Anil Madaree

bcl-2 protein expression in aggressive and non-aggressive basal cell carcinomas.

bcl‐2, the well known anti‐apoptotic gene, cloned more than a decade ago, promotes cell viability without promoting cell proliferation. With few exceptions, high bcl‐2 protein expression is associated with a favourable outcome in epithelial tumours. bcl‐2 immunoreactivity in basal cell carcinomas (BCCs) is contradictory, with 67–100% immunopositivity being reported. Although BCCs are traditionally regarded as low‐grade, indolent tumours, aggressive BCCs (A‐BCCs) are mutilative, locally destructive tumours that often recur. bcl‐2 protein expression as a predictor of BCC aggressiveness is poorly documented in the English‐language literature. The bcl‐2 protein immunoprofile of 50 clinically non‐aggressive (NA‐BCCs) and 25 clinically A‐BCCs was investigated. Of the latter, 17 manifested with one, two or three recurrences. bcl‐2 protein expression in each of the recurrences was also evaluated. bcl‐2 expression was scored as follows: 0–5% positive cells=negative, 6–25%=1+, 26–50%=2+, 51–75%=3+, >75%=4+. “High” labeling encompassed 3+ or 4+ labeling while “low” labeling referred to 1+ or 2+ labeling. Although bcl‐2 positivity was noted in all BCCs, low bcl‐2 labeling was a statistically significant feature of A‐BCCs (p < 0.01). High bcl‐2 labeling of NA‐BCCs was a reflection of the bcl‐2 labeling of the dominant constituent nodular or superficial subtypes. Micronodular BCCs revealed 2+ or 3+ labeling. Initial and recurrent A‐BCCs with a pure or predominantly infiltrative component, demonstrated 1+ or 2+ bcl‐2 labeling. The differential bcl‐2 expression in the various clinicopathological subtypes of BCCs suggests that, despite the common derivation of these tumours from a primitive basaloid stem cell and a limited potential for metastasis, they form a heterogeneous group of tumours that differ markedly in histologic and biological behaviour. While the superficial and nodular BCCs are indolent slow‐growing tumours with high bcl‐2 labeling, the aggressive BCCs are infiltrative, desmoplastic tumours with low bcl‐2 labeling. In mixed tumours, heterogeneity of labeling is a distinctive feature and is contributed to in part by the labeling trends of the different histological subtypes. The micronodular BCC shows varied bcl‐2 labeling but in combined tumours occupies a niche intermediate between the non‐aggressive nodular and superficial and the aggressive infiltrative subtypes. The initial and subsequent biopsies of recurrent, adequately excised BCCs share a pure or mixed, predominantly infiltrative, stroma‐rich histomorphology with low bcl‐2 labeling, reflecting the immunoprofile of a more aggressive growth pattern.

Membranous fat necrosis in lipomas.

Membranous fat necrosis (MFN) is an under-recognized variant of fat necrosis (FN) that is characterized by the presence of membranocystic foci in which cysts are lined by an eosinophilic, homogeneous membrane with pseudo-papillary luminal projections. Although MFN has been described in systemic adipose tissue, it has not been described in lipomas. We report the rare occurrence of MFN in four lipomas. The lipomas ranged in size between 9 and 22 cm and occurred in menopausal women in the left shoulder, right upper back, right thigh, and gluteal regions. In two cases the membranocystic foci were identified macroscopically, whereas in the other two cases MFN was only identified on histologic assessment. Apart from the typical histologic appearance of the membranocystic foci, the membranes have a distinct histochemical profile that includes consistent Sudan black positivity and either periodic acid-Schiff or Ziehl-Neelsen positivity. In all cases, there was autofluorescence of the membranes on immunofluorescent examination of unstained sections. These membranocystic foci have the typical staining reactions of ceroid pigment. The exact cause of MFN in lipomas is not known, but in view of their large sizes, traumatic and ischemic etiologies are proposed.

Folliculosebaceous cystic hamartoma

Summary Although folliculosebaceous cystic hamartoma (FCH) is an uncommon cutaneous entity with distinct classical and variant histopathologic features, it lacks distinctive typifying clinical features. Since the original description of five cases of FCH by Kimura et al.1 in 1991, 12 cases have been documented. We report a further case of FCH presenting as facial lesion in a 35 year old African male. FCH comprises prominent epithelial and mesenchymal components. The epithelial component is characterised by folliculosebaceous proliferation with cyst‐like infundibular dilatation, and the mesenchymal component exhibits variable fibroplasia, vascular and neural proliferation and adipocyte metaplasia. Awareness of the lesion is important to avoid confusion with other cystic or cyst‐like cutaneous lesions that contain prominent epithelial folliculosebaceous and variable mesenchymal components.Abbreviations: FCH, folliculosebaceous cystic hamartoma.

Giant congenital naevus of the scalp and cranium: case report and review of the literature

Congenital pigmented naevi are lesions that are usually confined to skin. We report a giant congenital naevus of the scalp which involved skin, galea, full thickness cranial bone, dura and the intracranial venous sinuses. The literature on giant congenital naevi with direct involvement of underlying bone is reviewed.

Chronic orbital hematic cysts : A case for craniofacial correction

Chronic hematic cysts are rare conditions that usually present to the ophthalmic surgeons with displacement of the globe. There is usually no, or minimal, bone involvement. Two patients with unusual presentations of chronic orbital hematic cysts are reported. These cysts resulted in significant expansion and erosion of the bony orbits. The presentation, operative findings, and reconstruction are reported and discussed.

A method of repairing the no. 3 facial cleft

A method of correction of an incomplete no. 3 facial cleft in an infant is presented. It is compared with previously described repairs, and its advantages are outlined.

Reconstruction of both upper and lower lips

Major defects of both the upper and lower lips occurring in the same patient are unusual and challenging problems that could confront a plastic- or maxillofacial surgeon. We have encountered two such patients and detail their presentation, reconstructive technique used and the postoperative outcome.