bluuebunny/crossref_metadata_2025 huggingface dataset:
Differentiation of Malignant Lymphoma and Non‐Lymphoma by an Occlusive Dressing Method Employing Bromodeoxyuridine
Authors: Ohtake Naoki , Kanzaki Tamotsu , Nakano Ritsuko
Published: April 2015

Although lymphoma cells can proliferate in skin tissue, lymphocytes which have infiltrated the skin due to inflammatory changes are generally unable to do so. It may be possible to differentiate malignant lymphomas from benign lymphocytic infiltrations in skin tissue by detection of cell cycle‐related antigens. We developed a novel in vivo method for studying the cell kinetics of human skin using bromodeoxyuridine (BrdU) with an occlusive dressing. Following the application of BrdU, BrdU‐labeled lymphoid cells were counted in the dermis. The patients studied included 22 with various types of lymphomas (lymphoma group) and 22 with different forms of inflammatory skin disease (non‐lymphoma group). Skin specimens were obtained after applying occlusive adhesive plasters containing 2% BrdU dissolved in 0.9% sodium chloride solution and were then immunostained with anti‐BrdU monoclonal antibody. The average percentages of labeled cells were 15.9 ± 7.6% for the lymphoma group and 4.7 ± 2.6% for die non‐lymphoma group. This difference was statistically significant (p<0.0001). Using this method, malignant lymphomas and benign lymphocytic infiltrations of the skin could be differentiated by counting BrdU‐labeled lymphoid cells, and this method could help in determining a prognosis.
Malassezia spp Carriage in Patients with Seborrheic Dermatitis
Authors: Pechère Marc , Krischer Joachim , Remondat Catherine , Bertrand Catherine , Trellu Laurence , Saurat Jean‐Hilaire
Published: April 2015

The role of Malassezia spp in seborrheic dermatitis (SD) is controversial. To compare the cutaneous density and the cultural characteristics of Malassezia in persons with or without SD, quantitative cultures were obtained by stripping the forehead with a tape placed on Leeming and Notman medium. Plates were incubated at 37°C in a plastic bag, and colonies were counted after 14 days. High yeast density was defined as >100 colony forming units (CFU)/tape. Volunteers were divided into four groups depending on their HIV serology [HIV (+) versus HIV (‐) or unknown] and their clinical status (with or without SD). 126/129 cultures were positive (97.7%). Malassezia spp density was low on clinically normal skin in all HIV (‐) persons (40/40) but was high in 8/34 (24%) HIV (+) persons without SD (p<0.001). In SD patients, high densities were found in 10/22 (45%) HIV (+) and in 17/33 (52%) HIV (‐) persons. The strains could be divided into three basic groups on the basis of their cultural characteristics. Colony morphology type A predominated on normal skin (72%), and morphology type C predominated on persons with SD (78%). High yeast density can be present without skin symptoms. The pathogenicity of Malassezia seems more likely to be determined by the subtype present on the skin rather than by its density.
Macular Lesions in Leprosy: A Clinical, Bacteriological and Histopathological Study
Authors: Sarkar Rashmi , Kaur Inderjeet , Das Ashim , Sharma Vinod K.
Published: April 2015

Among 150 untreated patients of leprosy, 19 had only macular lesions; three were of the indeterminate type, and eight each were of the tuberculoid and the borderline types, according to the Indian Association of Leprologists (IAL, 1981) classification. The clinical, bacteriological, and histopathological parameters of these 19 patients were studied both before and after six months of WHO Multi Drug Therapy (MDT/1982). A single macule was present in seven (36.84%) patients. In twelve (63.16%), two or more were seen. In eighteen (94.74%), one or more peripheral nerves were enlarged. The size of the macules varied from 5 to 15 cm, and there were no changes seen even after treatment. In most (94.74%) of the patients, the macules were hypopigmented. The surfaces were rough and dry in seven (36.84%) but smooth in the other twelve (63.16%). The margins were well defined in the seven (36.84%) patients with single macules but ill defined in the other twelve (63.16%). After six months of antileprosy treatment, the single macules showed some resolution. Slit skin smear examination was negative in all cases before and after treatment. Clinico‐histopathological correlations were seen in only six (31.58%) patients; the clinical diagnoses were indeterminate and tuberculoid leprosy in three (15.79%) patients each. In the indeterminate group, the clinico‐histopathological correlation was 100%; it was 37.50% in the tuberculoid group. There were no correlations between the clinical and histopathological parameters in thirteen (68.42%) cases. After six months of treatment, the histopathology became nonspecific in all patients. The lepromin test was positive in six (31.58%) patients; four were of the tuberculoid group and one each from the indeterminate and borderline leprosy groups. Hence, although macular lesions can be seen throughout the leprosy spectrum, it is difficult to correlate their clinical, bacteriological and histopathological parameters.
Metastatic Cutaneous Plasmacytoma: A Case Report Associated with IgA λ Multiple Myeloma and a Review of the Literature of Metastatic Cutaneous Plasmacytomas Associated with Multiple Myeloma and Primary Cutaneous Plasmacytomas
Authors: Kato Naoko , Kimura Kumiko , Yasukawa Kana , Aikawa Keiko
Published: April 2015

We present the case of a 67‐year‐old Japanese woman with immunoglobulin A lambda (IgA λ) multiple myeloma (MM). She had firm nodular cutaneous lesions on the trunk and scalp without adjacent bone involvement. The patient was diagnosed as having IgA λ MM of stage IIIA with 52% plasmacytosis in the bone marrow six months before the appearance of the cutaneous lesions. The abnormal plasma cells showed moderate to marked dysplasia in both the bone marrow and skin lesions. The abnormal plasma cells in the bone marrow exhibited abnormal karyotypes: 41, XX, der (1) t (1p; 1q), −4, −10, −14, −16, −17, 17p+, that differed from the “unfavorable” karyotype reported previously.

We reviewed the cases of metastatic cutaneous plasmacytoma in MM and cases of primary cutaneous plasmacytoma that have been reported in English or Japanese and identified the Ig class. Among the 83 cases of metastatic cutaneous plasmacytomas in MM, IgG, IgA, IgD, and Bence‐Jones protein were found in 52%, 23%, 16%, and 6%, respectively. A disproportionately high frequency of IgD λ MM was found to have spread to the skin, compared with the frequency of IgD MM itself, which was present in only around 2% of the MM cases. Among the 18 primary cutaneous plasmacytomas, IgG, IgA, and Bence‐Jones protein were found in 56%, 11%, and 17%, respectively, but no IgD was found.
Idiopathic Acquired Anhidrosis: Reversible Generalized Anhidrosis after Sunstroke
Authors: Chung Tae‐Suk , Lee Seung Hun
Published: April 2015

Idiopathic acquired generalized anhidrosis is a very rare condition in which the pathogenesis is still unknown. Although varied findings have been reported, no consistent abnormal findings in sweat glands have been established by histological study or electronmicroscopic study. An 18‐year‐old Korean boy suffered from generalized anhidrosis after sunstroke. Physical and neurologic examination could not reveal any abnormal findings. There were no specific changes in the sweat glands, but amorphous vacuole‐like structures were seen in the cytoplasm of secretary cells. We reviewed the previous reports about this rare condition and compared them with our patient.
Eosinophil Activation and In situ Interleukin‐5 Production by Mononuclear Cells in Skin Lesions of Patients with Drug Hypersensitivity
Authors: Mikami Chikage , Ochiai Kenichi , Umemiya Keiko , Matsumura Ryutarou , Kagami Masaru , Tomioka Hisao , Sato Yuichi , Tanabe Emiko
Published: April 2015

In order to determine the inflammatory mechanisms of skin lesions in patients with drug hypersentivity, we examined eosinophil activation and interleukin‐5 (IL‐5) production in infiltrating lymphocytes. First, we showed that the number of peripheral eosinophils and the level of serum IL‐5 at the eruption‐active stage were both significantly higher than those in healed skin eruptions. Histological and immunohistological examination revealed that CD4+ T cells and eosinophils significantly more densely infiltrated drug eruptions than control skin lesions. The infiltrating eosinophils were also shown to be activated by immunostaining using anti‐secreted formed eosinophilic cationic protein monoclonal antibody. The expression of mRNA for IL‐5 in the infiltrating mononuclear cells at drug eruptions was shown by in situ hybridization. These results suggest that infiltrating CD4+ T cells might regulate both peripheral and tissue eosinophils and facilitate allergic inflammation at drug eruptions by means of IL‐5 production.
A Case of Sarcoidosis Involving the Tongue
Authors: Nagata Yoshiko , Kanekura Takuro , Kawabata Hisashi , Shimomai Kouji , Higashi Yuko , Setoyama Mitsuru , Kanzaki Tamotsu
Published: April 2015

Sarcoidosis is a systemic granulomatous disorder which commonly affects the skin. Involvement of the tongue is rare; a review of the previous literature over the last 30 years revealed only six cases of sarcoidosis affecting the tongue. We studied a case of sarcoidosis involving the tongue in a 32‐year‐old Japanese woman with characteristic clinical and pathological findings. She visited our department with a complaint of a tongue lesion of which she had been aware for a month. A diagnosis of sarcoidosis was made for the lesion by clinical and pathological examinations. Oral involvement by sarcoidosis is rare, however this disorder should be considered as a possible cause of intraoral granulomatous lesions.
A Novel Genodermatosis Caused by Mutations in Plakophilin 1, A Structural Component of Desmosomes
Authors: McGrath John A.
Published: April 2015

Desmosomes are adhesive intercellular junctions that link adjacent cells and provide anchoring points for the keratin filament cytoskeleton. The mechanical integrity of desmosomes depends on a complex network of transmembranous and cytoplasmic proteins and glycoproteins each encoded by distinct genes. Recently, naturally occurring human mutations in one of these desmosomal structural components, plakophilin 1, have been described. The clinical features of the affected individuals, who have total ablation of plakophilin 1, comprise a combination of skin fragility and ectodermal dysplasia with loss of hair, reduced sweating and nail dystrophy. Desmosomes in the skin are small and poorly formed and there is widening of intercellular spaces between keratinocytes as well as detachment of the keratin filament network from the cell membrane. These clinicopathological observations demonstrate the relevance of plakophilin 1 to keratinocyte adhesion and epidermal morphogenesis. This new form of genodermatosis represents the first example of human desmosome gene mutations and its clinical and ultrastructural characteristics are highlighted in this article.
Characterization of Infiltrating T Cells in Human Scalp Explants from Alopecia Areata to SCID Nude Mice: Possible Role of the Disappearance of CD8+ T Lymphocytes in the Process of Hair Regrowth
Authors: Tsuboi Hiromi , Tanei Ryoji , Fujimura Takao , Ohta Yukinori , Katsuoka Kensei
Published: April 2015

T cells may play a role in the pathogenesis of alopecia areata (AA). We attempted to elucidate the linkage between infiltrating T cells and hair regrowth processes by grafting scalp skin from the affected region of patients with AA onto severe combined immune deficiency (SCID) nude mice.

When the AA scalp was grafted onto the mice, the grafts were accepted, and normal hair regrowth was observed. Before grafting, CD4+ and CD8+ T cells had infiltrated into the peribulb area. After grafting, the telogen hair shifted to anagen hair, and the CD4+ and CD8+ T cell infiltrates in the bulb area decreased in all cases. CD8+ T cells had almost disappeared from all portions of the follicles. It has been suggested that CD8+ T cells play a crucial role in the pathogenesis of AA. The absence of CD8+ T lymphocytes that responded to follicular autoantigens may induce hair regrowth in the grafted skin.

In addition, the CD4+ human T cells that had infiltrated or still remained in the upper‐middle portions including the bulge area accompanied the HLA‐DR expression after grafting. Infiltrating or surviving T cell phenotypes and locations changed during the hair cycle in the grafts. These results indicate that the location of infiltrated T cells and their phenotypes may participate not only in hair loss but also in regrowth of hair in AA.
Livedo Vasculitis Associated with Regional Cytophagic Histiocytoses
Authors: Kuno Yoshinori , Numata Tokio , Tsuji Takuo
Published: April 2015

We report a 70‐year‐old woman who developed recurrent multiple ulcers and residual atrophic scars on her legs and feet. The histology showed fibrinoid material in the dermal vessel walls causing partial to complete occlusion of the lumina. Capillary tufting and dilatation were also noted in the dermis. There was no vasculitis or panniculitis. Extravasated red blood cells were seen throughout the dermis; these were engulfed by benign‐appearing histiocytes around the dermal‐fat junction. As she was generally well and there was no evidence of the presence of cytophagic cells in her extracutaneous organs, she was diagnosed with regional phagocytic histiocytoses supposedly triggered by extravasated red blood cells.
A Case of Generalized Morphea with a High Titer of Anti‐Borrelia burgdorferi Antibodies
Authors: Nakashima Tomoko , Maeda Manabu , Hayashi Takao , Kitamura Ken
Published: April 2015

A 69‐year‐old male had noticed pruritus on the back for the previous 3–4 years and cutaneous sclerosis with swelling of the dorsum of the neck had developed in the last one and a half years. However, he had never complained of Raynaud's phenomenon of the fingers, dry mouth, or dry eyes. At this first visit to our hospital, he complained of erythematous cutaneous sclerosis with swelling of the dorsum of the neck. Histopathological findings biopsed from the neck showed epidermal hyperplasia with elongation of rete ridges and homogeneous and fibromatous changes of the dermis with dense perivascular cell infiltration consisting of mononuclear cells or lymphocytes with several nests of incontinentia pigmenti. However, there were no sclerotic changes in blood vessels in the upper dermis biopsied from the forearm skin, although slightly homogeneous and fibromatous changes of the dermis were seen. In the clinical course, the cutaneous sclerotic change enlarged to extend to the bottom of the cheek, forearm, and lower legs. These clinical features and histopathological findings led to the diagnosis of generalized morphea. Hematologic examination showed positive anti‐Borrelia burgdorferi IgM antibodies, although there were no positive anti‐Borrelia burgdorferi IgG antibodies. These results revealed that there can be a close association of localized scleroderma with Borrelia burgdorferi and that generalized morphea may also represent a Borrelia infection.
Cutaneous Mucormycosis
Authors: Mizutari Kumiko , Nishimoto Katsutaro , Ono Tomomichi
Published: April 2015

The patient, a 59‐year‐old male, had been diagnosed as having alcoholic hepatopathy 20 years previously. He noticed localized swelling on his left leg after fishing in a river. The patient was diagnosed as having cutaneous mucormycosis upon histological and mycological examination of the skin. Gradual improvement of the symptoms was noted four weeks after administration of itraconazole and fruconazole; these were discontinued after five months.
Solitary Cellular Schwannoma (Neurilemmoma) Showing Malignant Changes: Evaluation through Magnetic Resonance Imaging (M.R.I.), Surgical Intervention, and Histopathology
Authors: Sehgal Virendra N. , Gupta Ram L. , Bhatia Arti , Kumar Sunil , Jain Sanjeev , Kapoor Vibhu
Published: April 2015

Schwannoma (neurilemmoma) are common benign tumors arising from the peripheral nerve sheath. Malignant transformation is uncommon. A unique case showing such a transformation is reported highlighting the roles of magnetic resonance imaging, surgical intervention, and histopathology. The case was thoroughly investigated by learning the details of the sequence of events leading to the current status. The evaluation was made through magnetic resonance imaging. In addition, computed tomography and conventional radiography were used to locate any foci of calcification. Subsequently, the tumor's gross and microscopic morphology was defined by surgical intervention and histopathology. Malignant schwannoma of the left leg occupying the entire calf is extremely uncommon. Only ten cases have been reported thus far, including the current one from the Indian subcontinent. Malignant transformation in a schwannoma differs significantly from malignant nerve sheath tumors (erroneously called malignant schwannomas). An endeavour has been made to differentiate malignant transformation in schwannoma from other malignant peripheral nerve sheath tumors. An innovation in this direction is magnetic resonance imaging. This investigative procedure is imperative in such situations, along with surgery and histopathology, which may also help in classifying the condition.
The SAPASI Is Valid and Responsive to Psoriasis Disease Severity Changes in a Multi‐Center Clinical Trial
Authors: Fleischer Alan B. , Feldman Steven R. , Dekle Catherine L.
Published: April 2015

We developed a structured Psoriasis Area Severity Index (PASI)‐like instrument, the Self‐administered PASI (SAPASI), that allows subjects to assess accurately the severity of their psoriasis. The major limitation of our previous SAPASI validity studies is that all were performed in a single academic center, raising questions about the generalizability of the instrument. We administered the SAPASI to 182 subjects in a 12‐week, multicenter, double‐blind clinical trial of topical tazarotene for psoriasis. On the same day, investigators blind to the SAPASI rating determined the degree of erythema, induration, scale, body surface area (BSA) affected, and overall lesion severity of the subjects' psoriasis. Using these data, we calculated an investigator PASI‐Equivalent. Correlation analysis shows that for both initial and final assessments of psoriasis severity, the SAPASI score reflects the PASI‐Equivalent score in a significant way (p=.000l), although the correlation is a modest one (r=0.3 to 0.5). Significant (p=.0001), modest correlations were found between the subjects' reported BSAs and the investigators' reported BSAs. To assess responsiveness, the proportional changes of the SAPASI and PASI‐Equivalent were found to be modestly signficantly correlated (r=0.2, p=.QA). The results of this study support the general validity of the SAPASI and demonstrate that the SAPASI can detect changes in disease severity in a clinical trial. Significant correlations were also observed between SAPASI components and their investigator‐reported counterparts in this multicenter trial. To the best of our knowledge, the current study represents the first multicenter validity study performed on a psoriasis severity instrument, and clearly demonstrates the value of this instrument in assessing the psoriasis severity in a population.
Pityriasis Rosea in a Patient with Behçet's Disease Treated with Interferon Alpha 2A
Authors: Durusoy Çiçek , Alpsoy Erkan , Yilmaz Ertan
Published: April 2015

Interferons have been used for the treatment of many diseases because of their immunomodulatory, antiviral, antitumoral, and antiproliferative effects. Systemic interferon alpha 2a (IFN‐α2a) is also efficacious in the management of Behçet's disease (BD). Many adverse cutaneous reactions related to IFN‐α have been reported. In the light of the current literature, we report here the first case of Pityriasis rosea (PR) that developed while receiving IFN‐α2a for BD. However, since this is the first report on this association, further observations are needed to determine their clinical relevance.
Cutaneous Mucinous Nodules Associated with Proliferating Synovitis of Rheumatoid Arthritis
Authors: Nihei Yoshimichi
Published: April 2015

Rheumatoid arthritis (RA) is occasionally associated with specific or non‐specific cutaneous conditions. In this report, we describe unusual cutaneous nodules arising on the skin overlying the inflamed joints of two patients with RA. The nodules were histopatho‐logically characterized by mucinous granulation tissue associated with neutrophilic infiltration and proliferation of starry‐shaped mesenchymal cells. The affected joints of both cases showed synovitis with synovial tissue hyperplasia due to RA. Because hyaluronic mucin, which is the major component of synovial fluids, was deposited in the nodules, intradermal inoculation of synovial cells seemed to be responsible for the nodular development. The nodules of one patient spontaneously resolved in several months. We are unaware of any report describing similar cases. Such nodules should be included as a cutaneous complication of RA, distinct from neoplasias.
Successful Treatment of Adolescent Pemphigus Vulgaris by Immunoadsorption Method
Authors: Ogata Kimiko , Yasuda Kayo , Matsushita Mitsuji , Kodama Hajime
Published: April 2015

A 15‐year‐old girl with pemphigus vulgaris did not respond to oral administration of prednisolone at 45 mg/day. The skin and oral mucous membrane lesions recurred after effective treatments with methylprednisolone pulse therapy and combination therapy with prednisolone and cyclosporine. The finally successful treatment involved eleven cycles of immunoadsorption using a tryptophan column and administration of a moderate dose of prednisolone. Serum γ‐globulin level and anti‐intercellular antibody titer decreased from 1.08 g/dl to 0.5 g/dl and 1:320 to 1:20, respectively. She has been well controlled with 21.5 mg/day prednisolone for 8 months after the final adsorption. Considering the physical, mental and social situation of adolescent student patients, immunoadsorption is a highly preferable choice among a variety of treatment modalities for pemphigus vulgaris because it makes the term of hospitalization shorter and avoids undesirable side effects from initial high dose corticosteroids.
Squamous Cell Carcinoma in a Renal Transplant Recipient with Linear Porokeratosis
Authors: Anzai Saburo , Takeo Naoko , Yamaguchi Tomiko , Sato Toshihiro , Takasaki Syuji , Terashi Hiroto , Takayasu Susumu , Takahashi Shinichi
Published: April 2015

A 40‐year‐old man developed squamous cell carcinoma on a perianal lesion of linear porokeratosis after renal transplantation. The tumor metastasized to the left inguinal lymph node 25 months after the primary tumor was excised. p53 overexpression was observed in the tumor cells, but not in the porokeratotic lesion. Interestingly, continuous subcutaneous infusion of peplomycin for the lymph node metastasis significantly improved the warty lesions of porokeratosis. In this patient, immunosuppressive agents might have accelerated the development of carcinoma on a skin area with malignant potential.
Paget's Disease Arising Near a Male Areola without an Underlying Carcinoma
Authors: Takeuchi Tsunemichi , Komatsuzaki Makoto , Minesaki Yoshinori , Yokoi Kiyoshi , Kamide Ryoichi , Niimura Michihito , Yamada Tsunemasa
Published: April 2015

We report a 56‐year‐old man with Paget's disease occurring near the left areola without any underlying breast carcinoma. Histologically, there was no evidence suggesting continuity with a lactiferous duct, accessory breast, or microscopic gynecomastia. We review previous case reports of Paget's disease occurring in unusual sites and discuss their nomenclature from the histogenetic point of view.
The Correlation of the Metastatic Ability with Keratin Expression in Cultured Murine Melanoma Cell Lines, B16‐F1 and‐F10
Authors: Kawaguchi Masakazu , Katagata Yohtaro , Kondo Shigeo
Published: April 2015

Keratin is an intermediate filament that is a major structural protein of epithelial cells. Until now, the expression of keratin in melanoma cells has not been well understood. Recently, it has been reported that keratin expression is correlated with invasive and metastatic behavior in a variety of cell types.

We report keratin expression in cultured murine melanoma cell lines B16‐F1 (low incidence of lung colonization) and F10 (high incidence of lung colonization) using an aqueous solution (10 mM Tris‐HCl (pH 7.4)/10 mM EDTA/phenylmethyl sulphonyl fluoride (PMSF, 10 µg/ml). By comparing these two cell lines, we investigated whether differences in keratin expression can influence the metastatic ability of tumor cell lines in vitro. However, no remarkable differences in keratin expression were found in these cell lines.
An Assessment of the Role of Candida albicans Antigen in Atopic Dermatitis
Authors: Morita Eishin , Hide Michihiro , Yoneya Yasuko , Kannbe Masayuki , Tanaka Akira , Yamamoto Shoso
Published: April 2015

An immediate hypersensitivity reaction to Candida albicans (C. albicans) antigen has been observed in patients with atopic dermatitis. Recent data from a comparative study of the immune response to C. albicans antigen in patients with atopic dermatitis and non‐atopics suggest a shift form type 1 helper T cells to type 2 helper T cells in the immune response to C. albicans antigen in atopic dermatitis. To delineate the role of C. albicans in the pathogenesis in atopic dermatitis, we evaluated skin reaction of C. albicans antigen, as well as the serum IgE antibody level against C. albicans in patients with atopic dermatitis, patients with nasal allergy, and non‐atopics. In addition, the clinical effect of antifungal drugs was evaluated in the patients with atopic dermatitis. As a result, we found that immediate hypersensitivity to C. albicans antigen is strongly correlated with the patients with atopic dermatitis. On the other hand, the delayed‐type hypersensitivity to this antigen, which is highly prevalent in atopics without dermatitis as well as non‐atopics, was reduced in most of these patients. Antifungal drugs markedly improved the skin manifestations in patients with atopic dermatitis that have IgE antibodies against C. albicans, and the serum IgE levels also decreased. These results suggest that C. albicans antigen is a potent intrinsic factor in inducing skin lesions in atopic dermatitis because of IgE‐mediated hypersensitivity of C. albicans antigen.
Pseudolymphoma Syndrome due to Carbamazepine
Authors: Saeki Hidehisa , Etoh Takafumi , Toda Kiyoshi , Mihm Martin C.
Published: April 2015

We described a 29‐year‐old Japanese woman with a pseudolymphoma syndrome due to carbamazepine. Physical examination revealed a diffuse erythematous papular eruption over almost all of her body with generalized lymphadenopathy. Histopathologic examination disclosed histology compatible with the nodular pattern of pseudo‐T‐cell lymphoma. The Southern blot analysis did not disclose the monoclonality of the gamma T cell recepter gene. We consider that it is very important to recognize this pseudolymphoma syndrome due to carbamazepine to avoid possibly subjecting the patient to unnecessary chemotherapy.
Annular Vasculitis in Association with Sarcoidosis
Authors: Cecchi Roberto , Giomi Andrea
Published: April 2015

We report a case of cutaneous vasculitis with annular features in association with sarcoidosis. A 36‐year‐old woman presented with fever, polyarthralgias, erythema nodosum, bilateral hilar lymphadenopathy, and induration of a long‐standing scar on the face. In addition, she developed annular, erythematous, and purpuric patches over her thighs and buttocks that were histologically characterized by a small vessel leukocytoclastic vasculitis. The presence of circulating immune complexes in the early stages of sarcoidosis might be related to the occurrence of the vascular damage.
Cellular Neurothekeoma with Possible Neuroendocrine Differentiation
Authors: Chang Sung‐Eun , Lee Tae‐Jin , Ro Jae Y. , Choi Jee‐Ho , Sung Kyung‐Jeh , Moon Kee‐Chan , Koh Jai‐Kyoung
Published: April 2015

We report a case of cellular neurothekeoma showing unusual immunohistochemical findings and occurring on the left upper arm of a healthy 48‐year‐old woman. She presented with a 1 cm, red, asymptomatic, dermal nodule of 1 year duration. A biopsy showed dermal proliferation of plexiform fascicles of spindle‐shaped or polygonal cells with plentiful eosinophilic cytoplasms. The immunohistochemical profile included negative stains for S‐100, CD34, factor XIIa, CD68, HMB45, cytokeratins, and EMA, strongly positive stains for neuron specific enolase (NSE), synaptophysin, and chromogranin A, and focally positive ones for NKI/C3 and α‐smooth muscle actin. Ultrastructural analysis showed undifferentiated mesenchymal cells with cytoplasmic projections and abundant RER. Although we couldn't find any confirmative cell type in this cellular tumor, we believe that cellular neurothekeoma is predominantly composed of undifferentiated cells that can exhibit features of neuroendocrine cells in addition to fibroblastic or myofibroblastic ones, suggesting a divergent cell origin.
Two Cases of Gigantic Dystrophic Calcinosis Cutis Caused by Subcutaneous and/or Intramuscular Injections
Authors: Kanda Akira , Uchimiya Hiroshi , Ohtake Naoki , Setoyama Misturu , Kanzaki Tamotsu
Published: April 2015

We describe two female patients with gigantic dystrophic calcinosis cutis caused by a large number of sunbcutaneous and/or intramuscular injections which they received when they were much younger. Laboratory data and physical examinations were generally within normal limits, and we detected no disease which might induce cutaneous calcification. There are many reports of dystrophic calcinosis cutis caused by injection of several kinds of drugs. However, we found no previous report describing a patient with calcinosis cutis induced by local tissue injury from a large number of injections and with extraordinarily widespread calcification at the injection sites. Because we do not know the exact drugs injected, it is difficult to say if a specific ingredient in the injections was related to this condition. We do know that a large number of subcutaneous or intramuscular injections were frequently administered to patients who had difficulty in maintaining venous infusions in the past, so there may be similar cases of dystrophic calcinosis cutis which have not been reported.
A Case of Cutaneous Extramedullary Hematopoiesis in Myelofibrosis with a Preponderance of Eosinophilic Precursor Cells
Authors: Kwon Kyung‐Sool , Lee Jae‐Bong , Jang Ho‐Sun , Chung Tae‐Ahn , Oh Chang‐Keun
Published: April 2015

A 48‐year‐old Korean man with myelofibrosis had erythematous papules and nodules on his scalp, anterior chest, back, lower abdomen, and both thighs. Skin biopsy showed cellular infiltration on the perivascular dermis and subcutaneous fat. Infiltrates were composed mainly of myeloid cells, especially of eosinophilic precursor cells. Erythroid and a few megakaryocyte precursors were also found. We diagnosed cutaneous extramedullary hematopoiesis with an interesting preponderance of eosinophile precursor cells.
Adenocarcinoma with Signet Ring Cells of the Axilla: Two Case Reports and Review of the Literature
Authors: Kuno Yoshinori , Tsuji Takuo , Yamamoto Keizo
Published: April 2015

Adenocarcinoma with signet ring cells (ASRC) is a rare skin neoplasm whose histology shows a solid tumor intermingled with signet ring cells in variable numbers. There have been only ten reported cases. All were elderly males affected on the eyelids except for a single case in the axilla. Two new patients with ASRC of the axilla are described. In both of them, immunohistochemical studies revealed neoplastic cells that had differentiated toward apocrine glands. These are the second and third reported cases of ASRC in the axilla, one of them is the first ASRC case in a female. It seemed that the apocrine sweat gland or aberrant breast tissue in the axilla were possible origins of these tumors.
Juvenile Chronic Myelogenous Leukemia, Neurofibromatosis 1, and Xanthoma
Authors: Jang Kyoung‐Ae , Choi Jee‐Ho , Sung Kyung‐Jeh , Moon Kee‐Chan , Koh Jai‐Kyoung , Im Dong‐Jin
Published: April 2015

The triple association of leukemia, xanthomatous skin lesions, and neurofibromatosis 1 (NF) was first described by Royer et al. in 1958. Most of the leukemias were of the juvenile chronic myelogenous type (JCML). We describe a 7‐year‐old male child with xanthoma, neurofibromatosis 1, and juvenile chronic myelogenous leukemia. His mother also had NF1. We suggest that the presence of xanthomas and NF1 in a young child should raise awareness of the possible development of JCML, especially in patients with a family history of NF1.
Localized Soft Tissue Angiomatosis with Subsequent Development of Angiolymphoid Hyperplasia with Eosinophilia
Authors: Misago Noriyuki , Tanaka Taturou , Kodera Hanako , Narisawa Yutaka
Published: April 2015

We report an unusual case of arteriovenous (AV) malformation (localized form of soft tissue angiomatosis): a reaction of angiolymphoid hyperplasia with eosinophilia (ALHE) developed over the lesion of this pre‐existing AV malformation. To the best of our knowledge, there is no other report of ALHE in association with a pre‐existing bona fide AV malformation. A 71‐year‐old woman consulted our clinic because a reddish, dome‐shaped tumor on her preauricular region, present as a slightly elevated, skin‐colored tumor since her childhood, had rapidly enlarged and become more elevated with color change during the preceding two months. The histological features of most of the lesion corresponded to those of soft tissue angiomatosis (localized form). The proliferative vessels underlying the soft tissue angiomatosis streamed out and welled into the dermis with an accompanying prominent inflammatory infiltrate composed of lymphoid cells and eosinophils: these histological features were characteristic of ALHE. The recent abrupt clinical changes in the tumor were considered to represent a reaction to the angiomatosis with development of ALHE.
Acanthotic Type of Eccrine Poroma on the Arm: Report of a Case
Authors: Ohno Tomoya , Ueda Daizo , Koike Shun'ichi , Dekio Satoshi , Jidoi Joji
Published: April 2015

A 72‐year‐old Japanese man with eccrine poroma on the arm is described. To the best of our knowledge, he is the fifth patient with this tumor on the arm reported from Japan. The histopathological type of the tumor of our patient was unique because it was acanthotic; those of the previous patients were all of the intradermal type.
Localized Hypopigmented Mycosis Fungoides in a 12‐Year‐Old Caucasian Boy
Authors: Grunwald Marcelo H. , Amichai Boaz
Published: April 2015

Mycosis fungoides is uncommon during childhood. We describe a Caucasian child who presented a single hypopigmented lesion of mycosis fungoides.
Intraepidermal Expression of Basement Membrane Components in the Lesional Skin of a Patient with Dystrophic Epidermolysis Bullosa
Authors: Muramatsu Tsutomu , Ko Toshiko , Honoki Kumiko , Hatoko Mituso , Shirai Toshihiko , Vnittanakom Pramote
Published: April 2015

The patient was a 15‐year‐old male. Since birth, he had developed blistering and erosion of the skin. Biopsy skin specimen of the bullous lesions showed subepidermal blister formation. Electron microscopic examination revealed that tissue separation had occurred at the sublamina densa level. By indirect immunofluorescence using antibodies specific for α6 integrin, laminin 5, type IV collagen, and type VII collagen, all of these basement membrane components were detected as coarse granular intracytoplasmic deposits only in the basal and suprabasal cells of the blister roof. In the non‐blistered regions, these basement membrane components showed a linear pattern similar to that seen in normal skin. These findings suggest that intraepidermal expression of basement membrane components was closely related to the blister formation. The biological meaning of intraepidermal expression of basement membrane components were also discussed.
Subcutaneous Emphysema with Spontaneous Pneumomediastinum and Pneumothorax in Adult Dermatomyositis
Authors: Jang Kyoung‐Ae , Kim So‐Hyung , Choi Jee‐Ho , Sung Kyung‐Jeh , Moon Kee‐Chan , Koh Jai‐Kyoung
Published: April 2015

We describe a 32‐year‐old patient with adult dermatomyositis who developed dyspnea and worsening of pre‐existing infarcted skin lesions of the fingers. Chest radiographs showed diffuse hazy reticulonodular infiltration in both lungs, subcutaneous emphysema, pneumomediastinum, and pneumothorax. The pulmonary symptoms and cutaneous lesions gradually improved with a high dose of prednisolone. Although subcutaneous emphysema and pneumomediastinum occur frequently in association with traumatic disruption of cutaneous and mucosal barriers and assisted ventilation, it has rarely been observed in patients with interstitial pneumonitis in connective tissue diseases. Although dermatomyositis and subcutaneous emphysema are all relatively well‐known diseases to dermatologists, the occurrence of spontaneous pneumomediastinum and pneumothorax and subsequent subcutaneous emphysema in connective tissue diseases such as dermatomyositis is unfamiliar. We discuss the possible mechanisms of this condition.
Palmoplantar Keratoderma (Voerner) with Composite Keratohyalin Granules: Studies on Keratinization Parameters and Ultrastructures
Authors: Hashimoto Ken , Mizuguchi Richard , Tanaka Kazuaki , Dorman Michael
Published: April 2015

A case of the Voerner type palmoplantar keratoderma was studied for abnormalities of keratinization parameters. An enzyme and materials used to build the marginal band or cellular envelope of the cornified cell were all abnormally expressed; i.e. transglutaminase I (TGK), loricrin, and involucrin were abnormally immunostained. In the normal controls, their expression was limited to the upper epidermis, mainly in the granular layer. In the lesional skin, they were detected from the suprabasal layer to the lower horny layer. Filaggrin, the protein of the keratohyalin granule, was also expressed more widely than in controls. Ultrastructural abnormalities included a significantly higher frequency of composite keratohyalin granules than controls, early formation of a marginal band in the midepidermis, and, most remarkably, the clumping of tonofilaments causing vacuolization of the cytoplasm of affected keratinocytes.
Repeated 5–Aminolevulinic Acid‐Based Photodynamic Therapy Following Electro‐Curettage for Pigmented Basal Cell Carcinoma
Authors: Itoh Yoshiyasu , Henta Tetsuro , Ninomiya Yoshiharu , Tajima Shingo , Ishibashi Akira
Published: April 2015

5–Aminolevulinic acid‐based photodynamic therapy (ALA‐PDT) in the standard manner is ineffective for pigmented basal cell carcinoma (pBCC), because melanin absorbs the photoactivating light interred for protoporphyrin IX. The objective of this study was to assess the therapeutic outcome of pBCCs with repeated ALA‐PDT following removal of pigmentation with electro‐curettage. After electro‐curettage, 16 pBCCs were treated with a combination of topical application of 20% ALA in O/W emulsion and topical instillation of 10% ALA solution, followed by photoactivating light. ALA‐PDT was performed more than three times. Fourteen of 16 pBCCs showed CR. Two pBCCs showing PR or NR were excised. Repeated ALA‐PDT following electro‐curettage was effective for pBCC.
Trichotillomania and Trichophagia Leading to Trichobezoar
Authors: Sharma Nand Lal , Sharma Ramesh Chander , Mahajan Vikram Kumar , Sharma Ravi Chand , Chauhan Dayal , Sharma Ashok Kumar
Published: April 2015

A 14‐year‐old female presented with the complaints of loss of hair, scalp pruritus, and pain in the abdomen. On careful work‐up, she was found to have trichotillomania as well as trichophagia. Investigations also revealed a trichobezoar which completely filled the stomach. Hemogram showed moderate hypochromic anemia. Her detailed psychiatric profile showed a few additional features like obsessive hand washing, knuckle cracking, nose picking and body rocking. Her trichobezoar was removed surgically, and she had an uneventful post‐operative recovery. She is being maintained on fluoxetine and is doing well. The role of a multi‐disciplinary approach to trichotillomania patients is highlighted.
A Case of Linear Scleroderma and Myasthenia Gravis
Authors: Kim Hee Sung , Chun Yoon‐Sun , Hann Seung‐Kyung , Park Wook‐Hwa
Published: April 2015

We report a case of a 28‐year‐old woman with myasthenia gravis who developed linear scleroderma seven years later. Myasthenia gravis and scleroderma are rarely found in direct association with each other; there are only five such reported cases, all of which were systemic scleroderma patients. Although localized and systemic scleroderma are distinct entities, autoimmunity is believed to be involved in the pathogenesis of both. Myasthenia gravis and scleroderma may occur coincidentally, but an autoimmune predisposition seems to be the more likely underlying cause, as evidenced by an increased incidence of autoantibodies and autoimmune diseases.
Pityrosporum Folliculitis: Renal Transplantation Case Report
Authors: Alves Emerson Vicente , Martins Jose Eduardo Costa , de O. Ribeiro Eliane Barbosa , Sotto Mirian N.
Published: April 2015

Pityrosporum folliculitis is caused by the fungus Pityrosporum ovale. It is characterized by the presence of pruriginous follicular papulae and papulae‐pustules in face, upper part of the trunk, and upper limb root. It is more prevailing in places with hot and humid climates. Its incidence can be associated with either immunosuppressive or chemotherapy states secondary to pathiologies. We report herewith a case of pityrosporum folliculitis in a patient who had previously underwent kidney transplantation and thes result of the itraconazol therapeutics given.
Malignant Hidroacanthoma Simplex: A Case Report
Authors: Lee Woong‐Jae , Seo Young‐Joon , Yoon Ji‐Seog , Suhr Ki‐Beom , Lee Jeung‐Hoon , Park Jang‐Kyu , Suh Kwang‐Sun
Published: April 2015

Hidroacanthoma simplex is a benign tumor of the skin originating from or showing differentiation to the sweat glands. It grossly resembles seborrheic keratosis or Bowen's disease and histologically shows intraepidermal focal growth of epithelial cells. Malignant transformation of this tumor is rare. We report a case of pigmented hidroacanthoma with malignant transformation in a 67‐year‐old woman. There was a 20‐year history of a skin lesion on the right thigh, which first appeared as a small verrucous papule, progressed to a dark‐brown colored patch, and then to a pigmented plaque. Histologically, the primary tumor was composed of small squamoid cells with marked cellular atypia. Most of the tumor cells were located in the epidermis. Immunohistochemically, the cytoplasm of some tumor cells showed a positive reaction for epithelial membrane antigen, but not for either carcino‐embryonic antigen or the S‐100 protein.
Acquired Vulvar Smooth Muscle Hamartoma: A Case Report and Review of the Literature
Authors: Kwon Kyung‐Sool , Lee Chea‐Wook , Seo Kyung‐Hyung , Park Jung‐Hum , Oh Chang‐Keun , Jang Ho‐Sun , Chung Tae‐Ahn
Published: April 2015

A 36‐year‐old Korean woman had had a flesh‐colored, indurated plaque with pruritus on the labium majora for five years. The lesion was not found in association with hyperpigmented or hypertrichotic patches. Results of biopsy specimens showed an excess of haphazardly oriented smooth‐muscle bundles in the mid to lower dermis with an unremarkable overlying epidermis. Our diagnosis was an acquired smooth‐muscle hamartoma in the vulva. Although there have been previously reported cases of acquired smooth‐muscle hamartoma, this was the first reported case in the vulva. We also describe the characteristics differing between our case and the six previously reported ones.
Melasma in Men: A Hormonal Profile
Authors: Sialy Ravinder , Hassan Iffat , Kaur Inderjeet , Dash R.J.
Published: April 2015

Melasma in men is much less common than in women. In the present communication, we evaluated circulating levels of LH, FSH, and testosterone in 15 men with idiopathic melasma. When compared with eleven age matched control men, the circulating LH was significantly higher and testosterone was markedly low in the melasmic men. We conclude that male melasma involves subtle testicular resistance.
Acute Infectious Urticaria: Clinical and Laboratory Analysis in Nineteen Patients
Authors: Sakurai Michiyo , Oba Misao , Matsumoto Kentaro , Tokura Yoshiki , Furukawa Fukumi , Takigawa Masahiro
Published: April 2015

We treated 19 Japanese patients with acute urticaria presumably caused by infection during the five years from 1994 to 1998. The patients' ages ranged from 2 to 66 years (8 males and 11 females). Most of them had urticaria, angioedema, high fever, neutrophilia, and high serum levels of C reactive protein (CRP). The skin rash lasted more than 24 hours. In four patients, a flow cytometric analysis revealed that the percentage of circulating T cells bearing T‐cell receptor Vβ3 was decreased during the active stage and that this decrease was sustained for at least 2 to 3 weeks. This suggests that certain T‐cell populations were numerically altered in association with the occurrence of the disease. A retrospective review indicated that the combination therapy with corticosteroid and antibiotics was more effective than the single use of either agent.
Conventional Cold Excision Combined with Dermabrasion for Rhinophyma
Authors: Gupta Somesh , Handa Sanjeev , Saraswat Abir , Kumar Bhushan
Published: April 2015

A 65‐year‐old man, farmer by occupation, presented with redness and gradual enlargement of the nose. Examination revealed marked nodular enlargement of the nose and loss of normal nasal contours. Sebaceous material could be expressed from widened pores. The patient was diagnosed as rhinophyma of moderate degree. He was treated with cold knife excision combined with dermabrasion. A literature scan revealed that currently there is no evidence of superiority of much popular laser surgery over conventional cold knife surgery combined with dermabrasion for rhinophyma. Conventional surgery is time‐tested, and it does not require expensive equiment or special training.
Keratosis Lichenoides Chronica: Marked Response to Calcipotriol Ointment
Authors: Chang Sung‐Eun , Jung Eui‐Chang , Hong Seung‐Mo , Choi Jee‐Ho , Sung Kyung‐Jeh , Moon Kee‐Chan , Koh Jai‐Kyoung
Published: April 2015

Keratosis lichenoides chronica (KCL) is a rare dermatosis characterized by a distinctive seborrheic dermatitis‐like facial eruption, together with violaceous, papular, and nodular lesions on the extremities and trunk, typically arranged in a linear and reticulate pattern. KLC is resistant to therapy, although spontaneous remission has been reported. We describe a 35‐year‐old woman with KLC who had the typical features of widespread violaceous, reticulate, and striae‐like erutpions with a prominent keratotic component over a nine‐year period and who responded well to treatment with calcipotriol ointment. The immunohistochemical profiles are presented in addition to typical histopathologic features.