Abelardo Moreno

Angiogenesis and malignant melanoma. Angiogenesis is related to the development of vertical (tumorigenic) growth phase

To study angiogenesis in early steps of melanoma progression, 113 cutaneous melanomas 1mm or less in thickness were stained with Ulex europaeus lectin. Vascular density was determined in the areas of greatest vascularization. To avoid the effect of anatomic location, the quotient between vascular density at the tumor base and in normal skin (vascular ratio) was obtained in each case. Of these melanomas, 46 were immunohistochemically stained for the presence of vascular endothelial growth factor (VEGF). Positivity was scored from 1–4 by comparing staining of melanoma cells with keratinocytes. Vascular ratio values in vertical growth phase melanomas were higher than those in radial growth phase when counting per 200 or 400 magnification (2.29±1.3 and 2.48±1.5 for vertical growth phase and 1.34±0.62 and 1.41 ±0.83 for radial growth phase melanomas, respectively). This difference was statistically significant (p < 0.0001 and p<0.001 at × 200 and × 400, respectively). Also, VEGF staining was stronger in vertical growth phase melanomas when compared with radial growth phase melanomas (Chi square, p < 0.025).

Prognostic factors in laryngeal carcinoma: A multifactorial study of 416 cases

The prognostic significance of 20 clinical and histologic parameters was evaluated in a series of 416 laryngeal carcinomas treated between 1969 and 1981 at the Hospital de Santa Cruz y San Pablo, Barcelona, Spain. Clinical follow‐up ranged from 2 to 13 years. The variables considered were: age, smoking habits, previous laryngeal disease, duration of clinical symptoms, motility of vocal cords, interval between diagnosis and treatment, postoperative infection, topographic location of the tumor, previous tracheostomy, ulceration, tumor size, resection margins, histologic grading, patterns of growth, types of invasion, mitotic index, depth of invasion, positive lymph nodes, T categories and N categories. Fourteen parameters were found to be significantly related to survival. After a multifactorial study using Coxs life table regression model, 5 of those 14 parameters were found to influence survival independently. The five variables ordered according to prognostic significance were: (1) positive lymph nodes, (2) T categories, (3) histologic grading, (4) ulceration, and (5) location.

Cutaneous reactions secondary to heparin injections

Ten to 20 days after starting prophylactic doses of heparin in six patients, large, indurated, erythematous plaques appeared at the sites of the subcutaneous injections. Pruritus, local tenderness, and burning sensation or pain were present. No skin necrosis developed. Heparin was discontinued and topical corticosteroids were applied to the involved areas. Five to 9 days later the lesions had resolved completely. The reaction seen in the six patients is similar to the early erythematous phase of the so-called heparin necrosis. There is a spectrum of cutaneous changes ranging from mild erythematous pruritic areas to large symptomatic plaques and to heparin necrosis, following subcutaneous injections of heparin.

Cutaneous angiomas in POEMS syndrome

POEMS syndrome is an unusual plasma cell dyscrasia with multisystemic manifestations featuring polyneuropathy, organomegaly, endocrinopathy, M protein and constant skin involvement. We have seen a 58-year-old white man presenting with generalized eruptive angiomas as a rare skin manifestation of this syndrome. We review the literature and discuss the pathogenesis of vascular proliferation in this unusual entity.

Expression of death-related genes and their relationship to loss of apoptosis in T1 ductal breast carcinomas

Expression of the death‐related proteins (DRPs) Bcl‐2, Bax, Bcl‐x and Bak that regulate cell survival and death was examined using immuno‐histochemical methods in a group of 142 T1 (<2 cm) ductal breast carcinomas. Immunostaining results were correlated with loss of apoptosis and clinico‐pathological parameters such as histological grade (HG) and lymph node involvement. Expression of anti‐apoptotic proteins Bcl‐2 and Bcl‐x was found in 57.0% and 62.75% of tumors, respectively. Bcl‐2 expression, but not Bcl‐x expression, was related to loss of apoptosis. Expression of the apoptotic proteins Bax and Bak was present in 58% of Bcl‐2‐negative tumors and associated significantly with an increase in apoptosis. Expression of these DRPs was associated significantly with the HG of the tumors: Bcl‐2 and Bak expression was predominant in HG I/II tumors, whereas expression of Bcl‐xL and Bax was commonly observed in HG III tumors, as occurs for p53 over‐expression. Our results suggest that the loss or gain of apoptosis is regulated tightly in T1 breast carcinomas through the expression of different effectors along with tumor cell differentiation. Int. J. Cancer (Pred. Oncol.) 79, 103–110, 1998.© 1998 Wiley‐Liss, Inc.

Calciphylaxis associated with alcoholic cirrhosis

Calciphylaxis is an uncommon disease characterized by calcification of dermal vessels that determines skin necrosis. Calciphylaxis has been almost exclusively reported in association with renal failure and altered phosphor–calcium metabolism. Only a few cases have been described in hyperparathyroidism, malignancies, and, recently, cirrhosis. We report a patient that developed calciphylaxis related to end‐stage alcoholic cirrhosis, without any alteration in the phosphocalcic and parathyroid hormone metabolisms. Possible contributing factors were repeated albumin infusions and low levels of protein C and S.

Synergistic cooperation between c-Myc and Bcl-2 in lymph node progression of T1 human breast carcinomas.

The overexpression of Bcl-2, an anti-apoptotic oncogene, identifies human T1 breast cancer patients who have an increased risk of lymph-node metastasis. We examined in these patients (n=142) whether the c-Myc oncogene influences metastatic progression in conjunction or not with Bcl-2 expression and the loss of apoptosis in tumors. The association between Bcl-2 and lymph-node metastasis was only significant when c-Myc was concomitantly expressed (χ2 test, p=0.008). Moreover, very large associations (pOR=6.4) between c-Myc and lymph-node metastasis were observed among Bcl-2 positive tumors and tumors with loss of apoptosis (pOR=8.4). In contrast, the metastatic advantage linked to Bcl-2 was decreased (pOR=2) when c-Myc was not coexpressed. It is concluded that the synergism between Bcl-2 and c-Myc oncogenes may promote metastasis in breast tumors, linked to loss of apoptosis.

Simultaneous occurrence of cutaneous T cell lymphoma and low-grade B cell lymphoproliferative diseases: A report of two cases

Two previously unreported patients with cutaneous T cell lymphoma associated with systemic low-grade B cell proliferations are presented. The first patient had Waldenströms macroglobulinemia and the second had simultaneous chronic lymphocytic leukemia. The use of immunosuppressive drugs or a genetic predisposition may have contributed to the second malignancy. However, the possibility that malignant helper/inducer T lymphocytes were a factor in the promotion of the proliferation of B cells cannot be excluded.

Generalized acquired cutis laxa associated with coeliac disease: evidence of immunoglobulin A deposits on the dermal elastic fibres

Summary Acquired cutis laxa (ACL) is an uncommon elastolytic disorder of unknown aetiology. In rare instances. ACL has been reported in association with autoimmune diseases and dermal deposit of immunoglobulins, suggesting that destruction of elastic tissue may be immunologically mediated. We report a 35‐year‐old man with generalized acquired cutis laxa (GACL) associated with a persistent papular erythematous eruption that histopathologically showed some resemblance to dermatitis herpetiformis. A marked reduction and degeneration of dermal elastic fibres was noted in biopsies from loose‐hanging skin. Direct immunofluorescence from non‐inflammatory loose skin revealed granular immunoglobulin A (IgA) deposits at the basement membrane zone and fibrillar IgA deposits in the dermal papillae. IgA deposits were also observed on the elastic fibres of the reticular dermis. Electron microscopy of skin from the submammary fold revealed fragmented elastic fibres, partial absence of peripheral microfibrils and abundant neutrophils, some of which were degranulated and adjacent to elastic fibres. Immunoelectron microscopy of an erythematous papule revealed IgA deposits around dermal elastic fibres. Antigliadin, antireticulin and antiendomysium antibodies were present. Jejunal biopsies showed a gluten‐sensitive enteropathy. A possible IgA‐mediated immune mechanism for the development of GACL in our patient is suggested.

Multiple Fibrofolliculomas and Trichodiscomas

A late-onset, sporadic case of multiple fibrofolliculomas and trichodiscomas is reported. This case and other reports in the literature suggest to the authors that benign neoplasms derived from the mesodermal component of the pilar apparatus may present in various combinations and may also be associated with other hamartomatous skin proliferations. The wide spectrum of published combinations may be due to similarities in clinical presentation and biopsy-sampling uncertainties.