Cutaneous angiosarcoma with skin metastases and persistent bloody pleural effusions.

Cutaneous angiosarcoma is a rare aggressive malignancy of vascular origin that usually arises in the scalp or face of elderly men. We describe a case of primary cutaneous angiosarcoma with skin metastases and presumed metastases to the lung in a 58-year-old man who presented with persistent bloody pleural effusions, an asymptomatic nontraumatic red patch on the forehead of 2 to 3 months' duration, and a pair of purpuric papules on his left mid back of unknown duration. Cutaneous metastases of angiosarcoma are uncommon. Spontaneous persistent bloody effusions without hemoptysis are distinctly uncommon, and pleural fluid cytology is repeatedly negative in lung or pleural angiosarcoma, making it difficult to diagnose without tissue biopsy.

Intravascular B-cell lymphoma: the role of skin biopsy.

Intravascular B-cell lymphoma is a rare aggressive systemic neoplasm with cutaneous and neurological presentations, which commonly eludes the diagnosis ante mortem. First reported in 1959 as "angioendotheliomatosis proliferans" by Pfleger and Tappeiner, it is a subtype of extranodal diffuse large-B-cell lymphoma defined by an intravascular proliferation of clonal lymphocytes. We describe a case of intravascular lymphoma in a 68-year-old female who presented with altered mental status and indurated, erythematous, ecchymotic plaques with overlying telangiectasia and ulceration. The diagnosis was made by skin biopsy of an abdominal plaque revealing large hyperchromatic cells filling the lumina of several small blood vessels within the dermis and subcutis. CD20 and CD79a immunostains were strongly positive, confirming the diagnosis of intravascular large-B-cell lymphoma. On review of a previous biopsy from another institution, which was reported to be nondiagnostic, we were able to find tumor cells in the blood vessels but only very focally. The presence of a brisk, perivascular, nonneoplastic lymphocytic infiltrate may have obscured the identification of tumor cells. This case illustrates an unusual subtype of extranodal diffuse large-B-cell lymphoma, which demonstrates protean clinical presentations, requires microscopic examination for diagnosis, but can be easily overlooked on skin biopsy.

The long-term host response to liquid silicone injected during soft tissue augmentation procedures: a microscopic appraisal.

BACKGROUND: Silicone has a long history of use as a soft tissue filler. MATERIALS AND METHODS: As a contribution to the clarification of the role and fate of this material when used as a filler in soft tissue augmentation techniques, 35 skin biopsies were examined by light microscopy. These biopsies were obtained from target areas where liquid silicone had been injected in 25 patients between 1 and 23 years prior, for the correction of depressed scars on the face. RESULTS: The microscopic study revealed in 100% of the cases the continued presence, in significant amounts, of the silicone previously injected into the target areas, where it failed to elicit any significant adverse reaction. CONCLUSION: Owing to its high permanence and to its inertness, reflected by the lack of any adverse reaction to its presence in the target site, silicone should be regarded as a valuable filler, at least for the correction of small depressed facial scars.

Silicone augmentation of the lip.

This article discusses the use of medical-grade liquid silicone injections for perioral rejuvenation and lip augmentation and treating various scars and defects in these areas. Recommended concepts and techniques for optimum results are also highlighted based on 40 years' experience with liquid silicone injections. The benefits of combining silicone injections with other modalities of therapy, such as electrosurgery and shave excision, are included where applicable.

Acute handling stress modulates methylphenidate-induced catecholamine overflow in the medial prefrontal cortex.

Although stress is an extensively investigated phenomenon, the effects of specific stressors on the pharmacologic activity of routinely administered drugs are less well characterized. We designed the present study to investigate the effect of handling stress on catecholaminergic responsivity following an acute methylphenidate (MP, Ritalin) challenge in the medial prefrontal cortex (mPFC). Norepinephrine (NE) and dopamine (DA) levels were simultaneously measured in 15-min samples of PFC dialysate using HPLC coupled with electrochemical detection. Sprague-Dawley rats were handled for 15 min, which produced an increase from basal extracellular DA and NE levels. Handling stress attenuates the DA response when administered 2 h prior to IP MP, whereas handling stress enhances the DA response when administered simultaneously with IG MP. These findings suggest that persistent alterations in mesocorticolimbic DA-ergic activity are induced by a short exposure to restraint stress as evidenced by the altered response to MP challenge.

Treatment of acne scars with liquid silicone injections: 30-year perspective.

BACKGROUND: This article addresses the use of liquid injectable silicone as both an immediate and long-lasting treatment for broad-based, depressed acne scars. The only filler substance that maintains precision and permanence in improving and/or correcting these types of acne scar defects is medical-grade liquid silicone. OBJECTIVE: We describe five patients with a history of acne scarring who showed improvements from injections of liquid silicone at the initial treatment session and lasting over a 10-, 15-, and 30-year follow-up period. METHODS: Monthly liquid silicone injections using a technique known as the microdroplet, multiple-injection approach. RESULTS: This article documents the safety, effectiveness, and precision of silicone in addition to highlighting the fact that its permanence is what distinguishes it from other filler materials. CONCLUSION: As a precise and permanent filling substance used for soft tissue augmentation, liquid injectable silicone can improve and/or eliminate depressed, broad-based acne scars through a technique known as the microdroplet, multiple-injection

Dermatitis-like squamous cell carcinoma.

A 78-year-old man with a 2-year history of a large dermatitis-like plaque of his thigh is described. It had a raised elevated border, resembling persistent fungal dermatitis (tinea corporis). However, it proved to be a squamous cell carcinoma, prompting this description and a reminder that skin cancer may mimic dermatitis.

Adjustment of subtle postoperative nasal defects: managing the "near-miss" rhinoplasty.

Rhinoplasty entails several steps that affect the appearance and function of the nose in an interrelated way. Occasionally, an excellent result can be marred by a minor imperfection and lead to dissatisfaction of both patient and surgeon. For significant pathology, revision rhinoplasty can be performed safely if the architecture and physiology of the nose are respected. To correct the "near-miss" result, minor corrections can successfully restore the aesthetic result. This can require a different frame of reference and approach and can often be thought of in terms of soft tissue correction. Subcutaneous fibrosis, skin depressions, asymmetries, and deficits can be corrected with minor procedures and techniques not routinely associated with rhinoplasty. We detail several methods that can be used to restore simply and effectively an otherwise excellent rhinoplasty result.