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Biomedical subjects

Leslie Robinson-Bostom

Publications and source records attributed to Leslie Robinson-Bostom.

At least 19 recordsLinked to original sources
PubMed2006

Skin cancer after transplantation: a guide for the general surgeon.

The success of organ transplantation has been accompanied by serious concerns regarding the incidence and management of potentially catastrophic cutaneous carcinogenesis in transplant recipients. Delivery of the highest quality of care requires a concerted effort toward collaboration between multiple surgical and medical specialties. The purpose of this review is to provide the general surgeon with a practical, user-friendly guide to the important components of comprehensive dermatologic care for organ transplant recipients (OTRs) with references to more detailed sources of information.

Chemoprevention↗
PubMed2006

Nephrogenic fibrosing dermopathy and calciphylaxis with pseudoxanthoma elasticum-like changes.

Nephrogenic fibrosing dermopathy (NFD) and calciphylaxis are rare conditions that are associated with chronic kidney disease. Histopathologic changes, including dystrophic dermal calcification, often in association with elastic fibers have been observed in NFD and calciphylaxis. A pattern of dermal elastic fiber calcification that mimics pseudoxanthoma elasticum (PXE) has been previously reported as an incidental finding in the setting of calciphylaxis. Despite a shared association with renal disease and abnormal calcium deposits, however, NFD and calciphylaxis are discrete pathologic processes with distinct clinical and histopathologic features. Criteria for each are reviewed through case presentation of a patient meeting the clinical and histopathologic criteria for both NFD and calciphylaxis with histologic features mimicking PXE.

Adult↗
PubMed2006

Localized argyria after exposure to aerosolized solder.

GOAL: To understand localized argyria to better manage patients with the condition OBJECTIVES: Upon completion of this activity, dermatologists and general practitioners should be able to: 1. Discuss how localized and generalized argyria differ. 2. Describe how to diagnose argyria. 3. Identify treatment options for argyria.

Aerosols↗
PubMed2006

Thrombogenic vasculopathy with diffuse neutrophilic inflammation: a histologic manifestation of a tick bite.

We describe 5 cases of tick bite reactions with dermal necrosis and sparse interstitial to dense diffuse dermal neutrophilic infiltrates associated with thrombogenic vasculopathy. Tick bite reactions classically consist of moderately dense perivascular infiltrates composed of an admixture of inflammatory cells. Each of our patients had embedded tick parts, with interesting histologic features.

Aged↗
PubMed2005

Type III hyperlipoproteinemia with xanthomas and multiple myeloma.

BACKGROUND: Type III hyperlipoproteinemia usually results from an inherited defect in the composition of apolipoprotein E and is associated with atherosclerosis. An acquired form of the type III phenotype may rarely be associated with myeloma and immunoglobulin-lipoprotein complexes. OBSERVATION: We present the case of a 72-year-old man with a history of well-controlled, unclassified hypercholesterolemia and hypertriglyceridemia, without evidence of atherosclerotic disease. He subsequently developed refractory dyslipidemia, palmar crease, and tuberous xanthomas. Type III hyperlipoproteinemia was confirmed, and nonclassic defective apolipoprotein E. Common secondary causes of hyperlipidemia were ruled out. A workup for malignancy revealed monoclonal IgA gammopathy. Immunostaining confirmed IgA antibodies complexed to the patient's very low-density lipoprotein (VLDL) fraction, causing gross impairment of VLDL metabolism. Conventional therapy for type III hyperlipoproteinemia was attempted but ineffective. Thus, chemotherapy was initiated for his myeloma, with subsequent lowering of his IgA, cholesterol, and triglyceride levels, and improvement of his xanthomas. CONCLUSION: There are several unusual features to this case. Planar xanthomas can be associated with myelomas, but usually in the setting of normal lipids. Type III hyperlipoproteinemias are not usually refractory to standard therapy and are only rarely associated with IgA myeloma. IgA antibodies complexed to the patient's VLDL caused gross impairment of VLDL metabolism. The patient's apolipoprotein E genotype (heterozygote E2/E3) is not typical for expression of the heritable type III phenotype (homozygote E2/E2). These features support a causal relationship between this patient's multiple myeloma and type III hyperlipoproteinemia rather than two independent, coexistent conditions.

Aged↗
PubMed2005

Proliferating multicentric reticulohistiocytosis associated with papillary serous carcinoma of the endometrium.

Multicentric reticulohistiocytosis (MRH) is a rare histocytic disease characterized by destructive arthritis in association with classic skin findings. Although MRH is not strictly a paraneoplastic disease, one quarter of cases are malignancy related. We report a case of MRH with an initial remission followed by an acute exacerbation several years later heralding the clinical presentation of endometrial carcinoma. During this flareup a skin biopsy specimen revealed a diffuse dermal infiltrate composed of histiocytes with ground-glass cytoplasm and multiple atypical mitoses. Approximately 40% of the cells stained with the proliferation marker Ki-67. Treatment of endometrial carcinoma resulted in improvement of skin and joint symptoms, and a repeat biopsy specimen no longer demonstrated mitotic figures. These findings support a reactive and proliferative cause of MRH.

Aged↗
PubMed2005

Relationship of treatment delay with surgical defect size from keratinocyte carcinoma (basal cell carcinoma and squamous cell carcinoma of the skin).

Larger keratinocyte carcinoma (KC) lesions are associated with higher morbidity. This study examined the association of potentially modifiable characteristics, including treatment delay, with KC defect size after Mohs micrographic surgery (MMS). A stratified random sample of patients treated for KC with MMS were selected for telephone interview. Two hundred and nineteen interviews were completed (refusal rate 24%). Regression models were used to examine the predictors to defect size and delay. Anatomic site, age, histology, and gender predicted defect size (R(2) = 0.39) and were used as control variables. Self-reported delay between initial physician examination and MMS predicted defect size (p = 0.0004), with greater than 1 y delay being associated with a doubling of defect size (adjusted odds ratio (OR) 2.0; 95% confidence interval (CI) 1.3-3.1). Delays of this duration were associated with initial examination by a primary provider (unadjusted OR 3.9; 95% CI 1.7-8.8), misdiagnosis (unadjusted OR 6.8; 95% CI 2.5-18.7), being treated without biopsy (unadjusted OR 23.3; 95% CI 6.5-83.7), and multiple surgical removals (unadjusted OR 6.2; 95% CI 2.5-15.5). All but provider specialty were independent predictors of delay. Attention to processes of care delivery for KC may have a greater impact on morbidity than efforts are earlier detection by the public.

Adult↗
PubMed2005

Spiradenocylindrocarcinoma: a malignant hybrid tumor.

BACKGROUND: Eccrine spiradenomas and cylindromas are benign, slowly growing, cutaneous adnexal neoplasms, recently hypothesized to arise from a common pluripotential cell; malignant variants are rare. We found 48 cases of malignant spiradenomas and 33 cases of malignant cylindromas reported in the English literature. Benign tumors demonstrating both spiradenomatous and cylindromatous features have been infrequently reported. Recent immunohistochemical studies of these two tumors have provided compelling evidence that these two tumors may merely represent a single tumor type with a spectrum of histological features. CASE REPORT: We describe two cases of a malignant variant of this rare hybrid tumor occurring in a 62-year-old male and a 72-year-old female. CONCLUSION: We propose the term 'spiradenocylindrocarcinoma' to describe malignant tumors with features of both a spiradenoma and a cylindroma. In conjunction with histological features of malignancy, p53 and Ki-67 immunohistochemical staining may provide helpful clues in determining the malignant potential of this tumor. Further studies are needed to clarify the biologic behavior of such lesions.

Adenoma, Sweat Gland↗
PubMed2005

Post-Mohs micrographic surgical margin tissue evaluation with permanent histopathologic sections.

BACKGROUND: Incomplete resection of nonmelanoma skin cancer is associated with a relatively high rate of recurrent tumors. Mohs micrographic surgery provides microscopic evaluation of tumor margins to ensure complete excision of nonmelanoma skin cancers at high risk of recurrence. OBJECTIVE: This purpose of this study is to confirm the histologic accuracy of Mohs excision of facial skin cancers by evaluating an additional layer of tissue with permanent histopathologic sections after Mohs excision. METHODS: Two hundred ninety-six Mohs cases were identified, which, after excision, were sent to a single plastic surgeon for reconstruction. This plastic surgeon routinely takes an additional layer and sends for permanent histopathologic evaluation at the time of reconstruction. A review of the pathology reports and tissue specimens on these patients provides valuable data on tumor margins and the effectiveness of the Mohs technique for tumor excision. RESULTS: Two excisions of nodular basal cell cancer were determined by the pathologist to have positive tumor involvement on post-Mohs permanent tissue. On additional review, one specimen was interpreted to be more consistent with follicular epithelium, and the second was verified as a focus of nodular basal cell cancer. CONCLUSION: These data support the high reliability of Mohs surgery for margin control.

Basal Cell Carcinoma↗
PubMed2005

Multinucleated atypia of the vulva.

Multinucleated atypia of the vulva (MAV) is an entity with a distinctive histologic pattern of multinucleation in the basal and middle layers of the squamous epithelium that may mimic human papillomavirus (HPV)-related squamous atypias. MAV is rarely reported in the literature, and we believe it should be considered in the differential diagnosis of flesh-colored vulvar papules and vulvar epidermal atypias with multinucleated squamous cells. We describe the case of a 49-year-old patient with the diagnosis of MAV. Results of histopathologic examination revealed a focal area of multinucleation in the basal to middle epithelial layers of the vulvar squamous epithelium, accompanied by mild hyperkeratosis and chronic inflammation. HPV was not identified in the lesion by in situ hybridization techniques.

Biopsy, Needle↗