Primary Cutaneous CD4+ Small/Medium T-Cell Lymphoproliferative Disorders (SMPLPD), demographical, clinical, therapeutic and prognostic aspects: a retrospective monocentric analysis

Primary Cutaneous CD4+ Small/Medium T-Cell Lymphoproliferative Disorders (SMPLPD), also known as PCS-TCLPD, represent a rare group of hematologic diseases primarily affecting the skin. In this retrospective single-centre case series study, we aimed to investigate the demographic, clinical, therapeutic, and prognostic aspects of SMPLPD. We collected data from cases diagnosed between 2010 and the present, employing histopathological and immunohistochemical methods following WHO criteria. We included 22 patients with a median age of 61.50 years and median time between clinical onset and diagnosis of 3.00 months. Surgical excision with conservative margins was the primary choice, showing clinical remission in 17 cases, while non-surgical treatments, including radiotherapy, high-potency steroid treatment and ablative laser, achieved clinical remission in four cases. Clinical presentations varied, but the most common one was a single violaceous nodule/papule on upper body parts. In conclusion, our single-centre case series provides valuable insights into SMPLPD, highlighting the effectiveness of surgical treatments and the potential of non-surgical ones. Even if controversial, the benign nature of SMPLPD emphasizes the importance of achieving tumour clearance with acceptable aesthetic outcomes.

Nodular basal cell carcinoma on an autologous split-thickness skin graft after melanoma surgery

Not available

Reflectance Confocal Microscopy Combined with Dermoscopy and Histology in the Diagnostic Setting of Pigmented Eccrine Poroma: A Retrospective Study

INTRODUCTION

Pigmented eccrine poroma (PEP) is a unique variant of a benign adnexal tumor known as eccrine poroma. Distinguishing PEPs from other pigmented lesions can be challenging due to overlapping clinical and dermoscopic features.

OBJECTIVES

To provide a comprehensive analysis of the dermoscopic, confocal (RCM), and histological features of PEPs.

METHODS

We undertook a retrospective study of the clinical, dermoscopic, RCM and histopathological features of PEPs that were surgically excised and histopathologically recognized. Data on epidemiological, clinical, dermoscopic, RCM and histopathological features were collected from the databases of the Skin Cancer Unit, IRCCS Policlinico di Sant' Orsola, between January 2021 and May 2023.

RESULTS

The study population consisted of 61 patients, including 34 females (55.7%) and 27 males (44.3%). Dermoscopic examination of 61 PEPs revealed the presence of irregular borders (55.7%), milia-like cysts (50.8%), brown pseudo-network (41%), cerebriform pattern (34.4%), comedo-like openings (29.5%), atypical vessels (26.2%), glomerular vessels (18%), fingerprint-like perifollicular structures (8.2%), dots (4.9%) and dotted vessels (4.9%). RCM imaging was collected from 11 cases and showed mostly well-defined tumor nests with small cells in 100% of cases, bright structures in the upper dermis representing melanocytes and melanophages (63.6%), dark round spaces within the tumor nests (54.5%), well-demarcated borders of the nest (45.5%) and dilated and prominent vessels in upper dermis (27.3%). Histopathological pattern analysis revealed PEP sensu stricto (PEPss) as the most frequent (54.1%).

CONCLUSIONS

The distinctive dermoscopic patterns, along with the confocal features aid in the differentiation from other pigmented lesions.

Nb-UVB and PUVA therapy in treating early stages of Mycosis Fungoides: A single-center cross-sectional study

INTRODUCTION

Mycosis fungoides (MF) and Sezary Syndrome are the most common forms of cutaneous T-cell lymphoma. Early-stage MF is known to have an indolent behavior, and the EORTC guidelines recommend treating patients with skin-directed therapies, such as phototherapy, instead of systemic therapies. Phototherapy is a popular therapeutic option, with two commonly used light sources-PUVA and narrow band-nb UVB. PUVA is less commonly used due to its potential carcinogenic role, but it has systemic effects, while nb-UVB has mostly skin-limited effects. There is ongoing debate regarding the role of UVB light, and in 2021, the Cutaneous Lymphoma Italian Study Group reached a consensus on technical schedules for NB-UVB and PUVA for MF. This study aims to analyze and compare the efficacy of the two phototherapy options in treating early-MF patients.

MATERIALS AND METHODS

The study included patients diagnosed with stage IA/B MF in the last 10 years, who had at least 12 months of follow-up data and a minimum of 24 phototherapy sessions (PUVA or nb UVB) and treated with topical steroids apart from phototherapy.

RESULTS

Results showed that the two phototherapy options were similarly effective in treating early MF, with no significant differences in clinical response, although PUVA was associated with more adverse effects.

CONCLUSIONS

The study provides valuable insights into the use of phototherapy in early MF, and the results can be used to guide treatment decisions and improve patient outcomes.

Postsurgical hypertrophic scars after nonmelanoma skin cancer surgical excision: clinical and confocal microscopy outcomes of topical 5-fluorouracil in an adjuvant setting

Postsurgical hypertrophic scars management after skin cancer surgical excision can be challenging. In this work we evaluated clinically and with confocal microscopy the outcomes after using topical fluorouracil in an adjuvant setting.

BRAF V600K vs. BRAF V600E: a comparison of clinical and dermoscopic characteristics and response to immunotherapies and targeted therapies

BACKGROUND

A number of mutations related to malignant melanoma (MM) have been identified, and of the mutated genes, BRAF has been found to be altered in > 50% of cases. Most of these have been BRAF V600E mutations, whereas the incidence of BRAF V600K may vary from 10% to 30%. Little is known about the clinical prognostic correlations of BRAF V600K MMs. We evaluated the clinical and dermoscopic features, incidence, therapy response and outcomes in the medium to long term.

AIM

To compare the clinical and dermoscopic characteristics, the response to systemic therapies and the prognosis among MMs with BRAF V600E and BRAF V600K mutations.

METHODS

We retrieved the data of patients tested in our centre for MM from 2012 to 2015, including clinical features, dermoscopic pictures, clinical history and tumour mutations. Only patients with BRAF V600E and BRAF V600K mutations were included. Any MMs positive for BRAF V600K mutation were collected, and the number of V600K cases and their features were used to extract the same number of patients with BRAF V600E from our database using a matching method. The clinical and dermoscopic presentation, therapy response and disease progression of the two groups were then evaluated.

RESULTS

In total, 132 cases of BRAF V600E-mutated MMs were identified, and then randomized with a propensity-score method to match the 10 retrieved cases of BRAF V600K mutation. Both groups had a nodular appearance to the tumours and an advanced disease stage, and no significant differences in dermoscopic features were highlighted. During the follow-up period, four patients with BRAF V600K died of disease-specific causes. Moreover, we found a higher frequency of metastasis, a faster disease progression and more rapid mortality in patients with BRAF V600K.

CONCLUSION

Despite the small size of this study, the results show similar clinical and dermoscopic characteristics between V600E and V600K mutations, but compared with BRAF V600E MMs, BRAF V600K MMs seem to be less responsive to therapy and have a worse prognosis.

Oral Manifestations in Melanoma Patients Treated with Target or Immunomodulatory Therapies

BACKGROUND

BRAF (v-raf murine sarcoma viral oncogene homolog B1) and MEK (mitogen activated protein kinase) inhibitors, as well as immunotherapy against cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) and the programmed cell death 1 (PD-1) receptor and its ligand (PD-L1), have shown good results in improving the disease-free survival of patients with metastatic melanoma (MM). The aim of this review is to summarize the main oral adverse events (oAEs) occurring in patients undergoing target or immunotherapy. We proposed two separate sections: oAEs during the treatment with (1) target therapies with BRAF and MEK inhibitors and tyrosine kinase inhibitors (gingival hyperplasia, pigmentation disorders, squamo-proliferative lesions) and (2) immunotherapies with CTLA-4 or PD1 inhibitors (lichenoid reactions, immuno-bullous reactions, xerostomia and other reactions). Adverse events frequently include oAEs, although these are often misdiagnosed and under-reported. Indeed, the oral cavity is not routinely evaluated during clinical practice. The symptomatology related to oAEs is significant since it may represent the first manifestation of a severe systemic reaction, possibly leading to difficulties in nutrition with a consequent impact on patients' quality of life. A careful examination of the oral cavity is recommended during the evaluation of oncologic patients in order to promptly detect the onset of new manifestations.

Cutaneous and Mucosal Melanomas of Uncommon Sites: Where Do We Stand Now?

Melanomas arising at uncommon sites include a group of lesions related to unusual localizations in specific ethnic groups. The rarity of the disease often represents a limit to the participation of patients in specific trials. However, this peculiar genetic scenario has important therapeutic implications regarding new oncologic therapies. The aim of this article is to review the clinical features, somatic alterations and therapeutic options for melanomas of uncommon sites. They can be classified as cutaneous and mucosal lesions affecting the nail apparatus, palms/soles, oral mucosa, genital area and scalp. The prognosis may be worse compared to melanomas of other districts, and a prompt diagnosis may dramatically influence the outcome. Dermatologists and oncologists should therefore distinguish this melanoma subgroup in terms of surgical intervention and medical treatment. Due to the lack of mutations in genes usually found in cutaneous melanomas, the discovery of novel targets is required to develop new strategies and to change the prognosis of non-responders or wild-type patients.

The role of topical imiquimod in melanoma cutaneous metastases: A critical review of the literature

Despite of the emerging new systemic and local oncologic treatments (immunotherapy and checkpoint inhibitors, oncolytic viral treatments and injected immunostimulants) the management of skin melanoma metastasis can be still challenging. The main aim of this review was to assess the efficacy and the role of imiquimod in local metastatic melanoma disease. An extensive literature review was performed from September 2000 to March 2020 using PubMed, MEDLINE, Embase, and Cochrane Library databases. Selected articles regarded topical imiquimod, its mode of action as an antitumoral agent and its applications in melanoma metastases treatment. We analyzed a total of 18 published article of clinical cases and small case series and five studies: two retrospective large case series, two Phase I and II clinical trials and one cohort non randomized study. Generally, the treatment is safe and well tolerated. Imiquimod lead to an unstable locoregional control. The use of topical imiquimod for the treatment of MM cutaneous metastases should be considered in selected cases and in palliative settings.

It's time for Mohs: Micrographic surgery for the treatment of high-risk basal cell carcinomas of the head and neck regions

Basal cell carcinoma (BCC) is the most common variety of non-melanoma skin cancer and its incidence is increasing worldwide. The centrofacial sites (area H) are considered a high-risk factor for BCC local recurrence. Mohs micrographic surgery (MMS) is a technique that allows intraoperative microscopic control of the surgical margins and is a good treatment option when tissue conservation is required for esthetic or functional reasons or for high-risk lesions. The present study aimed to evaluate the recurrence rate of head and neck high-risk BCCs comparing MMS vs conventional surgical excision. Clinical data of patients diagnosed from September 2014 to March 2017, referring to the Dermatology Unit of the Policlinico Sant'Orsola-Malpighi, University of Bologna, were retrospectively evaluated (285 treated with MMS and 378 treated with traditional surgery). Of the 285 patients treated with MMS, 9 experienced a recurrence (3.1%). Of the 378 patients treated with traditional surgery, 53 relapsed (14%), 13 of whom presented residual tumor on the deep or lateral margins of the main surgical specimen. Our study confirms the trend reported in the literature that MMS represents the best treatment option for high-risk BCCs arising in the head and neck region or presenting as a recurrence (P < .00001). Many more MMS centers and more trained dermatologists are needed worldwide in order to deal with the increasing number of BCC diagnosed every year.

149 Preliminary Results of the Oxytocin Treatment on the Collection of Cat Semen by Urethral Catheterization After Pharmacological Induction

Urethral catheterization after pharmacological induction (Ur.Ca.P.I.) has been developed as a method to collect semen from cats (Zambelli et al. 2008 Theriogenology 69, 485-490). This procedure is based on contraction of the vas deferens induced by the α-agonist medetomidine and the subsequent release of sperm into the urethra. To ensure adequate sedation, the medetomidine dosage is 130 µg kg−1. Usually, a single collection of semen is done by catheterization immediately after medetomidine takes effect. A 3.5 French (Fr) gauge urinary tom cat catheter with the tip cut is inserted 90 mm deep into the urethra. Even in the absence of clinical signs, the cut catheter tip may cause minor trauma to the urethral mucosa. Aims of this study were to test a new catheter and evaluate effects of oxytocin administration on quality and quantity of semen collected. The study was performed on 8 client-owned, pubertal domestic cats, 10 to 18 months old. These cats were randomly allocated into 2 groups: control and treatment, with 3 and 5 cats, respectively. In each group, 2 semen collections were performed. The catheter had a diameter of 4 Fr and a rounded tip without mandrel and it was inserted 90 mm deep. In both groups, the first collection was performed as effects of medetomidine were apparent. In the control group, the second collection was done 10 min later. However, in the treated group, 5 IU of oxytocin was injected intramuscularly immediately after semen collection, with the second collection performed 10 min later. Semen was evaluated for volume, concentration, rate of progressive motility, curvilinear speed (VCL), morphology, and vitality. Comparisons between collections and between groups were done with a Student’s t-test. Comparing the second versus first collection in the control group, there was only an increase in volume (9.33 v. 2.67 µL; P < 0.05). In contrast, in the oxytocin group, all parameters evaluated were better (P < 0.05) for the second collection. As expected, the first collection was not different between the 2 groups for any parameter. However, for the second collection, there were differences (P < 0.05) between the oxytocin and the control group for volume (12.6 v. 3.7 µL), concentration (1252.6 v. 858 × 106 sperm mL−1), progressive motility (90.2 v. 77.8%), VCL (137.71 v. 117.94 µm s−1), morphologically normal sperm (87.0 v. 81.4%), and vitality (86.4 v. 82.8%). Oxytocin may be involved in mobilization of sperm from the epididymis. We concluded that oxytocin improved recovery of sperm from epididymal reserves, resulting in sperm with better morphology and function than those present in the vas deferens.

Retinal processing and opponent mechanisms mediating ultraviolet polarization sensitivity in rainbow trout (Oncorhynchus mykiss)

A number of teleost fishes have photoreceptor mechanisms to detect linearly polarized light. We studied the neuronal mechanism underlying this ability. It was found that a polarized signal could be detected in rainbow trout (Oncorhynchus mykiss) both in the electroretinogram (ERG) and in the compound action potential (CAP) measured in the optic nerve, indicating a strong retinal contribution to the processing of polarized light. The CAP recordings showed a W-shaped sensitivity curve, with a peak at 0 degrees , 90 degrees and 180 degrees , consistent with processes for both vertical and horizontal orientation. By contrast, the ERG recordings reveal a more complex pattern. In addition to the peaks at 0 degrees , 90 degrees and 180 degrees , two additional peaks appeared at 45 degrees and 135 degrees . This result suggests a specialized contribution of the outer retina in the processing of polarized light. The spectral sensitivity of the mechanisms responsible for these intermediate peaks was studied using chromatic adaptation. Here we show that long wavelength-sensitive (LWS) cone mechanism adaptation shifted the intermediate peaks towards 90 degrees , whereas ultraviolet-sensitive (UVS) cone mechanism adaptation shifted the peaks away from 90 degrees towards either 0 degrees or 180 degrees . These results provide further confirmation that the 90 degrees peak is dominated by the LWS cone mechanism and the 0 degrees and 180 degrees peaks are dominated by the UVS cone mechanism. In addition, a pharmacological approach was used to examine the retinal neural mechanisms underlying polarization sensitivity. The effect of blocking negative feedback from horizontal cells to cones on the ERG was studied by making intraocular injections of low doses of cobalt, known to block this feedback pathway. It was found that the intermediate peaks seen in the ERG polarization sensitivity curves were eliminated after application of cobalt, suggesting that these peaks are due to outer retinal inhibition derived from feedback of horizontal cells onto cones. A simple computational model was developed to evaluate these results. The model consists of opponent and non-opponent processing elements for the two polarization detectors. This model provides a first approximation analysis suggesting that opponent processing occurs in the outer retina for polarization vision. Although it seems that polarization vision uses a slightly more complicated coding scheme than colour vision, the results presented in this paper suggest that opponent and non-opponent channels process polarization information.

Behavioural discrimination of polarized light in the damselfish Chromis viridis (family Pomacentridae)

In this study, we demonstrate the capacity for damselfish (green chromis, Chromis viridis) to discriminate between different e-vector orientations of ultraviolet polarized light. We examined the ability of green chromis to resolve small differences in e-vector orientation of ultraviolet polarized light. Fish were successfully trained to swim towards an e-vector orientation of polarized light using a behavioural chamber. C. viridis was able to discriminate between the horizontal and the vertical plane of ultraviolet polarized light independent of brightness content of the stimuli. However, e-vector discrimination capability disappeared when the ultraviolet portion of the light stimuli was removed, indicating that the presence of ultraviolet light was critical for e-vector discrimination. Fish could also distinguish between relatively small e-vector orientations of ultraviolet polarized light. Functional implications for high e-vector discriminative capabilities could be used in functional domains such as feeding and communication.

Visual cues eliciting the feeding reaction of a planktivorous fish swimming in a current

The visual plankivorous feeding behaviour of the shiner perch(Cymatogaster aggregata) was investigated by means of a flow tank operated at various current speeds. Artemia salina was used as prey. In a second set of experiments, Artemia was darkened with black ink,to compare the visually mediated behaviour of C. aggregata while feeding on dark prey vs feeding on natural (i.e. semi-transparent)prey. The positions of the fish and its prey at the time of the feeding reaction of C. aggregata were measured in three dimensions. Prey were on average closer and more in line with the fish's axis when feeding reactions to darkened Artemia were considered, in comparison with natural Artemia. Three potential mechanisms triggering the feeding reaction of C. aggregata were explored: the prey may trigger a reaction in C. aggregata when it reaches a threshold (1) angular size, (2)angular velocity, or (3) rate of change of the angular size (i.e. loom) of the prey as it is carried passively by the current towards the fish. Our results show that angular velocity may trigger the fish's reaction when using semi-transparent prey, while loom may trigger the reaction to darkened prey. This suggests that feeding behaviour of planktivorous fish is flexible and can use different cues to trigger a motor reaction to prey with different visual characteristics. The feeding reaction appeared to occur at longer distances for semi-transparent rather than darkened Artemia. We suggest that semi-transparent Artemia were visible at greater distances because of their higher scattering (i.e. diffuse reflectance) that made them appear brighter when viewed against a dark background.

Amyloid precursor protein in platelets: a peripheral marker for the diagnosis of sporadic AD

BACKGROUND

An altered pattern of amyloid precursor protein (APP) forms consisting in a reduced ratio between the upper (130 kDa) and the lower (106 to 110 kDa) immunoreactivity bands has been described in platelets of patients with AD.

OBJECTIVE

To evaluate the sensitivity and the specificity of platelet APP forms' ratio (APPr) as a marker for AD.

METHODS

Eighty-five patients with probable AD and 95 control subjects (CON), including healthy individuals and neurologic patients, entered the study. Platelet APPr was evaluated by means of Western Blot analysis and immunostaining in the whole platelet homogenate, and calculated by the ratio between the optical density (OD) of the upper (130 kDa) and the lower (106 to 110 kDa) APP immunoreactive bands.

RESULTS

Mean APPr levels were decreased in AD patients (mean OD +/- SD = 0.35 +/- 0.18) compared with the CON group (mean OD +/- SD = 0.92 +/- 0.38) (DF 1, 178, p < 0.0001). Accuracy levels measured by Receiver Operating Curve analysis showed that a cut-off level of 0.57 resulted in a sensitivity of 88.2% and a specificity of 89.4%, with an area under the curve of 0.945. APPr levels were significantly associated with disease severity (mild AD versus moderate AD: p < 0.0001; moderate AD versus severe AD: p < 0.05).

CONCLUSION

Platelet APPr allowed to differentiate AD from normal aging and other dementing disorders with high sensitivity and specificity. These findings suggest that platelet APPr may be of help as an adjunctive diagnostic tool in clinical practice.

A case of chondrodystrophic dwarfism in the Italian late Upper Paleolithic

During excavations by P. Graziosi at Romito Cave near Papasidero (Cosenza) in Calabria, Italy, two skeletons (Romito 1 and 2) were discovered in a common grave. Although the specimens were briefly described by Messeri (Atti X Riuniuone Scientifica Ist. Ital. Preist. Protost., pp. 301-307, 1966), it is generally unknown in the anthropological literature that one of these individuals is a chondrodystrophic dwarf. As such, the specimen provides the earliest known case of dwarfism in the human skeletal record, extending the time span of this genetically determined growth abnormality to approximately 10,000 years ago. The specimen (Romito 2) exhibits features typical of chondrodysplasia, including a high domed skull, compressed cranial base, and in the postcranial skeleton extremely shortened diaphyseal lengths. The unique combination of these features suggests this pathological condition is acromesomelic dysplasia. Besides providing evidence for a greater antiquity of dwarfism than previously known, the fact that this individual reached late adolescence attests to tolerance of Upper Paleolithic groups for severely abnormal individuals and their ability to support members who were of limited economic value to the social group.

Dwarfism in an adolescent from the Italian late Upper Palaeolithic

There have been numerous reports of pathological conditions in the hominid fossils, but these have only involved trauma or age-related deterioration in the health of otherwise normal individuals. Here we describe a skeleton of a young male from Riparo del Romito in Calabria, dated to the Epi-Gravettian of southern Italy. The preserved skeletal elements show that this individual (Romito 2) had the skull and long-bone morphology consistent with a mesomelic form of dwarfism, most probably the autosomal recessive disorder acromesomelic dysplasia. Generally recognized at birth, persons with acromesomelic dysplasia usually have normal intelligence and are free of serious medical problems. However, growth deficiency is severe (adult height typically is 110-120 cm) and mobility at the elbows is restricted. These physical impairments would have greatly interfered with the individual's participation in subsistence activities and would have been a substantial handicap in a nomadic hunting and gathering group. Thus, besides being the earliest known case of dwarfism in the human record, this skeleton provides evidence of tolerance of, and care for, a severely deformed individual in the Palaeolithic.