Summary
Background
Cutaneous squamous cell carcinoma (CSCC) is the second most frequent cancer in humans after basal cell carcinoma, and its incidence is dramatically rising. CSCC is rarely ...problematic, but given its high frequency, the absolute number of complicated cases is also high. It is necessary to identify molecular markers in order to recognize those CSCCs with poor prognosis. There is controversy concerning the role of epidermal growth factor receptor (EGFR) as a marker of prognosis in CSCC. In addition, EGFR‐targeted therapies have emerged in recent years and a better understanding of the role of EGFR in CSCC may be of help for some patients in predicting prognosis and guiding curative management.
Objectives
To evaluate the role of EGFR as a prognostic factor in CSCC.
Methods
We evaluated clinical and histopathological features, including events of poor clinical evolution, in a series of 94 cases of CSCC. We also analysed EGFR expression by immunohistochemistry, fluorescent in situ hybridization and quantitative polymerase chain reaction.
Results
We detected EGFR in 85 cases (90%), with overexpression in 33 cases (35%), and aberrant EGFR expression in the cytoplasm in 50 cases (53%). EGFR overexpression in the primary tumours was associated with lymph node progression, tumour–nodes–metastasis stage progression and proliferation (Ki‐67 staining) in CSCC. EGFR overexpression and poor grade of differentiation were the strongest independent variables defining lymph node metastasis and progression in CSCC in a logistic regression model.
Conclusions
We demonstrate that EGFR overexpression has prognostic implications associated with lymph node metastasis and progression in CSCC.
What's already known about this topic?
Cutaneous squamous cell carcinoma (CSCC) is the second most frequent cancer in humans and sometimes exhibits a poor outcome.
Epidermal growth factor receptor (EGFR) activation in keratinocytes induces cellular proliferation, increases cell survival and induces resistance to apoptosis.
While the expression of EGFR has been extensively studied in CSCC, there is some controversy surrounding its prognostic significance.
What does this study add?
Based on the results of our study, EGFR overexpression appears to have prognostic implications associated with lymph node metastasis and progression in CSCC.
There was no association between the level of EGFR protein, detected by immunohistochemistry, and the level of EGFR RNA.
What is the translational message?
We provide evidence that EGFR expression is a molecular marker for poor clinical outcome in cases of CSCC.
EGFR‐targeted therapies might be helpful in selected patients with metastatic CSCC.
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Linked Comment: Griewank. Br J Dermatol 2017; 176:1126–1127
Summary
Background
Human parvovirus B19 (B19V) has been associated with a number of dermatological and systemic conditions, including myocarditis and autoimmune syndromes.
Objectives
To determine the ...frequency of B19V DNA detection in a large dermatopathology practice, and to characterize the histopathological patterns involved.
Methods
We selected for polymerase chain reaction (PCR) detection of B19V a total of 1815 skin biopsies pertaining to entities allegedly related to B19V, as well as cases suspected clinically of representing paraviral exanthemas. Immunohistochemical detection of B19V viral protein 2 (VP2) was performed in 92 PCR‐positive cases.
Results
B19V DNA was found by PCR in 402 out of 1825 biopsy specimens (22%). VP2 protein was identified by immunohistochemistry in only three instances of papular purpuric ‘gloves‐and‐socks’ syndrome.
Conclusions
As the virus has the capacity to persist in different tissues (including the skin) for long periods, it could represent merely an innocent bystander, so no pathogenetic significance can be inferred from the PCR positivity for B19V in the vast majority of dermatological conditions studied.
What's already known about this topic?
Many dermatological diseases have been linked to parvovirus B19 infection due, among other evidence, to the presence of viral DNA in tissue specimens.
What does this study add?
Polymerase chain reaction detection of viral DNA in 22% of 1825 tested cases confirms data of previous shorter series and casts doubts on a pathogenic role for parvovirus B19 (B19V) in these conditions.
What is the translational message?
We have found B19V DNA in skin biopsies showing the full spectrum of histopathological inflammatory patterns in a wide variety of dermatological ailments.
As B19V persists in the skin, additional studies (e.g. seroconversion, detection of B19V DNA in serum samples or immunohistochemical demonstration of B19V in endothelial cells of the papillary dermis) are required in order to link pathogenetically, a given cutaneous disorder with B19V.
Linked Comment: Söderlund‐Venermo. Br J Dermatol 2017; 177:900–901.
Plain language summary available online
Background
Panniculitis occurring in dermatomyositis is uncommon, with only a few cases described in the literature, most of them as case reports.
Objective
This report describes the ...clinicopathological and immunohistochemical findings in a series of 18 patients with panniculitis associated with dermatomyositis.
Methods
In each patient, we collected the clinical data of the cutaneous lesions as well as the characteristic clinical and laboratory findings. A series of histopathologic findings was recorded in the biopsy of each patient. A panel of antibodies was used in some cases to investigate the immunophenotype of the infiltrate. Data of treatment and follow‐up were also collected.
Results
Of the 18 patients, 13 were female and 5 were male, ranging in age from 13 to 74 years (median, 46.4 years). In addition to panniculitis, all patients presented pathognomonic cutaneous findings of DM and reported proximal muscle weakness prior to the diagnosis of panniculitis. Muscle biopsy was performed in 17 patients and MRI in one, all with the diagnosis of inflammatory myopathy. None of the patients presented any associated neoplasia. Panniculitis lesions were located in the upper or lower limbs. Histopathology showed a mostly lobular panniculitis with lymphocytes as the main component of the infiltrate. Most cases showed also numerous plasma cells and lymphocytes surrounding necrotic adipocytes (rimming) were frequently seen. Lymphocytic vasculitis and abundant mucin interstitially deposited between collagen bundles of the dermis were also frequent findings. Late‐stage lesions showed hyaline necrosis of the fat lobule and calcification. Immunohistochemistry demonstrated that most lymphocytes of the infiltrate were T‐helper lymphocytes, with some B lymphocytes in the lymphoid aggregates and small clusters of CD‐123‐positive plasmacytoid dendritic cells in the involved fat lobule.
Conclusion
Panniculitis in dermatomyositis is rare. Histopathologic findings of panniculitis dermatomyositis are identical to those of lupus panniculitis. Therefore, the final diagnosis requires clinic–pathologic correlation.
Linked article: This article is commented on by A. Kuhn, pp. 1231–1232 in this issue. To view this article visit https://doi.org/10.1111/jdv.15149
Crystalglobulinemia is an extremely rare pathology that is associated in most cases with plasma cell dyscrasia, mainly multiple myeloma. In most cases, it may be the manifestation of incipient ...gammopathy or it manifests shortly after diagnosis. We report a patient with ischemic lesions of thrombotic origin in lower limbs. Subsequently, renal involvement occurs, in view of this involvement, it is suspected that the patient may have an associated vasculitis. After performing the biopsy and with the subsequent diagnosis of monoclonal gammopathy of uncertain significance, the diagnosis is made. We review the most recent bibliography of patients who have been diagnosed with crystalglobulinemia associated with plasma dyscrasia focusing in those with thrombotic vasculopathy or acute renal failure. In our case, in addition to being associated with monoclonal gammopathy of undetermined significance that is less frequent, the debut of the symptoms is years before the detection of the monoclonal peak. This could speak of patients with a low peak of monoclonal component (not detected by immunoelectrophoresis) who could have kidney and vascular damage.
Summary
Cutaneous graft‐versus‐host disease (GVHD) is a frequent complication of allogeneic bone marrow transplant and haematopoietic cell transplantation, but it is rarely presented as a Wolf's ...isotopic response. We report a patient who developed chronic lichenoid GVHD following the dermatomes previously affected by varicella zoster virus (VZV) infection. Nineteen months later, the same patient suffered from reactivation of GVHD at the injection site of an influenza vaccination. We review the literature concerning GVHD appearing after VZV infection and discuss the possible implications of this case and the pathogenic hypotheses.
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