Poikiloderma of Civatte: a histopathological and ultrastructural study.

BACKGROUND: Poikiloderma of the face and neck (Civatte) has not been studied in depth for decades, especially as far as the histopathology is concerned. MATERIAL AND METHODS: We studied 50 consecutive patients with poikiloderma of Civatte (PC). Their evaluation included: history, physical examination, lesional skin biopsy and histological examination of sections stained with hematoxylin-eosin, PAS, Fontana-Masson, acid orcein Giemsa for elastic fibers and toluidine blue for mast cells. In 10 randomly selected subjects, a second skin biopsy was performed and specimens were examined under the electron microscope. RESULTS: There were 34 females (68%) and 16 males. The mean age at diagnosis was 47.8 years for females and 61.7 years for males. Histological examination revealed an atrophic (62%), flattened (84%) epidermis with hyperkeratosis (92%) and occasional follicular plugging (34%). In some cases, mild hydropic degeneration of the basal cell layer was evident (46%). Melanin was irregularly distributed in the lower epidermis (94%), and melanophages were often present in the dermis (92%). The most prominent and constant feature (100%) was solar elastosis of the papillary dermis. The blood vessels were almost invariably dilated (96%) with a mild perivascular lymphohistiocytic infiltrate (78%), sometimes with plasmacytes (56%). At the ultrastructural level, the epidermis showed only minor changes. The dermoepidermal junction was intact. The most constant findings were swelling and disruption of the collagen fibers as well as focal degeneration of the collagen bundles. Occasionally, several vacuolar spaces were found just under the basal lamina. Melanin-laden macrophages scattered in the dermis were also detected. CONCLUSIONS: PC shows distinct histological and ultrastructural features, supporting the theory that it represents a separate entity. The histology of PC is characteristic but not pathognomonic. On this basis, the differential diagnosis from Riehl's melanosis, poikiloderma atrophicans et vasculare and other acquired poikilodermas can be made. Ultrastructural findings were consistent with the histological findings. Changes of the dermal connective tissue (solar elastosis) predominated, providing morphological evidence for the role of ultraviolet radiation in the pathogenesis of PC.

Bile canaliculi are defective in hepatic involvement of organ failure and recovery of liver function is due to their secondary regeneration.

OBJECTIVE: To investigate the morphological changes in the liver in patients with organ failure and hyperbilirubinemia and to correlate them to the outcome. DESIGN: A case series prospective study. SETTING: Intensive care units of two general hospitals. PATIENTS: Twelve patients in organ failure with predominant hepatic involvement, aged 16 to 69 years (mean 56 years). INTERVENTIONS: Liver biopsy was performed on all patients 3-15 days after organ failure. A second biopsy was also performed on all four surviving patients, as well as on 3 patients just before death at a mean time of 16 days (6-32) and 31 days (14-55), respectively, after the first biopsy. The samples were studied by electron microscopy and findings were assessed according to Rappaport's designation. MEASUREMENTS AND MAIN RESULTS: In the first biopsy it was shown that in zone III there was complete degeneration of bile canaliculi and hepatocytes in contrast to zone I. The grade of histological severity for zone III is positively correlated to the bilirubin concentration (p = 0.001). In the specimens from the second biopsy, it was shown that numerous, newly formed secondary bile canaliculi per 20 consecutive hepatocytes had developed in zone III in the surviving patients, whereas there was a complete absence of such canaliculi in the patients who died (mean +/- SD: 9.6 +/- 3.2 vs 0). CONCLUSIONS: It appears that the destruction of primary bile canaliculi is a striking anatomical defect in patients with organ failure and impaired bilirubin excretion. The restoration of liver function coincides with adequate formation of new secondary bile canaliculi in zone III, giving credence to the hypothesis that this formation is an important structural change responsible for the improvement in liver function.

Correlation of haematological, electron microscopic and cytogenetic findings in 20 patients with preleukaemia.

A combined haematological, ultrastructural and chromosomal study was made in 20 patients with preleukaemia. There was evidence of specific correlations between (a) Hb F levels and pancytopenia or profound anaemia, (b) chromosomal and electron microscopic findings and (c) thrombocytosis and ringed sideroblasts. The above findings might be of importance in identifying subgroups of preleukaemic patients with different prognosis.

Knee joint injury by mercury from a broken thermometer: case report and review of the literature.

An 11-year-old boy injured the inner side of his left knee when accidentally breaking a mercury thermometer. He immediately developed an acute synovitis. Soft tissues and synovium containing metallic mercury droplets were completely removed at operation. The patient recovered within five weeks. Symptoms and signs of acute or chronic mercury poisoning were not observed. However, because injury by a mercury thermometer may become very serious if the metal is absorbed by the tissues and disseminated through the circulatory system, immediate local excision of tissue is necessary. Interestingly, the histologic appearance of the synovial membrane was remarkable by the lack of any foreign body giant cell reaction.