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A 73-year-old man presented with a 4-mm asymptomatic, smooth, dome-shaped lesion on the right fourth finger with a clinical impression of a cyst/dermatofibroma. Histological examination showed a trichilemmal cyst with 3 nests of small blue round cells within the basal layer of the cyst lining. There were many mitotic figures and apoptotic bodies. The stain for cytokeratin 20 "decorated" the tumor cells with an unequivocal perinuclear dot-like pattern, confirming their Merkel cell origin. Dermal Merkel cell carcinoma (MCC) arising in association with benign adnexal tumors or cysts, with or without epithelial involvement, is a rare event. MCC in situ in this context has not been previously reported. The immunostain for cytokeratin 20 is an important ancillary study in diagnosing MCC. Our case supports the view that a subset of MCCs is of intraepithelial origin and underscores the clinical importance of surveillance for changes in an "innocent" cyst.

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A 46 year old male with acute promyelocytic leukemia treated with all-trans retinoic acid (ATRA), developed fever, bilateral erythematous nodules in his axillary area, lower abdomen and inguinal region. Histopathologic examination of the skin biopsy revealed dense neutrophil infiltration in the dermis without vasculitis. The diagnosis of Sweet's syndrome was made. High dose methylprednisolone was administered and the lesions started to improve within 24 hours.

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Summary:We previously demonstrated findings suggestive of autologous GVHD in patients receiving IL-2-activated peripheral blood stem cells (PBSC) with IL-2 after transplantation. A pilot study was designed to test tolerability, feasibility and frequency of autologous GVHD and engraftment using IL-2 and ␣-IFN posttransplantation. After cyclophosphamide (6 g/m 2 ) and carboplatin (1800 mg/m 2 ), patients with high-risk stage II or III breast cancer received chemotherapy and rhG-CSF mobilized autologous PBSC that had been cultured in IL-2 for 24 h. Subcutaneous administration of IL-2 began on day 0 at 6 × 10 5 IU/m 2 /day for 5 of 7 days each week and continued for 4 weeks. Once engraftment occurred, ␣-IFN was initiated at a dose of 1 × 10 6 /m 2 /day subcutaneously for 30 days. Thirty-four consecutive patients with stage II (n = 20), IIIA (n = 6) and IIIB (n = 8) disease were treated. All patients were without evidence of disease at the time of transplantation. The average time required for the ANC to reach 500/mm 3 was 10 days (range: 8-11 days) and for platelets to reach 20 000/mm 3 was 10.7 days (range: 6-21 days). Forty-seven percent of patients (n = 16) completed the full course of immunotherapy; the remaining patients received attenuated doses due to patient's request (n = 6), development of temperature Ͼ38؇C (n = 3), development of neutropenia (n = 3), serious infection (n = 1) and miscellaneous reasons (n = 5). Four patients experienced transient moderate toxicities (level 3) including elevated liver function tests, nausea, rash and capillary leak syndrome. Pathological findings suggestive of skin GVHD developed in 43% of patients (12/28 patients) when skin biopsies were evaluated in a blinded fashion. At 13 months post-transplant (median; range: 5-24 months), 28 patients (82%) remain diseasefree. These results demonstrate the feasibility and toxicity of this regimen along with pathological findings compatible with autologous GVHD of the skin. Keywords: interleukin-2; ␣-interferon; breast cancer; stem cell transplantation; immunotherapy Hematopoietic stem cell (HSC) transplantation may improve disease-free survival for selected women with stage II-IV breast cancer. 1-3 Any attempt to further improve therapeutic efficacy by increasing chemotherapy dose may result in excessive nonhematologic toxicities. Immunomodulation, in conjunction with high-dose chemotherapy and HSC transplantation may offer a potential benefit by providing a non-cross-resistant mechanism of tumor cell kill with non-overlapping toxicities. In addition, immunotherapy following autologous HSC transplantation has been associated with the development of graft-versushost disease (GVHD). [4][5][6] The generation of autologous GVHD in patients undergoing autologous HSC transplantation using immunomodulation, has been described in patients with breast cancer, multiple myeloma, lymphoma and acute myelogenous leukemia. [7][8][9][10][11][12] In the allogeneic BMT setting, the existence of GVHD is presumed to be associated with a graft-versus-tumor...

We describe a case of congenital smooth muscle hamartoma with hypertrichosis and pseudo-Darier's sign, and suggest that it is a clinicohistopathological entity distinct from Becker's naevus.