Infiltrative basal cell carcinoma occurring in sites of biopsy-proven nodular basal cell carcinoma

OBJECTIVE: The authors studied factors associated with short-term treatment response in 38 nondepressed subjects with DSM-III-R obsessive-compulsive disorder (OCD). METHOD: The subjects completed 12 weeks of treatment with paroxetine (N = 20), placebo (N = 8), or cognitive-behavioral therapy (N = 10). Clinician and self-rated measures were gathered at baseline, during treatment, and after treatment. RESULTS: Seventeen (45%) subjects had "much" or "very much" improvement and achieved at least a 40% decrease in their total Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score. Responders had lower obsessive-compulsive scores on the Symptom Checklist 90-Revised, had a lower checking score on the Maudsley Obsessive-Compulsive Inventory, were less likely to have had prior drug therapy, and in general suffered more obsessive-compulsive symptoms. They were significantly less likely to have hoarding obsessions and corresponding compulsions. The latter finding was confirmed using multiple regression analysis. CONCLUSION: Hoarding is an important symptom that predicts poor treatment response in patients with OCD.     

Immunohistochemical localization of nephrocalcin, a kidney-specific glycoprotein, to renal cell carcinoma

OBJECTIVES: Nephrocalcin (NC), an acidic glycoprotein produced by renal proximal tubule cells and functioning as an inhibitor of calcium oxalate monohydrate crystalization, has been previously shown to have increased urinary excretion in patients with renal cell carcinoma (RCC). The current study uses immunohistochemical techniques to localize NC to cells of primary RCC. METHODS: We studied 29 kidneys removed because of RCC. Slides were deparaffinized and stained after incubating with anti-NC antibody by using the avidin-biotin-peroxidase complex techniques. Uptake of stain by tumor cells and adjacent normal renal cells was compared. RESULTS: Twenty-seven kidneys (93%) showed positive staining for RCC tumor cells; 2 kidneys staining positive for normal proximal tubule cells failed to stain adjacent RCC tumor cells (7%). CONCLUSIONS: The data suggest that enhanced production of urinary NC in patients with RCC derives from cells of the primary tumor.     

Defective granzyme B gene expression and lytic response in T lymphocytes infiltrating human renal cell carcinoma

BACKGROUND: For over 60 yr, researchers and engineers have based investigations and the design of cockpit displays and structures upon the presupposition that during flight the pilot maintains a head alignment coincident with the aircraft's vertical axis (z-axis). Recent simulator studies have verified the existence of a pilot neck reflex which refutes this long-standing assumption. This reflex, named the opto-kinetic cervical reflex (OKCR), occurs during visual flight and is theorized to be an attempt by the pilot to stabilize a retinal image of the horizon to maintain spatial orientation. As a result, during initial banking maneuvers, pilots view a fixed-horizon image and not a moving-horizon. The research objectives were to determine if the OKCR occurs during actual flight of high performance jet aircraft and to model the response. HYPOTHESIS: Pilots of high performance aircraft will exhibit the OKCR. Additionally, the OKCR is dependent on the phase of banking (entering into or exiting from a banked position). METHODS: This was an observational study in which the head positions of nine pilots were recorded during actual F-15 aircraft flight and subsequently analyzed. RESULTS: Objective data indicate the OKCR caused pilots to tilt their heads during aircraft bank (p < 0.0001). Also, the reflex was found to be independent of the bank phase. CONCLUSION: The OKCR was shown to be a strong, natural response and the flight results correlated closely with simulator results. The effect of these results on pilot training, spatial disorientation, physiological injury and safety, and the redesign of displays for aircraft attitude and virtual reality are discussed.     

Metastasizing auricular basal cell carcinoma

Basal cell carcinoma represents the most common skin cancer and involves the head and neck area in 80% to 85% of all patients treated. Despite their frequent occurrence, metastatic spread from these tumors is rare. This paper presents a case of a patient who had a metastasizing basal cell carcinoma. Despite control of primary disease by radical surgery and adjunctive irradiation, bony metastasis was found within nine months of therapy. Palliative therapy was given, but the patient died five months later. The pathophysiology of the metastasizing basal cell carcinomas is described, and a rationale for therapy presented.     

Adhesion molecule expression in basal cell carcinoma

OBJECTIVE: Extending recall intervals can be an important strategy for making children's dental care more efficient. The purpose of this study was to describe the recall intervals that the clinicians decided were appropriate for children and adolescents when they were instructed to extend and individualise the routines based on clinical judgement. In addition, the effect on recall interval of the profession of the clinician (dentist or dental hygienist), the child's age and the need for fillings were studied. DESIGN: In a four week period in 1995, all dentists and dental hygienists in one county in Norway reported recall intervals for 2,513 children aged 3 to 18 years. RESULTS: The mean current interval since the previous examination was 17.1 months (SD = 4.7 months) and the mean proposed interval until the next examination was 16.4 months (SD = 4.4 months). Approximately 50% of children were evaluated by the clinicians to be suitable for recall intervals of 20 months or more and 10% were assessed as requiring a new examination within 12 months. The length of the current recall interval, the age of the child, whether or not the child received fillings, and whether the decision-maker was a dentist or a dental hygienist were statistically significantly associated with the length of the proposed recall interval. CONCLUSIONS: Basing recall intervals on clinical judgement resulted in intervals longer than 12 months for the majority of the children.     

Cryotherapy of basal cell carcinoma in oculoplastic surgery

Cryotherapy was an effective modality in the treatment of basal cell carcinoma in the eyelid and periorbital area and cured 93% of the 29 lesions in 25 patients. This method was especially advantageous in patients with blood clotting disorders; those with medical contraindications to, or who refused, classical surgery; patients who had prior radiation or surgery; patients with the basal cell nevus syndrome or xeroderma pigmentosa; and in patients with medial canthal tumors. Experimental cryotherapy in the albino rabbit showed their lacrimal system is not adversely affected by freezing in the temperature range required for tumor death.     

Diagnosing basal cell carcinoma by dermatoscopy

BACKGROUND: Dermatoscopy (DS) has been used primarily to evaluate pigmented skin lesions. Little information is available on DS findings of basal cell carcinoma (BCC). Dermatoscopy is a noninvasive technique that allows visualization of cutaneous features from the skin surface to the papillary dermis. Basal cell carcinoma, the most common cutaneous malignancy, is traditionally diagnosed clinically and confirmed with biopsy. OBJECTIVE: To determine the dermatoscopic features of nonpigmented basal cell carcinomas. Methods: The dermatoscopic findings of 27 lesions that clinically were suspicious for BCC were analyzed. RESULTS: Of these 27 clinically suspect lesions, the biopsies revealed BCC in 20 specimens and squamous cell carcinoma (SCC) in two specimens. Twenty of these 22 specimens had dermatoscopic findings of BCC: diffusely distributed, branching blood vessels, asymmetric, and narrow blood vessels distributed deeper in the dermis, or a milky-red corona with superficial wide blood vessels. One nodular BCC in our study showed no distinct findings. CONCLUSIONS: Many BCCs have characteristic DS findings; however, dermatoscopic examination of some tumours will not demonstrate any known characteristic findings. As such, the DS criteria we propose for BCC are best utilized as an adjunctive study of clinical impressions. Biopsy remains the definitive diagnostic tool.     

Entry and trafficking of granzyme B in target cells during granzyme B-perforin-mediated apoptosis

In the widely accepted model of granule-mediated killing by cytotoxic lymphocytes, granzyme B entry into the target cell is facilitated by the pore forming molecule, perforin. Using indirect immunofluorescence and also direct visualization of fluorescein isothiocyanate (FITC)-conjugated granzyme B, we demonstrate internalization in the absence of perforin. Induction of the lytic pathway, however, required a second signal that was provided by perforin or adenovirus (Ad2). The combination of agents also resulted in a dramatic relocalization of the granzyme. Microinjection of granzyme B directly into the cytoplasm of target cells resulted in apoptosis without the necessity of a second stimulus. This suggested that the key event is the presence of granzyme B in the cytoplasm, and that when the enzyme is internalized by a target cell, it trafficks to an intracellular compartment and accumulates until release is stimulated by the addition of perforin. We found that the proteinase passed through rab5-positive vesicles and then accumulated within a novel compartment. On the basis of these results, we propose a new model for granzyme-perforin-induced target cell lysis in which granzyme B is subjected to trafficking events in the target cell that control and contribute to cell death.     

The heterogenous nature of in vivo basal cell carcinoma

The effects of tetramethylpyrazine, an alkaloid isolated from a Chinese herb Ligusticum wallichii Franch have been assessed in portal hypertensive rats. Portal hypertension was induced by partial portal vein ligation in Sprague-Dawley rats. Two weeks after ligation, when the hyperdynamic state had stabilized, rats were anaesthetized after an overnight fast and cannulated for measurement of mean arterial pressure, portal venous pressure, cardiac index and heart rate. Tetramethylpyrazine (3.0, 9.9 and 30mgkg(-1)) induced dose-dependent reductions of portal venous pressure and mean arterial pressure after intravenous infusion. The maximum percentage reduction of portal venous pressure after tetramethylpyrazine was 6.0+/-0.8, 9.3+/-1.6 and 20+/-2% of baseline for doses of 3.0, 9.9 and 30.0mgkg(-1), respectively. Also, total peripheral resistance was significantly reduced by tetramethylpyrazine and cardiac index was slightly increased. Our results showed that tetramethylpyrazine induced portal pressure reduction in portal hypertensive rats.     

Recurrent basal cell carcinoma treated with cryosurgery

OBJECTIVE: Ureteral stenosis secondary to vasculitis is a rare disease. The etiology and treatment of this unusual cause of ureteral obstruction are discussed. METHODS/RESULTS: We report a case of ureteral obstruction secondary to Churg-Strauss vasculitis in a 45-year-old man. The patient was treated with prednisone and cyclophosphamide. Subsequently ureteral resection and reanastomosis were performed. CONCLUSIONS: Vasculitis of the ureter should be considered in patients with connective tissue disorders who present with ureteral dilatation. In some cases ureteral stenosis may require surgery in combination with steroid and/or immunosuppressive therapy.     

Immunohistochemical localization of metallothionein in hepatocellular carcinoma: preferential expression in non-cancerous cirrhotic nodules

Metallothionein (MT), an oncofocal gene product was strongly expressed in 35%-95% of hepatocytes in hepatocellular carcinoma (HCC) and MT-positive hepatocytes were localized mainly in the non-cancerous cirrhotic nodules but not in malignant hepatocytes. On the other hand, <10% hepatocytes showed weak staining for MT in chronic hepatitis and cirrhosis of liver. Strong expressions of MT in non-cancerous cirrhotic nodule in HCC and low expressions in liver cirrhosis without HCC indicate a relationship between malignant transformation of hepatocytes and the expression of MT.     

Primary basal cell carcinoma of the limbal conjunctiva

BACKGROUND: The authors describe a 66-year-old man with primary basal cell carcinoma of the conjunctiva. He presented with a fleshy nodular conjunctival lesion of 4 months' duration, located at the nasal limbus of the left eye. No associated cutaneous lesions were present. RESULTS: The lesion was completely excised, and results of histopathologic examination showed a primary basal cell carcinoma of the conjunctiva. CONCLUSION: This report provides clinicopathologic evidence that primary basal cell carcinoma can rarely occur in the conjunctiva. The authors summarize two well-documented previously reported cases of this unusual lesion.     

Metastatic basal cell carcinoma presenting as unilateral lymphedema

BACKGROUND: Metastatic basal cell carcinoma (MBCC) is rare, occurring in only 0.0028-0.55% of all basal cell carcinomas (BCCs). Patients with MBCC may present with a variety of findings, related to the site of metastasis. OBJECTIVE: Clinical presentation of a MBCC that became symptomatic due to unilateral lymphedema and a review of the relevant literature. METHODS: Case report with literature review. RESULTS: Patients may present with lymphadenopathy, ulcerations, anemia, bone pain, or muscle weakness related to the site of metastasis. In this reported case, MBCC presented as unilateral lymphedema. Risk factors for MBCC include radiation, large and invasive tumors, and a history of recurrence. The average survival time for localized lymph node metastasis in BCC is 3.6 years. This patient is currently 2 years since MBCC presentation and is currently without evidence of recurrence. CONCLUSION: To our knowledge, we report the first case of MBCC that presented as unilateral lymphedema.     

Intralesional bleomycin-mediated electrochemotherapy in 20 patients with basal cell carcinoma

BACKGROUND: A new anticancer therapy, electrochemotherapy (ECT), has been introduced that entails exposing cancerous tissues to short pulses of electricity during chemotherapy. This enhances cell membrane permeability and has been shown to have potent antitumor effects in vitro in animal models and in several clinical trials, including nevoid basal cell carcinoma (BCC). OBJECTIVE: We report the effects of ECT on 20 patients with primary BCC. METHODS: Electrical pulses were delivered to 54 tumors after administration of intralesional bleomycin sulfate. RESULTS: Complete responses were observed in 53 (98%), and in the majority of these (94%) after a single treatment. No recurrences have been recorded with a mean of 18 months of observation. CONCLUSION: Although these are preliminary results, ECT appears to be an effective alternative to surgical excision for the treatment of primary BCC.     

The treatment of basal cell carcinoma patients by dermatologists in Netherland

OBJECTIVE: To determine the policy of dermatologists practising in the Netherlands in the treatment of basal cell carcinoma. DESIGN: Written enquiry. SETTING: Catharina Hospital, Eindhoven, the Netherlands. METHOD: All 293 dermatologists practising in the Netherlands were sent a questionnaire in May 1996 containing 15 questions about diagnosis and treatment of basal cell carcinoma. RESULTS: Eighteen forms dropped off because of termination of the practice or joint completion in group practices. The response was 76% (208/275). The diagnosis was made usually on the basis of histological examination (71% of the respondents; 84% in a tumour recurrence). Excision was the preferred treatment for all subtypes of basal cell carcinoma; second choices were cryosurgery or curettage/electrocoagulation. Roentgen contact therapy has been practically abandoned. New methods such as photodynamic therapy and immunotherapy are being used only sporadically on an experimental basis. Most dermatologists regarded tumour recurrences as a bigger problem than primary tumours. They attempt to reduce the percentage of recurrences by giving advice about risk factors (sunlight). CONCLUSION: Too little use is being made of diagnostic biopsy to enable an optimal choice of therapy of basal cell carcinomas, especially in cases of recurrence tumours.     

Immunohistochemical localization of human tear lysozyme

Possible local sources of human tear lysozyme were investigated using an indirect immunofluorescence technique. Lysozyme was identified in 20% to 50% of acinar and ductular epithelial cells of both main and accessory lacrimal glands. The staining was granular in character and confined to the apices of the cells. Cells that stained positive tended to be grouped. Interstitial tissues of main and accessory lacrimal tissues did not stain. Conjunctiva and all other ocular tissues examined were unstained by antilysozyme antisera. Our findings are compatible with lysozyme either being produced in lacrimal tissue or being concentrated from plasma. The absence of any other lysozyme-specific fluorescence in the interstitial elements of the lacrimal tissues supports the notion of local synthesis by acinar lacrimal tissue.     

Risk of cancer among patients with cutaneous basal cell carcinoma

A population-based cohort of 37,674 patients diagnosed during the period 1978-1991 and registered in the Danish Cancer Registry with basal cell carcinoma of the skin (BCC) were followed for the occurrence of new malignancies. BCC patients experienced significantly increased cancer incidence rates compared with the general Danish population. The elevated cancer risk was not restricted to new cutaneous malignancies. Cancers at various sites, including lip, salivary glands, larynx, lung, breast, kidney and non-Hodgkin lymphoma occurred in significant excess. Patients diagnosed with BCC before the age of 60 years were at higher risk of developing new malignancies than patients diagnosed with BCC at an older age. This age association pertained particularly to breast cancer, testicular cancer and non-Hodgkin lymphoma.     

Collision tumor of cutaneous malignant melanoma and basal cell carcinoma

BACKGROUND: Enhanced external counterpulsation (EECP) has been demonstrated to be an effective treatment for angina and exertional ischemia in patients with coronary disease. HYPOTHESIS: It is hypothesized that the ability of EECP to enhance the recruitment or development of coronary collaterals in coronary artery disease may be determined by the relative magnitude of diastolic augmentation (DA) and systolic unloading (SU). This study examines the relation between the proposed EECP effectiveness ratio (DA/SU), as assessed by finger plethysmography, and changes in descending aortic flow as assessed by Doppler echocardiography in 15 patients during EECP. METHODS: Varying external cuff pressures (0-275 mmHg) were used to generate a range of DA/SU ratios. The effect on aortic antegrade systolic and retrograde diastolic flow was assessed by Doppler echocardiography to determine whether there was an optimal EECP effectiveness ratio that maximizes the hemodynamic effects of EECP. With increasing DA/SU there was an initial positive linear increase in both systolic and diastolic flow volume. Systolic flow maximized at an effectiveness ratio of 1.5 and diastolic flow at a ratio of 2.0 RESULT: Therefore, effectiveness ratios (DA/SU) in the range of 1.5-2.0 are optimal for maximizing the hemodynamic effects of EECP.     

Immunohistochemical expression of bcl-2 protein in squamous cell carcinoma and basaloid carcinoma of the esophagus

In the present study, the expression of bcl-2 protein in esophageal squamous cell carcinoma (SCC) and basaloid carcinoma (BC) was immunohistochemically examined, and its relation to tumor progression and postoperative survival was determined in SCC. A total of 42 SCC and 4 BC tumor samples were fixed with formalin, embedded in paraffin, and stained using monoclonal bcl-2 protein antibody, clone 124. Immunoreactivity was semiquantitatively scored, and the staining results were compared with the pathologic features and survival rates. The cytoplasm of basal cells from the normal esophageal epithelium was stained. In some well- and moderately differentiated SCCs, bcl-2 protein-positive reaction was observed in the peripheral part of the tumor cord, but in poorly differentiated SCC, the cells were weakly or hardly stained. However, in BC, the cells were strongly stained. The immunoreactivity was positive in 45.2% of the SCCs and all of the BCs. There were no significant differences in pathological features or patient survival between the bcl-2 protein-positive and protein-negative SCCs. In conclusion, the expression was not related to tumor progression and had no prognostic significance in SCC. Conversely, BC had strong immunohistochemical expression, probably associated with the differentiation of carcinoma cells simulating the basal cells of the esophagus.