1,720,998 research outputs found
Diving into the blue: in vivo microscopic characterization of the dermoscopic blue hue
No full textBackground: In dermoscopy the presence of a blue hue is a clue for malignancy, although a blue tint is sometimes observable in benign lesions.
Objective: To identify the in vivo confocal microscopy correlates of the blue hue for improving diagnostic accuracy for melanoma.
Methods: Fifty-seven melanomas, 41 junctional, 88 compound, and 27 Spitz nevi were studied by dermoscopy, confocal microscopy, and histopathology.
Results: Confocal microscopy enabled the distinction between blue areas and blue veil, the former characterized by plump cells corresponding to melanophages and inflammatory infiltrate at histology, the latter by the contemporary presence of epidermal and dermal features consistent with diagnosis of melanoma, such as disarranged pattern, pagetoid cells, cytologic and architectural atypias, nonhomogeneous and cerebriform clusters, and dermal nucleated cells.
Limitations: Confocal microscopy failed to accurately distinguish Spitz nevi, because of the presence of cytoarchitectural disarray in the epidermis and the upper dermis.
Conclusion: Confocal microscopy enabled the in vivo identification of characteristic cytological substrates correlated with the blue features in dermoscopy
Alterations of 9p21 analysed by FISH and MLPA distinguish atypical spitzoid melanocytic tumours from conventional Spitz's nevi but do not predict their biological behaviour
No full textAlterations of 9p21 analysed by FISH and MLPA distinguish atypical spitzoid melanocytic tumours from conventional Spitz's nevi but do not predict their biological behaviour Aim: Histopathological criteria alone cannot predict the biological behaviour of spitzoid melanocytic tumours. The aim of this study was to investigate whether 9p21 status influence the prognosis of the spitzoid melanocytic tumours, peculiar lesions whose biological behaviour cannot be predicted by histopathological criteria alone. Methods and results: Twenty-eight atypical spitzoid tumours, 12 conventional Spitz's nevi and one congenital Spitz's nevus were studied by fluorescent in-situ hybridization (FISH) and multiple ligation-dependent probe amplification (MLPA) for the presence of 9p21 deletion. The 28 patients were aged 3-56 years (mean 32, median 35), and follow-up ranged between 4 and 156 months (mean 51, median 48). Eight patients (28.5%) experienced lymph node metastasis (three cases with macrometastasis and five with micrometastasis). Of those with macrometastasis, two are alive after 159 and 26 months, whereas a third developed widespread metastases and died after 26 months. All of the other patients are alive. Statistically, the thickness (P = 0.01) and the diameter (P = 0.009) of the lesions significantly correlated with metastasis. Deletion of 9p21 by FISH analysis was observed in eight spitzoid tumours (28.5%), and MLPA demonstrated alterations of 9p21, particularly deletion of CDKN2A, in the same lesions, whereas all Spitz's nevi, except the congenital one, were of unaltered 9p21 status (P < 0.0001). Deletion of 9p21/CDKN2A did not correlate with the presence of metastasis. Conclusion: Alterations at 9p21 locus are significantly more frequent in spitzoid tumours than in Spitz's nevi, but do not predict their biological behaviour
Histopathological evidence of North American blastomycosis in Italy: report of two cases
No full textNo clinical reports of blastomycosis in Italy have been published until now. We here report two cases of histologically diagnosed, unexpected cutaneous involvement in patients, aged 78 and 52 years, living in North Italy and never having been abroad. The histological differential diagnosis between blastomycosis and other fungal pathogens is discussed. Even in the absence of culture the present cases can confidently be considered as genuine examples of Blastomyces dermatitidis infection in Italy
Diving into the blue: In vivo microscopic characterization of the dermoscopic blue hue
No full textBACKGROUND:
In dermoscopy the presence of a blue hue is a clue for malignancy, although a blue tint is sometimes observable in benign lesions.
OBJECTIVE:
To identify the in vivo confocal microscopy correlates of the blue hue for improving diagnostic accuracy for melanoma.
METHODS:
Fifty-seven melanomas, 41 junctional, 88 compound, and 27 Spitz nevi were studied by dermoscopy, confocal microscopy, and histopathology.
RESULTS:
Confocal microscopy enabled the distinction between blue areas and blue veil, the former characterized by plump cells corresponding to melanophages and inflammatory infiltrate at histology, the latter by the contemporary presence of epidermal and dermal features consistent with diagnosis of melanoma, such as disarranged pattern, pagetoid cells, cytologic and architectural atypias, nonhomogeneous and cerebriform clusters, and dermal nucleated cells.
LIMITATIONS:
Confocal microscopy failed to accurately distinguish Spitz nevi, because of the presence of cytoarchitectural disarray in the epidermis and the upper dermis.
CONCLUSION:
Confocal microscopy enabled the in vivo identification of characteristic cytological substrates correlated with the blue features in dermoscopy.Background: In dermoscopy the presence of a blue hue is a clue for malignancy, although a blue tint is sometimes observable in benign lesions. Objective: To identify the in vivo confocal microscopy correlates of the blue hue for improving diagnostic accuracy for melanoma. Methods: Fifty-seven melanomas, 41 junctional, 88 compound, and 27 Spitz nevi were studied by dermoscopy, confocal microscopy, and histopathology. Results: Confocal microscopy enabled the distinction between blue areas and blue veil, the former characterized by plump cells corresponding to melanophages and inflammatory infiltrate at histology, the latter by the contemporary presence of epidermal and dermal features consistent with diagnosis of melanoma, such as disarranged pattern, pagetoid cells, cytologic and architectural atypias, nonhomogeneous and cerebriform clusters, and dermal nucleated cells. Limitations: Confocal microscopy failed to accurately distinguish Spitz nevi, because of the presence of cytoarchitectural disarray in the epidermis and the upper dermis. Conclusion: Confocal microscopy enabled the in vivo identification of characteristic cytological substrates correlated with the blue features in dermoscopy. © 2007 American Academy of Dermatology, Inc
Sentinel lymph node biopsy in clear cell sarcoma.
No full textA case of practical application of sentinel lymph node biopsy in clear cell sarcoma is discussed
Expression of calretinin in odontogenic keratocysts and basal cell carcinomas: A study of sporadic and Gorlin-Goltz syndrome-related cases
No full textGorlin-Goltz syndrome (GGS), is an autosomal dominant inherited disorder related to germline mutation of PTCH1 gene, characterised by the presence of multiple developmental anomalies and tumours, mainly basal cell carcinomas (BCC) and odontogenic keratocysts (OKC). We analysed and compared the expression of calretinin in 16 sporadic OKCs, from 15 patients, and 12 syndromic OKCs from 11 patients; in 19 BCC's and 2 cutaneous keratocysts (CKC) belonging to 4 GGS patients, 15 sporadic BCCs and 3 steatocystomas (SC). Calretinin was negative in 10 of 12 syndromic OKCs, focally positive (<5% of cells) in 2; six sporadic OKCs were negative, 6 focally and 4 diffusely positive (p = .02, cases focally and diffusely positive vs. cases negative). All BCCs of 3 GGS patients were negative, the fourth patient presented two BCCs negative and 5 focally or diffusely positive; 7 sporadic BCCs were negative and 8 focally positive (p = NS). Two CKCs resulted negative in one GGS patient; 2 sporadic SCs were positive, and a third was negative. PTCH1 mutations produce an altered PTCH protein and an aberrant activation of Sonic hedgehog (SHH) pathway, leading to tumoral proliferation. It has been demonstrated that treatment of human foetal radial glia cells with SHH reduces, whereas the blockage of SHH increases calretinin expression. We found a lower expression of calretinin in syndromic OKCs compared to sporadic cases. Although calretinin's value in differential diagnosis between sporadic and syndromic tumours appears not crucial, our results shed light on the possible link between SHH dysfunction and calretinin expression in GGS-related tumours
Perinatal aspergillosis: a case with fatal outcome.
No full textAspergillosis is an uncommon perinatal infection diagnosed with increasing frequency in recent years. We report a premature infant who required both nutrition and ventilation artificially assisted and developed a disseminated invasive nosocomial infection from Aspergillus flavus. Autopsy revealed marked hypotrophy of the thymus and multisystem invasive aspergillosis chiefly involving the vascular and alimentary systems and also the respiratory tract, the central nervous system, and the skin. From what we know, this is the first case of the literature with a misleading initial clinical presentation involving the alimentary tract (hepatomegaly, ingravescent cholestatic icterus) and evolving in intestinal occlusion
Impact of Dermoscopy and Reflectance Confocal Microscopy on the Histopathologic Diagnosis of Lentigo Maligna/Lentigo Maligna Melanoma
Full text linkBACKGROUND: Equivocal pigmented lesions of the head are usually biopsied to avoid inappropriate treatment. Clinical approach has evolved from simple visual examination to sophisticated techniques for selecting the biopsy sites. OBJECTIVE: This study aimed to retrospectively evaluate the efficiency of dermoscopy (DE) and reflectance confocal microscopy (RCM) in sampling a histopathologically representative focus of lentigo maligna/lentigo maligna melanoma. METHODS: Punch biopsies and surgical excisions of 72 patients, 37 men and 35 women (median age 70.6 years, range 39-90 years), affected by lentigo maligna/lentigo maligna melanoma of the head, sent from a single dermatology clinic, were reviewed for the presence of 5 histopathologic criteria: atypical junctional melanocytes, increased junctional melanocytes, follicular colonization, pagetoid spread and melanocytic junctional nests, plus other minor features. Forty-two patients were biopsied under DE and 30 under RCM guidance. RESULTS: Accuracy of the 2 techniques in sampling a representative tissue overlapped in most cases, although RCM selected sites to biopsy with more histopathologic criteria, in particular pagetoid spread and melanocytic nests. Interestingly, with RCM, inflammation and melanophages were observed more in biopsy than in excision. False positive cases were not registered. CONCLUSION: Compared with the sampling at naked eye, our results show that DE and RCM help selecting the most appropriate areas for biopsies, thus allowing not only more robust histopathologic diagnoses, but also a more accurate microstaging of tumor
Reactive Granulomatous Dermatitis during Anti-TNF Therapy: A Case Report and Review of the Literature
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