Clinical Features and Treatment of Dermatofibrosarcoma Protuberans Affecting the Vulva: A Literature Review.

BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is a low-to-intermediate grade cutaneous neoplasm with a low propensity for metastasis and a high rate of local recurrence. It typically presents as a dermal plaque or nodule on the trunk, limbs, or head and neck region. Vulvar DFSP has also been described, although it is less common. OBJECTIVE: To review the available literature and discuss the clinical course of DFSP affecting the vulva. MATERIALS AND METHODS: We reviewed the existing English-language literature on DFSP of the vulva with respect to clinical presentation, diagnosis, treatment, and outcome. RESULTS: Thirty three case reports and series were included (n = 54 patients). Vulvar DFSP most commonly presents as a slowly enlarging tender or asymptomatic mass on the labia majora, with histological findings of classic DFSP. Most patients were treated with wide local excision. Three patients were treated with Mohs micrographic surgery, which may decrease local recurrence and seems well suited for use in vulvar DFSP. CONCLUSION: This literature review comprehensively reviews and describes the clinical presentation of vulvar DFSP and the treatment options for this rare vulvar neoplasm.

Phytoextraction by arsenic hyperaccumulator Pteris vittata L. from six arsenic-contaminated soils: Repeated harvests and arsenic redistribution.

This greenhouse experiment evaluated arsenic removal by Pteris vittata and its effects on arsenic redistribution in soils. P. vittata grew in six arsenic-contaminated soils and its fronds were harvested and analyzed for arsenic in October, 2003, April, 2004, and October, 2004. The soil arsenic was separated into five fractions via sequential extraction. The ferns grew well and took up arsenic from all soils. Fern biomass ranged from 24.8 to 33.5 g plant(-1) after 4 months of growth but was reduced in the subsequent harvests. The frond arsenic concentrations ranged from 66 to 6,151 mg kg(-1), 110 to 3,056 mg kg(-1), and 162 to 2,139 mg kg(-1) from the first, second and third harvest, respectively. P. vittata reduced soil arsenic by 6.4-13% after three harvests. Arsenic in the soils was primarily associated with amorphous hydrous oxides (40-59%), which contributed the most to arsenic taken up by P. vittata (45-72%). It is possible to use P. vittata to remediate arsenic-contaminated soils by repeatedly harvesting its fronds.

Timing of phosphate application affects arsenic phytoextraction by Pteris vittata L. of different ages.

The effects of timing in phosphate application on plant growth and arsenic removal by arsenic hyperaccumulator Pteris vittata L. of different ages were evaluated. The hydroponic experiment consisted of three plant ages (A45d, A90d and A180d) and three P feeding regimens (P200+0, P134+66 and P66+134) growing for 45 d in 0.2-strength Hoagland-Arnon solution containing 145 microg L(-1) As. While all plants received 200 microM P, P was added in two phases: during acclimation and after arsenic exposure. High initial P-supply (P200+0) favored frond biomass production and plant P uptake, while split-P application (P134+66 and P66+134) favored plant root production. Single P addition favored arsenic accumulation in the roots while split-P addition increased frond arsenic accumulation. Young ferns (A45d) in treatment P134+66 were the most efficient in arsenic removal, reducing arsenic concentration to below 10 microg L(-1) in 35 d. The results indicated that the use of young ferns, coupled with feeding of low initial P or split-P application, increased the efficiency of arsenic removal by P. vittata.

Clinical features of shiitake dermatitis: a systematic review.

Shiitake dermatitis is a rare cutaneous reaction to lentinan, a polysaccharide component in the cell walls of shiitake mushrooms (Lentinula edodes). Herein, we systematically review the case report and case series English-language literature on shiitake dermatitis, which refers to a total of 50 patients (38 males, 12 females; mean age: 44.58 years). The majority of cases occurred after the consumption of raw mushrooms, whereas 22% of cases were caused by the eating of lightly or undercooked mushrooms. The most common clinical presentations, localized symptoms, and systemic findings include linear flagellated dermatitis (98%), pruritus (78%), and fever, diarrhea, and mucosal ulcers, respectively. The diagnosis of this entity continues to be based on clinical findings as laboratory abnormalities, and the findings of skin biopsies and patch/prick tests are nonspecific and inconsistent. The condition is self-limiting, resolving in approximately 12.5 d without treatment. Based on the included case reports, it appears that medical treatment may slightly shorten the course of disease (to 9-11 d, varying by therapy) but should be considered on an individual patient basis. However, the treatment of symptoms, reassurance, and the avoidance of re-exposure are sufficient treatment recommendations for this condition.

Arsenic chemistry in the rhizosphere of Pteris vittata L. and Nephrolepis exaltata L.

This greenhouse experiment evaluated the influence of arsenic uptake by arsenic hyperaccumulator Pteris vittata L. and non-arsenic hyperaccumulator Nephrolepis exaltata L. on arsenic chemistry in bulk and rhizosphere soil. The plants were grown for 8 weeks in a rhizopot with a soil containing 105 mg kg(-1) arsenic. The soil arsenic was fractionated into five fractions with decreasing availability: non-specifically bound (N), specifically bound (S), amorphous hydrous-oxide bound (A), crystalline hydrous-oxide bound (C), and residual (R). P. vittata produced larger plant biomass (7.38 vs. 2.32 mg plant(-1)) and removed more arsenic (2.61 vs. 0.09 mg pot(-1) arsenic) than N. exaltata. Plant growth reduced water-soluble arsenic, and increased soil pH (P. vittata only) in the rhizosphere soil. P. vittata was more efficient than N. exaltata to access arsenic from all fractions (39-64% vs. 5-39% reduction). However, most of the arsenic taken up by both plants was from the A fraction (67-77%) in the rhizosphere soil, the most abundant (61.5%) instead of the most available (N fraction).

Optimum P levels for arsenic removal from contaminated groundwater by Pteris vittata L. of different ages.

Optimization of arsenic uptake by Pteris vittata may reduce the remediation time and cost of arsenic-contaminated groundwater. This greenhouse experiment evaluated the effects of five doses of P (0, 150, 300, 450 and 600 microM P) and two fern ages (45 and 90 d old) on the effectiveness of arsenic removal using 18 L of contaminated groundwater per plant. Arsenic-depletion was monitored weekly over a period of 74 d. It took 38 d for 45-d ferns in the no P treatment to deplete the arsenic to the target concentration of 10 microg L(-1) from 126 microg L(-1). During the 74-d study, the best treatment for 90-d ferns was at 150 microM of P, reducing the arsenic concentration to 12 microg L(-1). Because arsenic uptake and removal is inversely related to the P-status, P-free Hoagland solution would maximize arsenic uptake in a short term. However, on a long-term basis, ministering the 0.2-strength Hoagland solution at 150 microM P may be an effective approach for maximizing plant biomass production and arsenic removal.