The clinical features of adult-type IgA vasculitis have not been well characterized. To analyze the
characteristics of IgA vasculitis in adults, patients diagnosed with IgA vasculitis based on EULAR/PRINTO/PRES criteria
(2012) in our institution between 2003 and 2012 were studied, comprising 85 adults (age ≥ 21 years) and 37 pediatric
patients (≤ 20 years). Compared with pediatric cases, adult disease showed significantly higher serum C-reactive protein
and IgA values, a lower percentage of cases was associated with infections (56.5% vs 89.2%, P < 0.001) but there was a
greater range of infections affecting different tissues and organs, and there was occasional cases with malignancy (8.2%)
including four cases of lung carcinoma and three with hematological disorders. The skin lesions in adults tended to be
widely distributed on the abdomen and waist (15.3% vs 2.7%, P = 0.045). Adult cases were associated with greater renal
involvement, as evidenced by proteinuria, hematuria and/or urinary casts, compared with the pediatric group (76.2% vs
48.6%, P = 0.003) and disease recalcitrance was also significantly higher (38.8% vs 18.9%, P = 0.031). Examination of
the serum levels of immunoglobulins in adults showed that a sole increase in IgA was associated with renal and
gastrointestinal manifestations, but this was not seen in cases with concurrent increases of IgA and IgG or IgA, IgG and
IgM. Although the retrospective nature of the study is a limitation, it identified possible associations with the wide range
of infections, more severe renal damage, and malignancy in adult IgA vasculitis.
The duct-like structures present in 7 cases of benign and malignant eccrine poroma were examined by immunohistochemical staining for carcinoembryonic antigen (CEA), involucrin, and S-100 protein. The demonstration of CEA and involucrin was helpful in the recognition of these structures. The overt immunopositivity precedes morphological evidence for duct formation. On the basis of the CEA immunostaining, the duct-like structures were divided into 4 types: 1) mature acrosyringeal structure, 2) cystic luminal structure lined by elongated cells, 3) immature acrosyringeal structure, and 4) vacuole- or dot-like potential lumen in a single cell. Involucrine was observed in the lining cells of 1) and 2). None of the 4 types showed positive reactivity for S-100 protein, suggesting the irrelevance of these structures to the secretory element of sweat gland. The polymorphism of the ductal formation tended to be more remarkably observed in malignant eccrine poromas than in the cases of benign eccrine poroma and poroepithelioma tested.
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