Biomedical subjects
R J Reed
Publications and source records attributed to R J Reed.
Minimal deviation malignant melanoma arising in a congenital nevus.
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Stem cell (immunoblastic) lymphoma. A variant of B lymphocytic lymphoma.
From a histologic review of cases coded as Hodgkin's disease and reticulum cell sarcoma, 12 cases were selected as examples of stem cell lymphoma in which the preponderant cell has characteristics of the B immunoblast. Clinically, these lesions affect the elderly (average age 57.3 years), disseminate early, and, with a few exceptions, progress rapidly to a fatal termination. Morphologically, the neoplastic stem cells, which have pyroninophilic cytoplasm, form diffuse infiltrates with an admixture of acidophilic cells. As a regional variation, the pattern in these lesions overlaps histologically with that seen in angioimmunoblastic lymphadenopathy. The overlap in patterns is presumptive evidence that the angioimmunoblastic pattern at times may be a precursory expression of the stem cell lymphoma. On the basis of morphologic features, these tumors are interpreted as a variant of B cell lymphomas.
The histogenesis of molluscum contagiosum.
In the group of viral induced epidermal hyperplasias, the inverted, follicular, and lobulated pattern of a lesion of molluscum contagiosum is distinctive. The proposed epithelial progenitors have included epidermis, sebaceous glands, and hair follicles. A study of 77 cases of molluscum contagiosum implicates folliclular neogenesis as a primary histogenetic determinant. Areas of hair bulb differentiation are common at the periphery of a lesion of molluscum contagiosum and occasionally are associated with areas of sebaceous gland differentiation. In areas of active viral replication, the neogenetic follicular epithelium expands to form rounded lobules which extrude viral particles and keratinized debris into dilated ostia. In inflamed molluscum contagiosum, the inflammatory response is reminiscent of the invasive--destrictive pattern of cell-mediated immunity.
Gangliocytic paraganglioma.
Six cases of upper intestinal gangliocytic paraganglioma, five in the duodenum and one in the jejunum, are reported. Three histologic patterns, each comparable to patterns in paraganglioma, ganglioneuroma, or carcinoid-islet cell tumor, are mixed in varying proportions. The complex histologic patterns encountered within these tumors reflect the differentiation of pluripotent cells. Although the parent cell is not identified in this study, gangliocytic paragangliomas may arise from cells which normally reside in the mucosal crypts and are presumably derived from cells originating in the neural crest. Three of the six tumors contain stromal amyloid. In one case, studied by electron microscopy, dense-cored cytoplasmic vesicles almost fill some of the tumor cells. Gangliocytic paragangliomas share the features of stromal amyloid and dense-cored vesicles with other neurocrine tumors.
Cutaneous manifestations of neural crest disorders (neurocristopathies).
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Mesocercaria in the skin of man in Louisiana.
Two areas of intradermal swelling removed from the upper thigh and iliac crest of a 43-year-old man in Louisiana were each found to contain a larval trematode about 0.5 mm in length. Based on morphology reconstructed from serial sections, the two worms were identified as a mesocercaria of an undescribed species belonging to the subfamily Alariinae.
Unusual variant of lupus erythematosus or lichen planus. Clinical, histopathologic, and immunofluorescent studies.
Eleven patients with a skin disorder in which clinical, histopathologic, and immunofluorescent findings showed overlap features of both lupus erythematosus (LE) and lichen planus (LP) were observed for several years. Clinical lesions were extremely long-term and consisted primarily of livid red to violaceous atrophic patches and plaques, most common on acral aspects of the extremities. Nails were also commonly involved, often showing anonychia. Histologic changes combined cell-rich and cell-poor lichenoid patterns in the papillary dermis, suggesting both LP and LE. The major immunofluorescent finding in all patients was the presence of ovoid bodies at the dermal-epidermal (D-E) junction and in the upper dermis. Most patients showed both a linear arrangement and a clustering pattern of these bodies. Four patients also had coexistant but poorly developed linear deposits of immunoglobulins and complement at the D-E junction.
Functioning lipoadenoma of the parathyroid gland.
Lipoadenoma is a rare tumor of the parathyroid gland composed of adult adipose tissue and irregular trabeculae of parathyroid cells. This variant of adenoma is poorly documented. Similar lesions that have been either functional or apparently nonfunctional have been reported as adenoma with unusual stromal development and as parathyroid hamartoma, respectively. In this report, the second case of a functional lipoadenoma of the parathyroid gland is described.
Plantar lentiginous melanoma: a distinctive variant of human cutaneous malignant melanoma.
The neoplastic system of human cutaneous melanoma includes three generaly recognized variants: lentigo maligna, superficial spreading melanoma, and nodular melanoma. Lentiginous melanomas other than lentigo maligna constitute a fourth group, of which plantar lentiginous melanoma qualifies as an anatomic subgroup. Histologically and clinically, plantar lentiginous melanoma (PLM) is characterized by a period of radial growth and often by one or more foci of regression. In 27 of 33 plantar melanomas, a characteristic lentiginous, radial component of melanocytic proliferation was noted. In the remaining six cases, histological material failed to document a radial component. Eighteen of the 27 patients with PLM were blacks, and 18 patients died of distant metastasis. Tumors invasive to level II did not metastasize, but at levels IV and V and in tumors with a high mitotic rate, the prognosis was poor. The presence of lymph node metastases at the time of initial therapy correlated with a poor prognosis group.
Monomorphic adenomas of salivary glands. Trabecular-tubular, canalicular, and basaloid variants.
Eleven cases of monomorphic adenoma of the salivary glands are interpreted as variants of pleomorphic adenomas (mixed tumors) that lack chondroid or myxomatous components. Nine of these tumors were in the parotid gland and two were on the hard palate. Monomorphic adenomas are usually encapsulated and frequently are partially cystic. Their histologic pattern may be confused with that of adenoid cystic carcinoma, but they grow in an expansile fashion and usually are monolobular. Histologically, they may be divided into trabecular-tubular, canalicular, and basaloid variants. Morphologically, they bear a resemblance to basaloid sweat-gland tumors (eccrine spiradenoma and cylindroma).
Primary adenovillous carcinoma of the bladder.
Two cases of primary adenovillous carcinoma of the bladder are presented: one in a normally placed bladder and the other in an exstrophied bladder. The close association of these 2 neoplasms with coexistent cystitis glandularis would seem to support the possible precancerous nature of the latter entity. The remarkable similarity of these neoplasms to villous adenocarcinomas of the rectum is also described, a finding which may reflect the close embryologic origin of the rectum and bladder neck. A brief review of the classification of vesical adenocarcinomas is also given.
Letter: Training programs and specialty boards.
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Topical chemotherapy of lentigo maligna with 5-fluorouracil.
Three patients with biopsy-proven lentigo maligna were treated with topical 5-fluorouracil. Treatment consisted of twice daily application of 5% 5-fluorouracil cream for 13, 6, and 9 weeks, respectively. Two patients demonstrated presence of invasive melanoma; in one the melanoma was evident before chemotherapy, and in the other the lesion became evident after chemotherapy. In both the lentigo was treated topically and the melanoma excised locally. Posttreatment followup times through April 1, 1974 have been 42, 24, and 22 months, respectively. There has been no evidence of metastases in any patient. Topical chemotherapy with 5-fluorouracil cream appears to offer an encouraging alternative method of therapy for lentigo maligna of the face.
Lichen striatus: a model for the histologic spectrum of lichenoid reactions.
Three phases of lichenoid reactions are defined: 1) the primary phase, 2) the established phase; and 3) the senescent phase. Lichen striatus is characterized by a primary pattern that may be apparent in the epidermis, the hair follicles, and rarely the sweat glands and ducts. Focal areas of established lichenoid reaction, that are indistinguishable from lichen planus, are common. They usually are confined to the tips of elongated rete ridges. Established lichenoid patterns are occasionally present in hair follicles and are indistinguishable from those seen in lichen planopilaris. Eccrine hidradenitis, a feature of lichen striatus, is rarely seen in lichen planus. Lichen planus may be an adaptive epidermal response to a clone of aggressive lymphocytes and, as such, may be a manifestation of auto-immunity. In lichen striatus, senescent lichenoid patterns resemble those seen in lichen nitidus.
Macrophage-mediated destruction of human malignant cells in vivo.
Macrophages require a plasma component, designated "recognition factor" (RF), for the expression of optimal function. The RF activity was profoundly depleted in plasma from patients with malignant disease, and the degree of depletion and the severity of the malignant state seemed to be related. Since experiments demonstrated that an active RF significantly inhibited tumor growth, clinical studies were initiated to investigate the influence of intratumor administration of an active RF fraction. Glucan, a potent macrophage activator, was also employed alone or combined with RF. These studies were undertaken to enhance the recognition of malignant cells by macrophages and to mobilize and activate macrophages intralesionally. The initial 9 patients studied had malignant melanoma, adenosquamous carcinoma of the lung, or carcinoma of the breast. Control and experimental lesions were injected; subsequently biopsies were performed at varying intervals for histologic evaluation. Always when glucan or glucan and RF fraction were administered intralesionally, the size of the lesion was strikingly reduced in as short a period as 5 days. This reduction was associated with necrosis of the tumor and a monocytic infiltrate. In small lesions, resolution was complete, whereas in large lesions, resolution was partial. The amount of glucan injected and the quantity of residual tumor appeared to be related. The induced necrosis of the tumor nodule was associated with an increase in plasma levels of circulating RF activity.
The clinical diagnosis of malignant melanoma.
The diagnosis of malignant melanoma thus rests upon an appreciation of sometimes subtle but definite signs detectable by careful observation of color, border, and surface of the lesions. Differential diagnosis lies among several cutaneous lesions, neoplastic and nonneoplastic. At times the lesions that are most difficult to distinguish from malignant melanomas are certain pigmented basal cell carcinomas, thrombosed hemangiomas, and certain types of moles. An attempt has been made in this review to describe and illustrate those features of pigmented lesions that are most helpful in diagnosis.
Common and uncommon melanocytic nevi and borderline melanomas.
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