A rare case of atypical cellular neurothekeoma in a 68-year-old woman.

Cellular neurothekeoma is a benign dermal lesion of uncertain differentiation. The atypical variant of cellular neurothekeoma, characterized by features such as large size, deep penetration, diffusely infiltrative borders, vascular invasion, high mitotic rate and marked cytologic pleomorphism, has been very rarely reported in the literature. We present the clinical, histopathological and immunohistochemical profile of a new case of atypical cellular neurothekeoma in a 68-year-old female patient who was diagnosed with ductal breast carcinoma in situ before. An erythematous painless papule arose in her right breast, and tentative clinical diagnosis was orientated toward skin metastasis of breast cancer or fibroma. Upon histological examination, the lesion showed the histological and immunohistochemical features of atypical variant of cellular neurothekeoma with high mitotic rate, marked cellular pleomorphism and penetration into subcutaneous fat. A further unusual feature in our patient was her age, because she is the oldest patient reported in the literature with diagnosis of atypical cellular neurothekeoma so far. Prognosis remains uncertain because only few cases of atypical cellular neurothekeoma have been reported in the literature, with a very limited follow-up time. Our report contributes to a better characterization of the clinical and morphologic features of atypical cellular neurothekeoma.

Heterogeneity of banana allergy: characterization of allergens in banana-allergic patients.

BACKGROUND: Banana is a frequent cause of food allergy, particularly in latex-sensitized patients. OBJECTIVE: The aim of the study was to get insights in immunoglobulin (Ig)E antibody responses of patients with a history of allergic reaction to banana but not to latex. METHODS: In four patients who complained about symptoms after banana consumption, skin prick tests (SPTs) with aeroallergens, latex, banana, avocado, and kiwi were performed. Total and specific serum IgE to birch pollen, rBet v 1 and rBet v 2, latex, banana, avocado, and kiwi were determined by the CAP method (Pharmacia Diagnostics, Uppsala, Sweden). Allergens were identified by immunoblotting with banana extract and recombinant banana profilin. Two patients underwent double-blind, placebo-controlled food challenges (DBPCFC) with banana. RESULTS: All patients showed a positive SPT to banana, and three were IgE-CAP positive (> or = class 2). Two patients were also sensitized (SPT and CAP) to latex, avocado, kiwi, and birch pollen. In the immunoblot these two patients' sera reacted to 32- to 34-kDa proteins, which had already been described as major banana allergens. In both patients banana allergy was confirmed by DBPCFC. The third patient also had a sensitization to avocado, but not to latex or pollen. Immunoblot analysis detected a single band at 70 kDa. The fourth patient was sensitized to birch pollen, rBet v 1 and rBet v 2, but not to latex. Immunoblot analysis in this patient's serum was positive with recombinant banana profilin. CONCLUSIONS: The relevance of banana as a source of food allergy was confirmed in two patients by DBPCFC. In 1 of 2 patients, in whom banana allergy was not a consequence of latex sensitization, a 70-kDa protein was identified as a banana allergen, and in the other patient profilin was detected as a putative cross-reactive allergen.