[Long-term anamnesis of idiopathic fibrosing alveolitis].
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Biomedical subjects
Publications and source records attributed to A M Vavilov.
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Comprehensive clinical, morphologic, and ultrastructural studies of 12 cases with various forms of carcinoma of the sweat glands permitted distinguishing the clinical nodular and papular-cystic forms. Histologically malignant analogs of benign tumors, primary adenocarcinomas, and unclassified tumors are distinguished. The histogenetic appurtenance of the tumors of the latter group may be identified only by ultrastructural studies that help detect a number of organ specificity signs. Electron microscopy used in the diagnosis of poorly differentiated tumors of the skin helps carry out adequate therapeutic strategy and permitted a better validated prediction.
The immunocytochemical method with monoclonal antibodies to human and murine epidermis basal-cell antigen (BCAg) has been used in studies on the disorders in keratinocyte differentiation in epidermal tumors and mycosis fungoides. The fluorescence intensity augmented and BCAg distribution in the cytoplasm grew more diffuse as the degree of the tumor cell differentiation lowered. In mycosis fungoides the BCAg reaction has been positive first in the suprabasal layers; as the disease progressed, the fluorescence has involved the entire epidermis. The BCAg test is a sensitive tool for estimating the epidermal cell maturity in processes associated with impaired differentiation of keratinocytes.
A case of tertiary active syphilis in a 41-year-old male patient is described, who had not been administered specific treatment. Clinical symptoms of the disease manifested without apparent provoking factors; they were characterized by extensive involvement and no visceral abnormalities.
In 47 patients with stage I mycosis fungoides, biopsy of skin has revealed substantial changes in epidermis acanthosis with confluent epidermal processes, focal dystrophy of basal cells, mitoses in various epidermal layers, parakeratotic foci without a granular layer. Histoautoradiographic and immunomorphological studies demonstrated that enhanced proliferative activity of keratinocytes that was more pronounced in stages I and II mycosis fungoides and impaired epidermal differentiation that was predominant in neoplastic stage III underlay the above changes. There was ultrastructural evidence for abnormal epidermal keratinization. It was proposed that epidermal abnormalities made an important contribution to the development of mycosis fungoides.
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Based on a review of the literature and the authors' own experience comprising 20 cases, clinical and histological characteristics of sweat gland cancers (SGC) are detailed. Two clinical variants of SGC are distinguished: exophytic (or exophytic-endophytic) with ulceration and endophytic (intradermal). The lapse of time between detection of a SGC and its removal generally ranges from 12 months to 2 or more years. It is shown that diagnostic and prognostic considerations warrant classifying these cancers into two groups: those arising from benign tumors and retaining their histologic and ultrastructural features (one example of such a tumor is malignant poroma) and primary cancers (e. g., mucoid adenocarcinoma). Cancers of the first group, which comprise a majority of all SGC, run a more favorable course.
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Angiolymphoid hyperplasia with eosinophilia (ALHE) is characterized by the appearance of tumour-like nodes on skin and subcutaneous fat. Vascular proliferation with inflammatory infiltration consisting of lymphocytes and eosinophiles, as well as structures of lymphoid follicle type were revealed microscopically. A description is given of a patient, 34 yr. old, with typical clinical and morphological manifestations of ALHE. Basing on the literature and on the own experience the authors suggest that ALHE and Kimura disease are variants of one nosologic form.
Clinico-morphological characteristics of 105 acrospiromas surgically removed within 10 last years is presented. In 6 patients the tumour was considered as a malignant acrospiroma which, according to the literature and the authors' material, is prone to recurrence. The features of a diagnostic significance are discussed in detail: the development of tumour in the cyst, growth of squamous cells and clear (due to the glycogen) cells, formation of structures resembling the sweat glands ducts. Electron-microscopic examination indicates the histogenetic link of acrospiroma with the elements of sweat gland ducts (intracytoplasmic ducts, periluminal cells, the lack of clear signs of secretion). All this relates also to the tumour described in the literature as a clear-cell hydradenoma.
The WHO histological classification of skin tumors (Geneva, 1980) has first distinguished a new nosologic variety of skin carcinoma, metatypic carcinoma (MTC) being intermediate between basalioma and squamous cell carcinoma. Separation of MTC from the group of basaliomas is important prognostically because this tumor is capable of metastasizing, whereas MTC diagnosis is difficult because it simulates basalioma clinically and morphologically. The study of the mitotic regimen in 13 cases of MTC and 20 cases of basalioma showed this method to be adequate for differential diagnosis of these tumors. The values of the mitotic regimen in MTC always differed from similar values in basalioma: the mitotic activity, the specific content of dividing cells at the stage of metaphase, and the rate of pathologic mitoses increased considerably, there appeared multipolar and monocentric mitoses, bridges, three-phase metaphases.
Experience gained so far by cryogenic surgery indicates that the possibilities of cryodestruction of sizable pathological formations are fairly limited. To overcome this barrier, it is necessary to change the status of the tissues, making them more sensitive to cryodestruction. The theoretical investigations suggest that microwave irradiation is one of the factors capable to change the status of tissues and to raise their sensitivity to cold exposure. Experiments made on the liver and muscles from rabbits, dogs and guinea-pigs have demonstrated that preliminary microwave irradiation followed by local freezing promotes the death of tissues 4-6-fold as compared to control.
The paper presents clinical and morphological characteristics of neoplasms arising in epidermal cysts (73 observations). It is emphasized that the epithelium of epidermal cyst may be the source of growth of not only benign cystic epithelioma ("proliferating epidermal cyst" as designated by the foreign authors) but also of squamous cell carcinoma. Cystic epithelioma (54 observations) is a slowly growing tumor represented by outgrowths in the cyst lumen of differentiated squamous epithelium apt to form smaller cysts. A predominance in cystic epithelioma of the basal type cells and complexes of squamous epithelial cells with hyperchromic and slightly polymorphous nuclei (7 observations) is considered to be the initial sign of malignancy of the noninvasive cancer type. Cancer arising in epidermal cyst (11 observations) is characterized by rapid growth, invasion into derma and trend for relapses. Frequently it has the structure of keratinizing squamous cell carcinoma. A malignant tumor is described characterized by a combination of cystic epithelioma, squamous cell carcinoma of pseudosarcomatous structure in some areas and glandular formations whose origin is obscure.
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