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Biomedical subjects

G F Kao

Publications and source records attributed to G F Kao.

34 records · Page 2Linked to original sources

Squamous-cell carcinoma of the scalp arising in lesions of discoid lupus erythematosus.

Squamous-cell carcinoma may arise in scars of chronic discoid lupus erythematosus. Although there have been 19 cases reported previously, detailed histopathologic features of this entity have not been recorded. We report a patient with extensive chronic discoid lupus erythematosus involving the scalp with subsequent development of multiple squamous-cell carcinomas. The tumors were locally aggressive with recurrences and invasion into the underlying skull and dura. The patient died of respiratory failure 4 1/2 years after initial surgical treatment. There was no clinical evidence of metastasis. Squamous carcinoma arising in discoid lupus erythematosus can be regarded as a low-grade carcinoma. Although about 20% of patients developed local recurrences and metastasis developed in about 30%, fatality occurred in only two patients (10.5%). Pertinent literature is reviewed, and the histopathologic findings, differential diagnosis, and biologic behavior of this tumor are discussed.

Aged↗

Kaposi's sarcoma in a renal transplant patient receiving cyclosporine.

A patient of Middle-Eastern descent developed Kaposi's sarcoma of the skin and lymph nodes after renal transplantation while receiving medical immunosuppression, including the use of cyclosporine. The clinical presentation of this patient resembled that of the HTLV-III-associated Kaposi's sarcoma. The tumors totally regressed seven weeks after cessation of immunotherapy. This case, along with other recently reported cases of Kaposi's sarcoma in postrenal transplant patients receiving cyclosporine, illustrates a rare complication of current immunosuppressive therapy.

Adult↗

Aggressive digital papillary adenoma and adenocarcinoma. A clinicopathological study of 57 patients, with histochemical, immunopathological, and ultrastructural observations.

Fifty-seven examples of a rare eccrine sweat gland tumor (aggressive digital papillary adenoma and adenocarcinoma) were studied by means of light microscopy, electron microscopy, and immunoperoxidase techniques. The neoplasm occurred as a single, painless mass, almost exclusively on the fingers, toes, and adjacent skin of the palms and soles. Microscopic features were distinct from those of other eccrine sweat gland tumors and often led to the diagnosis of such metastatic carcinoma as that of the breast. The characteristic histologic features included tubuloalveolar and ductal structures with areas of papillary projections protruding into cystic lumina. The stroma varied from thin, fibrous septae to areas of dense, hyalinized collagen. Forty tumors were classified as adenoma (ADPA) and 17 as adenocarcinoma (ADPAca). Histologically, ADPAca was distinguished from ADPA by its poor glandular differentiation and by necrosis, cellular atypia and pleomorphism, invasion of soft tissue and bone, and invasion of blood vessels. Eighteen (50%) patients with ADPA and 8 (47.0%) who had ADPAca developed recurrent lesions (2 months to 9 years) after surgical removal of the tumor. Seven (41.2%) patients with ADPAca developed metastases, of which 5 involved the lung. Three patients died of metastases, 5 to 20 years after surgical treatment of the primary tumor. The histologic malignant features in ADPAca are indicative of potential for distant metastasis and fatality. The recognition of aggressive digital papillary adenoma and adenocarcinoma as a distinct clinicopathological eccrine sweat gland neoplasm is important because of the potential for aggressive local growth and distant metastasis.

Adenocarcinoma, Papillary↗

Bowenoid papulosis. A clinicopathologic study with ultrastructural observations.

One hundred eight patients were studied who had anogenital lesions showing microscopic features as seen in bowenoid papulosis (BP), a recently described condition occurring most commonly in young adults. Patients typically show multiple papules, small nodules, or plaques that clinically mimic verrucae or nevocellular nevi. Although the lesions show microscopic cytologic atypia, a distinction from Bowen's disease, erythroplasia of Queyrat, and other forms of carcinoma in situ can usually be made on the basis of histologic and clinical criteria. The disorder responds to conservative treatment, although recurrences are not uncommon. Evolution of the lesions to invasive carcinoma was not observed. Mounting evidence links the development of BP to infection with human papilloma virus, but other viruses, as well as hormonal and immunologic factors, may also play a role.

Adolescent↗

Paget's disease of the ectopic breast with an underlying intraductal carcinoma: report of a case.

Paget's disease may occur at mammary and extramammary sites. Mammary Paget's disease typically involves the nipple and adjacent skin. Almost all such cases are associated with an underlying ductal carcinoma of the breast. A case of Paget's disease occurring at the site of an ectopic breast adjacent to a supernumerary nipple and associated with an underlying intraductal carcinoma is described. A search of the literature revealed no previous report of such cases. Detailed clinical history and histopathologic, histochemical, and follow-up information on this case are presented. The literature on mammary and extramammary Paget's disease is reviewed.

Biopsy↗

Episodic hyperhidrosis on the dorsum of hands.

A 21-year-old man presented with a 6-year history of episodic localized hyperhidrosis on the back of his hands. Results of the neurologic examination were normal. Profuse sweating of the affected skin was elicited by exercise, raising core temperature, direct heat, and intradermal injections of cholinergic drugs. Examination of the affected skin by electron microscopy and light microscopy with special stains and enzyme methods revealed prominent hyperplasia of otherwise normal eccrine sweat glands and ducts and increased surrounding stromal hyaluronic acid.

Adult↗

Cutaneous mercury granuloma. A clinicopathologic study and review of the literature.

Cutaneous mercury granulomas are rarely encountered. Clinically they pose difficulty in diagnosis when there is no clear history of penetrating injury by objects containing metallic mercury. Histologic, chemical, and scanning electron microscopic studies of such cutaneous lesions were performed on four cases from the Armed Forces Institute of Pathology files. Reported cases from the literature were reviewed. Metallic mercury in tissue sections appears as dark, opaque globules, usually spherical in shape and of varying sizes and numbers. A zone of collagen necrosis often surrounds the mercury globules. A granulomatous foreign body-giant cell reaction and a mixed inflammatory cellular infiltrate composed of neutrophils, lymphocytes, histiocytes, plasma cells, and occasional eosinophils are usually present. Epidermal and dermal necrosis, with or without ulceration or pseudoepitheliomatous hyperplasia, is also a common finding. The gold lysis test and energy-dispersive x-ray analysis confirmed the presence of metallic mercury in the tissue. Following cutaneous injury from mercury, systemic toxicity may develop and death may even occur. An approach to clinical management is discussed.

Adolescent↗

Carcinoma cuniculatum (verrucous carcinoma of the skin): a clinicopathologic study of 46 cases with ultrastructural observations.

Forty-six examples of carcinoma cuniculatum, a rare variant of squamous cell carcinoma of the skin, were studied by means of light and electron microscopy and immunoperoxidase techniques. The tumors usually presented as ulcerated, fungating, and polypoid masses with openings of sinus tracts onto the skin surface that exuded foul-smelling greasy material when pressure was applied. On microscopic examination the tumors were seen to be composed mainly of mature squamous keratinocytes with foci of cellular atypia. Electron microscopic studies revealed features of well-differentiated squamous cell carcinoma. The tumor may affect any cutaneous area of the body, and there is a predilection for the feet, particularly the soles. The cause must still be determined, but trauma, chronic irritation, and/or viral infection may play a role. The neoplasm is a low-grade carcinoma capable of local invasion, extension into bone, and rare metastasis to the regional lymph node. Although immunoperoxidase studies revealed no inclusions, infection by human papilloma virus (HPV) remains a possibility.

Adult↗

Unusual cystadenofibromas: endometrioid, mucinous, and clear cell types.

Cystadenofibromas are benign ovarian neoplasms containing both epithelial and stromal components. The epithelial component is usually of simple serous type resembling fallopian tube epithelium. Occasionally, tumors with unusual epithelial pattenrs are encountered. In this study, 16 cystadenofibromas with unusual epithelium are described. Twelve are examples of an endometrioid type, 3 of a clear cell (mesonephroid) type, and 1 of a mucinous-type epithelium. The stromal component in all tumors is identical to that of ordinary cystadenofibromas. One of the patients with a tumor containing endometrioid epithelium developed recurrence in the vagina after surgical removal of the ovarian tumor. The rest of the clinical features of these tumors are similar to those of ordinary cystadenofibromas with the exception that the median age is 10--20 years greater in the unusual-epithelium group.

Adenofibroma↗

Benign and low grade variants of mixed mesodermal tumor (adenosarcoma) of the ovary and adnexal region.

Eleven examples of a rare group of neoplasms composed of both epithelial and mesenchymal components are reported. Ten arose from the ovary and one arose separately in the para-ovarian region. The neoplasms are distinctive in that the stoma is more cellular than that of adenofibromas, but epithelial component is not malignant, as in carcinosarcoma and mixed mesodermal tumors, and the stoma is not sarcomatous in the low grade varieties. The 11 cases were highly variable in the cellularity and atypism of the stromal cells. The term, adenosarcoma, for these tumors is not acceptable because some were too low a grade to be regarded as sarcomas, and reports of the uterine counterpart disclose that some contain heterologous elements. For that reason, a term that will embrace the full spectrum of changes in the stroma--benign through sarcomatous--is needed. We propose that they be regarded as variants of mixed mesodermal tumor so that both the benign neoplasms and low grade sarcomas can be accommodated under one designation. Of the 11 cases, five lowest grade examples were all confined to the ovary and did not recur after surgical excision, but some of these were borderline in malignancy and probably would have progressed if untreated. Two of the 3 intermediate grade neoplasms extended beyond the ovary but were arrested by surgical excision. The 3 highest grade neoplasms were overly sarcomatous. One of these extended beyond the ovary but was arrested by combination chemotherapy. The para-ovarian adenosarcoma (also high grade) metastasized and proved fatal.

Adenofibroma↗

Cystadenofibromas of the ovary with epithelial atypia.

Epithelial atypia is rarely encountered in ovarian cystadenofibromas. Ten examples are reported with cytological features identical to serous tumors with low malignant potential. In two neoplasms the epithelium resembled an atypical endometrial hyperplasia, and one of these had squamous metaplasia. These two neoplasms probably qualify as endometrioid tumors of low malignant potential. None of the 10 patients had recurrence following excision of their neoplasm, and no similar patients have been encountered with neoplasms in more advanced stages. Even though aggressive behavior has not yet been established, the histologic features suggest a low degree of malignant potential and long-term follow-up of patients is warranted. Cystadenofibromas iwth epithelial atypia probably have less malignant potential than serous tumors of low malignant potential possessing the same epithelial characteristics because cystadenofibromas with atypia have less epithelial surface area and the epithelium is enveloped by connective tissue more than it is in serous tumors of low malignant potential.

Adenofibroma↗

Treatment of canine malignancies by 1200 R total body irradiation and autologous marrow grafts.

Twenty-five dogs with malignant lymphoma (L) and 18 dogs with solid, nonhematologic tumors (ST) were treated with 1200 R total body irradiation (TBI). Rescue from the otherwise lethal hemopoietic toxicity by infusion of autologous marrow aspirated before TBI was attempted, and survival, response to TBI, and immune reactivity post-grafting were determined. Eight L dogs survived more than 14 days post TBI and marrow grafting, and 12 out of 19 evaluable dogs showed a decrease of 75 per cent or more in clinically detectable tumor. There was no evident relationship between clinical status or marrow status before TBI and survival of more than 14 days or tumor response to TBI. Seven of the 8 survivors ultimately developed recurrent tumor. Eight ST dogs survived more than 14 days. Only 4 of 14 evaluable ST dogs showed significant clinical response of their tumor to TBI. Humoral and cellular immune reactivity were significantly impaired during the 10-week period following TBI and marrow grafting in all dogs studied. These results indicate that therapy in addition to lethal doses of TBI is necessary to cure spontaneous L or to significantly affect ST in dogs. They also provide baseline data which are necessary to assess the immunotherapeutic effectiveness of allogeneic marrow grafts.

Animals↗