Transition between solar keratosis and basal cell carcinoma.

Transition from solar keratosis (SK) to squamous cell carcinoma (SCC) is well known and vastly documented. The possible relation between SK and basal cell carcinoma (BCC) is rarely mentioned in the dermatopathological literature. In order to identify the characteristics of the relation between SK and BCC, 40 slides of the head and neck regions in which both SK and BCC had been diagnosed, were retrieved from a collection in the Institute of Pathology of Beilinson Medical Center, seen between 1984 and 1994. Gradual and continuous transition between SK and BCC was found in 15 (37.5%) of these 40 slides. In order to estimate the prevalence of this phenomenon, 73 additional slides, which had been diagnosed as BCC of the head and neck, were re-examined. Atypia of the spinous layer, as an initial marker for the development of SK, was sought in each slide. Revision revealed spinous layer atypia in 26 (35.6%) slides, in addition to the previously diagnosed BCC. In seven (9.6%) the transition between atypical spinous cells and BCC was gradual and continuous. A gradual and continuous transition between SK and BCC can be explained by the presence of pluripotent stem cells in the epidermis. Stem cells, following malignant transformation, may differentiate in different directions, resulting in both SK and BCC.

Fulminant metastasizing chondroid syringoma of the skin.

A case of malignant chondroid syringoma of skin with widespread metastases is recorded. Several features of mixed tumors are discussed, and the pertinent literature is reviewed.

Late metastases (beyond ten years) of cutaneous malignant melanoma. Literature review and case report.

A case of late metastasis of a primary malignant melanoma of the sole of the foot after a disease-free interval of 13 years in a premenopausal woman is presented. The clinicopathologic findings are described, and the literature concerning late metastases (beyond 10 years) of melanoma is reviewed. Only seventeen documented cases have been previously reported, to which we add our own case. Sixteen of these eighteen cases concerned premenopausal women. This phenomenon suggests that female gonadal hormones may exert an inhibitory effect on cutaneous melanoma, hence lengthening the disease-free interval.

Primary malignant melanoma of the vermilion of the lower lip.

A 30-year-old man with primary nodular, rapidly growing malignant melanoma of the vermilion of the lower lip is described. The tumor was excised with wide tumor-free margins and an Abbe-Estlander reconstruction was carried out. The literature on oral melanomas has also been reviewed with special attention given to melanoma of the lip which is extremely rare (31 reported cases). This case is highly unusual in two respects: the melanoma was a nodular type, level 5, while nearly all melanomas reported previously have been superficial with slow radial growth; it was a small lesion arising on the vermilion and not an extension from the cutaneous junction or oral mucosa.

Surgical treatment of livedo vasculitis.

Surgical treatment for livedo vasculitis as a primary approach is not mentioned in the literature. A young female patient suffering from livedo vasculitis (atrophie blanche) was admitted with huge ulcerations and pre-ulcerative, infarcted skin areas of both feet and ankles. The lesions were promptly excised and skin grafted with excellent results. The course of treatment, including several surgical procedures, is described.

Histopathological observations in the canine prostate treated by local microwave hyperthermia.

A large series of repeated experiments were performed applying localized microwave hyperthermia to the prostate in dogs using a new water-cooled skirt-type antenna [1], operating at 915 MHz, as part of a new hyperthermia apparatus being developed for the treatment of the prostate in humans. The prostate gland of 20 male dogs was heated repeatedly under general anesthesia, at temperatures between 40 degrees C and 47 degrees C, and for different lengths of time up to 10 h. The prostate and other tissues were evaluated histopathologically following treatments. Invariably, all treatments by hyperthermia of the prostate caused a mononuclear inflammatory infiltration in the interstitium and polymorphonuclear infiltration in the glandular elements. Permanent tissue damage was found to be time-and temperature-dependent. Heating at 42.5 degrees C (+/- 0.5 degrees 5C) for up to 1.5 h was found to be harmless and could be safely repeated with our equipment. This study was part of a preclinical evaluation of a new antenna and apparatus.

Paget's disease of the nipple resembling an acantholytic disease on microscopic examination.

Two biopsies of an erosive lesion of the nipple had an appearance of an acantholytic disease without showing malignant cells. Only a third biopsy through the nipple with removal of a larger portion revealed some nests of atypical, large cells with clear cytoplasm, typical of Paget's disease. Immunohistochemical findings with carcinoembryonic antigen confirmed the diagnosis of Paget's disease of the nipple. This is the first case of Paget's disease which shows extensive acantholysis on microscopic examination and which resembles pemphigus vulgaris histologically. Acantholytic diseases are easily distinguished from Paget's disease and have never been mentioned in the differential diagnosis of this disease. A large biopsy through the nipple with the removal of a liberal portion of the nipple is suggested in every case of a suspected unilateral lesion of the nipple in order to avoid the overlooking of small nests of Paget's cells, as in our first biopsies, showing a histological picture of an acantholytic disease.

Atypical clear cell acanthoma.

Two cases of clear cell acanthoma (CCA) with marked signs of cellular atypia and mitotic figures are reported. Although the nature of CCA is not completely understood, it is considered to be a benign epithelial tumor. Our cases show that these lesions can develop malignant features.

[Appendiceal carcinoma]. / Appendixkarzinome

Three cases of carcinoma of the vermiform appendix are reported. The rarity of the disease has been emphasized as well as the resulting lack of clinical experience. Medical literature on the subject has been reviewed.

Buschke-Ollendorff syndrome of the scalp: histologic and ultrastructural findings.

Buschke-Ollendorff syndrome is an association of connective tissue nevi and osteopoikilosis that usually appears in the first decades of life. The nevi occur on the trunk and extremities. In a 48-year-old man with this rare syndrome the connective tissue nevus was located on the scalp and was pruritic. Histologically, involvement of the epidermis with cystic dilatation of the hair follicles and an abnormality of mucopolysaccharides were present. The nevi in this syndrome may involve an alteration in the three components of connective tissue to a variable degree.

Nodular secondary syphilis mimicking cutaneous lymphoreticular process.

We hereby report a case presenting a rare form of secondary syphilis with an unusual nodular eruption accompanied by pruritus and generalized lymphadenopathy, bearing a striking resemblance to lymphoma. The histologic picture was also misleading and was compatible with lymphocytoma cutis. The diagnosis was eventually made after results of serologic tests for syphilis were found to be positive, with an extremely high titer of VDRL, and dark-field microscopy had demonstrated spirochetes in a nodular lesion. Secondary syphilis should thus be considered in the differential diagnosis of nodular lesions resembling lymphoreticular disease. It is also suggested that syphilis be added to the list of diagnoses belonging to the category of pseudolymphoma.

Suture granuloma simulating lung neoplasm occurring after segmentectomy.

A suture granuloma was resected which developed after segmentectomy of a squamous cell carcinoma of the lung and radiologically mimicked a neoplasm. This report emphasises that although the appearance of the lesion may be typical for malignancy, the possibility of a benign suture granuloma should be considered, especially if the lesion appears shortly after surgery.

Liver cirrhosis and hepatocellular carcinoma after prolonged exposure to TNT: causal relationship or mere coincidence?

Macronodular liver cirrhosis and hepatocellular carcinoma were found in a 61-year-old male who had been exposed for 35 years to Trinitrotoluene (TNT). The question whether TNT had induced these pathological processes is raised.

Morbidity and recurrence rates after surgical treatment of malignant melanoma by scalpel versus CO2 laser beam.

A retrospective study was carried out on 219 patients who underwent surgical treatment of a malignant melanoma. A scalpel was used in 96 patients in group 1 and CO2 laser beam was used in 123 patients in group 2. The average length of hospitalization for group 2 was longer (16.3 versus 12.8 days for group 1). This was due to failure of the skin graft; 32.5 per cent in group 2 versus 15.6 per cent in group 1 (p = 0.005). The accumulative rate of recurrence for both groups was almost the same although there were significant differences according to the various parameters. Male patients in group 2 had a significantly higher rate of recurrence as compared with female patients in the same group (p less than 0.001) and male patients in group 1 (p = 0.002). In both groups, there was a significantly higher rate of recurrence for ulcerated primary lesions and those lesions more than 1.6 millimeters thick (p = 0.05). Patients in group 2, with lesions more than 3 millimeters in thickness, had a higher rate of recurrence than those in group 1 (54.6 versus 40.6 per cent). In both groups, patients who underwent elective regional dissection of lymph nodes had a lower rate of recurrence (19.4 per cent) than those patients who did not undergo dissection (53.6 per cent) (p = 0.001). It is suggested that thermal damage to the blood and lymph vessels incurred during laser excision may be more extensive than has been reported. These damaged walls may cause the higher rate of distal metastases of malignant melanoma from a primary lesion more than 1.6 millimeters in thickness; primarily in male patients.

Conjunctival involvement in pemphigus vulgaris: a clinical, histopathological and immunofluorescence study.

Eleven patients with pemphigus vulgaris and with eye complaints had histopathological and direct immunofluorescence (DIF) studies on biopsies of their conjunctivae. In eight of the patients the ocular symptoms preceded the other manifestations of pemphigus. None of the 11 patients had any detectable conjunctival blisters or erosions. The conjunctivitis in three of the patients proved on histopathology and DIF to be a manifestation of pemphigus vulgaris. In the remaining patients, conjunctival hyperaemia with or without a mucoid discharge was observed, but there were no specific histopathological features, although one of them had a positive DIF.

Cutaneous malignant melanoma in young adults under age 30.

Epidemiologic and clinicopathologic features of malignant melanoma in 129 patients (44 males, 85 females) aged < or = 30 years between 1961 and 1992 were investigated. The number of new young melanoma patients (29 of 216 during the 1960's) declined to 52 of 676 during the 1980's. Predominant sites were legs among females, and head, neck and back among males. Nodular type lesions (56.6%) outnumbered superficial spreading tumors (38.8%). Thirty-one patients (24%) died of melanoma (median survival 2.9 years), with higher male mortality. A decrease in mortality rate was observed over the decades. The relationship between various parameters was analyzed. Nodular lesions were smaller and thicker than superficial spreading lesions, occurred more frequently in males, and carried a worse prognosis (34% mortality) than superficial spreading type tumors (14%); mortality rate was higher for thick (>4 mm) and for large tumor volumes (>300 mm3) vs. thin and small sized lesions, respectively (P = 0.000 for each). Average tumor thickness and volume declined throughout the last three decades. From the data obtained, a typical profile of a young melanoma patient is drawn.