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J Wechsler

Publications and source records attributed to J Wechsler.

278 records · Page 16Linked to original sources
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Aortic angiosarcoma clinically mimicking polyarteritis nodosa.

We report two patients in whom angiosarcoma of the aorta (ASA) with distal emboli and skin metastases was initially clinically misdiagnosed as polyarteritis nodosa (PAN). Both presented with features highly suggestive of systemic necrotizing vasculitis, including constitutional symptoms, orchitis (in one), leg pain with sensory neuropathy, livedo, focal areas of skin necrosis, painful cutaneous nodules demonstrating vasculitis or inconspicuous changes on biopsy, raised acute phase reactants, and transient improvement with systemic corticosteroids. Repeated skin biopsies revealed an atypical endovascular cell proliferation with strong reactivity for factor VIII. Magnetic resonance angiography (MRA) demonstrated an intra-luminal aortic tumour at the infra-renal level. In retrospect, the (PAN)-like features appeared to involve exclusively the lower part of the body in these patients.

Aged↗
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Reproducibility of histopathologic diagnosis and classification of non-melanocytic skin cancer: a panel exercise in the framework of the multicenter southern European study HELIOS.

AIMS AND BACKGROUND: The reproducibility of histologic diagnoses, and in particular of the distinction between basal and squamous cell forms, has been evaluated in the framework of a multicenter case-control study (in Italy, France, Spain and Switzerland) aimed to assess the causes of non-melanocytic skin cancers. METHODS: A panel composed of 10 pathologists from the collaborating centers was appointed. A total of 1,774 slides of routine diagnoses were blindly reviewed by a second panelist; discordant diagnoses underwent a third examination. Controversial and interesting cases were discussed during general sessions. RESULTS: The results showed a high degree of concordance (99.5%), with a Cohen's kappa of 0.85 (95% CI, 0.77-0.94) in the assessment of malignancy of lesions. The concordance in the distinction between large morphologic groups, basal cell carcinoma and squamous cell carcinoma was also high (Cohen's kappa = 0.85; 95% CI, 0.82-0.89). The assessment of histologic subtypes, degree of invasion and differentiation showed a lower degree of concordance, presumably as a consequence of a weaker consistency in the relevant classifications. CONCLUSIONS: The reproducibility study has therefore validated the epidemiologic study and in particular allowed to correct some misclassifications that could have lessened the analysis of the case-control study. In general, because of its characteristics (number of pathologists and variety of their origins, the large number of cases examined, blind examination of histologic slides), the conclusions of the study may show a certain degree of generalization, at least with regard to the countries represented. Routine histologic diagnoses of cutaneous carcinoma showed a high degree of reliability with reference to the assessment of malignancy and the distinction between basal and squamous cell carcinoma morphotypes.

Adult↗
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[Primary malignant cutaneous lymphomas excluding mycosis fungoides. Anatomoclinical study of 16 cases].

Cutaneous primary lymphomas excluding mycosis fungoides and Sezary Syndrome represent a rare condition. Few papers are published on the subject. The authors report a retrospective study of 16 cases concerning only these primary lymphomas. It comprises 10 adults and 6 children. In 13 cases the cutaneous tumor was solitary without extra-cutaneous lesion, in 3 cases there was a satellite simultaneous lymph node. The most frequent location was head and neck region (7 cases with 4 cases from children); limbs were concerned too (5 cases/16); more rarely trunk. Our cases were classified with reference to lennert's classification. We found that large cells lymphomas were predominant: centroblastic (4 cases), lymphoblastic (4 cases), immunoblastic lymphomas (6 cases). The clinical course was unfavourable in 50% of our cases in less than 3 years: 6 lethal cases, and 2 metastatic disseminations. These 8 cases belonged to the pejorative group of lymphomas (large cells type). The 2 cases with small cells population (centrocyto-centroblastic and lymphoplasmocytoïd type) were free of disease for 5 and 2 years after diagnosis. Thus, our experience suggests that there is a relations hip between the histologic type of cutaneous lymphoma and the course of the disease. In disseminated cases, the extra-cutaneous extension was located in lymph nodes, bone marrow, as it was mentioned in literature.

Adult↗