Biomedical subjects
Publications and source records attributed to J L Verret.
We describe the clinicopathological findings in five cases of an acquired vascular tumour involving periungual or subungual tissue. We believe that these represent acral arteriovenous tumours (cirsoid aneurysms). There are no previous reports of subungual or periungual acral arteriovenous tumours.
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A case is reported of a 20 year-old man who had progressive poikiloderma, cutaneous atrophy, plantar keratosis, and, from birth, blister formation regressive in infancy. Ultrastructural study performed on poikilodermic and atrophic lesions showed that dermoepidermal "clefts" or " vacuolizations " observed in optical microscopy did correspond to a cleavage between lamina densa and undamaged basal cells membrane. Sixty cases of congenital poikiloderma with blisters and keratosis have been reviewed in the literature; 13 out of these, are as the present case, similar to the original observation of Th. Kindler ; the common clinical features of these cases (cutaneous atrophy, mucous membrane involvement) and probably autosomic recessive inheritance, allow to consider, according to the authors opinion, Kindler 's syndrome as a peculiar entity.
The systemic complications of therapy with lithium are well known, but toxidermia has only been recognised since 1968. The carbonate (Teralithe) is the lithium salt which is mainly responsible, leading to minor dermatoses: oedema, pruritus, alopecia, urticaria, purpura, allergic vasculitis, pretibial ulceration. Some more specific conditions have been individualised by their severity and rarity: acne form eruptions, seborrheic dermatitis, follicular keratoses and psoriasis-like dermatosis as well as true psoriasis induced or aggravated by lithium. The authors review the literature and discuss the pathogenesis of these toxidermias. The cause of some dermatoses can be explained, especially the allergic vasculitis and psoriasis lesions. The underlying mechanism of most of these conditions remains unknown, but excessive tissue concentrations of the drug probably play an important role in inducing these complications.
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The case of a 37 year old man with systemic malignant cutaneous mastocytosis is reported. The outcome was fatal after eight months. Death was due to a diffuse hemorrhagic syndrome which originated in an abnormal circulating heparinoid. Nosologically, this is a border-line case between mast cell leukemia and leukemic systemic mastocytosis.
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This case concerned a 67 old farmer who presented a vegetating and crusted tumor of the right knee. Histological examination revealed intracellular round structures PAS + within an inflammatory dermal granuloma, including epithelioid and giant cells. Alternaria could be isolated on cultures from biopsies of the tumor. Ultrastructural study specifies the morphological aspects of Alternaria within dermal granuloma; furthermore, large numerous myelinic bodies were present within the parasitic cells. The clinical aspect of the patient led to hormonal explorations and a Cushing's disease yet unrecognized was ascertained, that probably represented the "special terrain" which made the growth of Alternaria possible. The survey of the available literature revealed two cases of alternariosis and Cushing's syndrome, but in these two cases the diagnosis of the endocrinopathy was already established when the cutaneous infection developed. The lesion cleared within a month after electrocoagulation, local iodine compound and griseofulvine per os, with nonrelapse 12 months after.
In 10 cases of cutaneous lymphomas, outflow of nuclear material into the cytoplasm of tumoral cells was observed ultrastructurally. Various stages of this phenomenon could be visualized. These observations were made in various types of epidermotropic and on epidermotropic cutaneous lymphomas but they are particularly evident in Crosti's reticulosis. These nuclear abnormalities were observed prior to any treatment; they are unrelated with tissue preparation and are very different from the well-known nuclear degeneration processes. They have been observed in various but exceptional physiological or pathological conditions, but have apparently not been noticed in earlier works on cutaneous lymphomas, except in 1 case of Crosti's reticulosis. No prognosis implication of these images was found. Their significance is not clear, but could be related with mitotic disorders.
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