Basal cell carcinoma with prominent central palisading of epithelial cells mimicking schwannoma

Basal cell carcinoma (BCC), the most common malignant neoplasm of skin, may show a wide spectrum of histologic appearances. The presence of peripheral palisades is a very characteristic feature of BCC but, to our knowledge, central nuclear palisading has never been described. We report two cases of BCC exhibiting striking central nuclear palisading with Verocaylike bodies, in a pattern reminiscent of schwannoma. Peripheral palisades and clefts were also present in most tumor nodules and lobules, giving the neoplasms the overall configuration of otherwise typical solid BCC. In addition, foci of conventional BCC could be found adjacent, and in transition, to schwannoid areas. The immunohistochemical study showed strong reactivity for keratins (AE1 and AE3) in tumor cells, whereas no immunostaining for S-100 or muscle-specific actin was found. This previously undescribed histological feature of BCC should lead us to include BCC in the list of tumors to be considered in the differential diagnosis of a cutaneous neoplasm with schwannoid features.     

Pachydermodactyly in a Young Girl: Cutaneous Manifestation of a Psychiatric Disorder?

Abstract: ; Pachydermodactyly is a benign process characterized by painless fusiform skin swellings affecting radial and ulnar aspects of the proximal interphalangeal joints of the fingers. We report a case of this condition in a young girl, suggesting a major role of psychiatric disorder in the development of cutaneous lesions.     

Desmoplastic melanoma may mimic a cutaneous peripheral nerve sheath tumor: Report of 3 challenging cases

Desmoplastic melanoma (DM) and cutaneous malignant peripheral nerve sheath tumors (MPNST) reveal histological and immunohistochemical similarities, including S100 positivity and negative staining for conventional melanocytic markers. We present 3 cases of cutaneous S100‐positive spindle cell tumors in elderly patients, in which first findings led to initial misdiagnoses as cutaneous MPNST and benign peripheral sheath nerve tumor (neurofibroma). The identification of adjacent atypical melanocytic hyperplasia in the overlying skin along with tumor cell proliferation, also in the superficial dermis, the neurotropic component and the absence of any relationship between the tumor and a major nerve, pre‐existing neural benign tumor or the existence of stigmata suggestive of neurofibromatosis raised consideration of a DM. Careful attention should be paid to the presence of a firm dermal nodule and atypical scar lesions especially in sun‐exposed areas (mainly head and neck region) in elderly patients associated with S100‐positive spindle cell proliferation, solar elastosis and adjacent atypical melanocytic proliferation. In such cases, the possibility of a DM should be excluded with caution, especially if the tumor reveals a paucicellular morphology resembling various non‐melanocytic neoplasms including malignant or benign peripheral sheath nerve tumors.     

Real‐time assessment of 13C metabolism reveals an early lactate increase in the brain of rats with acute liver failure

Intracranial hypertension is a severe complication of acute liver failure (ALF) secondary to brain edema. The pathogenesis of cerebral edema in ALF is not clear, but seems to be related to energy metabolism in which lactate may have an important role. The aim of this study was to follow the synthesis of brain lactate using a novel in vivo metabolic technology in a rat model of ALF. Time‐resolved ¹³C MRS of hyperpolarized ¹³C₁‐pyruvate was used to quantitatively follow the in vivo conversion of pyruvate to its substrates in a model of devascularized ALF in rats. Rats with ALF showed a significant increase in the lactate to pyruvate ratio from 36% to 69% during the progression of liver disease relative to rats with portocaval anastomosis. Rats with ALF also showed a significant increase in the alanine to pyruvate ratio from 72% to 95%. These increases were detectable at very early stages (6 h) when animals had no evident disease signs in their behavior (without loss of righting or corneal reflexes). This study shows the dynamic consequences of cerebral in vivo ¹³C metabolism at real time in rats with ALF. The early detection of the de novo synthesis of lactate suggests that brain lactate is involved in the physiopathology of ALF. Hyperpolarization is a potential non‐invasive technique to follow the in vivo metabolism, and both the development and optimization of ¹³C‐labeled substrates can clarify the mechanism involved in ALF. Copyright © 2014 John Wiley & Sons, Ltd.     

Three-dimensional ultrasound evaluation of the fetal brain: the three horn view.

OBJECTIVE: To describe an easy technique for obtaining one of the most important views of the fetal brain and image. The entire lateral ventricle including the anterior, posterior and inferior horns is demonstrated on one image. We propose to call this view, obtained in an oblique plane 'the three horn view'. METHODS: Depending upon the scanning technique employed there are two ways to obtain the three horn view: (1) by two-dimensional (2D) transvaginal transfontanelle sonography obtained by using the left and right Oblique-1 sections, and (2) by three-dimensional (3D) imaging of the fetal brain, is obtained by acquiring a volume scan of the brain orienting the fetal head in the three main orthogonal planes and by rotating or tilting the midcoronal section to the left and right. RESULTS: To illustrate the technique of obtaining the three horn view four normal fetal brains were scanned. Two scans utilized the 2D transvaginal transfontanelle approach and two scans utilized the 3D scanning technique. The same technique was then applied to six fetuses with various brain malformations with inflicted changes in the shape of the proposed three horn view. CONCLUSION: The three horn view, depicting the anterior, posterior, and inferior horns on the same image, was easy to obtain using both the 2D and the 3D ultrasound techniques. It provided diagnostic and clinically useful information much like neonatal transfontanelle ultrasound imaging after which it was emulated.