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Linear immunoglobulin A bullous dermatosis is a rare autoimmune disease with a good response to dapsone. We present the case of a female patient who was diagnosed with bullous pemphigoid and initially treated with systemic steroids; however, a poor response to the medication led to treatment discontinuation and loss to follow-up. The patient had lost vision in the left eye 2 years before this study and recently experienced decreased vision in the right eye.

We report a case of idiopathic lymphoplasmacellular mucositis (ILPM) of the vulva in a 48-year-old woman with partial interferon-γ receptor 1 (IFN-γR1) deficiency. The lesion had an unusual ulcerovegetative presentation. Remarkable response was observed with oral and topical steroids in the first 3 weeks. However, the lesion recurred after tapering oral steroids and continuous low-dose oral steroids were required to suppress recurrence. To the best of our knowledge, this is the first case report of ILPM in a patient with partial IFN-γR1 deficiency. ILPM should be included in the differential diagnosis of persistent vulvar ulcerovegetative lesions.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive hematologic malignancy that usually occurs in elderly individuals and manifests with skin lesions followed by involvement of the lymph nodes, bone marrow, and peripheral blood. We report our experience of establishing the diagnosis of a case of BPDCN in an 86-year-old man. The related literature is reviewed, and the differential diagnosis and treatment modality of this rare entity are discussed.

Sentinel lymph node biopsy (SLNB) is a standard procedure in the management of clinically node-negative melanoma. However, few studies have been performed on SLNB in Asia, which is an acral melanoma-prevalent area. This study evaluated the clinicopathologic prognostic factors of disease-free survival (DFS) and overall survival (OS) in Taiwanese patients with cutaneous melanoma who received wide excision and SLNB. The prognosis of patients with false-negative (FN) SLNB was also evaluated. Methods: Malignant melanoma cases were reviewed for 518 patients who were treated between January 2000 and December 2011. Of these patients, 127 patients with node-negative cutaneous melanoma who received successful SLNB were eligible for inclusion in the study. Results: The SLNB-positive rate was 34.6%. The median DFS was 51.5 months, and the median OS was 90.9 months at the median follow-up of 36.6 months. Multivariate analysis revealed that patients whose melanoma had a Breslow thickness greater than 2 mm had a significantly shorter DFS than patients whose melanoma had a Breslow thickness of 2 mm or less [hazard ratio (HR), 3.421; p = 0.005]. Independent prognostic factors of OS were a Breslow thickness greater than 2 mm (HR, 4.435; p = 0.002); nonacral melanoma (HR, 3.048; p = 0.001); and an age older than 65 years (HR, 2.819; p = 0.036). During the follow-up period, 13 of 83 SLN-negative patients developed a regional nodal recurrence. The SLNB failure rate was 15.7% and the FN rate was 22.8%. Compared to patients with a true-positive SLNB, patients with FN SLNB had a significantly shorter DFS (p = 0.001) but no significant difference in OS (p = 0.262). Conclusion: Except for the pathologic subtypes, prognostic factors in Taiwan are similar to those used in other melanoma-prevalent countries. Identifying and closely monitoring patients at risk of nodal recurrence after a negative SLNB is important.

Oncocytic lipoadenoma is a rare tumor, with only 18 cases having been reported since the first in 1998. We encountered a case of oncocytic lipoadenoma presenting as a slowly growing parotid mass in a 71-year-old man. This tumor is characteristically comprised of a mixture of oncocytes and adipocytes. The present case is one of five reported cases of oncocytic lipoadenoma showing sebaceous differentiation. The results of immunohistochemical study with DOG1 antibody supported the origination of this tumor in the striated duct.

A case of syringotropic mycosis fungoides without internal organ involvement received total skin electron beam therapy (TSEBT) and evolved into poikilodermatous mycosis fungoides. Subsequent oral psoralen plus ultraviolet A (PUVA) therapy achieved complete remission. The value of TSEBT for syringotroopic mycosis fungoides is illustrated in this case.

Pigmented epithelioid melanocytoma (PEM), or animal-type melanoma, is an unusual variant of melanoma which has been reported to have indolent behavior and a relatively good prognosis. We report a 12-year-old girl with PEM on the third finger web of her right hand. Histopathologically, it was composed of heavily pigmented dermal epithelioid and spindled melanocytic tumor cells. A sentinel lymph node biopsy was negative, and no recurrence was noted 1 year later. We reviewed 173 previously published cases of PEM or so-called animal-type melanoma in the literature. Among the 173 cases and our case, extremities were the most common sites of occurrence (52/129, 40.3%), and most of the depth of invasions were Clark level IV and V [76/114 (66.7%) and 33/114 (28.9%), respectively]. Lymph nodes metastasis was noted in 39/89 (43.8%) of the cases being investigated. Only two cases died of the disease with visceral metastasis. Thus, a more advanced level of invasion and the presence of lymph node metastasis did not imply a definitely malignant clinical course, because spreading beyond lymph nodes was rare (5/174, 2.9%). However, long-term follow-up with more cases and further research are needed to fully delineate the true biological nature of this pigmented melanocytic tumor.

Unilateral eyelid involvement, as the only manifestation of discoid lupus erythematosus (DLE), is very rare. Here, we report the case of a 41-year-old woman who presented with erythema and swelling of her left upper eyelid, which was initially misdiagnosed as cutaneous lymphoid hyperplasia. She had initially received radiotherapy at another institute for treatment. Our examinations established the diagnosis of DLE, and direct immunofluorescence confirmed this diagnosis. The skin lesion improved after treatment with topical steroids and oral hydroxycholoroquine.

Lipedematous alopecia is an uncommon disease that mainly affects African American and Egyptian women. This report is of an 18-year-old Taiwanese woman who presented with asymptomatic boggy and thickened scalp for 10 years. In the last 6 months, there was diffuse hair loss on the affected scalp without scarring. Histopathologically, there were increased thickness of subcutaneous fat layer, mild perivascular lymphocytic infiltration, and separated collagen bundles in the dermis. Alcian blue stain demonstrated mucin deposition in the dermis and subcutis, whereas magnetic resonance imaging showed thickened scalp with expanded subcutaneous fat layer. The clinical findings and imaging study established the diagnosis of lipedematous alopecia. The pathogenesis and disease etiology remain unclear. The coexistence of mucin is extremely rare and its significance should be further investigated.

Myopericytoma is a benign tumor composed of myoid-appearing oval to spindle-shaped cells arranged in a concentric perivascular pattern of growth. It arises most commonly in the dermis or subcutaneous tissue of the extremities in adults, and presents as a well-circumscribed, slow-growing, painless firm tumor. We describe a case of myopericytoma with unusual clinical presentation as scarring alopecia in a 14-year-old girl without any underlying disease, who presented with a 2-month history of a pink patch with hair loss on her frontal scalp. Under the diagnosis of discoid lupus erythematosus, an incisional biopsy was also performed. The biopsy specimen revealed a myopericytoma characterized by a subcutaneous large vein-like structure surrounded by spindled, stellate, and cuboidal cells with multiple small branching vascular spaces. The overlying dermis was fibrotic with dilated vessels and the number of hair follicles was decreased. No features of lupus erythematosus were noted and a lupus band test was negative. Total excision was performed. No recurrence occurred in the following 2 years.

Necrobiotic xanthogranuloma is an uncommon granulomatous disease involving the skin and extracutaneous tissues. It is characterized by indurated, yellow-red plaques and nodules, involving primarily the face and less frequently the trunk and extremities. The disease has a strong association with paraproteinemia and other hematologic or lym-phoproliferative disorders. Histologically, the dermal part shows xanthogranulomatous change with extensive necrobiosis and many Touton and foreign-body giant cells. Here, we describe a case of a 46-year-old man with a 1-year history of multiple cutaneous lesions over the trunk and thighs. Necrobiotic xanthogranuloma was diagnosed by histology and clinically associated with paraproteinemia. This case is also unusual in that there was no periorbital involvement, which is believed to be a typical feature of this disease.

Dermatofibrosarcoma protuberans (DFSP) is an indolent sarcoma known for its propensity for local invasive growth and recurrence. It typically presents as a protuberant tumor mass. Rare nonprotuberant presentations have recently been described; these invariably present as pigmented or depressed plaques. Lesions arising in the subcutaneous compartment and without cutaneous manifestations have rarely been reported or emphasized in the literature. Here we report a case of deep DFSP that lacked discernible epidermal or dermal changes, was mistaken for a lipoma, and localized entirely within the subcutaneous compartment. Ultrasonography may not be useful in differentiating DFSP from benign tumors. In addition, a review of the English language literature revealed that these deep-seated tumors might be more common than originally believed. For this purpose, the current case is presented to raise awareness for DFSP, which can be present entirely in the subcutis without cutaneous manifestations and thus easily overlooked.

Subcorneal pustular dermatosis (SPD) and pyoderma gangrenosum (PG) are two neutrophilic dermatoses. Coexistence of these diseases in the same patient is rare and may be a strong indicator of IgA dysglobulinemia. We describe a 69-year-old man who presented with waxing and waning flaccid pustules covering his trunk and four limbs. Poorly healing ulcerations, which usually progressed into larger nodules after debridement, were also noted. Repeated cultures were negative for bacteria, and the patient was diagnosed with SPD and PG. Serum protein electrophoresis and immunofixation revealed a monoclonal IgA lambda protein. A subsequent bone marrow biopsy revealed a normocellular marrow. While PG and SPD can occur individually in a variety of associated diseases, such as rheumatoid arthritis, systemic lupus erythematosus and inflammatory bowel disease or infection; however, their coexistence is strongly indicative of IgA dysglobulinemia.

Blueberry muffin baby is a rare neonatal skin disorder. Causes for the generalized hemorrhagic purpuric eruptions include congenital infections, hemolysis, and tumors. We report a 2.5-month-old female baby with a blueberry muffin appearance, respiratory distress, and decreased activity and appetite. Skin biopsy showed diffuse infiltrates of myeloperoxidase- and lysozyme-positive blast-like cells in dermis and superficial subcutis. Bone marrow study confirmed the diagnosis of acute monocytic leukemia with leukemia cutis. The skin nodules regressed spontaneously without chemotherapy over several days, and the peripheral blood cell counts normalized. This spontaneous remission lasted for 2 months. Spontaneous remission of infantile leukemia is rare, and its mechanism remains unknown. Although overt leukemia relapsed in some of these patients, a delay in chemotherapy spared these infants of the toxic effects of treatment.

In 1998, an outbreak of enterovirus 71-associated hand, foot, and mouth disease occurred in Taiwan. Pathologic studies of two fatal cases with similar clinical features revealed two different causative agents, emphasizing the need for postmortem examinations and modern pathologic techniques in an outbreak investigation.

The article offers information on the clinical presentation of primary cutaneous mucinous carcinoma. Topics discussed include primary cutaneous mucinous carcinoma is a rare, slow‑growing tumor with indolent clinical course; mentions the characteristic pathological changes are tumors with pools of mucin divided by thin fibrous septa; and also mentions the diagnosis of primary cutaneous mucinous carcinoma should be differentiated from metastasis of mucinous adenocarcinoma from other organs.

The article presents a case study of a 68-year-old man who had diagnosed with cutaneous lymphoepithelioma-like carcinoma (LELC), highlighting LELC's dermoscopic features and histopathologic correlation.

Surgical resection is considered a crucial treatment in patients with primary colonic lymphoma, but combining surgery with chemotherapy has provided additional therapeutic benefits in some studies. To further explore the optimal therapeutic approach in different clinical scenarios, we reviewed cases with localized large-cell lymphoma and analyzed the factors related to the outcomes. The 74 cases diagnosed between February 1979 and October 2010 were retrospectively reviewed for clinical features, laboratory findings, and pathological diagnosis. The outcomes were correlated with their demographics and different treatment modalities. Of the 74 cases, only the patients who had complete tumor resection had significantly improved progression-free survival (PFS). The patients treated with resection and chemotherapy had better overall survival (OS) and PFS than those treated with resection alone. The OS and PFS of the patients who were treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy without surgery were similar to those of patients treated with CHOP and resection, but the patients treated with resection followed by cyclophosphamide, vincristine, and prednisone (COP) chemotherapy had significantly better OS and PFS than the patients treated with COP chemotherapy alone. For patients with diffuse large B-cell lymphoma (DLBCL), rituximab-based chemotherapy with or without resection had similar OS and PFS. We conclude that chemotherapy alone provides similar therapeutic effect compared with surgery and chemotherapy and that surgical resection can be spared if an endoscopic diagnosis could be made. [ABSTRACT FROM AUTHOR]

Chronic sclerosing dacryoadenitis and chronic sclerosing sialadenitis have been shown to belong to the group of diseases referred to as IgG4-related sclerosing disease. The authors report a case of the simultaneous occurrence of IgG4-related sclerosing disease in both lacrimal and submandibular glands, clinically simulating malignant lymphoma. A cervical lymph node and a Warthin’s tumor were also involved. This unique case of multiple organ involvement in IgG4-related sclerosing disease is documented. [ABSTRACT FROM PUBLISHER]

Only 2 cases of nasopharyngeal small cell carcinoma have been reported. Another case of this rare type of nasopharyngeal tumor confirmed by immunopositivity for CD56, synaptophysin, and chromogranin A is described in this study. The tumor was also negative for cytokeratin (CK) 20 and thyroid transcription factor-1. Clinical investigation did not find any primary tumor in other anatomic sites. Therefore, this case was established as a primary nasopharyngeal small cell carcinoma. Epstein-Barr virus was shown to be absent by Epstein-Barr virus encoded RNA in situ hybridization study in this case, which further distinguished it from conventional nasopharyngeal carcinoma. Clinical features of this case and 2 previously reported cases are compared. They do not differ from conventional nasopharyngeal carcinoma in clinical presentation, but the prognosis seems to be worse. More cases are needed to confirm the observation and for understanding the clinical behavior of this rare type of nasopharyngeal tumor. [ABSTRACT FROM PUBLISHER]

Sclerosing angiomatoid nodular transformation (SANT) is a peculiar splenic vascular lesion that is characterized by marked stromal sclerosis and the presence of plasma cells, which shares histopathological features associated with IgG4-related sclerosing disease. The cinicopathological features of 10 cases of SANT were reviewed and immunohistochemistry with IgG4 and IgG antibodies was performed. Nine other various splenic lesions served as controls. Five cases of SANT were found incidentally. Three cases of SANT had multiple tumors and five had associated abdominal disseminated calcifying fibrous tumors (CFT). IgG4+ plasma cells were found in all of the cases of SANT and in calcifying fibrous tumors. The densities of IgG4+ and IgG+ cells and the IgG4/IgG ratios were significantly higher in SANT than in control spleens ( P= 0.001, 0.006, and 0.028, respectively). Serum IgG4 concentration was elevated in one case. In conclusion, SANT can occur either as a solitary or as multiple tumors. Frequent association with abdominal disseminated CFT simulating carcinomatosis was observed. A statistically significant number of IgG4+ plasma cells was found in all of the cases of SANT and the associated CFT. Whether they are related to the IgG4-related sclerosing disease or not is debatable and warrants further investigation. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 39-year-old man who suffered fever for one year of unknown origin. He was observed to have a positive antinuclear antibody (ANA) and diagnosed of stage intravascular large B-cell lympyhoma (IVLBCL) involving the bone marrow, skin and spleen. The patient was treated with chemotherapy with cyclophosphamide, rituximab and doxorubicin for five consecutive days. A discussion of intravascular lymphoma (IVL) is also included.

Background: Cutaneous Rosai-Dorfman disease (CRDD) shares the histopathological features of abundant plasma cells and stromal fibrosis with IgG4-related sclerosing disease. The possible role of IgG4+ plasma cells in CRDD was investigated. Methods: Twelve cases of CRDD were reviewed, and their lesions were immunostained with anti-IgG4 and anti-IgG antibodies. The number of IgG4+ and IgG+ plasma cells and their ratios were estimated. Serum IgG4 and IgG concentrations were measured in two recent cases. Results: Many IgG4+ and IgG+ plasma cells were found in all 12 cases. IgG4+ plasma cells ranged from 21 to 204 per high-power field (HPF) (mean 117/HPF), and IgG+ plasma cells ranged from 114 to 759/HPF (mean 349/HPF). All cases had more than 30 IgG4+ cells/HPF, except one case. The IgG4/IgG ratio ranged from 16% to 51% (mean 34%). Serum IgG4 concentration and serum IgG4/IgG ratio were increased in one recent case. Various degrees of stromal fibrosis were present in all cases. Conclusions: The presence of many IgG4+ plasma cells and stromal fibrosis suggests that CRDD may be related to IgG4-related sclerosing disease. Many IgG4+ plasma cells is another feature of CRDD, and serum IgG4 may be elevated. [ABSTRACT FROM AUTHOR]

Background Although an umbilical nodule is common in neonates and young infants, an umbilical nodule of poor therapeutic response will increase the likelihood of other uncommon etiology. Clear cell acanthoma (CCA) has never been described as an oozing umbilical nodule on infants. Methods To present a case of CCA which occurred on an 8-month-old female infant presenting with one weeping nodule on the umbilicus since early neonate. The lesion underwent skin biopsy and subsequent hematoxylin-eosin and periodic acid-Schiff staining. Result Three courses of liquid nitrogen cryosurgery were performed after the diagnosis of CCA was confirmed. The lesion resolved rapidly. Conclusion This report presents the first and youngest case of umbilical CCA in the English literature. This case supports the inflammatory dermatosic nature of CCA. [ABSTRACT FROM AUTHOR]

Splenosis usually occurs after traumatic rupture of the spleen with autotransplantation of splenic tissue to ectopic sites. Most commonly, it occurs as intraperitoneal nodules, which are found either incidentally or after symptomatic complications. Subcutaneous splenosis is a rare condition mostly observed in abdominal surgical scars. Reported herein is a case of subcutaneous splenosis developed in an exit gunshot wound scar on the left lower chest wall 9 years after splenectomy. The lesion presented as an asymptomatic subcutaneous nodule, which was excised under the impression of a skin tumor. Microscopically, there were multiple subcutaneous nodules resembling splenic tissue with red and white pulp. They were confirmed to be ectopic splenic tissue by immunohistochemical staining of the vascular lining cells (CD8+, CD31+, and CD34–). Only 11 cases of subcutaneous splenosis have been reported before. The present case was the third case occurring in an exit gunshot wound scar, and the diagnosis was confirmed by immunohistochemical study. [ABSTRACT FROM AUTHOR]

Polyvinylpyrrolidone (PVP), a polymer of the monomer N-vinylpyrrolidone with various molecular weights, was originally developed as a plasma expander. Currently, it is widely used in hair sprays, skin care products, fruit juices, and as a retarding agent in drugs such as procaine and hormones. PVP polymers with a molecular weight greater than 20,000 cannot be excreted by the kidneys and therefore are phagocytosed and permanently stored in the reticular endothelial system, leading to the so-called PVP storage disease. We report a case of localized cutaneous PVP storage disease presenting with persistent upper lip swelling and mimicking cheilitis granulomatosa, which has never been reported before. [ABSTRACT FROM AUTHOR]

We report a case of simultaneous occurrence of Hodgkin's lymphoma and Kaposi's sarcoma within the same lymph nodes of a 61-year-old woman without human immunodeficiency virus (HTV) infection. Epstein-Barr virus (EBV) was detected in the Hodgkin cells and Reed-Sternberg cells by EBV LMP-1 immunostaining and Epstein-Barr virus encoded early RNA (EBER) in situ hybridization. In contrast, Kaposi's sarcoma cells were positive for human herpes virus 8. This case is documented because the occurrence of 2 independent tumors infected by 2 unrelated viruses within the same lymph nodes of a patient without HIV infection has rarely been observed. [ABSTRACT FROM AUTHOR]

Twenty-three patients with primary salivary gland lymphoma were diagnosed between 1990 and 2001. The sites of involvement were the parotid gland in 13, the submandibular gland in 9 and the minor salivary gland in 1. The sites of lymphoma involvement beyond the salivary glands were the cervical lymph nodes in 7, bone marrow in 3, the axillary lymph nodes in 3, the nasopharynx in 2, the abdominal lymph nodes in 2, the palate, the subconjunctiva, and the spleen in 1 each patient. Histologically, 19 patients had lymphomas of mucosa-associated lymphoid tissue (MALT) with myoepithelial sialadenitis in 13, 3 patients had diffuse large cell lymphomas and 1 had follicular lymphoma. Six patients were in stage I, 4 in II, 1 in III and 12 in IV. Eight of 23 patients (35%) had autoimmune diseases before or after the diagnosis of NHL and all suffered from MALT lymphoma. Four patients with parotid MALT lymphoma had primary or secondary Sjögren’s syndrome. One each patient suffered from hyperthyroidism, systemic lupus erythematosus, membranoproliferative glomerulonephritis and cryoglobulinemia, respectively. All the 6 stage I patients had achieved complete remission (CR) without relapses 17–84 months (median 44 months) after treatment. Excluding a stage IV patient with follicular lymphoma who died at 3.5 months without treatment, CR was achieved in all of the remaining 16 patients. However, a high relapse rate (9/16, 56%) was noted in stage II–IV patients. These patients tended to relapse in the original sites, but achieved CR again after chemotherapy or radiotherapy. One patient with MALT lymphoma developed histologic transformation into diffuse large lymphoma during relapse and died of refractory disease. Overall, only 2 patients succumbed. The overall survival and relapse-free survival rates at 5 years were 94.7 and 51.4%, respectively. Thus, salivary gland lymphoma proved to be an indolent disease. Copyright © 2004 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Kikuchi's disease (KD) is a self-limiting lymphadenitis mostly affecting the cervical lymph nodes of young individuals. It has been classified into three histological subtypes and postulated to progress from the proliferative type (PT) to the necrotizing type (NT) and finally resolve into the xanthomatous type (XT). Since KD has been shown to be an apoptotic disease, the apoptotic activity was studied by the TUNEL method on 6, 12, and 6 cases of PT, NT, and XT, respectively, to see if the apoptotic activity could be shown to decrease in the order of the postulated sequence of evoluation. Significant statistical difference among the three subtypes was found ( P = 0.050). Further analysis revealed that PT versus NT was significant ( P = 0.010), but NT versus XT ( P = 0.385) or PT versus XT ( P = 0.310) was not. Analysis of three stages of NT was also significant ( P = 0.019). Immunohistochemical study showed that abundant CD8+ T cells and cytotoxic protein positive cells were present in PT and NT, but were relatively low in XT. Our results showed progression of PT to NT, but not from NT to XT. Xanthomatous type was not the resolving stage of KD, but seemed to be a distinctive histological variant of KD caused by either different etiology or an unusual host reaction. [ABSTRACT FROM AUTHOR]

OBJECTIVEThe object of the study was to determine the incidence of the presence of Epstein-Barr virus-derived latent membrane protein-1 (LMP-1) gene in various head and neck cancers by polymerase chain reaction method.STUDY DESIGNProspective study.METHODSDuring a 5-year period, polymerase chain reaction was used to investigate the presence of LMP-1 gene in various head and neck cancers from different locations and histopathological types, noncancerous nasopharyngeal biopsy samples, and tonsillectomy specimens from patients with chronic hypertrophic tonsillitis.RESULTSOf 202 patients enrolled in the study, 53 were diagnosed by pathological study with oropharyngeal carcinoma, 45 with nasopharyngeal carcinoma, 26 with oral cavity carcinoma, 26 with laryngohypopharyngeal carcinoma, 31 with nasopharyngeal lymphoid hyperplasia, and 21 with tonsils with lymphoid hyperplasia. After the application of polymerase chain reaction, the LMP-1 gene was not detected in any sample from oral cavity carcinoma, laryngohypopharyngeal carcinoma, or nasopharyngeal lymphoid hyperplasia or from tonsillectomy specimens but was detected in only one case of tonsillar carcinoma. On the contrary, the LMP-1 gene was detected in 43 (95.6%) of 45 samples from patients with nasopharyngeal carcinoma. The statistical analysis shows a significant association (P <.001) between the presence of LMP-1 gene and tumor localization in the nasopharynx.CONCLUSIONSThe study shows that the presence of LMP-1 gene detected by polymerase chain reaction in the tumor cell is only significantly associated with tumor located in the nasopharynx, implying that Epstein-Barr virus plays a trifling role in the tumorigenesis of carcinomas arising from other head and neck locations. The polymerase chain reaction method that was used is a potential tool for screening nasopharyngeal carcinoma. [ABSTRACT FROM AUTHOR]

OBJECTIVE The object of this study was to determine the incidence of p53 mutation in recurrent nasopharyngeal carcinoma refractory to radiotherapy.STUDY DESIGN Prospective study.METHODS There were 31 patients enrolled in this study between 1995 and 1998. All patients had received radiotherapy but none of them had undergone chemotherapy or local salvage surgery previously.RESULTS The p53 status of each tumor was analyzed by polymerase chain reaction and by sequencing of exons 5 to 8 (codons 126-306). Five (16.1%) of 31 patients had mutations in the p53 gene, of which 2 were non-sense mutations, 2 were transition mutations, and 1 was a frameshift deletion mutation. The majority of the p53 mutations were found in exon 5. There is no significant difference in the incidence of p53 mutation compared with that of the previous reports for the primary disease. Based on the clinicopathologic data, there was no specific difference found between these 5 patients and the others.CONCLUSIONS This study shows that p53 mutation is an infrequent event and may have no essential role in recurrent nasopharyngeal carcinomas. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses the case of a 73-year-old man diagnosed with Churg-Strauss syndrome with asymptomatic pulmonary embolism.

Cutaneous lupus erythematosus (LE), polymorphous light eruption (PMLE), lymphocytic infiltration of Jessner (LIJ), and cutaneous lymphoid hyperplasia (CLH) are often difficult to differentiate fro one another by light microscopic examination. We conducted an immunohistochemical analysis of the mononuclear cell infiltrates in 13 LE, 12 PMLE, 10 LIJ, and 13 CLH with various antibodies. Antibodies L26, UCHL1, and S100 achieved statistically significant differences among the four diseases, but because of the overlaps in the number of UCHL1(+) T cells and S100 protein (+) cells in individual cases, these two antibodies were not useful. Only CLH could be distinguished from LE, PMLE, and LIJ by a greater number of CD20(+) B cells. The latter three conditions could not be differentiated. Contrary to previous reports, plasmacytoidmonocytes were not found to be increased in LIJ for the differentiation of the latter from LE and PMLE. Our results support the conclusion that CLH is a reactive lymphoid hyperplastic process with proliferation of both B and T cells, whereas the T cell was the predominant cell type in the infiltrates of LE, PMLE, and LIJ, indicating that they were related to T cell disorders. The histiocyte was only a minor component cell. The plamacytoid monocyte in general was not significantly present in all four conditions, but relatively more plasmacytoid monocytes were present in CLH. [ABSTRACT FROM AUTHOR]