ABSTRACT
Microcystic adnexal carcinoma (MAC) is a locally aggressive neoplasm that has recently been recognized as a clinicopathologic entity. Its histologic appearance includes both pilar and eccrine differentiation. We initially treated two patients with MAC of the cheek and of the nasolabial fold, respectively; by microscopically controlled excision because of the contiguous growth of the tumors. Despite the benign histologic appearance, there was deep and extensive infiltration of the subcutaneous tissue. Both patients responded favorably to initial treatment with microscopically controlled excision. In addition, immunoperoxidase staining for carcinoembryonic antigen supported the dual differentiation of this unusual neoplasm. We speculate that previous radiotherapy may be an important predisposing factor in the pathogenesis of MAC.
Subject(s)
Carcinoma/pathology , Facial Neoplasms/pathology , Lip Neoplasms/pathology , Nose Neoplasms/pathology , Sweat Glands/pathology , Biopsy , Carcinoembryonic Antigen/analysis , Carcinoembryonic Antigen/immunology , Carcinoma/diagnosis , Carcinoma/immunology , Carcinoma/surgery , Cell Transformation, Neoplastic/immunology , Diagnosis, Differential , Facial Neoplasms/diagnosis , Facial Neoplasms/immunology , Facial Neoplasms/surgery , Female , Humans , Immunoenzyme Techniques , Male , Middle Aged , Neoplasm Invasiveness , Neoplasm Recurrence, Local , Sweat Gland Neoplasms/diagnosis , Sweat Gland Neoplasms/pathologyABSTRACT
All dermatologists need to work at both the national and the local level to make our national dermatologic organizations reflect our surgical skills. At the local level, we should seek to become well integrated into the hospital staff and to document our competency when we take courses to learn new techniques. As more dermatologists are granted hospital privileges and become respected as valuable members of their medical community, this will help dignify and legitimize all of us on every level.
Subject(s)
Dermatology/organization & administration , Medical Staff Privileges , Dermatology/education , Education, Medical, Continuing , General Surgery/education , Humans , Institutional Practice , Interprofessional Relations , Medical Staff, Hospital , Societies, Medical , United StatesABSTRACT
Permanent arterial occlusion can be obtained experimentally by using plastic micro-spheres, polymerising materials (Histo-Acryl, Paladur) and direct current thrombosis. Certain limitations in their use arise from the properties of the substances. In our experience, plastic microspheres are not suitable for blocking entire organs or large vascular territories. They are more appropriate for occlusion of individual, small vessels by super-selective injections. Sole use of polymerising materials is not possible; they are best used in combination with other techniques (magnets, balloon catheters). Induction of thrombosis by small direct currents (50 volt, 10 mA). produces permanent and complete occlusion. The method can be used selectively or super-selectively. Unwanted thrombosis can be avoided by using catheters with the smallest possible external diameters.
Subject(s)
Embolization, Therapeutic/methods , Acrylic Resins/therapeutic use , Animals , Arteriovenous Fistula/therapy , Electrocoagulation , Embolization, Therapeutic/adverse effects , Gastrointestinal Hemorrhage/therapy , Kidney Neoplasms/blood supply , Kidney Neoplasms/therapy , Methylmethacrylates , Microspheres , Renal Artery , Splenic ArterySubject(s)
Microsomes/enzymology , Monoamine Oxidase/metabolism , Myocardium/enzymology , Salivary Glands/enzymology , Spleen/innervation , Sympathetic Nervous System , Vas Deferens/enzymology , Animals , Carbon Isotopes , Cattle , Centrifugation, Density Gradient , Liver/enzymology , Male , Norepinephrine/analysis , Rats , Succinates/metabolism , Tritium , Tryptamines/metabolismSubject(s)
Bile Acids and Salts/metabolism , Bile/metabolism , Cholesterol/metabolism , Clofibrate/pharmacology , Phosphatidylcholines/metabolism , Animals , Catheterization , Cholecystectomy , Cholesterol/blood , Chromatography, Gas , Chromatography, Thin Layer , Clofibrate/administration & dosage , Clofibrate/blood , Clofibrate/urine , Dogs , Gallbladder/physiology , Glucuronates/urine , Mass Spectrometry , Phospholipids/metabolism , Time Factors , Triglycerides/blood , Triglycerides/metabolismABSTRACT
Artemisinic acid [1] has been converted into artemisinin [3] in 2 steps via reduction of the exocyclic methylene group and photooxidation of the resulting dihydroartemisinic acid [2].
Subject(s)
Antimalarials/chemical synthesis , Artemisinins , Drugs, Chinese Herbal/chemical synthesis , Sesquiterpenes/chemical synthesis , Molecular Structure , Oxidation-Reduction , TemperatureABSTRACT
Microcystic adnexal carcinoma is a distinct clinicopathologic entity with combined pilar and eccrine differentiation. Clinically it resembles other adnexal neoplasms, but it tends to be deeply invasive and locally aggressive. A 47-year-old man with microcystic adnexal carcinoma of the left cheek with deep dermal and subcutaneous invasion was successfully treated by microscopically controlled excision. The possible etiologic association with teenage radiation therapy is discussed.
Subject(s)
Carcinoma/surgery , Facial Neoplasms/surgery , Microsurgery/methods , Adolescent , Cheek , Humans , Male , Middle AgedABSTRACT
Treatment of neurotropic malignant melanoma of the nasal ala combining microscopically controlled surgery and examination of formalin-fixed paraffin-embedded tissue cut in the horizontal plane followed by S100 immunohistochemical staining is described. The spindle-shaped cells were strongly S100 positive and detection of the melanoma cells, which were embedded in a dense collagenous stroma and infiltrating into the neurovascular spaces, was greatly accentuated by the S100 immunohistochemical stain. The coordinated skills of the dermatologic surgeon, dermatopathologist, and plastic surgeon contributed toward the best treatment for neurotropic melanoma in this patient.