1/9. Prognostic factors in Paget's disease of the vulva: a study of 21 cases.Twenty-one cases of vulvar Paget's disease were studied to assess possible prognostic indicators, including presence and depth of invasion, status of resection margins, tumor dna cell content, and immunoreactivity for p53 and estrogen receptor proteins. Immunostaining for cytokeratin 7 (CK7), cytokeratin 20 (CK20), and gross cystic disease fluid protein-15 (GCDFP) were also performed. patients were 45 to 82 years of age (mean, 66.9 years). Ten of 21 patients (47.6%) had invasive Paget's disease. Dermal invasion was < or = 1 mm in 7 of 10 cases and 2 mm, 3 mm, and 8 mm in the remaining three invasive tumors. Of the seven patients with minimally invasive Paget's disease (< or = 1 mm depth of invasion), five are alive with no evidence of disease, one died of an unrelated illness, and one is alive with biopsy-proven in situ Paget's disease, having refused operative treatment. Of the three patients with more than minimally invasive Paget's disease (> 1 mm), all had nodal metastases; one patient is alive with no evidence of disease, one died of undertermined causes, and one died of metastatic Paget's disease. The remaining 11 patients had Paget's disease confined to the epidermis and its adnexal structures. Seven of these patients were alive at last follow-up with no evidence of disease. Of the remaining four patients, one died of metastatic cervical cancer, one died of metastatic bladder cancer, one died of an unrelated illness, and one patient is alive with biopsy-proven in situ Paget's disease and awaiting operative treatment. Twenty of the 21 cases represented primary vulvar Paget's disease while one represented possible local spread from a cervical adenocarcinoma. The immunoprofiles were GCDFP /CK7 /CK20- in 14 cases, GCDFP /CK7 /CK20 in 4 cases, and GCDFP-/CK7 /CK20- in 2 cases. All tumors were estrogen receptor-negative. Immunostaining for p53 was positive in 16 tumors and negative in four tumors. Seven of 12 (58%) patients with positive margins experienced local recurrence of Paget's disease, while the disease recurred in 1 of 4 patients with negative margins. recurrence was observed in 3 of 5 patients with diploid tumors and in 4 of 10 patients with aneuploid tumors. Neither of these differences is statistically significant. This study supports the recognition of a category of minimally invasive vulvar Paget's disease that has a low risk of distant metastasis and death caused by disease. Status of surgical resection margins, tumor cell dna ploidy, estrogen receptor expression, and p53 immunoreactivity are not predictive of local recurrence.- - - - - - - - - - ranking = 1keywords = epidermis (Clic here for more details about this article) |
2/9. Primary invasive signet-ring cell melanoma.The histopathological variants of malignant melanoma include the common type (lentigo maligna, superficial spreading melanoma, nodular melanoma, acrolentiginous melanoma), spindle cell, desmoplastic, balloon cell, pleomorphic (fibrohistiocytic), myxoid, small cell melanoma and malignant blue nevus. Recently, signet-ring cell melanoma was introduced as an additional cytologic variant. We describe a 72-year-old patient with a primary signet-ring cell melanoma of the skin located on the upper arm. Histopathologic examination disclosed a melanocytic tumor extending from the epidermis to the deep reticular dermis. Numerous pleomorphic tumor cells showed large, intracellular vacuoles and oval to spindle-shaped nuclei at their periphery. Mitotic figures and multinucleated melanocytes were also observed. Some of the signet-ring cells exhibited cytoplasmatic periodic acid-Schiff (PAS)-positivity. immunohistochemistry showed positive reaction of the tumor cells for S-100, HMB-45 protein and vimentin, confirming their melanocytic differentiation. Tumor cells were negative for cytokeratins, epithelial membrane antigen (EMA), and carcinoembryonic antigen (CEA). The signet-ring cell melanoma disclosed an invasion to Clark Level IV and tumor thickness of 2.2 mm. Signet-ring cell melanoma is a rare morphologic variant of melanoma. Its recognition is important for differentiation from other tumors featuring signet ring cells.- - - - - - - - - - ranking = 1keywords = epidermis (Clic here for more details about this article) |
3/9. Distal phalangeal metastasis of extramammary Paget's disease.A rare case of phalangeal metastasis of extramammary Paget's disease in a 68-year-old man is described. The patient developed an erythematous, slightly elevated area in the pubic region. A biopsy specimen demonstrated numerous, large, rounded cells with ample pale-staining cytoplasm proliferating in the epidermis. With a diagnosis of extramammary Paget's disease, he underwent wide local excision and inguinal node dissection. Eleven months postoperatively, the patient developed a tender, red, swollen right ring finger. Bone X-ray showed that the distal phalanx of the ring finger had completely dissolved. Histopathological examination demonstrated proliferation of tumor cells in the adipose tissue. They had poorer and darker cytoplasm than the Paget's cells in the epidermis of the pubic region. Immunohistochemically, these cells showed the same staining pattern as did the Paget's cells at the primary site. Accordingly, the patient was diagnosed with distal phalangeal metastasis of extramammary Paget's disease. Two weeks after the appearance of the distal phalangeal metastasis, the patient died of cancerous pleurisy. It has been reported that patients with phalangeal metastasis have a very poor prognosis.- - - - - - - - - - ranking = 2keywords = epidermis (Clic here for more details about this article) |
4/9. Keratin profiles may differ between intraepidermal and intradermal invasive eccrine porocarcinoma.We report two cases of eccrine porocarcinoma (EPC), one of intrepidermal EPC (IEEPC) and one of intradermal invasive EPC (IDEPC) in an immunohistochemical study of cytokeratins (CK) using nine different anti-keratin antibodies against CK1, 7, 8, 10, 14, 16, 17, 18 and 19. IEEPC expressed terminal differentiated CK1 and CK10. In contrast, IDEPC expressed simple-epithelial keratins such as CK7, 8, 18 and 19. Keratin expression of IEEPC preserves the immunophenotypes of normal epidermis. IDEPC, however, expresses poorly differentiated keratin. These results suggest that the keratin profiles of EPC are correlated with the invasive degree and reflect the clinical prognosis of EPC.- - - - - - - - - - ranking = 1keywords = epidermis (Clic here for more details about this article) |
5/9. Squamous cell carcinoma presenting as subcutaneous nodules.Four patients with squamous cell carcinomas (SCCs) presenting as subcutaneous nodules of the head were referred for Mohs micrographic surgery. In each case initial histologic sections showed no connection between the tumor and epidermis, raising the possibility that each was a metastasis from an occult SCC. Careful searches for occult SCCs were unrevealing. Subsequent step sections through the entire tumors revealed narrow connections to the overlying epidermis in three of the four cases.- - - - - - - - - - ranking = 2keywords = epidermis (Clic here for more details about this article) |
6/9. Epidermotropic metastatic squamous cell carcinoma. Report of two cases showing histologic continuity between epidermis and metastasis.Two unusual cases of squamous cell carcinoma (SCCa) metastatic to skin from distant sites occurred. In both metastatic sites, the malignant squamous epithelium fused with benign surface epithelium, and the resulting transition simulated that typically seen in primary cutaneous SCCa. We believe that this previously unreported phenomenon is an expression of the natural tendency of squamous epithelium to "heal" denuded connective tissue surfaces by proliferation followed by epithelial fusion. Because epithelial continuity can be established between benign keratinocytes and metastatic SCCa, one cannot rely on this single morphologic finding to separate primary from metastatic disease.- - - - - - - - - - ranking = 4keywords = epidermis (Clic here for more details about this article) |
7/9. subcutaneous tissue involvement by T-cell lymphoma. A report of 2 cases.BACKGROUND: T-cell lymphomas may involve the subcutaneous tissue as a manifestation of generalized disease. However, T-cell lymphomas rarely present with extensive involvement of the subcutaneous fat without other sites of disease. OBSERVATIONS: We describe 2 women who presented with fever and subcutaneous nodules or masses. In case 1, the nodules were generalized and did not respond to chemotherapy. The patient died 2 months after diagnosis. In case 2, the mass was large but localized and responded to chemotherapy. The tumor subsequently recurred in a cervical lymph node 9 months later, and the patient was being treated with chemotherapy 15 months after initial diagnosis. Histologically, biopsy specimens from both patients revealed malignant lymphoma involving the subcutaneous tissue. The dermis and epidermis were not involved. At low power the lesions resembled panniculitis, but high-power examination revealed cytologic atypia of the malignant lymphoid cells. Immunohistochemical studies revealed T-cell lineage. In case 2, the neoplastic cells also expressed the CD30 antigen, were positive for Epstein-Barr virus rna, and carried the t(2;5) (p23;q35) chromosomal translocation. We interpreted case 1 as an example of subcutaneous panniculitic T-cell lymphoma. We believe that case 2 is best classified as anaplastic large cell lymphoma of T-cell lineage. CONCLUSIONS: A variety of T-cell lymphomas rarely present with only subcutaneous tissue involvement. knowledge of this phenomenon and recognition of the cytologic atypia of the lymphoid cells will help to prevent misdiagnosis.- - - - - - - - - - ranking = 1keywords = epidermis (Clic here for more details about this article) |
8/9. Bullous lesions in Kaposi's sarcoma: case report.Bullous lesions have been only rarely described in Kaposi's sarcoma (KS), and their histopathologic features have never been described in detail. We report a case of bullous lesions of KS in an 82-year-old Italian woman. The patient had typical smooth pale reddish-grey slightly-raised KS plaques on the legs, present for at least 10 years. Several dull grayish-pink blisters (0.5 to 2 cm in diameter) affected both dorsa of her feet and ankles symmetrically. Two punch biopsies were taken, one from an infiltrated KS plaque on the right buttock and the other from a bullous lesion on the right foot. Histopathologically, the late KS plaque on the buttock showed typical features of KS, with an increased number of spindle cells arranged in short bundles and extravasation of erythrocytes. The bullous lesion on the foot showed a full-thickness vascular neoplasm involving the upper and lower dermis and the subcutaneous fat. The upper portion of the lesion contained many newly formed, highly-dilated blood vessels, touching the overlying epidermis and separated from it by a narrow band of collagen and endothelial cells; wide, empty spaces characterized the superficial dermis, in which preexisting venules and bands of collagen associated with non-atypical endothelial cells floated. All these findings would suggest a lymphangiomatous lesion, if the presence of specific diagnostic criteria of KS were not recognizable at a deeper level of the lesion. Various criteria actually suggest that the bullous lesion may be regarded as an epiphenomenon of a KS plaque lesion: (a) full-thickness involvement of the reticular dermis and, in this case, also of the subcutaneous fat; (b) dense and patchy lymphoplasmocytic infiltrate typical of plaque lesions and, much less frequently, of patch lesions; (c) presence of ectatic blood vessels, filled with plasma and erythrocytes (pseudoangiomatous findings), a nonpathognomonic but highly characteristic finding of the plaque lesion; and (d) as in the KS plaque lesions, in the bullous lesion as well the reticular dermis was characterized by an increased number of anastomosing bizarrely shaped vascular spaces lined by non-atypical endothelial cells. We hypothesize that the prevalence of lymphangiomatous differentiation in the upper dermis represents one of the many features of KS lesions. When present, it may correlate with the clinical feature of a blister.- - - - - - - - - - ranking = 1keywords = epidermis (Clic here for more details about this article) |
9/9. 99m Tc MIBI prone scintimammography in breast Paget's disease: a case report.A 99m Tc MIBI prone scintimammography (PSM) was performed in a case of underlying Paget's disease of the breast. 99m Tc MIBI PSM showed a diffuse scintigraphic image like a spread of uptake from the deeply located zones of the breast toward epidermis. In vivo, 99m Tc MIBI PSM represents the spread of neoplastic Paget's cells probably attracted by chemotactic factors released by keratinocytes. This spread in Paget's disease is correlated to neu oncogene overexpression which increases the metastatic activity as a consequence of motility enhancement and growth stimulation effect. These scintigraphic images suggest that 99m Tc MIBI PSM could be relevant in management of Paget's disease of the breast.- - - - - - - - - - ranking = 1keywords = epidermis (Clic here for more details about this article) |