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Anaplastic large cell lymphoma presenting as a soft-tissue mass mimicking sarcoma
Journal of the American Academy of Dermatology Volume 32, Number 6
Pearls
COMMENT: Salicylate intoxication in children has occurred primarily from accidental ingestion and is now rare because of childproof caps. This report reminds us of the possibility of salicylate poisoning from application of salicylic acid-containing preparations. Cases of toxicity from ointment application have occurred in children with ichthyosis or psoriasis, possibly related to the associated erythroderma. Clinical signs in infants include vomiting, tachypnea, seizures, coma, and, rarely, paralysis. Periodic examination of salicylate levels is warranted in infants and young children treated with salicylatecontaining ointment for generalized skin disorders.
Amy S. Paller, MD
Immunohistochemical expression melanomas and intradermal nevi
of BCL-2
Saenz-Santamaria MC, Reed JA, McNutt al. J Cutan Path01 1994;21:393-7.
in
NS, et
The BCL-2 gene is an oncogene involved in tumorigenesis by blocking apoptosis (programmed cell death) that is thought to promote neoplasia by preventing death of neoplastic cells, thereby allowing unchecked growth. The authors evaluated a seriesof primary and metastatic melanomas as well as intradermal melanocytic nevi for expression of BCL-2 using a monoclonal antibody directed to BCL-2 protein. They found that normal melanocytes, nevi, and melanoma cells all expressed the protein, although melanoma cells demonstrated variable but weak staining. Expression of Ki-67, a proliferation antigen, was restricted to melanomas. They concluded that expression of BCL-2 could not be involved in malignant transformation of melanocytes because of its widespread expression. COMMENT: Expression of BCL-2 has received significant attention of late since it was first shown to be overexpressed in follicular B-cell lymphomas associated with a 14; 18 translocation. Studies have been ongoing to determine whether this can be used as a marker for malignancy. Unfortunately, as with many “malignancy markers,” there is significant nonspecificity and, as shown in this article, expression by normal cells.
Clay J. Cockerell, MD
Anaplastic soft-tissue
of wisdom 1045
large cell lymphoma presenting mass mimicking sarcoma
Bueso-Ramos CE, Pugh WC, Path01 1994;7:497-500.
Butler
as a
JJ. Mod
A 79-year-old man had a 2 cm nodule above the left elbow. Histopathologic examination of an incisional biopsy specimen suggested the diagnosis of malignant fibrous histiocytoma, but the correct diagnosis was determined to be anaplastic largecell Ki-1 lymphoma in the reexcision specimen. Anaplastic large-cell Ki-1 lymphoma may rarely present as a solitary soft tissue nodule composed of elongate, pleomorphic cells that resemble sarcoma cells. Myxoid areas, a storiform pattern of cell growth and bizarre tumor giant cells typical of malignant fibrous histiocytoma, are usually absent. The neoplastic cells stain with antibodies to leukocyte common antigen (CD45), pan-T cell markers, and BerH2 (CD30). Alvin R. Solomon, MD
Potential biological effects following dose interventional procedures
high X-ray
Wagner LK, Eifel PJ, Geise RA. J Vast Intervent Radio1 1994;5:71-84. Skin injuries have been reported to occur after extended exposures to fluoroscopy during interventional therapeutic procedures, such as embolization of aneurysms and arteriovenous malformations. Temporary epilation and erythema may occur with lower doses and moist desquamation, ulceration, and dermal necrosis at higher doses. Skin injury may be delayed for several weeks after the exposure. Typical threshold doses are approximately 3 Gy (300 rad) for temporary epilation, 6 Gy (600 rad) for erythema, and 15 to 20 Gy (1500-2000 rad) for ulceration and necrosis. Fluoroscopic exposure times longer than 1 hour can result in skin injury. Protocols need to be developed to ensure that the radiation dose to any skin site remains below the threshold for skin injury. Elizabeth A. Abel, MD
Pearls
COMMENT: Salicylate intoxication in children has occurred primarily from accidental ingestion and is now rare because of childproof caps. This report reminds us of the possibility of salicylate poisoning from application of salicylic acid-containing preparations. Cases of toxicity from ointment application have occurred in children with ichthyosis or psoriasis, possibly related to the associated erythroderma. Clinical signs in infants include vomiting, tachypnea, seizures, coma, and, rarely, paralysis. Periodic examination of salicylate levels is warranted in infants and young children treated with salicylatecontaining ointment for generalized skin disorders.
Amy S. Paller, MD
Immunohistochemical expression melanomas and intradermal nevi
of BCL-2
Saenz-Santamaria MC, Reed JA, McNutt al. J Cutan Path01 1994;21:393-7.
in
NS, et
The BCL-2 gene is an oncogene involved in tumorigenesis by blocking apoptosis (programmed cell death) that is thought to promote neoplasia by preventing death of neoplastic cells, thereby allowing unchecked growth. The authors evaluated a seriesof primary and metastatic melanomas as well as intradermal melanocytic nevi for expression of BCL-2 using a monoclonal antibody directed to BCL-2 protein. They found that normal melanocytes, nevi, and melanoma cells all expressed the protein, although melanoma cells demonstrated variable but weak staining. Expression of Ki-67, a proliferation antigen, was restricted to melanomas. They concluded that expression of BCL-2 could not be involved in malignant transformation of melanocytes because of its widespread expression. COMMENT: Expression of BCL-2 has received significant attention of late since it was first shown to be overexpressed in follicular B-cell lymphomas associated with a 14; 18 translocation. Studies have been ongoing to determine whether this can be used as a marker for malignancy. Unfortunately, as with many “malignancy markers,” there is significant nonspecificity and, as shown in this article, expression by normal cells.
Clay J. Cockerell, MD
Anaplastic soft-tissue
of wisdom 1045
large cell lymphoma presenting mass mimicking sarcoma
Bueso-Ramos CE, Pugh WC, Path01 1994;7:497-500.
Butler
as a
JJ. Mod
A 79-year-old man had a 2 cm nodule above the left elbow. Histopathologic examination of an incisional biopsy specimen suggested the diagnosis of malignant fibrous histiocytoma, but the correct diagnosis was determined to be anaplastic largecell Ki-1 lymphoma in the reexcision specimen. Anaplastic large-cell Ki-1 lymphoma may rarely present as a solitary soft tissue nodule composed of elongate, pleomorphic cells that resemble sarcoma cells. Myxoid areas, a storiform pattern of cell growth and bizarre tumor giant cells typical of malignant fibrous histiocytoma, are usually absent. The neoplastic cells stain with antibodies to leukocyte common antigen (CD45), pan-T cell markers, and BerH2 (CD30). Alvin R. Solomon, MD
Potential biological effects following dose interventional procedures
high X-ray
Wagner LK, Eifel PJ, Geise RA. J Vast Intervent Radio1 1994;5:71-84. Skin injuries have been reported to occur after extended exposures to fluoroscopy during interventional therapeutic procedures, such as embolization of aneurysms and arteriovenous malformations. Temporary epilation and erythema may occur with lower doses and moist desquamation, ulceration, and dermal necrosis at higher doses. Skin injury may be delayed for several weeks after the exposure. Typical threshold doses are approximately 3 Gy (300 rad) for temporary epilation, 6 Gy (600 rad) for erythema, and 15 to 20 Gy (1500-2000 rad) for ulceration and necrosis. Fluoroscopic exposure times longer than 1 hour can result in skin injury. Protocols need to be developed to ensure that the radiation dose to any skin site remains below the threshold for skin injury. Elizabeth A. Abel, MD