The usefulness of a diagnostic biopsy clinic in a genitourinary medicine setting: recent experience and a review of the literature

Genital diseases include a wide range of lesions e.g. infectious and inflammatory. In most cases a clinical diagnosis is reached without the need for a biopsy. Nonetheless, a genital biopsy is safe and may help to confirm the diagnosis. We established a dedicated diagnostic biopsy clinic in 2003. Our objective was to evaluate the effectiveness of our diagnostic biopsy clinic and compare it with other Genitourinary medicine (GUM) clinics in the UK. A retrospective case-note study was performed on 71 patients referred to the biopsy clinic with persistent genital lesions over a 12-month period. Forty-seven biopsies were performed (71% biopsy rate). 43 specimens (92%) were appropriate for histopathological diagnosis. Of these 15% were lichen planus, 15% lichen sclerosis, 10% psoriasis, 7.5% each: eczema, Zoon's and non-specific balanitis. The remainder represented a variety of other conditions. In 27 cases (68%) the clinical diagnosis was consistent with the histological result. The possibility of self-referral and walk-in nature of our GUM service substantially decrease the waiting times for assessment of anogenital disorders. We had a lower biopsy rate for the diagnosis of non-specific balanitis (7.5%) compared with the average rate (21.5%) in 14 UK GUM clinics and good agreement between clinical and histological diagnosis. An empirical first treatment, with simple emollients before biopsy, appears to be a safe clinical approach for the treatment of non-specific balanitis. A multidisciplinary approach (GUM physicians, dermatologists and urologists/gynaecologists) could help prevent unnecessary biopsies and improve correlation between clinical and histological diagnosis.     

Solar keratoses and their relationship to non-melanoma skin cancers

Solar keratoses belong to the list of clinically invisible dermatoses, as the loss of their horny layer may create the illusion that they have disappeared, and numerous subclinical lesions can be highlighted by 5-fluorouracil therapy. Solar keratoses are recognized as potential precursors for squamous cell carcinoma. However, basal cell carcinoma (BCC) may develop in a soft type of solar keratoses as a consequence of migration of pluripotential adnexal epithelial cells in reparative response to trauma, particularly in areas rich in adnexal structures, such as the face. These intraepithelial resident adnexal cells may result in the development of BCC following chronic solar exposure and damage.     

神经酰胺与相关皮肤病的研究进展

神经酰胺（ceramide,Cer）由长链鞘氨醇碱和脂肪酸组成,参与皮肤屏障的构成、调节皮肤免疫及细胞周期、分化与凋亡等过程。神经酰胺的合成代谢异常与多种皮肤疾病相关，如特应性皮炎、银屑病等。本文就神经酰胺与相关皮肤病的研究进展进行综述。     

The performance of telescoping fat pad biopsies for detecting systemic amyloidosis: a four and a half year retrospective analysis and brief review of the fine needle aspiration literature

Systemic amyloidosis has historically been diagnosed by organ biopsy and Congo red staining, with reported sensitivities that exceed 90%. The abdominal fat pad fine needle aspiration (FNA), introduced in the 1970's, carries sensitivity estimates largely derived from studies with deficiencies. Patient follow‐up is often unclear and proportionally low numbers of patients are verified as true negatives. Issues in other studies include only testing verified systemic amyloidosis cases. The telescoping fat pad biopsy (TFPB) is used as an alternative to FNA and is similarly carried out quickly with low morbidity. Although the two methods would seem to be comparable intuitively, this has not been established because sensitivity data for the TFPB method is scarce to non‐existent. The charts of 58 consecutive patients who underwent TFPB screening for amyloidosis in a single hospital from August of 2010 to January 2015 were examined. All six TFPB positive patients were determined to be true positives. Eight TFPB negative patients were concurrently determined to have systemic amyloidosis by other methods – organ biopsy (7) and mass spectrometry (1) resulting in a 43% sensitivity. The remaining patients were categorized into 25 true negatives and 18 that were indeterminate based on clinical course and other biopsy results.     

Erosive pustular dermatosis of the scalp successfully treated with oral prednisone and topical tacrolimus

Erosive pustular dermatosis of the scalp is a rare inflammatory disorder of the scalp, affecting elderly patients after local trauma and leading to scarring or cicatricial alopecia. Case Report: An elderly female patient complained of painful pustules on the parietal region bilaterally with progressive enlargement and ulceration. A biopsy suggested erosive pustular dermatosis of the scalp and the patient was treated with prednisone 40 mg/day and 0.1% topical tacrolimus. After 10 weeks complete closure of the eroded areas was observed and a stable scarring alopecia developed.     

狼疮性肾炎患者的临床表现与病理类型的相关性分析

目的 :　探讨狼疮性肾炎患者的临床表现、实验室检查与病理类型之间的关系 ,为临床治疗提供依据。方法 :　本文对 5 4例患者在B超定位下 ,用Meghini肾穿刺针抽吸法获取肾组织 ,标本分别作HE染色、直接免疫荧光 (作抗人IgG、IgM、IgA、C3和HBsAg染色 )和电镜检查 ,以及患者的临床表现、实验室检查等分析。统计学分析采用STATA (4.0 )软件进行Fisher检验。结果 :　 5 4例患者的病理类型分轻微病变型 (2例 )、膜型 (7例 )、膜增生型 (11例 )、系膜增生型 (8例 )、弥漫增生型 (16例 )、局灶节段增生型 (8例 )和硬化型 (2例 )共 7型 ,其血尿、蛋白尿、尿蛋白定量、血清低白蛋白 ,肾小管上皮细胞变性坏死、萎缩、基膜增生 ,肾间质炎症细胞浸润、纤维化、血管内膜增厚 ,直接免疫荧光检测中抗人IgM、IgA和C3阳性 ,临床轻度损害型等指标在 7型之间比较差异均有显著性 (P <0 .0 5 ) ,以及各型之间数据分布不一致 ,均以膜增生型和弥漫增生型中较为明显。 7例进行电镜检查 ,发现上皮下均有电子致密物沉积。结论 :　肾穿刺活检对于狼疮性肾炎患者的临床治疗和预后判断具有指导意义     

Annular lichenoid dermatosis of youth: Report of the first Japanese case and published work review

Annular lichenoid dermatosis of youth is a recently described skin disease with particular clinicopathological features. It has been so far described in 35 patients, all of whom (but one) were white. We report here the first case of annular lichenoid dermatosis of youth in a Japanese patient, who is the youngest reported with this diagnosis, and briefly review the salient clinicopathological features of this condition. Our observation shows that annular lichenoid dermatosis of youth can also affect Japanese patients; therefore, Japanese dermatologists should be aware of this particular dermatosis.     

板层小体与相关皮肤病研究进展

板层小体是一种反面高尔基体或溶酶体相关的分泌性细胞器,其合成和分泌受高尔基pH调节器、鱼鳞病基因、细胞外环境等多因素调控。表皮内板层小体包含如脂类、酶类、蛋白酶抑制剂、抗微生物肽等装载物,是参与形成皮肤多种屏障的重要结构。表皮内板层小体异常与一些皮肤屏障受损皮肤病的病理机制相关,如特应性皮炎、鱼鳞病相关综合征等。本文对板层小体与相关皮肤病研究进展进行综述。     

Simple modification to the punch biopsy technique to minimize handling and crush artefact

A number of techniques have been described to retrieve the tissue core after punch biopsy. We describe a simple modification to the punch-biopsy technique that minimizes instrumentation, handling and the subsequent risk of crush artefact. Our technique is simple, quick and economical and essentially involves rotation of the punch through 90 degrees then lateral extraction with a degree of upward traction, which usually leaves the tissue core deposited beside the skin defect. At this point it can be easily grasped with a square of gauze or detached if required using scissors or a scalpel blade.     

Large‐cell neuroendocrine carcinoma of the skin: ultrastructural and immunohistochemical findings

Large‐cell neuroendocrine carcinoma (LCNEC) is an uncommon and aggressive neuroendocrine tumor, found mainly in the lung. Although LCNEC has been reported in various organs, LCNEC of the skin is extremely rare, poorly recognized and probably underestimated. Here we report a case of LCNEC of the skin, focusing on the histopathological and ultrastructural findings in detail. The patient was an 85‐year‐old Japanese woman presented with a mass on her right upper eyelid. Biopsy specimen showed an infiltrative mass with extension into the subcutis. Tumor cells were arranged in organoid and trabecular patterns with sheets, nests and trabecular cords. Extensive necrotic areas were observed. Most of the tumor cells were characterized by large cell size, polygonal shape, low nuclear‐cytoplasmic ratio, coarse nuclear chromatin and frequent nucleoli. They were positive for CD56, NSE, AE1/AE3, CK7, and negative for CK20, TTF‐1, synaptophysin and chromogranin A. A systematic radiographic examination revealed no additional neoplastic lesions other than the right upper eyelid mass. These findings suggest that the present case is a LCNEC of the skin. The existence of LCNEC in the skin should be recognized, as it is a rare variant of carcinoma that can potentially be misconstrued as a metastasis or as Merkel cell carcinoma.     

Onychomycosis and the diagnostic significance of nail biopsy

Onychomycosis is the most common cause of deformed nails. It is often confused clinically with other nail diseases such as psoriasis. A cross sectional study was carried out in 120 clinically suspected onychomycosis patients to assess the diagnostic utility of nail unit histopathology. The majority of the patients were males (72.5%) in the age group of 20-40 years (55%). Involvement of fingernails alone (37.5%) was found to be more common than toenails (12.5%). Distal and lateral subungual onychomycosis [DLSO] (76.6%) was the predominant morphological type noted. Direct microscopy with 10% potassium hydroxide (KOH) preparation revealed fungal filaments in 82.5% of the cases. Mycological culture on Sabouraud's dextrose agar with and without cycloheximide indicated fungal isolates in 44% of the cases, with Trichophyton mentagrophytes being the most common isolate (38.3%). The combined approach with KOH preparation and culture showed the evidence of fungus in 103 cases (85.8%). Of the rest of the 17 cases in whom both these procedures failed to confirm a diagnosis, nail unit biopsy was carried out in 15 consenting patients. Fungal hyphae (better demonstrable on PAS staining) were evident in 14 cases (93.3%). Other histopathological features observed among these patients were subungual hyperkeratosis, neutrophilic infiltrate, parakeratosis, hemorrhage, and serum crusts. We concluded that histopathological examination of nails is a valuable diagnostic aid in onychomycosis, especially if routine parameters fail to establish a diagnosis.     

Refractory macrophage activation syndrome in the setting of adult‐onset Still disease with hemophagocytic lymphohistiocytosis detected on skin biopsy treated with canakinumab and tacrolimus

A 19‐year‐old Caucasian female with adult‐onset Still disease (AOSD) presented for evaluation of an acute clinical decompensation and atypical annular papules and plaques with purpura on the lower extremities. A punch biopsy demonstrated histiocytes with engulfed degenerated erythrocytes and lymphocytes, consistent with hemophagocytic lymphohistiocytosis (HLH). HLH, clinically referred to as macrophage activation syndrome, is a rare complication of AOSD and is life‐threatening. Relevant clinical, laboratory, and histologic features of this diagnosis are reviewed.