Reflectance-mode confocal microscopy for the in vivo characterization of pagetoid melanocytosis in melanomas and nevi

Pagetoid infiltration of the epidermis by melanocytes is a relevant criterion for the histologic diagnosis of melanoma, although sporadically observable in benign lesions. Since in vivo reflectance-mode confocal microscopy enables the visualization of superficial layers at cellular-level resolution, the different aspects and the diagnostic significance of epidermal alterations and pagetoid cell infiltration were investigated on 84 benign and malignant melanocytic lesions by confocal microscopy and compared with histopathology. The observation of a disarranged pattern in superficial layers appeared characteristic for malignant lesions. In vivo identification of pagetoid cells, clearly present in the majority of melanomas and in a few benign lesions, seemed useful for melanoma diagnosis. An excellent concordance between confocal microscopy and histopathology was achieved. Moreover, identification of some characteristic features by confocal microscopy, such as large and numerous closely arranged cells extended to the stratum corneum, was strongly correlated with malignancy. In conclusion, confocal microscopy enabled a very good identification of melanocytes spreading upward in a pagetoid fashion in melanocytic lesions. Thus, when pagetoid melanocytosis is observable by means of confocal microscopy, melanoma diagnosis should be considered, whereas it cannot be excluded in the absence of pagetoid cells, lacking in at least 10% of malignant lesions

Expression of p27(kip1) in basal cell carcinomas and trichoepitheliomas

Immunohistochemical analysis was used to evaluate p27(kip1) expression in normal hair follicles and in a series of 39 basal cell carcinomas (BCC) (13 of superficial type, 7 infiltrating, 7 morphea-like, 12 nodular) and 20 trichoepitheliomas (TE) (9 of classic type, 9 immature, 2 desmoplastic). The labeling index (LI) was derived semi automatically by means of a computer-assisted cellular image analyzer, and statistical analysis was carried out using the Student t test. A positive reaction for p27(kip1) was detected in the hair germ papillae, in supramatrical cells, and in the inner pilar sheath, whereas matrical cells and the outer pilar sheath were negative. All BCC and TE cases showed a positive immunoreaction for p27(kip1), but the staining pattern was different in the two groups of lesions, being patchy with focal peripheral accentuation in TE and more diffusely dispersed in BCC. The quantitative study showed lower p27(kip1) expression in BCC (LI = 27.51 +/- 12.55) than in TE (LI 45.27 +/- 20.27) (P < 0.0001). Statistically significant differences were also observed between TE subgroups and nodular or infiltrating BCC subtypes. The Occurrence of a wide overlap of LI values hampers the practical application of a p27(kip1) LI it, the differential diagnosis between BCC and TE in difficult cases, however

Histopathological evidence of North American blastomycosis in Italy: report of two cases

No clinical reports of blastomycosis in Italy have been published until now. We here report two cases of histologically diagnosed, unexpected cutaneous involvement in patients, aged 78 and 52 years, living in North Italy and never having been abroad. The histological differential diagnosis between blastomycosis and other fungal pathogens is discussed. Even in the absence of culture the present cases can confidently be considered as genuine examples of Blastomyces dermatitidis infection in Italy

Perinatal aspergillosis: a case with fatal outcome.

Aspergillosis is an uncommon perinatal infection diagnosed with increasing frequency in recent years. We report a premature infant who required both nutrition and ventilation artificially assisted and developed a disseminated invasive nosocomial infection from Aspergillus flavus. Autopsy revealed marked hypotrophy of the thymus and multisystem invasive aspergillosis chiefly involving the vascular and alimentary systems and also the respiratory tract, the central nervous system, and the skin. From what we know, this is the first case of the literature with a misleading initial clinical presentation involving the alimentary tract (hepatomegaly, ingravescent cholestatic icterus) and evolving in intestinal occlusion

Microscopic in vivo description of cellular architecture of dermoscopic pigment network in nevi and melanomas

Objective: To characterize the microscopic aspects of the dermoscopic pigment network in vivo, by means of confocal scanning laser microscopy. Design: Confocal imaging was performed on melanocytic lesions characterized by pigment network at dermoscopy. Some confocal architectural and cytologic features, as observed at the dermoepidermal junction, were morphologically described and quantified by means of a dedicated program. Setting: University medical department. Study Population: We studied confocal images of 15 melanomas, 15 dermoscopic atypical nevi, and 15 common nevi. Main Outcome Measures: Features referring to aspect, size, regularity, homogeneity, and infiltration of dermal papillae and to cellular size, regularity, and atypia were described by 2 observers on confocal images. Mean dermal papillary diameter, mean cell area, and shape irregularity were quantified by drawing papillae and cell contours on confocal images and measured with the use of a computer program. Results: Pigment network in melanomas consisted of large basal cells that circumscribed small to medium-sized dermal papillae with marked cellular atypia, sometimes infiltrating dermal papillae. On the other hand, common acquired nevi were characterized by lack of atypical cells and edged dermal papillae. Atypical nevi presented intermediate characteristics between clearly benign and malignant lesions. Conclusion: Cellular atypia was the most sensitive feature for melanoma diagnosis, whereas the presence of nucleated cells infiltrating dermal papillae was the most specific one

Diving into the blue: In vivo microscopic characterization of the dermoscopic blue hue

BACKGROUND: In dermoscopy the presence of a blue hue is a clue for malignancy, although a blue tint is sometimes observable in benign lesions. OBJECTIVE: To identify the in vivo confocal microscopy correlates of the blue hue for improving diagnostic accuracy for melanoma. METHODS: Fifty-seven melanomas, 41 junctional, 88 compound, and 27 Spitz nevi were studied by dermoscopy, confocal microscopy, and histopathology. RESULTS: Confocal microscopy enabled the distinction between blue areas and blue veil, the former characterized by plump cells corresponding to melanophages and inflammatory infiltrate at histology, the latter by the contemporary presence of epidermal and dermal features consistent with diagnosis of melanoma, such as disarranged pattern, pagetoid cells, cytologic and architectural atypias, nonhomogeneous and cerebriform clusters, and dermal nucleated cells. LIMITATIONS: Confocal microscopy failed to accurately distinguish Spitz nevi, because of the presence of cytoarchitectural disarray in the epidermis and the upper dermis. CONCLUSION: Confocal microscopy enabled the in vivo identification of characteristic cytological substrates correlated with the blue features in dermoscopy.Background: In dermoscopy the presence of a blue hue is a clue for malignancy, although a blue tint is sometimes observable in benign lesions. Objective: To identify the in vivo confocal microscopy correlates of the blue hue for improving diagnostic accuracy for melanoma. Methods: Fifty-seven melanomas, 41 junctional, 88 compound, and 27 Spitz nevi were studied by dermoscopy, confocal microscopy, and histopathology. Results: Confocal microscopy enabled the distinction between blue areas and blue veil, the former characterized by plump cells corresponding to melanophages and inflammatory infiltrate at histology, the latter by the contemporary presence of epidermal and dermal features consistent with diagnosis of melanoma, such as disarranged pattern, pagetoid cells, cytologic and architectural atypias, nonhomogeneous and cerebriform clusters, and dermal nucleated cells. Limitations: Confocal microscopy failed to accurately distinguish Spitz nevi, because of the presence of cytoarchitectural disarray in the epidermis and the upper dermis. Conclusion: Confocal microscopy enabled the in vivo identification of characteristic cytological substrates correlated with the blue features in dermoscopy. © 2007 American Academy of Dermatology, Inc

Alterations of 9p21 analysed by FISH and MLPA distinguish atypical spitzoid melanocytic tumours from conventional Spitz's nevi but do not predict their biological behaviour.

Alterations of 9p21 analysed by FISH and MLPA distinguish atypical spitzoid melanocytic tumours from conventional Spitz's nevi but do not predict their biological behaviour Aim:  Histopathological criteria alone cannot predict the biological behaviour of spitzoid melanocytic tumours. The aim of this study was to investigate whether 9p21 status influence the prognosis of the spitzoid melanocytic tumours, peculiar lesions whose biological behaviour cannot be predicted by histopathological criteria alone. Methods and results:  Twenty-eight atypical spitzoid tumours, 12 conventional Spitz's nevi and one congenital Spitz's nevus were studied by fluorescent in-situ hybridization (FISH) and multiple ligation-dependent probe amplification (MLPA) for the presence of 9p21 deletion. The 28 patients were aged 3-56 years (mean 32, median 35), and follow-up ranged between 4 and 156 months (mean 51, median 48). Eight patients (28.5%) experienced lymph node metastasis (three cases with macrometastasis and five with micrometastasis). Of those with macrometastasis, two are alive after 159 and 26 months, whereas a third developed widespread metastases and died after 26 months. All of the other patients are alive. Statistically, the thickness (P = 0.01) and the diameter (P = 0.009) of the lesions significantly correlated with metastasis. Deletion of 9p21 by FISH analysis was observed in eight spitzoid tumours (28.5%), and MLPA demonstrated alterations of 9p21, particularly deletion of CDKN2A, in the same lesions, whereas all Spitz's nevi, except the congenital one, were of unaltered 9p21 status (P < 0.0001). Deletion of 9p21/CDKN2A did not correlate with the presence of metastasis. Conclusion:  Alterations at 9p21 locus are significantly more frequent in spitzoid tumours than in Spitz's nevi, but do not predict their biological behaviour