Hepatitis C virus (HCV) infection is the most common blood-borne chronic infection in the United States. Chronic lymphocytic sialadenitis and sicca syndrome have been reported in chronic HCV ...infection. Up to 55% of these patients may have xerostomia; the mechanisms of the xerostomia and salivary gland (SG) hypofunction remain controversial. The objectives of this project are to establish if xerostomia associates with SG and HCV infection and to characterize the structural changes in SG and saliva composition. Eighteen HCV-infected patients with xerostomia were evaluated for SG dysfunction; 6 of these patients (patients 1–6) were further evaluated for SG histopathological changes and changes in saliva composition. The techniques used include clinical and laboratory assessment, SG ultrasonography, histological evaluation, sialochemical and proteomics analysis, and RNA in situ hybridization. All the HCV patients had low saliva flow, chronic sialadenitis, and SG fibrosis and lacked Sjögren syndrome (SS) characteristic autoantibodies. Further evaluation of a subgroup of 6 HCV patients (patients 1–6) demonstrated diffuse lymphocytic infiltrates that are predominantly CD8+ T cells with a significant increase in the number of inflammatory cells. Alcian Blue/periodic acid–Schiff staining showed significant changes in the ratio and intensity of the acinar secretory units of the HCV patients’ minor SG. The submandibular glands showed significant ultrasonographic abnormalities in the parenchyma relative to the parotid glands. Significant changes were also observed in the concentration of sodium and mucin 5b. Although no significant correlation was observed between the lymphocytic infiltrates and the years of HCV chronic infection, a positive correlation was observed between HCV RNA–positive epithelial cells and the years of HCV infection. Consistent with the low saliva flow and xerostomia, patients showed changes in several markers of SG acinar and ductal function. Changes in the composition of the saliva suggest that HCV infection can cause xerostomia by mechanisms distinct from SS.
Summary
Background
Recent studies have shown an increasing incidence of cutaneous adnexal carcinomas (CACs).
Objectives
The aim of our study was to evaluate incidence and survival for cases of CACs ...and investigate their association with other skin neoplasms.
Methods
We conducted a population‐based study. Data on incident cases of CACs were obtained from the Tuscany Cancer Registry between 1985 and 2010. In order to determine whether the occurrence of squamous cell carcinoma (SCC) among patients with CAC is higher or lower than expected in the general population, the standardized incidence ratio (SIR) was calculated.
Results
A total of 242 patients with CAC were observed; the age‐standardized incidence rate was 3·8 cases per million person‐years. From 1997 to 2010 crude incidence rates increased by 159%. Age‐specific incidence was higher in men over 80 years old than in women of the same age and younger individuals. Carcinomas of sweat gland origin prevailed; the most common histotype was porocarcinoma and the most frequently affected site was the head/neck. Overall, 88% of CACs were diagnosed at a localized stage. The 5‐year overall survival and disease‐specific survival rates were 59% 95% confidence interval (CI) 53–65 and 94% (95% CI 91–98), respectively. In the observation cohort, the number of SCCs was significantly higher than expected as the SIR was calculated to be 33·7 (P < 0·001).
Conclusions
Increasing incidence warrants awareness and early diagnosis of CACs. Increased SCC incidence among patients with these tumours highlights the relevance of careful skin examination and follow‐up.
What's already known about this topic?
Cutaneous adnexal carcinomas (CACs) are rare tumours, but their incidence is increasing.
The rarity of these tumours has made it difficult to gain sufficient clinicopathological experience regarding the diagnosis and treatment of CACs.
CACs can be a diagnostic challenge owing to mostly nonspecific clinical presentation and histopathological variety that often requires specific expertise for a definite diagnosis.
What does this study add?
CAC incidence increased from 2·5 per million person‐years in 1985–87 to 19 per million person‐years in 2009–10; from 1997 the incidence has constantly increased, rising to 159% in 2010.
In patients with CAC, the risk of squamous cell carcinoma is 34 times higher than in the general population.
Considering demographic evolution with a progressively ageing population and higher incidence of CACs among the elderly, it is reasonable to expect a further increase in the future.
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Linked Comment: Andersen. Br J Dermatol 2019; 180:453–454.
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The scrotum is a rare site for metastases and represents less than 1% of the body's total surface area. Clinically, metastatic deposits in the scrotum can present in a variety of ways. They may ...appear as solitary cutaneous nodules, papules, plaques, or generalized induration or edema. Indeed, scrotum metastasis may be mistaken for other skin lesions since several dermatologic conditions can present with inflammation or dermatitis of the scrotum. Properly diagnosing cutaneous metastasis requires histopathological examination since the clinical appearances are, as described, highly variable and non-specific. We present a 63-year-old man with painless nodules on the scrotal skin. Excisional biopsy of the nodules revealed a metastasis from rectal squamous cell carcinoma. The incidence of this kind of tumors is estimated around 0.1-0.25 per 1000 colorectal neoplasms.
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Cutaneous leiomyosarcoma is a rare malignant mesenchymal tumor of smooth muscle origin of unknown etiology. Leiomyosarcomas located on the skin include superficial leiomyosarcomas and metastatic ...leiomyosarcomas. Superficial leiomyosarcomas represent 7-10% of all cases of leiomyosarcoma and are subdivided into cutaneous and subcutaneous lesions based on skin location. We report a case of an 81-year-old woman who presented a slow growing tender single nodule on the left thigh and describe its clinical and dermoscopic features.
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