The reason why the cutaneous form of sarcoidosis is well known in the literature is because of its spectrum of manifestations granting it the fame of a Great Imitator. The mystery shrouding the pathogenesis of this rare cutaneous disease is still there (in spite of the fundamental progress of the various diagnostic methods in current day medicine). The production of the morphological substrate-the epithelioid cell granuloma-which is considered to be characteristic of skin sarcoidosis, could, however, also be the end result of a reaction to i) various specific infectious agents such as Leishmaniasis cutis, coccidioidomycosis, etc., ii) certain residual bacterial or other mycobacterial antigens which, at the moment of setting the diagnosis are-by definition-non-infectious but still immunogenic, as well as iii) different tumor antigens in lesional tissue or other location. Often, differentiating between sarcodiosis and a sarcoid-like reaction, based on the updated criteria for cutaneous sarcoidosis, is problematic to downright impossible. A future characterization of the genetic signature of the two conditions, as well as the implementation of additional mandatory panels for i) the identification of certain infectious or ii) non-infectious but immunogenic and iii) tumor antigens in the epithelioid cell granuloma (or in another location in the organism), could be a considerable contribution to the process of differentiating between the two above-mentioned conditions. This will create conditions for greater accuracy when setting the subsequent therapeutic approaches.

No abstract

Metatypical basal cell carcinoma (MTBCC) represents a high-risk type of cutaneous tumour. We report about three different patients with relapsing advanced large MTBCC: one of the scalp and two of the cheek region. Such patients required in most of the cases a complex surgical approach to achieve a stable and complete remission. In the first presented patient a combination of flaps and grafts has been performed. We describe tailored surgical approaches. By this contrivance it is possible to treat even elderly patients with exposed bone after complete excision effectively and safe. Interdisciplinary team work is for the benefit of these patients.

No abstract

The acute involution of the thymus is induced by either exogenous or endogenous factors, including some infections (infection type involution). The present study was focused on both detection and immunocytochemical analysis of NGF immunopositive mast cells in child thymus with acute infection-induced involution. Autopsy thymus specimens from children with infection diseases (Sepsis, Encephalomyelitis, Varicella) were examined at light and electron microscopic level and compared to normal infantile thymuses. We observed a redistribution of NGF immunopositive mast cells in infection-affected child thymus, which lobular architecture was collapsed. A positive correlation between the degree of the involutive changes, increased distribution and enhanced NGF immunoreactivity of mast cells was defined. The possible involvement of NGF immunopositive mast cells in the process of acute thymus involution is discussed.