A.V. Lalinga

Immunoglobulin gene rearrangement analysis in composite hodgkin disease and large B-cell lymphoma: evidence for receptor revision of immunoglobulin heavy chain variable region genes in Hodgkin-Reed-Sternberg cells?

Immunoglobulin heavy chain gene (IgH) rearrangement was studied in a patient showing the occurrence of classical Hodgkin disease and large B-cell lymphoma (LBCL) in the same lymph node. The VHDHJH region was amplified by polymerase chain reaction, the template being the DNA extracted from single Hodgkin and Reed-Sternberg and LBCL cells, microdissected on hematoxylin-eosin–stained sections by laser capture. A repeated VH4DH3JH4 segment was found in Reed-Sternberg cells, whereas a repeated VH3DH3JH4 segment was observed in LBCL cells. Rearranged VH genes carried somatic mutations in both populations, indicating a common germinal center cell origin. The IgH rearrangement found in clonally related Reed-Sternberg cells differed from the one of LBCL cells in the VH region but showed the same JH and DH segments with no variation from the respective germline sequence. The DH–JH junction is the first immunoglobulin gene segment rearranged in precursor B cells. Because the possibility of secondary Ig gene rearrangement in peripheral lymphoid organs has recently been reported, in the patient described here Reed-Sternberg and LBCL cells might originate from a common precursor in which secondary VH replacement took place during the germinal center reaction, giving rise to two different clonally related lymphomas.

Lipomatous mixed tumour of the skin: a histological, immunohistochemical and ultrastructural study

Summary Background Mixed tumours are composed of an admixture of an epithelial/myoepithelial and usually a myxochondroid stromal component. Adipocytes are found more rarely, and account for a minor part of the tumour. To date, only three cases of mixed tumour/pleomorphic adenoma of the salivary gland have been described, showing an extensive adipocyte content of more than 90% of the tumour tissue. Owing to this peculiarity, some authors have defined it as ‘lipomatous pleomorphic adenoma’. We are not aware of previously reported similar lesions in the skin.

Quantitative in situ evaluation of telomeres in fluorescence in situ hybridization‐processed sections of cutaneous melanocytic lesions and correlation with telomerase activity

Summary Background Telomere length is correlated with cellular ageing and immortalization processes. In some human cancers telomere length measurement has proved to be of diagnostic and prognostic value. Results comparable with the traditional terminal restriction fragment length determination by Southern blotting have been obtained in metaphase and interphase cells in some studies by fluorescence in situ hybridization (FISH) analysis; FISH additionally allows for the quantification of telomeres at the cellular level.

Usefulness of CDX2 in the diagnosis of extramammary Paget disease associated with malignancies of intestinal type.

1 Del Castillo LF, Garcia C, Schoendorff C et al. Spontaneous apparent clinical resolution with histologic persistence of a case of extramammary Paget’s disease: response to topical 5-fluorouracil. Cutis 2000; 65:331–3. 2 Imakado S, Abe M, Okuno T et al. Two cases of genital Paget’s disease with bilateral axillary involvement: mutability of axillary lesions. Arch Dermatol 1991; 127:1243. 3 Archer CB, Louback JB, MacDonald DM. Spontaneous regression of perianal extramammary Paget’s disease after partial surgical excision. Arch Dermatol 1987; 123:379–82. 4 Brown RS, McCormack M, Lankester KJ, Spittle MF. Spontaneous apparent clinical resolution with histologic persistence of a case of extramammary Paget’s disease: response to topical 5-fluorouracil. Cutis 2000; 66:454–5.

Posttransplant primary cutaneous CD30(Ki-1)-positive anaplastic large T-cell lymphoma. A case report

agents in this setting is growing. Voriconazole is a new broad-spectrum antifungal agent active on Aspergillus spp., Candida spp. and other fungi. Voriconazole has previously been used as a salvage treatment for five patients with phaeohyphomycosis, all of whom were cured. The in vitro voriconazole mean MIC for three isolates of M. mycetomatis was 0Æ05 mg mL, compared with 0Æ08 and 0Æ03, respectively, for itraconazole and amphotericin B. The favourable outcome for our patient shows that voriconazole can be a valuable nonsurgical treatment for M. mycetomatis eumycetoma, although it requires high daily doses and lengthy administration. Dose and duration of antifungal treatment, as well as absence of bone involvement, seem predictive of the success of eumycetoma medical therapy. Without bone involvement initial medical treatment may facilitate limited surgical excision or even, as in our case, may be sufficient for a total cure. All authors stress the importance of lengthy follow-up before concluding that treatment has been successful. Our patient was disease-free 4 years after the end of treatment, confirming the efficacy of voriconazole treatment alone. To our knowledge, this is the first report of voriconazole treatment of eumycetoma. Voriconazole could represent a real progress in the antifungal treatment of mycetoma due to M. mycetomatis. Unfortunately, the prohibitive cost of this drug may limit its use, especially in endemic countries.

Macrophage migration inhibitory factor in the human prostate: identification and immunocytochemical localization.

Macrophage migration inhibitory factor (MIF) is a lymphokine originally identified for its capacity to inhibit the random migration of macrophages. Recent data have further extended knowledge of the physiological role of this protein, showing that MIF is produced by several human organs and tissues. The present study was intended to evaluate the expression and tissutal localization of MIF in the human prostate.

Necrobiotic Palisading Granuloma at Injection Site of Disodium Clodronate: A Case Report

The authors describe an adverse localized cutaneous reaction caused by the injection of disodium clodronate, histologically presenting as a necrobiotic palisading granuloma. This lesion is considered as an immunological type of granuloma that can be caused by various chemical or physical stimuli. Disodium clodronate should be included among the medicaments that can trigger this infrequent type of tissue reaction.

A rare case of papular-purpuric palmoplantar lesions.

Papular-purpuric gloves and socks syndrome is an uncommon, acute, self-limiting skin disease, usually of infectious etiology, which, in addition to skin involvement (characterized by typical purpuric exanthema limited to the hands and feet), manifests in lesions in the oral cavity. Bagot and Revuz first implicated parvovirus B19 in the etiology of this syndrome in 1991, since when numerous studies have indicated its involvement in >50% of cases. In other cases, viruses such as herpesvirus type 6, cytomegalovirus (CMV), and coxsackie B6, bacteria such as Arcanobacterium haemolyticum, and drugs such as trimethoprim-sulfamethoxazole have been implicated.