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The authors clinically evaluated a new high-frequency ultrasound (US) scanner to determine the value of US for dermatologic applications.A 20-MHz US scanner was used to visualize normal skin at eight sites in 10 healthy volunteers and to evaluate 200 skin lesions (45 malignant, 155 benign).In normal skin, the dermis was markedly echogenic and sharply demarcated from hypoechoic subcutaneous fat. The epidermis was not resolved except on the palm and sole. Only three superficial lesions were not identified with US; evaluation of another three was limited by shadowing. Thickness of the lesions visualized was 0.2-26.0 mm (mean, 1.9 mm +/- 2.6). Most lesions (77%) were hypoechoic, 9% were anechoic, 12% had mixed echogenicity, and 2% were isoechoic or hyperechoic.The diagnostic role of high-frequency US appears limited. It did not help differentiate benign from malignant lesions, but it did enable accurate delineation of deep margins of lesions and allowed noninvasive measurement of thickness. These features may help in the preoperative evaluation of skin tumors and in monitoring the response to therapy for certain inflammatory conditions.

Malignant mesotheliomas of the pleura and peritoneum are well-recognized risks of asbestos exposure. We determined the asbestos body content of the lungs from 24 cases of malignant mesothelioma (19 pleural, five peritoneal) and compared such to the content of lungs from 50 consecutive adult autopsies and four cases of overt asbestosis using a Clorox-digestion concentration technique. The cores of 90 asbestos bodies were examined by energy dispersive x-ray analysis and compared with similar data from 120 standard asbestos fibers and 20 fiberglass fibers. The malignant mesothelioma patients had asbestos body counts intermediate between those of the general population and those of patients with asbestosis, although some of the mesothelioma cases overlapped with the general population. These latter cases often lacked an identifiable occupational exposure to asbestos. EDXA studies demonstrated an amphibole core in 88 of the 90 asbestos bodies (amosite or crocidolite in 80 of 88, anthophyllite or tremolite in eight of 88), and chrysotile in two instances.

Fifty-five cases of unsuspected carcinoma were found in 847 consecutive suprapubic prostatectomy specimens. All 55 patients have been followed for a minimum of 5 years. The crude 5-year survival rate is 54 per cent. Twenty-four of these patients were followed for 10 years, and their survival rate is 37 per cent. The differentiation and size of the cancer have a direct bearing upon the clinical outcome. The 5- and 10-year survival rates for patients with well differentiated cancers are 75 per cent and 47 per cent, respectively. The 5- and 10-year survival rates for those with less than well differentiated cancers are 33 per cent and 14 per cent, respectively. We have presented evidence that patients with small, well differentiated cancers discovered by suprapubic prostatectomy need not have secondary radical prostatectomy: We have no evidence that conservative therapy, i.e., estrogens or castration, alters the prognosis in this group. The indications are that secondary radical prostatectomy may be a rational approach for treating the moderately or poorly differentiated cancers and the large cancers discovered by suprapubic prostatectomy.

Gliomatosis peritonei, a rare complication of solid ovarian teratomas, is a miliary, mature glial implantation on the peritoneum or omentum. Two new cases are reported and 30 previously reported cases are reviewed. Gliomatosis peritonei is thought to be benign in almost all cases and thus deserves no treatment except for confirmatory biopsy. It must be differentiated from teratomatous implants because the latter may imply poor prognosis and require aggressive therapy. The prognostic value of serum alpha-fetoprotein levels in patients with immature ovarian teratoma is not conclusive. The presence of glial fibrillary acidic protein confirms the glial nature of the implants.

Caripito itch, a pruritic dermatosis rarely seen in the United States, is caused by contact with moths of the genus Hylesia —specifically, with urticating abdominal hairs of the adult female moth. The purpose of this study was to investigate an outbreak of Caripito itch that occurred in thirty-four of thirty-five crew members of a British oil tanker who were exposed to Hylesia moths at the port of Caripito, Venezuela. Methods of investigation included general history and physical examination of all crew members, complete inspection of the ship, transparent-tape slide preparations from involved skin, cutaneous histopathologic studies, and entomologie examination of the moths. The patients had a typical papulourticarial eruption, primarily on exposed surfaces. Although Hylesia moths do not occur in the United States, primary care physicians and dermatologists, especially those located in port cities, should be aware of cutaneous lepidopterism caused by Hylesia moths.

Three patients with advanced atherosclerotic vascular disease developed multiple cholesterol emboli. The clinical presentation typically includes livedo reticularis of the lower part of the body and purple toes. Small areas of necrosis and ulceration may be present distally, despite palpable pulses. Muscular and abdominal pain, as well as alterations in renal function, may also occur. Cutaneous biopsy reveals characteristic cholesterol clefts within atheromatous debris filling small, deep arterial lumen. Pathophysiologic mechanisms are discussed.

From November 1976 to March 1979 the Southwest Oncology Group treated 298 patients with limited (disease confined to the chest and encompassed by one radiotherapy port) small-cell carcinoma of the lung with combination chemotherapy and radiotherapy with or without BCG immunotherapy. Two induction chemotherapy programs were utilized: (1) cyclophosphamide, vincristine, methotrexate, fluorouracil; or (2) cyclophosphamide, doxorubicin, and vincristine. Patients received 4500 rads of radiation therapy to the bulk primary tumor and 3000 rads to whole brain followed by maintenance chemotherapy. One-half of all the patients were randomized to receive one vial (5 x 10(8)) of high viability Pasteur BCG by scarification technique given on days 8 and 15 of each 21--28 day treatment cycle. Increased granulocytopenia accompanied the addition of BCG immunotherapy. Patients receiving BCG achieved a response rate of 49% vs. those patients not receiving BCG of 44% (P = 0.579). Median response duration was 40 weeks for the BCG arms and 38 weeks for the arms without BCG; survival was no different, 42 weeks for the BCG arms vs. 50 weeks for the arms without BCG. In patients who responded to therapy and survived longer than one year, those who continued to receive BCG therapy demonstrated a slight, yet significant, survival benefit over those patients not receiving BCG (93 weeks vs. 81 weeks, P = 0.03). It appears that BCG immunotherapy has no beneficial effect on response rate, duration of response, or survival in programs using chemotherapy and radiotherapy for control of limited small-cell carcinoma of the lung except in this small group of long-term survivors.

A case of primary histiocytic lymphoma involving the left temporal lobe and hypothalamus is presented. This lesion was associated with a pituitary microadenoma shown immunohistochemically to contain prolactin and with lactational changes in the breasts. The interruption by the neoplasm of neural pathways from cells producing prolactin inhibitory factor in the hypothalamus and increased production of prolactin by the pituitary are suggested as the probable mechanism. The association of lactational changes in the breasts with primary lymphoma of the brain has not been reported.

While the occurrence of malignancy in the pregnant female is not uncommon, invasion of the products of conception is apparently rare, having been previously reported only 24 times. We report a 25th case, one of malignant melanoma metastatic to the placenta.

The heterogeneity of lung carcinomas was recognized in the past, but few previous studies attempted to quantitate this heterogeneity. In the present study 100 consecutive cases of lung carcinoma (65 surgical resections and 35 autopsies) were collected, and either the entire tumor or ten blocks were examined in a blinded and randomized fashion using the revised (1981) WHO classification. At least three of five panelists agreed on the major histologic type present for 94 per cent of the slides. Agreement for the diagnosis of small cell carcinomas (at least four of five observers) was 98 per cent, but only 72 per cent agreement was attained for the subtyping of small cell carcinomas (e.g., oat cell versus intermediate). Only 34 per cent of the cases were homogeneous according to the majority of the panelists. An additional 21 per cent of the cases showed minor (subtype) heterogeneity (e.g., mixtures of acinar and papillary patterns in adenocarcinoma). Forty-five per cent of the cases showed major heterogeneity, i.e., at least one slide from the case showed a major histologic type different from that of the remainder. Seven small cell carcinomas were homogeneous, whereas in eight cases mixtures of small cell and other cell types were seen. In all but one of the cases involving bronchioloalveolar cell patterns, other patterns of adenocarcinoma were present elsewhere in the tumor. In all six cases involving giant cell carcinoma patterns, adenocarcinoma patterns were also present in some sections. Heterogeneity was identified by extensive sampling of the entire tumor and was seldom recognized in biopsy specimens.

TUMORS of the islands of Langerhans have been associated with three distinct entities: hyperinsulinism; the nlcerogenie Zollinger – Ellison syndrome; and a syndrome of diarrhea unassociated with gastric hypersecretion. This report documents a fourth type of humoral activity, that of hyperglucagonism, associated with an alpha-cell carcinoma of the pancreatic islets. It is probable that cases of this disorder are at present unrecognized, or classified otherwise. Therefore, the clinical, laboratory and cytologic findings whereby this condition may be identified are set forth. Case Report A 42-year-old housewife was first seen in February, 1963, because of a bullous and eczematoid dermatitis of . . .

Three methods for a simple dopa (L-3,4-dmydroxyphenylalanine) reaction for frozen and paraffin-embedded sections and electron microscopy are presented. The classic methods were modified using fixatives and buffers currently used in enzyme histochemistry and electron microscopy. Cacodylate-buffered formaldehyde and glutaraldehyde proved to be excellent fixatives for light and electron microscopy dopa reactions, respectively. The sensitivity and specificity of the reaction were increased, replacing phosphate buffer with cacodylate buffer in the stock and working dopa solutions. These studies indicate that cacodylate buffer favors the enzymatic oxidation of dopa and interferes with its complete auto-oxidation. The three fractions of tyrosinase were demonstrated in human epidermal melanocytes, including the ribonucleoprotein-bound fraction, which had not been heretofore histochemically demonstrated.

1. Twenty-eight cases of eosinophilic granuloma of bone in children and adults, all but one with symptomatically solitary lesions, are reported. The skull, femur, ribs, and mandible were the most frequent sites of involvement. 2. No diagnostic roentgenographic characteristics were found. Lesions of the flat bones were generally punched-out osteolytic lesions. Lesions of long bones were easily confused with malignant tumors. Biopsy is considered imperative to establish the diagnosis. 3. Transition of eosinophilic granuloma to Hand-Schuller-Christian disease or Abt-Letterer-Siwe syndrome has not been encountered in these cases and we have some doubts whether the reported cases of transition represent true changes from one form to another. 4. Therapy has included excision, curettage, small doses of irradiation, or nothing. Evaluation of any one form of treatment is impossible. All the lesions reported in this study healed regardless of the therapy. 5. Meticulous microbiological studies of the tissue from these lesions seem indicated.

The ultrastructure of papillary cystadenoma lymphomatosum (PCL), Warthin's tumor, of the parotid salivary gland has been described. The oncocytic cells are filled with mitochondria. Two morphologic forms of mitochondria are seen. The cells of the striate ducts in the normal parotid, have specializations associated with fluid transport and are structurally most nearly akin to the oxyphils. The subcellular hyperplasia of mitochondria may be a manifestation of aberrant function.

Torre's syndrome is characterized by the association of sebaceous neoplasms and keratoacanthomas with visceral malignancies. We report on a patient in whom the cutaneous manifestations of Torre's syndrome dramatically increased following immunosuppression.

• A case of a highly destructive, cytologically nondysplastic squamous epithelial lesion of the middle ear is presented. The cranial nerve involvement and bone destruction are more extensive than has been seen in cholesteatoma. Cultures are negative forPseudomonas, and the patient does not have the reported diathesis for malignant otitis externa. The gross and microscopic features are those of verrucous carcinoma. To our knowledge, the middle ear has not been previously reported as a site of involvement by verrucous carcinoma. (Arch Otolaryngol107:63-65, 1981)

The results of the detailed radiographic and angiographic studies and operative findings in a case of primary intranasal meningioma exclude the presence of an intracranial component.

Erythema dyschromicum perstans (EDP) was first described in 1957, and electron microscopic studies were reported in 1969. Herein, we describe five cases and compare light and electron microscopic findings, direct and indirect immunofluorescence, and dopa-positive melanocyte counts between normal and affected skin. The results indicate that EDP is a clinically characteristic disorder with a lichenoid reaction in its active phase. This lichenoid reaction leads to a pronounced incontinence of pigment and to decreased numbers of melanocytes and of tyrosinase activity in the involved epidermis. These findings support the suggestion that EDP and lichen planus pigmentosus are possibly the same entity. Direct inmunofluorescence and fine structural studies show similar findings to lichen planus. Patients have low-titer antibodies to extranuclear basal cell components.

• A 46-year-old man with a long history of Gaucher's disease involving the spleen, bone marrow, and multiple bones presented with apparent sinusitis. He had radiologic opacification and histologically documented involvement by Gaucher's disease of the maxillary antra. Bony involvement of the mandible and maxilla has rarely been reported. To the best of our knowledge, this represents the first reported case of paranasal sinus involvement by Gaucher's disease. ( Arch Otolaryngol Head Neck Surg 1988;114:203-206)

Clinical challenges associated with the cytologic detection of eight cases of occult pulmonary carcinoma are presented. The pulmonary lesions were successfully localized and resected in three of six cases encountered since the availability of flexible fiberoptic bronchoscopy and selective bronchial brushing. Two of the resected neoplasms were unequivocally in situ, while preoperative radiotherapy precluded accurate pathologic determination of invasiveness in the third. The reported experience with unequivocal in situ bronchogenic carcinoma localized and treated surgically prior to invasion through the basement membrane now totals 17 cases (15 previously reported). Forty-four additional cases (43 previously reported) have been localized and resected following early invasion. From this group totaling 61 occult carcinomas, only two patients (3 percent) are known to have died of pulmonary carcinoma during a followup ranging from 2 to 20 years.

Pale cells that resemble those of Paget's disease have been found within apparently normal epidermis in a variety of benign papules. Although they have been considered an artifact, they show characteristic premature keratinization. In contrast to other dyskeratotic processes they mature into orthokeratotic squamae. The histopathologic, ultrastructural and immunocytochemical features of these cells are illustrated, and the differential diagnosis is reviewed.

We report two instances of Hansen's disease as a complication of lymphoma. Although patients with leprosy may be at risk for the development of neoplasia, the converse has only rarely been reported. Nonetheless, granulomatous lesions in patients with lymphoreticular malignancy should suggest appropriate studies to rule out Hansen's disease, as illustrated by the cases detailed herein.

We discuss a disorder that, although at first considered of possible fungal origin, now is known to be due to an alteration of erythrocytes induced by petrolatum-based antibiotic ointment. In this country, the structures of myospherulosis have been seen most often in tissues from the nose and paranasal sinuses following surgery in this region. Our studies show that both components of the vehicle of a commonly used tetracycline antibiotic ointment, lanolin and petrolatum, either separately or together, produce the structures of myospherulosis in vitro. It is recommended that a nonpetrolatum-based substance be used in nasal packing for purposes of hemostasis.

Summary Laryngeal atresia is a rare, life-threatening anomaly. A case is reported with histological analysis of the deformity. Although there are different theories of glottic development, all authors agree that the primitive glottis is occluded at one time by an epithelial plug. Laryngeal atresia is felt to represent a lack of recanalization of the embryonic larynx. Laryngeal embryology is reviewed and the various types of laryngeal atresia are compared to the stages of laryngeal development.

A case of a primary carcinoid islet cell tumor of the duodenum is reported, demonstrated by histochemistry, electron microscopy, and immunofluorescence to be composed of alpha cells containing glucagon-like material. The patient was found on admission to have hyperglycemia and a diffuse skin rash. Primary duodenal glucagonoma has not been previously reported.

P. tularensis, the causative organism of tularemia, can be readily and positively identified in formalin-fixed and paraffin-embedded human tissues. This was done in eight of nine cases examined. The diagnostic and therapeutic implications of this advance are discussed.

An experimental model was developed to study the direct effect of propranolol hydrochloride on myocardial infarct volume as produced by a standard coronary artery ligation. A ligature was placed around the left anterior descending coronary artery at the bifurcation of the apical branch in 21 dogs with normal coronary artery distribution. Propranolol hydrochloride (1 mg/kg) was administered intravenously to nine of the dogs one hour after ligation. Six hours after ligation, the left ventricle was sliced and incubated in nitro blue tetrazolium solution. The nonstained muscle was excised and weighed. In this model, the use of a β-adrenergic blocking agent decreased the myocardial infarct volume by 34%. Such an agent may have a place in the treatment of certain patients with myocardial infarction in order to decrease the extent of muscle damage.

The cytoplasmic body that forms, in addition to the nuclear inclusion, in cells infected with cytomegalovirus has been shown to be an aggregate of lysosomes. These lysosomes appear and surround viruses as they are released from the nucleus. The extent of inactivation of the virus remains to be determined. The outer of the two coats of CMV is derived from the inner nuclear membrane during the exodus of the virus from the nucleus.

Immunofluorescence and electron microscopy were used to study changes in liver cells of cynomolgus monkeys and tissue cultures of hamster kidney cells (HKL) infected with the Asibi strain of yellow fever virus. Specific viral antigen was first seen in HKL cells by immunofluorescence at 12 to 15 hours. The amount of antigen increased gradually through 24 hours. Membrane-limited particles containing dense cores were seen at 18 hours in the electron microscope. These particles measured 42 = 2 millimicrons in diameter. Ultrastructural changes in the HKL cells were limited to a fine vesicular alteration in the endoplasmic reticulum and the appearance of virus particles within vacuoles. The liver cells of cynomolgus monkeys inoculated with yellow fever virus showed a progressive loss of glycogen and a reorganization of the ribosomes into polyribosomes. Characteristic virus particles were not seen and the immunofluorescent observations corroborated the paucity of parenchymal cells containing mature virus.

Rift Valley fever virus produces a necrotizing hepatitis in mice that is similar to certain other virus hepatitides. The virus infects the hepatic parenchymal cells and new virus is formed in the cytoplasm within a membrane- limited system resembling the Golgi apparatus. Unique structural alterations of the ergastoplasm are associated with this process and may be manifestations of metabolic dysfunction. The acidophilic nuclear inclusion is not formed of virus matrix or virus particles and may represent a degenerative phenomenon. Changes in the Kupffer cells follow infection of the parenchymal cells.

Myospherulosis has recently been shown to be composed of altered erythrocytes. Mysopherules have been produced in vivo and in vitro using a petrolatum-based tetracycline antibiotic ointment (Achromycin®). In the reported study, myospherules were produced in vitro using either lanolin or petrolatum, the two components of the vehicle of this ointment. Additionally, human fat produced myospherules in vitro .

• In two separate specimens received for histopathologic examination, pigmented fungal elements were found within or on embedded wood splinters associated with a foreign-body reaction. The fungus was found to be in direct contact with the surrounding dermis. These findings support the concept of inoculation as a pathogenetic mechanism in cutaneous chromomycosis. (Arch Dermatol1984;120:107-108)