Biomedical subjects
D T King
Publications and source records attributed to D T King.
Giant cell arteritis in an elderly black woman.
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Idiopathic calcinosis of scrotum.
A forty-three-year-old man complained of painless, firm scrotal nodules which had first appeared at age sixteen. These were diagnosed clinically as multiple epidermoid inclusion cysts and were excised. Histologically they were composed of calcified, amorphous, granular material, characteristic of idiopathic calcinosis of the scrotum. This is a rare, benign condition without any recognized underlying metabolic abnormalities. The cause of idiopathic calcinosis of the scrotum is unknown, but we believe it is due to dystrophic calcification of dartoic muscles.
Need for immediate examination of cryptorchid testis by pathologist.
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Syringometaplasia: mucinous and squamous variants.
The eccrine sweat ducts are normally lined by cuboidal epithelial cells which may rarely undergo metaplasia, i.e. syringometaplasia. Two lesions were observed in which eccrine sweat ducts displayed the mucinous and squamous variants of syringometaplasia. The first lesion clinically and histologically appeared to be a plantar wart. Microscopically, it consisted of a central invagination surrounded by marked epidermal acanthosis and hyperkeratosis. The invagination was lined by keratinocytes admixed with mucin-filled goblet cells. The mucin was positive by the Alcian blue (pH 2.5) and mucicarmine stains. Numerous eccrine sweat ducts led into the invagination and were focally lined by the mucin-laden cells. Recognition of mucinous syringometaplasia is important since it may be confused with primary or metastatic adenocarcinoma of the skin. The second lesion occurred on the outer ear and was clinically believed to be chondrodermatitis nodularis helicis. Microscopically, there were many islands of atypical squamous cells within the papillary and reticular dermis. These epithelial islands represented squamous syringometaplasia since many contained central lumina with eosinophilic cuticles and blended with normal ductal structures. It is important not to confuse this metaplastic change with invasive squamous cell carcinoma. Squamous syringometaplasia may be analogous to necrotizing sialometaplasia, a recently described phenomenon which occurs in minor salivary glands.
Apocrine cystadenoma of the skin of the chest.
A black patient with an enlarging apocrine cystadenoma on the chest is presented herein. This location is very infrequent for this benign lesion. This is the second report of an apocrine cystadenoma in a black person.
Sebaceous carcinoma of the skin with visceral metastases.
Sebaceous carcinoma is an uncommon cutaneous malignant neoplasm that rarely metastasizes. We report a case in which a moderately well-differentiated sebaceous carcinoma arising on the anterior aspect of the chest produced widespread visceral metastases. This unexpected clinical behavior underscores the fact that sebaceous carcinoma of the skin can sometimes be very biologically aggressive.
Lymphangiosarcoma arising from lymphangioma circumscriptum.
A lymphangiosarcoma arose at the site of a preexisting lymphangioma circumscriptum on the skin of the anterior part of the abdominal wall. To our knowledge, this is only the second such case to be reported, and in both patients, the preexisting lymphangioma circumscriptum had been exposed to substantial x-ray therapy. Since it is possible that x-irradiation may play a role in the development of this unusual malignant neoplasm, it seems advisable that lymphangioma circumscriptum not be exposed to substantial amounts of such radiation, if feasible.
Touch preparations in diagnosis of skin disorders.
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Chief cell intracytoplasmic fat used to evaluate parathyroid disease by frozen section.
The chief cells of parathyroid adenomas were found to contain less intracytoplasmic fat than normal parathyroid glands and/or the adjacent rims of nonadenomatous parathyroid tissue. The amount of sudanophilic material in the chief cells was relatively uniform for each individual adenoma, but varied between patients. In half of the patients with parathyroid adenomas, Sudan-positive granules were generally absent from the adenomatous cells, whereas in the other half the granules were easily identifiable. The chief cells of secondary hyperplasia showed a less uniform pattern in each gland. In some areas, the stain for intracellular fat was negative, while adjacent cells contained prominent Sudan-positive granules. These findings suggest that staining frozen sections for intracellular fat is a useful but limited aid in the differentiation of parathyroid adenomas from normal parathyroid gland tissue.
Actinomycosis of the urinary bladder. Association with an intrauterine contraceptive device.
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Simultaneous occurrence of familial benign chronic pemphigus (Hailey-Hailey disease) and syringoma on the vulva.
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Halo congenital nevus without histological inflammation.
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The need for adequate postmortem examination of the ductus arteriosus in neonates.
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Giant cell tumor of the tendon sheath involving skin.
Giant cell tumor of the tendon sheath is the second most common tumor of the fingers and hands but is only rarely mentioned in the dermatologic literature. Although its pathogenesis has been debated, it is probably a type of fibrous histiocytoma. This tumor is almost always benign but may locally invade the overlying dermis and be confused with a malignant neoplasms. It often extends to the synovium of the adjacent joint space and necessitates total excision to prevent local recurrence. Therefore, excision should be undertaken by a physican who is surgically qualified for such procedure. We report a case that illustrates the clinical and pathologic aspects of this lesion.
Malignant neoplasms of the paranasal sinuses involving the skin.
Malignant neoplasms of the mucosa and minor salivary glands of the paranasal sinuses may involve the skin by direct extension. When a tumor appears on the overlying skin, these sinuses should be considered as a possible site of origin. Adenoid cystic carcinoma of the paranasal sinuses arise from minor salivary glands. They can infiltrate overlying skin and easily be confused with a primary cutaneous adenoid cystic carcinoma. Malignant melanomas of the paranasal sinuses are clinically very aggressive. They are often amelanotic, and this may lead to an incorrect histopathologic diagnosis. Hence, physical and radiological examination of the nose, mouth, and paranasal sinuses should be performed whenever a tumor appears in the overlying skin that does not have a clear cutaneous origin or whenever the primary site of a metastatic malignant melanoma is unknown.
Persistent creatine kinase MB isoenzyme without cardiac disease.
Although the creatine kinase MB isoenzyme may be useful in the diagnosis of myocardial injury, it is also found in the sera of patients with a number of noncardiac diseases. It may also occur in apparently normal individuals, as described in this case report. Hence, the diagnosis of myocardial injury should never be based solely on the presence of creatine kinase MB isoenzyme in the serum, but should be supported by additional clinical and laboratory data.
Multiple cutaneous metastases of a scapular chondrosarcoma.
The onset of metastatic chondrosarcoma in a young woman was heralded by the appearance of multiple firm, tender, cutaneous nodules two years after the primary tumor in the left scapula had been resected. Chondrosarcoma rarely metastasizes to the skin, but when it does, it may have an identical histological appearance to a cartilaginous tumor of the skin, an entity that is generally considered clinically benign. Although it is very unlikely that an occult chondrosarcoma will be first manifested clinically by a solitary cutaneous metastasis, the abrupt appearance of multiple cutaneous cartilaginous lesions would seem to warrant an investigation for primary chondrosarcoma.