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A B Ackerman

Publications and source records attributed to A B Ackerman.

At least 19 recordsLinked to original sources

Pruritic urticarial papules and plaques of pregnancy.

We report an intensely pruritic cutaneous eruption that occurs in the third trimester of pregnancy. The clinical manifestations include erythematous urticarial papules and plaques that begin on the abdomen and spread to involve the thighs and occasionally the buttocks and arms. This dermatosis appears to be clinically distinct from previously described pruritic eruptions occurring in pregnancy. Biopsy specimens of the lesions show two histological patterns. We propose that this entity be termed "pruritic urticarial papules and plaques of pregnancy (PUPPP)".

Abdomen

Carcinoma in situ.

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Carcinoma in Situ

Extramammary Paget's disease. A critical reexamination.

Fifty-five patients with extramammary Paget's disease were the source of material for this study. Step-sections were done through most of the specimens. Clinical information, including follow-up, was obtained on 45 of the 55 patients. Extramammary Paget's disease could be divided histologically according to where Paget cells were found, namely: 1) wholly within the epidermis and the epithelial structures of adnexa, and the dermis; 3) within the epidermis, the epithelial structures of adnexa, and contiguous epithelia of other organs such as the genitourinary and gastrointestinal tracts. Our conclusions are that extramammary Paget's disease is more than one disease and in most instances begins in the epidermis as an adenocardinoma and extends from there into contiguous epithelium of hair follicles and eccrine sweat ducts. Uncommonly, Paget cells extend from the epidermis into the dermis and from there may metastasize. Rarely, extramammary Paget's disease results from direct extension into the skin of an adenocarcinoma in a contiguous organ such as the genitourinary or gastrointestinal tract.

Adenocarcinoma

Evolution, maturation, and regression of lesions of psoriasis. New observations and correlation of clinical and histologic findings.

The evolution, maturation, and regression of lesions of psoriasis were studied histologically. The earliest histologic changes in pinhead-sized macules of psoriasis consist of a superficial perivascular infiltrate of lymphocytes and histiocytes and dilation and tortuosity of the blood vessels in the dermal papillae. Some lymphocytes move upward into the spinous zone of the epidermis and slight intercellular edema develops. Above these slight spongiotic foci, and after the granular layer disappears, the cornified layer becomes compact, and parakeratosis and epidermal hyperplasia develop. Only then do neutropils move through the epidermis into the mounds of parakeratosis. These changes, initially focal and episodic, become more confluent and constant, resulting in formation of clinical plaques. In spontaneously resolving lesions, inflammatory cells disappear first, the other changes next, and tortuosity of blood vessels in the dermal papillae last.

Capillaries

Assessment of biopsy techniques and histopathologic interpretations of primary cutaneous malignant melanoma.

The biopsy techniques utilized for diagnosis in 1,161 patients with primary cutaneous malignant melanoma treated at the New York University Medical Center were reviewed. Eight hundred sixty-four (74%) biopsies were of the excisional type and 269 (23%) were incisional. Twenty-eight biopsies (3%) could not be assessed. Two hundred fifty-two consecutive patients referred for treatment of malignant melanoma to the authors for the last three years were studied to determine whether standard techniques of biopsy and uniform criteria for histopathologic diagnosis and staging were being utilized. One hundred forty-nine of these patients (59%) had total excisional biopsies of their lesions and 103 (41%) had incisional biopsies. Of the latter group, 66 (64%) were for lesions less than 2 cm in diameter and were situated in areas other than the face. The biopsy specimens obtained from 123 patients were reviewed by at least one other pathologist as well as our own (A.B.A.). For these 123 patients a difference of histologic diagnosis between pathologists occurred in 11 (9%). In 58 (47%) there was a discrepancy in assignment of Clark levels or a failure to assess Clark levels. Tumor thicknesses as measured by Breslow were read in only 22 (18%) of these 123 patients. The inadequacies of many of the biopsy specimens and discrepancies in histopathologic interpretation indicate that acceptable biopsy techniques and reproducible diagnostic criteria have not yet been generally adapted for primary cutaneous malignant melanomas.

Biopsy

Histopathology of remodelling induced by PUVA in the superficial dermis.

The histopathological alterations induced by PUVA within the skin are reported in a patient treated for psoriasis. The main impact is located at the site of former psoriatic plaques in which the target is the microvasculature. A residual coating sheath is present around vessels and fibrosis appears in the superficial dermis. These remodellings interfere with the normal dermo--epidermal relationships; the epidermis contains atypical keratinocytes, and melanocytes are no longer recognizable.

Adult

Subcorneal pustular dermatosis: a variant of pustular psoriasis.

A patient with clinical lesions typical of subcorneal pustular dermatosis of Sneddon and Wilkinson also had stigmata of psoriasis, namely psoriatic plaques, pitting of nails, and psoriatic arthritis. Histologic studies of the pustular lesions were consonant with pustular psoriasis. Correlating the phenomena of previously reported cases of subcorneal pustular dermatosis with those of our patient, we conclude that subcorneal pustular dermatosis of Sneddon and Wilkinson is but another variant of psoriasis.

Aged

Is actinic granuloma a specific condition?

Evidence is presented that actinic granuloma is not a specific connective tissue disorder as it is thought to be by O'Brien. Granulomatous inflammation does not result simply from a response to elastotic fibers, but is a consequence of primary pathologic processes that are unrelated to damaged elastotic material. Twenty-one of 30 lesions in our series that fulfill O'Brien's criteria of his concept of actinic granuloma were clinically and histologically examples of granuloma annulare. The other nine lesions were of other granulomatous diseases such as foreign-body reaction and late secondary syphilis.

Adult

Bowenoid papulosis of the genitalia.

We report 34 cases of bowenoid papulosis of the genitalia. In each case, the patient had numerous reddish brown or violaceous papular lesions, some distinctly verrucoid, situated on the genitalia. Although clinically the lesions invariably appeared benign, histologic examination of specimens from the genital lesions in each patient showed changes of squamous cell carcinoma in situ. Many of the patients gave a history of preceding viral lesions on the genitalia. Therapy in all cases was conservative but thoroughly ablative. We view bowenoid papulosis as a new entity whose biologic behavior if untreated is as yet unknown.

Adolescent

The patch stage of mycosis fungoides. Criteria for histologic diagnosis.

It has long been claimed that a specific histologic diagnosis of mycosis fungoides cannot be made in the premycotic" or "eczematous" (patch) stage of the disease. Indeed, the histologic features of the premycotic lesions were constantly said to be those of "chronic non-specific dermatitis." We studied 46 biopsy specimens of patch lesions from patients in whom mycosis fungoides was unequivocally established by clinical events (i.e., concurrence or later development of typical plaque and/or nodular lesions) and indubitable histologic findings. We divided patch lesions into early nonatrophic patches and late atrophic ones. The early patches are considered to be evolving lesions of mycosis fungoides, whereas late patches represent resolving plaques of the disease. On the basis of this study, we concluded that histologic diagnosis can be made with near certainty in patch lesions of the disease. We found that the critical feature for histologic diagnosis of early and late patch lesions of mycosis fungoides is the presence of an increased number of mononuclear cells distributed singly or in small collections within an epidermis devoid of spongiotic microvesiculation. Other important features are lacunae surrounding intraepidermal mononuclear cells which gives them the appearance of "haloed cells." A sparse infiltrate of mononuclear cells is present around the blood vessels of the superficial, and sometimes the deep, vascular plexus. Atypical mononuclear cells are not necessary for the diagnosis of early patch lesions of mycosis fungoides, but they are found commonly in late patch lesions. Late atrophic patches show a thinned epidermis, loss of the usual configuration between rete ridges and dermal papillae, and coarse collagen throughout a thickened papillary dermis.

Adolescent