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Biomedical subjects

C D Fletcher

Publications and source records attributed to C D Fletcher.

At least 253 records · Page 14Linked to original sources

Solitary fibrous tumour arising at unusual sites: analysis of a series.

Solitary fibrous tumours ('pleural fibromas') are well-recognized in the pleura, but their rare occurrence at other sites has only become appreciated in recent years, as a consequence of which extrapleural examples often go unrecognized or misdiagnosed. Eight cases (three peritoneal, two retroperitoneal, two intrapulmonary and one mediastinal) are presented herein. All but one presented in adulthood, and three were asymptomatic chance findings. Size ranged from 0.8 to 26 cm in maximum diameter. To date, none has behaved in an aggressive fashion. Histologically, these lesions are entirely comparable to their pleural counterparts, and accurate diagnosis is largely dependent on appreciation of their potential extrapleural location. Immunohistochemistry in seven cases favoured myofibroblastic/fibroblastic differentiation, in keeping with the putative submesothelial origin of these lesions.

Actins↗

Plexiform xanthoma: an unusual variant.

We present a 35-year-old male patient with a recurrent xanthoma within the dermis of the elbow. There was no clinical evidence of hyperlipidaemia. The very unusual feature in this case was the presence of a plexiform growth pattern, not to our knowledge previously described in xanthomata. This necessitated distinction from a true neoplasm, most particularly of neural type.

Adult↗

Dermatofibrosarcoma protuberans presenting in infancy and childhood.

Dermatofibrosarcoma protuberans (DFSP) is a not uncommon low-grade cutaneous sarcoma of uncertain histogenesis, which typically arises in early to middle adult life. Traditionally, it is regarded as extremely uncommon in infants and children, and this diagnosis may therefore easily be overlooked in young patients. Eight such cases (representing 5.9% of the available DFSPs on file) are presented of which two were congenital. Age range at presentation was 14 months to 12 years. Five arose on the trunk. Most had originally been mistaken for unclassified sarcoma, a fibromatosis, or diffuse neurofibroma. The histologic features were entirely comparable to the more usual adult cases except that all had a plaque-like, rather than nodular, growth pattern. Short-term follow up has revealed no recurrences. DFSP is not so rare in childhood and warrants wider recognition in order to ensure appropriate treatment.

Age Factors↗

Adult and infantile myofibromatosis: a report of three cases affecting the oral cavity.

Myofibromatosis is a rare but well recognized entity which was originally thought to affect only neonates and infants. It is now apparent however that adults may also be affected. Solitary cases affecting the oral cavity appear to be rare and only two cases of solitary lesions in adults appear in the literature. This report documents three solitary cases; two typical lesions in infants and a lesion from the tongue of an adult. The lesions were composed of small polygonal cells and large elongated cells in a scant fibrous stroma. The elongated spindle cells were identified as myofibroblasts by immunocytochemistry and electron microscopy. The lesions showed characteristic features which enabled them to be distinguished from other fibrous lesions and from benign or malignant smooth muscle tumors with which they have frequently been confused.

Actins↗

Prevention of bone loss by hormone replacement therapy is probably not due to stimulation of calcitonin secretion.

Weekly fasting serum calcitonin levels and biochemical indices of bone metabolism were measured in 13 postmenopausal women being given hormone replacement therapy over a period of 8 weeks. All of the biochemical indices except urinary hydroxyproline creatinine ratios fell significantly, indicating that the treatments were effective in reducing bone turnover. Calcitonin levels fell significantly and, within the individual, levels were positively correlated with adjusted calcium levels. These findings do not support the theory that estrogen conserves bone by stimulating calcitonin secretion.

Alkaline Phosphatase↗

Sinusoidal hemangioma. A distinctive benign vascular neoplasm within the group of cavernous hemangiomas.

Twelve cases of sinusoidal hemangioma, a distinctive subset of the group of lesions known as cavernous hemangioma, are described. All presented as solitary subcutaneous/deep dermal lesions in adults, predominantly females. Five arose on a limb and five on the trunk; two of the latter were situated in mammary subcutaneous tissue. Histologically they were characterized by dilated, interconnecting, thin-walled vascular channels that frequently showed a pseudopapillary pattern. These vessels had a predominantly lobular architecture but peripherally showed focally ill-defined spread into subcutaneous tissue. The lining endothelium was single-layered but showed focal pleomorphism and hyperchromasia, which, combined with the pseudopapillae and apparent infiltrative pattern in areas, raised the possibility of angiosarcoma in four cases, most notably in the breast lesions. This possibility was further suggested by the presence of pseudonecrotic central infarction in two cases. Follow-up in eight cases, however, has revealed no tendency for either local recurrence or metastasis.

Adult↗

Cytogenetic analysis of a plexiform fibrohistiocytic tumor.

A plexiform fibrohistiocytic tumor was analyzed cytogenetically after short-term in vitro culture. The stemline karyotype of this tumor was interpreted as 46,XY, -6, -8,del(4)(q25q31), del(20)(q11.2), + der(8)t(8;?)(p22;?), + mar. We believe this to be the first report of chromosome findings in this recently described histological entity.

Chromosome Aberrations↗

Mid-line presentation of cervical lymphomata.

Three cases of lymphoma are reported, all of which presented as a mid-line cervical swelling and appeared to be localised disease. The importance of early removal of such lesions is emphasized.

Adult↗

Carcinosarcoma arising in eccrine spiradenoma. A clinicopathologic and immunohistochemical study of two cases.

Malignant change in a benign eccrine spiradenoma is rare. Only 13 such cases have been previously reported. Two further cases are described herein, both of which were carcinosarcomas and arose in middle-aged women. In each case continuity was demonstrated between the benign and malignant epithelial components and the sarcomatous element. In case 1 the sarcomatous component showed osteocartilaginous and rhabdomyoblastic differentiation, whereas in case 2 only osteosarcoma was evident. To our knowledge, carcinosarcoma has not been previously described arising in eccrine spiradenoma. The literature regarding malignant eccrine spiradenoma is reviewed.

Adenoma, Sweat Gland↗

The enigmatic eccrine epithelioma (eccrine syringomatous carcinoma)

Eccrine epithelioma is an exceedingly rare cutaneous tumor thought to represent the malignant counterpart of the eccrine dermal syringoma. To data, only 10 accepted cases appear to have been reported. Two additional cases are described here and the literature is reviewed. The first case showed the typical histologic features of eccrine epithelioma. The second case showed extensive clear cell change (due to glycogen accumulation), reminiscent of the clear cell syringoma; conspicuous pseudo-apocrine metaplasia was also noted. The latter appearance has not been previously described in eccrine epithelioma.

Aged↗

Sarcomatoid variant of anaplastic large-cell Ki-1 lymphoma.

Although anaplastic large-cell Ki-1 lymphomas can mimic a variety of tumors, a correct diagnosis is usually not difficult to reach if it is recognized that lymphoma cells can assume bizarre and pleomorphic appearances and that the pattern of growth can be purely sinusoidal. We report a unique case of a 45-year-old man presenting with a leg lesion that showed sarcomatoid growth patterns. The subcutaneous/dermal tumor displayed a myxoid stroma reminiscent of myxoid malignant fibrous histiocytoma. In a subsequent lymph node biopsy, a well-developed storiform pattern was formed by interweaving fascicles of plump spindle and oval neoplastic cells, reminiscent of pleomorphic/storiform type of malignant fibrous histiocytoma. The lymphoid nature of the tumor cells was documented by immunoreactivity for leukocyte common antigen, Ki-1 antigen, and the T-cell marker UCHL1. We conclude that the presence of a storiform or myxoid pattern does not disqualify the diagnosis of lymphoma; this possibility should always be pursued in pleomorphic tumors because the treatment is substantially different from that for sarcoma, carcinoma, or melanoma.

Antibodies, Monoclonal↗

Glomeruloid hemangioma. A distinctive cutaneous lesion of multicentric Castleman's disease associated with POEMS syndrome.

A histologically distinctive cutaneous hemangioma occurring in two patients with biopsy-proven multicentric Castleman's disease associated with POEMS (polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes) syndrome are reported. The lesions were multiple, and appeared as red to purple papules over the trunk and proximal limbs. Microscopically, ecstatic dermal vascular spaces were seen filled with aggregates of capillaries, resulting in structures reminiscent of renal glomeruli. Interspersed between the blood-filled capillary loops were plump "stromal" cells possessing clear vacuoles and periodic acid-schiff-positive eosinophilic globules. These cells had the immunohistochemical profile of endothelial cells (positivity for factor VIII-related antigen, and negativity for leukocyte common antigen, macrophage marker, and muscle-specific actin), and probably represented immature elements that had accumulated immunoglobulins and other proteinaceous material from the circulation. Because vascular lesions may appear before the full-blown POEMS syndrome develops, we suggest careful evaluation and follow-up of all patients presenting with glomeruloid hemangioma or cherry-type capillary hemangioma with focal glomeruloid features for potential development of this syndrome.

Adult↗

Atypical 'pseudosarcomatous' variant of cutaneous benign fibrous histiocytoma: report of eight cases.

Eight cases of benign cutaneous fibrous histiocytoma containing scattered, bizarre, pleomorphic cells of multinucleate or histiocyte-like type are described. All arose in adults and four had originally been diagnosed as sarcomas. Lesions of this type are not well-known and merit wider recognition in order to avoid inappropriate treatment. Differential diagnosis principally includes atypical fibroxanthoma and pleomorphic malignant fibrous histiocytoma.

Adult↗

QBEND/10, a new monoclonal antibody to endothelium: assessment of its diagnostic utility in paraffin sections.

The immunoreactivity of a new monoclonal antibody to endothelium. QBEND/10, in formalin-fixed, paraffin-embedded sections from a variety of vascular and lymphatic tumours is described and compared to that of two other endothelial markers, von Willebrand factor and Ulex europaeus agglutinin, type 1. All the benign tumours of blood vascular origin showed immunoreactivity whereas only five out of eight lymphangiomas demonstrated a weak focal reaction with QBEND/10. Primitive lumina in epithelioid and spindle cell haemangioendotheliomas were highlighted in all the cases. Tumour cells in angiosarcoma forming vasoformative areas and solid areas showed immunopositivity to QBEND/10 in 17/23 and 13/24 cases respectively, and complementary immunoreactivity for von Willebrand factor was observed. Proliferating vessels and the majority of spindle cells in Kaposi's sarcoma were positive in all 40 cases. Only one of 54 cases of carcinoma showed luminal reaction to QBEND/10. However, 17 of 45 spindle cell tumours displayed a positive reaction. QBEND/10 is an additional marker for demonstrating endothelial differentiation and has some advantages over currently available antibodies.

Antibodies, Monoclonal↗