Laura A. Taylor

Histological immune response patterns in sentinel lymph nodes involved by metastatic melanoma and prognostic significance

To further characterize the micromorphometric immunological pattern to metastatic melanoma in sentinel lymph node (SLN) biopsies and completion lymph node (CLN) dissections and their relation to 5‐year overall survival (OS).

High ALDH1 expression correlates with better prognosis in tumorigenic malignant melanoma

Aldehyde dehydrogenase 1 (ALDH1) has been proposed as biomarker of stem cells for certain human cancers. ALDH1 expression has been correlated with poor patient outcomes in a variety of malignancies but better patient outcomes in others, and its prognostic significance in malignant melanoma is unclear. Thus, 68 melanoma patients with comprehensive clinical and pathologic follow-up data were used to construct a tissue microarray. A modified histological score (H-score) with a maximum score of 300 was used to quantify immunohistochemical staining for ALDH1. Survival time was defined as the time between diagnosis and melanoma-specific death. Using univariate logistic regression, a low (<80 H-score) ALDH1 score showed 3.7-fold increase in risk for melanoma-specific death within 10 years when compared with high (>80) ALDH1 levels (P=0.017). Odds of MSD were lower by a factor of ~0.9 for each 10-point increase in H-Score. Median survival time was 44.1 months and 180.9 months for patients with low and high ALDH1 expression, respectively. Using multivariate analysis, ALDH1 H-score was found to be an independent prognostic factor. These findings suggest that ALDH1 expression in malignant melanoma has a favorable effect on patient survival. Further study is needed elucidate the function of this enzymatic protein in melanoma progression.

Leishmania tropica: Combined debulking and imiquimod for the treatment of nonresponsive cutaneous leishmaniasis

THERAPEUTIC CHALLENGE OldWorld Leishmania infection is typically a self-limiting disease with therapies such as fluconazole and liposomal amphotericin offered occasionally to speed healing, reduce scarring, limit complications, or a combination of these. Nevertheless, some individuals may have lesions that are not selfhealing or responsive to standard treatments (Figs 1 and 2). Although topical and intralesional therapies exist, such as intralesional pentamidine isethionate, many are not available in the United States. Thus, other options may be sought.

Atypical retiform hemangioendothelioma arising in a patient with Milroy disease: a case report and review of the literature

Retiform hemangioendothelioma (RH) is a rare vascular neoplasm with a high rate of local recurrence and low metastatic potential. We describe an unusual case of RH in a 45‐year‐old patient with Milroy disease, with a prominent solid component diffusely involving a chronic lymphedematous leg. This case is consistent with the postulated relationship between lymphedema and vascular neoplasms developing as a result of local immune dysfunction, and highlights the need to closely monitor patients with Milroy disease for pathologic changes. Our case highlights a unique example of RH with atypical features. There are several noteworthy unusual clinical and histologic findings including diffuse involvement of an entire limb, solid component with cytologic atypia, D2‐40 expression, and first‐time‐reported association with Milroy disease. Given the atypical histologic presentation of cytologic atypia, solid areas and atypical immunohistochemical profile with D2‐40 positivity, this case could cause diagnostic difficulty, especially in the setting of such a broad clinical differential.

Isolated subcutaneous sarcoid-like granulomatous inflammation occurring at injection sites: 3 patients treated successfully with minocycline

INTRODUCTION Subcutaneous sarcoidosis is a rare manifestation of systemic sarcoidosis in which firm asymptomaticto-tender subcutaneous nodules develop secondary to sarcoidal granulomas involving the panniculus. Sarcoidosis implies systemic disease, but subcutaneous lesions may present with absent or mild systemic involvement. Here we report 3 cases of isolated subcutaneous nodules with sarcoidal granulomas after subcutaneous injections that improved after treatment with minocycline.

The utility of adaptive eLearning in cervical cytopathology education

Adaptive eLearning allows students to experience a self‐paced, individualized curriculum based on prior knowledge and learning ability.

HER3 Expression Is a Marker of Tumor Progression in Premalignant Lesions of the Gastroesophageal Junction

Overexpression of receptor tyrosine kinases (RTK), including members of the HER family, has prognostic and therapeutic significance in invasive esophagogastric carcinoma. RTK expression in premalignant gastroesophageal lesions has not been extensively explored. Formalin-fixed paraffin-embedded tissue samples of esophageal biopsy specimens from 73 patients with Barrett’s esophagus with either low-grade dysplasia (LGD) (n = 32) or high-grade dysplasia (HGD) (n = 59) were analyzed for HER1, HER2, HER3 and CMET expression by immunohistochemistry (IHC). Immunophenotype was correlated with histologic and clinical features. High-grade dysplasia (HGD) was associated with overexpression of HER1 (20.7% vs. 3.1%, p = 0.023), HER2 (5.3% vs. 0.0%, p = 0.187) and HER3 (47.4% vs. 9.4%, p<0.001) compared to low-grade dysplasia (LGD). There was a significant association of HER2 (20.0% vs. 2.1%, p = 0.022) and HER3 (80.0% vs. 40.4%, p = 0.023) overexpression in HGD lesions associated with foci of invasive carcinoma compared to those without invasive foci. Overexpression of CMET was observed in 42.9% of specimens, was increasingly observed with HGD compared to LGD (58.3% vs. 36.7%, p = 0.200), and was most often co-expressed with HER3 (62.5% of HER3-positive specimens vs. 38.2% of HER3-negative specimens, p = 0.212). In summary, HER3 is frequently overexpressed in high-grade dysplastic lesions of the gastroesophageal junction and may be a marker of invasive progression. These data provide rationale for targeting HER2 and HER3 pathways in an early disease setting to prevent disease progression.

Cryptococcal cellulitis in a heart transplant recipient

Cryptococcosis is an invasive fungal infection most often caused by the encapsulated yeasts Cryptococcus neoformans and Cryptococcus gattii. C neoformans is the major pathogenic member of the genus, thought to account for approximately 80% of isolates worldwide, and is found in pigeon droppings, soil, and rotting vegetation.1 The incidence in the United States is approximately 5 cases per 100,000.2 However, the global burden is much more significant, with more than 1 million new cases and more than 600,000 deaths a year.3 Most patients with cryptococcosis are immunocompromised because of HIV infection, immunosuppressive therapy, or malignancy. Although cryptococcal infections begin in the lungs via inhalation of the basidiospore, the classical clinical manifestation is meningoencephalitis. Nonmeningeal, nonpulmonary symptoms are less common and generally reflect disseminated disease. Cutaneous manifestations are seen in approximately 15% of patients with systemic cryptococcosis and can have a variety of presentations, including papules, plaques, and ulcers.4 Here we present an uncommon case of cutaneous cryptococcosis presenting as cellulitis in a heart transplant recipient.