Gustavo Henrique Soares Takano

Aspectos dermatoscópicos do siringocistoadenoma papilífero associado a nevo sebáceo

Syringocystadenoma papilliferum is a rare benign adnexal tumor that frequently shows apocrine differentiation. It usually develops on the scalp and is associated with a nevus sebaceus in 40% of cases. Although the clinical presentation may differ, its histology is characteristic. Reports have been made of dermoscopy used in cases of adnexal tumors such as eccrine poromas, hidradenomas and angiohistiocytomas; however, up to the present moment there have been no reports of dermoscopy in a case of syringocystadenoma. This paper describes the dermoscopic features found in a case of syringocystadenoma associated with a nevus sebaceus, revealing a polymorphous vascular pattern including a horseshoe-shaped arrangement of vessels.

Mosaic epidermolytic ichthyosis - case report

Epidermolytic ichthyosis is a rare autosomal dominant disease that manifests at birth with fragile blisters and erosions that evolve into hyperkeratotic lesions associated or not with erythroderma. When the disease is associated with a mutation in cytokeratin 1, it may be related to hyperkeratosis of palms and soles, but this is not usually found when cytokeratin 10 is mutated. The disease can present in a mosaic form, due to post zygotic mutation of the gene involved, constituting an individual formed by two populations of genetically distinct cells - one carrier of the mutation and the other without it. We report a case of mosaic epidermolytic ichthyosis diagnosed in a female patient.

Ineficácia in vivo da terbinafina em leishmaniose cutânea causada por Leishmania (Leishmania) amazonensis em camundongos C57BL/6

The efficiency of terbinafine was tested in C57BL/6 mice inoculated with the Leishmania (Leishmania) amazonensis strain MHOM/BR/PH8. The mice were administered: terbinafine at a dose of 100mg/kg/d by via oral; 0.9% saline solution orally as the control; and subcutaneous sodium stibogluconate 400mg SbV/kg/d as gold standard, for 20 days. Terbinafine was demonstrated to be ineffective when compared to the controls, using clinical and parasitological parameters and the limiting dilution assay.The efficiency of terbinafine was tested in C57BL/6 mice inoculated with the Leishmania (Leishmania) amazonensis strain MHOM/BR/PH8. The mice were administered: terbinafine at a dose of 100mg/kg/d by via oral; 0.9% saline solution orally as the control; and subcutaneous sodium stibogluconate 400mg SbV/kg/d as gold standard, for 20 days. Terbinafine was demonstrated to be ineffective when compared to the controls, using clinical and parasitological parameters and the limiting dilution assay.

Amelanotic metastatic cutaneous melanoma

Dermatoscopy of melanocytic lesions has guided the decision of when or not to biopsy a lesion. The use of this tool has increased clinical examinations sensitivity and specificity in 89% and 96% respectively. However, dermatoscopic evaluation of amelanotic or hypomelanotic melanomas, as well as metastases, can be difficult. There is still no standardization for the analysis of these pathologies, which relies mostly on their vascular pattern. We describe the dermatoscopy of acral metastatic amelanotic melanoma.

A generalized Blaschko linear congenital eruption

tions were also stained with anti-Ki-67 (Dako, Clone MIB-1) and MCPyV LTA (CM2B4). Additional IHC staining for SSTR2 (UMB-1) and SSTR5 (UMB-4) expressions was performed in all cases as recommended previously by K€ orner et al. The response ‘1+’ was consistent with the low level of immunoreactivity and ‘0’ – the absence of expression. The values ‘2+ or 3+’ corresponded to the medium and high levels of expression. Group 1 included 14 (44%) patients (4 pts + 10 pts, respectively), who had an expression value of 0 or 1+. Group 2 included 18 (56%) patients (8 pts + 10 pts, respectively), who had an expression value of 2+ or 3+. For PFS evaluation, patients with stage IV were excluded from analysis. PFS evaluation for stages I-III revealed a significant difference between the groups (Fig. 1a). For the group 1 (n = 13), median of PFS was 8.18 months (95% CI, 4.6–11.6), while in the group 2 (n = 15), it was 33.4 months (95% CI, 25.5–41.3), P = 0.004. PFS analysis for stages I–II also identified differences in PFS between the group 1 (n = 12) and group 2 (n = 10) (Fig. 1b). The median PFS was 6.2 months (95% CI, 2.7–9.7) and 50 months (95% CI, 15.8– 84.9), respectively, P = 0.01. SSTR5 expression was completely absent in the majority (28/32; 87.5%) of the investigated cases. MCPyV expressed in 69% cases. SSTRs status was not correlated with MCPyV. Other factors, such as age, level of ki-67, the presence of the MCPyV, did not affect the results of the study. Expression of the MCPyV LTA was associated with a better prognosis, but the data were not statistically significant (PFS for stages I–III, groups 1 and 2, was 12 months and 29 months, respectively, P = 0.05). This study was approved by the Research Council of the N. N. Blokhin Russian Cancer Research Center. One of the limitations of our study is the orphan disease status of MCC: it comprises of a limited number of patients; nevertheless, to the best of our knowledge, this is the largest cohort of MCC patients studied by IHC for SSTR2 and SSTR5 to date and we need to accumulate evidence in orphan disease. This work was supported by N. N. Blokhin Russian Cancer Research Center. K.V. Orlova,* V.V. Delektorskaya, Y.V. Vishnevskaya, T.T. Kondratieva, N.F. Orel, A.A. Markovich, L.V. Demidov, S. Subramanian Department of Biotherapy, N. N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation, Department of Pathology, N. N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation, Department of Chemotherapy, N. N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation, EAFO Educational & Research Center, Eurasian Federation of Oncology, Moscow, Russian Federation *Correspondence: K.V. Orlova. E-mail: krisman03@gmail.com

PD-L1 MAY MEDIATE T CELL EXHAUSTION IN A CASE OF EARLY DIFFUSE LEISHMANIASIS CAUSED BY LEISHMANIA (L.) AMAZONENSIS

Introduction Diffuse cutaneous leishmaniasis (DCL) is a rare disease form associated with Leishmania (L.) amazonensis in South America. It represents the “anergic” pole of American Tegumentary Leishmaniasis, and the explanation for its resistance to treatment remains elusive. We aimed to study some possible immunological mechanisms involved in the poor DCL treatment response by evaluating some cell surface molecules obtained from a patient with DCL by flow cytometry. Case presentation A 65-year-old DCL patient who initially failed to respond to the standard treatment for the disease showed vacuolated macrophages filled with amastigotes in lesion biopsy, and L. (L.) amazonensis was identified through ITS1PCR amplification. The Leishmania skin test and indirect immunofluorescence analysis revealed negative results. Peripheral blood from the patient was collected after a few months of treatment, when the patient presented with no lesion. Peripheral blood mononuclear cells were analyzed ex vivo and in vitro after 48 h of stimulation with soluble L. (L.) amazonensis antigen (SLA). Cell death, surface molecules, and intracellular molecules, such as IFN-γ and granzyme B, were analyzed in the cells using flow cytometry. Analysis of the surface markers showed an increased expression of the inhibitory molecule programmed death ligand 1 (PD-L1) in the monocytes restimulated with SLA (approximately 65%), whereas the negative controls were 35% positive for PD-L1. Conversely, compared with the negative controls, we observed a decrease in CD4+IFN-γ+ T cells (8.32 versus 1.7%) and CD8+IFN-γ+ T cells (14% versus 1%). We also observed a relevant decrease in the granzyme B levels in the CD8+ T cells, from 31% in the negative controls to 5% after SLA restimulation. Conclusion The dysfunctional activation of PD-L1 inhibitory pathway after Leishmania antigen stimulation and reduced levels of IFN-gamma and granzyme B-producing cells could be closely related to unresponssiveness to standard drug treatment of DCL patient.

Wade’s histoid leprosy in a 14-year-old teenage boy

Wades histoid leprosy (HL) is a rare variant of multibacillary leprosy, with characteristic clinical, immunologic, histopathologic, and bacteriologic features. It is associated with resistance to sulfa drugs or polychemotherapy and is rarely observed in patients who have not undergone prior treatment. Clinically, HL resembles keloid or dermatofibroma. Furthermore, HL is rare in children and is difficult to diagnose even by experts. This report describes a case of HL in a 14-year-old Brazilian boy, who presented with multiple nodular and tumor-like lesions, simulating keloids. He had not undergone prior treatment with anti-leprosy drugs, which accentuates the relevance of this case report.

A panel of markers for identification of malignant and non-malignant cells in culture from effusions

The aim of the present study was to identify cell types in primary culture from malignant and non-malignant effusions. Effusion samples were subjected to cytology and culture. Immunocytochemistry was performed in cytological slides to evaluate malignancy (positivity for malignancy markers) and in culture slides for identification of cell types in growth. A total of 143 effusion samples (pleural n=76; peritoneal n=37; pericardial n=4; and peritoneal lavage n=26) were analyzed. Cell growth was observed in 34.9% of all samples and immunocytochemistry for identification of cell types in culture slides was conclusive in 90% of them. In non-malignant samples (n=28), growth of mesothelial cells, macrophages and of both cell types was identified in 82.14, 10.71 and 7.14%, respectively. In malignant samples (n=17, all carcinomas), growth of malignant epithelial cells and of both malignant epithelial and mesothelial cells was identified in 41.17 and 23.52%, respectively. In the remaining 35.29% of malignant samples, the only cells in growth were mesothelial and/or macrophages instead of malignant epithelial cells. In conclusion, in culture of malignant effusions, mesothelial cells may be simultaneously identified with malignant epithelial cells. Besides, mesothelial cells and macrophages may be the only cells identified in malignant effusion culture. Therefore, a broad panel of cell markers should be used for unmistakable identification of cells in studies of effusion primary culture. The ideal malignant effusion sample to obtain culture of neoplastic cells should be that without the presence of mesothelial cells and macrophages.

Cytological diagnosis of paracoccidioidomycosis: A report of four cases

Paracoccidioidomycosis (PCM) is a common deep mycosis in South America caused by Paracoccidioides brasiliensis, a dimorphic fungus. Biopsy is the most frequent diagnostic method. The aim of this article is reporting four cases of PCM, in which intraoral involvement simulated squamous‐cell carcinoma and was diagnosed by exfoliative cytology. We highlight this diagnostic tool as a simple, low cost, painless, noninvasive, and fast diagnostic method for PCM. Diagn. Cytopathol. 2013;41:374–376.

Expression of laminin-5 γ2 chain in cutaneous pseudocarcinomatous hyperplasia

Background: Since the use of laminin‐5 as a marker of invasiveness has been proposed by several authors, our objective was to compare the expression of this protein in pseudocarcinomatous hyperplasia and squamous cell carcinoma (SCC).