Occupational argyria; light and electron microscopic studies and X-ray microanalysis

Microscopic studies have been performed on skin biopsies from five patients with occupational argyria. Small brown-black granules were present in the dermis on light microscopy and were intensely refractile with dark-field illumination. Electron microscopy showed that the granules were electron-dense, round or oval in shape and varied in size from 30 nm to 100 nm. They were most numerous in relation to the basal lamina of the eccrine sweat glands, but were also present in relation to the basal lamina of the epidermis and dermal elastic fibres. X-ray microanalysis confirmed that many of the granules contained silver and sulphur. However, selenium, mercury, titanium and iron were also identified and it is probable that these elements were deposited in the skin also as a result of occupational exposure.     

Chrysiasis: electron microscopic studies and X-ray microanalysis

A case of chrysiasis was studied by light and electron microscopy, X-ray microanalysis, and neutron activation analysis. The microscopic examination showed gold deposits in the perivascular areas in macrophages, and by electron microscopy studies gold was found exclusively in the phagolysosomes (aurosomes) indifferent ultrastructural patterns. The X-ray microanalysis confirmed that the phagolysosome contained gold. The concentration in light-exposed skin was 750–770 p.p.m. measured by the neutron activation analysis.     

Tattoos: light and transmission electron microscopy studies with X-ray microanalysis

Although the microscopic appearance of tattoos is well described, in many instances the nature of the pigment remains obscure. The presence of a specific pigment is sometimes implied from the colour of the tattoo and when sensitivity is present by a positive patch test (Cronin, 1980). Analysis of the pigment in tattoos has occasionally been described using techniques such as laser microprobe analysis and selected area diffraction studies (Silberberg & Leider, 1970). When made available from the tattooist the dye can also be analysed using X-ray fluorescence spectrometry (Clark & Black, 1979). Electron microscopy with X-ray microanalysis can detect numerous elements with certainty but surprisingly the technique has rarely been applied to tattoos. Taaffe, Knight & Marks (1978) identified mercury using scanning electron microscopy and X-ray microanalysis but due to the small amounts present there was uncertainty as to whether the metal represented contamination. This paper describes the use of X-ray microanalysis in the investigation of tattoos and correlates the findings with light and transmission electron microscopy appearances. The theoretical aspects of the technique have been described previously (Bleehen et al., 1981).     

Syringocystadenoma papilliferum: light and electron microscopic studies.

Light microscopic and electron microscopic studies of a lesion displaying a typical histopathological picture of syringocystadenoma papilliferum (S.P.) are reported. Light microscopic serial sections showed that the tumor parenchyma extended to the epithelium just above the intrafollicular sebaceous duct. The tumor thus presumably develops from the epithelial region corresponding to the intrafollicular duct of the apocrine sweat gland. Electron microscopy revealed a non-keratinized intracytoplasmic cavity and intercellular canaliculi apparently formed as a continuation of this cavity. Keratinized cells were absent from the glandular and duct epithelium and even from the superficial epithelial portion of acanthotic areas. Neither myoepithelial cells nor secretory granules were identified in areas showing tubular, glandular, or sinusoidal structures. It was concluded that the tumor differentiates towards both the intrafollicular and intradermal duct of the embryonic apocrine sweat gland apparatus.     

Localized lipodystrophy with panniculitis: light and electron microscopic studies

A 41-year-old woman with localized lipodystrophy histologically showed lymphohistiocytic inflammation within adipose tissue at the periphery and loss of adipose tissue in the center of the lesion. Ultrastructurally, various degrees of lipophagocytosis by macrophages and giant cells were seen, starting with the projection of cytoplasmic processes into the fat droplet and engulfing pieces of the fat droplet which finally were digested. Laboratory investigations revealed a high serum gamma-globulin level and a positive antinuclear antibody, suggestive of a connective tissue disease or autoimmune disease.     

Farber''s lipogranulomatosis in siblings: light and electron microscopic studies

Two cases of Farber's lipogranulomatosis in siblings are reported. The clinical features included contractures of the limbs with swelling of the joints and subcutaneous nodules and erythematous infiltrated plaques. On histology there were many large foam cells in the dermis, and electron microscopy showed numerous large cells with round cytoplasmic lamellar and microtubular bodies.     

Microcystic adnexal carcinoma--a light and electron microscopic studies

Microcystic adnexal carcinoma (MAC) in a 48-year-old Japanese male was studied. A firm nodule had appeared on the right side of his upper lip at the age of 38 years and then had gradually enlarged. Light microscopic examinations revealed numerous strands and islands of basaloid cells and keratinous cysts with desmoplastic stroma in the dermis and subcutaneous tissue. Some keratinous cysts showed early calcification and some contained pilar structures. Clear cells resembling sebaceous gland cells were observed in the strands of tumor cells connecting the keratinous cysts. In the middle dermis, there were small ductal structures containing amorphous eosinophilic material. Immunoperoxidase staining for carcinoembryonic antigen was focally positive in the lumina of small ducts, on the ductal lining surface of tumor cells, and in the contents of keratinous cysts. Electron microscopic examinations revealed tumor cells resembling non-keratotic keratinocytes, and containing tonofilaments, mitochondria, and vacuoles. In some parts, tumors were differentiated to various types of sebaceous gland, sweat duct, or sweat secretary segments. Sebaceous gland cells contained lipid droplets and glycogen. Tumors differentiated to sweat duct had a marked similarity to embryo eccrine duct in the lower epidermis because of the presence of multivesicular dense bodies and periluminal filamentous zones and the absence of myoepithelial cells. Tumors differentiated to sweat secretary segments had a similarity to embryo eccrine secretary segments because of the absence of multivesicular dense bodies, periluminal filamentous zones and myoepithelial cells.     

Red tattoo reactions: X-ray microanalysis and patch-test studies

Eighteen patients who developed cutaneous reactions to red tattoos were studied to identify the chemicals responsible for the reactions to modern red tattoo pigments. Biopsies from the tattoos were examined histologically and the chemical composition of the red pigments was analysed by X-ray microanalysis. A variety of metallic elements including aluminium, iron, calcium, titanium, silicon, mercury and cadmium were detected. Patch tests were performed to the relevant chemicals in nine cases, and only one patient reacted to mercury. This study demonstrates that although reactions to mercury still occur, other red dyes containing a variety of inorganic pigments may provoke a cutaneous inflammatory response.     

Colloid milium: light and electron microscopic investigations

A case of colloid milium (‘juvenile type’) is presented. Histochemically the colloid material showed the well known similarity to amyloid where especially in the upper portions of the colloid immunoglobulin and complement depositions could be found. Fibrin was demonstrated predominantly in the periphery of individual colloid islands. Electron microscopically, colloid exhibited a fibrillary structure. On the surface of the islands as well as enclosed within the colloid material numerous desmosome-like structures could be visualized and sometimes also nuclear remnants were present. In circumscribed areas a fibrillary transformation of keratinocytes was observed. On the basis of these findings it is concluded that colloid represents tonofilament-like material and therefore is of epidermal origin.     

Acquired cutis laxa (generalized elastolysis): light and electron microscopic studies.

The case is described of a 44-year-old man with acquired cutis laxa. The primary clinical manifestation was an erythema of the chest. Gradually there developed persistent circumscribed lesions in other areas of the skin, spreading into large erythematous plaques with loose skin. Slight restrictive ventilatory insufficiency, elongation of the vocal cord and diverticulosis of the colon were also found, indicating a chronic and widespread disorder. Skin biopsies showed diminution and degeneration of the elastic fibres. The light-microscopic features were subdivided in relation to the various skin manifestations. Ultrastructure of the skin showed various amounts of electron-dense, amorphous material and loosely bound microfibrils in and around elastic and collagen fibres as well as some microfibrils with knobs in the interfibrouer, were found normal. It is suggested that the first changes in the elastic fibres induced an inflammatory response and mild mucinous changes of the collagen fibres. Furthermore elastic fibres seemed to be replaced by newly formed collagen.     

Dyskeratotic degeneration of epidermal cells in pityriasis rosea: light and electron microscopic studies

We studied biopsies from twenty-nine patients with pityriasis rosea. All specimens showed features of subacute or chronic dermatitis as previously reported, but sixteen cases (55%) had dyskeratotic cells within the epidermis. Ultrastructurally, these cells contained an aggregation of tonofilaments, many vacuoles and intracytoplasmic desmosomes. Previously, only non-speci fic histological changes had been described in pityriasis rosea, but the presence of dyskeratotic cells seems to be a significant feature.     

Silica granuloma: scanning electron microscopy and energy dispersive X-ray microanalysis.

A 46-year-old woman had 1-month-old erythematous papules on the left elbow and both knees where acupuncture with gold needles had been performed twenty years earlier. She also had a 2-month-old pruritic scar lesion on the nape. Histopathologic findings showed sarcoidal granulomas. The presence of silica components in the granulomas was confirmed by scanning electron microscopy (SEM) of the lesion on the nape and energy dispersive X-ray microanalysis (EDXA) of the lesions on the nape and the left elbow. We suggest that acupuncture with gold needles may be one cause of silica granuloma.     

Kaposi's sarcoma: a light and electron microscopic study

A patient with diabetes mellitus who developed the typical classic lesions of Kaposi's sarcoma is described. Our patient presented with a reddish-purple papulonodular lesion on the right foot of five months' duration. A skin biopsy specimen showed a proliferation of spindle cells forming numerous vascular slits and a diffuse extravasation of erythrocytes. The patient's sera was negative for human immunodeficiency virus (HIV) antibodies and cytomegalovirus (CMV) antibodies. Ultrastructural examination demonstrated fibroblast-like spindle cells phagocytosing and digesting red blood cells to form vascular spaces. The patient died, due to gastrointestinal hemorrhage, and the autopsy revealed an extensive visceral involvement of Kaposi's sarcoma.     

Porokeratoses: immunohistochemical, light and electron microscopic evaluation

Punch biopsy specimens of 14 patients with porokeratosis of Mibelli (n = 1), disseminated superficial porokeratosis (n = 6), disseminated superficial actinic porokeratosis (n = 4), porokeratosis plantaris, palmaris et disseminata (n = 2), and punctate porokeratosis (n = 1) were obtained for light and electron microscopy for evaluation of possible differences between these clinical variants. Langerhans cells in close contact with early degenerating keratinocytes could be observed in the epidermis. To study the cellular composition of the epidermal inflammatory infiltrate immunohistochemistry was performed. These studies demonstrated that the predominant cell type in these infiltrates are helper T cells, intermingled with Leu-6+ Langerhans cells. Despite the clinical variation and possible different etiologic or triggering mechanisms, the immunohistochemical and morphologic changes in all types of porokeratosis are the same and seem to represent a uniform reaction pattern.     

Lichen nitidus: electron microscopic and immunofluorescence studies

Skin biopsies from a patient suffering from lichen nitidus were studied by electron microscopy and immunofluorescence studies. Complete disintegration of the stratum basale in the central area of the lesion and signs of acantholysis in the border area were found. In the central part of the lesion the dermo-epidermal junction was severely damaged in most places. In the dermal infiltrate, macrophages and lymphocytes were found with a considerable representation of Sézary cells, not previously reported in lichen nitidus. The ultrastructural changes are identical with those found in lichen planus. No in vivo bound immunoglobulins, fibrinogen, or complement C3 were found.     

Electron microscopic X-ray microanalysis of metals deposited in oral mucosa.

A 35-year-old woman exhibited bluish-brown discoloration of her buccal mucosa suggesting malignant melanoma. Histopathological examination revealed that the pigment was not melanin but caused by metal deposits. Electron microscopically, metallic particles were located on the lamina densa of basal laminae at mucosal epithelium, nerve fibers, and blood vessels and on the microfilaments of elastic fibers as well as in macrophages and fibroblasts. Electron microscopic point X-ray microanalysis revealed that these metallic particles were composed of Ag, Se, Fe, Co, Cu, and S. Analysis suggests that these metals were derived from dental amalgam and that the discoloration was caused by amalgam tattoo.     

Acrodermatitis chronica atrophicans: A light and electron microscopic study

Degeneration of the elastica and collagen fibres in skin biopsies from patients with acrodermatitis chronica atrophicans was studied with light and electron microscopy. Elastic fibres were involved in the infiltrative stage while the elastin plexus was still present. In the atrophic phase, only fragments of elastic and oxytalan fibres were seen and the elaunin plexus was absent. Some collagen fibres were surrounded by osmiophilic material. In all biopsies, myelin sheaths were collapsed without axon structures. Spirochetes could be demonstrated in 69% of the biopsies and were most numerous in infiltrative and nodular lesions. The loss of elasticity of the skin in the atrophic phase may be caused by the destruction of both elastic and elastin fibres.     

Cold urticaria with vasculitis: report of a case with light and electron microscopic, immunofluorescence and pharmacological studies

An unusual form of essential acquired cold urticaria occurring in a 30-year-old woman is reported. Exposure of the skin to cold produced immediate wealing and angio-oedema with subsequent deep bruising, and severe systemic symptoms. Light microscopic, ultrastructural and immunofluorescence studies of serial biopsies from the cold-evoked skin lesions established a time course for the histological events occurring during the evolution of the inflammation. The appearance of complement (C3) in dermal blood vessels preceded the deposition of fibrin and immunoglobulin and obvious mast-cell degranulation. These secondary changes accompanied a perivascular infiltrate of mixed inflammatory cells and lysis of both neutrophil and eosinophil leukocytes. Later, disruption of vascular endothclium was notable. Elevated histamine levels in venous blood draining a cold-challenged limb indicated that histamine was released, possibly from skin mast cells, during the development of the urticaria.