CDX-2 homeobox gene expression.
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Adenocarcinoma↗
Biomedical subjects
Daniela Massi
Publications and source records attributed to Daniela Massi.
Vulvar lichen planus associated with ulcerative colitis. A case report.
BACKGROUND: Lichen planus (LP) is a common inflammatory dermatosis the diagnosis of which can be very complex when it affects the female genital area exclusively. The condition should be managed by both dermatologists and gynecologists because the association between vulvar LP and other immune-mediated disorders occurs frequently. CASE: Vulvar LP was diagnosed in 37-year-old woman whose past history was significant for ulcerative colitis (UC) since the age of 21. The oral mucosa and skin were completely unaffected, but whitish papules and plaques were seen diffusely on the whole vulvar region, which had become sclerotic and edematous. Microscopic examination of lesional tissue confirmed the diagnosis, showing classic histologic features in spite of the mixed and hypertrophic clinical variant. Oral therapy with cyclosporin at an initial dose of 250 mg/d led to complete remission within 3 months. CONCLUSION: This case is reported on for the rarity of isolated vulvar involvement by LP and for the excellent response to treatment.
Adult↗
A 10-year-old in situ melanoma?
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Biopsy↗
Tumor angiogenesis as a prognostic factor in thick cutaneous malignant melanoma. A quantitative morphologic analysis.
The prognostic value of the extent of neovascularization in cutaneous melanoma is a highly controversial issue. The aim of the current study was to evaluate whether the morphometric analysis of tumor vascularity may be helpful in predicting the clinical outcome of patients with thick cutaneous melanomas. A series of 15 patients with melanoma (>3 mm in thickness) who did not experience disease progression after long-term follow-up (10 years) and 30 matched controls who underwent recurrence and/or metastases were selected for the study. Microvessels were immunohistochemically stained with anti-CD31 antibody. Several parameters, including vessel number, vascular density, vessel area, equivalent circle diameter, perimeter, shape factor, compactness, and the number of vascular ramifications per 100 vessel sections, were quantitatively assessed by a computer-aided semi-automatic image analysis system. Mean vessel area was 341.69 microm2 in cases without progression and 512.55 microm2 in the progressed melanomas (P=0.008, Mann-Whitney U test). The mean equivalent circle diameter was 18.95 microm in non-progressed melanomas and 22.57 microm in progressed melanomas (P=0.009). The mean number of ramifications was 0.8 in cases without progression and 1.9 in the controls (P=0.03). Microvessel count and vascular density were higher in progressed cases (17.37 vs. 11.73 and 28.94/mm2 vs. 19.55/mm2, respectively), but the difference did not reach statistical significance (P=0.06). Our results suggest that neovascularization is a critical event in the progression of thick melanoma. Its prognostic significance is better assessed by quantification of vessel area, equivalent circle diameter, and microvessel branching, whereas microvessel count and vascular density do not provide significant prognostic information.
Adult↗
Leishmaniasis recidiva cutis: an unusual two steps recurrence.
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Aged↗
False "melanocytic" parameters shown by pigmented seborrheic keratoses: a finding which is not uncommon in dermoscopy.
BACKGROUND: Dermoscopic evaluation of pigmented lesions includes assessment of criteria suggestive of melanocytic proliferation. Dermoscopic diagnosis may be hampered when a nonmelanocytic lesion displays one or more melanocytic features. OBJECTIVE: To evaluate the incidence of misleading dermoscopic features characteristic of melanocytic lesions in pigmented seborrheic keratosis (PSK). METHODS: We evaluated 402 clinically typical PSKs from 138 patients with at least one clinically identifiable PSK. RESULTS: Approximately 10% of PSKs displayed one or more melanocytic features, the most frequent being a "false" pigment network. CONCLUSION: The occurrence of a "false" pigment network in PSK can be misleading in the differential diagnosis of clinically equivocal lesions. A correct diagnosis can only be obtained if all available dermoscopic criteria are appropriately assessed together with the clinical examination.
Adult↗
Giant melanoma displaying gross features reproducing parameters seen on dermoscopy.
BACKGROUND: The basis of dermoscopy is the strict relationship between dermoscopic features and histology of pigmented skin lesions. METHODS: When observed under dermoscopy, a pigmented lesion displays a series of features which enable an experienced clinician to classify the lesion with higher accuracy than that expected by visual inspection alone. RESULTS: We have observed a peculiar case of a giant cutaneous melanoma occurring on the abdomen of a 45-year-old woman, displaying clinical features strictly resembling those of melanoma under dermoscopy. DISCUSSION: The interest of this case is actually purely morphologic, showing for the first time, depending on the extraordinary growth of the lesion, the appearance of gross features strictly reproducing those microscopically found under dermoscopy in smaller lesions.
Abdomen↗
Clinically and dermoscopically featureless melanoma: when prevention fails.
We report a case of amelanotic melanoma that was clinically and dermoscopically featureless; it was repeatedly missed during examination at a pigmented lesion clinic. Dermoscopy evidenced a peculiar vascular pattern, and only the adoption of a specific diagnostic algorithm including the atypical vascular pattern among the major diagnostic criteria would have helped the observer make the correct diagnosis. The risk of false-negative diagnosis by both clinical examination and dermoscopy during melanoma screening as well as the possible role of dermoscopy in the diagnosis of amelanotic melanoma are discussed.
Dermatology↗
Sinonasal undifferentiated carcinoma, nasopharyngeal-type undifferentiated carcinoma, and keratinizing and nonkeratinizing squamous cell carcinoma express different cytokeratin patterns.
Sinonasal undifferentiated carcinoma (SNUC) is a highly aggressive malignant neoplasm that is often difficult to distinguish from other poorly differentiated carcinomas arising in the sinonasal tract. To search for a differential cytokeratin (CK) expression that could be useful for diagnostic purposes, we compared the expression of a large panel of CKs in a series of 6 SNUCs, 10 poorly differentiated squamous cell carcinomas (SCCs), 10 nonkeratinizing squamous cell carcinomas (NKSCCs), and 5 nasopharyngeal-type undifferentiated carcinomas (NPTCs). SCC, NKSCC, and NPTC frequently showed immunoreactivity for CK5/CK6, CK8, CK13, and CK19. In addition, SCC and NKSCC expressed CK14, which was not detected in NPTC, and SCC expressed CK7 (60% of cases) and CK4 (30% of cases), which were absent in NKSCC and NPTC. Three NKSCCs were associated with a Schneiderian papilloma, and the results of the immunostaining were similar in the two components, with the exception of CK4 and CK7, which were expressed by the papilloma and not by the carcinoma. In contrast to other carcinomas, SNUC was characterized by the exclusive expression of CKs of simple epithelia, such as CK8 (100% of cases), CK7 (50% of cases), and CK19 (50% of cases). Thus, there are significant differences in the pattern of CK expression between SNUC, SCC, NKSCC, and NPTC, which could be of diagnostic aid. Moreover, these findings support the hypothesis that SNUC is a separate entity from SCC and NPTC of the sinonasal tract.
Adult↗
The comparative role of immunohistochemistry and electron microscopy in the identification of myogenic differentiation in soft tissue pleomorphic sarcomas.
There is increasing evidence that histological classification of pleomorphic soft tissue sarcomas is prognostically useful, since a number of studies have provided evidence that myogenic differentiation is associated with a more aggressive clinical behavior. The aim of the current study was to analyze the role of electron microscopy in comparison with immunohistochemistry in the classification of soft tissue pleomorphic sarcomas. Thirty-nine pleomorphic sarcomas of the somatic soft tissues for which material for immunohistochemical and ultrastructural analysis was available were selected for this study. Cases were classified according to the criteria of the WHO classification of soft tissue tumors on the basis of the histologic appearance and of the results of immunohistochemical analysis, and then diagnoses were reconsidered at the light of the results of the ultrastructural analysis. The group of myogenic sarcomas included 13 leiomyosarcomas, 8 myofibrosarcomas, and 1 rhabdomyosarcoma, while the group of nonmyogenic sarcomas included 11 undifferentiated pleomorphic sarcomas/malignant fibrous histiocytomas (MFH), 4 myxofibrosarcomas, and 2 liposarcomas. Overall, there was a good concordance between immunohistochemistry and electron microscopy in recognizing myogenic differentiation in soft tissue pleomorphic sarcomas. Discrepancies included 1 case showing no immunoreactivity for muscle markers, which displayed ultrastructural features allowing reclassification as leiomyosarcoma, and 2 cases initially classified as undifferentiated pleomorphic sarcoma/MFH, which were reclassified as myofibrosarcomas after ultrastructural analysis. Ultrastructural analysis allowed the identification of pleomorphic sarcomas with myofibroblastic phenotype, a category that is not identifiable based on histologic and immunohistochemical profile. Notably, fibronexus junction was identified in tumor cells of 4 pleomorphic myofibrosarcomas, while 2 other lesions showed putative fibronexus junction structures, consisting of electron-dense straight fibrils adjacent to the cell surface, not clearly in continuity with cytoplasmic actin filaments. In conclusion, the results indicate that immunohistochemistry and electron microscopy can usefully complement each other in the classification of soft tissue pleomorphic sarcomas.
Actins↗
Circinate sarcoidosis of the face.
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Biopsy↗
Disseminated superficial actinic porokeratosis in a patient with Sjögren syndrome.
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Administration, Oral↗
Idiopathic atrophie blanche.
A 41-year-old woman presented with a 3-year history of purpuric lesions followed by superficial, painful ulcers and development of lesions on the lower legs and on the dorsa of the feet, particularly in the summer. The patient was asymptomatic during the winter months. On physical examination she had irregular, scleroatrophic, white-ivory, coalescent lesions on a livedoid basis, with purpuric and, in some lesions, pigmented borders with numerous telangiectatic capillaries. These lesions were localized on the medial sides of the lower legs and on the dorsa of the feet (Figure 1). Laboratory investigations were normal or negative, including complete blood cell count, platelets, coagulation indexes, erythrocyte sedimentation rate, serum immunoglobulins, antinuclear antibodies, anti-double-stranded DNA, anticardiolipin, antiphospholipids, antineutrophilic cytoplasmic antibodies, circulating immunocomplexes, complement fractions (C3, C4), cryoglobulins, rheumatoid factor, and Rose-Waaler reaction. The only laboratory abnormality was an elevated fibrinogen level (472 mg/dL). Doppler velocimetry excluded a chronic venous insufficiency. Thoracic x-ray and abdominal ultrasound were normal. A digital photoplethysmograph revealed functional Raynaud's phenomenon. A biopsy specimen taken from a purpuric lesion showed an atrophic epidermis with parakeratosis and focal spongiosis. An increased number of small-sized vessels were observed within a sclerotic dermis. Most of the vessels in the upper dermis were dilated and showed endothelial swelling; some were occluded due to amorphous hyaline microthrombi (Figure 2). There were fibrinoid deposits around the vessels with thickening of the vessel walls. Extravasated erythrocytes were found throughout the upper and mid-dermis. There was a sparse perivascular lymphocytic infiltrate but no vasculitis. Direct immunofluorescence showed a perivascular microgranular deposit of IgM (+), C3 (++), and fibrinogen/fibrin (+++). On the basis of clinical, serologic, histopathologic, and immunopathologic findings, a diagnosis of idiopathic atrophie blanche was made. The patient was treated with dapsone (50 mg p.o. q.d.) and pentoxifylline (400 mg p.o. t.i.d.) with pain relief and complete resolution of the ulcerations after 6 weeks of therapy.
Administration, Oral↗
Immunohistochemical study of carbonic anhydrase isozymes in human skin.
An increasing number of carbonic anhydrase (CA) isozymes have been discovered in human organs. However, there is little evidence concerning their expression in mammal skin, humans included, and the isozymes involved have not been identified yet. In this study, the distribution of three CA isozymes I, II and IX in human skin from healthy subjects was investigated using an immunohistochemical technique. Specific staining for CA I and II was detected in the basolateral plasma membrane of the epithelial cells of the spinous and basal layers of epidermis as well as in the endothelium of capillaries in the papillary dermis. A marked CA II immunoreactivity was mostly found in secretory cells of the sweat glands. No signal for CA IX was detected but on the plasma membranes and the cytoplasm of cells surrounding the hair shaft. The significance and biological role of CA isozymes expression in human skin is discussed.
Adult↗
Results of surveillance programme aimed at early diagnosis of cutaneous melanoma in high risk Mediterranean subjects.
OBJECTIVE: To investigate the impact of a surveillance program aimed at early diagnosis of melanoma in a cohort of subjects classified at risk on the basis of their number of nevi. To compare the number of observed cases of melanoma in the cohort to that expected number in the general population of the same area. METHODS: Two hundred and eighteen subjects with no personal or family history of melanoma residing in the Florence district who showed more than 30 common acquired nevi and 3 or more atypical nevi (high-risk) have been followed for an average period of 3.4 years (range 1-6.5); an additional intermediate-risk group with 237 subjects was also enrolled. RESULTS: Four incident melanomas were detected in 218 high-risk subjects followed for a total of 741.7 person-years; no melanoma was detected in the lower risk group. All the 4 detected melanomas were in situ (Clark level I), with an average interval since enrollment of 4.6 years (range 1.4-6.5). In accordance with age-and sex-specific incidence rates of melanoma (including in situ forms) in the general population of the area, the standardized incidence ratio (SIR) in the cohort was 44.1 (95% CI 16.5-117.5). CONCLUSIONS: Subjects with more than 30 common nevi and 3 or more atypical nevi show about a 40-fold increased risk of developing melanoma. Even allowing for some degree of diagnostic anticipation due to periodic controls the risk appears higher than in the intermediate risk population. As a consequence of active follow up of individuals, all the detected tumors were at favourable prognosis. Periodic examination of these subjects should therefore be recommended as part of a prevention program for cutaneous melanoma in southern European populations.
Adolescent↗
Hyalinizing spindle cell tumor with giant rosettes and low-grade fibromyxoid sarcoma: an immunohistochemical and ultrastructural comparative investigation.
Hyalinizing spindle cell tumor with giant rosettes (HSCTGR) and low-grade fibromyxoid sarcoma (LGFMS) are 2 variants of fibrosarcoma, which share several clinicopathologic features. This study compares the light microscopic, immunohistochemical, and ultrastructural features of 2 examples of HSCTGR and 3 of LG FMS to determine the degree of overlap of these 2 tumors. HSCTGR were composed of bland spindle cells within hyalinized to myxoid stroma. Scattered throughout the lesions were characteristic rosette-like structures, formed by a central collagenous core surrounded by spindled neoplastic cells. LGFMS consisted of a mixture of fibrous and myxoid areas, composed of fibroblast-like cells arranged in a swirling, whorled growth pattern. Immunohistochemical analysis showed diffuse positivity for vimentin in all cases, while few scattered tumor cells stained for CD57, CD34, factor XIIIA, and actin. The extracellular matrix showed intense positivity for type IV collagen, laminin, and fibronectin, with the exception of myxoid areas of LGFMS and the central core of the giant rosettes in HSCTGR. Ultrastructurally, both tumor types were composed of cells with the features of fibroblasts, embedded in a collagenous stroma with irregular deposits of amorphous basal lamina-like substance. In conclusion, HSCTGR and LGFMS share similar immunophenotypic and ultrastructural features, and together with other fibrosing fibrosarcomas, like sclerosing epithelioid fibrosarcoma, may constitute a subset of fibrosarcomas formed by fibroblasts capable of producing large amounts of basal lamina-like material.
Adult↗