Suprabasal acantholysis--an unusual feature of necrolytic migratory erythema

Necrolytic migratory erythema: clinicopathologic study of 13 cases

BACKGROUND

The clinical mucocutaneous manifestations of glucagonoma syndrome are recognized easily when they occur in the classic pattern of acral or periorificial lesions evolving in recurrent crops, with an annular and migratory distribution, in a patient with diabetes mellitus who has had recent weight loss and anemia. Not infrequently, noncharacteristic clinical and histopathologic features are observed and, in these cases, the diagnosis of pancreatic neoplasm may be delayed.

AIM

To review the clinical and histopathologic features of cutaneous manifestations of glucagonoma syndrome.

METHODS

The clinicopathologic features of 13 patients (eight women) with widespread or localized cutaneous eruption as a manifestation of islet cell pancreatic carcinoma with marked glucagon secretion (glucagonoma) were reviewed.

RESULTS

The definitive diagnosis of the cutaneous eruption was established at the time of diagnosis of the pancreatic neoplasm (three patients) or afterwards (10 patients). In nine patients, the mucocutaneous manifestations preceded the diagnosis of the pancreatic neoplasm by 1 month to 3 years (mean, 12 months). In only eight biopsy specimens were the histopathologic features considered to be suggestive or characteristic of necrolytic migratory erythema. Diffuse parakeratosis, that occasionally arose abruptly from normal epidermis, was observed in 12 biopsy specimens. By the time necrolytic migratory erythema was diagnosed, the pancreatic carcinoma had metastasized to the liver, regional lymph nodes, or bone in 12 patients.

CONCLUSION

Increased awareness of the polymorphic mucocutaneous and nonspecific histopathologic features of glucagonoma syndrome is needed to avoid unnecessary delay in the diagnosis of this syndrome.

The effect of diabetes mellitus on the expression of Argyrophilic nucleolar organizer regions (AgNORs) in mucosal epithelium under experimental denture bases in rats

BACKGROUND

Expression of argyrophilic nucleolar organizer regions (AgNOR) was counted on mucosal epithelium to detect whether the AgNOR count (the number of AgNOR per nucleus) is, for 20 weeks, affected by streptozotocin-induced diabetes mellitus.

METHODS

Diabetic rats were applied non-denture wearing, non-pressure contact, continuous pressure (0.5, 1.5 or 3.4 kPa) and intermittent pressure (10.5, 33.0 or 81.7 kPa), respectively.

RESULTS

In the non-denture wearing or the non-pressure contact group, AgNOR count was almost constant (ranging 1.86-1.92) without significant difference. Under continuous pressure, AgNOR count significantly decreased at earlier stage and finally recovered to the non-pressure contact group. A similar effect of continuous pressure appeared to manifest itself in intermittent pressure, but to a greater degree. Consequently, AgNOR count under intermittent pressure showed no recovery at 20-week stage.

CONCLUSION

: Diabetes mellitus exerted, by itself, no influence on the cellular proliferative activity under continuous pressure, whereas the activity deteriorated under intermittent pressure.

The glucagonoma syndrome: a review of its features and discussion of new perspectives

Glucagonoma syndrome is a paraneoplastic phenomenon characterized by an islet alpha-cell pancreatic tumor, necrolytic migratory erythema, diabetes mellitus, weight loss, anemia, stomatitis, thromboembolism, and gastrointestinal and neuropsychiatric disturbances. These clinical findings in association with hyperglucagonemia and demonstrable pancreatic tumor establish the diagnosis. Glucagon itself is responsible for most of the observed signs and symptoms, and its induction of hypoaminoacidemia is thought to lead to necrolytic migratory erythema. Liver disease and fatty acid and zinc deficiency states may also contribute to the pathogenesis of the eruption in some cases. Most patients are diagnosed too late in the clinical course for cure, but successful palliation of symptomatology can usually be achieved with surgical and medical intervention. This paper reviews the glucagonoma syndrome, paying particular attention to its cutaneous features, and provides new perspectives in our current understanding of this phenomenon.