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Esdaile BA, Hollowood K, Burge S. A serpiginous eruption. ACTA ACUST UNITED AC 2012; 148:385-90. [PMID: 22431782 DOI: 10.1001/archderm.148.3.385-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Thum C, Hollowood K, Birch J, Goodlad JR, Brenn T. Aberrant Melan-A expression in atypical fibroxanthoma and undifferentiated pleomorphic sarcoma of the skin. J Cutan Pathol 2011; 38:954-60. [PMID: 22050092 DOI: 10.1111/j.1600-0560.2011.01798.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Chee Thum
- Department of Pathology, Western General Hospital, The University of Edinburgh, Edinburgh, UK
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3
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Warbrick-Smith J, Hollowood K, Birch J. Dermatofibrosarcoma protuberans recurring as a hybrid dermatofibrosarcoma/giant cell fibroblastoma in an adult: A case report. J Plast Reconstr Aesthet Surg 2010; 63:e785-7. [DOI: 10.1016/j.bjps.2010.06.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 06/27/2010] [Indexed: 11/25/2022]
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Carroll RP, Segundo DS, Hollowood K, Marafioti T, Clark TG, Harden PN, Wood KJ. Immune phenotype predicts risk for posttransplantation squamous cell carcinoma. J Am Soc Nephrol 2010; 21:713-22. [PMID: 20110382 DOI: 10.1681/asn.2009060669] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Cutaneous squamous cell cancer (SCC) affects up to 30% of kidney transplant recipients (KTRs) within 10 years of transplantation. There are no reliable clinical tests that predict those who will develop multiple skin cancers. High numbers of regulatory T cells associate with poor prognosis for patients with cancer in the general population, suggesting their potential as a predictive marker of cutaneous SCC in KTRs. We matched KTRs with (n = 65) and without (n = 51) cutaneous SCC for gender, age, and duration of immunosuppression and assessed several risk factors for incident SCC during a median follow-up of 340 days. Greater than 35 peripheral FOXP3(+)CD4(+)CD127(low) regulatory T cells/microl, <100 natural killer cells/microl, and previous SCC each significantly associated with increased risk for new cutaneous SCC development (hazard ratio [HR] 2.48 [95% confidence interval (CI) 1.04 to 5.98], HR 5.6 [95% CI 1.31 to 24], and HR 1.33 [95% CI 1.15 to 1.53], respectively). In addition, the ratio of CD8/FOXP3 expression was significantly lower in cutaneous SCC excised from KTRs (n = 25) compared with matched SCC from non-KTRs (n = 25) and associated with development of new cutaneous SCCs. In summary, monitoring components of the immune system can predict development of cutaneous SCC among KTRs.
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Affiliation(s)
- Robert P Carroll
- Transplantation Research Immunology Group, Nuffield Department of Surgery, Nuffield Department of Clinical Laboratory Sciences, John Radcliffe Hospital, Oxford, United Kingdom.
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Saunders H, Buchanan JAG, Cooper S, Hollowood K, Sherman V, Wojnarowska F. The period prevalence of oral lichen planus in a cohort of patients with vulvar lichen sclerosus. J Eur Acad Dermatol Venereol 2010; 24:18-21. [DOI: 10.1111/j.1468-3083.2009.03338.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sherman V, Reed J, Hollowood K, Littlewood T, Burge SM. Poromas and porokeratosis in a patient treated for solid-organ and haematological malignancies. Clin Exp Dermatol 2009; 35:e130-2. [PMID: 19958368 DOI: 10.1111/j.1365-2230.2009.03751.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We describe a patient with previous solid-organ (testicular, oesophageal) and haematological (acute myeloid leukaemia) malignancies, in whom chronic cutaneous graft-versus-host disease was complicated by poromas and porokeratosis. Chemotherapy, total body irradiation, longstanding immunosuppression and ultraviolet radiation may all have played a part in the pathogenesis of the skin tumours.
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Affiliation(s)
- V Sherman
- Department of Dermatology, Churchill Hospital, Oxford, UK.
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8
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Mahendra G, Kliskey K, Williams K, Hollowood K, Jackson D, Athanasou NA. Intratumoural lymphatics in benign and malignant soft tissue tumours. Virchows Arch 2008; 453:457-64. [PMID: 18813946 DOI: 10.1007/s00428-008-0660-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 07/16/2008] [Accepted: 08/20/2008] [Indexed: 01/13/2023]
Abstract
Soft tissue sarcomas do not generally metastasise via lymphatics, and the presence or absence of lymphatic vessels within sarcomas and benign soft tissue tumours is not known. In this study, we determined whether lymphatic vessels were present in a wide range of benign and malignant soft tissue lesions by examining intratumoural expression of the lymphatic endothelial cell markers, Lyve-1 and podoplanin. Intratumoural Lyve-1+/podoplanin+ lymphatics were not identified in sarcomas apart from all cases of epithelioid sarcoma (a tumour which is known to metastasise to lymph nodes) and a few cases of leiomyosarcoma, rhabdomyosarcoma and synovial sarcoma. Intratumoural lymphatics were also absent in most benign soft tissue tumours. Reparative and inflammatory soft tissue lesions contained lymphatics, as did all (pseudosarcomatous) proliferative myofibroblastic lesions including nodular, proliferative and ischaemic fasciitis, elastofibroma, nuchal fibroma and deep fibromatosis. Our results show that most soft tissue sarcomas do not contain intratumoural lymphatics, a finding which is consistent with the infrequent finding of sarcoma metastasis to lymph nodes. In contrast to fibrosarcoma and a number of other malignant spindle cell tumours, proliferative fibroblastic/myofibroblastic lesions of soft tissue contain intralesional lymphatic vessels.
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Affiliation(s)
- G Mahendra
- Department of Pathology, University of Oxford, Nuffield Orthopaedic Centre, Oxford, OX3 7LD, UK
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9
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Imko-Walczuk B, Lally A, Le Mire L, Casabonne D, Hollowood K, Bordea C, Wojnarowska F. Melanomas in renal transplant recipients: the London experience, and invitation to participate in a European study: reply from authors. Br J Dermatol 2007. [DOI: 10.1111/j.1365-2133.2006.07568.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Although it is generally recognized that some benign sweat gland neoplasms may show appreciable mitotic activity, there are few reports of its quantitative analysis in specific tumor types or of its correlation with clinical behavior. The presence of a large number of mitoses in a sweat gland tumor for which the histologic criteria of malignancy are not well defined, particularly in association with nuclear abnormalities, may produce a considerable diagnostic challenge. We recently encountered such a problem in a putative case of hidradenoma papilliferum. Therefore, we have undertaken a retrospective clinicopathologic study of 19 cases originally diagnosed as hidradenoma papilliferum or probable hidradenoma papilliferum, with a particular emphasis on the relationship of the mitotic index to clinical behavior. The age range of the cases was 41 to 92 years (mean 56.8 years). In all cases in which the margins could be evaluated, the tumors were well circumscribed (15/15), but in 4 cases circumscription could not be assessed because the specimen was fragmented. All showed focal mild nuclear pleomorphism. Mitoses were present in both epithelial and myoepithelial cells. The mitotic index varied from 0 to 5.3 mitoses/mm2 (0 to 13 mitoses per 10 high power fields (hpf); 1 hpf=0.246 mm2), with a mean of 2.4/mm2 (6/10 hpf) and a median of 0.8/mm2 (2/10 hpf). No atypical mitoses were identified. The proliferative fraction (MIB-1 index) correlated with the mitotic index (correlation coefficient 0.94; P<0.0001) and varied from 1% to 10.5% (mean 3.9%, median 3.0%). There were no recurrences or metastases over a mean period of 8 years. Consequently, we have shown that the mitotic index in these lesions can be variable and often high, but it does not predict a more aggressive outcome.
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Affiliation(s)
- James Sington
- Department of Cellular Pathology, John Radcliffe Hospital, Oxford
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12
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Abstract
BACKGROUND It is well documented that renal transplant recipients are at increased risk of developing skin cancers, in particular squamous cell carcinomas. Less extensively reviewed in the literature is the increased incidence of malignant melanoma. We have reviewed 10 patients in the Oxford renal transplant population who developed 12 melanomas following transplantation. OBJECTIVES To determine the incidence and characteristics of melanoma in renal transplant recipients. METHODS We reviewed the case notes and pathology of all patients who developed melanoma within the Oxford Renal Transplant Unit. The clinical details were recorded including date of transplant, immunosuppressive therapy, interval between transplant and melanoma, site of occurrence, history of sun exposure, type of clinician diagnosing the melanoma, history of other skin malignancies and outcome. From the histopathology we documented various prognostic factors. RESULTS Ten patients developed 12 melanomas (one patient had three melanomas) from a population of 1874 transplanted patients. The total number of transplant years was 11 942.2. The incidence of melanoma in our population was 12 per 11 942.2 transplant years, which is approximately 8 times greater than the standardized rate for this region. We found that the mean interval between transplant and melanoma was approximately 11 years (median 8.5). A dermatologist was the diagnosing clinician in at least 67% of cases. Melanomas occurred on the trunk in the majority of cases (58%), followed by the upper limb (25%). All patients apart from one are alive with no recurrence of their melanoma. One patient died as a result of metastatic melanoma. The mean follow-up period following melanoma was 3.7 years. In all patients apart from the patient who died, the melanomas were < 1 mm Breslow thickness. That patient's melanoma was 4.5 mm thick. There was no precursor naevus in eight of the 12 melanomas. In two there was a precursor dysplastic naevus. In the cases in vertical growth phase the tumour-infiltrating lymphocyte response was absent in four cases and nonbrisk in one patient. CONCLUSIONS In the Oxford transplant population studied melanomas occurred at approximately 8 times the rate in the general population. This is the highest rate reported in the literature. The patients had a better outcome than reported previously. This may be due to detection at a relatively early stage. Renal transplant recipients attend dedicated dermatology clinics in Oxford, which may have contributed to the early diagnosis and good outcome.
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Abstract
BACKGROUND Systemic immunosuppression is a significant risk factor for cutaneous squamous cell carcinoma (SCC). p53 is mutated and overexpressed in up to 90% of cutaneous SCC lesions. Despite considerable evidence that the immune response is important in the control of cutaneous SCC, there are no studies documenting potential tumour-associated antigens. OBJECTIVES We tested the hypothesis that individuals with cutaneous SCC have functional circulating CD8+ T cells specific for p53. METHODS Interferon-gamma immunosorbent assays were used to screen peripheral blood mononuclear cells for reactivity to six p53-derived HLA-A*0201-restricted epitopes from HLA-A*0201-positive patients and controls. RESULTS We observed significantly elevated frequencies of p53-specific CD8+ T cells in seven of 26 individuals with cutaneous SCC and in one of 10 controls. The degree of lymphocytic infiltrate significantly correlated with the frequency of CD8+ T cells specific for p53 epitopes, but not with control epitopes. CONCLUSIONS Overall, these data suggest that p53 may represent a target for CD8+ T cells in a proportion of individuals with cutaneous SCC.
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Affiliation(s)
- A P Black
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, UK
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15
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Abstract
A 48-year-old woman presented with a 20-year history of an asymptomatic depressed atrophic plaque on the abdomen. Five years earlier a punch biopsy of the same lesion had been carried out and a diagnosis of dermatofibroma was made. She was reassured and discharged. Further consultation was sought due to extension and thickening of the lesion. Re-examination of the initial and new incisional biopsy specimens, along with histochemical staining for CD34, established the diagnosis of atrophic dermatofibrosarcoma protuberans. A wide local excision was carried out. There has been no recurrence at 9 months of follow up.
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Affiliation(s)
- Vania Sinovich
- Department of Dermatology, Oxford Radcliffe Hospitals, Oxford, UK.
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Swan MC, Banwell PE, Hollowood K, Goodacre TEE. Late recurrence of dermatofibrosarcoma protuberans in the female breast: a case report. ACTA ACUST UNITED AC 2005; 58:84-7. [PMID: 15629172 DOI: 10.1016/j.bjps.2004.06.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2003] [Accepted: 06/14/2004] [Indexed: 11/23/2022]
Abstract
The case presented is of a 39-year-old female who, at the age of 13 years, had had a "dermatofibroma" excised from her left breast. Twenty-six years later she developed an unsightly "stretched scar". Excision biopsy demonstrated a dermatofibrosarcoma protuberans (DFSP). This was managed by wide local excision, preservation of the nipple-areolar complex, and immediate reconstruction with a pedicled latissimus dorsi flap. Review of the original histology confirmed the presence of DFSP, revising the original diagnosis. Most DFSPs recur within 3 years of primary excision. Such prolonged latency prior to recurrence has not been previously described. This reinforces the need to educate patients regarding the importance of long-term scar surveillance following skin tumour excision.
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Affiliation(s)
- M C Swan
- Department of Plastic and Reconstructive Surgery, Radcliffe Infirmary, University of Oxford, Woodstock Road, Oxford OX2 6HE, UK
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17
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Chamberlain AJ, Hollowood K, Turner RJ, Byren I. Tumid lupus erythematosus occurring following highly active antiretroviral therapy for HIV infection: A manifestation of immune restoration. J Am Acad Dermatol 2004; 51:S161-5. [PMID: 15577760 DOI: 10.1016/j.jaad.2004.04.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Tumid lupus erythematosus (LE) is a relatively rare and only recently recognized subset of chronic cutaneous lupus. We report a case occurring in a male with HIV infection whereby his rash was only unmasked by immune restoration following highly active antiretroviral therapy (HAART). The phenomenon of latent inflammatory or autoimmune disease appearing following HAART is now recognized as the "immune restoration syndrome" and tumid LE has not been reported in this setting previously. Fortunately this variant of lupus does not result in scarring and is responsive to anti-malarials, allowing continuation of HAART in this patient.
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18
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Abstract
The case is presented of a 29-year-old female who, at the age of 13 years, developed bilateral verrucous thickening of her areolae. Despite the condition causing her significant psychosocial morbidity, a specialist referral was initially denied on the grounds that no treatment was apparently available. The condition progressively deteriorated over the subsequent 14 years. She was eventually referred for a dermatology opinion, and the diagnosis of nevoid hyperkeratosis was made. Topical therapy with keratolytics was unsuccessful, and she was referred for a plastic surgery review. Bilateral shave excision of the lesion was performed under general anesthesia, with a satisfactory outcome and no evidence of recurrence at 10 months.
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Affiliation(s)
- Marc C Swan
- Department of Plastic and Reconstructive Surgery, Radcliffe Infirmary, Oxford, United Kingdom.
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19
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Abstract
Epidermolytic hyperkeratosis (EH) is an abnormality of epidermal maturation, most commonly due to mutations in keratins 1 and 10, which may be a congenital or an acquired defect. The term epidermolytic acanthoma was applied to a solitary discrete epidermal proliferation characterized by EH. Subsequently there have been several reports of disseminated epidermolytic acanthomas. We report a rare case of multiple epidermolytic acanthomas localized to the scrotum. With the aetiology of epidermolytic acanthoma unknown, trauma has been postulated as a possible cause. Our patient repetitively scratched his scrotum for 5 years and we believe that this action triggered his multiple scrotal epidermolytic acanthomas.
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Affiliation(s)
- J P Banky
- Department of Dermatology, Oxford Radcliffe Hospitals, Oxford, UK
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21
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Giele H, Hollowood K, Gibbons CLMH, Wilson DJ, Athanasou NA. Subungual melanoma with osteocartilaginous differentiation. Skeletal Radiol 2003; 32:724-7. [PMID: 14534752 DOI: 10.1007/s00256-003-0697-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2003] [Revised: 08/18/2003] [Accepted: 08/19/2003] [Indexed: 02/02/2023]
Abstract
Osteocartilaginous metaplasia is known to occur rarely in melanomas, particularly in subungual melanomas. We present a case of a calcified subungual soft tissue tumour in which biopsy of the lesion showed malignant round and spindle-shaped tumour cells, many of which were associated with the formation of cartilage and osteoid-like material. Subsequent resection showed clear histological evidence of a subungual melanoma. Tumour cells expressed S100, melan-A and neurone-specific enolase but were negative for HMB45. Diagnostic radiological and histological features and the nature of the osteocartilaginous differentiation within this lesion is discussed.
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Affiliation(s)
- H Giele
- Nuffield Department of Orthopaedic Surgery, University of Oxford, Nuffield Orthopaedic Centre, Oxford, OX3 7LD, UK
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22
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Cooper SM, Turner GDH, Hollowood K, Gatter K, Hatton C, Gray D, Russell-Jones R, Wojnarowska F. Primary cutaneous large cell CD30+ lymphoma in a renal transplant recipient. Br J Dermatol 2003; 149:426-8. [PMID: 12932261 DOI: 10.1046/j.1365-2133.2003.05441.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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23
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Middleton M, Harris AL, Kurwa H, Millard P, Hollowood K, Cassell O. BDS Melanoma Guidelines. Br J Dermatol 2003; 148:1081-2; author reply 1082. [PMID: 12786860 DOI: 10.1046/j.1365-2133.2003.05349.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Goodlad JR, Batstone PJ, Hamilton D, Hollowood K. Follicular lymphoma with marginal zone differentiation: cytogenetic findings in support of a high-risk variant of follicular lymphoma. Histopathology 2003; 42:292-8. [PMID: 12605649 DOI: 10.1046/j.1365-2559.2003.01580.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS The pathogenesis and clinical significance of marginal zone differentiation in follicular lymphoma remains to be determined, although genetic alterations are likely to be important determinants of both. We therefore report the cytogenetic findings in three cases of follicular lymphoma with marginal zone differentiation studied by routine karyotyping and in-situ hybridization. METHODS AND RESULTS The morphology and immunophenotype of each case was typical of follicular lymphoma displaying marginal zone differentiation. Karyotyping, performed on GTL-banded preparations of cell cultures derived from fresh lymph node tissue, revealed a complex karyotype in all three cases, including t(14;18)(q32;q21) and abnormalities associated with progression and/or transformation of follicular lymphoma. In addition, trisomy 3 was found in one case and translocations between the q27-29 region of chromosome 3 and chromosome 2 in the other two cases; the latter was identified only in subclones derived from less complex stem lines possessing t(14;18). In-situ hybridization, performed on sections cut from routinely processed paraffin-embedded tissue blocks, localized cells possessing these abnormalities of chromosome 3 to both the follicular and marginal zone components of two lymphomas studied in this way. CONCLUSIONS Trisomy 3 and alterations involving the q27-29 region of chromosome 3 are implicated in the pathogenesis of de novo marginal zone lymphoma. Their presence in the current cases indicates that they may also be responsible for marginal zone differentiation in follicular lymphoma when cells harbouring these genetic alterations are exposed to the appropriate microenvironment. Our findings are consistent with follicular lymphoma with marginal zone differentiation as a high-risk variant of follicular lymphoma.
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Affiliation(s)
- J R Goodlad
- Department of Pathology, Highland Acute Hospitals NHS Trust, Raigmore Hospital, Inverness, UK.
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Sheridan AT, Hollowood K, Sakuntabhai A, Dean D, Hovnanian A, Burge S. Expression of sarco/endo-plasmic reticulum Ca2+-ATPase type 2 isoforms (SERCA2) in normal human skin and mucosa, and Darier's disease skin. Br J Dermatol 2002; 147:670-4. [PMID: 12366411 DOI: 10.1046/j.1365-2133.2002.04916.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The recent report that mutations in ATP2A2, which encodes the Ca2+ transporting sarco/endo-plasmic reticulum pump type 2 isoforms (SERCA2), cause Darier's disease (DD) suggests that SERCA2 plays an important role in epidermal cell adhesion and differentiation. However, no data exist regarding SERCA2 expression in normal human skin, mucosa and DD. OBJECTIVES We have therefore investigated SERCA2 expression in normal human skin (40 samples), oral and vaginal mucosa (13 samples) and DD lesional skin (six samples). MATERIALS AND METHODS These investigations were performed with a mouse monoclonal antibody specific for human SERCA2, using a standard ABC immunoperoxidase technique. RESULTS SERCA2 was expressed in all specimens. SERCA2 expression was pronounced in the subnuclear aspect of basal epidermal keratinocytes, with variable suprabasal expression. SERCA2 expression was also observed in the infundibulum and outer root sheath of hair follicles; germinative and mature cells of sebaceous glands; secretory coil and duct of eccrine glands; apocrine gland cells, and arrector pili muscle. Fibroblasts and blood vessels (endothelium and muscle) expressed SERCA2, whereas nerves did not. SERCA2 expression was observed throughout oral and vaginal mucosa. In DD skin, strong SERCA2 positivity was detected in the basal, suprabasal and acantholytic lesional cells. Perilesional DD skin was comparable to normal skin. CONCLUSIONS These findings support the hypothesis that SERCA2 is an important player in cutaneous biology, and provide baseline data that will facilitate the design and interpretation of functional studies of cutaneous SERCA2.
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Affiliation(s)
- A T Sheridan
- Department of Dermatology, The Oxford Radcliffe Hospitals, Old Road, Headington, UK
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Abstract
We report two cases of keratosis follicularis spinulosa decalvans in a Caucasian family involving a 28-year-old woman and her mother. This is an unusual family in that no male relatives are similarly affected. Secondly, both patients have no significant eye changes but quite extensive scarring alopecia. To the best of our knowledge this is the second reported family in the UK.
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Affiliation(s)
- N P Khumalo
- Department of Dermatology, Groote Schuur Hospital, Capetown, South Africa
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28
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Senghore N, Cunliffe D, Watt-Smith S, Hollowood K. Extraneural perineurioma of the face: an unusual cutaneous presentation of an uncommon tumour. Br J Oral Maxillofac Surg 2001; 39:315-9. [PMID: 11437432 DOI: 10.1054/bjom.2000.0616] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Perineurioma is an uncommon, benign tumour of the peripheral nerve sheath that has two major clinicopathological forms -- intraneural and extraneural. We present a case of extraneural perineurioma that occurred at an unusual site -- the facial skin of a 70-year-old woman -- which illustrates the wide, and potentially misleading, clinicopathological spectrum of this poorly recognized tumour.
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Affiliation(s)
- N Senghore
- Department of Oral and Maxillofacial Surgery, John Radcliffe Hospital, Oxford, UK
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29
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Abstract
AIMS The histological distinction of desmoplastic melanoma from cutaneous scar tissue, particularly in the context of re-excision specimens or possible recurrence, may be very difficult. Immunostaining for S100 protein is often used to discriminate although there are little data on S100 expression in scar tissue. The aim of this study was to assess whether S100-positive cells are present in dermal scars and, if so, their extent, distribution and nature. METHODS AND RESULTS Twenty-two re-excision specimens of previously biopsied nonmelanocytic skin lesions were reviewed. Formalin-fixed paraffin-embedded sections containing dermal scars were stained by a standard ABC immunoperoxidase technique for S100 protein, CD1a and neurofilaments. The distribution and morphology of positive cells within the dermal scar tissue were documented. Cells expressing S100 protein were identified within the scars of 21 of the 22 cases. The number of S100-positive cells varied between cases but in four specimens was substantial. They displayed a variety of morphological appearances but the majority were spindle-shaped. A few showed mild cytological atypia. It is suggested that the majority represent Schwann cells with a minority of Langerhans cells and cells of uncertain lineage. CONCLUSION S100-positive cells, including spindle cells showing mild atypia, are found in cutaneous scars. S100 staining of re-excision specimens or putative recurrences of desmoplastic melanoma should be interpreted with caution.
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Affiliation(s)
- A Robson
- Department of Cellular Pathology, Level 1, John Radcliffe Hospital, Headley Way, Oxford, UK
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30
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Goodlad JR, Davidson MM, Hollowood K, Batstone P, Ho-Yen DO. Borrelia burgdorferi-associated cutaneous marginal zone lymphoma: a clinicopathological study of two cases illustrating the temporal progression of B. burgdorferi-associated B-cell proliferation in the skin. Histopathology 2000; 37:501-8. [PMID: 11122431 DOI: 10.1046/j.1365-2559.2000.01003.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS A relationship between Borrelia burgdorferi and primary cutaneous B-cell lymphoma (PCBCL) has recently been confirmed following demonstration of the organism in lesional skin of patients with PCBCL. We report herein two cases of B. burgdorferi-associated PCBCL which strengthen this association by demonstrating the organism in cutaneous B-cell infiltrates present at sites in which PCBCL subsequently developed. METHODS AND RESULTS All studies were performed on formalin-fixed paraffin-embedded tissues. These were examined by routine light microscopy and immunohistochemically by a standard streptavidin-biotin-complex technique. Genotypic studies were also undertaken using semi-nested polymerase chain reaction (PCR) for immunoglobulin heavy chain gene rearrangement, and nested PCR for B. burgdorferi flagellin gene. Both patients presented with erythematous skin lesions, biopsy of which showed dense perivascular infiltrates comprising small T-lymphocytes and collections of B-blasts. Primary cutaneous marginal zone lymphoma (MZL) developed subsequently in both cases at the same site. PCR for B. burgdorferi flagellin gene was positive in the perivascular lymphocytic infiltrates and the succeeding lymphomas in both patients. CONCLUSIONS These results show that, at least in some instances, PCBCL arises from chronically stimulated lymphoid tissue acquired in the skin in response to B. burgdorferi infection. This may have significant therapeutic implications and warrant further studies on the extent of this association.
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Affiliation(s)
- J R Goodlad
- Department of Pathology, Raigmore Hospital, Inverness, UK.
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Goodlad JR, Davidson MM, Hollowood K, Ling C, MacKenzie C, Christie I, Batstone PJ, Ho-Yen DO. Primary cutaneous B-cell lymphoma and Borrelia burgdorferi infection in patients from the Highlands of Scotland. Am J Surg Pathol 2000; 24:1279-85. [PMID: 10976703 DOI: 10.1097/00000478-200009000-00012] [Citation(s) in RCA: 189] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although a link between primary cutaneous B-cell lymphoma (PCBCL) and Borrelia burgdorferi infection has long been suspected, previous studies have not demonstrated a significant association. The authors looked for evidence of B. burgdorferi in 20 cases of PCBCL from the Scottish Highlands, an area with endemic Lyme disease, and compared their findings with those in 40 control patients (20 undergoing wide reexcision at sites of malignant melanoma and 20 biopsies of inflammatory dermatoses). All studies were performed on formalin-fixed, paraffin-embedded tissues. The cases of PCBCL were classified according to criteria described by the European Organization for Research and Treatment of Cancer Cutaneous Lymphoma Project Group using a combination of morphology, immunohistochemistry, and seminested polymerase chain reaction (PCR) for immunoglobulin heavy chain gene rearrangement. A nested PCR was performed on deoxyribonucleic acid (DNA) extracts from the lymphoma and control cases using primers to a unique conserved region of the B. burgdorferi flagellin gene. B. burgdorferi-specific DNA was detected in seven of 20 lymphoma cases (five of 12 marginal zone lymphomas, one of five primary cutaneous follicle center cell lymphomas, one of three diffuse, large B-cell lymphomas of the leg) and in one melanoma reexcision patient of 40 control subjects. The relationship between B. burgdorferi and PCBCL was significant when compared with the control groups separately (p <0.05) or in combination (p <0.01). These results provide strong evidence to support the concept of B. burgdorferi-driven lymphomagenesis in the skin.
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Affiliation(s)
- J R Goodlad
- Department of Pathology, Raigmore Hospital, Inverness, Scotland, UK.
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Hollowood K, Rogers D. Forensic sciences in clinical medicine: A case study approach. BMJ 1999; 318:1294. [PMID: 10231286 PMCID: PMC1115676 DOI: 10.1136/bmj.318.7193.1294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Goodlad JR, Hollowood K, Smith MA, Chan JK, Fletcher CD. Primary juxtaarticular soft tissue lymphoma arising in the vicinity of inflamed joints in patients with rheumatoid arthritis. Histopathology 1999; 34:199-204. [PMID: 10217559 DOI: 10.1046/j.1365-2559.1999.00629.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS Primary soft tissue lymphoma is uncommon and little is known regarding its aetiology and pathogenesis. In a review of 37 soft tissue lymphomas we uncovered three cases associated with rheumatoid arthritis which we report herein. METHODS AND RESULTS The clinical records and pathology of the cases are described together with the results of in situ hybridization studies with oligonucleotide probes to Epstein-Barr virus (EBV) encoded RNA (EBER). All three patients were females with a long-standing history of rheumatoid arthritis ranging from 9 to 17 years. Each presented with a soft tissue mass in the vicinity of a joint affected by rheumatoid disease. All had received prior treatment with nonsteroidal anti-inflammatory drugs and one also received gold, penicillamine and intra-articular steroids to affected joints. None had received methotrexate. Histologically, the juxtaarticular soft tissue masses were all B-cell lymphomas. None were associated with EBV as determined by in situ hybridization. CONCLUSIONS These cases document an association between rheumatoid arthritis and soft tissue lymphoma of B-cell type, arising in the vicinity of an affected joint. Chronic local immune stimulation may have played a significant role in the genesis of these lymphomas, unlike the frequently reversible and EBV-positive lymphomas that occur in rheumatoid patients on immunosuppressive therapy.
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Affiliation(s)
- J R Goodlad
- Department of Pathology, Raigmore NHS Trust, Inverness, UK
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Abstract
The germinal centre is a fundamental component of the humoral immune response, representing a unique microenvironment where antigen-activated B lymphocytes undergo clonal expansion, mutate their immunoglobulin, and are subject to a stringent selection process based on their antigen affinity. This review highlights recent advances in the understanding of the cell kinetic process of activation, proliferation, differentiation, and death of germinal centre cells, which are beginning to provide important insights into the regulation of this highly complex reaction. Their definition may have considerable pathological import given the involvement of the germinal centre in non-Hodgkin's lymphomas and recent evidence suggesting that abnormal germinal centre reactions may be involved in the pathogenesis of Hodgkin's disease and some autoimmune diseases.
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Affiliation(s)
- K Hollowood
- Department of Cellular Pathology, John Radcliffe Hospital, Headington, Oxford, U.K
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Ramachandra S, Hollowood K, Bisceglia M, Fletcher CD. Inflammatory pseudotumour of soft tissues: a clinicopathological and immunohistochemical analysis of 18 cases. Histopathology 1995; 27:313-23. [PMID: 8847061 DOI: 10.1111/j.1365-2559.1995.tb01521.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Pseudosarcomatous proliferation of myofibroblasts, fibroblasts and inflammatory cells have been reported in a wide variety of sites and are most commonly termed inflammatory pseudotumours. Despite increasing recognition, the occurrence of inflammatory pseudotumour in somatic soft tissue is poorly documented, such that these lesions are commonly mistaken for a variety of benign and malignant neoplasms. This report documents our experience of 18 cases of soft tissue inflammatory pseudotumour. All arose in adults (median age 54.5 years; range 28-83 years) and showed no sex predilection. Anatomical location was varied but the head and neck region and abdominal cavity were most common. They displayed a spectrum of histological appearances but all were characterized, to a greater or lesser extent, by an admixture of myofibroblasts and fibroblasts, most commonly arranged in short interwoven fascicles, together with a polymorphic inflammatory cell component, consisting principally of lymphocytes and plasma cells. In some cases xanthoma cells were prominent. Simple surgical excision appeared to be curative. The importance of recognizing the presence of a wide clinicopathological spectrum is emphasized and the differential diagnosis, especially from fibrohistiocytic neoplasms or Hodgkin's disease, is discussed.
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Affiliation(s)
- S Ramachandra
- Department of Histopathology, St Thomas's Hospital (UMDS), London, UK
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Hollowood K, Fletcher CD. Malignant fibrous histiocytoma: morphologic pattern or pathologic entity? Semin Diagn Pathol 1995; 12:210-20. [PMID: 8545588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Since the concept of malignant fibrous histiocytoma (MFH) was introduced and subsequently popularized in the 1960's and 1970's, it has become widely regarded as the commonest soft-tissue sarcoma of adulthood. Although the initial notion that MFH was a true histiocytic tumor showing faculative fibroblastic differentiation has been disproved, and despite the lack of definable, reproducible diagnostic criteria and considerable immunophenotypic, ultrastructural and karyotypic heterogeneity, MFH is still accepted widely as a discrete clinicopathologic entity. On the other hand several recent studies have expressed considerable doubts about MFH, or at least pleomorphic MFH, as an "entity" and have suggested that it represents a common morphologic manifestation of a host of poorly differentiated sarcomas and, more rarely, other neoplasms. This article reviews the clinicopathologic features of MFH and its established variants in the context of this debate and considers the evidence for and against their continued acceptance as distinct entities or as a cohesive group. We conclude that the pleomorphic, giant cell and inflammatory variants each represent heterogeneous diagnostic groups which are hard to defend as cohesive entities, while the myxoid ("myxofibrosarcoma") and angiomatoid types are distinct, reproducible tumor types.
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Affiliation(s)
- K Hollowood
- Department of Histopathology, St Thomas's Hospital (U.M.D.S.), London, England
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Hollowood K, Fletcher CD. Soft tissue sarcomas that mimic benign lesions. Semin Diagn Pathol 1995; 12:87-97. [PMID: 7770677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Although it is well known that a variety of benign mesenchymal neoplasms and reactive proliferations may mimic sarcomas, the fact that some types of sarcoma commonly are misinterpreted as benign is less widely appreciated. This review considers five such lesions in soft tissue: low grade fibromyxoid sarcoma, low grade myxofibrosarcoma (myxoid "MFH"), well differentiated liposarcoma (atypical lipoma), epithelioid sarcoma, and so-called inflammatory fibrosarcoma. Principal reasons for their underrecognition are their generally bland cytology, often relative hypocellularity, and indolent clinical course. Common to several of these lesions, however, is a tendency for histological and hence biological progression in local recurrences, underlining the importance of accurate diagnosis and adequate treatment of the primary lesion. This review considers the principal clinicopathologic features, differential diagnosis and (where appropriate) nosologic status of this treacherous group of neoplasms.
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Affiliation(s)
- K Hollowood
- Department of Histopathology, St Thomas's Hospital, London, England, U.K
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Hollowood K, Stamp G, Zouvani I, Fletcher CD. Extranodal follicular dendritic cell sarcoma of the gastrointestinal tract. Morphologic, immunohistochemical and ultrastructural analysis of two cases. Am J Clin Pathol 1995; 103:90-7. [PMID: 7817952 DOI: 10.1093/ajcp/103.1.90] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Tumors showing differentiation toward follicular dendritic cells are rare and usually occur in lymph nodes. Their occurrence at extranodal sites was recognized recently. This report documents two further extranodal cases, one arising in the small intestine of a 23-year-old woman and the second in periduodenal retroperitoneal soft tissue of a 63-year-old man. Both neoplasms displayed a typical biphasic morphologic pattern, composed of large cells with indistinct cytoplasmic borders creating a syncytial appearance, admixed with spindle cell areas resembling malignant fibrous histiocytoma, and infiltrated by numerous small T lymphocytes. Expression of CD21 and CD35, together with ultrastructural demonstration (in one case) of long cytoplasmic processes connected by desmosomes, confirmed follicular dendritic cell differentiation. One case also expressed HLA-DR, and both showed aberrant epithelial membrane antigen staining. Neither tumor showed CD45 expression. In both cases the tumors were treated by local excision. Case 1 has shown an unusually aggressive course with extensive intraperitoneal recurrence. The biphasic morphologic pattern and tumor immunophenotype are discussed in relation to increasing evidence of immunophenotypic and morphologic heterogeneity of normal follicular dendritic cells.
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Affiliation(s)
- K Hollowood
- Department of Histopathology, St. Thomas Hospital (U.M.D.S.), London, United Kingdom
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Abstract
A 46 year old woman presented with the CREST variety of systemic sclerosis and occult gastrointestinal bleeding due to vascular malformations of her stomach. Partial gastrectomy cured her anaemia. In systemic sclerosis, visceral angiography should be performed early when initial investigations have been negative.
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Affiliation(s)
- M M el-Omar
- Gastrointestinal Laboratory, Rayne Institute, St Thomas' Hospital, London, UK
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Hollowood K, Fletcher CD. Rhabdomyosarcoma in adults. Semin Diagn Pathol 1994; 11:47-57. [PMID: 8202646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Rhabdomyosarcomas occur in adults in one of two forms; as sporadic cases of the juvenile histological types and more commonly, if controversially, as the major adult form, pleomorphic rhabdomyosarcoma. This review documents the historical background to the fluctuating diagnostic popularity of pleomorphic rhabdomyosarcoma, together with a presentation of its defining clinicopathologic characteristics, and presents the clinicopathologic features of the juvenile types as they occur in adults. The concept of pleomorphic rhabdomyosarcoma as a distinct clinicopathologic entity, presenting as an aggressive, predominantly spindle-cell tumor arising in the skeletal musculature of middle-aged adults and defined by the presence of large, pleomorphic tumor cells, which show, at least focally, immunophenotypic or ultrastructural sarcomeric muscle differentiation, is discussed and supported.
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Affiliation(s)
- K Hollowood
- Department of Histopathology, St Thomas's Hospital (U.M.D.S.), London, England
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Affiliation(s)
- S M Wilkinson
- Department of Dermatology, North Staffordshire Hospital Centre, Stoke-on-Trent, UK
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Abstract
We have observed a high incidence of pemphigus foliaceous, in the absence of therapy with penicillamine, within a small population of patients with rheumatoid arthritis. We suggest that penicillamine as well as inducing autoimmune disease might exacerbate subclinical pemphigus foliaceous in this group, accounting for those few patients whose skin disease fails to resolve following drug withdrawal. Pemphigus and rheumatoid arthritis have both been associated with HLA DR4, which was present in all three of our patients who were tested.
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Affiliation(s)
- S M Wilkinson
- Department of Dermatology, North Staffordshire Hospital Centre, Stoke-on-Trent, UK
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44
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Hollowood K, Fletcher CD. Pseudosarcomatous myofibroblastic proliferations of the spermatic cord ("proliferative funiculitis"). Histologic and immunohistochemical analysis of a distinctive entity. Am J Surg Pathol 1992; 16:448-54. [PMID: 1599023 DOI: 10.1097/00000478-199205000-00003] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Pseudosarcomatous myofibroblastic proliferations have been recognised at a variety of sites. We describe five lesions of the spermatic cord, four of which were incidental findings at inguinal herniorrhaphy. The patients' age range was 52-76 years. In all cases, sarcoma was suspected histologically, but each lesion showed morphologic features in keeping with fasciitis-like lesions described at other sites. Two cases showed actin positivity, supporting this interpretation. All were marginally or incompletely excised. One recurred locally. We believe that ischemia or torsion is of pathogenetic importance at this site. We propose that the term "proliferative funiculitis" be used to describe this type of reactive process when it presents in the spermatic cord.
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Affiliation(s)
- K Hollowood
- Department of Histopathology, St Thomas's Hospital, London, England
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45
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Abstract
The changes in splenic germinal center (GC) cell proliferation were measured during primary and secondary responses to a T-dependent antigen in vivo to examine the regulation of the GC reaction. Adult C3H/HeN mice were immunized with sheep red blood cells and boosted 7 or 21 days later. GC cell proliferation was assessed by measurement of GC cell birth rates using a stathmokinetic technique. Actual GC growth and regression were assessed in terms of total splenic volume and number. Pre-existing GC had a mean cell birth rate of 33 cells/1000 cells/h. The GC reactions following each immunization showed a biphasic pattern of changes in cell birth rate, comprising an initial fall immediately succeeded by a transient, but significant, increase. These fluctuations occurred earlier in secondary compared to primary responses. Significant increases in total GC volumes succeeded the peaks of cell birth rate following both primary and early secondary immunization. However, there was a substantially smaller increase following later secondary immunization. We propose that the initial cell birth rate reduction is due to inhibition of pre-existing GC clones and represents one component of the phenomenon of GC dissociation. The succeeding peak birth rate represents early, massive proliferation of newly activated antigen-specific clones. The different patterns of GC expansion, despite similar proliferative responses, may reflect different pathways of differentiation dependent on the timing of antigenic stimulation.
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Affiliation(s)
- K Hollowood
- UMDS, Department of Histopathology, St Thomas' Hospital, London
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Hollowood K, Holley MP, Fletcher CD. Plexiform fibrohistiocytic tumour: clinicopathological, immunohistochemical and ultrastructural analysis in favour of a myofibroblastic lesion. Histopathology 1991; 19:503-13. [PMID: 1723956 DOI: 10.1111/j.1365-2559.1991.tb01498.x] [Citation(s) in RCA: 111] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Plexiform fibrohistiocytic tumour is a recently described, seemingly benign neoplasm of superficial soft tissue which is poorly recognized and the differentiation pattern of which remains obscure. Fourteen new cases are presented here. These presented predominantly in the upper limb of infants and children, although the age-range was wide. A morphological spectrum depending on the relative proportions of the spindle cellular and nodular histiocyte-like components was evident. Immunohistochemical analysis revealed positivity of tumour cells in both components for smooth muscle actin, suggestive of myofibroblastic differentiation, as was borne out ultrastructurally in two cases. In addition, a minority of the histiocyte-like cells were also CD68 positive but negative for leucocyte common antigen, HLA-DR, Mac387 and lysozyme. In view of the ultrastructural and other immunohistochemical results, this is regarded as further evidence that the CD68 epitope recognized by KP-1 is not confined to cells of monocyte/macrophage or myeloid lineage. Plexiform fibrohistiocytic tumour appears to be a clinicopathologically distinctive myofibroblastic neoplasm which may warrant reclassification in due course.
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MESH Headings
- Actins/analysis
- Adolescent
- Adult
- Antibodies, Monoclonal/immunology
- Antigens, CD/analysis
- Antigens, Differentiation, Myelomonocytic/analysis
- Child
- Child, Preschool
- Female
- Fibroblasts
- Histiocytoma, Benign Fibrous/chemistry
- Histiocytoma, Benign Fibrous/pathology
- Histiocytoma, Benign Fibrous/ultrastructure
- Humans
- Infant
- Infant, Newborn
- Male
- Microscopy, Electron
- Middle Aged
- Soft Tissue Neoplasms/chemistry
- Soft Tissue Neoplasms/pathology
- Soft Tissue Neoplasms/ultrastructure
- Staining and Labeling
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Affiliation(s)
- K Hollowood
- Department of Histopathology, St Thomas's Hospital (UMDS), London, UK
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Abstract
It has been hypothesized that inhibition of germinal centre cell apoptosis may underlie the development of follicle centre cell lymphomas. We have performed a comparative, quantitative study of apoptotic cell death in germinal centres and in the neoplastic follicles of centroblastic-centrocytic, follicular, non-Hodgkin's lymphoma (Cb/Cc NHL). Ten cases each of reactive follicular hyperplasia and Cb/Cc NHL were analysed. One-micrometre-thick resin-embedded sections were examined at x 1000 magnification. The total numbers of cells, nuclear containing apoptotic bodies, and mitoses were counted in each follicle and the apoptotic and mitotic indices were derived. Transmission electron microscopy was performed on selected cases to confirm the typical features of apoptosis. The mean apoptotic (4.9 per cent) and mitotic indices (0.9 per cent) for the germinal centres were significantly higher (P much less than 0.001) than those for the neoplastic follicles (0.9 and 0.14 per cent). These results lend support to the recent proposal that reduced apoptotic cell death may be important in the pathogenesis of follicular lymphomas.
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Affiliation(s)
- K Hollowood
- UMDS, Department of Histopathology, St Thomas' Hospital, London, U.K
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Abstract
Putative sarcomas of follicular dendritic cells are extremely uncommon and only small case numbers have been clearly documented. A major difficulty in their delineation has been the persistent controversy over the phenotype and ontogeny of normal follicular dendritic cells. Two new cases arising in adult females are presented herein, both of which had initially been mistaken for metastases from a true soft tissue sarcoma. Their morphology, immunophenotype, and ultrastructure (in one case) are described in order to aid their wider recognition. In the light of these findings, the nature and origin of follicular dendritic cells are discussed.
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Affiliation(s)
- K Hollowood
- Department of Histopathology, St Thomas's Hospital (U.M.D.S.), London, U.K
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Abstract
S-phase fraction, an index of cellular proliferation, and DNA ploidy were measured by DNA flow cytometry in a retrospective study of lymph node biopsy specimens from 83 cases (before treatment) of follicular non-Hodgkin's lymphoma, Working Formulation categories B and C. The correlations between these measures and survival, clinical stage, symptoms and histopathological factors were investigated. Aneuploidy was rare (n = 16) and had no effect on length of survival or transformation to high grade lymphoma. The overall mean S-phase fraction was 3.6%; for the whole series increasing S-phase fraction was associated with decreased survival. A high S-phase fraction (more than 5%) in initial biopsy specimens was also associated with an increased risk of subsequent high grade transformation at relapse. There was no difference between the survival or proliferative activity of tumours composed of mainly small cleaved cells compared with those composed of mixed small and large cells. There was no difference in survival or proliferative activity between tumours showing a pure follicular growth pattern and those with a mixed follicular and diffuse growth pattern. Multifactorial analysis showed that an S-phase fraction of more than 5% and B symptoms were the most important factors determining survival in these follicular non-Hodgkin's lymphomas.
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