Esophageal lichen planus:A case report and review of the literature

Esophageal involvement by lichen planus(ELP),previously thought to be quite rare,is a disease much more common in women and frequently the initial manifestation of mucocutaneous lichen planus(LP).Considering that the symptoms of ELP do not present in a predictable manner,ELP is perhaps more under-recognized than rare.To date,four cases of squamous cell carcinoma in association with ELP have been reported,suggesting that timely and accurate diagnosis of ELP is of importance for appropriate follow-up.In this case report,a 69-year-old female presented with dysphagia and odynophagia.She reported a history of oral LP but had no active oral or skin lesions.Endoscopic examination revealed severe strictures and web-like areas in the esophagus.Histologic examination demonstratedextensive denudation of the squamous epithelium,scattered intraepithelial lymphocytes,rare eosinophils and dyskeratotic cells.Direct immunofluorescence showed rare cytoid bodies and was used to exclude other primary immunobullous disorders.By using clinical,endoscopic,and histologic data,a broad list of differential diagnoses can be narrowed,and the accurate diagnosis of ELP can be made,which is essential for proper treatment and subsequent follow-up.

肢端角化性弹性组织角化症

A 45-year-old white woman presented with several years’history of firm, shiny papules on the lateral hands with slight extension to the dorsal fingers. The lesions first appeared between the index fingers and thumbs on both hands. They gradually increased in number, coalescing into plaques and affecting the junction between the palmar and dorsal skin. The patient did not have involvement of her feet. She had been diagnosed previously with chronic eczema that had failed to respond to multiple topical medications. In addition, the patient’s sister had similar lesions on both hands. The patient denied any symptoms of hyperhidrosis, excessive sun exposure, or trauma. The plaques were asymptomatic, but were cosmetically unappealing to the patient. On physical examination, small, firm, skin-colored, hyperkeratotic papules, coalescing into plaques, were located on the junction between the palmar and dorsal skin on both lateral margins of the thumb and on the radial side of the index finger (Fig. 1). There were no lesions on the feet. A biopsy taken from a papule on the patient’s left hand was consistent histologically with acrokeratoelastoidosis. The biopsy showed marked degeneration of collagen in the dermis with solar elastosis and some smudging of the papillary dermal collagen (Fig. 2). She was treated with clobetasone cream to the affected areas on the hands. After 6 weeks of treatment, she reported no significant improvement.

基底细胞癌的发展与宿主免疫反应和基质改变相关的组织学分析

Neoplastic progression is characterized in part by escape from immune surveillance and formation of growth-permissive stroma. Basal cell carcinoma (BCC) can be subclassified into low-and high-risk types for local recurrence. To determine whether these types of BCC correlate with alterations in local host immune response and stroma and whether these changes follow stepwise histologic progression from low-to high-risk subtypes, we assessed the clinicopathologic features in 175 consecutive primary (nonrecurrent) BCC excision specimens. BCCs exhibited a significantly higher frequency of mixed rather than homogeneous growth patterns (76%vs. 24%, P ≤0.0001). Nodular (84%) was the most common pattern identified followed by superficial (77%), infiltrative (27%), morpheic (5%) and micronodular patterns (4%). Only superficial (12%of all BCC) and nodular (12%) patterns were identified in BCC with a homogeneous histologic phenotype. Micronodular and infiltrative-morpheic patterns were not identified together in mixed patterned BCCs, and these high-risk types were contiguous with nodular BCC. Superficial predominant BCC (major growth pattern) was significantly associated with trunk and extremity location (76%) and skin without solar elastosis (82%), whereas BCC harboring a nodular growth pattern component was significantly associated with a head and neck location (63%) and the presence of adjacent solar elastosis (all P ≤0.03). Significant correlations were identified for BCC subtypes with inflammatory and stromal alterations: superficial BCC with old regression and moderate to dense peritumoral lymphocytic infiltrates; high-risk types correlated with active regression; infiltrative and morpheic BCC with fibrosing tumor stroma; and micronodular BCC with loss of both host inflammatory and stromal tumor responses. Evaluating the theoretical histologic stepwise model of BCCprogression (superficial-to-nodular-to-micronodular,or superficial-to-nodular-to-infiltrative-to-morpheic BCC types)-revealed significant linear correlations with host response and alterations of tumor stroma (r ≤0.54, P ≤0.0001).BCC exhibit distinct epithelial-stromal-inflamm- atory patterns that correlate with BCC subtype and tumor progression. This ostensible pathway of diminishing host response and gain of permissive tissue environment highlights neoplastic evolution from low to high risk for local recurrence of BCC and implicates a histologic continuum reflecting dynamic host-BCC interactions.

表达CD34的皮肤原发性恶性黑色素瘤:罕见黑色素瘤表型1例报道及文献回顾

Background: The histological diagnosis of malignant melanoma can be challenging. Immunohistochemical techniques may define a critical role in certain cases, specifically in establishing a primary diagnosis of melanoma. CD34 is a hemopoietic stem cell antigen expressed in bone marrow and endothelial cells, and may also be expressed in vascular and spindle cell tumors; it is generally negative in malignant melanoma. Case report: An 83-year-old white female presented with a 3-4 mm area on her right upper back, which had been present for several years. Histologic sections showed a polypoid distortion by sheets and nodules of transformed amelanotic melanocytes lying in intimate apposition to an attenuated epidermis without a concomitant radial growth phase. Tumor cells were extensively S-100 and CD34 positive and showed focal immunoreactivity with melan-A and HMB-45. Discussions: We present a case of malignant melanoma of nodular subtype, which strongly expressed CD34. The spectrum of abnormal phenotypes in malignant melanoma is reviewed, and a possible explanation for the presence of GD34 is discussed. This case demonstrates the potential of malignant melanoma to express CD34, defining an infrequently recognized aberrant phenotype. Whether or not expression of this marker is associated with a more aggressive clinical course remains to be determined.

口腔梭形细胞脂肪瘤

Spindle cell lipoma is typically seen in the neck/trunk region of middle-aged and older men. Rare cases of oral spindle cell lipoma have been reported. An entity described as myxoid lipoma of the oral cavity has rarely been reported but appears to be more properly classified as spindle cell lipoma. We describe the largest series yet of oral spindle cell lipoma involving the tongue (4), buccal mucosa (1), floor of mouth (1), and lip (1). The patients (3M; 4F) ranged from 31 to 88 years old. All presented with mass lesions. All were circumscribed and composed of mature adipocytes admixed with bland spindled cells. In two cases the adipocytes appeared atrophic, imparting a pseudo-lipoblastic appearance. No true lipoblasts were seen and none had the characteristic vasculature of a myxoid liposarcoma or the characteristic hyperchromatic cells of well differentiated liposarcoma. The stromal background of all cases contained characteristic wiry collagen and myxoid ground substance. The myxoid ground substance was prominent in four cases. Immunohistochemical stains for CD34 highlighted the bland spindle cells in all cases. The combination of the histologic features and the immunoreactivity for CD34 confirmed the diagnosis. Spindle cell lipoma should be considered in the differential diagnosis of oral cavity mesenchymal tumors.

Tale of Two Alopecias: Alopecia Areata and Central Centrifugal Cicatricial Alopecia Occurring in the Same Patient

Introduction:Scarring and non-scarring alopecias have rarely been described to occur together in the same patient.Distinguishing these two different types of alopecia is important as treatment and prognosis can be different.Case presentation:Here,we report the first case of simultaneous alopecia areata(AA)and central centrifugal cicatricial alopecia(CCCA)in a 35-year-old woman.New alopecic patches were noted on her frontal and vertex scalp.Biopsy of the frontal scalp revealed miniaturized hair follicles and dense lymphocytic infiltrate surrounding the hair bulbs,consistent with AA;while biopsy of the vertex scalp revealed decreased hair follicles,perifollicular fibroplasia with eccentric atrophy of the follicular epithelium,and premature desquamation of the inner root sheath at the level of the lower isthmus,consistent with CCCA.Discussion:Proposed mechanisms of these two alopecia types occurring together include loss of immune privilege,genetic predisposition,as well as unknown external factors that trigger an autoimmune lymphocytic response.Most recently,the peptidylarginine deiminase type III gene has been implicated in both diseases.Although treatment options can overlap between thetwo diseases,treatment response can differ and CCCA tendsto have a worse prognosis.Conclusion:Awareness of this concomitant presentation of two alopecic types is important for appropriate treatment and prognostication.