors as controls. MAIN OUTCOME MEASURES: Clinical characteristics of cutaneous lesions, clinical outcomes, histologic features, and immunohistochemical markers. RESULTS: Eighty-six percent (43 of 50) of the patients had known stage IV cancer, and skin metastasis was the presenting sign in 12% (6 of 50). In 45% (21 of 47) of the biopsies, the lesions were not suspected of being metastases owing to unusual clinical presentations. Seventy-six percent of the patients died of disease (median survival, 5 months). On pathologic review, many metastases from adenocarcinomas were either recognized or suspected, but the primary site was not easily identified based on histologic findings alone. Metastases from small cell carcinomas and sarcomas were histologically misinterpreted as primary skin tumors. Immunohistochemical analysis using a panel including p63, B72.3, calretinin, and CK5/6 differentiated metastatic carcinoma from primary skin adnexal tumors. CONCLUSIONS: Cutaneous metastases can have variable clinical appearances and can mimic benign skin lesions. They are usually seen in patients with advanced disease, but they can be the presenting lesion. Although many metastatic adenocarcinomas can be recognized based on histologic findings alone, immunohistochemical analysis is an important diagnostic adjunct in some cases.

An electrocution by metal kite line.

A case is reported in which death is caused due to electrocution by a copper wire that was used as string of the kite. Electric current flowed through the copper wire of cut down kite when it touched power line transmitting alternate current of 240 V at 50 Hz. The free end of copper wire had abraded against the victim's shoulder, neck and face, and finally entangled around the ear. A unique type of electrical injury is noticed due to contact with live copper wire. This paper stresses the unique danger of the kite flying.

Diagnostic role of fine-needle aspiration of pancreatic allograft to detect rejection.

The purpose of this study was to assess whether the same principles to evaluate renal transplant by fine-needle aspiration (FNA) for rejection could be applied to pancreatic allograft. Between 1996-1998, 25 ultrasound-guided FNAs on 13 patients with pancreatic allograft were performed and ThinPrep made. The percentage of lymphocytes, lymphoblasts, monocytes, eosinophils, plasma cells, immunoblasts, and macrophages were calculated. Simultaneous peripheral smear was obtained and "total corrected increment" score calculated. Subsequent core biopsy was available in six patients. A total of seven FNAs on three patients were inadequate because of insufficient epithelial cells. No evidence of rejection reported in nine patients was confirmed on biopsy in five patients. One patient reported as suspicious later showed rejection on biopsy. Thus, FNA may be used to monitor the graft status with faster turnaround times. Rejection may be a focal process and FNA may be used for sampling multiple sites. Cytologic diagnosis fairly accurately detects early rejection. Core biopsies are warranted in unsatisfactory specimens and when FNA is suspicious for rejection.

Application of adjunct techniques in cytologic material in the diagnosis of rhabdomyosarcoma: case report and review of the literature.

A 4(1/2)-yr-old female presented with right-sided pleural effusion and a retroperitoneal mass. Cytologic analysis of the pleural fluid yielded malignant small round blue cells, which were noncohesive, 3-4 times the size of lymphocytes. The malignant cells had hyperchromatic, pleomorphic nuclei with moderate amounts of vacuolated cytoplasm. A few fiber-shaped cells were also seen. Immunostains for desmin, muscle-specific actin were positive; ultrastructural findings of thick and thin actin-myosin filaments confirmed the diagnosis of embryonal rhabdomyosarcoma. This case illustrates the importance of performing appropriate immunohistochemical stains and ultrastructural studies on cytological material to arrive at a definitive diagnosis.

Diagnostic role of fine-needle aspiration of bone lesions in patients with a previous history of malignancy.

At the present time fine-needle aspiration (FNA) is considered a routine diagnostic procedure in evaluating neoplastic vs. nonneoplastic lesions in many organs, with high sensitivity and specificity. The purpose of this study was to assess the utility of FNA in areas of diagnostic difficulty and its limitations in evaluating bone lesions in patients with a previous history of malignancy. From 1989 to 2000, 249 CT-guided FNAs of bone lesion were performed at our institutions; 187/249 (75.1%) patients had a previous history of malignancy. Aspirated material was air-dried for Diff-Quik stain or fixed in ethanol for Papanicolaou staining. Subsequent surgical tissue was available in 69/187 (36.9%) of the cases. There were 114 males and 73 females, ages 14-86 yr (mean, 64 yr). The primary tumor site was lung 49, genitourinary 46, breast 31, gastrointestinal 28, hematopoietic 26, soft tissue/skin 5, and thyroid 2. There were 125 FNAs of the vertebral spine, 19 from the pelvis, 11 from the ribs, 9 from the sternum, 5 from the femur, and 18 from miscellaneous bone sites. Out of 187, 166 (88.7%) were malignant aspirates confirming the patients' primary malignancies. The most common malignancy encountered was adenocarcinoma, 126/187 (67.4%). Surgical tissue was available for review in 69 patients and the results were in agreement with the FNAs diagnosis in all cases. Nine out of 187 (4.8%) cases were diagnosed as marrow elements on cytological material. These patients have been followed for 1-9 yr and have failed to reveal signs or symptoms of clinical recurrence. Three out of 187 (1.6%) cases showed osteomyelitis. Nine out of 187 (4.8%) were unsatisfactory specimens, with biopsy follow-up available in four cases, showing three metastatic tumors and one case of osteomyelitis. FNA of metastatic bone lesions is a major step in pretreatment diagnosis. On satisfactory specimens, the cytological diagnosis viewed in the clinical-radiological context proves to be similar to surgical diagnosis. FNA is an excellent technique with a high accuracy rate in assessing metastatic bone lesions.

Damage due to lightning when it strikes the face.

A case of death due to lightning is discussed in reference to autopsy findings that revealed damage to the tongue, pharynx, larynx, sclera and oesophagus for the first time. The damage described in the present paper must be considered when there is direct lightning strike on the face.

An injury subjacent to lac ornament in a case of lightning.

This is a report of a case in which, for the first time, direct lightning strike had caused burn injuries associated with internal soft-tissue bruising and visceral injury subjacent to lac jewellery on the chest. The burn injury depicted a symmetrical pattern, which was almost 5 times larger than the size of the jewellery. Surprisingly, there was bruising of soft tissue beneath the burn, associated with extravasation of blood in anterior mediastinum, contusion of anterior border of lungs, contusion to heart and rent by burn to the blouse of the victim over the front and back, all in one line, showing very unusual injury of lightning strike.

"Manja" - a dangerous thread.

Every year many innocent lives are claimed and many more suffer severe life threatening injuries in India, Pakistan and Bangladesh due to accidental injuries glass-coated kite-lines (manja) that are sharp, cutting effect. The present article discusses the mechanism, pathology, and medico-legal aspects and how to prevent manja-related injuries.

Burns caused by fan heater used for managing post-operative hypothermia in a premature neonate.

Generally fan forced area heaters are considered to be incapable of causing burn injury. A case is presented where such a heater was used to prevent post-operative hypothermia after cut-back anoplasty to correct low anorectal malformation (imperforate anus) in a premature neonate. The neonate sustained dermo-epidermal (second degree) burns to the abdominal wall and right forearm which were swaddled with cloth and deep (third degree) burns to the fingers of left hand that were exposed as intravenous line was inserted at dorsum of the hand.