Gül Erkin

Cutaneous mastocytosis : demographic aspects and clinical features of 55 patients

Background  Mastocytosis is a rare, heterogeneous group of disorder with abnormal increase of mast cells in one or more organ systems.

Effect of PUVA, narrow-band UVB and cyclosporin on inflammatory cells of the psoriatic plaque

Background:  Because antigen presenting is necessary for T‐cell activation, antigen‐presenting cells should be involved in the pathogenesis of psoriasis. In this study, our purpose was to evaluate and compare effects of PUVA, cyclosporine A and narrow‐band UVB on dendritic cells and activated lymphocytes in the psoriatic lesions.

A case of lupus vulgaris successfully treated with antituberculous therapy despite negative PCR and culture

A 14-year-old boy presented with a pink firm plaque with well-defined borders in the right infra-orbital skin area. On diascopy, the infiltrate exhibited a typical apple-jelly appearance. No acid-fast bacilli could be demonstrated. A polymerase chain reaction (PCR) assay did not reveal the presence of mycobacteria in a lesional biopsy sample. Culture of biopsied tissue on Loewenstein-Jensen medium was negative. Although the tuberculosis culture and PCR did not confirm tuberculosis, a diagnosis of lupus vulgaris was made considering the clinical and histopathological findings. After a 9-month antituberculous therapy, the lesion disappeared. We believe that a diagnosis of lupus vulgaris still depends more on clinical and histopathological findings than on tuberculosis culture or PCR.

Sweet's syndrome and erythema nodosum: a companionship or a spectrum?--a case report with review of the literature.

A 47-year-old woman presented to the emergency department with an eruption of 4 days’ duration. The eruption started on the face, neck, and hands. Later, lesions appeared on the arms and legs, accompanied by arthralgia. She had a 9-day history of an upper respiratory tract infection for which she was prescribed levofloxacin and acetaminophen. She recalled that she had also used dipyrone during the prodromal phase of the infection. In addition, she had suffered from vitiligo for 20 years, together with hypertension, hyperlipidemia, and fibromyalgia. Dermatologic examination revealed the following: on the face, ears, and ‘V’ region and back of the neck, erythematous and highly edematous papules and plaques, some of which were pseudovesicular (Fig. 1); at the extensor surfaces of the arms, erythematous, pustular papules and plaques with some dusky red centers, resembling target lesions; at the dorsal and palmar surfaces of the hands, painful, highly edematous plaques, some of which were also targetoid, and multiple separate tiny pustules; at the anterior aspects of the legs, 10–20 pale, erythematous, painful, indurated nodules (Fig. 2), accompanied by similar lesions on the sides of the thighs and on the dorsum of the left foot. All other aspects of the dermatologic examination, including the oral mucosa, scalp, and nails, were normal, except for the depigmented macules and patches on the dorsal surfaces of the hands and volar surfaces of the wrists, which were consistent with vitiligo. The rest of the physical examination was normal. There was no lymphadenopathy. The liver function tests were normal. She had leukocytosis [20.6 · 10/L; normal, (4–10) · 10/L], with a neutrophilic predominance of 78% in the peripheral smear, and an elevated C-reactive protein level (5.35 mg/ dL; normal, 0–0.8 mg/dL) and sedimentation rate (96 mm/h; normal, 0–20 mm/h). She had anemia with a hemoglobin level of 10 g/dL (normal, > 12 g/dL for females). She was hospitalized and systemic corticosteroid therapy was initiated with the clinical diagnosis of Sweet’s syndrome. All samples, including an excisional skin biopsy obtained from one of the lesions on the leg and punch biopsies taken from the neck and from one of the

Clinical and histopathological response to acitretin therapy in lipoid proteinosis.

Abstract Lipoid proteinosis (LP) is a rare autosomal recessive genodermatosis associated with deposition of periodic acid-Shiff (PAS)-positive hyaline material in skin, mucosa, and other tissues. LP is caused by loss-of-function mutations in the extracellular matrix protein 1 gene (ECM1). No curative therapy is available. In this report, we describe the clinicopathological and genetic features of a Turkish LP family with four cases, and evaluate the response of acitretin therapy. Patients were presented with hoarseness and beaded eyelid papules, thickened frenulum, hyperkeratotic plaques and infiltrated warty papules and nodules. Skin biopsies revealed deposition of PAS-positive hyaline material in dermis. A homozygous nonsense mutation in exon 3 of the ECM1 gene, R53X, was detected in the family. Acitretin therapy was administered in two patients, in whom some regression and softening of skin lesions were achieved. However, no histopathological change in PAS-positive deposition could be detected. Although there is no current effective treatment for LP, acitretin may be helpful for patients, especially those who complain about hyperkeratosis.

Acute generalized exanthematous pustulosis induced by bleomycin and confirmed by patch testing

Acute generalized exanthematous pustulosis is a potentially severe disease caused by drugs in about 90% of cases. To the best of our knowledge, acute generalized exanthematous pustulosis following use of bleomycin has not been previously reported. Here we report a case of acute generalized exanthematous pustulosis induced by bleomycin, which was confirmed by patch testing.

Nevus-Associated versus de novo Melanoma: Do They Have Different Characteristics and Prognoses?

Aim: The aim of this study was to determine if nevus-associated melanoma differs in characteristics and prognosis from de novo melanoma. Patients and Methods: The study included 118 melanoma patients. Clinical findings were retrospectively evaluated. For histopathological parameters, HE sections were reexamined. The differentiation between de novo and nevus-associated melanoma was based on the histopathological evidence of a precursor nevus. In addition, all analyses were repeated in all cases in which nevus-associated melanoma was defined based on patient anamnesis. Results: Among all patients, 28 (23.7%) had nevus-associated melanoma. Nevus-associated melanoma was most commonly located on the extremities (50%), followed by the trunk (25%), whereas de novo melanoma was most commonly located in the head and neck region (32.2%), followed by the acral region (31.1%). Other clinical findings and histopathological parameters did not differ significantly between the two groups (p > 0.05). The findings remained consistent following the repeated analysis of all cases in which nevus-associated melanoma was defined based on patient anamnesis. Conclusions: Nevus-associated melanoma was most commonly located on the extremities and the trunk, whereas de novo melanoma was most commonly located in the head and neck and the acral region. Furthermore, nevus-associated melanoma was similar to de novo melanoma in terms of prognosis and other disease characteristics.

Long-term follow-up of early mycosis fungoides patients treated with narrowband ultraviolet B phototherapy

Background: Narrowband ultraviolet B (UVB) provides complete response (CR) in 54–91% of early mycosis fungoides (MF) patients. Data concerning relapse rate and relapse-free interval after discontinuation of therapy need clarification. The purpose of this study was to evaluate the relapse rate and the relapse-free intervals of early MF patients after achieving complete response with narrowband UVB phototherapy. Methods: Retrospective evaluation of data, which belong to early MF patients treated with narrowband UVB phototherapy between May 2000 and July 2010, and followed-up until May 2012 in a single institution, for the occurrence of relapse and the time to relapse. Results: Of 31 patients, who were followed-up for a mean of 56.5 ± 30.2 months (median 55 months, range 20–120 months), relapse was observed in 11 (35.5%) patients, within a mean of 28.8 ± 18.2 months (median 33 months, range 4–59 months), whereas 20 (64.5%) patients stayed relapse-free for a mean of 54.2 ± 28.8 months (median 55.5 months, range 20–119 months). Patients received maintenance phototherapy with a median duration of 12 months (range 1–30 months) after achieving complete response. Conclusion: Results indicate that narrowband UVB phototherapy may induce low relapse rates and long relapse-free intervals for early MF.

Slowly Growing Nodule on the Trunk: Cutaneous Granular Cell Tumor.

Granular cell tumor (GCT) is a rare benign neoplasm of the skin that accounts for 0.5% of all soft-tissue tumors. The tumor mostly presents with a symptomatic slowly growing solitary nodule and overlying normal skin; therefore, it is not always considered in the differential diagnosis. Here, we report a 58-year-old female patient who presented with a 4-year history of a slowly growing mass, with a dimension of 5 × 4 cm on her left waist, diagnosed as a GCT at the histopathological examination. The neoplastic cells had centrally located nuclei and granular eosinophilic cytoplasm and stained positively for S100, neuron-specific enolase, and CD68 antibodies. Fifteen months after surgery, the patient still showed no signs of local recurrence or metastases. Although a large diameter is a feature of malignant GCT, our case with cutaneous GCT was localized on the trunk and did not present malignant features clinically and histopathologically.

Comparison of Growth Hormone Receptor, IGF-1R and IGFBP-3 Between Tumoral and Non-Tumoral Areas in Non-Melanoma Skin Cancers Melanositik Olmayan Deri Kanserlerinde Tümöral ve Peritümöral Alanlardaki Büyüme Hormonu Reseptörü, İnsülin Benzeri Büyüme Faktörü-1 Reseptörü ve İnsülin Benzeri Büyüme Faktörü Bağlayici Protein-3'ün Karşilaştirilmasi

Abstract Objective: A relationship between the pathogenesis of some cancers and growth hormone, insulin-like growth factor-1 and insulin-like growth factors binding protein-3 has been shown. Our aim was to evaluate the expression of growth hormone receptor, insulin-like growth factor-1 receptor and insulin-like growth factors binding protein-3 in actinic keratosis, basal cell carcinoma and squamous cell carcinoma, and to compare the expression patterns of tumoral areas with normal epidermis and skin appendages. Material and Method: The formalin-fixed, paraffin-embedded tissues of 40 patients which were diagnosed as 15 actinic keratosis, 15 basal cell carcinoma and 15 squamous cell carcinoma were analyzed for growth hormone receptor, insulin-like growth factor-1 receptor and insulin-like growth factors binding protein-3 with the immunohistochemical method using the streptavidin-biotin-peroxidase technique. Results: There was no difference between tumoral areas of actinic keratosis, basal cell carcinoma and squamous cell carcinoma in expression of growth hormone receptor and insulin-like growth factors binding protein-3 (P>0.05). However, a significantly higher expression of insulin-like growth factor-1 receptor was observed in tumoral areas of squamous cell carcinoma (P<0.01). In basal cell carcinoma, a significantly lower intensity of immunostaining with growth hormone receptor, insulin-like growth factor-1 receptor and insulin-like growth factors binding protein-3 in tumoral areas than skin appendages was seen (P <0.01). In squamous cell carcinoma, higher expressions of growth hormone receptor, insulin-like growth factor-1 receptor and insulin-like growth factors binding protein-3 in tumoral areas than peritumoral epidermis was found (P =0.06, P <0.01 and P =0.02, respectively). Conclusion: Our study points out that, growth hormone receptor, insulin-like growth factor-1 receptor and insulin-like growth factors binding protein-3 have a role in the pathogenesis of non-melanoma skin cancers, especially squamous cell carcinoma. Öz Amac: Buyume hormonu, insulin benzeri buyume faktoru-1 ve insulin benzeri buyume faktoru bağlayıcı protein-3 bazı kanserlerin patogenezi ile ilişkili bulunmuştur. Aktinik keratoz, bazal hucreli karsinom veya skuamoz hucreli karsinomda buyume hormon reseptoru, insulin benzeri buyume faktoru-1 reseptoru ve insulin benzeri buyume faktoru bağlayıcı protein-3 ekspresyonunun belirlenmesi ve tumoral alanların ekspresyon ozelliklerinin normal epidermis ve deri ekleriyle karşılaştırılması amaclandı. Gerec ve Yontem: Kırk hastaya ait formaldehitle fikse edilmiş, parafine gomulmuş aktinik keratoz (n=15), bazal hucreli karsinom (n=15) ve skuamoz hucreli karsinom (n=15) tanısı almış doku ornekleri streptavidin- biotin-peroksidaz tekniği kullanılarak immunohistokimyasal metodla buyume hormon reseptoru, insulin benzeri buyume faktoru-1 reseptoru ve insulin benzeri buyume faktoru bağlayıcı protein-3 varlığı acısından incelendi. Bulgular: Calışmamızda, aktinik keratoz, bazal hucreli karsinom ve skuamoz hucreli karsinomun tumoral alanları arasında buyume hormon reseptoru ve insulin benzeri buyume faktoru bağlayıcı protein-3 ekspresyonu acısından anlamlı fark bulunmazken (P>0.05); insulin benzeri buyume faktoru-1 reseptoru ile skuamoz hucreli karsinomda tumoral alanlarda anlamlı olarak daha fazla ekspresyon izlendi (P<0.01). Bazal hucreli karsinomda buyume hormon reseptoru, insulin benzeri buyume faktoru-1 reseptoru ve insulin benzeri buyume faktoru bağlayıcı protein-3 ile tumoral alanların deri eklerinden anlamlı olarak daha az şiddette boyandığı goruldu (P<0.01). Skuamoz hucreli karsinomda tumoral alan buyume hormon reseptoru, insulin benzeri buyume faktoru-1 reseptoru ve insulin benzeri buyume faktoru bağlayıcı protein-3 ile peritumoral epidermisten daha fazla şiddette boyanma gosterdi (sırasıyla P=0.06, P <0.01 ve P =0.02). Sonuc: Calışmamız buyume hormon reseptoru, insulin benzeri buyume faktoru-1 reseptoru ve insulin benzeri buyume faktoru bağlayıcı protein-3’un melanositik olmayan deri kanserlerinde ve ozellikle skuamoz hucreli karsinomda patogenezde rolu bulunduğunu gostermektedir.