Giuseppe Noto

Proliferating Tricholemmal Cyst Should Always Be Considered as a Low-Grade Carcinoma

Proliferating tricholemmal cyst Malignancy Carcinoma Prof. M. Aricò, Department of Dermatology, University of Palermo, Policlinico ‘P. Giaccone’, via del Vespro 131, I-90143 Palermo (Italy), Fax +39 91 6554021, E-Mail istderm@mbox.unipa.it Proliferating tricholemmal cyst (PTC) is an uncommon append-ageal skin neoplasm undergoing outer root sheath differentiation, showing a compact, abrupt tricholemmal keratinization without granular layer interposition. PTC shares this kind of keratinization with the tricholemmal cyst, with the outer root sheath at the level of the isthmus where the inner root sheath disappears, and with an infundibular sac in catagen and telogen hairs [1]. PTC may also present matrical structures with a pattern similar to that detectable in squamous carcinomas with pilar differentiation [2, 3]. Clinically, PTC usually appears as a

Multiple nevoid spiradenomas.

This report delineates a new clinical presentation of multiple benign spiradenoma (BS), a diffuse linear nevoid pattern. A 16-year-old girl, in otherwise good health, had many papulonodular lesions, varying in color from blue-gray to bright red, disposed linearly on the right half of her body, involving the periorbital region, cheek, lateral side of the neck, trunk, linea alba, right thigh, and leg. Only a few nodules were slightly painful. Lesions were reported to be present at birth; no family members had similar lesions, either in solitary or multiple form. Excisional biopsies of three lesions from the neck, abdomen, and leg, respectively, were performed; histologically, all three samples showed a picture of BS. In some areas, the tumor was directly connected to a pilosebaceous unit. Furthermore, a focal area with pilar differentiation at the periphery of the lobules was observed, which might suggest that BS can differentiate toward various cutaneous adnexal structures. Our patient probably is the first one reported with diffuse linear nevoid lesions of BS, present at birth and involving the right half of the body.

Localized crusted scabies in the acquired immunodeficiency syndrome

Crusted scabies (CrS) is an uncommon occurrence among patients with AIDS. Indeed to date only five cases have been described, all with widespread lesions. A case of localized CrS appearing as a yellowish and crusted plaque on the second right toe is reported in a woman with AIDS. Scraping off the verrucous surface, as well as punch‐biopsy revealed many mites within the horny layer. The infestation is related to the cutaneous immune response and thus CrS should be considered an opportunistic infestation in AIDS. The importance of the early diagnosis of CrS in order to prevent disseminated lesions and involvement of other health‐care workers is underlined.

Transfusion-associated graft-versus-host disease : report of two further cases with an immunohistochemical analysis

Transfusion‐associated graft‐vs.‐host disease (tGVHD) is a severe disease usually affecting immunocompromised hosts with haematological neoplasia. Two patients with acute leukaemia are reported, who developed fatal tGVHD after blood transfusions. Intercellular adhesion molecule 1 (ICAM‐1), vascular cell adhesion molecule 1 (VCAM‐1) and endothelial leucocyte adhesion molecule 1 (ELAM‐1) expression and the CD4/CD8 ratio were assessed in lesional skin. ICAM‐1 was strongly expressed on epidermal keratinocytes and endothelial cells (EC) and correlated with HLA‐DR staining. VCAM‐1 was strongly expressed on EC in the superficial dermal vessels. ELAM‐1 stained weakly on EC in some of the superficial vessels. CD8+ lymphocytes showed prominent epidermotropism; the CD4/CD8 ratio was 0.8 in case 1 and 1.2 in case 2. Infiltrating cells were positive for CD3, CD11a, and CD18. Langcrhans1 cells were almost completely absent. The dermatologist must be aware of the importance of such a rare, unexpected and almost always fatal complication of blood transfusion, in order to make an early diagnosis. Irradiation of blood products is the only effective way to prevent tGVHD in all subjects at risk.

Multifocal cutaneous leishmaniasis: a new clinical presentation of the disease.

Sir, Cutaneous leishmaniasis (CL) is an infection caused by protozoa belonging to the genus Leishmania (L.). The disease is transmitted by sandflies: Phlebotomus (P.) spp. and Lutzomyia spp. are the most frequently involved. Disease reservoirs are represented by dogs, mice, rats, wild rodents and, more rarely, humans. CL is very frequent in the Mediterranean Basin, especially in Sicily. L. infantum, transmitted by P. pappatasi, P. perfiliewi and P. perniciosus, is responsible for all cases observed in Sicily. From the clinical point of view, CL in the Mediterranean Basin is usually characterized by a single, polymorphous lesion located on exposed areas, in particular the face, followed by the upper limbs. In the last few years, we have observed several patients with CL characterized clinically by multiple, monomorphous, slightly inflammatory, papular or papulo-nodular lesions. Some of these lesions appeared as “twin lesions”. We believe that this presentation represents a new clinical variety of CL, which has been called “multifocal CL” by other authors (1–3). The hypothesis of a new carrier involvement is advanced.

Reticulate postinflammatory hyperpigmentation with band-like mucin deposition.

Background Mucinoses of the skin are a group of disorders sharing accumulation of mucin in the skin or hair follicles. Postinflammatory hyperpigmentation, with pigmentary incontinence, is due to loss of melanin from epidermal basal cells and its accumulation in dermal macrophages.

Increased SS bonds in chronic solar elastosis: a study with N-(7-dimethylamino-4-methyl-3-coumarinyl) maleimide (DACM) stain

We have studied the distribution of SH groups and SS linkages in solar elastosis, in comparison with that in aged and juvenile sun-unexposed skin, using N-(7-dimethylamino-4-methyl-3-coumarinyl) maleimide (DACM) stain. In heavy solar elastosis we found increased fluorescence for SS bonds in the upper and middle reticular dermis in the elastotic masses; these were separated from the epidermis by a network of actinically-damaged, SS-positive elastic fibers, showing irregularly and variously interwoven oxytalan and elaunic fibers. These latter, unlike the elastotic masses, revealed also SH groups. In moderate and weak elastosis, where the thick irregular masses were absent, the fluorescence for SH and SS linkages was present in equal proportions in the altered elastic fibers; collagen bundles revealed only fluorescence for SS bonds. Aged and juvenile sun-unexposed skin showed the same proportions of SH and SS linkages in the changed elastic fibers. Collagen bundles of aged and juvenile skin showed fluorescence for SS bonds; SH groups were present on a few collagen fibers only in aged skin. Our results are consistent with opinion supporting an elastic origin of elastotic degeneration, which could be the consequence of a defect, due to chronic solar exposure, in one of the steps--degradation or synthesis--of metabolic turnover of elastic fibers, resulting in abnormal and excessive polypeptide chains extremely rich in disulfide bonds.

Lack of Antiandrogenic Effects of Topical Bifonazole on Sebaceous Glands and Hairs in the Hamster Flank Organ

The activity of topically applied bifonazole was evaluated in vivo in the three androgen-dependent structures of the hamster flank organ, i.e. the pigmented spot, sebaceous glands and hairs. Topical bifonazole in our experience did not demonstrate any morphological effect on sebaceous gland and hair even when applied in the dosage of 3 mg/cm2/day. On the basis of our morphometric results we can conclude that topically applied bifonazole does not interfere with cutaneous androgen metabolic transformations in the pilosebaceous unit of the flank organ.

The wild taxa utilized as vegetables in Sicily (Italy): A traditional component of the Mediterranean diet

BackgroundWild vegetables in the Mediterranean Basin are still often consumed as a part of the diet and, in particular, there is a great tradition regarding their use in Sicily.In this study, an ethnobotanical field investigation was carried out to (a) identify the wild native taxa traditionally gathered and consumed as vegetables in Sicily, comparing the collected ethnobotanical data with those of other countries that have nominated the Mediterranean diet for inclusion in the UNESCO Representative List of the Intangible Cultural Heritage of Humanity and (b) highlight new culinary uses of these plants.MethodsInterviews were carried out in 187 towns and villages in Sicily between 2005 and 2015. A total of 980 people over the age of 50 were interviewed (mainly farmers, shepherds, and experts on local traditions).Plants recorded were usually collected in collaboration with the informants to confirm the correct identification of the plants. The frequencies of citation were calculated.ResultsTwo hundred fifty-three taxa (specific and intraspecific) belonging to 39 families, and 128 genera were recorded (26 were cited for the first time). The most represented families were Asteraceae, Brassicaceae, Apiaceae, Amaryllidaceae, Malvaceae, and Polygonaceae. Only 14 taxa were cited by 75% of the people interviewed.The aerial parts of wild plants, including leaves, tender shoots, and basal rosettes, are the main portions collected, while the subterranean parts are used to a lesser extent. For some vegetables, more parts are utilized. Most of the reported vegetables are consumed cooked.In addition to the widely known vegetables (Borago officinalis, Beta spp., Cichorium spp., Brassica spp., Carduus spp., etc.), the so-called ancient vegetables are included (Onopordum illyricum, Centaurea calcitrapa, Nasturtium officinale, Scolymus spp., Smyrnium rotundifolium), and some unique uses were described.Comparing the Sicilian findings to those from other countries, a very high number of vegetable taxa were detected, 72 of which are eaten only in Sicily, while 12 are consumed in all the Mediterranean countries examined.ConclusionsThe research shows a high level of Sicilian knowledge about using wild plants as a traditional food source. Wild vegetables are healthy and authentic ingredients for local and ancient recipes, which are fundamental to the revitalization of quality food strictly connected to traditional agroecosystems.

Morphea-like cutaneous mucinosis

Abstract A whitish, indurated, oval plaque, lasting for 1.5 year, was observed in the right paraumbilical skin of a middle-aged man in otherwise good health. No erythema was present or referred. Histological examination revealed massive deposits of a globular, slightly basophilic, amorphous substance in the dermis, accompanied by a slight perivascular mononuclear cell infiltrate and scattered mast cells. Special staining with Alcian blue at pH 2.5 confirmed the intense deposition of mucin involving the entire dermis, sparing epidermis, adnexa and perivascular areas. No abnormal laboratory results indicating lupus erythematosus or thyroid dysfunction were present. Morphea was excluded on clinical and histological grounds. A plaque-like form of cutaneous mucinosis was diagnosed. Plaque-like mucinosis and reticular erythematous mucinosis (REM) syndrome are currently considered to be the same disease, although some authors noted a different response to treatment. Clinical presentation of our case was unusual: no erythema preceded or accompanied the plaque growth, which had a whitish, indurated, morphea-like appearance from the beginning but with preservation of hair follicles, quite different from archetypical REM syndrome based on clinical grounds.