bluuebunny/crossref_metadata_2025 huggingface dataset:
Nephrogenic Fibrosing Dermopathy: A Review of the Massachusetts General Hospital Experience
Authors: Goddard D. , Lio P. , Kay J. , Liu V.
Published: August 2010

We have undertaken a review of the Massachusetts General Hospital experience of nephrogenic fibrosing dermopathy (NFD). Twelve cases were identified, and the dermatopathologic features of lesional skin biopsies were examined. We looked systematically at nine parameters and graded each on a scale of 0 (minimal or none) to 3 (highest or most): 1) extent of fibrocytic proliferation, 2) extent of collagen thickening, 3) extent of vascularity, 4) extent of pannicular involvement, 5) extent of elastolysis, 6) presence of mucin, 7) presence of calcification, 8) presence of giant cells, and 9) presence of inflammation. Results demonstrate that fibrocytic proliferation, collagen thickening, inflammation, and vascularity most commonly were classified as grade 1–2; mucin deposition and elastolysis varied from 0–2; pannicular involvement ranged from 1–3; nearly all had calcification grade of 0, and there were no giant cells detected in any of the twelve cases. Comparing our results to published reports suggests that there are some interesting observations. Our cases tended to be less fibrocellular, have less mucin, and have more vascularity than the initial 14 cases described by Cowper et al (2001). The implications of the dermatopathologic findings for clinical course and prognosis are currently being evaluated.
Apparent Reactivation of a Fibrohistiocytic Proliferation with Features of Dermatofibroma and Dermatomyofibroma Following Systemic Immunosuppression
Authors: High W.A. , Charissi C. , Cruz P.D. , Ehrig T. , Cockerell C.J.
Published: August 2010

A 41 year‐old man presented with an atrophic, hyperpigmented plaque on the right lower abdomen present since“birth”. He denied any prior activity at the site, and had been told it was a “scar” from a prenatal insult. Six months earlier, he developed idiopathic focal sclerosing glomerulonephritis and was placed on 70 mg prednisone per day. He had not demonstrated evidence of lupus eythematosus. Shortly after beginning this regimen, erythematous and tender papules developed around the quiescent plaque. He had tapered his prednisone dose to 60 mg per day, but additional papules continued to erupt. An ellipse biopsy was performed which included a portion of the atrophic plaque and several surrounding papules. Histological examination revealed a proliferation of fibrohistiocytes between and amongst collagen bundles. In some areas, fibrohistiocytes entrapped collagen in a fashion reminiscent of a dermatofibroma. In other areas, particularly that of the atrophic plaque, the fibrohistiocytes were less numerous and more delicate in appearance. Scattered rudimentary fascicles were demonstrated. Adnexal structures were preserved. Immunohistochemical staining revealed the fibrohistiocytes to be positive for factor XIIIa and actin, but negative for desmin, CD34, S‐100, procollagen I, and CD68. This lesion demonstrated unique clinical/histiological aspects not well characterized in the literature.
Androgen Receptor Expression Helps to Differentiate BCC From Trichoblastoma and Trichoepithelioma
Authors: Izikson L. , Bhan A. , Zembowicz A.
Published: August 2010

Histological differentiation between basal cell carcinoma and benign trichoblastic neoplasms such as trichoepithelioma and trichoblastoma can be difficult on small biopsies. Therefore, several attempts have been made to identify immunohistochemical differences between these entities. Recent studies showed androgen receptor expression in a number of mature epithelial structures in the skin and in epithelial neoplasms including basal cell carcinoma. In contrast, androgen receptor expression was absent in mature hair follicles or the few trichogenic neoplasms studied to date. These findings suggested that androgen receptor expression might be a useful adjunct in the histological differential diagnosis between basal cell carcinoma and benign trichoblastic neoplasms. Therefore, we performed immunohistochemical analysis of androgen receptor expression in 32 basal cell carcinomas and 10 benign trichoblastic tumors (6 trichoepitheliomas and 4 trichoblastomas). In our study, expression of androgen receptor was detected in 78% of basal cell carcinomas. None of the trichoblastic tumors showed any androgen receptor immunoreactivity. These results confirm the lack of androgen receptor expression in benign trichoblastic neoplasms and indicate that finding of androgen receptor expression points to basal cell carcinoma as the most likely diagnosis.
Eccrine Mucinous Metaplasia Associated with An Apocrine Cystadenoma
Authors: Jiang J , Petronic‐Rosic V , Hoag J , Shea CR
Published: August 2010

Mucinous metaplasia occurs uncommonly in cutaneous pathology, usually at specialized anatomic locations (genitalia, palms, soles) and within restricted pathologic contexts (inflammation, trauma). Here we report a unique case of eccrine mucinous metaplasia associated with an apocrine cystadenoma. A 13‐year‐old girl had an asymptomatic, 4‐mm nodule on the chest. Histopathology demonstrated a typical apocrine cystadenoma in the upper and middle dermis. Adjacent to this neoplasm was a cluster of coiled eccrine secretory ducts, of which the inner layer was almost entirely replaced by benign‐appearing cells containing abundant, non‐sulfated acid mucopolysaccharides. At eight months’ follow‐up, there was no recurrence. Our case demonstrates that, very uncommonly, mucinous metaplasia may be associated with a pathogenetically separate, adjacent neoplasm, in this instance an apocrine cystadenoma.
Congential Nevus Mimicking Melanoma in Infancy
Authors: Keehan P. , Rye B. , Cockerell C.
Published: August 2010

A five‐month old girl presented with a 5 cm brown patch on her right lower leg. The lesion had a 6 mm area of hyperpigmentation that was removed by shave biopsy for pathologic diagnosis. The clinical diagnosis at the time was that of congenital nevus but the multicolored appearance of the lesion raised the index of suspicion for melanoma. Histology revealed junctional activity with melanocytes distributed in the dermis including migration around appendages and among collagen bundles as seen in congenital nevi. However, there were some unusual features that warranted careful analysis. The lesion was asymmetric, with numerous single melanocytes in confluence at the dermo‐epidermal interface. Single cells and nests were noted in the epidermis. Our case illustrates a congenital nevus with atypical patterns easily confused with those of melanoma. Our lesion exhibited pagetoid melanocytes, which is considered virtually diagnostic of melanoma. However, these melanocytes were monomorphous as opposed to the pleomorphic appearance found in melanoma. Additionally, there was evidence of cellular maturation in the dermis as well as a lack of variance in nest size, which favors the diagnosis of congenital nevus1.
Congenital Erosive and Vesicular Dermatitis with Reticulated Scarring
Authors: Lian F. , LI A. , Maberry S. , Cockerell C.
Published: August 2010

Congenital erosive and vesicular dermatitis healing with reticulated scarring is a rare entity presenting in the early childhood. It is manifest as crusted erosions and vesicles that heal relatively rapidly forming unique reticulated scars. Cohen first reported this entity in 1985 and since then, only ten patients have been reported. We herein report an additional case of this extremely unusual disorder. A 23 month‐old girl who was noted to have “rashes” and sores over her body at birth. Her twin sister was unaffected. She was born preterm at 35 weeks gestation but her developmental milestones have been within normal range. On exam she had depressed and somewhat macerated erosions and erythema primarily on her trunk, axillae, and ears. No vesicles or bullae were present. The skin biopsy showed neutrophilic and eosinophilic infiltrates with abundant crusting. Cultures were negative for infectious agents and direct immunofluorescent studies were also negative. Over the next two years she periodically developed erosions which healed quickly. However, the depressed reticulated scars have persisted and are more sensitive to sun exposure. This scarring disorder may be associated with mild ongoing blistering and must be distinguished from other congenital blistering disorders and immunobullous diseases. The pathophysiology remains unclear.
Cutaneous Congenital Plexiform Cellular Schwannoma: A Simulant of Malignant Peripheral Nerve Sheath Tumor of Childhood – A Case Report and Literature Review
Authors: Matthews M. , Raj J. , Charissi C. , Cockerell C.
Published: August 2010

Cutaneous plexiform schwannoma is a rare multilobulated variant of benign schwannoma. When presenting as the cellular subtype with significantly increased proliferative rate, diagnostic consideration of a malignant peripheral nerve sheath tumor is prompted. However, follow up demonstrates a benign natural history with propensity for local recurrence and typical lack of association with neurocutaneous syndromes. These lesions most commonly occur as cutaneous and subcutaneous masses of the extremities in the first four decades. Only 9 cases of congenital tumors are reported. A case of congenital plexiform cellular schwannoma, presenting as a cutaneous mass measuring 3.5 × 2.5 × 2.0 cm, excised from the left upper arm of a 16 month old female is discussed. Regions of increased cellularity and proliferation co‐localized and were unassociated with nuclear anaplasia. Mitotic figures numbered 7 per 10 400x fields. The tumor cells were strongly immunoreactive for S‐100 protein. The MIB‐1index was multifocally 25% and p53 protein over expression was present in 50% of nuclei. Following excision with free margins the tumor locally recurred after 16 months. The recurrence was morphologically identical to the original lesion. Recognition of the clinical and morphological characteristics of this rarely encountered benign neoplasm will facilitate in diagnosing this entity.
Metastatic Esophageal Carcinoma Masquerading as Inflammatory Breast Carcinoma
Authors: Nebesio C. L. , Yuraitis M. , Helft P.R. , Goulet R.J. , Billings S.D.
Published: August 2010

Metastasis to the breast from extramammary neoplasms is rare. Such metastatic neoplasms can mimic inflammatory breast carcinoma clinically and histologically, presenting a diagnostic challenge. A 50‐year‐old woman with a history of esophageal adenocarcinoma in clinical remission presented with rapid onset unilateral breast swelling with warmth and erythema. Based upon the clinical presentation, an underlying breast carcinoma was suspected. A punch biopsy revealed a poorly differentiated adenocarcinoma with extensive involvement of the dermal lymphatics. The clinical and histologic differential diagnosis included inflammatory carcinoma secondary to a primary breast carcinoma vs. metastatic esophageal adenocarcinoma to the skin of the breast. To resolve this question, immunohistochemical stains for estrogen and progesterone receptors and CDX‐2 were performed. CDX‐2 is an intestinal homeobox gene that is expressed in intestinal epithelium and tumors with intestinal differentiation including esophageal adenocarcinoma. CDX‐2 expression has not been reported in breast carcinoma. The tumor cells were positive for CDX‐2 but negative for both steroid receptors. The diagnosis of metastatic esophageal adenocarcinoma to the skin of the breast was confirmed. This case emphasizes the importance of confirming the tumor lineage in inflammatory carcinoma of the breast. CDX‐2 can be a useful tool in establishing a gastrointestinal origin of cutaneous metastases.
Respiratory Epithelial Orbital Cyst: Report of a Case and Review of the Literature
Authors: Pasternak S , Humayun M , Walsh N
Published: August 2010

Orbital cysts include the common epidermoid and dermoid cysts, cysts of conjunctival origin and cysts lined by respiratory‐type epithelium. Respiratory epithelial cysts are exceedingly rare and have been reported in common locations for dermoid cysts (superotemporal and superonasal anterior orbit) and in sites atypical for dermoid cysts. Most represent maxillary sinus mucoceles extending into the orbital floor. In some patients, a history of orbital trauma or previous sinus surgery has been implicated in the implantation of the respiratory epithelium in the orbit. Rarely, the respiratory epithelial cyst has been considered to be a choristoma. We report the case of a 72‐year‐old woman who presented with a cyst in the anterior superotemporal orbit. There was no history of recent or remote trauma. The clinical impression was of a dermoid cyst. Histopathologic examination revealed a cyst lined by non‐keratinizing squamous epithelium. A few goblet cells were present and focally, short strips of ciliated mucin secreting columnar cells were identified. The histopathologic findings were those of a respiratory epithelial cyst of the orbit. Given the rarity of this entity, valuable information can be gleaned from critical evaluation and reporting of new cases, in the context of existing data in the literature.
Differential Expression of JunB in Cutaneous CD30‐Positive Disorders
Authors: Perna A.G. , Major A. , Reed J.A. , Lopez‐Terrada D.
Published: August 2010

Although some classic differences exist histologically between malignant and benign CD30‐positive lymphoproliferative disorders of the skin, the distinction can only be made by correlation with the patient’s clinical course. There has been limited investigation into the genetic abnormalities seen in this class of disorders. Cutaneous ALCL has been shown to exhibit increased expression of JunB, but differences in expression of JunB between c‐ALCL and benign CD30‐positive cutaneous lymphoproliferative disorders have yet to be evaluated. A study to determine the prevalence of JunB coexpression in CD30‐positive cells of primary cutaneous anaplastic large cell lymphoma and benign CD30‐positive disorders of the skin was undertaken. The two c‐ALCL cases had an average of 98.3%(+/− 0.7%) of CD30‐positive cells coexpressing JunB and the seven benign CD30‐positive disorders exhibited an average of 88.9%(+/− 7.4%) of CD30‐positive cells coexpressing JunB. There was a trend towards lower JunB and CD30 coexpression with benign CD30 lesions compared to cutaneous ALCL, but with our limited sample size, this difference did not achieve statistical significance. Further investigation is needed to more fully evaluate the sensitivity of the expression of JunB and other proteins as markers for clinical behavior in CD‐30 positive lymphoproliferative disorders.
Trends in Clark Level and Breslow Thickness of Invasive Cutaneous Malignant Melanoma over a 50‐Year Period in Olmsted County/Rochester, MN
Authors: Pierson D. , Subtil A. , Pittelkow M. , Scott C. , Weenig R. , Vachon C.
Published: August 2010

Incidence of invasive melanoma is reported to be steadily increasing worldwide. Whether due to an actual increase in disease, or increased surveillance and changes in diagnostic criteria, or both is unknown. The purpose of this study was to analyze Clark Level and Breslow thickness trends in a population‐based sample over five decades. All cases of invasive melanoma, a total of 200, diagnosed from 1985–1999 were identified using the Rochester Epidemiology Project that incorporates medical‐surgical index information for all residents of Rochester/Olmsted County. These findings updated two previous studies of invasive melanoma from 1950–1985, resulting in 296 total cases over the 1950–1999 period. The incidence of Clark level II lesions increased from 0% in 1950–1959 to 51% in 1990–1999, while Clark level V lesions decreased from 38% to 4%. Moreover, the incidence of lesions with Breslow 4 mm decreased from 25% to 7%. These variations were found to be statistically significant (p = <0.01). The decreases in Clark level and Breslow thickness seen in this population‐based sample over the last 5 decades suggests that a significant component of increased invasive melanoma incidence may be explained by increased surveillance and earlier detection.
Glomus Coccygeum: Report of a Case
Authors: Rahemtullah A. , Szyfelbein K. , Zembowicz A.
Published: August 2010

The glomus coccygeum is a vestigial structure related to the canals of Sucquet‐Hoyer, an arteriovenous anastomosis surrounded by glomus cells derived from modified smooth muscle and involved in thermoregulation. It is an incidental finding in specimens from the sacral area and may represent a diagnostic challenge to the unaware observer. We present a case of a glomus coccygeum, presenting as a 1.5 mm structure adjacent to a typical pilonidal cyst excised from a 7‐month‐old boy, that was the subject of a second opinion consultation. The lesion showed small to medium sized clusters of predominantly epithelioid cells with moderate amounts of clear to eosinophilic cytoplasm, intercellular borders and plump, round nuclei with fine chromatin. These cells were closely associated with small vascular channels and nerves. Immunohistochemistry revealed that the epithelioid cells expressed vimentin, muscle‐specific actin, neuron‐specific enolase, and S‐100 protein, were weakly positive for smooth muscle actin, and negative for desmin, synaptophysin and chromogranin. The endothelial cells of the vascular channels were antibody CD31 positive. Recognition of the histological features of glomus coccygeum is important to avoid confusion with glomus tumor and neural or smooth muscle neoplasms in the sacral area.
Will Skin Pathologists ever be Replaced by Noninvasive Diagnostic Tools (Computers)?
Authors: Rao B. , Katz B. , Wei N. , Park P.
Published: August 2010

Title: Will skin pathologists ever be replaced by noninvasive diagnostic tools (computers)? Intro: There are now many new non‐invasive tools being developed to diagnose skin cancer, specifically melanocytic neoplasms. Whether these tools will ever be able to diagnose as well as a pathologist remains to be seen. In this paper, we will review most of the newly developed tools and discuss their specificity, sensitivity and diagnostic accuracy. Method: We reviewed the literature on currently available noninvasive diagnostic tools to find the published sensitivity and specificity rates of these tools. Tools without published information on their diagnostic accuracy were not included. We tabulated the accuracy data on the remaining tools and evaluated their relative diagnostic accuracy. Results: Melafind was found to have a specificity of 68–85% and a sensitivity of 95%–100%. Siascope was found to have a specificity of 82.7% and a sensitivity of 80.1%. Solarscan was found to have a specificity of 83% and a sensitivity of 100%. Comments: Non‐invasive tools may be helpful in managing melanocytic neoplasms in patients with numerous lesions or with lesions in a cosmetically important site i.e. face. At present these tools cannot replace the value of a biopsy, microscopically reviewed by a pathologist.
Mycosis Fungoides Mimicking Lichen Planus
Authors: Rao Babar K. , Merino Janet , Rahman Irfan
Published: August 2010

Introduction: To report an uncommon case of mycosis fungoides in a 62‐year‐old female. Case presentation: A 62‐year‐old Black female presented to our clinic with a wide spread of hyper‐pigmented erythematous grayish plaques on trunk, extremities and face. There were no associated systemic illnesses and laboratory work was otherwise within normal range. Two skin biopsies were taken from the trunk and extremity. Both of the biopsies reveal similar features of coexisting like lichen planus and mycosis fungoides. There was interface dermatitis, vacuolar degeneration, prominent colloid body formation and lichenoid lymphonocytic inflammation through out the dermis. Epidermis was atrophic with overlying hyper and parakeratosis. There were many areas of epidermotrophism with collections of atypical lymphocytes. There was also marked pigmentory incontinence in the dermis. Comment: We present an uncommon case of mycosis fungoides with changes of lichen planus. It is important familiarise oneself with uncommon presentations of mycosis fungoides. It may be worthwhile to look for mycosis fungoides, while reviewing a classical case of lichen planus with clinical presentation of lichen planus.
Cutaneous Metastasis: A Single Institution Clinical and Histopathologic Experience
Authors: Sariya D. , Adams‐McDonnell R. , Cusack C. , Xu X. , Elenitsas R. , Seykora J. , Pasha T. , Zhang P. , Baldassano M. , Lessin S. , Wu H.
Published: August 2010

Forty‐four cases of biopsy‐proven cutaneous metastases from internal organ or soft tissue malignancies were retrieved at a single institution from 1990 to 2004. All cases had detailed clinical and follow‐up data. There were 19 males and 25 females, with a wide age range (37–86 years). Most (75%) had advanced (stage IV) disease at the time of metastasis. In four patients skin metastasis was the presenting lesion. The most common primary site for men is lung and for women, breast and lung. In nearly half of patients cutaneous metastasis was not the clinical diagnosis. The prognosis was grave (67% died of disease within a median of 7 months). Independent, blinded review by four dermatopathologists showed that without a detailed clinical history, most metastases from carcinomas were correctly suspected based on histologic patterns. However, metastases from small cell carcinomas and sarcomas were difficult to distinguish from primary skin tumors. Histologic recognition of a primary site was often difficult without pertinent clinical history. None of the metastasis had a combined immunohistochemical profile of B72.3 (−), CA125 (−), calretinin (+), p63 (+) and CK5/6 (+), which was commonly seen in skin adnexal tumors. This immunohistochemical panel appears to best differentiate the two entities.
Cutaneous Hyalohyphomycosis Secondary to Paecilomyces Species Treated with Voriconazole in an Immune Compentent Host
Authors: Skelton H. , Edwards H. , Smith K.
Published: August 2010

Paecilomyces, a hyalohyphomycosis, is an uncommon cause of cutaneous and subcutaneous infections. Most cases reported have occurred in patients with impaired host defenses or following a surgical procedure, and have proven highly resistant to anti fungal therapies. A 60‐year‐old man presented with scattered non‐healing verrucous lesions as well as ulcers and excoriations on the upper extremities and trunk. The lesion had begun shortly after the patient was scratched by prickly okra. The patient had no underlying health problems and he was on no medication. Histology revealed epidermal hyperkeratosis, acanthosis, with papillomatosis with intraepidermal micro‐abscess formation. Within the dermis there was a mixed acute and chronic granulomatous infiltrate. With GMS stain numerous pleomorphic yeast forms and pseudohyphael forms were seen. Cultures confirmed Paecilomyces species. The patient was treated with Voriconazole with complete resolution of his lesion. Paecilomyces is an emerging fungal pathogen, which in our immune competent patient manifest as widespread cutaneous disease.
Porokeratosis Causing Change in Melanocytic Nevi
Authors: Thompson CT
Published: August 2010

Porokeratosis is an uncommon cause of clinical change in pigmented lesions. We report two cases of so‐called “collision” lesions, in which the cause of clinical change in melanocytic nevi was porokeratosis. One biopsy was submitted concurrently with a biopsy from another anatomic site, which was a superficial pattern basal cell carcinoma. Both the melanocytic nevus and the basal cell carcinoma contained coronoid lamellae, focal diminution of the granular layer and subjacent dyskeratotic keratinocytes, consistent with disseminated superficial actinic porokeratosis (DSAP). The melanocytic nevus, from the lower back, was a broad compound melanocytic nevus, associated with elongated, pigmented rete (lentiginous) and small melanocytes in the papillary and superficial reticular dermis (superficial congenital pattern). There was no evidence of external irritation. The second case showed a similar coronoid lamella, focal diminution of the granular layer and dyskeratotic keratinocytes. There was additional parakeratosis away from the parakeratotic column and a lichenoid host response, suggesting external irritation.
Primary Malignant Mesothelioma Presenting as an Umbilical Tumor
Authors: Tomaszewski M‐M. , Lupton GP
Published: August 2010

Malignant mesothelioma presenting as a primary umbilical tumor is not reported in the English literature, to our knowledge. We present a 63‐year‐old woman with a painless and initially skin colored nodule in the umbilical area, which within one month became erythematous. The performed biopsy revealed an infiltrating glandular and ductal proliferation involving the dermis, subcutaneous fat and underlying skeletal muscle embedded in a loose and mucinous stroma. The tumor cells were of medium size with round to oval nuclei and prominent nucleoli. Mitoses were conspicuous. The tumor cells showed a positive reaction for kermix, EMA, CK5/6, calretinin and CK7 and a negative reaction for CK20, CEA, Ber‐Ep4, S100 protein, TTF‐1, PRP, ERP, and Leu‐7. Since calretinin is both a sensitive and specific marker of reactive and neoplastic mesothelial cells, a diagnosis of malignant mesothelioma, epithelioid variant, was made. The performed exploratory laparotomy showed no evidence of malignancy and wide excision of the umbilical area showed no evidence of residual tumor. Follow‐up examinations of the patient with repeated CT scans for the past two years were negative for recurrent or metastatic disease. We conclude that this malignancy likely developed in a setting of umbilical abnormalities associated with mesothelial remnants.
Anaplastic Large Cell Lymphoma Masquerading as an Infectious Syndrome
Authors: Wolgamot G. , Chien A. , Kussick S. , Olerud J. , Argenyi Z.
Published: August 2010

The clinical manifestations of anaplastic large cell lymphoma can be remarkably deceptive. A 41‐year‐old female presented with fever, productive cough, fatigue, arthralgias, and lymphadenopathy. She had been camping in the Southwest, and had visited some bat caves. At the same time, her son developed a similar illness. The patient’s white cell count was 23,000, and radiology demonstrated diffuse bilateral infiltrates. Extensive workup for bacterial and fungal organisms were noncontributory, however, a viral exposure could not be excluded. The patient subsequently developed an umbilicated vesicular rash on her torso. Initial skin biopsies showed a perivascular mixed infiltrate, with no evidence of microorganisms. After clinical progression, a subsequent skin biopsy demonstrated a perivascular infiltrate of large mononuclear cells, with vesicular nuclei and abundant cytoplasm, immunophenotypically characteristic of anaplastic large cell lymphoma. With elucidation of the process, lymphomatous involvement of the blood, pleural fluid, CSF, and nodal tissue was identified. Despite chemotherapy, the patient passed away. Exposure to an infectious agent may have unmasked the patient’s lymphoma.
Balloon Cell Melanoma: Case Report
Authors: Yemelyanova Anna , Dugan Elizabeth M.
Published: August 2010

Balloon cell melanoma (BCM) is a rare histological variant of amelanotic melanoma. The differential diagnosis of clear cell lesion includes BCM, renal cell carcinoma, clear cell sarcoma as well as a number of histiocytic and infectious processes. We report a case of BCM in a 33 year‐old Indonesian man who presented with a non‐tender, freely movable, non‐pigmented left thigh nodule, which had been present for a year. On microscopic examination tumor consisted of a nodular infiltrate present within the dermis with superficial invasion of subcutaneous fat. Tumor cells formed nested aggregates were relatively bland in appearance and had abundant, clear cytoplasm, enlarged nuclei and prominent eosinophilic nucleoli. Rare mitotic figures were present within the deep portion of the neoplasm. No definitive nests were seen at the dermal epidermal junction or within the epidermis. Histochemical stains AFB, PAS/D, and GMS were negative. Immunoperoxidase studies were positive with antibodies to vimentin, S100, HMB45, CD68, and negative with cytokeratin, Factor XIIIA, and lysozyme. The diagnosis of BCMM was favored based on histological features, and immunoperoxidase staining pattern. We believe this case can provide additional information to help establish diagnostic criteria of this rare variant of melanoma.
Progressive Mucinous Histiocytosis
Authors: Young A. , Olivere J. , Yoo S. , Martins C. , Barrett T.
Published: August 2010

Progressive mucinous histiocytosis is a rare, benign, non‐Langerhans cell histiocytosis limited to the skin. A total of ten cases, all women, in four families, and one sporadic case have been described in the English literature. The disorder usually begins in childhood and progresses slowly. We report two sporadic cases of adult‐onset progressive mucinous histiocytosis in unrelated African American women, age 48 and 55 years old respectively, who developed red‐brown and flesh‐colored, asymptomatic papules on the face, arms and legs without truncal, mucosal or visceral involvement. The lesions show no spontaneous regression. Both patients lack associated systemic symptoms including polyuria, polydipsia or seizures. There is no underlying hyperlipidemia, paraproteinemia or lymphoproliferative disease. No family history of similar lesions can be identified. Light microscopy reveals dermal proliferation of spindle‐shaped histiocytes with abundant mucin deposition. Electron microscopy demonstrates a high number of myelin‐figures or zebra bodies in the cytoplasm of histiocytes. On immunohistochemistry, positive staining with macrophage markers CD68, HAM56 and lysozyme, and Factor XIIIa, a transglutaminase present in dermal dendrocytes, and negative staining with Langerhans cell markers CD1a and S100, and CD34, a marker present in dermal dendritic cells derived from uncommitted mesenchymal cells, are observed.
I Forgot to Shave My Hands: Spiny Keratoderma of the Palms and Soles
Authors: Han Amy , Torres Gisela , Castrovinci Anthony , Gilliam Anita C.
Published: August 2010

A 57 year‐old Caucasian man presented with multiple, asymptomatic, spiny papules on the palms and soles that he had been shaving off with a razor for many years. He was otherwise healthy with no personal or family history of any skin disease. The clinical impression was punctate porokeratosis. Histology revealed columns of parakeratin arising from epidermis with underlying hypogranulosis. There was no associated dyskeratosis, vacuolization, or dermal infiltrate beneath the parakeratotic column. A diagnosis of spiny keratoderma of the palms and soles or “music box spine dermatoses” was made. Spiny keratodermas encompass a group of rare hereditary and acquired diseases. This entity was previously classified as porokeratosis palmaris et plantaris, porokeratosis punctata, or punctate porokeratotic keratoderma. The clinical, histologic, and electron microscopic features of spiny keratodermas are distinct. This entity should be distinguished from porokeratosis and punctate keratodermas which can be linked to cutaneous and internal malignancies, respectively. In the acquired form, spiny keratodermas have been reported to be associated with polycystic kidney disease, liver cysts, Darier’s disease, and hyperlipoproteinenia. Spiny keratoderma does not resolve spontaneously and treatment is very difficult.
Postanginös Sepsis durch hämolytische Streptokokken bedingt
Authors: Tesdal Martin
Published: August 2010

Zusammenfassung:  Ein geheiter Fall von postanginöser Sepsis, durch hämolytische Streptokokken verursacht, wird näher geschil dert. Die Badterien wurden in mehreren Blutkulturen in abnehmender Menge während des Krankheitsverlaufes nachgewiesen. Ein morphologisch und kulturell ähnliche Bakterienart wurde in einem Abscess am Halse gefunden. Klinische Besserung trat ungefähr gleichzeitig mit der Abgrenzung eines diffusen perivasculären cervi‐calen Infiltrats ein. In der ersten Blutkultur liess sich eine deutliche Zunahme der Bakterienanzahl in den Virulenversuchen nachweisen. Die prognostische Bedeutung der Virulenzversuche samt der Blut‐transfusion von geeigneten, beimpften Spendern wird erläutert.
Die Bedeutung der Hauttemperaturen für das Verständnis des fieberhaften Zustandes
Authors: IPSEN. JOHANNES
Published: August 2010

Die Aufgabe dieser Arbeit ist zu untersuchen, ob man durch Messung der Hauttemperatur darüber Aufklärung bekommen kann, ob bei Fieber eine Wilrmeretention stattfindet, oder ob ein gesteigerter Stoffwechsel das Fieber erzeugt.

Die Wärmeabgabe geschiet zum grösstem Teil durch die Haut (92%), teils durch Verdampfung von dieser, teils durch Wärmeausstrahlung. Es wird besprochen, wie diese beiden Faktoren von der Hauttemperatur abhängig sind, sodass wir in dieser ein Mass für die Wärmeabgabe haben.

Die Temperatursteigerung ist teils am Fieber nach Sulfosininjektionen (Schroeder), teils bei Malariaanfällen untersucht. Hauttemperaturen wurden an verschiedenen Stellen des Körpers teils in einem Vorstadium, teils während des Anfalles gemessen und mit der Rektaltemperatur verglichen.

Es zeigte sich, dass die Hauttemperatur an den meisten Stellen der Körpertemperatur parallel stieg, nur in einigen Fällen trat ein Sinken an den Füssen allein ein, ein Verhältnis, das doch auf Grund seiner Beschränkung nicht das Totalbild Sindern kann. Dasselbe zeigte sich auch während eines Versuches, der unter exakten äusseren Bedingungen vorgenommen wurde.

Aus den Venuchen ergab sich mit Sichetheit, dass bei dem Sulfosinfieber und bei den Malariaanfällen keiae Warmeretention stattfindet. Die Sieigerung der Körperlemperatur muss deshalb einer gesleigerlen Wärmeproduciion, einem gesleigerlen Sloffwechsel, zugrundeUegen.

Während die durch Steigerung des Stoffwechsels vermehrte Wärmemenge bei Mb. Basedowii durch verhältnismässig hohe Hauttemperaturen reguliert wird, sodass die Körpertemperatur normal bleibt, ist das nicht der Fall bei Fieberzuständen, jedenfalls nicht in den untersuchten Fällen. Man regulieri beim Fieber nichi oder nur in geringem Grade mit den Hautgefässen.
Individual Variations in the Relation between Urea Clearance and Creatinin Clearance
Authors: Bing Iens , Bjering Tage
Published: August 2010

Earlier investigators (HAYMAN, HALSTED and SEYLER, BJERING, COPE) have shown that the relation between urea clearance and creatinin clearance is fairly constant in both healthy persons and renal patients and that it lies at about 0.50.

Examples are given, whereafter it is shown that in some patients with »nephrosis» there are considerable individual variations from the normal value, so that sometimes the relation is found to be constant at about 0.25 and at other times about 0.75, the examinations being spread over periods up to more than three years. In all cases the individual patient also shows a distinctly wide margin between the figures, for which no explanation can be offered as a rule, for it can be seen to be due neither to variation in diuresis nor to dietetic changes. According to the present view of the excretion of the two substances, the variations must presumably be the result of the changes in the tubules, and whereas the creatinin clearance provides an indication of changes in the glomerular function, the urea clearance thus provides a measure of the sum of the changes in glomeruli and tubuli.

The authors discuss the applicability of »standard clearance», and suggest that it should at any rate only be employed when the concentration index for urea is above 75.
Klinische Studien über den chronischen Gelenkrheumatismus
Authors: EDSTRÖM GUNNAR
Published: August 2010

242 Fälle von Febris rheumatica c. arthritis chron. und 262 Fälle von Polyarthritis rheumat. chron. sind hinsichtlich ihrer prodromalen Krankheitsbilder untersucht worden.

In diesem ersteren Material waren in der Zeit unmittelbar vor dem klinischen Ausbruch des akuten Polyarthritis‐Syndroms klinische Zeichen einer Tonsillitis oder Peritonsillitis bei 49% der Fälle (297mal von 602 sicher festgestellten Erkrankungen) und Zeichen eines anderen infektiösen Zustands in Naso‐Pharynx, Larynx und Ohrengegend in 19% (114mal von 602 Erkrankungen) vorhanden. In 28 ½% war kein prodromaler infektiöser Zustand mit bestimmtheit zu konstatieren.

In der letzteren Hälfte des Materials, die Fälle von Polyarthritis rheumat. chron., waren die entsprechenden Hundertsätze 10%, 5% und 73%. Insgesamt in nur 50 Fällen, d. h. 19%, waren hier prodromale Infektionen der Mundhöhle, des Rachens oder der oberen Luftwege zu verzeichnen. Wie vieles ist hier auf das Spiel des Zufalls zurückzuführen? Gibt es überhaupt hier einen Zusammenhang von derselben oder analogen Bedeutung wie bei den Febrisrheumatica‐Fällen?

Die Frage der Bedeutung der Fokalinfektion wird im Anschluss daran kurz gestreift.
Über die Natur des normalen gelben Harnfarbstoffs Urochrom und seine Beziehung zum Uroerythrin
Authors: WEISS M.
Published: August 2010

Der normale gelbe Harnfarbstoff Urochrom ist durch die alkalischen Valenzen des Harns mit gelber Farbe gelöstes Uroerythrin.

Beide Farbstoffe können durch colorimetrischen Vergleich mit den gleichen künstlichen Farbmischungen quantitativ bestimmt werden.

Die stärkste Urochrom‐Uroerythrinausscheidung wird bei totalem Gallenwegsverschluss im Beginne der Erkrankung beobachtet. Sie beträgt hier rund 350 mg p. d., während normalerweise nur etwa 70 mg durch den Harn ausgeschieden werden.

Die Menge von 350 mg dürfte auch die im normalen Stoffwechsel eines Erwachsenen gebildete Quantität sein, von der physiologisch der grösste Teil durch die Leber abgebaut wird.

Das Urochrom‐Uroerythrin gehört zu den Stauungszeichen des Harns. Je grösser die durch die verschiedensten Ursachen auslösbare Behinderung der Lebercirkulationen ist, umso mehr nähert sich der im Harn aufscheinende Wert dem bisher festgestellten Maximum von 350 mg.

Die Urochrom‐Uroerythrinausscheidung ist bei schweren Nierenschädigungen (Schrumpfniere), ebenso aber auch bei kachektischen Zuständen der verschiedensten Art und im Senium vermindert.

Es wird hypothetisch die Abstammung des Urochrom‐Uroerythrins aus einem in den Zellen bezw. Zellkernen enthaltenen Farbstoff erörtert und die bei den Eiterkörperchen sichtbar in Erscheinung tretende Gelbfärbung damit in Zusammenhang gebracht.
Sur un effet curieux de l'acide nicotique (hyperémie périarticulaire)
Authors: ASK‐UPMARK ERIK
Published: August 2010

L'auteur décrit le cas d'une femme de 31 ans, souffrant depuis 4 ans d'un état post‐encéphalitique et qui réagit à l'administration d'acide nicotique par une intense hyperémie cutanée, exclusivement localisé dans la peau des articulations des extrémités. Il effleure, dans la discussion du cas, la question d'un lien éventuel entre le tronc cérébral et les articulations.
Studien über die Regulation vom Citronensäuregehalt des Blutserums II
Authors: ALWALL NILS , NILSBY IVAR
Published: August 2010

Verschiedene Forscher haben geltend machen wollen, 1) dass die Verbrennung der Citronensäure im wesentlichen in der Leber vor sich gehe; die Hypercitrikämie bei Leberschäden sei cine natürliche Folge der Hemmung dieser Leberfunktion; 2) dass die Nieren eine starke und die Leber eine nur geringe Fähigkeit besitze, Citronensäure zu eliminieren; eine sekundäre Nierenschädigung wird als mögliche Erklärung fär die Steigerung des Citronensäuregehalts im Blutserum (C/S) bei Leberkrankheiten angesehen. Die Versuche, auf die sich die letztere Ansicht gründet, sind an narkotisierten Tieren ausgeführt worden.

Die vorliegende tierexperimentelle Untersuchung an Kaninchen will die Frage nach der Bedeutung der Nieren (und der Leber) für die Citronensäureverbrennung sowie die Einwirkung der Narkose auf den C/S unter wechselnden Versuchsbedingungen beleuchten. Die folgenden Ergebnisse erscheinen wichtig:

Einc sukzessive und starke Erhöhung des vorher normalen oder suhnormalen C/S vollzieht sich in den ersten Stunden nach a) Nephrektomie in mässig tiefer Urethannarkose (wie schon von einem andern Untersucher gezeigt worden ist) oder kurzem Ätherrausch sowie b) Zuziehen von einige Stunden vorher im Ätherrausch angelegten lockeren Ligaturen urn die Nierenstiele.

Eine solche Steigerung des C/S nach Nephrektomie blieb in den moisten oder mehreren Versuchen aus, a) wenn zwischen dem Ätherrausch und der Abschnürung der Nieren durch bei der Narkose angelegte Ligaturen 1–2 Tage verflossen waren, b) wenn die Nieren in sehr leichter Urethannarkose entfernt wurden.

Bei tiefer Urethannarkose kann der C/S ohne Nephrektomie steigen.

Bei Belastung durch subcutan oder intravenös zugeführte Citronensäure vor und nach der Abschnürung der Nieren unter den bei II a genannten Bedingungen fanden wir, dass die Herausnahme der Nieren nicht die Fähigkeit dieser Tiere vermindert, nach einer gewissen C/S‐Steigerung für kürzere Zei t die einverleibte Citronensäme zu eliminieren.

Die Bedeutung dieser Befunde wird erörtert. Beide obenerwähnten Forscher därften recht haben: nicht nur die Nieren, sondern auch die Leber (im nierenlosen Organismus dürfte die Citronensäure im wesentlichen inder Leber abgebaut werden) vermag in vivo Citronensäure in grossem Ausmass zu verbrennen. Die Schlussfolgerungen beider Forscher zur Erklärung der Hypercitrikämie bei Hepatitiden dürften nicht erschöpfend sein.

Die Untersuchung ist mit geldlicher Unterstützung aseitens der »Stiftelsen Therese och Johan Anderssons minee» durchgeführt worden.
Apports cliniques de la pneumostratigraphie sus‐ et sous‐diaphragmatique1
Authors: GIRAUD G.
Published: August 2010

La pneumostratigraphie, nouvelle méthode radiographique, donne une image extérieure très exacte des organes normaux et pathologiques médiastinaux et abdominopelviens; elle en précise avec finesse le contour externe en utilisant le contraste aérique clair créé par l'infiltration des espaces celluleux exo‐séreux. Elle résulte de la conjonction de deux méthodes radiologiques déjà très fructueuses: stratigraphie et pneumomédiastin ou pneumorétropéritoine, et repousse très loin les limites de chacune d'elles.

Chaque pneumostratigramme nous apporte un gain en puissance d'analyse stratigraphique par le renforcement des contrastes, et un gain en étendue par l'inscription, dans chaque plan séparé, des plus fins prolongements des images du pneumomédiastin, souvent broussailleuses sur les radiogrammes simples.

L'association avec les contrastes gazeux endocavitaires (estomac, œsophage, côlon, péricarde, vessie) conduit à une pariétographie également très fructueuse.

Les meilleures voies d'introduction du contraste aérique sont la voie précoccygienne, qui atteint directement la grande coulée commune périaortique, et la voie rétromanubriale, qui donne de très bons contrastes en avant du plan trachéo‐bronchique. La première seule a une portée générale. La seconde explore surtout la loge thymique.

Les résultats obtenus par cette méthode la placent au premier rang des méthodes d'analyse morphologique et discriminative:

des segments aortiques sus‐ et sous‐stricturaux dans la coarctation, des dimensions d'un canal artériel persistant

des adénopathies et tumeurs médiastinales para‐aortiques simulant l'anévrysme, des tumeurs thymiques

des veines pulmonaires et cave inférieure qui sont inscrites sur toute leur longueur

des adénopathies et infiltrations pleuro‐médiastinales des tumeurs œsophagiennes et bronchiques

des tumeurs surrénales et des images ganglionnaires gastriques et spléniques qui peuvent les simuler

des diamètres segmentaires des gros troncs aortiques et pulmonaires et des cavités cardiaques

des tumeurs gastriques, de leur extension rétrogastrique et des kystes de la face inférieure du foie

du pancréas, parfaitement inscrit dans toutes ses parties

des adénopathies aortico‐mésentériques hodgkiniennes

des néoformations de la vessie, de l'utérus, et de leur extension dans le ligament large.
THYROCALCITONIN
Authors: Sørensen O. Helmer , Hellesen Claus
Published: August 2010

Abstract Thyrocalcitonin is a hypocalcaemic factor formed in the C cells, which are mainly concentrated in the thyroid gland. By inhibition of bone resorption, thyrocalcitonin lowers the calcium concentration in the blood.

The authors have isolated thyrocalcitonin from thyroid tissue of pigs, and from 4 out of 8 human thyroids, removed surgically because of goitre. Two of these four goitres were diffuse and toxic and two were nodous and loxic.

The technique of preparation of thyrocalcitonin is based on fractioning on columns of Sephadex G‐50 and G‐75, on a hydrochloric acid extract from thyroid tissue, after salt precipitation of the inactive, high‐molecular proteins, whereby the preparation is purified from 50 to 100 times.

With respect to magnitude and duration the fall in the serum calcium concentration is proportional to the dose of thyrocalcitonin administered. Five hours after subcutaneous injection of from 1 to 2 units of thyrocalcitonin, the serum calcium concentrations are higher than the zero values. Most likely this indicates that the parathyroid glands surpass their compensating duty.

The response to thyrocalcitonin in rabbits is different from that observed in rats, the reduction in the serum calcium concentration being much more prolonged in the rabbit. This is most likely caused by the fact that the parathyroid reserve of these animals is low.
ELEVATED BODY TEMPERATURE AND THE SURVIVAL OF RED BLOOD CELLS
Authors: Karle Hans
Published: August 2010

Abstract When elevating the body temperature of rabbits, whose red cells were labelled with 51Cr of DF32P, by injecting bacterial pyrogen, injecting heated milk, or by external heating in a climatic chamber, it was found that most probably pyrexia entails increased haemolysis.
CORONARY MORTALITY AND LIVING STANDARD
Authors: Brummer Pekka
Published: August 2010

Abstract No significant correlation is found between the coronary mortality and the coffee, cocoa, tea and alcohol consumption in 20 countries. On the other hand, there is a highly significant correlation between cigarette production and coronary mortality, but not between the latter and cigars and other tobacco products. The significant correlation between coronary mortality and cigarette production applies to both male and female mortality.
PLASMA FREE FATTY ACID TURNOVER RATE IN OBESITY
Authors: Björntorp Per , Bergman Halvar , Varnauskas Edvardas
Published: August 2010

Abstract. Free fatty acid turnover rate was measured by constant infusion of 1‐14C palmitic acid complexed to human albumin in eight extremely obese patients and in seven controls after a 12‐hour fast. In some of these patients these measurements were performed also during work, in a few of the obese patients before and after physical training. The results were expressed in relation to different body compartments. It was found that free fatty acid turnover rate was higher at rest in the obese than in controls. This difference disappeared when free fatty acid turnover rate was calculated per kg body weight or per kg body fat. When calculated per kg lean body mass, however, the obese patients again had higher values of free fatty acid turnover rate than the controls. During a standard work load the obese did not show lower free fatty acid turnover rates during work than the controls, even if the increase in two of the obese patients, who had a high turnover rate at rest, was small during work. The results thus give no evidence of a decreased fatty acid turnover rate in obesity. On the contrary, after fasting for 12 hours it seems to be higher than normal.
IN VIVO DIAGNOSIS OF LÖFFLER'S ENDOCARDITIS PARIETALIS FIBROPLASTICA
Authors: Nagy Z. , Bajtai A. , Bencsáth P. , Vaslaki L.
Published: August 2010

Abstract. A clinically and pathologically verified case of endocarditis parietalis fibroplastica Löffler is described. The prominent clinical signs were progressive congestive cardiac failure, persistent blood eosinophilia, afebrility. The hemodynamic picture simulated constrictive pericarditis. On the basis of morphological findings in the initial phase the case might have represented the classical Löffler or the Lennox type of the disease. Clinical and pathological considerations are discussed.