bcl-2 Protein expression in melanocytic neoplasms of the skin

Journal of the American

262

Academy

Pearls of wisdom

Fasciitis (not scleroderma) longed exposure to an organic roethylene)

following prosolvent (trichlo-

Waller PA, Clauw D, Cupps T, et al. J Rbeutnatol 1994;21:1567-70. Two cases of diffuse fasciitis with eosinophilia (eosinophilic fasciitis) occurring after exposure to trichloroethylene are described. One patient was exposed through contaminated underground well water. The second patient was a physicist who was exposed via contact with his skin. The syndrome described was similar to the eosinophilia-myalgia syndrome. COMMENT:Trichloroethylene should be added to the list of chemicals that can induce a sclerodermoid syndrome.

Jefrey P. Callen, MD

Pyoderma gangrenosum psoriatic arthritis

in association

Smith DL, White CR Jr. Arthritis

Rheurn

with 1994;

37: 1258-60. Two episodes of pyoderma gangrenosum were described in conjunction with active psoriatic arthritis. Although pyoderma gangrenosum has regularly been reported in conjunction with rheumatoid-like arthritis (either seronegative or seropositive) and enteropathic arthropathy, it has not been previously reported with psoriatic arthritis. Therapeutic issues could be of interest in such a patient; however, this patient’s pyodemra gangrenosum responded to corticosteroids and the psoriasis did not flare.

of Dermatology August 1995

eruptions include a mixed infiltrate of lymphocytes, eosinophils, and neutrophils in the papillary dermis and, in some cases, an increase in the number of dermal macrophages, which may be strikingly large and contain ingested elastin. Because patients receiving GM-CSF may also be receiving several other medications such as antibiotics, the presence of enlarged dermal macrophages is an important clue to the diagnosis of GM-CSF-induced eruptions.

Clay J. Cockerell, MD

Immunoreactivity ous lymphomas

for bcL2 protein in cutanein lymphoid hyperplasias

Triscott JA, Ritter JH, Swanson BE, et al. J Cutan Path01 1995;22:2-10 The B-cell leukemia/lymphoma gene (bcl-2) produces a unique protein product believed to protect lymphoid cells from apoptosis. This gene is frequently rearranged in nodal follicular lymphomas as well as in diffuse lymphoproliferations. In this study, the authors examined cutaneous lymphoid intiltrates and cutaneous malignant lymphomas by means of immunohistochemistry to determine whether this protein is expressed in benign as well as malignant lesions. Stains detected this protein in 58% of the malignant lymphomas and 33% of cutaneous lymphoid hyperplasias. Both primary and secondary cutaneous lymphomas stain positively for bcl protein. They concluded that immunoperoxidase stains for bcl protein are of little help in separating benign from malignant cutaneous lymphoid infiltrates or primary from secondary cutaneous lymphomas.

Clay J. Cockerell, MD

Jeeey P. Callen, MD

bcl-2 Protein Report of three cases of cutaneous reactions granulocyte macrophage-colony-stimulating factor and a review of the literature Scott GA. Am J Dermatopathol

to

1995;17:107-14.

Granulocyte-macrophage colony-stimulating factor (GM-CSF) is a cytokine used to stimulate the growth and maturation of granulocytes and macrophages in a variety of clinical settings. Cutaneous side effects of GM-CSF therapy include local erythematous urticarial reactions at the site of injection as well as diffuse morbilliform eruptions that usually arise within 3 days after administration of the medication. These resolved within 10 days after the medication had been discontinued. Histologic features of

plasms

expression of the skin

Ramsay JA, From 1995;8: 143-9.

L,

in melanocytic Kahn

HJ.

Mod

neoPath01

The authors evaluated the expression of bcl-2 protooncogene protein products in benign and malignant melanocytic neoplasms of the skin. bcl-2 Protein is the product of a proto-oncogene situated on chromosome 18 coding an intramitochondrial protein that protects cells from apoptosis or programmed cell death. Translocations in the gene juxtaposing it with the immunoglobulin heavy chain gene on chromosome 14 is associated with human B-cell lymphomas. Intense study has been conducted in several neoplasms evaluating the expression of this proto-onco-

Journal of the American Academy of Dermatology Volume 33, Number 2, Part 1

gene. In this article, the authors found high expression of bcl-2 in both benign and malignant melanocytic neoplasms with a loss of bcl-2 protein expression with increasing tumor progression. Whether bcl-2 protein has prognostic significance in melanocytic neoplasms remains unanswered. This study seems to indicate that its expression may be widespread and somewhat nonspecific. Clay J. Cockerell, MD

UV-irradiated melanocytic melanoma in situ Tronnier N, Wolff 1995;1:1-7.

HH.

nevus simulating Am

J Dermatopathol

The authors evaluated morphologic and histologic changes in 12 nevi from 10 patients, the changes occurred after a single episode of UV irradiation. They observed melanocytes at and above the derrnoepidermal junction simulating melanoma in situ in three lesions. Increased expression of -45 antigen was also noted, which is indicative of an activation of melanocytes. In some cases, UV irradiation of nevi may lead to histologic findings that simulate melanoma, which should be kept in mind when these lesions are evaluated. Clay J. Cockerell, MD

The incidence of common and atypical melanocytic nevi in randomly selected healthy individuals Dabkowski J, Omuleci A, Kot P. Przegl Dermatol 1994;81;318-23 (Polish) Three hundred healthy people 21 to 80 years of age (17 1 women, 129 men) were examined for common and atypical melanocytic nevi. The average number of common melanocytic nevi was 15.2 per person, identical in both sexes, with the highest number of them noted in the age group 31 to 40 years (mean, 25.9 years). In men the number of common melanocytic nevi averaged 6.7; women had less (11.6). Most common melanocytic nevi were seen on the trunk and upper extremities. Light complexion, eyes, and hair all correlated positively with the number of common nevi, as did a history of intense solar exposure. No moles were seen in 22 persons (7.3%). Atypical melanocytic nevi were found in only 6.6% of those examined (one to four nevi per person). The average number of common melanocytic nevi among those with one or more atypical melanocytic nevi was 37.8. Robert A. Schwartz, MD, MPH

Pearls of wisdom

263

Role of scatter factor in the pathogenesis AIDS-related Kaposi sarcoma

of

Naidu YM, Rosen EM, Zitnick R, et al. Proc Nat1 Acad Sci USA 1994;91:5281-5. Scatter factor, an angiogenic cytokine that stimulates cell motility, was found in large quantities in medium conditioned with type II human T-cell leukemia virus (HTLV-I&infected T cells that induces the conversion of endothelial cells to Kaposi’s sarcoma (KS) tumor celllike phenotype. They also found that scatter factor was a mitogen for KS cells in vitro and was present within KS cells in vivo. The scatter factor receptor, c-met proto-oncogene, was found to be expressed by KS cells both in vitro and in vivo. In addition, antibodies against scatter factor blocked the HTLV-II CM angiogenicity. This work showed that T cells activated by retrovirus infection produce scatter factor in large amounts. The authors propose that scatter factor may play a role in both initiation and maintenance of Kaposi’s sarcoma. Retrovirus infection of T cells causes these cells to produce scatter factor locally, stimulating endothelial cells to migrate nearby and become factor XlIIa-positive, c-met-expressing, spindleshaped Kaposi’s sarcoma cells that further expand the neovascularization by producing cytokines and promoting the autocrine- and paracrine-mediated growth of Kaposi’s sarcoma cells. COMMENT:Scatter factor, which is identical to hepatocyte growth factor, is another cytokine that be important in the pathogenesis of Kaposi’s sarcoma. Robert A. Schwartz, MD, MPH

Treatment of HIV-related hairy leukoplakia with podophyllum resin 25% solution Gowdey G, Lee RK, Carpenter WM. Oral Surg Oral Med Oral Path01 Oral Radio1 Endod 1995;79:64-7. Ten HIV-seropositive patients with bilateral hairy leukoplakia on the tongue were treated unilaterally with podophyllin resin 25% solution. Treated and untreated areas were examined several times thereafter by a blinded investigator. Significant resolution of the treated side was noted on days 2,7, and 30; the most significant improvement was noted on day 2 after treatment. Side effects of treatment were minimal; these included burning sensation, bad or altered taste, and pain, which occurred immediately after application and resolved quickly. These authors conclude that the single application of podophyllin resin 25% solution is efficacious in the short-term alleviation of hairy leukoplakia. Neal S. Penneys, MD