Solitary mastocytoma with massive eosinophilic infiltration

An 11-month-old girl had a yellowish brown nodule that histologically had an unexpectedly massive infiltrate of eosinophils in the dermis. This histologic feature made determining the correct diagnosis of cutaneous solitary mastocytoma difficult until we performed specific histochemical staining for mast cells.

Psychiatric liaison issues in cancer care in Japan

To clarify the psychiatric liaison issues in Japan, this paper briefly introduces a survey of physician attitudes and practices regarding cancer care in Japan and preliminarily reports on an "active" liaison program developed at one Japanese general hospital. The survey of physicians from 31 teaching hospitals, including all cancer centers, revealed that 56% of physicians do not inform patients of a diagnosis of cancer. Thus, actual psychiatric consultation referrals were very few due to the physician's fear of harming his relationship with the cancer patient. One medical unit, in which about one-quarter of the cancer patients were told their diagnoses by the unit chief physician, showed significantly higher rates of psychiatric consultation after the introduction of an "active" liaison program in that hospital. These results suggest that the liaison program can positively influence the rate of psychiatric consultation referrals for cancer patients when the physician discloses the diagnosis to the patient. Consultation-liaison psychiatry in cancer care is expected to develop in Japan, because most physicians report a trend toward informing patients of their cancer diagnosis.

Histoanalytical study of the cellular infiltrate in the tuberculin reaction

In contrast to the generally held view, in previous studies it has been found that the histopathological changes in delayed-type hypersensitivity reactions to intradermal purified protein derivative of tuberculin (PPD) in humans were not uniform. These were classified into three types based on their resemblance to features seen in other dermatoses, i.e.: (i) perivascular dermatitis type; (ii) basal spongiotic dermatitis type; and (iii) erythema multiforme type. These histopathological patterns correlated well with the clinical response seen in tuberculin hypersensitivity of tested subjects. In the present study, the immunohistopathological features in 44 skin biopsy specimens were assessed quantitatively by using multivariate analysis. The numbers of infiltrating cells in the epidermis and in the dermis which were immunohistologically positive to monoclonal antibodies against various mononuclear cells were counted separately to determine if there was any statistical correlation between the histopathological patterns and the phenotypes of infiltrating cells. As a result, a significant correlation was found between the histopathological patterns and the phenotypes of cells infiltrating the epidermis, such as CD8+ cells, CD4+ cells, CD11c+ cells and interleukin 2 receptor positive cells. All these cells showed a high correlation coefficient to the expression of HLA-DR antigen by keratinocytes. Next, factors that might regulate the inflammation and interaction among the infiltrating cells were assessed.(ABSTRACT TRUNCATED AT 250 WORDS)

A model for feature linking via collective oscillations in the primary visual cortex

A neural network model for explaining experimentally observed neuronal responses in cat primary visual cortex is proposed. In our model, the basic functional unit is an orientation column which is represented by a large homogeneous population of neurons modeled as integrate-and-fire type excitable elements. The orientation column exhibits spontaneous collective oscillations in activity in response to suitable visual stimuli. Such oscillations are caused by mutual synchronization among the neurons within the column. Numerical simulation for various stimulus patterns shows that as a result of activity correlations between different columns, the amplitude and the phase of the oscillation in each column depend strongly on the global feature of the stimulus pattern. These results satisfactorily account for experimental observations.

Acquired zinc deficiency in breast-fed infants

Zinc deficiency in breast-fed infants is a rare disease caused by a low level of zinc in their mother's milk. Premature infants are more vulnerable to develop zinc deficiency than full-term infants because, despite their high zinc requirements, they have insufficient body stores of zinc and a poor capability to absorb zinc from the gut. The clinical aspect of zinc deficiency is acrodermatitis enteropathica, in which the severity is proportional to the zinc level. The patients respond well to oral zinc supplements.

Generalized eruptive histiocytoma: a report of a variant case showing the presence of dermal indeterminate cells

We describe a 14-year-old Japanese girl with a variant of generalized eruptive histiocytoma. She presented with the characteristic features of classical generalized eruptive histiocytoma but with the following minor differences. Clinically, some of the papular eruptions tended to coalesce to form plaques. Histoligically, some of the histiocytic cells were S-100 protein- and OKT-6-positive; these were thought to be indeterminate cells because they lacked Birbeck granules. In addition, PAS-positive cells were few and there were some intermingled lymphocytes and a few eosinophils.

Tyrosinemia II: report of an incomplete case and studies on the hyperkeratotic stratum corneum

We report a case of tyrosinemia II in a 20-year-old man who had painful palmoplantar hyperkeratotic lesions and corneal erosion. His serum tyrosine level was more than 10 times above normal. Though dietary control failed to eliminate the skin lesions, etretinate cleared them temporarily and grafted skin from the buttock did not become hyperkeratotic during the observation period of 1 1/2 years. Amino acid analysis in the hyperkeratotic stratum corneum disclosed a moderate increase not only in soluble tyrosine but also in other amino acid contents. Turnover time of the hyperkeratotic stratum corneum was greatly elongated as compared with that of the grafted site.

Erythema induratum of Bazin as a type of tuberculid

We report three cases of patients with erythema induratum of Bazin who showed extreme tuberculin hypersensitivity reactions and a good therapeutic response to isoniazid. In the first patient satellite lesions with epithelioid granuloma formation developed 3 weeks after injection of purified protein derivative. In the second patient a high fever developed 1 day after injection of purified protein derivative, and the third patient blistered at the injection site; the histopathologic pattern was similar to erythema multiforme. Immunohistologic study of the epithelioid granulomas demonstrated a predominance of Leu-1--bearing, Leu-3a--bearing, and human lymphocyte antigen-DR-expressing cells. We conclude that erythema induratum of Bazin represents a tuberculid caused by heightened delayed-type hypersensitivity to components of tubercle bacilli released from latent foci of infection.

Primary adenoid cystic carcinoma masquerading as syringoma of the scalp

We report a case of primary adenoid cystic carcinoma of the scalp in a 72-year-old man. It consisted of syringomalike papules scattered on an erythematous plaque that showed a loss of hair. Histologically, the papular lesion at first showed numerous tadpole-like tubular structures similar to those found in syringoma. Subsequent histologic studies over 2 years revealed the presence of numerous cribriform tumor masses penetrating into the subcutis, reaching the galea aponeurotica. Immunohistochemically, the neoplastic cells showed no staining with either polyclonal (P) or monoclonal (M) antibodies to carcinoembryonic antigen. M-cytokeratin, M-vimentin, and P-S-100 protein antibodies were positive only focally as were other antibodies, including anti-actin, anti-human lactalbumin, anti-beta 2 microglobulin, and breast cancer--associated antigens. The neoplastic cells showed no binding to lectins that characteristically react with the sweat apparatus, except for concanavalin A (con A) and peanut agglutinin (PNA), although the striking histopathologic resemblance to syringoma suggested its histogenic relation to eccrine glands initially.

Chronic vulvar purpura

We described a 56-year-old Japanese woman with a long-standing asymptomatic vulvar purpuric lesion. Histological studies revealed massive hemorrhage, deposition of hemosiderin and a moderate lymphohistiocytic infiltration. We speculate that chronic intrapelvic congestion with increased venous pressure possibly due to abdominal ptosis played an important role in the pathomechanism for this persistent purpuric lesion of the vulva.

Histopathologic pattern analysis of human intracutaneous tuberculin reaction

The involvement of cellular immune reactions in the pathogenesis of many inflammatory dermatoses can be postulated from their histopathologic features, e.g., those dermatoses that show a perivascular lymphohistiocytic infiltration in the dermis in addition to their own characteristic epidermal changes. Several granulomatous dermatoses further show an additional infiltration of epithelioid cells. However, experimental production of similar changes is usually not feasible in animals. A human model is needed of delayed-hypersensitivity skin reaction induced by a definite antigen. After closely observing the histopathologic changes of the skin reactions to the purified protein derivative (PPD) of tuberculin, we noted that all patients did not show uniform histologic patterns at intradermal PPD injection sites. Therefore, we have tentatively analyzed histopathologically the pattern of tuberculin skin reactions at injection sites 48 h to 1 year after injection in eight healthy volunteers and 63 patients with various dermatoses. We classified the reactions at 48 h into three types, based on the extent of the tissue damage (i.e., their resemblance to features noted in corresponding inflammatory dermatoses): (a) the perivascular dermatitis type, (b) the basal spongiotic dermatitis type, and (c) the erythema multiforme type. There was a clear correlation between the magnitude of macroscopic skin reactions and these histopathologic patterns. Even those with clinically negative reactions showed a reaction pattern of perivascular dermatitis, whereas those who clinically developed prominent inflammatory reactions with blister formation always showed a erythema multiforme-like histologic pattern. Interestingly, in more than half of the cases, the dermal cellular infiltrate had a mixture of various numbers of neutrophils in addition to mononuclear cells.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ultrasonic evaluation of two cases of primary lymphoma of the intestine]

Two cases of primary malignant lymphoma of the intestine were examined by ultrasonography. In the first case, the lymphoma originated from the terminal ileum and caused intussusception. The tumor was significantly hypoechoic. In the second case, the tumor showed pseudokidney sign. The echo level of the tumor was low and the size of the tumor was over 10 cm.

Multicentric reticulohistiocytosis in a child with sclerosing lesion of the leg. Immunohistopathologic studies and therapeutic trial with systemic cyclosporine

Multicentric reticulohistiocytosis affecting a 13-year-old boy induced a sclerosing change of the leg. The cellular infiltrate comprising activated T lymphocytes and macrophages and human lymphocyte antigen (HLA)-DR expression by keratinocytes in lesional skin all suggest the involvement of cellular immune reactions. We administered systemic cyclosporine but could not obtain a favorable effect without a concomitant low dosage of prednisone.

Subcutaneous sarcoidosis with extensive caseation necrosis

We report a 24-year-old male patient with sarcoidosis who developed subcutaneous nodules on his thighs and buttocks at the sites of repeated intramuscular injections. Histologically, there were extensive areas of caseation necrosis surrounded by typical sarcoidal granuloma. The nodules regressed spontaneously over a period of 4 months, concurrently, both his bilateral hilar adenopathy and the results of immunological tests, returned to normal. We think that these lesions developed at the sites of subcutaneous scar tissue induced by frequent injections in childhood. We believe the pathomechanism to be similar to that for scar sarcoidosis, and that the extensive caseation necrosis reflected a regressing stage of the disease.