Melanoma is the most dangerous form of skin cancer. Hence, a better understanding of molecular mechanisms in melanoma pathogenesis is urgently needed, which provides a new insight into the therapy of melanoma. DTL gene is screened out in melanoma pathogenesis by integrated bioinformatics analysis, and its expression is validated in the tissue and cell samples of melanoma. Forced DTL expression facilitates the proliferation, invasion, migration and EMT of melanoma cells, while DTL knockdown suppresses the biological behavior of melanoma cells. In addition, DTL promotes the malignancy of melanoma in vivo. Mechanistically, BUB1 is the crucial downstream target of DTL. Reduced DTL expression suppresses BUB1 expression, while enhanced DTL expression induces BUB1 upregulation. Rescue experiments showed that growing and migrating of melanoma cells induced by DTL are partially impaired by BUB1 inhibition. In addition, the expression of phosphorylated ERK (p-ERK) and the downstream transcription factor E2F1 are reduced when DTL expression is blocked. Meanwhile, BUB1 levels are decreased when the expression of p-ERK or E2F1 is repressed. Notably, the growth and migration of melanoma cells by inhibition of ERK and knockdown of E2F1 was rescued by overexpressing BUB1. DTL gene may be a prognosis marker and represent a unique potential target for melanoma patients. DTL supports the biologically malignant activity of melanoma cells via the ERK/E2F1/BUB1 axis.

Background: The causal relationship between insomnia and migraine is contradictory and no study has been carried out among the Chinese population to date. Methods: In this case, we conducted a case-control study and a bidirectional mendelian randomization (MR) analysis to determine whether insomnia is causally related to the development of migraine. The instrumental variables for insomnia were derived from the largest genome-wide association study of 1,331,010 participants, while the genetic instruments for migraine were available from the largest meta-analysis of migraine with 59,674 cases and 316,078 controls. Results: In case-control study, subjects with insomnia have significantly higher risk of migraine (OR=4.29, 95% CI: 3.21-5.74, P<0.001), compared with those without insomnia. The bidirectional two-sample MR analysis revealed that insomnia was significantly associated with higher risk of migraine (OR=1.24, 95% CI: 1.11-1.38, P=1.01x10-4), and the results were validated in the UK Biobank data. The results showed no indication for directional pleiotropy effects as assessed by the MR-Egger intercept (P>0.05). Conclusion: Conclusively, our study highlighted that increased migraine risk was confined to subjects with a genetic pre-disposition to insomnia, and these findings had potential implications for improving the sleep quality to reduce the burden of migraine.

临床资料 患者,男,46 岁. 因"面颊、腰背部及四肢伸侧多发暗红丘疹结节1年余,伴瘙痒"来我科就诊.患者1年前发现面颊、腰背部及四肢伸侧暗红丘疹,伴痒感,外院曾以"湿疹、虫咬皮炎及结节性痒疹"等治疗,疗效欠佳,后皮损缓慢增多,搔抓后结痂,来我科就诊.患者长期居住于湖北省恩施市,无明确麻风接触史.否认肝炎、结核及麻风等传染病史.否认家族中有类似疾病史.

红皮病又称剥脱性皮炎,是一种由多种原因引起的严重的综合征.内脏恶性肿瘤皮肤可出现多种表现,称为副肿瘤性皮肤病,包括恶性肿瘤相关性红皮病.尽管恶性肿瘤并不占有重要的地位,但恶性肿瘤相关性红皮病临床诊治具有更大的挑战性.

A case of myopericytoma is reported.A 66-year-old female presented with a subcutaneous nodule on the right lateral heel for 6 years.Histopathological examination showed a tumor mass with clear boundaries in the dermis.The tumor mass consisted of solid cellular regions and vascular lacunae of various sizes.The cells in the solid areas included round or short spindle cells with eosinophilic cytoplasm,concentrically arranged around the blood vessels,forming a typical onion-ring appearance.There were no atypical cells.The tumor cells were positive for calponi,H-caldesmon and SMA.The diagnosis of myopericytoma was made.

BackgroundMultinucleate cell angiohistiocytoma (MCAH) is an uncommon benign fibrohistiocytic and vascular proliferation, which usually occurs as slow-growing grouped reddish-brown to purple papules and nodules on the distal extremities or face. Patients with generalized MCAH are extremely rare and to our knowledge, there are no more than 11 cases reported previously in the medical literature.ObjectiveTo describe the clinical, histopathologic features and immunohistochemical characteristics of all reported cases of generalized MCAH and investigate any potential clinicopathological correlations.MethodsA systematic review of the literature was done with information collected and organized in a table. A new case report is also described in a 42-year-old female with generalized MCAH. Histopathologic and immunohistochemical features of multiple biopsies were analyzed.ResultsMen and women are equally affected. It is crucial to take multiple biopsies preferably from newly formed lesions to reach the correct diagnosis. The divergent results in immunohistochemistry staining for CD68 and estrogen receptor (ER) alpha necessitate further studies to reach a precise etiology and pathogenesis and secure it with certainty.ConclusionAwareness of the clinicopathological hallmarks is important to avoid underdiagnosis of MCAH and the immunohistochemical features may contribute to understanding the pathogenesis of this rare disease.

报告1例临床表现为靶样损害的动脉瘤样纤维组织细胞瘤.患者女,60岁.因左大腿内侧结节1个月余就诊.皮肤科检查:左大腿内侧可见一直径约1 cm,黑褐色结节,边缘环绕紫红色晕,无触痛.皮损手术全切行组织病理检查示表皮角化过度,表皮突下延,基底层色素增加,真皮浅中部增生的纤维组织细胞及胶原纤维形成境界清楚的团块,其内可见血窦样结构,但无血管内皮细胞,并可见含铁血黄素沉积,无细胞异形性,普鲁士蓝染色阳性.免疫组化肿瘤细胞不表达Ⅷ因子、CD34、CD31、S-100蛋白、平滑肌肌动蛋白(SMA)、结蛋白(desmin)、细胞角蛋白(CK)和CD68,而波形蛋白(vimentin)阳性表达.结合临床诊断表现为靶样损害的动脉瘤样纤维组织细胞瘤.术后随访6个月余未见复发或转移.

A 46-year-old male patient developed scatterred reddish-brown plaques and nodules on the back 6 years prior to the presentation. Then, the lesions gradually spread to the axillary fossa and protothorax, and became indurated with slight itching in winter. Laboratory examination revealed hypergammaglobulinemia. Computed tomography(CT)scan showed multiple nodular or patchy shadows in both lungs, lymphadenectasis in axillary, mediastinal and inguinal regions, and spleen enlargement. Histopathological examination of skin lesions showed granulomatous infiltrates with plenty of lymphocytes, histiocytes and mature plasma cells in the middle and lower dermis with the presence of lymphoid follicle-like structures, but no cell atypia was observed. Immunohistochemical study showed positive staining for CD38, CD138, CD79a, κ and λ light chains. According to clinical manifestations and laboratory examination results, the patient was diagnosed with cutaneous and systemic plasmacytosis.

Objective To detect the expressions of nerve growth factor (NGF) and its receptors tyrosine kinase A (TrkA) as well as p75 neurotrophin receptor (p75NTR) in the lesions of lichen planus.Methods Biopsy specimens were collected from the lesions of 32 patients with lichen planus and normal skin of 12 healthy human controls and subjected to paraffin embedding.Immunohistochemical avidin-biotin complex (ABC) method was used to detect the expressions of NGF,TrkA and p75NTR.Results NGF and TrkA,which were located in the cytoplasm of keratinocytes,were strongly or moderately expressed in the lesional skin specimens,but absent or weakly expressed in the normal skin specimens (both P ＜ 0.01).No significant differences were observed in the expression of p75NTR between the lesional and normal skin specimens,or in the expressions of NGF,TrkA or p75NTR among specimens from patients in different age groups,patients of different gender or lesions at different sites (all P ＞ 0.05).There was a positive correlation between the expression of NGF and TrkA in the lesions of lichen planus (R2 =0.535,P ＜ 0.01).Conclusion NGF may play a certain role in the development of lichen planus via its highaffinity receptor TrkA.

报告1例穿通型毛母质瘤.患者女,58岁.颈部右侧一质硬性结节伴轻度瘙痒1年余.皮肤科检查:颈部右侧一大约1 cm×1 cm的圆形质硬结节,边界清楚,表面附有黑褐色痂.手术切除后行皮损组织病理学检查:真皮可见由嗜碱性细胞、过渡细胞及影细胞组成的肿瘤团块,并与表皮相通.结合临床及病理表现诊断为穿通型毛母质瘤.

皮肤平滑肌瘤较少见,病因尚不明确,多发性者更为罕见.现将武汉市协和医院皮肤科确诊1例多发性皮肤平滑肌瘤报告如下. 1 病历摘要 患者男,54岁.右小腿起结节20余年,渐增多,于2010年10月21日就诊.患者20年前无明显诱因于右小腿胫前出现大小不等结节,肤色或淡红色,无明显自觉症状,皮疹渐增多.近七八年渐出现疼痛感,曾在当地就诊,未明确诊断,未予处理.

患者男,22岁.因指、趾甲萎缩变形7年余,颈部及胸、背部网状色素沉着2年余,于2011年11月4日到我院就诊.患者7年前无明显诱因双手指甲萎缩变形,随后双足趾甲也出现类似表现,先后在多家医院诊断为"甲癣"、"甲营养不良",给予相应治疗均无明显好转,后患者放弃治疗.2年前,患者颈部出现网状色素沉着斑,无自觉症状,皮损逐渐增多蔓延至胸、背部等处.患者发病以来无结膜充血、畏光、头发及牙齿异常等其他症状,大小便正常.

患者男,18岁. 主诉:右小腿紫红色结节、斑块及疣状增生18年. 现病史:患者出生时发现右膝前黄豆大红褐色丘疹、结节,随年龄增长皮疹逐渐增多、增大,形成斑块,并部分融合呈疣状,沿小腿内侧向下延伸至胫前1/2的部位,大致呈带状分布.偶尔感疼痛及瘙痒,轻微外伤后易出血,未行任何处理.

The follicular hybrid is composed of more than two components of pilosebaceous unit. There are several studies of hybrid cyst, combination of trichilemmal and epidermoid cyst was the most frequently reported. In this paper, we reported one case of hybrid cyst composed of bullous pilomatricoma and epidermoid cyst. A 14-year-old girl was complaint of a solitary flesh-colored to erythematous nodule with flaccid appearance sized 3.2 × 1.8 cm in diameter on her right upper back for one year. The histologic findings showed there were edema and proliferation of capillaries in the superficial dermis, a cyst in the middle to deep dermis. There were laminated keratins in the cystic space. The cyst wall was composed of two different components, one was composed of epithelial cells containing of granular layer, and another consisted of basophilic cells, transient cells and shadow cells. The cyst not related with Gardner's syndrome. Hybrid cyst such as trichilemmal cyst, epidermoid and pilomatricoma cysts maybe have same clinical features or mimicking each others, but we can distinguish them from histopathology evaluation.

International Journal of DermatologyVolume 54, Issue 3 p. 338-342 Case report Acanthosis nigricans, tripe palms, and sign of Leser-Trélat in a patient with gastric adenocarcinoma: case report and literature review in China Na Zhang MD, Na Zhang MD Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, 430022N.Z. and Y.Q. contributed equally to this work.Search for more papers by this authorYue Qian MD, Yue Qian MD Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, 430022N.Z. and Y.Q. contributed equally to this work.Search for more papers by this authorAi Ping Feng MD, Corresponding Author Ai Ping Feng MD Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, 430022 Correspondence Dr Ai Ping Feng Department of Dermatology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China E-mail: [email protected]Search for more papers by this author Na Zhang MD, Na Zhang MD Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, 430022N.Z. and Y.Q. contributed equally to this work.Search for more papers by this authorYue Qian MD, Yue Qian MD Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, 430022N.Z. and Y.Q. contributed equally to this work.Search for more papers by this authorAi Ping Feng MD, Corresponding Author Ai Ping Feng MD Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, 430022 Correspondence Dr Ai Ping Feng Department of Dermatology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China E-mail: [email protected]Search for more papers by this author First published: 15 May 2013 https://doi.org/10.1111/ijd.12034Citations: 9 There are no potential conflicts existing among the authors. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat References 1Ramos ESM, Carvalho JC, Carneiro SC. Cutaneous paraneoplasia. Clin Dermatol 2011; 29: 541–547. 2Schwartz RA. Acanthosis nigricans. J Am Acad Dermatol 1994; 31: 1–19; quiz 20–22. 3Cohen PR, Grossman ME, Silvers DN, et al. Tripe palms and cancer. Clin Dermatol 1993; 11: 165–173. 4Khaled A, Abdallah MB, Tekaya R, et al. Tripe palms with oligoarthritis, two rare paraneoplastic syndromes heralding a small cell lung cancer. J Eur Acad Dermatol Venereol 2009; 23: 579–580. 5Ponti G, Luppi G, Losi L, et al. Leser-Trelat syndrome in patients affected by six multiple metachronous primitive cancers. J Hematol Oncol 2010; 3: 2. 6Longshore SJ, Taylor JS, Kennedy A, et al. Malignant acanthosis nigricans and endometrioid adenocarcinoma of the parametrium: the search for malignancy. J Am Acad Dermatol 2003; 49: 541–543. 7Puri N. A study of pathogenesis of acanthosis nigricans and its clinical implications. Indian J Dermatol 2011; 56: 678–683. 8Abreu Velez AM, Howard MS. Diagnosis and treatment of cutaneous paraneoplastic disorders. Dermatol Ther 2010; 23: 662–675. 9Pentenero M, Carrozzo M, Pagano M, et al. Oral acanthosis nigricans, tripe palms and sign of leser-trelat in a patient with gastric adenocarcinoma. Int J Dermatol 2004; 43: 530–532. 10da Costa Franca AF, Siqueira NS, Carvalheira JB, et al. Acanthosis nigricans, tripe palms and the sign of Leser-Trelat in a patient with a benign hepatic neoplasia. J Eur Acad Dermatol Venereol 2007; 21: 846–848. 11Fetil E, Ozkan S, Gurler N, et al. Recurrent leser-trelat sign associated with two malignancies. Dermatology 2002; 204: 254–255. 12Mukherjee S, Pandit S, Deb J, et al. A case of squamous cell carcinoma of lung presenting with paraneoplastic type of acanthosis nigricans. Lung India 2011; 28: 62–64. 13Moore RL, Devere TS. Epidermal manifestations of internal malignancy. Dermatol Clin 2008; 26: 17–29, vii. 14Krawczyk M, Mykala-Ciesla J, Kolodziej-Jaskula A. Acanthosis nigricans as a paraneoplastic syndrome. Case reports and review of literature. Pol Arch Med Wewn 2009; 119: 180–183. 15Yeh JS, Munn SE, Plunkett TA, et al. Coexistence of acanthosis nigricans and the sign of Leser-Trelat in a patient with gastric adenocarcinoma: a case report and literature review. J Am Acad Dermatol 2000; 42: 357–362. 16Scully C, Barrett WA, Gilkes J, et al. Oral acanthosis nigricans, the sign of Leser-Trelat and cholangiocarcinoma. Br J Dermatol 2001; 145: 506–507. 17Cohen PR, Grossman ME, Almeida L, et al. Tripe palms and malignancy. J Clin Oncol 1989; 7: 669–678. 18Haase I, Hunzelmann N. Activation of epidermal growth factor receptor/ERK signaling correlates with suppressed differentiation in malignant acanthosis nigricans. J Invest Dermatol 2002; 118: 891–893. 19Koyama S, Ikeda K, Sato M, et al. Transforming growth factor-alpha (TGF alpha)-producing gastric carcinoma with acanthosis nigricans: an endocrine effect of TGF alpha in the pathogenesis of cutaneous paraneoplastic syndrome and epithelial hyperplasia of the esophagus. J Gastroenterol 1997; 32: 71–77. 20Anderson SH, Hudson-Peacock M, Muller AF. Malignant acanthosis nigricans: potential role of chemotherapy. Br J Dermatol 1999; 141: 714–716. Citing Literature Volume54, Issue3March 2015Pages 338-342 ReferencesRelatedInformation

收集2010年我院住院治疗的过敏性紫癜患者168例,对其发病特点及临床表现进行分析. 1资料与方法 1.1病例168例过敏性紫癜(HSP)患者均为我院住院病人,诊断均参照美国风湿学会过敏性紫癜诊断标准.1患者年龄4～ 58岁,平均15.3岁,＜20岁139例(72.4％),≥20岁29例.男116例,平均年龄14.3岁;女52例,平均年龄17.0岁. 1.2方法回顾性分析168例患者的临床资料,其中包括一般资料、好发季节、发病诱因、药物过敏史、首发症状、临床表现等.

A 42-year-old man presented with a slowly spreading,asymptomatic,infiltrated erythematous patch in the fight side of the chest and back for more than half a month.Dermatologic examination revealed a poorly marginated,pink infiltrated patch sized 5 cm × 7 cm in the right subscapular region of the back and chest.Histopathologically,there was an infiltrate of numerous mononuclear cells in the superficial dermis as well as between collagen fibers in the middle and deep dermis,with epidermotropism of some cells and formation of Pautrier's microabscesses.Mild atypia was observed in some infiltrating mononuclear cells.Immunohistochemistryshowed that the mononuclear cells were positive for CD3,CD4 (scattered),CD5,CD8,CD45Ro,the cytotoxicgranule-associated protein TIA-1,but negative for CD7,CD20,CD30,CD56,CD68,CD79α,and granzyme B,with the percentage of Ki-67-positive cells higher than 20％.T cell receptor (TCR) rearrangement was negative.The final diagnosis was unilesional interstitial mycosis fungoides.

者女,32岁.右腰背部红色斑块8年余,斑块渐增大,后红斑表面出现凹陷并萎缩,病程中无明显自觉症状,于2010年10月28日就诊.患者发病前皮损局部无外伤史.既往体健,家族中无类似疾病患者.