Wolfgang Jurecka

Increased dermal angiogenesis after low-intensity laser therapy for a chronic radiation ulcer determined by a video measuring system

Acute and chronic radiation-induced dermatitis can occur after high doses of ionizing radiation of the skin. We describe a patient with a long-lasting radiotherapy-induced ulcer that healed after low-intensity laser therapy. A video measuring system was used to determine the number of dermal vessels in the ulcer before and after laser treatment. We found a statistically significant increase in the number of dermal vessels after low-intensity laser therapy in both the central and marginal parts of the ulcer compared with its pretreatment status.

Immunoreactivity of B-cell markers (CD79a, L26) in rare cases of extranodal cytotoxic peripheral T- (NK/T-) cell lymphomas.

The monoclonal antibodies L26 (CD20) and CD79a are very useful reagents for the immunohistochemical assessment of B-cell lineage in lymphoproliferative disorders. Although very few CD20-positive peripheral T-cell lymphomas (PTL) have been reported, comprehensive analyses of CD79a reactivity in extranodal PTL and NK/T-cell lymphomas have not been performed previously. This study investigated CD79a (clone JCB117) and CD20 reactivity in 94 extranodal non–B-cell lymphomas (enteropathy-type intestinal T-cell lymphoma [n = 52], nasal NK/T-cell lymphoma [n = 11], and primary cutaneous PTL [n = 31]) and in 17 cases of nodal PTL, unspecified. In four cases (enteropathy-type intestinal T-cell lymphoma [n = 3] and nasal NK/T-cell lymphoma [n = 1]), the majority of tumor cells stained for CD79a (all CD20 negative) and one cutaneous PTL, unspecified, was CD20 positive (CD79a negative). Extensive immunophenotyping and polymerase chain reaction–based molecular analyses revealed that all five B-cell marker–positive extranodal lymphomas had a cytotoxic phenotype and did indeed represent monoclonal peripheral T-cell proliferations. To minimize the risk of misinterpretation of lymphoma cell lineage, especially in cases of extranodal lymphoproliferative disease, we suggest the use of both CD79a and CD20 in combination with a panel of antibodies reactive to T cells, such as βF1 and CD5, and to T cells and NK cells, such as CD3, CD2, CD56, and TIA-1.

Disseminated superficial porokeratosis and immunosuppression

We present a patient who developed skin lesions typical of disseminated superficial porokeratosis (DSP) while on immunosuppressive therapy for pemphigus foliaceus. Phototesting with artificial light sources did not have any effect on the DSP lesions. The literature describing occurrence of DSP on immunosuppression is reviewed and possible pathogenetic mechanisms are discussed.

Disseminated superficial actinic porokeratosis: Experimental induction and exacerbation of skin lesions

A 55-year-old woman with disseminated superficial actinic porokeratosis (DSAP) had lesions on sun-exposed skin areas that were exacerbated during the summer months and involuted in winter. This is the third report in which induction and exacerbation of DSAP lesions were achieved by irradiation with artificial ultraviolet light sources. Our data show that UVB plus UVA is more effective in inducing new or exacerbating preexisting skin lesions than either wavelength alone. We believe that testing with the appropriate ultraviolet light sources is a practical means to differentiate between DSAP and disseminated superficial porokeratosis.

Porokeratoses: Immunohistochemical, light and electron microscopic evaluation

Punch biopsy specimens of 14 patients with porokeratosis of Mibelli (n = 1), disseminated superficial porokeratosis (n = 6), disseminated superficial actinic porokeratosis (n = 4), porokeratosis plantaris, palmaris et disseminata (n = 2), and punctate porokeratosis (n = 1) were obtained for light and electron microscopy for evaluation of possible differences between these clinical variants. Langerhans cells in close contact with early degenerating keratinocytes could be observed in the epidermis. To study the cellular composition of the epidermal inflammatory infiltrate immunohistochemistry was performed. These studies demonstrated that the predominant cell type in these infiltrates are helper T cells, intermingled with Leu-6+ Langerhans cells. Despite the clinical variation and possible different etiologic or triggering mechanisms, the immunohistochemical and morphologic changes in all types of porokeratosis are the same and seem to represent a uniform reaction pattern.

Punctate keratoderma-like lesions on the palms and soles in a patient with chloracne: a new clinical manifestation of dioxin intoxication?

We report what we believe to be a novel skin manifestation of dioxin intoxication. A 30‐year‐old woman with 2,3,7,8‐tetrachlorodibenzo‐p‐dioxin levels of 144,000 pg g−1 blood fat presented with severe chloracne that affected the entire integument. She also exhibited acral granuloma annulare‐like lesions and distal onycholysis and, at a later time point, showed signs of hypertrichosis, as well as brownish‐grey hyperpigmentation of the face. In addition, she developed punctate keratoderma‐like lesions on the palms and soles. These lesions were negative for human papillomavirus and histologically characterized by cone‐shaped hyperkeratoses invaginating, but not penetrating, into the dermis. Squamous syringometaplasia of the eccrine glands was observed in the immediate vicinity of these lesions. Both clinically and histologically these alterations are essentially indistinguishable from what is described as keratosis punctata palmaris et plantaris (KPPP). Although a fortuitous coincidence of chloracne and KPPP cannot be formally excluded, the possibility exists that in our patient toxic levels of dioxin were causally involved in this disorder of keratinization.

Value of micromorphometric criteria of sentinel lymph node metastases in predicting further nonsentinel lymph node metastases in patients with melanoma.

Patients with metastases in the sentinel node (SN) are advised to undergo complete lymph node dissection, although the majority of them will have no further metastatic disease. Some of these patients undergo unnecessary surgery. In this study, we tried to predict the likelihood of further non-SN metastases on the basis of earlier published micromorphometric classifications of SN metastases. Metastases in the SN were re-evaluated on the basis of the microanatomic location of the lesions according to the Dewars criteria, the S-classification of SN, and tumor burden in accordance with the Rotterdam criteria. The results of these classifications were correlated with the presence of further non-SN metastases. Specimens of 124 positive-SN basins and subsequent complete lymph node dissection were investigated. Further metastases in non-SNs were found in 30 lymph node basins (24.2%). All of the abovementioned classification systems were significantly correlated with non-SN tumor status. Especially, in patients with SN metastases in subcapsular location, a maximum depth of invasion of less than 0.3 mm (stage I according to the S-classification) or metastases of less than 0.1 mm in diameter had a very low probability of further non-SN metastases (0–5%). The validity of earlier published classifications of SN metastases-based on the micromorphometric criteria in predicting non-SN status was confirmed. Especially, in patients with subcapsular metastases, SI stage metastases or metastases of less than 0.1 mm had a very low risk of further non-SN metastases.

Plexiforme neurofibroma of the skin

Three cutaneous tumors showing massively thickened nerve fascicles, with a myxomatous matrix in a diffuse tumor mass, were studied by light and electron microscopy, immunohistochemically, and with 3H-thymidine autoradiography. Corresponding to plexiforme neurofibroma, these tumors were called plexiforme neurofibroma of the skin and are compared with nerve sheath myxoma (i.e., cutaneous lobular neuromyxoma, bizarre cutaneous neurofibroma, neurothekoma, and others). In the tumors, a high proportion of perineurial cells (30%) could be detected. Compared with results from regenerating nerves, organized traumatic neuroma, and other types of neurofibroma, these findings show that all constituents of normal peripheral nerves, especially Schwann cells and perineurial cells, may be involved in the growth of peripheral nerve sheath tumors. Furthermore, autoradiography demonstrated a high proliferative activity in one of the tumors. The possible clinical relevance of this finding and the question of whether these tumors may bear a higher risk for malignancy will be discussed.

Linear focal elastosis (elastotic striae): increased number of elastic fibres determined by a video measuring system

We present an unusual case of linear focal elastosis occurring exclusively on the legs of a 13‐year‐old girl. An increase of elastic fibres (EF) was demonstrated histologically, and the number of EF in lesional and normal skin was quantified using a video measuring system. EF were found to be increased by about 100% in lesional skin compared with unaffected skin. EF were elongated, thinned and split at their ends with a paintbrush formation. Dedicated to Eva Jurkowitsch, MD, on the occasion of her birthday.

Demodicidosis Mimicking Granulomatous Rosacea and Transient Acantholytic Dermatosis (Grover’s Disease)

A patient with rosacea-like lesions and transient acantholytic dermatosis (TAD; Grovers disease), who showed follicle mites and perifollicular granulomas in involved skin, is presented. A possible relationship between the infestation with the follicle mite and TAD in this case is discussed.