Showing papers by "Saul Suster published in 1987"

Adenosquamous carcinoma of the gallbladder with spindle cell features. A light microscopic and immunocytochemical study of a case.

Abstract: A case of adenosquamous carcinoma of the gallbladder showing extensive spindle transformation is presented. By light microscopy, areas showing interwoven fascicles of fusiform, poorly differentiated cells closely resembling a sarcoma were seen to merge imperceptibly with areas showing more obvious glandular and squamous cell features. Immunocytochemistry utilizing tissue-specific antibodies against intermediate filaments demonstrated the exclusive presence of prekeratin antibodies in both components of the tumour, thus establishing the epithelial nature of this neoplasm. The importance of immunological phenotyping in the differential diagnosis of epithelial tumours of the gallbladder showing pseudosarcomatous features is underscored.

Spindle cell squamous carcinoma of the lung immunocytochemical and ultrastructural study of a case

Abstract: A case of squamous cell carcinoma of the lung showing extensive spindle transformation is presented. On light microscopy, the tumour showed sheets and fascicles of elongated fusiform cells resulting in a growth pattern which closely resembled a sarcoma. Immunocytochemistry using tissue-specific antibodies against intermediate filaments demonstrated exclusive labelling of the tumour cells with prekeratin antibodies. Electron microscopy showed well-formed intercellular junctions and thick bundles of tonofilaments within the cytoplasm of the cells further confirming the squamous epithelial nature of the neoplasm. The findings in the present case point to the existence of a non-metaplastic spindle cell variant of squamous carcinoma of the lung. The possible mechanisms which may account for the spindle shape of the cells are reviewed.

Verrucous pseudonevoid melanoma

Abstract: A case of an unusual variant of malignant melanoma resembling a papillomatous dermal nevus is presented here. The lesion was initially diagnosed as a Spitz nevus, and recurred locally five months after excision. The features which distinguish this lesion from the more common types of benign dermal nevi include the architectural atypia of the melanocytes, with a tendency for continuous proliferation of single cells along the dermoepidermal junction, as well as the presence of cytologic atypia with large hyperchromatic nuclei and mitoses. Despite its seemingly innocent appearance, distinction of this low-grade variant of melanoma from its benign counterparts is of importance in order to avert the possibility of recurrence and potential metastases.

Bilateral Koebner phenomenon in lichen sclerosus et atrophicus

Abstract: A Israeli woman was referred to the Dermatology Clinic of the Sheba Medica! Center for the appearance of bilateral and symmetric lesions on her shoulders that followed the lines of pressure of her brassiere's shoulder straps. Examination of the lesions disclosed linear areas of thinned, slightly depressed, and atrophic epidermis rimmed by a zone of gray-white, thickened, and wrinkled skin that measured 6 X 3.5 cm on each side (Fig. 1). The lesions appeared to follow a strikingly symmetric distribution (Fig. 2). The patient's past history was noncontributory, and baseline laboratory examinations were within normal limits. A punch biopsy specimen was taken from the lesion. Histologic examination showed mild hyperkeratosis and atrophy of the epidermis, with flattening of the cells in the stratum Malphigii and blunting of the rete ridges. The upper dermis showed edema, with homogonization of the collagen fibers in the remainder of the dermis. A sparse bandlike inflammatory infiltrate could be appreciated in the mid-dermis (Fig. 3). The histologic picture was consistent with that of lichen sclerosus et atrophicus (LSA). Owing to the peculiar location and distribution of the lesions, the possibility of a Koebner phenomenon was entertained. Subsequent pelvic exami-

A reappraisal of Richter's syndrome. Development of two phenotypically distinctive cell lines in a case of chronic lymphocytic leukemia.

Abstract: Richter's syndrome, the development of a malignant lymphoma in a patient with preexisting chronic lymphocytic leukemia (CLL) is an infrequent but well-documented phenomenon generally thought to represent a monoclonal proliferation of B-lymphocytes arising from the CLL. A heterogeneous population of cells consisting of sheets of transformed lymphocytes in combination with clusters of bizarre, atypical histiocytes developed in a patient with a history of longstanding CLL. Immunocytochemistry using a panel of monoclonal and polyclonal antibodies by immunoperoxidase techniques identified the presence of both B-lymphocytic and monocytic-histiocytic cell lines of differentiation. A mechanism of multiple differentiation is proposed to account for the dual cell population observed in this patient. Review of the literature appears to indicate that this phenomenon often may be involved in cases diagnosed as Richter's syndrome. The demonstration of cellular heterogeneity in the current case underscores the need for establishing a more precise definition for the histologic characterization of the terminal malignancy in Richter's syndrome.

Nodal angiolymphoid hyperplasia with eosinophilia.

Abstract: Angiolymphoid hyperplasia with eosinophilia (AHE) is a benign process of unknown origin that tends to mainly affect the skin and subcutaneous tissue. A case is presented of AHE arising in a lymph node in the absence of dermal or subcutaneous involvement. The unusual location and histologic characteristics of the lesion prompted an initial diagnosis of Hodgkin’s disease. Follow-up and review of the biopsy at a later date disclosed the characteristic features of AHE. The present case illustrates the ubiquitous nature of this process. AHE should be included in the differential diagnosis in lymph nodes showing effacement of their architecture by a diffuse, predominantly eosinophilic cellular infiltrate.

Epithelioid leiomyosarcoma of the stomach. A case study of the intermediate filaments.

Abstract: The intermediate filament typing of skeletal and smooth muscle tumors has shown that these neoplasms are characterized by the combined expression of desmin and vimentin intermediate filaments. A case of epithelioid leiomyosarcoma of the stomach was studied by conventional light microscopy and by indirect immunofluorescence using tissue-specific antibodies against intermediate filaments. The tumor cells labeled strongly with vimentin antibodies and were negative for desmin and prekeratin. This peculiar staining pattern may be the result of poor differentiation of the tumor cells with resultant loss of expression of desmin, or may be due to origin from a distinctive smooth muscle cell characterized by the exclusive expression of vimentin intermediate filaments.

Solitary painful piezogenic pedal papule in a patient with rheumatoid arthritis

Abstract: A 56-vear-old woman with a 12-year history of rheumatoid arthritis was seen in the dermatology clinic of the Chaim Sheba Medical Center for a rapidly spreading ringed eruption developing over the shins, which was diagnosed as erythema marginatum. Her physical examination also revealed a solitary white nodule that measured approximately 2 cm in greatest diameter located on the medial aspect of her left heel. The nodule was extremely painful and caused much discomfort to the patient when she walked. She also had a history of multiple firm small nodules located mainly around small ioints, which would persist for periods of months at a time, only to disappear following therapy for her rheumatoid condition with steroids, salicylates, and Immuran (azathioprine). The heel papule had been present for Ihe past 10 years and had not responded to therapy with conservative measures. On her present admission, a second node was found on her forearm, iust below the elbow (Fig. 1). A punch biopsy from this node revealed the classic features of a rheumatoid nodule, with a palisading granuloma containing deeply eosinophilic homogeneous material in the center. Owing to the history of rheumatoid arthritis and the histologic confirmation of a rheumatoid nodule, the lesion on the heel was thought to represent another manifestation of the disease. Careful examination, however, demonstrated that the nodule and the pain were present only when the patient exerted pressure on the heels by pressing her foot against a firm surface (Fig. 2) and that both disappeared as soon as this pressure was relieved. A diagnosis of solitary painful piezogenic pedal papule was entertained on this basis and a punch biopsy was performed to confirm the diagnosis. Histology revealed thickened epidermis and hyperkeratosis, thickened collagen fibers and fat in subcutis showing loss of compartmentalization of the normal fat.

Fibrosarcoma of the urinary bladder. Study of a case showing extensive chondroid differentiation.

Abstract: A case of primary fibrosarcoma of the urinary bladder showing extensive chondroid differentiation was studied by light microscopy and immunofluorescent microscopy using tissue-specific antibodies against intermediate filaments. The tumor cells were uniformly and positively labeled with vimentin antibodies and were negative for desmin and keratin, thus confirming the nonmuscle mesenchymal origin of the neoplasm. The value of intermediate filament typing in the differential diagnosis of spindle cell tumors of the urinary bladder is discussed, and a review of the literature on the subject is presented. It is postulated that the retained capacity for continued differentiation displayed by this tumor may account for the relatively better prognosis observed for this patient.

Development of epidermal cysts following chronic dermabrasion.

Abstract: A man who had suffered from poliomyelitis at the age of 12 was seen at our dermatology clinic for the presence of multiple slow-grov^'ing, elevated, round, and firm dermal tumors showing a strikingly symmetric distribution on the trunk. The patient was paraparetic and walked with the assistance of two mt'tal crutches that had horseshoe-shaped metal handles (Fig. 1). When using his hands, the patient would habitually rest his body against the crutches (Fig. 2). Adopting a segmental distribution along the borders of these areas of hyperpigmentation were multiple round, firm, elevated subcutaneous nodules that measured from 0.52.5 cm in greatest diameter (Fig. .i). Biopsy of the lesions revealed a normal epidermis, with a cystic structure occupying the upper and mid-dermis. The wall of the cyst was composed of multiple layers of squamous epithelium containing an innermost layer of granular cells (Fig. 4). The cyst contained horny material arranged in laminated layers.

Intradermal Bullous Dermatitis due to Candidiasis in an Immunocompromised Patient

Abstract: DISSEMINATED candidiasis has become one of the most frequent complications in immunocompromised patients.1In some cases this may be difficult to establish, becauseCandidaorganisms are cultured from blood samples in only 25% of patients with systemic disease2and serological tests may prove to be unreliable.3Superficial cutaneous involvement byCandidaorganisms in immunocompromised patients is a wellrecognized complication; however, hematogenous spread to the skin is rare. A variety of skin lesions have been described in association with disseminated candidiasis, including subcutaneous nodules and pustules,4verrucous plaques,5macronodular hemorrhagic lesions,6maculonodular rash,7diffuse erythematous papular rash,8necrotic pustules and ulcerative plaques mimicking ecthyma gangrenosum,9,10and purpura fulminans.11We report a previously undescribed complication of disseminated candidiasis, presenting as extensive hemorrhagic and bullous skin lesions. Histological examination of the lesions revealed intradermal bulla formation with massive involvement byCandidaorganisms. Early recognition

Induction of cutaneous plasma cell tumor as a complication of adjuvant immunotherapy with methanol extraction residue of bacillus Calmette-Guérin.

Abstract: Methanol extraction residue (MER), a cell wall fraction of bacillus Calmette-Guerin, has been reported to exhibit immunomodulating properties which permit its successful use as an adjuvant of immunotherapy in cancer patients. Its beneficial immunostimulatory effects are generally thought to be due to nonspecific stimulation of cell-mediated immunity. Little attention has been focused on its humoral stimulating properties. A case is presented of a patient undergoing treatment with adjuvant immunotherapy with MER for malignant lymphoma who developed a cutaneous plasma cell tumor at the injection site of the drug. This complication may represent the result of enhanced humoral immunity induced by the MER treatment. The development of a cutaneous plasma cell tumor must be added to the list of known MER toxicities, and may constitute an indication for the discontinuation of treatment with this agent.