No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Occupational dermatitis in workers exposed to detergents, disinfectants, and antiseptics
Abstract
Anti-infective prevention has led to a significant use of disinfectants, detergents, and antiseptics in various areas of activities. Most of these products are skin irritants and allergens, which can cause skin disorders in exposed workers. The authors conducted a descriptive and retrospective study on occupational dermatitis diagnosed at an occupational dermatology hospital consultation service, targeting exposed workers in the health, food, and cleaning industries. These included 20.9% (61 of 291) of the patients seen at this consultation. An occupational origin was proven for 50 of these 61 patients. The most frequent dermatoses were irritant contact dermatitis (42%) and allergic contact dermatitis (26.3%). The main allergens were disinfectants and antiseptics (26.3%), especially quaternary ammoniums, aldehydes, and nickel. Patients exposed to disinfectants, detergents, and antiseptics in the workplace represent an important part (about 1 of 5) of occupational dermatology consultations, although factors may be contributory. Prevention and knowledge are necessary for this increasing issue.
... Quaternary ammonium compounds (quats) are a family of chemicals that possess antimicrobial properties. As a result, quats have found application as antiseptics, disinfectants, detergents, and preservatives in a wide range of products that span from performance textiles (Musante 2016) to cleaners and disinfectants (Loddé et al., 2012;Gonzalez et al., 2014). The presence of quats in consumer and commercial products raises the potential for human exposure (Dao et al., 2012). ...
... Spraying, wiping, and washing surfaces such as floors and countertops or medical devices (e.g. instruments), and skin cleansing with products that contain certain quats are associated with allergic or irritant asthma and contact dermatitis among healthcare, food preparation, and cleaning workers as well as the general public (Bernstein et al., 1994;Burge and Richardson 1994;Kieć-Świerczyńska and Kręcisz 2000;Purohit et al., 2000;Nettis et al., 2002;Jowsey et al., 2007;Suneja and Belsito 2008;Loddé et al., 2012;Gonzalez et al., 2014). Specifically, exposure to benzalkonium chloride (BAC) and benzethonium chloride (BEC) quats has been associated with asthma and dermatitis (Bernstein et al., 1994;Burge and Richardson 1994;Kieć-Świerczyńska and Kręcisz 2000;Purohit et al., 2000;Nettis et al., 2002;Benjamin et al., 2012;Dao et al., 2012). ...
This method was designed for sampling select quaternary ammonium (quat) compounds in air or on surfaces followed by analysis using ultraperformance liquid chromatography tandem mass spectrometry. Target quats were benzethonium chloride, didecyldimethylammonium bromide, benzyldimethyldodecylammonium chloride, benzyldimethyltetradecylammonium chloride, and benzyldimethylhexadecylammonium chloride. For air sampling, polytetrafluoroethylene (PTFE) filters are recommended for 15-min to 24-hour sampling. For surface sampling, Pro-wipe® 880 (PW) media was chosen. Samples were extracted in 60:40 acetonitrile:0.1% formic acid for 1 hour on an orbital shaker. Method detection limits range from 0.3 to 2 ng/ml depending on media and analyte. Matrix effects of media are minimized through the use of multiple reaction monitoring versus selected ion recording. Upper confidence limits on accuracy meet the National Institute for Occupational Safety and Health 25% criterion for PTFE and PW media for all analytes. Using PTFE and PW analyzed with multiple reaction monitoring, the method quantifies levels among the different quats compounds with high precision (<10% relative standard deviation) and low bias (<11%). The method is sensitive enough with very low method detection limits to capture quats on air sampling filters with only a 15-min sample duration with a maximum assessed storage time of 103 days before sample extraction. This method will support future exposure assessment and quantitative epidemiologic studies to explore exposure-response relationships and establish levels of quats exposures associated with adverse health effects.
... In general, health effects from cleaning products have been more studied in the occupational setting (Habib et al. 2006). Results from epidemiologic studies suggest that professionals' use of bleach, toilet cleaners, multi-purpose cleaners, and cleaning sprays may cause respiratory and skin problems (Medina-Ramon et al. 2003, 2004Henneberger 2005;Mirabelli et al. 2007;Bello et al. 2009;Lynde et al. 2009;Zock et al. 2009Zock et al. , 2010Quirce and Barranco 2010;Vizcaya et al. 2011;Arif and Delclos 2012;Loddé et al. 2012). The main compounds identified as being responsible for skin and respiratory problems are disinfectants, preservatives, fragrances, and solvents (Medina-Ramon et al. 2003, 2004Henneberger 2005;Mirabelli et al. 2007;Bello et al. 2009;Lynde et al. 2009;Magnano et al. 2009;Zock et al. 2009Zock et al. , 2010Quirce and Barranco 2010;Vizcaya et al. 2011;Arif and Delclos 2012;Loddé et al. 2012). ...
... Results from epidemiologic studies suggest that professionals' use of bleach, toilet cleaners, multi-purpose cleaners, and cleaning sprays may cause respiratory and skin problems (Medina-Ramon et al. 2003, 2004Henneberger 2005;Mirabelli et al. 2007;Bello et al. 2009;Lynde et al. 2009;Zock et al. 2009Zock et al. , 2010Quirce and Barranco 2010;Vizcaya et al. 2011;Arif and Delclos 2012;Loddé et al. 2012). The main compounds identified as being responsible for skin and respiratory problems are disinfectants, preservatives, fragrances, and solvents (Medina-Ramon et al. 2003, 2004Henneberger 2005;Mirabelli et al. 2007;Bello et al. 2009;Lynde et al. 2009;Magnano et al. 2009;Zock et al. 2009Zock et al. , 2010Quirce and Barranco 2010;Vizcaya et al. 2011;Arif and Delclos 2012;Loddé et al. 2012). ...
In recent years, more attention has been paid to exposure of the general population to household products. In order to assess exposure, it is necessary to generate exposure data. For this reason, a preliminary study of dishwashing liquid contact on Brest university students was performed. Dishwashing liquid is frequently used and when it is improperly mixed it can liberate harmful molecules. As for university students, they may have a repetitive contact with dishwashing liquid during their academic studies. Relevant parameters as frequency of dishwashing, duration, and amount of dishwashing liquid were assessed from questionnaires and laboratory tests. Tests revealed that overall no difference between the sexes and the type of residential household on dishwashing was present on this population. Amount of washed items and duration was significantly correlated, which could seem logical but remarkable considering the lack of correlation between other parameters. Values of 1.39 and 58.8 μg/kg bw/day for the 95th percentile of dermal and inhalation probabilistic exposure were found, respectively. Dermal exposure coincides with deterministic published data. In the case of inhalation exposure no published data are available. Higher inhalation exposure value may show that dermal exposure is diminished by high dilution of dishwashing liquid in water.
... In general, health effects from cleaning products have been more studied in the occupational setting (Habib et al. 2006). Results from epidemiologic studies suggest that professionals' use of bleach, toilet cleaners, multi-purpose cleaners, and cleaning sprays may cause respiratory and skin problems (Medina-Ramon et al. 2003, 2004Henneberger 2005;Mirabelli et al. 2007;Bello et al. 2009;Lynde et al. 2009;Zock et al. 2009Zock et al. , 2010Quirce and Barranco 2010;Vizcaya et al. 2011;Arif and Delclos 2012;Loddé et al. 2012). The main compounds identified as being responsible for skin and respiratory problems are disinfectants, preservatives, fragrances, and solvents (Medina-Ramon et al. 2003, 2004Henneberger 2005;Mirabelli et al. 2007;Bello et al. 2009;Lynde et al. 2009;Magnano et al. 2009;Zock et al. 2009Zock et al. , 2010Quirce and Barranco 2010;Vizcaya et al. 2011;Arif and Delclos 2012;Loddé et al. 2012). ...
... Results from epidemiologic studies suggest that professionals' use of bleach, toilet cleaners, multi-purpose cleaners, and cleaning sprays may cause respiratory and skin problems (Medina-Ramon et al. 2003, 2004Henneberger 2005;Mirabelli et al. 2007;Bello et al. 2009;Lynde et al. 2009;Zock et al. 2009Zock et al. , 2010Quirce and Barranco 2010;Vizcaya et al. 2011;Arif and Delclos 2012;Loddé et al. 2012). The main compounds identified as being responsible for skin and respiratory problems are disinfectants, preservatives, fragrances, and solvents (Medina-Ramon et al. 2003, 2004Henneberger 2005;Mirabelli et al. 2007;Bello et al. 2009;Lynde et al. 2009;Magnano et al. 2009;Zock et al. 2009Zock et al. , 2010Quirce and Barranco 2010;Vizcaya et al. 2011;Arif and Delclos 2012;Loddé et al. 2012). ...
In recent years, more attention has been paid to exposure of the general population to household products. In order to assess exposure, it is necessary to generate exposure data. For this reason, a preliminary study of dishwashing liquid contact on Brest university students was performed. Dishwashing liquid is frequently used and when it is improperly mixed it can liberate harmful molecules. As for university students, they may have a repetitive contact with dishwashing liquid during their academic studies. Relevant parameters as frequency of dishwashing, duration, and amount of dishwashing liquid were assessed from questionnaires and laboratory tests. Tests revealed that overall no difference between the sexes and the type of residential household on dishwashing was present on this population. Amount of washed items and duration was significantly correlated, which could seem logical but remarkable considering the lack of correlation between other parameters. Values of 1.39 and 58.8 μg/kg bw/day for the 95th percentile of dermal and inhalation probabilistic exposure were found, respectively. Dermal exposure coincides with deterministic published data. In the case of inhalation exposure no published data are available. Higher inhalation exposure value may show that dermal exposure is diminished by high dilution of dishwashing liquid in water.
... In general, health effects from cleaning products have been more studied in the occupational setting (Habib et al. 2006). Results from epidemiologic studies suggest that professionals' use of bleach, toilet cleaners, multi-purpose cleaners, and cleaning sprays may cause respiratory and skin problems (Medina-Ramon et al. 2003, 2004Henneberger 2005;Mirabelli et al. 2007;Bello et al. 2009;Lynde et al. 2009;Zock et al. 2009Zock et al. , 2010Quirce and Barranco 2010;Vizcaya et al. 2011;Arif and Delclos 2012;Loddé et al. 2012). The main compounds identified as being responsible for skin and respiratory problems are disinfectants, preservatives, fragrances, and solvents (Medina-Ramon et al. 2003, 2004Henneberger 2005;Mirabelli et al. 2007;Bello et al. 2009;Lynde et al. 2009;Magnano et al. 2009;Zock et al. 2009Zock et al. , 2010Quirce and Barranco 2010;Vizcaya et al. 2011;Arif and Delclos 2012;Loddé et al. 2012). ...
... Results from epidemiologic studies suggest that professionals' use of bleach, toilet cleaners, multi-purpose cleaners, and cleaning sprays may cause respiratory and skin problems (Medina-Ramon et al. 2003, 2004Henneberger 2005;Mirabelli et al. 2007;Bello et al. 2009;Lynde et al. 2009;Zock et al. 2009Zock et al. , 2010Quirce and Barranco 2010;Vizcaya et al. 2011;Arif and Delclos 2012;Loddé et al. 2012). The main compounds identified as being responsible for skin and respiratory problems are disinfectants, preservatives, fragrances, and solvents (Medina-Ramon et al. 2003, 2004Henneberger 2005;Mirabelli et al. 2007;Bello et al. 2009;Lynde et al. 2009;Magnano et al. 2009;Zock et al. 2009Zock et al. , 2010Quirce and Barranco 2010;Vizcaya et al. 2011;Arif and Delclos 2012;Loddé et al. 2012). ...
... When skin disorders and allergy symptoms were combined into a single illness category, significant associations were observed for alcohol, bleach, glass cleaner, and detergent use, but not for perox-ide and quaternary ammonium compounds. Detergent use is well documented to be a risk factor for allergic dermatitis in healthcare workers [60][61][62]. Overall, this investigation, in combination with the others cited previously, demonstrates a strong connection between skin, allergy, and respiratory illness, particularly among those exposed in an occupational setting. However, the relationship with cleaning product use is confounded by other factors. ...
Healthcare facility staff use a wide variety of cleaning and disinfecting products during their daily operations, many of which are associated with respiratory or skin irritation or sensitization with repeated exposure. The objective of this study was to characterize the prevalence of cleaning and disinfection product use, glove use during cleaning and disinfection, and skin/allergy symptoms by occupation and identify the factors influencing glove use among the healthcare facility staff. A questionnaire was administered to the current employees at a midwestern Veterans Affairs healthcare facility that elicited information on cleaning and disinfection product use, glove use during cleaning and disinfection, skin/allergy symptoms, and other demographic characteristics, which were summarized by occupation. The central supply/environmental service (2% of the total survey population) and nursing occupations (licensed practical nurse: 3%, nurse: 26%, nursing assistant: 3%, other nurses: 10% of the total survey population, respectively) had the highest prevalence of using cleaning or disinfecting products, specifically quaternary ammonium compounds, bleach, and alcohol. Glove use while using products was common in both patient care and non-patient care occupations. The factors associated with glove use included using bleach or quaternary ammonium compounds and using cleaning products 2–3 or 4–5 days per week. A high frequency of glove use (≥75%) was reported by workers in most occupations when using quaternary ammonium compounds or bleach. The use of alcohol, bleach, and quaternary ammonium compounds was associated with skin disorders (p < 0.05). These research findings indicate that although the workers from most occupations report a high frequency of glove use when using cleaning and disinfection products, there is room for improvement, especially among administrative, maintenance, and nursing workers. These groups may represent populations which could benefit from the implementation of workplace interventions and further training regarding the use of personal protective equipment and the potential health hazards of exposure to cleaning and disinfecting chemicals.
... Detergents, surfactants, disinfectants, and antiseptics are common causes of occupational dermatitis-both ICD (42%) and ACD (26.3%) [25]. Shampoos contain the irritating chemical sodium lauryl sulfate and related detergents. ...
Contact dermatitis accounts for 95% of occupational skin disorders. Irritant contact dermatitis (ICD) is often caused by cumulative exposure to weak irritants, accounting for 80% of all cases of contact dermatitis. ICD can co-exist with atopic dermatitis (AD) and allergic contact dermatitis (ACD). Patients with AD and ACD may have a lower inflammatory threshold for developing ICD. Therefore, it needs to be distinguished from lesions of AD and ACD. ICD Patients report stinging and burning in excess of pruritus. Pruritus is classically reported by patients with AD and ACD. ICD lesions are typically well-demarcated unlike AD and ACD. ICD is diagnosed by exclusion. Patients undergo testing to rule out type I and type IV hypersensitivity. Negative results suggest a diagnosis of ICD. Management consists of irritant identification and avoidance with regular emollient use. Although ICD is more common in certain occupations, genetics and environment play significant roles in its development.
... Fathi [9] reported that 90-95% of work related dermatoses are contact dermatitis, and 91.1% of occupational contact dermatitis are irritant contact dermatitis. Loddé [10] showed that the number of irritant contact dermatitis is higher than that of allergic contact dermatitis among cases of dermatitis due to occupational origin. ...
... However, Paris et al. (2012) suggested that quaternary ammonium compounds may contribute to work-related asthma. In addition, quaternary ammonium compounds may also be associated with dermatitis, which could be an issue if people wear a mask coated with these compounds (Lodde et al. 2012). Although these two studies did not report concentration in the working solution or how the workers applied these compounds in detail, these health issues warrant further study. ...
Surgical face masks are commonly used by the general public in indoor environments. However, masks could be contaminated, resulting in secondary microbial infections when they act as touchable fomites. Therefore, we evaluated the ability and durability of a covalently bound antimicrobial surfactant coated onto mask surfaces before use to reduce the bacterial burden upon exposure to aerosols. With regard to bacteria that settled onto the mask surface, this antimicrobial product provided >99.3% efficiency for all three tested bacterial species. In addition, the antimicrobial ability of the coated mask maintained efficacy at least one week after coating. For bioaerosols that came into contact with the mask (103 CFU/m3), the antimicrobial agent reduced the average colony rates by 91.8%, but the rates decreased with increased bioaerosol concentrations. Moreover, regardless of whether the coated mask was processed with the bioaerosol penetration test or the National Institute for Occupational Safety and Health (NIOSH) certified sodium chloride aerosol test, the filtration performance of the surgical mask was not significantly altered. These results demonstrate that this antimicrobial product has a durable inhibitory activity for the reduction of bacterial burdens on masks.
... In most countries, women have higher representation in wetwork occupations such as housekeeping, nursing, hairdressing and floristry, compared with men, and this might be a reason for their higher prevalence of hand dermatitis [37,38]. Hand dermatitis in 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 women is also more common among younger women in their 20s, compared with older age groups [36,39]. ...
Wet-work can be defined as activities where workers have to immerse their hands in liquids for more than two hours per shift, or wear waterproof (occlusive) gloves for a corresponding amount of time, or wash their hands more than twenty times per shift. This review considers the recent literature on wet-work exposure, and examines wet-work as a main risk factor for developing irritant contact dermatitis of the hands. The aim of this paper is to provide a detailed description of wet-work exposure among specific occupational groups who are extensively dealing with water and other liquids in their occupations. Furthermore, it highlights the extent and importance of the subsequent adverse health effects caused by exposure to wet-work.
... Patients exposed to detergents, disinfectants and antiseptics represent an important proportion of occupational dermatology consultations (2). N,N-didecyl-N-methylpoly(oxyethyl) ammonium propionate is a quaternary ammonium compound that is used for disinfecting surgical instruments and as a wood preservative, owing to its low corrosiveness. ...
Background: Irritant contact dermatitis (ICD) is an occupational disease that involves non-immunological inflammatory mechanisms of the skin, resulting from a response to exposure to irritants, physical, or biological. ICD disease often occurs in car wash employees who are exposed to laundry soap containing sulfate. Most of the factors that cause ICD are the length of exposure to chemicals or from the workers themselves such as knowledge, use of personal protective equipment, and personal hygiene. The purpose of this study was to determine the effect of using personal protective equipment (PPE) and exposure to sulfate content of car wash soap on the incidence of ICD in car wash employees in the city of Malang with and without a history of skin disease. Method: The research method uses an analytic observational research type with a cross sectional design. The samples studied were 84 respondents who were car wash employees in the city of Malang, both those who had a history of skin diseases (39 respondents) and those who did not have a history of skin diseases (45 respondents). Data were analyzed using univariate and bivariate tests with SPSS application. Results: The results of the chi square test showed that there were significant differences in risk factors (p < 0.05) on the incidence of ICD. Conclusion: The conclusion of this study is there is an effect of the use of PPE and exposure to sulfate content on the incidence of ICD in car wash employees in the city of Malang with and without a history of skin diseases.
The frequency of surface disinfectant use has increased over the last several years in public settings such as schools, especially during the COVID‐19 pandemic. Although these products are important for infection control and prevention, their increased use may intensify the exposure to both persons applying the disinfection product as well as bystanders. Safety assessments have demonstrated that these products, when used as intended, are considered safe for use and effective; however, point‐of‐contact effects (such as respiratory or dermal irritation) may still occur. Additionally, relative exposures may vary significantly due to the wide variation in disinfectant formulation and application methods. Quantitative estimations of exposures to two commonly used active ingredients, quaternary ammonium compounds (QACs) and ethanol, are not well characterized during product use and application scenarios. To assess the potential for health risks attributable to increased use in classroom settings, as well as to quantitatively evaluate the potential exposure to both ethanol and QACs, student and adult bystander surface and air measurements were collected in a K‐8 school setting in Ohio, United States, over a three‐day period. Direct‐reading instruments were utilized to collect real‐time air samples that characterized mass fraction concentrations following the use of the QAC‐ and ethanol‐based disinfectants. Furthermore, surface and air sampling of microbial species were conducted to establish the overall bioburden and effectiveness of each disinfectant to inform the comparative risk and health effect impacts from the tested products use scenario. Both tested products were approximately equally effective at reducing bioburdens on desk surfaces. In some classrooms, concentrations of QAC congeners were significantly increased on desk surfaces following the application of the disinfectant spray; however, the magnitude of the change in concentration was small. Ethanol was not measured on surfaces due to its volatility. Airborne concentrations increased immediately following spray of each disinfectant product but rapidly returned to baseline. Each of the QAC congeners listed in the product safety data sheets were detected and measurable on desk surfaces; however, air concentrations were generally below the limit of detection. The 15‐min time‐weighted averages (TWAs) of both QACs and ethanol in the air were below respective health effects benchmarks, and therefore, the negative impact on health outcomes is considered to be minimal from short‐term, repeated use of ethanol‐ or QAC‐based spray products in a school setting when the products are used as directed.
Facial contact dermatitis is frequently encountered in medical practice in both male and female patients. Identifying the underlying cause can be challenging, and the causative agent may be overlooked if it is not considered during the assessment of a patient. The two main types of contact dermatitis are irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD). The mechanisms and common causative agents vary for both ICD and ACD, but the clinical picture is often similar, particularly for chronic disease. Facial contact dermatitis can be successfully treated by avoiding the causative agent. In this review, we focus on the clinical assessment of a patient with facial contact dermatitis and the mechanisms of both ICD and ACD. Common causative agents, including emerging allergens, are discussed in detail, and suggestions are made regarding the management of patients with proven ICD or ACD of the face.
Formalin-fixed, paraffin-embedded tissue sections from 45 patients with mammary and extramammary Paget's disease were stained immunohistochemically with the use of a polyclonal antiserum directed against a 14-amino acid segment of the cerbB-2 oncoprotein. Positive membrane staining, which correlates with gene amplification, was found in 15 of 19 cases (79%) of mammary Paget's disease, 4 of 13 cases (31%) of vulvar Paget's disease, none of 8 cases of scrotal Paget's disease, and none of 5 cases of perianal Paget's disease. Of the 19 patients with mammary Paget's disease, specimens of underlying breast tissue were available from 14; all contained a concurrent ductal adenocarcinoma. Concordance of c-erbB-2 antigen staining between the underlying breast carcinomaand the pagetoid component was observed in 12 cases. Of the 13 patients with vulvar Paget's disease, 2 had superficial stromal invasion, and 3 had underlying, deeply invasive adenocarcinomas. One superficially invasive case was positive for c-erbB-2 expression. One additional case of vulvar Paget's disease had an associated primary pagetoid endocervical adenocarcinoma that spread into the endometrium; both the endocervical and vulvar components stained positively for the c-erbB-2 antigen. The results of this study indicate that the c-erbB-2 oncoprotein may play a role in the pathogenesis of extramammary Paget's disease. These results also suggest that the c-erbB-2 oncoprotein may function in vivo to promote intraepithelial spread of adenocarcinoma cells.
4 Resumo: O carcinoma verrucoso é uma rara e indolente forma do carcinoma espinocelular descrita por Ackerman em 1948. Sua localização preferencial é a cavidade oral. Clinicamente manifesta-se como lesão verrucosa, de progressivo e lento crescimento e bom prognóstico. O tratamento de escolha é a exérese cirúrgica, devendo o paciente ser regularmente acompan- hado devido ao risco de recorrências. Palavras-chave: carcinoma de células escamosas; carcinoma de células escamosas/diagnóstico; carcinoma de células escamosas/patologia. Abstract: Verrucous carcinoma is a rare and indolent variant of the squamous cell carci - noma described by Ackerman in 1948. The oral cavity is a most common site. Clinically, it presents most often as a slow-growing verrucous lesion. The prognosis is good. Treatment of choice is surgery. Patients require frequent reevaluation because recurrences may occur.
Paget’s disease (PD) is an uncommon intraepithelial neoplasm first described by Sir James Paget in 1874 as nipple ulceration associated with an underlying breast carcinoma mass.1 There are two different subtypes of PD; one occurs in the nipple, which is called mammary Paget’s disease (MPD), and the other occurs in other sites and is better known as extramammary Paget’s disease (EMPD).1,2
The origin of the neoplasm is not yet entirely understood, and there are several hypotheses concerning the origin of Paget’s cells. Some authors suggest that EMPD has an intraepidermal origin from adnexal structures, specifically from apocrine glands2 or multipotent stem cells in the epidermal basal layer3. On the other hand, the origin of MPD is believed to originate from an intraductal cancer that has spread by upward migration to the nipple.4
PD predominantly affects white women between 50 and 80 years old.5–7 Clinically, the disease presents as an erythematous well-demarked plaque, and the surface may have a scaly, grayish crust with erosion and ulceration. In some cases, pruritus and pain are found.4,7–11 The diagnosis is confirmed by a biopsy that presents a thickened epidermis, with papilomatosis, enlargement of the interpapillary ridges, hyperkeratosis or parakeratosis on the surface,11 and the characteristic Paget’s cells with a clear abundant cytoplasm.12 The cytoplasm of those cels are Acid-Schiff stain (PAS) positive and diastase resistant, whch indicates the presence of neutral polysaccharides and supports the glandular origin of the cels.12 Staining with antibodies to carcinoembryonic antigen (CEA), low molecular weight cytokeratin (Cam 5.2), and cytokeratin 7 (CK7) are also positive, they are markers of glandular epithelium .3,4,8–10,12
MPD treatment is well established, as 80–98% of the cases are associated with ductal carcinoma. Surgical intervention is decided according to the oncological indication for the ductal carcinoma of the breast.8,9,13 It consists of the resection of the MPD with free margins.4,8–13 The MPD prognosis is good, with a low recurrence rate.4,12,13,14
Even though the standard treatment for EMPD is also surgical, with intraoperatory margin control, the prognosis is not satisfactory, and there is a high recurrence rate.5,15,16 For these reasons, new treatments, such as radiotherapy, CO2 laser, Imiquimod and others, are being investigated. However, none of them has shown to be effective for treatment in most cases.5–7,15
The objective of this study was to analyze the clinical evolution and interventions on patients with Paget’s disease followed in our ambulatory clinic between January 1991 and December 2007.
This study was aimed to test if the frequency of oral lesions bears statistical correlation or not with the condition of cutaneous psoriasis.
Two groups were examined, one made up of 166 patients with skin psoriasis and the other with the same number of individuals with a negative history of skin diseases (control group), matched by age, race, and sex. Patients with psoriasis were grouped according to their having localized or generalized forms of the disease. The oral mucosa was thoroughly examined in both groups. Data were analyzed using chi-square test, Fisher's test, the odds ratio (OR) with a 95% confidence interval (CI), and the Ryan-Holm step-down Bonferroni procedure. The overall significance was set at P < or = 0.05.
The oral lesions significantly associated with psoriasis were fissured tongue (FT, OR = 2.7; 95% CI: 1.3-5.6), and geographic tongue (GT, OR = 5.0; 95% CI: 1.5-16.8). Other factors analyzed, such as topical and/or systemic medication for treatment of psoriasis versus nontreated patients, and localized versus generalized forms of psoriasis presented no statistical association with the frequency of FT or GT lesions (p>0.05).
Patients with psoriasis presented no specific oral lesion different from those seen in the control group. Although further investigation is warranted to establish whether or not either FT or GT can be characterized as an oral expression of psoriasis, the present investigation did find for both these types of lesions that the frequency of each bore a statistically significant relation with the presence of cutaneous psoriasis.
Wound healing in certain individuals leads to the development of keloid tumors which exhibit abnormal collagen metabolism and an increased abundance of extracellular matrix components. Comparison of fibronectin levels in fibroblasts derived from keloids and normal dermis revealed a relative increase in intracellular and extracellular fibronectin in the keloid-derived cells. While fibronectin was similarly processed, compartmentalized, and degraded by both cell types, fibronectin biosynthesis was found to be accelerated as much as fourfold in keloid fibroblasts due to a corresponding increase in the amount of accumulated fibronectin mRNA. These changes account for the elevated steady-state level of the molecule in keloid fibroblasts and suggest that increased fibronectin in keloid lesions is due to overproduction by the wound-healing fibroblasts. Glucocorticoid treatment stimulated fibronectin biosynthesis in both normal and keloid fibroblasts. However, the amount of stimulation was less for the keloid-derived cells, indicating a limitation on maximal rates of fibronectin biosynthesis. These observations suggest that separate mechanisms act to control basal and maximal rates of fibronectin production. Biosynthesis of the 140-kilodalton fibronectin receptor was also found to be increased in keloid fibroblasts, suggesting some level of coordinate regulation for fibronectin and fibronectin receptor expression.
O câncer de boca e orofaringe é de comportamento agressivo e, no Brasil, a incidência é considerada uma das mais altas do mundo, sendo o mais comum da região de cabeça e pescoço. OBJETIVO: O objetivo deste trabalho é analisar os aspectos clínico-epidemiológicos dos pacientes e a evolução da doença. FORMA DE ESTUDO: Clínico retrospectivo. CASUÍSTICA E MÉTODO: Foram arrolados 43 casos de carcinoma espinocelular (CEC) de boca e 25 de orofaringe do Serviço de Cirurgia de Cabeça e Pescoço da Santa Casa de Misericórdia de Santos e do Hospital Ana Costa entre os anos de 1997 a 2000. Informações sobre idade, sexo, profissão, raça, hábitos de tabagismo e etilismo, uso de prótese dentária, origem do encaminhamento do paciente ao tratamento, localização da lesão, estadiamento clínico, grau de diferenciação histológica, tratamento, sobrevida e presença de segundo tumor primário foram analisados estatisticamente pelo Teste Exato de Fischer. RESULTADOS: Dos pacientes com CEC em boca, a relação de incidência masculino-feminino foi de 3,35:1, a idade variou de 46 a 91 anos (mediana de 62), 90,7% eram caucasianos, 81% foram referenciados por profissionais médicos, 76,8% eram tabagistas, 74% etilistas, 79% não utilizavam prótese dentária. O sítio mais acometido foi a língua (51,1%), 53% apresentaram-se nos estádios III e IV, 72,1% eram de grau histológico II, 53% foram tratados por cirurgia e 47% por cirurgia e radioterapia adjuvante e 9,3% apresentaram segundo tumor primário. Para a orofaringe, a relação masculino-feminino foi de 11,5:1, com idade entre 40 e 81 anos (mediana de 58), 92% eram caucasianos, 92% foram encaminhados por médicos, 84% eram tabagistas, 80% etilistas, 52% não utilizavam prótese, as tonsilas palatinas foram o sítio mais acometido (76%), 96% estavam em estádios III e IV, 84% eram de grau II, 80% foram tratados por cirurgia associada a radioterapia, 16% a cirurgia para resgate de falha após radioterapia e 4% a cirurgia exclusiva e 8% tiveram segundo primário. Não houve relação estatisticamente significativa entre o estadiamento e os hábitos de tabagismo, etilismo e uso de prótese. Tais hábitos, a faixa etária e o grau histológico não tiveram relação significativa com o sítio do tumor. Estavam vivos e livres de doença 69,7% dos pacientes com tumor de boca e 22% de orofaringe. CONCLUSÃO: O médico ou dentista que dá o atendimento inicial é fundamental no reconhecimento das lesões, para que se possa estabelecer o diagnóstico precoce.
Paget's disease (PD) of the skin is characterized by intraepidermal adenocarcinoma cells, which contain clear cytoplasm and abundant mucin. Nearly all cases of mammary PD (MPD) are associated with underlying ductal carcinoma of the breast, whereas in the majority of cases of extramammary PD (EMPD) no underlying regional malignancy is identified. Mucins are high molecular weight glycoproteins produced by epithelial cells. Different mucin genes are expressed in various types of tissues such as mammary glands, intestinal mucosa, and adnexal structures of the skin. We studied the immunohistochemical expression of apomucin MUC1, MUC2, MUC5AC in MPD, and EMPD. MUC1 is commonly expressed in most cases of PD. MUC5AC is a unique mucin that is exhibited in the majority of cases of EMPD, but not in any MPD. Of the 13 patients with MPD who all had associated breast ductal carcinoma, both Paget cells and underlying ductal carcinoma exhibited the phenotype (MUC1+MUC2−MUC5AC−). This mucin phenotype is also expressed by Toker cells, which have been identified in the epidermis of five of 50 nipples in mastectomies without MPD. Of the three patients with perianal PD who all had associated rectal adenocarcinoma, Paget's cells expressed MUC2 constantly but expressed MUC1 and MUC5AC variably. Seven patients with intraepidermal vulvar PD and two patients with scrotal–penile PD had no identifiable underlying malignancy. Paget cells from all of these nine cases of EMPD expressed a uniform phenotype of mucin (MUC1+MUC2−MUC5AC+). One case of vulvar PD associated with underlying apocrine carcinoma had a phenotype (MUC1+MUC2−MUC5AC−) identical to that of normal apocrine glands. The skin appendage and Bartholin's glands from 20 normal-appearing vulvar skin samples and anal glands from 10 hemorrhoidectomies were also studied. Only Bartholin's gland expressed a mucin phenotype identical to that of intraepidermal EMPD. The results of the present study indicate that 1) MPD may arise from either mammary glands or epidermal Toker cells, 2) intraepidermal EMPD in the anogenital areas may arise from ectopic MUC5AC+ cells originating from Bartholin's or some other unidentified glands, and 3) unique expression of MUC2 in perianal PD indicates its origin from colorectal mucosa. We conclude that the study of mucin gene expression is useful in identifying the histogenesis of PD.
IntroductionPigmented Paget's disease of the breast is an uncommon disease. Histology shows intraepidermal pagetoid cells positive for cytokeratin 7. We report a difficult case with an atypical clinic presentation as a pigmented lesion and unusual immunohistochemical results such as absence of expression of cytokeratin 7 (CK7).ObservationA 68-year-old woman presented a heterogeneous pigmented lesion on the left nipple extending to the areola, over a period of six years. Histologic study of biopsy showed intraepidermal proliferation of atypical cells positive for melanocytic markers but negative for CK7. The clinicopathological features were consistent with malignant lentigo. Nevertheless, histological study of the whole lesion after complete surgical excision was in favour of mammary Paget's disease, while CK7 remained negative.DiscussionPigmented Paget's disease of the breast is infrequent, with only a few cases reported in the literature and is suggestive of malignant melanoma or pigmented metastasis of mammary adenocarcinoma. Immunohistochemistry is necessary, especially using CK7 staining, which is usually positive (sensitivity of almost 100%), except in some rare cases such as ours. In these difficult cases, study of a wider panel of antibodies may be necessary for diagnosis.
Pigmented mammary Paget's disease is a rare variant of mammary Paget's disease. The clinical appearance mimics malignant melanoma. This paper describes a case of asymptomatic, slightly pigmented spots on the right mammary nipple. The pigmented nipple was histopathologically diagnosed as mammary Paget's disease with an underlying intraductal carcinoma. This case suggests the importance of conducting skin biopsies of developing pigmented spots on the nipples in elderly people.
Topical vitamin D3 analogues are a mainstay of treatment in mild to moderate plaque psoriasis. Vitamin D3 analogues exert their effect in psoriasis via binding nuclear vitamin D3 receptors on genes involved in cellular proliferation, differentiation and inflammation. Currently available synthetic vitamin D3 analogues include calcipotriol, maxacalcitol, tacalcitol and calcitriol. These agents are only minimally systemically absorbed and therefore have few systemic side effects. Local irritation is the most frequently noted side effect and can be managed by combining vitamin D3 analogues with other topical or systemic therapies, such as topical corticosteroids or narrow-band UVB phototherapy. The use of a vitamin D agent helps improve the efficacy of topical corticosteroids for psoriasis and helps minimize the potential for adverse events associated with topical corticosteroid treatment. Care should be taken when combining with other topical therapies due to potential inactivation of either agent. Topical vitamin D3 analogues can be a cost-effective addition to a psoriasis treatment regimen, especially when compliance is encouraged by the tolerability of these agents and more costly systemic agents are avoided.
Accurate clinicopathologic correlation can be crucial to arriving at the correct microscopic diagnosis.
We reviewed the clinical information provided on the dermatopathology requisition forms for melanocytic lesions submitted by community dermatologists.
The clinical information provided and the microscopic diagnoses rendered were recorded in a retrospective, unblinded fashion for 100 consecutive melanocytic lesions submitted as wet tissue to our dermatopathology department.
Biopsy specimens were received from 60 community dermatologists and 5 nurse practitioners/physician assistants. Clinical morphology (ie, papule) was provided in 33% of cases. With respect to the ABCDE criteria, 55% of cases had none, 12% had one criterion, 21% had two criteria, 10% had 3 criteria, 2% had 4 criteria, and none had all 5 criteria. No forms stated whether the biopsy specimen was a partial or complete sampling of the lesion. Asymmetry was provided 4% of the time, border irregularity 8%, color 39%, diameter 22%, and evolution 10%. A family or personal history of melanoma was provided in 8% of cases. No requisition forms mentioned the "ugly duckling" sign. Dermatoscopy information and a clinical photograph were provided once each. In 19 cases, the only information on the requisition form was one of the phrases: "r/o atypia," "r/o atypical nevus," "r/o Clark's," or "r/o dysplastic nevus." In 10 cases, the only information was "r/o nevus."
Only 100 consecutive melanocytic lesions were studied in a retrospective, unblinded fashion.
Important clinical information regarding pigmented lesions is often not provided on the requisition form. Potential reasons for this deficit and suggestions for improvement are discussed.
James Paget 1,2 was born in 1814, one of seventeen children. He studied at St. Bartholomew's Hospital, where he made-his first original observation. Small, hard specks were often seen at that time in muscle and he became very curious as to their nature. Since St. Bartholomew's did not have a microscope, he traveled to the British Museum, and discovered Trichinella spiralis. In 1842, he began to assist in the cataloguing of the College of Surgeons' Museum. In the next year, he was given the lectureship in physiology at St. Bartholomew's, and was appointed Warden of the new residential college for medical students of that hospital. His lectures attracted increasing numbers of students, and ultlmately he was made assistant surgeon.
Pigmented Paget's disease is a rare variant that is often confused clinically and histologically with melanoma in situ. Herein, we describe a case of pigmented extramammary Paget's disease involving the axilla of a 79-year-old white male thought initially to represent malignant melanoma clinically and histologically. Review of the literature reveals that pigmented variant of Paget's disease, either mammary or extramammary, could be initially misdiagnosed as melanoma unless this entity is considered in the differential diagnosis, and additional confirmatory studies are performed.
Pigmented mammary and extramammary Paget disease are rare entities in both males and females that mimic melanoma both clinically and histologically. Furthermore, Paget disease can be associated with increased number of benign melanocytes, thus resulting in additional diagnostic difficulty, especially when only hematoxylin and eosin-stained sections are examined and a limited immunohistochemical study is performed. Using standard hematoxylin and eosin-stained sections and routine immunohistochemical studies, we describe and characterize 7 cases of pigmented extramammary and mammary Paget disease. In all cases, malignant epithelial cells showed intracytoplasmic pigment, along with an immunohistochemical epithelial phenotype. In 2 of the cases, immunohistochemistry revealed numerous dendritic processes positive for melanocytic markers, thus resulting in an initial diagnosis of melanoma. Careful analysis confirmed that the immunolabeling corresponded to cytoplasmic labeling of melanocyte dendrites surrounding tumor cells. The correct diagnosis of pigmented Paget disease can be reached after close histologic examination and detailed evaluation of immunohistochemical studies. The latter are especially important in some extraordinary cases in which there may be an associated intraepithelial melanocytic hyperplasia.
We report a unique case of Paget's disease of vulva and breast. Sequentially the patient had invasive ductal carcinoma of the breast, 5 years later was diagnosed with vulvar Paget's with underlying adenocarcinoma and after another 2 years was diagnosed with Paget's disease of the breast.
A 58-year-old woman with invasive ductal cancer of the left breast was treated with lumpectomy, lymph node dissection, radiation therapy and tamoxifen. Five years later and after complaints of longstanding vulvar pruritus, the patient was diagnosed with vulvar Paget's disease and treated with simple vulvectomy, which revealed a concurrent underlying adenocarcinoma. Subsequently there was recurrence of vulvar malignancy and wide local excision was performed. Seven years after the initial diagnosis of the breast cancer, a biopsy of a left areolar red, ulcerated lesion revealed Paget's disease of the breast.
Physicians need to be cognizant of the rare occurrence of mammary and extramammary Paget's disease with underlying malignancies in both locations. A thorough physical examination including biopsy is essential for early detection and appropriate management.
Since the initial description in 1874,1 mammary Paget disease has remained a rare disease that accounts for 1% to 5% of all breast cancers and may be associated with underlying breast malignant neoplasm.2,2- 4 It is uncommon in men. To our knowledge, only 1 other case of the disease occurring in a man has been reported in the absence of an underlying breast carcinoma.3
Dendritic cells (DC) are the most potent antigen-presenting cells of the organism. They are specialized to capture, process, and present antigen via the MHC class II as well as the MHC class I pathways to CD4+ and CD8+ T cells, respectively. This results in T cell-mediated immune responses that are likely to counteract the generation and propagation of tumors in vivo. Therefore, we studied the distribution of dendritic cells in mammary Paget's disease. Paraffin-embedded samples of Paget's disease of the breast (n=27) and of disease-free epidermis of the nipple (n=10) were investigated immunohistochemically for the presence of dendritic cells, in particular of Langerhans cells, using antibodies against S-100, CD1a, and HLA-DR, as well as novel reagents against Langerin/CD207, DC-LAMP/CD208 and p55 (Fascin), the latter two being specific for mature dendritic cells. Paget samples presented a decrease of CD1a+, S-100+, and Langerin+ intraepidermal Langerhans cells in almost all cases. This was paralleled by a concentration of immature dendritic cells in the tumor-infiltrated tissue itself. Similar to infiltrating breast carcinoma we observed a marked increase of DC-LAMP+ and p55+ mature dendritic cells in the corial tissue beneath the tumor. These cells were almost always found in ribbon-like or nodular lymphocytic infiltrates. Moreover, rare mature dendritic cells were also found in the Paget cell-infiltrated epidermis of the nipple, i.e. in the tumorous lesion itself. These findings may indicate an effective ongoing anti-tumor immune response in this part of spreading breast cancer.
Of 100 cases of Paget's disease of the breast admitted to the National Career Institute of Milan from 1940 to 1974, 91 were statistically evaluated. They were divided in two groups according to presence or absence of a palpable nodule. The results of surgical treatment in terms of 5 and 10 year survival rates were 59 and 44%, respectively, with a median survival of 9 years. For the two separate subgroups, those with a palpable nodule were 38 and 22% for 5 and 10 years, respectively, while those without a palpable nodule were 92 and 82% for 5 and 10 years, respectively. For the two groups the median survival was 3.6 and 16.4 years, respectively. The extent of surgery should be dependent on the presence of absence of palpable nodules under the nipple. For the two groups (with and without) extended radical mastectomy and the Patey-Dawson mastectomy are recommended.
Fibroblasts were isolated from keloid, normal skin, and normal scar and maintained in tissue culture for four passages. Growth kinetics were the same for all groups on days 2 through 12. However, the rate of collagen synthesis per fibroblast was greater in keloid derived cells than any controls at all growth phases. Keloid fibroblasts have an autonomous capacity to synthesize collagen at a significantly increased level in vitro, which may explain in part why these lesions are characterized by increased collagen deposition.
We have reviewed a series of 585 scalp biopsies taken for histologic evaluation of hair loss and have looked for syringoma-like eccrine sweat duct proliferation. This feature was found in 6 specimens with scarring alopecia and one each with alopecia areata and female-pattern alopecia. Syringoma-like sweat duct proliferation appears to play no role in the etiology of hair loss.
A case of bilateral Paget's disease of the breast in a 74-year-old woman is reported. The clinicopathological features of the case are presented and the rarity of this clinical entity is reviewed.
Eruptive syringoma is a rare variant of syringoma that appears on anterior surfaces of the body, including the neck, chest, and arms. Textbooks state that this eccrine-derived tumor arises at puberty. We describe four cases of eruptive syringoma that began in childhood. We review the literature on this entity and suggest that the disorder typically presents between the ages of 4 and 10 years. Eruptive syringoma is a benign tumor that should be considered among the papular dermatoses of childhood.
Two cases of perioral psoriasis are described. A brief review of various dermatologic conditions that should be included in the differential diagnosis is included.
The clinical course and morphologic (light and ultrastructural) characteristics of a case of verrucous carcinoma of the lower gingival mucosa are presented. Clinical course of the patient was unfavorable following surgery (supposedly incomplete) and radiotherapy (6,000 R) of the tumor. The therapeutic factors that may influence an unfavourable prognosis are commented upon, especially in regard to a slow-growing neoplasm with a generally good course.
Regulation of collagen gene expression was studied in keloids and fibroblast cultures established from keloid biopsies from 9 patients. The collagen concentration in keloid tissue was not different from that in normal skin. The activities of 2 enzymes catalyzing intracellular collagen biosynthesis, prolyl 4-hydroxylase (PH) and galactosylhydroxylysyl glucosyltransferase (GGT) were significantly elevated in the keloids, the mean increase in the former enzyme being 5-fold and in the latter 3-fold with respect to the controls. The mean procollagen production rate in the keloid fibroblasts was at the control level, with only 1 keloid cell line showing a procollagen synthesis rate higher than the mean value + 2 SD of the controls. The mean PH and GGT activities of the keloid fibroblasts were not elevated, but PH activity in 2 cell lines and GGT activity in 1 cell line were higher than the mean + 2 SD for the controls. Cellular type I, III, IV, and V procollagen mRNAs were measured by slot blot hybridization using specific human cDNA clones for the various collagen types. The amounts of type I, III, and V procollagen mRNAs corresponded to the ratios in which these collagen types are produced by fibroblasts. No synthesis of type IV procollagen mRNA by keloid fibroblasts was observed. The total amount of type I and III procollagen mRNAs correlated significantly (p less than 0.01) with the procollagen synthesis rate measured after radioactive labeling of the cells in the keloid and control fibroblasts, indicating that collagen production in these cells is mainly controlled by regulating the final steady state levels of collagen mRNA. The results suggest that fibroblasts isolated from keloids often synthesize normal amounts of collagen.
A 73-year-old man presented with a skin-colored, asymptomatic, 3-mm papule on the right infraorbital region of the face. The duration of the lesion was not known. A clinical diagnosis of papilloma was made. The patient did not have any other skin lesions. Past and family history were noncontributory. A simple excision of the lesion was performed. Histologic examination of the papule revealed two lesions next to each other: the first one consisted of an intradermal nevus, the second, of a typical syringoma (Fig. 1).
Verrucous carcinoma is a well-defined variant of the squamous cell carcinoma. Although it is reported to be rare in the Scandinavian countries, 16 cases have been diagnosed in the Southern part of Norway from 1975 to 1982. The clinical and histological characteristics were investigated. The most common site of occurrence was the mandibular alveolar ridge. The average age was 71 years, and unlike most other series of verrucous carcinoma, there was a female predominance and use of tobacco seemed to be the exception. The patients mainly complained of ill-fitting dentures. Adequate surgical excision appears to be the treatment of choice.
Eruptive hidradenoma, a rare type of syringoma, was studied histologically, histochemically, and electron microscopically in two patients. In spite of its peculiar clinical differences, such as occurrence of numerous lesions with limited distribution to anterior surfaces of the body, it showed features identical to the eyelid type syringoma. Direct connections were found between the lesions and epidermis and between individual lesions, but not between the lesions and underlying eccrine secretory segments. Also, cystic or tubular spaces were lined with an "immature eccrine intra-epidermal type" of epithelium which possessed a periluminal tonofilament band, lysosomes, keratohyaline granules, and often underwent complete keratinization. No secretory epithelium was found in the lesion. Dermal histiocytes with typical Langerhans cell granules and collagen fiber bundles were seen in parenchyma. It seemed that the lesion was undergoing constant destruction and regeneration.
The psoriasiform lesions, including psoriasis, Reiter's syndrome, and geographic tongue, are discussed. The entity of “ectopic geographic tongue” is given special attention, and eight new cases are presented. Two examples of oral psoriasis and two examples of oral lesions of Reiter's syndrome are also reported. The similarities, differences, and possible relationship of these diseases are discussed.
Psoriasis of the lips was observed in a 54-year-old female who had suffered from psoriasis vulgaris for 18 years. The psoriasis of the lips was preceded by protrusion of the upper teeth. Topical corticosteroid and later 5-fluorouracil treatment were ineffective. The disease recurred even after replacement of the vermilion by plain mucosa. The disease was successfully treated by replacement of the protruding teeth by a nonirritating prosthesis.Copyright © 1982 S. Karger AG, Basel
Immunophenotypes of mammary (MPD) and extramammary Paget's disease (EPD) are still not well understood. Thirty-four formalin-fixed paraffin-embedded tissue sections from 33 patients with 6 MPD and 28 EPD were studied immunohistochemically with the use of polyclonal c-erbB-2 and pS2 antisera, and monoclonal nm23, B6.2, GCDFP-15, and p53 antibodies. Cases of MPD expressed a high incidence of c-erbB-2 and nm23 compared with those of EPD (100% vs. 29%; p < 0.01, and 83% vs. 29%; p < 0.05, respectively). Although high expression of B6.2 (> 83%) and moderate expression of GCDFP-15 (33-39%), pS2 (33-46%) and p53 (39-50%) were seen, the positivity was not significantly different between MPD and EPD. These findings indicate that MPD and EPD share immunohistochemical features but partially differ in their patterns of antigen expression.
Paget's disease of the breast generally affects middle-aged and older females. In the majority of cases, it is considered to be the result of epidermal spread from a contiguous mammary duct carcinoma. We report the first case in an adolescent female with an accessory nipple. The histomorphology and immunophenotypic findings support the hypothesis of in situ transformation and suggest a histologic spectrum exists in terms of cytologic atypia.
Paget's disease of the nipple is a rare lesion nearly always associated with an underlying breast cancer, clinically impalpable and radiologically undetectable in about 40% of the patients. Fourty-four cases (28 mastectomies and 16 biopsies of the nipple) of Paget's disease of the nipple without clinically and radiologically detectable breast tumor were retrospectively studied by means of histochemistry and immunohistochemistry. Histochemical study showed that Paget cells were PAS positive and diastase resistant, and alcian blue positive at pH 2.5 in 32% and 18%, respectively. Immunohistochemical study showed that Paget cells were EMA and c-erbB-2 positive in 100% and 84%, respectively. Four of the six EMA positive and c-erbB-2 negative cases of Paget's disease of the nipple in which the underlying tumor could be pathologically analyzed were associated with ductal carcinoma in situ of cribriform or mixed types. These findings are helpful for differentiating Paget's disease from other lesions of the nipple, namely Bowen's disease and eczema which do not react with both antibodies, and from nipple adenoma which exhibits a positive staining with anti-EMA antibody and no reactivity with anti-c-erbB-2 antibody.
Syringomas may be at least partially under estrogen and/or progesterone influence, as they are more common in women and are known to proliferate at puberty. During pregnancy and the premenstrual period an increase in tumor size has also been described. We examined nine syringomas using immunohistochemical markers for estrogen (ER) and progesterone (PR) receptors. Scattered tumor cells displaying nuclear and cytoplasmic staining for ER were noted in one of the nine cases. Intense nuclear and cytoplasmic staining for PR was noted in most (> 80%) of the neoplastic cells in 8/9 syringoma cases. Current immunohistochemical evidence supports the theory that syringomas are under hormonal control.
Verrucous carcinoma is a slowly growing, well-differentiated neoplasm with a predilection for the oral cavity.
Data on the association of human papillomavirus (HPV) with oral verrucous carcinoma are very scarce. We searched for the presence of HPV in different stages of the tumour in a patient repeatedly treated by means of surgery, cryotherapy, radiotherapy and chemotherapy over a decade.
HPV DNA was detected in archival tumour tissue by nested PCR. HPV types were identified based on restriction fragment analysis.
HPV type 11 was found in 1 early-stage and HPV 16 in 2 late-stage biopsy specimens of the tumour.
Our findings provide further evidence for a role of HPV in oral verrucous carcinoma. The case history emphasizes the importance of a joint clinicopathological approach to this tumour.
Although syringoma of the eyelids and the cheeks are well known and defined, vulvar syringoma is a rare clinical variant of this benign eccrine tumor. A case of syringoma of the vulva exacerbated during pregnancies with regression in the periods in between is presented. Histopathological examination showed typical features of syringomas. Only 20 patients with vulvar syringoma have been previously reported in the literature.
Cell cycle checkpoints are regulatory pathways that control the order and timing of cell cycle transitions and ensure that
critical events such as DNA replication and chromosome segregation are completed with high fidelity. In addition, checkpoints
respond to damage by arresting the cell cycle to provide time for repair and by inducing transcription of genes that facilitate
repair. Checkpoint loss results in genomic instability and has been implicated in the evolution of normal cells into cancer
cells. Recent advances have revealed signal transduction pathways that transmit checkpoint signals in response to DNA damage,
replication blocks, and spindle damage. Checkpoint pathways have components shared among all eukaryotes, underscoring the
conservation of cell cycle regulatory machinery.
Neoplastic transformation of lichen planus is a rare event. However, squamous cell carcinoma may develop in 0.3%–3% of patients with the oral form of the disease. On the other hand, less than 30 cases arising in cutaneous lichen planus have been reported, and only four cases of verrucous carcinoma in association with either form, one with an oral lesion and three with cutaneous lesions (one hypertrophic and one ulcerative).
This report describes the unusual progression of a hypertrophic lichen planus plaque of the right leg to a verrucous carcinoma in a 40-year-old woman.
We report the first case of synchronous Paget's disease of the vulva and breast diagnosed within a period of 7 months. This is the fourth case of mammary Paget's disease associated with either preceding or following vulvar Paget's disease documented in the literature. With consideration of increasing age of the population, and the fact that vulvar Paget's disease affects elderly women and that breast cancer is the most common malignancy of women in the United States, one can anticipate the occurrence of these two conditions to be more prevalent in the future.