A retrospective review of 1539 patients with cancer of unknown primary site seen at Yale-New Haven Hospital from 1922 to 1981 was performed. Information was obtained from the Tumor Registry. The method of diagnosis, patient characteristics, year of diagnosis, histologic features, treatment received, and survival were analyzed. The most common cell type was adenocarcinoma. Survival overall was poor, with a median survival of 5 months for the entire group. Age and year of diagnosis did not appear to significantly influence survival. Closer examination of a small subset of those patients with squamous cell carcinoma revealed a very high ma1e:female ratio, possibly related to tobacco and alcohol abuse. Nearly 9% of these patients were found to have a history of one or more unrelated malignancies.Cancer 57:120-124, 1986.E.rAsTA-ric CANCER of unknown primary site is a M persistent and perplexing problem. The incidence of metastatic malignant disease of undetermined origin generally ranges between 0.5% and 7.0%, depending in part upon the scope and duration of the diagnostic investigation.' The diagnosis was ranked as the eighth most common site of cancer in one large series,2 and may constitute 10% to 1590 of referred patients with solid tumors.',4The median survival from the time of diagnosis has ranged from 2 to 6 months, with less than 25% of patients surviving beyond 1 How exhaustive the search for the primary tumor should be is difficult to define." The major purpose ofan extensive examination of the patient with occult primary cancer is to identify a neoplastic process for which extended survival or cure is possible with an accepted treatment." Generally, only 10% to 15% of patients will have tumors for which effective systemic therapy is available.' A second popular reason to continue the search is to identify a cancer for which there is no known effective therapy, in which case no treatment need be given, thus preventing the toxic side effects of useless treatment. Because of the improved diagnostic methods and the use of more aggressive systemic chemotherapy for cancer patients available during the last decade. we believed that
Psoriasis is a common inflammatory, hyperproliferative skin disorder that affects 1% to 2% of the population of Western Europe and the United States. Because the clinical presentation of psoriasis is varied, many times the definitive diagnosis depends on the histological examination. However, the histological changes of psoriasis are as varied as the clinical presentations. Therefore, a combination of histopathologic features must be present for the diagnosis of psoriasis to be made. In this article, we review the clues for the histopathologic diagnosis of each type and stage of psoriasis, such as psoriasis vulgaris, pustular psoriasis, and erythrodermic psoriasis, as well as the histopathologic differential diagnosis of these entities.
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