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Biomedical subjects

J Toonstra

Publications and source records attributed to J Toonstra.

72 records · Page 4Linked to original sources
PubMed1987

Diffuse large cell lymphomas of follicular center cell origin presenting in the skin. A clinicopathologic and immunologic study of 16 patients.

This report describes the clinical, histologic, and immunologic characteristics of 16 diffuse large cell lymphomas of follicular center cell origin with only skin lesions at presentation. These patients presented with nodular and tumorous skin lesions, which in 10 of 16 cases were confined to a circumscribed area on the trunk. Four patients, all elderly women, presented with skin tumors on the lower legs. Histologically, these 16 lymphomas showed nonepidermotropic diffuse dermal infiltrates, mainly consisting of large follicular center cells, with a variable admixture of small cleaved cells, immunoblasts, T-lymphocytes, and macrophages. The relative numbers of large cleaved and large noncleaved cells, respectively, varied considerably in these lymphomas. Immunophenotypically, almost all lymphomas expressed monotypic surface immunoglobulins and HLA-DR antigens, whereas all lymphomas were reactive with B-cell-associated monoclonal antisera B1, Leu-14, and/or To15. Three of four elderly female patients presenting with disease on the lower legs died. Of the 12 other patients, 11 are currently alive and in complete remission, which suggests a favorable prognosis for this type of cutaneous large cell lymphoma.

Adult↗
PubMed1986

The presence of IgE molecules on epidermal Langerhans cells in patients with atopic dermatitis.

Skin sections of clinically involved and clinically normal-looking skin from patients with atopic dermatitis were incubated with anti-human IgE antibodies using the indirect immunoperoxidase technique. Apart from positive dermal anti-IgE staining, positive epidermal anti-IgE staining was also observed. The morphology of the epidermal staining cells suggested the involvement of dendritic cells. This was confirmed by positive immuno-double labelling with OKT6 and anti-IgE. This phenomenon seemed to be specific for atopic dermatitis since skin sections from normal non-atopic controls, patients with allergic asthma, contact dermatitis, and schistosomiasis showed no epidermal anti-IgE staining. To further elucidate the nature of the epidermal anti-IgE staining cells, epidermal cell suspensions were prepared from clinically involved skin from patients with atopic dermatitis. These cell suspensions also showed positive anti-IgE staining cells and positive immuno-double labelling with OKT6 and anti-IgE. Immunogold electron microscopy with anti-IgE on epidermal cell suspensions from patients with atopic dermatitis showed gold particles on the cell membranes of cells containing Birbeck granules, being Langerhans' cells. Epidermal cell suspensions from normal non-atopic controls were negative. The presence of IgE molecules on epidermal Langerhans' cells, which seems to be specific for patients with atopic dermatitis, provides an explanation for the high frequency of positive patch test reactions to inhalant allergens.

Adolescent↗
PubMed1986

Solitary nonepidermotropic T cell pseudolymphoma of the skin.

A possibly new type of T cell pseudolymphoma is described in three cases. It presented as a small, solitary lesion on the trunk of 3 to 5 months' duration. It was slightly elevated, round, and erythematous, with a diameter of 1 to 2 cm. It showed a tendency to regress spontaneously. In sharp contrast to its benign clinical appearance and biologic behavior, a distinct malignant histopathologic picture was observed, however. It was characterized by a nonepidermotropic bandlike subepidermal infiltrate dominated by large T lymphocytes with cerebriform nuclei identical in morphologic and immunologic characteristics to the abnormal cellular component of cutaneous T-cell lymphomas.

Adult↗
PubMed1986

Immunohistochemical characterization of plasma cells in Zoon's balanoposthitis and (pre)malignant skin lesions.

A retrospective study in 9 patients with Zoon's balanoposthitis was done to determine the immunoglobulin class distribution in the plasma cellular infiltrate. This was carried out on paraffin-embedded specimens using an unlabelled antibody peroxidase-antiperoxidase method. In all lesions IgG-producing plasma cells predominated. IgA- and IgD-positive cells were also present in about equal quantities but fewer than IgG. IgM-positive cells were either absent or present in very low numbers. Especially in erosive lesions a high number of plasma cells was noticed. The kappa/lambda ratio was variable with a preference for lambda in 5 of 8 cases. These findings are suggestive of a nonspecific polyclonal stimulation of B cells, which might be caused by a persistent infection. The above-mentioned findings were compared with premalignant and malignant skin lesions in which a major amount of plasma cells was present in the inflammatory infiltrate. Comparable results were obtained with slight variations. The role of plasma cells in these infiltrates is discussed.

Adult↗
PubMed1985

Actinic reticuloid simulating Sézary syndrome. Report of two cases.

A report is given on two male patients who showed all the main characteristics of Sézary syndrome (SS). When phototested, however, they proved to be extremely photosensitive, which suggested a diagnosis of actinic reticuloid (AR). This was supported by the predominance in blood and skin specimens of lymphoid cells with a suppressor/cytotoxic phenotype, the absence of clonal cell proliferation and a benign clinical course. Differential diagnostic problems of SS and erythrodermic AR are discussed.

Aged↗
PubMed1985

Immunocytoma of the skin simulating lymphadenosis benigna cutis.

We report a case of primary cutaneous lymphoma, of the lymphoplasmacytoid type (immunocytoma), in which a small neoplastic component was obscured by a dominating reaction exhibiting characteristic features of lymphadenosis benigna cutis. This abnormal cell population was identified because of the unusual cytomorphology of the tumor cells, which showed deeply indented nuclei in combination with a distinctly plasmacytic cytoplasm. Monoclonality was revealed by the cytoplasmic positively of the tumor cells for lambda chains only. This case strongly suggests that in at least a number of cases of lymphadenosis benigna cutis, a low-grade malignant lymphoma may be present.

Adult↗
PubMed1985

Cutaneous 'bronchogenic' cyst.

A case of a congenital 'bronchogenic' cyst of the skin over the right scapula of a 4-year-old boy is reported. The continuity of its epithelial lining with the epidermis and its appendages is stressed and the consequences of this relationship for current theories about the pathogenesis of cutaneous ciliated cysts are discussed.

Bronchi↗
PubMed1985

Leser-Trélat sign in mycosis fungoides. A further case report.

A 61-year-old woman is presented who developed numerous seborrheic keratoses within a few weeks. About 2 months later the patient noticed a progressive generalized erythematosquamous eruption on which the diagnosis of mycosis fungoides was made. PU-VA therapy resulted in complete remission of the mycosis fungoides lesions together with a resolution of the seborrheic keratoses. This is the third report of the Leser-Trélat sign in mycosis fungoides. The cases associated with malignant lymphomas are briefly reviewed.

Dermatitis, Seborrheic↗
PubMed1985

Bullosis diabeticorum. Report of a case with a review of the literature.

The case of a male diabetic patient with recurrent bullous lesions restricted to the hands is reported. Areas of spongiosis in the epidermis, as well as subepidermal blister formation, were observed in repeated biopsies. On electron microscopy, separation was seen at the level of the lamina lucida. No immunopathology was observed in involved skin. A review of forty-four reported cases of bullosis diabeticorum is given.

Adolescent↗
PubMed1984

Sézary syndrome with early immunoblastic transformation.

Two patients with clinical manifestations of Zézary syndrome are reported. In both cases from an early stage of the disease in addition to characteristic Sézary cells large numbers of immunoblasts were present in skin lesions and peripheral lymph nodes and in one case also in the blood. Their relationship to the characteristic Sézary cells was shown by morphological, cytochemical and immunological methods. The infiltrates in the skin were epidermotropic in one case and nonepidermotropic in the other. Lymph node structure was effaced by diffuse infiltration of abnormal lymphoid cells. These were found to proliferate in the skin as well as in lymph nodes. Cytogenetical studies of blood lymphocytes indicated an abnormal hypodiploid clone in both cases. Immunologically the tumour cells had properties of peripheral T-lymphocytes but whereas all abnormal cells exhibited inducer/helper cell characteristics in one case, only a minority of the lymphocytes revealed these characteristics in the other case. In this case the tumour cell population changed into a more pleomorphic type. The classification of the cases is discussed.

Female↗
PubMed1984

'Persistent' annular erythema of infancy.

An unusual annular erythema occurred in a 6-month-old girl. Recurrent annular lesions appeared on the face and back, but annular lesions persisted for ten months on the distal extremities. Eleven months after the eruption appeared, it resolved completely without recurrence. This seemingly unique condition is compared with other cases of chronic annular erythemas, especially those previously described as erythema gyratum perstans.

Back↗
PubMed1983

Multilobated cutaneous T cell lymphoma. Report of two cases resembling Crosti's reticulosis.

2 middle-aged men are described with slowly progressive papular and nodular lesions, limited to the skin of the back. Clinically and histologically both resembled Crosti's reticulosis ('réticulo-histiocytome du dos de l'adulte'). It was determined by electron microscopic, enzyme cytochemical and immunological studies that the 'histiocyte' component, which was derived from T lymphocytes, consisted of blast-like cells with characteristic multilobated nuclei with nucleoli in marginal position. For this type of lymphoma, which may have been described previously as lymphocytoma cutis or reticulum cell sarcoma, the term 'multilobated cutaneous T cell lymphoma' is proposed. According to its slowly progressive clinical course it may be classified as a malignant lymphoma of low grade malignancy.

Diagnosis, Differential↗
PubMed1982

Cutaneous T-cell lymphoma, multilobated type, expressing membrane differentiation antigens of precursor T-lymphocytes.

Monoclonal antibodies to human T-cell membrane antigens were used to evaluate the immunological phenotype of the tumour cells in two cases of a recently described cutaneous T-cell lymphoma of 'multilobated' type. In one case the distinctive abnormal blast cells expressed positivity for OKT6, anti-HTAI, OKT4 and Leu-3a, and showed binding capacity for peanut agglutinin (PNA). These are properties normally displayed by immature cortical thymocytes. The antigen expression of the abnormal blast cells in the other case was OKT3, Leu-I, OKT4, Leu-3a in the absence of PNA-binding; these properties bear more resemblance to more mature T-inducer/helper cells. When combined with consideration of the morphological aspects we suggest that in both cases the abnormal cells represented precursor T-lymphocytes.

Antigens, Neoplasm↗
PubMed1982

Cutaneous T-cell lymphoma, multilobated type.

Three cases of a new type of lymphoma of the skin are described. Clinical manifestations were the development of papules, nodules and tumours which slowly progressed in size and extent in one region of the skin of elderly men. Dissemination to a regional lymph node occurred in only one. Histopathologically the lesions demonstrated a variably perivascular or diffuse dermal infiltrate often with a nodular configuration and sparing the epidermis and a clear subepidermal zone. The infiltrates were dominated by abnormal lymphoid cells with irregular nuclei and blast cells exhibiting a characteristic combination of multilobated nuclei with marginal nucleoli. By immunological and enzyme cytochemical methods the cells were identified as T lymphocytes. It is suggested that the cases described represent different parts of spectrum running from lymphocytoma cutis-like conditions to disseminated malignant lymphoma.

Cell Nucleus↗
PubMedDate not supplied

First reported case of Mycobacterium ulcerans infection in a patient from China.

Buruli ulcers have not been previously described in China, and only once at higher latitudes on the northern hemisphere. A patient who travelled in the Shan Dong Province in the People's Republic of China developed an ulcer which was proven to be a Buruli ulcer. The clinical picture and histopathological findings from biopsy specimens are characteristic for a Buruli ulcer, and also the growth in culture (Coletsos medium) at a restricted temperature of 30 degrees C. A multiplex polymerase chain reaction (PCR) based on the amplification of the gene encoding for 16S ribosomal RNA and a nested PCR based on the Mycobacterium ulcerans specific repeated sequence 2404 were performed. These PCR investigations identified the bacteria as M. ulcerans, subspecies shinshuense. The patient was initially treated with clarithromycin and rifampicin, which was changed to ciprofloxacin and rifabutin when rifampicin resistance of the first isolate was established. There were no signs of reactivation of the disease 6 months after the end of treatment. M. ulcerans infection occurs above 30 degrees latitude on the northern hemisphere in China and is caused by M. ulcerans, subspecies shinshuense. This case appears to be cured by chemotherapy alone, in contrast to the general experience that surgical treatment is indicated. The granulomatous reaction with only fragments of acid-fast bacteria in the biopsy at the end of treatment many indicate the development of an adequate cell-mediated immune response leading to resistance to the infection.

Adult↗