Persistent nodular lesions caused by "bee-sting therapy".
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Biomedical subjects
Publications and source records attributed to E Alessi.
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A slowly growing malignant tumor of the nail unit in a 74-year-old female is reported. At light microscopy, the tumor was composed of small keratinous cysts with abrupt central keratinization, and of solid nests and strands of atypical keratinocytes filling the dermis and penetrating the phalangeal bone. In our view, this can be regarded as the malignant analog of the keratin cysts arising from the nail bed epithelium, as first reported by Samman in 1959. Since, according to several authors, the nail bed epithelium is comparable to the outer root sheath of the follicle and since the reported tumor showed some analogies with malignant proliferative trichilemmal cyst, it is suggested that this new entity be designated as malignant proliferating onycholemmal cyst.
Tissue samples from 19 HIV-seropositive immunocompromised patients suffering from oral hairy leukoplakia, chronic vesicular or ulcerative herpes simplex, chronic nonmetameric herpes zoster, secondary syphilis, condylomata acuminata, molluscum contagiosum, or disseminated cutaneous mycobacteriosis were examined ultrastructurally in order to better define the fine structure of the causative organisms in parasitic conditions and to clarify the host-parasite relationships. Taking into account the few data in the literature regarding the same disorders in immunocompetent subjects, no striking differences in the morphology of the infectious agents or in the types of parasitism were found. Nevertheless, isolated herpesvirus and papillomavirus virions were found outside the infected cells, and this observation, if confirmed in a larger series of cases, could suggest a persistent infectivity of the lesions in immunocompromised patients. Moreover, electron microscopy proved to be useful for diagnostic purposes; in one case of disseminated cutaneous mycobacteriosis, repeated cultures failed to grow the organism.
A case of well-differentiated syringomatous carcinoma in a 50-year-old woman is reported. The tumor was located on the scalp and manifested as a slowly enlarging patch of alopecia. It was misdiagnosed as alopecia areata for years and subsequently was erroneously considered to be a benign syringoma on the basis of the results of a punch biopsy. When the correct diagnosis was made, the patient was referred to a plastic surgery department for the complete removal of her lesion.
Carcinomas with eccrine differentiation include a complex group of tumors with many different histopathological subtypes. Most of these tumors share some histopathological features, namely, horn cysts and dermal tubular structures. In this work we describe an eccrine carcinoma with a peculiar spiralled pattern suggesting acrosyringeal differentiation.
A 4-year-old male presented with an indurated papular plaque on his right nasolabial fold. The lesion, present since the child was a few months of age, progressively extended in a band-like fashion up to the upper lip. Microscopically, there was almost complete replacement of the hair follicles by trichoepithelioma-like epithelial proliferations associated with hyperplastic sebaceous glands. We interpret this lesion as a localized form of the clinicopathological entity known as generalized hair follicle hamartoma.
When benign cephalic histiocytosis (BCH) was described for the first time in 1971, it was considered a nosologic entity due to its peculiar clinical presentation, but in the last few years its individuality has been questioned because of histopathological features overlapping with other non-X histiocytoses such as generalized eruptive histiocytosis (GEH). To solve this question, we examined with light microscopy using blinded technique 18 biopsy specimens obtained from 14 patients affected by BCH in comparison with 4 biopsies of GEH, 11 biopsies of papular xanthoma, and 25 biopsies of juvenile xanthogranuloma (JXG) of childhood. In the examined specimens, we identified three distinct patterns of proliferation of histiocytes we named "papillary dermal," "lichenoid," and "diffuse." With the exception of some peculiar histopathological features of BCH, observed only in the "papillary dermal pattern," a close histological relationship was observed among BCH, GEH, and JXG early nonxanthomatous stage. Our data suggest that BCH might be a localized form of GEH or an aborted phase of JXG.
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We report an exceptional case of multiple miliary osteomas of the face in an elderly woman, which developed in the absence of previous inflammatory or neoplastic skin disease. Excellent aesthetic results were achieved by surgical removal of about 90 miniature stones present in the facial skin of the patient.
We report an exceptional case of smooth muscle tumor arising in an aberrant areola. In spite of the malignant histopathologic features of the tumor, the patient is healthy 6 years after complete surgical removal of his lesion.
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The Italian Cooperative Group on AIDS & Tumors (GICAT) is collecting data on the epidemiological and clinical features of Kaposi's sarcoma (KS) in Italy, a country where intravenous drug users (IVDUs) comprise the largest group affected by AIDS. As of December 31st 1989, among 5317 cases of CDC-defined AIDS reported to the National Registry of AIDS, there were 419 (8%) cases of KS. Twenty-five percent of all of the homosexual men with CDC-defined AIDS had KS, while only 3% of the IVDU patients with CDC-defined AIDS had KS. The first case of KS was observed in 1982, 2 cases in 1983, 7 cases in 1984, 17 cases in 1985, 55 cases in 1986, 89 cases in 1987, 120 cases in 1988 and 128 cases in 1989. Of the 226 cases of KS reported to GICAT, 60% were in homosexual men, 21% in IVDUs, and 9% in heterosexuals. An increased number of KS has been observed since 1982, although the number of new cases in the past year seems to have been stable, possibly due to the usual delay in notification. There is, however, an actual decrease of the percentage of KS among AIDS patients, from 18% in 1984 to 6% in 1989. Almost half of the patients had had a diagnosis of AIDS prior to the appearance of KS, but in 25% of the patients KS was the first AIDS manifestation. Almost all patients had skin involvement either alone or in association with other sites, whereas very few patients had only lymph node involvement. Only treatment with alpha-2 interferon was able to obtain complete remission in 9% of evaluable patients.(ABSTRACT TRUNCATED AT 250 WORDS)
The case of a patient who developed multiple soft fibroma-like lesions on his lower extremities affected by lymphedema and Kaposi's sarcoma is reported. To the best of our knowledge, the coexistence of these three pathologic processes is unusual and has never been described before in the literature.
Pleomorphic peripheral T-cell lymphomas (PPTL) arising primarily in the skin are uncommon. The observation of pleomorphic T-cell lymphoma composed of 100% CD30+ cells is rare. We report the case of a woman in whom such a tumor manifested itself with a single cutaneous lesion. It was composed of medium to large cells expressing markers of helper/inducer T-lymphocytes, as well as activation (CD30) and proliferation antigens (Ki-67), but not the CD25 activation antigen. The lesion was excised and the patient is alive and disease free 2 years after the diagnosis. This case confirms previous reports about the favorable course of some cutaneous pleomorphic lymphomas, and shows that the activation antigen expression and proliferation antigen (Ki-67) expression do not seem to worsen the prognosis.
A selected population of 41 homosexual/bisexual asymptomatic HIV-positive subjects were administered neurophysiological tests to assess language, memory, attention, logic faculties and visuo-motor functions. HIV-positive subjects differed from individually matched control subjects only in certain measures of verbal memory. Longitudinal evaluation performed after 1.5 years, however, did not indicate any further development of this mild amnesic deficit. Despite the small number studied in our sample, there seems to be a trend for older subjects to be at greater risk of developing AIDS and cognitive abnormalities than younger subjects, while differences in immunological status play a significant role in disease progression.
The first case of primary gamma/delta cutaneous T-cell lymphoma (CTCL) with a fatal outcome is reported. The patient had the clinical and histopathologic features of disseminated pagetoid reticulosis, a rare form of CTCL characterized by a strong epidermotropic lymphoid infiltrate. Extensive immuno-cytochemical studies showed that the neoplastic cells were almost exclusively localized in the epidermis, expressed the gamma/delta variant of the T-cell receptor (CD3+, TCR-delta-1+) and were CD5+, CD7+, CD27+, CD29+, CD43+, CD44+, CD45+, CD45RA+, CD54+, CD69+, but beta F1-, Ti gamma a-, BB3-, A13-, CD2-, CD4-, CD8-, CD11a-, CD49d-, CD25-, CD30-, and HLA-DR-. A comparison of our results with those of the literature, which have not included gamma/delta T-cell receptor analysis, suggests that some reported cases of pagetoid reticulosis may have phenotypes similar to our case. Electron microscopy studies demonstrated that the gamma/delta T lymphocytes were villous, containing dense and multivesicular bodies, and formed close contacts with the surrounding keratinocytes, suggesting that these cells should have a role in the skin-associated lymphoid tissue. The proliferating cells in our case might represent the neoplastic counterpart of the recently reported CD2- subset of normal human peripheral blood gamma/delta T lymphocytes.
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