p21(waf) correlates with DNA replication but not with prognosis in invasive breast cancer.

BACKGROUND/AIMS: p21(waf) plays a central role both in the regulation of the cell cycle and in DNA replication. Accordingly, p21(waf) is a putative tumour suppressor. The role of p21(waf) expression in breast cancer is still unclear, particularly with respect to the clinical situation. Therefore, this retrospective study was designed to investigate the value of immunohistochemically detected p21(waf) expression in invasive breast cancer. METHODS: Cellular expression of p21(waf) was assessed in 307 breast cancer tissues by immunohistochemistry using the monoclonal antibody, clone 4D10. The data were correlated to established and functional factors of prognosis (age, menopausal status, tumour size, nodal status, tumour grade, receptor status, proliferating cell nuclear antigen (PCNA) expression, Her-2/neu expression, and p53 expression), and to clinical follow up (median observation time, 82 months). RESULTS: Ninety nine of 307 (32.2%) tumour tissues were considered p21(waf) positive (nuclear staining). In the entire study group, p21(waf) expression correlated only with increased PCNA expression (chi(2) test: p = 0.029), and with none of the other investigated markers. In node negative patients (n = 134), p21(waf) expression correlated with increased tumour size and increased PCNA expression, whereas the node positive subgroup (n = 161) showed no correlation with these parameters (lymphonodectomy was done in 295 women). With respect to clinical outcome, p21(waf) expression showed a definite favourable trend in both subgroups (N0: p21(waf) negative, 23 of 87; p21(waf) positive, nine of 43. N+: p21(waf) negative, 63 of 107; p21(waf) positive, 23 of 52), but this observation was not significant (p > 0.05). Multivariate analysis for disease free survival as indicated by Cox regression analysis included all factors investigated. The most striking parameters were nodal status (relative risk (RR), 1.74; p = 0.00001), receptor status (RR, 0.59; p = 0.0085), tumour size (RR, 1.42; p = 0.02), and Her2/neu expression (RR, 1.56; p = 0.033). p21(waf) expression was not significant in the multivariate analysis (p > 0.05). CONCLUSIONS: p21(waf) expression is an independent factor but fails to be of prognostic or predictive value in multivariate analysis. These data confirm the hypothesis of a p53 independent p21(waf) induction and suggest a functional role in the inhibition of PCNA mediated DNA replication.

[Gingival hyperplasia and serous papules due to cyclosporin treatment]. / Gingivahyperplasie und Seropapeln unter Cyclosporinbehandlung.

After 3 months of immunosuppressive treatment with cyclosporin because of a focal segmental glomerulosclerosis, a 13-year-old female developed marked gingival hyperplasia, hypertrichosis of the arms and papulo-vesicular skin lesions on the left leg. Histological and immunohistological examinations of the gingivae showed hyperplasia of the mucosa with perivascular infiltrates of plasma and B cells in the submucosa. The lesions on the leg revealed signs of cutaneous vascular inflammation with eosinophils, but there was no evidence of leucocytoclastic vasculitis. Ten months after discontinuation of cyclosporin, the lesions had nearly regressed. The patient's renal function deteriorated progressively to the point of terminal insufficiency.

Atrophoderma vermiculatum. Case reports and review.

Two patients, a father and a daughter, with atrophoderma vermiculatum are presented. The chief characteristics of this rare, benign condition that usually begins in childhood are a symmetric worm-eaten or reticular atrophy of the cheeks that may extend to the ears or forehead. An autosomal dominant mode of inheritance is present in this family. The prominent characteristics, cause, histologic findings, and rare associated medical conditions are reviewed. The prognosis is good, with many instances of spontaneous regression. Primarily a cosmetic problem, therapy for this condition is aimed at reassurance, genetic counseling, and dermabrasion where appropriate.

[Systemic cutis laxa-like pseudoxanthoma elasticum]. / Systemisches Cutis-laxa-artiges Pseudoxanthoma elasticum.

According to Pope the pseudoxanthoma elasticum (PXE) can be divided into four types using clinical genetical criteria. In contrast to the classical form the recessive type II is not only characterized by a wrinkeled appearance and laxity of the skin, furthermore there are no clinical symptoms indicating visceral disease. We report two patients with cutis laxa-like skin. In addition the patients suffered from pathological changes of the eye. In one of them an alteration of the peripher vascular system could be observed.

Hyperkeratotic form of porokeratosis Mibelli.

A case with a hyperkeratotic form of porokeratosis Mibelli is reported. The clinical characteristics were a nonfamilial occurrence, hyperkeratotic verrucous plaques with an erythema and a segmental distribution. The histopathology showed cornoid lamellae and additional atypical findings. By electron microscopic study Civatte bodies and other degenerated epidermal cells were clarified.

[Herpes gestationis. Immunopathologic studies in mother and child]. / Herpes gestationis Immunpathologische Untersuchungen bei Mutter und Kind

Herpes gestationis is a nosologically undefined uncommon bullous disease in pregnancy. In a patient with herpes gestationis C3, C5 und C9 deposits could be demonstrated by immunohistological methods at the epidermal basement membrane (BM). Deposits of immunoglobulins, properdin and C3PA were absent. Autoantibodies against BM were found in the serum of the mother by using rabbit oesophagus but not with normal human skin as antigen. In the sera of mother and child a factor could be demonstrated which in vitro leads to complement fixation in human epidermal BM. Immunopathological findings may speak in favor of a nosological entity of herpes gestationis with respect to dermatitis herpetiformis and bullous pemphigoid.

[The so-called "benign gonoccocal sepsis"]. / Beitrag zur Kenntnis das sogenannten "benignen Gonokokken-Sepsis"

Five female patients with benign gonococcal sepsis were seen during the second half of 1974. All cases presented the typical clinical triad of fever, arthralgias and characteristic skin lesions, the macroscopic and microscopic appearance of which could be best classified as superficial vasculitis. Skin biopsies were taken from 3 patients and the histopathological findings are discussed in detail. Genital symptoms were slight or absent, and only very few gonococci could be detected in stained smears from genital sites. However, Neisseria gonorrhoeae could be cultured without difficulty from the genitourinary tract in all cases, while cultures from blood and skin lesions were sterile. In fresh pustules gonococci could be demonstrated by immunofluorescence in 2 cases. The complement-fixation-test is regarded as a useful supplementary diagnostic procedure.