Biomedical subjects
Publications and source records attributed to A B Ackerman.
Five examples of a distinctive sebaceous malformation, designated "folliculosebaceous cystic hamartoma," form the basis of this study. Criteria are proposed for specific diagnosis of this hamartoma and for differentiation of it from sebaceous gland hyperplasia, steatocystoma, dermoid cyst of skin, and sebaceous trichofolliculoma.
This essay places the concept of "primary acquired melanosis" of the conjunctiva in historical perspective and shows that it and its analogs, namely, lentigo-melanosis (Hutchinson), melanotic freckle (Hutchinson), melanose circonscrite precancereuse (Dubrueilh), melanotische precancerose (Miescher), lentigo maligna (Clark), precancerous melanosis (Reese), benign, precancerous, and cancerous melanosis (Zimmerman), atypical melanocytic hyperplasia (Silver et al.), and benign acquired melanosis (Zimmerman), are synonyms for melanoma in situ. The issue is not merely semantic or philosophical; it is urgently practical. If a clinician takes literally the meaning of a lesion designated "benign melanosis" and considers it to be benign, rather than the malignant melanoma that it actually is, a patient who bears that flat pigmented lesion may one day die of metastasis from an elevated sequella of it. The same is true of "primary acquired melanosis," which is not simply a condition of blackening by melanin, but a flat melanoma that, if not removed completely, may give rise one day to metastases that cause death. To avoid such misconstructions, we advocate naming melanomas in all organs "melanoma" and those that are confined to epithelial structures "melanoma in situ." Euphemisms like lentigo maligna and primary acquired melanosis are evasions of the diagnosis of melanoma, and use of them may be harmful. For that reason, they should be eschewed.
Explore the source record for details and available documents.
Although the term "nevus cell" was introduced nearly a century ago and is used daily in the parlance of general pathology and dermatopathology, writings about the subject indicate that agreement has yet to be reached about the nature of these cells. On the basis of all of the evidence about "nevus cells," morphological and biochemical, that has been accumulated to date, we conclude that they are simply melanocytes.
In order to have an integrated system to classify acquired melanocytic nevi, specifically those that evolve through junctional, compound, and dermal phases, we propose to name them for those who first recognized or popularized them: Unna, Miescher, Spitz, and Clark. Historical, philosophical, and semantic justifications for an eponymic classification of acquired melanocytic nevi are presented.
Several classifications of vulvar diseases have been proposed, but none of them is either consistent internally or applicable clinically and histopathologically. Ambiguous and even inexplicable terms such as "atypical epithelial hyperplasia (dysplasia)", "vulvar dystrophy," "vulvar atypia," "atrophic dystrophy," "mixed dystrophy," and "vulvar intra-epithelial neoplasia" prevent clinicians and histopathologists from communicating effectively with each other. In addition, these terms have different meanings to dermatologists, pathologists, and gynecologists--if indeed they have any meaning at all. If that maelstrom of confusion is to be avoided, diagnoses by histopathologists must be made in the language of clinical medicine. Only then will clinicians be able to understand those diagnoses and thereby manage patients rationally. For example, if findings by conventional microscopy are those of squamous-cell carcinoma in situ of the vulva, the diagnosis of pathologists should be Bowen's disease or bowenoid papulosis and not "vulvar intra-epithelial neoplasia"--a term that is just as applicable to seborrheic keratosis as it is to Bowen's disease and bowenoid papulosis.
Explore the source record for details and available documents.
A report by Tozawa and Ackerman (Am J Dermatopathol 9(6):474, 1987) upon a distinctive type of basal cell carcinoma with a particular type of follicular differentiation has stimulated lively correspondence in the literature of dermatopathology. The lesion in question presents itself clinically as a basal cell carcinoma on the face and histopathologically as a neoplasm typified by small size, sharp circumscription, and a unique combination of kinds of follicular differentiation, namely, follicular germs and infundibula. The principal point of contention concerning this neoplasm has been whether it is truly a special variant of basal cell carcinoma or whether it is actually a trichoepithelioma. More extensive studies of this singular neoplasm, including its occurrence in patients with nevoid basal cell carcinoma syndrome, and review of the very few portrayals of it in the literature, have consolidated our view that it is indeed a special variant of basal cell carcinoma. We now present (a) new information about an early stage in the evolution of the neoplasm in point, (b) evidence to validate classification of it as a basal cell carcinoma, and (c) a critical appraisal of other lesions that might pose problems in differential diagnosis. Finally, justification is provided for the designation "infundibulocystic basal cell carcinoma."
For clinical dermatologists, proliferations of melanocytes confined to the epidermis (and epithelial structures of adnexa) are either flattish melanocytic nevi (junctional type) or flat lesions (macules and patches) of malignant melanoma (malignant melanoma in situ). The same should be true for histopathologists. During the past 30 years, however, histopathologists have avoided making specific diagnoses of malignant melanoma in situ by utilizing a variety of nondiagnostic, euphemistic descriptions for it such as melanotic freckle of Hutchinson, melanosis circumscripta precancerosa of Dubreuilh, active junctional nevus, lentigo maligna, atypical melanocytic hyperplasia, melanocytic dysplasia, and melanocytic intraepithelial neoplasia. Each of these terms evades a specific diagnosis of malignant melanoma in situ, a diagnosis than can, and should, be made clinically and histopathologically if reliable criteria are used. The legitimacy of a concept of malignant melanoma in situ in the context of historical perspective and the importance of that concept for management of patients are the themes of this essay.
Sixty-four specimens of mixed tumors of the skin were studied by conventional microscopy. Sections from all 64 specimens were stained by hematoxylin and eosin, and sections from 18 of those specimens were stained by immunoperoxidase techniques for the presence of S-100 protein, carcino-embryonic antigen (CEA), keratin, actin, vimentin, epithelial membrane antigen (EMA), and gross cystic disease fluid protein-15 (GCDFP-15). Two distinctive histopathological patterns of mixed tumors of the skin became apparent, namely, apocrine and eccrine. Mixed tumors with apocrine features are by far the most common. Immunoperoxidase techniques, in our experience, do not enable differentiation between apocrine and eccrine types of mixed tumors.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Pseudocarcinomatous hyperplasia is not fundamentally a hyperplasia of epidermal epithelium, but rather a hyperplasia of adnexal epithelia, namely, of follicular infundibula and eccrine ducts. All examples of pseudocarcinomatous hyperplasia are responses to an underlying inflammatory or neoplastic process. That process can usually be discerned beneath the pseudocarcinomatous hyperplasia in the biopsy specimen. Application of criteria that pertain mostly to architectural pattern (silhouette) enables pseudocarcinomatous hyperplasia to be differentiated histopathologically from squamous cell carcinoma.
Explore the source record for details and available documents.
Hairy leukoplakia and hairy tongue are the two most common hairlike lesions of the human tongue. Despite their hairlike appearance, the two conditions are very different clinically, histopathologically, and biologically. Those differences are the concern of this article.