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Biomedical subjects

N S Penneys

Publications and source records attributed to N S Penneys.

At least 19 recordsLinked to original sources

Cutaneous histopathology of Conradi-Hunermann syndrome.

The histopathology of the skin in the ichthyosiform erythroderma associated with classical Conradi-Hunermann syndrome has been rarely described. Skin biopsies from 2 infants with the classical features of Conradi-Hunermann syndrome including ichthyosiform erythroderma contained hyperkeratosis, dilated ostia of pilosebaceous structures, and calcium salts in the stratum corneum detectable with special stains. An unusual feature of one case was dilatation of acrosyringeal structures. We hypothesize that dilatation of acrosyringeal structures is analogous to the plugging noted in pilosebaceous units. Taken together, the ichthyosiform erythroderma of Conradi-Hunermann has a distinctive histologic appearance.

Chondrodysplasia Punctata

Analysis of the polymerase chain reaction in the detection of herpesvirus DNA from fixed and stained tissue sections.

BACKGROUND AND DESIGN: The polymerase chain reaction (PCR) is a molecular diagnostic technique that has been applied to many infectious processes. Stained and unstained Tzanck smears, vesicle fluid swabs, and crusts have all been used as the source for template DNA for the PCR to document evidence of herpes simplex virus and varicella-zoster virus infection. Thirty-five cases with histologic evidence of acute herpesvirus infection were retrieved from archival tissue blocks that were up to 5 years old. Paraffin and hematoxylin-eosin-stained tissue sections obtained from routinely prepared glass slides from these cases were then examined for herpesvirus DNA using the PCR. RESULTS: The PCR-detected herpesvirus DNA from 34 (97.1%) of 35 paraffin tissue samples. Herpes simplex virus and varicella-zoster virus DNA were detected in eight and 26 of these cases, respectively. For hematoxylin-eosin-stained tissue samples, PCR detected herpesvirus DNA sequences in 16 (45.7%) of 35 cases. Herpesvirus DNA was isolated from paraffin tissue sections and recently prepared hematoxylin-eosin-stained tissue samples obtained from archival tissue blocks that were up to 5 and 2 years old, respectively. CONCLUSIONS: The PCR can detect herpesvirus DNA in extremely high yield from unstained paraffin-embedded tissue samples with histologic evidence of acute herpesvirus infection that are up to 5 years old. Herpesvirus DNA can also be identified in approximately 50% of these cases from hematoxylin-eosin-stained tissue sections obtained from routinely prepared glass slides.

DNA, Viral

Merkel cells and prurigo nodularis.

BACKGROUND: Increased numbers of dermal nerves have been demonstrated in prurigo nodularis and have been theoretically linked to the intense pruritus. We hypothesized that the neuronal proliferation in prurigo nodularis might be associated with an increased density of Merkel cells because they are also a component of the neurocutaneous system. METHODS: We examined skin biopsy specimens from 20 cases of prurigo nodularis for Merkel cells with the use of a standard immunohistochemical assay (avidin-biotin-peroxidase complex system) with an antibody to cytokeratin 8 (CAM 5.2). Six cases of lichen simplex chronicus were examined as controls. RESULTS: Merkel cells were present in the interfollicular area of the basal cell layer in 15 (75%) of 20 prurigo nodularis cases and in one (17%) of six cases of lichen simplex chronicus. CONCLUSION: Merkel cells are increased in number in prurigo nodularis and may be a component of the neurocutaneous abnormality associated with this disorder.

Humans

Merkel cells in neurofibromas and neurilemomas.

Merkel cells are an integral component of the cutaneous nervous system. They are commonly associated with dermal nerves under normal physiological conditions. We postulated that Merkel cells may be present in increased numbers within the epidermis overlying benign peripheral nerve sheath tumours such as neurilemomas and neurofibromas. Paraffin-embedded skin biopsy specimens from 21 patients with neurilemomas and 26 with neurofibromas, were analysed for the presence of Merkel cells using a standard immunohistochemical assay (avidin-biotin-peroxidase complex system) with an antibody to cytokeratin 8 (CAM 5.2). Ten cases of leiomyomas were examined as controls. Merkel cells were identified in the interfollicular area of the basal cell layer overlying 14 of 21 (67%) neurilemomas and nine of 26 (35%) neurofibromas. Merkel cells were more frequently observed in increased numbers in a linear array within the basal cell layer in neurilemomas than in neurofibromas, where they were found as individual cells. No Merkel cells were found in the epidermis overlying leiomyomas. The results of this study suggest that Merkel cells are quantitatively increased in the basal cell layer of the epidermis overlying benign peripheral nerve sheath tumours, particularly neurilemomas.

Humans

CD44 expression in alopecia areata and androgenetic alopecia.

CD44 is a widely distributed cell surface protein thought to be involved in multiple steps of normal immune cell function, including T-cell activation, and in cellular adhesion where it mediates cell attachment to hyaluronate. In normal skin, CD44 is found by immunohistochemical means to be primarily in eccrine coil cells. In this study, we have looked at the expression of CD44 in normal scalp and in two different hair disorders, androgenetic alopecia and alopecia areata. In normal scalp and androgenetic alopecia, CD44 was found in its normal distribution in eccrine coil cells. In scalp of 30 patients with alopecia areata, there was no expression of this glycoprotein. Patients were also assessed pre and post treatment for their alopecia areata, and even though they had no significant hair regrowth, 2 patients regained expression of CD44, indicating a variable expression of this protein in the alopecia areata disease process. The absence of CD44 expression in alopecia areata-affected scalp may give further information regarding the pathogenesis of this disease.

Adolescent

Metastatic prostatic carcinoma histologically mimicking malignant melanoma.

Prostatic carcinoma rarely metastasizes to the skin. We describe a case in which inguinal metastasis occurred. Histologically, the tumor was composed of pale-staining cells which had pronounced epidermotropism, producing a pagetoid pattern mimicking that seen in malignant melanoma. The diagnosis was confirmed by demonstrating prostatic specific antigen in tumor cells.

Aged

CD44 expression in Merkel cell carcinoma may correlate with risk of metastasis.

We retrospectively studied 25 cases of cutaneous primary, locally recurrent or metastatic Merkel cell carcinoma to see if expression of the cell surface marker CD44 correlated with metastatic potential. In 3 of 6 cases in which metastasis was documented, CD44 was found on membranes of tumor cells. Three cutaneous lesions associated with local metastasis did not express CD44. Three primary tumors expressed CD44 but had not disseminated at the time of this report; follow-up after excision of the primary lesion in these cases was less than 6 months. None of the primary or locally recurrent Merkel cell carcinomas followed longer than 6 months (14 of 19 cases) expressed CD44. We conclude that expression of CD44 in Merkel cell carcinoma may eventually be of some value in the assessment of prognosis of cutaneous Merkel cell carcinoma.

Aged

Eccrine angiomatous hamartoma (nevus): immunohistochemical findings and review of the literature.

Eccrine angiomatous hamartoma (nevus) is a rare form of congenital tumorous malformation with proliferation of eccrine secretory coils and ducts, surrounding capillary angiomatous channels and occasionally other minor elements. To date, there have been only about 24 cases reported in the literature. We report an additional case with more detailed description of the microscopic findings, including immunohistochemical observations. The patient was a 28-year-old female who presented with painless, flesh- to reddish brown-colored, violaceous or bluish subcutaneous nodules on the extremities and trunk. The tumors did not show sweating following exertion. The histologic features were comparable to the previously reported cases. The hamartomatous eccrine sweat glands and ducts and a few apocrine glands demonstrated qualitatively diminished antigens commonly found in the eccrine sweat apparatuses, such as carcinoembryonic antigen (CEA) and S-100 protein. The findings of CD34, CD44, human nerve growth factor receptor and Ulex europaeus antigens have not been previously reported. The histologic features suggested a "hamartomatous" growth rather than a true neoplastic process.

Adult

Cylindroma expresses immunohistochemical markers linking it to eccrine coil.

Nerve growth factor, S-100 protein, CD44, and CD34 have unique expressions in or surrounding eccrine coil but are not found in eccrine duct or apocrine gland. We studied 15 cases of cutaneous cylindroma to see if these antigens are found in this neoplasm. All were found in cylindroma to varying degrees. These results link the histogenesis of cylindroma to the eccrine coil. A unique feature of cylindroma is the large number of prominent dendritic cells most likely representing Langerhans cells that permeate the tumor aggregates.

Antigens, CD

Comparison of Tzanck smear, viral culture, and DNA diagnostic methods in detection of herpes simplex and varicella-zoster infection.

OBJECTIVE: To compare Tzanck smears, viral cultures, and DNA diagnostic methods using the polymerase chain reaction (PCR) in detection of herpes simplex virus (HSV) or varicella-zoster virus (VZV) infection in clinically suspected cases. DESIGN: A 12-month trial comparing PCR with viral cultures and Tzanck smears in patients with clinically suspected HSV or VZV infection. SETTING: Both ambulatory and hospitalized patients were recruited from a tertiary referral center and the Miami (Fla) Veterans Affairs Medical Center. PATIENTS: Convenience samples of patients clinically suspected to have HSV (n = 48) or VZV (n = 35). To be included in the final analysis patients needed to have a positive Tzanck smear, viral culture, or PCR result. Patients who were clinically suspected to have HSV but had VZV by viral culture or PCR were analyzed in the VZV group. Similarly, patients who were clinically suspected to have VZV, but had HSV by viral culture or PCR were analyzed in the HSV group. Seventy-seven patients were available for final analysis: HSV (n = 30), VZV (n = 32), and 15 control cases who did not have evidence of viral infection. RESULTS: For HSV, PCR detected HSV DNA sequences in 73% of stained smears and 83% of unstained smears. For VZV infection, VZV DNA sequences were detected in 88% of stained smears and 97% of unstained smears. Viral DNA sequences were not detected in the 15 control cases. Viral cultures were positive in 83% and 44% of HSV and VZV cases, respectively. The Tzanck smear was positive in 60% and 75% of HSV and VZV cases, respectively. CONCLUSIONS: PCR is a reliable method for detecting HSV and VZV DNA sequences from single stained and unstained Tzanck smears. It is clearly superior to viral culture in identifying VZV infection and is equivalent to conventional culture techniques in identifying cases of HSV.

Chickenpox

Demonstration by S-100 protein staining of increased numbers of nerves in the papillary dermis of patients with prurigo nodularis.

BACKGROUND: We hypothesized that hyperplasia of papillary dermal nerves was a constant feature of prurigo nodularis. OBJECTIVE: We tested this hypothesis by examining sections from 25 cases of prurigo nodularis, 25 cases of skin lesions characterized by epidermal hyperplasia without clinical pruritus, and 22 cases of clinically pruritic dermatoses with variable degrees of epidermal response for the presence of papillary dermal nerves. METHODS: We used a standard immunohistochemical assay with an antibody to S-100 protein as a means of identification of nerves. RESULTS: In 24 of 25 cases of prurigo nodularis, papillary dermal nerves were identified by immunostaining. Cutaneous nerves were present in 1 of 22 cases of epidermal hyperplasia with pruritus and were absent in the papillary dermis in nonpruritic cases. CONCLUSION: We conclude that hypertrophy of cutaneous papillary dermal nerves is a relatively constant feature of prurigo nodularis. The presence of papillary dermal nerves suggests a neurocutaneous component in the pathogenesis of prurigo nodularis.

Humans

UVB phototherapy of the pruritic papular eruption of the acquired immunodeficiency syndrome.

BACKGROUND: Pruritic papular eruption (PPE) is a chronic dermatosis frequently seen in human immunodeficiency virus (HIV)-positive patients. UVB phototherapy has been successfully used to treat a similar inflammatory condition (Ofuji disease) as well as pruritus of systemic origin. OBJECTIVE: We describe the successful treatment with UVB of seven of eight patients with PPE. METHODS: Eight HIV-positive patients with PPE were treated. The number of papules in a specified area of skin and the intensity of pruritus were monitored before, during, and after UVB phototherapy given three times a week. Biopsy specimens were taken before and after therapy and systemic immune function was evaluated. RESULTS: Both the number of papules as well as pruritus decreased after UVB treatment in all but one patient. Immunoperoxidase staining showed a relative decrease in CD4+, CD8+, and CD2+ cells in all samples studied except for the patient noted to be unresponsive to the therapy. CONCLUSION: UVB phototherapy is effective in the treatment of patients with PPE. This is associated with a significant decrease in inflammation and number of T cells from various subsets within the dermis, thereby implicating these cells in the pathogenesis of this disorder.

Acquired Immunodeficiency Syndrome

Basal cell carcinoma of the scrotum. Report of three cases and review of the literature.

BACKGROUND: Although basal cell carcinoma (BCC) is the most common human malignancy, only 21 cases involving the scrotum have been previously reported. OBJECTIVE: Our purpose is to describe three additional cases of scrotal BCC and review the literature summarizing the clinical features and identifying any predisposing factors. METHODS: We retrospectively reviewed 21 cases of scrotal BCC and described three new cases. Polymerase chain reaction (PCR) was used to detect human papillomavirus (HPV) DNA in our biopsy specimens. RESULTS: Scrotal BCCs present as persistent ulcerations or plaques without identifiable predisposing factors. Lymphatic, pulmonary, or skin metastases were present in 3 of 24 cases (13%) resulting in death in one case. PCR did not detect HPV DNA in our three cases. CONCLUSION: Scrotal BCC rarely occurs and should be considered in the diagnosis of a persistent scrotal ulcer or plaque. Metastatic disease may be more common than with other BCCs and wide local excision or Mohs micrographic surgery may be the most appropriate initial therapeutic approach.

Aged

Detection with the polymerase chain reaction of human papillomavirus DNA in condylomata acuminata treated in vitro with liquid nitrogen, trichloroacetic acid, and podophyllin.

BACKGROUND: The mechanisms of action for local treatments used against condylomata acuminata are unknown, but most are believed to cause physical destruction of infected tissue. OBJECTIVE: Our purpose was to determine whether liquid nitrogen, trichloroacetic acid (TCA), and podophyllin damage HPV DNA found in condylomata acuminata. METHODS: Fourteen genital warts were excised from 14 patients and divided. One part was treated with liquid nitrogen, the second and third parts were treated with TCA and podophyllin, respectively, and the remainder served as a control. DNA was then extracted from tissue by proteolytic digestion and amplified by the polymerase chain reaction. Dot blots were performed with the use of radiolabeled consensus and HPV type-specific probes. RESULTS: HPV DNA was amplified and detected in 100% of untreated specimens, in 92% of specimens treated with liquid nitrogen, and in 15% and 7% of specimens treated with podophyllin and TCA, respectively. CONCLUSION: TCA and podophyllin damage HPV DNA more effectively than does liquid nitrogen.

Biopsy