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  • 1
    Keywords: CANCER ; Germany ; PATIENT ; LYMPH-NODES ; SKIN ; treatment ; PROBE ; IDENTIFICATION ; AGE ; MALES ; MELANOMA ; REGION ; SURFACE ; LOCALIZATION ; TECHNETIUM-99M ; MALIGNANT-MELANOMA ; ULTRASONOGRAPHY ; malignant melanoma ; SONOGRAPHY ; BIOPSY ; DISSECTION ; DYE ; LOCATION ; lymphoscintigraphy ; M1 ; sentinel lymph node (SLN)
    Abstract: BACKGROUND. Dissection of the "sentinel lymph node" (SLN) as identified by lymphoscintigraphy is becoming increasingly important in the treatment of patients with malignant melanoma. The purpose of the current study was to determine whether the SLN also could be identified by ultrasound. METHODS. Sixty-seven patients with malignant melanoma (40 females and 27 males, with an average age of 48.8 years) in whom extirpation of the SLN was indicated underwent ultrasonography of the regional lymph nodes prior to preoperative lymphoscintigraphy. The location of the melanoma was the legs in 30 patients, the arms in 14 patients, and the trunk in 23 patients. During regional ultrasonography, the location of the lymph nodes that differed in the cortex/medulla ratio from the surrounding lymph nodes was marked on the skin corresponding to the planes of insonation (M1) when the probe was held vertically to the skin surface. After lymphoscintigraphy using technetium-99m, the position of a gamma probe at which the highest count rate vertical to the skin surface was recorded also was marked (M2). RESULTS. in the inguinal region, the agreement between M1 and M2 was found to be 100% (40 of 40 SLNs) and was 72.5% in the axilla (29 of 40 SLNs). In patients with melanomas located on the leg, the location of M1 and M2 agreed in 97% of cases (36 of 37 lymph nodes in 30 patients); in patients with melanomas located on the arms, the agreement was 76% (13 of 17 lymph nodes in 14 patients) and in patients with melanomas located on the trunk, the agreement was 75% (21 of 28 lymph nodes in 23 patients). The position documented by ultrasound relative to the neighboring structures of the SLN was confirmed intraoperatively in all cases. CONCLUSIONS. The results of the current study indicate that the SLN in patients with melanoma located on the limbs, especially the legs, are characterized by a specific sonomorphologic pattern. Preoperative sonography might constitute an important addition to lymphoscintigraphy in the planning of SLN biopsy. (C) 2003 American Cancer Society
    Type of Publication: Journal article published
    PubMed ID: 12673722
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  • 2
    Keywords: CANCER ; CELLS ; EXPRESSION ; GROWTH ; IN-VITRO ; proliferation ; tumor ; carcinoma ; Germany ; human ; IN-VIVO ; VITRO ; VIVO ; SITE ; SITES ; GENE ; HYBRIDIZATION ; PROTEIN ; DIFFERENTIATION ; TISSUE ; TUMORS ; PATIENT ; CARCINOGENESIS ; KERATINOCYTES ; SKIN ; IN-SITU ; PROGRESSION ; AMPLIFICATION ; COMPARATIVE GENOMIC HYBRIDIZATION ; immunohistochemistry ; CHROMOSOMAL-ABERRATIONS ; skin carcinogenesis ; LOCALIZATION ; PHENOTYPE ; SQUAMOUS-CELL CARCINOMA ; CARCINOMAS ; squamous cell carcinoma ; p21 ; NONMELANOMA SKIN CANCERS ; FLUORESCENCE ; OVEREXPRESSION ; ORGANIZATION ; TERMINAL DIFFERENTIATION ; P53 MUTATIONS ; SKIN-CANCER ; CYCLIN D1 ; in situ hybridization ; CELL CARCINOMA ; REGRESSION ; RE ; TUMORIGENICITY ; CANCER DEVELOPMENT ; LOCUS ; function ; CANCERS ; in vivo ; genomic ; aberrant differentiation ; cdk4 ; KERATINOCYTES HACAT ; keratoacanthoma ; nonmelanoma skin cancer ; ORGANOTYPIC COCULTURE ; tumor regression
    Abstract: Non-melanoma skin cancers, in particular keratoacanthomas (KAs) and squamous cell carcinomas (SCCs), have become highly frequent tumor types especially in immune-suppressed transplant patients. Nevertheless, little is known about essential genetic changes. As a paradigm of 'early' changes, that is, changes still compatible with tumor regression, we studied KAs by comparative genomic hybridization and show that gain of chromosome 11q is not only one of the most frequent aberration (8/18), but in four tumors also the only aberration. Furthermore, 11q gain correlated with amplification of the cyclin D1 locus (10/14), as determined by fluorescence in situ hybridization, and overexpression of cyclin D1 protein (25/31), as detected by immunohistochemistry. For unraveling the functional consequence, we overexpressed cyclin D1 in HaCaT skin keratinocytes. These cells only gained little growth advantage in conventional and in organotypic cocultures. However, although the control vector-transfected cells formed a well-stratified and orderly differentiated epidermis-like epithelium, they showed deregulation of tissue architecture with an altered localization of proliferation and impaired differentiation. The most severe phenotype was seen in a clone that additionally upregulated cdk4 and p21. These cells lacked terminal differentiation, exhibited a more autonomous growth in vitro and in vivo and even formed tumors in two injection sites with a growth pattern resembling that of human KAs. Thus, our results identify 11q13 gain/cyclin D1 overexpression as an important step in KA formation and point to a function that exceeds its known role in proliferation by disrupting tissue organization and thereby allowing abnormal growth
    Type of Publication: Journal article published
    PubMed ID: 16547504
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  • 3
    Keywords: EXPRESSION ; GROWTH ; proliferation ; carcinoma ; Germany ; INHIBITION ; PATHWAY ; DISTINCT ; GENE ; GENES ; microarray ; PROTEIN ; DIFFERENTIATION ; TISSUE ; TUMORS ; SKIN ; IN-SITU ; AMPLIFICATION ; COPY NUMBER ; immunohistochemistry ; NUMBER ; MUTATIONS ; ONCOGENE ; HUMAN HOMOLOG ; HEAD ; PREVALENCE ; PRECURSORS ; EFFECTOR ; basal cell carcinoma ; N-MYC ; CELL CARCINOMA ; SUBSET ; fluorescence in situ hybridisation ; LOCUS ; tissue microarray ; NMYC ; HUMAN NEUROBLASTOMA ; SPECIMENS
    Abstract: Formation of basal cell carcinoma (BCC) has been linked to deregulation in the sonic hedgehogh (Shh) signalling pathway. Though mutations of the genes, PTCHI and SMO, are known to be involved in aberrant Shh signalling, the distinct downstream effectors of these genes are poorly described. Studies have indicated that the NMYC oncogene is a potential Shh downstream effector. To assess the expression of Nmyc protein and gene copy numbers of the NMYC gene locus in a representative BCC tumour collection, immunohistochemistry (IHC) and fluorescence in situ hybridisation (FISH) were performed on 273 BCC specimens of different growth patterns and anatomic localisations on tissue microarray (TMA) sections. High Nmyc protein expression was detected in 72.7% (160/220) of all BCC specimens. Strong Nmyc immunopositivity was more frequently found in infiltrative BCCs compared to nodular/superficial BCCs (p=0.005), and in BCCs of the head compared to BCCs of other anatomic localisations (p=0.021). The prevalence of NMYC copy number gains was 17.5% (37/211), including three tumours with nodular differentiation that exhibited a distinct high-level amplification of the NMYC locus. These data indicate that high expression of the Shh downstream mediator, Nmyc, is a frequent event in BCC, predominantly in more aggressive subtypes. Although the NMYC copy number gain found in a subset of cases might contribute to this aberrant Nmyc protein expression by a gene dosage effect, our data suggests that Nmyc protein can also be induced by aberrant Shh signalling, acting as an effector molecule of the Shh pathway. Novel systemic anti-sense NMYC inhibition strategies could be a promising option for therapy-refractory BCC
    Type of Publication: Journal article published
    PubMed ID: 16596176
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  • 4
    Keywords: CELLS ; GROWTH ; GROWTH-FACTOR ; INHIBITOR ; CELL ; Germany ; human ; POPULATION ; GENE-EXPRESSION ; DIFFERENTIATION ; MECHANISM ; CARCINOGENESIS ; TISSUES ; SKIN ; BIOLOGY ; CYCLE ; fibroblasts ; IN-SITU ; REVERSE-TRANSCRIPTASE ; PROMOTER ; AGE ; LENGTH ; NETHERLANDS ; REPLICATION ; HEMATOPOIETIC STEM-CELLS ; histone deacetylase inhibitor ; HaCaT ; organotypic culture ; molecular biology ; SKIN KERATINOCYTES ; telomere length ; STRAINS ; HTERT GENE ; HISTONE ACETYLATION ; regeneration ; GROWTH-FACTORS ; CULTURES ; Age-dependent telomere attrition ; COCULTURES ; HTERT ; In situ telomere length analysis ; Melanocyte ; Telomere length heterogeneity
    Abstract: Telomerase- and telomere length regulation in normal human tissues is still poorly understood. We show here that telomerase is expressed in the epidermis in situ independent of age but was repressed upon the passaging of keratinocytes in monolayer culture. However, when keratinocytes were grown in organotypic cultures (OTCs), telomerase was re-established, indicating that telomerase activity is not merely proliferation-associated but is regulated in a tissue context-dependent manner in human keratinocytes. While not inducible by growth factors, treatment with the histone deacetylation inhibitor FK228 restored telomerase activity in keratinocytes grown in monolayer cultures. Accordingly, CHIP analyses demonstrated an acetylated, active hTERT promoter in the epidermis in situ and in the epidermis of OTCs but a deacetylated, silenced hTERT promoter with subsequent propagation in monolayer culture suggesting that histone acetylation is part of the regulatory program to guarantee hTERT expression/telomerase activity in the epidermis. In agreement with the loss of telomerase activity, telomeres shortened during continuous propagation in monolayer culture by an average of similar to 70 base pairs (bp) per population doubling (pd). However, telomere erosion varied strongly between different keratinocyte strains and even between individual cells within the same culture, thereby arguing against a defined rate of telomere loss per replication cycle. In the epidermis in situ, as determined from early-passage keratinocytes and tissue sections from different age donors, we calculated a telomere loss of only similar to 25 bp per year. Since we determined the same rate for the non-regenerating melanocytes and dermal fibroblasts, our data suggest that in human epidermis telomerase is a protective mechanism against excessive telomere loss during the life-long regeneration. (C) 2009 Published by Elsevier B.V
    Type of Publication: Journal article published
    PubMed ID: 19419690
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  • 5
    Keywords: RECEPTOR ; proliferation ; ACTIVATION ; DENDRITIC CELLS ; TOLERANCE ; CYTOKINE ; REGULATORY T-CELLS ; SKIN-LESIONS ; TNF FAMILY-MEMBER ; TRANCE
    Abstract: Recently, it was discovered that the receptor activator of nuclear factor kappa B (RANK)/RANK ligand (RANKL) is part of an important signal transduction pathway for tissue homoeostasis. Therefore, we were interested in investigating RANKL expression in the epidermis of skin lesions from patients with different subtypes of cutaneous lupus erythematosus (CLE) and psoriasis as well as normal healthy donors. Using the tissue microarray technique, skin biopsy specimens were evaluated by immunohistochemistry. RANKL showed a significantly increased expression in the epidermis of skin biopsy specimens from patients with psoriasis (median: 4, range: 0-5) compared to patients with CLE (median: 0, range: 0-4) (P 〈 0.001). No significant differences in epidermal RANKL expression between the CLE subtypes were detected. These data show a different expression of RANKL in the epidermis of skin lesions from patients with CLE compared to those with psoriasis suggesting that RANKL might play an important role in the pathogenesis of the disease.
    Type of Publication: Journal article published
    PubMed ID: 21692859
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  • 6
    Keywords: DISEASE ; FREQUENCY ; PATHOGENESIS ; MULTIPLE-SCLEROSIS ; LUPUS-ERYTHEMATOSUS ; LOCALIZED SCLERODERMA ; DEFECTIVE SUPPRESSOR FUNCTION ; BOSENTAN ; ENDOTHELIN-RECEPTOR ANTAGONIST ; PULMONARY ARTERIAL-HYPERTENSION
    Abstract: OBJECTIVE: To determine the frequency and suppressive capacity of regulatory T cells (T(reg)) and their association with clinical parameters in patients with systemic scleroderma (SSc). METHODS: Peripheral blood from 25 patients with SSc, 15 patients with localised scleroderma (LS) and 29 healthy controls (HC) was studied. Analysis of CD4(+) forkhead box P3 (Foxp3)(+) and CD4(+)CD25(++)Foxp3(+) Treg subpopulations was carried out by flow cytometry and cell proliferation was quantified by (3)H-thymidine incorporation. Quantitative analysis of T(reg) was further performed in skin biopsies from 17 patients with SSc and 21 patients with LS using anti-CD4 and anti-Foxp3 monoclonal antibodies for immunohistochemistry. RESULTS: The frequency of CD4(+)Foxp3(+) and CD4(+)CD25(++)Foxp3(+) Treg in peripheral blood from patients with SSc was not significantly different from that of patients with LS or HC. The suppressive capacity of CD4(+)CD25(++) Treg in SSc was also found to be similar to that of HC. Phenotypic and functional data revealed no significant difference between the limited or diffuse form of SSc. Moreover, therapy with bosentan showed no significant effect on the frequency of T(reg) during the course of the disease. However, the frequency of T(reg) in skin lesions from patients with SSc or LS, determined as the percentage of CD4(+) cells expressing Foxp3 in the inflammatory infiltrate, was significantly reduced compared with other inflammatory skin diseases. CONCLUSION: These results indicate that although the authors found no defect in the frequency or function of peripheral T(reg) subpopulations, the reduction of CD4(+)Foxp3(+) T(reg) in the skin of patients with SSc may be important in the pathogenesis of the disease.
    Type of Publication: Journal article published
    PubMed ID: 21097800
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  • 7
    Keywords: CELLS ; EXPRESSION ; DEATH ; PATHOGENESIS
    Abstract: Cutaneous lupus erythematosus (CLE) is a heterogeneous autoimmune disease. Different pathogenetic mechanisms, including the accumulation of apoptotic keratinocytes in CLE, have been reported. Therefore, we investigated whether CLE and other inflammatory skin diseases differ with regard to the epidermal expression of molecules that are crucial for the initiation and regulation of apoptosis. In this study, 241 skin biopsies from patients with CLE, psoriasis (PSO), lichen planus (LP) and healthy controls (HCs) were analysed immunohistochemically using the tissue microarray (TMA) technique. The TUNEL assay and anti-activated caspase-3 antibodies revealed a significant increase of apoptotic keratinocytes in CLE lesions compared with HCs. Furthermore, we detected a significant increase in the epidermal expression of CD95 in CLE specimens compared with PSO, LP and HCs. These data suggest that the accumulation of apoptotic keratinocytes in CLE might be due to the increased epidermal expression of CD95, resulting in increased activity of the extrinsic apoptotic pathway in the disease.
    Type of Publication: Journal article published
    PubMed ID: 24079735
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  • 8
    Keywords: SURVIVAL ; AGENTS ; Germany ; INHIBITION ; THERAPY ; TOXICITY ; COMMON ; DISEASE ; DISEASES ; NEW-YORK ; DRUG ; TIME ; PATIENT ; AUTOIMMUNE-DISEASE ; treatment ; leukemia ; LYMPHOCYTES ; POPULATIONS ; MULTIPLE-MYELOMA ; AGENT ; POTENT ; multiple myeloma ; DISORDERS ; NEUROPATHY ; THERAPIES ; AUTOIMMUNE-DISEASES ; thalidomide ; development ; FATIGUE ; CD4(+) ; CYTOKINE PRODUCTION ; EXPANSIONS ; leukocytoclastic vasculitis ; T-CELL REPERTOIRE
    Abstract: Thalidomide, an agent with antiangiogenic and immunomodulatory properties, is therapeutically effective in multiple myeloma, leprosy, and autoimmune diseases. The most common clinical toxicities of thalidomide are constipation, neuropathy, fatigue, sedation, rash, tremor, and edema. We here describe for the first time a patient who developed leukocytoclastic vasculitis during therapy with thalidomide. Of the 260 patients treated with thalidomide in our institution, this is the first patient who developed autoimmune disease. We conclude that patients with malignant disorders who are treated with thalidomide should be carefully monitored for the development of autoimmune disorders. Whether autoimmune phenomena also occur during treatment with new drugs such as PS-341 or potent immunomodulatory agents remains to be evaluated
    Type of Publication: Journal article published
    PubMed ID: 14625789
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  • 9
    Abstract: The purpose of this study was to characterize regulatory T cells (T(reg)) in skin lesions and peripheral blood from patients with dermatomyositis (DM) and to determine the serum levels of regulatory cytokines in the disease. In skin biopsy specimens from patients with DM, immunohistochemistry was performed for CD4(+), CD25(+), forkhead/winged helix transcription factor (FoxP3)(+), transforming growth factor (TGF)-beta(+) and interleukin (IL)-10(+) cells. Additionally, we defined the number of T(reg) subpopulations in peripheral blood by flow cytometry using monoclonal antibodies against CD4, CD25, FoxP3, CD45RO, CD95, CCR4 and CLA. The levels of TGF-beta and IL-10 were also determined in serum samples from patients with DM by enzyme-linked immunosorbent assays. Controls included patients with cutaneous lupus erythematosus, psoriasis and atopic dermatitis (AD) as well as healthy donors. The frequency of FoxP3(+) cells was significantly reduced in skin lesions from patients with DM (p 〈 0.001) compared to psoriasis and AD. Moreover, the number of cells positive for TGF-beta was lower in DM than in psoriasis and AD, while IL-10(+) cells were significantly reduced only compared to psoriasis. The number of CD4(+)CD25(++)FoxP3(+) T(reg) in the peripheral blood of patients with DM was significantly reduced compared to healthy controls (p 〈 0.05), whereas other cell populations showed no significant differences. Finally, TGF-beta and IL-10 serum levels were significantly lower in patients with DM compared to healthy controls (p 〈 0.05). These data suggest that the depletion of T(reg) and their main effector cytokines in the skin and the serum of patients with DM may be an important factor in the pathogenesis of the disease.
    Type of Publication: Journal article published
    PubMed ID: 20843660
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  • 10
    Keywords: CELLS ; EXPRESSION ; tumor ; TUMOR-CELLS ; carcinoma ; PROTEIN ; MERKEL CELLS ; METASTASIS ; BREAST-CARCINOMA ; HUMAN-TUMOR-CELLS ; HOMOPHILIC BINDING ; INTEGRIN ALPHA(V)BETA(3) ; L1 ; MALIGNANT-MELANOMA ; NEURITE OUTGROWTH ; P-SELECTIN ; TRABECULAR CARCINOMA
    Abstract: Background: The neuroendocrine carcinoma of the skin is a rare malignant neuroendocrine tumor, which frequently metastasizes in regional lymph nodes or visceral organs. As adhesive interactions with endothelia, leukocytes, or thrombocytes enable malignant cells to penetrate the endothelium and to circulate in blood or lymphatic vessels, we here addressed the adhesion molecules CD171 (L1CAM) and CD24, which are known to be expressed by neurons, neuroblastomas, and other malignant tumors. Methods: Thirty-one neuroendocrine carcinomas of the skin (22 primary tumors, four recurrent tumors, and five metastases) were included in the study. Immunohistochemical staining of CD171 and CD24 was performed by the streptavidin- biotin-peroxidase-complex technique and a nickel-enhanced diaminobenzidine (DAB) reaction using the monoclonal antibodies UJ 127.11 and ML-5, respectively. Results: CD171 expression was detected in most neuroendocrine carcinomas of the skin, and staining was less frequent in metastases and recurrences in comparison with primary tumors which was statistically significant. The majority of neuroendocrine carcinomas of the skin was also positive for the mucin-like adhesion protein CD24. In contrast to tumor cells, cytokeratin 20-positive Merkel cells in 12 trichoblastomas and one fibroepithelioma of Pinkus were all negative for CD171 and CD24 staining. Conclusions: Expression of CD171 and CD24 is found in most neuroendocrine carcinomas of the skin, which may be used diagnostically. Further studies will assess whether this feature may contribute to metastasis of neuroendocrine carcinomas of the skin by facilitating transendothelial migration or tumor cell dissemination as has been suggested for other malignancies
    Type of Publication: Journal article published
    PubMed ID: 12834484
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