Emel Öztürk Durmaz

Diagnostic utility of Ki-67 and Cyclin D1 immunostaining in differentiation of psoriasis vs. other psoriasiform dermatitis.

Background: Differentiation of psoriasis from non-psoriasis psoriasiform dermatitis (NPPD) may be difficult for dermatopathologists, as lack of distinctive histopathological features in a subset of cases may cause confusion in diagnosis. Objective: As the prototype of psoriasiform dermatitis, psoriasis is a hyperproliferative skin disorder with increased epidermal turnover compared with NPPD, we investigated the role of proliferation markers, Ki-67 and Cyclin D1 as diagnostic tools to differentiate psoriasis from other psoriasiform dermatitis. Methods: Histopathological specimens of psoriasis (n = 35) and NPPD (n = 36, 14 pityriasis rubra pilaris, 12 pityriasis rosea and 10 lichen simplex) cases were reviewed and immunohistochemically stained for Ki-67 and Cyclin D1. Ki-67 and Cyclin D1 positive cells were counted for suprabasal, and total epidermal immunostaining per mm2. Results: Suprabasal and total epidermal cell counts for Ki-67 were found to be significantly higher in the psoriasis group compared with the NPPD group (p < 0.05). An important and interesting feature was the presence of a cut-off value for the suprabasal/total epidermal cell count ratio of 75% for Ki-67 immunostaining, which was higher in all patients having psoriasis (range, 77.1% – 92.4%) and lower in all NPPD cases (range, 21.0% – 73.3%). However, suprabasal Cyclin D1 cell counts were higher in the psoriasis group compared with the NPPD group (p < 0.05), total epidermal Cyclin D1 cell counts were not statistically significant in either group (p = 0.167), and a cut-off value for suprabasal/total epidermal cell count ratio to distinguish these two entities was not detected using this immunostain. Conclusions: We suggest that Ki-67 is a more sensitive marker than Cyclin D1 in terms of having a cutoff value of 75% for the suprabasal/total epidermal immunoreactive cell count ratio, which we believe could be useful for dermatopathologists in differentiating psoriasis from other psoriasiform dermatitis.

Oyster-shaped hyperkeratotic plaques on the penis.

A 26-year-old man presented with a one-week history of lesions on the glans penis. The patient also stated that he had recurrent episodes of genital warts, which had been electrocauterized on previous occasions. He denied trauma, medication and history of another skin disorder. Physical examination revealed remarkably thick and hard, hyperkeratotic, oyster-shaped scales adherent to multiple erythematous lesions on the glans penis. Hyperpigmented, clustered verrucous papules, which coalesced to form plaques, were also detected on the shaft of his penis (Figure 1). A shave biopsy from a hyperkeratotic lesion on the glans penis was performed; photomicrographs are presented in Figure 2A, B.

Immunoreactivity of Wilms tumor 1 (WT1) as an additional evidence supporting hemangiomatous rather than inflammatory origin in the etiopathogenesis of angiolymphoid hyperplasia with eosinophilia

Background Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare vascular proliferative disorder mainly located in the periauricular region. The etiopathogenesis of ALHE is unknown, and it is still controversial as to whether the entity represents a benign vascular neoplasm or an inflammatory process. Aim Recently, the intracytoplasmic staining pattern of Wilms tumor 1 (WT1) on immunohistochemistry has highlighted true vascular neoplasms, such as microvenular hemangioma, tufted angioma, and spindle cell hemangioma, which has made it helpful to distinguish ALHE from vascular malformations, as there is a negative staining pattern in the other entities. We aimed to investigate the immunoreactivity of ALHE specimens for WT1 as well as glucose transporter protein 1 (GLUT1) immunohistochemistry, an important and sensitive marker for the diagnosis of infantile hemangioma, which recently has been described to label other hemangiomas, such as verrucous hemangioma. Material and methods Clinical data and histopathological specimens from patients diagnosed with ALHE were reviewed, and immunohistochemical staining and microscopic analysis for WT-1 and GLUT1 were performed. Results Intracytoplasmic endothelial staining of WT1 was detected in 19 of 20 ALHE specimens. GLUT1 was not detected in any ALHE specimen. Conclusions We conclude that ALHE may represent a true hemangioma (i.e., benign vascular neoplasia) characterized by an eosinophil- and lymphocyte-rich inflammatory component as opposed to the reactive inflammatory dermatosis with a positive intracytoplasmic staining pattern for WT1. As far as we are aware, WT1 staining for ALHE has not been described to date.

Pruriginöse follikuläre Porokeratose: Korrespondenz

die Porokeratose ist eine relativ seltene Verhornungsstörung, die durch anuläre Plaques gekennzeichnet ist. Deren keratotische Ränder entsprechen histopathologisch einer kornoiden Lamelle [ 1 ] . Die follikuläre Porokeratose (FP) ist eine seltene Variante mit multifokalen kornoiden Lamellen mit einer follikulären Einheit und relativ kleinen, bräunlichen papulösen Läsionen [ 2 ] . Ein 30-jähriger Mann stellte sich mit einer einjährigen Vorgeschichte von stark juckenden, persistierenden Hautläsionen an den unteren Extremitäten vor. Der Juckreiz war so stark, dass die Lebensqualität des Patienten eingeschränkt war. Eine vorhergehende Therapie mit topischen und intraläsionalen Kortikosteroiden hatte zu keiner Besserung geführt. Sonst gab es keine weiteren medizinischen Auffälligkeiten bei dem Patienten und keine bemerkenswerte familiäre Vorbelastung. Die klinische Untersuchung der Beine ergab mehrere monomorphe, fl ache bräunliche Papeln mit Anzeichen einer randständigen und zentralen Hyperkeratose. Die Dermatoskopie zeigte eine periphere und zentrale Hyperkeratose mit gelegentlicher follikulärer Beteiligung vor einem bräunlichen, blassen strukturlosen Hintergrund mit fokalen linearen Gefäßen (Abbildung 1 ). Die Histopathologie ergab mehrere kornoide Lamellen mit follikulärer Beteiligung in allen Läsionen. Charakterisiert wurden diese durch ein säulenförmiges parakeratotisches Stratum corneum, fehlendes Stratum granulosum und apoptotische basale Keratinozyten (Abbildung 2 ). Außerdem wurde ein leichtes lymphozytäres Infi ltrat in der oberen Dermis festgestellt. Aufgrund des starken Juckreizes und der multifokalen follikulären Verteilung der kornoiden Lamellen, wurde eine pruriginöse FP diagnostiziert. Der Patient begann eine topische Therapie mit 5-Floururacil-Salbe, konnte jedoch nicht nachuntersucht werden. FP ist eine seltene Erkrankungsform; nur etwa 18 Fälle sind publiziert. Weitere seltene Varianten der Porokeratose sind die verruköse Porokeratose der Genitalien (Porokeratosis ptychotropica), eine Porokeratose, die eine Lichen planus-ähnliche Keratose imitiert, eine zosteriforme Porokeratose und eine hyperkeratotische Variante der Porokeratosis Mibelli [ 3, 4 ] . Morphologisch unterscheidet sich eine FP von Clinical Letter