Waine C. Johnson

Adenoid squamous cell carcinoma (adenoacanthoma): A clinicopathologic study of 155 patients

The lesions of adenoid squamous cell carcinoma develop in exposed areas, particularly about the head and neck regions in persons with fair skin who spend considerable time outside. The microsocopic features consist of invasion of the corium by proliferating atypical epithelial cells forming an adenoid pattern. The adenoid structure is usually composed of a single peripheral layer of cohesive cuboidal epithelial cells, and toward the center of the lobule there is acantholysis with formation of lumina containing dyskeratotic cells. The precursor stages of adenoid squamous cell carcinoma are classified histopathologically as senile keratosis with acantholysis. The most frequent histologic site of origin in this material was from the upper part of the pilary outer root sheath but some arose from the epidermis. Mucin associated with the adenoid structure showed identical histochemical reactions to those of mucin occurring in the pilary sheath and epidermis (hyaluronic acid) and differed from those of mucin seen in sweat glands (sialomucin). Among 155 patients having 213 lesions of adenoid squamous cell carcinoma there was metastasis in 3 patients (to regional lymph nodes in 2 and to regional lymph nodes and to lung in 1) and direct extension in 2 patients, which led to the death of the 5 patients. Surgical excision is the treatment of choice.

Male Pattern Alopecia A Histopathologic and Histochemical Study

Three hundred and forty‐seven tissue specimens were studied from 23 patients with male pattern alopecia. Characteristic features of pattern alopecia included: the presence of miniature or vellus follicles; a marked enlargement of the sebaceous glands and arrectores pilorum muscles; the presence of connective tissue streamers beneath the vellus follicles; and the thinning of the dermis. A mild perivascular infiltrate of mononuclear cells and mild capillary dilatation was sometimes seen. An increased number of mast cells was often a prominent feature. Histochemical procedures were performed for glycogen, acid mucosaccharides, inorganic substances, and enzymes including alkaline phosphatase, acid phosphatase, beta glucuronidase, cholinesterase, aminopeptidase, oxidases and dehydrogenases. Histochemical studies did not reveal any significantly abnormal enzyme changes other than the altered vascular and nerve supply to the miniature follicles.

Arteriovenous hemangioma (arteriovenous shunt). A clinicopathological and histochemical study

Sixty‐nine patients with predominantly asymplomatic solitary angiomatous lesions were studied. Lips and perioral skin were the usual location, and the lesion occurred almost exclusively in adults. The essential histopathologic features are multiple dilated vascular channels located in the corium or submucosa and without significant epidermal participation. Anastomosing vascular spaces are lined by endothelial cells and thin‐walled veins contrast sharply with arteries showing thick fibromuscular walls. The pathogenesis of these peculiar hemangiomas is unknown, but they probably represent hamartomas with numerous arteriovenous shunts and arise from the subpapillary vascular plexus. Simple surgical excision is curative and represents the treatment of choice. The term of arteriovenous hemangioma is proposed for this clinicopathologic entity and should be considered in the differential diagnosis of other acquired benign hemangiomas and vascular lesions occurring in middle‐aged patients.

Prognostic significance of cytomorphology in the cutaneous t-cell lymphomas

In this retrospective study, the degree of differentiation of atypical lymphoid cells was assessed in pretreatment cutaneous biopsy specimens from 248 patients with cutaneous T‐cell lymphomas (mycosis fungoides and Sézary syndrome) and the findings were correlated with the subsequent therapeutic results. Overall, patients with a predominance of cells with hyperchromatic nuclei (well‐differentiated lymphoid cells) in cutaneous infiltrates responded better to treatment with improved survival rates than patients with infiltrates composed predominantly of cells with pale vesicular nuclei (poorly differentiated lymphoid cells). Infiltrates with a predominance of poorly differentiated lymphoid cells were observed primarily in patieets with advanced (tumor) stages of disease. However, comparison of the therapeutic results achieved for the two cytomorphologic patterns in patients at comparable stages of advanced disease did not reveal significant differences, indicating that the presence of poorly differentiated cells in large proportions does not have additional prognostic implications beyond those obtained from usual staging procedures. We speculate that the atypical cells with large, pale vesicular nuclei found in lesions of cutaneous T‐cell lymphoma are not a more malignant cell population but rather evolve from more hyperchromatic cellular forms, perhaps a byproduct of malignant dedifferentiation.

Lichenoid Benign Keratosis

One hundred thirty‐eight patients who presented with solitary cutaneous lesions appearing clinically as papules or plaques and histologically showing a lichenoid tissue reaction were studied. Many of the lesions occurred in sites not usually exposed to sunlight and histologically the lesions did not show significant atypical change in keratinocytes and many did not show evidence of solar elastosis in the superficial corium. Our study indicates that the lesions are benign keratoses showing a lichenoid tissue reaction or lichenoid benign keratoses.

Mycetoma formation in Trichophyton rubrum infection.

An adult male patient with a chronic Trichophyton rubrum infection of the feet, toe nails and groin, for 15 years, developed on the dorsum of the right foot a tumour with draining sinuses. Histological examination of tissue from the growth revealed granulomatous inflammation with abscesses containing granules characteristic of mycetoma. T. rubrum was cultured from skin scrapings and toe nails. The concurrent complete clearing of the superficial lesions and the mycetoma during treatment with griseofulvin, as well as the disappearance of complement fixing antibodies against T. rubrum antigen, indicate that this hitherto unreported complication of a dermatophyte infection may be related and may not be coincidental to the infection.

Tritiated Thymidine Uptake in Pig Skin

Tritiated thymidine (3HT) was used in one of three ways to label deoxyribonucleic acid replication in epidermal cells of miniature swine: (1) the radioactive material was injected intracutaneously in vivo; (2) the radioactive material was injected intracutaneously into biopsy specimens and the specimens incubated in vitro in Eagles medium, or (3) uninjected biopsy specimens were incubated in Eagles medium with added 3HT. The first two methods yielded the same proportions of labeled cells with uniform distribution of labeled cells. The third method resulted in labeling of cells mainly at the periphery of the biopsy specimens. The advantages of the in vitro over the in vivo technique of injection of 3HT includes the fact that injecting a biopsy specimen avoids the problems of large amounts of radioactive waste disposal in animal studies or the legal and ethical problems of tracer studies in humans.Tritiated thymidine (3HT) was used in one of three ways to label deoxyribonucleic acid replication in epidermal cells of miniature swine: (1) the radioactive material was injected intracuta

The Origin of Dermal Fibrocytes in Wound Repair

Whether blood mononuclear cells are totipotential and can give rise to fibrocytes is still controversial. Most recent studies seem to favor that fibrocytes arise locally from perivascular resting undifferentiated cells. We have attempted to determine the origin of fibrocytes utilizing tritiated thymidine (3HT) autoradiography. Multiple skin incisional wounds were produced in the dorsa of rats and a subsequent single intraperitoneal injection of 3HT was given at varying periods after injury. Biopsies were taken from individual animals at varying intervals up to 192 h after injury. Sections representing biopsies up to 15.5 h after injury, taken from animals injected at 4, 7, 8, and 11.5 h after injury, did not show labeling of monocytes, fibrocytes or endothelial cells. Biopsies taken from these same animals at varying intervals after 16 h showed labeling of these cells. These observations indicate that new-labeled fibrocytes which appeared in the wound were labeled at a distant site since labeling did not occur locally 1 h after a pulse injection of 3HT. Our findings thus support the concept that blood-borne mononuclear cells can give rise to some of the fibrocytic cells in repair of wounds.

A resinous mounting medium compatible with azo-dye staining for alkaline phosphatase.

Thick sections, 75-125 μ, are required for adequate demonstration of blood vessels and occasional other structures which show alkaline phosphatase activity. The mounting medium described has been found to be superior for thick sections to others which we have used such as polyvinylpyrrolidone, polyvinylacetate or glycerol-gelatin. The mounting technique consists of dehydration in absolute ethanol, one change of equal parts of ethanol and cumene, clearing in ethyl benzene, and mounting with synthetic resin dissolved in ethyl benzene.

Connective Tissue Nevus

An 8-year-old girl presented with a two-year history of a progressive ‘wrinkling’ of her cheeks. Examination revealed the skin of both cheeks appeared irregularly furrowed with a linear pattern radiating outward from the nose and mouth. A biopsy showed changes consistent with a connective tissue nevus. The patient is being reported because of the unusual clinical appearance.