ABSTRACT
A 77-year-old white male presented to the clinic with two isolated cutaneous tumors on his forehead. A cutaneous biopsy showed a focally folliculotropic CD4 cutaneous lymphoma. The tumors were irradiated with a complete response, and he was started on oral bexarotene. He experienced localized cutaneous relapse 3 months into treatment. These new tumors now revealed a surprisingly CD8 cytotoxic phenotype, but with the same clone. A systemic workup was negative. His regimen was switched to romidepsin, and he was treated with local radiation again. Another 3.5 months passed in remission until he developed widespread cutaneous tumors. Positron emission tomography/computed tomography revealed multifocal systemic disease involving his diaphragm, liver, distal duodenum, proximal jejunum, anterior chest wall including pectoral muscles, and lungs without significant adenopathy. He died a few days later. Given his full clinical and pathological course, he was given the diagnosis of an aggressive primary cutaneous T-cell lymphoma, unspecified.
Subject(s)
Antineoplastic Agents/administration & dosage , CD4-Positive T-Lymphocytes/drug effects , CD8-Positive T-Lymphocytes/drug effects , Depsipeptides/administration & dosage , Drug Substitution , Lymphoma, T-Cell, Cutaneous/drug therapy , Skin Neoplasms/drug therapy , Tetrahydronaphthalenes/administration & dosage , Aged , Bexarotene , Biomarkers, Tumor/analysis , Biopsy , CD4-Positive T-Lymphocytes/immunology , CD4-Positive T-Lymphocytes/pathology , CD8-Positive T-Lymphocytes/immunology , CD8-Positive T-Lymphocytes/pathology , Chemoradiotherapy , Disease Progression , Fatal Outcome , Humans , Immunohistochemistry , Immunophenotyping , Lymphoma, T-Cell, Cutaneous/immunology , Lymphoma, T-Cell, Cutaneous/pathology , Male , Neoplasm Metastasis , Phenotype , Skin Neoplasms/immunology , Skin Neoplasms/pathology , Treatment OutcomeABSTRACT
OBJECTIVE: The objective of this study was to determine the degree to which trabecular bone contributes to the radiographic visibility of lamina dura. STUDY DESIGN: Segments of human cadaver mandible were obtained and split longitudinally. Two identical radiographs were made of each segment (1) before the removal of any additional bone and after (2) the removal of a small amount of the lamina dura at the apex of a tooth, (3) block removal of trabecular bone, and (4) smoothing of the endosteal surface of the external cortex. The radiographs were projected in random pairs for each sample. Six dentists judged whether a difference in the amount of lamina dura could be detected between 2 sets of radiographs. RESULTS: Chi-square analysis revealed a significant radiographic difference between radiographs made initially and after removal of the lamina dura and trabecular bone. CONCLUSIONS: Fewer than half of the changes of lamina dura loss alone could be detected radiographically by the observing dentists, whereas nearly all cases of the loss of periapical lamina dura in conjunction with loss of trabecular bone could be detected.