Primary cutaneous Langerhans cell sarcoma without Birbeck granules: indeterminate cell sarcoma?

An 88-year-old white male presented with a rapidly growing skin nodule on the scalp. Clinically, the nodule did not appear unusual for an ordinary cutaneous neoplasm on sun-exposed skin of an elderly white male. Histopathological examination showed sheet-like epithelioid tumor cell growth with a vaguely nested pattern and frank malignant features, resembling malignant melanoma. However, the tumor cells possessed irregularly convoluted nuclei with nuclear groves, frequent multinucleation and fine vesicular cytoplasm, features highly suggestive of histiocytes. Immunohistochemistry studies showed that the tumor cells were diffusely positive for S-100 protein and CD1a and negative for HMB-45, Melan-A, cytokeratin and CD30. The provisional diagnosis of Langerhans cell sarcoma was thus favored. To confirm this diagnosis, electron microscopic examination was performed. Although classic features of histiocytes were readily identifiable, no Birbeck granules could be found upon a thorough search on repeated sections. These results are indicative of the indeterminate cell nature of the tumor. We propose a diagnosis of primary cutaneous indeterminate cell sarcoma for this unusual histiocytic neoplasm. Current classification of histiocytic neoplasms and differential diagnosis are reviewed.     

Composite cutaneous atypical vascular lesion and Langerhans cell histiocytosis after radiation for breast carcinoma: can radiation induce Langerhans cell histiocytosis?

Atypical vascular lesions (AVLs) refer to small vascular proliferations in radiated skin that may progress to angiosarcoma and typically develop after breast-conserving therapy for breast carcinoma. We present a case of composite AVL and Langerhans cell histiocytosis (LCH) in a 57-year-old woman who received surgery and radiation therapy for ductal carcinoma of the breast. The patient developed AVLs 4 years after radiation. Biopsies of multiple erythematous nodules at the same site one year later revealed intermixed AVL and LCH, some of which coexisted within the same lesion. To our knowledge, LCH has not been recorded at the site of radiation in the English language literature. Our case not only highlights the importance of close cutaneous surveillance and a low threshold for biopsy in patients with breast-conserving surgery and radiation therapy, but also raises the possibility of radiation as the inducement of cutaneous LCH.     

Quality of life in melanoma patients during adjuvant treatment with pegylated interferon-α2b: patients' and doctors' views

Treatment of malignant melanoma with IFN-α has been associated with significant side-effects. The aim of this retrospective monocentric non-randomized study was first to evaluate the impact on quality of life (QOL) in 30 melanoma patients treated with once weekly 2?μg/kg PEG-IFN-α2b for 18 months, and second to examine whether there is a difference in patients' and physicians' perception of QOL. Data on QOL were collected by means of the EORTC QLQ-C30 questionnaire completed by the patient before consultation at baseline and every three months during treatment. A second questionnaire was filled out independently by the physician, based on the consultation and patient file. All data were routinely collected in an outpatient care unit. At baseline, patients had more favorable mean values on almost all dimensions of the EORTC QLQ-C30 than follow-up assessments. In comparison to published low-dose IFN-α2a data, once weekly 2?μg/kg PEG-IFN-α2b was associated with stronger impairment in most QOL single dimensions but with almost no differences regarding the global health status. QOL documented by physicians was significantly higher than QOL from the patients' questionnaires in all QOL dimensions (p<0.05). PEG-IFN-α2b has measurable effects on QOL. Measuring QOL based only on physicians' patient files without explicitly determining patients' assessments leads to a profound underestimation of impairment of QOL.     

Induction by tumour necrosis factor α of dose-related changes in Langerhans cell frequency in mice

Abstract It has been demonstrated previously that tumour necrosis factor α (TNF-α) provides an important signal for the migration of epidermal Langerhans cells (LC) from the skin. Intradermal administration to mice of homologous recombinant TNF-α induces both a rapid reduction in the frequency of LC local to the site of exposure and, somewhat later, an accumulation of dendritic cells in draining lymph nodes. It has been proposed recently, however, that the influence of TNF-α on LC function may be dose-dependent in nature with lower concentrations inducing migration, but higher concentrations immobilizing LC in the epidermis. To investigate this proposal we examined the kinetics and dose-response relationships of TNF-α-induced LC migration in mice. At all concentrations tested (50, 150 or 300 ng/ear), intradermal exposure to TNF-α caused within 30 min a significant reduction in the frequency of MHC class II (Ia)⁺ LC within epidermal sheets. With the lower concentrations of TNF-α this effect was still apparent when LC were enumerated in the epidermis up to 4 h following cytokine treatment. In contrast, however, exposure of mice to 300 ng of TNF-α was consistently associated with a considerably less marked, and statistically insignificant, reduction in LC frequency by 4 h. These data indicate that at all concentrations of the cytokine examined here, TNF-α was able to stimulate a rapid (within 30 min) reduction in epidermal LC numbers, but that the rapidity with which the epidermis was repopulated following the initiation of LC migration was influenced by the concentration of TNF-α administered. It is suggested that TNF-α may influence not only the tempo of LC migration, but also the kinetics of epidermal repopulation. Received: 18 June 1998 / Received after revision: 25 February 1999 / Accepted: 19 March 1999     

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.     

重组人干扰素α-2b喷雾剂联合CO2激光治疗尖锐湿疣

尖锐湿疣（CA）为人乳头瘤病毒（HPV）感染所致的性传播疾病。CA的治疗方法很多，临床虽可治愈，但复发率很高。为此，笔者采用重组人干扰素α-2b喷雾剂（商品名：捷扶，由天津华立达生物工程有限公司生产）联合CO2激光治疗尖锐湿疣，取得满意疗效。现报告如下。     

α-2b干扰素,5-Fu联合治疗尖锐湿疣

<正> 临床资料72例均为本中心1989年7月～1990年8月门诊尖锐湿疣患者,以病理组织学检查为诊断依据。其中男44例,女28例,年龄21～42岁,平均29.6岁;病程:半个月～7年;皮损部位:以包皮、冠状沟、系带、小阴唇、大阴唇为多。初治60例,曾用其它方法治疗复发12例。治疗方法随机分组:Ⅰ组,皮损局部注射α-2b干扰素(军事医学科学院微生物研究所生产)2～5万IU/次;Ⅰ组,皮损局部注射2.5%5-Fu(上海海普药厂     

单剂量α－2b干扰素治疗复发性生殖器疱疹

我们采用单剂量α-2b干扰素局部注射法治疗复发性生殖器疱疹(GH),取得较为满意的效果,现将60例完成观察的病例作如下报道.     

肌肉注射重组人干扰素α2b加重银屑病1例

临床资料患者男，45岁。1年前因患“乙型病毒性肝炎”于2004年11月9日入住我院传染科。入院后给予抗病毒、降转氨酶等药物对症治疗，于5天后给予肌肉注射胸腺五肽1mg，qod，应用15天后于皮肤注射处出现红色斑丘疹，上有银白色鳞屑。经我科会诊，疑诊为“银屑病”。该患者否认银屑病史及家族史，未给予治疗。停胸腺五肽20天后皮疹消退。为进一步治疗乙型病毒性肝炎，于2004年12月20日肌肉注射重组人干扰素α2b注射液300万U，qod，20天后于头皮、腰部皮肤出现米粒至豆粒大小红斑疹，上有银白色鳞屑，再次请我科会诊，确诊为“银屑病”，未给予治疗。出院后继续应用重组人干扰素a2b注射液4个月后，皮疹泛发全身，期间未应用其他任何药物。     

α-2b干扰素加西咪替丁治疗扁平疣疗效观察

扁平疣是人乳头瘤病毒引起的易诊难治的皮肤病，自2001～2004年5月我们应用干扰素联合西咪替丁治疗64例扁平疣患者，取得较好疗效，现报道如下。     

重组干扰素α-2b联合激光治疗尖锐湿疣35例

1　临床资料　 3 5例均为 1998年 10月～ 2 0 0 0年 10月我站ＳＴＤ门诊患者 ,均有典型临床表现 ,5 %醋酸白试验阳性。其中男 2 6例 ,女 9例 ;年龄 2 0～ 5 0岁 ,平均 3 7.5岁 ;病程 15天～ 5月 ,平均 5 1.1天。初次发病者 2 0例 ,复发者 15例。同时合并淋病者 3例。 2 6例男性患者中 ,尿道口内尖锐湿疣 (ＣＡ ) 4例 ,肛周 1例 ,余均发生于冠状沟、包皮等处 ;9例女性患者中合并宫颈ＣＡ者 2例。2　治疗方法2 .1　激光治疗　常规消毒 ,以 2 %利多卡因局部浸润麻醉 ,将二氧化碳激光 (输出功率调至 2 5Ｗ )对准疣体切割 ,烧灼范围超出疣体 2ｍ…     

CO2激光联合重组人干扰素α-2b凝胶治疗尖锐湿疣

我们应用CO₂激光联合重组人干扰素α-2b凝胶(商品名尤靖安)外用治疗尖锐湿疣,并与CO₂激光配合重组人干扰素α-2b局部注射进行比较,报道如下。     

Identification of TROP2 (TACSTD2), an EpCAM-like molecule, as a specific marker for TGF-β1-dependent human epidermal Langerhans cells

Langerin (CD207) expression is a hallmark of epidermal Langerhans cells (LCs); however, CD207(+) cells comprise several functional subsets. Murine studies showed that epidermal, but not dermal, CD207(+) cells require transforming growth factor-β 1 (TGF-β1) for development, whereas human data are lacking. Using gene profiling, we found that the surface molecule TROP2 (TACSTD2) is strongly and rapidly induced during TGF-β1-dependent LC commitment of human CD34(+) hematopoietic progenitor cells or monocytes. TROP2 is conserved between mouse and human, and shares substantial amino-acid identity with EpCAM, a marker for murine epidermal LCs. To our knowledge, neither TROP2 nor EpCAM expression has been analyzed in human dendritic cell (DC) subsets. We found that (i) all human epidermal LCs are TROP2(+)EpCAM(+); (ii) human dermis lacks CD207(+)EpCAM(-) or CD207(+)TROP2(-) DCs, i.e., equivalents of murine dermal CD207(+) DCs; and (iii) pulmonary CD207(+) cells are TROP2(-)EpCAM(-). Moreover, although EpCAM was broadly expressed by pulmonary and intestinal epithelial cells, as well as by bone marrow erythroid progenitor cells, these cells lacked TROP2. However, although TROP2 is expressed by human LCs as well as by human and murine keratinocytes, most murine LCs, except of a small subset, lacked TROP2. Therefore, TROP2 is a marker for human TGF-β1-dependent epidermal LCs.     

α-2b干扰素局部注射治疗尖锐湿疣的疗效观察

尖锐湿疣为人乳头瘤病毒(HPV)感染所致的性传播性疾病。尖锐湿疣的治疗方法很多，临床虽可治愈，但复发率高。为此，我们采用二氧化碳激光联合α-2b干扰素局部注射治疗尖锐湿疣，取得满意疗效，现将结果报告如下。     

微波联合α-2b干扰素治疗肛门尖锐湿疣疗效观察

我们参照局部5点浸润麻醉法1进行肛周麻醉,采用微波联合α-2b干扰素皮损基底部注射治疗肛门尖锐湿疣(CA),取得满意效果,现报道如下.