Engrailed Homeobox 1 and Cytokeratin 19 Are Independent Diagnostic Markers of Eccrine Porocarcinoma and Distinguish It From Squamous Cell Carcinoma.

OBJECTIVES: The diagnostic utility of En1 in the histopathologic differentiation of eccrine porocarcinoma (EPC) from invasive squamous cell carcinoma (SCC) was investigated. METHODS: Expression of En1 and CK19 in 16 cases of EPC was immunohistochemically examined and compared with that in 32 cases of SCC. RESULTS: In all 16 EPCs, En1 was expressed in 3% to 100% of tumor cells. In 20 of the 32 SCCs, En1 was expressed in 3% to 90% of tumor cells. A total of 13 of the 16 EPCs and five of the 32 SCCs were judged as En1 positive, with a cutoff value of 25%. In addition, 11 of the 16 EPCs and four of the 32 SCCs were CK19 positive. The frequencies of En1- and CK19-positive cases were significantly higher in EPCs than in SCCs. In a logistic regression analysis for predicting EPC, En1 and CK19 were independent markers. When expression patterns of En1 and CK19 were combined, none of the 32 SCCs was both positive. In contrast, 15 of the 16 EPCs were positive for either En1 or CK19. CONCLUSIONS: A combination of En1 and CK19 expression can improve the accuracy of histologic diagnosis of EPC.

Estrogen dermatitis that appeared twice in each menstrual period.

A 23-year-old woman presented with millet-sized red papules that were scattered over her chest and abdomen. She stated that since the age of 20, she had recurrently suffered from pruritic eruptions that coincided with ovulation and the time prior to menstruation, and that they persisted for a few days before vanishing spontaneously leaving some pigmentation. A skin biopsy specimen revealed spongiotic bullae in the epidermis and marked infiltration of lymphocytes accompanied by some histiocytes and eosinophils in the upper dermis. An intradermal test for conjugated estrogen showed an urticarial reaction that faded in about four hours. Although the test did not strictly meet the criterion (erythema to remain for more than 24 hours for papulovesicular eruptions), it was concluded that the timing of the episodes along with the result of the test suggested that a diagnosis of estrogen dermatitis was highly probable. There have been several reports of this condition since it was first reported as a distinct entity in 1995; but whatever the reasons, the flares were observed only before menstruation in these cases, despite the fact that the serum estrogen levels showed a double-peaked pattern during each menstrual period. This is considered to be a rare case of estrogen dermatitis that flared twice in each menstrual period. Limited improvement was noted in the symptoms even without treatment.