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Localized hypertrichosis associated with traumatic panniculitis
P7761
P8578
Immunohistochemical expression of cytokeratin 15, cytokeratin 19, follistatin, and Bmi-1 in basal cell carcinoma Seunghyun Sohng, MD, Yeungnam University Medical Center, Daegu, South Korea; Byeongsu Kim, Yeungnam University Medical Center, Daegu, South Korea; Donghoon Shin, Yeungnam University Medical Center, Daegu, South Korea; Jinhwa Choi, Yeungnam University Medical Center, Daegu, South Korea; Jongsoo Choi, Yeungnam University Medical Center, Daegu, South Korea; Youngkyung Bae, Yeungnam University Medical Center, Daegu, South Korea
Merkel cell carcinoma in association with benign follicular structures: Report of 2 cases Julia Shlyankevich, MD, Massachusetts General Hospital, Boston, MA, United States; Daniel Lantz, MD, University of Washington Department of Medicine Division of Dermatology, Seattle, WA, United States; Evan George, MD, University of Washington Department of Clinical Pathology, Seattle, WA, United States; Galina Stetsenko, MD, University of Washington Department of Medicine Division of Dermatology, Seattle, WA, United States; Paul Nghiem, MD, PhD, University of Washington Department of Medicine Division of Dermatology, Seattle, WA, United States; Stevan Knezevich, MD, VA Medical Center Department of Anatomic and Clinical Pathology, Seattle, WA, United States Background: Merkel cell carcinoma (MCC) is a rare and aggressive tumor often presenting as a small painless nodule on sun-exposed skin. Positive staining for cytokeratin 20 (CK20) in a perinuclear dot like staining pattern on immunohistochemistry is an important diagnostic tool that helps differentiate this neoplasm from other small basaloid tumors. MCC arising within benign adnexal tumors or cysts is exceedingly rare. We describe 2 cases of this phenomenon.
Backgrounds: Basal cell carcinoma (BCC) is the most common cutaneous neoplasm. Despite numerous previous studies, the origin of BCC is still controversial. Objective: The aim of this study is to evaluate whether BCC arise from the hair follicle rather than the epidermal basal cell. Methods: In this study, we examined the expression of the immunohistochemical (IHC) stainings of CK15, CK19, follistatin, and Bmi-1 in BCC, trichoblastoma, actinic keratosis (AK), and squamous cell carcinoma (SCC). Twenty cases of histopathologically proven BCC, 13 cases of trichoblastoma, 19 cases of SCC, and 21 cases of AK were selected from the patients who had visited the Department of Dermatology of the Yeungnam University Medical Center. Results: For CK15, labeling indexes of BCC (83.0%) and trichoblastoma (84.4%) were statistically and significantly higher than that of AK (15.9%) and SCC (15.8%). Strong positivity (3+ or more) was observed in 85% of BCC, 100% of trichoblastoma, 4.8% of SCC, and 0% of AK. In CK15 staining, BCC and trichoblastoma showed positivity more frequently than SCC and AK. For CK19, labeling indexes of BCC (8.1%), trichoblastoma (6.6%), AK (3.5%) and SCC (14.8%) revealed no difference. For follistatin, labeling indexes of BCC (51.1%) and trichoblastoma (70.1%) were statistically and significantly higher than that of AK (0.9%) and SCC (8.5%). Strong positivity (3+ or more) was observed in 50% of BCC, 76.9% of trichoblastoma, 4.8% of SCC, and 0% of AK. In follistatin staining, BCC and trichoblastoma showed positivity more frequently than SCC and AK. For Bmi-1, labeling indexes of BCC (74.4%) and trichoblastoma (84.7%) were statistically and significantly higher than that of AK (24.7%) and SCC (18.6%). Strong positivity (3+ or more) was observed in 85% of BCC, 84.6% of trichoblastoma, 4.8% of SCC, and 10.5% of AK. In Bmi-1 staining, BCC and trichoblastoma showed positivity more frequently than SCC and AK. Conclusion: In this study, positivity of CK15, follistatin and Bmi-1 in BCC and trichoblastoma was significantly higher than that of SCC and AK. These findings suggest that BCC and trichoblastoma share the same differentiation toward the hair follicle. In addition, CK15, follistatin, and Bmi-1 can be useful as markers to differentiate BCC from SCC.
Case 1: A 61-year-old female presented with a nodule on the right elbow clinically diagnosed as a benign cyst but with subsequent histopathology revealing an MCC arising in the wall of, and adjacent to, a trichilemmal cyst. The neoplastic cells showed typical perinuclear dot-like reactivity to CK20. After sentinel lymph node biopsy and adjuvant radiation to the primary site, the patient has been recurrencefree for 4 years. Case 2: A 79-year-old female presented with a small tender nodule on the rim of her left ear that had grown in size over 3 months and was concerning for a basal cell carcinoma. Excision and histopathology revealed a trichilemmoma with an in situ MCC. Immunostaining showed CK20 reactivity characteristic for MCC. Wide local excision was performed with sentinel lymph node biopsy (negative) and the patient has been recurrence-free for [1 year. Discussion: Merkel cells have recently been demonstrated in high concentration in the infundibulum and isthmus of the hair follicle. We are not aware of a previous report in the literature of an MCC arising in association with a trichilemmoma. While MCCs in association with the hair follicle and hair follicle tumors have previously been thought to be collision tumors, these cases, in particular the in situ nature of case 2, further support the hypothesis that a subset of MCCs may actually originate from the Merkel cells of the follicular epithelium. In analogy to other malignant tumors arising within cystic structures, it is possible that this feature, when associated with a Merkel cell carcinoma, may be associated with a more favorable prognosis.
Commercial support: None identified.
Commercial support: None identified.
P8096
P7904
Localized hypertrichosis associated with traumatic panniculitis Ju Yun Woo, MD, Department of Dermatology, School of Medicine, Ewha Womans University, Seoul, South Korea; Eun Ah Suhng, MD, Department of Dermatology, School of Medicine, Ewha Womans University, Seoul, South Korea; Hae Young Choi, MD, PhD, Department of Dermatology, School of Medicine, Ewha Womans University, Seoul, South Korea; Ji Yeon Byun, MD, PhD, Department of Dermatology, School of Medicine, Ewha Womans University, Seoul, South Korea; You Won Choi, MD, PhD, Department of Dermatology, School of Medicine, Ewha Womans University, Seoul, South Korea Hypertrichosis is the overgrowth of hair on any part of the body beyond the normal limit for a particular age, sex, and race, and can be classified as generalized or localized. Acquired and localized hypertrichosis can be observed in various skin diseases, such as Beckers nevus, pretibial myxedema, and also occur secondarily to drug use and inflammatory diseases. Traumatic panniculitis is characterized by inflammation and necrosis in the subcutaneous fat after blunt trauma, especially on the shin. Rarely, localized hypertrichosis is associated with traumatic panniculitis. A 23-year-old woman visited our clinic for a brownish oval-shaped patch covered with numerous long hair on her right shin. The patch was slightly atrophic and asymptomatic. Four months ago, she experienced blunt trauma at the same site on the shin. Although she did not receive any treatment, the excoriated patch resolved spontaneously and hair had grown at the site of trauma after 2 months. Incisional biopsy was performed and the biopsy specimen showed infiltrations of histiocytes and lymphocytes in the subcutaneous fat septum, as well as fat lobule. Vascular density was slightly increased and focal thrombi in the vascular lumen were observed in the dermis and the subcutaneous fat tissue. Hair follicle in the dermis showed no significant histologic change. Herein, we report a rare case of localized hypertrichosis after traumatic panniculitis.
NY-ESO-1 expression is associated with primary cutaneous melanoma thickness Mara Giavina Bianchi, MD, Faculdade de Medicina da Universidade de S~ao Paulo, S~ao Paulo, Brazil; Cyro Festa Neto, MD, PhD, Faculdade de Medicina da Universidade de S~ao Paulo, S~ao Paulo, Brazil; Lyn Duncan, MD, Massachusetts General Hospital, Boston, MA, United States; Miriam Sotto, MD, PhD, Faculdade de Medicina da Universidade de S~ao Paulo, S~ao Paulo, Brazil Cutaneous melanoma incidence is increasing at epidemic rates and is associated with a worldwide increase in melanoma mortality. Advances in targeted therapy and immunotherapy have revolutionized the treatment of patients with advanced stage melanoma; nevertheless, there remains a need for reliable therapy that provides a long-term survival advantage. The cancer-testis antigen NY-ESO-1 is very immunogenic and is a promising candidate for immunotherapy. The study herein examines NY-ESO-1 antigen expression in primary cutaneous melanoma in the context of primary tumor characteristics, and patient outcome, including progression and melanoma-associated mortality. This is a retrospective cohort of 109 melanocytic tumors including invasive primary cutaneous melanoma (n ¼ 79 in 78 patients), melanoma in situ (n ¼ 10) and benign melanocytic nevus (n ¼ 20). The invasive melanomas included a wide range of tumor thickness: \1.0 mm (n ¼ 24); 1.01- 2.0 mm (n ¼ 23); 2.01-4.0 mm (n ¼ 6) and tumors [4.0 mm (n ¼ 26). NY-ESO-1 expression was detected immunohistochemically in 20% of invasive melanoma (16/79) and less frequently in in situ melanoma (1/10). NY-ESO-1 was not detected in benign nevi (0/20). NY-ESO-1 expression did not correlate significantly with sex, race, skin type, age, tumor location, ulceration, sentinel lymph node, progression, or survival. However, NY-ESO-1 was observed more often in tumors with a measured thickness of [2.0 mm (P ¼ .02), and less commonly in superficial spreading melanoma than other melanomas subtypes (P \.02).
Commercial support: None identified.
Commercial support: None identified.
AB74
J AM ACAD DERMATOL
MAY 2014
P8578
Immunohistochemical expression of cytokeratin 15, cytokeratin 19, follistatin, and Bmi-1 in basal cell carcinoma Seunghyun Sohng, MD, Yeungnam University Medical Center, Daegu, South Korea; Byeongsu Kim, Yeungnam University Medical Center, Daegu, South Korea; Donghoon Shin, Yeungnam University Medical Center, Daegu, South Korea; Jinhwa Choi, Yeungnam University Medical Center, Daegu, South Korea; Jongsoo Choi, Yeungnam University Medical Center, Daegu, South Korea; Youngkyung Bae, Yeungnam University Medical Center, Daegu, South Korea
Merkel cell carcinoma in association with benign follicular structures: Report of 2 cases Julia Shlyankevich, MD, Massachusetts General Hospital, Boston, MA, United States; Daniel Lantz, MD, University of Washington Department of Medicine Division of Dermatology, Seattle, WA, United States; Evan George, MD, University of Washington Department of Clinical Pathology, Seattle, WA, United States; Galina Stetsenko, MD, University of Washington Department of Medicine Division of Dermatology, Seattle, WA, United States; Paul Nghiem, MD, PhD, University of Washington Department of Medicine Division of Dermatology, Seattle, WA, United States; Stevan Knezevich, MD, VA Medical Center Department of Anatomic and Clinical Pathology, Seattle, WA, United States Background: Merkel cell carcinoma (MCC) is a rare and aggressive tumor often presenting as a small painless nodule on sun-exposed skin. Positive staining for cytokeratin 20 (CK20) in a perinuclear dot like staining pattern on immunohistochemistry is an important diagnostic tool that helps differentiate this neoplasm from other small basaloid tumors. MCC arising within benign adnexal tumors or cysts is exceedingly rare. We describe 2 cases of this phenomenon.
Backgrounds: Basal cell carcinoma (BCC) is the most common cutaneous neoplasm. Despite numerous previous studies, the origin of BCC is still controversial. Objective: The aim of this study is to evaluate whether BCC arise from the hair follicle rather than the epidermal basal cell. Methods: In this study, we examined the expression of the immunohistochemical (IHC) stainings of CK15, CK19, follistatin, and Bmi-1 in BCC, trichoblastoma, actinic keratosis (AK), and squamous cell carcinoma (SCC). Twenty cases of histopathologically proven BCC, 13 cases of trichoblastoma, 19 cases of SCC, and 21 cases of AK were selected from the patients who had visited the Department of Dermatology of the Yeungnam University Medical Center. Results: For CK15, labeling indexes of BCC (83.0%) and trichoblastoma (84.4%) were statistically and significantly higher than that of AK (15.9%) and SCC (15.8%). Strong positivity (3+ or more) was observed in 85% of BCC, 100% of trichoblastoma, 4.8% of SCC, and 0% of AK. In CK15 staining, BCC and trichoblastoma showed positivity more frequently than SCC and AK. For CK19, labeling indexes of BCC (8.1%), trichoblastoma (6.6%), AK (3.5%) and SCC (14.8%) revealed no difference. For follistatin, labeling indexes of BCC (51.1%) and trichoblastoma (70.1%) were statistically and significantly higher than that of AK (0.9%) and SCC (8.5%). Strong positivity (3+ or more) was observed in 50% of BCC, 76.9% of trichoblastoma, 4.8% of SCC, and 0% of AK. In follistatin staining, BCC and trichoblastoma showed positivity more frequently than SCC and AK. For Bmi-1, labeling indexes of BCC (74.4%) and trichoblastoma (84.7%) were statistically and significantly higher than that of AK (24.7%) and SCC (18.6%). Strong positivity (3+ or more) was observed in 85% of BCC, 84.6% of trichoblastoma, 4.8% of SCC, and 10.5% of AK. In Bmi-1 staining, BCC and trichoblastoma showed positivity more frequently than SCC and AK. Conclusion: In this study, positivity of CK15, follistatin and Bmi-1 in BCC and trichoblastoma was significantly higher than that of SCC and AK. These findings suggest that BCC and trichoblastoma share the same differentiation toward the hair follicle. In addition, CK15, follistatin, and Bmi-1 can be useful as markers to differentiate BCC from SCC.
Case 1: A 61-year-old female presented with a nodule on the right elbow clinically diagnosed as a benign cyst but with subsequent histopathology revealing an MCC arising in the wall of, and adjacent to, a trichilemmal cyst. The neoplastic cells showed typical perinuclear dot-like reactivity to CK20. After sentinel lymph node biopsy and adjuvant radiation to the primary site, the patient has been recurrencefree for 4 years. Case 2: A 79-year-old female presented with a small tender nodule on the rim of her left ear that had grown in size over 3 months and was concerning for a basal cell carcinoma. Excision and histopathology revealed a trichilemmoma with an in situ MCC. Immunostaining showed CK20 reactivity characteristic for MCC. Wide local excision was performed with sentinel lymph node biopsy (negative) and the patient has been recurrence-free for [1 year. Discussion: Merkel cells have recently been demonstrated in high concentration in the infundibulum and isthmus of the hair follicle. We are not aware of a previous report in the literature of an MCC arising in association with a trichilemmoma. While MCCs in association with the hair follicle and hair follicle tumors have previously been thought to be collision tumors, these cases, in particular the in situ nature of case 2, further support the hypothesis that a subset of MCCs may actually originate from the Merkel cells of the follicular epithelium. In analogy to other malignant tumors arising within cystic structures, it is possible that this feature, when associated with a Merkel cell carcinoma, may be associated with a more favorable prognosis.
Commercial support: None identified.
Commercial support: None identified.
P8096
P7904
Localized hypertrichosis associated with traumatic panniculitis Ju Yun Woo, MD, Department of Dermatology, School of Medicine, Ewha Womans University, Seoul, South Korea; Eun Ah Suhng, MD, Department of Dermatology, School of Medicine, Ewha Womans University, Seoul, South Korea; Hae Young Choi, MD, PhD, Department of Dermatology, School of Medicine, Ewha Womans University, Seoul, South Korea; Ji Yeon Byun, MD, PhD, Department of Dermatology, School of Medicine, Ewha Womans University, Seoul, South Korea; You Won Choi, MD, PhD, Department of Dermatology, School of Medicine, Ewha Womans University, Seoul, South Korea Hypertrichosis is the overgrowth of hair on any part of the body beyond the normal limit for a particular age, sex, and race, and can be classified as generalized or localized. Acquired and localized hypertrichosis can be observed in various skin diseases, such as Beckers nevus, pretibial myxedema, and also occur secondarily to drug use and inflammatory diseases. Traumatic panniculitis is characterized by inflammation and necrosis in the subcutaneous fat after blunt trauma, especially on the shin. Rarely, localized hypertrichosis is associated with traumatic panniculitis. A 23-year-old woman visited our clinic for a brownish oval-shaped patch covered with numerous long hair on her right shin. The patch was slightly atrophic and asymptomatic. Four months ago, she experienced blunt trauma at the same site on the shin. Although she did not receive any treatment, the excoriated patch resolved spontaneously and hair had grown at the site of trauma after 2 months. Incisional biopsy was performed and the biopsy specimen showed infiltrations of histiocytes and lymphocytes in the subcutaneous fat septum, as well as fat lobule. Vascular density was slightly increased and focal thrombi in the vascular lumen were observed in the dermis and the subcutaneous fat tissue. Hair follicle in the dermis showed no significant histologic change. Herein, we report a rare case of localized hypertrichosis after traumatic panniculitis.
NY-ESO-1 expression is associated with primary cutaneous melanoma thickness Mara Giavina Bianchi, MD, Faculdade de Medicina da Universidade de S~ao Paulo, S~ao Paulo, Brazil; Cyro Festa Neto, MD, PhD, Faculdade de Medicina da Universidade de S~ao Paulo, S~ao Paulo, Brazil; Lyn Duncan, MD, Massachusetts General Hospital, Boston, MA, United States; Miriam Sotto, MD, PhD, Faculdade de Medicina da Universidade de S~ao Paulo, S~ao Paulo, Brazil Cutaneous melanoma incidence is increasing at epidemic rates and is associated with a worldwide increase in melanoma mortality. Advances in targeted therapy and immunotherapy have revolutionized the treatment of patients with advanced stage melanoma; nevertheless, there remains a need for reliable therapy that provides a long-term survival advantage. The cancer-testis antigen NY-ESO-1 is very immunogenic and is a promising candidate for immunotherapy. The study herein examines NY-ESO-1 antigen expression in primary cutaneous melanoma in the context of primary tumor characteristics, and patient outcome, including progression and melanoma-associated mortality. This is a retrospective cohort of 109 melanocytic tumors including invasive primary cutaneous melanoma (n ¼ 79 in 78 patients), melanoma in situ (n ¼ 10) and benign melanocytic nevus (n ¼ 20). The invasive melanomas included a wide range of tumor thickness: \1.0 mm (n ¼ 24); 1.01- 2.0 mm (n ¼ 23); 2.01-4.0 mm (n ¼ 6) and tumors [4.0 mm (n ¼ 26). NY-ESO-1 expression was detected immunohistochemically in 20% of invasive melanoma (16/79) and less frequently in in situ melanoma (1/10). NY-ESO-1 was not detected in benign nevi (0/20). NY-ESO-1 expression did not correlate significantly with sex, race, skin type, age, tumor location, ulceration, sentinel lymph node, progression, or survival. However, NY-ESO-1 was observed more often in tumors with a measured thickness of [2.0 mm (P ¼ .02), and less commonly in superficial spreading melanoma than other melanomas subtypes (P \.02).
Commercial support: None identified.
Commercial support: None identified.
AB74
J AM ACAD DERMATOL
MAY 2014