Cutaneous mastocytosis (CM) or urticaria pigmentosa is characterized by abnormal proliferation and accumulation of mast cells. Clinically, CM usually presents as symmetrically distributed red- brown macules or papules...Cutaneous mastocytosis (CM) or urticaria pigmentosa is characterized by abnormal proliferation and accumulation of mast cells. Clinically, CM usually presents as symmetrically distributed red- brown macules or papules that develop weals, erythema and often pruritus on stroking (Darier’ s sign). The histological hallmark of the disease is an increase in oval to spindle- shaped mast cells in the dermis located around blood vessels and skin appendages. We describe three patients with a new clinicopathological type of CM, which clinically mimics a histiocytic disorder and histologically mimics leucocytoclastic vasculitis (LV). Three infants (two boys and one girl) developed generalized reddish- yellow- brown macules of 3- 10 cm with occasional scaling and crusting on the trunk and extremities without further symptoms or organ involvement except variable itching. Histology revealed diffuse and dense dermal infiltrates of eosinophils, neutrophils and nuclear debris with perivascular accentuation, imitating LV. This infiltrate masked large epithelioid cells, positive for macrophage markers, which by special histochemical stains for metachromatic granules turned out to be mast cells. This is the first report of this new variant of CM, which may cause considerable diagnostic difficulties both clinically and histopathologically.展开更多
BACKGROUND: Clinicopathologic staging of colorectal cancer remains the best predictor of survival. Prognostication for an individual with colorectal cancer remains elusive. This study was designed to investigate the i...BACKGROUND: Clinicopathologic staging of colorectal cancer remains the best predictor of survival. Prognostication for an individual with colorectal cancer remains elusive. This study was designed to investigate the incidence of free surface colorectal cancer cells detected by cytology during elective open curative resection, to correlate their presence with particular clinicopathologic variables and determine whether their presence was predictive of cancer-specific survival. METHODS: Over a six-year period in one institution, all elective colon and intraperitoneal rectal cancer specimens were assessed during primary resection for the presence of free colorectal cancer cells by means of a simple and tested specimen imprint cytology methodology. Clinicopathologic variables were assessed prospectively and blinded to cytology results. All patients were followed up routinely until death and if the patient was not seen within the last six months, information was obtained from the New South Wales Registry of Births, Deaths and Marriages in Australia. RESULTS: Overall, 26 of 281 (9.25 percent) colorectal cancers had positive cytology for cancer cells on the peritoneal surface of the bowel. Poorly differentiated tumors were significantly associated with positive cytology. Tumor penetration, presence of vascular or neural invasion, mucinous characteristics, lymph node status, and operative procedure performed were not statistically significant predictors of positive cytology. Overall, 43 of the 281 patients (15.3 percent) died during the mean followup period of 49.2 months from cancer-related deaths. Of these patients, 8 had positive cytology and 35 had negative cytology results. Cancer-specific survival assessed with the log-rank test was significantly associated with positive cytology in univariate (P = 0.008) and multivariate analysis (P < 0.001). CONCLUSION: In this study, the presence of free surface colorectal cancer cells has been shown to be predictive of survival and is independent of direct peritoneal invasion and lymph node status. Thus, further assessment of this simple prognostic variable is warranted and selection of patients with positive cytology for possible adjuvant therapies may be beneficial.展开更多
文摘Cutaneous mastocytosis (CM) or urticaria pigmentosa is characterized by abnormal proliferation and accumulation of mast cells. Clinically, CM usually presents as symmetrically distributed red- brown macules or papules that develop weals, erythema and often pruritus on stroking (Darier’ s sign). The histological hallmark of the disease is an increase in oval to spindle- shaped mast cells in the dermis located around blood vessels and skin appendages. We describe three patients with a new clinicopathological type of CM, which clinically mimics a histiocytic disorder and histologically mimics leucocytoclastic vasculitis (LV). Three infants (two boys and one girl) developed generalized reddish- yellow- brown macules of 3- 10 cm with occasional scaling and crusting on the trunk and extremities without further symptoms or organ involvement except variable itching. Histology revealed diffuse and dense dermal infiltrates of eosinophils, neutrophils and nuclear debris with perivascular accentuation, imitating LV. This infiltrate masked large epithelioid cells, positive for macrophage markers, which by special histochemical stains for metachromatic granules turned out to be mast cells. This is the first report of this new variant of CM, which may cause considerable diagnostic difficulties both clinically and histopathologically.
文摘BACKGROUND: Clinicopathologic staging of colorectal cancer remains the best predictor of survival. Prognostication for an individual with colorectal cancer remains elusive. This study was designed to investigate the incidence of free surface colorectal cancer cells detected by cytology during elective open curative resection, to correlate their presence with particular clinicopathologic variables and determine whether their presence was predictive of cancer-specific survival. METHODS: Over a six-year period in one institution, all elective colon and intraperitoneal rectal cancer specimens were assessed during primary resection for the presence of free colorectal cancer cells by means of a simple and tested specimen imprint cytology methodology. Clinicopathologic variables were assessed prospectively and blinded to cytology results. All patients were followed up routinely until death and if the patient was not seen within the last six months, information was obtained from the New South Wales Registry of Births, Deaths and Marriages in Australia. RESULTS: Overall, 26 of 281 (9.25 percent) colorectal cancers had positive cytology for cancer cells on the peritoneal surface of the bowel. Poorly differentiated tumors were significantly associated with positive cytology. Tumor penetration, presence of vascular or neural invasion, mucinous characteristics, lymph node status, and operative procedure performed were not statistically significant predictors of positive cytology. Overall, 43 of the 281 patients (15.3 percent) died during the mean followup period of 49.2 months from cancer-related deaths. Of these patients, 8 had positive cytology and 35 had negative cytology results. Cancer-specific survival assessed with the log-rank test was significantly associated with positive cytology in univariate (P = 0.008) and multivariate analysis (P < 0.001). CONCLUSION: In this study, the presence of free surface colorectal cancer cells has been shown to be predictive of survival and is independent of direct peritoneal invasion and lymph node status. Thus, further assessment of this simple prognostic variable is warranted and selection of patients with positive cytology for possible adjuvant therapies may be beneficial.
