BACKGROUNDCarcinomas of the skin are by far the most common human malignancies. Continuous exposure to ultraviolet (UV) light facilitates the development of precancerous lesions (actinic keratosis [AK]) that may progress to invasive squamous carcinomas. Apoptosis, triggered by the activation of CD95 (Fas), is one of the most important defense mechanisms against UV light–induced carcinogenesis in experimental models, but the dynamics of CD95 expression in patients with sun‐induced lesions are largely unknown.METHODSThe authors studied the expression of CD95 (Fas) in biopsy samples of normal skin (not exposed to sun) and compared it with chronically sun‐exposed skin (as evidenced by solar elastosis), AK, squamous cell carcinoma (SCC) and basal cell carcinoma (BCC), and keratoacanthomas (KA).RESULTSNormal skin keratinocytes expressed CD95 in cytoplasmic membranes and intercellular bridges in the basal layer. In chronically sun‐exposed keratinocytes (solar elastosis, no evidence of dysplasia), CD95 expression was up‐regulated and was observed throughout the entire thickness of the epidermis. However, in actinic keratosis there was a complete absence of Fas in approximately two‐thirds of the cases (8 of 12). In invasive SCC, CD95 was expressed focally and weakly only at the sites of contact with stromal lymphocytes. Keratoacanthomas consistently expressed CD95 at the interface with the inflammatory cells. No staining was observed in BCC.CONCLUSIONSCD95 (Fas) up‐regulation in chronically sun‐exposed keratinocytes indicates an important role in the control of sun‐induced damage. Further sun exposure results, however, in significant down‐regulation of this defense mechanism, proportional to the degree of dysplasia. Cancer 2002;94:814–9. © 2002 American Cancer Society.DOI 10.1002/cncr.10277
Uterine carcinosarcomas are uncommon, aggressive neoplasms usually afflicting postmenopausal women. Histologically, they are characterized by the presence of both malignant epithelial and stromal cells. The latter may be either homologous or heterologous in nature. The cytologic diagnosis of carcinosarcoma via fine‐needle aspiration (FNA) was previously described for primary tumors arising in the parotid gland, breast, lung, and ovary. Although the diagnosis of uterine carcinosarcoma via cervicovaginal, endometrial, and peritoneal fluid cytology has been described, the FNA cytology diagnosis of recurrent uterine carcinosarcoma has only been rarely described. We present a case of recurrent uterine carcinosarcoma in a 59‐yr‐old woman, diagnosed by ultrasound‐guided FNA cytology. Cytologic smears showed a biphasic neoplasm consisting of both malignant columnar epithelial and spindle cells, in a background of tumor diathesis. This case illustrates the diagnostic utility of aspiration cytology in the investigation of recurrent carcinosarcoma in clinically suspicious lesions arising postsurgery. Diagn. Cytopathol. 23:108–113, 2000. © 2000 Wiley‐Liss, Inc.
Primary pulmonary sarcomas are uncommon neoplasms. Primary fibrosarcoma of the lung is extremely rare, and only 53 cases have been documented in the literature to date. To our knowledge, the diagnosis of primary lung fibrosarcoma by fine-needle aspiration cytology has never been reported. We report a case of pulmonary fibrosarcoma diagnosed by fine-needle aspiration cytology and core biopsy. The neoplasm consisted of interweaving fascicles of minimally atypical spindle cells with slender nuclei and scant cytoplasm. Positive immunohistochemistry for vimentin along with nonreactivity of tumor cells for keratin, S100 protein, desmin, α-smooth muscle actin, and CD34 supported the the diagnosis. The diagnosis was later confirmed by histologic and ultrastructural findings following lobectomy. A meticulous clinical search for a possible primary neoplasm elsewhere was unsuccessful, and lung was established as the primary site. Fine-needle aspiration cytology and core biopsy are reliable methods for establishing a diagnosis of fibrosarcoma.
IntroductionWhipple disease is a rare systemic infection caused by Tropheryma whippelii that usually manifests with joint pain, weight loss, diarrhoea and abdominal pain. However, in some cases the infection may involve other organs and tissues.Case presentationWe report on a 44-year-old man with Whipple disease which led to renal amyloidosis and end-stage renal failure. In this case, the patient was diagnosed with Whipple disease and commenced on a 12-month trimetoprime-sulfametoxasole therapy with good result. Six months after cessation of therapy the patient was readmitted to hospital due to signs of renal failure. An urgent kidney biopsy was performed which revealed secondary amyloidosis. Despite intensive immunosuppressive treatment, renal parameters gradually deteriorated and haemodialysis was started eventually. Three months later the patient’s general condition dramatically worsened with bloody diarrhoea, bilious vomiting and progressive malnutrition. The repeated endoscopic examination confirmed severe recurrence of Whipple disease. Ceftriaxone and total parenteral nutrition was started what greatly improved patient’s state.ConclusionsTo our knowledge based on systematic review, this is the first case report on Whipple disease complicated by secondary amyloidosis and kidney failure maintained on permanent renal replacement therapy. It is strongly suspected that the use of immunosuppressive treatment in such cases may exacerbate the course of Whipple disease and cause life-threatening complications.
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