Biomedical subjects
Publications and source records attributed to R J Reed.
Multilocular renal cyst is an uncommon lesion of controversial histogenesis. The authors report a case of renal multilocular cyst with müllerian (ovarian)-like stroma. We suggest that this finding would support a dysontogenetic origin for the lesion.
Between 1958 and 1990, 82 patients with acral lentiginous melanoma were treated by the Tulane Surgical Service with regional perfusion, excision of lesion, and lymph node dissection. The patient group comprised 27 white men, 29 white women, 18 black men, and 8 black women, with an average age of 61 years. More foot lesions than hand lesions were reported, and all the lack men had foot lesions. In stage I patients, overall 5-year survival rates were 65% at 5 years and 44% at 10 years, with differences by race and gender. The black men did poorest, with a 13% 10-year survival rate. Survival rates were worse with increasing disease stage when calculated using univariate analysis. The 5-year survival rate of all patients with stage III and stage IV disease was 26%. A multivariate analysis was performed in 78 of 82 patients in whom all variables of Clark's level, age, race, stage, and sex were known. A strong relationship was observed between decreasing survival time and increasing Clark's level, with stage of marginal significance. In a multivariate analysis of patients with stage I disease, an increasing level of invasion was found to be significant, with a trend for a relationship to thickness. A trend toward decreased survival time was observed in men and blacks.
Patterns in giant congenital nevi are classified as to extent of cellular involvement of the reticular dermis and by the quality of the fibrous matrix. In addition, classifications are influenced by degrees of cellular atypia. Two general categories are defined. In one, the phenomena are relatively independent of those operative at the dermal-epidermal interface. The lesions are characterized as dermal congenital tumorous dysplasias-blastomas. They are subdivided into major, intermediate, and minor categories and into mature and immature variants. In these variants, disparate populations in the patterns of nodules and plaques (lumpy-bumpy variants) qualify as dermal variants of minimal deviation melanoma as seen in the setting of giant congenital nevi. The respective melanomas in this category are small-cell malignant neoplasms (melanoblastomas of infancy and childhood). In a second category in the clinical setting of giant congenital nevus, rare childhood and some adult melanomas of a more common histologic type evolve from lentiginous and junctional components in patterns that recapitulate those of the dysplastic nevus syndrome. The suspicious areas in all categories are evaluated by the same clinical criteria. In the dysplasia-blastoma category, enlarging nodules must be biopsied. The criteria for the evaluation of lesions in the dysplastic nevus syndrome and in the category of minimal deviation melanoma have application to the unstable regions in giant congenital nevi.
BACKGROUND: Soft tissue augmentation with processed fat has been used clinically for several years. This material has been termed "autologous collagen" since it was presumed it was composed primarily of collagen and fibrous tissue from lipocyte cell walls. OBJECTIVE: To examine the histologic behavior of dermis implanted with processed fat. METHOD: Volunteers were injected with processed fat intradermally in the post auricular area and these sites were biopsied at one week, one month, and three months. RESULTS: Early biopsies revealed no intact adiopocytes but a significant inflammatory infiltrate. Subsequently biopsies revealed replacement of the inflammatory reaction with cellular fibrosis and expansion of the dermis. CONCLUSION: Intradermal injection of processed fat results in deposition of fibrous material and collagen due to the response of the recipient site. The material itself contains very little collagen.
OBJECTIVES: To determine if alcoholic men who achieved stable abstinence experienced fewer deaths than those who relapsed and to develop a model predictive of premature mortality. DESIGN: A cohort of alcoholic men recruited into a prospective study of neurocognitive effects of alcoholism was followed up from 1 through 11 years. A demographically equated group of nonalcoholic men was also followed up. Alcoholics were classified as stable abstainers or relapsers. SETTING: Alcoholics were patients or ex-patients from a Department of Veterans Affairs Alcoholism Treatment Program and/or members of local chapters of Alcoholics Anonymous. PARTICIPANTS: There were 234 alcoholic men who met the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, criteria for alcohol dependence. Follow-up status regarding relapse and mortality was obtained for 199 alcoholic subjects (85%). Of these, 101 had relapsed and 98 had abstained. Ninety-eight nonalcoholic controls equated for age, education, and sex also participated. Mortality status was obtained for 92 subjects in this group (94%). EXCLUSIONS: Major medical and psychiatric illness and history of nonalcoholic drug abuse. MAIN OUTCOME MEASURE: Death during a follow-up period of 1 through 11 years. Death was ascertained through the National Death Index, the California State Department of Health and Vital Statistics, the State Department of Motor Vehicles, and through personal contact with informants, relatives, and significant others of the subjects. RESULTS: There were 19 deaths among relapsed alcoholics compared with the expected number of 3.83 (99% confidence interval (CI), 9.64 to 33.38). Among abstinent alcoholics there were four deaths (expected = 3.21; 99% CI, 0.67 to 12.59). The standardized mortality ratio for relapsed alcoholics was 4.96, which significantly exceeded the expected ratio (P less than .001), whereas the standardized mortality ratio for abstinent alcoholics (1.25) was indistinguishable from the expected. Cox proportional hazards analysis was used to determine if any of several demographic, medical, cognitive, or drinking history variables (in addition to relapse) helped predict mortality among alcoholics. Only relapse was significantly related to increased mortality (chi 2 = 9.15, P = .003). CONCLUSIONS: Alcoholic men who achieve stable abstinence do not differ from nonalcoholic men in mortality experience; however, alcoholics who relapse die at a rate 4.96 times that of an age-, sex-, and race-matched representative sample from the US Bureau of the Census.
A distinctive systematized epithelial nevus and associated multifocal carcinomas of the microcystic and sclerosing sweat duct type affected the lower extremities of a 9-year-old girl. The carcinomas were well differentiated and were both adenosyringomatous and microcystic. They qualify as microcystic and compound. In both the epithelial nevi and the carcinoma, primordial potentials are recapitulated.
It is generally believed that many non-Korsakoff alcoholics have subtle defects in memory. To determine whether such defects vary as a function of length of abstinence (LOA), we performed extensive memory testing with: (1) recently detoxified (n = 31; LOA-29 days); (2) intermediate-term abstinent (n = 28; LOA = 1.9 years); (3) long-term abstinent (n = 32; LOA-7.0 years) alcoholics; and (4) nonalcoholic controls (n = 37). All subjects were matched on age and education. Alcoholics were matched on years of alcoholic drinking. Memory measures were divided into the following domains: verbal learning, verbal recall, visual learning, visual recall, and paired associate learning. A series of MANOVAs were conducted that revealed a significant relationship between visual learning and length of abstinence, and a significant interaction between age and length of abstinence on visual recall. Long-term abstinent subjects were not significantly different from controls on any test. We conclude that memory disturbance demonstrable among recently detoxified alcoholics in the early weeks of their abstinence is not evident in demographically matched long-term abstinent alcoholics with similar drinking histories.
The designation combined nevus gives recognition to mixed cytologic patterns. In the common variant, plump, pigmented spindle cells form fascicles among nests of ordinary nevus cells. In other variants, one or several cellular components that share cytologic features with either a blue nevus or a Spitz nevus are represented. Ninety-five cases, 49% of which were of the common type, were studied. Grossly, most of the lesions were darkly pigmented papules or nodules. The clinical diagnosis in three-fourths of the cases was nevus, blue nevus, or melanoma. Fifteen percent had concomitant histologic features of melanocytic dysplasia, and most of these lesions were of the common type. For the common variant, the cytologic features, pattern of apparent infiltration, and variable representation of the features of a premalignant melanocytic dysplasia often mislead a pathologist in interpreting and predicting biologic potential. In combined nevi, the phenotypic diversity and genetic lability of melanocytic nevus cells is manifested.
A case of metastatic malignant melanoma simulating a giant cell tumor of bone is reported. This case typifies the diversity of expression of malignant melanoma. Osteoclast-like giant cells were present only in the femoral head metastasis and were not present in the primary lesion. The giant cell component may be reflective of an inherent and indiscriminant expression which may be seen in a variety of neoplastic bone lesions.
Twenty-eight cases of minimal deviation melanoma (MDM) in the histologic setting of halo nevus formed the basis for this study. Requisites for this study included at least one of the following: a remnant of a halo nevus in a MDM; remnants of both MDM and halo nevus in a common melanoma; and a MDM of Spitz or dermal type, or MDM arising in premalignant dysplasia in which the vertical growth components manifested distinctive cytologic features and cytophilia for lymphocytes. Many of the lesions apparently represented neoplastic progressions involving a population of cells at the dermal-epidermal interface (accretive growth). Some of the lesions qualified as dermal variants and apparently represented neoplastic progressions in a dermal component (interstitial growth). Most examples of MDM in this study were borderline in size (less than 1.00 mm in vertical dimensions). The borderline MDM were interpreted as brief (and in some cases perhaps ephemeral) neoplastic interludes. For the 12 cases with follow-up, there have been no metastases or local recurrences.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The implications of cytologic atypia, patterns of growth, stromal refractoriness, and immune responses in actinic keratoacanthoma are examined here in a speculative manner with the following conclusion: keratoacanthoma is a generic designation for a spectrum of invasive, keratinocytic hyperplasias. In this context, hyperplasia may affect both genomically normal and abnormal keratinocytes. In keratoacanthoma, it does so indiscriminately. The universality of the process in which both benign and neoplastic clones are affected qualifies as immunostimulation. The affected keratinocytes, regardless of genomic characteristics, extend beyond their sustaining stroma into retinaculum and the basement membrane, as an immunologic barrier, is disrupted. Following a period in which the stroma and the immune response are refractory, one or more clones of keratinocytes are exposed to an immune response. For the adnexal contributions, the eventual encounter with the immune response is brief and short-lived. The fate of these genomically intact cells is predictable: complete regression is the inviolate pathway. For the genomically deranged populace, the results of the encounter are unpredictable and potentially manifold. The options, variably expressed, include regression, spatial progression (expansion in space), and neoplastic progression (expansion in the number and types of neoplastic clones). In some actinic keratoacanthomas, neoplastic clones are represented in either focal or extensive carcinomalike patterns from the inception of the hyperplasia. In them, a potential for neoplastic progressions is inherent. If autonomous, aggressive clones are selected in the progressions, the transition from universal hyperplasia (keratoacanthoma) to malignancy (carcinoma) is effected. In the transition, hyperplastic, genomically intact, follicular keratinocytes are not affected; actinically deranged keratinocytes are. The final pathway for an individual evolving lesion is unpredictable, but in some cases it leads to biologic carcinoma (carcinoma ex-keratoacanthoma).
Explore the source record for details and available documents.
Explore the source record for details and available documents.
This paper presents a case of a cardiac myxoma with cutaneous emboli. The diagnosis of a cardiac lesion was anticipated after the histologic examination of a skin lesion. The first clue to the existence of a cardiac myxoma was a distinctive intravascular lesion of a dermal vessel. The clinical and pathologic features of cardiac myxoma are discussed. In addition, new evidence regarding the nature of a previously reported case of metastasizing cardiac myxoma is also presented.
We report 32 cases of fibroma of tendon sheath. Most cases presented as a painless mass in the distal portion of an extremity. Ganglion cyst was the most frequent clinical diagnosis. The median patient age was 30.5 years, and 60% of the patients were male. Only one lesion is known to have recurred. The lesions, which averaged 1.5 cm, were light tan, firm, and nodular. Histologic features common to all lesions were (a) a predominantly fibrous matrix containing (b) fibroblast-like spindle cells. Elongated, slitlike spaces were observed in many lesions, and nine cases had areas closely resembling nodular fasciitis. Myofibroblasts and fibroblasts were observed in the three cases studied by electron microscopy. The histologic findings were similar to those previously described for fibroma of tendon sheath. Although slitlike spaces are present in most instances, this finding is not specific for fibroma of tendon sheath, nor is it invariably present. Fasciitis-like changes have been noted in previous series. Our findings, as well as those from prior studies, indicate that fibromas of tendon sheath are heterogeneous. The diagnosis is made only after other fibrous, nodular lesions of the extremities are excluded. Fasciitis-like lesions heretofore classified as fibroma of tendon sheath are more appropriately classified as tenosynovial counterparts of nodular fasciitis.