Diffuse Plane Research Articles

Diffuse normolipemic plane xanthomatosis and Sweet syndrome: A double marker of monoclonal gammopathy of undetermined significance

Diffuse normolipemic plane xanthomatosis and Sweet syndrome: A double marker of monoclonal gammopathy of undetermined significance

Calculation of Positron Distribution in the Presence of a Uniform Magnetic Field for the Improvement of Positron Emission Tomography (PET) Imaging Using GEANT4 Toolkit

Introduction Range and diffusion of positron-emitting radiopharmaceuticals are important parameters for image resolution in positron emission tomography (PET). In this study, GEANT4 toolkit was applied to study positron diffusion in soft tissues with and without a magnetic field for six commonly used isotopes in PET imaging including 11C, 13N, 15O, 18F, 68Ga, and 82Rb. Materials and Methods GEANT4 toolkit was used to simulate the transport and interactions of positrons. Calculations were performed for the soft tissue phantom (8 mm ×8 mm × 8 mm). Positrons were emitted isotropically from the center of the phantom. By the application of a magnetic field perpendicular to the path of positrons, lateral scattering of positrons could be prevented due to Lorentz force. When the positron energy was below the cut-off threshold (0.001 MeV), the simulation was terminated. Results The findings showed that the presence of a magnetic field increased the rate of positron annihilation. At magnetic field strengths of 3, 7, and 10 Tesla, 18F with the lowest decay energy showed improvements in the ratio of full width at half maximum (FWHM) resolution to the peak of curve by 3.64%, 3.89%, and 5.96%, respectively. In addition, at magnetic field strengths of 3, 7 and 10 Tesla, 82Rb with the highest decay energy showed improvements in resolution by 33%, 85%, and 99%, respectively. Conclusion Application of a magnetic field perpendicular to the positron diffusion plane prevented the scattering of positrons, and consequently, improved the intrinsic spatial resolution of PET imaging, caused by positron range effects.

Treatment of Diffuse Planar Xanthoma of the Face after One Session of 1,444-nm Neodymium-Doped Yttrium Aluminium Garnet Laser.

Dear Editor: A 41-year-old man presented with a 10-year history of progressive diffuse plane xanthoma of the face, neck, upper extremities, and flank (Fig. 1). His triglyceride, lipoprotein, and cholesterol levels were normal. Other conditions (e.g., monoclonal gammopathy, lymphoproliferative disease, or normolipemic xanthomatous skin disease) were excluded on the basis of findings from lipid electrophoresis and immunoelectrophoresis, blood cell counts, radiography of the skull, and electron microscopy, which were consistent with diffuse idiopathic plane xanthoma. He received multiple CO2 laser treatments at other hospitals, but with no curative effect. We proposed to remove the plane xanthoma with a 1,444-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) laser (AccuSculpt; Lutronic Corporation, Goyang, Korea). Two 1×1 cm2 test areas, one on each earlobe, were treated with 1,444-nm Nd:YAG laser by external beam irradiation with 80 J in total by using the following treatment parameters: pulse energy, 100 mJ; pulse rate, 20 Hz (power, 2.0 W). In both areas, the lesions were ablated into the superficial dermis until papillary bleeding occurred. After 1 month, both test areas showed resolution of the lesions without recurrence. Then, a 1,444-nm Nd:YAG laser was used for the full-face plane xanthoma lesions. The full-face plane xanthoma lesions were destroyed by irradiating with 918 J in total by using the external beam with the same treatment parameters as the test shots. Postoperatively, hydrocolloid dressings (DuoDERM Extrathin; Convatec International, Skillman, NJ, USA) together with antiseptic ointment were applied until reepithelization. After 1 month, the lesions showed erythema and some atrophic scars. There were no residual xanthoma lesions after 6 months; however, scar formation on the right lower cheek and textural changes in at least 50% of the treated area were observed (Fig. 2). Fig. 1 Plane xanthoma. Yellowish maculopapular lesions had spread over the entire face. Fig. 2 Six months after the full lesional treatment, focal and mild textural changes and scarring are observed. Most therapeutic options in the treatment of plane xanthoma are based on mechanical removal through excision, chemabrasion, dermabrasion, or ablative laser therapy1. Several studies suggest that the 1,444-nm laser achieves superior lipolysis compared with other laser wavelengths2,3,4. Theoretically, more effective laser lipolysis is anticipated with the 1,400-nm wavelength because it has a >10-fold higher affinity to fat than the 1,064-nm wavelength3. Youn and Holcomb2 indicated that the 1,444-nm wavelength provided both the highest efficiency for fatty tissue ablation and the greatest thermal confinement compared with the 1,064- and 1,320-nm wavelengths. Tark et al.3 reported a marked reduction in fat volume identified by using in vivo minipig and in vitro human fat experiments, with the 1,444-nm wavelength compared with the 1,064-nm wavelength. However, the mechanism of action of this laser in the treatment of xanthomas may depend not only on thermal lipolysis but also on nonspecific thermal effects. Superficial scar formation due to thermal damage to the surrounding tissue may act as a shield covering the leftover lesions underneath. To the best of our knowledge, this is the first study to describe the clinical application of a 1,444-nm laser for the treatment of xanthoma. In conclusion, 1,444-nm Nd:YAG laser therapy is an alternative treatment for facial diffuse plane xanthoma that shows fast reepithelialization. However, the risk of skin textural change and scar formation remains a challenge.

Simultaneous occurrence of a CD30 positive/ALK-negative high grade T-cell lymphoma and plasma cell myeloma: Report of a case

Simultaneous occurrences of T-cell and B-cell neoplasms are rare, and etiological relationships between these two malignancies are poorly understood. We report the case of a 76-year-old man who presented with hypercalcemia, multiple skin nodular lesions, fatigue, episodic fever, and night sweats. PET/CT scan showed diffuse skin and subcutaneous fat plane active lesions, supra- and infra- diaphragmatic active lymph nodes, liver and spleen involvement, bone marrow infiltration, and nonspecific bilateral lung nodules. A skin biopsy showed a high grade CD30-positive/ALK-negative T-cell lymphoma. A bone marrow biopsy showed involvement by the same neoplastic cells. Additionally, a monoclonal lambda restricted plasma cell population (15% of marrow elements) was identified, which, in view of an IgA lambda spike in the serum, was consistent with plasma cell myeloma. To the best of our knowledge, this case is the first reported case of a plasma cell neoplasm associated with an aggressive CD30-positive ALK-negative systemic T-cell lymphoma with skin involvement. Reporting such cases is important as it adds to the pool of rare cases of concomitant T-cell neoplasms and plasma cell myelomas, and might help in determining an etiological relationship, if any, between these two hematological malignancies.

Modelling diffuse scattering of the disordered crystal structure of Na2SiF6

Many crystalline materials are not perfectly ordered, but are disordered to a smaller or larger extent. The properties of such materials are often related to the nature of the disorder. In diffraction experiments, disorder is observable as diffuse scattering. In routine X-ray structure determinations, only Bragg reflections are considered, leading to average crystal structure models. Methods to derive the average structure from the Bragg reflections are very well established, whereas diffuse scattering is rarely accounted for and mostly ignored. Our attempts at modelling the disordered structure of crystalline sodium fluorosilicate will be presented. Although the average crystal structure is known [1], there is some uncertainty about the true space group [2]. Na2SiF6assumes a crystalline morphology that resembles that of ice and is therefore known as an ice–analog material [3]. In the average crystal structure (in space group P321), the asymmetric unit contains two ordered sodium cations (both sitting on a two-fold axis) and two disordered SiF62-anions (one sitting on a 3-fold axis and the other on a 32 site). Each anion can occupy two alternative sites in the unit cell, related by a non-crystallographic mirror plane at z = ¼. The occupation is mutually exclusive for both anions. Diffuse scattering can be observed as planes perpendicular to l in the hnl and nkl precession images where these diffuse planes can be found at integer l. For l odd, the diffuse scattering is more intense. Also there are diffuse clouds of intensity around certain Bragg peaks. In the hkn planes, diffuse streaks are visible parallel to a*, b*, and a* - b*, while some Bragg peaks have diffuse clouds of intensity around them. The pattern of streaks and clouds evolves when going to higher order planes. In the figure below, the hk1 precession image is illustrated. The observed diffuse scattering features will be interpreted in terms of structural models obtained by Monte Carlo simulations.

Xanthomas: Clinical and pathophysiological relations

Xanthomas are well circumscribed lesions in the connective tissue of the skin, tendons or fasciae that predominantly consist of foam cells; these specific cells are formed from macrophages as a result of an excessive uptake of low density lipoprotein (LDL) particles and their oxidative modification. Until recently, xanthelasma was considered to be only a cosmetic lesion; however, according to the results of recent prospective studies it is connected with an increased cardiovascular risk and reduced average lifespan. Pathogenetic mechanisms involved in the development of xanthomas resemble early stages of atherogenesis. In clinical practice, xanthomas can signalise various congenital or acquired dyslipidemias. The most prevalent form of xanthomas is xanthelasma palpebrarum. Tendinous and tuberous xanthomas are typical for autosomal dominant hypercholesterolemia, as well as for some rare conditions, such as cerebrotendinous xanthomatosis and familial β-sitosterolemia. In patients with familial hypercholesterolemia, the presence of tendinous xanthomas has been shown to be associated with a two to four times higher risk for cardiovascular disease. Eruptive xanthomas are skin manifestations of a severe hypertriglyceridemia and implicate an elevated risk for acute pancreatitis or type 2 diabetes mellitus. Xanthoma striatum palmare is pathognomic for primary dysbetalipoproteinemia, whereas diffuse plane xanthomas are frequently associated with paraproteinemia and lymphoproliferative disorders. Thorough familiarity with the clinical presentation of xanthomas helps in the diagnosis and follow-up of different forms of dyslipidemia. Moreover, xanthelasma palpebrarum, the most prevalent form of xanthomas, is connected with increased risk of atherothrombotic disease independently of conventional cardiovascular risk factors. To fully understand the pathogenesis, further experimental and clinical research is required.

Atomic mobilities in fcc Cu–Mn–Ni–Zn alloys and their characterizations of uphill diffusion and zero-flux plane phenomena

Abstract An effective approach to establish the atomic mobility parameters of quaternary Cu-rich fcc Cu–Mn–Ni–Zn alloys is presented through assessments of the critically-reviewed experimental diffusivities available in the literature by means of DICTRA (DIffusion Controlled TRAnsformation) software. In the quaternary Cu-rich fcc Cu–Mn–Ni–Zn alloys, atomic mobilities in ternary fcc Cu–Mn–Ni and Cu–Ni–Zn boundary systems were directly taken from our previous work, while atomic mobilities in ternary fcc Cu–Mn–Zn boudnary system were assessed as a function of temperature and composition in this work. Since no experimental data were available, the atomic mobility database for fcc Ni–Mn–Zn alloys was not assessed but just directly extrapolated based on the three constituent binary alloys. Considering that the accurate quaternary interdiffusion coefficients were usually absent in the literature, atomic mobilities in fcc Cu–Mn–Ni–Zn alloys were extrapolated based on the assessed atomic mobilities in the 4 ternary boundary systems. On the basis of the obtained mobility parameters, simulations of a series of ternary and quaternary diffusion couple experiments were performed. The concentration profiles and the diffusion paths in diffusion couples were well reproduced by the presently obtained parameters. Furthermore, 3D views of the concentration profiles, diffusion fluxes, chemical potential and quaternary interdiffusion coefficients surfaces were calculated with the obtained atomic mobilities to analyze the uphill diffusion and zero-flux plane phenomenon in some quaternary diffusion couples. In addition, simple criteria for judging whether the uphill diffusion and/or zero-flux plane can occur are also proposed.

Cutaneous xanthomatous infiltrate

Xanthomatous infiltrate indicates aggregation of foamy histiocytes in the dermis. It may show nodular, interstitial, diffuse, perivascular, perifollicular pattern and corresponds to various disorders, including neoplasm, deposition, inflammation, and infection. Usually xanthomatous infiltrate represents hyperlipidemic xanthoma, such as eruptive xanthoma, tuberous xanthoma, and xanthelasma. They can be also seen in normolipidemic conditions, including diffuse plane xanthoma, papular xanthoma, and verruciform xanthoma. Xanthomatous infiltrate can also be seen in certain infectious diseases, especially lepromatous leprosy. This lecture reviews and summarizes various conditions of cutaneous xanthomatous infiltrate and emphasizes the diagnostic pitfalls in different settings.

Analytical real-time measurement of a three-dimensional weld pool surface

The ability to observe and measure weld pool surfaces in real-time is the core of the foundation for next generation intelligent welding that can partially imitate skilled welders who observe the weld pool to acquire information on the welding process. This study aims at the real-time measurement of the specular three-dimensional (3D) weld pool surface under a strong arc in gas tungsten arc welding (GTAW). An innovative vision system is utilized in this study to project a dot-matrix laser pattern on the specular weld pool surface. Its reflection from the surface is intercepted at a distance from the arc by a diffuse plane. The intercepted laser dots illuminate this plane producing an image showing the reflection pattern. The deformation of this reflection pattern from the projected pattern (e.g. the dot matrix) is used to derive the 3D shape of the reflection surface, i.e., the weld pool surface. Based on careful analysis, the underlying reconstruction problem is formulated mathematically. An analytic solution is proposed to solve this formulated problem resulting in the weld pool surface being reconstructed on average in 3.04 ms during welding experiments. A vision-based monitoring system is thus established to measure the weld pool surface in GTAW in real-time. In order to verify the effectiveness of the proposed reconstruction algorithm, first numerical simulation is conducted. The proposed algorithm is then tested on a spherical convex mirror with a priori knowledge of its geometry. The detailed analysis of the measurement error validates the accuracy of the proposed algorithm. Results from the real-time experiments verify the robustness of the proposed reconstruction algorithm.

Treatment of Mycosis Fungoides with Bexarotene Results in Remission of Diffuse Plane Xanthomas

Cutaneous xanthomas develop as a result of intracellular and dermal deposition of lipids in either hyper- or normolipidemic patients. Plane xanthomas may signal the presence of an underlying monoclonal gammopathy, chronic myelomonocytic leukemia, or cutaneous T-cell lymphoma. Investigators have suggested that xanthomatized T cells may result in induction of plane xanthomas. We report the case of a patient with mycosis fungoides (MF) and plane xanthomas who was treated with bexarotene for his MF. Significant improvement in the clinical signs of MF was observed within 3 months. We also observed a substantial regression of the xanthomas after 5 months of treatment. Complete clinical remission of both the MF and xanthomas was obtained after 6 months. The patient was still free of xanthomas after 3 years of follow-up. Bexarotene led to the clearing of the cutaneous lesions of cutaneous T-cell lymphoma and plane xanthomas. This may be due to an effect of bexarotene on the aberrant T cells that may cause xanthomatization.

Noise control for cooling fans on heavy vehicles

In this paper two different objects for fan passive noise control have been examined: heat exchangers and inlet/outlet parallel splitter silencers based on micro-perforated panels. The first object is theoretically and experimentally examined while the second is only examined experimentally. Throughout this paper two measurement methods were used. The ISO 15186-1:2000 to test the acoustic transmission for a diffuse field and plane wave testing in a duct of a sample cut from each heat exchanger type. Based on an anisotropic equivalent fluid model a theoretical model for the heat exchanger acoustic transmission is presented. A new type of splitter silencers based on micro-perforated plates, which can add damping up 10-20 dB in the frequency range of interest (<5 kHz), are also presented.

Evidence for Point Transformations in Photoactive Molecular Crystals by the Photoinduced Creation of Diffuse Diffraction Patterns

Time-resolved diffuse X-ray scattering is one powerful method for monitoring the progression from the creation of local structural changes inside a crystalline material up to the transformation of the whole crystalline bulk. In this work, we study the mechanism of phototransformation of a molecular crystal by time-resolved diffuse X-ray scattering. Here, an optical excitation source, like a pulsed laser, initiates structural transformations which are monitored by X-ray scattering techniques. We have studied the dimerization process of the molecular switch α-styrylpyrylium (trifluoromethanesulfonate) TFMS, in particular for understanding whether cooperative effects influence the changes of the structure in the bulk and its periodicity. Upon illumination with optical light, α-styrylpyrylium TFMS instantaneously photoswitches. Depending on the optical fluence, X-ray diffuse planes are observed prior to phototransformation of the bulk. In the early stages of transformation, the analysis reveals systems of randomly distributed islands of product clusters with gradual growth in size and amount. The degree of transformation follows the optical excitation profile, i.e., the spatial absorption of the laser beam. In the present studies, no influence of cooperativity on the photodimerization process has been found.

Magnetorotational instability in magnetic diffusion dominated accretion discs

We investigate the stability of partially ionised, differentially rotating, diffusive disc threaded by both azimuthal and vertical magnetic field. The general stability criterion of such a disc in the presence of axisymmetric fluctuations can be stated purely in terms of ambipolar and Hall diffusivities. It is shown that the disc is magnetorotationally unstable if the sum of scaled ambipolar and Hall diffusivities are larger than some numerical constant determined by the rotation profile of the disc. This criterion suggests that the diffusive discs are always unstable to almost radial fluctuations. The field geometry and obliqueness of wavevector (encapsulated together in the topological factor $g$), plays dual role of not only assisting MRI in ambipolar--Ohm dominated disc but also making otherwise stable region in Hall--ambipolar diffusion plane unstable.

Langevin Dynamics Simulations of Protein Fencing of PIP2

Anionic phosphotidylinositol 4,5-bisphosphate (PIP2) occupies only 2∼3% of the phospholipids in the inner leaflet of the plasma membrane, but participates in numerous cellular processes. Concentrated pools of PIP2 on the membrane surface appear to be the source for such PIP2-involved cellular processes, and recent experimental observations indicate that a “protein fence” prevents PIP2 from diffusing out of the pool. Here the necessary properties of the protein fence are examined using Langevin dynamics simulation with effective potential maps. PIP2 molecules are modeled as explicitly diffusing spheres, and the rest of the system represented by steric and electrostatic potentials. Simple models of charged or porous rods, as well as rigid proteins are considered. Retardation by electrostatic forces from a rod is only significant when the charges are highly concentrated and close to the diffusion plane; charge densities and geometries of proteins are insufficient to effectively block diffusion. Hence, fencing appears to be dominated by steric effects, though even a small (> 1%) opening in a porous rod in contact with the surface results in substantial leakage. The three protein fence candidates, actin, human septin, and yeast septin, are known to self-assemble into filaments on the cell surface and to interact with PIP2. Simulations reveal that actin is a poor fence for all depths and orientations simulated because its arch-type shape leaves passageways for diffusion. In contrast, the septins effectively block PIP2 diffusion when buried in the membrane to 10∼15 A from the lipid surface. Free energy calculations using an implicit membrane model support the possibility of burial of septins at these depths. It is also possible that the septins are not buried as deeply, but associate with other proteins or peptides to make a fence.

Diffuse plane xanthomatosis associated with monoclonal gammopathy

Diffuse plane normolipemic xanthomatosis (DPNX) is a rare, non-inherited disease that is often associated with systemic diseases, mainly malignant hematological (especially multiple myeloma) or lymph proliferative disorders. The DPNX can precede the appearance of such conditions by several years, so careful follow-up and periodic laboratory examinations are recommended even for patients that seemed to have no underlying disease. We describe a case associated with monoclonal gammopathy. This case shows that dermatological lesions can be the first manifestation of important hematological diseases and so physicians should be familiarized with this entity.

Xantomatosis plana difusa asociada a tumor hematológico y neoplasia sólida. Hallazgos de una autopsia

Diffuse plane xanthomatosis is an uncommon subtype of non-Langerhans histiocytosis. We report a case of a 78 year-old woman with a history of monoclonal gammopathy of undetermined significance and diffuse plane xanthomatosis since 1995. She consulted for malaise and died four days after admission. Autopsy was requested. Findings were diffuse plane xanthomatosis with extensive involvement of internal organs, lymphoplasmacytic lymphoma and cecal adenocarcinoma. Final event was acute bronchopneumonia. This entity is a subtype of histiocytosis. It affects skin and involves mucous membranes in 40% of the cases. Extracutaneous extension has been reported. It is usually associated with haematologic disorders. In this case, the patient had a lymphoplasmacytic lymphoma and colonic adenocarcinoma. We highlight the importance of recognition its association with monoclonal gammopathies and solid tumors in order to make a proper follow up of patients.

Diffuse Normolipemic Plane Xanthoma in a Child with Common Variable Immunodeficiency

Diffuse plane xanthoma is extremely rare in children. Although it may be associated with systemic disorders, its etiology remains obscure in a number of patients. The case of a boy with common variable immunodeficiency and normal serum lipid levels, who developed diffuse plane xanthoma during treatment with intravenous immunoglobulins, is reported.

Diffuse plane xanthomas, a cutaneous marker for monoclonal gammopathies and lymphoproliferative diseases

Diffuse plane xanthomas, a cutaneous marker for monoclonal gammopathies and lymphoproliferative diseases

Low-temperature magnetic properties and high-temperature diffusive behavior ofLiNiO2investigated by muon-spin spectroscopy

In order to elucidate the effect of Ni ions in the Li layer on magnetism and Li diffusion of ${\text{LiNiO}}_{2}$, we have measured muon-spin rotation and muon-spin relaxation $({\ensuremath{\mu}}^{+}\text{SR})$ spectra for the polycrystalline ${\text{Li}}_{1\ensuremath{-}x}{\text{Ni}}_{1+x}{\text{O}}_{2}$ samples with $x=0.02$, 0.03, and 0.15. Weak transverse-field-${\ensuremath{\mu}}^{+}\text{SR}$ measurements demonstrated the existence of a bulk ferromagnetic transition at ${T}_{\text{m}}=48(6)\text{ }\text{K}$ for the $x=0.03$ sample and 161(7) K for $x=0.15$ while the $x=0.02$ sample exhibited an antiferromagnetic transition at 18(4) K. Zero-magnetic-field-(ZF) ${\ensuremath{\mu}}^{+}\text{SR}$ measurements below ${T}_{\text{m}}$ clarified the formation of static ferromagnetic (FM) order for the $x=0.03$ and 0.15 samples but only a highly disordered antiferromagnetic (AF) order for the $x=0.02$ sample. Therefore, the variation in the low-$T$ magnetism with $x$ is most unlikely due to the change in the concentration of an AF NiO-type domain or an FM Ni-rich cluster but likely due to a homogeneous change in the whole system. In the paramagnetic state, ZF- and longitudinal-field-${\ensuremath{\mu}}^{+}\text{SR}$ spectra exhibited a dynamic nuclear field relaxation. From the temperature dependence of the field fluctuation rate, a diffusion coefficient of ${\text{Li}}^{+}$ ions $({D}_{\text{Li}})$ at 300 K was estimated about $0.39(3)\ifmmode\times\else\texttimes\fi{}{10}^{\ensuremath{-}11}\text{ }{\text{cm}}^{2}/\text{s}$ for the $x=0.02$ sample and $0.12(7)\ifmmode\times\else\texttimes\fi{}{10}^{\ensuremath{-}11}\text{ }{\text{cm}}^{2}/\text{s}$ for $x=0.15$. On the other hand, the related compound, ${\text{LiCrO}}_{2}$, did not show any diffusive behavior even at the highest temperature measured $(=475\text{ }\text{K})$. Considering the hindrance of diffusion by Ni in the ${\text{Li}}^{+}$ diffusion plane and the fact that ${\text{LiCrO}}_{2}$ is electrochemically inactive, the estimated ${D}_{\text{Li}}$ is thought to be very reasonable for the positive electrode material of Li-ion batteries. Furthermore, at low temperatures where the ${\text{Li}}^{+}$ ions are static, the internal magnetic field was still found to be fluctuating, due to a dynamic local Jahn-Teller distortion of the ${\text{Ni}}^{3+}$ ions in a low-spin state with $S=1/2({t}_{2g}^{6}{e}_{g}^{1})$.

Diagnosis and treatment of cutaneous paraneoplastic disorders

The skin plays a critical role in the detection of internal malignances. Cutaneous signs of these disorders afford clinicians opportunities for early diagnosis and treatment. We aim to succinctly review the recognition, diagnosis, and treatment of selected cutaneous paraneoplastic diseases. Skin disorders that may be associated with paraneoplastic syndromes include: cutaneous metastases, tripe palms, Sweet's syndrome, glucagonoma, Paget's disease and extramammary Paget's disease, acanthosis nigricans, Birt-Hogg-Dube syndrome, basal cell nevus syndrome, Bazex syndrome (acrokeratosis paraneoplastica), carcinoid syndrome, Cowden's disease(multiple hamartoma syndrome), dermatomyositis, erythema gyratum repens, ichthyosis aquisita, von Recklinghausen's disease, pityriasis rotunda, pyoderma gangrenosum, Quincke's edema (angioedema and paraneoplastic uricaria), paraneoplastic pemphigus, Degos' disease, superior vena cava syndrome, Werner's syndrome, diffuse normolipemic plane xanthomas, and yellow nail syndrome. Treatment for these disorders depends on the nature and anatomic distribution of the primary neoplastic process.