Primary cutaneous langerhans cell sarcoma: a report of four cases and review of the literature.

Langerhans cell sarcoma (LCS) is a rare but potentially life-threatening neoplastic condition. The diagnosis of LCS requires morphological and immunophenotypic characterization to distinguish it from other epithelioid-appearing malignancies. Four cases of LCS were encountered in the consultative practices of 2 of the authors. The patients ranged in age from 54 to 88 years of age. In 2 of the cases the patients had a history of acute myelogenous leukemia with eruptions occurring after initiation of decitabine. One patient died within 3 months of presenting with the skin eruption, whereas the other patient is in remission. In the other 2 patients, there was no antecedent history; the presentation was in the context of a solitary nodule. One patient declined treatment and died of disseminated metastatic disease. The other patient had complete excision with no evidence of recurrent or metastatic disease. In all cases, the biopsies showed a sheet-like growth of large atypical epithelioid cells. Phenotypic studies revealed positivity for CD4, CD1a, and S100 in all and variable staining for langerin, lysozyme, CD83, CD31, and CD14. Cutaneous LCS represents a terminally differentiated myeloid tumor with a variable but potentially aggressive clinical course. It may be related to a common stem cell defect given the association with acute leukemia. The morphology ranges from atypical appearing Langerhans cell to a high-grade large cell epithelioid malignancy mimicking amelanotic nodular melanoma.

Pachydermodactyly from repetitive motion in poultry processing workers: a report of 2 cases.

BACKGROUND: Pachydermodactyly is a rare, benign, acquired form of digital fibromatosis. The etiology of pachydermodactyly is unknown but is believed to be due to repeated mechanical injury of the skin. We report 2 cases identified in poultry processing workers and review other conditions associated with these cutaneous findings. OBSERVATIONS: The 2 workers in this report were employed as a chicken catcher and a chicken hanger. On examination, both workers had marked lateral thickening of the digits, with associated pain and pruritus. The workers' skin condition developed despite the use of protective gloves, and their symptoms improved when removed from work. However, the swelling due to fibromatosis persisted. CONCLUSIONS: Similar cutaneous findings have been reported in other occupations exposing individuals to repetitive skin trauma, and many patients demonstrating a compulsive habit of hand manipulation. This supports the conclusion that pachydermodactyly in these patients reflects repeated skin trauma. Repetitive mechanical injury in the poultry processing environment can result in considerable compensatory tissue changes. Preventive measures are needed to protect workers.

Outcomes of revascularized acute mesenteric ischemia in the American College of Surgeons National Surgical Quality Improvement Program database.

This report examines outcomes of revascularization for acute arterial mesenteric ischemia (AAMI) using the American College of Surgeons National Surgical Quality Improvement Program database. Patients with International Classification of Diseases, 9th Revision and Current Procedural Terminology codes indicating AAMI with concomitant mesenteric revascularization were identified. Demographic, risk factor, procedural, morbidity, and mortality data were examined. Associations with morbidity and mortality were analyzed by logistic regression. One hundred forty-two cases of AAMI were identified. Seventy-one cases were thrombotic and 71 were embolic according to revascularization codes. Mean age was 66 years, 84 per cent of patients were white, and 54 per cent were female. Unadjusted major morbidity and mortality rates were 69 and 30 per cent, respectively. Patients with thrombotic AAMI were more likely to have a lower body mass index, greater than 10 per cent weight loss in the past 6 months, and a history of smoking. Patients with embolic AAMI were more likely to present emergently with sepsis. Unadjusted morbidity and mortality rates were 78 and 38 per cent for embolic and 61 and 23 per cent for thrombotic AAMI, respectively. Multivariable predictors of morbidity included bowel resection at the time of revascularization, transfer admission, and involvement of a surgical resident. Multivariable predictors of mortality included impaired functional status, increased age, and postoperative sepsis. Cause of AAMI was not a significant predictor of morbidity or mortality. In a large sample of AAMI cases, AAMI remained a highly lethal and morbid condition. Predictors of morbidity and mortality included indicators of advanced presentation, treatment delay, and patient-related factors specific to AAMI, including debility and advanced age. Efforts directed at prevention and increasing the speed of diagnosis and definitive treatment appear to be necessary to improve outcomes.