Persistent Nodules Research Articles

Biological markers of preneoplastic foci and neoplastic nodules in rodent liver.

Foci of altered hepatocytes are regularly observed early during hepatocarcinogenesis in rodents. The abnormal hepatocytes may show a number of different phenotypes as characterized by various cytomorphological and cytochemical markers. The first appearance and the further development of the abnormal cell populations depend on the dose of the carcinogen given and on the duration of the carcinogenic treatment. According to cytochemical, morphometric and autoradiographic findings in rats receiving low doses (2-10% of the LD 50/kg bw/day) of hepatocarcinogens for limited periods ("stop" experiments), glycogenotic (clear or acidophilic) hepatocytes indicate the first step of the neoplastic cell transformation which can be detected by these methods at present. The glycogenotic cells undergo a characteristic metamorphosis and give rise to basophilic tumor cells poor in glycogen, but rich in ribosomes. Under extreme experimental conditions, such as a single or repeated application of higher doses of one or several chemical carcinogens a puzzling picture emerges which is "reversible" to a large extent after withdrawal of the respective compounds. This observation points to a phenotypic instability of the cellular changes induced in certain experimental systems. Foci of altered hepatocytes persisting after withdrawal of the carcinogenic compounds are considered preneoplastic lesions. They may transform into neoplastic nodules which are also persistent and share a number of cytomorphological and cytochemical markers with the focal lesions. The persistent nodules progress to hepatocarcinomas after lag periods of weeks or months. However, the foci may also progress to hepatocarcinomas without passing a nodular intermediate stage. The development of both neoplastic nodules and carcinomas from the preneoplastic glycogen storage foci can proceed independent of further administration of carcinogen. The sequence of cellular changes during hepatocarcinogenesis derived from the experimental results in rodents is strongly supported by observations in humans, especially by the increasing reports on the appearance of hepatic tumors in patients who suffer from inborn hepatic glycogenosis.

Leishmania mexicana: Immunology and histopathology in C3H mice

C3H mice were infected subcutaneously with 10 5 promastigotes of Leishmania mexicana and subsequent lesions were examined at 3, 5, and 8 months. All animals developed persistent nonulcerating nodules of variable size which did not metastasize. The nodules contained amastigotes with a mononuclear infiltrate of histiocytes, lymphocytes, and plasma cells, but without formation of tuberculoid-type granulomas. Neutrophils and eosinophils were also encountered in some cases. Specific antileishmanial antibodies and delayed-type hypersensitivity to leishmanial antigen were present at 3, 5, and 8 months postinfection. L. mexicana infection in C3H mice differs from classic self-healing cutaneous leishmaniasis by the pesistence of nonhealing, nonulcerating, nonmetastasizing lesions, despite evidence of cellular and humoral immunity.

Solitary thyroid nodules.

A study was made of 67 patients with solitary thyroid nodules in which strict criteria to eliminate the probability of cancer, including a history of radiation to the neck, were used. Twelve (17.9%) were found to have histologic malignancy. This figure is threefold that of a study made by one of the authors 11 years earlier, but comparable to others more recently reported from cancer centers elsewhere. It is not certain whether the apparent increase is actual or merely the result of more careful screening of patients for referral. Shrinking of the nodule by thyroid suppression therapy had been definite but incomplete in three nodules, one of which was found to be malignant. Excision is recommended for all persistent thyroid nodules.

Topically Applied Thiabendazole in the Treatment of Scabies

Forty patients were treated for scabies with a 10% suspension of thiabendazole applied externally. Thirty-two patients (80%) had a satisfactory response to one course of therapy, while a second course was necessary in six (15%). Two patients (5%) required intralesional injections of triamcinolone diacetate because of persistent scabious nodules.

Atypical radiographic appearance and clinical presentation of pulmonary tuberculosis.

Fourteen patients with unusual presentation of pulmonary tuberculosis are described. Often, exposure to the tubercle bacillus was not apparent. In other cases, there was tuberculous infection or reactivation of a previous focus in individuals with altered immunity. The radiographic presentation often differed from the classic cavitating upper lobe disease. Persistent pneumonia, cavities, and nodules were seen in other areas of the lung including the anterior segments and the lung bases. Isolated effusion and solitary nodules were also evident. Increased suspicion of tuberculosis should be maintained when evaluating persistent parenchymal consolidation, effusion, and cavitating pulmonary disease.

Residual Nonmalignant Pulmonary Nodules in Choriocarcinoma

Successful chemotherapeutic treatment of metastatic choriocarcinoma of the lungs is usually accompanied by disappearance of the metastases on the roentgenogram and restoration of elevated human chorionic gonadotropin (HCG) levels to normal. A patient is presented who had residual persistent pulmonary nodules following chemotherapy despite a return of HCG levels to normal. Histologic examination of one of the persisting nodules revealed no residual tumor. Residual pulmonary nodules in choriocarcinoma can be assumed to be benign under the following circumstances: (1) the elevated HCG titers return to and remain in the normal range; (2) other metastases completely resolve; and (3) the residual nodules show no increase in size. Successful chemotherapeutic treatment of metastatic choriocarcinoma of the lungs is usually accompanied by disappearance of the metastases on the roentgenogram and restoration of elevated human chorionic gonadotropin (HCG) levels to normal. A patient is presented who had residual persistent pulmonary nodules following chemotherapy despite a return of HCG levels to normal. Histologic examination of one of the persisting nodules revealed no residual tumor. Residual pulmonary nodules in choriocarcinoma can be assumed to be benign under the following circumstances: (1) the elevated HCG titers return to and remain in the normal range; (2) other metastases completely resolve; and (3) the residual nodules show no increase in size.

Inflammatory angiomatous nodules with abnormal blood vessels occurring about the ears and scalp (pseudo or atypical pyogenic granuloma).

SUMMARY.— Persistent angiomatous nodules and plaques about the ears and scalp with distinctive histological features are described. Of the 12 women and 2 men affected, 9 showed involvement of the external auditory meatus, the pinna or the retroauricular fold. Three patients presented with lesions in the occipital region and solitary nodules affecting the nasolabial fold and forehead occurred in 2 patients. Eight patients had multiple lesions with bleeding and pruritus as the main symptoms. Several recurred after removal. The characteristic histological features were the presence of abnormal hypertrophied capillaries with greatly swollen endothelial cells and an associated lympho-histiocytic and eosinophil infiltrate. The abnormal endothelial cells showed absent or greatly diminished alkaline phosphatase activity, but enhanced reactions were obtained to certain hydrolytic and oxidative enzymes as compared to normal capillary endothelium. Pseudopyogenic granuloma appears to be an entirely benign reactive condition. Its relationship to ordinary pyogenic granuloma and to subcutaneous angiolymphoid hyperplasia with eosinophilia is discussed.

Subcutaneous angiolymphoid hyperplasia with eosinophilia.

SUMMARY.— Persistent subcutaneous nodules on the head and neck with distinctive histological features of angiolymphoid hyperplasia with eosinophilia are reported in nine patients. They were all young adults and had one or more lesions ranging from 1 to 10 cm. in diameter. Apart from blood eosinophilia, there were no systemic manifestations. While some lesions persisted for several years, the condition appears to be benign. The nodules lie mainly in the sub-cutis but sometimes extend into the overlying dermis and deeply into muscle or fascia. They are composed of unencapsulated masses of angiolymphoid hyperplasia with the following components: 1. Exuberant proliferation of capillary vessels, often with imperfectly canalized masses of endothelium. 2. Massive infiltration with eosinophils and an excess of mast cells. 3. Reticulin formation but little collagenous fibrosis. 4. Lymphoreticular hyperplasia, increasing with the duration of the lesion and leading to lymphoid follicle formation in lesions of one year or more duration. The clinical and histological features suggest enough common ground for regarding subcutaneous angiolymphoid hyperplasia with eosinophilia as a distinct pathological entity. Its relation to Kimura's disease as described in Japan is discussed.

PENILE NODULES AS A MAJOR MANIFESTATION OF SUBACUTE ANGIITIS.

Introduction Polyarteritis has been associated with a variety of cutaneous manifestations. These have included urticarial, bullous, infarctive, petechial, purpuric, plaque, and nodular lesions. 1 In the periarteritic form of this disease, ie, the type affecting medium-sized muscular arteries, nodular skin lesions have been most frequently described. These lesions are characteristically evanescent, frequently pulsatile, pea sized, and may or may not be tender. They usually occur in crops and may be found along the course of an artery. These nodules are found in as many as 20% of the patients with periarteritis nodosa. 2,3 We have recently observed a patient with subacute small vessel angiitis whose unusual primary manifestation of illness has been the presence of multiple persistent nodules of his penis. Of additional interest in this case has been a relatively benign course over a five-year period. Report of a Case History. —A 33-year-old white male was first seen in

PERSISTENT NODULES IN SCABIES. A CASE REPORT WITH A REVIEW OF THE LITERATURE.

A case of scabies with persistent pruritic nodules is described. Histology, etiology, and the literature are discussed.

Responses of Human Subjects to Vaccines in Saline-in-Mineral Oil Emulsion

Summary Three groups of adult donors were inoculated with Hemophilis pertussis bacterial vaccine of exceptional antigenicity. One group of 5 donors received 3 injections of saline vaccine totalling 75 billion cells. The other groups of 5 donors each received, respectively, 30 billion and 75 billion cells emulsified in Falba and mineral oil. All 3 groups developed approximately maximal antibody responses. Seven of the 10 subjects injected with the emulsified vaccine retained palpable nodules at the injection sites for 6 to 12 months. In several instances these nodules became tender and increased in size periodically. In 6 of the 10 subjects the abscesses ruptured spontaneously or required incision. No bacteria were cultivated from the pus evacuated. Reinjection of vaccine or even of a skin test dose of agglutinogen caused rapid but evanescent focal inflammation at the sites of the persistent nodules. These focal reactions about the depôts of H. pertussis bacterial vaccine are interpreted as instances of bacterial hypersensitivity, coexistent with hypersensitivity of the Arthus type which is believed to be the basis of the pertussis skin-test. The use in human subjects of pertussis vaccine emulsified in oil in the present dosage is obviously impracticable.

THE TREATMENT OF OBSTINATE CHOREA WITH NIRVANOL

During the last fifteen years the capacity of nirvanol to produce a syndrome known as "nirvanol sickness" has been widely utilized in German clinics in the treatment of violent choreas.¹Nirvanol is phenyl-ethyl-hydantoin, an hypnotic resembling phenobarbital in its pharmacologic action, but with a five instead of a six membered ring nucleus. "Nirvanol sickness" consists of fever, rash and eosinophilia, coming on sharply in a high percentage of persons treated, usually from six to twelve days after the first administration of the drug. It has been generally observed that following the appearance of this syndrome the course of the disease is shortened. Recently similar reports have come from England.²Poynton and Schlesinger³have even observed the disappearance of persistent rheumatic nodules, accompanied by a lowering of temperature and quieting of the pulse rate, in four patients with "subacute rheumatism" who were given the usual course of nirvanol

PERSISTENT NODULES IN SCABIES

Our purpose in this paper is to call attention to a complication of scabies consisting of the occurrence and persistence, after thorough treatment, of pruritic pea-sized nodular lesions. These persistent nodules occurred in five cases of scabies which we have observed during the past year and a half. The lesions have varied from the size of a small to that of a large pea, have been red or brownish red, and have always been definitely infiltrated, and where the skin was loose as on the penis, they could easily be picked up between two fingers. In all cases they were intensely pruritic. Many of the penile lesions showed a definite central depression, and in several cases they seemed to subside only to recur in the same and other locations. With the following exceptions, a careful search of the voluminous literature pertaining to scabies failed to reveal any mention of