British Journal of Dermatology (1976) 95, Supplement 14, 9.
SUMMARIES OF PAPERS
Nerve supply as a stimulator of the growth of tissues, including skin I.W.WHIMSTER Department of Dermatology, St Thomas's Hospital, London
It is common for benign excesses of cutaneous tissues in man to be associated with excessive innervation of the tissue concerned. Examples to be demonstrated include certain 'benign tumours' supranumerary digits, traumatic neuromas, etc. These simple observations inevitably raise the question of which is the cause and which the effect. Does a benign excess of tissue somehow attract to it an increased nerve supply, or does increased innervation on occasions itself promote excessive tissue growth ? It will be shown that in lower vertebrates the nerve supply to tissues, including skin, has a very definite role in promoting the growth of the tissues supplied. Examples to be demonstrated will show: (1) That the regeneration of amputated tails and digits is dependent on an intact nerve supply. (2) That there is a quantitative relationship between the neural excess and the amount of tissue growth induced by it. (3) That supernimierary tails can be caused to develop by diverting the transected spinal cord to the floor of a skin wound. (4) That 'benign tumours' of skin develop at sites where groups of isolated viable nerve cells have been implanted in the floor of skin wounds. In these animal models it would seem that excess growth of skin (and other) tissues occurs secondarily in response to increased innervation, and that if innervation is reduced regenerative growth is deficient. The implication is that the nerve supply is the cause and the tissue growth the eflfect.
Enzyme cytochemical and immunocytological characterization of cutaneous lymphomas O.BRAUN-FALCO AND G.BURG Dermatology Clinic, University of Munich, Germany
It was the purpose of our study to provide a functional approach to the characterization and classification of cutaneous lymphomas by means of enzyme cytochemical methods (nonspecific esterases.
10
Summaries of papers
chloracetate esterase, acid and alkaline phosphatase, leucine aminopeptidase, peroxidase) and immunocytological methods (immunoglobulin bearing (B) lymphocytes, spontaneous rosette forming and anti T cell globulin bearing (T) lymphocytes) to differentiate cells harvested from cutaneous lymphomatous infiltrates. The cellular infiltrates have been evaluated qualitatively and quantitatively in 164 skin biopsies and 61 suspensions from homogenized tissue in 88 patients with the following diseases: benign ljonphocytoma and benign inflammatory reactions from insect bites, specific skin infiltrates in chronic lymphatic leukaemia, specific skin infiltrates in monocytic leukaemia, mycosis fungoides, Sezary's syndrome, reticulosis and reticulosarcoma. Differentiation and classification of these diseases has been achieved based on their typical enzymecytochemical and immunocytological patterns.
Mycosis fungoides with leukaemic transformation CHRISTINE I.HARRINGTON Rupert Hallam Department of Dermatology, Hallamshire Hospital, Sheffield
An illustrated clinical case of a patient with mycosis fungoides who presented in November 1973, age 57 years, and died of leukaemia in November 1975. Histology ofthe skin confirmed the clinical diagnosis of 'plaque stage' mycosis fungoides. Detailed investigations, including bone marrow examination, chest tomography, liver and spleen scan and lymphography, were normal. Topical steroids and ultra-violet light controlled the skin lesions until May 1974, when prednisolone and cyclophosphamide were given, followed by intermittent radiotherapy to painful lesions. Marked deterioration in September 1975 necessitated treatment with anti-mitotics in conjunction with the Department of Oncology. In November 1975 the patient developed a streptococcal septicaemia, a dramatic fall in platelet count and, over a period of 3 days, a rise in white cell count from ii,ooo/mm^ to 25,000/mm^. He died 5 days later with a white count of 40,000/nim^ of which 57% were blast cells and 7% were myelocytes. The mononuclear cells had a primitive, bizarre morphology. Post-mortem examination revealed mycosis cell infiltrates in the liver, spleen, thymus, lymph nodes, skin and bone marrow. A definite diagnosis of mycosis fungoides, with exclusion of systemic involvement at the onset, was achieved. Bone marrow involvement and leukaemic transformation in mycosis fungoides are rare. Was this due to marrow infiltration producing a 'spill-over' of primitive cells into the blood, did a true leukaemic transformation occur and was chemotherapy a factor in producing the leukaemic change ?
SUMMARIES OF PAPERS
Nerve supply as a stimulator of the growth of tissues, including skin I.W.WHIMSTER Department of Dermatology, St Thomas's Hospital, London
It is common for benign excesses of cutaneous tissues in man to be associated with excessive innervation of the tissue concerned. Examples to be demonstrated include certain 'benign tumours' supranumerary digits, traumatic neuromas, etc. These simple observations inevitably raise the question of which is the cause and which the effect. Does a benign excess of tissue somehow attract to it an increased nerve supply, or does increased innervation on occasions itself promote excessive tissue growth ? It will be shown that in lower vertebrates the nerve supply to tissues, including skin, has a very definite role in promoting the growth of the tissues supplied. Examples to be demonstrated will show: (1) That the regeneration of amputated tails and digits is dependent on an intact nerve supply. (2) That there is a quantitative relationship between the neural excess and the amount of tissue growth induced by it. (3) That supernimierary tails can be caused to develop by diverting the transected spinal cord to the floor of a skin wound. (4) That 'benign tumours' of skin develop at sites where groups of isolated viable nerve cells have been implanted in the floor of skin wounds. In these animal models it would seem that excess growth of skin (and other) tissues occurs secondarily in response to increased innervation, and that if innervation is reduced regenerative growth is deficient. The implication is that the nerve supply is the cause and the tissue growth the eflfect.
Enzyme cytochemical and immunocytological characterization of cutaneous lymphomas O.BRAUN-FALCO AND G.BURG Dermatology Clinic, University of Munich, Germany
It was the purpose of our study to provide a functional approach to the characterization and classification of cutaneous lymphomas by means of enzyme cytochemical methods (nonspecific esterases.
10
Summaries of papers
chloracetate esterase, acid and alkaline phosphatase, leucine aminopeptidase, peroxidase) and immunocytological methods (immunoglobulin bearing (B) lymphocytes, spontaneous rosette forming and anti T cell globulin bearing (T) lymphocytes) to differentiate cells harvested from cutaneous lymphomatous infiltrates. The cellular infiltrates have been evaluated qualitatively and quantitatively in 164 skin biopsies and 61 suspensions from homogenized tissue in 88 patients with the following diseases: benign ljonphocytoma and benign inflammatory reactions from insect bites, specific skin infiltrates in chronic lymphatic leukaemia, specific skin infiltrates in monocytic leukaemia, mycosis fungoides, Sezary's syndrome, reticulosis and reticulosarcoma. Differentiation and classification of these diseases has been achieved based on their typical enzymecytochemical and immunocytological patterns.
Mycosis fungoides with leukaemic transformation CHRISTINE I.HARRINGTON Rupert Hallam Department of Dermatology, Hallamshire Hospital, Sheffield
An illustrated clinical case of a patient with mycosis fungoides who presented in November 1973, age 57 years, and died of leukaemia in November 1975. Histology ofthe skin confirmed the clinical diagnosis of 'plaque stage' mycosis fungoides. Detailed investigations, including bone marrow examination, chest tomography, liver and spleen scan and lymphography, were normal. Topical steroids and ultra-violet light controlled the skin lesions until May 1974, when prednisolone and cyclophosphamide were given, followed by intermittent radiotherapy to painful lesions. Marked deterioration in September 1975 necessitated treatment with anti-mitotics in conjunction with the Department of Oncology. In November 1975 the patient developed a streptococcal septicaemia, a dramatic fall in platelet count and, over a period of 3 days, a rise in white cell count from ii,ooo/mm^ to 25,000/mm^. He died 5 days later with a white count of 40,000/nim^ of which 57% were blast cells and 7% were myelocytes. The mononuclear cells had a primitive, bizarre morphology. Post-mortem examination revealed mycosis cell infiltrates in the liver, spleen, thymus, lymph nodes, skin and bone marrow. A definite diagnosis of mycosis fungoides, with exclusion of systemic involvement at the onset, was achieved. Bone marrow involvement and leukaemic transformation in mycosis fungoides are rare. Was this due to marrow infiltration producing a 'spill-over' of primitive cells into the blood, did a true leukaemic transformation occur and was chemotherapy a factor in producing the leukaemic change ?
