Anita Dixon

Factors predictive of recurrence of basal cell carcinoma.

Thirty recurrent basal cell carcinomas were compared with 74 nonrecurrent basal cell carcinomas to identify clinical and histologic features predictive of recurrence. Three clinical parameters were evaluated: age, duration, and location; only location proved to be of prognostic significance. Among the histologic parameters, statistically significant differences between the recurrent and nonrecurrent groups were found in: measured distance to the resection margins, shape of cell groups, growth pattern, contour of invading edge, and degree of peripheral palisading and nuclear pleomorphism. Degree of fibrosis, cystic change, and atypical squamous change were of possible prognostic significance. There were no statistically significant differences between the two groups regarding: measured depth of invasion and diameter, degree of inflammation, actinic change, tumor necrosis, nuclear hyperchromasia, nucleoli, mitoses, amount of melanin or amyloid, and size of cell groups. Based on histologic findings, the pathologist may in many cases be able to suggest to the surgeon which tumors are more likely to recur and therefore require more aggressive therapy.

Prospective Evaluation of Intestinal Metaplasia and Dysplasia Within the Cardia of Patients with Barrett's Esophagus

The prevalence of cardia versus noncardiagastric intestinal metaplasia in patients with Barrettsesophagus was assessed prospectively. Four-quadrantbiopsies were obtained from the cardia from 119consecutive patients with Barretts esophagus and 64control patients. Gastric surveillance biopsies wereobtained in 108 of the Barretts patients and 58 controlpatients. There was a significantly greater prevalence of cardia intestinal metaplasia inshort-segment Barretts (10.2%), but not traditionalBarretts (3.3%), compared to control patients (0%) (P= 0.009). Dysplastic changes were significantly morefrequent in the metaplastic epithelium within theesophagus than in the cardia (P < 0.0001). Asignificantly greater prevalence of noncardia intestinalmetaplasia compared to cardia intestinal metaplasia wasfound in each of the three groups of patients;however, the prevalence of noncardia intestinalmetaplasia between short-segment, traditional, andcontrol patients was not significantly different. Cardiaintestinal metaplasia was an infrequent finding inpatients with Barretts esophagus and appears to developindependently from that in the remainder of thestomach.

Histologic features predictive of basal cell carcinoma recurrence: results of a multivariate analysis

Previous univariate analysis of 30 recurrent and 74 non‐recurrent basal cell carcinomas identified 6 histologic parameters predictive of recurrence: distance to the closest resection margin, growth pattern, shape of cell groups, contour of invading edge, degree of peripheral palisading, and nuclear pleomorphism. Re‐analysis of the data by multivariate analysis to select the few most important independent prognostic variables identified two parameters in each of two final models: resection margin distance and growth pattern (Model 1), and resection margin distance and shape of cell groups (Model 2). Based on these variables, a logistic regression equation could be derived for each model to calculate the predicted probability of recurrence or non‐recurrence.

Pulmonary mucinous cystic tumor. Case report with review of the literature

Mucinous cystic tumors of the lung are exceedingly rare. We describe the case of a 59-year-old white man with a left upper lobe mass documented on chest radiographs 11 years before thoracotomy. Grossly, the lobectomy specimen contained a 4.5 x 4.5 x 4.0 cm cystic gelatinous mass with complete occlusion of the anterior segmental bronchus by mucinous material. Although microscopically this pulmonary mucinous cystic tumor contained a focus of marked glandular atypia consistent with adenocarcinoma, the patient has remained free of recurrence or metastasis during 5 years of close postoperative follow-up. Pulmonary mucinous cystic tumors appear to have a remarkably favorable prognosis and should be distinguished from other common lung neoplasms.

Infection Due to Paecilomyces lilacinus: A Challenging Clinical Identification

We describe a case of noninvasive sinusitis caused by Paecilomyces lilacinus in a patient with diabetes mellitus. Cure was achieved by endoscopic drainage and aspiration of the fungal mass. We discuss the difficulty in and clinical importance of distinguishing Paecilomyces from Aspergillus.

Histologic evolution of basal cell carcinoma recurrence.

The biological behavior and appropriate therapy of recurrent basal cell carcinoma (BCCA) is controversial, with some studies suggesting that this tumor becomes more aggressive with each recurrence, and other studies indicating that the majority are aggressive from the onset. The authors studied the histologic evolution of BCCA by comparing 29 original tumors with their subsequent recurrences to determine if there were any predictable histologic changes. There were borderline statistically significant changes only in degree of fibrosis, prominence of nucleoli, and mitotic frequency. There were no statistically significant changes in any of the other parameters, including those that were shown previously to be predictive of recurrence or aggressive behavior. The results of this study clearly indicate that the majority of recurrent BCCAs are aggressive from the onset, and that in many cases this can be predicted from the histomorphology of the original tumor.

Metastatic Basal Cell Carcinoma: Report of a Case Presenting with Respiratory Failure

Metastasis from basal cell carcinoma (BCC) of skin is rare. A case of a 58-year-old male presenting with increasing shortness of breath and right pleural effusion is described. Open right pleural biopsy demonstrated metastatic carcinoma consistent with BCC. Review of medical records from another hospital revealed that four years previously a recurrent BCC had been excised from the left back. One and three years prior to this excision, a skin lesion at this same site had been treated with electrocautery. Review of the skin excision slides demonstrated infiltrating BCC histologically very similar to the metastatic pleural neoplasm. The patient died two months after the pleural biopsy. At autopsy, the cutaneous BCC had not recurred and metastatic BCC extensively infiltrated the pleura bilaterally, with focal involvement of underlying lung parenchyma, subcarinal lymph nodes, diaphragm, and pericardium.

Two Unusual Presentations of Urogenital Histoplasmosis and a Review of the Literature

Two unusual clinical presentations of urogenital histoplasmosis are described. A review of the literature on urogenital histoplasmosis is provided.

Spectrum of intestinal metaplasia in the upper foregut: inter-relationships and associated features

Spectrum of intestinal metaplasia in the upper foregut: inter-relationships and associated features

Prospective evaluation of the role of H. pylori and progression of Barretts esophagus to adenocarcinoma or multifocal high-grade dysplasia (mHGD)

Prospective evaluation of the role of H. pylori and progression of Barretts esophagus to adenocarcinoma or multifocal high-grade dysplasia (mHGD)