Analytical Study of Ocular Surface Changes in Patients of Chronic Kidney Disease undergoing Hemodialysis and Peritoneal Dialysis

Objectives?The idiopathic group is a significant cause of chronic kidney disease (CKD) in developing countries. Literature available on ocular surface changes has predominantly been reported in patients undergoing hemodialysis. Little is known about the changes in patients undergoing peritoneal dialysis. The present study aimed to identify ocular surface changes in an idiopathic group of CKD undergoing dialysis. Aim?To compare tear film disorders and the severity of ocular surface changes (goblet cell density, squamous metaplasia, and corneoconjunctival calcification) in patients of idiopathic etiology with CKD undergoing hemodialysis and peritoneal dialysis. This is an analytical study. Materials and Methods?Asymptomatic adult patients of idiopathic CKD, on treatment with dialysis underwent comprehensive ophthalmic examination, including best-corrected visual acuity, slit-lamp examination, and a dilated fundus examination. Dry eye assessment was done by ocular surface staining score, Schirmer test, and tear breakup time (TBUT). Conjunctival impression cytology was studied to assess changes on ocular surface. Chest X-rays for aortic calcification were reviewed and data analyzed. Results?Both eyes of 76 patients of hemodialysis and 32 patients of peritoneal dialysis were studied. Ocular surface staining (OSS) scores were low. Impression cytology showed a drop in goblet cell density, presence of squamous metaplasia, and conjunctival keratinization significantly more in the hemodialysis group. No correlation was seen between the presence of conjunctival calcification and aortic calcification. Conclusion?The hemodialysis group had mild subclinical dry eye but keratinization of conjunctiva was seen. Similarly, advanced squamous metaplasia was seen in the peritoneal dialysis group. These changes were positively correlated to decrease in goblet cell density.

Poroqueratosis de localización nasal. Reporte de un caso / Porokeratosis of nasal location. Case report

RESUMEN La poroqueratosis es un trastorno de la queratinización, con herencia autosómica dominante en la mayoría de los casos, vinculada posiblemente a la presencia de un clon mutante de queratinocitos en expansión. Tiene diferentes formas clínicas: de Mibelli, actínica superficial diseminada, lineal, puntiforme, palmoplantar y facial atípica. El diagnóstico se confirma con la histología, presentándose típicamente la laminilla cornoide, que no es patognomónica de esta afección. En el tratamiento de esta patología se utilizan desde agentes tópicos como emolientes, 5-fluorouracilo, calcipotriol, imiquimod y retinoides como terapia sistémica. Otras opciones terapéuticas descritas son extirpación quirúrgica, criocirugía y dermoabrasión cuando se trata de formas localizadas o únicas. Se decide reportar el caso de una paciente femenina con poroqueratosis de afección exclusiva del área nasal por su rara frecuencia y escasos reportes sobre esta forma de presentación en la actualidad.

ABSTRACT Porokeratosis is a disorder of keratinization, with AD inheritance in most cases; possibly linked to the presence of a mutant clone of expanding keratinocytes, in addition to the overexpression of the p53 gene that could be related to an oncogenic potential. This disorder has also been associated with factors such as UVR, immunosuppression cases such as HIV +, liver or kidney failure, transplantation of organs that would act as triggers of this disease. It differs from other pathologies due to the presence of a peripheral hyperkeratotic ring which is usually asymptomatic in half of the patients. Clinically it can occur in different ways: porokeratosis de Mibelli, superficial actinic disseminated, linear, punctate, palmoplantar and atypical facial. Diagnosis is confirmed with histology, with the cornoid lamella typically present, which is not pathognomonic of this condition and consists of a parakeratotic keratinocyte column that extends from an invagination of the epidermis through the stratum corneum. The treatment to choose, will depend on the patient´s age; Size and location of the lesions, the aesthetic implications and the general condition of the affected person. They are used from topics such as emollients, 5-fluorouracil, calcipotriol, imiquimod. Retinoids are found as an option for systemic therapy. Another procedure considers surgical removal, cryosurgery and dermabrasion when dealing with localized or unique forms. We report a case of a 44-year-old female patient who presents with compatible dermatosis porokeratosis, affecting only the nasal area.

Primary intraosseous squamous cell carcinoma ex-odontogenic cyst

Squamous cell carcinomas of the oral cavity are quite common, but primary intraosseous squamous cell carcinomas (PIOSCCs) are rare. Their origin from lining of different odontogenic cysts has been documented. More than 50% of such cases have been reported to occur in periapical inflammatory cysts, and less than 10 cases are reported to arise from odontogenic keratocyst (OKC). One such rare case of a PIOSCC, which presented as an OKC initially, is being reported

Ictiosis Lamelar autosómica recesiva: revisión de la literatura y caso clínico / Autosomal recessive lamellar ichthyosis: review of the literature and clinical case

Resumen Las ictiosis congénitas autosómicas recesivas (ICAR) son poco frecuentes a nivel mundial con una incidencia de 1:300,000 nacimientos, se caracterizan por trastornos de la queratinización, entre sus variantes engloban las formas no sindrómicas de ictiosis, como la ictiosis laminar (IL), la eritrodermiaictiosiforme congénita (EIC) y actualmente se incluyen la ictiosis arlequín, el bebé colodión autorresolutivo, el bebé colodión autorresolutivoacral y la ictiosis en traje de baño. Desde el punto de vista genético son heterogéneas, originadas por una mutación en el gen de la transglutaminasa 1 y se las haasociado a TGM1, ALOXE3, ALOX12B, NIPAL4, CYP4F22 y ABCA12. Clínicamente, la ictiosis se caracteriza principalmente por piel gruesa, escamas laminares adherentes con hendiduras profundas. En este trabajo pretende revisar los conocimientos actuales en el campo de las ICAR, incluyendo aspectos clínicos, histológicos, ultraestructurales, genético-moleculares, tratamiento,y también su manejo clínico.

Abstract The autosomal recessive congenital ichthyosis (ARCI) is a rare worldwide condition with an incidence of (1: 300,000 births), characterized by disorders of keratinization, among its variants encompass the non-syndromic forms of ichthyosis, such as laminar ichthyosis (IL) , congenital ichthyosiform erythroderma (EIC) and currently include harlequin ichthyosis, self-healing colodion baby, acral self-healing colodion baby and ichthyosis in swimsuits. From a genetic point of view, they're heterogeneous, originated by a mutation in the gene of transglutaminase 1 and associated with TGM1, ALOXE3, ALOX12B, NIPAL4, CYP4F22 and ABCA12. Clinically, ichthyosis is mainly characterized by thick skin, adherent lamellar scales with deep clefts. The aim of this work is to review the current knowledge in the field of ICAR, including clinical, histological, ultrastructural, genetic-molecular and therapeutic aspects as well as its clinical management.

Dermatosis Terra Firma-Forme / Terra Firma-Forme Dermatosis

RESUMEN Presentamos un caso típico de Dermatosis Terra Firma-Forme en un adolescente sano de 13 años de edad, visto recientemente en el Servicio de Dermatología de nuestro hospital. Con este caso queremos mostrar las características clínicas de esta dermatosis que con frecuencia no es correctamente diagnosticada o bien pasa desapercibida durante años lo que origina preocupación y ansiedad en el paciente además de pruebas diagnósticas innecesarias. Su diagnóstico es clínico apoyado en la dermatoscopía y el tratamiento sencillo, presentando escasas recidivas.

SUMMARY We report a typical case of a Terra Firma-Forme Dermatosis in a 13-year-old healthy male recently seen in the Dermatology Department of our hospital. The aim of the authors is to show clinical features of this frequently misdiagnosed and underreported dermatosis causing concern and anxiety in the patient as well as unnecessary diagnostic tests. Its diagnosis is clinical supported by dermoscopy and its simple treatment presents few recurrences.

Comedogenicity of Oils

Introduction: Controversies exist regarding comedogenicityand antimicrobial property of different oil. In Kerala, oilapplication to the face is a daily routine for many. Givingadvice to our acne patients regarding oil application hasalways been without much conviction. Study aimed to assessthe comedogenecity of coconut oil on rabbit ear.Material and methods: This study was conducted by theDermatology department in Amala Institute of MedicalSciences animal house, with the guidance from the researchdepartment. This study was conducted on rabbit ear model toassess comedogenic potential and antimicrobial properties ofcommonly used oils.Results: All the oils studied were equally comedogenic andshowed no antibacterial property.Conclusion: Application of coconut oil, mustard oil orliquid paraffin to acne prone skin is not advisable in ourenvironmental conditions and there is no antibacterial propertyfor any of these oils.

A clinical evaluation on the effect of astringent on keratinization of oral mucosa before and after the insertion of complete denture

Context: Conventional complete dentures still remain a viable method of treatment for many patients in this era of fixed prosthesis like dental implants. All patients undergoing complete denture treatment need nonsurgical preprosthetic treatment for the preparation of healthy denture bearing mucosa as well-keratinized healthy mucosa is desirable for a complete denture. Aims: To evaluate and compare the keratinization before and after denture insertion at intervals of 1 week and 1 month. Settings and Design: The present study was conducted on 24 completely edentulous male subjects divided into control and study groups. Each patient in study group was asked to massage with astringent on the denture bearing mucosa over a 4-week period. Subjects and Methods: Exfoliative cytology was used to collect the surface cells from the palatal mucosa and buccal mucosa. The first smear was taken before the denture insertion. The second and third smears were taken after the stimulation treatment with astringent gel for each patient after 1 week and after 4 weeks. Each smear was stained with the Papanicolaou's technique. The number of basal cells, intermediate cells, and superficial cells were recorded to calculate the degree of keratinization. Statistical Analysis Used: Descriptive statistics, paired samples t-test, independent t-test, and repeated-measures analysis of variance. Results: The result showed statistically significant increase in the keratinization of palatal mucosa after 4 weeks of astringent therapy and no effect was noted in the keratinization of buccal mucosa. Conclusions: Astringent has shown to increase keratinization of palatal mucosa, and so it can be used to increase the quality of the denture bearing mucosa; moreover, the astringent stimulation has no effect on the keratinization of buccal mucosa.

Clinical evaluation and comparison of three surgical procedures for treatment of root surface exposure after epulis resection / 中华口腔医学杂志

Objective@#To evaluate and compare the clinical effects of three surgical procedures for the periodontal treatment of root surface exposure after resection of epulis.@*Methods@#Thirty patients with epulis were selected in this study and the exposed root surfaces of the patients′ teeth were covered with laterally transposition flap, laterally pedicled transposition flap or coronally advanced flap combined with a connective tissue graft in the treatments of epulis. At the time of follow-up during the operation, 3 months after operation and 6 months after operation, respectively, the color, shape and quality of the gum in the operation area and the coordination of the diaphragm and diaphragm were observed, and the root surface exposure (recession depth, RD) and angle were recorded. Keratinized tissue height (KTH), root coverage rate (RC) and patients′ satisfaction with the surgery were also recorded.@*Results@#The flap widths in groups of laterally pedicled transposition flap and coronally advanced flap combined with a connective tissue graft were significantly wider than that in the group of laterally transposition flap at three-month and six-month follow-ups after the surgery. The width of keratoderma [(2.70±1.16) mm] in the group of laterally transposition flap was significantly lower at 6 months postoperatively than that in the other two groups [(4.80±1.14) and (4.90±1.66) mm, respectively] (P<0.01). At the 6th month after surgery, the root flap coverage was at the lowest level [(24±43)%] in the group of laterally transposition flap, and it was significantly lower than that in the other two groups [(80±23)% and (86±24)%, respectively] (P<0.01). There was no significant difference of the root flap coverage between groups of laterally pedicled transposition flap and coronally advanced flap combined with a connective tissue graft. At the time of follow-up, patients were satisfied with the aesthetic effects of the three surgical procedures.@*Conclusions@#After the resection of the gingival tumor, the defect of the gingiva is caused. The laterally pedicled flap and pedicled flap combined with connective tissue transplantations for soft tissue repairing can achieve satisfactory aesthetic effects which are superior to the effect of simple flap technique.

Treatment of 3 cases of nipple areola Ellman radiofrequency cutting combined with vitamin A / 中华整形外科杂志

Objective@#To observe the efficacy and safety of Ellman radiofrequency cutting combined with Avia in the treatment of hyperkeratosis of nipple and areola.@*Methods@#Three patients treated from February 2015 to February 2016 were given radiofrequency curettage to remove hypertrophic keratinizing skin lesions. After surgery, avitrea capsules were given orally and externally.@*Results@#All 3 patients completed the treatment. Three months after the surgery, the original keratinizing plaques in the nipples and areola on both sides of the patients fell off, the skin became thinner, and the appearance and color of the nipples and areola completely returned to normal.Follow-up of 2-3 years showed no skin thickening and pigmentation, and no recurrence.@*Conclusions@#Ellman radiofrequency cutting combined with avia is a safe and effective treatment for hyperkeratosis of nipple and areola.

Terra Firma-Forme Dermatosis: A Report of Four Cases and Review of the Literature / 대한피부과학회지

Terra firma-forme dermatosis is characterized by asymptomatic dirt-like papules and plaques. It appears as dirt-like lesions, but is known to develop in persons with normal hygiene habits. Terra firma-forme dermatosis is rarely reported and has an unknown etiology. It is hypothesized to occur as a result of abnormal keratinization. Terra firma-forme dermatosis is usually detected in children and young adults. Its characteristic features include disappearance with alcohol swabbing. Thus, wiping with alcohol-soaked cotton is recommended before any other examination in cases where terra firma-forme dermatosis is suspected.

A Systems Biology Approach for Studying Heterotopic Ossification: Proteomic Analysis of Clinical Serum and Tissue Samples / 基因组蛋白质组与生物信息学报·英文版

Heterotopic ossification (HO) refers to the abnormal formation of bone in soft tissue. Although some of the underlying processes of HO have been described, there are currently no clinical tests using validated biomarkers for predicting HO formation. As such, the diagnosis is made radiographically after HO has formed. To identify potential and novel biomarkers for HO, we used isobaric tags for relative and absolute quantitation (iTRAQ) and high-throughput antibody arrays to produce a semi-quantitative proteomics survey of serum and tissue from subjects with (HO) and without (HO) heterotopic ossification. The resulting data were then analyzed using a systems biology approach. We found that serum samples from subjects experiencing traumatic injuries with resulting HO have a different proteomic expression profile compared to those from the matched controls. Subsequent quantitative ELISA identified five blood serum proteins that were differentially regulated between the HO and HO groups. Compared to HO samples, the amount of insulin-like growth factor I (IGF1) was up-regulated in HO samples, whereas a lower amount of osteopontin (OPN), myeloperoxidase (MPO), runt-related transcription factor 2 (RUNX2), and growth differentiation factor 2 or bone morphogenetic protein 9 (BMP-9) was found in HO samples (Welch two sample t-test; P < 0.05). These proteins, in combination with potential serum biomarkers previously reported, are key candidates for a serum diagnostic panel that may enable early detection of HO prior to radiographic and clinical manifestations.

Harlequin Ichthyosis in a 4-year-old male: Case report

@#Harlequin ichthyosis (HI) is a rare type of congenital keratinization disorder that, when left untreated, usually leads to early neonatal demise. A clinical diagnosis of HI is considered when a patient presents with thick plate-like scaling of the skin together with eclabium, ectropion, and nasal hypoplasia. The diagnosis can be confirmed by genetic testing to determine mutation in the adenosine triphosphate-binding cassette A12 (ABCA12) gene. Early administration of systemic retinoids to promote desquamation and emollients to control excessive scaling and dryness of the skin lead to better prognosis in most cases of HI. We present the case of a 4-year-old male with HI who has been successfully managed with bland emollients and systemic acitretin therapy, which we started when he was 1 year old.

Harlequin Ichthyosis in a 4-year-old male: Case report

@#Harlequin ichthyosis (HI) is a rare type of congenital keratinization disorder that, when left untreated, usually leads to early neonatal demise. A clinical diagnosis of HI is considered when a patient presents with thick plate-like scaling of the skin together with eclabium, ectropion, and nasal hypoplasia. The diagnosis can be confirmed by genetic testing to determine mutation in the adenosine triphosphate-binding cassette A12 (ABCA12) gene. Early administration of systemic retinoids to promote desquamation and emollients to control excessive scaling and dryness of the skin lead to better prognosis in most cases of HI. We present the case of a 4-year-old male with HI who has been successfully managed with bland emollients and systemic acitretin therapy, which we started when he was 1 year old.

Uso de N-acetilcisteína tópica en ictiosis: experiencia clínica en una serie de casos / Use of topical N-acetylcysteine ​​in ichthyosis: clinic experience in a series of cases

Las ictiosis son trastornos generalizados de la queratinización, que se caracterizan por presentar hiperqueratosis y/o descamación. El tratamiento es sintomático e incluye terapias tópicas y sistémicas. La N-Acetilcisteína (NAC) tópica ha mostrado utilidad en algunos reportes. Se describirá la experiencia con el uso de NAC 10% y urea 5% en novobase II (NB II) en 6 pacientes con distintos tipos de ictiosis hereditarias. Caso Nº1: Escolar masculino de 7 años con Ictiosis lamelar (IL) en tratamiento con fórmula de NAC hace 4 años con buena respuesta. Caso N°2, 3 y 4: Escolar masculino de 7 años, escolar masculino de 5 años y lactante masculino de 1 año 8 meses con Ictiosis recesiva ligada a X (IRLX), en tratamiento con fórmula de NAC con buena respuesta. Caso N°5: Mujer de 18 años con Eritrodermia ictiosiforme congénita (EIC), inicia tratamiento con fórmula de NAC, pero se suspende por mala tolerancia. Caso N°6: Preescolar femenina de 3 años, con Ictiosis epidermolítica (IE), inicia tratamiento con fórmula de NAC con mala tolerancia por lo que también se suspende. Se evaluaron los efectos de la fórmula de NAC en diferentes tipos de ictiosis, mostrando un buen perfil de seguridad y eficacia en IL e IRLX, sin embargo, en EIC e IE su uso estuvo restringido por efectos adversos. El tratamiento con fórmula de NAC presenta buena respuesta y tolerancia en pacientes con IL e IRLX, por lo que podría considerarse en el tratamiento habitual de estos pacientes.

Ichthyosis are generalized disorders of keratinization, characterized by hyperkeratosis and/or scaling. Treatment is symptomatic and includes topical and systemic therapies. Topical N-acetylcysteine (NAC) has shown utility in some reports. We describe the experience using 10% NAC and 5% urea in novobase II (NB II) in 6 patients with different types of hereditary ichthyosis. Case N°1: 7-year-old boy with lamellar Ichthyosis (IL) in treatment with NAC formula 4 years ago, with good response. Case N°2, 3 and 4: 7-year-old boy, 5-year-old boy and 1-year-8-month-old male infant, with X-recessive recessive Ichthyosis (IRLX) in treatment with NAC formula with good response. Case N°5: An 18-year-old woman with congenital ichthyosiform erythroderma (EIC) begins treatment with NAC formula but is discontinued because of poor tolerance. Case No. 6:3-year-old girl, with epidermolytic Ichthyosis (IE), starts treatment with NAC formula with poor tolerance and is also suspended. The effects of the NAC formula on different types of ichthyosis were evaluated, showing a good safety and efficacy profile in IL and IRLX, however, in EIC and IE, its use was restricted by adverse effects. Treatment with NAC formula has a good response and tolerance in patients with IL and IRLX, so it could be considered in the usual treatment of these patients.

Ocular Manifestations of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis / 한양의대학술지

Steven-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare and sometimes life-threatening hypersensitivity mucocutaneous disease triggered mostly by medication and infections Major involving tissues are the mucous membranes of oral, gastrointestinal, respiratory, integument, and gynecologic tissues. Even after recovering from skin problems without sequelae, survivors can have serious ocular complications leading to blindness despite local and systemic therapy. There is no definite effective systemic and local treatment for SJS/TEN. Early detection and aggressive treatment are important for the long-term prognosis of the eye. Eyelid margin and palpebral conjunctiva and fornix should be checked thoroughly to detect the cicatrical changes that make chronic ocular surface failure such as limbal cell deficiency and complete ocular surface keratinization. Amniotic membrane transplantation and cultivated oral mucosal graft are beneficial to reduce the risk of ocular surface failure.

Proliferating trichilemmal tumour: a case report with review of literature.

Proliferating trichilemmal tumour is a solid-cystic neoplasm that shows trichilemmal differentiation similar to that of the isthmus of the hair follicle histologically characteristed by the presence of trichilemmal keratinization. Proliferating Trichilemmal Tumour (PTT) appears mainly in elderly women and is in general a solitary lesion on the scalp. Proliferating trichilemmal tumours generally have a benign clinical course, and a clinical differentiation from squamous cell carcinoma is often difficult. We report a case of PTT in a 30 year old man presenting as a solitary 10x8 cm ulcerated nodule on the scalp since 3 months clinically resembled a malignant tumour. The therapeutic approach is surgical removal with a wide clear margin.

Paraqueratosis granular: revisión de la literatura a propósito de un caso / Granular parakeratosis: review of the literature apropos of a case

La paraqueratosis granular es un desorden de la queratinización adquirido, secundario a un error en la diferenciación epidérmica. Se presenta en forma de pápulas y placas pruriginosas, eritematosas o de color marrón oscuro, que afectan áreas intertriginosas. Su patogénesis es desconocida, pero algunos casos han sido relacionados con ciertos factores, tales como irritantes físicos o agentes químicos. Entre los hallazgos histopatológicos se incluyen un estrato córneo engrosado, paraqueratosis compacta con retención de gránulos de queratohialina, mientras que el estrato granuloso está preservado. Presentamos un caso de paraqueratosis granular axilar en una mujer y se revisan las principales características clínicas, histológicas y terapéuticas de esta inusual entidad.

Granular parakeratosis is a rare acquired keratinization disorder suspected as a consequence of an error in epidermal differentiation. Clinically it appears as dark or erythematous pruritic papules and plaques, that usually involve intertriginous areas. The pathogenesis of this entity is unknown, but some cases have been related to different factors, such as physical irritation or chemical agents. Histopathologic features include a thickened stratum corneum, compact parakeratosis with retention of keratohyalin granules whereas the stratum granulosum is preserved. We report a case of axillary granular parakeratosis in an adult female and a revision of the clinical, therapeutic and histological features of this unusual entity

Patogênese das lesões associadas à intoxicação por Ramaria flavo-brunnescens em bovinos / Pathogenesis of lesions associated with poisoning by Ramaria flavo-brunnescens in cattle

O estudo da patogênese da intoxicação pelo cogumelo Ramaria flavo-brunnescens em bovinos foi realizado através da avaliação retrospectiva de tecidos selecionados de nove casos espontâneos e quatro casos experimentais. Para a investigação da patogênese das lesões observadas na língua, esôfago, casco e cauda, foram avaliadas as alterações histopatológicas e aspectos histoquímicos e histoquímico-ultra-estruturais das lesões. As técnicas histoquímicas utilizadas foram o Tricrômico de Masson e a oxidação seletiva da ceratina (OSC). O estudo histoquímico-ultra-estrutural foi realizado através da técnica de Swift sob microscopia eletrônica de transmissão. Os pelos da vassoura da cauda foram examinados sob microscopia de luz polarizada. Todas as alterações observadas nas estruturas ceratinizadas estudadas, mas especialmente nas que sofrem ceratinização dura, revelaram defeitos na ceratinização. Aliando ao estudo morfológico os resultados obtidos através da técnica da OSC e da microscopia eletrônica/técnica de Swift pode-se associar os defeitos na ceratinização a uma redução na quantidade de aminoácidos sulfurados (cistina), principalmente nas estruturas que sofrem ceratinização dura, sendo este provavelmente o principal mecanismo patogenético na intoxicação por R. flavo brunnescens em bovinos.

The pathogenesis of the lesions of Ramaria flavo-brunnescens poisoning in cattle was studied throughout the retrospective evaluation of selected tissues from nine spontaneous and four experimental cases of the disease. The pathogenesis of lesions observed in the tongue, esophagus, hoof, and tail was investigated analyzing microscopic lesions, histochemical and histochemical-ultrastructural changes. Histochemical techniques utilized were Masson's Trichrome and Selective Oxidation of Keratin (SOK). The histochemical-ultrastructural study was acomplished throughout the Swift method under transmission electron microscopy. Hair shafts of the tip of the tail were analyzed under polarized light. Lesions of varying degrees of severity were observed. All changes observed in the keratinized structures studied, mostly in the hard keratin, showed defective keratinization. The morphologic study and the results obtained with SOK and Swift techniques showed that the defective keratinization results of low amounts of sulphur containing amino acids (cystine) in hard keratin structures. This is probably the main pathogenetic mechanism of the lesions observed in R. flavo brunnescens poisoning in cattle.

Correlation between vascular endothelial growth factor expression and malignancy grading in biopsy specimens of tongue cancers

Expressions of Cytokeratin and Ki-67 in the Development of the Pilomatricoma / 대한피부과학회지

BACKGROUND: Pilomatricoma (PM) is benign follicular tumor composed of the basophilic cells, transitional cells, shadow cells, squamoid cells and keratin filaments/amorphous debris. At present, PM is assumed to differentiate toward hair-forming cells of hair follicles but definite direction is not clear. OBJECTIVES: This study was made in order to investigate the pathways of cell differentiation associated with sudden keratinization in PM. METHODS: In the present study, 19 cases of human PM was histopathologically examined and classified into 4 groups according to the chronological stages. RESULTS: In the chronological stages according to Kaddu's classification, there were 2 cases of early lesion, 6 cases of fully developed lesion, 7 cases of early regressive lesion and 4 cases of late regressive lesion. The basophilic cells changed into the shadow cells or amorphous debris through the transitional cells moving toward the exterior of the PM, as well as toward the interior. As keratinization occurs, some inner basophilic cells which had been located in marginal areas of keratinization lost their tight cell-cell bonding. These cells showed edematous/vesicular and squamoid changes. High molecular weight cytokeratin was expressed in a linear pattern in some early and fully developed lesions. There were fewer layers of basophilic cells between the stroma and squamoid cells/amorphous debris than between the stroma and shadow cells. Ki-67 was expressed strongly both basal and overlying basophilic cells. Apoptotic bodies were detected in most transitional cell layers and some amorphous debris zones. CONCLUSIONS: The present study suggests dual pathways of cell differentiation in PMs. In the sudden keratinization pathway, the basophilic cells, transtional cells, shadow cells, and squamoid cells are suddenly keratinized, and the basophilic cells become early the transitional cells or squamoid cells. Cytoplasmic expressions of Ki-67 and cytokeratin in the basophilic cells show that the basophilic cells differentiate toward the innermost layer of the outer root sheath cells.