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Skin tumors developing from "alien" cellular elements
Some skin neoplasms come from cells whose precursors are located in various tissues of the body, and these cells themselves are “alien” to the skin and are adapted to vital activity under the conditions of this organ. An example is the white growth epidermocytes (Langerhans cells). They arise from precursors located in the bone marrow, and then, being already in a differentiated (mature) form, move freely from the skin to the local lymph nodes along the skin lymphatic system. Other examples: T-lymphocytes, which are usually found in small quantities in the dermis or epidermis; mast cells of the skin, also formed from the precursors in the bone marrow. The proliferative diseases discussed in this section — histiocytosis X, cutaneous T-cell lymphoma and mastocytosis — are the primary skin diseases that develop, respectively, from the three cell types. Histiocytosis X. It is described in detail in Chapter 13. In the skin, histiocytosis manifests itself in many forms, including single or multiple lesions, from papules and nodules to flaky erythematous plaques, which in infants may resemble lesions in seborrheic dermatitis (see above). Histologically, histiocytosis X, which affects the skin, in all its forms is accompanied by pronounced cellular infiltration. The first form is diffuse dermal infiltration of large rounded or oval cells with pale pink cytoplasm, containing moderately stained nuclei with notches or notches. The second form is represented by bundles of similar cells, gathering in small clusters, similar to granulomas. The third form is also characterized by dermal infiltration of cells with frothy cytoplasm, as in xanthoma (see above). Sometimes a different number of eosinophils is detected in the infiltrate, especially in the first form of histiocytosis X. Since the described changes in all forms of the disease are not specific, they do not have diagnostic value, therefore ultrastructural identification of elongated granules with longitudinal striations is often required (Birbeck granules; MS Birbeck). These granules are characteristic of white mature epidermocytes (Langerhans cells), of which histiocytic tumor elements (X-cells) are supposed to develop. Special immunohistochemical techniques are also used to identify cell surface markers characteristic of Langerhans cells and histiocytic X-cells. Among these markers should be called the CD1 antigenic differentiation cluster (see Chapter 5). Fungal mycosis (cutaneous T-cell lymphoma). it a group of lymphoproliferative diseases affecting the skin (see chapter 13). Initially, two types of T-cell leukemias were distinguished: fungal mycosis, which is a chronic proliferative process, and a nodular rash variant, which was called sudden fungal mycosis (mycosis fungoides d'emblee). Currently, various types of T-cell lymphoma of the skin are known, including fungal mycosis, a nodular syphilism, as well as variants of adult T-cell leukemia and lymphoma. The latter disease may have a rapid progressive course. So, fungal mycosis is a lymphoproliferative disease of T-cell nature, which primarily occurs in the skin and can be transformed into generalized lymphoma. For most patients, the disease for many years still remains localized in the skin, only in some individuals there is a rapid systemic spread of the process. This disease can occur at any age, but in most cases affects people over the age of 40. External changes in fungal mycosis look like flaky red-brown spots, plaques or mushroom nodules. For the early fungal stage, mycosis, when there is no nodal spread and internal organs are not affected, eczema-like changes are typical. Then, thick, irregular erythematous plaques appear. In the future, the development of multiple large (up to 10 cm or more in diameter) red-brown nodules occurs parallel to the systemic distribution. Sometimes ulcers appear on plaques and nodules. As a rule, many areas of the skin on the body, limbs, face and scalp are affected. In some patients, the appearance of malignant T-lymphocytes in the blood is accompanied by diffuse erythema and desquamation of the entire body surface (erythroderma). This condition is called Sezary syndrome (A.Sezary). Causes of cutaneous T-cell lymphoma are currently under investigation. It was found that the aggressive form of T-cell lymphoma is caused by infection of helper T-cells by a specific retrovirus (the causative agent of T-cell human leukemia, HTLV-I) [according to Cotran RS, Kumar V., Collins T., 1998].
This increases the likelihood that normal T-cell lymphoma can be infectious. Early-stage T-cell lymphoma is often treated topically with steroid drugs or ultraviolet radiation, with more advanced systemic therapy being shown at later stages. A distinctive histological sign of fungal mycosis is the presence of Sesari-Lutzner cells (A.Sezary, F.Lutzner). These C04 antigen-positive T-helper cells form characteristic clusters in the form of cords in the surface layer of the dermis. At the same time, individual cells penetrate into the epidermis and over time can form small clusters there, the so-called microabscesses of Lime (LMPautrier). For cells Sesari-Lutzner characteristic folded nuclear membrane; The cores have the form of twisted structures. Along with the fact that spots and plaques show pronounced infiltration of the epidermis with these cells (epidermotropism), in the more developed tumor nodes, malignant T cells often lose their tendency to epidermotropism, grow deep into the dermis and gradually disseminate the lymphatic vessels and peripheral sections of the blood system. Mastocytosis. The term "mastocytosis" refers to a group of rare diseases that are characterized by a high content of mast cells in the skin (mast cells, or labrocytes). Sometimes a similar picture is noted in other organs. The localized skin form of the disease, which affects mainly children and makes up more than 50% of all cases of mastocytosis, is called spotty mastocytosis (pigmented urticaria). In this form, multiple rashes (mastocytomas) are noted, although immediately after birth, occasional lesions occur. Approximately 10% of persons with this pathology of mast cells show the systemic nature of the disease with obese cell infiltration in many organs. More often, adults are ill, who, unlike the localized form, have a very bad prognosis. The clinical picture of mastocytosis is diverse. In case of spotted mastocytosis, multiple fat-cell infiltrates are widespread in the skin. They consist of round or oval reddish-brown unshearable papules and small plaques. Sometimes mastocytomas manifest as one or more reddish-brown nodules that can cause itching and have a blister structure. In systemic mastocytosis, those skin lesions that are similar to foci in the spotty form of the disease are expressed in infiltration of fat cells of the bone marrow, liver, spleen and lymph nodes. Many symptoms and syndromes of mastocytosis are caused by the effects of histamine, heparin and other substances released from the cytoplasmic mast cell granules as a result of degranulation. Darya syndrome (FJDarier) - a type of erythematous dermatosis - is expressed in focal edema and erythema (sometimes blisters) that occur when combing the affected skin. Dermatographism - a focal form of edema of the skin, it resembles a zone of redness that occurs in normal skin when injected with a sharp instrument. Itching and hyperemia result from the use of certain foods, changes in temperature, alcohol and certain drugs (morphine, codeine, aspirin). There are watery nasal discharge (rhinorrhea), rarely gastrointestinal or nasal bleeding, which may be due to the anticoagulant effect of heparin. There are bone pains (the result of involvement in the process of osteoblasts and osteoclasts). In both spotted mastocytosis and single mastocytoma, histological changes range from clusters of small numbers of spindle-shaped and stellate mast cells located around the superficial blood vessels of the dermis to huge numbers of round or oval mastocytes densely located in the upper and middle layers of the dermis. In addition, fibrosis and edema, as well as a small number of eosinophils, are noted in varying degrees. With normal staining of histological sections (hematoxylin and eosin), mast cells are not easily distinguished from lymphocytes. In order to reliably reveal cytoplasmic granules in them, one should use metachromasia reactions in toluidine blue stains or according to the Giemsa method. However, in the case of pronounced mast cell degranulation, it is difficult to recognize these cells in histological sections even with the help of the indicated methodological approaches, then electron microscopy should be used.
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Skin tumors developing from "alien" cellular elements
- The value of connective tissue elements, endothelial cells and blood cell elements in the mechanisms of inflammation
The role of connective tissue elements in the development of the inflammatory process is extremely important. Sometimes inflammation is identified with the response of histion, the structural unit of connective tissue to the action of the altering factor. As you know, connective tissue consists of cells, fibers and the main substance. Specific fixed cells are fibroblasts and reticular cells,
- Tumors developing from vessels
This group includes tumors significantly differing from each other both in structure and in biological potencies. We will focus on the most common vascular tumors, which, according to the modern international classification, are usually divided into benign, intermediate, and malignant tumors. The basis of this separation are three
- INDICATIONS FOR PHOTODYNAMIC THERAPY OF BASAL CELL SKIN CANCER USING APPLICATION FORMS OF PHOTOSENSITIZER
Kolbina M.S. **, Volgin V.N. *, Sokolova T.V. ** Main Military Clinical Hospital named after acad.N.N. Burdenko *; State Institute of Postgraduate Medical Education of the Ministry of Defense of the Russian Federation **, Moscow Objective: To develop methods of photodynamic therapy using the photodithazine photosensitizer application form in various clinical forms and localizations of basal cell carcinoma
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Sokolovskaya A. A. *, Volgin V.N. **, Sokolova T.V. * State Institute of Postgraduate Medical Education of the Russian Federation; The main military clinical hospital named after acad. N.N. Burdenko **, Moscow In recent years there has been a steady increase in the incidence of malignant skin neoplasms (OCD). A special place among them is occupied by basal cell skin cancer (BKRK), to which
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- Tumors of the glands of the skin and hair follicle
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- Neoplasia (tumors) of the skin
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