Oya Oguz

The correlation of angiogenesis with metastasis in primary cutaneous melanoma: a comparative analysis of microvessel density, expression of vascular endothelial growth factor and basic fibroblastic growth factor

Aim: To establish whether there is a correlation between angiogenesis and metastasis in primary cutaneous melanoma (PCMM). Methods: We studied the microvessel density and the expression of vascular endothelial growth factor (VEGF) and basic fibroblastic growth factor (bFGF) in 22 cases of PCMM with metastasis at presentation (metastatic group) and 28 cases of PCMM without metastasis for 24 months or more (non‐metastatic group). Microvessels were stained with CD31/PECAM‐1 antibody and counted. We assessed the proportion of VEGF expression in tumour cells, lymphocytes infiltrating the tumour (TIL) and lymphocytes at the periphery of the tumour, as well as the proportion of bFGF expression in tumour cell cytoplasms, nuclei and intra‐ and peritumoral vessels. Results: An increased microvessel density was detected in the metastatic group (15–33 [24.09±5.55] versus 2–24 [12.96±6.02]). Moreover, enhanced expression of VEGF in tumour cells and peritumoral lymphocytes (Chi‐square p = 0.038 and p = 0.018) and bFGF in peritumoral vessels (&khgr;2p = 0.013) correlated with the simultaneous presence of melanoma metastasis in PCMM. Furthermore, microvessel density was correlated with the expression of bFGF in peritumoral vessels (rs = 0.53, p = 0.049) and VEGF in tumour cells (rs = 0.37, p = 0.019). Conclusion: Microvessel density as well as the expression of both VEGF and bFGF might be informative concerning the progression of melanoma.

Non-pustular palmoplantar psoriasis: is histologic differentiation from eczematous dermatitis possible?

Abstract:  The differential diagnosis of psoriasis affecting palmoplantar skin might be troublesome because of the anatomic properties of this region. Both palmoplantar psoriasis and eczematous dermatitis of this skin area share similar histologic features. The punch biopsies from 17 patients with psoriasis and 25 with eczematous dermatitis were evaluated, blind to the clinical diagnosis. Vertically situated multiple foci of parakeratosis, alternating with orthokeratosis, were the only statistically significant feature in the differential diagnosis of palmoplantar psoriasis [76.5% (13/17), p = 0.005]. In contrast, multiple foci of parakeratosis [70.6% (12/17)], loss of granular layer at least in focal areas [41.2% (7/17)], presence of neutrophils at the summits of parakeratosis [4% (1/17)], presence of neutrophils and/or plasma in the parakeratotoic foci [94.1% (16/17) and 11.8% (2/17)], psoriasiform epidermal hyperplasia [88.2% (15/17)], spongiosis restricted to the lower parts of the epidermis [47.1% (8/17)], dyskeratotic cells [82.4% (14/17)], thinning of suprapapillary plate [58.8% (10/17)], edema of the papillary dermis [29.4% (5/17)], presence of tortous and dilated capillaries in the papillary dermis [52.9% (9/17) and 76.5% (13/17)] and extravasated erythrocytes [29.4% (5/17)] were found to be more common in palmoplantar psoriasis compared with eczematous dermatitis; but none of them was statistically significant. Interestingly, spongiotic vesicles were seen in most of the patients with psoriasis [76.5% (13/17)]. In conclusion, according to our findings, many features of palmoplantar psoriasis overlapped with those of eczematous dermatitis. However, detection of multiple parakeratotic foci, placed vertically, alternating with orthohyperkeratosis, could be considered in favor of palmoplantar psoriasis.

The clinical features and histopathologic patterns of folliculotropic mycosis fungoides in a series of 38 cases

The recognition of folliculotropic mycosis fungoides (FMF) may pose diagnostic challenges, owing to the variety of histopathological findings.

Evaluation of time-dependent response to psoralen plus UVA (PUVA) treatment with topical 8-methoxypsoralen (8-MOP) gel in palmoplantar dermatoses

Background  Topical psoralen plus UVA (PUVA) is an effective treatment for localized forms of eczema, psoriasis, and palmoplantar pustulosis, which avoids some of the undesirable side‐effects of systemic psoralens.

Primary cutaneous CD30‐positive large B‐cell lymphoma associated with Epstein‐Barr virus

Because of its distinctive clinical features and histopathological characteristics, zosteriform connective tissue nevus is considered a separate entity from other connective tissue nevi. Only two cases have previously been reported in the worldwide dermatological literature. Here we report a zosteriform connective tissue nevus in a 3-year-old boy with similar clinical presentation. From the Departments of Dermatology and Pathology, Federal University of Sao Paulo,

Conjunctival involvement in familial chronic benign pemphigus (Hailey-Hailey disease)

A 25‐year‐old woman with a 1‐year history of malodorous, red, and eroded lesions in frictional sites was seen in the dermatology department. She did not give a family history of a similar condition. She had an 18‐month‐old baby and her initial complaint was of genital pruritus with profuse vaginal discharge which appeared within 2 months of delivery. She was treated for candidal vaginitis but pruritus persisted and skin lesions occurred on both sides of the groin. The lesions subsided as long as the local treatment for candidal vaginitis was continued, but recurred more than three times in a year, each time with additional and more severe lesions involving the axillae, retroauricular sites, and scalp. She received no specific treatment during this time and her complaint about the eyes was the reason she was referred to a dermatologist.

Kaposi Sarcoma Related to an Ectopic Hypothalamic Adrenocorticotropic Hormone-Secreting Adenoma: Case Report

OBJECTIVE We aim to report a case of Kaposi sarcoma (KS) with Cushings syndrome caused by endogenic glucocorticoid-induced immunosuppression. CLINICAL PRESENTATION A 43-year-old woman presented with delirium, hirsutism, fatigue, and hypertension. At the time of presentation, physical findings showed a Cushingoid appearance, with moon-like facies, hirsutism, and hyperpigmentation. Laboratory findings showed the following: adrenocorticotropic hormone, 86.7 pg/mL (normal range, 0–46 pg/mL); baseline cortisol level, 50 μg/dL (normal range, 6.2–19 μg/dL); potassium, 2.2 mEq/L (normal range, 3.5–5 mEq/L); and midnight cortisol level, 33 μg/dL. Serum cortisol levels failed to suppress after low and high doses of dexamethasone; these findings confirmed the diagnosis of ectopic adrenocorticotropic hormone production. Magnetic resonance imaging revealed a 12 × 15-mm, round, hypothalamic mass lesion in the center of the median eminence. INTERVENTION Endoscopic biopsy from the floor of the third ventricle was performed, and pathological examination of the lesion showed a diffuse adrenocorticotropic hormone-secreting adenoma. The patient developed diffuse skin lesions that were proven to be a KS by skin biopsy while she was prepared for transcranial surgery. After surgical removal of the adenoma, she became hypocortisolemic and required cortisol replacement. Within 1 month after surgery, all KS lesions disappeared spontaneously. CONCLUSION Excessive cortisol may induce immunosuppression. KS is one of the most common malignant tumors of patients with immunosuppression. To the best of our knowledge, this is the first case of Cushings syndrome with KS caused by endogenous glucocorticoid-induced immunosuppression.

Skin lesions of lymphomatoid papulosis with a white halo

To the Editor A 29-year-old woman presented with a 2-month history of pink papules surrounded by a white halo localized at the outer and inner aspects of the extremities. No lesions had arisen on any other part of the skin and they initially appeared on her upper extremities. The lesions were well-defined erythematous papules and nodules, measuring 0.5–1 cm in diameter, with a 3-mm surrounding rim of hypopigmented halo (figs 1 and 2). The central lesion did not blanch with diascopy. The halo was always present at presentation and the papules disappeared spontaneously, leaving hyperpigmented macules that persisted for 6–8 weeks. There was no depigmentation disorder such as vitiligo and there was no lymphadenopathy or hepatosplenomegaly. Systemic and internal examination exhibited no abnormalities. Her medical history did not reveal any disorders; she neither had allergic status nor a family history of atopy. The results of a complete blood cell count, liver function tests and urinalysis were normal. The lactic dehydrogenase level was slightly elevated. The histological examination of the biopsy taken from a papular lesion on the arm revealed a dense and diffuse infiltration in the upper and mid-dermis. The infiltration was composed of CD45RO+ T lymphocytes, histiocytes, sparse eosinophils as well as neutrophils (figs 3 and 4), intermingled with CD30+ large atypical cells (fig. 5). These atypical cells had large vesicular nuclei with prominent nucleoli and abundant cytoplasm. There was mild lymphoid infiltration obscuring the dermoepidermal junction in the overlying epidermis. The vasculature was prominent with swollen endothelial cells. There were rare mitotic figures within the infiltration. According to this findings, the diagnosis was established as Lymphomatoid papulosis (LyP) type A. After the biopsy, psoralen plus ultraviolet A (PUVA) treatment four sessions per week was initiated. The patients’ lesions improved after 2 months’ of therapy. She was seen at a followup visits after 8 months and had no evidence of recurrence. LyP is a recurrent cutaneous CD30+ lymphoproliferative disorder characterized by self-healing papules and nodules within

Milia in regressing plaques of mycosis fungoides: provoked by topical nitrogen mustard or not?

Objective  To report three cases of mycosis fungoides with milia formation in the regressing lesions.

The role of various immersion liquids at digital dermoscopy in structural analysis

BACKGROUND Dermoscopy is a useful method that allows dermal and epidermal structures to be easily analysed non-invasively. AIM In this study, immersion oil, which is widely used in dermoscopy, and ultrasound gel, which is less preferred, are evaluated comparatively in terms of displaying structural parameters and number of air bubbles in the image. METHODS A total of 71 nevomelanocytic or non-melanocytic pigmented lesions were taken up for this study. Structural characteristics of the obtained images were assessed by an experienced observer who scored the images in terms of color, pigment network, globule, vascular structure, number of air bubbles and other pigmentation parameters. RESULTS In the images obtained through immersion oil or ultrasound gel from all of the lesions, no statistical difference was found between the average values of air bubbles and in the evaluation of structural components (t=1.09, P=0.2). In the identification of pigment network in melanocytic lesions, immersion oil was observed to be more appropriate than ultrasound gel (t=0.01, P=0.02). CONCLUSIONS Ultrasound gel may be preferred in the assessment of mucosa and nail bed lesions. Ultrasound gel is a good alternative compared to immersion oil in pigmented skin lesions as it is cheap and easily removable.