bluuebunny/crossref_metadata_2025 huggingface dataset:
Focal Regression‐Like Changes in Dysplastic Back Nevi :A Diagnostic Pitfall for Malignant Melanoma
Authors: Hassanein A. , Depick‐Smith N. , Magill M. , Bandarchi B.
Published: August 2010

Regression in melanoma can be complete or partial. Melanocytic nevi may show focal regression‐like changes (RLC). We studied the incidence of RLC in a total of 777 melanocytic back nevi. These included 17 cases of blue nevi, 28 cases of compound nevi, 385 cases of compound dysplastic nevi, 34 cases of congenital compound nevi, 26 cases of congenital intradermal nevi, 58 cases of intradermal nevi, and 229 cases of junctional dysplastic nevi. The dysplastic nevi were categorised according to the associated cytologic atypia (mild, moderate, and severe). 21 malignant melanomas of the back were also reviewed for regression. RLC were seen with a striking correlation with the degree of cytologic atypia in dysplastic nevi. RLC were seen in 4.5% of mildly, 9.6% of moderately, and 17.2% of severely dysplastic compound nevi. RLC were seen in 10.3% of mildly, 18.8% of moderately, and 39.3% of severely dysplastic junctional nevi. The incidence of regression in non‐dysplastic nevi was much less, ranging from 2.9% to 3.6%. We believe this phenomenon is probably related to trauma/irritation. Caution should be taken before rendering the diagnosis of regressed malignant melanoma on the back since dysplastic nevi may show focal similar changes.
Desmoplastic Spitz Nevi
Authors: Hughes A. , Mehregan D. R.
Published: August 2010

We have reviewed sixteen patients with the diagnosis of desmoplastic Spitz nevus. The age of our patients ranged between seven years and fifty‐four years. We noted a predominance of twelve female patients and four male patients. Histologically, ten of the sixteen cases were well circumscribed and symmetric. In six cases we were unable to ascertain the overall architectural features because of the biopsy technique. Only three cases showed significant junctional melanocytic nesting. In five cases there were rare nests of melanocytes at the dermo‐epidermal junction and in eight cases there was no evidence of melanocytic nesting at the dermo‐epidermal junction. Dermal mitotic figures were rare, with five cases showing a single dermal mitotic figure. The lesions did not arise in sun damaged skin as evidenced by the rarity of actinic elastosis within our specimens. Additional clinical and histologic findings and follow up will be reported.
Expression of P63 in Primary Cutaneous Adnexal Neoplasms and Adenocarcinoma Metastatic to the Skin
Authors: Ivan Doina , Hafeez Diwan A. , Prieto Victor G.
Published: August 2010

p63, a recently identified homologue of p53 gene, has been reported to be essential in the development of epithelia and is mainly expressed by basal and myoepithelial cells. The purpose of this study was to investigate the pattern of p63 expression in cutaneous adnexal neoplasms and to assess its possible value in the differential diagnosis of primary cutaneous neoplasms versus adenocarcinomas metastatic to the skin. Immunohistochemical analysis using p63 monoclonal antibody (clone 4A4) was performed on formalin‐fixed, paraffin‐embedded archival tissue from 20 benign adnexal tumors, 10 malignant adnexal tumors, and 14 adenocarcinomas metastatic to the skin. The expression of p63 was evaluated in epidermal cells, skin appendages and metastatic tumor cells. p63 was consistently expressed in the basal/suprabasal cells of epidermis and cutaneous appendages, including the basal/myoepithelial cells of sweat glands. Thirteen out of 20 (65%) benign adnexal tumors showed strong p63 expression; the remaining 7(35%) cases had over 50% p63‐positive nuclei. All primary cutaneous carcinomas, including adenocarcinomas, expressed p63. In contrast, none of the metastatic adenocarcinomas to the skin was positive for p63 (p < 0.0001). Based on our findings, analysis of p63 expression may be a helpful tool in the differential diagnosis of primary versus metastatic cutaneous adenocarcinomas.
Hair Matrix Differentiation in a Trichogenic Adnexal Neoplasm.
Authors: Iwenofu O.H. , Lamar W.L. , Clark S.H. , Crowson A.N.
Published: August 2010

Pilomatricoma is a distinctive tumor characterized by a dual population of proliferating germinative cells and shadow cells and is beleived to derive from the hair matrix. Rarely, benign and malignant adnexal tumors can show pilomaticoma‐like or hair matrix differentiation. We present a 69‐year‐old man with a ruptured cystic nodule of the left cheek. Histology revealed a dermal tumor composed of nests of basaloid cells which manifested peripheral palisading and abortive hair papilla formation with a modified stroma and pilomatricoma‐like areas. This lesion shares features of a trichogenic adnexal neoplasm with those of a tumor having hair matrical differentiation, and has been rarely reported under the designation “follicular” basal cell carcinoma (BCC). This case illustrates an example of this unusual occurrence of hair matrix differentiation in a benign basaloid adnexal neoplasm as characterized by the presence of basaloid and shadow cells; the absence of individual cell necrosis and mitotic activity prompts us to doubt that it represents a form of nodular BCC, but rather it more likely reflects a hamartoma of the follicular anlage.
Expression of CD44 and Its Isoforms in Oral Lichen Planus
Authors: Kaya Gürkan , Kaya Hakan , Augsburger Eric , Samson Jacky , Saurat Jean‐Hilaire , Lombardi Tommaso
Published: August 2010

CD44 is a transmembrane glycoprotein which has multiple isoforms resulting from alternative splicing of ten variant exons (v1‐v10). Standard CD44 (CD44s) is the cell‐surface receptor for hyaluronate and is involved in lymphocyte homing and activation. The function of the variant CD44 isoforms (CD44v) is unknown. Recently we observed an altered expression of CD44s and CD44v in different inflammatory skin diseases. In cutaneous lichen planus (LP) CD44s and CD44v are expressed in the epidermis whereas dermal lymphocytes express strongly CD44s and weakly CD44v3 and are negative for CD44v. In this study we examined the expression of CD44s and CD44v (CD44v3, CD44v4, CD44v5, CD44v6, CD44v7, CD44v7v8 and CD44v10) in active oral LP lesions by immunohistochemistry. CD44s was highly expressed by keratinocytes and dermal lymphocytes. Epithelial expression of CD44v4, CD44v7, CD44v7v8 and CD44v10 was decreased or absent. Biopsies did not contain CD44v3, CD44v7, CD44v7v8 and CD44v10‐positive lymphocytes. Lymphocyte expression of CD44v4, CD44v5 and CD44v6 was observed. Unlike CD44v4 and CD44v5, CD44v6 was expressed by large quantities of lymphocytes. Our results show that the expression of CD44v in oral LP is different from cutaneous LP, which suggests that differential expression of CD44v may play a role in the generation of LP in different locations.
Comparison of Seborrheic Keratoses, Inflamed Seborrheic Keratoses, and Inverted Follicular Keratoses Using P53, BCL‐1, and BCL‐2
Authors: Ko C. , Binder S.
Published: August 2010

While cell cycle markers have been used to differentiate benign versus malignant lesions and to classify malignant lesions, benign keratoses have not been well studied using such markers, and the relation of the cell cycle to inflammation or irritation of benign keratoses is unclear. We compared the immunohistochemical staining patterns of 10 seborrheic keratoses, 10 inflamed seborrheic keratoses, and 10 inverted follicular keratoses using antibodies to p53, bcl‐1, and bcl‐2. Staining with antibodies to p53 was increased in inverted follicular keratoses compared to inflamed or non‐inflamed seborrheic keratoses. Bcl‐1 staining was similar in all lesions. A population of bcl‐2‐positive dendritic cells was seen within the epidermal portion of inverted follicular keratoses. Keratinocyte bcl‐2 staining was higher in seborrheic keratoses compared to the other two keratoses. Bcl‐2 may be increased in seborrheic keratoses as an anti‐apoptotic mechanism while increased p53 may trigger apoptosis in inverted follicular keratoses.
Atypical Neurofibroma with Bizarre Giant Cells
Authors: Kristjansson Arni K , Stone Mary
Published: August 2010

A 27‐year‐old woman presented with a 5 mm papule on her cheek. She had no family history or stigmata of neurofibromatosis. Biopsy showed a diffuse dermal proliferation of spindle cells embedded in a slightly myxomatous stroma which entrapped adnexae. They displayed cytologic atypia with hyperchromatic nuclei and bizarre multinucleated giant cells. No mitosis were identified. Immunohistochemistry showed the spindle cells to be S‐100 and collagen IV positive, but MART‐1 negative. The differential diagnosis included desmoplastic melanoma, malignant peripheral nerve sheath tumor (MPNST) and atypical neurofibroma. Both atypical neurofibroma and desmoplastic melanoma are S‐100 positive, show variable atypia and can have bizarre multinucleated giant cells. However, the lack of epidermal melanocytic hyperplasia, mitosis and the positive collagen type IV staining, favor nerve sheath differentiation. In neurofibromatosis, neurofibromas may undergo malignant degeneration resulting in MPNST. Whether atypical neurofibroma represents a transitional stage is unknown. Mitotic activity and necrosis strongly suggest MPNST. The biologic potential of cutaneous atypical neurofibroma has not been well studied, but they appear to behave in a benign fashion. This case demonstrates the diagnostic challenge of atypia in neurofibromas and highlights the need for further studies on the behavior of these rare variants.
Histologic Comparison of Scleromyxedema and Nephrogenic Fibrosing Dermopathy
Authors: Kucher C. , Xu X. , Pasha T. , Elenitsas R.
Published: August 2010

Background: Nephrogenic fibrosing dermopathy (NFD), can be strikingly similar, if not indistinguishable, histologically from scleromyxedema. Both disorders consist of a dermal and subcutaneous proliferation of fibroblast‐like cells with mucin production. NFD has been shown to contain an increased number of dual positive CD34 and procollagen cells, as well as an increased number of factor XIIIa positive cells. To our knowledge, there has been no direct comparison between the histologic and immunophenotypic properties of scleromyxedema and NFD. Design: Nine biopsies from eight cases of NFD and eight biopsies from eight cases of scleromyxedema were identified. Standard immunohistochemical techniques for antibodies toward CD34, procollagen I, CD31, SMA, and factor XIIIa were applied. A colloidal iron stain was used to evaluate for dermal mucin. Amount of antibody expression and mucin production were then evaluated using a grading scale of 0–3. Results: Both NFD and scleromyxedema were found to have similar immunophenotypic expression. Both demonstrated increased numbers of CD34 and procollagen‐positive fibroblast‐like cells, as well as increased numbers of factor XIIIa positive cells. Increased vessels and stromal mucin were identified in both diseases without significant differences. Conclusions: Although scleromyxedema and NFD are clinically distinct diseases, theirÂ morphologic and immunophenotypic appearances are likely to be similar.
Keratinocyte Dysplasia in Hematopoietic Stem Cell Transplant Recipients in the Day 28 to 84 Post Transplant Period.
Authors: Li Ning , Argenyi Zsolt , Sale George , Myerson David
Published: August 2010

Severe keratinocyte dysplasia (SKD) has been reported in the early post‐transplant period of hematopoietic stem cell transplant (HCST) patients, with a frequency as high as 47.4%. In the period less than 3 weeks post‐transplant it was associated with cyclophosphamide conditioning. The purpose of our study was to determine the prevalence of SKD in a later post‐transplant period, from 28 days to 84 days, and study the possible causes. The 2003 slide file (227 slides) of Seattle Cancer Care Alliance was examined for skin biopsies from patients who had undergone HCST. Twenty‐two cases (9.7%) showed SKD. A control group of 22 biopsies matched for days post‐transplant and age were selected from the remaining 205 biopsies. SKD was associated with a busulfan conditioning regimen, 72.7% in the SKD group and 36.3% in the control group (p = 0.016). SKD was not associated with cyclophosphamide (p = 0.174), fludarabin (p = 0.263) or total body irradiation (p = 0.50). Although active GVHD (grade 2 or 3) was more commonly seen in SKD group (45.5%) than the control group (22.2%), it did not show significant difference (p = 0.052). Our study showed that SKD developed in 9.7% of the skin biopsies from days 28 to 84 post‐transplant, and was associated with busulfan conditioning regimen.
Cutaneous Leishmaniasis in an American Sol‐dier Who Returned from Iraq – A Case Report
Authors: Lin T.Y.D. , Parrish C. , Bussian A. , Omura E.
Published: August 2010

A 27‐year‐old male soldier who was stationed in Iraq from 3/03 to 9/03 presented to a local dermatologist in 4/04 with several red slightly raised non‐ulcerated nodules over the right wrist and ventral arm developed 2–3 months prior to the visit. The clinical impression was sporotrichosis. A punch biopsy was performed on a subcutaneous nodule and showed a granulomatous inflammatory process with scattered loosely organized clusters of epithelioid histiocytes palisading around dermal mucin, mainly involving the papillary and mid dermis. A diagnosis of granuloma annulare was suggested. Intralesional triamcinolone was used and the lesions initially improved but later recurred. However on deeper sections, there were scattered granulomas with a dominant necrotizing granuloma consisting of epithelioid histiocytes palisading around a central area of necrosis surrounded by lymphoplasmacytic and neutrophilic infiltrates. In 5/04, he presented to the Birmingham VA Medical Center with similar lesions. A repeat biopsy again showed a necrotizing granulomatous inflammation. In addition, numerous intracytoplasmic organisms with kinetoplasts were present within histiocytes. The findings were consistent with leishmaniasis due to L. major as confirmed by polymerase chain reaction at Walter Reed Hospital. As more US soldiers return from the Middle East, previously rare cutaneous leishmaniasis will be seen more commonly.
Nodular Hidradenoma Arising in a Nevus Sebaceus of Jadassohn
Authors: Michael Magill J. , Jain Sima M. , Devore Amy , Chin Gloria , Hassanein Ashraf M.
Published: August 2010

Nevus sebaceous of Jadassohn, a cutaneous hamartoma, results from disordered development of epidermal, follicular, sebaceous and apocrine differentiation that typically appears as a yellow verrucous plaque on the scalp or face. We present a 36‐year‐old white male with a congenital, nodular lesion along the hairline of his forehead, which had been traumatized repeatedly during hair grooming. Clinically, it was a well‐demarcated, curvilinear, erythematous, non‐tender plaque with no umbilication, ulceration or discharge. The periphery had a circumferential tan‐yellow, raised, waxy serpiginous border. Microscopically, the specimen had epidermal papillomatous hyperplasia with dilated infundibula of irregular mature sebaceous lobules, and mid‐dermal apocrine gland lobules. Within the hamartoma, was a well‐circumscribed, multi‐lobulated dermal tumor with epidermal and follicular attachments, focal ductal differentiation and cystic changes. Two distinct cell types were present; in the center were large polyhedral cells with focal clear cytoplasm, and at the periphery were spindle‐shaped cells with basophilic cytoplasm. These findings were typical of nodular hidradenoma arising within a nevus sebaceous of Jadassohn, a rare event with only seven cases previously documented in the literature.
Extranodal Anaplastic Large Cell Lymphoma of the Eyelid
Authors: Mathur V. , Park H.K. , Finley J.
Published: August 2010

A sixty‐nine‐year‐old male patient, without a significant prior medical history, presented with a rapidly enlarging, 2 cm non‐tender nodule on the right lower eyelid. The lesion persisted in spite of an incision and drainage. Following an excision, the histology revealed a diffuse infiltrate of atypical mononuclear cells within the dermis. The cells were large, monomorphic, with irregular to convoluted nuclei, prominent nucleoli, amphophilic cytoplasm. They were very mitotically active. Immunohistochemical stains for CD45, CD3, and CD30 were strongly positive. Pancytokeratin, CD20, and ALK (Anaplastic Lymphoma Kinase fusion protein) were negative. The histopathologic diagnosis was CD30 (Ki‐1) positive anaplastic large cell lymphoma. The margin was positive for involvement by lymphoma. The lesion was re‐excised with no evidence of residual involvement by lymphoma. A primary cutaneous anaplastic large cell lymphoma was favored over systemic involvement based on the clinical presentation of a single eyelid nodule and ALK negativity. He was referred to a hematology‐oncologist for further management. Anaplastic large cell lymphoma is a distinctive type of malignant lymphoma with a relatively favorable prognosis. It frequently involves the skin, however, to the best of our knowledge, presentation of this lymphoma type as a single lesion on the eyelid is extremely rare.
Cutaneous Sparganosis: A Case Report and Literature Review
Authors: Matthews M. , Murphy B. , Wharton J. , Lian F. , Oracion R. , Sunga O. , Cockerell C.
Published: August 2010

Sparganosis is a helminthic infection caused by the migrating larvae of the cestode genus Spirometra. Human infection is most commonly encountered in regions of the Far East where it has been associated with dietary consumption and medicinal usage of raw snake and frog tissue preparations or the drinking of contaminated water. Approximately 63 cases of sparganosis have been reported in the United States and reports of cutaneous sparganosis are very rare within the world literature. A case of cutaneous sparganosis involving the lateral abdominal region of a 54‐year‐old Filipino American women is discussed. Clinically the lesion presented as a cutaneous nodule. Skin punch biopsy revealed a sparganum possessing an undulating body wall with outermost microvillus layer overlying a thick tegument. Two thin smooth muscle layers and deeper subtegumental cells resided subjacent to the tegument. Calcareous corpuscles and intermixed mesenchymal tissues occupied the central regions of the larval worm. The inflammation consisted of a dense perivascular lymphohistiocytic infiltrate with scattered eosinophils and surrounding dermal fibrosis. Cutaneous sparganosis is rarely encountered in dermatology and dermatopathology practice, hence recognition of the clinical, histomorphological and patient history characteristics associated with this helminthic infection will facilitate in diagnosing this entity.
Atypical Compound Nevus Arising in Mature Cystic Ovarian Teratoma (Dermoid Cyst)
Authors: McHugh J. , Fullen D.
Published: August 2010

Mature cystic ovarian teratomas (MCOT) are the most common ovarian neoplasm and contain components of one or more embryonic germ cell layers. Ectodermal components are most common. Rarely (1–3%), malignant transformation can occur in MCOT and are usually epidermoid, although multiple case reports of melanomas have been described. Four compound nevi and three blue nevi have also been reported; however, atypical (dysplastic) nevi have not been reported to our knowledge. A 28‐year‐old woman presented with a right ovarian mass. A 5 × 4 × 2.5 cm cystic ovarian mass was filled with hair and grumous keratinaceous debris. The lining was smooth with a 1 cm dark macule. Histologically, the mass was predominantly lined by epidermis and appendages. The pigmented lesion consisted predominantly of melanocytic nests irregularly disposed on sides and tips of distorted rete ridges, some with bridging between adjacent rete ridges, and junctional extension lateral to the small dermal component of nevus. Slight fibrosis invested some rete ridges. Moderate atypia was present. Although melanomas and melanocytic nevi have rarely been described previously in MCOT, we present the first atypical (dysplastic) compound nevus, to our knowledge. This case expands the spectrum of melanocytic lesions arising in MCOT.
Lymphoepithelioma‐Like Carcinoma of the Skin: A Case Report
Authors: Mitsuhashi T. , Tsuchida T. , Arai E. , Ban S. , Shimada T. , Kuramochi A. , Hirose T. , Shimizu M.
Published: August 2010

Lymphoepithelioma‐like carcinoma of the skin is a rare tumor with a microscopic resemblance to lymphoepitheliomatous carcinoma of the nasopharynx. We present a 93‐year‐old man with papules on the left auricle to the cheek that were gradually enlarged. By the time of a biopsy, it grew to a 5.0 × 3.0 × 2.8 cm dark red mass, and necrotic debris was attached to the surface. Histologically, a relatively well‐demarcated, dermal‐hypodermic multiple lobules were composed of irregular islands of atypical epithelial cells. The uniform tumor cells had moderate amounts of lightly eosinophilic cytoplasm and vesicular nuclei with one or two prominent nucleoli. A dense lymphocytic infiltrate was present within the neoplastic islands, obscuring the epithelial component. The neoplastic cells were unconnected to the overlying epidermis. Neither squamous nor glandular differentiation was present. Immunohistochemically, the neoplastic cells were positive for epithelial membrane antigen and cytokeratin, and negative for latent membrane protein 1. No Epstein‐Barr virus‐encoded RNA (EBER) was detected by in situ hybridization. The negativity for Epstein‐Barr virus may be a help in the differential diagnosis from metastatic undifferentiated nasopharyngeal carcinoma, which is uniformly positive for EBER.
Increasing Expression of the Retinoic X Receptor‐B During Malignant Melanoma Progression
Authors: McAlhany S.J. , Reed J.A.
Published: August 2010

Retinoic X receptor‐b (RXR‐b) is a heterodimerization partner for vitamin D receptor (VDR). 1,25‐dihydroxyvitamin D3 activation of VDR leads to growth inhibition in numerous cell lines, including some melanoma lines. Evaluation of VDR and RXR‐b expression in vivo in melanocytic neoplasms will increase our understanding of this pathways potential role in growth control. Previous studies in our laboratory showed decreased VDR expression in superficially invasive melanoma, and progressive loss of expression in deeply invasive melanomas and metastatic melanomas (MET). We next sought to evaluate RXR‐b expression. Twenty‐eight melanocytic neoplasms including 8 melanomas in situ (MIS), 9 primary invasive melanomas (PIM), and 11 MET were evaluated for RXR‐b expression by immunohistochemistry. Nuclear labeling was assessed as 0 (0%), 1+(<5%), 2+(>5% but <50%), or 3+(>=50%). A significant increase in RXR‐b expression from low (0–1+) to high (>1+) was found when comparing MIS to PIM and MET (chi2 p < 0.05). These data suggest: 1) potential loss of 1,25‐dihydroxyvitamin D3 induced growth inhibition during melanoma progression may be due to decreased VDR expression without concomitant loss of RXR‐b; and 2) increased RXR‐b expression during melanoma progression may offer selective advantage through alternative signaling pathways.
Subcutaneous Panniculitis‐Like T Cell Lymphoma Developing in a Patient with Chronic B‐Cell Lympocytic Leukemia
Authors: Shahabi L , Schapiro B , Cotton J
Published: August 2010

Subcutaneous panniculitis‐like T‐cell lymphoma (SPTCL) is an unusual peripheral lymphoma most typically presenting with a cytotoxic (CD8‐positive, TIA‐1‐positive) immunophenotype. SPTCLs may have an indolent or highly aggressive clinical course. Histologically, SPTCL may be notoriously difficult to diagnosis. Cases of SPTCL with a deceptively benign appearance similar to that of subcutaneous lupus erythematosus have been described. SPTCL associated with a concomitant systemic leukemia/lymphoma has not been documented in the literature. We report a case of SPTCL arising in a 65‐year‐old female with a well‐established history of B‐cell lymphocytic leukemia (BCLL). She presented with two months of recurrent fever and painless erythematous nodules on bilateral lower extremities that were clinically felt to be erythema nodosum. Initial biopsies demonstrated a polymorphous lobular infiltrate with neutrophils, karyorrhexis and lipomembranous change. An excisional biopsy demonstrated an atypical lymphoid population that expressed CD8 and TIA1. PCR analysis confirmed T‐cell receptor gene arrangement. The patient was treated with systemic chemotherapy with resolution of her symptoms and complete remission. This is the first well documented case of SPTCL occurring in a patient with long standing B‐CLL, and highlights the difficulty of establishing an unequivocal diagnosis of SPTCL.
Eosinophilic Neuritis and Eosinophilic Panniculitis in a Patient with Advanced Aids
Authors: Soldano Anthony C. , Amsbaugh Sean , Groben Pamela A.
Published: August 2010

A 32‐year‐old immunocompromised African American male on multiple medications with a history of psoriasis and prurigo nodularis presented with a new generalized, painful, pruritic, papular eruption. Histologic sections revealed epidermal changes of lichen simplex chronicus with superficial and deep perivascular infiltrate consisting of lymphocytes and frequent eosinophils. Two important histological features also identified were eosinophilic panniculitis and prominent perineural eosinophilic infiltrate with focal areas showing eosinophils extending into the substance of the nerve. A right thigh sample was also sent for Gram stain, AFB and fungal cultures, all of which were negative. Laboratory findings at this time were significant for a peripheral blood eosinophilia. The patients’ topical corticosteroid prescription was increased with minimal relief. Hypereosinophilic syndrome with dermatoses in HIV infected patients is well documented. We present a patient with advanced AIDS, generalized painful, pruritic, papular rash and peripheral blood eosinophilia. The pattern of inflammation on HIV dermatoses seen in our patient not previously described in the literature is the perineural eosinophilic infiltrate and eosinophilic panniculitis. We propose two possible explanations for these histological findings: (1) hypereosinophilic syndrome in AIDS patients is a heterogeneous disorder and may include eosinophilic neuritis with panniculitis, or (2) an exuberant drug reaction.
Penile Cutaneous Metastasis of Prostate Adenocarcinoma: Report of a Case
Authors: Iwenofu O.H. , Sawh R.N. , Pitha J.V. , Lightfoot S.A.
Published: August 2010

Adenocarcinoma of the prostate is the most common visceral malignancy in men and has a tendency to metastasize to the axial skeleton, lungs, adrenal, and liver. Cutaneous metastasis is extremely rare and portends resistance to therapy and poor prognosis. We report an unusual case of metastatic prostatic adenocarcinoma to the penile skin. A 77‐year‐old man presented with two‐month history of a subcutaneous nodule on the dorsal aspect of the glans penis in the region of the coronal ridge. The patient was seven years status‐post radical prostatectomy for adenocarcinoma of the prostate, and had previously received both radiation and hormonal therapy for metastatic bone disease. The penile nodule was excised and microscopic examination showed infilteration of the dermis by malignant acini exhibiting a cribriform growth pattern and central comedonecrosis. Immunohistochemical staining revealed that the tumor cells were negative for prostate specific antigen (PSA), thyroid transription factor‐1, cytokeratin 7, and cytokeratin 20, but were strongly and diffusely positive for prostatic acid phosphatase (PAP). Based on these findings, a diagnosis of metastatic prostatic adenocarcinoma was established. In addition to the unusual location on the penis, this case also demonstrates the importance of immunostaining for PAP when metastatic prostatic adenocarcinoma is suspected.
A Case of Diabetic Coma with Renal Insufficiency.
Authors: MÖRDRE S. KJELLAND
Published: August 2010

Resumé.

A woman, 22 years of age, was admitted to hospital with diabetic coma and died after 24 hours.

There was no certain information about any previous kidney or bladder disease.

For a fortnight before admission she was ailing with pains in the abdomen and thirst, but no definite fever.

She was comatose when admitted.

She had severe hyperglycæmia (0.9%, Hagedorn and Normann Jensen's method), urea retention (2.57%) and acidosis of the blood (v. Slyke, 20.7%), slight albuminaria, marked glycosuria (4% by polarimeter), and absent Gerhardt's reaction and acidosis of the urine, and also greatly diminished excretion of phenol‐sulphone‐phthalein.

The possibility of diabetes complicated by nephritis or merely a »diabetic kidney» is here discussed as the cause of the clinical picture.
Nephritis Caused by Tuberculosis.
Authors: Holten Cai
Published: August 2010

Resumé

The following main conclusions mya be drawn from this investigation into the non‐specific inflammations of the kidney in tuberculosis:

 Haemorrhagic nephritis.

  insular nephritis.

  glomerular nephritis.

 Amyloid inflitration with or without oedema and with or without other disturbances of function.

  Combination of both 1) and 2) in which, however, the haemorrhagic nephritis is transient.

  Temporary albuminuria the significance and origin of which are not clear.

  Contracted Kidney; probably very rare.

  Specific tuberculous changes as a complication of amyloid disease.

  Haemorrhagic nephritis occurs in all the stages of phthisis. It is probably due to the presence of tubercle bacilli in the kidneys. Its prognosis is dependent upon the progress of the phthisis, since it is usually benign itself. It often occurs after pleurisy (dry and exudative) and haemoptysis. Functional disturbances are, as a rule, slight.

  The amyloid kidnkey comprises those cases previously described as parenchymatous nephritis. It is only found in the 3rd stage. Its clinical course is variable and distict from the nephroses. It only rarely leads to absolute renal insufficiency but frequently to hyposthenuria which is found simultaneously with the discovery of the albuminmuria or develops later. In nearly all the cases of amyloid kidney diminished power of dilution and excretion of water are found. Oedema is present in about half the cases but to a marked degree only in a small number. Fatty degeneration is far from constant amyloid kidney. Microscopic amyloid infiltration is often seen where it cannot be demonstrated macroscopically.

  Amyloid disease is the commonest non‐specific renal complication of tuberculosis. Then comes haemorhagic nephritis, the other forms being rare.

This work was carried out at the suggestin of Dr. Würtzen who has very kindly given me advice and afforded me every facilityi during its course, for which I am greatly indebted to him. I also have to thank him and Dr. Tobiesen for the readiness with which they placed the extensive material of the $oSresund Hospital at my disposal.
Further Contributions to the Problem of the Function of the Parathyroid Glands and the Pathogenesis of true Epilepsy
Authors: Bisgaard Axel
Published: August 2010

Ink parathyroid insufficiency conditons in man and animals dysregulation occurs, The latter can thus be emplotyed to detect insufficiency of the glands.

 No difference could be demonstrated between the dysregulation in parathyroid insufficinecy and the other cases investigated. Experiments with substitution therapy using parathyroid extract showed a perceptible orthoregulating effect in all cases (the dog excepted), and the negative or paradoxical reaction to the introduction of acid has also been identical in epilepsy, »dysregulation», and post‐oprative tetany. This group of disease therefore, seems in this point to have the same pathological basis.

 By means of the acid administration test thereis a possibility of measuring the strength of the regulatory mechanism or the capacity of the parathyroid glands.

 Parathyroid tablets (Armour's) proved to be inactive even in doses of as many as 50 tablets daily by the mouth. Nor was a subcutaneous injection of thyroid and liver extract and physiological NaCl solution active.

 Ergot fluid extract in rising doses (up to 110 drops × 4) produced tetany and dysregulatin in 2 cases which disappeared again after the ergot was stopped. Adrenalin in doses of 1 mg. subcutaneously every other hour for 5 days had no effect on the regulation.

 It may be assumed that the parathyroids have an internal secretion forming a parahormone which has a regulating action in NH3 metabolism.
Etudes sur l'achylie neurogéne et cellulaire.
Authors: Thomsen Elnar
Published: August 2010

La cholécystectomie (de même que la néphrectomie et la splénectomie) ne diminue pas les capcités sécrétoires de l'estomac.

L'intoxication d'un chien par le corps thyroïde produit certaines destructions cellulaires et de l'hypochylie, mais cesse, les glandes gastriques reprennent leur fonctionnement (fig. 7).

Les injections de toxine diphtéritique produisent une violente inflammation de la muqueuse gastrique; il s'y joint des lésions des cellules glandulaires et une achylie gastrique totale (fig. 8). Toutefois, l'épithélium cylindrique de la surface demeukre indemne.

Par l'intoxication alcoolique on produit également chez le chien une gastrite aiguë, mais d'un caractère moins violent. On peut la transformer peu à peu à peu en une gastrite chornique avec hypochylie. L'affection est l'objet d'examens attentifs aux différents stades de son évolution. Quand les glandes gastriques cessent de fonctionner, ellesmontrent presque les même détails cellulaires qu'après la section des vaues.

L'auteur compare enfin des préparations empruntées à des estomaces humains, atteints d'hypochylie et d'achylie, avec ses résultats expérimentaux (fig. 9, 10 et 11).
Untersuchungen über die Prognose der Scharlachnephritis.
Authors: Hansborg. Harald
Published: August 2010

Resumé

284 Individuen, die eine Scarlatinanephritis 1 bis 10 Jahre vorher durchgemacht haben, sind mit Hinblick auf ein Nierenleiden nachuntersucht worden.

Bei 23 wurde orthostatische Albuminurie festgestellt. Die Unabhängigkeit derselben von der Scarlatinanephritis wird bestätigt.

Bei 1 Pt. wird eine chronische Nephritis nachgewiesen, die doch nicht eine folge von Scarlatinanephritis zu seink Scheint.

Bei 259 Patienten wird bei Nachuntersuchung überhaupt kein Anzeichen eines Nierenleidens gefunden.

Bei einzelnen derselben hielt die Albuminurie 1‐3 Jahre nach der Scarlatinanephritis an, um dann zu schwinden.

Nur bei 1. Patienten wurde eine andauernde Albuminurie, durch 5 Jahre beobachtet, vorgefunden. Die Albuminurie war stets das einzigste Symptom, und ganz überwiegend von der linken Niere stammend.
»La combustion spontanée» dans les œuvres littéraires ou scientifiques.
Authors: JOSEPHSON C. D.
Published: August 2010

Dans la littérature médicale du XVII:ème—XIX:ème siècle on trouve une cinquantaine de cas de soi‐disant combustion spontanée. Ce terme signifie une combustion totale ou presque totale du corps d'un alcoolique, soit qu'on croie à un embrasement tout‐à‐fait spontané, soit qu'on admette une inflammation des gaz expiratoires, saturés de spiritueux, ou celle de la peau et des chairs, imbibés d'alcool, par un feu (chandelle allumée, pipe) placé au voisinage immédiat du sujet. On s'imaginait que l'individu pouvait ainsi être consumé au point qu'il n'en restât qu'un petit tas de cendres. Ce feu avait encore des propriétés extraordinaires; il ne pouvait pas être éteint par de l'eau (excepté peutêtre de l'eau bénite ou du purin) et il n'incendiait pas les objets entourants le sujet, comme le plancher, les parois, le mobilier etc. de la chambre. La suie de ce feu était, elle aussi, d'un caractère spécial.

En 1848, une cour d'assises allemande eut à juger une affaire de meurtre avec incendie volontaire, ce dernier ayant pour but d'effacer les vestiges du crime. L'expertise conclut d'abord à une combustion s'pontanée. La cour cependant nomma une commission scientifique, formée de savants de premier ordre, pour élucider la question. Cette commission montra avec une pleine evidence que la combustion spontanée était absolument contraire aux lois de la nature et qu'il n'y fallait voir qu'une invention de l'esprit sans le moindre fondement de vérité. Après cette époque on n'entend plus parler de la c. s. dans la littérature médicale (sauf une fois, en 1870).

Avant comme après cette époque on recontre dans les œuvres d'imagination des récits de combustion spontanée, car les romanciers trouvèrent le sujet d'un intérêt extraordinaire. En 1834, Marryat, dans son roman, Jacob Faithful, fait périr ainsi la mère de Jacob. Dickens, dans son roman Bleak House, de 1852, laisse un vieux alcoolique, le chiffonier Mr Krook, prendre feu spontanément et mourir de la même mort. Ces deux auteurs décrivent seulement le résultat final et l'impression produite sur l'entourage. Zola au contraire, en sa qualité de naturalists convaincu, donne, dans son roman Le Docteur Pascal, une description détaillée de la marche du procès, à propos de la combustion totale d'un vieux alcoolique. Dans leur details, la situation et le résultat sont chez Zola presque identiques à ceux de Mr Krook chez Dickens. En tous cas les trois auteurs précités ne laissent sub‐sister en fin de compte qu'un petit tas de cendres. Il y a pourtant une différence: chez Marryat et Dickens il s'agit d'une combustion tout à fait spontanée, Zola se montre plus moderne et mieux documenté: Macquart, plongé dans la stupeur alcoolique, brûle après avoir pris feu par le moyen de sa pipe allumée.

Désormais, sans doute, les actes de la combustion spontanée sont clos dans la littérature romanesque, comme ils le sont depuis longtemps déjà dans la littérature scientifique.
Combination of chemo‐therapy and treatment by collapse in pulmonary tuberculosis
Authors: Gravesen Johs.
Published: August 2010

The speaker emphasized the patho‐anatomical changes in which every specific chemical method as the sole therapeutic agent must prove insufficient, namely the definitely fibrotic phthisical cases with more pronounced destructive changes and such massive foci of exudative nature, the central parts of which are more or less doomed to destruction. In the case of such processes the sanocrysin may bring about a mitigation in the disease, though this mitigation may quite well lead to enlargement of an already existing cavity — or to the formation of a new one — clearly demonstrated by several clinical cases. According to the speaker's opinion, it should be emphasized that the justifiability of sanocrysin to be considered a specific for a disease of such manifold varieties as tuberculosis, should be determined only by the extent to which it was able to cure a more or less limited acute tuberculous affection. That this is the case of choibe was demonstrated by a number of cases. When it has proved capable of doing this, the next step would be to enlarge its usefulness and to combine it with such therapeutic means which have proved to be valuable in cases of anatomical changes, where sterilization alone cannot be expected to bring about complete recovery. A number of cases were demonstrated, the X‐ray pictures of which showed the various reasons for, and the possibilities and results of combining sanocrysin treatment with the different methods of collapse (artificial pneumothorax, thoracoplasty, etc.). By te aid of about sixty pictures thrown on the screen, the different forms of these two co‐operating methods of treatment were demonstrated. The speaker, in conclusion, pointed out the importance of planning the treatment for each case in such a way as to secure a direct inter‐action between the two principles involved and, by correct « dosage » of the two forms of treatment, effecting the least possible functional disturbance and the best possible result. In the experience of the speaker the two forms of treatment, so far from causing each other difficulties, were quite often of mutual assistance, even where they in particular cases were used simultaneously.
Du Calcium du Sang
Authors: Salvesen H.‐A.
Published: August 2010

C'est la glandule parathyroïdienne quil règie le taux du calcium dans le sang (1); une insufflsance parathyroïdienne se manifeste par une diminution du calcium du sang. Mais d'une diminution du calcium du sang on ne peut conclure à une insufflsance parathyroïdienne, car il est deux autres facteurs qui peuvent influencer le calcium du sang. Ce sont:

°Les matières albuminoïdes du plasma. l'auteur et le Dr Linder (2) ont montré que la diminution des albuminoïdes du plasma qu'on observe dans la néphrose et dans la néphrite détermine une diminution du calcium du sang. II est vraisemblable que c'est le calcium le moins actif qui subit la diminution; de la sorte il ne se produit pas de lélanie. Cette diminution du calcium n'est pas influencée par une médication calcique. II est faux de prétendre (Zondek) que la diminution du calcium dans les maladies de reins ne survient que quand ill existe en mêne temps une insuffisance rénale, car cette forme d'abaissement du taux du calcium apparait le plus souvent dans la néphrose, où il n'existe pas d'insuffisance résale;

°l'administration de phosphates. De même que Hastings et Mc Intosh (3), l'auteur a provoqué des convulsions tétaniques typiques chez le chien normal, en administrant de grosses doses de phosphates par voie buccale. Les convulsions sont dues à l'abaissement du calcium et disparaissent complètement avec une mêdication calcique. Le fort abaissement du calcium dans l'urémie est dû à une augmentation des phosphates du sang.

l'auteur émet l'opinion que la tétanie des enfants est due à un facteur endogène, notamment à une insuffisance parathyroïdienne relative, à laquelle s'ajoute un facteur exogène, celui‐ci agissant par une absorption exagérée de phosphates résultant de l'alimentation artificielle (lait de vache), ainsi que l'a signalé Jeppson (4).
Ueber die Patogenese des Filtrationsödems
Authors: Iversen Pout , Nakazawa Fusakichi
Published: August 2010

Wir haben die Beobachtungen Hagedorn's Rasmussen's und Rehberg's bestätigt, dass man bei Nephrosepatienten mit Ödeme derart geringe Tc Werte findet, dass dies allein ein Filtra‐tionsödem erklären kann.

Bei akuter Albuminurie stellten wir auch einen Fall von kolloidosmotischem Druck fest, der genügend gross ist, um die Entstehung des Ödems zu erklären.

Bei beiden Patientgruppen muss man vermuten, dass die Albuminu‐rie von grosser patogenetischer Bedeutung ist.

Wo Th nicht pathologisch erhöht ist, wird man Ödem der unterea Oliedmassen bei Tc niedriger als 240 bekommen können.

Bei Pt. mit Herzödem ist es bewiesen, dass stets eine Herabsetzung von Tc. besteht, diese kann sehr gering oder sehr gross sein.

Es ist verwahrscheinlicht worden, dass die Stasis‐Albuminurie bei Herzinsuffizienz eine Rolle fur diese Herabsetzung von Tc. spielt.

Die Herabsetzung von Tc kann so gross sein, dass sie in sich selbst zur Genüge die Entstehung der Ödeme erklärt, in alien Fällen spielt aber die Vermehrung des Th die von schlechtem Kreislauf her‐stammt, eine bedeutende Rolle, und ist in einigen Fällen notwendig.

Trc im Ham ist am grössten, wenn die Albuminurie am niedrigsten ist, ein Umstand, dem grosse Bedeutung beigemessen wird
A case of acute myeloic leukaemia with recovery after treatment with neosalvarsan
Authors: Holsti Östen
Published: August 2010

A case of what is considered an acute leucaemic myelosis in a 37 year old farmers wife is described. There is a history of a lifelong habitual obstipation and of a purulent oral affection since childhood. Abdominal discomfort, gastro‐enteritis and lastly signs of a severe anemia with haemorrhagic diathesis‐ precede the onset of the acute condition. The latter is marked by exazerbation of the oral affection, high fever, great prostration and development of gangrenous processes in the mouth. A bloodexamination showed 25 % Hgb, 1,490,000 erythrocytes, 45,000 white bloodcells of which c:a 80 % are myelocytes. Seven neosalvarsan injections were given intravenously within two weeks. The gangrenous areas were sponged with weak neosalvarsan solution and later the oral “sepsis” was thoroughly eradicated. Recovery took place slowly, myelocytes disappeared after two months. The patient is one year later in good health, better than for years. Her bloodpicture is normal except for a slight reduction in the haemoglobin value, which is 63 %.
Wasserstoffionconcentration und Fermentgehalt im Duodenalsaft.
Authors: NORGAARD A. , THAYSEN. TH. E. HESS
Published: August 2010

Durch eine fractionierte Aufheberung des Duodenalsafts wurde folgendes festgestellt.

Die PH‐werte der einzelnen Proben schwanken innerhalb weiten Grenzen von PH 8.5 bis > 1.0, kleinere Schwankungen sind häufiger. Die grössten Schwankungen werden durch das Einströmen des sauren Magensafts ins Duodenum, die die neutrale oder leicht alkalische Reaktion in eine stark saure ändert, hervorgerufen.

In Fällen von Achylia gastrica sind die Schwankungen der PH‐Werte viel kleiner um etw. 1.5 PH.

In einem Falle starker Hyperazidität wurde in allen Proben konstant sehr niedrige PH‐Werte gefunden.

Die Lipasemenge der einzelnen Proben ist eine sehr variierende, und schwankt im grossen und ganzen mit den PH‐Werten parallel.

Bei PH‐Werten bis 4.5‐5.0 findet man konstant eine sehr geringe Lipasewirkung, bei Werten von PH 6.5–8.5 ist die lipolytische Kraft des Duodenalsafts am stärksten, aber in den einzelnen Proben eine sehr schwankende, auch bei ungefähr derselben Reaktion.

Die Diastase und das Trypsin folgen im allgemeinen die für die Lipase aufgestellten Regeln, doch findet man auch bei relativ stark saurer Reaktion eine wenn auch nicht grosse Trypsinwirkung.

Es scheint als ob die Salzsäure die Lipase direkt zerstört.

In einem Falle pancreatogener Fettdiarrhoe wurde in allen den aufgeheberten Proben innerhalb c. 2 1/2 Stunden konstant eine sehr geringe Lipasemenge bei einem hohen und stetig steigenden PH‐Wert gefunden, was als pathologisch angesehen werden muss.
Über die Anwendung des Donnaneffektes auf Nucleinsäureverbindungen.
Authors: HAMMARSTEN. EINAR
Published: August 2010

Die angeführten Versuche heben die Möglichkeit hervor, dass die Nucleinsäure infolge ihrer relativen Stärke als Säure und der Non‐Diffundibilität ihres Anions, unter abwechselndem Einfluss von Kohlensäure und sogenannten Neutralsalzen, bedeutende Schwankungen in der Wasserstoffionenkonzentration in Zellkernen bedingen könnte. Der für solche Schwankungen zu Grunde liegende Ionenumtausch wäre eine direkte Anwendung des für die Biologie so ausserordentlich bedeutungsvollen Donnaneffektes.