Arlene J. Herzberg

Acne keloidalis : transverse microscopy, immunohistochemistry, and electron microscopy

The earliest stages of acne keloidalis are not well characterized. In the present study, transverse sections of the early lesions revealed follicular units in several stages of inflammation. These follicles surrounded the central follicular units that gave rise to the clinically evident papule. Despite a spectrum of inflammatory changes, the most marked inflammation consistently occurred in the deep infundibular and isthmian levels of the hair follicles. Two follicles, presumably in the earliest stage, exhibited primarily an acute folliculitis and perifolliculitis, with destruction of the follicular wall and the release of hair. Central follicles showed predominantly acute neutrophilic or chronic lymphocytic inflammation at the upper isthmian levels and granulomatous inflammation at the deeper isthmian levels. Other follicles showed scar at the isthmian levels trapping hair fragments in the inferior portion of the follicle, with granulomatous inflammation and scarring. Sebaceous glands were absent in all stages of folliculitis in seven of eight follicular units.

Extravascular extravasation of radiographic contrast media: Effects of conventional and low-osmolar agents in the rat thigh

We compared the damage resulting from intradermal injection of four commonly used radiographic contrast media in laboratory rats. Sixty percent meglumine diatrizoate (Reno M 60) and ioxaglate (Hexabrix) produced significantly more ulceration and crusting on gross inspection and more necrosis, edema, and hemorrhage on histologic evaluation than iopamidol 300 (Isovue) or 0.9% (normal) saline. Thirty percent meglumine diatrizoate (Reno M Dip) had an intermediate toxicity, resulting in significantly more visible swelling and more microscopically detected hemorrhage than iopamidol or saline, but less ulceration/crusting and necrosis than Reno M 60 and ioxaglate. Since the three contrast agents of similar osmolality produced different degrees of tissue damage, our results suggest that factors other than high osmolality are partially responsible for determining the severity of injuries from extravasated contrast media.

Adenoid cystic carcinoma of the breast metastatic to the kidney. A clinically symptomatic lesion requiring surgical management

Adenoid cystic carcinoma (ACC) of the breast is a rare histologic type of breast cancer associated with a good prognosis. A woman who earlier had a pulmonary metastasis surgically resected 6 years postmastectomy developed clinically symptomatic bleeding from a renal metastasis 12 years postmastectomy. An atypical angiographic picture (moderate vascularization) for secondary renal neoplasms was observed. The characteristic histologic features of ACC were present in all specimens; ultrastructural characteristics of ACC were identified in the renal lesion. Successful surgical management of these metachronous solitary metastases demonstrates the therapeutic utility of aggressive management in maintaining disease control of this histologic type of breast cancer.

Chronologic aging in black skin.

Histologic studies examining chronologic aging in skin have been confined to white skin. In the present study, we examined the features of sun-protected black skin from individuals 6 weeks to 75 years of age with light and electron microscopy. With age, the dermoepidermal junction became flattened with multiple zones of basal lamina and anchoring fibril reduplication. Microfibrils in the papillary dermis became somewhat more irregularly oriented. Compact elastic fibers showed cystic changes and separation of skeleton fibers with age. The area occupied by the superficial vascular plexus in specimens of equal epidermal surface length decreased from the infant to young adult (21–29 years old) to adult (39–52 years old) age groups, then increased in the aged adult (73–75 years old) age group. With the exception of the vascularity in the aged adult group, the above features are similar to those seen in aging white skin, and suggest that chronologic aging in white and black skin is similar. In addition, there was a decrease in the number of melanocytes with age. Basal keratinocyte melanin granule density increased with age to age 52 and remained dense in the aged adult group, even as the number of melanocytes decreased.

DNA ploidy of malignant melanoma determined by image cytometry of fresh frozen and paraffin-embedded tissue

Image analysis of DNA content was performed from single nuclei of melanoma monolayer imprints made from fresh frozen (issue of 14 patients with primary malignant melanoma and 16 patients with local recurrences at the incision site and local or distant metastases. This procedure requires fewer cells and is an advantage when the quantity of tumor available is limited, especially in thin low Breslow depth cutaneous melanomas. Image analysis allowed reproducible measurement of DNA ploidy from 100 cells. The frequency of aneuploidy was similar in primary and metastatic melanomas. Three of 3 patients with euploid primary melanomas showed no evidence of recurrences or meta‐stases, though one died of unrelated disease with short follow‐up. The 4 patients with primary melanoma who developed metastases had aneuploid primaries; two of these patients died of metastatic disease. Three of 4 patients with euploid metastatic tumors were free of disease at last follow‐up, and 1 patient died with stable disease. Nine of 12 patients with aneuploid tumors died of metastatic disease. The frequency of DNA ploidy in the present image analysis study correlated with previous (low cytometry studies. In 9 patients with primary tumors with a Bin‐slow depth greater than 0.75 mm, the. DNA content was also determined in nuclei obtained from formalin‐fixed paraffin‐embedded tissue. The frequency of aneuploidy was higher in fresh tissue (7 of 9) as compared with paraffin‐embedded tissue of the same cases (4 of 9).

Congenital mitral insufficiency secondary to anomaious mitral arcade in an adult

SG. Two-dimensional echocardiographic features of coronary arteriovenous fistula. AM HEART J 1982;104:872. 6. Agatston AS, Chapman E, Hildner FJ, Samet P. Diagnosis of a right coronary artery-right atrial fistula using two-dlmensional and Doppler echocardiography. Am J Cardiol 1984; 54~238. 7. Miyatake K, Okamoto M, Kinoshita N, Fusejima K, Sakakibara H, Nimura Y. Doppler echocardiographic features of coronary arteriovenouse fistula-complementary roles of cross-sectional echocardiography and the Doppler technique. Br Heart J 1984;51:508. 8. Goldman ME. Real-time two-dimensional Doppler flow imaging: a word of caution. J Am Coll Cardiol 1986;7:89. 9. Miyatake H, Izumi S, Okamoto M, Kinoshita N, Asonuma H, Nakagawa H, Yamamoto K, Takamyta M, Sakakibara H, Nimura Y. Semiquantitative grading of severity of mitral regurgitation by real-time two-dimensional Doppler flow imaging technique. J Am Co11 Cardiol 1986

Endocardial Fibroelastosis With Coronary Artery Thromboembolus and Myocardial Infarction

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Acne keloidalis: a review.

We report a case of an 18-month-old male, born to a woman with third trimester febrile illness, who had a history of congestive heart failure and respiratory distress, cardiomegaly, and electrocardiographic (ECG) findings suggestive of cardiomyopathy and myocarditis. After gradual improvement in heart size and function with pharmacologic therapy, he developed a terminal episode of respiratory distress and cardiogenic shock, with ECG findings of an anterolateral infarct. At autopsy it was found that endocardial fibroelastosis with mural thrombi in the left ventricle had been complicated by thromboembolism to the left anterior descending coronary artery, resulting in transmural infarction of the anteroseptal region of the left ventricle. Myocardial infarction is a potential but unusual thromboembolic complication of endocardial fibroelastosis. A high index of suspicion for coronary artery thromboemboli should be maintained in pediatric patients with cardiomyopathy and suspected myocardial infarction.