John T. Headington

Characterization of factor XIIIa positive dermal dendritic cells in normal and inflamed skin

The immunocytochemical identification and characterization of indigenous dermal dendritic cells (dermal dendrocytes) using a rabbit polyclonal antibody to clotting enzyme factor XIII subunit A (FXIIIa) was carried out on normal and inflamed human cutaneous tissue. The immunophenotype of FXIIIa positive dendritic cells was analysed with a panel of 18 monoclonal antibodies using immunoperoxidase and double immunofluorescence staining techniques.

Topical tretinoin in the treatment of aging skin

We review the use of topical tretinoin (all-trans-retinoic acid) in the treatment of aging skin. We have found topical tretinoin capable of improving aged-appearing skin in both a double-blind, vehicle-controlled trial and our clinic patients. The most impressive improvement occurs after application of tretinoin 0.1% cream for 8 to 12 months. Side effects have been limited to a mild, transient, and clinically insignificant burning sensation in the eyes and mild irritation of tretinoin-exposed skin.

Sustained improvement with prolonged topical tretinoin (retinoic acid) for photoaged skin.

We performed a 22-month trial of topical tretinoin (retinoic acid) in the treatment of photoaging. Thirty patients participated in a 4-month, randomized, blinded, vehicle-controlled study that has been reported previously; 21 patients continued tretinoin therapy on an open-label basis, participating in the study for a total of 10 months, and 16 patients continued for 22 months. During the open-label study, the statistically significant improvement that had occurred in fine and coarse wrinkling and skin texture during our original study was sustained, despite reductions in dose or frequency of application of tretinoin. The number of discrete lentigines decreased by 71% compared with the number before therapy. Histologic findings included a statistically significant thickening of the epidermis. Side effects were limited to a cutaneous retinoid reaction that diminished as therapy proceeded.

Membranous basal cell adenoma of parotid gland, dermal cylindromas, and trichoepitheliomas: Comparative histochemistry and ultrastructure

A basal cell adenoma of parotid, eccrine dermal cylindromas and trichoepitheliomas occurring in the same patient were examined by light and electron microscopy and histochemistry. The eccrine and parotid adenomas were similar both structurally and histochemically except for the presence of Langerhans cells in the cutaneous adenoma and well differentiated mucinous cells in the parotid tumor. The three different hamartomas found in this individual may represent the effect of a single pleiotropic gene acting on ontogenetically related stem cells.

Prophylactic cephaloridine in the prevention of postoperative pelvic infections in premenopausal women undergoing vaginal hysterectomy

Abstract A prospective double-blind study was performed utilizing 3 Gm. of cephaloridine or placebo on the day of operation in premenopausal women undergoing vaginal hysterectomy. In approximately two years, 100 of 138 women eligible for the study elected to participate; 50 patients received placebo and 50 received active drug. The preoperative profile of the two groups of patients was similar. Postoperatively, there were statistically significant differences in the clinical courses of the two groups of patients. In those women receiving cephaloridine prophylaxis, fewer patients had postoperative morbidity (p

Primary mucinous carcinoma of skin: histochemistry and electron microscopy.

Two primary mucinous carcinomas of skin were studied by histochemistry and by light and electron microscopy. Enzyme histochemistry showed a pattern of reactivity similar to that found in eccrine secretory epithelium. Mucin histochemistry substantiated previous reports of probable sialomucin formation. Electron microscopy revealed a highly differentiated neoplasm with a mode of mucin secretion similar to that observed in the dark (mucinous) cell of the eccrine coil. The natural history of mucinous carcinoma of skin indicates that although local growth is the rule, lymph node metastasis may occur.

Oral submucosal dendrocytes: factor XIIIa+ and CD34+ dendritic cell populations in normal tissue and fibrovascular lesions

Factor XIIIa+ and CD34+ dendritic cells, believed to be subsets of monocyte/macrophages, have been identified in dermis and in dermal tumors. The purpose of this study was to determine the presence and distribution of analogous cell types in oral sub‐mucosa and oral fibro‐vascular lesions. Antibodies to XIIIa, CD34, S‐100 protein, and macrophage antigen (MAC 387) were tested on formalin‐fixed, paraffin‐embedded tissue sections from normal mucosa, peripheral fibroma (PF), peripheral ossifying fibroma (POP), peripheral giant cell granuloma (PGCG), pyogenic granuloma (PG), lymphangioma (La), benign fibrous histiocytoma (BFH), idiopathic histiocytosis (IH), angiofibroma (Af) using an ABG immunoperoxidase technique. Numbers of positively stained cells were compared to unstained cells in the tumors. XII la positive submucosal dendrocytes (GD34‐, S‐100‐, MAC 387‐) were found in abundance in normal tissue in characteristic distributions: collagen‐associated, vessel‐associated, and lymphoid‐associated. The percentage of XIIIa+ cells in the oral tumors was as follows: PF: 10–30%, POF: 5–10%, PGCG: 0–5%, PG: 5–20%, La: 0%, BPH: 5–25%, IH: 0%, and Af: 10–20%. CD34+ dendrocytes (XIIIa‐, S‐100‐, MAC 387‐) were few in number and were found in deeper submucosa, especially around skeletal muscle. Other than blood vascular endothehum, CD34+ cells were not generally seen in the oral tumors studied. It is concluded that two previously unrecognized dendrocyte populations reside in normal submucosa. XIIIa+ cells participate in the formation of some oral reactive and neoplastic lesions.

Malignant clear cell acrospiroma.

The histologic features of a malignant clear cell acrospiroma were those of infiltrative local growth, frequent mitoses and angiolymphatic invasion. The histochemical and ultrastructural findings were similar to those reported for benign clear cell acrospriomas. Amputation of the leg and regional node dissection were required for clinical control. Evaluation of this case and review of the literature suggests that the malignant clear cell acrospiroma often behaves in an aggressive manner and frequently metastasizes. As a consequence, therapeutic strategies should be appropriately planned.

Topical minoxidil for hair regrowth

Minoxidil, a potent peripheral vasodilator used orally for refractory hypertension, has produced hypertrichosis. To determine the efficacy and safety of 1% or 5% topical minoxidil for the stimulation of scalp hair regrowth, we studied fifteen normotensive patients, five with androgenic alopecia and ten with alopecia areata diagnosed clinically and by biopsy, for 12 months. Three of five patients with androgenic alopecia using 5% minoxidil for 12 months noted hair regrowth, ranging from minimally observable hair to an appreciable restoration of larger, pigmented, terminal hair in one patient. Among the patients with androgenic alopecia, regrowth response corresponded to the serum minoxidil blood levels. None of the patients with alopecia areata receiving either 1% or 5% minoxidil noted hair regrowth despite comparable minoxidil blood levels. Improved local absorption of topical minoxidil solution may promote hair regrowth in androgenic alopecia.

The t(2;5)-associated p80 NPM/ALK fusion protein in nodal and cutaneous CD30+ lymphoproliferative disorders.

A high percentage of extracutaneous CD30+ anaplastic large cell lymphomas (nodal ALCL) carry a specific chromosomal translocation, t(2;5) (p23;q35), that results in abnormal expression of p80 NPM/ALK chimeric protein (p80). The protein p80 may be detected by immunohistochemistry using polyclonal (anti‐p80) or monoclonal (ALK1) antibody directed against the ALK epitope. Although nodal ALCL, primary cutaneous ALCL, and lymphomatoid papulosis type A (lyp A) have similar histologic and immunohistochemical features, the expression of p80 in these cutaneous lesions has not been extensively studied. We immunostained tissues from 10 nodal ALCL, 8 primary cutaneous ALCL, 24 lyp A, and positive and negative controls using polyclonal rabbit anti‐p80 and the avidin‐biotin‐peroxidase labeling method. Reactivity was determined by comparing staining intensity to positive controls [4 nodal ALCL with t(2;5)] and negative controls (21 non‐ALCL lymphomas). Only cutaneous lesions staining positively with anti‐p80 were further studied with the monoclonal antibody ALK1 and reverse transcription polymerase chain reaction (RT‐PCR) for p80 messenger RNA. All positive controls (4/4), but none of the negative controls (0/21) nor lyp A (0/24), were immunoreactive for anti‐p80. Sixty percent (6/10) of nodal ALCL and a single case (12%) of primary cutaneous ALCL were immunoreactive for anti‐p80. In this exceptional cutaneous lesion, although we did not find NPM/ALK by RT‐PCR, we detected strong expression of ALK using ALK1. We conclude that t(2;5) is rarely involved in the pathogenesis of cutaneous CD30+ lymphoproliferative disorders.