Biomedical subjects
Publications and source records attributed to R L Sanchez.
A review of the literature showed that angiosarcomas of the anterior abdominal wall are rare neoplasms and that all published cases have been preceded by irradiation and/or prior surgery. We believe that our case of a primary angiosarcoma of the anterior abdominal wall is unique and that chronic lymphedema secondary to morbid obesity may be of etiologic importance.
Actinic damage of dermal tissues produces several distinct clinical patterns. Three patients are described as having discrete, soft, cordlike bands on the forearms that extend from dorsal areas of actinic damage and senile purpura to greatest prominence in flexural regions with less solar damage. Histochemical analyses and light and electron microscopy studies of the plaques showed changes consistent with solar elastosis. The clinical variants of actinic elastosis and the possible origins of the abnormal elastic fibrils found in the dermis of chronically sun-damaged skin are discussed. Solar elastotic bands are an unusual form of actinic degeneration.
We saw two newborn infants with striated muscle hamartoma. One patient had numerous associated congenital anomalies. The clinical appearance of both lesions was that of a soft fibroma. Histologically, striated muscle fibers and nerve bundles were seen in the central core and also at the periphery of the lesion, below the epidermis. A marked number of sebaceous glands, vellus hair follicles, and eccrine glands were also present. We propose the term striated muscle hamartoma, which points out the most remarkable feature of these lesions.
A 5-month-old male was examined in our dermatology clinic with numerous palmoplantar milia. The child had early congenital syphilis with palmoplantar desquamation, which was followed by the development of milia. Histologic and electron microscopic features suggested that these secondary milia probably derived from the epidermis.
Eight of ten patients with chronic or subacute cutaneous lupus erythematosus completed 16 weeks of oral isotretinoin therapy (80 mg/day). All eight patients noted an excellent clinical response without significant side effects. (Two patients did not return to initial two-week follow-up.) Peripheral blood B- and T-cell counts were unaffected by therapy. Therapy was associated with resolution of routine histopathologic abnormalities, conversion of abnormal lesional direct immunofluorescence microscopy to normal, normalization of the epidermis on electron microscopy, and reduction of all T cells near the dermoepidermal junction without change in ratio of T-helper/inducer cells to T-suppressor/cytotoxic cells. Isotretinoin is a clinically effective short-term therapy for chronic or possibly for subacute cutaneous lupus erythematosus. The primary mechanism of action remains unestablished.
Electron microscopic examination in a case of papular xanthoma revealed the presence of myelinlike laminated bodies in the cytoplasm of the foam cells. To our knowledge, similar bodies have been described in large numbers in only two cases of congenital self-healing histiocytosis and one case of generalized eruptive histiocytoma. The presence of laminated bodies may be a morphologic characteristic of papular xanthoma. However, this possibility should be confirmed by identification of the same inclusions in other cases of this disease.
Trichostasis spinulosa is a common disorder of follicular hyperkeratosis that is often confused clinically with similar disorders, such as keratosis pilaris and eruptive vellus hair cysts. Six patients from the UTMB dermatology clinic who had trichostasis spinulosa are presented. Two of the six also had keratosis pilaris and one had eruptive vellus hair cysts. The present study was undertaken to compare and contrast the clinical presentation and histopathologic appearance of these three disorders. The results of the study and review of the literature revealed differences in distribution of lesions and microscopic appearance of follicular and histopathologic material.
Orf is an occupational skin disease acquired through contact with infected animals. In humans, orf is usually a self-limited disease that resolves spontaneously within four to 24 weeks. We report a case with multiple lesions of orf, acquired by contact with a wild sheep. The patient was temporarily immunosuppressed by a concomitant viral hepatitis. We reviewed the histologic and electron microscopic findings. Also, we attempted to stain the Parapoxvirus in the skin of the patient, using the immunoperoxidase technique. The antiserum was obtained from sheep immunized against orf. We used lesional skin from sheep infected with orf as a positive control. The negative results of this technique in the patient's skin indicated that Parapoxvirus infecting wild sheep is antigenically different from that causing the disease in domestic animals.
Ten patients with sinus histiocytosis with massive lymphadenopathy (SHML) also had cutaneous involvement. Seven of the ten were children. The skin lesions were solitary in three patients and multiple in seven. They were papular or nodular, up to 4 cm in diameter, and often had a xanthomatous appearance. Microscopically, they were constituted by a dermal infiltrate made up predominantly of histiocytes, plasma cells, and lymphocytes. Some of the histiocytes contained phagocytosed lymphocytes in their cytoplasm. The microscopic differential diagnosis includes dermatofibroma, xanthoma, Tangier disease, histiocytosis X, reticulohistiocytoma, juvenile xanthogranuloma, and leprosy.
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Congenital smooth muscle hamartoma usually manifests as a well-circumscribed, hyperpigmented plaque, frequently hypertrichotic, on the trunk or extremities. We report such a lesion in a 7-month-old girl that presented as a linear, mottled, purplish red plaque appearing in areas to be atrophic, involving her right buttock, posterior thigh and leg, and fifth toe. Although the clinical appearance suggested linear morphea, a biopsy specimen had numerous haphazardly oriented bundles of smooth muscle in the reticular dermis. Masson trichrome staining, smooth muscle specific actin, and electron microscopic studies confirmed the smooth muscle nature of the cells. A diagnosis of smooth muscle hamartoma was made. To our knowledge, this linear clinical presentation has not been described previously.