Skin Infiltration Research Articles (Page 1)

Abstract Background Parotid gland tumors constitute the majority of salivary gland neoplasms, with a predominance of benign lesions. Malignant counterparts, although less common, necessitate more aggressive treatment strategies. Differentiating between benign and malignant tumors based on clinical findings alone is challenging. Magnetic Resonance Imaging (MRI), particularly when combined with diffusion-weighted imaging and apparent diffusion coefficient (ADC) analysis, provides valuable insights into lesion characteristics. Histogram analysis of ADC maps may enhance diagnostic precision by capturing the distribution of diffusion values within tumors. We aimed to assess the diagnostic accuracy of the MRI and ADC histogram analysis and the inter-observer agreement in differentiating benign and malignant parotid gland masses. Results This cross-sectional retrospective study involved 100 patients who underwent MRI examination and had histopathologically proven parotid tumors. Conventional and diffusion-weighted MRI sequences were analyzed by two radiologists. ADC values and histogram metrics were compared between benign and malignant lesions, and inter-observer agreement was evaluated. Among 100 patients (57% males), 59% had benign and 41% had malignant parotid tumors. Most lesions were unilateral (80%) and located in the superior lobe (57%). Malignancy was associated with solid composition (P = 0.027), hypointense T2 (P = 0.011), ill-defined margins (P = 0.010), high diffusion (P < 0.001), lymphadenopathy (P = 0.001), skin infiltration (P = 0.023), and vascular invasion (P = 0.006). MRI feature assessment showed excellent agreement between observers, with κ values ranging from 0.820 to 1.000 (P < 0.001), confirming high reliability in interpreting composition, signals, margins, enhancement, and diffusion. Malignant lesions had significantly lower ADC values (median = 0.9 vs 1.4–1.5; P < 0.001) and higher skewness (P = 0.008). Lesions’ ADC values showed near-perfect inter-observer agreement (ICC = 0.959, P < 0.001). Using ADC < 1.15 × 10⁻3 mm2/s, observer 1 achieved 80.6% accuracy (AUC = 0.847, P < 0.001), and observer 2 reached 78.6% accuracy (AUC = 0.857, P < 0.001), with high sensitivity and specificity in both. Mean ADC had the best performance (AUC = 0.793, accuracy = 74.3%, P < 0.001). Minimum ADC showed 64.3% accuracy (AUC = 0.720), and Maximum ADC had the highest sensitivity (80.5%) but lower accuracy (67.2%, AUC = 0.712, P < 0.001). Conclusions MRI combined with ADC histogram analysis demonstrates high diagnostic performance and excellent inter-observer agreement in differentiating benign and malignant parotid gland tumors. This approach can enhance preoperative assessment and guide clinical decision-making.

Evaluation of T-cell receptor (TCR) β-chain constant region 1 (TRBC1) expression is an alternative T-cell clonality assessment method. However, evaluation of TRBC1 immunohistochemistry (IHC) for distinguishing mycosis fungoides (MF)/Sezary syndrome (SS) from reactive inflammatory infiltrates in skin is incomplete. We evaluated the utility of a novel dual TRBC1-CD3 IHC stain in skin biopsies with MF/SS (n=40), reactive (n=24), or atypical T-cell infiltrates indeterminant for MF/SS (n=9). Twenty of 24 reactive cases showed clear polytypic TRBC1 expression (median percent TRBC1 positivity among CD3-positive T cells [%TRBC1+] 50% in dermis, 42.5% in epidermis among all cases), while 34/40 MF/SS were clearly monotypic (%TRBC1+ either ≤20% or ≥85%) (sensitivity 85.0%, specificity 91.7%, positive predictive value 94.4%, negative predictive value 78.6%). Discordance between TRBC1 expression and diagnosis was associated with few neoplastic/monotypic T cells and/or lack of physical separation between neoplastic and non-neoplastic populations. Among patch/plaque MF/SS, TRBC1 showed similar diagnostic sensitivity (80.0% vs. 86.7%) and high categorical correlation (monotypic vs. not monotypic, 80%) with TCR gene rearrangement results. TRBC1 interpretation was reproducible, with ≥2/3 and 3/3 pathologists rendering identical interpretations in 100% and 86% of cases, respectively, after independent review and 100% agreement following collective review. Digital image analysis confirmed visual %TRBC1+ accuracy (r=0.9749, P<0.0001). On the basis of these results, we propose %TRBC1+ cutoffs of <25% or >75% for establishing T-cell monotypia in skin. Considering such thresholds, TRBC1-CD3 evaluation facilitated diagnostic refinement in 7/9 (78%) atypical cases. Overall, TRBC1-CD3 IHC clearly and rapidly aids diagnosis of cutaneous T-cell proliferations.

Abstract Background Transperineal prostate biopsy (TPPBx) under local anaesthesia (LA) has gained momentum in recent years. It is a simple, alternative office procedure to transrectal biopsy of prostate, with higher cancer detection and lower infection rates. This is the first reported transperineal biopsy in Malaysia using PrecisionPoint. We aim to determine clinically significant prostate cancer with TPPBx and its associated complication utilizing this method of biopsy. Methods We retrospectively reviewed medical records of patients who underwent TPPBx between November 2020 and September 2022. Electronic medical system was utilized to review patients’ information, PSA results, mpMRI reports (prostate volume, PI-RADS scoring) and complications experienced. Data were analysed to determine clinically significant prostate cancer (biopsy result with International Society of Urological Pathology (ISUP) grade 2 and above). Local anaesthesia was given through perineal skin infiltration as well as periprostatic nerve block. We performed our procedure using transrectal linear probe with biplane transducer for visual guidance using cognitive fusion. Biopsies were done in accordance with Ginsburg protocol. Ethics approval was obtained from University of Malaya Research Ethics Committee (UMREC) Results Total of 65 patients underwent transperineal biopsy under local anaesthesia from November 2020 to May 2022. All patients had mpMRI prior to the procedure. Prostate cancer was detected in 32 (49.2%) patients regardless of whether they had a previously negative transrectal prostate biopsy. Of the 65 patients, 27 (41.5%) were diagnosed with clinically significant prostate cancer requiring active treatment. The number of patients with clinically significant cancer was highest in the mpMRI reported PI-RADS 5 group with 15 patients (51.7%), followed by PI-RADS 4 group, with 10 patients (38.5%) and the PI-RADS 3 group, with two patients (20%). Complications reported were haematuria (33.8%) and acute urinary retention (6%). There were no reported urinary tract infections or sepsis as well as rectal bleeding after freehand transperineal biopsy of prostate. Conclusion Freehand transperineal biopsy of prostate using PrecisionPoint demonstrated an acceptable cancer detection yield while avoiding significant infection.

BackgroundPsoriasis is an immune-mediated chronic inflammatory condition characterized by significant neutrophil infiltration in the skin. Given that the spleen is the largest peripheral immune organ in the body, it is important to investigate whether it has any impact on skin inflammation in psoriasis.MethodsTo investigate this mechanism, a psoriatic mouse model was established by IMQ application. Flow cytometry and immunohistochemistry analyses were performed to determine the percentage of various immune cells in the spleen. The role of neutrophils was specifically assessed using the anti-Gr-1 antibody. Splenic granulopoiesis was evaluated using EdU labeling. To understand the spleen's role in skin inflammation, splenectomy was performed on the experimental mice. IL-6 levels were measured by ELISA, and P-STAT3 in neutrophils was detected via immunofluorescence. Further examination of IL-6's effects on neutrophil formation involved treating mice with IL-6 antibody. The severity of psoriasis was evaluated through histological staining and PASI scoring.ResultsOur study revealed that the spleens of psoriatic mice were enlarged compared to those of vehicle mice. Among immune cell populations, neutrophils showed the most significant changes, with marked increases in both spleen and skin of psoriatic mice and patients, contributing to disease progression. Post-splenectomy, neutrophil infiltration in the skin was reduced by approximately 60% in psoriatic mice. This indicates that the neutrophils in the skin were primarily derived from the spleen. Additionally, the spleen showed a notable capacity for granulopoiesis with elevated neutrophils. Moreover, we found elevated IL-6 levels in the skin, blood, and spleen in the model, which was decreased after splenectomy. Treatment with an IL-6 antibody reduced neutrophil formation in both the spleen and skin, which alleviated skin inflammation in psoriatic mice. Additionally, P-STAT3 signaling was decreased following IL-6 antibody treatment. The neutrophil infiltration in spleen and skin was decreased after injection with the inhibitor of P-STAT3, which also alleviated the inflammation of psoriatic model. Thus, IL-6 served as the dominant regulator of spleen granulopoiesis, a process potentially mediated by P-STAT3 signaling.ConclusionsThe spleen plays a crucial role in the immune microenvironment of psoriasis as a major site of granulopoiesis, influencing neutrophil infiltration in the skin of psoriatic mice. Additionally, IL-6 is a key regulator of neutrophil formation in the spleen of psoriatic mice, likely through P-STAT3-dependent mechanisms.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13062-025-00675-2.

Acquired tick resistance (ATR) is well characterized in tick-exposed animals, compromising tick fitness through antibody-mediated activation of basophils. Yet, anti-tick vaccines inducing ATR have had limited success. Here, we describe a neuroimmune event preceding ATR that leads to rapid host-mediated tick removal. Tick-sensitized guinea pigs mechanically remove ticks within 3–6 hours via an acquired neuroimmune-induced itch response that correlates with increased dermal expression of itch-associated genes like OSM and skin infiltration by T cells and macrophages, independently of IgG and IgE antibodies. When we expose humans to ticks, a similar immune response is observed. Blocking T cells before tick sensitization prevents immune cell infiltration to bite sites and abrogates scratching and tick removal. This neuroimmune response is independent of Trpv1 as tick-sensitized guinea pigs treated with resiniferatoxin remove ticks effectively. Itch-induced tick removal or IITR offers a novel approach to tick-borne disease prevention through early tick detection and removal.

ABSTRACTBackgroundThe patch test evaluates skin erythema, infiltration, papules and vesicles following exposure to various substances, including metals, cosmetics and medicines. Accurate evaluation of these conditions requires consistent skin score assessments, precise visual grading and minimal inter‐expert variability.ObjectivesThis study aimed to develop a skin irritation artificial intelligence model based on the YOLOv5x object detection framework to automatically detect skin irritation from the patch test images for multiple test substances.MethodsPatch test images were collected with test sites marked to enable the YOLOv5x algorithm to locate the samples. An expert assigned a score to each sample (0–4) for training and validation. The model was trained using 83 629 data points. Evaluation and validation were performed with 1312 and 1536 data points, respectively.ResultsThe model achieved an overall accuracy of 0.983 at both 24 and 48 h, with an F1 score (harmonic mean of recall and precision) of 0.982. The areas under the curve (AUCs) for scores 0, 1 and 2 were 0.914, 0.838 and 0.865, respectively. The sensitivity for a score of 0 was 0.997.ConclusionThese findings suggest that this AI model effectively supports and classifies skin irritation, thereby facilitating faster and more accurate dermatological evaluations.

Background: Leprosy, caused by Mycobacterium leprae, persists as a global health issue where the primary challenges are not merely microbial but are deeply rooted in delayed diagnosis and poor treatment adherence. These delays, often driven by profound social stigma, lead to progressive, irreversible disability and sustain community transmission. Erythema Nodosum Leprosum (ENL), an acute immunological complication, further devastates patients' quality of life and complicates management. Case presentation: A 53-year-old Indonesian farmer presented with a 15-year history of untreated leprosy, a journey of neglect initiated by fear of treatment side effects and community ostracism. Clinical examination revealed advanced borderline lepromatous (BL) leprosy with diffuse skin infiltration, multiple anesthetic plaques, and thickened, tender peripheral nerves. He had established WHO Grade 1 disability, characterized by significant sensory loss in his hands and feet and early intrinsic muscle atrophy. A slit-skin smear confirmed a bacteriological index of +3 with a morphological index of 5%, indicating a high load of viable bacilli. Histopathology confirmed BL leprosy with a concurrent mild ENL reaction. A comprehensive, patient-centered management plan was initiated, including a 12-month course of multidrug therapy (MDT-MB), adjunctive care, and intensive counseling. Conclusion: This case powerfully illustrates the "shadow effect" of leprosy—how years of untreated disease, fueled by psychosocial barriers, culminate in a complex nexus of advanced infection, immunological reaction, and permanent neurological impairment. The patient's successful re-engagement with the health system underscores that eradicating the burden of leprosy requires a paradigm shift from a purely pharmacological approach to a deeply humanistic one. Effective control hinges on building compassionate health systems that actively dismantle stigma, empower patients with knowledge, and deliver holistic, multidisciplinary care to prevent the profound human cost of neglect.

Gain-of-function mutations in STimulator of INterferon Genes (STING) cause STING-Associated Vasculopathy with Onset in Infancy (SAVI), a rare autoinflammatory disease characterized by debilitating inflammatory lung disease and hallmark skin manifestations, such as chilblains and progressive, non-healing ulcers. Mice expressing the most common SAVI-associated variant STING V154M (VM) recapitulate many clinical features of SAVI, including inflammatory lung disease, but do not develop spontaneous skin lesions. In this study, we show that a single low dose of ultraviolet B (UVB) irradiation, which induces only transient skin inflammation in wild-type (WT) mice, causes severe and progressive skin injury in VM mice. Notably, this phenotype persisted in VM mice depleted of hematopoietic cells and reconstituted with WT bone marrow, demonstrating that STING V154M expression in non-hematopoietic cells is sufficient to drive persistent skin inflammation. Further analysis identified endothelial cells expressing STING V154M as the primary driver of the cutaneous phenotype. Flow cytometry and bulk RNA sequencing showed that VM mice exhibited reduced early skin infiltration of macrophages and dendritic cells after UVB exposure. These findings establish a critical link between endothelial STING activation, impaired recruitment of skin myeloid cells, and defective resolution of acute inflammation, offering new insights into the pathogenesis of SAVI-associated skin disease.

T follicular helper cell lesions and mimics in dermatopathology: From theory to practice

Incontinentia pigmenti or Bloch-Sulzberger syndrome, is a rare multisystem, X-linked dominant disorder that most commonly occurs in female newborns. It is usually lethal, and most pregnancies with male fetuses result in miscarriage or stillbirth, while in female newborns, it can appear with different severity and multiorgan symptoms, including dermatological, neurological, ophthalmological, and dental abnormalities. Skin changes usually appear immediately after birth or in the first few weeks of life, following four stages: vesicular, verrucous, hyperpigmented, and hypopigmented. In the neonatal period, IP is clinically diagnosed based on the appearance of vesicles arranged in a linear pattern following Blaschko’s lines, representing the first stage of skin involvement. The differential diagnosis of a vesicular eruption in a neonate is extensive and includes various infectious and non-infectious causes. We report a case of a one-day-old female neonate who presented at birth with erythematous vesicles linearly distributed on the extremities, over the thorax and abdomen. Based on suspicious Blaschkoid skin lesions and eosinophilic skin infiltration in biopsy, incontinentia pigmenti was diagnosed. Early recognition of IP is crucial for appropriate management and monitoring of potential complications, particularly those involving the central nervous system and eyes. Although there is no specific cure for IP, a multidisciplinary approach involving dermatologists, neurologists, ophthalmologists, and dentists can help optimize the quality of life of affected infants.

Transplantation of adipose-derived mesenchymal stromal/stem cells (ASCs) has successfully alleviated the severity of psoriasis. Although several therapeutic mechanisms of mesenchymal stromal/stem cells (MSCs) for psoriasis have been elucidated using the imiquimod (IMQ)-induced psoriasis-like dermatitis model, the effects of MSC transplantation on pathways other than the interleukin (IL)-23/T helper 17 (Th17) axis, including the IL-36 pathway, remain unclear. In this study, we aimed to investigate the efficacy of ASC transplantation for the IMQ-induced psoriasis-like dermatitis in male C57BL/6J mice, and to elucidate its effects on the IL-36 pathway as well as the IL23/Th17 axis. ASCs (2.0 × 106 cells) from mouse inguinal white adipose tissue were subcutaneously injected into the dorsal skin of mice. After the topical application of IMQ cream for 5 consecutive days, objective severity scores, cytokine gene expression levels, and neutrophil infiltration grade were determined to evaluate their efficacy. Anti-IL-23p19 antibody treatment was used for comparison. ASCs slightly ameliorated IMQ-induced epidermal thickening, although anti-IL-23p19 antibodies had no effect on any skin manifestations. Anti-IL-23p19 antibody and ASC suppressed the expressions of Il17a, Il17f, and Il22 mRNAs and neutrophil infiltration in IMQ-applied skin, but not the expression of Il1f6 and Il1f9. ASC also suppressed the expressions of Il23, Il6, Il1b, Tnfa, Lipocalin-2, and Cxcl5 mRNAs, which were not suppressed by anti-IL-23p19 antibody treatment. In conclusion, ASC transplantation suppressed activation of the IL-23/Th17 axis and neutrophil infiltration, and inhibited the activation of a broader range of inflammatory mediators except for IL-36 expression in IMQ-applied skin compared with anti-IL-23p19 antibody treatment.

To report the clinical characteristics, diagnosis, treatment and prognosis of one patient with primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma (CD8+ PCAECTL), and to strengthen the understanding of this extremely rare type of lymphoma. The clinical manifestations, diagnosis, treatment course, and prognosis of one patient with CD8+ PCAECTL admitted to our hospital were retrospectively analyzed. The patient is a 42-year-old female, with infiltrative skin rash on naso-facial and back as the main clinical manifestations. After pathological examination of the affected skin tissue, immunohistochemistry, molecular biology, and imaging, the diagnosis was confirmed as CD8+ PCAECTL, T3aN0M0 stage. Alternating chemotherapy with CHOP/HD-MTX (methotrexate, 6 g/m2) regimen was administered, and achieved complete remission (CR) after 4 cycles. After undergoing chemotherapy with DHAP regimen (cisplatin 100 mg/m2, d 1 + cytarabine 2 g/m2, q 12h, d 2 + dexamethasone 40 mg/d, d 1-4), the patient was mobilized for peripheral blood stem cells using recombinant human granulocyte colony-stimulating factor (G-CSF), and a sufficient number of CD34+ cells were successfully collected. Preconditioning was conducted with the BEAM regimen, followed by consolidation therapy with autologous hematopoietic stem cell transplantation (AHSCT). The patient remained in a disease-free survival state after 20 months of follow-up post-AHSCT. CD8+ PCAECTL is extremely rare in clinical practice, with insidious onset and difficult early diagnosis. It is mainly characterized by the proliferation of epidermotropic CD8+ cytotoxic T cells and aggressive clinical course. At present, there is still no unified standard for the optimal treatment regimen, and the prognosis is very poor. Consolidation therapy with AHSCT after achieving remission through induction chemotherapy can improve the survival and prognosis of the CD8+ PCAECTL patients.

Cutaneous T-cell lymphoma (CTCL) is a heterogeneous group of lymphoproliferative disorders characterised by skin infiltration by malignant memory T cells. While most patients will present with an indolent disease, others will follow a highly aggressive clinical course. Currently, defining disease prognosis remains challenging. Ectopic expression of gametocyte-specific factor 1 (GTSF1) has emerged as a potential prognostic biomarker. However, its contribution to CTCL carcinogenesis remains unknown. Here, we report that GTSF1 contributes to carcinogenesis by partially modifying the memory/effector phenotype of the malignant T cells. GTSF1 knockdown in CTCL cells led to T-cell activation and production of IFNγ and TNFα. Advanced stages of the disease are associated with decreased production of these cytokines. Notably, we show that patients classified with high expression of GTSF1 are associated with a worse disease prognosis. Taken together, our findings indicate that GTSF1 expression in CTCL cells allows them to acquire memory T-cell phenotype. Malignant memory T cells have a decreased production of immune-responsive cytokines, leading to a diminished immune response and disease progression. GTSF1 is an important candidate as a prognostic biomarker. Furthermore, understanding the specific function of GTSF1 might help develop novel targeted treatment options for CTCL patients.

ABSTRACTAimTo assess the adjunctive effect of periodontal therapy on psoriasis‐related outcomes in a combined experimental model of ligature‐induced periodontitis and Imiquimod (IMQ)‐induced psoriasis. Also, this experiment aimed to study the impact of TNF‐α inhibitors on the periodontium.MethodsFifty‐six C57/BL6J mice were randomly allocated to seven experimental groups: (a) control group (P–Pso–) with no treatment; (b) periodontitis (P+Pso–) with periodontal therapy; (c) periodontitis (P+Pso–) with TNF‐α inhibitor; (d) psoriasis (P–Pso+) with TNF‐α inhibitor; (e) periodontitis and psoriasis (P+Pso+) with periodontal therapy; (f) P+Pso+ with TNF‐α inhibitor; and (g) P+Pso+ with both periodontal therapy and TNF‐α inhibitor. Samples (maxilla, dorsal skin and blood) were harvested immediately after death. Measures of periodontitis distance between the cemento‐enamel junction and alveolar bone crest (CEJ–ABC) and number of osteoclasts and psoriasis (epidermal thickness and infiltrate cells (per 0.03mm2)) severity, as well as systemic inflammation (IL‐6, IL‐17A and TNF‐α) were collected.ResultsIn the P+Pso+ group, a significant adjunctive effect of periodontal therapy to TNF‐α inhibitors was found in the reduction of epidermal thickening and inflammatory infiltrate of the dorsal skin (p < 0.05). Similarly, treatment with TNF‐α inhibitor resulted in a significant adjunctive effect to periodontal therapy in the reduction of alveolar bone loss (p < 0.05). These changes were accompanied by a significant decrease in the circulating levels of IL‐6 and IL‐17A when both periodontal therapy and TNF‐α inhibitor were administered.ConclusionsThe combination of periodontal therapy and TNF‐α inhibitor showed a positive synergetic effect in the treatment of comorbid experimental ligature‐induced periodontitis and IMQ‐induced psoriasis via the reduction of systemic inflammation.

Atopic dermatitis (ad) is a chronic inflammatory skin disease, with recent studies indicating that immune cells, such as monocytes and inflammatory cytokines, play a crucial role. By retrieving datasets from public databases and analysing immune cell infiltration in lesional skin using CIBERSORT, we found that monocytes and M2 macrophages were significantly upregulated in atopic dermatitis. Differentially expressed gene (DEG) functional enrichment analysis revealed that cytokine-cytokine receptor interaction was the most significantly enriched pathway. Further analysis of cytokines and their receptors, along with their correlation with infiltrating immune cells, identified IL36G-expressing monocytes as a key target in atopic dermatitis. We compared immune cell infiltration and cytokine-related targets in similar inflammatory skin diseases, such as psoriasis and urticaria, to evaluate similarities and differences among these three skin conditions. The analysis revealed that IL36G-expressing monocytes were also highly expressed in psoriasis but did not play a pivotal role in urticaria. Finally, we used molecular docking to predict and validate drugs targeting IL36G. Our study highlights IL36G-expressing monocytes as a common key target in atopic dermatitis and psoriasis, offering novel insights and therapeutic strategies for these related diseases.

Introduction: Secondary Cutaneous Lymphomas (SCL) result from nodal or extranodal lymphoma dissemination and are characterized by skin infiltration. Diagnosing SCL is complex and requires clinical, histopathological and molecular evaluations. SCL can present with diverse manifestations, with disseminated lesions indicating a poor prognosis. This report describes a rare case of ALK-positive Anaplastic Large Cell Lymphoma (ALCL) with cutaneous involvement. Case Report: An 18-year-old male presented with an eight-month history of a tumoral lesion with serohematic crusts on the anterior thoracic region and satellite erythematous-violaceous nodules. No systemic B symptoms were reported. Histopathology revealed a diffuse proliferation of large pleomorphic lymphoid cells in the dermis and hypodermis. Immunohistochemistry showed strong positivity for CD30, EMA and ALK, supporting the diagnosis of secondary cutaneous involvement by ALK-positive nodal/systemic ALCL. Bone marrow biopsy confirmed lymphoma infiltration. The patient was referred for surgical and hematological evaluation and initiated chemotherapy protocols. Discussion: SCL accounts for up to 50% of cutaneous lymphomas and presents as nodules, plaques or ulcerations. Disseminated lesions within six months of diagnosis reduce survival rates significantly. Accurate differentiation between primary and secondary lymphoproliferative diseases requires imaging, bone marrow biopsy and molecular techniques. Treatment includes chemotherapy, radiotherapy and emerging therapies such as checkpoint inhibitors, CAR-T cells and targeted agents like brentuximab vedotin. ALK-positive ALCL is generally associated with a more favorable prognosis compared to ALK-negative subtypes. Conclusion: Early diagnosis and intervention are critical for improving survival in SCL patients. Dermatologists play a crucial role in recognizing these lesions and initiating multidisciplinary management. Introduction: Secondary Cutaneous Lymphomas (SCL) result from nodal or extranodal lymphoma dissemination and are characterized by skin infiltration. Diagnosing SCL is complex and requires clinical, histopathological and molecular evaluations. SCL can present with diverse manifestations, with disseminated lesions indicating a poor prognosis. This report describes a rare case of ALK-positive Anaplastic Large Cell Lymphoma (ALCL) with cutaneous involvement. Case Report: An 18-year-old male presented with an eight-month history of a tumoral lesion with serohematic crusts on the anterior thoracic region and satellite erythematous-violaceous nodules. No systemic B symptoms were reported. Histopathology revealed a diffuse proliferation of large pleomorphic lymphoid cells in the dermis and hypodermis. Immunohistochemistry showed strong positivity for CD30, EMA and ALK, supporting the diagnosis of secondary cutaneous involvement by ALK-positive nodal/systemic ALCL. Bone marrow biopsy confirmed lymphoma infiltration. The patient was referred for surgical and hematological evaluation and initiated chemotherapy protocols. Discussion: SCL accounts for up to 50% of cutaneous lymphomas and presents as nodules, plaques or ulcerations. Disseminated lesions within six months of diagnosis reduce survival rates significantly. Accurate differentiation between primary and secondary lymphoproliferative diseases requires imaging, bone marrow biopsy and molecular techniques. Treatment includes chemotherapy, radiotherapy and emerging therapies such as checkpoint inhibitors, CAR-T cells and targeted agents like brentuximab vedotin. ALK-positive ALCL is generally associated with a more favorable prognosis compared to ALK-negative subtypes. Conclusion: Early diagnosis and intervention are critical for improving survival in SCL patients. Dermatologists play a crucial role in recognizing these lesions and initiating multidisciplinary management.

Pain management in posterior fossa surgeries poses significant challenges, with opioid-based approaches causing unwanted side effects. This study evaluates the efficacy of posterior scalp block using bupivacaine and dexmedetomidine compared to skin infiltration for managing perioperative pain. In this prospective, double-blind, randomized controlled trial, 34 adult patients undergoing elective posterior fossa surgeries were equally assigned to either posterior scalp block or skin infiltration groups. Outcomes measured included hemodynamic parameters, pain scores, opioid consumption, time to first analgesic, and sedation levels. The posterior scalp block group showed significantly lower opioid consumption (211.47 ± 101.95 mcg vs 305.88 ± 117.10 mcg; p < 0.01) and pain scores (VAS 2.29 ± 0.9 vs 5.06 ± 1.3; p < 0.001) at 24 hours post-surgery. This group also demonstrated better hemodynamic stability and fewer rescue opioid requirements (9 vs 15 patients; p < 0.009). Posterior scalp block with bupivacaine and dexmedetomidine significantly improves pain management, reduces opioid use, and provides better hemodynamic stability compared to skin infiltration in posterior fossa surgeries. CTRI/2023/07/0554959.

Skin infiltration by neutrophils is a hallmark of the chronic inflammatory skin disease psoriasis, yet the mechanisms underlying neutrophil recruitment and positioning in chronically inflamed skin remain poorly understood. In this study, we demonstrate the significant impact of a total genetic deficiency of secretory leukocyte protease inhibitor (SLPI) on neutrophil migration in mouse skin. Without SLPI, neutrophils displayed an unconventional migratory pattern, characterized by altered interactions with vessel walls and reduced efficiency in extravasating from blood vessels into skin tissue during the early stages of experimental psoriasis. This was associated with changes in tissue motility, positioning neutrophils farther from the skin entry vessels and closer to the skin surface. Neutrophil diapedesis was partially dependent on SLPI within the neutrophils themselves. The impact of SLPI on neutrophil movement was further supported by the increased migration of human neutrophils in the presence of neutrophil-penetrant recombinant SLPI. Additionally, our data suggest that neutrophils with varying capacities for vessel wall interaction are released from the bone marrow into circulation in an SLPI-dependent manner. These findings establish a role for SLPI in regulating the spatiotemporal infiltration of neutrophils into the skin in psoriasis, highlighting its relevance to psoriasis pathophysiology.

Heavy metal pollution in groundwater is a serious threat to ecological security and human health. High arsenic, iron, and manganese groundwaters are widely distributed in the Poyang Lake Plain in the middle reaches of the Yangtze River. Urbanization and anthropogenic activities have further aggravated heavy metal pollution in groundwater. Source analysis and health risk assessment of heavy metals will provide a scientific basis for the precise prevention and control of heavy metal pollution in groundwater and the health management of residents in this area. In this study, the northeast of Nanchang City,the central city of Poyang Lake Plain,was selected as the study area,and 94 groundwater samples were collected. The PMF and health risk assessment models were used to analyze and evaluate the pollution sources and health risks of heavy metals in groundwater in the study area. The results showed that：① The mean concentration of heavy metals in groundwater followed the order of Mn&gt;Fe&gt;As&gt;Zn&gt;Al&gt;Cd&gt;Pb&gt;Cu&gt;Hg； the average concentrations of Mn, Fe, and As exceeded the corresponding standard limits； and the spatial distributions of the heavy metals were quite different. ② Source analysis results showed that the mixture of natural and agricultural sources, transportation emissions, waste incineration, and mineral dissolution were the major heavy metal sources, among which the contributing rate of the mixture of natural and agricultural sources was the highest （80.1%）. ③ The health risk assessment showed that the risk of the drinking water pathway was much higher than that of the skin infiltration pathway. The non-carcinogenic health risk （HI） was mainly caused by As through the drinking water pathway, and the non-carcinogenic HI to both children and adults in the study area was higher than the safety level （HI&gt;1）. The carcinogenic risk （CR） caused by As in adults through the two pathways and in children through the drinking water pathway, and the carcinogenic risk caused by Cd in children through the drinking water pathway were all higher than the maximum acceptable risk level （1E-04）. For drinking water safety, the concentrations of As and Cd should be controlled before drinking.

Enhanced apoptosis and inflammation allied with autophagic and apoptotic Leishmania amastigotes in the seemingly undamaged ear skin of clinically affected dogs with canine visceral Leishmaniasis.