Significance of COX‐2 and VEGF expression in histopathologic grading and invasiveness of meningiomas

Meningiomas are slow‐growing neoplasms that recur locally. Their morphologic grading does not always correlate with patient outcome. We evaluated the status of several immunohistochemical markers with histopathologic parameters in various grades of meningioma.Eighty‐eight meningioma specimens were examined immunohistochemically to determine the status of Ki‐67, cyclin D1, epidermal growth factor receptor (EGFR), cyclooxygenase‐2 (COX‐2), vascular endothelial growth factor (VEGF), and bcl‐2. Several clinical and pathological parameters were investigated.Forty‐nine Grade I, 33 Grade II, and 6 Grade III meningiomas were observed. VEGF and Ki‐67 expression was correlated with higher tumor grade. The association between grade and other immunohistochemical markers expression was not significant. A correlation was observed between COX‐2 expression and invasiveness to the brain or adjacent soft tissue. Tumor recurrence was correlated with brain or adjacent soft tissue invasion. We also observed a relationship between VEGF level and COX‐2 expression, and they were both correlated with necrosis.Immunohistochemical evaluation of VEGF, COX‐2, and Ki‐67 expression can provide information regarding the behavior of meningiomas, particularly for cases in which histological grading is not straightforward.     

Alopecia areata. How not to miss Satoyoshi syndrome?

Satoyoshi syndrome is a multisystem disorder of suspected autoimmune etiology, characterized predominantly by alopecia, muscle spasms and diarrhea. Antinuclear antibodies are present in 60% of patients. The syndrome primarily affects girls and young women. Trichoscopy shows regularly distributed yellow dots, indistinguishable from typical alopecia areata. The condition may be easily misdiagnosed and treated as alopecia areata. On the basis of an in‐depth analysis of all published cases we developed diagnostic criteria for Satoyoshi syndrome. We also suggest that two subtypes of the disorder should be distinguished, the ANA‐positive Satoyoshi syndrome with generally good response to systemic glucocorticosteroid therapy and the ANA‐negative Satoyoshi with less favorable prognosis. In our opinion all patients will alopecia areata (in particular alopecia totalis) should be inquired about muscle spasms and diarrhea and tested for antinuclear antibodies to decrease the risk of missing Satoyoshi syndrome.     

Conjunctival melanoma in a child: A clinicopathological report

We report a case of a 16 years old Asian Indian boy who presented with a large brownish lesion measuring 20 × 12 mm on the temporal conjunctive in his right eye. Anterior segment optical coherence topography revealed cystic spaces without scleral involvement. The patient underwent conjunctival excisional biopsy using “no touch” technique with double freeze-thaw cryotherapy to underside of the adjacent conjunctival margins. Excision involved 4 mm of the surrounding apparently normal conjunctiva. Absolute alcohol epitheliectomy was done at the limbus and surrounding 2 mm of cornea to devitalize residual atypical melanocytes if any. Histopathology confirmed diagnosis of conjunctival melanoma. We started the patient on topical mitomycin C 0.04% with one weekly on and off cycles postoperatively. No recurrence was noted after nine months follow up.     

Histopathological study of mixed connective tissue disease from 32 autopsy cases in Japan

Abstract

In order to identify the histological specificity of newly defined connective tissue disease, we examined 32 autopsy cases of mixed connective tissue disease (MCTD) which fulfilled the disease criteria proposed by the Japanese MCTD Committee. The age of the 32 cases ranged from 19 to 79 with an average age of 43 years. The male: female ratio was 3∶29. The duration of illness was 7.9 years on average. These tendencies were not so specific compared with other connective tissue diseases. In reference to the cause of death, pulmonary hypertension associated with severe pulmonary arterial lesions such as plexogenic arteriopathy and intimal thickening was found in 16 cases, which was 34% of all total autopsy cases. Totally pulmonary diseases including pulmonary hypertension, pulmonary fibrosis and interstitial pneumonitis amounted to half of all fatal cases. Following pulmonary disease, esophageal fibrosis, sialoadenitis and cardiac involvement succeeded. Although clinical signs such as dysphagia or hypomotility did not necessarily present before death, the frequency and severity of histological changes of the esophagus cannot be ignored. Accompanied with sicca syndrome, the salivary gland showed variable stages of inflammatory changes from slight lymphocytic infiltration in the periductal region to severe parenchymatous atrophy with severe fibrosis. Autopsy cases of MCTD disclosed myocardial damage in not a few cases, which were often accompanied with fibrosis, and these features were very similar to the those of esophageal lesions. On the other hand, involvement of the kidney, skin and muscle was very slight in MCTD compared with those of systemic lupus erythematosus, progressive systemic sclerosis and polymyositis/dermatomyositis. The kidney lesion was characterized by membranous glomerulonephritis. Skin continued to be scleroedematous in spite of long term illness. Muscle showed slight lymphocytic infiltration around small vessels and interstitium. In addition to serological and clinical features, histopathological study revealed specific features of MCTD different from other connective tissue diseases. In treatment and follow-up of the patients of MCTD, special care should be paid to the conditions of this disease which reflect the histological changes as presented here.     

Sea urchin spines in the stratum corneum: an early finding related to trauma

Penetrating trauma from sea urchin (Echinoidea) spines has been shown to cause numerous cutaneous reactions, ranging from initial pain that rapidly dissipates and resolves to chronic inflammation and formation of characteristic sea urchin granulomas. Many of these skin‐colored or violaceous papules and nodules form weeks to months after injury, and may be surgically excised. Histopathologic examination commonly shows well‐defined granulomas, the majority of which represent sarcoidal‐type granulomas. Other microscopic patterns, such as foreign body reactions and chronic inflammation, have also been shown. Retained spine fragments are birefringent on polarized microscopic examination and are most likely found in the dermal layer. Herein, we describe a case of traumatic sea urchin cutaneous injury with a unique early cutaneous trauma reaction in a young male who lived in Hawaii. Histopathologic exam was significant for retained spines in the layer of the stratum corneum, but no signs of granulomatous inflammation were observed. This case report emphasizes the unique features of our case and reviews the common clinical and histopathologic features of sea urchin cutaneous reactions.