Daniel J Santa Cruz - Academia.edu (original) (raw)
Papers by Daniel J Santa Cruz
Archives of Dermatology, 1994
Are dermatologists greedy? A better question: are doctors greedy? The most relevant question is t... more Are dermatologists greedy? A better question: are doctors greedy? The most relevant question is this: why is the subject of physician greed ignored by organized medicine? Certainly, the public talks about physician greed. "Fraud and Abuse Are Milking Medicare" runs the headline in a recent magazine article that featured the subtitle, "Dermatologists Removes a Simple Growth and Bills for Multiple Growths." The question remains: why, despite the present uproar over escalating medical care costs, does the medical profession fail to engage the issue of inappropriate reimbursement? This article explores some of the reasons and possible remedies for our diffidence.
Human Pathology, 1982
The authors examined the histopathology of cutaneous involvement in 31 cases of nonleprous mycoba... more The authors examined the histopathology of cutaneous involvement in 31 cases of nonleprous mycobacterial infection. Cases include three patients with Mycobacterium kansasii infection, two with M. fortuitum infections, and one each with M. marinum and M. chelonei infections, as well as 18 with M. tuberculosis infections. In the remainder, species were not identified. The histopathologic picture was variable and often did not suggest mycobacterosis. The authors identified seven basic pathologic patterns of skin involvement: 1) abscess, 2) well-formed (tuberculoid) granulomas, 3) diffuse histiocytic infiltration, 4) panniculitis, 5) nonspecific chronic inflammation, 6) naked (sarcoidal) granulomas, and 7) rheumatoid-like nodules. Intermediate forms were also found. Some cases showed adnexal or epidermal involvement, while others showed variably distributed dermal infiltration. The results indicate that a wide variety of cutaneous, clinical, and histologic guises may be assumed by mycobacterial infections in normal and immunocompromised hosts.
Journal of Infection, 1981
Several points can be made from analysis of the published cases of cutaneous mycobacteriosis and ... more Several points can be made from analysis of the published cases of cutaneous mycobacteriosis and those in our series: 1) mycobacterial cutaneous infections are probably more common than is reported-we collected 34 cases over a 10-year period; 2) most patients with cutaneous infections caused by nontuberculous mycobacteria have significant underlying disease; 3) there is a relative lack of classic histologic features in patients with cutaneous mycobacteriosis, and there appear to be diverse forms of clinical presentation; 4) a high index of suspicion is needed in evaluating patients with possible cutaneous mycobacteriosis, and appropriate cultures must be done to establish the diagnosis. In attempting to provide a practical classification of cutaneous mycobacteriosis which includes infection by nontuberculous mycobacteria, we propose the following grouping, which uses simple terms, avoids confusing nomenclature, and incorporates pathophysiologic descriptions and prognostic information: 1) Mycobacteriosis caused by inoculation from an exogenous source. 2) Cutaneous mycobacteriosis caused by spread from an endogenous source. Contiguous spread originates most often with osteomyelitis, but also occurs through autoinoculation of the perirectal, oral, or vaginal skin as organisms are passed or expectorated from pulmonary or genitourinary tuberculosis. 3) Cutaneous mycobacteriosis caused by hematogenous spread. This group includes lupus vulgaris, nodules and abscesses, and acute disease with hemorrhagic pustules. Some mycobacterioses will be difficult to classify when inoculation or hematogenous spread cannot be ruled out. However, the system of classification we have proposed should help clinicians understand and diagnose the diverse forms of cutaneous mycobacterial infections.
Journal of Cutaneous Pathology, 1979
An extensive congenital melanocytic nevus is described which, in its deeper portion, had striking... more An extensive congenital melanocytic nevus is described which, in its deeper portion, had striking neurofibromatous features. At the dermal subcutaneous junction, there were prominent subendothelial collections of nevus cells in large veins. Similar findings have been described in neurofibromatosis. The apparent relationship of these two disorders both histologically and clinically suggests a histogenetic relationship between nevus and Schwann cells.
Journal of Cutaneous Pathology, 1981
Two cases of epidermoid carcinoma in situ of the skin, one with mucinous metaplasia and the other... more Two cases of epidermoid carcinoma in situ of the skin, one with mucinous metaplasia and the other with sebaceous metaplasia, are reported. These unique cases suggest a spectrum of differentiation possible by neoplastic epidermal keratinocytes, which may help in the understanding of the histogenesis of certain skin neoplasms.
Journal of Cutaneous Pathology, 1980
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Journal of Cutaneous Pathology, 1977
A case of pigmented storiform neurofibroma (PSN) is presented. The lesion was present in the shou... more A case of pigmented storiform neurofibroma (PSN) is presented. The lesion was present in the shoulder of a 7-year-old black girl and recurred after 10 years. The characteristic storiform pattern and melanin production are the relevant features for histologic diagnosis. The histogenesis and taxonomic position of this lesion is discussed with emphasis on its relationship with dermatofibrosarcoma protuberans (DFSP) and cellular blue nervus.
Dermatology, 1977
25 cases of atypical sweat duct proliferation in association with cutaneous tumors are described.... more 25 cases of atypical sweat duct proliferation in association with cutaneous tumors are described. 20 of these were keratoacanthomas. The compression of the duct either in its dermal or intraepidermal portion is considered to be the etiology. Similar changes are seen with decubitus ulcer and stasis dermatitis. Atypical sweat duct hyperplasia may be useful as an extra aid in the differentiation of keratoacanthoma from well-differentiated squamous cell carcinoma.
Cancer, 1979
A breast tumor is described which presented as an exophytic mass, and which by both light and ele... more A breast tumor is described which presented as an exophytic mass, and which by both light and electron microscopic examination had a biphasic histologic composition. In the superficial area adjacent to the epidermis, it showed tubular differentiation similar to a cutaneous tubular apocrine adenoma and salivary basal cell adenoma, and, in the deeper portion, it had the characteristic features of adenoid cystic carcinoma. Their possible interrelationships are discussed, and mammary adenoid cystic carcinoma is briefly reviewed.
Cancer, 1978
Lymphangioma circumscriptum, a rare long-term complication of chronic lymphedema, has been descri... more Lymphangioma circumscriptum, a rare long-term complication of chronic lymphedema, has been described only twice following radical mastectomy. The case discussed in this report developed 25 years after radical mastectomy and radiation therapy. Both this condition and lymphangiosarcoma, its malignant counterpart, may arise in lymphedematous extremities regardless of the etiology of the lymphatic obstruction.
Cancer, 1981
Seventeen cases are reported of a variety of cutaneous fibrous histiocytoma, which we have design... more Seventeen cases are reported of a variety of cutaneous fibrous histiocytoma, which we have designated as aneurysmal ("angiomatoid") fibrous histiocytoma. These lesions differ from the classical cutaneous fibrous histiocytoma in both their clinical presentation and pathologic features. Clinically, they may be larger than the usual cutaneous fibrous histiocytoma, are blue, black, or dark red, and have a cystic consistency. They are most commonly located on the extremities and may be associated with symptoms of pain and rapid growth. The clinical diagnosis of fibrous histiocytoma is seldom considered in the differential diagnosis, which may include malignant melanoma, hemangioma, neurofibroma, and nonspecific cyst. Histologically, the lesions are characterized by the presence of large, blood-filled tissue spaces, which, at times, account for up to one half their size. These spaces lack an endothelial lining, being surrounded and lined by histiocytes, many of which contain hemosiderin pigment, fibroblasts, and foam cells. The solid portions of the tumor have the usual features of a cutaneous fibrous histiocytoma. This "angiomatoid" lesion is closely allied to what has been termed "hemosiderin histiocytoma," which appears to be a precursor stage in its formation. The presence of extravasated erythrocytes in combination with a spindle-cell stroma may lead to an erroneous diagnosis of Kaposi's sarcoma. This cutaneous tumor has architectural and cytologic similarities to its malignant soft tissue counterpart recently described as angiomatoid malignant fibrous histiocytoma. However, unlike the latter, the cutaneous lesion is benign and lacks the prominent inflammatory infiltrate, pleomorphic appearance, and systemic manifestations of its soft tissue counterpart. The distinctive clinical and pathologic features of the cutaneous lesion serve to separate it as a specific variant of the cutaneous fibrous histiocytomas.
Archives of Dermatology, 1991
Archives of Dermatology, 1991
Archives of Dermatology, 1981
Page 1. Hidradenoma Papilliferum of the Eyelid Daniel J. Santa Cruz, MD; Philip G. Prioleau, MD; ... more Page 1. Hidradenoma Papilliferum of the Eyelid Daniel J. Santa Cruz, MD; Philip G. Prioleau, MD; Morton E. Smith, MD Hidradenoma papilliferum (papillary hidradenoma) is a benign, usually asymptomatic neoplasm with apocrine ...
The American Journal of Dermatopathology, 1986
We report seven cases of atypical cutaneous fibrous histiocytoma, which appears to be a variant o... more We report seven cases of atypical cutaneous fibrous histiocytoma, which appears to be a variant of cutaneous fibrous histiocytoma (dermatofibroma). These patients are all middle-aged women (mean, 39 years old) with small nodules occurring on the trunk and limbs. The lesions are characterized by marked focal cellular atypia, the absence of mitoses, and xanthomatous changes in both mononuclear and giant cells--all found within a small dermal nodule (approximately 1 cm) separated from an acanthotic epidermis by a Grenz zone. Their benign nature is demonstrated by the absence of recurrence, even after 9 years follow-up time.
The American Journal of Dermatopathology, 1990
Three cases of cutaneous epithelioid angiosarcoma with solid pattern were studied by immunohistoc... more Three cases of cutaneous epithelioid angiosarcoma with solid pattern were studied by immunohistochemistry and electron microscopy. The neoplasms followed a slow, protracted course with local recurrences and regional lymph node metastases. The correct histological diagnosis was delayed by the close histological simulation of carcinomas, misleading ultrastructural findings, and largely negative immunohistochemical markers. Two of the patients have been followed for at least 48 months and are still alive. Some seemingly undifferentiated epithelioid angiosarcomas may entail a better prognosis than originally suspected.
Journal of the American Academy of Dermatology, 1992
Angioendotheliomatosis has recently been separated into two types. Malignant angioendotheliomatos... more Angioendotheliomatosis has recently been separated into two types. Malignant angioendotheliomatosis is a lymphoma in which the neoplastic cells accumulate in vascular lumens. Reactive angioendotheliomatosis is a proliferation of capillaries that is less well characterized. Our purpose was to describe the clinical and histopathologic features of three cases of reactive angiomatosis in patients with cryoproteinemia. Clinical and histologic data were correlated. Immunoperoxidase staining and electron microscopy were used in the histologic evaluation. All three cases showed tufts of capillaries with luminal deposits of cryoproteins. Immunohistochemical studies showed that the cellularity of the tufts was primarily caused by a proliferation of pericytes. Cryoproteinemia can cause angiomatosis that simulates a vascular neoplasm.
Archives of Dermatology, 1994
Are dermatologists greedy? A better question: are doctors greedy? The most relevant question is t... more Are dermatologists greedy? A better question: are doctors greedy? The most relevant question is this: why is the subject of physician greed ignored by organized medicine? Certainly, the public talks about physician greed. "Fraud and Abuse Are Milking Medicare" runs the headline in a recent magazine article that featured the subtitle, "Dermatologists Removes a Simple Growth and Bills for Multiple Growths." The question remains: why, despite the present uproar over escalating medical care costs, does the medical profession fail to engage the issue of inappropriate reimbursement? This article explores some of the reasons and possible remedies for our diffidence.
Human Pathology, 1982
The authors examined the histopathology of cutaneous involvement in 31 cases of nonleprous mycoba... more The authors examined the histopathology of cutaneous involvement in 31 cases of nonleprous mycobacterial infection. Cases include three patients with Mycobacterium kansasii infection, two with M. fortuitum infections, and one each with M. marinum and M. chelonei infections, as well as 18 with M. tuberculosis infections. In the remainder, species were not identified. The histopathologic picture was variable and often did not suggest mycobacterosis. The authors identified seven basic pathologic patterns of skin involvement: 1) abscess, 2) well-formed (tuberculoid) granulomas, 3) diffuse histiocytic infiltration, 4) panniculitis, 5) nonspecific chronic inflammation, 6) naked (sarcoidal) granulomas, and 7) rheumatoid-like nodules. Intermediate forms were also found. Some cases showed adnexal or epidermal involvement, while others showed variably distributed dermal infiltration. The results indicate that a wide variety of cutaneous, clinical, and histologic guises may be assumed by mycobacterial infections in normal and immunocompromised hosts.
Journal of Infection, 1981
Several points can be made from analysis of the published cases of cutaneous mycobacteriosis and ... more Several points can be made from analysis of the published cases of cutaneous mycobacteriosis and those in our series: 1) mycobacterial cutaneous infections are probably more common than is reported-we collected 34 cases over a 10-year period; 2) most patients with cutaneous infections caused by nontuberculous mycobacteria have significant underlying disease; 3) there is a relative lack of classic histologic features in patients with cutaneous mycobacteriosis, and there appear to be diverse forms of clinical presentation; 4) a high index of suspicion is needed in evaluating patients with possible cutaneous mycobacteriosis, and appropriate cultures must be done to establish the diagnosis. In attempting to provide a practical classification of cutaneous mycobacteriosis which includes infection by nontuberculous mycobacteria, we propose the following grouping, which uses simple terms, avoids confusing nomenclature, and incorporates pathophysiologic descriptions and prognostic information: 1) Mycobacteriosis caused by inoculation from an exogenous source. 2) Cutaneous mycobacteriosis caused by spread from an endogenous source. Contiguous spread originates most often with osteomyelitis, but also occurs through autoinoculation of the perirectal, oral, or vaginal skin as organisms are passed or expectorated from pulmonary or genitourinary tuberculosis. 3) Cutaneous mycobacteriosis caused by hematogenous spread. This group includes lupus vulgaris, nodules and abscesses, and acute disease with hemorrhagic pustules. Some mycobacterioses will be difficult to classify when inoculation or hematogenous spread cannot be ruled out. However, the system of classification we have proposed should help clinicians understand and diagnose the diverse forms of cutaneous mycobacterial infections.
Journal of Cutaneous Pathology, 1979
An extensive congenital melanocytic nevus is described which, in its deeper portion, had striking... more An extensive congenital melanocytic nevus is described which, in its deeper portion, had striking neurofibromatous features. At the dermal subcutaneous junction, there were prominent subendothelial collections of nevus cells in large veins. Similar findings have been described in neurofibromatosis. The apparent relationship of these two disorders both histologically and clinically suggests a histogenetic relationship between nevus and Schwann cells.
Journal of Cutaneous Pathology, 1981
Two cases of epidermoid carcinoma in situ of the skin, one with mucinous metaplasia and the other... more Two cases of epidermoid carcinoma in situ of the skin, one with mucinous metaplasia and the other with sebaceous metaplasia, are reported. These unique cases suggest a spectrum of differentiation possible by neoplastic epidermal keratinocytes, which may help in the understanding of the histogenesis of certain skin neoplasms.
Journal of Cutaneous Pathology, 1980
Skip to Main Content. ...
Journal of Cutaneous Pathology, 1977
A case of pigmented storiform neurofibroma (PSN) is presented. The lesion was present in the shou... more A case of pigmented storiform neurofibroma (PSN) is presented. The lesion was present in the shoulder of a 7-year-old black girl and recurred after 10 years. The characteristic storiform pattern and melanin production are the relevant features for histologic diagnosis. The histogenesis and taxonomic position of this lesion is discussed with emphasis on its relationship with dermatofibrosarcoma protuberans (DFSP) and cellular blue nervus.
Dermatology, 1977
25 cases of atypical sweat duct proliferation in association with cutaneous tumors are described.... more 25 cases of atypical sweat duct proliferation in association with cutaneous tumors are described. 20 of these were keratoacanthomas. The compression of the duct either in its dermal or intraepidermal portion is considered to be the etiology. Similar changes are seen with decubitus ulcer and stasis dermatitis. Atypical sweat duct hyperplasia may be useful as an extra aid in the differentiation of keratoacanthoma from well-differentiated squamous cell carcinoma.
Cancer, 1979
A breast tumor is described which presented as an exophytic mass, and which by both light and ele... more A breast tumor is described which presented as an exophytic mass, and which by both light and electron microscopic examination had a biphasic histologic composition. In the superficial area adjacent to the epidermis, it showed tubular differentiation similar to a cutaneous tubular apocrine adenoma and salivary basal cell adenoma, and, in the deeper portion, it had the characteristic features of adenoid cystic carcinoma. Their possible interrelationships are discussed, and mammary adenoid cystic carcinoma is briefly reviewed.
Cancer, 1978
Lymphangioma circumscriptum, a rare long-term complication of chronic lymphedema, has been descri... more Lymphangioma circumscriptum, a rare long-term complication of chronic lymphedema, has been described only twice following radical mastectomy. The case discussed in this report developed 25 years after radical mastectomy and radiation therapy. Both this condition and lymphangiosarcoma, its malignant counterpart, may arise in lymphedematous extremities regardless of the etiology of the lymphatic obstruction.
Cancer, 1981
Seventeen cases are reported of a variety of cutaneous fibrous histiocytoma, which we have design... more Seventeen cases are reported of a variety of cutaneous fibrous histiocytoma, which we have designated as aneurysmal ("angiomatoid") fibrous histiocytoma. These lesions differ from the classical cutaneous fibrous histiocytoma in both their clinical presentation and pathologic features. Clinically, they may be larger than the usual cutaneous fibrous histiocytoma, are blue, black, or dark red, and have a cystic consistency. They are most commonly located on the extremities and may be associated with symptoms of pain and rapid growth. The clinical diagnosis of fibrous histiocytoma is seldom considered in the differential diagnosis, which may include malignant melanoma, hemangioma, neurofibroma, and nonspecific cyst. Histologically, the lesions are characterized by the presence of large, blood-filled tissue spaces, which, at times, account for up to one half their size. These spaces lack an endothelial lining, being surrounded and lined by histiocytes, many of which contain hemosiderin pigment, fibroblasts, and foam cells. The solid portions of the tumor have the usual features of a cutaneous fibrous histiocytoma. This "angiomatoid" lesion is closely allied to what has been termed "hemosiderin histiocytoma," which appears to be a precursor stage in its formation. The presence of extravasated erythrocytes in combination with a spindle-cell stroma may lead to an erroneous diagnosis of Kaposi's sarcoma. This cutaneous tumor has architectural and cytologic similarities to its malignant soft tissue counterpart recently described as angiomatoid malignant fibrous histiocytoma. However, unlike the latter, the cutaneous lesion is benign and lacks the prominent inflammatory infiltrate, pleomorphic appearance, and systemic manifestations of its soft tissue counterpart. The distinctive clinical and pathologic features of the cutaneous lesion serve to separate it as a specific variant of the cutaneous fibrous histiocytomas.
Archives of Dermatology, 1991
Archives of Dermatology, 1991
Archives of Dermatology, 1981
Page 1. Hidradenoma Papilliferum of the Eyelid Daniel J. Santa Cruz, MD; Philip G. Prioleau, MD; ... more Page 1. Hidradenoma Papilliferum of the Eyelid Daniel J. Santa Cruz, MD; Philip G. Prioleau, MD; Morton E. Smith, MD Hidradenoma papilliferum (papillary hidradenoma) is a benign, usually asymptomatic neoplasm with apocrine ...
The American Journal of Dermatopathology, 1986
We report seven cases of atypical cutaneous fibrous histiocytoma, which appears to be a variant o... more We report seven cases of atypical cutaneous fibrous histiocytoma, which appears to be a variant of cutaneous fibrous histiocytoma (dermatofibroma). These patients are all middle-aged women (mean, 39 years old) with small nodules occurring on the trunk and limbs. The lesions are characterized by marked focal cellular atypia, the absence of mitoses, and xanthomatous changes in both mononuclear and giant cells--all found within a small dermal nodule (approximately 1 cm) separated from an acanthotic epidermis by a Grenz zone. Their benign nature is demonstrated by the absence of recurrence, even after 9 years follow-up time.
The American Journal of Dermatopathology, 1990
Three cases of cutaneous epithelioid angiosarcoma with solid pattern were studied by immunohistoc... more Three cases of cutaneous epithelioid angiosarcoma with solid pattern were studied by immunohistochemistry and electron microscopy. The neoplasms followed a slow, protracted course with local recurrences and regional lymph node metastases. The correct histological diagnosis was delayed by the close histological simulation of carcinomas, misleading ultrastructural findings, and largely negative immunohistochemical markers. Two of the patients have been followed for at least 48 months and are still alive. Some seemingly undifferentiated epithelioid angiosarcomas may entail a better prognosis than originally suspected.
Journal of the American Academy of Dermatology, 1992
Angioendotheliomatosis has recently been separated into two types. Malignant angioendotheliomatos... more Angioendotheliomatosis has recently been separated into two types. Malignant angioendotheliomatosis is a lymphoma in which the neoplastic cells accumulate in vascular lumens. Reactive angioendotheliomatosis is a proliferation of capillaries that is less well characterized. Our purpose was to describe the clinical and histopathologic features of three cases of reactive angiomatosis in patients with cryoproteinemia. Clinical and histologic data were correlated. Immunoperoxidase staining and electron microscopy were used in the histologic evaluation. All three cases showed tufts of capillaries with luminal deposits of cryoproteins. Immunohistochemical studies showed that the cellularity of the tufts was primarily caused by a proliferation of pericytes. Cryoproteinemia can cause angiomatosis that simulates a vascular neoplasm.