Role Of Skin Biopsy Research Articles

Cutaneous Complications after Autologous Stem Cell Transplantation

Autologous stem cell transplantation (ASCT) has become more prevalent for high-grade non-Hodgkin's lymphoma (NHL) over the past decade. ASCT serves as a salvage treatment for high-risk or relapsed patients, offering potential long-term remission. Cutaneous modifications post-ASCT can be classified as early (within 100 days) and late (after 100 days). Understanding these changes is crucial for timely diagnosis and management. Early modifications typically include transient erythema, hyperpigmentation, and acute dermatitis, often linked to the conditioning regimen. Late modifications, occurring months to years posttransplantation, can encompass chronic skin changes such as scleroderma-like features and persistent pigmentary alterations. Emerging evidence challenges the notion that ASCT is free of graft-versus-host disease (GVHD), with incidences of auto-GVHD reported. However, cutaneous GVHD post-ASCT, though uncommon, poses significant diagnostic challenges. Cutaneous GVHD manifestations range from mild eruptions to severe, systemic involvement. The role of skin biopsy in these cases is invaluable, providing histopathological confirmation and distinguishing GVHD from other dermatoses. Recognizing the early and late cutaneous modifications following ASCT is essential for clinicians. Despite the rarity of skin GVHD in ASCT, awareness and prompt biopsy can facilitate accurate diagnosis and appropriate management, improving patient outcomes.

The role of skin biopsy in the detection of exposure to endocrine disrupting chemicals in Mediterranean cetaceans

Use of skin biopsy is proposed as a sensitive non-lethal technique for the hazard assessment of Mediterranean cetaceans exposed to endocrine disrupting chemicals (EDCs). EDCs are a structurally diverse group of compounds that may adversely affect the health of humans and wildlife or their progeny, by interaction with the endocrine system. In the Mediterranean environment top predators accumulate high concentrations of polyhalogenated aromatic hydrocarbons (PHAHs) and toxic metals, incurring high toxicological hazard. In this paper, the hypothesis that Mediterranean cetaceans are potentially at risk due to PHAH-EDCs is investigated using skin biopsy samples. Benzo-a-pyrene monoxigenase (BPMO) activity in skin biopsies was used as a potential indicator of exposure to different organochlorines (OCs) known to have endocrine disrupting properties. The main objective of this paper was to use this non-destructive ecotoxicological tool to define the potential hazard to Mediterranean odontocete and mysicete species, comparing the present data with values detected in other cetaceans from heavily polluted areas, affected by pseudohermaphroditism and other reproductive dysfunction. Subcutaneous tissue consisting of skin and blubber was obtained from striped dolphins (Stenella coeruleoalba), bottlenose dolphins (Tursiops truncatus), common dolphins (Delphinus delphis) and fin whales (Balaenoptera physalus) in the Mediterranean basin. Sampling was performed in the western Ligurian Sea, between Corsica and the French-Italian coast, and in the Ionian Sea. High concentrations of DDT metabolites and PCB congeners (known as Endocrine Disruptors) were detected in the different species. Significant differences in BPMO induction and OC levels were found between odontocetes and mysticetes. Differences in organochlorine bioaccumulation and consequently potential risk due to endocrine disruptors were primarily related to different positions in the marine food web. A statistical correlation was found between BPMO activity and organochlorine (op’DDT, a potent estrogen and antiandrogen and pp’DDE, a potent antiandrogen) levels in skin biopsy specimens of the endangered Mediterranean population of common dolphin. Several conclusions on the potential risk to Mediterranean cetaceans can be drawn from comparison of the levels of OC-EDs detected in Mediterranean odontocetes with those in white whales (Delphinapterus leucas) of the St Lawrence estuary and bowhead whales (Balaena mysticetus) affected by pseudohermaphroditism and other reproductive dysfunction. Finally, these results suggest that BPMO induction may be an early sign of exposure to EDCs such as OCs and a warning of the possibility of transgenerational effects through exposure of future generations via the placenta and milk.

Letter to the Editor: The Role of Skin Biopsy in the Management of Immune Checkpoint Inhibitor Toxicity.

Letter to the Editor: The Role of Skin Biopsy in the Management of Immune Checkpoint Inhibitor Toxicity.

Preliminary Observations on the Role of Skin biopsy in the Evaluation of Subjects with Autonomic and/or Somatic Symptoms (2534)

Preliminary Observations on the Role of Skin biopsy in the Evaluation of Subjects with Autonomic and/or Somatic Symptoms (2534)

Role of histopathology in diagnosis of leprosy- A tertiary care hospital based study

Introduction: Leprosy is continuous spectrum of varied clinicopathological manifestations of the disease.1 leprosy still continues to be one of major health problem due to consequent disabilities and social stigma.2,3 Timely diagnosis helps in proper treatment and reduce the chances of recurrence. It is chronic infection which affects skin and peripheral nerves.4,5 The nerve biopsies are difficult, diagnosis mainly depends upon clinical examination of skin lesions and histopathological diagnosis. Most of leprosy cases were diagnosed without histopathological examination.6 The aim of the present study was to know the Role of skin biopsy in diagnosing leprosy cases. Materials and Methods: This was a cross sectional comparative study of skin biopsies of clinically suspected or diagnosed leprosy cases coming to the tertiary care hospital. Results: Sixty two (62) biopsies were included in the study. All biopsies were classified histologically compared with clinical diagnosis. Out of 62 cases, BB was the main clinical diagnosis comprising 19(30.6%) followed by BL 16(25.8%), LL 11(17.8%), IND 9(14.5%), BT 5(8.1%) and TT 2(3.2%) remaining. Out of these 62 cases, 40 (64.5%) cases histopathological diagnosis were agreed with clinical diagnosis. Conclusion: Histological examination is an important tool in the accurate diagnosis of leprosy. Indeterminate and borderline leprosy cases diagnosed on clinical grounds are difficult due to it's varied presentation and could mimic with other diseases, therefore histopathological examination is useful to confirm diagnosis and accurate typing of leprosy for proper treatment. Keywords: Leprosy, histopathology TT-tuberculoid, BT-Borderline Tuberculoid, BB-Borderline Borderline, BL-Borderline Lepromatous, LL-Lepromatous leprosy.

Which Method for Diagnosing Small Fiber Neuropathy?

Introduction: Small fiber neuropathies (SFN) induce pain and/or autonomic symptoms. The diagnosis of SFN poses a challenge because the role of skin biopsy as a reference method and of each neurophysiological test remain to be discussed. This study compares six methods evaluating small sensory and autonomic nerve fibers: skin biopsy, Quantitative Sensory Testing (QST), quantitative sweat measurement system (Q-Sweat), Laser Evoked Potentials (LEP), Electrochemical Skin Conductance (ESC) measurement and Autonomic CardioVascular Tests (ACVT).Methods: This is a single center, retrospective study including patients tested for symptoms compatible with SFN between 2013 and 2016 using the afore-mentioned tests. Patients were ultimately classified according to the results and clinical features as “definite SFN,” “possible SFN” or “no SFN.” The sensitivity (Se) and specificity (Sp) of each test were calculated based on the final diagnosis and the best diagnostic strategy was then evaluated.Results: Two hundred and forty-five patients were enrolled (164 females (66.9%), age: 50.4 ± 15 years). The results are as follows: skin biopsy: Se = 58%, Sp = 91%; QST: Se = 72%, Sp = 39%; Q-Sweat: Se = 53%, Sp = 69%; LEP: Se = 66%, Sp = 89%; ESC: Se = 60%, Sp = 89%; Cardiovascular tests: Se = 15%, Sp = 99%. The combination of skin biopsy, LEP, QST and ESC has a Se of 90% and a Sp of 87%.Conclusion: Our study outlines the benefits of combining skin biopsy, ESC, LEP and QST in the diagnosis of SFN.

The role of skin biopsy in differentiating small-fiber neuropathy from ganglionopathy.

The role of skin biopsy in differentiating small-fiber neuropathy from ganglionopathy.

The role of skin biopsy in differentiating small-fiber neuropathy from ganglionopathy.

We aimed to test the clinical utility of the leg:thigh intraepidermal nerve-fiber (IENF) density ratio as a parameter to discriminate between length-dependent small-fiber neuropathy (SFN) and small-fiber sensory ganglionopathy (SFSG) in subjects with signs and symptoms of small-fiber pathology. We retrospectively evaluated thigh and leg IENF density in 314 subjects with small-fiber pathology (173 with distal symmetrical length-dependent SFN and 141 with non-length-dependent SFSG). A group of 288 healthy subjects was included as a control group. The leg:thigh IENF density ratio was calculated for all subjects. We used receiver operating characteristic curve analyses to assess the ability of this parameter to discriminate between length-dependent SFN and SFSG, and the decision curve analysis to estimate its net clinical benefit. In patients with neuropathy, the mean IENF density was 14.8 ± 6.8/mm at the thigh (14.0 ± 6.9/mm in length-dependent SFN and 15.9 ± 6.7/mm in patients with SFSG) and 7.5 ± 4.5/mm at the distal leg (5.4 ± 3.2/mm in patients with length-dependent SFN and 10.1 ± 4.6/mm in patients with SFSG). The leg:thigh IENF density ratio was significantly (P < 0.01) lower in patients with length-dependent SFN (0.44 ± 0.23) compared with patients with SFSG (0.68 ± 0.28). The area under the curve of the receiver operating characteristic analysis to discriminate between patients with length-dependent SFN and SFSG was 0.79. The decision curve analysis demonstrated the clinical utility of this parameter. The leg:thigh IENF ratio represents a valuable tool in the differential diagnosis between SFSG and length-dependent SFN.

The role of skin biopsy in differentiating idiopathic Parkinson's disease from other types of parkinsonism.

Parkinson’s disease is one of the most common neurodegenerative disorders with a worldwide distribution. It has variable and complex phenotype with motor and non-motor manifestations, causes considerable psychosocial morbidity and consumes significant health care resources. Changing population demographics, and in particular, an ageing population in western societies is likely to result in gradually increasing prevalence. Despite significant advances in the understanding of disease pathology, the diagnosis of idiopathic Parkinson’s disease (IPD) remains largely clinical, with discriminatory investigations such as Ioflupane (123I)-labelled single-photon emission computed tomography (DaTSCAN) being used only in the minority of patients. However, postmortem studies have historically demonstrated the fallibility of relying on clinical phenotype and in differentiating IPD from ‘Parkinson’s plus’ conditions such as multiple system atrophy (MSA). An in vivo accessible peripheral biomarker for IPD and MSA would, therefore, be of great value to direct therapy and more accurate patient counselling. The three papers discussed below assess the value of one of the most promising of the available candidate biomarkers in this context; phosphorylated alpha-synuclein (p-α-Syn) which has recently been identified within dermal nerve fibres in IPD. In the first paper, the authors examine the utility of p-α-Syn as a biomarker for diagnosis of IPD, the second looks at p-α-Syn as a biomarker for MSA and the third at using p-α-Syn to differentiate IPD from MSA.

Role of skin biopsy in papulosquamous lesions—a comparative study

Dermatologists make their clinical diagnosis mostly through skin reaction patterns. This study was done to assess the correlation between the clinical diagnoses of papulosquamous lesions made at dermatological clinics and the diagnosis of these lesions at biopsy. Our study lends insight into the list of most common to least common lesions of papulosquamous lesions. This is a cross-sectional study conducted at a dermatological clinic, on those patients who consulted to a dermatologist. This presumptive investigation on papulosquamous lesion was implied on 83 patients as lichen planus, lichen nitidus, lichen striata, lichenoides dermatitis, psoriasis, pityriasis rubra pilaris, pityriasis rosea, pityriasis lichenoides, pityriasis lichenoides et varioliformis acuta (PLEVA) and Reiter’s disease and then the biopsy was performed on these patients for the confirmation of the clinical diagnosis to assess that diagnosis given by biopsy in these patients matched to the clinical diagnosis and whether it showed any deviation from the clinical diagnosis made by dermatologist. The histopathology report confirmed the clinical diagnosis in 67.5 % and gave the diagnosis in 32.5 % of the total number of cases, which means that 32.5 % cases were those in which the diagnosis provided by the biopsy did not match the diagnosis provided by the clinical diagnosis. The total number of cases was 83: lichen planus occurred most frequently, i.e. 32.5 %, biopsy confirmed diagnosis in 21 patients and gave correct diagnosis in six patients, followed by psoriasis 24.1 %. In the case of psoriasis, seven patients were misdiagnosed at clinics, and in these patients, biopsy gave the correct diagnosis of psoriasis. The frequency of pityriasis rubra pilaris and lichenoides dermatitis was the same, 14.5 %. About six patients with pityriasis rubra pilaris and six cases with lichenoides dermatitis were given wrong diagnosis at clinics, and the correct diagnosis was provided at biopsy; PLEVA was diagnosed in 6 % of the cases and pityriasis rosea in 3.6 %. Reiter’s disease occurred in about 2.4 % of the cases and lichen nitidus and lichen striata in 1.2 % of the cases. Biopsy gave the correct diagnosis of one patient with pityriasis rubra pilaris, one with Reiter’s disease and one with PLEVA. This research investigation, postulated and enquired on the basis of histopathology reports, confirmed the clinical hypothesis in 67.5 % of cases and gave the diagnosis in 32.5 % of the total number of cases. These results verified the aforementioned hypothesis that the patients who are diagnosed with the papulosquamous lesion must undergo biopsy for the confirmation of the disease.

Extensive vascular calcification in diabetic uremic patient

Uremic calcific arteriopathy in uremia was recently described by Oliver Kirschberg et al.1 Skin biopsy was performed for diagnosis. Many other diagnostic tools are available, such as plain X-ray, computed tomography (CT), and the aortic calcification index. Here we present a 72-year-old man with uremia who had been undergoing hemodialysis for 20 years; he was admitted owing to fever and poor wound healing. The role of skin biopsy is debated, due to poor wound healing and potential sepsis, and we made a diagnosis of calciphylaxis without skin biopsy by plain X-ray with typical findings. His Agatston calcium score for the coronary artery was only 117.9. Laboratory data were as follows: 9.1 mg/dL total calcium, 8 mg/dL phosphate, and 400 pg/mL intact parathyroid hormone (PTH) level. X-ray is useful to differentiate intimal and medial calcification.2 Atherosclerosis is plaque-like in the former and circumferential in the latter. A radiological survey of the chest and hands revealed extensive calcification over the radial artery (Figures 1–3, black arrowhead), the ulnar artery (white arrowhead), the palmar digital arteries proper (black arrow), and deep palmar arch (white arrow). In the current literature it is rare to find descriptions of such “vivid” small vessels in the hand. Cervical spine X-ray with calcification of bilateral common carotid arteries showed a circumferential pattern. We suggest that X-ray should be performed first for diagnostic purposes because of its low cost and high availability. Figures 1–3 Plain X-ray over the left hand (Figures 1 and 2) disclosed calcification over the radial artery (black arrowhead), ulnar artery (white arrowhead), palmar digital arteries proper (black arrow), and deep palmar arch (white arrow). Cervical spine X-ray (Figure 3) revealed bilateral common carotid artery calcification (black arrow).

Progressive disseminated histoplasmosis as a presentation of AIDS in a patient from the Congo: the role of skin biopsy

Progressive disseminated histoplasmosis is frequently fatal in HIV patients, and the standard diagnostic techniques can cause treatment delay. Skin biopsy can help in the differential diagnosis, allowing also an earlier treatment initiation.

PO15-TU-07 Intravascular B-cell lymphoma presenting with cauda equina syndrome: the role of skin biopsy

PO15-TU-07 Intravascular B-cell lymphoma presenting with cauda equina syndrome: the role of skin biopsy

Role of skin biopsy in the diagnosis of peripheral neuropathic pain

Evaluation of epidermal nerve fiber density (ENFD) allows objective, pathologic, and minimally invasive assessment of small myelinated and unmyelinated cutaneous axons. In addition to providing diagnostic confirmation of neuropathies affecting these "small fibers," this procedure has advanced clinical care by dramatically increasing awareness of the role of small myelinated and unmyelinated axons in disorders of peripheral nerve and in neuropathic pain. This review highlights the technical aspects of skin biopsy for ENFD determination, the role of skin biopsy in the diagnosis of small-fiber neuropathy and ganglionopathy, and the diagnostic approach to the patient with peripheral neuropathic pain.

Painful sensory neuropathy: prospective evaluation using skin biopsy.

In patients presenting with painful, burning feet with minimal signs of neuropathy, the following questions were addressed: 1) How many of these patients have a peripheral neuropathy? 2) What is the role of skin biopsy in establishing a diagnosis of neuropathy? 3) What conditions are associated with the neuropathy? and 4) What laboratory studies are useful in this patient population? A total of 117 consecutive patients referred for evaluation were prospectively studied. All underwent nerve conduction studies (NCS) and a battery of blood tests, including antinerve antibodies. If NCS were normal, a punch biopsy of the skin of the distal leg was performed to ascertain the intraepidermal nerve fiber (IENF) density. In a subset of 32 patients, the sensitivity of skin biopsy was compared to quantitative sudomotor axon test (QSART) and quantitative sensory tests (QST). Three groups emerged. Group 1, with abnormal NCS (n = 60, 34 F/26 M, mean age 60 +/- 14 years), represented 51% of the cohort. The majority had neuropathies of undetermined cause, but 18 (30%) had associated conditions. Group 2, with normal NCS and reduced IENF density (n = 44, 29 F/15 M, mean age 57 +/- 14 years), represented 38% of the cohort. Three in this group had associated conditions. Group 3, with normal NCS and IENF density (n = 13, 6 F/7 M, mean age 53 +/- 13 years), represented 11% of the cohort; most had no diagnoses but two had MS. In a comparative subset analysis, skin biopsy was more sensitive than QSART or QST in diagnosing a neuropathy. Patients presenting with painful feet are heterogeneous, consisting of both large and small fiber sensory neuropathies. In rare cases, a central cause for pain can be found. Over one-third of patients required a skin biopsy to diagnose a small fiber sensory neuropathy. A limited battery of blood tests facilitated diagnosis, but serum antinerve antibodies were not helpful.

The role of skin biopsies in bone marrow transplant recipients

Bone marrow transplant (BMT) recipients frequently develop rashes as a consequence of their disease, its treatment or because of a complication such as infection. These rashes are often clinically atypical, yet appropriate management is dependent upon correct diagnosis and therefore a skin biopsy is often performed. In a group of 101 consecutive BMT recipients, 25 patients had a total of 34 skin biopsies. A specific histopathological diagnosis was made in 65% (22/34), including graft vs. host disease (GVHD) (15 cases), infection (4 cases), drug reaction (1 case) and recurrent lymphoma (1 case). Therapy was changed following the biopsy in 77% (17/22) of these cases. In 35% (12/34) the histological changes were non-specific, however, in 10 of these cases GVHD had been suspected clinically and its exclusion was therefore useful. Skin biopsy is of considerable value in the diagnosis and subsequent management of BMT recipients who develop a rash.

Lafora's disease. The role of skin biopsy

Lafora's disease is a neurometabolic disease characterized by progressive myoclonus epilepsy. It is thought to be transmitted by autosomal recessive inheritance. The diagnosis of Lafora's disease is based on both clinical symptomatology and histologic detection of intracytoplasmic periodic acid-Schiff-positive inclusions, termed Lafora bodies. Despite the absence of cutaneous clinical findings, typical inclusions are present in eccrine duct cells and peripheral nerve of skin biopsies. By electron microscopy, the inclusions are electron-lucent and contain glycogenlike granules and filamentous material. Skin biopsy is a convenient and the least invasive method of establishing the diagnosis of Lafora's disease.