Cutaneous B-cell lymphoma

The various morphologic and functional subtypes of nodal B-cell lymphomas can also be found in the skin. These reflect the various steps of lymphocyte differentiation including maturation from the pre-B lymphocyte to the well-differentiated B2 lymphocyte or plasma cell in the peripheral blood. The subtypes of cutaneous B-cell lymphomas have been discussed (Kiel classification); the percentages indicate the frequencies of the subtypes among a total of 736 cutaneous lymphomas of both T-cell and B-cell origin: Lymphocytic lymphoma (7 per cent). Immunoglobulin-producing lymphomas, including the rate plasmacytoma of the skin, lymphoplasmacytoid immunocytoma, which represents the largest group of cutaneous B-cell lymphoma (12 per cent), and immunoblastic lymphoma, which is the most aggressive form in this group (8 per cent). Cutaneous B-cell lymphoma arising from or related to follicular center cells, including centrocytic lymphoma (7 per cent), mantle-cell lymphoma, centroblastic/centrocytic lymphoma (6 per cent), the highly malignant centroblastic lymphoma (4 per cent), and lymphoblastic lymphoma, Burkitt type. The Ann Arbor staging system is not applicable to cutaneous B-cell lymphoma; therefore, a TNM staging system has been proposed. The diagnosis of cutaneous B-cell lymphoma is based primarily on cytomorphologic features. Differentiation of cutaneous B-cell lymphoma from pseudolymphoma of the skin cannot be based on a single criterion; a spectrum of characteristic features must be evaluated. Analysis of the infiltrating cells in cutaneous B-cell lymphoma using monoclonal antibodies demonstrates that the proliferation of the neoplastic clone is accompanied by a mixture of accessory cells of various origins, including T cells, macrophages, and dendritic reticulum cells. As in nodal B-cell lymphomas, several factors may be involved in the generation of cutaneous B-cell lymphoma, including persistent antigenic stimulation and loss of regulatory mechanisms for lymphocyte proliferation and differentiation in conjunction with environmental and other factors.

[Nosologic relation of dyskeratosis follicularis (Darier) and pemphigus benignus chronicus familiaris (Hailey-Hailey). Position based on a case report]

After a case report and a review of the literature, we discuss the nosologic position of Darier's disease and benign familial chronic pemphigus (Hailey-Hailey). Although the clinical and histological pictures of these diseases overlap, characteristic clinical features make differentiation possible.

[Malignant melanomas in pregnancy]

A malignant melanoma was diagnosed and treated during pregnancy in twelve patients average age 29 (19-38) years. Eleven patients were in stage I and one in stage II. One patient presented with 2 primary malignant melanomas. There was no essential difference in localisation or melanoma type in comparison with non-pregnant melanoma patients. From histological criteria (tumor thickness and prognostic index) eight patients in stage I had an intermediate and three a high risk of metastases. When compared with non-pregnant melanoma patients the pregnant patients presented with relatively more melanomas having intermediate and high metastases risk. No prediction as to the course of the disease can be made because of the small number of patients. Published data show, however, that in a pregnant subgroup pregnancy has a negative influence on the course of malignant melanoma.

Primary cutaneous atypical histiocytosis with possible dissemination

Three unusual cases that were clinically suspected to be cutaneous malignant lymphomas were investigated by electron microscopy and enzyme cytochemistry. By conventional histology, a monomorphous infiltrate of medium-sized histiocytoid cells with occasional cytoplasmic vacuoles was seen. More characteristic was the ultrastructural finding of giant multivesicular bodies and pleomorphic granules in numerous neoplastic cells. These organelles seem to be closely related and to represent a market of a clinical entity. On cryostat sections some neoplastic cells were strongly positive, some weakly positive, and others negative for lysosomal enzymes (acid phosphatase, alpha-naphthyl-acetate esterase). Several cases with the same cytoplasmic structures and similarities in clinical presentations (disseminated cutaneous nodules and larger masses) and good responses to various modes of treatment (excision, x-ray irradiation, chemotherapy) have been described in the literature. However, a fatal course is also possible.

Preputial abscesses caused by beta-lactamase-producing gonococci

Preputial abscesses occurred in three men who had had sexual intercourse with prostitutes in Thailand. Neisseria gonorrhoeae could be grown from the lesions. Two of the strains were tested for beta-lactamase production and proved positive. While all three patients showed no clinical signs of urethritis, urethral swabs were positive for gonococci in two.

[UV-ray sensitivity of patients with malignant melanoma]

In 77 patients with malignant melanoma and 74 control subjects without skin tumors caused by sunlight, the minimal erythema dosage (MED) in the UV-C and UV-B areas, immediate pigment darkening (IPD), and minimal tanning dose (MTD) were determined according to skin type. Direct (MED-UV-B, MED-UV-C) and inverse (IPD, MTD) correlations were established according to skin type. These parameters showed no differences between patients with malignant melanoma and the control group.

Bullous amyloidosis

A patient with a 12-year history of a relapsing bullous dermatosis is presented. Unusual clinical features included urticarial erythema, conspicuous mottled hyper- and depigmentation, lichenification and ichthyosiform hyperkeratosis. Serum immunoglobulin E levels were elevated. Histological examination showing deposits of amyloid in the uppermost dermis confirmed the diagnosis of bullous amyloidosis. Ultrastructurally, blister formation occurred at the level of the lamina lucida. The amyloid did not react with a panel of antibodies directed against amyloid fibril proteins. No underlying systemic disease was found. The bullous eruption responded to prednisolone therapy.

[Porokeratosis plantaris, palmaris et disseminata]

A 24-year-old female patient was treated for many years for "verrucae vulgares". Signs of porokeratosis were found by microscopy. Her medical history, the distribution of the hyperkeratotic-verruciform lesions and the characteristic histology features permitted the diagnosis to be made of porokeratosis plantaris, palmaris et disseminata.

[Malignant melanomas of the vulva]

In 13 patients, mean age 57 (31-78) years, with malignant melanoma of the vulva, 7 of the tumors occurred on the Labia majora, 4 on the Labia minora and 2 on the clitoris. 8 cases involved nodular malignant melanomas, 2 cases each involved a superficial-spreading form and an acrolentiginous form, and one case involved a non-classifiable malignant melanoma. According to histological criteria 10 of 13 tumors showed a high risk of metastasising. At the time of diagnosis one of the patients was in stage II and one in stage III of the disease. Of the 13 patients, 6 died, as a result of the tumor, 5 within the first 2 years. The mean survival time was 15 (6-28) months. In three other cases the disease has reached an advanced stage: stage Ib, II or III. Up to now only 4 patients have remained symptom free, the symptom free interval averaging 62 (33-84) months. This investigation confirms the special characteristics of malignant melanomas of the vulva, which are the predominance of tumors having a bad prognosis and the rapidly progressing course of the disease.

[Ichthyosis hystrix with parakeratosis in the form of cornoid lamellae]

We report on a keratinization disorder in four brothers in a family in which members had been affected in three generations. Clinical signs and genetic, histopathologic, autoradiographic and ultrastructural examinations all support the diagnosis of hystrixlike, proliferative ichthyosis with cornoid lamellae and autosomal dominant inheritance. The relationship of the disorder to other hystrixlike genetic keratinization disorders is discussed.

[Anorectal malignant melanomas: report on 7 personal cases and 374 cases from the literature. Report of the experiences of a tumor center]

Seven cases of anorectal malignant melanoma are described and presented together with 374 cases reported on in the literature. The therapeutic procedure in stage I and II disease relies on radical surgery (abdominosacral rectum amputation), combined in cases of local metastasation with adjuvant chemoimmunotherapy using DTIC and BCG. In stage III disease therapeutic measures can achieve palliation only.

A probable case of rotavirus exanthem

A generalized maculopapular exanthem and signs of hepatitis developed in a 28-year-old man one week after his two sons had suffered from rotavirus gastroenteritis. The patient's serum contained rotavirus antibody at titers of 1:256 and 1:512. Other known causes of exanthemata were excluded by clinical and laboratory investigations. The epidemiologic evidence and the results of serological tests suggested that the rotavirus caused the patient's exanthem.

[Centromere antibodies and antibodies against Scl 70 nucleoprotein in progressive systemic scleroderma. Diagnostic and prognostic significance]

Frequency and diagnostic significance of two scleroderma-specific antinuclear antibodies were examined in 104 patients with progressive systemic scleroderma (PSS). Antibodies against an antigen in the centromere region of chromosomes (centromere antibodies) were demonstrated by indirect immuno-fluorescence on HEp-2 cells in 18 patients (17%) and antibodies against Scl-70 nucleoprotein (Scl-70 antibodies) by gel precipitation with soluble nuclear extracts (ENA) in 21 patients (20%). In none of the patients did both antibodies occur. In patients with Scl-70 antibodies severe illness was predominant with extensive cutaneous sclerosis in 86%, lung involvement in 85% and joint involvement in 89%. Humoral inflammatory signs were marked in this group. Patients with centromere antibodies predominantly had acroscleroderma (56%) with subcutaneous calcinosis (83%) and telangiectasias (83%), as known from the CREST syndrome. Humoral immune phenomena were rare. With regard to Raynaud's syndrome, involvement of the oesophagus, age and the duration of disease, there was no difference between the two groups. On the other hand, in patients with centromere antibodies lung involvement (22%) and joint involvement (35%) was significantly less common (P less than 0.01) than in all other scleroderma patients. Centromere antibodies and Scl-70 antibodies, which can be demonstrated already in the symptom-poor early phase of PSS, can thus be used as diagnostic parameters for different forms of PSS with differences in the degree of skin and organ involvement.

The effect of aromatic retinoid Ro 10-9359 (etretinate) on fingernail growth

Fingernail growth was studied in 28 patients who were receiving systemic treatment with the aromatic retinoid, Ro 10-9359 known as Tigason (etretinate; AR). A group of 15 patients with psoriasis was compared with a group of 13 patients with other dermatoses which are known to have a good response to AR therapy. In the second group, oral therapy with AR appeared to have no effect on the daily growth rate of fingernails (99 +/- 4 microns). With AR treatment, the nail-plate growth rate in the psoriatics increased to 132 +/- 5 microns.

Collagen synthesis in scleroderma: selection of fibroblast populations during subcultures

In progressive systemic scleroderma, excessive deposition of collagen leads to fibrosis of several tissues including the skin. It has been found that different populations of fibroblasts are present in scleroderma skin; these can be obtained by establishing cell cultures from different layers of the involved skin. Excessive overproduction of collagen was noted in primary cultures of cells obtained from deeper layers of the skin of patients in an early stage of the disease, whereas control fibroblasts did not manifest significant variations dependent on the layers of skin used to initiate the cultures. The synthesis of type-I and -III collagen was found to be altered concomitantly. The production of collagen and collagenous proteins was then followed during subcultivations of overproducing fibroblasts. In many cell strains, increased synthesis of collagen and/or non-collagenous proteins had already been lost after the first subcultivation, whereas overproduction was stable in others. However, after five passages, most of the cultures showed normal collagen synthesis, which probably indicates a loss of phenotype due to successive subcultures or overgrowth by another population of fibroblasts.

Nevoid malignant melanoma

Primary cutaneous malignant melanomas with histological features suggestive of benign nevocytic nevi were studied. From a total of about 3,500 cases, 33 patients with sufficient records, histological slides, and follow-up (at least 5 years for disease-free cases) were found; 15 of them had developed metastases, and 8 had died of disseminated melanoma. Some of the following histological characteristics were always observed: cellular atypia, mitoses, infiltration of adnexa, and in the deeper dermis, infiltrative growth, pigmented tumor cells, sharply demarcated tumor nests, and the absence of maturation. Tumor thickness was the most important prognostic criterion. Clinically, the tumors corresponded to nodular and superficial spreading melanomas. It is concluded that, in rare instances, malignant melanomas strongly resemble benign melanocytic/nevocytic nevi. Such cases do not appear to have a lower degree of malignancy and should be treated as normal malignant melanomas.

Epidermal synthesis and expression of HLA-DR on keratinocytes in lupus erythematosus

It has been suggested that aberrant expression of HLA-DR plays an important role in the induction of an autoimmune reaction. In lupus erythematosus (LE), skin represents a major target for autoimmune attack. We therefore tested lesional and nonlesional skin from 11 patients with different clinical subtypes of LE for the presence of HLA-DR molecules on keratinocytes using a monoclonal antibody against a non-polymorphic HLA-DR determinant. In all lesions tested, HLA-DR-positive keratinocytes were present, whereas in nonlesional skin, these cells remained HLA-DR negative. To exclude the possibility of passive absorption of DR molecules, the de novo synthesis of HLA-DR was demonstrated by the presence of cytoplasmic HLA-DR gamma chains in keratinocytes. If aberrant HLA-DR expression is a primary event, it could facilitate the recognition of autoantigens on keratinocytes by immunocompetent cells. Alternatively, the synthesis of DR molecules could be induced as a secondary event by mediators derived from the inflammatory infiltrate.

Treatment of benign, semimalignant, and malignant skin tumors with the Nd:YAG laser

Reported are first experiences with Nd:YAG laser treatment of benign, semimalignant, and malignant skin tumors in 90 patients. Treated lesions included condylomata acuminata, basal cell carcinomas, solar keratosis, squamous cell carcinomas, and secondary malignant skin tumors. First clinical and histological results are promising, but long-term follow-up is required to judge the definite efficacy of this therapeutical modality.

Effect of retinoids on collagen production by chondrocytes in culture

The effect of vitamin A and of some of its derivatives on chondrocytes in culture has been studied. In the presence of retinoids the proliferation of the cells decreased and they lost their characteristic polygonal shape and assumed a fibroblast-like morphology. All retinoids also caused dedifferentiation of chondrocytes as indicated by the induction of types I and III collagen. 13-cis retinoic acid (= isotretinoin) was the most active derivative in this aspect. Since appropriate control of the synthesis of extracellular matrix proteins is a prerequisite for their normal physiological function, alterations such as those observed here may be involved in the pathogenesis of side effects which are observed during the treatment of dermatological disorders with retinoic acid derivatives.

[Cutis laxa. Classification, clinical aspects and molecular defects]

Cutis laxa summarizes a heterogeneous group of diseases which are characterized by loose skin. An additional to the clinical variants of cutis laxa, a brief review of the elastin pathway is given and possible defects in cutis laxa are discussed.

[Therapy of atopic eczema]

When a decision is being made on the therapy of atopic eczema, the complex pathogenetic interactions involved in this disease have to be taken into consideration. The acute inflammatory changes respond to short-term glucocorticoid steroid treatment (topical); long-term steroid therapy should be avoided. In chronic lichen-type lesions, non-steroid topical applications can be helpful. Frequent acute infections of the skin require the application of antimicrobials. Intense pruritus is treated by antihistamines (possibly also H2-antagonists). Due to the well-known psychosomatic influence in this disease, careful counseling of the patient (and if a child, of the family) is necessary. Pathogenetically relevant allergic reactions of the immediate type can be treated successfully in some cases by hyposensitization. Prophylactic measures include allergen avoidance (climate therapy, no pets, well-established food allergens etc.). Possible new perspectives may be seen in the development of agents acting at the disturbed T-cell regulation, as well as by the introduction of mast-cell-blocking substances. The basis of every therapeutic approach in atopic eczema is, however, intensive skin care, using emollients and oil baths, especially during the remission phase.

[Cutis hyperelastica circumscripta. A case report with a morphologic study]

This is a report on a 20-year-old female patient with localized cutis hyperelastica. Light and electron microscopy revealed an increase of elastic fibers compared to collagen tissue.

[Cutaneous leiomyosarcoma]

Primary cutaneous leiomyosarcomas are rare mesenchymal skin tumors with relatively good prognosis and low risk of metastasis if there is no subcutaneous involvement. A 48-year-old patient with a primary cutaneous leiomyosarcoma of ten years duration is described. Therapy and differential diagnosis are discussed.

Prognostic classification of malignant melanoma by clinical criteria

In a retrospective study of 503 well-documented cases of primary malignant melanoma (stage I) clinical criteria were analysed for their prognostic relevance. The maximum elevation (in mm) of the tumour was found to be the most important single prognostic factor. There was a close association with tumour thickness, measured histologically by the method of Breslow (correlation coefficient = 0.73). A combination of elevation and three additional clinical criteria (site, nodule- or lesion-diameter, and surface defects such as erosion, ulceration or bleeding) allowed a further improvement in prognostic accuracy. This clinical classification into low-risk and high-risk melanomas was as effective as the use of tumour thickness measured histologically, and can therefore be used for the preoperative planning of treatment.

Argon laser therapy of verrucous nevi

In one patient afflicted with a systemic verrucous nevus, a marked improvement was obtained by repeated treatments with an argon laser. In two patients it was possible to remove localized verrucous nevus completely. There was no recurrence in the follow-up of 8 and 14 months, respectively.

Effect of vitamin A and its derivatives on collagen production and chemotactic response of fibroblasts

Vitamin A and several other retinoids were added to fibroblast cultures in order to study possible alterations in biochemical properties and cellular responsiveness. The proliferation of cells was inhibited as the concentration of retinoids increased from 10(-9) to 10(-5) mol/l. Synthesis of non-collagenous proteins and production of both type I and type III collagen were decreased. The onset of type III collagen synthesis by tendon fibroblasts in culture was delayed. Furthermore, the chemotactic response of fibroblasts to fibroblast-conditioned medium was markedly reduced in the presence of retinoids (10(-6) to 10(-12) mol/l).

A three-year experience with the argon laser in dermatotherapy

Since January 1980, 477 patients were treated with an argon laser, 337 afflicted with vascular lesions and 140 with nonvascular lesions. Laser therapy of portwine stains gave good results in 70% of the adult patients, but it was disappointing in patients younger than 18 years of age. Other vascular lesions, such as telangiectasia, venous lake, angiofibroma, lymphangioma, and cherry angioma, were also treated with success. For the removal of tattoos the argon laser is not an optimal modality. In our experience it should only be used in skin areas, where dermabrasion cannot be performed. Therapy of epidermal nevi, xanthelasma of the eyelids, verrucae, vulgares , and sebaceous gland hyperplasia gave preliminary promising results in some patients.

[Dermatitis herpetiformis Duhring with linear deposits of IgA (linear IgA dermatosis)]

Three patients with linear deposits of IgA along the epidermal basement membrane were studied. The clinical and histopathological picture as well as the response to dapsone were typical of dermatitis herpetiformis. Two of the three patients were HLA-B8/DR3-positive. By immunoelectron microscopy, the previously reported two types of linear IgA deposits were confirmed: in one patient, the IgA precipitates were localized below the basal lamina as in dermatitis herpetiformis, in the other two above the basal lamina in the lamina lucida as in bullous pemphigoid. The immunoelectron microscopic findings imply that in some patients with linear IgA dermatosis a pathomechanism different from that in classical dermatitis herpetiformis may be operative.

Structural changes in axillary eccrine glands following long-term treatment with aluminium chloride hexahydrate solution

Axillary skin biopsies from fifteen patients with axillary hyperhidrosis who had received long-term treatment with aqueous aluminium chloride solution were examined histologically. The apocrine glands were normal, but the eccrine glands showed conspicuous morphological changes of varying severity. These included vacuolization of the secretory epithelium, dilatation of eccrine acini with atrophy of secretory cells, and accumulation of PAS-positive, diastase-resistant material in the dilated lumen of the secretory coils. The histological changes correlated in most patients with decreased secretion of sweat. We conclude that long-term blockage of the distal acrosyringium due to aluminium salts may lead to functional and structural degeneration of the eccrine acini.

Alkaline phosphatase activity in non-Hodgkin's lymphomas and pseudolymphomas of the skin

Alkaline phosphatase enzyme activity was studied histochemically in 60 non-Hodgkin lymphomas and 10 pseudolymphomas of the skin. Among the 37 B-cell lymphomas, membrane-bound alkaline phosphatase activity was demonstrated in 8 cases. In none of the 23 cutaneous T-cell lymphomas studied could membrane-bound alkaline phosphatase be detected. Among the pseudolymphomas, 2 cases revealed alkaline phosphatase activity. It was not possible to draw any particular clinically significant conclusions from the membrane-bound alkaline phosphatase reactions. Looking for the microenvironmental conditions of lymphoproliferative processes in the skin, alkaline phosphatase-positive capillaries were seen predominantly in the T-cell lymphomas. The stromal reaction showing a proliferation of alkaline phosphatase-positive fibroblasts was more pronounced in cutaneous B-cell lymphomas. In conclusion, membrane-bound alkaline phosphatase in lymphoproliferative processes in the skin, as in the lymph node, characterize a distinct group of B lymphocytes related to follicle center cells. The clinical relevance of this finding remains to be determined.

[Allergic vasculitis caused by vitamin B6]

A patient developed extensive bulloushaemorrhagic lesions on the lower legs after taking analgesic preparations. Allergologic tests yielded an Arthus-type reaction with vitamin B6. The histological and immunofluorescence examination of a lesional and test site biopsy showed the picture of a superficial and deep vasculitis with deposits of C3 at the basement membrane of dermal venules.

Some statistical data, diagnosis, and staging of cutaneous B-cell lymphomas

Cutaneous B-cell lymphomas represent a considerable number of skin lymphomas (about one-third) primarily showing skin manifestation without any extranodal involvement detectable using routine and special staging procedures. Differentiation from cutaneous T-cell lymphomas can be achieved clinically; histologically, due to the distinct growth pattern in the skin; and by immuno- or enzymophenotyping of the proliferating cells. Further differentiation of subtypes of cutaneous B-cell lymphomas is based primarily on cytomorphologic phenotyping of the cells. Classification of B-cell lymphomas with "primary" cutaneous manifestation according to the TNM system discloses a more adequate basis for prognostic and therapeutic considerations than the Ann Arbor classification for nodal lymphomas.

Immunoenzymatic typing of lymphoplasmacytoid skin infiltrates

Monoclonal immunoglobulin-producing lymphomas (immunocytomas, plasmacytomas, and immunoblastomas) constitute 15 to 20% of all cutaneous lymphomas. Their differentiation from polymorphous lymphoplasmacytoid inflammatory or pseudolymphomatous infiltrates may be difficult if sections are stained for a single light chain only. It was the aim of the study to elucidate the ratio of the kappa- to lambda-positive cells in 10 lymphoproliferative, 5 pseudolymphomatous, and 42 inflammatory lymphoplasmacytoid cutaneous infiltrates and to characterize them by the type of Ig (alpha, gamma, mu, kappa, or lambda) synthesized intracellularly. An indirect immunoenzymatic double-labeling method (alkaline phosphatase and peroxidase) was used for the simultaneous demonstration of kappa and lambda light chains and alpha, gamma, and mu heavy chains in paraffin sections. Ig-producing lymphomas of the skin show patchy monoclonal proliferations of cells synthesizing kappa IgM in almost 50% of the cases (5 of 10). Monoclonality is claimed if the ratio of lambda- to kappa-positive cells is at least 1:10, or vice versa. In polyclonal inflammatory and pseudolymphomatous infiltrates, the lambda/kappa ratio never exceeds 1:5. The most common cell type found in these reactive infiltrates produces gamma heavy chain; some produce alpha chain, but only a few produce mu chain. In high-grade malignant lymphomas, the tumor cells may lose their capacity for Ig production.

[Tap water iontophoresis in the treatment of hyperhidrosis of the hands and feet]

Seven patients with hyperhidrosis of the palms or soles resistant to topical application of aluminum chloride solution were treated successfully with tap water iontophoresis. After an average of 10 or 11 treatments 80% sweating suppression was found on palms and 74% suppression on soles. As side effects of treatment discomfort and transient skin irritation were observed depending on the amperage used. The effect lasts up to several weeks; however, maintenance treatment on an individual schedule is required.

Lung involvement in scleroderma

Lung involvement (LI) was studied by lung function (LF) in 101 scleroderma patients (circumscribed scleroderma, n = 17; progressive systemic scleroderma [PSS], n = 84; with the subtypes I, acroscleroderma [n = 19]; 2, proximal ascending scleroderma [n = 61]; 3, trunk scleroderma [n = 4]). Eighteen percent of morphea, 32 percent of type 1, 56 percent of type 2, and 75 percent of type 3 patients had impaired LF. The LI was more frequent (57 percent vs 45 percent) and more severe (20 percent vs 3 percent) in PSS with systemic inflammation (form A) compared to those without (form B). Elevated lymphocytes/neutrophils in bronchoalveolar lavage (BAL) were found associated with form A and severe LI. The LF of patients showing an inflammatory cell pattern in initial BAL (n = 3) worsened, whereas those with normal BAL findings (n = 4) did not. Collagenase activity in BAL was significantly elevated in those with elevated lymphocytes/neutrophils in lavage. Patients with type 2 or 3 of PSS, especially form A, carry a higher risk of developing severe LI than circumscribed scleroderma, type 1, or form B patients. Differential cell count and collagenase activity in BAL is correlated with active disease and provides prognostic information.

Laser therapy of venous lakes (Bean-Walsh) and telangiectasias

In 18 patients, venous lakes, and in 77 patients, telangiectasias were successfully treated with the argon laser. Because treatments were easy to perform and patients were not impaired by therapy, the argon laser is the treatment of choice for these conditions in our experience.

Alkaline phosphatase positive lymphoma

Alkaline phosphatase (AP) activity on cryostat sections of the skin of 38 cases of non-Hodgkin's lymphomas of the B cell type and of 10 cases of lymphadenosis benigna cutis have been studied. Membrane-bound AP activity has been found in 8 out of 28 cases of low-grade malignant lymphomas of the B cell type and in 2 out of 10 cases of lymphadenosis benigna cutis. This is a known phenomenon in the latter. In the literature of non-Hodgkin's lymphoma AP activity is related to the intermediate type of lymphocytic lymphoma. Further studies are needed to demonstrate that the AP activity correlates with a specific cell type in the B lymphoid cell differentiation.

Distribution of T-cell subsets as defined by monoclonal antibodies in skin lesions of psoriasis vulgaris

Cryostat tissue sections from skin lesions of 16 patients suffering from chronic stationary psoriasis vulgaris were assayed for the presence of distinct T-cell subpopulations with monoclonal antibodies. Using two pan-T surface markers (M-T 4-11 and Lyt 3) the total number of infiltrating T-cells was measured. This cell population was further dissected into Leu 3a (helper/inducer) and M-T 8-11 (cytotoxic/suppressor) positive subsets. Percentages of T-cell subpopulations were within the ranges found in healthy peripheral blood and were thus regarded as normal.

[Morphologic studies in the treatment of nevus flammeus with argon laser]

Immediately after the argon laser impact one finds necrosis of epidermis and superficial dermis. Dilated vessels down to a depth of 0.8 mm are filled with coagulated erythrocytes. After 2 days there is initial restoration of epidermis, and dilated vessels are filled with agglutination thrombi. With and after the 6th day fibroblasts and capillary blood vessels grow into the thrombi, and later on vessels are completely replaced by granulation tissue and after 2-4 weeks by newly formed fibrous tissue.

Collagen synthesis in generalized morphea

Synthesis of collagen and non-collagenous proteins was measured in fibroblast cultures derived from different layers of the dermis from a patient with an early stage of localized scleroderma. Increased synthesis of collagen was found in fibroblasts grown from the subcutaneous fat of this patient, whereas cells obtained from the papillary dermis revealed normal metabolism. These data agree with the results obtained in previous experiments with cells derived from patients with progressive systemic sclerosis in primary culture, thus indicating that the two diseases have a common pathomechanism. Several subcultures of the activated fibroblast populations were also studied. Normal collagen synthesis in these cultures was observed after the fifth passage, probably indicating selection of cell populations or loss of the previous phenotype.

Circulating Sézary cells in the diagnosis of Sézary syndrome (quantitative and morphometric analyses)

Plastic-embedded circulating Sézary cells were examined in semithin and thin sections (assisted by the nuclear contour index-NCI). Eight cases of Sézary syndrome were analyzed as well as 11 controls (3 cases of widespread eczemas and 8 cases of erythroderma), 7 cases of mycosis fungoides, and 3 healthy individuals. Discriminating criteria between Sézary syndrome and benign diseases were sought: in addition to Sézary cells (NCI greater than 6.5) intermediate lymphocytes (5.0 less than NCI less than or equal to 6.5) proved to be helpful. Cases with Sézary syndrome were clearly differentiated when the following 3 ultrastructural criteria were fulfilled: (1) Sézary cells (SC) greater than 9%; (2) intermediate lymphocytes (IL) greater than 20%; (3) the sum of SC and IL greater than 37%. A good correlation between thin and semithin sections was obtained (correlation coefficient for Sézary cells r = 0.82). Usually the values of SC were slightly higher on thin sections. The diagnosis of SS can be made on semithin sections when the ultrastructural criteria are fulfilled. In this way 8 of 12 samples of Sézary syndrome were correctly classified. Therefore, semithin sections (studied by light microscopy) are recommended as a routine method in the diagnosis of cases suspected of Sézary syndrome, whereas thin sections (studied by electron microscopy) appeared to be necessary in problem cases only.

Pityriasis rubra pilaris: a clinico-pathological and therapeutic study with special reference to histochemistry, autoradiography, and electron microscopy

Five patients with pityriasis rubra pilaris (PRP) were analyzed by means of light and electron microscopy as well as by histochemistry and autoradiography. The results were compared with findings in psoriasis vulgaris. In PRP we found a moderate increase of the labeling index of epidermal cells, a highly increased labeling index of dermal infiltrating cells, and a mild spongiosis, and in the stratum granulosum, a decreased number of tonofilaments and an increased number of keratinosomes. The horny layer in PRP showed a pronounced histochemical and electron microscopical parakeratosis, even when histological parakeratosis was absent. In contrast with psoriasis vulgaris, there was no exocytosis of polymorphonuclear leucocytes into the epidermis, the papillomatosis index was normal, and there were no tortuous capillaries in the dermal papillae. The stratum granulosum was always present and sometimes thickened, showing electron microscopical changes different from those referred to in psoriasis. These changes point to a relatively distinct pattern of epidermal changes in PRP.

[Determination of pathogens in blood in disseminated gonococcal infection. Case report and overview of the literature]

Although Neisseria gonorrhoeae has been recognized as causative agent of infectious disease not only of the genital region but also of other organs already at the end of the 19th century, disseminated gonococcal infection as a clinical entity has been defined fairly recently, i.e., during the last decade. In particular, it has been very difficult for a long time to detect Neisseria gonorrhoeae in the blood of patients suffering from this form of gonorrhea. Therefore, the case of a 22-year-old woman is presented who developed fever, arthritis, and pustules and from whose cervix, rectum, and blood Neisseria gonorrhoeae could be grown. Based on the reports in the literature and our own experience indispensable and further desirable diagnostic measures to be adopted in such cases are discussed.