Distinct histopathologic features of radiation-induced chronic sinusitis

Background

Chronic rhinosinusitis (CRS) is a commonly observed sequela after radiation therapy to the paranasal sinuses. The histopathologic features of radiation-induced CRS have yet to be determined and may have major implications in disease management.

Methods

A structured histopathology report was utilized to analyze sinus tissue removed during functional endoscopic sinus surgery (FESS). Histopathology variables, Lund-Mackay score (LMS), and 22-item Sino-Nasal Outcome Test (SNOT-22) scores were compared among patients with radiation-induced CRS (CRSr), CRS without nasal polyps (CRSsNP), and CRS with nasal polyps (CRSwNP).

Results

Fifteen CRSr, 43 CRSsNP, and 56 CRSwNP patients who underwent FESS were analyzed. Compared with CRSsNP, CRSr cases had increased squamous metaplasia (40.0% vs 9.3%, p < 0.013) and subepithelial edema (53.3% vs. 2.3%, p < 0.001). Compared with CRSwNP, CRSr cases had fewer eosinophils per high-power field (20.0% vs 50.0%, p < 0.034), less basement membrane thickening (33.3% vs 76.8%, p < 0.002), and fewer eosinophil aggregates (0.0% vs 30.4%, p < 0.009). CRSr had significantly greater mean LMS (13.47 ± 5.13 vs 7.07 ± 4.79, p < 0.001) compared with CRSsNP.

Conclusion

Radiation-induced CRS patients exhibited greater squamous metaplasia and subepithelial edema when compared with a cohort of patients with CRSsNP, and decreased eosinophilia and basement membrane thickening compared with a cohort of CRSwNP patients. CRSr cases demonstrated no difference in eosinophilia or neutrophilia compared with CRSsNP, and decreased eosinophilia compared with CRSwNP, lending further credence to the unique nature of radiation in the development of CRS in this patient group. These findings may have major implications with regard to extent of surgical intervention and medical management.

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Case of tumoral melanosis with a massive infiltration of CD163+ and CD68+ macrophages

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Dermatoscopy of palmar wart with falooda seed appearance

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A rare case of lues maligna with ocular involvement presenting as an unmasking immune reconstitution inflammatory syndrome in a patient with HIV infection

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HTLV-1 carrier psoriasis patients treated by anti-IL-23/IL-17

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Effectiveness of weekly azathioprine pulse in the treatment of chronic plaque psoriasis: an open-label study: reply to author

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Updating and identifying a novel mutation in the PMVK gene in classic porokeratosis of Mibelli

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Papules on the arms and renal cell carcinoma

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HRAS mutation in phacomatosis pigmentokeratotica without extracutaneous disease

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Plasmacytoid dendritic cells and type I interferon in the immunological response against warts

Summary

Background

Plasmacytoid dendritic cells (pDCs) are the most potent producers of type I interferons (IFNs), and are involved in the pathogenesis of several cutaneous infectious (especially viral), inflammatory/autoimmune and neoplastic entities. Their role in the pathogenesis and regression of human papilloma virus (HPV)-induced skin lesions has not been well studied.

Aim

To investigate pDC occurrence and activity in HPV-induced skin lesions, including inflamed and uninflamed warts as well as epidermodysplasia verruciformis (EDV)-associated lesions.

Methods

In total 20 inflamed and 20 uninflamed HPV-induced skin lesions (including 7 EDV lesions) were retrieved from our database, and the tissue was immunohistochemically tested for pDC occurrence and activity using anti-BDCA-2 and anti-MxA antibodies, respectively.

Results

pDCs were present in all 20 inflamed warts and absent from all 20 uninflamed cases. MxA expression was also diffuse and strong in 75% (15/20) inflamed warts, but not in any of the uninflamed warts.

Conclusions

pDCs constitute a central component of the inflammatory host response in inflamed warts, possibly contributing to their regression through production of type I interferons.

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Cutaneous squamous cell carcinoma of the scalp extending to the skull: A case report and review of the literature

Summary

Squamous cell carcinoma (SCC) of the scalp has increased prevalence in older patients and often presents later in life. Mohs micrographic surgery remains the most effective treatment in most cases. Delayed presentation may result in localized bony invasion or distant metastases. We present a case of an elderly woman presenting with extension of SCC into the parietal bone of the skull.

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The American Academy of Oral Medicine Clinical Practice Statement: medication-induced oral reactions

Publication date: Available online 23 July 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Eric T. Stoopler




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Surgical management of temporal bone osteoradionecrosis: Single surgeon experience of 47 cases

Publication date: Available online 23 July 2017
Source:American Journal of Otolaryngology
Author(s): Sameep Kadakia, Arvind Badhey, Jared Inman, Moustafa Mourad, Yadranko Ducic
PurposeTo report the outcomes of 47 patients with temporal bone osteoradionecrosis treated primarily with surgical resection in order to analyze whether flap type and hyperbaric oxygen use affect wound breakdown.Materials and methodsBetween January 1998 and January 2016, 47 patients were treated for temporal bone osteoradionecrosis with surgery. Some patients were also treated with hyperbaric oxygen. Resection of grossly necrotic temporal bone was followed by immediate reconstruction with local, regional, or free flaps. Minimum follow-up was 6months. If patients had breakdown of their initial reconstructions, secondary reconstruction was performed with either a regional or free flap. During the post-operative period, wound breakdown, flap complications, and patient survival were noted.Results30 patients developed ORN from primary radiotherapy while 17 had post-operative radiation. It was found that wound breakdown was significantly associated with type of flap reconstruction (p=0.02) with local flap reconstruction portending a poorer prognosis. Hyperbaric oxygen was not associated with decreased wound breakdown (p=0.5).ConclusionsSurgical treatment can be an effective treatment for temporal bone osteoradionecrosis, without hyperbaric oxygen providing any additional benefit. Reconstruction with regional or free flaps may be a more reliable method to resurface defects compared to local flaps.



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Surgical management of temporal bone osteoradionecrosis: Single surgeon experience of 47 cases

To report the outcomes of 47 patients with temporal bone osteoradionecrosis treated primarily with surgical resection in order to analyze whether flap type and hyperbaric oxygen use affect wound breakdown.

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Réponse des auteurs à la lettre à propos de l’article : « Télédermatologie en milieu carcéral : étude rétrospective de 500 télé-expertises »

Publication date: Available online 22 July 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): B. Khatibi, A. Bambe, C. Chantalat, M. Resche-Rigon, A. Sanna, C. Fac, M. Bagot, F. Guibal




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Should radiographic progression still be used as outcome in RA?

Publication date: Available online 22 July 2017
Source:Clinical Immunology
Author(s): Désirée van der Heijde, Robert Landewé
Radiographs of hands and feet are traditionally the images that are used to assess structural damage progression in drug trials in patients with rheumatoid arthritis, aiming at proving the disease modifying capacity of a drug. Although treatment has largely improved over the past decade and consequently radiographic progression is limited in control arms in clinical trials, recent trials are still able to show inhibition of structural progression by new drugs. The requirements for the successful use of radiographic progression as an outcome in rheumatoid arthritis trials will be discussed in this paper.



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Sesame allergy in adults

Publication date: Available online 23 July 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Philip H. Li, Natasha Gunawardana, Iason Thomas, Kok Loong Ue, Leonard Siew, Timothy J. Watts, Keyna Bintcliffe, Rubaiyat Haque, Krzysztof Rutkowski, Isabel Skypala, Stephen J. Till




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Blood eosinophil-to-basophil ratio in patients with sinonasal polyps

Publication date: Available online 23 July 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Giuseppe Brescia, Umberto Barion, Claudia Zanotti, Francesco Cinetto, Luciano Giacomelli, Alessandro Martini, Gino Marioni
BackgroundIn a recent preliminary study, eosinophil and basophil counts were calculated in chronic rhinosinusitis with nasal polyps (CRSwNP) using conventional histologic and immunohistochemical methods. The tissue eosinophil-to-basophil ratio differed in the CRSwNP endotypes considered.ObjectiveTo compare the blood eosinophil-to-basophil ratio (bEBR) in a large series of patients with CRSwNP with that in a control group of consecutive rhinological patients with no evidence of nasal, paranasal, or systemic inflammatory disorders.MethodsA retrospective study was performed on 334 patients with CRSwNP to compare the preoperative bEBR among different endotypes and with controls (69 cases).ResultsThe mean bEBR was significantly higher in the CRSwNP group than in the control group (P = .0006). The eosinophil and basophil counts were significantly and directly correlated in the CRSwNP cases (P = .0000). The mean bEBR was significantly higher in the sub-cohorts of CRSwNP with allergy (P = .0007), asthma (P = .0000), and aspirin-exacerbated respiratory disease (P = .0153). The mean bEBR was significantly higher in the sub-cohort with eosinophilic CRSwNP than in the sub-cohort with noneosinophilic CRSwNP (P = .0000).ConclusionThis study confirms the increasingly interesting role emerging for blood eosinophils and basophils in different CRSwNP endotypes. The bEBR seems to be a parameter worth investigating in different CRSwNP endotypes, because it is significantly higher in patients with allergy, asthma, and aspirin-exacerbated respiratory disease.



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Identifying the relationship between beliefs and medication adherence in asthma

Publication date: Available online 23 July 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Holly Foot, Adam La Caze, Neil Cottrell




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Utility of minor determinants for skin testing in inpatient penicillin allergy evaluation

Publication date: Available online 23 July 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Bob Geng, Jacqueline J. Eastman, Karen Mori, Melinda Braskett, Marc A. Riedl
BackgroundMost patients with a history of penicillin allergy can tolerate penicillin. Skin testing can identify tolerant patients, but not all known allergenic determinants are commercially available. Protocols exist that use only available reagents, but the sensitivity and safety of these protocols, particularly for hospitalized patients, are controversial.ObjectiveTo determine the number of hospitalized patients referred for penicillin skin testing who showed unique positivity to the minor determinants penicilloate and penilloate.MethodsA retrospective chart review was conducted of all inpatients who underwent penicillin skin testing at 1 institution. Patients were referred by their treating physician. All patients underwent skin prick testing to benzylpenicilloyl polylysine (major determinant), penicillin G, penicilloate, penilloate (minor determinants), amoxicillin, and positive and negative controls. If the result was negative, then intradermal testing was done with the same penicillin determinants and the negative control. A 4-mm wheal with flare was considered a positive reaction.ResultsInpatient penicillin skin testing was done in 528 subjects. Any positive test reaction was found in 107 subjects (20%). Three subjects (3%) reacted to penilloate only, 25 (23%) reacted to penicilloate only, 2 (2%) reacted to penicillin G only, and 8 (8%) reacted to amoxicillin only. Sixty-eight subjects (64%) reacted to a compound other than the major determinant.ConclusionThis study found a high rate of exclusively positive skin test reactions to the minor determinants penicilloate and penilloate. Because patients with positive test reactions are at increased risk of reaction to drug challenge, these data support the use of these reagents for penicillin skin testing in hospitalized patients.



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Component-resolved diagnosis in hymenoptera allergy

Publication date: Available online 22 July 2017
Source:Allergologia et Immunopathologia
Author(s): D. Antolín-Amérigo, B. Ruiz-León, E. Boni, T. Alfaya-Arias, M. Álvarez-Mon, J. Barbarroja-Escudero, D. González-de-Olano, C. Moreno-Aguilar, M. Rodríguez-Rodríguez, M.J. Sánchez-González, L. Sánchez-Morillas, A. Vega-Castro
Component-resolved diagnosis based on the use of well-defined, properly characterised and purified natural and recombinant allergens constitutes a new approach in the diagnosis of venom allergy. Prospective readers may benefit from an up-to-date review on the allergens. The best characterised venom is that of Apis mellifera, whose main allergens are phospholipase A2 (Api m1), hyaluronidase (Api m2) and melittin (Api m4). Additionally, in recent years, new allergens of Vespula vulgaris have been identified and include phospholipase A1 (Ves v1), hyaluronidase (Ves v2) and antigen 5 (Ves v5). Polistes species are becoming an increasing cause of allergy in Europe, although only few allergens have been identified in this venom.In this review, we evaluate the current knowledge about molecular diagnosis in hymenoptera venom allergy.



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Single and multiple food allergies in infants with proctocolitis

Publication date: Available online 22 July 2017
Source:Allergologia et Immunopathologia
Author(s): B.T. Koksal, Z. Barıs, F. Ozcay, O. Yilmaz Ozbek
BackgroundFood protein-induced allergic proctocolitis is a frequent cause of rectal bleeding in infants. Characteristics of infants with multiple food allergies have not been defined.ObjectiveThis study aimed to identify characteristics of infants with proctocolitis and compare infants with single and multiple food allergies.MethodsA total of 132 infants with proctocolitis were evaluated retrospectively. All of the infants were diagnosed by a paediatric allergist and/or a paediatric gastroenterologist according to guidelines. Clinical features of the infants, as well as results of a complete blood count, skin prick test, specific immunoglobulin E, and stool examinations or colonoscopy were recorded.ResultsCow's milk (97.7%) was the most common allergen, followed by egg (22%). Forty-five (34.1%) infants had allergies to more than one food. Infants with multiple food allergies had a higher eosinophil count (613±631.2 vs. 375±291.9) and a higher frequency of positive specific IgE and/or positive skin prick test results than that of patients with a single food allergy. Most of the patients whose symptoms persisted after two years of age had multiple food allergies.ConclusionsThere is no difference in clinical presentations between infants with single and multiple food allergies. However, infants with multiple food allergies have a high blood total eosinophil count and are more likely to have a positive skin prick test and/or positive specific IgE results.



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