classic kaposi sarcoma in 2 hiv negative hispanic women
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P6651Betel nut and oral cancer
Farhan Khan, MD, MBA, Center for Clinical Studies, Webster, TX, United States;Marigdalia Ramirez-Fort, MD, Center for Clinical Studies, Houston, TX, UnitedStates; Rana Mays, MD, Center for Clinical Studies, Webster, TX, United States;Stephen Tyring, MD, PhD, Center for Clinical Studies, Webster, TX, United States
A 50-year-old otherwise healthy Indian woman presented with painful whitepapillary projections on the anterior buccal mucosa. Biopsy revealed verrucoussquamous cell carcinoma. She had been chewing betel nut since childhood. Betel(areca catechu) nut is common in many Asian and Oceanic countries. Traditionally,betel leaves are combined with the nut and chewed for their psychoactive stimulanteffect. Betel is used regularly by approximately 10% of the world’s population,making it the fourth most widely used addictive substance. Regular chewing causesa red/orange discoloration of the teeth. Chronic exposure is an independent riskfactor for oral, pharyngeal, and esophageal cancers. The most common malignancyis squamous cell carcinoma of the buccal mucosa, particularly the verrucous variant.Concurrent tobacco or alcohol use can further increase risk of malignancy. Otherassociated oral pathology includes severe periodontal disease, gingival recession,and submucosal fibrosis.
AB158
cial support: None identified.
CommerP6733Classic Kaposi sarcoma in 2 HIV negative Hispanic women
Ashley Ojeaga, Center for Clinical Studies, Houston, TX, United States; FarhanKhan, MD, MBA, Center for Clinical Studies, Webster, TX, United States;Marigdalia Ramirez-Fort, MD, Center for Clinical Studies, Houston, TX, UnitedStates; Rachel Gordon, MD, Center for Clinical Studies, Houston, TX, UnitedStates; Stephen Tyring, MD, PhD, Center for Clinical Studies, Webster, TX, UnitedStates
Background: Kaposi sarcoma (KS) is a virus-induced neoplasm of the endothelial celllineage. The lesions are characterized by the appearance of red or purple, blotchesor nodules that are often papular. The classic form occurs most commonly on thelower extremities of elderly men of Eastern European and Jewish descent. In theUnited States, it is the most prevalent neoplasm found in individuals with AIDS,occurring up to 20,000 times more in persons with AIDS than in the generalpopulation. In addition, the classic variant of KS is more common in males with amale to female ratio of 15 to 1. Few cases of classic KS in HIV-negative women havebeen described in the literature.
Case reports: The first patient, an 85-year-old Hispanic woman with a medicalhistory of shingles and KS on the lower legs presented to our clinic for furthermanagement. She first exhibited lesions of KS 3 years before presenting to our clinicand was formally diagnosed with a biopsy 1 year before presentation. Physicalexamination revealed dark papules, associated with pain and swelling on thebilateral lower extremities. There was no evidence of lymphodenopathy. She alsopresented with a dermatomal rash on her upper right back. Lesions were biopsiedand histopathologic examination revealed a subtle proliferation of dermal vascularstructures and red blood cell extravasation. Spindle cells were seen with a milddegree of cytological atypia and the overlying epidermis showed acanthosis.Immunohistochemical studies for human herpes virus type 8 (HHV-8) were positive.Patient’s pain was well controlled with opiates and she was advised to beginchemotherapy. The second patient, an 83-year-old Hispanic womanwith a history ofdiabetes mellitus and anemia secondary to chronic renal insufficiency presentedwith slightly raised, purpuric lesions on her right lower leg with mild desquamation.A biopsy confirmed KS and immunohistochemical stains confirmed the presence ofHHV-8. The patient’s pain was controlled with pregabalin and she was referred forradiotherapy. Both women were HIV negative.
Conclusion: Kaposi sarcoma is rare in HIV-negative women. We report 2 unusualcases of classic KS presenting in the lower extremities of two elderly Hispanicwomen with no indication of HIV infection. To our knowledge, the presented casesare amongst the few cases of classic KS observed in HIV-negative Hispanic women.
cial support: None identified.
CommerJ AM ACAD DERMATOL
P6213Clinically inapparent basal cell carcinomas detect by stereoscopic highmagnification dermatoscopy
Luis Fernando Kopke, MD, Dapele Dermatologia, Florianopolis, Brazil
Some studies have shown that the diagnostic accuracy of basal cell carcinomas, evenin academic institutions, may be only 70%. The aid of dermatoscopy greatlyimproved this scenario. However, most of basal cell carcinomas are not pigmentedand dermatoscopy uses the pigment primarily as a means of reading. Other studiesshow that the finding of arborizing vessels in skin tumors has great predictive factorin the detection of basal cell carcinoma, pigmented or not, being probably the maindermatoscopic feature of these tumors. The arborizing vessels can be very subtleand sometimes can be hardly seen with common dermatoscopy (monocular and 10-fold magnification). This work shows an observation of 153 consecutive basal cellcarcinomas examinedwith stereoscopic highmagnification dermatoscopy, inwhich32 basal cell carcinomas virtually undetectable on clinical examination were found.They were seen by scanning with the dermatoscopy mainly in the nasal area, or inareas identified as concerns by the patient, but clinically, nothing suggested a basalcell carcinoma. The detection of these tumors was based exclusively on theobservation of the characteristic vascular pattern viewed with dermatoscopy. Thesefindings may have great importance in the postoperative control of basal cellcarcinomas as they could help in early diagnosis, as well as better understanding ofsituations classified as recurrence, but in fact could represent a new tumor detectedeven before evident clinical signs in area previously treated.
cial support: None identified.
CommerP6522Clinicopathologic correlation of MUC5AC expression in advanced extra-mammary Paget disease
Hiroo Hata, MD, Department of Dermatology Hokkaido University GraduateSchool of Medicine, Sapporo, Japan; Daichi Hoshina, Department ofDermatology Hokkaido University Graduate School of Medicine, Sapporo,Japan; Erina Homma, Department of Dermatology Hokkaido UniversityGraduate School of Medicine, Sapporo, Japan; Hiroshi Shimizu, Department ofDermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan;Riichiro Abe, Department of Dermatology Hokkaido University Graduate Schoolof Medicine, Sapporo, Japan; Satoru Aoyagi, Department of Dermatology,Hokkaido University Graduate School of Medicine, Sapporo, Japan
Generally, patients with in situ extramammary Paget disease (EMPD) have a goodprognosis, whereas the presence of dermal invasion or metastasis significantlyincreases morbidity and mortality. Previous studies have proposed to revealmechanisms underlying the EMPD pathogenesis; however, molecular markers thatreflect the invasiveness and the progression have not been established yet. Thepurpose of this study was to identify a reliable marker for predicting the risk ofinvasion and metastasis in EMPD. First, we performed an initial microarray screen ofin situ, invasive or metastatic lymph node of EMPD, indicating that the over and/orreduced expression of MUC1, 2, 5AC, and 6 directly correlates invasion andprognosis. To confirm these MUC protein expressions, we analyzed 44 specimensfrom 38 primary EMPD cases by immunohistochemical staining. Labeling rates oftumor cells were scored by stainning intensity on a four-tiered scale ((-) ; (3+)) todetermine the correlation between the scores of expression of these molecularmarkers and the types of EMPD lesion. All specimens showed 3+ positive for MUC1,and negative for MUC6.MUC5AC expressionwas detected in 19 specimens out of 44(43.2%). Invasive lesions and metastatic lymph nodes tended to express MUC5ACsignificantly higher than in situ (P \ .01) MUC2 was positive in 10 specimens(22.7%). There was no significant difference between MUC2 expression andinvasiveness. In conclusion, we emphasize that the degree of the expression ofMUC5ACmay correlate the invasiveness and progression in EMPD, and also may be auseful marker to extract high-risk EMPD cases.
cial support: None identified.
CommerAPRIL 2013