Eruptive keratoacanthoma and squamous cell carcinoma complicating imiquimod therapy: response to oral acitretin

An 87-year-old woman with eruptive keratoacanthomas complicating recent imiquimod therapy is presented. Lesions developed both at and distal to the treatment site. She responded well to 8 weeks of oral acitretin with resolution of most lesions and no recurrence at 6 months post treatment. A remaining lesion was excised and found to be a well-differentiated squamous cell carcinoma. Keratoacanthoma and squamous cell carcinoma should be considered in any patient developing rapidly growing keratotic nodules in association with recent imiquimod therapy. The aetiology and treatment of eruptive keratoacanthomas is briefly discussed.     

Generalized eruptive keratoacanthoma with vitiligo followed by the development of prurigo nodularis: A case report and published work review

Herein, we report a unique case of generalized eruptive keratoacanthoma (GEKA) in a 47‐year‐old Chinese man presenting with extensive pruritic papules and nodules accompanied by oral lesions. He also had a 2‐year history of vitiligo and long‐term experience of working outdoors. Biopsies were consistent with keratoacanthoma . Interestingly, prurigo nodularis (PN) was found in histopathology at 1‐year follow up. To our knowledge, this is the first report describing a case of GEKA with oral lesions complicated with vitiligo and developed with PN.     

Effectiveness and limitations of reflectance confocal microscopy in detecting persistence of basal cell carcinomas: a preliminary study

Background/Objectives: Reflectance confocal microscopy (RCM) can accurately and non‐invasively diagnose basal cell carcinoma (BCC). The use of RCM in assessing responses to saucerization or curettage and cautery of BCC has not been established. The aim of the present study was to expound the usefulness of RCM in assessing treatment responses of BCC to saucerization or curettage and cautery 8–12 weeks after treatment. Methods: Eight sequential patients, with 11 superficial BCCs, were recruited. Lesions were evaluated clinically and dermoscopically. Three operators performed RCM imaging for each BCC at baseline and 8–12 weeks after treatment. Diagnostic criteria for RCM diagnosis included streaming of basal cells and the presence of cord‐like structures and horizontal vessels. Results were compared against histopathology. Difficulties in establishing tumour clearance were identified and the effectiveness of RCM in assessing the response to treatment was explored. Results: At baseline, all lesions were consistent with superficial BCC. At 8–12 weeks after treatment, RCM correctly diagnosed 10 of 11 lesions as tumour free. Furthermore, RCM was reliable across operators of variable experience and the findings were confirmed histopathologically. Limitations were identified, but appeared to be related to operator experience. Conclusion: The diagnosis of BCC was straightforward and reliable in the present study. Thus, RCM appears useful in assessing the early treatment response of superficial BCC treated with saucerization or curettage and cautery despite operator‐dependant limitations.     

角化棘皮瘤和鳞状细胞癌P21和P53蛋白表达的比较研究

目的：通过检测Ｐ＾２１和Ｐ＾５３蛋白在角化棘皮瘤（ＫＡ）和磷状细胞癌（ＳＣＣ）中的表达,探讨两病之间的关系。方法：用免疫组化技术检测１１例ＫＡ和２８例ＳＣＣ皮损部位Ｐ＾２１和Ｐ＾５３蛋白的表达。结果：Ｐ＾２１蛋白在ＫＡ和ＳＣＣⅠ－Ⅱ中的表达密度分级有统计学意义（Ｐ＝０．０２）。Ｐ＾５３在两病的表达无统计学差异。结论：Ｐ＾２１和Ｐ＾５３在ＫＡ和ＳＣＣ中表达的异同不能作为ＫＡ和ＳＣＣ的鉴别诊断指标。     

An overview of interventional radiology techniques for the diagnosis and management of vascular anomalies: Part 1

Minimally invasive percutaneous and endovascular strategies performed by interventional radiologists have become the mainstays of treatment for vascular anomalies, with improved outcomes, decreased complication rates, and reduced morbidity. The aim of this article is to introduce physicians who care for patients with vascular anomalies to state-of-the-art advancements in interventional radiology (IR) for diagnosis and treatment. Part 1 of this review will focus on sclerotherapy and cryoablation. Part 2 will discuss embolization, endovenous laser ablation, and image-guided percutaneous biopsy. Select vascular anomalies will be discussed as examples to highlight IR diagnostic and/or treatment techniques.     

Keratoacanthoma centrifugum marginatum associated with mechanical trauma: Response to acitretin—A case report and review of the literature

Keratoacanthoma centrifugum marginatum (KCM) is a very rare variant of keratoacanthoma, characterized with progressive centrifugal growth, central healing, and atrophy. Due to its rarity and lack of distinctive histopathological features, KCM often raises diagnostic and therapeutic challenge. We present a case of a 76‐year‐old Caucasian woman with a single large tumor on her right shin that responded to oral retinoids. The patient presented history of local trauma. The tumor developed over the course of 20 months from a scar. To the best of our knowledge, this is the fifth case of KCM associated with mechanical trauma as a possible triggering factor.     

Cutaneous metastasis of SMARCA4-deficient thoracic sarcoma: A diagnostic dilemma with therapeutic implications

SMARCA4-deficient thoracic sarcoma (SMARCA4-DTS) is a recently recognized entity with undifferentiated rhabdoid morphology and mutations in the switch/sucrose nonfermenting BRG1-associated factors complex. Patients are typically males in their fifth decade with a history of smoking who present with rapidly progressive intrathoracic disease and follow an aggressive clinical course. Metastatic disease is reported in up to 77% of cases; however, to our knowledge, cutaneous metastasis has not been reported nor has it been reported as the initial manifestation of the disease. Recognizing SMARCA4-DTS from other types of epithelioid tumors that involve the skin is clinically relevant, as targeted therapies for SMARC-deficient tumors are currently being investigated and early clinical trial data show therapeutic benefit.     

Combination therapy with acitretin and glycyrrhizin in generalized pustular psoriasis with liver test abnormalities: A case series

Liver test abnormalities (LTA) are a frequent extracutaneous manifestation in generalized pustular psoriasis (GPP). Due to possible hepatotoxicity of systemic monotherapy, it is challenging to simultaneously achieve clinical remission and LTA normalization. However, evidence for therapy is lacking. The aim of this study was to assess the effectiveness of combination therapy of acitretin and glycyrrhizin in nine GPP patients with LTA. During the acute phase of GPP, a combination of acitretin (0.5 mg/kg/d PO) and glycyrrhizin (80 mg/d intravenous) was initiated. After 2 weeks, all the patients promptly achieved at least 77% improvement in the severity score of GPP, as well as a significant reduction of liver enzymes. The patients were continuously treated with tapered doses of acitretin (20‐30 mg/d PO) and glycyrrhizin (150 mg/d PO), and presented stable conditions during the 12‐month follow‐up. In conclusion, we consider that the combination of acitretin plus glycyrrhizin is an effective and safe therapy in GPP patients with LTA.     

Case series of tongue necrosis from vascular complications after chin augmentation with hyaluronic acid: Potential pathophysiology and management

Background

Even though the chin is considered a safe injection area for facial filler augmentation, tongue necrosis is a rare complication in this area.

Objective

Our aim was to present case series of rare complications from chin filler augmentation with possible pathophysiology and management.

Methods

From our thorough literature search found only one case report of tongue necrosis from chin filler augmentation. We present case series of unilateral tongue necrosis from vascular occlusion following hyaluronic acid injection in the chin, which was successfully treated with a high-dose hyaluronidase injection resulting in complete recovery in all patients.

Results

Variation in vascular anastomosis leads to a possible cause of vascular occlusion. The lingual artery is the primary arterial supply for the tongue, which is an exclusive target for embolism. Two main responsible arteries and branches are the deep lingual and sublingual arteries. The submental artery variation was previously described as the cause of this event. We proposed potential pathophysiology of the occlusion, not only the variation of vasculature but bone. The midline lingual foramen, an anatomical bone variation on the surface of the midline inferior jaw, was found to be another possible cause. This foramen contains a branch of the submental and sublingual artery, which includes the perforating artery, median perforating artery, or both. Filler injection with a sharp needle on the bone can potentially increase the risk of this vascular incident. A high dose of hyaluronidase administered with multiplane injections was accomplished with complete recovery.

Conclusions

Tongue necrosis from vascular complications after hyaluronic acid filler injection can occur. Not only vessels but bone variation pathology were possible causes.     

Serum omentin levels: A possible contribution to vascular involvement in patients with systemic sclerosis

Adipokines have been shown to be potentially involved in various pathological processes of systemic sclerosis (SSc), including inflammation, vasculopathy and fibrosis, through their pleiotropic effects. Omentin is a member of the adipokines, and has a protective effect against vascular inflammation and pathological remodeling leading to atherosclerosis as well as a vasodilatory effect. To assess the potential role of omentin in the development of SSc, we determined serum omentin levels by enzyme‐linked immunosorbent assay in 66 SSc and 21 control subjects and evaluated their clinical correlation. Serum omentin levels were significantly decreased in diffuse cutaneous SSc patients compared with limited cutaneous SSc patients, while comparable between total SSc patients and healthy controls. In diffuse cutaneous (dc)SSc, patients with a disease duration of 5 years or less had serum omentin levels significantly lower than those with a disease duration of more than 5 years. In total SSc, serum omentin levels were significantly higher in patients with elevated right ventricular systolic pressure than in the others, while serum omentin levels did not correlate with fibrotic and systemic inflammatory parameters. These results suggest that a loss of omentin‐dependent protection against vascular inflammation and remodeling may be related to pathological vascular events of early dcSSc. The elevation of serum omentin levels may serve as a marker of vascular involvement leading to pulmonary arterial hypertension in SSc, which is possibly due to the compensatory induction of omentin against the increased pulmonary vascular tone.     

FISH for MYC amplification and anti-MYC immunohistochemistry: useful diagnostic tools in the assessment of secondary angiosarcoma and atypical vascular proliferations

Background: Secondary angiosarcoma and benign but microscopically atypical vascular proliferations (herein referred to as atypical vascular lesion or AVL) are rare consequences of radiation therapy and/or chronic lymphedema most commonly seen in breast cancer patients. Differentiating angiosarcoma from AVL can be difficult due to overlapping clinical and microscopic features. Recently, amplification of MYC has been associated with 55–100% of secondary angiosarcomas but is reportedly absent in AVL. We examined a series of secondary angiosarcoma and AVL for MYC amplification by fluorescence in situ hybridization (FISH) and expression by immunohistochemistry to investigate the diagnostic utility for discriminating angiosarcoma from AVL. Methods: Cases of secondary angiosarcoma (n = 8) and AVL (n = 4) were retrieved from our archives and examined by FISH and immunohistochemistry. Results: All angiosarcoma cases (8/8 = 100%) demonstrated high‐level MYC amplification by FISH, whereas all AVLs (0/4 = 0%) were negative for MYC amplification. Additionally, all angiosarcoma cases (8/8 = 100%) demonstrated nuclear positivity for MYC, whereas all AVLs (0/4 = 0%) were negative. Conclusion: Amplification of MYC and nuclear expression of MYC is present in secondary angiosarcoma but not AVL. These ancillary tests can be useful to distinguish angiosarcoma from AVL in difficult cases. Fernandez AP, Sun Y, Tubbs RR, Goldblum JR, Billings SD. FISH for MYC amplification and anti‐MYC immunohistochemistry: useful diagnostic tools in the assessment of secondary angiosarcoma and atypical vascular proliferations.     

Effectiveness and safety of polidocanol for the treatment of hemangiomas and vascular malformations: A meta‐analysis

A meta‐analysis was conducted to investigate the efficacy and safety of polidocanol versus other conventional therapies in treating hemangiomas (HMs) and vascular malformations (VMs). Literature search was conducted in the Cochrane, Embase, PubMed, Web of Science, CNKI, CBM, VIP, and WanFang databases until March 5, 2017. A meta‐analysis was conducted using Revman 5.3 software. A total of 19 randomized controlled trials (RCTs) involving 1,514 participants met the inclusion criteria. Regarding the effectiveness, statistically significant differences were observed between polidocanol and all the independent treatments (p = .006), but not between polidocanol and pingyangmycin (p = .16). Combination therapy of polidocanol with any other conventional treatments (p = .0001), pingyangmycin (p = .005) or hemoclip (p = .008) elicited a better response compared to treatment with these treatments independently. A meta‐analysis on the risk of adverse events (AEs) showed a lower risk for polidocanol versus other treatments, for example, all the conventional treatments used independently (p < .00001) and pingyangmycin (p < .00001). Combination therapy of polidocanol with pingyangmycin also yielded a significantly lower risk of AEs (p < .00001). Polidocanol is at least as effective as other conventional therapies on HMs and VMs (especially venous malformations). The former is much safer. Combining its use with other treatments may produce excellent results. Our study provides strong evidence supporting the use of polidocanol for HMs and VMs.     

Photochemotherapy of vascular cells with 8-methoxypsoralen and visible light: differential effects on endothelial and smooth muscle cells

BACKGROUND: The long-term efficacy of percutaneous transluminal coronary angioplasty is limited by the restenosis which occurs in approximately 40% of patients, usually within 6 months of the procedure. PURPOSE: The present study was designed to evaluate the effects of 8-methoxypsoralen (8-MOP) activated with visible light on the properties of bovine aortic smooth muscle cells (SMC) and endothelial cells (EC) in vitro. METHODS: Cells were seeded in polystyrene wells, allowed to attach over a 24-h period, incubated with 1, 20, or 50 microg/ml 8-MOP and then exposed to 12 J/cm2 visible light (447 nm). Cell counts were performed for up 14 days (n = 4-6 wells per time point), and each experiment was performed in triplicate. Cellular migration, morphology, and size were also analyzed. RESULTS: The lowest 8-MOP dose (1 microg/ml) had no significant effect on SMC proliferation, while the highest dose (50 microg/ml) induced cytostasis. An intermediate dose of 8-MOP (20 microg/ml) produced a transient and reversible inhibition of proliferation. There was no significant effect on proliferation of EC at lowest dose of 8-MOP (1 microg/ml). However, in contrast to the SMC experiments, a transient and reversible inhibition of EC proliferation was seen at both 20 and 50 microg/ml 8-MOP. CONCLUSIONS: These experiments demonstrate that while 8-MOP photoactivated with 447 nm visible light can reversibly inhibit the proliferation of both SMC and EC in a dose-dependent fashion, SMC are more sensitive to the treatment than EC.