Kaposi Sarcoma; Immunohistochemical Study of Some Diagnostic and Prognostic Markers
Amal A. El-Ashmawy* and Ghada A.El-Ayat**
Department of Dermatology and Venereology* ,Department of Pathology**.
Faculty of Medicine, Tanta University.
Abstract
Background
Kaposi sarcoma (KS) poses problems in histologic diagnosis because of its broad morphologic spectrum and mimicry of many benign vasoproliferative lesions . The variability in the biologic behavior of KS among individuals in the same group remains enigmatic.
Objective
To evaluate the role of latent nuclear antigen-1 of human herpes virus -8 (HHV-8 LNA-1) ,CD31, CD34 (diagnostic markers) ,cyclin D1 , p27Kip1, Ki-67, p53 and Bcl-2 (prognostic markers) in classical cutaneous (C- KS).
Patients and Methods.
The present study comprised a total of 42 patients; 15 cases of classical C-KS (HIV–ve) and 27 cases of mimickers .KS patients classified into two groups; GI included 7 patients [patch/ plaque] and GII [tumor] included 8 patients. using immunohistochemistry (IHC), we tested of HHV-8 LNA-1 ,CD31, CD34, cyclin D-1 , p27Kip1, Ki-67, p53 and Bcl-2 in the tissue of C- KS.
Results
CD31 and CD34 positivity were demonstrated as in all cases of KS and also in other mimickers but varied in intensity .All KS cases showed positive staining for HHV-8 (100%) ,but KS mimickers were all negative for this antigen. The percentage of expression for cyclin D1, p53 and Bcl-2 showed statistically significant increase in the GII than GI , [Cyclin D1(P=0.007) ,p53( P=0.006) and Bcl-2( P=0.005)]. The expression of p27Kip1 showed statistically significant increase in the GI than GII ( P=0.002) .The percentage of expression for Ki-67 showed no significant difference between the two groups (P=0.489).
Conclusion.
Positive immunostaining for HHV-8 LNA-1 exhibits high sensitivity and specificity for the diagnosis of KS and is, thus, useful for distinguishing it from the mimickers. Cyclin D1, p27Kip1 p53 and Bcl-2 differential expressions are involved in KS progression (prognostic markers).Keywords. Kaposi sarcoma , HHV-8 LNA-1, Cyclin D1, p27Kip1 ,Ki-67, p53 and Bcl-2
BASAL CELL CARCINOMA: POSSIBLE ROLE OF SOME PROLIFERATIVE AND APOPTOTIC FACTORS
*Abdel-Ghani Selim, **Amal El-Ashmawy , **Shereen Gheida, **Naeim Abd-Elnaby and **Rania El-Tatawy
Departments of *Pathology , **Dermatology and Venereology. Faculty of Medicine, Tanta University.
ABSTRACT
Recurrence of BCC following treatment is common and the majority of recurrences appear in the first 3 years. We examined the original tumors of 20 BCC cases, 8 of whom had recurrence after an average of 2.7 years and 12 of whom had no recurrence during an average of 3.2 years follow up. Using immunohistochemistry, we tested for CD31, Ki-67, EGF-R, PCNA expression (as cell cycle promoters) and Bcl-2, p53, Bax expression (as apoptosis markers) in the tumor tissue. The percentage of expression for Ki-67 showed highly significant increase in the recurrent tumors than in the non-recurrent ones(X2 =7.83 and P value =0.001).The percentage of expression for CD31, EGF-R showed statistically significant increase in the recurrent tumors than in the non- recurrent ones [CD31(X2 =4.211 and P value=0.047) and EGF-R(X2 =7.62 and P value =0.022)].Expression of PCNA was positive in all BCC cells with no significant differences. The percentage of expression for Bcl-2 showed highly significant increase in the non- recurrent tumors than recurrent ones (X2 =13.23 and P value =0.001). The percentage of expression for p53 was positive in all BCC cells with statistically significant increase in the recurrent tumors than in the non-recurrent ones (X2 =3.112 and P value =0.048). The expression of Bax was negative in 75% of recurrent cases and 58.3% in non- recurrent ones and weak positive in 25% in recurrent cases and 41.7 in non- recurrent cases(X2 =1.59 and P value =0.443). These results show that cell cycle promoters as (Ki-67, CD31, EGF-R and PCNA) and apoptosis markers as (Bcl-2, p53 and Bax) expressions differ between BCC which later recur and do not recur.
Hypereosinophilic disorders : Immunohistochemical and electron microscopic study
Amal El-Ashmawy , Shereen Gheida , Laila Mansour and *Maha Shamloula
Departments of Dermatology and Venereology, *Pathology, Faculty of Medicine, Tanta University.
Abstract
Background and objective: Hypereosinophilia is a common biological finding. It may be primary or secondary. Helper (CD4+) T cells that display a (type 2) cytokine profile appear to be primarily involved in these disorders. This study was designed to study lymphocytic cellular infiltrate by immunohistochemical studies and eosinophils by electron microscope in some clinically diagnosed hypereosinophilic disorders.
Methods: Histopathological evaluation of 25 cases of hypereosinophilic disorders was done. Immunohistochemical staining using anti CD3 , CD4 ,CD8 mouse monoclonal antibody and electron microscopic study were done.
Results : All cases were expressing CD3. Wells syndrome and Churg-Strauss were expressing CD4.All cases were expressing CD8 except hypereosinophilic syndrome . Electron microscopic study of
Hypereosinophilic syndrome was showing abnormality in eosinophils.
Conclusion: Hypereosinophilic disorders may be due to T cell defects with release of many cytokines lead to attraction and sometimes abnormalities of eosinophils. These conclusion need further investigation.
A Clinical , Microbiologic and Histopathological Study of Pityriasis Amiantacea
Abstract
Background: Pityriasis amiantacea (PA) was a papulosquamous condition of the scalp that presents with asbestos-like thick scales attached to the hair shaft.
Aim of the Work: Study the clinical, microbiologic and histopathological aspects of PA.
Patients and Methods: 50 patients collected from Department of Dermatology and Venereology were subjected to, mycological, bacteriological and histopathological study to determine the etiology of PA.
Results: The current study found that 64% of the cases have staphylococcus(S.) aureus and 36% have non scarring alopecia. The pathological diagnosis revealed that 56% of PA patients had psoriasis (Ps), 24% seborrheic dermatitis (SD) , 12% tinea capitis, 4
sebopsoriasis and 4% atopic dermatitis (AD).
Conclusion: PA represents a particular reaction pattern of the scalp to various inflammatory scalp diseases. The most frequent skin diseases associated with PA were Ps and SD. It is important to keep the diagnosis of tinea capitis in mind when evaluating PA patients. Staphylococci on the scalp could participate in the pathogenesis of PA.
Keywords. Pityriasis amiantacea, psoriasis, seborrheic dermatitis, tinea capitis, sebopsoriasis
Expression of CD10, CD30 ,CD56 and CD68 in some variants of peripheral T- cell lymphoma: an immunohistochemical study.
Amal El-Ashmawy, Arwa Hassan, Amany Abdel-Latif, Zeinab Abd El-Samad, Omnia Rizk*.
Departments of Dermatology and Venereology, Pathology*, Faculty of Medicine, Tanta University.
Abstract:
Peripheral T-cell lymphomas (PTCLs) are a group of non-Hodgkin’s lymphomas sharing a derivation from neoplastic T-cells. Angioimmunoblastic T-cell lymphoma (AITCL), subcutaneous panniculitis like T-cell lymphoma (SPTCL) and cutaneous anaplastic large cell lymphoma (CALCL) are among PTCL variants having cutaneous manifestations. We aimed to verify the utility of CD10, CD30, CD56 and CD68 immunohistochemical expression in the diagnosis of AITCL, SPTCL and CALCL. Fifteen patients with PTCLs including 5 AITCL, 5 SPTCL and 5 CALCL cases were included in the study. Involved skin and lymph node biopsy specimens were studied immunohistochemically for the expression ofCD10, CD30, CD56 and CD68. In AITCL, CD10 was expressed in lymph node in all cases and in the skin of one case. CD68 was expressed in all SPTCL cases and in none of AITCL or CALCL.Four cases of CALCL were CD30+ while one CALCL, all AITCL and SPTCL cases were CD30-negative. CD56 was expressed only in 3 cases of SPTCL (γ/δ TCL) and one case of CALCL. Coexpression of CD30 and CD56 was detected in one case of CALCL. In conclusion, among the 3 studied types of PTCL, CD10 (in lymph nodes) is a sensitive and specific marker for AITCL. CD68 is a sensitive and specific marker for SPTCL. CD30 was sensitive and specific for CALCL. However, one case of CD30-negative CALCL was detected. CD56 can help to differentiate between the two pathologic types of SPTCL, α/β and γ/δ TCL.They are important to distinguish for biologic, therapeutic and prognostic reasons. In addition, although coexpression of CD30 and CD56 in CALCL is arare finding, it might identify a subset of CD30+ lymphomas with more aggressive features.
Immunohistochemical Study of Survivin in Psoriasis
Abstract
Background: Psoriasis (Ps) is one of the most frequent skin diseases world-wide, with severe impact on the quality of the patient's life. Genetics and environmental factors may play an important role in the pathogenesis of the disease. Suppression of apoptosis is generally one of the accepted pathogenetic mechanisms of Ps and any epidermal hyperproliferative states. Survivin is a unique member of inhibitor of apoptosis (IAP) family proteins, it mediates its apoptosis suppressive function by the inhibition of caspase pathway. It is a bifunctional protein that functions as a key regulator of mitosis and inhibitor of programmed cell death. Aim of the Work: The aim of this study was to explore the role could be played by survivin in the pathogenesis of Ps. Patients and Methods: 10 cases of plaque Ps, 10 cases of erythrodermic Ps, (in both types lesional, prelesional skin were taken), and10 control specimens from normal skin were studied by immunohistochemical method for expression of survivin. Results: Survivin was detected in psoriatic lesions both plaque and erythrodermic distributed in epidermis, endothelium, and inflammatory cells with different levels. Also it was detected in the prelesional skin in both plaque and erythrodermic Ps, also in the epidermis, endothelium, inflammatory cells, but with lesser ratios, and focal expression. In the control specimens, survivin was confined to basal layer of epidermis, and significantly up regulated in Ps in comparison with the prelesional, and the control skin, but there was no significant difference between different types of Ps.
Keywords: Psoriasis, survivin, apoptosis and caspase.
Glutathione S-Transferase Gene Polymorphisms (GSTM1 and GSTT1) in Vitiligo Patients
Fatma A. Abd Rabou*, Hesham A.Alsorogy**, Shereen F. Gheida*and Amal A. EL-Ashmawy*
Departments of Dermatology and Venereology* and Clinical Pathology**
Faculty of Medicine ,Tanta University,Egypt
Abstract
Background: Vitiligo is an acquired pigmentary disorder of the skin characterized by white areas on the skin and pigment-producing cells (melanocytes) are absent from vitiligo lesions. Oxidative stress is a major pathogenesis hypothesis of vitiligo. The glutathione S-transferases (GSTs) are group of polymorphic enzymes that are important in protection against oxidative stress and chemical toxicity.Objectives: The aim of this work was to study the relation between glutathione S-transferase gene polymorphisms (GSTM1 and GSTT1) and pathogenesis of vitiligo.Subjects and Methods: This study included 40 patients with vitiligo and 10 healthy subjects served as controls, attending the Outpatient Clinic of Dermatology and Venereology Department of Tanta University Hospitals. Blood samples were collected from all patients for detection of GSTM1 and GSTT1 polymorphisms using the multiplex polymerase chain reaction (PCR) and blood samples were collected from control subjects for comparison.Results: In this study, there was non significant association with null type of both GSTM1& GSTT1 genotype and vitiligo susceptibility. There was significant association of vitiligo risk with GSTM1 null/ GSTT1 null type as well as GSTM1 present/GSTT1 null and GSTM1 null/ GSTT1 present when compared to the GSTT1 present/ GSTM1 present. There was non significant association with GSTM1 null type of vitiligo in focal, segmental and generalized subtypes. There was significant association with GSTT1 null type of vitiligo in generalized subtypes but GSTT1 null type of vitiligo in focal and segmental types showed non significant association with vitiligo susceptibility. Non significant association was shown in GSTM1 null/GSTT1 null type of vitiligo in focal and generalized types while it was significant in segmental type. Significant association with GSTM1 present/GSTT1 null type of vitiligo in focal and generalized types but non significant in segmental type. The GSTM1 null/GSTT1 present types of vitiligo subtypes showed a significant association with focal and generalized types but non significant association in segmental type. Significant association with GSTM1 present/ GSTT1 present type in segmental and generalized types but non significant in focal type.Conclusion: Collectively, the mechanistic study revealed new pieces in the vitiligo ’’puzzle’’, such as GST and 4-Hydroxy-2-nonenal (HNE)-protein which, together with the known one, namely hydrogen peroxide (H2O2), may well be included in the hypothetic redox-regulated mechanism of melanocyte loss, and might represent good candidates as therapeutic targets for this skin disease. Key words: Vitiligo,Glutathione S-transferase,Oxidative stress
Prolidase deficiency syndrome: a rare entity
Laila Mansour(MD) , Amal El-Ashmawy(MD) , Shereen Gheida (MD) and Arwa Hassan(MD)
Departments of Dermatology and Venereology, Faculty of Medicine, Tanta University.
AbstractProlidase deficiency is a rare inborn disorder of collagen metabolism characterized by chronic recurrent skin ulceration. A twenty five- year-old male with clinical features and laboratory criteria fulfilling the diagnosis of prolidase deficiency is presented in view of rarity of the condition
Topical Antioxidant and Narrowband Versus Topical Combination of Calcipotriol Plus Betamethathone Dipropionate and Narrowband in the Treatment of Vitiligo
*Noha Nabil Doghim (MD), *Arwa Mohammad Hassan (MD) *Amal Ahmad El-Ashmawy (MD), Shereen Farouk Gheida(MD)
Abstract
Introduction :Vitiligo is a specific, common, often heritable, acquired disorder characterized by well-circumscribed milky-white cutaneous macules devoid of identifiable functional melanocytes because of multifactorial and overlapping pathogenic mechanisms. The basic defect in vitiligo is loss of melanocytes. Narrowband ultraviolet B (NB-UVB) is an emerging, effective and safe therapy for vitiligo. Because of defective calcium homeostasis in depigmented skin, the vitamin D-3 analogs (calcipotriol and taclacitol) have been used topically in vitiligo, where modulation of the local immune response on specific T cell activation occurs. A new topical product containing a combination of vegetal catalase (CAT) and superoxide dismutase (SOD) has been used in vitiligo. In vitro studies demonstrated the capacity of this complex to dramatically reduce the production of free radicals in vitiligo cell and even to restore a normal level of melanin in melanocytes of vitiligo. Patients and Methods: The current study comprised a total of 40 patients with different clinical varieties of vitiligo. They were recruited from the Outpatient Clinic of Dermatology and Venereology Department, Tanta University Hospitals. The studied patients were divided into: G1: Included 20 patients subjected to topical combination of calcipotriol plus betamethazone dipropionate ointment with NB-UVB on the left side of the patient and NB-UVB alone on the right side of the same patient. G2: Included 20 patients subjected to topical SOD/CAT gel with NB-UVB on the left side of the patient and NB-UVB alone on the right side of the same patient. Results: Comparison in the response of the treatment in GI and GII between right and left side revealed no statistically significant difference between the two sides. Comparison in the response in the left side in G I and G II showed no statistically significant difference in repigmentation between the two groups. There were no significant correlation between the results of the combination treatment plus NB-UVB in both groups and clinical criteria of vitiligo patients. There were statistically significant differences between distribution of sites of the lesions in vitiligo patients and treatment with topical applications plus NB-UVB regarding response of the treatment in the face and neck in G II . While in G I the face had excellent response but not statistically significant. Conclusions: The current study had shown that NB-UVB treatment alone is a moderately effective treatment for vitiligo. Betamethasone dipropionate / calcipotriol, when used in combination with NB-UVB were found to be superior in efficacy than NB-UVB alone, but the results were not statistically significant, while SOS/CAT gel does not appear to add any incremental benefit to NB-UVB alone. It could be recommended that further studies should be performed on this subject.