Antonella Coggi

Coexpression of intermediate filaments in normal and neoplastic human tissues: a reappraisal.

The current view that coexpression of intermediate filaments (IFs) must be considered a bizarre and unpredictable phenomenon, which seriously jeopardizes the use of their localization in diagnostic applications, is critically reviewed in light of the evidence so far acquired by investigations in vivo and in vitro. A less dogmatic approach, which considers IF expression the result of a series of interactions between cells and their microenvironment instead of a function of their histogenesis, not only justifies the complex variety of coexpressions observed in normal and neoplastic tissues but also confirms the usefulness of IF expression in diagnostic applications and offers new opportunities for investigations, with special regard to immunoelectron microscopy.

Review of 120 biopsies performed on the balanopreputial sac. from zoon's balanitis to the concept of a wider spectrum of inflammatory non-cicatricial balanoposthitis.

Background: Long-lasting erythematous lesions involving the balanopreputial sac may be clinically difficult to classify, and biopsies may be performed in order to clarify the nature of the disease. However, our previous experience led us to consider several cases as histopathologically unclassifiable. Objective: To establish the causes of such unsatisfactory findings. Methods: We reviewed 120 balanopreputial sac biopsies performed at the surgical unit of our institute from January 1999 to December 2002 examining also the patients’ clinical records. Results: We found that a small group of previously unclassified cases showed common clinical and histopathological features. Clinically, all patients were uncircumcised and had long-lasting asymptomatic erythematous plaques on the balanopreputial sac with no erythroplastic or lichenoid features and no correlation with sexual intercourse. Histologically, all specimens showed a thinned and spongiotic epithelium, a band-like infiltrate of lymphocytes and histiocytes with a variable number of plasma cells in the upper part of the chorion and further signs of acute, subacute or chronic inflammation. Conclusions: In our view, these cases fall within a spectrum of inflammatory non-cicatricial disorders, ranging from almost pure lymphohistiocytic forms to forms which fulfil all criteria to be classified as balanitis circumscripta plasmacellularis of Zoon. We propose to classify these cases histologically as inflammatory non-cicatricial balanoposthitis and clinically as idiopathic inflammatory non-cicatricial balanoposthitis.

A Short History of Tattoo

Tattoo is a permanent pigmentation of the skin resulting from the introduction of exogenous substances. If this happens unintentionally—for example, after road injuries—it is called traumatic tattoo. However, the most common tattoos are decorative, related to current fashion or to a symbolic meaning. The etymological origin of the word tattoo is believed to have 2 major derivations: the first is from the Polynesian word “ta” which means “striking something,” and the second is the Tahitian word “tatau” which means “to mark something.” This word was introduced in Europe by the English explorer James Cook, who described the Polynesian technique of “tattaw” in his narrative of the voyage. The oldest example of tattoo dates back to 3000 BC and is represented by a mummy called “Ötzi the Iceman” discovered from the area of the Italian-Austrian border in 1991. Radiological examination of his bones showed osteochondrosis in areas where tattoos had been present. It has been speculated that these tattoos may have been related to pain relief treatments similar to acupuncture. If so, this practice may have existed at least 2000 years before its previously known earliest use in China. In ancient times the tattoo spread throughout Egypt and Rome until it was banned by the Emperor Constantine after his conversion to Christianity. Constantine believed that the human image was a representation of God and should not be disfigured or defiled. The practice of tattooing the body was never fully accepted by any of the 3 great monotheistic religions (Christianity, Judaism, and Islam). Although tattoos were forbidden among Christians by Pope Hadrian I in 787, the habit of tattooing the body survived secretly, especially in some places of Christian worship, like the Sanctuary of Loreto, where the “Friars-Tattooist” (“Frati-marcatori”) tattoo, a small devotional sign to the pilgrims, was used. The reintroduction of the tattoo in the Western world occurred after the ocean expeditions of the 18th century. At the end of the 19th century the use of tattooing spread among highest European social classes: famous “celebrity” tattoos included those of Tsar Nicholas II and Sir Winston Churchill. In recent decades the practice of tattoo has widely spread in the Western world to all social classes, with an increase of complications related to it, such as allergic, lichenoid, granulomatous, and pseudolymphomatous reactions or induction of skin diseases.

Cutaneous apocrine mixed tumor: derived from the apocrine duct of the folliculo-sebaceous-apocrine unit?

We report a case of cutaneous mixed tumor (CMT) composed of tubular branching structures lined by cells with apocrine characteristics. In addition, an apocrine duct in the outer sheath of an hair follicle was connected to the mixed tumor, a previously unreported finding. Follicular and sebaceous differentiation have been described in CMT, leading some observers to suggest the existence of an apocrine type of CMT and its presumed differentiation toward the folliculo-sebaceous-apocrine unit (FSAU). Our case demonstrated continuity of an apocrine duct in the FSAU and lends support to the previous speculations about the histogenesis of apocrine type of CMT.

Erratum: Cutaneous apocrine mixed tumor: Derived from the apocrine duct of the folliculo-sebaceous-apocrine unit? (American Journal of Dermapathology (1998) 20:1 (53-55)

We report a case of cutaneous mixed tumor (CMT) composed of tubular branching structures lined by cells with apocrine characteristics. In addition, an apocrine duct in the outer sheath of an hair follicle was connected to the mixed tumor, a previously unreported finding. Follicular and sebaceous differentiation have been described in CMT, leading some observers to suggest the existence of an apocrine type of CMT and its presumed differentiation toward the folliculo-sebaceous-apocrine unit (FSAU). Our case demonstrated continuity of an apocrine duct in the FSAU and lends support to the previous speculations about the histogenesis of apocrine type of CMT.

Syphilis with a lichen planus-like pattern (hypertrophic syphilis)

To the Editor, A 52-year-old Caucasian man presented with a 1-month history of a widespread pruritic cutaneous eruption. Physical examination revealed multiple violaceous plaques with verrucous surfaces asymmetrically distributed on the trunk and upper limbs, thus resembling hypertrophic lichen planus (Fig. 1). A centrally eroded nodule was also present on the scalp, while the interdigital spaces were involved by serous crusted lesions with fissures (Fig. 2). No mucosal lesions, genital ulcers, alopecia or lymphadenopathy was found. The patient denied the use of drugs. Histopathologic examination with hematoxylin– eosin staining showed irregular psoriasiform hyperplasia of epidermis with wedge-shaped hypergranulosis (Fig. 3). The dermis contained a lichenoid infiltrate composed of lymphocytes and plasma cells, and the latter were numerous around vessels (Fig. 4). Polymerase chain reaction and immunohistochemistry (Fig. 5) revealed the presence of Treponema pallidum in the epidermis and papillary dermis. Additionally, venereal disease research laboratory titers were

A 26-year-old man with an eczematous lesion on the nipple.

Maria Gavrilova, MD; Alejandro Martin-Gorgojo, MD; Carmen Ruiz-Domenech, MD; Maria-Dolores Alonso-Salvador, MD; Maria del Carmen Gomez-Mateo, MD; Esperanza Jorda-Cuevas, MD, PhD; Departments of Dermatology (Drs Gavrilova, Martin-Gorgojo, Ruiz-Domenech, and Jorda-Cuevas), Neurology (Dr Alonso-Salvador), and Anatomy Pathology (Dr Gomez-Mateo), Clinical University Hospital of Valencia, Valencia, Spain

Two Important Italian Scientists of the Renaissance and the First Book Ever Devoted to Nevi

Didacticandhands-oneducation, suchasattendingwoundsessions at the American Academy of Dermatology (http://www .aad.org) or wound healing meetings (http://www.sawc.org) and learning systematic evaluation andmanagement of VLUs (and other chronic wounds) from evidence-based guidelines for chronic wounds (Wound Healing Society; http://www .woundheal.org), is necessary. Dermatologists can assess their practice of treating VLUs through the newly released performanceimprovementcontinuingmedicaleducationactivityprovided by the American Academy of Dermatology. In addition, manufacturers of compression bandages create systems to assist in proper application and educate practitioners on application, so use of these systems, as opposed to elastic (acetype)wraps,wouldprovidemore standardized care.However, directmonitoringof individualpatients for adequate compression is not routine. Recently developed real-time subbandage pressure monitors using fiberoptic force sensors might help change that and ensure that all patients receive optimal compression. Finally, assessment ofwound improvement through closetrackingofwoundsizereductionbymeasurementsorphotographs isneeded,andtheuseof templates forpatientcareand procedures can be incorporated into electronic medical records, which can serve as a resource to ensure that all elements of evaluation andmanagement are performed.

A painful umbilical nodule in a 24-year-old woman

A 24-year-old Italian woman was admitted to our Department because of a big reddish nodule in the navel area that had appeared about one year before (Fig. 1). Her medical history was unremarkable. She denied any prior abdominal or pelvic trauma or surgeries. Physical examination demonstrated a 4-cm tender nodule, centered by a papule with a purplish color. The patient indicated that the lesion had progressively enlarged and that it was cyclically painful. On histopathological examination, numerous cystic cavities, different in shape and dimension, were present in the dermis, embedded in a vascular and cellular stroma (Fig. 2). These glands were composed of a single columnar cell layer that tended to flake off into the lumen. There was no cellular atypia or other evidence of malignancy (Fig. 3). Figure 3 A gland in secretory phase (hematoxylin and eosin, original magnification 40 9) Figure 1 A 4-cm tender nodule, centered by a papule with a purplish color, in the navel area

Secondary syphilis masquerading as lupus vulgaris in an HIV-infected patient: A diagnosis suggested by histology

We report a case of secondary syphilis mimicking lupus vulgaris in an HIV-infected patient. A 21-year-old Brazilian man presented with a two-month history of asymptomatic cutaneous lesions accompanied by fever and fatigue. Dermatological evaluation revealed an erythematous, crusted, large plaque on the neck with the ‘apple jelly’ sign on diascopy and two smaller scaly elements on the trunk and left palm. Bacteriological examinations for bacteria and mycobacteria gave negative results. Histology revealed psoriasiform epidermal hyperplasia and dermal lymphoplasmacytic infiltrate. Serology for syphilis was positive, and immunohistochemistry confirmed the presence of Treponema pallidum in lesional skin. A diagnosis of secondary syphilis was made, and the patient was successfully treated with benzathine penicillin G. Cutaneous manifestations of secondary syphilis are protean and skin tuberculosis may be considered in the differential diagnosis, especially in HIV-infected patients. In the current case, clinical examination, and particularly, ‘apple jelly’ sign positivity, was suggestive of lupus vulgaris, but only typical histopathology and immunohistochemistry led to the correct diagnosis of secondary syphilis.