Histiocytic sarcoma with secondary involvement of the skin and expression of CD1a: evidence of indeterminate cell differentiation?

BACKGROUND: Histiocytic sarcoma is an exceedingly rare malignant neoplasm composed of cells with a monocyte/macrophage phenotype. In the current nosology of histiocytic neoplasms, histiocytic sarcoma is separate from indeterminate cell histiocytosis, a generally benign disorder characterized by proliferation of a CD1a+ and S-100+ population of cells lacking Birbeck granules usually limited to the skin. METHODS: We present a case of histiocytic sarcoma in a 64-year-old man presenting as a peritonsillar mass and secondarily involving the skin. RESULTS: The malignant cells in the extracutaneous foci of disease expressed macrophage-associated antigens including S-100 but were CD1a-. The malignant cells in the skin coexpressed CD1a and S-100 but lacked ultrastructural features of Langerhans cells, findings indicative of indeterminate cells. CONCLUSIONS: We discuss the clinical and histopathologic differential diagnosis in association with prior reported cases of histiocytic sarcoma, particularly in cases involving the skin and cases expressing the Langerhans cell-associated antigen CD1a.     

A preclinical study testing “Focused multiple laser beams,” a new concept of irradiation with the 1064-nm Nd:YAG laser for skin rejuvenation

Introduction: In order to avoid epidermal heat damage, we developed a novel irradiation method termed “Focused multiple laser beams (FMLB),” which allows long-pulse neodymium:yttrium aluminum garnet (Nd:YAG) laser beams to be irradiated from several directions in a concentric fashion followed by focusing into the dermis without epidermal damage. This study aimed to assess whether FMLB achieves the desired dermal improvement without epidermal damage. Materials and methods: The dorsal skin of New Zealand White rabbits was irradiated with FMLB. Macroscopic and histological analyses were performed after 1 hour and 1, 2, 3 and 4 weeks. Real-time PCR analysis of type I and III collagen expression was performed at two and four weeks. Results: Control groups exhibited skin ulcers which were healed with scar formation whereas FMLB groups remained intact macroscopically. Histologically, FMLB group showed increase in dermal thickness at four weeks while the epidermis remained intact. Real-time PCR demonstrated that both type I and III collagen increased at two weeks but decreased at four weeks. Conclusions: FMLB can deliver the target laser energy to the dermis without significantly affecting the epidermis.     

Objective and subjective clinical effects of a Nd:YAG 532‐nm frequency‐doubled long‐pulsed diode pumped laser system on photoaging of the face: A retrospective study on color signs,texture and rhytids

BACKGROUND: Pulsed 532‐nm lasers have been widely used in the treatment of vascular and pigmented conditions of aged skin. In addition to lesion clearance, many patients report color and texture improvements to the skin. These improvements are often difficult to appreciate from photographic analysis alone, but are significant to the patient's impression of treatment success. OBJECTIVE: To grade and compare objective and subjective results of treatments with a 532‐nm frequency‐doubled pulsed Nd:YAG laser using criteria of skin color, skin texture, and wrinkles based on a blinded retrospective analysis of photographs compared with results from patient questionnaires. METHODS: Clinical before and after pictures from 20 patients (skin types I–IV) treated for diffuse vascular and pigmented lesions were selected for evaluation. A blinded grading was performed using criteria of skin color, skin texture, and wrinkles. Patients were asked by questionnaire to also grade improvement using the same criteria. The results of the blinded and patient grading were reported and compared using a chi‐squared analysis. RESULTS: Clinical improvements recorded by blinded photographic evaluation and patient evaluation agreed with no statistically significant differences. Both the blinded observers and patients recorded remarkable improvement in the color signs of photoaging, slight to moderate improvement in skin texture and fine wrinkles, and negligible improvement of medium depth and deep wrinkles. CONCLUSION: The 532‐nm pulsed laser is a safe and effective device for the treatment of the visible signs of photoaging of skin types I–III. In addition to improvements in color defects, objectively and subjectively significant improvements in texture and fine wrinkles can be expected. Little to no improvement in medium to deep wrinkles can be anticipated.     

Superficial acral fibromyxoma: a clinicopathological study of new 41 cases from the U.K.: should myxoma (NOS) and fibroma (NOS) continue as part of 21st‐century reporting?

Background Superficial acral fibromyxoma (SAF) remains poorly recognized by general pathologists and dermatopathologists, partly attributable to its relatively uncommon occurrence and recent documentation. Objectives To examine a series of SAF and document the U.K. experience with this new entity. Methods We reviewed 771 tumours reported between 1970 and 2006 in seven different U.K. hospitals and coded as myxoma, not otherwise specified (NOS), fibroma (NOS) or dermatofibroma (NOS) presenting at acral sites. Forty‐one cases of SAF were studied. Results The patients comprised 27 men and 14 women, age range 19–91 years (mean 50, median 47), presenting with a solitary mass or nodule with a mean size of 1·92 cm. The common clinical sites were the toes (n = 29) and fingers (n = 11) as well as the palm (n = 1), with more than 75% of cases close to or involving the nail bed. All cases presented with a painless mass except for four cases where pain was the presenting complaint. A history of trauma was reported in only two cases. Histologically, all cases presented as proliferation of spindle‐shaped and/or stellate cells with a storiform and fascicular pattern embedded in a fibromyxoid/collagenous stroma with conspicuous mast cells. Multinucleated cells were observed (n = 22), increased number of blood vessels in the stroma and extravasation of red blood cells (n = 4). The characteristic immunophenotype was CD34+, CD99+/?, epithelial membrane antigen+ focally/?, S100?, desmin?, smooth muscle actin?, HMB45? and cytokeratin?. Conclusions We describe a large series of 41 cases of SAF showing that it is a distinct entity with typical clinical, histological and immunohistochemical features. Follow‐up was available only in 12 patients, precluding a firm comment on recurrence. However, complete excision and follow‐up review is recommended.