'Eczematous' dermatitis of the nipple: clinical and histopathological differential diagnosis of Paget disease

The nipple can be affected by many malignant and benign entities. A wide variety of diseases including Paget disease, atopic dermatitis and nipple candidiasis can cause eczema-like changes in the nipple. In cases of diagnostic uncertainty, tissue sampling may be indicated. A true eczematous lesion, such as atopic dermatitis, typically shows a spongiotic dermatitis pattern. Paget disease, on the other hand, presents with infiltration of the nipple epidermis by neoplastic cells. The presence of atypical cells scattered in the epidermis in a pagetoid pattern opens up a histopathological differential diagnosis encompassing squamous cell carcinoma in situ and malignant melanoma, among others. Immunohistochemistry is commonly used to render a diagnosis. The objective of this article is to discuss Paget disease and highlight relevant clinical and histopathological differential diagnoses.

Claudin-4 Upregulation in Acantholytic and Autoimmune-Mediated Bullous Disorders

Claudin-4 is a key component of tight junctions, which play an important role in the formation of the epidermal barrier by forming a circumferential network in the granular layer that serves as a gatekeeper of the paracellular pathway. The aim of this study is to illustrate claudin-4 immunohistochemical staining patterns of different blistering disorders. We collected 35 cases, including two Hailey-Hailey disease, one Darier disease, three Grover disease, one acantholytic acanthoma, two warty dyskeratoma, 11 pemphigus vulgaris (PV) including six mucosal PV, and two pemphigus foliaceus. For comparison, we included five cases of normal skin, five eczema, and three bullous pemphigoid cases. Claudin-4 demonstrated weak-to-moderate expression in keratinocytes located in the stratum granulosum, keratinocytes surrounding hair follicles, and adnexal glands. Further, claudin-4 exhibited moderate-to-strong membranous staining in disrupted keratinocytes surrounding and within the acantholytic and bullous areas in 16/22 of the acantholytic cases (not seen in the six cases of mucosal PV) and all three bullous pemphigoids. This finding suggests that claudin-4 is upregulated in these conditions, which may be a compensatory response to the disrupted barrier function. This finding could shed light on the molecular mechanisms underlying disrupted barrier function in blistering disorders, independent of the specific underlying disease mechanism.

Malignant solitary fibrous tumor of the urinary bladder progressing to widespread metastases and death: a rare case report and literature review

Solitary fibrous tumor (SFT) of the urinary bladder has been rarely reported and malignant bladder SFT is even rarer. Here we present a case of an African-American male with SFT of the urinary bladder (intermediate risk) initially treated by cystoprostatectomy at the age of 59 years. Eight years later, he developed recurrence with widespread metastases to the liver, lungs, and abdominal cavity. He then received temozolomide and bevacizumab with good disease control. However, treatment was paused due to declining performance status. Follow-up at 1 year demonstrated growth of the metastatic lesions. Despite restarting therapy, the patient expired, 11 years after the original diagnosis. Autopsy was performed and revealed widespread metastases within the abdominal cavity (abdominal sarcomatosis) as well as liver, bilateral lung, and diaphragmatic involvement. The cause of death was determined to be metastatic SFT. A comprehensive literature review was performed. Although SFTs are commonly considered benign, a subset of SFTs of the urinary bladder behave aggressively. Risk assessment and proper follow-up for recurrence and metastasis is necessary. The patient was also found at autopsy to have two gastrointestinal stromal tumors (GISTs) in the stomach and near the gastroesophageal junction. To the best of our knowledge, this is the first reported case of a primary urinary bladder SFT resulting in death or having concurrent, multifocal GISTs, and only the second case of a bladder SFT that developed metastases after the initial diagnosis.

TRPS1: A Marker of Follicular Differentiation

The trichorhinophalangeal syndrome type 1 (TRPS1) immunohistochemical (IHC) stain has increased in use in recent years as a marker for breast carcinomas. The TRPS1 gene is involved in various tissues, including the growth and differentiation of hair follicles. This article seeks to evaluate the IHC expression of TRPS1 in cutaneous neoplasms with follicular differentiation, such as trichoblastoma (TB), trichoepithelioma (TE), and basal cell carcinoma (BCC). IHC studies were performed on 13 TBs, 15 TEs, and 15 BCCs with an antibody against TRPS1. The study found a variable staining expression of TRPS1 in the tumor nests of TB, TE, and BCC. BCCs were distinct in that none of the BCCs demonstrated intermediate or high positivity, while TBs and TEs showed intermediate-to-high positivity in 5/13 (38%) and 3/15 (20%) of cases, respectively. We observed a distinct staining pattern among the mesenchymal cells of TB and TE. We found that TRPS1 highlighted perifollicular mesenchymal cells adjacent to the nests of TB and TE tumor cells. This staining pattern was absent in BCCs, where only scattered stromal cells were positive for TRPS1. Papillary mesenchymal bodies were also highlighted by TRPS1 in TB and TE. TRPS1 stained various parts of the normal hair follicle, including the nuclei of cells in the germinal matrix, outer root sheaths, and hair papillae. TRPS1 may be a useful IHC marker for follicular differentiation.

A new pre-concentration procedure based on poly(styrene-co-maleamide and imide) copolymers modified with 2-hydrazinobenzothiazole prior to spectrophotometric monitoring of inorganic as (as As(III)) in edible vegetable oils

This study describes the development of 2-hydrazinobenzothiazole modified-amide/imide co-polymers for the extraction/pre-concentration of trace As(III), from edible vegetable oils. Their characterization was realized by help of instrumental techniques. The method is based on pH-dependent complexation between As(III) and co-polymeric chelators in presence of 35-fold excess As(V), their selective extraction into the mixed micellar phase, and detected at pH 2.0 and 6.0 by UV-vis spectrophotometer. The variables affecting extraction efficiency were optimized. From pre-concentration of 20-mL sample, the good linear relationships were obtained in range of 1-40 and 3-75 µg/L with DLs of 0.32 and 1.00 µg/L. The accuracy was verified by analysis of a certified sample without and with spiking. The method was applied into the analysis of iAs levels of samples. The results show that the functional co-polymers are efficient chelators, and exhibit great potential for the selective extraction of As(III) from edible vegetable oils.

FLI-1/Melan-A dual stain is an alternative to PRAME in differentiating metastatic melanoma from nodal nevus: A monocentric retrospective study

Melanocytic nevi existing in lymph nodes create a diagnostic challenge by mimicking metastases. PReferentially expressed Antigen in MElanoma (PRAME) immunohistochemical (IHC) stain can differentiate one from another. FLI-1 IHC expression has been shown in malignant melanoma with variable sensitivity while melanocytic nevi were reported to be negative. We hypothesized that FLI-1/Melan-A dual IHC staining may be used in the distinction of metastatic melanoma from nodal nevi and can be an alternative and/or complementary to PRAME. In this study, we examined 13 lymph nodes with metastatic melanoma and 13 lymph nodes with benign deposits. We stained all of the lymph nodes with FLI-1, FLI-1/Melan-A dual, and PRAME IHC stains. In addition, we stained paired skin samples of the metastatic lymph nodes with FLI-1 and PRAME. In primary cutaneous melanomas, 11 of 13 were positive for FLI-1 and PRAME expression (85%). Malignant cells in 12 and 13 lymph nodes showed positive expression of PRAME and FLI-1, respectively. Only one case with a nevic cell deposit was weakly positive for FLI-1 and the remaining benign cases were negative for both FLI-1 and PRAME. Our results show that FLI-1/Melan-A dual stain is as sensitive and specific as PRAME in distinguishing lymph nodes with metastatic melanoma from nodal nevi. Further studies with larger case numbers are needed to support our significant results.

Role of CD123 (+) Plasmacytoid Dendritic Cells in Etiologically Different Variants of Erythema Multiforme: A Monocentric Retrospective Study

Plasmacytoid dendritic cells (pDCs) constitute a subset of dendritic cells known to be the “professional” interferon type I (IFN-I) producers. pDCs play an important role in antiviral immunity, as well as linking innate and adaptive immunity. Under normal conditions pDCs are not present in skin. They are shown to be a part of the inflammatory infiltrate in different skin conditions including erythema multiforme (EM). This condition is considered to be a cell-mediated immune reaction to a wide variety of agents, most commonly herpes simplex virus. Nevertheless, the pathophysiology of EM still remains unclear. In this study, we grouped 32 biopsies from 30 patients diagnosed with EM, based on their etiology and analyzed the density and distribution of CD123 positive pDCs. In all cases we observed a greatly increased number of pDCs in the dermal inflammatory infiltrate. Virally-induced EM (by herpes simplex virus (HSV) and other viruses) was more likely to have a significantly higher number of pDCs compared to non-virally associated EM. Hence, we think that pDCs play a key role in the pathogenesis of EM independent of etiology and may play an increased role in virally-associated cases. Further studies on pDCs would clarify their importance in EM and improve our understanding of the pathophysiology of this disease.

Application of a novel poly(SMAm)-Tris-Fe3O4 nanocomposite for selective extraction and enrichment of Cu(I) /Cu(II) from beer, soft drinks and wine samples, and speciation analysis by micro-volume UV-Vis spectrophotometry

In this study, a novel functional nanocomposite was synthesized, characterized and selectively used in pH-controlled separation, pre-concentration and speciation analysis of Cu(I) and Cu(II) from sample matrices where extraction is assisted, facilitated and greatly enhanced by ultrasound energy. The hydrophilic composite material functionalized with tris(2-hydroxymethyl)aminomethane (Tris) and Fe₃O₄ NPs was characterized in detail by ATR-FT-IR, ¹H NMR, XRD, EDX peaks and SEM images. After optimization of the main variables influencing extraction efficiency such as pH, volumes of buffer, modified copolymer in acetone, CTAB and Triton X-114 at fixed concentrations including sonication conditions, the Cu(I) and Cu(II) were monitored against a blank at 347 nm by micro-volume UV-vis spectrophotometer. A good linearity was obtained in the range of 2-140 and 5-150 μg L^-1 for Cu(II) and Cu(I) with r² ≥ 0.993. The limits of detection (LODs) of 0.66 and 1.60 μg L^-1 for each analyte, were obtained from a pre-concentration of 70-fold. After validation, the method was applied to speciation of Cu(I), Cu(II), and total Cu in the pre-treated and diluted beverage samples before and after pre-oxidation of Cu(I) to Cu(II) due to be more sensitive of extraction process to Cu(II) at pH 6.0. The results were also compared with those obtained by FAAS analysis to ensure the reliability of the results. It was observed that there was a statistically good agreement between the results of both methods.

Use of 2-Hydrazinobenzothiazole-Modified Copolymer(s) as Potential Chelating Agent for Sensitive and Selective Determination of Low Levels of Mercury in Seafood by Ultrasound-Assisted Cloud-Point Extraction Combined with Spectrophotometry

In this study, a new method was developed for the pre-concentration of trace mercury from seafood samples prior to analysis by spectrophotometry. The method is based on the complexation between 2-hydrazinobenzothiazole (2-HBT)-modified copolymer(s) and Hg(II) in the presence of an ionic surfactant, cetyltrimethylammonium bromide (CTAB), as sensitivity enhancer at pH 4.5 and the extraction of the complex into the surfactant-rich phase of polyethylene glycol tert-octylphenyl ether (Triton X-114) as the extractant. The variables affecting extraction efficiency were evaluated and optimized. Due to the observation that the modified copolymers are 2.5-fold more sensitive and selective to the Hg²⁺ ions than the CH₃Hg⁺, the amounts of free Hg²⁺ and total Hg were determined at 325 nm by spectrophotometric detection of free Hg²⁺ and total Hg in the pre-treated and extracted fish samples using dilute acid mixture containing Triton X-114 and K₂Cr₂O₇, before and after oxidation of CH₃Hg⁺ to Hg²⁺ with mixture of KBr and KBrO₃ in the acidic media. The amount of CH₃Hg⁺ was calculated from the difference between total Hg and free Hg²⁺ amounts. The accuracy was tested by analysis of two certified samples. The results were statistically in good agreement with the certified values, and the precision was lower than 6.4%. The limits of detection were 1.40 (1.58) and 1.91 (2.11) μg L^-1 for Hg²⁺ from the two calibration solutions spiked before the pre-treatment, respectively. It has been observed that there is no significant matrix effect by comparison of slopes of the calibration curves. The method was applied to seafood samples for speciation analysis of free Hg²⁺ and CH₃Hg⁺. In terms of speciation, while total Hg is detected in the range of 12.6-143.8 μg kg^-1, the distribution of mercury in seafood was in the range of 7.4-53.3 μg kg^-1 for CH₃Hg⁺ and in 8.3-90.5 μg kg^-1 for free Hg²⁺.