Aortic Endograft and Epithelioid Sarcoma: A Random Association or Causality?

BACKGROUND: Angiosarcoma is an uncommon, malignant neoplasm often found in skin and soft tissue. Epithelioid angiosarcoma (EA) is a rarer, more aggressive form of angiosarcoma most common in men in their seventh decade. Dacron®, a polymer comprised of polyethylene terephthalate used in endografts for abdominal aortic aneurysm repairs, has been a suspected carcinogen associated with EA. Currently, three case reports exist in the literature purporting Dacron®-associated epithelioid angiosarcoma. Herein we report a case of Dacron®-associated EA.
CASE: A 64-year-old male with a recent history of a repaired type 2 endoleak and Dacron® endograft for his AAA presented with a painful skin eruption, fever, and weight loss. On exam, erythematous and violaceous papules and nodules were present on the patient's lower back. Biopsy revealed atypical, epithelioid cells forming vascular channels in a sheet-like and infiltrative pattern. These results and subsequent immunostaining were consistent with the diagnosis of EA. A bone marrow biopsy confirmed metastatic angiosarcoma.
CONCLUSION: This case further highlights Dacron® as a rare, but, potential carcinogen associated with EA.

J Drugs Dermatol. 2016;15(7):897-899.

Host-pathogen interactions between the skin and Staphylococcus aureus.

Staphylococcus aureus is responsible for the vast majority of bacterial skin infections in humans. The propensity for S. aureus to infect skin involves a balance between cutaneous immune defense mechanisms and virulence factors of the pathogen. The tissue architecture of the skin is different from other epithelia especially since it possesses a corneal layer, which is an important barrier that protects against the pathogenic microorganisms in the environment. The skin surface, epidermis, and dermis all contribute to host defense against S. aureus. Conversely, S. aureus utilizes various mechanisms to evade these host defenses to promote colonization and infection of the skin. This review will focus on host-pathogen interactions at the skin interface during the pathogenesis of S. aureus colonization and infection.

Innate and adaptive immune responses against Staphylococcus aureus skin infections.

Staphylococcus aureus is an important human pathogen that is responsible for the vast majority of bacterial skin and soft tissue infections in humans. S. aureus can also become more invasive and cause life-threatening infections such as bacteremia, pneumonia, abscesses of various organs, meningitis, osteomyelitis, endocarditis, and sepsis. These infections represent a major public health threat due to the enormous numbers of these infections and the widespread emergence of methicillin-resistant S. aureus (MRSA) strains. MSRA is endemic in hospitals worldwide and is rapidly spreading throughout the normal human population in the community. The increasing frequency of MRSA infections has complicated treatment as these strains are more virulent and are increasingly becoming resistant to multiple different classes of antibiotics. The important role of the immune response against S. aureus infections cannot be overemphasized as humans with certain genetic and acquired immunodeficiency disorders are at an increased risk for infection. Understanding the cutaneous immune responses against S. aureus is essential as most of these infections occur or originate from a site of infection or colonization of the skin and mucosa. This review will summarize the innate immune responses against S. aureus skin infections, including antimicrobial peptides that have direct antimicrobial activity against S. aureus as well as pattern recognition receptors and proinflammatory cytokines that promote neutrophil abscess formation in the skin, which is required for bacterial clearance. Finally, we will discuss the recent discoveries involving IL-17-mediated responses, which provide a key link between cutaneous innate and adaptive immune responses against S. aureus skin infections.

Merkel cell carcinoma in a patient treated with adalimumab: case report.

Merkel cell carcinoma (MCC) is a rare aggressive neuroendocrine tumor that manifests as an asymptomatic enlarging lesion often in the setting of immunosuppression, advanced age, or UV exposure. Immunosuppression has been associated with melanoma, lymphoma, and nonmelanoma skin cancer (NMSC). We present a case of a patient with a long-standing history of rheumatoid arthritis treated with adalimumab, methotrexate, and prednisone who developed a painless, rapidly enlarging lesion that was found to be MCC with lymph node involvement. As the use of tumor necrosis factor (TNF) alpha inhibitors becomes more popular, it is important to identify the potential long-term risks associated with chronic immune modulation. Systemic immunosuppression may be a risk factor for the development of advanced-stage MCC. Treatment with the TNF-alpha inhibitor adalimumab may enhance this risk.

The effect of race on the incidence of retinoblastoma.

PURPOSE: To examine the incidence of retinoblastoma for regional variations by race. METHODS: Age-adjusted incidence rates, rate ratios, and 95% confidence intervals were determined in 109 regions from 1993 to 1997 using compiled data from the International Agency for Research on Cancer. RESULTS: The rate ratio was 1.12 (range: 0.35 to 4.15) between white populations in the United States and Europe/Australia, 0.98 (range: 0.37 to 2.65) between Hispanic populations in Spain and the United States, and 1.44 (range: 0.29 to 1.79) between Hispanic populations in Uruguay and the United States. The rate ratio between Hispanic and white populations within the United States was 0.94 (range: 0.33 to 2.56). No differences were significant. CONCLUSIONS: Because retinoblastoma is a genetic disease, its incidence is similar among varied populations.

Decreasing listeriosis mortality in the United States, 1990-2005.

BACKGROUND: Listeria monocytogenes is among the most virulent foodborne pathogens, with 20% of clinical infections resulting in death. To explore listeriosis-associated mortality in the United States and to evaluate prevention efforts, we reviewed vital records over a 16-year period to assess demographic, temporal, and seasonal trends. METHODS: Nonperinatal listeriosis-associated deaths from 1990 through 2005 were identified from multiple-cause-coded death records and were combined with US census data to calculate mortality rates. Poisson regression was used to model time trends, and logistic regression was used to identify comorbid conditions associated with listeriosis on the death record. RESULTS: Of the 37,267,946 deaths occurring in the United States during the 16-year study period, 1178 included listeriosis on the death record. Listeriosis-related mortality rates decreased annually by 10.74% from 1990 through 1996 and by 4.26% from 1996 through 2005. Seasonal trends show a distinct peak in mortality from July through October. After adjustment for age, sex, and race/ethnicity, listeriosis was positively associated with human immunodeficiency virus (HIV) infection (odds ratio, 4.19; 95% confidence interval, 3.06-5.73), lymphoid and hematopoietic cancers (odds ratio, 5.27; 95% confidence interval, 4.47-6.22), and liver disease (odds ratio, 2.05; 95% confidence interval, 1.54-2.73) on the death record. CONCLUSIONS: Nonperinatal listeriosis-associated deaths in the United States have decreased, paralleling a decreasing trend in incidence. Strict monitoring of food manufacturing processes, as well as improved treatment for HIV infection, may have played influential roles in preventing human infections. Health care providers should be aware of seasonal listeriosis patterns, as well as conditions predisposing individuals to severe infection and death due to L. monocytogenes infection, to guide strategies for disease management and prevention.

Anisotropic Laplace-Beltrami Eigenmaps: Bridging Reeb Graphs and Skeletons.

In this paper we propose a novel approach of computing skeletons of robust topology for simply connected surfaces with boundary by constructing Reeb graphs from the eigenfunctions of an anisotropic Laplace-Beltrami operator. Our work brings together the idea of Reeb graphs and skeletons by incorporating a flux-based weight function into the Laplace-Beltrami operator. Based on the intrinsic geometry of the surface, the resulting Reeb graph is pose independent and captures the global profile of surface geometry. Our algorithm is very efficient and it only takes several seconds to compute on neuroanatomical structures such as the cingulate gyrus and corpus callosum. In our experiments, we show that the Reeb graphs serve well as an approximate skeleton with consistent topology while following the main body of conventional skeletons quite accurately.