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D D Leonard

Publications and source records attributed to D D Leonard.

9 recordsLinked to original sources

Concomitant granuloma annulare and necrobiosis lipoidica. Report of a case and review of the literature.

A case of concomitant granuloma annulare (GA) and necrobiosis lipoidica (NL) is presented. The etiology of these two disorders remains obscure. The similarity of the histopathology in GA and NL might suggest a common origin. However, a review of the 5 previous cases of concomitant GA and NL and recent biochemical, immunological and immunohistochemical studies comparing GA to NL indicates an independent etiology for these two histologically related disorders. Some evidence points toward a closer relationship of NL with diabetes than GA, while GA may be related to delayed-type hypersensitivity reactions.

Arm

Recurrent melanocytic nevi: clinical and histologic review of 175 cases.

Pigmented nevi, if excised incompletely, often recur and occasionally cause concern to the patient and the physician. In this study of 175 recurrent nevi from 173 patients, the clinical, gross, and microscopic features of recurrent nevi are described and criteria for diagnosis are developed. Rarely, recurrent nevi have atypical features that suggest malignant melanoma. The differential diagnosis entails clinical and histologic criteria that are presented.

Adolescent

Sclerosing sweat duct (syringomatous) carcinoma.

This report describes 20 sclerosing adnexal carcinomas of the skin that recapitulate the sweat duct and share certain microscopic features with benign syringoma. Clinically, the neoplasms were slow-growing, indurated nodules or plaques. Sixteen were located on the face, including five on the upper lip. Three were situated in the axilla, and one involved the buttock. Twelve of the tumors (group 1) were composed primarily of cords and nests of whorled squamous cells with clear cell change and variable keratinization. Lumens consistent with ductal differentiation were few and isolated in some of these lesions, but others had more numerous and complex ducts. The remaining eight neoplasms (group 2) contained large numbers of small, uniform ducts, and exhibited little keratinization. Each neoplasm in the series infiltrated subcutaneous tissue or deeper tissues and was accompanied by sclerotic, fibrous stroma. Sixteen of the lesions (80%) exhibited perineural growth. One tumor involved an underlying lymph node, probably by direct extension. Cytologic atypicality was mild or lacking, and mitotic figures were sparse. Seven of 15 tumors (47%) with follow-up recurred, in some instances many years after primary excision. Tumor-free margins in the initial excision specimen appeared to be a favorable prognostic factor. The most aggressive lesion in the series showed increased cytologic atypicality in recurrences.

Adult

Cutaneous lesions of lymphomatoid granulomatosis. Comparison with lymphomatoid papulosis.

Histopathologic changes in skin lesions from 14 patients with lymphomatoid granulomatosis (some of which were from the original series of Liebow, Carrington, and Friedman) are described. These are compared to the microscopic changes in skin lesions from 17 patients with lymphomatoid papulosis. Significant differences between the two diseases are present, notably the lack of epidermal and papillary dermal involvement and almost exclusive vasocentricity of the lesions of lymphomatoid granulomatosis. Lymphomatoid papulosis exhibits extensive involvement of the epidermis and papillary dermis. A diffuse cellular infiltrate is present in the reticular dermis as well as around blood vessels in lymphomatoid papulosis. The relationship of the two diseases to B- and T-lymphocytes is discussed.

Biopsy

Monsel's solution: a histologic nuisance.

Monsel's solution produces artifacts which can be troublesome if rebiopsy of a lesion is necessary. The tattoo produced can distort or obscure the basic pathologic process. It may lead an unwary pathologist into the false interpretation of the depth of a melanoma. Pathologists should recognize the artifact and we describe its characteristics. The use of Monsel's solution for hemostasis should be discouraged following biopsies of pigmented lesions or tumors which may prove to be diagnostic problems. The pathologist should be informed if Monsel's solution has been used.

Adult

Neurotropic melanoma. A variant of desmoplastic melanoma.

We report a group of neuroid, cutaneous tumors that are usually associated with, or preceded by a melanocytic dysplasia. For this clinicopathologic entity we have chosen the term neurotropic melanoma. The neurotropic melanoma is a cutaneous fibrous tumor whose clinical course is characterized by local infiltration, multiple recurrences, and commonly by metastases. Its microscopic picture is characterized by atypical "neuroma-like" patterns, by poorly defined margins, and by neurotropism. Its early or precursory melanocytic dysplasias include lentigo maligna (actinic or lentigo maligna variant), and a melanoma with borderline cytologic characteristics (minimal deviation variant). A third type is not preceded by a recognizable melanocytic dysplasia: it has "neuroma-like" qualities at its inception (de novo variant). In our 22 cases, the preponderant sites were the head, neck, and lip. The patients were fair-faced, and 18 of the patients were over 40 years old. Seventeen patients had one or more recurrences. Of 16 patients with follow-up, nine died with evidence of disease, five are alive with active disease, and seven are apparently free of disease.

Adult