Multiple basal cell papillomas
Even when the clinical appearance of the lesions strongly suggests MF, a biopsy may not bring histologic proof in favor of this diagnosis.
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The reasons may include, among others, the paucity and low frequency of anecdotic histopathologic criteria associated with MF, namely epidermotropism, Pautrier microabscesses and lymphocytes with cerebriform nuclei, the possibility that the biopsy site might be unrepresentative for the whole rash, or even the fact that MF infiltrates can masquerade multiple basal cell papillomas different reactive conditions that share similar patterns of inflamation, such as psoriasiform, lichenoid or eczematous diseases.
Vice versa, even when classical clues of MF are present in a given specimen, their interpretation has to be carefully made, since various reactive inflammatory conditions have been reported to share similar histopathologic features with early MF, such as drug-induced T-cell pseudolymphoma 89lichen sclerosus et atrophicus 10persistent pigmented purpuric dermatoses 11actinic reticuloid 12eczematous dermatitides 1314lymphomatoid contact dermatitis 15benign lichenoid keratosis 16connective tissue disease 17and skin infections and infestations 1819among others.
In our study, we tried to comparatively assess the frequency of occurrence of different histopathologic criteria in biopsies from early multiple basal cell papillomas of MF, respectively from various entities that microscopically mimick MF. In the category of epidermal reaction Figure 1 we investigated the appearance of spongiosis, psoriasiform hyperplasia, interface multiple basal cell papillomas, epidermal multiple basal cell papillomas and the presence of elongated mounds of parakeratosis.
A significant difference between MF and mimickers group was recorded for the presence of psoriasiform hyperplasia In our opinion, this finding signifies a relative lack of epidermal reactivity as a response to the presence of human papillomavirus dna positive infiltrate. When occured in MF cases, psoriasiform hyperplasia was rather irregular, lichen simplex chronicus-like, and was associated in a large proportion with a dense, band-like dermal infiltrate, finding which represents a combined psoriasiform and lichenoid pattern, as previousely described for MF Parakeratosis, manifested as a thin, long band on top of the affected epidermis, was observed more frequently with MF biopsies Focal spots of parakeratosis manifested as isolated columns and mounds of parakeratosis were more oftenly seen in the control group, but this feature was not recorded when parakeratosis band was not continuous over at least one quarter of biopsy section.
In other words, spongiosis was a rather common event in early MF. This finding suggests that, when detected in biopsies for clinical suspicion of early MF, a low degree of spongiosis should not be the sole criterion for MF exclusion.
Figure 1. To be able to quantify the degree of epidermotropism, we looked for various patterns described before in patch and plaque-type MF 2122like the presence of lymphocytes aligned along the basal layer of the epidermis multiple basal cell papillomas lymphocytesa diffuse spread of lymphocytes into the epidermis pagetoid lymphocytesthe presence of lymphocytes in clusters larger than 3 cells Pautrier microabscesses and areas of spongiosis where exocytosis of lymphocytes overwhelms the degree of intercellular edema usually seen with spongiotic dermatitides dysproportionate exocytosis Figure 2.
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A noteworhty feature was the occurrence of dysproportionate exocytosis in MF cases as compared to mimickers This finding correlates with the frequency of spongiosis detected in MF cases. In the same time it confirms that spongiosis may not be a truly exceptional event in early MF, but when joined by a dysproportionate number of lymphocytes in the epidermis, it may even multiple basal cell papillomas a feature of MF. Another notable observation regards the presence of Pautrier multiple basal cell papillomas, defined as collections of intraepidermal lymphocytes devoid of spongiosis.
Their presence correlates well with MF, since this feature was recorded in none of the control cases. They represent clusters of Langerhans cells that have been described before as pseudo-Pautrier abscesses, and usually appear in association with inflammatory dermatoses Their occurrence should not be regarded as a histopathologic clue for MF. Besides their cytologic features, the pseudo-Pautrier collections commonly develop in a background of spongiosis, a feature that may help in their discrimination from real Pautrier microabscesses, which are devoid of spongiosis.
Although traditionally linked to cutaneous lym- Figure 2. Atypical MF lymphocytes have been clasically described as having a convoluted, cerebriform nucleus, sometimes large, hyperchromatic, with a perinuclear halo. We tried to independently asses all these features in our study, and observed that less than one quarter of MF cases showed at least one form of lymphoid atypia Figure 3.
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The single most frequent atypical wart treatment thuja in the control group was the perinuclear halo, which can be possibly interpreted as a processing artefact.
Together with hyperchromasia, it had no discriminatory value between MF and mimicker groups. Cerebriform cells, despite being classicaly related to MF, were spotted in just two cases of our study, suggesting that their appearance is an exceptionally rare event in practice.
One reason for that may be of technical nature, since cell morphology can be influenced by section thickness, tissue processing protocol, staining etc. The occurrence of hypertrophic lymphocytes was the most reliable feature of atypia, reaching statistical significance Lymphocyte atypia in MF: a Hypertrophic and hyperchromatic tumoral lymphocytes at the dermalepidermal junction; b Cerebriform lymphocytes in dermal infiltrate.
We defined dermal reaction as changes induced by the presence of lymphoid infiltrate and included in this category some features such as papillary dermal fibrosis, papillary dermal edema, purpura and pigmented macrophages melanophages and siderophages Figure 4.
Multiple basal cell papillomas might be determined by the interaction of tumoral cells and their cytokine secretion with matrix proteins and matrix remodelation Edema of the papillary dermis was deemed unusual in MF by other investigators, although it was recorded in some of our MF cases.
For example, in the largest series of MF cases to date, Massone et al. The presence of papillary dermal edema in All other dermal reaction changes did not reach statistical significance between the groups. An interesting finding is the occurence of extravazated erythrocytes and siderophages in some early MF cases, usually those cases with poikilodermatous changes.
Purpura was seen with similar frequency in both our groups.
When attempting a histopathologic diagnosis, the presence of siderophages naturally brings into question the possibility of a pigmented purpuric dermatosis PPD. In some patients, MF and PPD have been shown to coexist 29a finding challenged by other investigators 11 MF in appropriate clinical setting. But similar patterns of inflamation can be manifested in cutaneous biopsies of secondary syphilis, actinic reticuloid, lichen simplex chronicus among others, thus the architectural criteria alone are insufficient for papilloma virus vaccino maschietti diagnosis of MF On the other hand, a strictly perivascular jejuni bacteria is rather common in reactive dermatoses and make MF unlikely, unless epidermotropic features or atypical lymphocytes are obvious.
When looking at the composition of dermal infiltrate, there were 6 biopsies in MF group Similarly, eosinophils were recorded in There was no statistical difference between gropus, meaning that the presence of low numbers of eosinophils in the dermal infiltrate could not be used as a histopathologic criterion to certainly rule out early MF.
None of the mimicker cases showed higher number of eosinophils. A reason for the relative paucity of eosinophils in the mimickers group might be the multiple basal cell papillomas that cases with overtly more eosinophils in the infiltrate were not selected, because they did not fulfill the criteria of histopathological mimickers of MF. Contrary to our finding, Dalton et al. An argument for the presence of eosinophils in some of our early MF lesions might be unknown previous treatment of lesions with topical multiple basal cell papillomas, Figure 4.
Regarding the distribution of the dermal infiltrate Figure 5the lichenoid pattern defined as a dense, band-like infiltrate in the upper dermis correlated well with MF lesions The presence of a dense lichenoid infiltrate usually explains the palpable papillomavirus et accouchement of the plaquetype MF lesions, and when seen in biopsies along with other architecutral changes, like psoriasiform epidermal hyperplasia, can be highly indicative of Figure 5.
All subtypes of epidermotropism gained high specificity for early MF, but their sensitivity was usually low to be used as pivotal diagnostic criteria. Although, in theory, lymphocyte atypia is traditionally considered a valid histopathologic clue for cutaneous lymphoma, the occurrence of cytologic features may vary depending on tissue processing and staining protocols.
Additionally, our study showed that morphologic criteria routinely assigned to reactive conditions, such as spongiosis, eosinophils and purpura with siderophages, were present in similar degrees in both case groups and may not allow differentiation of MF from mimickers. Despite recent advancements in the field of cutaneous lymphoma, evaluating biopsies from suspected cases of MF in its early stages and rendering a definitive diagnosis remain challenging tasks.
Provided the biopsy is accompanied by comprehensive clinical history, good description of the multiple basal cell papillomas, clinical pictures and efficient communication with reffering physician, we believe that a diagnosis of MF can be made with confidence.
In certain cases, however, relying just on histopathologic criteria might prove erroneous, since there is no single criterion sensitive and specific enough to discriminate between multiple basal cell papillomas MF and a pletora of reactive inflammatory rashes.
This work is licensed under a Creative Commons Attribution 4.
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High resolution imaging tehniques for trichodystrophies in Netherton syndrome. This hair shaft anomaly is not constantly present and it can be associated with other anomalies like trichorrhexis nodosa or pili torti.
According to some recent studies, the HPV infection may also increase the risk of cardiovascular diseases. Strains of HPV 16 and 18 are strains with a high multiple basal cell papillomas risk, known to cause almost all cases of cervical cancer while also increasing the risk to develop oropharyngeal cancer. Structura HPV women. Fig 1. Structure of HPV According to the CDC The Center for Disease Control and Prevention statistics from the United States of America, the genital HPV poate crete riscul de dezvoltare a mai multor infection is the most frequent STI sexually tipuri de cancer, precum cancerul colului uterin, transmitted infection ; this is because those over penisului, vaginului, anusului sau orofaringelui 40 types which may infect the genital region partea oral a faringelui .
Methods: We retrospectively analyzed hair samples from patients diagnosed with NS over the past 10 years in the Dermatology Clinic Timisoara by using scanning electron microscopy.
The samples were of scalp hair, eyebrows, eyelashes and pubic hair.
We also evaluated some of these samples with trichoscopy and confocal microscopy. Results: The scanning electron microscopy results multiple basal cell papillomas that trichorrhexis invaginata was evident in all cases, multiple basal cell papillomas by trichorrhexis nodosa and pili torti respectively. In these patients there was more than one type of trichodystrophy present at the same time.
All of these modifications were perceptible with the confocal scanning microscope and by trichoscopy. Discussion: The electron microscopy helps by supplying three-dimensional images of the hair shaft, thus enabling the observation of the hair samples with a greater clarity and sharpness than through classical methods. Also reflectance confocal microscopy and trichoscopy have proven to be very useful in the diagnosis of hair shaft anomalies.
Introducere: Tricorexis invaginata este tricodistrofia patognomonică pentru sindromul Netherton. Aceasta nu este prezentă în mod constant și poate fi asociată cu alte anomalii ale firului de păr, cum ar fi tricorexis nodosa sau pili torti. Metode: Prin folosirea microscopiei electronice, am analizat mostre de fire de păr provenite de la pacienți diagnosticați cu sindrom Netherton în Clinica de Dermatologie Timișoara în ultimii 10 ani.
Acestea au fost prelevate atat de la nivelul scalpului cat și sprâncenelor, genelor și părului pubian. Unele dintre aceste mostre au fost analizate și prin tricoscopie și microscopie confocală.
Rezultate: Tricorexis invaginata a fost prezentă la toți pacienții, fiind urmată ca frecvență de tricorexis invaginata și pili torti.