Begoña Vieites

Recovery of Mycobacterium tuberculosis DNA in biopsies of erythema induratum—results in a series of patients using an improved polymerase chain reaction technique

with the rate reported by Cardinali et al. (5%). Supporting the observations of Woo et al., our group recently described a case of severe psoriasis in a patient with CD that did not respond to specific therapies for psoriasis. EmA was absent, and IgA and IgG AGA serum levels were not raised. Diagnosis of CD was performed by jejunal biopsy, which showed atrophy of the intestinal villi. A gluten-free diet (GFD) was started, with rapid improvement of the duodenal mucosa and skin lesions. This case supports the association between CD and psoriasis, and the concept that psoriasis in CD patients can be improved by a GFD. This association was subsequently confirmed by Ojetti et al., who showed a higher prevalence of CD in psoriatic patients than in controls. However, we are partially in disagreement with the authors on the correlation between CD-associated antibody positivity in psoriatic patients and greater disease activity. In our study we described a case of severe psoriasis in a CD patient with IgA and IgG AGA and EmA negativity. On this basis, we cannot affirm that CD-associated antibodies, in particular IgA and IgG AGA and TGA, have a predictive role for the presence of severe psoriasis in patients with CD.

Clinicopathological and immnuohistochemical findings in a series of folliculosebaceous cystic hamartoma

Background:  Folliculo‐sebaceous cystic hamartoma (FSCH) is an uncommon skin condition presenting as a slow‐growing papulo‐nodular lesion, in or around the nose. Most cases are not clinically suspected and only histopathological examination allows the diagnosis. Pathological features include a dermal‐located infundibulo‐cystic structure with sebaceous glands radiating around, a stromal component encircling the epithelial structures, with clefts between the lesional epithelial and stromal parts, as well as between this and the adjacent dermis.

Male genital leiomyomas showing androgen receptor expression

Genital leiomyoma in men include those superficial leiomyomas arising in the scrotum and the areola. They are unusual neoplasms: few cases have been reported in the literature and they usually escape clinical diagnosis. Three cases of male genital leiomyomas are reported: two in the scrotum and one in the areola. They were all conservatively excised and the behaviour was completely benign in all cases. Histopathological examination showed the typical findings of superficial leiomyomas, with some minor differences between cases arising in the scrotum and those from the areola. Immunohistochemical findings not only confirmed the smooth muscle nature of all cases but also showed unequivocal immunostaining for androgen receptors in the leiomyomas from the scrotum. Immunostaining for androgen receptors in scrotal leiomyomas is, as far as we are aware, a previously unknown characteristic of male genital leiomyomas. This finding supports the role of steroid hormones in the growth of genital leiomyomas, similar to leiomyomas found in other locations.

Cutaneous Hodgkin-type lymphoproliferative lesion associated with immunomodulatory therapy for ulcerative colitis.

Immunomodulatory drugs have demonstrated efficacy in the therapy against autoimmune diseases such as rheumatoid arthritis, Crohns disease or ulcerative colitis. Tumor necrosis factor‐α (TNF‐α) represents a target molecule for the treatment of these entities. Use of monoclonal antibodies can block the proinflammatory function of TNF‐α. It has been shown that this action can reactivate quiescent chronic diseases as well as modify the immune response or potentiate carcinogens, thereby increasing the risk of secondary tumor development. In this context, different types of solid or hematological tumors have been documented. We present the case of a male with chronic ulcerative colitis who secondarily developed a cutaneous Hodgkin‐type lymphoproliferative lesion associated with immunodeficiency. This secondary tumor developed after 6 months of treatment with anti‐TNF‐α.

Primary Mucoepidermoid Carcinoma of the Skin Expressing p63

Primary mucoepidermoid carcinoma (MEC) of the skin is an unusual neoplasm with few cases reported in the English medical literature. It has to be differentiated from adenosquamous carcinoma, usually a high-grade neoplasm with poorer outcome, and metastasis from a primary MEC arising elsewhere in the body. We report a 78-year-old woman with an abdominal skin lesion of recent onset. Histopathological examination revealed a dermal located carcinoma with variable proportions of squamous differentiation and goblet cells. The patient died in a very short time for an unrelated disease. Immunohistochemical study showed staining for cytokeratins (AE1AE3, 7, and 34betaE12), epithelial membrane antigen (EMA), and p63, whereas cytokeratins 18 and 20 and gross cystic disease fluid protein (GCDFP15) were negative. We conclude that primary MEC of the skin is usually a slow-growing neoplasm that should be differentiated from adenosquamous carcinoma. The immunohistochemical staining for p63 is helpful to differentiate primary and metastatic MEC in the skin.

Histopathologic and immunohistochemical features of sea urchin granulomas

Paracentrotus lividus is the most common variety of sea urchin in the west coasts of Spain and has commercial value for the alimentary industry. Puncture with the spine of its rigid external skeleton may cause mechanical injury by skin penetration. It causes immediate local symptoms and, in some cases, a delayed reaction occurs in the site of injury, weeks to months later. In this case, persistent, firm, flesh‐colored papules or nodules develop.

Clinical relevance of epidermal growth factor receptor (EGFR) alterations in human pancreatic tumors.

Pancreatic cancer is a malignant neoplasm with an extremely poor prognosis. The mechanisms of aggressive growth and metastasis are currently not well understood. Expression of epidermal growth factor receptor (EGFR) has been suggested to be associated with the malignant transformation of pancreatic cancer. In this study, we examined the EGFR status of 52 pancreatic tumors by PCR-sequencing (exons 19 and 21), immunohistochemistry and FISH probes. We subsequently investigated the relationship between EGFR status and clinicopathological factors. Somatic alterations in EGFR (R841R, T571T and R831C) were observed only in ductal adenocarcinoma (3/34). In 4 (8%) of the 52 tumors analyzed EGFR was overexpressed, 6 (12%) of the tumors showed moderate expression while 19 (32%) were weakly stained. EGFR overexpression (3+ score) was frequently found in endocrine tumors (29%) followed of ampullary tumors (13%; p < 0.01). No significant correlation was observed between the presence of a somatic EGFR mutation and clinicopathological variables. Fluorescence in situ hybridization (FISH) analysis did not demonstrate amplification in any tumors. Only three somatic mutations in the EGFR gene were detected in pancreatic ductal adenocarcinoma and no association was observed with the clinical variables. Our results suggest that EGFR mutations are rare in pancreatic tumors and not associated with clinical prognosis, and treatment response.

CK19 expression in breast tumours and lymph node metastasis after neoadjuvant therapy

Neoadjuvant therapy is used in many patients with breast cancer before surgery, with the aim of reducing the tumour size, allowing conservative resections. Sentinel node biopsy is a conservative procedure for handling the axilla in breast cancer; however, the use of this technique after neoadjuvant treatment is under discussion. For sentinel node assay, methods based on the detection of cytokeratin 19 (CK19) mRNA, such as one‐step nucleic acid amplification (OSNA), are available. However, if systemic therapy could alter protein expression, then CK19 would not be a good target for analysing these nodes. The aim of this study was to evaluate the immunohistochemical expression of CK19 within different cancer types, and to compare its expression in breast tumours and axillary nodes before and after treatment.

Darier's disease with esophageal involvement.

TO THE EDITOR: Darier’s Disease (DD) is an uncommon, inherited, disorder characterized by abnormal keratinization in the epidermis, nails and mucosae [1]. Clinically, DD runs its course with hyperkeratotic papules distributed predominantly through seborrheic areas, with palma plantar involvement and nail dystrophy. Mucous membranes can also be affected, most frequently in the oral cavity and genital area [2,3]. Although the gastrointestinal tract is rarely involved, DD can occur mostly in the esophageal and rectal mucosae [4]. Although the patient’s health is not compromised, the prognosis may be overshadowed by the occurrence of viral, bacterial and fungal over-infections, such as Kaposi’s varicelliform eruption [5]. The development of malignant tumors is another potential risk, with isolated cases reported in patients with DD [6 8]. A 20-year-old male was admitted to the Emergency Department because of severe thoracic pain. DD was diagnosed when the patient was 12 years old. The pain was associated with odynophagia and anorexia and had escalated during the previous week. Physical examination revealed the presence of multiple rough and brownish keratotic papules distributed on the back, chest and axillae, consistent with DD. The patient denied drug abuse or ingestion of caustic substances. Blood assays, including cardiac enzymes, as well as chest X-ray and ECG showed no significant abnormalities. Owing to the intensity of the symptoms, an upper gastrointestinal endoscopy (UDE) was performed; the esophagus mucosa was erythematous and friable, and numerous patchy, round and deep ulcers were found (Figure 1). The lower third of the esophagus showed several smaller ulcers covered with a tiny film of mucosa suggesting the previous presence of bullous lesions. Histopathological examination of biopsies from the ulcers revealed the presence of shallow erosions in the mucosa, with dense infiltratation of neutrophiles in the squamous epithelium, extending to the lamina propria and submucosa. Acantholysis was conspicuous, with formation of suprabasal clefts containing acantholytic cells (Figure 2A). Submucosal villi projecting into the lacunae and isolated necrotic cells were also seen, but definite wellformed corps ronds or viral inclusions were absent.

Recomendaciones para la determinación de biomarcadores en cáncer de ovario epitelial. Consenso nacional de la Sociedad Española de Anatomía Patológica y de la Sociedad Española de Oncología Médica

Advances in the understanding of the histological and molecular characteristics of ovarian cancer now allow 5subtypes to be identified, leading to a more refined therapeutic approach and improved clinical trials. Each of the subtypes has specific histological features and a particular biomarker expression, as well as mutations in different genes, some of which have prognostic and predictive value. CA125 and HE4 are examples of ovarian cancer biomarkers used in diagnosis and follow-up. Currently, somatic or germinal mutations on BRCA1 and BRCA2 genes are the most important biomarkers in epithelial ovarian cancer, having prognostic and predictive value. In this article, a group of experts from the Spanish Society of Medical Oncology and the Spanish Society of Pathology review the histological and molecular characteristics of the 5subtypes of ovarian cancer and describe the most useful biomarkers and mutations for diagnosis, screening and tailored treatment strategy.