1/12. Immunohistochemical evaluation of the probability of skin metastasis in gastric cancer.We report the case of a 56-year-old man with advanced gastric cancer that manifested as multiple subcutaneous nodules. histology showed irregularly shaped cells with large nuclei and it also showed frequent mitotic figures clustered throughout the dermis. To predict whether metastasis was likely to occur, we performed a controlled study using gastric cancer cells from patients with or without metastases. Tumor cells that had metastasized showed more positive staining for Ki67, PCNA and p53 than those that had not metastasized, although there were no marked differences between the reactivities of these 2 groups for factor viii related antigen, CEA, EGF, or p21 staining. We conclude that immunohistochemical staining for Ki67, PCNA or p53 might be very useful in predicting the possible risk of metastasis of cancer cells.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
2/12. Animal type melanoma: a report of a case with balloon-cell change and sentinel lymph node metastasis.Animal type melanoma is a rare histopathologic variant of melanoma characterized by sheets and nodules of heavily pigmented epithelioid melanocytes that involve the entire thickness of the dermis. This human neoplasm mimics melanocytic neoplasms seen in gray horses and laboratory animals; thus, is termed animal type melanoma. It is quite rare and, with only a few reported cases, its biological behavior is not well understood. We report an example of animal type melanoma on the back of a 27-year-old man. The lesion showed areas of melanoma in situ, which ruled out the possibility of metastatic melanoma. Features of regression were also seen at dermo-epidermal junction and papillary dermis. In some areas, neoplastic melanocytes exhibited a balloon-cell appearance; in others the neoplasm was composed of sheets and fascicles of heavily pigmented epithelioid melanocytes that permeated the entire dermis and extended into the dermal-subcutaneous interface, mimicking a cellular blue nevus. Epithelioid melanocytes in deeper areas showed abundant, heavily pigmented cytoplasm and pleomorphic nuclei with prominent eosinophilic nucleoli and some mitotic figures. The neoplastic cells did not show evidence of maturation in deeper areas of the lesion. In some sections, a nodule of heavily pigmented epithelioid melanocytes was seen far from the main bulk of the lesion, at the dermal-subcutaneous interface, raising the possibility of a satellite lesion. A lymphoscintigraphy showed a sentinel lymph node in the right axilla and a subsequent axillary lymphadenectomy demonstrated that the architecture of the sentinel lymph node was effaced by metastatic melanoma. The patient received adjuvant chemotherapy with inteferon alfa-2b and four months after this treatment the patient is alive and well, without evidence of recurrences or additional metastases.- - - - - - - - - - ranking = 3keywords = dermis (Clic here for more details about this article) |
3/12. lung carcinoma with congenital plantar keratoderma as a variant of Clarke-Howel-Evans syndrome.A 32-year-old man was admitted to the Magdeburg University Hospital with icterus and for further diagnosis of suspected hepatitis. He also complained of generalized pruritus, abdominal pain, nausea, and diarrhea. The patient's history revealed the excision of a lymph node metastasis of the left groin showing pleomorphic macrocellular infiltrates, 2 months previously. The patient presented to our department with prominent hyperkeratosis of both feet, which had been present since early youth. The family history was negative. Both soles showed very thick, white and blackish hyperkeratosis with predominance of the heels and the forefeet (Fig. 1). The naturally occurring wrinkles of the skin of the toes were flattened. The palms were not affected, and neither was the oral mucosa. Further investigations revealed icterus of the sclera and multiple, firm tumors, which were located in the deep subcutaneous tissue, on the left hip, thigh, and buttock. From thorough clinical, laboratory and staging investigations, a non-small-cell bronchogenic carcinoma, with metastases of the liver, kidneys, adrenal glands, and several skin sites, was diagnosed. A skin biopsy specimen of the foot showed substantial acanthosis of the epidermis with hypergranulosis and excessive orthohyperkeratosis. The corneocytes were enlarged and arranged in a tile-like pattern (Fig. 2). The dermis was free of inflammatory infiltrates and human papillomavirus infection was ruled out by immunohistochemistry. Polychemotherapy was immediately started with 5-fluorouracil, mitomycin, and cisplatin, which was well tolerated. When the patient was admitted for the second cycle, however, his general health had worsened markedly. He complained of abdominal pain, severe weight loss, and nausea. Generalized metastases showed substantial progression. Chemotherapy could not be continued because of a Karnowsky index below 20%. The patient died 2 weeks later.- - - - - - - - - - ranking = 2keywords = dermis (Clic here for more details about this article) |
4/12. Ocular melanoma metastatic to skin: the value of HMB-45 staining.BACKGROUND: Cutaneous metastatic disease is an important finding that may represent the first sign of systemic cancer, or, if already known, that may change tumor staging and thus dramatically altered therapeutic plans. Although cutaneous metastases are relatively frequent in patients with cutaneous melanoma, they are less so from ocular melanoma. OBJECTIVE: To demonstrate the value of HMB-45, staining in the detection of ocular melanoma metastatic to skin. methods: The immunohistochemical stain HMB-45 a monoclonal antibody directed against intact human melanoma cells, was employed on a skin biopsy specimen from a cutaneous tumor. Results: HMB-45 staining was positive in the atypical hyperchromatic cells of the deep dermis. CONCLUSION: HMB-45 may be of value in the detection of ocular melanoma metastatic to skin. Cutaneous metastatic disease is a somewhat common and extremely important diagnosis. Although cutaneous metastases from cutaneous melanoma are relatively frequent, those from ocular melanomas are less so. Use of histochemical staining, especially the HMB-45 stain, allows confirmation of the diagnosis.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
5/12. A case of sister mary joseph's nodule from prostatic cancer.The metastasis of a visceral malignancy to the umbilicus is known as "sister mary joseph's nodule" (SMJN). We recently encountered an 80-year-old man in whom umbilical metastasis of prostatic cancer was revealed during the course of treatment. The lesion was a red, firm, elastic nodule, 2.5 cm in diameter, with a bumpy, irregular surface, but without subjective symptoms. In histopathological examination, atypical cells with intensely stained, small quasi-circular nuclei and weakly eosinophilic cytoplasm were found in all layers of the dermis. In some parts of these tumor cells, a gland-like structure was observed. Immunohistochemical investigation of the invading tumor cells disclosed immunoreactivity for prostate specific antigen and prostatic acid phosphatase, supporting a diagnosis of SMJN from prostatic cancer. His general condition gradually deteriorated, and he died 2 months later. prostate cancer often metastasizes to bones and lymph nodes, but rarely to the skin. Of all the cases of cutaneous metastasis of prostate cancer reported in japan, only three metastases have occurred to the umbilical region. The present case is therefore an example of a very rare condition.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
6/12. An unusual case of extramammary Paget's disease. Paget's disease of the glans penis probably originating from a prostatic duct carcinoma (transitional cell carcinoma of the prostate).A patient, having been treated by total cystectomy and Bricker's conduit operation for prostatic duct carcinoma with intraepithelial extension into the prostatic urethra and bladder, developed an annular, psoriasiform eruption around the external orifice of the urethra two and one-half years later. A biopsy of this lesion showed pagetoid changes of the epidermis. Microscopic examination of the surgical specimen, consisting of the glans penis and corpus spongiosum, demonstrated intraepithelial-tumor permeation into the glans penis, penile urethra, and periurethral glands (Littre). It seems reasonable to conclude that this is an unusual case of Paget's disease of the glans penis which probably originated from a prostatic duct carcinoma.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
7/12. Epidermotropically metastatic malignant melanoma. Differentiating malignant melanoma metastatic to the epidermis from malignant melanoma primary in the epidermis.In four instances, metastases to epidermis from primary cutaneous malignant melanomas at different sites showed histological features similar to those of cutaneous malignant melanoma primary in the epidermis. In these metastases, atypical melanocytes were present within the epidermis and in the upper part of the dermis much as in primary cutaneous malignant melanoma. Therefore, the presence of atypical melanocytes within the epidermis is not in itself an absolute criterion of malignant melanoma primary in skin. Nor does that finding absolutely deny malignant melanoma metastastic to the skin. Features that may enable histologic differentiation of epidermotropically metastatic malignant melanoma from primary cutaneous malignant melanoma are emphasized.- - - - - - - - - - ranking = 13keywords = dermis (Clic here for more details about this article) |
8/12. Inflammatory metastic carcinoma. Carcinoma erysipelatoides.A patient with pulmonary adenocarcinoma had an erythematous inflammatory lesion resembling erysipelas on the chest wall. Results of a skin biopsy disclosed groups of metastatic adenocarcinoma cells in the dermis, subcutaneous tissue, and lumina of the lymphatic vessels. The diagnosis of the inflammatory metastatic carcinoma should be considered in any persistent and therapeutically unresponsive skin eruption that resembles an infectious process. Careful attention to the clinical features, lack of febrile response, and absence of leukocytosis should assist in making the correct diagnosis of a noninfectious process.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
9/12. Malignant glomus tumor. A case report of widespread metastases in a patient with multiple glomus body hamartomas.Glomus tumors are characteristically benign solitary tumors. A few cases of malignant glomus tumors have been reported; however, they are usually only locally invasive, and metastases are exceedingly rare. We report a case of widespread metastases of a malignant glomus tumor involving the skin, lungs, jejunum, liver, spleen, and lymph nodes in a 63-year-old man with end-stage chronic renal failure. At autopsy, multiple glomus body hamartomas were also noted throughout the dermis proximal to the skin tumors. Histologically, the tumor was composed of monotonous round cells in solid sheets and investing numerous capillary-sized vessels. Approximately four to six mitoses were present per high-power field. The tumor cells were strongly immunoreactive for actin and vimentin, and ultrastructurally there were whorls of microfilaments with focal condensations. This case is exceptional because of its aggressive course.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
10/12. Bowenoid epidermotropic metastatic squamous cell carcinoma.Epidermotropic metastatic squamous cell carcinoma produced full-thickness cellular atypia of bowenoid carcinoma in situ or vulvar intraepithelial neoplasia, grade 3 (VIN 3), in a 73-year-old woman who had past history of uterine cervical carcinoma. The presence of intravascular tumor cell nests and areas showing smooth continuity of the malignant squamous cell nodules with the adjoining benign epidermis supported the possibility of the epidermotropic metastasis. To our knowledge, metastatic epidermotropic squamous carcinoma clinicopathologically simulating primary bowen's disease has not been reported.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
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