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Drabent P, Polivka L, Agopian J, Duong Van Huyen JP, Thiebaut PA, Dubreuil P, Hermine O, Molina TJ, Fraitag S. Establishing diagnostic criteria for mastocytosis in skin biopsies. Histopathology 2021; 80:501-514. [PMID: 34637148 DOI: 10.1111/his.14573] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/23/2021] [Accepted: 09/25/2021] [Indexed: 11/30/2022]
Abstract
AIMS The diagnosis of mastocytosis in skin biopsies can be challenging - particularly in cases with very few mast cells. More diagnostic criteria are needed. METHODS AND RESULTS We analyzed 103 skin biopsies from patients with mastocytosis and compared them with biopsies from inflammatory skin lesions and normal skin. Using CD117 immunostaining, we determined the mast cell distribution pattern, the percentage of mast cells in the inflammatory infiltrate, and the mast cell count per mm². We found that a sheet-like or subepidermal distribution of mast cells was specific for mastocytosis. The most significant feature was the percentage of mast cells and not the mast cell count. We found that a mast cell percentage above 40% was fully specific in both adults and children but lacked sensitivity, especially in adults. In children, all cases with a percentage below 40% harbored a number of mast cells above 90 per mm², allowing a straightforward diagnosis. In adults, the diagnosis was more challenging and cases with less than 40% of mast cells could be diagnosed on account of a number of mast cells above 40 per mm², with 88.5% sensitivity and 95.2% specificity. Additional signs might be useful in difficult cases. However, CD25 immunostaining was not useful. CONCLUSIONS We confirmed that the criteria currently applied in the bone marrow were not appropriate for the skin. Accordingly, we developed an algorithm for the diagnosis of mastocytosis in skin biopsies with a high level of interrater reproducibility (mean kappa 0.8).
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Affiliation(s)
- Philippe Drabent
- Department of Pathology, Necker-Enfants Malades Hospital, APHP, Paris, France.,Sorbonne Université, Paris, France
| | - Laura Polivka
- Department of Dermatology, Necker-Enfants Malades Hospital, APHP, Paris, France.,Centre de Référence des Mastocytoses (CEREMAST), Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Julie Agopian
- CRCM [Signaling, Hematopoiesis and Mechanism of Oncogenesis, CEREMAST, AFIRMM], Inserm U1068, Institut Paoli-Calmettes, Aix-Marseille University, UM105, CNRS UMR7258, Marseille, France
| | - Jean-Paul Duong Van Huyen
- Department of Pathology, Necker-Enfants Malades Hospital, APHP, Paris, France.,Université de Paris, Paris, France
| | | | - Patrice Dubreuil
- CRCM [Signaling, Hematopoiesis and Mechanism of Oncogenesis, CEREMAST, AFIRMM], Inserm U1068, Institut Paoli-Calmettes, Aix-Marseille University, UM105, CNRS UMR7258, Marseille, France
| | - Olivier Hermine
- Centre de Référence des Mastocytoses (CEREMAST), Necker-Enfants Malades Hospital, APHP, Paris, France.,Université de Paris, Paris, France.,Department of Hematology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Thierry Jo Molina
- Department of Pathology, Necker-Enfants Malades Hospital, APHP, Paris, France.,Université de Paris, Paris, France
| | - Sylvie Fraitag
- Department of Pathology, Necker-Enfants Malades Hospital, APHP, Paris, France.,Centre de Référence des Mastocytoses (CEREMAST), Necker-Enfants Malades Hospital, APHP, Paris, France.,Université de Paris, Paris, France
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Abstract
Atopic dermatitis (AD) shows many complex and interacting abnormalities of pharmacology, immunology and cellular control. Recent research in atopy has concentrated on abnormalities of cytokine production by T-helper cells. It is possible that cytokine imbalance causes many of the pharmacological and immunological changes seen in the disease. However, studies of second messenger control of cytokine release show that different second messenger signals may relate to the release and activation of particular cytokines. This review summarizes these findings and discusses how the second messenger defects reported in AD may relate to the abnormal cytokine profiles and the pharmacological abnormalities seen in the condition.
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