Disorder of hair growth in hyperprolactinemia

Functional hyperprolactinemia was found in five female patients, 25-35 years old, seeking medical consultation for hair loss, together with hypertrichosis (4x), disturbances of cyclic bleeding periods (4x), secondary amenorrhea (2x), galactorrhea (2x), seborrhea (2x) and persisting acne (1x). Other hormonal parameters including testosterone levels and thyroid gland function tests were unchanged. Prolactinoma was excluded by x-ray diagrams, partly also by computer tomograms of the sella. In two patients increased telogen effluvium was found by trichogram examination with some dystrophic hairs; in one patient only dystrophic hairs were seen, whereas, in two cases, hair loss was not present at the time of our clinical examination. These observations indicate that cutaneous symptoms such as seborrhea, acne, hypertrichosis/hirsutism, alopecia(= SAHA syndrome) may evidently occur in hyperprolactinemia, representing or mimicking androgen-induced skin symptoms. In such cases, therefore, evaluation of prolactin levels together with androgen blood levels and thyroid gland function tests should be performed to exclude underlying endocrinopathy.     

Hormonal Profiles and Prevalence of Polycystic Ovary Syndrome in Women with Acne

One of the important etiologic factors in acne is an increase in sebaceous gland activity, which is androgen dependent. Acne is a common manifestation of hyperandrogenemia. Therefore, acne may not only cause cosmetic concern but may also be a sign of underlying disease. In females, the most common cause of hyperandrogenemia is polycystic ovary syndrome (PCOS). The purpose of this study was to determine the hormonal profiles of women with acne and the prevalence of PCOS in women attending the dermatological clinic with acne problems. The diagnostic criteria of PCOS were clinical findings of menstrual disturbances and hyperandrogenism (acne, seborrhea, hirsutism), pelvic ultrasound imaging of PCO (multiple subcapsular ovarian cysts 2–8 mm. in diameter, with dense echogenic stroma), and an elevated luteinizing hormone (LH) to follicle stimulating hormone (FSH) ratio. There were 51 women with acne; 20 regularly menstruating volunteers without acne served as a control group. PCOS was found in 19 out of 51 patients with acne (37.3%) and none of the control group. Twenty acne patients had abnormal menstruation (39.2%). Acne cases had higher mean levels of serum total testosterone (T), free T, dehydroepiandrosterone sulfate (DHEAS) and prolactin (PRL). No statistically significant difference was observed for LH, FSH or sex hormone binding globulin (SHBG). Because of this high prevalence of PCOS in women with acne, all women presenting with acne should be asked about their menstrual pattern and examined for other signs of hyperandrogenemia. Hormonal profile determination as well as pelvic ultrasonography for ovarian visualization should be performed to confirm the diagnosis of PCOS in female acne patients who have menstrual disturbances.     

小汗腺肿瘤凝集素受体亲和组化研究

目的研究皮肤小汗腺肿瘤细胞表面凝集素受体的分布及变化规律.方法应用17种生物素化的凝集素,采用ABC方法检测了30例小汗腺良恶性肿瘤细胞表面凝集素受体的表达.结果马铃薯凝集素(STL)在小汗腺恶性肿瘤中阳性率较高,与良性肿瘤相比差异有显著性(P＜0.01),小汗腺恶性肿瘤中除阳性着染形态分布不规则外,还可见胞浆着染.结论小汗腺肿瘤在癌变过程中,其细胞表面复合糖糖基及细胞正常结构发生了有意义的变化.     

Assessment of cellular proliferation of eccrine acrospiromas and eccrine sweat gland carcinomas by AgNOR counting and immunohistochemical demonstration of proliferating cell nuclear antigen (PCNA) and Ki-67

Argyrophil nucleolar organizer regions (AgNORs) were counted and immunostaining using antibodies raised against proliferating cell nuclear antigen (PCNA) and Ki-67 was carried out on eccrine acrospiroma and eccrine sweat gland carcinoma, to determine the malignant potential and prognosis of these tumours. Formalin-fixed and paraffin-embedded tissue specimens surgically excised from 25 patients with eccrine sweat gland carcinoma (20 cases of eccrine porocarcinoma, four cases of ductal sweat gland carcinoma and one case of malignant clear cell hidradenoma) and 25 patients with eccrine acrospiroma (16 cases of eccrine poroma, four cases of poroid hidradenoma and five cases of clear cell hidradenoma) were used. PCNA and Ki-67 labelling indices were categorized semiquantitatively into four grades. Significant differences were noted between eccrine sweat gland carcinoma and eccrine acrospiroma with these three methods (P < 0.01). When a cut-off of 5 was chosen, the AgNOR value distinguished eccrine sweat gland carcinoma from eccrine acrospiroma with high specificity and sensitivity. Moreover, we compared the results of these three methods between stages 1 or 2 (17 cases) and stage 3 (eight cases) eccrine sweat gland carcinomas, and no significant differences were observed. From these findings, these three methods are useful in discriminating malignant from benign lesions of eccrine tumours, but have no value in estimating the aggressiveness of eccrine sweat gland carcinomas.     

Skin changes in long-term dialysis patients. clinical study

Fifty-one regular hemodialysis patients underwent clinicodermatologic examination. Twenty-three of them were on regular hemodialysis for 2-3 years (group I), 28 patients for more than 8 years (group II). Both groups were matched in regard to primary kidney disease, age, and sex. A characteristic feature found was a marked premature aging of the skin, mainly imposing as actinic elastosis. The incidence was related to the duration of hemodialysis (56.5% of patients of the first group and 100% of patients of the second group). There was also a correlation between time on hemodialysis and an increase of skin pigmentation. Other phenomena like xeroderma, decrease of sebaceous and sweat gland secretion, and Raynaud syndrome were also seen more frequently in the second group, but the extent of these alterations was equal in both groups. Seventy-eight percent of the patients of the first group and 43% of the second group suffered from generalized pruritus. Two different froms of pruritus could be observed, one possibly atopic, only occurring during regular hemodialysis, the other occurring independent of hemodialysis. accumulation of rare phenomena like carpal-tunnel syndrome and Dupuytren's contractures in group II together with the frequent occurrence of actinic elastosis implies systemic disturbance of collagen metabolism in long-term regular hemodialysis patients.     

An Immunohistochemical Study of BCA-225 in Various Skin Cancers

We performed an immunohistochemical study of BCA-225, which is a glycoprotein secreted by the T47D breast carcinoma cell line and recognized by monoclonal antibody BRST-1 (clone name: CU-18), in normal skin and various skin cancers. In normal skin, BCA-225 was positive only in the secretory portion of both eccrine and apocrine glands and in mature cells of the sebaceous gland. We observed 10 cases of squamous cell carcinoma of the skin, 10 cases of basal cell carcinoma without sebaceous differentiation, 3 cases of basal cell carcinoma with sebaceous differentiation, 6 cases of malignant trichilemmoma, 8 cases of eccrine porocarcinoma, 3 cases of ductal carcinoma, 1 case of malignant clear cell hidradenoma, 1 case of apocrine adenocarcinoma, 6 cases of extra-ocular sebaceous carcinoma, 5 cases of extramammary Paget's disease with underlying adenocarcinoma, and 11 cases of extramammary Paget's disease without underlying adenocarcinoma. Most of the cases of sweat gland carcinoma, basal cell carcinoma with sebaceous differentiation, sebaceous carcinoma, and extramammary Paget's disease were positive for BCA-225, while none of the cases of squamous cell carcinoma, basal cell carcinoma without sebaceous differentiation, or malignant trichilemoma were positive. Based on these findings, we believe that BCA-225 is useful in distinguishing tumors with sweat gland and sebaceous differentiation and extramammary Paget's disease from tumors without such differentiation.     

Epigenetic inactivation of the E-cadherin gene in eyelid sebaceous gland carcinoma

Background E‐cadherin and β‐catenin are crucial components of the cell–cell adhesion complex. Their loss has often been associated with tumour metastasis and poor clinical outcome. Both loss of E‐cadherin at the cell membrane and a stabilizing mutation in CTNNB1 (β‐catenin gene) have been associated with ovarian, colorectal, hepatocellular and nonmelanoma skin cancer, such as squamous and basal cell carcinomas. Absence of E‐cadherin may be caused by promoter hypermethylation of the E‐cadherin gene (CDH1). Objectives To determine the role of E‐cadherin promoter hypermethylation and CTNNB1 gene mutation in the aggressive behaviour of sebaceous gland carcinoma of the eyelid. Methods Thirty‐six cases of sebaceous gland carcinoma were subjected to E‐cadherin methylation‐specific polymerase chain reaction and mutational analysis for the CTNNB1 gene. E‐cadherin and β‐catenin staining was evaluated by immunohistochemistry. Results were correlated with the clinicopathological features of sebaceous gland carcinoma. Results Methylation of the E‐cadherin promoter region was detected in 72% of eyelid sebaceous gland carcinoma cases and loss of E‐cadherin immunostaining in 83%. E‐cadherin promoter hypermethylation showed a significant association with the loss of membranous E‐cadherin (P = 0·038) and it was of borderline significance with reduced disease‐free survival (P = 0·05). It was also found to be associated with advanced age (73%), tumour size ≥ 2 cm (77%), orbital invasion (83%), lymph node metastasis (60%), tumour recurrence (60%) and poor histological differentiation (90%). DNA sequencing revealed no stabilizing β‐catenin gene mutation in sebaceous gland carcinoma. Loss of membranous β‐catenin was observed in 61% cases, which associated significantly with both E‐cadherin promoter methylation (P = 0·0262) and loss of E‐cadherin membranous localization (P = 0·0015). Conclusion Epigenetic inactivation of the E‐cadherin gene causes loss of membrane‐bound E‐cadherin and could contribute to the reduced disease‐free survival in eyelid sebaceous gland carcinoma. Mutations in the β‐catenin gene do not seem to be involved in the pathogenesis of eyelid sebaceous gland carcinoma.     

Patterns of erythropoiesis and anaemia in leprosy

A total of 128 leprosy patients were investigated for the morphological type of anaemia, the underlying disturbances in iron metabolism and patterns of erythropoiesis and other cytomorphological changes in the bone marrow. The anaemia was a mild to moderate degree in paucibacillary (PB) leprosy, while in multibacillary (MB) leprosy it was of a severe degree. Iron deficiency was observed in only a few patients. Impaired iron utilization as observed in a anaemia of a chronic disorder was a common finding in MB leprosy (41.7%) and more so in new cases (50%). Megaloblastic erythropoiesis was also more frequent in MB leprosy (45.2%) as compared to PB leprosy (16%), accounting for the severe degree of anaemia in the former type. In 17.2% of the total patients (MB, 21.4%; PB, 9%) both megaloblastic erythropoiesis and features of impaired iron utilization were observed in bone marrow. Disturbances in iron metabolism and erythropoiesis were also observed but to a lesser degree in patients receiving specific antileprosy treatment. Irrespective of the type of disease and duration of treatment, increasing frequency of acid-fast bacillia (AFB) positivity and granulomas was observed in the bone marrow with an increasing severity of anaemia.     

Sweat gland tumors in Niger. Anatomopathology

The authors report 15 cases of sweat gland tumour observed over 2 years in Niger where their pathology was never studied. These tumours accounted for 0.38 p. 100 of all examinations performed during the same period at the pathological laboratory of the University of Niamey. They ranked sixth among the diagnoses of skin pathology. Only routine histological techniques were used. The diagnoses obtained could be divided into 5 groups. Eight women presented with partly solid cystic tumours located on the legs in 5 cases; their structure was typical of nodular hidradenoma. Two male patients had cyst-pitted tumours the superficial portion of which showed a structure of papillary eccrine adenoma, while the deep portion contained a multitude of cysts with atrophic walls; the authors consider this type of tumour as a variant of papillary eccrine adenoma. One patient had a syringocystadenoma which also included a large cyst. Finally, one patient presented with a chondroid syringoma in the axillary region, and 3 patients had histologically aggressive carcinomas located on the sole, forehead and axillary region respectively. Clinical and paraclinical investigations failed to detect any deep malignancy in these three patients, and their tumours were regarded as compatible with sweat gland carcinomas. In this series, two lesions were unusually numerous: carcinomas and nodular hydradenomas. The first named probably are a consequence of the socio-economic conditions prevailing in the population of Niger: poverty prevents patients from consulting for diseases which produce no symptoms, which artificially increases the apparent incidence of aggressive lesions. As for nodular hydradenomas, they are large owing to the presence of cysts.(ABSTRACT TRUNCATED AT 250 WORDS)     

Primary mucinous carcinoma of the skin

Primary mucinous carcinomas of the skin are very rare. To date, 120 cases have been described in the literature. This tumor is a histologic subtype of sweat gland carcinoma. Because of the histopathologic appearance, primary mucinous carcinoma of the skin can be mistaken for metastasis from extracutaneous sites. We report on the cases of two elderly women with mucinous carcinomas arising in the scalp. Immunohistochemical staining of both tumors was positive for low-molecular-weight cytokeratin and epithelial membrane antigen. Carcinoembryonic antigen was positive in Case 2. Neuroendocrine features represented by neuron-enolase-specific positivity were also observed in both cases, and Grimelius and chromogranin A positivity were observed in Case 2. In both cases, there was strong positivity for estrogen receptor and progesterone receptor. Image analysis cytometry showed a diploid DNA content with a low rate of proliferative cells and negativity for p53 and c-erbB-2 proteins in agreement with the low aggressiveness of these neoplasms.     

Mid-dermal elastolysis: a pathological and ultrastructural study of five cases

The aim of this study was to evaluate the presence of inflammatory phenomena and elastic fiber phagocytosis in mid-dermal elastolysis. The pathological and ultrastructural features of 5 Caucasian female patients (ranging from 26 to 40 years) with acquired diffuse asymptomatic areas of skin wrinkling have been reviewed. The clinical features of all cases were characteristic of this condition and only in one patient were erythematous urticaria-like, non pruriginous patches also observed. In 4 cases a history of prolonged sun bathing was present and in 3 cases there was a short history of oral contraception. The pathological study confirmed the typical absence of elastic fibers in the mid-reticular dermis. In two cases elastic fibers were still detectable in the periadnexal dermis. Hematoxylin and eosin sections showed a mild perivascular infiltrate in two cases, while in three patients histiocytes were scattered among collagen bundles. Multinucleated giant cells containing fragmented elastic fibers were detectable in one patient. Ultrastructural analysis revealed large mononuclear cells with phagocytic aspects toward elastic fibers in all cases.     

Coexpression of cytokeratin and vimentin intermediate filaments in benign and malignant sweat gland tumors

The coexpression of cytokeratin and vimentin intermediate filaments has been immunohistochemically evaluated in 124 benign and malignant sweat gland tumors of various types in comparison to normal sweat glands. In addition, all neoplasms have been stained by an antibody to alpha-smooth muscle actin. Epithelial cells reacted with the pan-cytokeratin antibody lu-5. In normal sweat glands, vimentin immunoreactivity was restricted to myoepithelial cells and to some cells of the coiled duct. In benign sweat gland tumors (n=88), coexpression of vimentin and alpha-smooth muscle actin was frequently found in basal cells of neoplasms considered to differentiate towards the secretory coil of the eccrine or apocrine gland. These included eccrine spiradenoma, apocrine cystadenoma, hidradenoma papilliferum, syringocystadenoma papilliferum, and cylindroma. Thus, in these tumors, vimentin-reactive cells corresponded to myoepithelial cells. Vimentin-positive cells were also found in 14 of 36 sweat gland carcinomas, including 1 case of sclerosing sweat duct carcinoma, 1 case of porocarcinoma, 4 cases of eccrine adenocarcinoma, 1 case of mucinous eccrine carcinoma, and 5 cases of apocrine adenocarcinoma. Co-expression of vimentin and alpha-smooth muscle actin was observed in some cells of eccrine and apocrine adenocarcino-mas. Therefore, in these neoplasms, some vimentin-positive cells appear to represent myoepithelial cells. In contrast, vimentin-positive cells in all other malignant tumors did not express alpha-smooth muscle actin. Our results indicate that coexpression of cytokeratin and vimentin may be frequently found in a variety of benign and malignant sweat gland tumors. In the majority of these neoplasms, vimentin-positive cells correspond to myoepithelial cells. Because vimentin is not specific for myoepithelial cells, additional stains for alpha-smooth muscle actin should be performed to prove the myoepithelial nature of vimentin-positive cells.     

Genetic changes in sweat gland carcinomas

The molecular pathogenesis of malignant appendageal tumors is poorly understood. Immunohistochemical staining, polymerase chain reaction (PCR)-based loss of heterozygosity (LOH) and sequencing analyses were performed in a mixed group of 21 sweat gland carcinomas. LOH was mostly confined to the chromosome arm 17p. None of the remaining 17 tumors showed LOH at any loci. Nuclear accumulation of p53 protein was observed in 3 tumors, all of which also showed LOH of 17p. One eccrine gland adenocarcinoma showed allelic loss of 17p and a Cys 176 Arg mutation in the p53 gene. The other three tumors that showed LOH of 17p, however, had wild-type p53 genes. A clear transition from benign eccrine poroma to porocarcinoma that was associated with p53 protein stabilization and allelic loss was observed in one tumor. One eccrine porocarcinoma/undifferentiated adnexal carcinoma showed prominent microsatellite instability, probably reflecting an underlying defect in DNA mismatch repair. Overexpression of erbB-2 was observed in three tumors. The low frequencies of LOH and p53 alterations in sweat gland carcinomas contrasted with the multiple genetic defects normally observed in cutaneous squamous cell carcinomas, and may be partly explained by the relative protection of cutaneous appendages from ultraviolet light and other environmental mutagens.     

Immunoglobulins Specific to Mosquito Salivary Gland Proteins in the Sera of Persons with Common or Hypersensitive Reactions to Mosquito Bites

Using the immunoblot technique, we analyzed the quality and quantity of IgG, IgG₄, and IgE specific to mosquito salivary gland (hereafter abbreviate as SG) components of Aedes albopictus in the sera of volunteers with common reactions and of 3 patients with severe reactions. In the volunteers with delayed reactions only or with both delayed and immediate reactions, IgG against SG components of A. albopictus formed several faint or moderately stained bands. Those with immediate reactions showed several intense bands and many other weak bands. In volunteers, who had been bitten by Aedes sp. frequently but had no skin reaction, and in severe cases, many intense IgG bands were observed. IgG₄ bound to SG components were found in the sera of the common reaction group at the levels of 24 and 48 kD, but, in one severe case, no bands were observed, although the total IgG was very high. IgE levels specific to SG components were much higher in severe cases than in the volunteers. These results indicate that high titers of specific IgG and IgE and lack of IgG₄ for particular components of SG may lead to severe allergic reactions in severe cases. Immunoblotting analysis of the antibodies also verified the possibility of developing in vitro tests to identify causative species of the mosquito for severe cases.     

Treatment of chronic discoid lupus erythematosus with thalidomide

Summary In an uncontrolled study the therapeutic effect of thalidomide on chronic discoid lupus erythematosus was investigated. In 24 patients (17 women, 7 men) with a history ranging from 0.5–32 years and unresponsive to any previous therapeutic measures, complete or substantial regression of the disease was observed in 19 cases (80%) after treatment with thalidomide. Side effects were somnolence, constipation, exanthema, oral dryness, and circulatory disturbances. None of these effects were serious.     

Varicella-zoster virus antigen expression of eccrine gland and duct epithelium in herpes zoster lesions

Background It is well known that varicella‐zoster virus (VZV) exhibits tropism for the epidermis and follicular epithelium, while little attention has been paid to eccrine gland and duct involvement by VZV. The presence of herpetic syringitis in immunocompromised hosts suggested the possibility of eccrine gland and duct involvement by VZV. Objectives To determine whether VZV antigens could be detected in eccrine gland or duct epithelium of herpes zoster (HZ) lesions obtained at various intervals after the onset of a rash, and whether this expression could also be detected in eccrine units from other inflammatory disease lesions suggestive of VZV infection. Methods We investigated immunohistochemically in vivo localization of VZV glycoprotein E (gE) antigen in HZ lesions and control inflammatory disease lesions, using the murine monoclonal antibody directed against the VZV gE. Results VZV gE was differentially detected in the epidermis, follicular and eccrine epithelium, and dermal infiltrating cells in HZ lesions obtained at various intervals after onset. The VZV gE was most persistently detected in eccrine units, regardless of the age of individual HZ lesions, compared with keratinocytes and follicular epithelium. The gE expression was also observed in other inflammatory disease lesions suggestive of VZV infection. Conclusions Immunohistochemical detection of VZV gE in eccrine epithelium can be a subtle clue to the diagnosis of HZ which displays most unusual manifestations, and VZV‐related disorders.     

Muir-Torre-Syndrom

The Muir-Torre syndrome (MTS) is a rare, autosomal-dominant inherited disease characterized by sebaceous gland tumors and at least one internal malignancy. In many cases a genetic defect known as microsatellite instability can be identified. Similar pathogenetic mechanisms are found in patients with the hereditary non-polyposis colon cancer syndrome, so that at least some patients with MTS are considered as having a phenotypic variant of that syndrome. A 66-year-old woman with MTS, developed multiple malignant cutaneous and visceral tumors over 32 years; in addition, she had multiple sebaceous gland adenomas. Microsatellite instability could be proved with 2 out of 5 studied markers. The family history was positive as numerous relatives of the patient's mother were reported to have developed internal malignancies.     

Benign lymphoepithelial lesion associated with squamous cell carcinoma of the skin: an immunohistochemical and molecular genetic study

BACKGROUND: Benign lymphoepithelial lesions (BLEL) are usually found in salivary glands in autoimmune disorders. Some LEL are recognized to already be, or may progress to become, lymphomas. Skin lesions similar to LEL have been described in lymphomas, and are caused by neoplastic lymphocytes which infiltrate adnexal structures. To date, BLEL have not widely been recognized in the skin. METHODS: We describe skin lesions similar to BLELs, at the periphery of squamous cell carcinomas (SCC) in 8 healthy patients, in one of whom the lesion recurred. Immunocharacterization of both epithelial and lymphocytic components and molecular genetic investigation was performed. Polymerase chain reaction (PCR) analysis was done to detect IgH chain gene, and T-cell receptor beta and gamma gene rearrangements. Association with Epstein-Barr virus (EBV) was also tested by in situ hybridization (ISH) for EBV-encoded RNAs (EBERs). RESULTS: Epithelial cells showed the immunophenotype of eccrine sweat gland ducts. Infiltrating lymphocytes expressed overwhelming B antigens and CD5. Neither clonal B and/or T proliferations nor EBERs signals were demonstrable. CONCLUSIONS: We observed skin lesions similar to BLELs, showing modifications of sweat gland duct and CD5+, B lymphocytic expansion. In our cases there were no associated autoimmune disorders; the local immunoresponse to SCC might have caused BLEL.     

Apocrine secretion in lacrimal gland cysts (dacryops): a common but underrecognized phenomenon

We present six cases (five females, one male; aged 26-81 years) of dacryops, also known as lacrimal gland cyst, all of which occurred at the outer canthal area below the upper eyelid. All presented clinically as a painless cystic lesion that was white to blue in color. Microscopically, in addition to typical features of dacryops, which is characterized by a partially cystic proliferation that includes a double layer of columnar to cuboidal epithelial cells associated with lobules of lacrimal gland tissue, we identified evidence of apocrine secretion (i.e. apical snouts projecting into the lumen), either in the cystic component of the proliferation or in contiguous lacrimal duct, in all cases. One example was unusual. It manifested, in addition to typical cyst formation, with areas of ductal and probably acinar hyperplasia. We conclude that apocrine secretion in dacryops is a common and underrecognized phenomenon. Dacryops should be distinguished from apocrine hidrocystoma, a lesion commonly encountered in the periorbital area in the practice of dermatopathology.     

Schweißdrüsen an der Rückseite der Ohrmuschel

Zusammenfassung 176 Gewebsproben aus Ohrmuscheln und 56 Gewebsproben aus dem übrigen Integument des menschlichen Körpers wurden vergleichend auf das Vorkommen von Schweißdrüsen untersucht.Es fand sich eine hochsignifikante Differenz in dem Sinne, daß an der Rückseite der Ohrmuschel zahlenmäßig nur ca. 25% der am übrigen Körper vorkommenden Schweißdrüsen gefunden wurden. Über 50% aller aus dem Ohr entnommenen Proben erwies sich als schweißdrüsenfrei.

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Retroauricular Sweat Glands

Summary 176 retroauricular tissue specimen and 56 skin excisions from other parts of the body were checked for the presence of sweat glands.The results obtained were highly significant. On the back side of the ear the number of perspiratory glands amounts to only 25% of the number in other parts of the body surface. In more than 50% of the retroauricular skin specimen no sweat glands could be found at all.