Cutaneous Reactions after COVID-19 Vaccines: Analysis of the Clinical and Histopathological Spectrum-Case Series and Review of the Literature

(1) Background: Various cutaneous adverse drug reactions (ADRs) are observed with the implementation of mRNA COVID-19 vaccines. To gain insight into the clinicopathologic features, we analyzed the correlation of histological and clinical data in 48 patients with these ADRs. (2) Methods: Single-center retrospective study in patients with ADRs after mRNA COVID-19 vaccination (mRNA-1273 and BNT162b2 vaccines). (3) Results: Distant generalized ADRs prevailed (91%), often appearing clinically as spongiotic dermatitis or maculopapular exanthema. Histopathological analysis revealed spongiotic changes (46%) and dermal superficial perivascular predominantly lymphocytic infiltrates (17%). Eosinophils were found in 66% of biopsies, neutrophils in 29%, and plasma cells only in 8% of biopsies. Most ADRs occurred after the second vaccine dose (44%). Histologically spongiotic changes were associated with clinical features of spongiotic dermatitis in only 50% of patients and maculopapular exanthema in the remaining patients. ADRs represented an aggravation of preexisting skin disease in 23% of patients. ADRs regressed within 28 days or less in 53% of patients and persisted beyond a month in the remaining patients. (4) Conclusions: Our study demonstrates a diverse spectrum of generalized ADRs, revealing correlations between histology and clinical features but also instances of divergence. Interestingly, in about half of our patients, ADRs were self-limited, whereas ADRs extended beyond a month in the other half.

[The value of histology in the diagnosis of non-neoplastic skin diseases]

The value of histology in the diagnosis of non-neoplastic skin diseases Abstract. The diagnosis of most non-neoplastic skin diseases is primarily based on patient history and clinical examination. However, histological evaluation of skin biopsies can be an invaluable tool in the diagnostic workup of clinically uncertain inflammatory skin conditions. For a correct interpretation of the histological findings, clinicopathological correlation as well as selection of an adequate biopsy technique and a suitable biopsy site are essential. In this article, general principles related to biopsies of inflammatory skin diseases are discussed and illustrated with examples from everyday practice.

Androgen receptor status is highly conserved during tumor progression of breast cancer

Background

With the advent of new and more efficient anti-androgen drugs targeting androgen receptor (AR) in breast cancer (BC) is becoming an increasingly important area of investigation. This would potentially be most useful in triple negative BC (TNBC), where better therapies are still needed. The assessment of AR status is generally performed on the primary tumor even if the tumor has already metastasized. Very little is known regarding discrepancies of AR status during tumor progression. To determine the prevalence of AR positivity, with emphasis on TNBCs, and to investigate AR status during tumor progression, we evaluated a large series of primary BCs and matching metastases and recurrences.

Methods

AR status was performed on 356 primary BCs, 135 matching metastases, and 12 recurrences using a next-generation Tissue Microarray (ngTMA). A commercially available AR antibody was used to determine AR-status by immunohistochemistry. AR positivity was defined as any nuclear staining in tumor cells ≥1 %. AR expression was correlated with pathological tumor features of the primary tumor. Additionally, the concordance rate of AR expression between the different tumor sites was determined.

Results

AR status was positive in: 87 % (307/353) of primary tumors, 86.1 % (105/122) of metastases, and in 66.7 % (8/12) of recurrences. TNBC tested positive in 11.4 %, (4/35) of BCs. A discrepant result was seen in 4.3 % (5/117) of primary BC and matching lymph node (LN) metastases. Three AR negative primary BCs were positive in the matching LN metastasis, representing 17.6 % of all negative BCs with lymph node metastases (3/17). Two AR positive primary BCs were negative in the matching LN metastasis, representing 2.0 % of all AR positive BCs with LN metastases (2/100). No discrepancies were seen between primary BC and distant metastases or recurrence (n = 17).

Conclusions

Most primary (87 %) and metastasized (86.1 %) BCs are AR positive including a significant fraction of TNBCs (11.4 %). Further, AR status is highly conserved during tumor progression and a change only occurs in a small fraction (4.1 %). Our study supports the notion that targeting AR could be effective for many BC patients and that re-testing of AR status in formerly negative or mixed type BC’s is recommended.

Abstract 5173: Androgen receptor status is highly conserved during tumor progression of breast cancer

Introduction: Many clinical trails are ongoing targeting androgen receptor (AR) in breast cancer (BC). Anti-androgen therapy is increasingly accepted in BC patients since the new compounds have less androgenic side effects. The assessment of AR status is generally performed on the primary tumor even when treating metastatic disease. To the best of our knowledge, nothing is known regarding discrepancies of AR status between the primary tumor and the metastatic site. Therefore, we investigated AR status on a large cohort of primary BCs and matched metastases.

Method: A next-generation Tissue Microarray (ngTMA) was constructed harboring 356 primary BCs, 133 matched metastases and 11 recurrences. A commercially available monoclonal AR antibody (DAKO) was used to evaluate AR-Status by immunohistochemistry. AR positivity was defined as ≥1% of nuclear staining in tumor cells. The results of the primary tumor and metastases/recurrences were compared. Additionally, the results of AR status were correlated with other pathological tumor features.

Result: AR could be evaluated in 353/356 (99.2%) of primary BCs and a positivity was detected in 307 (87%). A discordant result was seen in 4.3% metastasized BC's with informative results (5/117). Three negative BCs were positive in the metastases representing 16.7% of all negative BCs with informative results (3/18). Two BCs were positive in the primary and negative in the metastases representing 2.0% of all positive BCs with metastases and informative results (2/99). No discrepancies were seen between primary and loco-regional recurrences. Further, AR expression was significantly correlated with a positive estrogen (p<0.001) and progesterone receptor (p<0.001) status and a low proliferation (≤15%) (p<0.001). Negative AR status was significantly (p<0.001) associated with a higher tumor grade. Triple negative BCs were in 11.4% AR positive (4/35).

Conclusion: AR positivity is frequent in primary BCs (87%) and AR status is highly conserved during tumor progression. In a small fraction AR status changes (4.3%) either from positive to negative status or vise versa. However, even AR status is highly preserved we would recommend reevaluation of the metastatic site in negative BC's since a positive AR status can be seen in 16.7% of this subgroup.

Citation Format: André Grogg, Katrin Pfaltz, Claudia Lädrach, Nikola Cihoric, Martin Zweifel, Coya F. M. Tapia. Androgen receptor status is highly conserved during tumor progression of breast cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 5173. doi:10.1158/1538-7445.AM2015-5173

High tumor budding stratifies breast cancer with metastatic properties

Tumor budding refers to single or small cluster of tumor cells detached from the main tumor mass. In colon cancer high tumor budding is associated with positive lymph nodes and worse prognosis. Therefore, we investigated the value of tumor budding as a predictive feature of lymph node status in breast cancer (BC). Whole tissue sections from 148 surgical resection specimens (SRS) and 99 matched preoperative core biopsies (CB) with invasive BC of no special type were analyzed on one slide stained with pan-cytokeratin. In SRS, the total number of intratumoral (ITB) and peripheral tumor buds (PTB) in ten high-power fields (HPF) were counted. A bud was defined as a single tumor cell or a cluster of up to five tumor cells. High tumor budding equated to scores averaging >4 tumor buds across 10HPFs. In CB high tumor budding was defined as ≥10 buds/HPF. The results were correlated with pathological parameters. In SRS high PTB stratified BC with lymph node metastases (p ≤ 0.03) and lymphatic invasion (p ≤ 0.015). In CB high tumor budding was significantly (p = 0.0063) associated with venous invasion. Pathologists are able, based on morphology, to categorize BC into a high and low risk groups based in part on lymph node status. This risk assessment can be easily performed during routine diagnostics and it is time and cost effective. These results suggest that high PTB is associated with loco-regional metastasis, highlighting the possibility that this tumor feature may help in therapeutic decision-making.

Perineural Invasion in the Absence of Malignancy: Report of Two Cases and Review of the Literature

Perineural invasion is usually associated with invasion of the perineural space by malignant tumors. In this report, we describe 2 cases of perineural infiltration by benign-appearing epithelial cells in the skin. One case concerns a tumor-free reexcision specimen of a basal cell carcinoma and the other one an ulceration at the outer ear, consistent with acanthoma fissuratum, without a history of a previous excision. This finding was interpreted as a reactive process with dislocation of epithelium from the overlying epidermis into the perineural space.

Abstract 3460: Tumor budding is a predictive feature for lymph node metastasis in invasive ductal breast cancer

Background: Tumor budding is a phenomenon associated with epithelial mesenchymal transition and correlates with tumor invasiveness and metastasis in colon cancer. In breast cancer this histomorphological feature has not yet been determined. In this study we investigated the prognostic value of peritumoral budding (PTB) and intratumoral budding (ITB) in invasive ductal breast cancer and its correlation with lymph node status. Method: Two pathologists counted tumor buds within the tumor (ITB) and at the periphery (PTB) of 90 primary invasive ductal breast cancers. ITB and PTB were scored on whole tissue sections stained with a PanCK antibody. Budding was defined as isolated single cancer cells or microscopic cell clusters composed of ≥1 or up to 5 cells. A tumor was designated to have high-grade budding if it had an average of >10 buds. PTB and ITB were then correlated with pathological features of breast cancer. Results: Forty-eight percent (n=43) and 50% (n=45) were considered high-grade for either ITB or PTB, respectively. High-grade PTB was significantly (p=0.0044) associated with lymph node metastasis and ITB was significantly (p=0.0018) associated with hormone receptor positive tumors. ITB and PTB were frequent in Her2 negative (50% and 53%) tumors and breast cancer with higher T-category >T3 (57%). Neither PTB nor ITB showed an association with tumor grade or proliferation index as measured by Mib-1 staining. Conclusion: For the first time, we report that PTB is a strong (p=0.0044) predictive tumor feature of lymph node metastasis in invasive ductal breast cancer. The association of PTB with metastatic disease may be due to an increased occurrence of lymph vessels found at the tumor periphery. Additional studies are ongoing to determine if tumor budding can select for more aggressive subtypes of invasive breast cancer.

Citation Format: Mafalda Trippel, Katrin Pfaltz, Bodour Salhia, André Grogg, Inti Zlobec, Coya F. Tapia. Tumor budding is a predictive feature for lymph node metastasis in invasive ductal breast cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3460. doi:10.1158/1538-7445.AM2013-3460

Abstract 4574: FGFR1 amplification in high grade, estrogene receptor positive and metastasized breast cancers

Background: The FGFR1-gene (fibroblast growth factor receptor 1) is located at chromosome 8p12 encoding for a tyrosine kinase. FGFR1 is involved in cell cycle, differentiation, survival, apoptosis, and angiogenesis. Recently, it was shown that breast cancer cell lines harboring a FGFR1 amplification were more sensitive to treatment with an FGFR inhibitor. To estimate if FGFR inhibitors can be a therapeutic option in human breast cancer we investigated the prevalence and the histological subtypes of FGFR1 amplification in a large cohort of breast cancers. Methods: Tissue micro-arrays with 907 breast cancers were hybridized using the commercially available fluorescent in-situ hybridization probe (FGFR1/CEN8; ZytoVision®). The results were interpreted as following: a normal gene status was considered as a ratio (FGFR1/CEN8): 0.8-1.9, an amplification was defined as a ratio β2.0, a polysomy was defined as more than >4 FGFR1 and CEP8 signals. Results: FGFR1 amplification was observed in 8.9% (n=81), a normal gene status was found in 80.7% (n=732), and a polysomy was detected in 10.2% (n=93) tumors. FGFR1 amplified breast cancers showed the following features: expression of estrogen receptor 85% (67/78), ductal 72.8% (59/81), high grade (G3) 45.5% (35/77), her2 over-expression (score2+/3+) 16% (12/75), and 18% (13/72) recurrence. Comparing T (T1, T2, T3) and N (N0 and >N0)-categories between FGFR1 amplified and non-amplified tumors the following results were seen: T1: 25% (19/77) vs. 34% (245/719), T2: 56% (43/77) vs. 48% (345/719), T3: 9% (7/77) vs. 6% (43/719), N0: 44.5% (28/63) vs 53% (338/641), >N0: 55.5% (35/63) vs 47% (303/641). We could observe a slight better long term overall survival in patients treated with anti-hormonal therapy and FGFR1 amplified breast cancers (p=0.085). Conclusions: FGFR1 amplification is prevalent (8.9%) in breast cancer, especially among the most frequent subtypes such as estrogen receptor positive breast cancers (10%) and ductal type (8%). Further, FGFR1 amplified breast cancer showed often unfavorable/aggressive features such as a high tumor grade (45.5%), larger tumor diameter, and metastasis (55.5%). These patients are a clinically relevant group since they need aggressive adjuvant treatment regimen. The detection of FGFR1 amplification could help in the identification of some patients already at higher risk which might benefit from a new therapeutic option with FGFR1 inhibitors.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4574. doi:1538-7445.AM2012-4574

Deletion of μ- and κ-Opioid Receptors in Mice Changes Epidermal Hypertrophy, Density of Peripheral Nerve Endings, and Itch Behavior

The mu- (MOR) and kappa- (KOR) opioid receptors have been implicated in the regulation of homeostasis of non-neuronal cells, such as keratinocytes, and sensations like pain and chronic pruritus. Therefore, we have studied the phenotype of skin after deletion of MOR and KOR. In addition, we applied a dry skin model in these knockout mice and compared the different mice before and after induction of the dermatitis in terms of epidermal thickness, epidermal peripheral nerve ending distribution, dermal inflammatory infiltrate (mast cells, CD4 positive lymphocytes), and scratching behavior. MOR knockout mice reveal as phenotype a significantly thinner epidermis and a higher density of epidermal fiber staining by protein gene product 9.5 than the wild-type counterparts. Epidermal hypertrophy, induced by the dry skin dermatitis, was significantly less developed in MOR knockout than in wild-type mice. Neither mast cells nor CD4 T(h)-lymphocytes are involved in the changes of epidermal nerve endings and epidermal homeostasis. Finally, behavior experiments revealed that MOR and KOR knockout mice scratch less after induction of dry skin dermatitis than wild-type mice. These results indicate that MOR and KOR are important in skin homeostasis, epidermal nerve fiber regulation, and pathophysiology of itching.