Homogeneous staining regions for cyclin D1, a marker of poor prognosis in malignant melanoma

Homogeneous staining regions (HSRs) have been previously shown to confer a worse prognosis in solid tumors and myelodysplastic syndromes. We previously reported a single case of melanoma with HSR for cyclin D1 and postulated that HSR for cyclin D1 is an independent poor prognostic indicator. Herein, we report 7 cases of melanoma with HSR for cyclin D1. The cases occurred in elderly men and women with an average age of 65 years. Three cases occurred in areas of intermittent sun exposure, 2 cases occurred in chronically sun-damaged areas, and 2 cases were acral. HSR correlated with aggressive histology. The average Breslow depth was 2.7 mm (range, 1-11 mm), the average mitotic index was 5.1 per square millimeter, and 5 of the 7 cases were ulcerated. Clinical follow-up was available for 6 of the 7 cases. Five of the 6 cases for which clinical follow-up was available metastasized, and 1 patient died of metastatic melanoma. Three cases with metastatic disease occurred in primary melanomas with lower Breslow depths, ranging from 1.0 to 1.4 mm. These additional cases of melanoma with an aggressive clinical course provide further evidence of the prognostic significance of HSR for cyclin D1 in melanoma. Larger cohort studies are needed to validate this observation.     

Comparing GnRH agonist long protocol and gnrh antagonist protocol in outcome the first cycle of ART

Purpose  

This prospective study evaluated the efficacy of gonadotropin-releasing hormone (GnRH) antagonist protocol in comparison with the GnRH agonist protocol in the first cycle of assisted reproductive technique (ART).     

Expression of p53 in aggressive and non-aggressive histologic variants of basal cell carcinoma

Basal cell carcinoma (BCC) generally has an indolent course but a subgroup of BCCs tends to grow aggressively into deep tissues and even metastasize. Although studies have shown a positive correlation between mutations in the tumor suppressor gene p53 and aggressive behavior in epithelial tumors, the results for BCC are conflicting. We aimed to determine whether there is any relationship between p53 expression in BCC and histopathologic subtype of the tumor.Thirty-three formalin-fixed BCC tissue samples were examined at Hazrat-e Rasool University Hospital, Tehran, Iran, from March 2003 to April 2004. Tumors were categorized as aggressive (infiltrative or morpheic) and non-aggressive (nodular or superficial) based on histopathological examination of hematoxylin and eosin sections. p53 expression was demonstrated by immunohistochemical staining using the monoclonal anti-p53 antibody (PAb240) and results were reported using a semiquantitative score. Expression of p53 was compared between aggressive and non-aggressive tumors. All of the 11 aggressive tumors exhibited nuclear staining in more than 50% of the tumor cells. In the 22 non-aggressive tumors, less than 50% of cells showed positive staining. p53 immunoreactivity was significantly higher in aggressive BCCs than non-aggressive ones (x(2) test; p < 0.01). No correlation was found between p53 expression and the age of the patient or site of the tumor. History of childhood radiotherapy correlated positively with higher levels of p53 expression. We conclude that expression of p53 might be used as a marker to predict the aggressiveness of BCCs.     

Scabies presenting with bullous pemphigoid-like lesions

A wide range of clinical manifestations may be seen in scabies, from classic pruritic papules and burrows to secondary features such as impetigo. Bullus lesions are a less frequent. Twenty cases of scabies presenting with bullae have been reported so far in the medical literature. Differentiating this subtype of scabies from the immunobullous disease bullus pemphigoid is a diagnostic challenge. A 42-year-old man was referred to our dermatology outpatient clinic with 3-month history of severe pruritus and tense blisters affecting mainly the lower trunk, arms and legs. An initial biopsy was suggestive for bullous pemphigoid. Close physical examination revealed small excoriated papules and a few burrows on borders of the hands and wrists. Skin scraping of the lesions on wrists was positive for Sarcoptes scabiei. Another biopsy specimen from a recent blister revealed subepidermal bullae with fibrin and inflammatory cells, particularly eosinophils. Direct immunofluorescence exam was negative. The patient was treated with lindane lotion followed by crotamiton cream with near complete resolution of the lesions. Scabies must be considered in patients presenting with recent onset of unexplained pruritic bullous lesions. Biopsy and immunofluorescence studies together with skin scrapings for Sarcoptes scabiei could help to differentiate these cases from bullous pemphigoid. Antiscabietic treatment results in resolution of bullous lesions in the affected patients.