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Ingrown Toenail: Histopathologic and Immunohistochemical Study

Discussion in 'General Issues and Discussion Forum' started by podoalf, Jun 25, 2009.

  1. podoalf

    podoalf Active Member


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    Ingrown Toenail: Histopathologic and Immunohistochemical Study

    Fernandez-Flores, Angel MD, PhD; Martínez-Nova, Alfonso DPM; Salgado-Fernandez, Sara BSc


    The American Journal of Dermatopathology:
    July 2009 - Volume 31 - Issue 5 - pp 439-445


    Abstract

    Although ingrown toenail (IT) is a common problem, the morphologic alterations presented in this condition have rarely been presented in literature. We have studied 14 cases from 12 different patients and studied the biopsies of all of them, not only with routine techniques but also with histochemical stains (Masson trichrome, periodic acid-Schiff, and Gram) and with immunohistochemical techniques mindbomb homolog-1 (MIB-1), p63, D2-40, and AE1-AE3).

    The patients were clinically classified into 4 stages (1, 2a, 2b, and 3). The main changes evidenced were ingrowing of the squamous epithelium (either from the matrix or mostly from the hyponichium) and chronic plasma-cell rich inflammation with prominent vascularization. The intensity of these changes varied depending on the stage: whereas they were mild in stages 1 and 2a, they were prominent in stages 2b and 3. In advanced stages, the epithelial nests showed certain dyskeratosis. The expression of MIB-1 was, nevertheless, only basal and parabasal. p63 was intensively expressed by the epithelial nests.

    We therefore conclude that (a) IT shows epithelial ingrowing with accompanying granulation tissue; (b) according to the clinical stage of the disease, this pattern can be more or less complex; (c) in advanced stages of IT, the pattern can mimic a well-differentiated squamous cell carcinoma; (d) MIB-1 is not helpful in distinguishing IT from squamous cell carcinoma; (e) the high expression of p63 by the ingrowing epithelium should not be the source of a misdiagnosis of malignancy.
     
  2. podoalf

    podoalf Active Member

    Hi all !

    In this research we suggest that ingrown toenails in stage III (with piogenic granuloma) should be send to do the anatomopahlogic analisys, because can mimic like a squamous cell carcinoma.

    What do you think ?
     
  3. Lee

    Lee Active Member

    Hello,

    Very interesting study. I have yet to read the full text. Please can you clarify some of your recommendations based on your conclusions highlighted in your abstract?

    You recommended in your post that stage 3 IGTNs should be sent for "anatomopahlogic analisys" (I presume histopathological analysis?) since the samples you analysed indicated they can mimic squamous cell carcinoma - but your conclusion in your abstract states that "...MIB-1 is not helpful in distinguishing IT from squamous cell carcinoma; (e) the high expression of p63 by the ingrowing epithelium should not be the source of a misdiagnosis of malignancy." I'm not sure if I understand your points here, I suspect it's because I have yet to access the full text. Over expression of p63 has been noted in cancer
    (Finlan LE, Hupp TR. 2007 p63: the phantom of the tumor suppressor. Cell Cycle. 2;6(9):1062-71). I presume your conclusion is that whilst there is high expression seen in the samples you took, your other histopathology tests did not confirm cancer in these samples? And pretty much the same can be said for high levels of MIB-1 observed - sensitive for chronic granualtion tissue and cancer but not specific for either?

    Hope this makes sense. Looking forward to reading the full text.

    Lee
     
  4. linda5508

    linda5508 Welcome New Poster

    that was pretty long. I'll have to read it later
     
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