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C J Cockerell

Publications and source records attributed to C J Cockerell.

At least 73 records · Page 4Linked to original sources
PubMed1995

Sclerotic primary cutaneous leiomyosarcoma.

We describe the case of a painful primary cutaneous leiomyosarcoma that developed on the back of a 54-year-old white male over a 6-year period. The lesion had been sampled by punch technique and had been originally diagnosed as cutaneous sclerosis. Histologic examination of excisional tissue revealed a diffuse spindle cell neoplasm in the dermis that extended into the subcutis. There was extensive sclerosis and sparse cellularity in the deep portion and in several zones throughout the tumor. Immunostaining for desmin was negative, although stains for vimentin and smooth muscle actin were both strongly positive. Sclerotic cutaneous leiomyosarcoma should be recognized as a distinct but unusual variant of leiomyosarcoma that may be difficult to diagnose because of extensive sclerosis. Lesions may be painful and should be considered in the differential diagnosis of painful cutaneous neoplasms of the skin.

Actins↗
PubMed1995

Bacterial infections.

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AIDS-Related Opportunistic Infections↗
PubMed1995

Neoplastic disorders.

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AIDS-Related Opportunistic Infections↗
PubMed1995

Cutaneous vasculitis and rheumatoid factor positivity as presenting signs of hepatitis C virus-induced mixed cryoglobulinemia.

BACKGROUND AND DESIGN: Hepatitis C virus (HCV) infection is associated with mixed cryoglobulinemia, which can cause a vasculitis affecting various organs. To determine the prevalence of cutaneous vasculitis in patients infected with HCV, information concerning a series of 408 HCV antibody-positive outpatients was analyzed. Patients with a skin eruption were evaluated by a dermatologist for objective evidence of cutaneous vasculitis, and the sensitivity of cryoglobulins was compared with that of rheumatoid factor activity as a serologic marker of mixed cryoglobulinemia in these patients. RESULTS: Cutaneous vasculitis was identified in 10 of 408 HCV-infected patients (prevalence of at least 2%). The vasculitis was manifested as palpable purpura in eight patients, livedo reticularis in one patient, and urticaria in one patient. The skin eruption was a major presenting feature in each of the 10 patients and even led to the discovery of occult HCV infection in two patients. Histologic examination revealed leukocytoclastic vasculitis in six patients and necrotizing arteritis consistent with polyarteritis nodosa in two patients. All 10 patients had chronic active hepatitis and exhibited rheumatoid factor activity. Variable features attributable to mixed cryoglobulinemia included arthropathy, central nervous system abnormalities, and glomerular disease. Serum cryoglobulins were detected in only four patients. CONCLUSIONS: Practitioners should be alert to the possibility of HCV infection in patients presenting with palpable purpura, livedo reticularis, or urticaria, in which the underlying histologic features are those of leukocytoclastic vasculitis or necrotizing panarteritis. Positive serologic test results for HCV antibody and rheumatoid factor in such patients virtually confirm the diagnosis of HCV-induced mixed cryoglobulinemia.

Adult↗
PubMed1995

A comparison of the efficacy and safety of Jessner's solution and 35% trichloroacetic acid vs 5% fluorouracil in the treatment of widespread facial actinic keratoses.

BACKGROUND AND DESIGN: We compared the efficacy and safety of a medium-depth chemical peel with those of the standard regimen of topical fluorouracil in the treatment of widespread facial actinic keratoses (AK). Fifteen patients with severe facial actinic damage and similar numbers of AK on both sides of the face were treated on the left side with a single application of Jessner's solution and 35% trichloroacetic acid and on the right side with twice daily applications of 5% fluorouracil cream for 3 weeks. Evaluations were conducted before treatment and at 1, 6, and 12 months after treatment. Visible AK were counted, random skin biopsies performed, adverse effects monitored, and patients questioned about preference and perception of efficacy. RESULTS: Both treatments reduced the number of visible AK by 75% and produced equivalent reductions in keratinocyte atypia, hyperkeratosis, parakeratosis, and inflammation, with no significant alteration of preexisting solar elastosis and telangiectasia. Except for erythema that lasted 3 months in one patient, no untoward side effects were observed with the chemical peel. The majority of patients preferred the peel over fluorouracil because of the single application and less morbidity. CONCLUSION: The medium-depth peel induced by Jessner's solution and 35% trichloroacetic acid is a useful alternative therapeutic option for widespread facial AK, particularly for poorly compliant patients, because it equals fluorouracil in efficacy while being superior in terms of the convenience of a single application with little associated morbidity.

Drug Combinations↗
PubMed1995

Expression of transforming growth factor beta and transforming growth factor beta receptors on AIDS-associated Kaposi's sarcoma.

Several humoral growth factors may contribute to the development and growth of AIDS-associated Kaposi's sarcoma (KS). They are either provided by chronically activated cells of the immune system or in an autocrine/paracrine manner by the neoplastic cells themselves. Transforming growth factor beta(TGF-beta) may directly enhance the growth of KS cells and tumor matrix formation. To mediate a signal both TGF-beta receptors type I and type II (TbetaR-I and TbetaR-II) have to be expressed. We investigated the expression of TGF-beta, TGF-beta receptors types I and II, and endoglin, a nonsignaling-type TbetaR-III, by means of immunohistochemistry on skin biopsies from patients with AIDS-related KS. We found that the TGF-beta ligand was expressed by KS cells in 9 of 11 samples. TbetaR-II was strongly expressed in 10 of 12 samples, but none of the investigated tumor samples stained for TbetaR-I. Endoglin was weakly expressed on all KS lesions and stained the endothelium of tumor-associated vessels in 92% of the samples. These findings show that most KS lesions have the ability to produce TGF-beta and that KS cells maintain a high expression of TbetaR-II in the absence of TbetaR-I, which may allow KS to escape growth inhibitory effects of endocrine or paracrine TGF-beta.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Elective lymph node dissection for melanoma.

The role of elective lymph node dissection (ELND) in the management of primary melanoma of the skin is a controversial subject. Some authorities consider the indications for this procedure to be broad, whereas others rarely recommend ELND. Voluminous literature reflects these divergent opinions. Unfortunately, this can be confusing for the practitioner advising a patient with melanoma. We review arguments for and against ELND and review some of the most important studies of the effects of ELND on survival. We attempt to elucidate the sources of controversy inherent in these survival studies. Criteria for the selection of appropriate candidates for ELND are discussed. ELND with hyperthermic limb perfusion is also briefly reviewed.

Humans↗
PubMed1994

Comparative analysis of neovascularization in primary cutaneous melanoma and Spitz nevus.

Spitz nevus is a well-known histologic simulator of malignant melanoma. Vascularity of human neoplasms has been associated with prognosis as well as propensity for metastasis. Were vascularity significantly different between melanoma and Spitz nevus, it could serve as a feature to distinguish between these two neoplasms. We evaluated the vascularity of a series of primary cutaneous melanomas ranging from thin superficial spreading to nodular lesions as well as superficial compound and nodular deep Spitz nevi by using light-microscopic evaluation of factor-VIII-stained sections. Vascularity was density graded and microvessels were counted per x200 and x400 field. Vascular density and microvessel counts were significantly different between melanomas of 2+ and 3+ vascularity compared with all types of Spitz nevi. Although nodular malignant melanomata tended to have a greater degree of vascularity than thin melanomas, there was a significant population of both of these subtypes having few or many vessels. We conclude that the number of microvessels per x200 and x400 field in areas of greatest vascularity is significantly less in Spitz nevus than in malignant melanoma. There is a subset of melanoma, however, in which the number of microvessels may be low. Nodular melanomata tended to have a greater number of vessels than did thin superficial spreading lesions. Evaluation of microvessel count may be of assistance when coupled with clinical and histologic findings in distinguishing between melanoma and Spitz nevus in selected cases.

Blood Vessels↗
PubMed1994

Cutaneous clues to HIV infection: diagnosis and treatment.

The skin is one of the most important organs involved in patients with HIV infection. Because it is the one most readily evaluated by inspection, it is essential that clinicians be expert in the recognition of skin disorders that herald the presence of HIV disease or a change in the immune status of one already known to be infected. In this article, the most important cutaneous disorders in patients with HIV infection are discussed with special emphasis on those that can be used to assess prognosis or detect the presence of an opportunistic infection.

AIDS-Related Opportunistic Infections↗