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Immunohistochemistry in the Diagnosis of Cutaneous Infections

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Immunohistochemistry in the Diagnosis of Cutaneous Infections Immunohistochemistry in the diagnosis of cutaneous infections Ana María Molina Ruiz Thesis for the fulfillment of the PhD degree in Medical Science UNIVERSIDAD AUTÓNOMA DE MADRID FACULTAD DE MEDICINA Department of Internal Medicine TESIS DOCTORAL Immunohistochemistry in the Diagnosis of Cutaneous Viral and Bacterial Infections AUTHOR: Ana María Molina Ruiz DIRECTOR: Luis Requena Caballero Department of Dermatology, Fundación Jiménez Díaz, Department of Internal Medicine, Universidad Autónoma, Madrid Memoria para optar al grado de Doctor en Medicina con Mención Internacional al Título. Tesis presentada como compendio de publicaciones. UNIVERSIDAD AUTÓNOMA DE MADRID FACULTAD DE MEDICINA Departamento de Medicina Interna D. Luis Requena Caballero, Catedrático de Dermatología del Departamento de Medicina de la Universidad Autónoma de Madrid. CERTIFICA: Que Dña. Ana María Molina Ruiz ha realizado bajo mi dirección el trabajo “Immunohistochemistry in the Diagnosis of Cutaneous Viral and Bacterial Infections“ que a mi juicio reúne las condiciones para optar al Grado de Doctor. Para que así conste, firmo el presente certificado en Madrid a 3 de septiembre del año dos mil catorce. Vº Bº Director de la Tesis Doctoral Profesor Luis Requena Caballero Catedrático de Dermatología Departamento de Medicina, Facultad de Medicina Universidad Autónoma de Madrid DERMATOPATHOLOGIE FRIEDRICHSHAFEN BODENSEE Dermatopathologische Gemeinschaftspraxis PD Dr. med. Heinz Kutzner, Dermatologe Postfach 16 46, 88006 Friedrichshafen Dr. med. Arno Rütten, Dermatologe Prof. Dr. med. Thomas Mentzel, Pathologe Dr. med. Markus Hantschke, Dermatologe Dr. med. Bruno Paredes, Dermatologe, Pathologe Dr. med. Leo Schärer, Dermatologe Postfach 16 46, 88006 Friedrichshafen Siemensstr. 6/1, 88048 Friedrichshafen May 28, 2014 To Whom it May Concern Gentlemen, I have read Dr. Ana María Molina Ruiz Doctoral Thesis entitled “Immunohistochemistry in the diagnosis of cutaneous viral and bacterial infections” and I think that this research study on immunohistochemistry is very interesting both for dermatologists and pathologists nowadays because several of the antibodies reviewed in this paper are relatively new and their real applicability on daily routine has not been properly established yet. IHC continues to be one of the main adjunctive methods to conventionally stained sections in histopathology. This is mainly related to the fact that it is a relatively simple, fast, and inexpensive method. In this review, the authors highlight the main immunohistochemical techniques that have been used and continue to evolve in the diagnosis of mucocutaneous viral and bacterial infections, and discuss their applicability. Furthermore, I don’t think such an exhaustive study of the immunohistochemistry of cutaneous infections has been published previously, and therefore this work will probably be used frequently as an expert consult paper, both by dermatologists and dermatopathologists. Sincerely yours, Priv.-Doz. Dr. med. Heinz Kutzner Telefon: 07541/6044-13 e-mail: [email protected] Telefax: 07541/6044-23 Internet: http://www.dermpath.de MEDICAL UNIVERSITY OF GRAZ DEPARTMENT OF DERMATOLOGY CHAIRMAN: PROF. WERNER ABERER, MD DERMATOPATHOLOGY -REFERENCE CENTER RESEARCH UNIT DERMATOPATHOLOGY DIRECTOR: PROF. LORENZO CERRONI, MD Histopathologic Registry for Cutaneous Lymphomas of the Austrian Society of Dermatology & Venereology Histopathologic Registry for Cutaneous Melanomas of the Austrian Society of Dermatology & Venereology Graz, 21.05.2014 Lorenzo Cerroni, MD (Director) Helmut Kerl, MD (Consultant) To whom it may concern Steven Kaddu, MD Laila El Shabrawi-Caelen, MD Cesare Massone, MD Isabella Fried, I have read with great interest the Doctoral Thesis by Dr. Ana María Molina Ruiz, MD titled “Immunohistochemistry in the diagnosis of cutaneous viral and bacterial Molecular pathology infections”. Thomas Wiesner, MD In my opinion this research study on immunohistochemistry of infectious diseases is crucial for both dermatologists and dermatopathologists, particularly because several of the antibodies discussed and illustrated in the study are new and little-known in the dermatologic and dermatopathologic communities. In addition, as infectious disorders are a major health problem, and as a precise diagnosis is a pre-requisite for the correct treatment, this study addresses a very important problem and offers novel ways of properly managing these patients. The use of a continuously increasing number of newly raised and commercially available antibodies for immunohistochemistry has tremendously broadened the applicability of this technique in routine diagnostic procedures, and this is also relevant for the diagnosis of different types of infections. Immunohistochemistry represents a sensitive, specific and relatively unexpensive technique that allows a precise characterization of viral and bacterial infections in biopsy specimens, which may be very difficult or even impossible to diagnose using routine microscopy alone. Furthermore, to the best of my knowledge this is the only exhaustive and complete study of the immunohistochemistry of cutaneous infections that has been published in the medical literature, thus representing a crucial reference and source of relevant Department of Dermatology Division of information for both dermatologists and dermatopathologists. General Dermatology Medical University of Graz Auenbruggerplatz 8 A-8036 Graz, Austria Phone: +43-316- Sincerely, 385-13235 Fax: +43-316-385-14957 E- mail: [email protected] Prof. Dr. Lorenzo Cerroni Graz General Hospital Auenbruggerplatz A- 8036 Graz Immunohistochemistry in the Diagnosis of Ana M. Molina Ruiz Cutaneous Viral and Bacterial Infections To my family Eustoquio, Eladia, Rosa and Javier. 7 Immunohistochemistry in the Diagnosis of Ana M. Molina Ruiz Cutaneous Viral and Bacterial Infections “Science is a way of thinking much more than it is a body of knowledge" Carl Sagan 8 Immunohistochemistry in the Diagnosis of Ana M. Molina Ruiz Cutaneous Viral and Bacterial Infections Aknowledgments Quiero expresar mi más sincero agradecimiento al Profesor Luis Requena. Él es el científico más brillante que conozco y el motor de un servicio de Dermatología al que hace brillar junto él. Sin su infinita ayuda, apoyo, confianza, paciencia y entusiasmo hubiera sido imposible la realización de este proyecto. Trabajar al lado de alguien tan excepcional y con un cerebro tan bien estructurado científicamente convierte la dermatopatología en algo emocionante. This thesis would not have been possible without the help of Dr. Heinz Kutzner who generously contributed to the search and purchase of the immunohistochemical stains that were necessary for this project. His extremely helpful ideas, suggestions and quick responses while reviewing the articles were also vital in the process. I would also like to acknowledge Dr. Lorenzo Cerroni for his continuous support with this and other scientific projects. For teaching me Dermatopathology since the very first years of my residency and for coming to Madrid to be present during the presentation of the project. Gracias a mi padre, Eustoquio Molina, por haberme inculcado la ilusión por la ciencia y hacer de esa ilusión un hecho con sus sabios consejos y constante ayuda; a mi madre, Eladia Ruiz, por enseñarnos a valorar la importancia de estudiar y aprender cosas nuevas de una forma libre e independiente; y a Javier, mi pareja, por soportar mis largas tardes de ausencia frente al ordenador y por hacer que mi vida sea tan divertida y feliz. A todos ellos muchísimas gracias ayudarme en este proyecto. 9 Table of contents Immunohistochemistry in the Diagnosis of Ana M. Molina Ruiz Cutaneous Viral and Bacterial Infections Table of contents Abbreviations ............................................................................................................. 13 Introduction ............................................................................................................... 16 Research objectives .................................................................................................... 28 Material and methods ................................................................................................ 31 Results ........................................................................................................................ 37 CHAPTER 1 Immunohistochemistry in the diagnosis of cutaneous viral infections .. 38 ARTICLE 1 Immunohistochemistry in the Diagnosis of Cutaneous Viral Infections - Part I. Cutaneous Viral Infections by Herpesviruses and Papillomaviruses .................................. 39 ARTICLE 2 Immunohistochemistry in the Diagnosis of Cutaneous Viral Infections - Part II. Cutaneous Viral Infections by Parvoviruses, Polyomaviruses, Poxviruses, Paramyxoviridade, Picornaviridae, Retroviruses and Filoviruses ...................................... 40 CHAPTER 2 Immunohistochemistry in the diagnosis of cutaneous bacterial infections41 ARTICLE 3 Immunohistochemistry in the Diagnosis of Cutaneous Bacterial Infections ... 42 Conclusions ................................................................................................................ 44 Curriculum Vitae summary ......................................................................................... 52 11 Abbreviations Immunohistochemistry in the Diagnosis of Ana M. Molina Ruiz Cutaneous Viral and Bacterial Infections Abbreviations IHC: Immunohistochemistry LNA-1: Latent nuclear antigen-1 IHQ: Inmunohistoquímica
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