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Biomedical subjects

W A Caro

Publications and source records attributed to W A Caro.

At least 19 recordsLinked to original sources
PubMed1997

Lichenoid changes in mycosis fungoides.

BACKGROUND: The lichenoid tissue reaction (LTR) is present in a variety of dermatoses. Numerous histologic variants of mycosis fungoides (MF) have also been described. OBJECTIVE: Our purpose was to analyze a subset of patients with mycosis fungoides (MF) who had a prominent LTR at the time of presentation. METHODS: Clinical and pathologic features were evaluated in 12 patients with MF and an LTR. RESULTS: The primary complaint was intense pruritus (in 10 of 12 patients). An accelerated course was noted in one half of the patients including four with Sézary syndrome. Four patients died: two with Sézary syndrome and two with extensive patch/plaque MF. Lymphocyte atypia, prominent basal cell layer epidermotropism, and the presence of plasma cells and eosinophils may help to distinguish lichenoid MF from lichen planus. CONCLUSION: A subset of patients with MF present with lichenoid changes. The pathologic features may have a striking resemblance to lichen planus. Our findings suggest that lichenoid changes in MF tend to be associated with intense pruritus and may connote a poor prognosis.

Adult↗
PubMed1989

Parapsoriasis and mycosis fungoides: the Northwestern University experience, 1970 to 1985.

One hundred sixty skin biopsy specimens from 89 patients with the clinical diagnosis of large plaque parapsoriasis and 240 specimens from 106 patients with mycosis fungoides were reviewed. Through the use of chart reviews and a retrospective questionnaire, various factors (sex, age, history of eczema/atopy, occupation) were examined in these two patient groups. Mycosis fungoides developed in 30% of the patients in the parapsoriasis group. Nineteen percent of patients in the mycosis fungoides group had worked in industry. Once the clinical diagnosis of mycosis fungoides was considered, an average of four biopsy specimens were needed to establish the diagnosis. The average interval from the initial visit to the diagnosis of mycosis fungoides from examination of biopsy specimens was 22 months. These findings support further the view that large plaque parapsoriasis represents an important precursor of mycosis fungoides. A designation of premycosis fungoides would emphasize this relation more than the term parapsoriasis.

Adolescent↗
PubMed1989

Long-term follow-up of skin cancer in the PUVA-48 cooperative study.

Five-hundred fifty-one psoriasis patients receiving therapy with psoralen plus UVA light in seven medical centers for up to 10 years were evaluated for the development of skin cancer. Basal cell carcinoma developed in 13 patients (2.4%), and squamous cell carcinoma (SCC) developed in 9 (1.6%), an incidence that is significantly elevated over that in the general population. The increase in basal cell carcinoma was found only in patients with exposure to other carcinogenic agents, whereas the increase in SCC was also seen in patients without such exposures. Cumulative UVA dosage was not correlated with the development of basal cell carcinoma, but there was a trend of increasing numbers of SCCs in patients with higher dosages. Five of 9 patients had SCCs on sites that were not sun exposed. All patients with tumors had them treated surgically, and, to date, none have recurred. This study confirms a previous report of an increase in the incidence of SCC in psoriatic patients treated with PUVA.

Basal Cell Carcinoma↗
PubMed1987

Cutaneous squamous cell carcinoma and hypercalcemia.

An elderly man was admitted to the hospital with a large squamous cell carcinoma involving the right side of the chest wall. The patient was severely confused, and evaluation revealed pronounced hypercalcemia. With total surgical removal of the tumor, the serum calcium level fell to normal and his confusion cleared. Although hypercalcemia has been reported in association with a number of malignant tumors, including metastatic squamous cell carcinoma, this finding has been encountered only rarely with squamous cell carcinoma localized to the skin. The secretion of transforming growth factor or of another humoral substance has been postulated as the possible cause of hypercalcemia in this patient.

Aged↗
PubMed1987

Successfully treated Hodgkin's disease followed by mycosis fungoides: case report and review of the literature.

We report the case of a 30-year-old man who had Hodgkin's disease of the nodular sclerosing type and subsequently developed mycosis fungoides. The Hodgkin's disease was treated with radiation therapy and chemotherapy, and the patient was in complete remission. Seven years later mycosis fungoides occurred and rapidly became progressive. Autopsy revealed that the mycosis fungoides involved multiple organs without any evidence of Hodgkin's disease. The possible significance of the association of these two diseases is presented.

Adult↗
PubMed1986

Histiocytosis X. Flow cytometric DNA-content and immunohistochemical and ultrastructural analysis.

A 76-year-old man developed a generalized orange-red nodular eruption associated with constitutional symptoms. A biopsy specimen of a nodule revealed an extensive infiltration of histiocytes with relatively abundant cytoplasm and folded nuclei. Electron microscopy showed Langerhans' cell granules, which confirmed the diagnosis of histiocytosis X. Results of immunohistochemical studies revealed a pattern of antigen expression usually found in histiocytosis X, including Ia, T6, and S100. Analysis of the DNA content of the cells with flow cytometry revealed an aneuploid peak. The patient responded partially to topical mechlorethamine hydrochloride therapy.

Adult↗
PubMed1985

Photochemotherapy in cutaneous T cell lymphoma and parapsoriasis en plaques. Long-term follow-up in forty-three patients.

Forty-three patients with clinical plaque- and tumor-stage mycosis fungoides, the erythrodermic/Sézary syndrome variant of mycosis fungoides, and parapsoriasis en plaques were treated with oral psoralens and ultraviolet A (PUVA). Pretreatment skin biopsies, evaluated by light microscopy, revealed seventeen diagnostic, seventeen suggestive, and nine nonspecific specimens. Clinical and histologic parameters were followed for an average of 38.4 months (range, 4-67 months). Twenty-five patients had complete clearing, and fourteen did not respond. Most patients in the complete-response group had either plaque lesions of mycosis fungoides or parapsoriasis en plaques prior to PUVA. Most patients in the no-response group had either tumor lesions or the erythrodermic/Sézary mycosis fungoides at the start of PUVA. In the no-response group the treatment modalities used prior to PUVA were twice the number used in the complete-response group. Patients in the complete-response group had clearing of their lesions after an average PUVA dose of 117 joules/cm2. Relapse occurred in seventeen patients after an average remission time of 6.3 months and responded to additional PUVA. Patients whose skin remained clear after the first course of PUVA continued to have clear skin for up to 58 months, with an average complete remission of 29.5 months by the end of the study period. Histologic evaluation before PUVA and at clearing revealed a definite trend toward a normal microscopic picture, but at least a mild inflammatory infiltrate usually persisted. At the end of the study period, the lesions of ten patients had entirely cleared for an average of 44 months, the lesions of five had cleared during a second course of PUVA, five had stable limited-plaque disease while receiving maintenance PUVA, eleven were undergoing electron beam radiation therapy or chemotherapy for progressive disease, ten had died, and two patients were lost to follow-up. Therefore, in the early stage of mycosis fungoides, PUVA may induce significant disease-free intervals. Prior treatment with a variety of modalities, the patient's age, and/or the duration of disease may affect response to PUVA.

Adult↗
PubMed1985

Facial and scalp lipomas: case reports and study of prevalence.

Lipomas of the face and scalp are reportedly rare, comprising less than 2% of lipomas. Three such cases have recently been diagnosed in our clinic. Among 110 lipomas in our files, a total of 16 (14.5%) involved the face and scalp. The clinician rarely considered lipoma as the primary preoperative diagnosis. Often mistaken clinically for epidermal cysts, face and scalp lipomas appear more common than the literature would indicate.

Adolescent↗
PubMed1984

Malignant lymphoma presenting with cutaneous granulomas.

A 49-year-old man with fever, malaise, weight loss, and pneumonia developed cutaneous nodules and neurologic symptoms. Skin biopsy studies revealed granulomatous inflammation consistent with a sarcoid reaction, and mild granulomatous changes were noted on biopsy specimens of liver and bone marrow. A lymph node biopsy was unremarkable. Neurologic deterioration prompted an extensive workup that revealed an intracranial mass. A brain biopsy study revealed malignant lymphoma, large cell type. Autopsy study confirmed the diagnosis and showed no evidence of granulomatous infiltrates. The cutaneous granulomas represent a nonspecific immune response possibly related to the underlying lymphoma. The relationship between sarcoidosis and sarcoid reactions and lymphoma is discussed.

Brain↗
PubMed1984

Primary cutaneous T-cell lymphoma in a child.

Primary cutaneous lymphoma in childhood is extremely rare. An 11-year-old girl had lesions that were treated as infected insect bites until a biopsy was performed and the diagnosis of primary T-cell lymphoma was made. In contrast to the typically indolent course of cutaneous T-cell lymphoma in adults, the condition in children tends to disseminate rapidly.

Adolescent↗
PubMed1983

Clinical and pathologic cutaneous manifestations of malignant histiocytosis.

The clinical and pathologic changes in the skin of five patients with malignant histiocytosis were studied. The clinical signs included papules, nodules, noduloulcers and purpura. The histopathologic changes included exocytosis of inflammatory cells, infiltration of the papillary and reticular dermis with neoplastic histiocytes, and periadnexal and perivascular infiltrates. Phagocytosis of RBCs and nuclear debris by atypical histiocytes was seen in two cases. In one case, the skin lesions were the only initial manifestation of the disease. Skin involvement occurs in about 10% to 15% of all cases of malignant histiocytosis. Hence, it is important to include malignant histiocytosis in the differential diagnosis of patients with such skin lesions, especially when clinical symptoms may be suggestive of this disease.

Adolescent↗
PubMed1982

Histologic, immunofluorescent, and antinuclear antibody findings in PUVA-treated patients.

Twenty-two patients with psoriasis were treated with PUVA therapy for over two years. Skin biopsies from sun-exposed skin were evaluated before, during, and after PUVA therapy. No statistically significant epidermal changes were found when looking for hyperkeratosis, atrophy, melanin, or melanocyte numbers. No dyskeratosis was found. Dermal changes, including alterations in elastic tissue and collagen, were not statistically significant. Amyloid deposits were absent. The amount of mucin deposition was found to correlate with the length of PUVA therapy. In four patients, the mucin disappeared after withdrawal of PUVA, suggesting that this change is reversible.

Adult↗
PubMed1982

Progressive cutaneous protothecosis.

The diagnosis of severe progressive cutaneous protothecosis in a 34-year-old woman was made by skin biopsy and culture. Analysis of host defense mechanisms revealed a persistent defect in the ability of the patient's PMN to kill the infecting organism. Specific IgG and IgE antibody was demonstrated. Serum levels of complement and immunoglobulins were normal or elevated. The patient was not anergic and peripheral blood lymphocytes responded to nonspecific mitogens. Treatment with amphotericin B and tetracycline resulted in resolution of skin lesions and negative cultures.

Adult↗