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Skin Health and Disease Oct 2023Herein we present case report of a 73-year-old female who developed a rapidly growing, ulcerated lesion on her left superior eyelid. Despite treatment for suspected...
Herein we present case report of a 73-year-old female who developed a rapidly growing, ulcerated lesion on her left superior eyelid. Despite treatment for suspected infection, symptoms only marginally improved. Physical examination revealed a diffusely ulcerated multinodular tumour with overlying haemorrhagic and serosanguineous exudate. A shave biopsy led to a diagnosis of primary cutaneous anaplastic large cell lymphoma (pcALCL), a rare CD30+ lymphoproliferative disorder. The patient had no extracutaneous involvement on PET-CT and her prognosis is good given the indolent nature of pcALCL. Differential diagnoses included merkel cell carcinoma, periocular sebaceous carcinoma, lymphomatoid papulosis, and extranodal natural killer/T cell lymphoma. Prognosis for pcALCL is generally good. Treatment recommendation for pcALCL is surgical excision with negative margins for localised disease, while intravenous brentuximab vedotin is suggested for widespread, relapsed, and refractory disease.
PubMed: 37799372
DOI: 10.1002/ski2.277 -
Cureus Sep 2023Sebaceous carcinoma is a rare, aggressive cutaneous malignancy most commonly arising from the periocular area. Extraocular locations of sebaceous carcinomas,...
Sebaceous carcinoma is a rare, aggressive cutaneous malignancy most commonly arising from the periocular area. Extraocular locations of sebaceous carcinomas, particularly outside of the head and neck region, are rare and not well-described. We report a case of an 89-year-old Caucasian female with sebaceous carcinoma of the right wrist. She initially presented with a 1.2-centimeter friable nodule on the right wrist. Initial shave biopsy and subsequent pathologic evaluation revealed a basaloid neoplasm with sebaceous differentiation, atypia, and frequent mitoses, consistent with sebaceous carcinoma. The presented case reviews common clinical features and the pertinent histopathology of ocular and extraocular sebaceous carcinoma and provides a literature review of diagnosis, prognosis, and treatment.
PubMed: 37720114
DOI: 10.7759/cureus.45057 -
Cost Effectiveness and Resource... Sep 2023In an effort to minimize positive margins and subsequent re-excision after breast conserving surgery (BCS), many providers and facilities have implemented either a Full...
BACKGROUND
In an effort to minimize positive margins and subsequent re-excision after breast conserving surgery (BCS), many providers and facilities have implemented either a Full Cavity Shave (FCS) approach or adding the MarginProbe Radiofrequency Spectroscopy System.
OBJECTIVE
We sought to create a functioning Pro-Forma for use by facilities and payers to evaluate and compare the cost savings of implementing FCS or MarginProbe based on personalized variable inputs.
METHODS
A decision tree demonstrating three possible surgical pathways, BCS, BCS + FCS, and BCS + MarginProbe was developed with clinical inputs for re-excision rate, mastectomy as 2nd surgery, rate of reconstruction, and rate of 3rd surgery derived by a literature review. A surgical pathway cost formula was created using the decision tree and financial inputs derived by utilizing the nation's largest database of privately billed health insurance claims and Medicare claims data (fairhealth.org). Using the surgical pathway formula and financial inputs, a customizable Pro-Forma was created for immediate cost savings analysis of BCS + FCS and BCS + Marginprobe using variable inputs. Costs are from the perspective of third-party payers.
RESULTS
Utilizing MarginProbe to reduce re-excisions for positive margins can be associated with better cost-savings than FCS due to the increased pathology processing costs by using an FCS approach. The reduction in re-excision provided by both FCS and MarginProbe offset their increased expense to various degrees with cost savings of each method improving as baseline re-excisions rates increase, until ultimately each may become cost-neutral or cost-prohibitive when compared to BCS alone. Our data suggest that in the privately insured population, MarginProbe provides a cost-savings over BCS alone when baseline re-excision rates are over 20% and that FCS becomes cost-saving when baseline re-excision rates are over 29%. For Medicare patients, MarginProbe provides a cost-savings when baseline re-excision rates exceed 34%, and FCS becomes cost-saving for re-excision rates over 52%. Our Pro-Forma allows an individual provider or institution to evaluate the cost savings of the FCS approach and/or utilization of the MarginProbe device such that the additional cost or cost-savings of utilizing one or both of these methods can be quickly calculated based on their facility's volume and baseline re-excision rate.
CONCLUSIONS
Our data suggest that utilizing either an FCS approach or the MarginProbe radiofrequency spectroscopy system may be a cost-saving solution to reducing the rate of re-excisions depending on a facility or practice's surgical volume and baseline re-excision rate. The degree to which each of these interventions provides an added cost or cost-savings to healthcare payers can be evaluated by utilizing the Pro-Forma outlined herein with customizable variable inputs.
PubMed: 37716980
DOI: 10.1186/s12962-023-00477-1 -
Cureus Jul 2023Background Exosomes are membrane-derived nanovesicles produced by cells and play an important role in intercellular communication. Objectives This study aimed to...
Background Exosomes are membrane-derived nanovesicles produced by cells and play an important role in intercellular communication. Objectives This study aimed to investigate the effects of garlic exosome (GE) on hair growth. Methods Forty-two Sprague-Dawley/Wistar albino rats were randomly divided into six groups: non-shaved control, shaved control, topical control, GE 2 mg, GE 4 mg, and topical GE. At the end of the experiment, the number of hair follicles, follicle diameter, and subcutaneous tissue thicknesses were measured histopathologically. The Wnt-1, β-catenin, platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), transforming growth factor-β1 (TGF-β1), and collagen I levels were measured by the Western Blot method. Results The anagen follicle counts of the GE 2 mg, 4 mg, and topical GE groups were 66.57±15.49, 105.71±25.06, and 55.29±6.72, and were significantly higher than the control groups (p<0.01, p<0.001 and p<0.05, respectively). The follicle diameter of the GE 4 mg group was higher than the others (p<0.05). The Wnt-1, PDGF, VEGF, TGF-β1, and collagen I levels of all GE groups, and the β-catenin levels of the GE 4 mg and topical GE groups were significantly higher than the control groups (p<0.05). Conclusion GE induces hair growth in rats via the Wnt-1, β-catenin, VEGF, PDGF, and TGF-β1 signaling pathways.
PubMed: 37602007
DOI: 10.7759/cureus.42142 -
HCA Healthcare Journal of Medicine 2022Description Pleomorphic dermal sarcoma (PDS) can clinically and histopathologically mimic atypical fibroxanthoma (AFX). However, it has a more aggressive clinical course...
Description Pleomorphic dermal sarcoma (PDS) can clinically and histopathologically mimic atypical fibroxanthoma (AFX). However, it has a more aggressive clinical course with a higher recurrence rate and metastatic potential. This case presentation aims to report a rapidly-growing, exophytic, 4 cm tumor following a non-diagnostic shave biopsy 2 months prior and to highlight distinctive features between PDS and AFX needed to make the correct diagnosis. Like AFX, PDS occurs on the sun-damaged skin of the elderly, usually on the head and neck. Also, like AFX, PDS histopathologically consists of sheets or fascicles of epithelioid and/or spindle-shaped cells, often with multinucleation, pleomorphism, and numerous mitotic figures. Immunohistochemistry cannot distinguish PDS from AFX but is used to exclude other malignancies. PDS can be distinguished from AFX by size (PDS is usually >2.0 cm) and by the presence of more aggressive histopathologic features, such as subcutaneous involvement, perineural and/or lymphovascular invasion, and necrosis. PDS is a rare entity not well documented in the literature with confusing, misleading, and changing nomenclature. PDS is a diagnosis of exclusion made after complete excision of the tumor with the aid of histopathology and immunohistochemistry.
PubMed: 37425251
DOI: 10.36518/2689-0216.1334 -
Cureus May 2023Infections due to nontuberculous mycobacteria (NTM) are caused by mycobacterial species other than , , and . Patients who are immunocompromised have increased...
Infections due to nontuberculous mycobacteria (NTM) are caused by mycobacterial species other than , , and . Patients who are immunocompromised have increased susceptibility to pulmonary, lymphatic, and skin infections by these pathogens. We present a case of a 78-year-old male who presented to dermatology with a left dorsolateral hand infection after sustaining cat scratches in the setting of topical steroid therapy for suspected pyoderma gangrenosum. A shave biopsy of the lesion showed granulomatous dermatitis and associated acid-fast bacilli, while tissue culture grew . This case demonstrates cat scratches as an uncommon risk factor for cutaneous NTM disease. Although an association between cat scratches and human NTM infections has only been reported in two previous cases, it must be considered in cases of unusual and persistent cutaneous lesions, especially in immunocompromised patients, even those with only local immunosuppression from topical agents.
PubMed: 37313069
DOI: 10.7759/cureus.38901 -
Cureus May 2023Introduction Breast-conserving surgery (BCS) followed by adjuvant radiotherapy has similar overall survival compared to mastectomy but is associated with higher rates...
Introduction Breast-conserving surgery (BCS) followed by adjuvant radiotherapy has similar overall survival compared to mastectomy but is associated with higher rates of local recurrence. Positive surgical margins in BCS are the most important predictor of local recurrence. The aim of our study was to assess the risk factors associated with positive margins in women undergoing BCS for breast cancer in order to inform our clinical practice and minimize re-operation rates. Methods Patients with a diagnosis of breast cancer who underwent BCS from January 2013 to January 2021 were identified from our pathology database and included in the study. All patients underwent a lumpectomy with the removal of additional shaved cavity margins. Statistical analysis was used to assess the effect of patient clinical and pathological risk factors on the rate of positive margins. Results One hundred and twenty patients underwent BCS for breast cancer. Twenty-four percent of patients had positive margins. Of the 29 patients that underwent subsequent re-excisions, only 13 (45%) had residual disease in the re-excision specimen. In younger patients, tumors localized in lower quadrants and the presence of extensive intraductal component within invasive breast cancer increased the risk of positive margins. In addition, positive margins were encountered more significantly in patients with ductal carcinoma in situ (DCIS) compared to invasive tumors. Multivariate analysis showed that DCIS and young age were the only factors independently associated with positive margins. Conclusion DCIS and younger patients have a higher rate of positive margins during BCS than invasive breast cancer. For such patients at higher risk of positive margins, excision of cavity shave margins and intraoperative inking may be done to lower positive margin rates. Preoperative review of breast imaging, core biopsies, and counseling of patients about the likelihood of positive margins is important.
PubMed: 37265920
DOI: 10.7759/cureus.38399 -
ACS Nano Jun 2023Obesity is a major risk factor for multiple chronic diseases. Anthropometric and imaging approaches are primarily used to assess adiposity, and there is a dearth of...
Obesity is a major risk factor for multiple chronic diseases. Anthropometric and imaging approaches are primarily used to assess adiposity, and there is a dearth of techniques to determine the changes in adipose tissue (AT) at the molecular level. Extracellular vesicles (EVs) have emerged as a novel and less invasive source of biomarkers for various pathologies. Furthermore, the possibility of enriching cell or tissue-specific EVs from the biofluids based on their unique surface markers has led to classifying these vesicles as "liquid biopsies", offering valuable molecular information on hard-to-access tissues. Here, we isolated small EVs from AT (sEV) of lean and diet-induced obese (DIO) mice, identified unique surface proteins on sEV by surface shaving followed by mass spectrometry, and developed a signature of five unique proteins. Using this signature, we pulled out sEV from the blood of mice and validated the specificity of isolated sEV by measuring the expression of adiponectin, 38 adipokines on an array, and several adipose tissue-related miRNAs. Furthermore, we provided evidence of sEV applicability in disease prediction by characterizing sEV from the blood of lean and DIO mice. Interestingly, sEV cargo showed a stronger pro-inflammatory effect on THP1 monocytes compared to sEV and a significant increase in obesity-associated miRNA expression. Equally important, sEV cargo revealed an obesity-associated aberrant amino acid metabolism that was subsequently validated in the corresponding AT. Lastly, we show a significant increase in inflammation-related molecules in sEV isolated from the blood of nondiabetic obese (>30 kg/m) individuals. Overall, the present study offers a less-invasive approach to characterize AT.
Topics: Adipose Tissue; Liquid Biopsy; Extracellular Vesicles; Obesity; Humans; Animals; Mice; Biomarkers
PubMed: 37224410
DOI: 10.1021/acsnano.3c00422 -
JAAD International Jun 2023
PubMed: 37138829
DOI: 10.1016/j.jdin.2023.02.012