Peculiar histopathological features in minor salivary gland in lupus erythematosus.

Salivary glands (SGs) can be affected by lupus erythematosus (LE). Many authors debate whether this condition is a secondary manifestation of Sjögren syndrome (SS) or a glandular aspect of LE. The present study investigated the histopathological aspects of biopsied minor salivary glands from LE patients to analyze their peculiar features that lead to xerostomia. Twenty-three minor labial salivary gland (MLSG) cases were included in the study; the diagnosis of LE was rendered according to the American College of Rheumatology criteria. Twenty-three healthy MLSGs were used as a control, for comparison. Regarding lupus MLSG, the presence of hyalinization and thickening of ductal basement membrane, perivascular inflammatory infiltrate, epithelial spongiosis with no ductal lymphocytic aggression, vacuolar degeneration of the ductal cells and acinar serous metaplasia were statistically significant compared to the control group. In the LE group, there was a statistically significant correlation between acinar atrophy and acinar fibrosis; acinar atrophy and ductal ectasia; acinar fibrosis and ductal ectasia; ductal atrophy and ductal spongiosis with no lymphocytic focus, interstitial inflammatory infiltrate intensity and vasculitis as well as vascular thrombi and vasculitis. There were no morphological differences between the three subtypes of lupus analyzed. Minor salivary glands from patients diagnosed with LE present peculiar histopathological changes and may be a multisystemic presentation.

Actinic Granuloma Annulare With Scarring and Open Comedones.

Actinic granuloma and annular elastolytic giant cell granuloma are variants of granuloma annulare affecting, respectively, sun-exposed and sun-covered skin sites on where, besides classical findings, abundant elastophagocytosis is observed. Here, we report a case of exuberant actinic granuloma annulare that, in addition to extensive scarring, showed multiple overlying open comedones. Markedly dilated follicular infundibula filled with compact masses of laminated keratinous material were observed in proximity to dermal inflammation composed of many histiocytes and multinucleated giant cells in close association with degenerated elastic fibers and abundant elastophagocytosis.

Divided naevus of the penis: two paediatric cases with dermoscopic findings.

Divided or kissing naevi are located on adjacent parts of the body that are separated during embryogenesis. Divided naevus of the penis (DNP) is exceedingly rare, with < 15 cases reported in the English language literature. Divided penile naevi affect the glans penis and inner foreskin, which are anatomical structures believed to have a common embryological origin. We report the clinical, dermoscopic and histopathological findings of two children with DNP. To our knowledge, this is the first report of patients with DNP seen in South America, and the first in which dermoscopic findings are discussed; these included a large globular pattern in one patient, and homogeneous, streaked and globular patterns in the other.

The lip in lupus erythematosus.

Lupus erythematosus (LE) frequently compromises the skin, lips and oral mucosa. There is a large body of medical and dental literature about the cutaneous and mucosal lesions of LE, but very little has been written specifically about labial lupus. The lip has a peculiar anatomical and histological architecture, and LE lesions at this site may have some distinct features. This article reviews the existing data and adds some new concepts to the issue of labial lupus in all of its presentations, comparing such lesions to the well-established characterization of cutaneous LE (in acute, subacute and chronic lesions), and highlighting some special clinical features that may enable a better diagnosis and differential diagnosis of lip diseases.

Genital discoid lupus: a rare manifestation of cutaneous lupus erythematosus.

Cutaneous lupus erythematosus classically presents as sharply demarcated plaques with pigmentary changes and varying degrees of scarring typically affecting the face and scalp. Genital manifestations of lupus erythematosus have rarely been described in literature. Here we report two cases of discoid lupus erythematosus affecting the genital area. Both patients were equally affected by widespread discoid lesions on the head. Although rare, genital involvement of lupus erythematosus must be considered in the differential diagnosis of genital lesions.

Cheilitis glandularis: immunohistochemical expression of protein water channels (aquaporins) in minor labial salivary glands.

BACKGROUND: Cheilitis glandularis (CG) is a rare condition in which thick saliva is secreted from dilated ostia of swollen minor salivary glands from the lips. Aquaporins (AQPs) are membrane proteins that exhibit channel activity specific for water and small solutes. AQPs are essential for corporal homeostasis, and are widely expressed through human tissues. Most AQPs studies are based on renal and nervous pathophysiology; few involve salivary glands. Some previous investigators hypothesized that minor salivary gland structure and function is normal on CG. OBJECTIVES: To study possible salivary synthesis alterations in CG, we compared the expression of AQPs present in minor salivary glands in specimens with CG and controls by using immunohistochemistry. METHODS: Seven cases of CG and three normal controls were studied. RESULTS: Intensity and patterns of expression of AQP 1, 2 and 8 differed in CG compared with controls. AQP 4 and 5 (the most important AQP in salivary function) showed identical patterns in CG and controls. CONCLUSION: Our findings suggest that the expression and arguably, function of some of the AQPs may be altered in CG; consequently, water flow mechanism abnormalities with possible alteration in salivary composition seem to occur. External factors (mainly UV rays) seem to play an important role in CG; nonetheless, our findings suggest that there might be some degree of alteration on water transportation.

Selected examples of gas-phase ion chemistry studies.

Gas-phase ion chemistry is an area in mass spectrometry that has received much research interest since the mid fifties of the last century. Although the focus of mass spectrometric research has shifted the last twenty years largely to life science studies, including proteomics, genomics and metabolomics, there are still several groups in the world active in gas-phase ion chemistry of both positive and negative ions, either unimolecularly and/or bimolecularly. In this tutorial lecture the formation and determination of tautomeric ion structures and intra-ionic catalyzed tautomerization in the gas phase will be discussed. In addition, an example of formation of different tautomeric structures in protic and aprotic solvents under electrospray ionization conditions will be given, as established by gas-phase infrared multiphoton dissociation spectroscopy. This will be followed by presenting an example of time-resolved MS/MS which enables to identify the structure of an ion, generated at a particular molecular ion lifetime. At the end of the lecture the power of ion mobility will be shown in elucidating the mechanism of epimerization of bis-Tröger bases having chiral nitrogen centers.

Gas-phase reactions of the atomic oxygen radical cation with halogenated compounds.

Rate constants and product distributions have been measured for the reactions of O(+)˙((4)S) with the methyl halides (CH(3)F, CH(3)Cl, CH(3)Br, CH(3)I) and three perfluorinated compounds (CF(4), SF(6), SF(5)CF(3)) at 300 K in a flowing afterglow-selected ion flow tube (FA-SIFT). The reactions occur with high efficiency, despite the necessity for spin conversion in some processes. The mechanisms include charge transfer, atom abstraction, and fragmentation reactions. Computational modeling was carried out to provide insight into these processes.

Reflectance confocal microscopy as a new tool in the in vivo evaluation of desquamative gingivitis: patterns in mucous membrane pemphigoid, pemphigus vulgaris and oral lichen planus.

BACKGROUND: Desquamative gingivitis refers to a clinical manifestation associated with several mucocutaneous disorders. The most common are mucous membrane pemphigoid, pemphigus vulgaris and lichen planus. Their specific diagnosis is better established by histopathological and immunofluorescence evaluation. OBJECTIVES: To examine cases of desquamative gingivitis using reflectance confocal microscopy (RCM) and compare the findings with those of normal gingiva. To compare RCM findings in desquamative gingivitis with conventional histopathology of the biopsied lesions, in order to establish criteria for this noninvasive diagnostic technique. METHODS: A total of 25 cases of suspected mucous membrane pemphigoid, pemphigus vulgaris and lichen planus were included. RCM was performed on the gingiva of a healthy person and on gingival lesions. All lesions were biopsied in order to perform a RCM-histopathological correlation. RESULTS: Reflectance confocal microscopy examination of the gingival lesions suspected to be mucous membrane pemphigoid revealed a separation at the level of the dermal-epidermal junction, filled with small, bright structures interpreted as blood cells. Histopathological and immunofluorescence findings confirmed the diagnosis. For pemphigus vulgaris, RCM features were intraepithelial clefts with round, detached cells interpreted as acantholytic keratinocytes, similar to the histopathological features. Hyperkeratosis and spongiosis associated with infiltration of inflammatory cells, seen as small, bright cells intermingling with the honeycomb keratinocyte epithelial structure, were seen in lichen planus. Mildly bright, round structures interpreted as necrotic keratinocytes and mildly bright, stellate structures, interpreted as melanophages, were also seen in the dermis. These features were present on histopathology, confirming the diagnosis of lichen planus. CONCLUSION: We propose that RCM is a useful tool to help distinguish between the three most common causes of desquamative gingivitis.

Localization of fatty acyl and double bond positions in phosphatidylcholines using a dual stage CID fragmentation coupled with ion mobility mass spectrometry.

A high content molecular fragmentation for the analysis of phosphatidylcholines (PC) was achieved utilizing a two-stage [trap (first generation fragmentation) and transfer (second generation fragmentation)] collision-induced dissociation (CID) in combination with travelling-wave ion mobility spectrometry (TWIMS). The novel aspects of this work reside in the fact that a TWIMS arrangement was used to obtain a high level structural information including location of fatty acyl substituents and double bonds for PCs in plasma, and the presence of alkali metal adduct ions such as [M + Li](+) was not required to obtain double bond positions. Elemental compositions for fragment ions were confirmed by accurate mass measurements. A very specific first generation fragment ion m/z 577 (M-phosphoryl choline) from the PC [16:0/18:1 (9Z)] was produced, which by further CID generated acylium ions containing either the fatty acyl 16:0 (C(15)H(31)CO(+), m/z 239) or 18:1 (9Z) (C(17)H(33)CO(+), m/z 265) substituent. Subsequent water loss from these acylium ions was key in producing hydrocarbon fragment ions mainly from the α-proximal position of the carbonyl group such as the hydrocarbon ion m/z 67 (+H(2)C-HC = CH-CH = CH(2)). Formation of these ions was of important significance for determining double bonds in the fatty acyl chains. In addition to this, and with the aid of (13)C labeled lyso-phosphatidylcholine (LPC) 18:1 (9Z) in the ω-position (methyl) TAP fragmentation produced the ion at m/z 57. And was proven to be derived from the α-proximal (carboxylate) or distant ω-position (methyl) in the LPC.

The gas phase Smiles rearrangement of anions PhO(CH(2))(n)O(-) (n = 2-4). A joint theoretical and experimental approach.

A combination of experimental data [using (18)O labelling fragmentation data together with metastable ion studies in a reverse sector mass spectrometer (from a previous study)] and ab initio reaction coordinate studies at the CCSD(T)/6-31++G(d,p)//B3LYP/6-31++G(d,p) level of theory, have provided the following data concerning the formation of PhO(-) in the gas-phase from energized systems PhO(CH(2))(n)O(-) (n = 2-4). All DeltaG values were calculated at 298 K. (1) PhO(CH(2))(2)O(-) effects an ipso Smiles rearrangement (DeltaG(r) = +35 kJ mol(-1); barrier to transition state DeltaG(#) = +40 kJ mol(-1)) equilibrating the two oxygen atoms. The Smiles intermediate reverts to PhO(CH(2))(2)O(-) which then undergoes an S(N)i reaction to form PhO(-) and ethylene oxide (DeltaG(r) = -24 kJ mol(-1); DeltaG(#) = +54 kJ mol(-1)). (2) The formation of PhO(-) from energized PhO(CH(2))(3)O(-) is more complex. Some 85% of the PhO(-) formed originates via a Smiles intermediate (DeltaG(r) = +52 kJ mol(-1); DeltaG(#) = +61 kJ mol(-1)). This species reconverts to PhO(CH(2))(3)O(-) which then fragments to PhO(-) by two competing processes, namely, (a) an S(N)i process yielding PhO(-) and trimethylene oxide (DeltaG(r) = -27 kJ mol(-1); DeltaG(#) = +69 kJ mol(-1)), and (b) a dissociation process giving PhO(-), ethylene and formaldehyde (DeltaG(r) = -65 kJ mol(-1); DeltaG(#) = +69 kJ mol(-1)). The other fifteen percent of PhO(-) is formed prior to formation of the Smiles intermediate, occurring directly by the S(N)i and dissociation processes outlined above. The operation of two fragmentation pathways is supported by the presence of a composite metastable ion peak. (3) Energized PhO(CH(2))(4)O(-) fragments exclusively by an S(N)i process to form PhO(-) and tetrahydrofuran (DeltaG(r) = -101 kJ mol(-1); DeltaG(#) = +53 kJ mol(-1)). The Smiles ipso cyclization (DeltaG(r) = +64 kJ mol(-1); DeltaG(#) = +74 kJ mol(-1)) is not detected in this system.

Oral manifestations of inflammatory bowel disease: a review based on the observation of six cases.

Inflammatory bowel disease (IBD) comprises two chronic, tissue-destructive, clinical entities: Crohn's disease (CD) and ulcerative colitis (UC), both immunologically based. Bowel symptoms are predominant, but extra-intestinal complications may occur, including involvement of the oral cavity. Oral involvement during IBD includes several types of lesions: the most common are aphthae; uncommon lesions include, among others, pyostomatitis vegetans and granulomatous lesions of CD. Starting with a presentation of six patients with oral manifestations, which were crucial for the final diagnosis of IBD, a review on the subject is presented. Oral involvement in IBD may be previous or simultaneous to the gastrointestinal symptoms. However, in the majority of cases, bowel disease precedes the onset of oral lesions by months or years. In many patients, the intestinal symptoms may be minimal and can go undetected; thus, most authors believe that the bowel must be thoroughly examined in all patients with suspected IBD even in the absence of specific symptoms. Usually, the clinical course of oral lesions is parallel to the activity of IBD; therefore, oral manifestations are a good cutaneous marker of IBD.

Chloroquine -induced hair depigmentation.

A case of hair depigmentation induced by chloroquine diphosphate subacute overdosage in an 11-year-old patient with dermatomyositis is presented. Normal coloured hair growth occurred after normalisation of chloroquine dosage. A discussion on possible pathomechanisms of this phenomenon is made based on experimental data and previously reported patients with the same condition.

Fibroblastic rheumatism.

Fibroblastic rheumatism (FR) was first described in 1980 by Chaouat et al., and there have been few cases reported to date. The cause remains unknown. We report the first Latin-American patient with FR, to our knowledge, who is also the patient with the most striking dermatological features described in the literature. The diagnosis was based on the presence of a number of typical features. Clinically, the patient presented skin nodules and polyarthropathy with flexion contractures of the fingers. The histological findings compressed fibroblastic proliferation, thickened collagen fibres, dermal fibrosis and a decreased number of elastic fibres. Immunoreactivity for beta-catenin, alpha-smooth muscle actin and the monoclonal antibody HHF-35 showed myofibroblastic differentiation. Treatment with prednisone slightly reduced the number of nodules but did not improve the rheumatological symptoms. This condition has shown a poor response to many treatments proposed by previous authors. Further study will be necessary to identify effective treatment.