Philip G. Prioleau

Metastatic Crohn's disease.

Cutaneous granuloma formation distant from the gastrointestinal tract in patients with Crohns disease of the bowel has been called metastatic Crohns disease. We report two patients with this entity, including the first to present with an erysipelas-like eruption of the face. A review of the worlds literature reveals that all patients with metastatic Crohns disease have had gastrointestinal disease involving the colon or rectum. Clinical features of the nine previously reported cases are reviewed.

Verrucous carcinoma. A light and electron microscopic, autoradiographic, and immunofluorescence study

Verrucous carcinomas of the rectum, plantar surface of the foot, and oral cavity were studied by means of light and electron microscopy, and autoradiographic and immunofluorescent techniques. Histologic examination showed that each tumor was composed mainly of mature squamous epithelium, and each had foci of slight cellular atypia. The cells in S‐phase consistently were situated near the basal layer. Immunofluorescent examination with antibasement membrane antibody showed areas of marked focal thickening and other areas where basement membrane was absent. Ultrastructural examination showed reduplicated as well as normal basal lamina. Numerous interdigitating microvilli and well developed desmosomes characterized the cells above the basal layer. A proliferative basal zone underlying a thick layer of well differentiated nonproliferating keratinocytes and reduplicated basal lamina were seen in all tumors, regardless of location. These consistent findings constitute evidence that verrucous carcinoma is a morphologic and cytokinetic entity that may occur in multiple anatomic sites.

The histologic spectrum and significance of clear‐cell change in lung carcinoma

We reviewed 348 consecutive cases of lung carcinoma to determine the incidence and significance of clear‐cell carcinoma. Areas composed of clear cells were common in all types of lung carcinoma except small cell carcinoma. The clear cytoplasm in most cases contained glycogen. We found only one tumor fulfilling the World Health Organization (W.H.O.) criteria for clear‐cell carcinoma. There were 14 other tumors which contained over 50% clear cells and therefore could be considered clear‐cell carcinomas by some published criteria. Ten of these tumors also showed foci of epidermoid differentiation while four showed gland formation. The prognosis of tumors containing even large areas of clear cells does not appear to differ from that reported for the common lung carcinomas. We feel that clear‐cell carcinoma should not be considered a distinct clinicopathologic entity. Rather, tumors composed even predominantly of clear cells should be classified according to the major W.H.O. categories.

Lymphangioma circumscriptum following radical mastectomy and radiation therapy.

Lymphangioma circumscriptum, a rare long‐term complication of chronic lymphedema, has been described only twice following radical mastectomy. The case discussed in this report developed 25 years after radical mastectomy and radiation therapy. Both this condition and lymphangiosarcoma, its malignant counterpart, may arise in lymphedematous extremities regardless of the etiology of the lymphatic obstruction. Cancer 42:1989‐1991, 1978.

Major peripheral arterial occlusion due to malignant tumor embolism. Histologic recognition and surgical management

Four cases of major peripheral arterial occlusion due to malignant tumor emboli are reported. All of the emboli originated from primary lung carcinomas, three following resection of the lung tumor, and the fourth occurring spontaneously before discovery of the lung primary. Each patient underwent successful embolectomy and was discharged without any related deficits. Their survival ranged from three to seven months. These cases emphasize the possibility of tumor embolism either spontaneously or following surgical manipulation. Early pulmonary vein ligation and, if indicated, intrapericardial ligation should be performed at the time of resection to try to prevent this complication. Cancer 42:2009‐2014) 1978.

Verrucous lupus erythematosus: Ultrastructural studies on a distinct variant of chronic discoid lupus erythematosus†

Ten patients with classic discoid lupus erythematosus of the face associated with verrucous, papulonodular lesions on the arms and hands were studied by electron microscopy. The ultrastructural findings on the verrucous lesions included apoptotic keratinocytes, intraepidermal lymphocytes, and gapping, detachment, and reduplication of the basal lamina. Also, tubuloreticular inclusion bodies were present in the endothelial cells. These observations, together with the clinical, histopathologic, and immunofluorescence findings, suggest that the verrucous lesions represent a rare, but distinct, variant of chronic discoid lupus erythematosus.

Adenomatous Polyps of the Prostatic Urethra: A Cause of Hematospermia

Hematospermia is a common urologic problem that is not always evaluated by cystoscopic examination. We report on 4 patients with hematospermia in whom polypoid lesions were observed in the prostatic urethra near the verumontanum on cystoscopic examination. In 3 of these patients the lesions were adenomatous polyps, resembling a normal prostate, and in 2 the hematospermia resolved following resection. In the remaining patient the lesion proved to be an intraductal carcinoma. We believe that cystoscopy is indicated in all patients with hematospermia that does not resolve on antibiotic therapy. Polypoid lesions in the prostatic urethra should be resected as diagnostic and sometimes therapeutic measure.

Sweat gland differentiation in mammary adenoid cystic carcinoma.

A breast tumor is described which presented as an exophytic mass, and which by both light and electron microscopic examination had a biphasic histologic composition. In the superficial area adjacent to the epidermis, it showed tubular differentiation similar to a cutaneous tubular apocrine adenoma and salivary basal cell adenoma, and, in the deeper portion, it had the characteristic features of adenoid cystic carcinoma. Their possible interrelationships are discussed, and mammary adenoid cystic carcinoma is briefly reviewed.