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J Toonstra

Publications and source records attributed to J Toonstra.

At least 55 records · Page 3Linked to original sources
PubMed1990

UV-B-induced bullous pemphigoid restricted to mycosis fungoides plaques.

We describe a 77-year-old female patient with plaque-stage mycosis fungoides (MF) who developed bullous lesions in lesional skin only, while receiving short-wave ultraviolet radiation (UV-B) therapy. Histopathological and immunohistochemical examination resulted in a diagnosis of bullous pemphigoid (BP). Withdrawal of the UV-B treatment and application of a high-potency topical corticosteroid cream resulted in a rapid regression of the BP. As the bullous lesions were strictly confined to the MF plaques, the cutaneous infiltrate was probably involved also in the development of the BP. To our knowledge, this is the second case report of the coexistence of MF and BP and the first one in which the BP might be UV-B-induced.

Aged↗
PubMed1990

Sweet's syndrome.

Two women are reported both of whom exhibited, after an episode of an upper respiratory tract infection, painful, erythematous, sharply demarcated plaque-like lesions on the extremities, in combination with fever. In addition, one woman also had acute polyarthritis and episcleritis. The histological features of the lesions showed a perivascular neutrophilic infiltration in the dermis without signs of vasculitis, pathognomonic of Sweet's syndrome. One patient was successfully treated, initially with aspirin and later prednisone, the other with potassium iodide. Recognition of this syndrome is important in view of the dramatic response to treatment, particularly corticosteroids.

Adult↗
PubMed1990

Ultraviolet B-induced tumors in pigmented hairless mice, with an unsuccessful attempt to induce cutaneous melanoma.

An animal experiment is presented in which pigmented hairless mice were exposed once per fortnight to high doses of ultraviolet B (UVB) to study tumorigenesis. The aim of the study was to confirm a causal relationship between cutaneous melanoma and UV radiation, and to find an animal model to study it. The experiment was based on the hypothesis that the risk of developing a melanoma is increased by a history of severe sunburns. Pigmented hairless mice, Skh-hr2, were exposed once every fortnight to high doses of UVB radiation from fluorescent sunlamps, Westinghouse FS40 T12. Heavy actinic damage was observed for several days after each exposure. Seventeen of the 24 animals eventually developed tumors. Histopathologically, 80% of the tumors were squamous cell carcinomas. Depositions of melanophages were observed, but no melanomas. In this mouse experiment no causal relationship between cutaneous melanomas and UV radiation could be established.

Animals↗
PubMed1989

B cells and plasma cells in mycosis fungoides. A study including cases with B cell follicle formation or a monotypical plasma cell component.

B cells formed a distinctive component (greater than 5%) of the infiltrates in specimens of 28% (n = 12) of the 43 cases of mycosis fungoides studied. A large majority expressed surface immunoglobulin (Ig) D and/or IgM and a small minority IgA, similar to the proportions in inflammatory infiltrates. There was a prevalence of lambda light-chain expression. In about half of these cases, specimens revealed the formation of B cell follicles at various stages of development. Plasma cells formed a substantial number (greater than 25/mm2) in specimens from 21% (n = 9) of the patients. In six of these cases, including all four cases with advanced follicle formation, the same specimens were also rich in B lymphocytes. In most of the specimens the varying majorities of IgA or IgG producing cells and the polytypical expression of kappa and lambda light chains were similar to the patterns in inflammatory disorders. Two cases showed a striking prevalence of IgG, kappa-positive plasma cells, which was present in multiple specimens of one case and was associated with atypical plasmacytoid cells in a tumor of the other case. The pertinence of these observations for a special relationship between the abnormal T cells and the B cell component is discussed.

Adult↗
PubMed1989

Actinic reticuloid: immunohistochemical analysis of the cutaneous infiltrate in 13 patients.

An immunohistological study on cryostat sections of skin biopsies in 13 patients with actinic reticuloid has been performed using a panel of 21 monoclonal antibodies against lymphoid and non-lymphoid infiltrate cells. The infiltrate consisted of activated T cells, numerous histiocytes and macrophages, and small numbers of B cells. In 10 out of 13 patients the majority of the lymphocytes expressed the phenotype of suppressor cells. The number of Leu 8+ cells was inversely proportional to HLA-DR expression by the dermal infiltrate, which suggested a negative correlation between a state of activation and the concentration of Leu 8+ cells. There was a striking number of IgE bearing dendritic cells in the dermis associated with elevated serum IgE levels.

Aged↗
PubMed1989

Prognostic significance of CD30 (Ki-1/Ber-H2) expression in primary cutaneous large-cell lymphomas of T-cell origin. A clinicopathologic and immunohistochemical study in 20 patients.

The histologic and immunophenotypical features of 20 primary cutaneous large-cell lymphomas of T-cell origin were investigated and correlated with clinical data to obtain prognostically relevant criteria. Histologic evaluation, using the updated Kiel classification, showed that these large-cell lymphomas represent a morphologic spectrum, often making classification rather arbitrary. It is therefore concluded that the clinical relevance of histologic subtyping is limited for this group of lymphomas. Immunophenotypical studies revealed significant differences between CD30-positive and CD30-negative lymphomas. CD30-positive lymphomas generally presented with localized skin disease, and had a favorable prognosis (9 of 10 patients alive and in complete remission; median survival, 37 months). In contrast, CD30-negative lymphomas often presented with or rapidly developed generalized disease; all patients died of lymphoma (median survival, 17 months). These findings suggest that CD30 expression is an important prognostic parameter for this group of primary cutaneous large-cell lymphomas.

Antigens, CD↗
PubMed1989

Jessner's lymphocytic infiltration of the skin. A clinical study of 100 patients.

Jessner's lymphocytic infiltration of the skin is a well-known but poorly understood disorder. Some doubt still exists about whether it is a single entity or a heterogeneous group that can pass into polymorphous light eruption, discoid lupus erythematosus, or even malignant lymphoma. Therefore, a large number of patients with lymphocytic infiltration of the skin (N = 100; 46 male, 54 female) were examined to elucidate these questions. We conclude that lymphocytic infiltration of the skin is a single entity. Progression into polymorphous light eruption, discoid lupus erythematosus, or lymphoma was not observed. However, this study shows that lymphocytic infiltration of the skin and polymorphous light eruption cases occur simultaneously in 1 patient. In this study the cases of 10 patients with this combination are reported. An effective but harmless therapy is yet unknown. Intermittent use of topical steroids can be useful but is not effective in many patients.

Adolescent↗
PubMed1989

Actinic reticuloid. A clinical photobiologic, histopathologic, and follow-u study of 16 patients.

We report a detailed clinical, histopathologic, and photobiologic study of 16 Dutch patients with actinic reticuloid. All were middle-aged or elderly men who had persistent plaques on light-exposed skin only (two patients), extension of lesions to nonexposed areas (four patients), or prolonged or persistent episodes of erythroderma (10 patients). They were sensitive to UVB, UVA, and visible light. In 10 of 13 patients tested, the dermal infiltrate contained predominantly suppressor T cells. Many also had a reversed helper-suppressor T cell ratio. Circulating lymphocytes with deeply indented nuclei were present in all but were most pronounced in the most photosensitive erythrodermic patients. Tolerance induction therapy with UVB irradiation produced an excellent or good response in 13 of 15 patients. One patient responded to cyclosporine therapy.

Aged↗
PubMed1988

Aberrant immunophenotypes in mycosis fungoides.

Skin biopsy specimens from 40 patients with mycosis fungoides (MF) were examined by a selective procedure for the assessment of immunophenotypic deviation. In 19 cases (48%), aberrant phenotypes were detected. Type and degree of aberration differed greatly without apparent clinicopathologic correlation. Different phenotypes in the same patient occurring either simultaneously or during the course of the diseases were observed. Phenotypic aberration showed a statistically significant correlation with tumor stage MF, the large cerebriform tumor cell type, blast cell transformation, and diffuse dermal infiltration. In combination with longer-existing disease, more lymph node and visceral involvement and a higher mortality rate of MF in the aberrant group indicated an association with advanced disease. Its prognostic relevance for the individual patient, however, seemed limited because of the association of aberration and a long-lasting indolent course in many other patients. The assessment of phenotypic aberration formed a valuable contribution to the diagnosis of MF, especially in cases with little cellular atypia.

Adult↗
PubMed1988

The carcinogenic risks of modern tanning equipment: is UV-A safer than UV-B?

An animal experiment is presented in which three groups of albino hairless mice (Skh-hr 1) were exposed to daily doses of either UV-B or UV-A to study carcinogenesis. The UV-A was filtered carefully so as to eliminate contaminating UV-B. The doses required for acute effects (erythema and edema) were also determined for the two radiation modalities. In order to study the relative carcinogenic risks of exposures to UV-A and to UV-B, for both modalities, the doses causing skin tumors were compared to the doses required for eliciting acute effects in the skin. In the experiment on carcinogenesis all animals developed tumors, the ones exposed to UV-A as well as the ones exposed to UV-B. A striking difference, however, was that the induction times of the first tumors showed a larger spread in the mice exposed to UV-A than in the UV-B groups. Also, the development of successive tumors in each individual mouse was more spread in time in the UV-A group. A second difference between the effects on the skin was that in the animals exposed to UV-B no skin reactions were seen until the tumors developed. However, in most UV-A exposed animals, a marked scratching, probably caused by severe itching, and hyperkeratosis preceded the development of the tumors. Histologically at least 60% of the larger tumors induced by UV-A appeared to be squamous cell carcinomas. This finding is very similar for UV-B induced tumors. The elastic fibers in the UV-A exposed animals were also examined and actinic elastosis was observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

The expression of the Hodgkin's disease-associated antigen Ki-1 in cutaneous infiltrates.

Reactivity for Ki-1 antibody was studied in 145 patients with a large variety of cutaneous disorders. The antigen was consistently expressed and by a high proportion of tumour cells in infiltrates in which atypical cells revealed a 'histiocytic' appearance, i.e. lymphomatoid papulosis (LP), T-immunoblastic lymphoma with the characteristic of true histiocytic lymphoma, Hodgkin's disease, T-blast cell proliferation with giant multivesicular bodies, concurrent LP and mycosis fungoides (MF), and two cases of MF. Ki-1+ cells with the usual morphology of atypical T-cells formed a major component in 2 other cases of MF, and a minor component in 7 other cases of MF. A possible non-neoplastic counterpart was found in small to medium-sized Ki-1+ cells, including blast cells, which occurred occasionally in the T-cell infiltrates of eczema, actinic reticuloid, lichen planus and pityriasis lichenoides. Small Ki-1+ cells which were observed in the reactive B/T cell component of lymphocytoma cutis but also in similar components occurring occasionally in non-epidermotropic cutaneous T-cell lymphoma, and malignant B-cell lymphomas, might be analogous to the Ki-1+ cells in normal lymphoid tissue.

Antibodies, Monoclonal↗
PubMed1988

Skin lesions due to exposure to methyl bromide.

Six patients were occupationally exposed to high concentrations of methyl bromide during a fumigation procedure using adequate airway protection. Within a few hours all patients developed skin lesions, consisting of sharply demarcated erythema with multiple vesicles and large bullae. There was a striking predisposition for parts of the skin that were relatively moist or subject to mechanical pressure, such as axillae, groin, and abdomen. Microscopically, early skin lesions revealed necrosis of keratinocytes, severe edema of the upper dermis, subepidermal blistering, and diffuse infiltration of neutrophils and, to a lesser degree, eosinophils. Two patients developed an urticarial rash approximately one week after the exposure. On histologic examination, these late lesions showed combined features of a spongiotic dermatitis and urticaria. No immunopathologic manifestations were observed. In all patients, the skin returned to normal after four weeks, except for some residual hyperpigmentation. Plasma bromide levels after exposure strongly suggested percutaneous absorption of methyl bromide.

Administration, Topical↗
PubMed1987

Primary cutaneous large cell lymphomas of follicular center cell origin. A clinical follow-up study of nineteen patients.

In this study the clinical characteristics and follow-up data of nineteen patients with a diffuse large cell lymphoma of follicular center cell (B cell) origin, with only skin lesions at presentation, are reported. Sixteen of nineteen patients came to us with localized nodules or tumors, preferentially on the trunk, scalp, and lower legs. Remarkably, eight of eleven patients with disease confined to a limited area on the trunk had a history of slowly progressive papular lesions that had been present for 1 to 20 years prior to the development of rapidly growing skin tumors. Initial treatment, generally radiotherapy and/or polychemotherapy, resulted in complete remissions in seventeen of nineteen patients. Only three patients developed extracutaneous disease, whereas two other patients had recurrent disease in the skin at sites distant from the original skin lesions. Excluding three patients who had just finished initial treatment at the time of writing, twelve of sixteen patients were currently alive and in complete remission with a median survival of 44 months. Four patients died, three of whom were elderly women who had skin tumors on the lower legs when first seen. These results suggest that patients with a primary cutaneous large cell lymphoma of follicular center cell origin with disease confined to the trunk of scalp have a very favorable prognosis.

Adult↗
PubMed1987

T-cell signet-ring cell proliferation in the skin simulating true histiocytic lymphoma.

We report the case of a solitary ulcerating lesion on the elbow of a 32-year-old man. Routine histopathological examination strongly suggested a histiocytic malignancy. However, electron-microscopical, enzyme-cytochemical, and immunological studies revealed that the "tumor" cells were T lymphocytes with an unusual (Leu 1+, Leu 3a+, Leu 4+, Leu 5b+, OKT4+, HLA-DR+, Ki-1+, Leu MI+) immunological phenotype and an even more uncommon morphology characterized by the development of giant multivesicular bodies giving some cells a signet-ring cell appearance, and autophagocytosis. The lesion healed spontaneously, notwithstanding its malignant histology.

Adult↗
PubMed1987

Are Lisch nodules an ocular marker of the neurofibromatosis gene in otherwise unaffected family members?

A male patient with classical neurofibromatosis is reported. Examination of the other family members revealed 2 patients with solitary cutaneous neurofibromas and 2 with one or more Lisch nodules without other cutaneous or systemic signs of neurofibromatosis. This suggests that Lisch nodules can be a marker for the neurofibromatosis gene in otherwise unaffected family members.

Adult↗
PubMed1987

Abnormal T-lymphocytes in lymphomatoid papulosis. A cytomorphological study with a reconstruction of a major part of the cell differentiation cycle.

The abnormal cell population in lymphomatoid papulosis was studied by immunohistochemistry, light and electron microscopy in five cases. It resulted in a comprehensive description of all the main variants within the abnormal cell population. In one of the cases an irreversible intracytoplasmic process in the abnormal lymphocytes made it possible to demonstrate the derivation of lymphomatoid cells with cerebriform nuclei resembling the mycosis cells in mycosis fungoides from large histiocyte-like cells resembling the Reed-Sternberg cells in Hodgkin's disease. Variable numbers of the abnormal cells expressed Ki-1 reactivity in all four cases tested and T-cell associated antigens in two cases.

Adult↗