1
|
Toberer F, Winkler JK, Haenssle HA, Heinzel-Gutenbrunner M, Enk A, Hartschuh W, Helmbold P, Kutzner H, Helbig D. Metabolic Signature of Atypical Fibroxanthoma and Pleomorphic Dermal Sarcoma: Expression of Hypoxia-inducible Factor-1α and Several of Its Downstream Targets. Acta Dermatovenerol Croat 2022; 30:25-31. [PMID: 36153716] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Metabolic reprogramming mediated by hypoxia-inducible factors play a crucial role in many human cancers. HIF-1α is activated under hypoxic conditions and is considered a key regulator of oxygen homoeostasis during tumor proliferation under hypoxia. Aim of this research was to analyze the immunohistochemical expression of HIF-1α, VEGF-A, Glut-1, MCT4, and CAIX in atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS). 21 paraffin-embedded AFX and 22 PDS were analysed by immunohistochemistry, namely HIF-1α, VEGF-A (referred to as VEGF throughout the manuscript), Glut-1, MCT4, and CAIX. To quantify the protein expression, we considered the percentage of positive tumor cells (0: 0%, 1: up to 1%, 2: 2-10%, 3: 11-50%, 4: >50%) in relation to the staining intensity (0: negative, 1: low, 2: medium, 3: strong). HIF-1α expression (mean ± SD) in AFX (9.33±2.92) was significantly stronger than that in PDS (5.90±4.38; P= 0.007), whereas the expression of VEGF, Glut-1, MCT4, and CAIX did not show differences between AFX and PDS. When comparing all tumors without subgroup stratification, the expression of HIF-1α (P= 0.044) and MCT4 (P= 0.036) was significantly stronger in ulcerated tumors than in tumors without ulceration. Our findings provide the first evidence that HIF-1α-induced metabolic reprogramming may contribute to the pathogenesis of AFX and PDS. HIF-1α expression seems to be higher in AFX than in PDS, and ulcerated tumors show higher expression levels of HIF-1α and MCT4 irrespective of the diagnosis.
Collapse
Affiliation(s)
- Ferdinand Toberer
- Ferdinand Toberer, MD, Department of Dermatology, Venerology and Allergology, University Medical Center, Ruprecht-Karls-University Im Neuenheimer Feld 440, 69120 Heidelberg, Germany;
| | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Toberer F, Winkler JK, Haenssle HA, Heinzel-Gutenbrunner M, Enk A, Hartschuh W, Helmbold P, Kutzner H. [Immunohistochemical analysis of a hypoxia-associated signature in melanomas with positive and negative sentinel lymph nodes : Hypoxia-associated signature of primary cutaneous melanomas]. Hautarzt 2022; 73:283-290. [PMID: 34997269 PMCID: PMC8964660 DOI: 10.1007/s00105-021-04934-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 12/01/2022]
Abstract
Metabolic reprogramming mediated by hypoxia-inducible factors and its downstream targets plays a crucial role in many human malignancies. Excessive proliferation of tumor cells under hypoxic conditions leads to metabolic reprogramming and altered gene expression enabling tumors to adapt to their hypoxic environment. Here we analyzed the metabolic signatures of primary cutaneous melanomas with positive and negative sentinel node status in order to evaluate potential differences in their metabolic signature. We found a positive correlation of the expression of glucose transporter 1 (GLUT-1) with tumor thickness and ulceration in all melanomas with subgroup analyses as well as in the subgroup with a negative sentinel node. Furthermore, the expression of vascular endothelial growth factor (VEGF) was positively correlated with the presence of ulceration in melanomas with positive sentinel node.
Collapse
Affiliation(s)
- Ferdinand Toberer
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland.
| | - Julia K Winkler
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - Holger A Haenssle
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | | | - Alexander Enk
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - Wolfgang Hartschuh
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - Peter Helmbold
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - Heinz Kutzner
- Dermatopathologie Bodensee, Friedrichshafen, Deutschland
| |
Collapse
|
3
|
Toberer F, Haenssle HA, Laimer M, Heinzel-Gutenbrunner M, Enk A, Hartschuh W, Helmbold P, Kutzner H. Vascular Endothelial Growth Factor Receptor-3 Expression Predicts Sentinel Node Status in Primary Cutaneous Melanoma. Acta Derm Venereol 2020; 100:adv00235. [PMID: 32618346 PMCID: PMC9207649 DOI: 10.2340/00015555-3588] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This study analysed the expression of vascular endothelial growth factor-A (VEGF), VEGFR-2, and VEGFR-3 in primary cutaneous melanomas with positive and negative sentinel node status (SLN) (a total of 58 specimens divided into 2 groups of 29 for each status). The specimens were collected from the pathological archive of the department of Dermatology, Venereology and Allergology of the University Medical Center Heidelberg. A quantification score was developed for protein expression, by considering the percentage of positive melanoma cells (0: 0%, 1: up to 1%, 2: 2–10%, 3: 11–50%, and 4: > 50%) in relation to the intensity of staining (0: negative, 1: low, 2: medium, 3: strong). Tumoural VEGFR-3 expression (mean ± standard deviation) in SLN+ tumours (9.62 ± 3.09) was significantly stronger than in SLN– tumours (6.13 ± 3.87; p < 0.001). A binary logistic regression model proved VEGFR-3 expression and tumour thickness to be significant independent predictors of SLN. These data provide evidence that VEGFR-3 expression may play a critical role in the pathogenesis of malignant melanoma and that its investigation may help to improve the selection of patients with primary cutaneous melanoma for sentinel node biopsy.
Collapse
Affiliation(s)
- Ferdinand Toberer
- Department of Dermatology, University Medical Center, Ruprecht-Karls-University Heidelberg, DE-69120 Heidelberg, Germany. E-mail:
| | | | | | | | | | | | | | | |
Collapse
|
4
|
Toberer F, Haenssle HA, Heinzel-Gutenbrunner M, Enk A, Hartschuh W, Helmbold P, Kutzner H. Metabolic reprogramming and angiogenesis in primary cutaneous Merkel cell carcinoma: expression of hypoxia-inducible factor-1α and its central downstream factors. J Eur Acad Dermatol Venereol 2020; 35:88-94. [PMID: 32396987 DOI: 10.1111/jdv.16600] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/15/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Metabolic reprogramming and altered gene expression mediated by hypoxia-inducible factors play crucial roles during tumour growth and progression. Nevertheless, studies analysing the expression of hypoxia-inducible factor-1α and its downstream targets in Merkel cell carcinoma (MCC) are lacking but are warranted to shed more light on MCC pathogenesis and to potentially provide new therapeutic options. OBJECTIVES To analyse the immunohistochemical expression of hypoxia-inducible factor-1α (HIF-1α), vascular endothelial growth factor-A (referred to as VEGF throughout the manuscript), VEGF receptor-2 (VEGFR-2), VEGF receptor-3 (VEGFR-3), glucose transporter-1 (Glut-1), monocarboxylate transporter 4 (MCT4) and carbonic anhydrase IX (CAIX) in primary cutaneous MCC. METHODS The 16 paraffin-embedded primary cutaneous MCCs (Merkel cell polyomavirus (McPyV) positive/negative: 11/5) were analysed by immunohistochemistry, namely HIF-1α, VEGF, VEGFR-2 (KDR), VEGFR-3 (FLT4), Glut-1, MCT4 and CAIX. An established quantification score (QS) was applied to quantitate the protein expression by considering the percentage of positive tumour cells (0: 0%; 1: up to 1%; 2: 2-10%; 3: 11-50%; 4: >50%) in relation to the staining intensity (0: negative; 1: low; 2: medium; 3: strong). RESULTS HIF-1α was expressed in all MCCs and predominantly found at the invading edges of tumour margins. The HIF-1α downstream factors Glut-1, MCT4 and CAIX were expressed in 13 of 16 MCC (81%), 14 of 16 MCC (88%) and 16 of 16 MCC (100%), respectively. Interestingly, VEGF and VEGFR-2 were not expressed in tumour cells, whereas VEGFR-3 was expressed in all MCCs. HIF-1α was expressed significantly stronger in McPyV+ tumours (QS: 10.36 ± 2.41) than in McPyV- tumours (QS: 5.40 ± 1.34; P = 0.002). Similarly, VEGFR-3 was also expressed significantly stronger in McPyV+ tumours (QS: 10.00 ± 2.52) than in McPyV- tumours (QS: 5.40 ± 3.43, P = 0.019). CONCLUSIONS Our data provide first evidence for a role of HIF-1α in induced metabolic reprogramming contributing to MCC pathogenesis. The metabolic signatures of McPyV+ and McPyV- tumours seem to show relevant differences.
Collapse
Affiliation(s)
- F Toberer
- Department of Dermatology, Venerology and Allergology, University Medical Center, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - H A Haenssle
- Department of Dermatology, Venerology and Allergology, University Medical Center, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - A Enk
- Department of Dermatology, Venerology and Allergology, University Medical Center, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - W Hartschuh
- Department of Dermatology, Venerology and Allergology, University Medical Center, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - P Helmbold
- Department of Dermatology, Venerology and Allergology, University Medical Center, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - H Kutzner
- Dermatopathology, Bodensee, Friedrichshafen, Germany
| |
Collapse
|
5
|
Toberer F, Haenssle HA, Rütten A, Kazakov D, Kastnerova L, Enk A, Hartschuh W, Bertlich I, Hartmann J, Laimer M, Weyers W, Helmbold P, Kutzner H. Angiogenesis in Ocular and Extraocular Sebaceous Carcinoma. Acta Derm Venereol 2019; 99:1270-1274. [PMID: 31612234 DOI: 10.2340/00015555-3342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To shed more light on the pathogenesis of sebaceous carcinoma, we analysed the expression of proteins related to angiogenesis in 18 ocular and 22 extraocular sebaceous carcinomas using a broad panel of immunohistochemical markers. To quantify the expression of D2-40, vascular endothelial growth factor, vascular endothelial growth factor receptor-2 and -3, we calculated a quantification score by considering the percentage of positive tumour cells (0=0%, 1=up to 1%, 2=2-10%, 3=11-50%, and 4=>50%) in relation to the staining intensity (0=negative, 1=low, 2=medium, and 3=strong). Additionally, lymphatic microvessel density in the D2-40 stained sections was counted. Vascular endothelial growth factor receptor-3 (quantification score 9.42 ± 2.94) was significantly more strongly expressed than vascular endothelial growth factor receptor-2 (quantification score 2.15 ± 2.42, p < 0.001). Furthermore, epidermal vascular endothelial growth factor expression was negatively correlated with the intratumoural lymphatic vessel density, and the ratio of small lymphatics to large lymphatics was much higher in intratumoural tissue than in paratumoural tissue and in intraindividual control tissue, suggesting a lymphangiogenetic potential of sebaceous carcinoma.
Collapse
Affiliation(s)
- Ferdinand Toberer
- Department of Dermatology, Venereology and Allergology, University Medical Center, Ruprecht-Karls-University, Im Neuenheimer Feld 440, DE-69120 Heidelberg, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Nenoff P, Manos A, Ehrhard I, Krüger C, Paasch U, Helmbold P, Handrick W. [Non-viral sexually transmitted infections - Epidemiology, clinical manifestations, diagnostics and therapy : Part 1: Gonococci]. Hautarzt 2017; 68:43-49. [PMID: 27981386 DOI: 10.1007/s00105-016-3905-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Approximately 1 million people are infected per day worldwide by one or more sexually transmitted infections (STI) as estimated by the World Health Organization (WHO). Gonorrhoea represents an almost exclusively sexually transmitted infection, which predominantly affects mucous membranes of the genitourinary tract. Extragenital localization of infections is also possible, e. g. in the anorectal region. Currently, only syphilis and human immunodeficiency virus (HIV) are notifiable diseases according to the Infection Protection Act in Germany. In Saxony, an extended registration ordinance according to the German Infection Protection Act is in force, which means that besides syphilis the laboratory detection of Neisseria gonorrhoeae, Chlamydia trachomatis and genital mycoplasms are also notifiable infections. In particular, beginning in 2009 in Saxony a spectacular increase of registered infections due to N. gonorrhoeae was observed and in 2015 altogether 824 infections due to N. gonorrhoeae were reported. Alarming is the increase in resistance of N. gonorrhoeae against penicillin, doxycycline, ciprofloxacin and recently also against azithromycin and third generation cephalosporins. The so-called superbug of N. gonorrhoeae, which originated in Japan with multidrug resistance against most of the currently available oral antibiotics, has now arrived in Europe. Intramuscular or intravenous injection of ceftriaxone plus oral azithromycin, each given as single dose is the standard therapy for gonorrhoea.
Collapse
Affiliation(s)
- P Nenoff
- Labor für medizinische Mikrobiologie, Partnerschaft Prof. Dr. med. Pietro Nenoff & Dr. med. Constanze Krüger, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland.
| | - A Manos
- Beratungsstelle für sexuell übertragbare Krankheiten und AIDS, Gesundheitsamt Leipzig, Leipzig, Deutschland
| | - I Ehrhard
- Abt. Medizinische Mikrobiologie und Hygiene, Landesuntersuchungsanstalt für das Gesundheits- und Veterinärwesen Sachsen, Dresden, Deutschland
| | - C Krüger
- Labor für medizinische Mikrobiologie, Partnerschaft Prof. Dr. med. Pietro Nenoff & Dr. med. Constanze Krüger, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland
| | - U Paasch
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universität Leipzig, Leipzig, Deutschland
| | - P Helmbold
- Hautklinik des Klinikums der Universität Heidelberg, Heidelberg, Deutschland
| | - W Handrick
- Institut für Medizinische Diagnostik Oderland, Frankfurt (Oder), Deutschland
| |
Collapse
|
7
|
Avallone G, Helmbold P, Caniatti M, Stefanello D, Nayak RC, Roccabianca P. The Spectrum of Canine Cutaneous Perivascular Wall Tumors: Morphologic, Phenotypic and Clinical Characterization. Vet Pathol 2016; 44:607-20. [PMID: 17846233 DOI: 10.1354/vp.44-5-607] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [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: 01/23/2023]
Abstract
Perivascular wall tumors (PWTs) are defined as neoplasms deriving from mural cells of blood vessels, excluding the endothelial lining. The spectrum of human cutaneous PWT includes glomus tumor, hemangiopericytoma (HEP), myopericytoma, angioleiomyoma/sarcoma, angiomyofibroblastoma, and angiofibroma. The purpose of this study was to revise clinical presentation, cytology, histopathology, and immunohistology of canine cutaneous PWT with cytology typical of canine HEP. Diagnosis was established on the basis of vascular growth patterns (staghorn, placentoid, perivascular whorling, bundles from media) and immunohistology, including 7 smooth muscle markers and the cell membrane ganglioside of unknown origin recognized by the antibody 3G5 (CMG-3G5). Twenty cases were included. Ages ranged from 6 to 13 years; 12 dogs were males and 8 were females, and there was a prevalence of crossbreeds. Tumors arose from a single site with preferential acral location (10/20). Cytology revealed moderate to high cellularity in all cases, cohesive groups of cells (19/20), capillaries (18/20), and bi- to multinucleated cells (18/20). Six myopericytomas, 5 angioleiomyomas, 2 angioleiomyosarcomas, 2 HEP, 1 angiofibroma, and 1 adventitial tumor were identified. A definitive diagnosis was not possible in 3 cases. Smoothelin, heavy caldesmon, desmin, myosin, calponin, and CMG-3G5 were the most valuable markers to differentially diagnose canine PWT. Similar to reports in humans, canine HEP embodied a spectrum of neoplastic entities arising from different vascular mural cells. Before canine PWTs are assimilated into one prognostic category, a consistent classification and characterization of their biology is necessary. As proposed in humans, HEP should also be considered a diagnosis of exclusion in dogs.
Collapse
Affiliation(s)
- G Avallone
- DiPAV--Sezione Anatomia Patologica Veterinaria e Patologia Aviare, Facolta' di Medicina Veterinaria, Via Celoria 10, 20133 Milano, Italy
| | | | | | | | | | | |
Collapse
|
8
|
Abstract
Merkel cell carcinoma (cutaneous neuroendocrine carcinoma) is an uncommon, highly malignant, neuroendocrine skin tumour. Typically, the primary is a fast-growing tough dermal nodule that is characterized histologically by uniform round cells with a small cytoplasmic rim. The tumour cells express the cytokeratins 8, 18, 19, 20, neurofilament, synaptophysin, chromogranin, and neuron-specific enolase. A high frequency of local recurrences (25-77%) and lymph-node metastases (50%) are characteristic features of Merkel cell carcinoma. The 5-year survival rate is 30-74%. Merkel cell carcinomas are highly radiosensitive. Thus, besides surgical methods, radiation should be included into the treatment concept in every stage. We present four cases of Merkel cell carcinoma with different courses for a review-like discussion of this disease giving instructions for rapid diagnosis and effective therapy.
Collapse
Affiliation(s)
- P Helmbold
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie der Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany.
| | | | | | | | | |
Collapse
|
9
|
Ugurel S, Mentzel T, Utikal J, Helmbold P, Mohr P, Pföhler C, Schiller M, Hauschild A, Hein R, Kämpgen E, Kellner I, Leverkus M, Becker JC, Ströbel P, Schadendorf D. Neoadjuvant imatinib in advanced primary or locally recurrent dermatofibrosarcoma protuberans: a multicenter phase II DeCOG trial with long-term follow-up. Clin Cancer Res 2014; 20:499-510. [PMID: 24173542 DOI: 10.1158/1078-0432.ccr-13-1411] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [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: 11/16/2022]
Abstract
PURPOSE Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous tumor. COL1A1-PDGFB gene fusion is frequent in DFSP, rendering tumor cell proliferation and survival dependent on PDGFRβ (platelet-derived growth factor receptor β) signaling. This trial investigated imatinib as neoadjuvant treatment of DFSP, including long-term follow-up. EXPERIMENTAL DESIGN The primary endpoint of this multicenter phase II trial was response; secondary endpoints were safety, tumor relapse, and response biomarkers. Patients with advanced primary or locally recurrent DFSP and measurable disease by RECIST (response evaluation criteria in solid tumors) were eligible and received imatinib 600 mg/d until definitive surgery with histopathologic proof of tumor-free margins. RESULTS Sixteen patients received imatinib, and 14 patients were evaluable for all endpoints. Median treatment duration was 3.1 months; median tumor shrinkage was 31.5%. Best overall response was 7.1% complete response (CR), 50.0% partial response (PR), 35.7% stable disease, and 7.1% progressive disease (PD). Toxicity was moderate with 25.0% grade 3 and 4 events. During a median follow-up of 6.4 years, one patient developed secondary resistance to imatinib but responded to second-line sunitinib. This patient also presented local recurrence, distant metastasis, and death from DFSP. Exploratory analysis showed that response to imatinib was associated with decreased tumor cellularity and formation of strong hyalinic fibrosis. Weak PDGFRB phosphorylation and pigmented-type DFSP were associated with nonresponse. Additional to PDGFRB, the kinases EGFR and insulin receptor were found activated in a high percentage of DFSPs. CONCLUSION The neoadjuvant use of imatinib 600 mg/d in DFSP is efficacious and well tolerated. Long-term follow-up results do not definitely support smaller surgical margins after successful imatinib pretreatment, and presume that secondary resistance to imatinib might promote accelerated disease progression.
Collapse
Affiliation(s)
- Selma Ugurel
- Authors' Affiliations: Department of Dermatology, University of Würzburg, Würzburg; Dermatopathology Bodensee, Friedrichshafen; Skin Cancer Unit, German Cancer Research Center, Heidelberg; Department of Dermatology, University Hospital Heidelberg, Heidelberg; Department of Dermatology, University Medical Center Mannheim, University of Heidelberg, Mannheim; Department of Dermatology, Martin Luther University, Halle/Saale; Department of Dermatology, Elbe Klinikum Buxtehude, Buxtehude; Department of Dermatology, Saarland University Hospital, Homburg, Saarland; Department of Dermatology, University Hospital of Münster, Münster; Department of Dermatology, University of Kiel, Kiel; Department of Dermatology, Technical University Munich, Munich; Department of Dermatology, University Hospital Erlangen, Erlangen; Department of Dermatology, Helios Klinikum Erfurt, Erfurt; Department of Pathology, University of Göttingen, Göttingen; Department of Dermatology, University of Essen, Essen, Germany; and Department of Dermatology, Medical University Graz, Graz, Austria
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Affiliation(s)
- Maria R Gaiser
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany.
| | | | | |
Collapse
|
11
|
Toberer F, Werchau S, Christia E, Enk A, Schirmacher P, Helmbold P. Large lymphatic vessel density in primary malignant melanoma predicts sentinel node status. J Am Acad Dermatol 2013; 69:827-828. [PMID: 24124821 DOI: 10.1016/j.jaad.2013.04.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 04/10/2013] [Accepted: 04/16/2013] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - Alexander Enk
- Department of Dermatology, University of Heidelberg, Germany
| | | | - Peter Helmbold
- Department of Dermatology, University of Heidelberg, Germany.
| |
Collapse
|
12
|
Richter AM, Haag T, Walesch S, Herrmann-Trost P, Marsch WC, Kutzner H, Helmbold P, Dammann RH. Aberrant Promoter Hypermethylation of RASSF Family Members in Merkel Cell Carcinoma. Cancers (Basel) 2013; 5:1566-76. [PMID: 24252868 PMCID: PMC3875954 DOI: 10.3390/cancers5041566] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 10/23/2013] [Accepted: 11/08/2013] [Indexed: 12/03/2022] Open
Abstract
Merkel cell carcinoma (MCC) is one of the most aggressive cancers of the skin. RASSFs are a family of tumor suppressors that are frequently inactivated by promoter hypermethylation in various cancers. We studied CpG island promoter hypermethylation in MCC of RASSF2, RASSF5A, RASSF5C and RASSF10 by combined bisulfite restriction analysis (COBRA) in MCC samples and control tissue. We found RASSF2 to be methylated in three out of 43 (7%), RASSF5A in 17 out of 39 (44%, but also 43% in normal tissue), RASSF5C in two out of 26 (8%) and RASSF10 in 19 out of 84 (23%) of the cancer samples. No correlation between the methylation status of the analyzed RASSFs or between RASSF methylation and MCC characteristics (primary versus metastatic, Merkel cell polyoma virus infection, age, sex) was found. Our results show that RASSF2, RASSF5C and RASSF10 are aberrantly hypermethylated in MCC to a varying degree and this might contribute to Merkel cell carcinogenesis.
Collapse
Affiliation(s)
- Antje M. Richter
- Institute for Genetics, University of Giessen, Giessen D-35392, Germany; E-Mails: (A.M.R.); (T.H.); (S.W.)
| | - Tanja Haag
- Institute for Genetics, University of Giessen, Giessen D-35392, Germany; E-Mails: (A.M.R.); (T.H.); (S.W.)
| | - Sara Walesch
- Institute for Genetics, University of Giessen, Giessen D-35392, Germany; E-Mails: (A.M.R.); (T.H.); (S.W.)
| | | | - Wolfgang C. Marsch
- Department of Dermatology, University of Halle, Halle D-06120, Germany; E-Mail:
| | | | - Peter Helmbold
- Department of Dermatology, University of Heidelberg, Heidelberg D-69120, Germany; E-Mail: Peter.
| | - Reinhard H. Dammann
- Institute for Genetics, University of Giessen, Giessen D-35392, Germany; E-Mails: (A.M.R.); (T.H.); (S.W.)
| |
Collapse
|
13
|
Vlahova L, Doerflinger Y, Houben R, Becker JC, Schrama D, Weiss C, Goebeler M, Helmbold P, Goerdt S, Peitsch WK. P-cadherin expression in Merkel cell carcinomas is associated with prolonged recurrence-free survival. Br J Dermatol 2012; 166:1043-52. [PMID: 22283194 DOI: 10.1111/j.1365-2133.2012.10853.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a highly aggressive skin cancer, associated with advanced age, immunosuppression and Merkel cell polyomavirus (MCV) infections. As development and progression of cancer can be promoted by changes in cell adhesion proteins, we have previously analysed homo- and heterotypic cell-cell contacts of normal Merkel cells and MCCs and obtained indications for cadherin switching. OBJECTIVES To examine the prevalence and prognostic relevance of E-, N- and P-cadherin in MCCs. METHODS Paraffin-embedded MCC samples (n = 148) from 106 different patients were analysed by double-label immunostaining and immunofluorescence microscopy. MCV status was determined by real-time polymerase chain reaction. The cadherin repertoire and MCV status were correlated to clinical data, including tumour stage and recurrence-free survival. RESULTS Ninety-one per cent of all MCC were positive for N-cadherin whereas only 61·6% and 70·3% expressed E- and P-cadherin, respectively. P-cadherin was significantly more frequent in primary tumours than in lymph node metastases (81·9% vs. 40·9%, P = 0·0002). Patients with P-cadherin-positive primary tumours were in earlier tumour stages at initial diagnosis (P = 0·0046). Both in log-rank tests (P = 0·0474) and in multiple Cox regression analysis including age, sex, immunosuppression, stage at initial diagnosis and MCV status (hazard ratio 0·193, P = 0·0373), patients with P-cadherin-positive primary MCCs had significantly prolonged recurrence-free survival (mean 25·2 vs. 10·6 months; median 9·0 vs. 4·0 months). MCV DNA was detected in 78·2% of all MCC, more frequently in P-cadherin-positive MCC (P = 0·0008). CONCLUSION P-cadherin expression in MCCs predicts prolonged recurrence-free survival and may therefore indicate favourable prognosis.
Collapse
Affiliation(s)
- L Vlahova
- Department of Dermatology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Abstract
The small bowel harbors metastases of malignant melanoma in 5 % to 72 %, dependent on tumor stage and evidence of intestinal blood loss. Capsule endoscopy is sensitive in detecting small bowel metastasis. Computed tomography, magnetic resonance imaging, and PET-CT demonstrate extraintestinal intraabdominal metastases. Melanoma patients with signs of intestinal blood loss should be endoscopically investigated, including small bowel endoscopy. Selected patients in advanced tumor stage should also undergo small bowel endoscopy to plan a treatment strategy. A resection of intestinal metastases can improve the prognosis, if all metastases are removed.
Collapse
Affiliation(s)
- J G Albert
- Hautklinik, Universitätsklinikum Heidelberg.
| | | |
Collapse
|
15
|
Scholz IM, Hausser I, Behnecke A, Helmbold P. [A family with dystrophic alopecia and keratosis pilaris]. J Dtsch Dermatol Ges 2011; 9:1055-6. [PMID: 22123627 DOI: 10.1111/j.1610-0387.2011.07792.x] [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: 11/28/2022]
Affiliation(s)
- Ina M Scholz
- Universitäts-Hautklinik, Ruprecht-Karls-Universität Heidelberg Institut für Humangenetik, Ruprecht-Karls-Universität Heidelberg.
| | | | | | | |
Collapse
|
16
|
Helmbold P, Richter AM, Walesch S, Skorokhod A, Marsch WC, Enk A, Dammann RH. RASSF10 promoter hypermethylation is frequent in malignant melanoma of the skin but uncommon in nevus cell nevi. J Invest Dermatol 2011; 132:687-94. [PMID: 22113481 DOI: 10.1038/jid.2011.380] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The Ras association domain family (RASSF) consists of several tumor suppressor genes, which are frequently silenced in human cancers. We analyzed the epigenetic inactivation of RASSF2 and RASSF10 in malignant melanoma (MM) of the skin, including 5 MM cell lines, 28 primary MM, 33 metastases of MM, 47 nevus cell nevi (NCN), and 22 control tissues. The RASSF2 promoter was epigenetically downregulated in two MM cell lines only, but not in any of the investigated tumor samples. In contrast, hypermethylation of the RASSF10 promoter was found in all investigated cell lines, 19/28 (68%) of the primary MM and 30/33 (91%) of the MM metastases, 2/18 (11%) of the dysplastic NCN, and 0/29 (0%) of the non-dysplastic NCN (difference between MM and all nevi, P<0.001). RASSF10 promoter hypermethylation correlated with a reduced RASSF10 mRNA expression in 3/4 MM cell lines, and treatment with a DNA methylation inhibitor reactivated RASSF10 transcription. Furthermore, immunohistological RASSF10 expression corresponds negatively to its promoter methylation state. In summary, RASSF10 proved to be a characteristically epigenetically silenced tumor suppressor in melanomagenesis, and analysis of RASSF10 methylation status represents a new candidate tool to assist in discrimination between MM and NCN.
Collapse
Affiliation(s)
- Peter Helmbold
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany.
| | | | | | | | | | | | | |
Collapse
|
17
|
Scheiba N, Andrulis M, Helmbold P. Treatment of shiitake dermatitis by balneo PUVA therapy. J Am Acad Dermatol 2011; 65:453-455. [DOI: 10.1016/j.jaad.2010.03.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Revised: 03/23/2010] [Accepted: 03/28/2010] [Indexed: 10/18/2022]
|
18
|
Albert JG, Fechner M, Fiedler E, Voderholzer W, Lochs H, Trefzer U, Sterry W, Vay S, Stremmel W, Enk A, Marsch WC, Fleig WE, Helmbold P. Algorithm for detection of small-bowel metastasis in malignant melanoma of the skin. Endoscopy 2011; 43:490-8. [PMID: 21618149 DOI: 10.1055/s-0030-1256357] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIM The aim of this study was to develop an algorithm to detect small-bowel metastasis (SBM) of melanoma by sequential laboratory parameters and pan-intestinal endoscopy (PIE) including video capsule endoscopy (VCE). PATIENTS AND METHODS A total of 390 melanoma patients (AJCC stage I/II/III/IV, 140/80/121/49) were screened for signs of intestinal blood loss (fecal occult blood test [FOBT] or overt bleeding) in an open, multicenter, prospective study, and those who were positive underwent PIE. Independent of the presence of intestinal bleeding, all stage IV patients were offered PIE. Follow-up was obtained in 357 patients (91.5 %) for a median of 16 months. We undertook to identify possible associations between SBM and clinical and laboratory data. Survival data were analyzed with regard to clinical and laboratory data and small-bowel findings. RESULTS Intestinal blood loss was suspected in 49 of 390 patients (12.6 %), 38 of whom (77.6 %) agreed to undergo endoscopy. In 10 patients, SBM was detected by VCE (intention-to-diagnose, 20.4 %; AJCC III, n = 2; AJCC IV, n = 8). The SBM was resected in five patients. Total detection rates of SBM were 14 of 49 patients in stage IV (28.6 %, intention-to-diagnose), 2 of 121 in stage III (1.7 %), and 0 in stage I/II. In FOBT-positive patients, SBM detection rates were 72.7 %, 14.3 %, and 0 % in tumor stages IV, III, and I/II, respectively. Positive FOBT proved to be an independent negative prognostic factor for total survival in stage III and IV melanoma. CONCLUSIONS SBMs are frequent in advanced melanoma. In stage III patients, screening for intestinal blood loss by PIE may help to identify SBMs. In stage IV, indication for PIE should depend on the individual consequences of detecting SBM, but not on bleeding symptoms alone.
Collapse
Affiliation(s)
- J G Albert
- Department of Medicine I, Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Scholz IM, Helmbold P. Pachyonychia congenita Typ 2. J Dtsch Dermatol Ges 2011. [DOI: 10.1111/j.1610-0387.2010.07537_suppl.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Streit E, Hartschuh W, Helmbold P. [33-year-old woman with nodules on the nipple]. J Dtsch Dermatol Ges 2010; 8:915-6. [PMID: 21182739 DOI: 10.1111/j.1610-0387.2010.07438.x] [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: 11/30/2022]
|
21
|
Affiliation(s)
- Ina M Scholz
- Department of Dermatology, University of Heidelberg, Germany.
| | | |
Collapse
|
22
|
Abstract
Brooke-Spiegler syndrome is a rare, autosomal dominant disease characterized by multiple skin appendage tumors caused by various mutations in the CYLD gene on chromosome 16q12-q13. We describe a family, in which we performed a molecular-genetic examination and found a new mutation in exon 19 in the CYLD gene leading to a frameshift. It is important to be aware of this syndrome and its pathogenesis as its phenotypic features can vary so that apparently different diseases are caused by the same genetic defect. In addition, there may be malignant transformation of the generally benign tumors, so that a timely diagnosis is essential for appropriate monitoring and therapy.
Collapse
Affiliation(s)
- Ina M Scholz
- Department of Dermatology, University of Heidelberg, Germany.
| | | | | | | | | | | |
Collapse
|
23
|
Helmbold P, Lahtz C, Enk A, Herrmann-Trost P, Marsch WC, Kutzner H, Dammann RH. Frequent occurrence ofRASSF1Apromoter hypermethylation and merkel cell polyomavirus in merkel cell carcinoma. Mol Carcinog 2009; 48:903-9. [DOI: 10.1002/mc.20540] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
24
|
Lahtz C, Stranzenbach R, Fiedler E, Helmbold P, Dammann RH. Methylation of PTEN as a prognostic factor in malignant melanoma of the skin. J Invest Dermatol 2009; 130:620-2. [PMID: 19798057 DOI: 10.1038/jid.2009.226] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
25
|
Laffert MV, Helmbold P, Wohlrab J, Fiedler E, Stadie V, Marsch WC. Hidradenitis suppurativa (acne inversa): early inflammatory events at terminal follicles and at interfollicular epidermis*. Exp Dermatol 2009; 19:533-7. [DOI: 10.1111/j.1600-0625.2009.00915.x] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
26
|
Scholz IM, Nümann A, Froster UG, Helmbold P, Enk AH, Näher H. New mutation in the CYLD gene within a family with Brooke-Spiegler syndrome. J Dtsch Dermatol Ges 2009. [DOI: 10.1111/j.1610-0387.2009.07156.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
27
|
Abstract
Acute generalized exanthematous pustulosis (AGEP) is characterized by sudden onset of non-follicular aseptic pustules with erythema often accompanied by fever and leukocytosis. While the most frequent cause of AGEP is drug reactions, especially antibiotics. Occasional cases have been described as parainfectious. An 82-year-old female presented with recurrent AGEP along with a chronic urinary infection with Escherichia coli. Her cutaneous findings resolved following antibiotic therapy and prophylaxis. To the bets of our knowledge, this is the first case of AGEP associated with an Escherichia coli urinary tract infection.
Collapse
Affiliation(s)
- N Klein
- Universitäts-Hautklinik Heidelberg, Heidelberg.
| | | | | | | |
Collapse
|
28
|
Becker K, Goldberg M, Helmbold P, Holbach LM, Loeffler KU, Ballhausen WG. Deletions of BRCA1/2 and p53 R248W gain-of-function mutation suggest impaired homologous recombination repair in fragile histidine triad-negative sebaceous gland carcinomas. Br J Dermatol 2008; 159:1282-9. [PMID: 18717684 DOI: 10.1111/j.1365-2133.2008.08783.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sebaceous gland carcinomas represent rare malignancies of the skin and some 60% of them demonstrate high-grade microsatellite instability on the background of a defective mismatch repair system. However, a significant fraction of periocular sebaceous gland carcinomas exhibits microsatellite stability associated with a frequent loss of the candidate tumour suppressor fragile histidine triad (FHIT). OBJECTIVES We hypothesized that in those sebaceous gland carcinomas with microsatellite stability and loss of FHIT, effector molecules participating in homologous recombination repair (HRR), such as BRCA1/2, could be somatically inactivated. METHODS A pilot series of 10 paraffin-embedded sebaceous gland carcinoma specimens with a defined FHIT status was studied for loss of heterozygosity (LOH) events in the genes BRCA1, BRCA2, FHIT and WWOX. We sequenced the coding exons 5-8 of the p53 gene. RESULTS Sebaceous gland carcinomas with FHIT negativity displayed LOH and biallelic deletions of the BRCA1 gene in five of 10 (50%) of the sebaceous gland carcinoma specimens analysed. Tumour-specific genomic losses close to BRCA2 were also uncovered. A homozygous p53 R248W gain-of-function mutation as the result of a CGG to TGG transition was identified in one of seven sebaceous gland carcinomas. It has been demonstrated previously that p53 R248W mutants inactivate ATM-directed HRR. This particular sebaceous gland carcinoma presented with concomitant genomic deletions at the BRCA1 and BRCA2 loci, and also at the constitutively fragile sites FRA3B/FHIT and FRA16D/WWOX. CONCLUSIONS Our study demonstrates for the first time that microsatellite-stable FHIT-negative sebaceous gland carcinomas accumulate mutations that target central components of the HRR network. This observation will prompt investigations in synthetic lethality of BRCA-deficient sebaceous gland carcinomas by therapeutic poly(ADP-ribose) polymerase inhibitors.
Collapse
Affiliation(s)
- K Becker
- Universitätsklinik und Poliklinik für Innere Medizin I, Sektion Molek. GI Onkologie, Universität Halle-Wittenberg, 06120 Halle, Germany
| | | | | | | | | | | |
Collapse
|
29
|
Sandner A, Helmbold P, Winkler M, Gattenlöhner S, Müller-Hermelink HK, Holzhausen HJ. Cutaneous dissemination of nasal NK/T-cell lymphoma in a young girl. Clin Exp Dermatol 2008; 33:615-8. [PMID: 18616730 DOI: 10.1111/j.1365-2230.2008.02777.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In Europe and the USA, the incidence of primary nasal natural killer (NK)/T-cell lymphoma is rare. The skin is one of the predilection sites for dissemination. Cutaneous dissemination is a poor prognostic sign and is consistently fatal. We describe the case of a 17-year-old white German girl with a primary nasal NK/T-cell lymphoma and cutaneous dissemination. She presented with multiple maculopapular patches involving the trunk and thighs, and a 4-week history of headache, fever and fatigue. Biopsies of the skin and the nasal mucosa were taken. Pathological examination of both specimens revealed a NK/T-cell lymphoma. Epstein-Barr virus RNA was detected in the lymphoma cells by in situ hybridization. Unfortunately, the patient died of disease within 1 week.
Collapse
Affiliation(s)
- A Sandner
- Department of Otolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany.
| | | | | | | | | | | |
Collapse
|
30
|
|
31
|
Weisser H, Hartschuh W, Greiner A, Bischof M, Enk A, Helmbold P. Das Merkelzellkarzinom. Akt Dermatol 2008. [DOI: 10.1055/s-2007-995737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
32
|
|
33
|
Albert JG, Gimm O, Stock K, Bilkenroth U, Marsch WCH, Helmbold P. Small-bowel endoscopy is crucial for diagnosis of melanoma metastases to the small bowel: a case of metachronous small-bowel metastases and review of the literature. Melanoma Res 2007; 17:335-8. [PMID: 17885591 DOI: 10.1097/cmr.0b013e3282c3a706] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jörg G Albert
- First Department of Medicine, Martin-Luther-University Halle-Wittenberg, University of Heidelberg, Germany.
| | | | | | | | | | | |
Collapse
|
34
|
Jackowski S, Janusch M, Fiedler E, Marsch WC, Ulbrich EJ, Gaisbauer G, Dunst J, Kerjaschki D, Helmbold P. Radiogenic lymphangiogenesis in the skin. Am J Pathol 2007; 171:338-48. [PMID: 17591978 PMCID: PMC1941592 DOI: 10.2353/ajpath.2007.060589] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The time course of microvascular changes in the environment of irradiated tumors was studied in a standardized human protocol. Eighty skin biopsies from 40 patients with previously treated primary breast cancer were taken from irradiated skin and corresponding contralateral unirradiated control areas 2 to 8 weeks, 11 to 14 months, or 17+ months after radiotherapy (skin equivalent dose 30 to 40 Gy). Twenty-two biopsies of 11 melanoma patients who had undergone lymph node dissection were used for unirradiated control. We found an increase of total podoplanin(+) lymphatic microvessel density resulting mainly from a duplication of the density of smallest lymphatic vessels (diameter <10 microm) in the samples taken 1 year after radiation. Our findings implicate radiogenic lymphangiogenesis during the 1st year after therapy. The numbers of CD68(+) and vascular endothelial growth factor-C(+) cells were highly elevated in irradiated skin in the samples taken 2 to 8 weeks after radiotherapy. Thus, our results indicate that vascular endothelial growth factor-C expression by invading macrophages could be a pathogenetic route of induction of radiogenic lymphangiogenesis.
Collapse
Affiliation(s)
- Susanne Jackowski
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Abstract
Merkel cell carcinoma is a rare, rapidly growing, highly malignant dermal tumor which occurs preferentially on light-exposed skin in advanced age. The course of the disease is frequently characterized by the occurrence of lymph node metastases and local recurrences, even in the first year after removal of the primary tumour. The five-year overall survival rate is only about 65 %, despite rigorous therapy. The histological pattern is characterized by trabecular strands of small, uniform cells with large basophilic nuclei and typical neuroendocrine granules. The diagnosis is confirmed immunohistochemically by neuroendocrine and epithelial markers. The excision of the primary tumor is regarded as first-line therapy. Adjuvant radiatiotherapy is almost always indicated and should also include lymph node drainage. In the stage of nodal disease, a combination of excision and radiotherapy is recommended. Adjuvant chemotherapy can be applied in this stage, as in small-cell bronchial carcinoma. The prognostic advantage has, however, not been proven. Despite good response to radiatiotherapy and chemotherapy, with at least prolonged recurrence-free intervals, Merkel cell carcinoma is rarely curable at the distant metastasizing stage. Individually defined, aggressive treatment,including radiatiotherapy, may in future considerably improve the prognosis, especially in the early stages of the disease.
Collapse
Affiliation(s)
- H Weisser
- Hautklinik, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | | | | | | | | | | |
Collapse
|
36
|
Meiss F, Helmbold P, Meykadeh N, Gaber G, Marsch WC, Fischer M. Overlap of acute generalized exanthematous pustulosis and toxic epidermal necrolysis: response to antitumour necrosis factor-alpha antibody infliximab: report of three cases. J Eur Acad Dermatol Venereol 2007; 21:717-9. [PMID: 17448012 DOI: 10.1111/j.1468-3083.2006.02026.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
37
|
Rastetter M, Schagdarsurengin U, Lahtz C, Fiedler E, Marsch WC, Dammann R, Helmbold P. Frequent intra-tumoural heterogeneity of promoter hypermethylation in malignant melanoma. Histol Histopathol 2007; 22:1005-15. [PMID: 17523078 DOI: 10.14670/hh-22.1005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To investigate intra-tumoural coexistence and heterogeneity of aberrant promoter hypermethylation of different tumour suppressor genes in melanoma, we analyzed the intra-tumoural distribution of promoter methylation of RASSF1A, p16, DAPK, MGMT, and Rb in 339 assays of 34 tumours (15 melanoma primaries, 19 metastases) by methylation-specific PCR, correlation to histopathology and RASSF1A expression. We detected promoter hypermethylation of at least one gene in 74% of tumours (30%, 52%, 33%, 20%, and 40% for RASSF1A, p16, DAPK, MGMT and Rb, respectively). 70% of the cases exhibited an inhomogeneous methylation pattern (17%, 45%, 33%, 20%, and 40% for RASSF1A, p16, DAPK, MGMT and Rb, respectively). Samples from the core of the tumours represented the methylation state of the whole tumours more accurately than the periphery. Local intra-tumoural correlation was found between the promoter hypermethylation state of p16 and Rb or p16 and DAPK, or epitheloid tumour cell type and RASSF1A or p16 methylation. Mitosis rate and sex was correlated with methylation of RASSF1A. Histological results confirmed that promoter hypermethylation of RASSF1A led to aberrant expression patterns. We conclude that intra-tumoural inhomogeneity of promoter hypermethylation is frequent in melanoma and this supports the hypothesis of clonal instability during progression of melanomas. In prognosis studies, missing the intra-tumoural sample representativeness may result in a reduction of the sensitivities or specificities.
Collapse
Affiliation(s)
- M Rastetter
- AWG Tumour Genetics of the Medical Faculty, Martin Luther University Halle-Wittenberg, Germany
| | | | | | | | | | | | | |
Collapse
|
38
|
Sandner A, Kösling S, Helmbold P, Winkler M, Bloching MB, Holzhausen HJ. [Primary nasal natural killer/T-cell lymphomas: classification and clinicopathological features]. HNO 2007; 55:93-9. [PMID: 17103008 DOI: 10.1007/s00106-006-1470-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Nasal NK/T-cell lymphomas are rare malignancies in Europe or North America. Histological diagnosis is difficult, because tumors imbedded in large necrotic areas and neoplastic infiltrates may be admixed with small lymphocytes, plasma cells, eosinophils, and histiocytes, and thus the process could be misdiagnosed as chronic inflammation. Progression of the disease leads to septal perforation and may also result in destruction of the hard palate, and if left untreated it ends fatally. This introduced the term "lethal midline granuloma", a term which should not be used any more. MATERIAL AND METHODS Clinical features, pathohistology, and current classification of primary nasal NK/T-cell lymphomas are described against the background of the recent literature and a case report. RESULTS Immunophenotyping is essential for the diagnosis. Tumor cells are uniformly infected by Epstein-Barr virus, which could be verified by EBER in situ hybridization. Immunohistochemically, tumor cells are positive for CD56, cytoplasmic CD3epsilon, and CD2 and they express cytotoxic molecules like granzyme B, TIA-1, GMP17, and perforin. Therapeutic options are radio- or radiochemotherapy. On average, 2- and 5-year survival rates of 50% are obtained in stages I and II. The prognosis of advanced tumor stages is very poor. CONCLUSIONS Immunohistochemical and molecular genetic early diagnosis is of crucial prognostic relevance.
Collapse
Affiliation(s)
- A Sandner
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Martin-Luther-Universität Halle-Wittenberg, 06097, Halle/Saale.
| | | | | | | | | | | |
Collapse
|
39
|
Laerm A, Helmbold P, Goldberg M, Dammann R, Holzhausen HJ, Ballhausen WG. Prospero-related homeobox 1 (PROX1) is frequently inactivated by genomic deletions and epigenetic silencing in carcinomas of the bilary system. J Hepatol 2007; 46:89-97. [PMID: 17069925 DOI: 10.1016/j.jhep.2006.07.033] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [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: 02/16/2006] [Revised: 06/26/2006] [Accepted: 07/11/2006] [Indexed: 12/04/2022]
Abstract
BACKGROUND/AIMS Functional deletion of the transcription factor Prospero-related homeobox 1 (PROX1) causes abnormal cellular proliferation via down-regulated expression of the cell cycle inhibitors p27(kip1) and p57(kip2). Hence, we examined whether inactivation of the PROX1 gene can be demonstrated in malignant tumors of the bilary system. METHODS Seventeen paraffin-embedded specimens of carcinomas of the bilary system were subjected to loss-of-heterozygosity (LOH) and microsatellite instability analyses, methylation-specific polymerase-chain reaction (MSP) and immunohistochemical detection of PROX1 protein in tumor sections. RESULTS The marker D1S213 located close to PROX1 at 1q41 indicated LOH events in 50% of informative tumor samples analyzed. In contrast to intense cytoplasmic and nuclear staining of normal bile duct epithelia, PROX1 protein was absent or drastically reduced in 10 of 16 (63%) carcinomas. MSP revealed significant PROX1 promoter hypermethylation in 8 out of 17 clinical cases (47%). A correlation between clinicopathological characteristics and reduced PROX1 expression was not observed. CONCLUSIONS We demonstrate that mechanisms like genomic deletions and hypermethylation, which are prototypic for the inactivation of tumor suppressor genes, inactivate PROX1 in carcinomas of the bilary system. Our findings prompt the elucidation of molecular pathways involved in PROX1 dependent misregulation of differentiation and proliferation processes in bilary tract carcinomas.
Collapse
Affiliation(s)
- Antonia Laerm
- Universitätsklinik und Poliklinik für Innere Medizin I, Sektion Molek. GI Onkologie, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | | | | | | | | | | |
Collapse
|
40
|
Janusch M, Fischer M, Marsch WC, Holzhausen HJ, Kegel T, Helmbold P. The hand-foot syndrome--a frequent secondary manifestation in antineoplastic chemotherapy. Eur J Dermatol 2006; 16:494-9. [PMID: 17101468] [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] [Subscribe] [Scholar Register] [Accepted: 03/01/2006] [Indexed: 05/12/2023]
Abstract
The hand-foot syndrome (HFS) (palmoplantar erythrodysesthesia) designates acute, painful erythemas of the palms and soles of the feet caused by antineoplastic chemotherapies. The most frequent trigger substances are 5-fluoruracil and its derivates. At maximum severity, the HFS is bullous to erosive or ulcerous in character. The pathogenesis has not yet been clarified. Histologically, the HFS is characterized by a toxic keratinocyte reaction. Furthermore, there is sub-basal edema with a tendency to bullae, dilated blood and lymph capillaries and usually only mild perivascular lymphocytic infiltration. Early recognition and delineation from other differential diagnoses is prerequisite to targeted management of the disease. Depending on the severity, HFS requires dose reduction, interruption or switch in the antineoplastic chemotherapy.
Collapse
Affiliation(s)
- M Janusch
- Department of Medicine IV, Martin Luther University Halle-Wittenberg, Halle, Saale, Germany
| | | | | | | | | | | |
Collapse
|
41
|
Goldberg M, Rummelt C, Laerm A, Helmbold P, Holbach LM, Ballhausen WG. Epigenetic silencing contributes to frequent loss of the fragile histidine triad tumour suppressor in basal cell carcinomas. Br J Dermatol 2006; 155:1154-8. [PMID: 17107382 DOI: 10.1111/j.1365-2133.2006.07433.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [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: 11/28/2022]
Abstract
BACKGROUND Extensive exposure to ultraviolet radiation is associated with genetic alterations in basal cell carcinomas (BCCs), which represent some 75% of skin cancers. OBJECTIVES As recent data suggested the fragile histidine triad (FHIT) gene product to participate in DNA damage responses we wished to address whether functional deletion of this tumour suppressor participates in the development of BCC. Our study focused on epigenetic inactivation of the FHIT gene. METHODS Paraffin-embedded specimens from 17 patients with BCC were available for methylation-specific polymerase chain reaction (MSP), combined bisulphite-dependent restriction analysis (COBRA) of the FHIT gene and immunohistochemistry of its product. RESULTS We report for the first time that 100% of BCCs are negative for FHIT by immunostaining. Aberrant methylation of the FHIT promoter occurred in a significant portion of BCCs. MSP detected hypermethylation of the FHIT/FRA3B locus in nine of nine (100%) periocular BCCs and in six of eight (75%) BCCs from other body regions. COBRA yielded similar results, confirming that some 88% of the 17 BCCs analysed harbour epigenetic silencing of the FHIT gene. Loss of FHIT protein was demonstrated immunohistochemically, confirming that promoter hypermethylation correlated with loss of gene expression. CONCLUSIONS We have identified epigenetic silencing of the FHIT tumour suppressor gene as a frequent inactivation mechanism which is likely to contribute to functional deficiencies in DNA damage response of BCCs.
Collapse
Affiliation(s)
- M Goldberg
- Section of Molecular Gastroenterological Oncology of the First Department of Medicine, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | | | | | | | | | | |
Collapse
|
42
|
Helmbold P, Lautenschläger C, Marsch WC, Nayak RC. Detection of a physiological juvenile phase and the central role of pericytes in human dermal microvascular aging. J Invest Dermatol 2006; 126:1419-21. [PMID: 16557234 DOI: 10.1038/sj.jid.5700275] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
43
|
Ugurel S, Utikal J, Mohr P, Helmbold P, Pfoehler C, Schiller M, Kellner I, Schadendorf D. Imatinib in locally advanced dermatofibrosarcoma protuberans (DFSP): A phase II trial of the Dermatologic Cooperative Oncology Group (DeCOG). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.9561] [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] [Indexed: 11/20/2022] Open
Abstract
9561 Background: DFSP is known for its low metastatic potential but locally infiltrative growth, hereby enforcing extensive and often multiple surgical procedures. DFSP cells were recently shown to display chromosomal translocations of the regions 17q22 and 22q13, resulting in an autocrine growth stimulation loop via the platelet-derived growth factor (PDGF) pathway. The tyrosine kinase inhibitor imatinib blocks PDGF signal transduction, thus offering a new therapeutic option for DFSP patients. This multicenter phase II trial was aimed to investigate the efficacy of imatinib in locally advanced DFSP. Methods: The primary study endpoint was objective response, secondary endpoints were safety and relapse-free survival. Patients with histological proof of locally advanced primary or relapsed DFSP, measurable tumor parameters according to RECIST, and no evidence of distant metastases were eligible. Patients received imatinib 600 mg/d PO. Tumor measurements were performed at week 6 and 12, and every 8 weeks thereafter. At the end of imatinib treatment, at the earliest after week 12, residual tumors were surgically excised with histological proof of tumor-free margins. Results: By January 2006, nine out of 13 recruited patients were evaluable for response (per protocol, PP), three are still on treatment and one stopped treatment after 12 days due to side effects. Among the nine PP patients, seven partial responses, one stabilization, and one progression were observed. Five responders showed an ongoing tumor shrinkage until complete surgical excision, whereas two patients revealed an initial response at 6 weeks, followed by a disease progression at 12 weeks. None of the patients developed distant metastases under treatment or thereafter. Side effects were mostly mild to moderate (CTC grade 1–2). Severe side effects (CTC grade 3–4), reversible angina pectoris and septicemia, respectively, were observed in two patients. Conclusions: The study results indicate imatinib as a potent systemic treatment option in locally advanced DFSP. However, a subset of DFSP patients appeared resistant to imatinib, either primarily after treatment onset, or secondarily after showing an initial response. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- S. Ugurel
- Skin Cancer Unit, German Cancer Research Center, Mannheim, Germany; Department of Dermatology, Mannheim, Germany; Department of Dermatology, Buxtehude, Germany; Department of Dermatology, Halle, Germany; Department of Dermatology, Homburg, Germany; Department of Dermatology, Muenster, Germany; Department of Dermatology, Erfurt, Germany
| | - J. Utikal
- Skin Cancer Unit, German Cancer Research Center, Mannheim, Germany; Department of Dermatology, Mannheim, Germany; Department of Dermatology, Buxtehude, Germany; Department of Dermatology, Halle, Germany; Department of Dermatology, Homburg, Germany; Department of Dermatology, Muenster, Germany; Department of Dermatology, Erfurt, Germany
| | - P. Mohr
- Skin Cancer Unit, German Cancer Research Center, Mannheim, Germany; Department of Dermatology, Mannheim, Germany; Department of Dermatology, Buxtehude, Germany; Department of Dermatology, Halle, Germany; Department of Dermatology, Homburg, Germany; Department of Dermatology, Muenster, Germany; Department of Dermatology, Erfurt, Germany
| | - P. Helmbold
- Skin Cancer Unit, German Cancer Research Center, Mannheim, Germany; Department of Dermatology, Mannheim, Germany; Department of Dermatology, Buxtehude, Germany; Department of Dermatology, Halle, Germany; Department of Dermatology, Homburg, Germany; Department of Dermatology, Muenster, Germany; Department of Dermatology, Erfurt, Germany
| | - C. Pfoehler
- Skin Cancer Unit, German Cancer Research Center, Mannheim, Germany; Department of Dermatology, Mannheim, Germany; Department of Dermatology, Buxtehude, Germany; Department of Dermatology, Halle, Germany; Department of Dermatology, Homburg, Germany; Department of Dermatology, Muenster, Germany; Department of Dermatology, Erfurt, Germany
| | - M. Schiller
- Skin Cancer Unit, German Cancer Research Center, Mannheim, Germany; Department of Dermatology, Mannheim, Germany; Department of Dermatology, Buxtehude, Germany; Department of Dermatology, Halle, Germany; Department of Dermatology, Homburg, Germany; Department of Dermatology, Muenster, Germany; Department of Dermatology, Erfurt, Germany
| | - I. Kellner
- Skin Cancer Unit, German Cancer Research Center, Mannheim, Germany; Department of Dermatology, Mannheim, Germany; Department of Dermatology, Buxtehude, Germany; Department of Dermatology, Halle, Germany; Department of Dermatology, Homburg, Germany; Department of Dermatology, Muenster, Germany; Department of Dermatology, Erfurt, Germany
| | - D. Schadendorf
- Skin Cancer Unit, German Cancer Research Center, Mannheim, Germany; Department of Dermatology, Mannheim, Germany; Department of Dermatology, Buxtehude, Germany; Department of Dermatology, Halle, Germany; Department of Dermatology, Homburg, Germany; Department of Dermatology, Muenster, Germany; Department of Dermatology, Erfurt, Germany
| |
Collapse
|
44
|
Helmbold P, Gaisbauer G, Fiedler E, Stücker M, Wolter M, Marsch WC. Self-limited variant of febrile ulceronecrotic Mucha-Habermann disease with polyclonal T-cell receptor rearrangement. J Am Acad Dermatol 2006; 54:1113-5. [PMID: 16713489 DOI: 10.1016/j.jaad.2006.02.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Revised: 02/08/2006] [Accepted: 02/19/2006] [Indexed: 10/24/2022]
|
45
|
Abstract
BACKGROUND In primary melanomas, data on the degree of intratumoral heterogeneity to date have been lacking. OBJECTIVE Our purpose was to investigate intratumoral DNA stem-line heterogeneity in superficial spreading melanoma (SSM). METHODS Multiple measuring fields of 54 SSMs (tumor thickness median 1.60 mm) were studied by DNA image cytometry to obtain data on the number of DNA stem lines per tumor, their ploidy characteristics, and intratumoral distribution. Results were compared with standard histopathological criteria. RESULTS Twenty-three of 54 SSMs were found to have two or three distinct proliferating tumor cell stem lines (1.46 +/- 0.57 per tumor). Stem lines appeared spatially separated in 22 of 23 SMMs. At least 3 measuring fields per tumor were necessary to identify all stem lines with a likelihood of 95%. DNA heterogeneity correlated with tumor thickness, but occurred in 5 of 19 cases of pT1 melanoma. CONCLUSIONS Primary SSMs can be regarded as potentially clonally unstable with a tendency for spatial separation of tumor cell stem lines.
Collapse
Affiliation(s)
- Peter Helmbold
- Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Halle, Saale, Germany.
| | | | | | | |
Collapse
|
46
|
Abstract
BACKGROUND In nail apparatus melanomas (NAM), the role of standard melanoma prognostic factors is under discussion. The prognostic influence of traumas to the clinically apparent tumour has not been sufficiently examined. OBJECTIVES To estimate the influence of traumas against the background of standard prognostic factors on the course of NAM. METHODS In 33 patients (20 women, 13 men, median age 65.0 years) with NAM (median tumour thickness 3.5 mm), we retrospectively examined a detailed history of trauma to the affected extremity at first presentation. Histological or other standard prognostic factors and follow-up were studied prospectively using a standardized protocol. RESULTS Of 33 patients, 21 had suffered injury to the clinically apparent melanoma primary between 4 and 72 months prior to definitive surgical treatment (diagnostic biopsy up to 3 months ahead of excision of the melanoma was not considered). Eight of these patients had undergone inadequate therapy procedures. In Kaplan-Meier analysis, trauma to the clinically apparent tumour and tumour thickness were found to be significant prognostic factors for recurrence-free survival, and trauma to the clinically apparent tumour, Clark level and tumour thickness were significant prognosis predictors for overall survival. In Cox's proportional hazards model, trauma to the clinically apparent tumour was found to be a significant and independent risk factor with regard to overall survival (hazard ratio 5.39; P = 0.029). An influence of trauma on the primary pathogenesis of NAM could not be confirmed. Only three patients reported trauma prior to the onset of tumour. CONCLUSIONS From our data, trauma to the clinically apparent tumour might be a considerable risk factor in NAM. The diagnosis of NAM should be considered in lesions of the nail apparatus and further deterioration of the prognosis due to inadequate therapeutic attempts or injury to the NAM should be avoided.
Collapse
Affiliation(s)
- G Bormann
- Department of Dermatology, Martin Luther University Halle-Wittenberg, Ernst-Kromayer-Str. 5/6, D-06097 Halle (Saale), Germany.
| | | | | | | |
Collapse
|
47
|
Abstract
There is a lack of histopathological factors to sub-stratify prognosis in pT3/4 melanoma primaries. In the presented pilot study, the prognostic significance of different clinical and histopathological parameters was studied in thick primary melanoma taking paratumoral epidermal hyperplasia (PTEH) into consideration. Of 1632 melanoma patients in the melanoma register of the Martin Luther University Halle-Wittenberg in the years 1980 to 1987, 16 cases with tumor thickness (TT) of the primary > or = 3 mm, documented metastasis-free follow-up of 10+ years after primary therapy and available histologic sections were compared with an adequate recurrence control group (n = 62) by PTEH and standard prognostic parameters. PTEH was demonstrable in 15 of 16 patients of the metastasis-free group (PTEH penetration depth 1.42 +/- 0.82 mm/mean +/- SD) and 27 of 62 of controls (0.29 +/- 0.46 mm), P < or = 0.001. Of the standard prognostic parameters, TT, sex, location, and lack of nevus association also correlated with metastasis. In multivariate analysis, PTEH > or = 1 mm was the single independent parameter with the highest (negative) association to recurrence (odds ratio 52.3). Occurrence of PTEH might predict a more moderate course of disease in thick melanoma. Thus, it might become an easily determinable and effective tool to sub-stratify prognosis in thick primary melanoma of the skin. Further studies are necessary to prove these findings.
Collapse
Affiliation(s)
- Eva Drunkenmölle
- Department of Dermatology, Martin Luther University, Halle-Wittenberg, Halle (Saale), Germany
| | | | | | | |
Collapse
|
48
|
Fischer M, Fiedler E, Seidel C, Meiss F, Klapperstück T, Helmbold P, Dammann R. Cultivated keratinocytes express N-methyl-d-aspartate receptors of the NMDAR2D type. Arch Dermatol Res 2005; 297:316-8. [PMID: 16328341 DOI: 10.1007/s00403-005-0625-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Revised: 10/05/2005] [Accepted: 10/29/2005] [Indexed: 11/29/2022]
Abstract
N-methyl-D-aspartate receptors (NMDAR) can regulate the intracellular calcium concentration of keratinocytes (KC) and seem to be important for their growth and differentiation. The objective of this study was to identify the subtype(s) of this receptor expressed by KC in vitro. The mRNA was isolated from primary cultures of KC as well as from a KC cell line (HaCaT) and expression of the NMDAR subtypes determined by using RT-PCR. At the mRNA level, we found expression of only the constant NMDAR1 as well as the subtype NMDAR2D. In contrast to the other subtypes of NMDAR, NMDAR2D is characterized by low influence of magnesium to the receptor function. This characteristic is consistent with previously published functional investigations in KC. The identification of the NMDAR2D subtype in KC may be of value for the development of new therapeutic approaches.
Collapse
Affiliation(s)
- Matthias Fischer
- Department of Dermatology and Venereology, Martin-Luther-University Halle-Wittenberg, Ernst-Kromayer-Str. 5, 06097 Halle (Saale), Germany.
| | | | | | | | | | | | | |
Collapse
|
49
|
Danz B, Hellmann A, Stadie V, Dunst J, Richter C, Marsch WC, Helmbold P. Radiotherapy in multilocalized lymphedema-associated angiosarcoma. Eur J Dermatol 2005; 15:474-7. [PMID: 16280302] [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] [Subscribe] [Scholar Register] [Accepted: 07/25/2005] [Indexed: 05/05/2023]
Abstract
We report an 80-year-old woman, suffering from a recurrence of a multilocalized lymphedema-associated angiosarcoma of the right arm. The tumor consisted of solid tumor cell formations and "classical" spongiform tumor complexes. In the tumor periphery, pathological endothelial cell proliferates on pre-existing dilated lymphatic capillaries were detectable, which, together with immunohistology (CD 31+/Desmoplakin-1-2.17+/CD 34-), supported the diagnosis of lymphangiosarcoma. Complete remission was achieved under radioimmunotherapy (54 Gy/Interferon beta). A further recurrence 3 months later outside the primary therapy fields was successfully treated with radiotherapy alone. During a follow-up observation period of 3 years, there was neither local recurrence nor metastasis. This case demonstrates for the first time the long-lasting efficacy of photon radiation in a case of histologically-defined lymphangiosarcoma. Further studies should elucidate the suitability of radio monotherapy as first-line therapy in lymphedema-associated angiosarcoma with lymphatic endothelium-like immunohistology.
Collapse
Affiliation(s)
- Beate Danz
- Department of Dermatology Martin Luther University Halle-Wittenberg, Klinik und Poliklinik für Hautkrankheiten Ernst-Kromayer-Str. 5 D-06097 Halle (Saale), Germany
| | | | | | | | | | | | | |
Collapse
|
50
|
Fischer M, William T, Helmbold P, Wohlrab J, Marsch WC. Expression of epidermal N-methyl-D-aspartate receptors (NMDAR1) depends on formation of the granular layer--analysis in diseases with parakeratotic cornification. Arch Dermatol Res 2005; 296:157-62. [PMID: 15338240 DOI: 10.1007/s00403-004-0505-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 11/25/2022]
Abstract
Ionotrope glutamate receptors of the N-methyl-D-aspartate (NMDA) receptor type are expressed on keratinocytes and influence the intracellular calcium concentration. The importance of NMDA receptors in pathophysiological processes in the skin is, however, still unclear. Epidermal distribution patterns of NMDA receptors were investigated in dermatoses with parakeratotic cornification (psoriasis vulgaris and verrucae vulgares) and compared to the expression of filaggrin. The expression of NMDA receptors (R1 component) in paraffin-embedded normal epidermis (n = 22), psoriasis vulgaris (n = 21) and verrucae vulgares (n = 23) was examined and evaluated by means of digital image analysis. For quantitative characterization of the distribution patterns, a quotient was formed of the expression in the stratum granulosum and stratum basale ("NMDA ratio"). The distribution of NMDAR1 was compared to the immunohistochemical expression of filaggrin. Additionally the expression of filaggrin was investigated in HaCaT cells after treatment with the NMDA receptor antagonist MK-801. NMDA receptors were demonstrated in the epidermis of all preparations. In healthy skin, the highest receptor density was found in the stratum granulosum. This distribution pattern was basically also present in the dermatoses examined. Thus, the occurrence of parakeratosis in psoriasis vulgaris, but not in verrucae vulgares, was characterized by a significant reduction in the NMDA ratio (reduced expression of NMDAR1 in the upper epidermis). The immunohistochemical distribution of filaggrin was similar to that of NMDAR1. In HaCaT cells MK-801 suppressed the expression of filaggrin. NMDA receptors are expressed in human epidermis under physiological conditions especially in the stratum granulosum. Their reduced expression within parakeratotic epidermis in psoriasis vulgaris may be evidence of impaired intracellular calcium influx in this disease.
Collapse
Affiliation(s)
- Matthias Fischer
- Department of Dermatology and Venerology, Martin-Luther-University Halle-Wittenberg, Ernst-Kromayer-Str. 5, 06097 Halle (Saale), Germany.
| | | | | | | | | |
Collapse
|