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Diagnosing Skin Disease
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
The presence or absence of pain can be an important differentiating factor in the diagnosis of dermatologic disorders. Pyoderma gangrenosum and calciphylaxis are both classically characterized as being extremely painful. Additionally, the subjective symptom of pain is often associated with the presence of acute inflammation as seen in cellulitis, panniculitis, infected cysts, and even seborrheic keratoses when they become irritated. In the case of skin malignancies, the presence of pain may indicate perineural invasion.
Basal Cell Carcinoma
Published in Debjani Sahni, Adam Lerner, Bilal Fawaz, Advanced Skin Cancer, 2022
Multiple histological growth patterns have been described in BCC, with more than one pattern occasionally observed in a single tumor. However, all these types share a common histological feature of nests of atypical basaloid cells growing from the epidermis. The nests are characterized by the presence of peripheral palisading, central haphazard arrangement of cells, and clefting (retraction artifact), separating the tumor nests from the surrounding fibromyxoid stroma.2 The histological growth patterns are divided into low and high risk based on their propensity for recurrence. The main low-risk types include nodular, superficial, and cystic BCCs. High-risk growth patterns include (a) micronodular BCC, characterized by small nests of basaloid cells, and (b) basosquamous BCC, characterized by basaloid cells undergoing squamous differentiation. Another important high-risk histological feature is the presence of perineural invasion, which can be found rarely in any subtype (incidence of <1%).2–4,6
Multiprofessional Guidelines for the Management of the Patient with Primary Cutaneous Squamous Cell Carcinoma
Published in Niall MH McLeod, Peter A Brennan, 50 Landmark Papers every Oral & Maxillofacial Surgeon Should Know, 2020
Factors such as tumour diameter greater than 20 mm, tumour thickness greater than 4 mm, location on the ear, lips, and non-UVR exposed sites such as sacrum or sole of foot, and poor differentiation are indicators of increased risk of metastasis. Perineural invasion (PNI) is associated with an increased risk of tumour recurrence, lymph node metastasis, distant metastasis, and death.
Pathologic and Immunophenotypic Characterization of Syncytial Giant Cell Variant of Pediatric Hepatocellular Carcinoma. A Distinct Subtype
Published in Fetal and Pediatric Pathology, 2023
Mukul Vij, Jagadeesh Menon, Komalavalli Subbiah, Lexmi Priya Raju, Gowripriya Gowrisankar, Naresh Shanmugum, Ilankumaran Kaliamoorthy, Ashwin Rammohan, Mohamed Rela
Serial sectioning of the explanted liver showed biliary cirrhosis along with a single distinct vague yellowish white tumor nodule measuring 7 mm in the left lobe corresponding to the tumor nodule identified by the CT scan. Multiple cysts with biliary sludge were also noted around hilum. Bright-field microscopy demonstrated distortion of lobular architecture with micronodular cirrhotic transformation (Fig. 1C). The tumor nodule demonstrated round to polygonal cells arranged in sheets demonstrating high nucleo-cytoplasmic ratios, mildly to moderately anisomorphic nuclei, vesicular chromatin, small nucleoli and moderate to abundant f clear to pale eosinophilic cytoplasm (Fig. 1D). There were diffuse syncytial giant cells containing 4 to 10 nuclei (Fig. 2A). Partial tumor capsule, fatty change, intratumoral hematopoiesis, bile production, focal necrosis and stromal infiltration (Fig. 2B) were identified. There was no microvascular or perineural invasion. Immunohistochemistry studies revealed diffuse positivity for Hep-par1, Glypican-3, AFP, and glutamine synthetase (Fig. 3A–D). Epithelial cell adhesion molecule (EpCam) showed diffuse membranous and patchy cytoplasmic expression (Fig. 3E). B-catenin showed membranous expression. CD34 showed patchy sinusoidal expression. Few cells showed nuclear positivity for p53. Metallothionein showed focal nuclear and cytoplasmic expression. Ki67 proliferation index was around 15% (Fig. 3F). CK19 and nestin were negative.
Perineural Invasion as a Predictive Biomarker of Groin Metastases and Survival Outcomes in Vulvar Cancer: A Meta-Analysis
Published in Cancer Investigation, 2022
Vasilios Pergialiotis, Loukas Ferousis, Aggeliki Rouvali, Efstathia Liatsou, Dimitrios Haidopoulos, Alexandros Rodolakis, Nikolaos Thomakos
To date, perineural invasion remains an underrecognized potential route of metastatic spread of tumors, even though it seems to be directly related to survival outcomes of patients with several forms of cancer, predominantly those that are associated with squamous differentiation (26). In skin-related cancers, the American Joint Committee on Cancer (AJCC) has modified its staging system to include perineural invasion in tumor high-risk characteristics (27). Pathophysiologically, perineural invasion may occur independently in the absence of evident lymph or blood vessel related invasion. It is well established that nerve cells and tumors interact directly and that denervation of tumors leads to reduced volume of tumor-cell cytoplasm and karyopyknosis that ultimately trigger apoptosis (28). Similarly, decrease in acetylcholine receptors has been implicated in the inhibitory process of tumor occurrence or recurrence in experimental studies (29). Inhibition of other neurotransmitters such as dopamine has been also correlated with reduced neovascularization, tumor development and occurrence of metastases (30,31). Taking this information into consideration, it becomes understandable that the evaluation of perineural invasion should be considered not only as a prognostic factor of vulvar cancer survival but also as an exciting field for future research which may reveal novel therapeutic agents at least against tumors of squamous differentiation.
A direct transcutaneous approach to infraorbital nerve biopsy
Published in Orbit, 2022
Kelly H. Yom, Brittany A. Simmons, Lauren E. Hock, Nasreen A. Syed, Keith D. Carter, Matthew J. Thurtell, Erin M. Shriver
Cutaneous squamous cell carcinoma (SCC) is one of the most common cancers in the United States and can be associated with serious morbidity and even mortality with tumor spread. It is estimated that over 1 million Americans are diagnosed with SCC every year, and this number is expected to rise as the population ages.1–3 The outcome for most of these cases can be favorable with prompt diagnosis and surgical resection.4 However, a small proportion of patients do experience local recurrence, incomplete resection with invasive disease, and metastasis.1 SCC can spread by perineural invasion (PNI), whereby cancer cells propagate directly along or within the nerve sheath of local nerves. First described in 1835, the reported incidence of PNI in cutaneous SCC has ranged from 2.5% to 14%.5,6 Perineural invasion can severely impair or destroy the innervation of local structures, causing marked loss of function and facilitating spread into the central nervous system (CNS).7 Often misdiagnosed,8 PNI is associated with a poor prognosis.7,9 Three-year disease-specific survival for patients with SCC without PNI is 91% compared to 64% for SCC with PNI.10