A Rapidly Enlarging Recurrent Eyebrow Pilomatrixoma in a Nonagenarian.

A rapidly growing, large (horizontal diameter of 3.1 cm) eyebrow lesion in a nonagenarian patient was found on pathologic examination to demonstrate an admixture of islands of anucleated, washed out eosinophilic "ghost" cells with surrounding nucleated, small germinal basaloid cells. Further analysis disclosed adipophilin granular positivity in the necrotic zones, negative nuclear staining for androgen receptor and strong nuclear positivity for Ki67 in the basaloid cells (proliferation index of 50%). These findings are consistent with a highly mitotically active pilomatrixoma. The lesion recurred after initial resection but returned the same histopathologic features as the primary. Several clinical features were notably atypical for pilomatrixoma-specifically, the age of the patient, rapid lesion growth and recurrence, and clinical appearance and large size of the mass. The immunohistochemical findings can help to distinguish this tumor from other skin neoplasms, especially sebaceous carcinoma in an older individual.

Pleomorphic adenoma (formerly chondroid syringoma) of the eyelid margin with a pseudocystic appearance.

Among the adenomas and adenocarcinomas spawned by the adnexal glands of the eyelids, pleomorphic adenoma (also referred to as benign mixed tumor or chondroid syringoma in dermatopathology) is among the rarest. Pleomorphic adenomas (PAs) can arise from sweat glands in the dermis of the eyelid skin and must be distinguished from those of the accessory lacrimal glands of Krause and Wolfring. We describe an eyelid margin skin PA that appeared clinically to be a cyst and was not associated with an accessory lacrimal gland. Histopathologically, the lesion was circumscribed but nonencapsulated and composed of branching ductular structures with a double layer of epithelial cells set in a myxoid and sclerotic stroma that did not contain cartilage. The outer ductular (myoepithelial) cells delaminated to populate the stroma. Histochemistry disclosed abundant extracellular mucopolysaccharides that conferred the "cystic" character clinically. The inner ductular cells were uniformly positive for cytokeratin 7 and focally for gross cystic fluid disease protein-15, an apocrine marker. The inner and outer ductular cells were negative for alpha-smooth muscle actin. These pathologic findings support an apocrine (gland of Moll) origin for this tumor, which is consistent with the fact that there are no eccrine glands at the eyelid margin.

Intratarsal keratinous cysts of the Meibomian gland: distinctive clinicopathologic and immunohistochemical features in 6 cases.

PURPOSE: To describe 6 patients representing a new entity of Meibomian gland keratinous cysts. DESIGN: Retrospective, interventional, clinicopathologic study. METHODS: Review of clinical histories and findings, histopathologic evaluations, and immunohistochemical studies of the cysts' linings with monoclonal antibodies directed against cytokeratins and cell surface epithelial markers. RESULTS: Six patients with an average age of 62.5 years had noninflamed, upper eyelid nodules fixed to the tarsus. Eyelid eversion revealed a white-yellow nodular bulge in 3 cases, a bluish coloration in 2 cases, and a translucent appearance in 1 case. The cysts were lined by undulating squamous epithelium possessing an inner eosinophilic cuticle that produced a peculiar refractile, strand-like intracavitary keratin. Immunostaining for cytokeratin 17 and carcinoembryonic antigen showed strongly positive results in the Meibomian gland cysts and, by comparison, negative results in cutaneous epidermal cysts. Multiple recurrences occurred after incomplete excisions. CONCLUSIONS: After chalazia and sebaceous cell tumors, Meibomian gland keratinous cysts seem to be the third most common primary intratarsal lesion. Anterior fixation to the tarsus and posterior protrusion beneath the palpebral conjunctiva without inflammation suggest the diagnosis. Histopathologic and immunohistochemical evaluations can distinguish unequivocally the current entity from common epidermal cysts. The optimal treatment consists of an en bloc excision of the cyst with a tarsectomy, or else wide excision with intratarsal cautery of any remnants of the cellular lining.

Structure-activity relationship of alginate oligosaccharides in the induction of cytokine production from RAW264.7 cells.

Guluronate and mannuronate oligomers with various degree of polymerization were prepared from polyguluronate (PG) and polymannuronate (PM) with an alginate lyase from a Pseudoalteromonas sp., and their activities to induce cytokine secretion from mouse macrophage cell line RAW264.7 cells were examined. Enzymatically depolymerized unsaturated alginate oligomers induced tumor necrosis factor (TNF)-alpha secretion from RAW264.7 cells in a structure-depending manner, while the activities of saturated alginate oligomers prepared by acid hydrolysis were fairly low or only trace levels. These results suggest that unsaturated end-structure of alginate oligomers was important for the TNF-alpha-inducing activity. Among the unsaturated guluronate (G3-G9) and mannuronate (M3-M9) oligomers, G8 and M7 showed the most potent activity, respectively. Bio-Plex assay revealed that interleukin (IL)-1alpha, IL-1beta, and IL-6 secretion from RAW264.7 cells were also induced by unsaturated alginate oligomers with similar structure-activity relationship profiles as seen in TNF-alpha, and the most potent activities were observed with G8 and M7. These results suggest that G8 and M7 may have the most suitable molecular size or entire structural conformation as stimulant for cytokine secretion. Since antibodies to Toll-like receptor (TLR)2 and TLR4 effectively inhibited the G8- and M7-induced production of TNF-alpha, these alginate oligomers may stimulate innate immunity through the pattern recognition receptors on macrophages similar to microbial products.