Antibodies recognizing plasminogen, a key component of the fibrinolytic system, associate with venous thrombotic events in PR3-ANCA vasculitis. Here, we investigated the prevalence and function of anti-plasminogen antibodies in independent UK and Dutch cohorts of patients with ANCA-associated vasculitis (AAV). We screened Ig isolated from patients (AAV-IgG) and healthy controls by ELISA. Eighteen of 74 (24%) UK and 10/38 (26%) Dutch patients with AAV had anti-plasminogen antibodies compared with 0/50 and 1/61 (2%) of controls. We detected anti-plasminogen antibodies in both PR3-ANCA-and MPO-ANCA-positive patients. In addition, we identified anti-tissue plasminogen activator (tPA) antibodies in 13/74 (18%) patients, and these antibodies were more common among patients with anti-plasminogen antibodies (P ϭ 0.011). Eighteen of 74 AAV-IgG (but no control IgG) retarded fibrinolysis in vitro, and this associated with anti-plasminogen and/or anti-tPA antibody positivity. Only 4/18 AAV-IgG retarded fibrinolysis without harboring these antibodies; dual-positive samples retarded fibrinolysis to the greatest extent. Patients with anti-plasminogen antibodies had significantly higher percentages of glomeruli with fibrinoid necrosis (P Ͻ 0.05) and cellular crescents (P Ͻ 0.001) and had more severely reduced renal function than patients without these antibodies. In conclusion, anti-plasminogen and anti-tPA antibodies occur in AAV and associate with functional inhibition of fibrinolysis in vitro. Seropositivity for anti-plasminogen antibodies correlates with hallmark renal histologic lesions and reduced renal function. Conceivably, therapies that enhance fibrinolysis might benefit a subset of AAV patients.

The objective of this in vitro study was to explore the applicability of Raman spectroscopy to distinguish basal cell carcinoma from its surrounding noncancerous tissue; therefore, identifying possibilities for the development of an in vivo diagnostic technique for tumor border demarcation. Raman spectra were obtained in a two-dimensional grid from unstained frozen sections of 15 basal cell carcinoma specimens. Pseudo-color Raman images were generated by multivariate statistical analysis and clustering analysis of spectra and compared with histopathology. In this way a direct link between histologically identifiable skin layers and structures and their Raman spectra was made. A tissue classification model was developed, which discriminates between basal cell carcinoma and surrounding nontumorous tissue, based on Raman spectra. The logistic regression model, shows a 100% sensitivity and 93% selectivity for basal cell carcinoma. The Raman spectra were, furthermore, used to obtain information about the differences in molecular composition between different skin layers and structures. An interesting finding was that in four samples of nodular basal cell carcinoma, the collagen signal contribution in spectra of dermis close to a basal cell carcinoma, was markedly reduced. The study demonstrates the sensitivity of Raman spectroscopy to biochemical changes in tissue accompanying malignancy, resulting in a high accuracy when discriminating between basal cell carcinoma and noncancerous tissue.

Ninety-four H & E-stained slides of malignant melanoma were circulated to 6 pathologists in 2 university departments. For each slide, the growth phase of the lesion, Breslow thickness, and Clark level were determined by each observer. The aims of the study were to evaluate agreement between nonspecialist pathologists in identifying the vertical growth phase in malignant melanoma and to compare agreement for the growth phase with agreement for Breslow thickness and the Clark level. Our results show that although overall agreement for the growth phase is moderate, agreement between experienced observers is good. In fact agreement for the growth phase among this group was equal to the agreement for Breslow thickness. Overall agreement for Breslow thickness also was good but for the Clark level was only fair. These findings suggest that if the predictive value of the vertical growth phase proves to be robust, it will be used with an acceptable level of accuracy in routine diagnostic practice.

Imatinib, a synthetic tyrosine kinase inhibitor, is used as first-line therapy for chronic myeloid leukaemia. Imatinib treatment is associated with a variety of adverse effects, most of which are mild to moderate and generally abate after the first months of treatment. Cutaneous adverse reactions are often encountered in patients using imatinib. Pseudoporphyria is regularly associated with the use of medication, especially naproxen and other nonsteroidal anti-inflammatory drugs, but the list of culprits is expanding. We present a patient with imatinib-induced pseudoporphyria. Taking into account the rapidly growing use of imatinib, physicians should be aware of the possibility of imatinib-induced pseudoporphyria. Adequate photoprotection can improve treatment compliance.

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Scar formation is a physiologic reaction to dermal injury. We describe a 11-year-old girl and her 15-year-old cousin, who both presented with stellate scarlike lesions primarily located on the hands. Histopathologic examination confirmed scar tissue formation. There was no history of initiating trauma or other possible triggering factors. To our knowledge, this is the first reported case of spontaneous stellate scars in two young, second-degree family members, the exact pathogenesis of which remains to be elucidated.