Irving M. Reingold

Cutaneous metastases from internal carcinoma.

A series of 36 patients having cutaneous metastases, including 32 necropsied cases in necropsy series of approximately 2,300 cases of internal carcinoma derived from the Long Beach Veterans Administration Hospital. The lung was the primary site in 17 of the 36 cases, the gastro‐intestinal tract in 8 and the genito‐urinary tract in 10; the primary site of one was uncertain. The tumors of the lung most commonly metastasized to the skin of the chest and those of the gastro‐intestinal tract and genitourinary tract to the abdominal wall. The skin metastases were multiple except for 4 cases, usually widespread in location and occasionally appeared in small crops. The tumors were most commonly solid painless elevated nodules, ranging from one to 3 cm in diameter, having an intact overlying epidermis. The microscopic appearance had features of adenocarcinoma in 26 of the 36 cases. The skin tumors were indicative of progression of the primary tumor and early fatal termination, the duration of life averaging about 3 months after the appearance of the skin tumors. The necropsies revealed widespread metastases.

Malignant neoplasms metastatic to gingivae

Malignant neoplasms metastatic to the gingivae are rare. Our review of the literature revealed only eight acceptable examples. We are reporting two additional cases. One patient was a 58-year-old man with an adenocarcinoma of the lung which metastasized bilaterally to the maxillary gingiva. The second patient was a 27-year-old man with a synovial sarcoma which metastasized to multiple sites in the maxillary and mandibular gingiva. Clinically, gingival metastatic lesions are most often confused with hemangioma, pyogenic granuloma, giant-cell granuloma, and pepripheral fibroma. They usually occur late in the course of the disease and are associated with metastatic deposits in many other organs and tissues. Death usually occurs in a few weeks or months after discovery of the gingival metastasis.

Multicentric dermal-type cylindromas of the parotid glands in a patient with florid turban tumor.

Dermal‐type cylindromas of parotid glands in a patient with turban tumor, and various adnexal tumors, represent a rare diathesis, apparently not reported previously. A Caucasian man, born in 1916, had a scalpectomy for turban tumor in 1957. In 1957, 1960, and 1974, dermal type cylindromas were excised from portions of both parotid glands, developing from intercalated and striated ducts; they were considered benign, based on long term followup. Adnexal tumors included multiple dermal cylindromas, trichoepitheliomas, eccrine spiradenomas, and Bowens disease, and occurred on almost all skin surfaces. In November, 1976, a portion of a right parotidectomy included a 3.5 × 3‐cm malignant tumor having the characteristics of an invasive poorly differentiated spindle cell epidermoid carcinoma, which showed no evidence of originating from a malignant basal cell tumor. Several encapsulated and developing benign basal cell tumors were included in the specimen. Dermal‐type cylindromas of the parotid gland are considered to be a variant of basal cell adenoma, or monomorphic adenoma, basal cell type, since they consist of similar cell components, although of somewhat different arrangement and with prominent focal deposition of hyaline. Dermal‐type cylindromas should be excised conservatively as they appear. They must be differentiated from adenoid cystic carcinoma, which is an infiltrating neoplasm and requires a radical surgical approach.

Sialadenoma papilliferum of the oral cavity

Abstract Sialadenoma papilliferum is a rare, recently reported, salivary gland tumor with distinctive morphologic and clinical features. Morphologically, these lesions exhibit a prominent exophytic and papillary growth pattern and appear to arise from extralobular salivary gland ducts. Clinically, they are asymptomatic and slow growing and must be differentiated from other papillary lesions, including squamous-cell papilloma, verrucous carcinoma, and warty dyskeratoma.

Extraosseous osteosarcoma of the lung

Two cases of extraosseous osteosarcoma of the lungs are described and 3 cases previously reported in the literature are reviewed. All tumors were large, fleshy, osteoid masses occupying the hilar and central areas of the lungs. In 4, there were metastases in lymph nodes and viscera. The tumors in our patients appeared to be rapidly growing; they attained a size of 6 and 7 cm in greatest diameter, respectively, within a few months, and the patients developed symptoms related to pneumonitis. Both tumors were highly cellular, composed of fibrosarcoma and poorly differentiated mesenchymal tissue with formation of osteoid and immature and malignant cartilage and bone in variable quantity. The pathogenesis of this very rare neoplasm and its classification are discussed.

Urinary tract disease in spinal cord injury patients. I. A brief outline of the problem.

AMELIORATION of urinary tract disease remains a challenging problem in patients with spinal cord injury. Renal failure due to infection is the most frequent cause of death (Jousse, 1967; Nyquist and Bors, 1967). Antibiotic therapy has not proven adequate in many cases. Studies now appearing in the current literature indicate a resurgence of interest in the role of antibodies and other host immunity factors in urinary tract disease (Quinn and Kass, 1960; Kass, 1965). We were interested to explore the usefulness of autogenous vaccines in urinary tract disease. We are not aware of any previous clinical trials. The Spinal Cord Injury Service at the Veterans Administration Hospital, Long Beach, California, is well suited for such studies because these patients present an unusually high risk population for urinary infection. Although a long list of bacterial species are involved in urinary tract disease, only four or five Gram-negative bacilli are known to account for the large majority of cases. We hope to develop, eventually, autogenous vaccines that would help circumvent the considerable problem of serological heterogeneity within each bacterial species. Prior to considering clinical application of vaccines, it was necessary to answer the question: do antibodies play an important role in the pathogenesis of urinary tract infections? We have been studying the natural history of urinary tract infection and antibody response in selected spinal cord injury patients over periods of many months (more than three years in some cases). Our initial purpose was to accumulate data that would enable appraisal of: (1) the diagnostic and prognostic significance of a patients antibody titre to his own urinary flora, and (2) the reliability of antibody titre versus urine culture as a guide to the etiology of urinary tract disease.