Tove Eeg Larsen

Epidermal and dermal distribution of a myelomonocytic antigen (L1) shared by epithelial cells in various inflammatory skin diseases

The L1 antigen is a major cytosol component of human granulocytes that may also be expressed by macrophages and epithelial cells. Its epidermal and dermal occurrence was investigated in formalin-fixed routine biopsy material from eleven different inflammatory skin disorders. Localization was performed with a rabbit antiserum to L1 applied in an unlabeled antibody peroxidase-antiperoxidase method. L1 antigen was not found in normal skin except in epithelial cells of pilosebaceous units. However, epidermal L1 antigen was demonstrated in every biopsy specimen from lupus erythematosus, lichen planus, dermatitis herpetiformis, and atopic dermatitis, whereas granuloma annulare test results were usually negative. The occurrence of dermal L1 antigen depended on the composition of the inflammatory infiltrate; specimens rich in neutrophilic granulocytes (e.g., dermatitis herpetiformis) were particularly strongly stained. Extracellular dermal staining was also seen, especially in areas adjacent to accumulation of positive leukocytes. The varying epidermal occurrence of L1 antigen in skin diseases probably signified different degrees of proliferative activity of the epithelial cells and could apparently not be ascribed to uptake from the dermis.

A retrospective histological study of 669 cases of primary cutaneous malignant melanoma in clinical stage I. I. Histological classification, sex and age of the patients, localization of tumour and prognosis.

A selected series of 669 primary malignant melanomas of the skin, stage I, has been classified according to Clarks system into lentigo maligna melanoma (86), superficial spreading malignant melanoma (259), nodular malignant melanoma (194) and unclassifiable malignant melanoma (130). It was often difficult to distinguish between lentigo maligna melanoma and superficial spreading malignant melanoma, and sometimes also between this last type and nodular melanoma. There seem to be borderline cases between the respective types. The 10-year specific cumulative survival rate (approximately the cure rate) was 98.3% for the lentigo maligna melanomas, 78.6% for nodular malignant melanomas and 76.7% for the unclassifiable group of melanomas. The 5-year observed prognosis ofthe 3 main types is satisfactory compared with other investigations. As the prognosis of the 3 types of cutaneous malignant melanoma differs considerably the use of this classification is recommended. The number of unclassifiable cases is likely to be reduced in the routine work when several sections of each tumour are studied.

A case of multifocal liposarcoma

A 53-year-old man presented with a grade 2 liposarcoma in his left thigh and grade III liposarcomas in the mediastinum and omentum. Later, a grade 2 tumor was discovered in the musculature of his right thigh. In addition to recurrences, he developed lesions that were considered metastatic. He died 3 years later of multiple lesions. The case may represent a multifocal liposarcoma, which has been previously reported in only 35 cases.

A retrosepctive histological study of 669 cases of primary cutaneous malignant melanoma in clinical stage I. 6. The relation of dermal solar elastosis to sex, age and survival of the patient and to localization, histological type and level of invasion of the tumour.

A selected series of 669 primary malignant melanomas of the skin, stage I, was studied. The series includes 86 lentigo maligna melanomas, 259 superficial spreading malignant melanomas, 194 nodular malignant melanomas and 130 unclassifiable malignant melanomas. The tumour cell type was classified and the tumour cell pigmentation, the cellular atypia and the mitotic count was graded. The relation of these four tumour cell features to each other and to the tumour type was studied by X2tests. The prognostic value of these features in relation to the total series as well as to each tumour type was also examined. The most common features were mixed cellularity, little pigment, moderate atypia and low mitotic count. Most of these tumours were superficial spreading malignant melanomas. A good prognosis was related to spindle-shaped tumour cells, marked pigmentation, slight atypia and few mitoses. A bad prognosis was related to epithelioid tumour cells, little pigment, marked atypia and many mitoses. Variations of lentigo maligna melanoma tended to be more benign while variations of nodular malignant melanoma tended to be more malignant than the average. A superficial spreading malignant melanoma might vary in either direction.

TRANSIENT INTESTINAL LYMPHANGIECTASIA

ABSTRACT. Intestinal lymphangiectasia may be more protean in clinical manifestations and less rare than earlier suspected. A recent report points out that there are two types of the disorder, one congenital and the other acquired and transitory. A case is reported which fulfills the current clinical, laboratory, radiological and histological criteria for the diagnosis of the disease, and represents the first report in Scandinavia of transient intestinal lymphangiectasia with rapid and complete recovery within a few months after initiation of MCT diet.

Melanoma and Parkinson's disease

To the Editor: A 75 year old man with an ulcerating tumor on the front of the upper trunk presented at our department. For several years the patient had noticed a nevus in this location. Four to five months previous to the first visit at the department he had noticed suppuration from the nevus. For the last three years he had been treated with carbidopa and levodopa (1:4 in a combination drug) because of parkinsonism. The histological diagnosis of the surgically removed tumor was a nodular ulcerating malignant melanoma. The first report of a malignant melanoma arising in a patient on levodopa was reported in 1972 [1]. Levodopa, often in combination with carbidopa, is widely used in the treatment of Morbus Parkinson and parkinsonism. Levodopa is decarboxyiated to dopamine in the brain and compensating the lack of this neurotransmitter in the basal ganglia, but L-Dopa is an intermediary product in the biosynthesis of both cathecolamines and melanin as well. Two possible interactions between the drug and melanoma have been suggested: that levodopa was incorporated directly into the melanocytic tumor [2] or by increasing the secretion of growth hormone [3]. Up to know 21 cases of malignant melanoma in patients with parkinsonism have been reported. Out of these there were thirteen cutaneous melanomas [1,4-9], four ocular, one mucosal and three without recorded site of the primary tumor. It has been shown that levodopa is selectively incorporated into melanocytes in the presence of dopa decarboxylase inhibitor [10], and hence possibly develop carcinogenic effect on melanocytes. Even though the carcinogenic effect remains questionable, precautions towards development of melanomas in patients treated with levodopa seems advisable.

SCLERODERMA WITH MASSIVE REGIONAL LYMPHADENOPATHY

Abstract. Scleroderma in a two‐year‐old boy with gross enlargement of the right inguinal lymph nodes, as an early sign, is reported. Repeated lymph node biopsies revealed non‐characteristic reactive changes and hyperplasia, but eventually histological examinations of skin and muscle from the right leg were diagnostic. The effect of one year of D‐penicillamine therapy is briefly mentioned.

Growth stimulation by giant-cell tumor of bone? A case report

Overgrowth of the femur and tibia was observed in a 20-year-old man who had a giant cell tumor in his distal femur. Growth stimulation by the tumor is suggested to explain the overgrowth.