rosai 2015 javier arias-stella and his famous reaction

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International Journal of Gynecological Pathology34:314–322, Lippincott Williams & Wilkins, Baltimorer 2015 International Society of Gynecological Pathologists

Eponyms and Entities

Javier Arias-Stella and His Famous Reaction

Juan Rosai, M.D. and Robert H. Young, M.D.

Key Words: Arias-Stella reaction—Javier Arias-Stella, M.D.—History of Pathology.

There are many eponyms in gynecologic patho-logy, most of them ancient. Some refer to normalstructures of the female genital tract (such asBartholin, Wolff, Muller), some to clinically insignif-icant non-neoplastic processes (Naboth), and some tobenign primary and metastatic neoplasms of theovary (Brenner, Krukenberg). Among them standsout an eponym that designates a non-neoplasticlesion that can be easily confused with a malignanttumor, universally known as the Arias-Stella reaction(Fig. 1). This essay is devoted to this phenomenonand to the man whose discovery the eponymcelebrates. The man in question is Javier Arias-Stella(Fig. 2), a distinguished pathologist from Lima, Peru,and much of the story recounted here is a synopsis ofan account he wrote himself some years ago (1).Dr Arias-Stella, a native of Lima (Peru), graduated

from the School of Medicine of the UniversidadNacional de San Marcos (Lima) in 1951. He beganhis training in pathology while still in medical schoolby participating in the activities of the Departmentof Pathology. Javier took a particular interest ingynecologic pathology and personally handled mostof the specimens of that subspecialty. One day hestumbled on an endometrial curettage specimen froma 24-yr-old woman who had had a hydatidiform mole

expelled 5mo before, followed by a hysterectomy. Onpathologic examination, the uterine corpus wasinvolved by an invasive mole (chorioadenoma des-truens), but the most interesting changes were presentin the endometrium. Most of the endometrial glandshad an unremarkable secretory look, but others werelined by highly atypical cells with large, hyper-chromatic, and irregularly shaped nuclei. The ap-pearance was highly suggestive of a malignant tumor,but not one that he or his seniors could recognize.The changes were finally interpreted as most con-sistent with an early or in situ stage of endometrialcarcinoma, and their presence was not even men-tioned in the final pathology report. Javier was veryexcited by this finding. He looked in all the books andjournals available to him but found nothing similar.The lesion in question was beginning to recede in hismemory when a second case appeared, this one in a34-yr-old woman with an ectopic (tubal) pregnancy.

FIG. 1. Arias-Stella reaction. Marked nuclear pleomorphism isevident.

From the Centro Diagnostico Italiano, Milan, Italy; Departmentof Pathology, University of Utah Medical School, Salt Lake City,Utah (J.R.); and The James Homer Wright Pathology Laboratories(R.H.Y.), Massachusetts General Hospital, Harvard MedicalSchool, Boston, Massachusetts.The authors declare no conflict of interest.Address correspondence to Robert H. Young, MD, The James

Homer Wright Pathology Laboratories, Massachusetts GeneralHospital, 55 Fruit Street, Boston, MA. E-mail: [email protected].

314DOI: 10.1097/PGP.0000000000000223

mailto:[email protected]

mailto:[email protected]


The common denominator of these 2 cases was thepresence of viable chorionic tissue, which led Javierto consider the possibility that the atypical endome-trial changes were due to hyperstimulation of theendometrium by chorionic hormones. Another in-tensive review of the literature was again unsuccess-ful, but by this time Javier felt that he had somethingremarkable in his hands. By then he had graduatedfrom medical school and was trying to decide on hisimmediate future when another fortunate eventpresented to him. The Kellogg Foundation wasgiving grants to Latin American institutions to allowpromising young physicians (especially pathologists)to spend some time as fellows in prestigious medicalcenters in the United States. Javier applied and gotone such grant. He was given 3 choices where tospend the 3 yr of his fellowship: Memorial SloanKettering, Johns Hopkins, and Harvard MedicalSchool. Having been told that the person regarded asarguably the best surgical pathologist of the time was

Dr Fred Stewart (Fig. 3) at Memorial, he selectedthat institution, reasoning that a superb diagnosticianwould finally identify the nature of the mysteriousoccurrence that obsessed him.At Memorial he found a superb department,

populated by luminaries such as Frank Foote (thesecond in command), Philip Lieberman (the propo-nent of the PNET concept), Sophie Spitz (of Spitznevus fame), Arthur Allen (Sophie’s husband and anexpert in renal diseases), and several others. Javierwas one of many fellows (Fig. 4) who rotated throughthe various subspecialties, while struggling with hisfaltering English but holding his own in theinterpretation of the cases as a result of the intense,largely autodidactic learning he had gone throughduring his Lima years. These initial experiences werevery stimulating, however, they did not deviate Javierfrom his original goal. He initially had brought with

FIG. 3. Fred Stewart typing his own consultation report, as heusually did.

FIG. 2. Javier Arias-Stella, MD.

315JAVIER ARIAS-STELLA AND HIS FAMOUS REACTION

Int J Gynecol Pathol Vol. 34, No. 4, July 2015


him to New York the microscopic slides of those 2enigmatic cases and was waiting for the rightoccasion to show them to Dr Stewart to find out,once and for all, what they represented. Fred Stewartimpressed Javier as a man of few words and a sober,almost humble attitude. He kept a certain distancefrom the fellows, but once he got to know them hewas warm and friendly. His diagnoses were regardedas the final verdict by the members of the staff and themany pathologists from the area who came everymorning to show him their problem cases. Usually,he shared them with Frank Foote, and after a briefcomment he expressed his final opinion. Aroundnoon the mail arrived, containing a large number ofcases sent in consultation from other states and fromaround the world. Stewart looked at every slide ofevery case and dictated his reports in letters that, inaddition to the diagnosis and comments, oftencontained a good dose of humor and irony, usuallygentle but sometimes biting. An example of the latter

concerned a breast biopsy sent with the statement‘‘All the pathologists in our community have seen thiscase, and we all think this is benign.’’ Stewart’s replywas ‘‘Your community needs a good pathologist.This is cancer.’’ This story still circulates widely in theDepartment.The moment finally came, 2mo after his arrival,

when Javier, confident that he had reached a stage inwhich he could understand and be understood inEnglish, and after having rehearsed his speech onnumerous occasions, knocked at Dr Stewart’s door.The ‘‘chief’’ was in a jovial mood and welcomed himwith a ‘‘Hello, Javier, what can I do for you?’’Encouraged by this warm reception, Javier wentdirectly to the reason for his visit. While he was goingover the clinical history of the first case, Dr Stewartput the slide under the microscope and looked at itwithout saying a word. The same procedure tookplace for the second case. Javier was surprised by thelong time it took Dr Stewart to go over the 2 cases.

FIG. 4. Javier Arias-Stella (standing, far right) with the other second-year Memorial Hospital fellows.

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He had expected a quick diagnosis by the masterfollowed by a key reference that he had missed.Instead, he remained silent for what appeared toJavier to be an eternity. Then, suddenly, Dr Stewartput aside all the slides, turned toward Javier and said‘‘Javier, I don’t knowy I think you have a problemto study’’ Javier could not believe his ears. Whileleaving Dr Stewart’s office, he reasoned that if theperson acknowledged as the pathologist who knewmore than anybody else about tumors and tumor-likeconditions, did not know what the lesion was, hemight be facing a pathologic change as yet unde-scribed! And if this change, as he suspected, was theresult of chorionic hormonal overstimulation, it hadto be present in analogous cases. He then remem-bered the ‘‘Special Collection,’’ an archive ofparticularly interesting cases selected by Dr Stewartand other members of the staff and arranged by siteand diagnosis, which was an invaluable source oftraining for the fellows and the pathologists whospent time in the Department as visitors. Javiersearched in the section of the Special Collection ongynecologic tumors and selected the 20 or so cases inwhich viable chorionic tissue and endometrial glandswere present. He then took those slides to the fellows’room and started looking at the cases of hydatidi-form mole, choriocarcinoma, and other chorioniclesions. As he proceeded with his search, a sense ofexcitement overcame him when realizing that thealterations in question were also present in them. Insome instances they were obvious and in others lessevident, but there was no doubt that they were thesame as those of his 2 flagship cases. He then showedthe specimens to Dr Sophie Spitz. She did not utter aword, but next day she gave Javier a dozen or so casesof uterine abortion featuring the same changes.Frank Foote made his contribution to the study bylending Javier the book by H. T. Deelman DieHistopathologie der Uterusmucosa, published in Leip-zig in 1933. In the chapter on uterine atypias, theauthor had illustrated similar alterations but hadinterpreted them as trivial inflammatory/degenerativechanges of no functional significance. A final biblio-graphic search in the encyclopedic Henke-Lubarschtreatise also gave negative results.There was yet another potential source of material.

It was the place where he had his first medicalexperience in Lima, which happened to be a Women’sHospital. With the collaboration of 2 of his formercoworkers, he obtained the paraffin blocks of about200 cases of uterine abortions and a respectablenumber of chorionic tumors. Now the problem was

to have them cut and stained, being that the histologytechnicians at Memorial were supposed to do onlythe routine work assigned to them on a daily basis,and that any extra work had to be authorized by thechief technician and charged $1.50 per slide, aproposition that Javier could not afford. The solutionwas to cut and stain those sections himself in theHistology Laboratory after hours, after having obtainedthe permission from the chief technician to do so.Examination of this material further confirmed theoriginal postulate that the alterations occurred only inthe presence and functional activity of chorionicplacental tissue. At that point, Javier decided that thetime was ripe for a paper to be written. Helped with theEnglish grammar and syntax by 2 colleagues, Javier hadthe first draft of the manuscript ready in a few weeks.After some additional fine tuning, the paper was sent tothe prestigious Archives of Pathology, and 6mo later, inAugust 1954, it was published in that journal (2). All wasquiet until the spring of 1956, at which time a paper byTruemer (3) appeared describing the same changes. Asecond paper, of much greater significance for Javier,was published later on that year. The author was a DrJorgensen, from Odense (Denmark), and was entitled‘‘Sudden natural death owing to ruptured extrauterinepregnancy. Report of a case with atypical clinicalfeatures with comments on the Arias-Stella phenomen-on’’ (4). Javier, who by then was back in Lima, could notbelieve his eyes. He had done it! A new entity had beenadded to the gynecologic pathology repertoire, and thatentity carried his name. His years of compulsive searchwere vindicated, and his name was bound to beincorporated into the Hall of Fame of that specialty.Upon his return to Peru in 1956, Javier had joined the

faculty of the Department of Pathology, first at theUniversidad Mayor de San Marcos and later at theUniversidad Peruana Cayetano Heredia. He became fullprofessor and chairman in 1969 at the latter institution.In subsequent years, he probed further into thefrequency and nature of the remarkable pseudomalig-nant process he had identified. He was able to inducesimilar changes in experimental animals and proposed apathogenetic mechanism for its development (5). Varia-tions in the morphologic appearance led to a proposal ofthe existence of 5 histologic variants of this disorder,based on a comparison with the phases of the normalendometrium and the degree of atypicality present,namely: (1) minimal atypia [pattern]; (2) early secretorypattern; (3) secretory or hypersecretory pattern; (4)regenerative, proliferative, or nonsecretory pattern; and(5) monstrous cell pattern. Being bothered by errors andinaccuracies that he believed had been written about




‘‘his’’ reaction during the 4 decades after his originaldescription, he thought it was time to clarify and updatethe matter, which he did in a comprehensive review in2002 (5).Other interesting papers have appeared in subsequent

years, further defining and expanding the entity. Theseincluded the description of the reaction in severalextraendometrial sites, particularly the endocervix (6)but also the fallopian tube (7), endometriosis (ovarian,peritoneal, subcutaneous, umbilical) (Fig. 5), vaginaladenosis, ovarian germinal inclusion cysts, paraovarianand paratubal cysts, and even ovarian mucinouscystadenomas and luteal cysts of gestation and puer-perium (5). Finally, and just to prove that little is specificin pathology, the Arias-Stella reaction was observed inthe endometrium of nonpregnant perimenopausal orpostmenopausal women taking exogenous hormones (8).The fact that the reaction can also occur in the normalhuman gestational endometrium was conclusively dem-onstrated by Yolanda Oertel (a distinguished Peruviancytopathologist) by examining material from the famousHertig collection at the Carnegie Institute, the earliestcase being an endometrium lodging a blastocyst havingan estimated age of 17 days (9).As often happens when the name of an individual is

associated with a specific disorder, Dr Arias-Stella’sother contributions to pathology have been somewhatovershadowed by his momentous discovery. This isunfortunate, because those contributions are numerous,wide-ranging, and significant. They span a period of40 yr, from a report of 2 fatal cases of the Jarisch-Herxheimer reaction to penicillin in a patient withneurosyphilis (written as a medical student) to a

comprehensive study of a disease endemic to hiscountry, the Peruvian verruca, part of it carried outin collaboration with his colleagues and friends atMemorial Hospital and his son, Javier Arias-Stella, Jr,who is also an accomplished pathologist (10–13).Parenthetically, a grandson, of the same name, is alsoa pathologist and plans to follow in the footsteps of hisgrandfather by spending time at Memorial, specificallyas a surgical pathology fellow in a few years time. Otherarticles of the senior Dr Arias-Stella have dealt with thepathology of high-altitude, cardiovascular diseases ingeneral, and a host of infectious and neoplasticdisorders (14,15). Dr Arias-Stella was also coeditor ofthe journal Patologıa and of a textbook on pathologyproduced in collaboration with 3 other luminaries ofLatin American pathology: Pelayo Correa, Ruy PerezTamayo, and Luis Carbonell. Among his manyprofessional accolades, he was particularly proud (forobvious reasons) to be the recipient of the Fred StewartAward (see below).Last, but not least, and in the best tradition of Latin

American medicine, Dr Arias-Stella transcended theboundaries of his specialty to address the medical,

FIG. 5. Arias-Stella reaction involving ovarian endometriosis. Thepatient was pregnant (case courtesy of Dr Robert Soslow, NewYork, NY).

FIG. 6. Javier Arias-Stella in his office of Secretary of State for thePeruvian Government. The man in the portrait is Ramon Castilla,former President of Peru.

318 ROSAI AND YOUNG



social, and political problems of his country. He hascontributed editorials, essays, and articles to numerous

Peruvian periodicals and newspapers, and he hasparticipated actively in the political life of Peru. Heserved as Minister of Public Health from 1963 to 1965and 1966 to 1968, Minister of Foreign Affairs from1980 to 1983, and Secretary of State for the PeruvianGovernment to the United Nations from 1983 to 1985,interspersed with periods of exile (Figs. 6–8). On 1occasion, he was offered by his party to run as acandidate in Peru’s presidential election, an offer hewisely declined. His elevated status in the country isbest exemplified by the issuing of a Peruvian postagestamp carrying his likeness (Fig. 9).This is a remarkable recognition, which may be the

only one ever granted to a surgical pathologist. In goingover the comprehensive 2-volume book onMedicine andStamps edited by R. A. Kyle and M. A. Shapiro, Ph.D.,of the Mayo Clinic (16) one finds a fair number ofpathologists featured, but not a single card-carrying

FIG. 7. Javier Arias-Stella giving a speech at the United Nations asSecretary of State for the Peruvian Government.

FIG. 8. Javier Arias-Stella greeting President and Mrs Reagan while Secretary of State for the Peruvian Government.




diagnostic surgical pathologist. There are instead micro-biologists, parasitologists, chemists and biochemists,physicists, immunologists, and—of course—manyclinicians and surgeons. As for the anatomic pathol-ogists included in the catalog, their main activity—concordant with the philosophy at the time—wasthat of general pathologists, teachers, and habitues ofthe autopsy room [Xavier Bichat, Jean Charcot, JeanCorvisart (the personal physician of Napoleon);Camillo Golgi and Santiago Ramon y Cajal (brilliantneurohistologists but reluctant neuropathologists);Carl Rokitansky (anatomic pathologist extraordin-aire, but wedded to the humoral theory of disease);and—last but not least—Rudolph Virchow (nocomment needed)]. The only individual in thisprestigious list who could be labeled primarily as adiagnostician was George Papanicolaou (in a stampissued by the United States in 1978), but as we allknow he was not a surgical pathologist. Parentheti-cally, the 2 other medicine-related individuals por-trayed in Peruvian postage stamps besides Javier areDaniel Carrion (a medical student who died afterinoculating himself with the extract from a lesion

of ‘‘verruga peruana’’ to prove that it containedthe etiologic agent of Oroya’s fever, now known asCarrion disease or bartonellosis) and Jose Unanue,anatomist, educator, and a leader of the war ofPeruvian independence from Spain.To go back to our main subject, we should mention

that Javier never abandoned his pathology practicewhile performing the absorbing public duties listedabove. While living in New York in his capacity ofPeruvian ambassador to the United Nations, herequested and was granted a small office at MemorialHospital to review microscopic slides and work onvarious projects.The seminal contribution made by Dr Arias-Stella

brings up the issue of eponymic designations inmedicine in general and in particular in gynecologicpathology. At present, their use is discouraged forseveral reasons, to wit: (1) eponyms are ofteninaccurate, in the sense that sooner or later it isdiscovered that the entity in question had alreadybeen identified, described, and illustrated by some-body else. Examples abound: thyroid Hurthle cells byAskanazy, Rosai-Dorfman disease by Destombes,medullary thyroid carcinoma by Laskowsky, malig-nant cells in cytologic preparations of the uterinecervix (of Papanicolaou’s fame) by Babes (17) andmany others. (2) Obviously, an eponymic designationdoes not give a clue as to the nature of a process.Actually, it represents the total negation of theproposal made by a John Wilkins in the 17th centuryof an ‘‘analytic language.’’ In it, each word wasdefined by itself, in the sense that it contained all theelements of the object being named. This extravagantconcept was further developed by the legendaryArgentinian writer Jorge Luis Borges (18).As powerful as those arguments are, they need to

be weighed against the following: (1) an eponym isoften the only recognition that the profession grantsto the individuals who went through the effort ofidentifying the distinctiveness of a process, sometimesfacing strong opposition and even ridicule from theauthorities in the field, and who had the courage ofputting that proposal in writing for everybody tojudge its merits. We are somewhat skeptical of theworkers who claim a total lack of interest in havingtheir name attached to an entity in medicine andother sciences. Morris Kaposi was true to himselfwhen naming his disease ‘‘Kaposi sarcoma mihi’’(Kaposi sarcoma of mine), and Santiago Ramon yCajal was right (even if overly dramatic) when statingthat ‘‘each idea is a scientific creature, and that theauthor of its existence—the one who gave it life at the

FIG. 9. Peruvian postage stamp honoring Javier Arias-Stella,generically described as ‘‘Investigador.’’ The finger-like drawingson the back are representations of Inca-like figures.

320 ROSAI AND YOUNG



cost of great hardship—utters the same outraged crieson seeing his paternity disregarded as would themother who has had the life she nourished within hersnatched away’’ (19). (2) It avoids the difficult andsometimes impossible task of giving the disease ascientifically accurate designation. A good example isthe Reed-Sternberg cell of Hodgkin lymphoma. Overthe years, a large number of proposals have been maderegarding its nature: histiocytic, reticulum (dendritic),lymphocytic, epithelial (thymic), and others. If one hadto change the name of that cell each time a new theorywas advanced, that cell would have today a plethora ofundesirable synonyms. Instead, by just leaving theoriginal name alone, one did not have to worry aboutreaching a potentially incorrect conclusion and couldconcentrate instead on the markers that identify itconclusively. Perhaps the time has arrived, judging bythe sophisticated studies that have been carried on it‘‘proving’’ that the Reed-Stenberg cell is an activatedB lymphocyte (20). Nonetheless, traditionalists that weare, we will be quite happy if it stays the Reed-Sternberg cell, just as we hope Dr Hodgkin will alwaysbe honored by ‘‘his’’ disease.

Before we leave the subject of eponyms, we draw theattention of the reader to 2 works that can be very helpfulin researching the matter. The first is the bookAnatomicalEponyms by Dobson (21). Although the focus is onanatomy, as anatomy and histology are the bedrocks ofpathology, it contains many names which will be familiarto the reader. More specific to the subject at hand,gynecologic pathology, is the wonderful book of DrHarold Speert, first published in 1958 but fortunatelyrepublished in expanded form in 1996 (22). The mostrecent work is divided into 10 parts and we find Dr Arias-Stella in the section dealing with menstruation, pregnancy,and labor and sharing the title of one chapter with DrJohn Bard, who performed the first operation for ectopicpregnancy and Lawson Tait, one of the great pioneers ofoophorectomy. Dr Arias-Stella is in good company but soare they! Any lover of the great tradition of gynecologicpathology will enjoy perusing Speert’s book, which islavishly illustrated, an example of that being the frontis-piece that shows Montgomery Tubercles, Cullen Sign,and the Schiller Test.We now return to the person we honor, as his eponym

is one of the better known in surgical pathology.

FIG. 10. Javier Arias-Stella (sixth from the left) receiving, in 1991, the Fred Stewart Award at Memorial Hospital, flanked by the Pathologystaff (others in the picture left to right are Dr Patricia Saigo, Dr Robert Erlandson, Dr Juan Rosai, Dr Victor Reuter, Dr James Woodruff,Dr Carlos Cordon-Cardo, Dr Paul Peter Rosen, Dr Steven Sternberg, Dr Andrew Huvos, Dr Philip Leiberman, and Dr Marc Rosenblum).




Fundamental to Dr Arias-Stella’s observation was some-thing that is crucial in the day-to-day life of diagnosticpathologists, namely not overinterpreting non-neoplasticlesions as malignant because of an appearance that at firstglance suggests a neoplastic process. Dr Arias-Stellarevisited this topic in another classic contribution, the firstdetailed analysis of the now well-known atypical cytologicchanges seen in seminal vesicle epithelium. In a study (23)conducted both at Memorial Hospital and in Peru, heand his collaborator studied 152 pairs of seminal vesiclesand elucidated in detail for the first time an observationthat had just been touched upon in limited manner by afew prior workers. Interestingly, the histology textbooksthat the writers consulted at that time did not mentionwhat is now an established process, in large part datingback to Dr Arias-Stella’s paper.In conclusion, of all the many eponyms in pathology,

few relate to such a crucially important phenomenon withits implications for patient care as does the Arias-Stellareaction. That the prestigious award named in honor ofDr Stewart, himself always aware that probably nothingis more crucial for the diagnostic pathologist than thebenign versus malignant scenario, would subsequentlyhave Dr Arias-Stella as an awardee (24) (Fig. 10) is mostappropriate, not only because of the deserved nature ofthe honor, but its linkage of 2 luminous figures in thetradition of our discipline.

ACKNOWLEDGMENTS: The authors would like to

express their sincere thanks to Dr Javier A. Arias-Stella, III

for his great help in providing illustrations. Contact with

him was made possible by Dr Jennifer Stall, the Robert E.

Scully Fellow in Gynecologic Pathology at the Massachu-

setts General Hospital, who is also thanked.

REFERENCES

1. Arias-Stella J. A Scientific Discovery in a Developing Country:

An Example for Medical Researchers. Lima, Peru: UniversidadPeruana Cayetano Heredia; 2009.

2. Arias-Stella J. Atypical endometrial changes associated with

the presence of chorionic tissue. Arch Pathol. 1954;58:112–8.

3. Truemer KM. Atypical endometrium associated with unsus-

pected tubal pregnancy. Arch Pathol. 1956;61:149–52.

4. Jorgensen JV. Sudden natural death owing to ruptured extra-uterine pregnancy; report of a case with atypical clinicalfeatures with comments on the Arias-Stella phenomenon. ActaMed Leg Soc. 1956;9:311–6.

5. Arias Stella J. The Arias-Stella reaction: facts and fancies fourdecades after. Adv Anat Pathol. 2002;9:12–23.

6. Nucci MR, Young RH. Arias-Stella reaction of the endo-cervix: a report of 18 cases with emphasis on its variedhistology and differential diagnosis. Am J Surg Pathol. 2004;28:608–612.

7. Milchgrub S, Sandstad J. Arias-Stella reaction in fallopiantube epithelium. A light and electron microscopic study with areview of the literature. Am J Clin Pathol. 1991;95:892–5.

8. Huettner PC, Gersell DJ. Arias-Stella reaction in nonpregnantwomen: a clinicopathologic study of nine cases. Am J ClinPathol. 1994;13:241–7.

9. Oertel YC. The Arias-Stella reaction revisited. Arch Pathol LabMed. 1978;102:651–4.

10. Arias-Stella J, Arias-Stella C,J. Las inclusiones de Rocha-Limaen la verruga peruana. Folia Dermatol Peruana. 1996;7:37–42.

11. Arias-Stella J, Arias-Stella CJ. Formas histologicas de laverruga peruana. Folia Dermatol Peruana. 1997;8:15–20.

12. Arias-Stella J. Identificacion de la Bartonella bacilliformis, a lamicroscopıa de luz en la verruga peruana. Folia DermatolPeruana. 1998;9:16–21.

13. Arias-Stella J, Lieberman PH, Erlandson RA, et al. Histology,immunohistochemistry, and ultrastructure of the verruga inCarrion’s disease. Am J Surg Pathol. 1986;10:595–610.

14. Arias-Stella J, Valcarcel J. Chief cell hyperplasia in the humancarotid body at high altitudes; physiologic and pathologicsignificance. Hum Pathol. 1976;7:361–73.

15. Frenkel JK, Nelson BM, Arias-Stella J. Immunosuppressionand toxoplasmic encephalitis: clinical and experimentalaspects. Hum Pathol. 1975;6:97–111.

16. Kyle RA, Shampo MA. Medicine and Stamps. Huntington,NY: Robert E. Krieger Publishing Co; 1980.

17. Naylor B, Tasca L, Bartziota E, et al. In Romania It’s theMethode Babes-Papanicolaou. Acta Cytol. 2002;45:1–12.

18. Borges JL. El idioma analıtico de John Wilkins. In: Borges JR,ed. Obras completas, Emece Editores. Buenos Aires: EmeceEditores; 1974.

19. Ramon Y Cajal S. Advice for a Young Investigator. Cambridge,MA: The MIT Press; 1999.

20. Marafioti T, Hummel M, Foss HD, et al. Hodgkin and Reed-Sternberg cells represent an expansion of a single cloneoriginating from a germinal center B-cell with functionalimmunoglobulin gene rearrangements but defective immuno-globulin transcription. Blood. 2000;95:1443–50.

21. Dobson JA. Anatomical Eponyms. Edinburgh: E&S Living-tone; 1962.

22. Speert H. Obstetric and Gynecologic Milestones Illustrated.New York: Parthenon Publishing Group; 1996.

23. Arias-Stella J, Takano-Moron J. Atypical epithelial cells in theseminal vesicle. Arch Pathol. 1958;66:761–6.

24. Rosai J. 14th Recipient of the Fred W. Stewart Award: JavierArias-Stella, MD. Am J Surg Pathol. 1992;16:632.

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rosai 2015 javier arias-stella and his famous reaction

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