Clinicopathological features, MCPyV status and outcomes of Merkel cell carcinoma in solid-organ transplant recipients: a retrospective, multicentre cohort study.

BACKGROUND: The proportion of Merkel cell carcinomas (MCCs) in solid-organ transplant recipients (SOTR) harbouring Merkel cell polyomavirus (MCPyV) is unknown, as are factors affecting their outcomes. OBJECTIVE: To describe clinicopathological features of MCC in SOTR, investigate the tumoral MCPyV-status and identify factors associated with tumour outcomes. METHODS: Retrospective, international, cohort-study. MCPyV-status was investigated by immunohistochemistry and polymerase chain reaction. RESULTS: A total of 30 SOTR and 44 consecutive immunocompetent patients with MCC were enrolled. SOTR were younger at diagnosis (69 vs. 78 years, P < 0.001). Thirty-three percent of SOTR MCCs were MCPyV-positive vs. 91% of immunocompetent MCCs (P = 0.001). Solid-organ transplantation was associated with an increased cumulative incidence of progression (SHR: 3.35 [1.57-7.14], P = 0.002), MCC-specific mortality (SHR: 2.55 [1.07-6.06], P = 0.034) and overall mortality (HR: 3.26 [1.54-6.9], P = 0.002). MCPyV-positivity and switching to an mTOR inhibitor (mTORi) after MCC diagnosis were associated with an increased incidence of progression (SHR: 4.3 [1.5-13], P = 0.008 and SHR: 3.6 [1.1-12], P = 0.032 respectively) in SOTR. LIMITATIONS: Retrospective design and heterogeneity of SOTR cohort. CONCLUSIONS: MCPyV appears to play a less prominent role in the aetiopathogenesis of MCC in SOTR. SOTR have a worse prognosis than their immunocompetent counterparts and switching to an mTORi after the diagnosis of MCC does not improve progression.

The spectrum of benign dermal dendritic melanocytic proliferations.

Dermal melanocytoses (DMs) comprise a heterogeneous group of benign lesions, located on skin and mucous membranes, characterized by dendritic melanocytes in the dermis. Although they share common histopathological features, some variants may present only as bluish or grey patches, some only as papules/nodules/plaques and others may show combination of all of these lesions. Despite the fact that blue naevus (BN) is typically characterized with papulonodular lesions, its variants may show all of the aforementioned presentations. Mongolian spot, naevus of Ota and naevus of Ito are patchy DMs distinguished by their specific localizations. Apart from these classical forms, many atypical variants without unique clinicopathological characteristics have been described in the literature making the nomenclature of DMs more complicated. However, congenital dermal melanocytosis and acquired dermal melanocytosis seem to be crucial umbrella terms that encompass all patchy DMs in atypical locations. Papules or subcutaneous nodules on patchy lesions and association of epidermal pigmentation presenting as brownish patches may be encountered as rare features of DMs. On the other hand, delayed-onset subcutaneous nodules may be typical presentations of melanoma in patchy DMs; therefore, they deserve special attention. Large plaque-type BN with subcutaneous cellular nodules is a newly described entity, harbouring clinical features of various DMs together and has a high risk of melanoma. The whole spectrum of dermal dendritic melanocytic proliferations is discussed including novelties and controversial issues.

Cutaneous atypical papular CD8+ lymphoproliferative disorder at acral sites in a renal transplant patient.

A 20-year-old woman presented with a 2-month history of an acute symmetrical eruption, manifesting as asymptomatic ill-defined erythematous macules and hyperkeratotic papules on the palms. The patient was a renal transplant recipient, and the lesions had developed 2 months post-transplantation. Histologically, the eruption shared features of a reactive inflammatory condition called papular eruption of atypical CD8+ lymphocytes as well as primary cutaneous acral CD8+ T-cell lymphoma (a provisional indolent entity in the new World Health Organisation classification of lymphoid neoplasms, 2016). The latter disorder has been described to occur at acral sites in immunocompetent patients, whereas the former has previously been described only in patients infected with human immunodeficiency virus. The lesions in our patient healed after topical treatment with corticosteroids and alteration of immunosuppressive therapy, supporting the role of immunosuppression in this case. We classified our patient's condition as lying in the spectrum of the aforementioned two conditions, but the relationship between both diseases remains to be clarified. Awareness of these unusual conditions may prevent the use of unnecessary aggressive therapies in similar patients.

An update on cutaneous melanoma in Turkey: evaluation of 19-year data in a single tertiary centre and review of the literature.

BACKGROUND: Information on frequency of melanoma and its clinicopathological subtypes derived from dermatology clinics in Turkey is limited. OBJECTIVE: As data about melanoma show clear differences due to geographic and ethnic distribution, we scrutinized the rich data of our dermatology centre in Istanbul. METHODS: Consecutive patients diagnosed with melanoma in a tertiary dermatology clinic during the last 19 years were retrospectively investigated about the clinical presentation of the skin lesions during admission, frequency of subtypes and localization of the tumour. RESULTS: There were 227 patients with melanoma showing five different clinical presentations: 200 of them had totally 207 primary cutaneous melanoma (PCM) lesions, nine had PCM lesions associated with metastatic skin lesions, three presented with local recurrence, eight with only skin metastases and seven with regressed skin melanoma following systemic melanoma metastases. Histologically, 23.19% of the PCM lesions were intraepidermal (in situ) and Breslow thickness was less than 1 mm in 30.9% of the patients with invasive melanoma. The most common subtype was superficial spreading melanoma (SSM) (37.19%), followed by lentigo malignant melanoma (LMM) (31.4%), acral lentiginous melanoma (ALM) (19.32%) and nodular melanoma (NM) (6.76%). Head and neck region was the most common (34.78%) localization of PCM lesions. CONCLUSIONS: Different clinical presentations, including various types of cutaneous melanoma metastases, were seen. However, a great proportion of our patients were relatively early diagnosed, either having an in situ or an invasive PCM with a Breslow thickness ≤1 mm. Even though SSM was the most common subtype of PCM in our series, its rate was lower compared to many European countries. Furthermore, the rate of NM subtype was also low, while LMM and ALM rates were higher in comparison to studies originating from European countries. This striking discrepancy requires further studies to explain the probable causes.

Numerical investigation of flow and scour around a vertical circular cylinder.

Flow and scour around a vertical cylinder exposed to current are investigated by using a three-dimensional numerical model based on incompressible Reynolds-averaged Navier-Stokes equations. The model incorporates (i) k-ω turbulence closure, (ii) vortex-shedding processes, (iii) sediment transport (both bed and suspended load), as well as (iv) bed morphology. The influence of vortex shedding and suspended load on the scour are specifically investigated. For the selected geometry and flow conditions, it is found that the equilibrium scour depth is decreased by 50% when the suspended sediment transport is not accounted for. Alternatively, the effects of vortex shedding are found to be limited to the very early stage of the scour process. Flow features such as the horseshoe vortex, as well as lee-wake vortices, including their vertical frequency variation, are discussed. Large-scale counter-rotating streamwise phase-averaged vortices in the lee wake are likewise demonstrated via numerical flow visualization. These features are linked to scour around a vertical pile in a steady current.

An unusual case of mammary gland-like carcinoma of vulva: case report and review of literature.

INTRODUCTION: Accessory breast tissue is a very rare finding in the general population with an incidence of one to two percent. An even rarer occurrence is accessory mammary-like tissue which developed breast carcinoma. The authors present a case of aggressive and metastatic carcinoma of vulvar originating from mammary-like tissue. CASE: A 73-year-old Caucasian female presented with a lesion in her left vulva. The lesion was ulcerated and fragile. A dermatologist had evaluated the lesion and took a punch biopsy. Result was vulvar carcinoma. She was admitted to the gynecologic oncology clinic then after and was operated. After a radical vulvectomy and bilateral inguinal lymphadenectomy she received adjuvant radiotherapy because of lymph node metastasis. One year after the finish of radiotherapy patient was found to have lung and femur metastasis. She began to receive systemic chemotherapy for metastasis. CONCLUSION: Primary mammary-like adenocarcinoma of the vulva is exceedingly rare. There is no consensus about the diagnosis, treatment, and follow up of these patients in literature. However, given that histological data confirms these cancers are behaving like breast cancers instead of known patterns of vulva cancer, the best treatment practices for breast cancer may be applied to treat these vulvar carcinoma patients.

Prenatal diagnosis of multiple fetal anomalies in naphthalene-addicted pregnant women: a case report.

BACKGROUND: Naphthalene is one of the abused inhalants. It has been associated with acute and chronic health problems. To the authors' knowledge, prenatal exposure to naphthalene has never been discussed in humans. CASE: The authors discuss a case of naphthalene-addicted pregnant women with multiple fetal anomalies. At 15 weeks gestation, ultrasound screening demostrated multiple fetal anomalies: anencephaly, scoliosis, diffuse subcutaneous edema, flexion contracture of lower extremities, and hypoplastic left ventricle. Four weeks later obstetrical ultrasonography revealed that there was no fetal cardiac activity. The patient had a medical abortion. CONCLUSION: A stronger knowledge basis regarding naphthalene-related fetal anomaly is required to ensure accurate direct link, however the probability of naphthalene-related fetal anomaly must be considered.

C-Met expression pattern in uterine leiomyoma.

AIM: Growth factors take place in the formation and growth of uterine leiomyomas (LMs). Transforming growth factor beta (TGF-beta), epidermal growth factor (EGF), platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), fibroblast growth factor-2 (FGF-2), and insulin-like growth factor (IGF) contribute to the pathophysiology of LMs when they bind with a specific membrane receptor and transmit a signal into the cell. Little is known about hepatocyte growth factor (HGF) and its receptor system c-Met in formation and growth of uterine LMs. The aim of this study was to evaluate the c-Met receptor expression on human myometrium and uterine LMs. MATERIALS AND METHODS: The study was performed on human myometrium and uterine LMs. Expression of c-Met receptor was evaluated by immunohistochemical analysis. RESULTS: Overexpression of c-Met was found in all LM cases and in none of normal myometrium samples c-Met overexpression was seen. CONCLUSION: HGF and c-Met receptor complex seem to have role in development of uterine LMs.

Childhood mycosis fungoides: a report of 20 cases from Turkey.

BACKGROUND: Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphomas in adults. In the recent past, several reports have focused on an increased prevalence of MF in children. OBJECTIVE: The present study was aimed to evaluate the clinical characteristics, treatment modalities and disease progression in childhood MF patients from Turkey. METHODS: In a retrospective analysis of 368 MF patients in a referral center at Istanbul, Turkey, 20 patients were diagnosed before the age of 18 years and were included in the study. RESULTS: Childhood cases constituted 5.4% of all MF patients. The age at the time of diagnosis ranged between 2-18 years with a mean of 9.20 ± 4.52 and a median value of 9.50 years. The clinical presentation of MF consisted of solely patches in 60%, followed by plaques or plaques and patches in 40% of the patients. Hypopigmented lesions were seen in 45% and purpuric lesions in 30% of the patients. Four patients (20%) were diagnosed to have unilesional MF. The large majority of the patients (95%) had T1 N0 M0 or T2 N0 M0 disease. Sixteen patients were followed between 1-13 years (median: 3.75 years). All the patients were treated with skin directed treatments including topical corticosteroids, topical bexarotene, topical carmustine, narrow band UVB and PUVA. None of the patients progressed to an advanced stage. After an initial clearance, 69.2% of the patients were observed to have recurrences. CONCLUSION: In our experience, patches were more prevalent among childhood MF cases. Overrepresentation of hypopigmented and purpuric lesions was remarkable. Progression to an advanced stage was not seen. However, recurrences after discontinuation of therapy were common.