bluuebunny/crossref_metadata_2025 huggingface dataset:
Polysialogangliosides Expressed by Amelanotic Melanoma: A Possible Explanation for the Poor Response to Anti‐monosialoganglioside Antibody 202 in a Patient with Melanoma
Authors: Hamanaka Sumiko , Ota Takahisa , Asagami Chidori , Gondo Toshikazu , Yamaguchi Yasunori , Tai Tadashi , Kawashima Ikuo , Irie Reiko F. , Otsuka Fujio
Published: April 2015

A 52‐year‐old Japanese woman developed numerous amelanotic metastatic melanomas on the skin and in various organs three years after a surgical operation for primary melanoma on the right axilla. The patient was treated with monosialoganglioside specific monoclonal antibody 202; however, no apparent clinical effects were observed. Ganglioside analysis of a metastatic tumor demonstrated that it expressed GM3, GM2, GD3, GD2, and polysialogangliosides. Since polysialogangliosides rarely appear in melanomas, their expression may explain the patient's poor response to MAb 202. The relationship between ganglioside composition and the effect of anti‐ganglioside monoclonal antibody is discussed.
Basal Cell Carcinoma with Eccrine Differentiation
Authors: Nogita Toshitatsu , Ohta Asako , Hidano Akira , Watanabe Shinichi , Kawashima Makoto
Published: April 2015

We describe a light, electron microscopic, and immunohistochemical study of basal cell carcinoma with eccrine differentiation. The cytoplasm did not stain with fat stain on cryostat sections, but contained numerous gland‐like structures. Immunohistochemistry on formalin fixed, paraffin embedded tissues using antibodies to human involucrin, thirteen kinds of cytokeratin, S‐100 protein, and carcinoembryonic antigen (CEA) was performed. We found that tumor cells were positive for keratin, PKK1, MA‐903, No 8, No 19, AE 1, AE 3, and 5+8. Tumor cells were negative for S‐100 protein, CEA, and the other antigens examined. Electron microscopy demonstrated short microvilli and amorphous materials within the intracytoplasmic cavity. We concluded that this tumor is basal cell carcinoma with eccrine differentiation.
Erythema Induratum with Pulmonary Tuberculosis: Report of Three Cases
Authors: Cho Kwang Hyun , Lee Dong Youn , Chun Ho Su , Eun Hee Chul , Han Sung Koo
Published: April 2015

Three cases of erythema induratum which occurred in the patients with pulmonary tuberculosis are described. The cutaneous lesions were violaceous, indurated nodules on both lower legs above the malleoli. Histologically, tuberculoid granuloma with caseation necrosis was found in one case; necrotizing vasculitis was the prominent finding in other two cases. The erythema induratum promptly responded to antituberculous therapy. We believe that, in light of these cases, the association between erythema induratum and infection with tubercle bacilli should be re‐emphasized.
Gamma‐Interferon Therapy for Severe Cases of Atopic Dermatitis of the Adult Type
Authors: Nishioka Kiyoshi , Matsunaga Tsuyoshi , Katayama Ichiro
Published: April 2015

Recombinant gamma interferon (IFN‐γ) was employed to treat adult‐type atopic dermatitis. Eight cases received subcutaneous injections of 500,000 JRU of IFN‐γ for 8 weeks. They responded relatively well to this treatment; however, the overall response to the treatment was not significantly better than that to conventional therapy in the control group. There was no significant suppression of itch or erythema. Swelling was reduced at the 8th week in the treatment group. Frequency of flushing attacks on the face was reduced and disappeared within four weeks in 6 of these patients; however, a similar reduction of frequency was observed in the control group. Papular and lichenified lesions on the trunk and extremities responded significantly to the treatment later than 5 weeks after its initiation. Serum IgE level was not affected by the treatment. Seven had the same level of serum IgE before and after the treatment. The serum cytokine level in the treated patients was also unaltered. Therefore, although IFN‐γ treatment has some benefit in the treatment of severe cases of atopic dermatitis, it should be applied to limited cases because of its high cost.
The Effects of Non‐Interval PUVA Therapy on the Plaque Stage of Mycosis Fungoides
Authors: Nakamura Motonobu , Kobayashi Setsu , Matsubara Kunihiko , Tanaka Toshihiro , Furukawa Fukumi , Imamura Sadao
Published: April 2015

The effectiveness of non‐interval topical PUVA treatment was studied in four patients with mycosis fungoides at the plaque stage. Five regions of each patient were exposed to UVA immediately, 30 minutes, 60 minutes, 90 minutes, and 120 minutes, after topical application of 8‐methoxypsoralen, respectively. The effects of these treatments were evaluated by clinical appearance and histological findings after the 20th treatment. All five regions were more improved clinically and histologically than the control region, which was not given PUVA therapy. There were no clear differences clinically among these five regions. Biopsy specimens from each region revealed the disappearance of epidermotropism and a marked decrease in atypical mononuclear cell infiltrations in the dermis. From these data, we concluded that there were no clear differences between these five treatments clinically or histologically and that non‐interval PUVA therapy is useful for the early stages of mycosis fungoides. To our knowledge, this is the first report of non‐interval PUVA therapy for mycosis fungoides.
Assessment of Cellular Proliferation of Sebaceous Neoplasms by AgNOR Counts and Immunohistochemical Demonstrations of PCNA and Ki‐67
Authors: Ansai Shin‐ichi , Koseki Shin , Hozumi Yutaka , Kondo Shigeo , Aso Kazuo
Published: April 2015

We assessed cellular proliferation of sebaceous neoplasms by AgNOR counts and the immunohistochemical demonstration of proliferating cell nuclear antigen (PCNA) and Ki‐67, using formalin‐fixed and paraffin‐embedded tissue specimens. We used three categories of sebaceous neoplasms: four cases of sebaceoma, three cases of basal cell carcinoma with sebaceous differentiation (BCSD), and seven cases of sebaceous carcinoma (SC). Significant differences were noted between SC and non‐SC tumors (sebaceoma and BCSD) in AgNOR counts and semi‐quantitative grading of PCNA and Ki‐67 labelling indices (P<0.01). When a cut‐off value of 6 was chosen, the AgNOR value discriminated SC from non‐SC tumors with high specificity and sensitivity. When a cut‐off value of 25% was chosen, PCNA and Ki‐67 labelling indices also discriminated between these tumors. Significant differences were not observed between sebaceoma and BCSD with PCNA and Ki‐67 labelling indices. AgNOR counts of BCSD were a little higher than those of sebaceoma, but the number of cases was too small to perform statistical assessment. We consider AgNOR counts and semi‐quantitative grading of PCNA and Ki‐67 labelling indices to be useful in differentiating SC from BCSD and sebaceoma.
Cutaneous Malignant Hemangioendothelioma: Clinical and Histopathological Observations of Nine Patients and a Review of the Literature
Authors: Bhutto Abdul Manan , Uehara Keishi , Takamiyagi Atsushi , Hagiwara Keisuke , Nonaka Shigeo
Published: April 2015

Nine patients with cutaneous malignant hemangioendothelioma (CMHE) were reported in Okinawa. All the patients were elderly, between 75 and 93 years of age. Four patients were males and five were female. The onset of the disease ranged from 1 to 9 months before the first visit. Eight patients had lesions on the scalp, and one, on the face and cheek. The lesions were in the form of exudative erythematous purpura, erythematous purpuric ulcers, and tumors. One patient developed a systematic metastasis involving the lungs, heart and intestine, and two patients had local metastasis to the cervical lymph nodes. Histopathologically, the tumor vessels were proliferated irregularly and showed anastomosis. The lumens were lined by large and atypical endothelial cells. Most of the specimens were infiltrated with large numbers of red blood cells. By electron microscope, Weibel‐palade bodies were found inside the tumor cells located at the peripheral part of the lesion. The patients were treated by irradiation, IL‐2 injection, and/or surgery. They were treated for 3 months to 2 years. Eight patients died between 4 to 24 months after the onset of disease and one has survived. The prognosis was poor.
A Case of Multiple Eccrine Porocarcinoma with Stepping‐Stone Distribution on the Foot
Authors: Ujihara Mayumi , Hamanaka Sumiko , Hamanaka Yuichiro , Kamei Toshiaki
Published: April 2015

An 89‐year‐old woman had three tumors of several years' duration in a stepping‐stone distribution on the dorsum of her right foot. The two larger ones were diagnosed histologically as eccrine porocarcinomas, and the smallest of the three shared many clinical similarities with them. Eccrine porocarcinoma is a rare malignant tumor. We describe this peculiar case in which three tumors developed in the same region and discuss how they might have occurred. It is most likely that the three tumors of this case originated from nevoid tumors, and that the individual lesions exhibited malignant changes.
Erythema Gyratum Repens Unassociated with Underlying Malignancy
Authors: Kawakami Tamihiro , Saito Ryuzo
Published: April 2015

A case of erythema gyratum repens occurring in a 62‐year‐old woman is presented together with a review of the literature. Evaluation and follow‐up for the development of malignancy over a 32‐month period failed to reveal any evidence of malignancy. Formerly, all cases of erythema gyratum repens were evaluated in terms of an association with an underlying malignant disorder. To date, only sixty cases have been reported in the literature; 14 (23%) were not found to be associated with any neoplasm. Therefore, this term is now also used for cases unassociated with malignancy. Erythema gyratum repens is a cutaneous eruption with a characteristic diagnostic morphology resembling a wood grain pattern.
Electron Microscopic Observations of Epithelioid Cell Granulomas Experimentally Induced by Prototheca in the Skin of Mice
Authors: Horiuchi Yasuhiro , Masuzawa Mikio
Published: April 2015

Electron microscopic analysis was conducted on epithelioid cell granulomas experimentally induced by prototheca in the skin of mice. In BALB/c mice, epithelioid cell granulomas were easily induced. Each cell had a round nucleus with euchromatin on the margin, abundant cytoplasmic organelles, and particularly abundant rough endoplasmic reticulum (rER). Cells with a plasmacytoid appearance were the most common. Fibroblast‐like epithelioid cells were sometimes observed. The whole body and cell membrane of an organism was usually within the cytoplasm of epithelioid cell. In ICR mice, epithelioid cell granulomas were not easily induced. Cells which had ingested whole organisms had spindle shaped and/or oval nuclei with marginated heterochromatin and with abundant dilated rER. Near completion of organism digestion, the cells had irregular and/or indented nuclei with marginated heterochromatin and often one or two distinct nucleoli. The cytoplasm was often replaced with numerous phagocytic vacuoles. At higher magnification, secondary lysosomes and Golgi complexes forming Golgi lamellae could be seen in the cells in which cytoplasmic organelles such as endoplasmic organelles and mitochondria were abundantly present. In contrast to the BALB/c mice, the remnants of digested organisms, split up into many small pieces, could be seen in the cytoplasm. The cells with a fibroblast‐like appearance were most frequent, but plasmacytoid cells were sometimes observed. In the present study, the ultrastructural features of epithelioid cells in BALB/c and ICR mice clearly differed. Plasmacytoid cells were the most abundant in BALB/c mice, while fibroblast‐like cells were in ICR mice.
Werner's Syndrome Associated with Basal Cell Epithelioma
Authors: Morita Kazumasa , Miwa Mitsuru
Published: April 2015

A Japanese female with Werner's syndrome associated with basal cell epithelioma is reported. Werner's syndrome is prone to malignancy, and many such cases have been reported. However, basal cell epithelioma is rare in Werner's syndrome. In the presented case, a black nodule about 2 cm in diameter with erosion developed on her abdomen. The histology revealed the findings of basal cell epithelioma.
A Single Lesion Demonstrating Features of Eccrine Poroma and Poroid Hidradenoma
Authors: Misago Noriyuki , Kohda Hiromu
Published: April 2015

A case of a single poroma lesion with the features of eccrine poroma and poroid hidradenoma is reported. The patient was a 61‐year‐old woman with a soft nodule, light brown in color, located on the posterior aspect of the right knee and containing a pigmented papular lesion in its center. The histological features of the papular lesion and the nodule were consistent with those of eccrine poroma and poroid hidradenoma, respectively. The eccrine poroma portion consisted mostly of poroid cells. The number of cuticular cells was slightly greater than that of poroid cells in the poroid hidradenoma portion. The cuticular cells in this portion as well as the poroid cells in both portions were immunohistochemically positive for epithelial membrane antigen. The findings in this case suggest that there is a close relationship between eccrine poroma and poroid hidradenoma and support the view that poroid hidradenoma is a type of poroma.
The Porphyrias: A Brief Overview Based on 25 Years of Experience (1969–1994) by the Department of Dermatology of the Hospital Clinic and Faculty of Medicine of Barcelona, Spain
Authors: Mascaro Jose M.
Published: April 2015

The porphyrias are uncommon diseases caused by enzymatic deficiencies in the heme pathway. In the 25 year period 1969–1994, the Department of Dermatology of the Hospital Clinic of Barcelona has been able to study 793 cases of porphyria (724 cases of PCT, 27 of EPP, 26 of PV, 5 of CEP, 5 of HEP, 5 of AIP, 1 of HCP).

Homozygous expression of an enzymatic deficiency in the heme pathway produces severe disease. Commonly, clinical manifestations appear in the homozygous state (the autosomal recessive porphyrias). However, homozygous forms of autosomal dominant porphyrias may occur exceptionally.

Moreover, there are cutaneous porphyrias whose clinical manifestations do not permit dermatologists to classify them clearly into one of the well‐defined syndromes. These uncommon and atypical forms are difficult to recognize without biochemical and enzyme studies.

The porphyrias have a wide clinico‐biochemical spectrum, including a large proportion of well defined diseases. Nevertheless, atypical forms occur and may be difficult to evaluate. It is important to note the genetic heterogeneicity of porphyrias, which accounts for the varying phenotypic expression.
Leukemoid Reaction in Epidermal Squamous Cell Carcinoma
Authors: Kiyosawa Tomoharu , Hirano Shigeki , Nakamura Jinko , Murata Satoru , Demitsu Toshio , Kato Hideyuki , Yaoita Hideo
Published: April 2015

There have been no previous concrete reports of leukemoid reactions associated with squamous cell carcinoma originating in cutaneous tissue. Here we report a case of epidermal squamous cell carcinoma of the sacral region and an associated leukemoid reaction. The tumor invaded deeply and destroyed both the sacrum and coccyx. The white blood cell count was greater than 20,000/mm3. After resection of the tumor, white blood cells transiently decreased, but did not fall under 10,000/mm3. Post‐operative infection by methicillin‐resistant Staphylococcus aureus and Bacteroides caccae caused sepsis and further elevation of the leukocytes to greater than 50,000/mm3. The leukemoid reaction in the case appeared to have been caused initially by direct invasion of bone by epidermal squamous cell carcinoma and later by severe infection.
Tumoral Calcinosis: Report of a Case and Brief Review of the Literature
Authors: Abraham Zeev , Rozner Itzhak , Rozenbaum Michael
Published: April 2015

A patient with a 32‐year history of tumoral calcinosis is described. The calcified lesions involved the soft tissues in the hips, shoulders, and ankles. Periodically, a chalky semifluid material extruded through several cutaneous sinuses. Laboratory tests including serum calcium concentration were normal, except for slight elevation of serum phosphorous levels. Ophthalmologic examination revealed the interesting finding of subretinal angioid streaks. The dental radiograms disclosed pathognomonic short bulbous roots and partial obliteration of pulp cavities, while the radiological evaluation of the tumoral masses revealed typical features of tumoral calcinosis.
Milia Arising in Herpes Zoster Scars
Authors: Lee Won Soo , Kim Soo Jung , Ahn Sung Ku , Lee Seung Hun
Published: April 2015

Milia caused by proliferative tendencies of the epithelium after injury may occur in areas of bullous eruption (10). Even though the possibility of milia arising in herpes zoster scar is real, it has not been reported previously.

We describe a case of milia arising in herpes zoster scars as an another example of milia occurring in traumatized skin.
Localized Bullous Pemphigoid of the Vulva
Authors: Urano Shoko
Published: April 2015

I report a 78‐year‐old female patient with multiple erosive and erythematous inflammatory lesions of the vulva of seven months duration. She was diagnosed as bullous pemphigoid based on the following findings: subepidermal blister in the histological examination, linear deposition of IgG and C3 at the basement membrane zone on direct immunofluorescence studies, and positive IgG deposition on the epidermal side of saline‐split normal skin on the indirect immunofluorescence study.
Accuracy of the Clinical Diagnosis of Recessive X‐Linked Ichthyosis vs Ichthyosis Vulgaris
Authors: Cuevas‐Covarrubias Sergio A. , Kofman‐Alfaro Susana H. , Palencia Angélica Beirana , Díaz‐Zagoya Juan C.
Published: April 2015

The present study analyzes the accuracy of the clinical diagnosis of X‐linked ichthyosis (XLI) vs ichthyosis vulgaris (IV), in a sample of Mexican patients. The study was double blind, using steroid sulfatase (STS) activity as the golden standard. Twenty male patients were included; 16 corresponded to XLI and 4 to IV. The clinical diagnosis was correct in 9 of the 16 XLI cases (56%) and in 2 of the 4 IV cases (50%). Some clinical findings in XLI, such as cryptorchidism in patients and delayed labor in their mothers, were important features for diagnosis. Statistical analysis of the results showed: among physicians (n=2) Kappa value 0.50, specific concordance 0.40, and absolute concordance 0.75; other values were sensibility 0.56, specificity 0.50, positive predictive value 0.82, negative predictive value 0.22, accuracy 0.55, prevalence 0.80. In conclusion, the differential diagnosis of XLI and IV is very difficult, and we consider that this is not explained either by personal skills or by other conditions. It could be attributed to the similarities in skin manifestations of these two diseases. The performance of the STS assay is imperative in order to correctly diagnose the disease and offer adequate genetic counseling.
A Case of Ki‐1 Positive Anaplastic Large Cell Lymphoma Transformed from Mycosis Fungoides
Authors: Kudo Yoshiko , Katagiri Kazumoto , Ise Tomoko , Imaraura Yuzo , Takayasu Susumu
Published: April 2015

A case of cutaneous Ki‐1 positive anaplastic large cell lymphoma which developed in the plaque stage of mycosis fungoides was described. A 73‐year‐old woman who had suffered from pruritic scaly eruptions over her entire body for more than two decades was admitted because of an ulcerated tumor measuring 45 times 55 times 15 mm and several satellite tumors on the buttock. All tumorous lesions were resected without recurrence to date. Histochemical study revealed that the tumor consisted of large anaplastic cells which were Ki‐1 (CD30)‐positive and LCA‐negative. Some of the erythematous plaques contained LCA‐positive, small‐sized atypical lymphocytes. In other plaques which developed two years later, there were large Ki‐1‐positive atypical cells. In the specimens obtained from the tumor and the plaque, the same pattern of T‐cell receptor gene rearrangements was detected. These findings indicate that both Ki‐1 positive anaplastic cells in the tumor and atypical lymphoid cells in the plaques were derived from the same T cell clone.
Drug Induced Acute Generalized Exanthematous Pustulosis
Authors: Katagiri Kazumoto , Takayasu Susumu
Published: April 2015

A 62‐year‐old woman with diabetic triopathy developed widespread erythematous macules, numerous pustules, and a high fever after she underwent electric coagulation for vitreous hemorrhage. She was administered several drugs at that time. After discontinuation of the drugs, the eruption disappeared, and the fever returned to normal within two weeks. A positive patch test with isepamicin sulfate highly suggested that the symptoms described above were due to drug allergy. Cadralazine, which was positive in the drug lymphocyte stimulation test (DLST), could not be excluded from the causative drugs. A false‐positive DLST with ofloxacin was confirmed by an accidental challenge test. To our knowledge, this is the first report of acute generalized exanthematous pustulosis due to isepamicin sulfate and/or cadralazine.
A Case of Herpes Zoster Associated with Colitis
Authors: Okimura Hiroshi , Muto Masahiko , Ichimiya Makoto , Mogami Satoshi , Takahata Hiroaki , Asagami Chidori
Published: April 2015

A 58‐year‐old Japanese woman who had herpes zoster in association with colitis was successfully treated with intravenously administrated acyclovir. Vesicular lesions with red haloes ranged from the left side of her buttock to the left extremity, corresponding to the L4 to S2 dermatomes. Her colitis was considered to have been induced by varicella‐zoster virus, based on the facts that the clinical courses were correlated and that the innervation of the affected site of the colon corresponded to an infected dermatome (S2).
Epidemiological Analysis of Prognosis of 496 Japanese Patients with Progressive Systemic Sclerosis (SSc)
Authors: Nishioka Kiyoshi , Katayama Ichiro , Kondo Hirobumi , Shinkai Hiroshi , Ueki Hiroaki , Tamaki Kunihiko , Takehara Kazuhiko , Tajima Shingo , Maeda Manabu , Hayashi Seiji , Kodama Hajime , Miyachi Yoshiki , Mizutani Hitoshi , Fujisaku Atsushi , Sasaki Tetsuo , Shimizu Masatoshi , Kaburagi Junichi ,   Scleroderma Research Committee Japan
Published: April 2015

For the first time, we performed an epidemiological study of SSc in Japan to study the factors influencing prognosis, survival rate and cause of death of Japanese SSc patients and to compare our data with those from foreign countries.

Prognosis of 496 Japanese patients with progressive systemic sclerosis (SSc) was analyzed based on clinical data described in case cards provided by the members of the Scleroderma Research Committee of the Japanese Ministry of Health and Welfare. The essential observation period was from 5 to 20 years, at ending in 1994.

Ninety patients died (males 11, females 79). The age of onset of the deceased patients was significantly higher than that of surviving patients (deceased. 45.6 yrs, surviving 41.3 yrs). Statistically significant factors for a poor prognosis were as follows: Barnett type III > type II > type I, positive for anti‐Scl‐70 antibody, negative for anti‐centromere antibody. The survival rate at 5 years after the onset of the disease was 0.937, followed by 0.82 at 10 years, 0.567 at 20 years and 0.40 at 30 years after the onset. Sex was not a predictor for prognosis, although male patients died at an earlier stage of the disease. The most common causes of death were heart failure, pulmonary insufficiency, lung fibrosis, and renal failure. Twenty‐four patients had cancer of which 13 were lung cancers.

The current status of the survival rate and prognostic factors of 496 Japanese SSc patients is summarized. In future, more well‐controlled studies using the same criteria should be performed for the better understanding and management of SSc.
Pemphigoid and Pemphigus Foliaceus Successfully Treated with Topical Corticosteroids
Authors: Muramatsu Tsutomu , Iida Takashi , Shirai Toshihiko
Published: April 2015

Six patients with pemphigoid and three patients with pemphigus foliaceus were successfully treated with topical corticosteroids. This was especially effective in cases of pretibial localized pemphigoid and in mild cases of bullous pemphigoid and pemphigus foliaceus with negative or low‐titer circulating autoantibodies.
Bony Anomalies in a Patient with Reticulate Acropigmentation of Kitamura
Authors: El‐Hoshy Khaled , Hashimoto Ken
Published: April 2015

Reticulate acropigmentation of Kitamura [RAPK] is a rare pigmentary genodermatosis. This is a case report of a 23‐year‐old Saudi female who started manifesting the disorder in the 2nd decade. The patient had bony abnormalities in the form of absence of terminal phalanges of the 2nd, 3rd and 4th toes. These bone anomalies are extremely rare, and the association has never been described before in the literature.
Identification of mRNA‐Rich Keratinocytes in the Basal/Suprabasal Layers of Psoriatic Skin
Authors: Yokota Koichi , Matsue Hiroyuki , Shibaki Akihiko , Kawashima Toshimitsu , Kobayashi Hitoshi , Ohkawara Akira
Published: April 2015

In this study, we examined the relative amounts of mRNA expressed in normal versus psoriatic epidermis, using in situ hybridization with a biotinylated oligonucleotide poly d(T) probe. The hybridization image was analyzed by Laser Scanning Confocal Microscopy (LSCM). In normal human skin, hybridization signals were detected homogeneously throughout the epidermis, mostly in nucleus. These signals disappeared following RNase T2 or RNase A treatment, indicating that the target for this probe is RNA; by implication, mRNA. In psoriatic lesions, the overall signal intensity was significantly elevated, especially in the basal/suprabasal layers. Moreover, those signals were most prominent in the cytoplasm, not in the nucleus. In contrast, the signals of uninvolved epidermis adjacent to the psoriatic lesions were indistinguishable from those of normal skin in both signal intensity and hybridization profile. Our data are consistent with the notion that one of the characteristic features of psoriasis is an elevated (or uncontrolled) synthesis of mRNA and proteins.
Necrotizing Fasciitis Due to Group A Streptococci: A Clinicopathological Study of Six Patients
Authors: Misago Noriyuki , Narisawa Yutaka , Ryu Seiji , Gotoh Yumiko , Tanaka Tatsurou , Yokoyama Maiko , Kohda Hiromu
Published: April 2015

The recent worldwide appearance of invasive group A streptococcal infections has again called attention to streptococcal necrotizing fasciitis. However, in contrast to polymicrobial necrotizing fasciitis, the streptococcal form has not been thoroughly studied clinically. The objective of the study was to elucidate the characteristic features of recent cases of necrotizing fasciitis due exclusively to pure group A streptococci. We encountered six patients with these criteria at a single hospital in Japan during the last 12 years. A clinicopathological analysis was performed in these six patients. In three patients, the clinical signs and the laboratory findings were characteristic of systemic toxicity. In this group, the clinical presentation was a pale or blue‐gray lesion associated with severe intravascular coagulation histologically involving the vessels in the lesion. In the three patients without signs of systemic toxicity, a swollen, erythematous skin lesion persisted for as long as one week; histologically, the intravascular coagulation within these lesions was mild. In clinicopathological terms, the entity in these six patients could be clearly classified as either fulminant or subacute. In the fulminant type, immediate surgical debridement of necrotic fascia is required; in the subacute type, incision and drainage alone are sufficient.
Solitary Piloleiomyoma with an Unusual Clinical Appearance
Authors: Izumi Tatsuya , Kai Misaki , Shimizu Hiroshi , Tajima Shingo
Published: April 2015

We present a 66‐year‐old man with a solitary piloleiomyoma on the forehead. The lesion had unusual clinical features; it was a crusted and dome‐shaped nodule, which exhibited rapid growth. Histology revealed the typical features of piloleiomyoma. The unusual clinical features may have been due to its unique location, in which the downward growth of the tumor was prevented by the underlying frontal bone.
Evaluation of Sialyl Lewisx Antigen in the Skin and the Sera of Patients with Psoriasis Vulgaris
Authors: Ohta Keiji , Furukawa Fukumi , Fujita Mayumi , Kashihara‐Sawami Mari , Horiguchi Yuji , Ueda Masamichi , Kurokawa Shigeko , Takigawa Masahiro , Imamura Sadao
Published: April 2015

The roles of sialyl‐Lewisx antigen were evaluated in the pathogenesis of psoriasis. Sialyl‐Lewisxexpression was investigated immunohistochemically in the epidermis of normal human skin and erythematous lesional skin of psoriasis vulgaris by avidin‐biotin‐peroxidase complex procedures. A few sialyl‐Lewisx positive dendritic cells were detected in the epidermis of normal human skin. In 7 out of 9 cases of psoriasis vulgaris, the number of sialyl‐Lewisx‐positive epidermal dendritic cells increased in the erythematous lesion over the adjacent normal skin; there were no marked changes in the numbers of CD1a‐positive cells in the epidermis between the two skin types. In the double immunofluorescence studies, more than half of the sialyl‐Lewisx‐positive epidermal cells in psoriatic erythema were stained with a monoclonal Lag antibody that specifically reacts with Birbeck granules and related structures of human Langerhans cells. Furthermore, we determined the changes in serum levels of sialyl‐Lewisx antigens in patients with psoriasis. Although levels in the sera were not significantly elevated over those of controls, the increases correlated with the degree of disease activity. These findings suggest that sialyl‐Lewisx antigen is possibly involved in the development of psoriasis.
A Case of Pemphigus Vulgaris with Esophageal Involvement
Authors: Amichai Boaz , Grunwald Marcelo H. , Gasper Naava , Finkelstein Eve , Halevy Sima
Published: April 2015

Esophageal involvement in pemphigus vulgaris is rare, found more in women than in men, and can be the only manifestation of pemphigus. Esophageal involvement had been reported only among patients with pemphigus vulgaris and not in patients with other forms of pemphigus. We describe a case of pemphigus vulgaris in which the esophagus was severely involved with only few oral lesions and no involvement of the skin or oropharynx.
Bowen's Disease: Statistical Study of a 10 Year Period
Authors: Kovács Anikó , Yonemoto Kohzoh , Katsuoka Kensei , Nishiyama Shigeo , Harhai Imre
Published: April 2015

According to histological records, a total of 74 patients were diagnosed with Bowen's disease (B.d.) between 1 January 1984 and 31 December 1993 at the Department of Dermatology of Kitasato University. There was slight female predominance (36 ♂, 38 ♀), and 73% of the patients were older than 60 years; the mean age was 66.8 years. Fifteen patients had multiple (two‐five) lesions. In 13 patients, other benign skin lesions were also found. Arsenic exposure as etiologic factor could have been present in 2 cases. Only 3 patients had other associated malignant tumors, which does not confirm the paraneoplastic nature of B.d. One‐fifth of the lesions were on sun‐exposed areas (head, neck and hands). Although we excluded invasive carcinomas from our statistical study, we mention the 8 invasive carcinomas developing from B.d. in that period. Histopathological classification of B.d. is uncommon. Classifying our cases by Darier's histopathological classification, 63.3% of them belonged to the lenticular type. The malignant potential of different histopathological types of B.d. needs further investigation.
Intradermal Dermoid Cyst Associated with Occult Spinal Dysraphism
Authors: Misago Noriyuki , Abe Masamitsu , Kohda Hiromu
Published: April 2015

A 2‐year‐old boy with congenital lumbosacral skin lesions is described. He presented with associated occult spina bifida and a sagittal cleft of the vertebral body deep in the skin lesions. The skin lesions presented as a combination of a lipoma, telangiectasia, mild hypertrichosis, and a dermoid cyst. Magnetic resonance imaging (MRI) revealed that the lipoma extended to the spina bifida region, but that it did not connect to the dura. MRI also demonstrated no other spinal lesions requiring surgical treatment. The intradermal location of the dermoid cyst observed in our patient was unusual. We discuss the location of dermoid cysts in the lumbosacral region associated with spinal dysraphism.
Anti‐Lipase Activity of Kampo Formulations, Coptidis Rhizoma and Its Alkaloids against Propionibacterium acnes
Authors: Higaki Shuichi , Nakamura Motokazu , Morohashi Masaaki , Hasegawa Yoshinori , Yamagishi Takayoshi
Published: April 2015

Anti‐lipase activity of Kampo formulations, Coptidis Rhizoma (CR), and its alkaloids against Propionibacterium. acnes were examined in vitro. The amounts of propionic and butyric acids in the medium were measured as growth and lipase activity of P. acnes, respectively. In tributyrin‐PYG medium with each concentration of Kampo formulation, CR, or the alkaloids added, the production of propionic acid was suppressed remarkably more than that of butyric acid. The suppression of production of these acids by CR was higher than that of the alkaloids. Furthermore, no lipase‐negative colonies were found on the medium to which Kampo formulations were added.

From these observations, we concluded that not only Kampo formulations and CR, but also their alkaloids, showed suppression of growth of P. acnes, which reduced anti‐lipase activity. Furthermore, it was suggested that Kampo formulations and Kampo crude drugs with anti‐lipase activity to P. acnes should be synergistic when their ingredients are combined.
Counts of Common and Atypical Melanocytic Nevi in Korean Young Men: Assessment of Their Risks and Correlations with Associated Factors
Authors: Kim Young Gull , Cho Kwang Hyun
Published: April 2015

Two hundred and thirty‐five Korean young men were examined for the count of melanocytic nevi (MN). The mean count of common MN of at least 2 mm diameter was 16.1. Three subjects had more than 50 common MN and another four had clinically atypical MN. We determined skin phototype by interview with questionnaires in the same persons as proposed by Fitzpatrick. All subjects were classified with respect to skin phototype and the number of previous sunburns. The correlations between common MN and the skin phototype or the number of previous sunburns were statistically analyzed. The skin phototype showed the correlation with the number of common MN, which means if skin phototype of any subject belongs to type I, he could to be predicted to have many more common MN than subjects with darker phototypes, like type VI. The correlation between number of previous sunburns and number of common MN was not statistically significant. This study shows persons at moderate risk of cutaneous melanoma (CM) do exist and skin phototype is associated with the prevalence of common MN in Koreans.
Successful Treatment of a Therapy‐Resistant Severely Pruritic Skin Eruption of Malignancy‐Associated Dermatomyositis with High‐Dose Intravenous Immunoglobulin
Authors: Kikuchi‐Numagami Katsuko , Sato Maki , Tagami Hachiro
Published: April 2015

Malignancy‐associated dermatomyositis developing in a middle‐aged Japanese female was successfully treated by removal of her gastric cancer. However, five years later, concomitant with catching a cold, her severely pruritic skin lesions recurred on exposed areas. Six years after the start of corticosteroid therapy for her annoying skin lesion, we started to treat her with high‐dose intravenous immunoglobulin (IVIG) infusion therapy because of the difficulty of reducing the dosage of oral prednisone, that had secondarily induced adverse effects. After five courses of the therapy, her recalcitrant, pruritic, erythematous skin lesions improved dramatically, enabling a satisfactory reduction in the dosage of oral prednisone. There were no significant adverse side effects with IVIG.
In vitro Interleukin‐5 (IL‐5) Production by Peripheral Blood Mononuclear Cells from Patients with Drug Hypersensitivity
Authors: Mikami Chikage , Ochiai Kenichi , Kagami Masaru , Tomioka Hisao , Tanabe Emiko
Published: April 2015

It has been shown that CD4+ lymphocytes and eosinophils pathologically infiltrate the dermis in skin eruptions due to hypersensitivity to the administration of certain drugs associated with peripheral eosinophilia. However, the mechanisms involved in drug related skin eruptions with eosinophilia are largely unknown. There are several methods of diagnosing drug hypersensitivity, but no single in vitro method is available for the detection of the sensitizing drug.

In order to elicit the mechanism of drug related skin eruption with eosinophilia and to establish effective methods for diagnosing drug hypersensitivity, we studied in vitro IL‐5 production by peripheral mononuclear cells (PBMC) from patients with drug related skin eruptions (n=8). Significant increase in IL‐5 from exposure to drug alone (n=3) and drug with PHA (n=3) were noted, whereas PBMC from normal subjects (n=7) exhibited no such stimulation. Six of the eight cases showed a significant decrease in the number of peripheral blood eosinophils when the skin eruptions healed compared with those at the onset. Histopathological features revealed mild to moderate infiltration of eosinophils. Immunohistopathologically, infiltration of CD4+ and CD8+ lymphocytes and CD4+ cells were predominant within the dermis of drug related skin eruption sites in all cases. This study suggested that the IL‐5 production of sensitized mononuclear cells might be a critical mediator in drug hypersensitivity with eosinophilia and an important diagnostic marker.
Distribution of Lectin UEA‐I in Trichilemmal Carcinoma, Squamous Cell Carcinoma, and Other Epithelial Tumors of the Skin
Authors: Ko Toshiko , Muramatsu Tsutomu , Shirai Toshihiko
Published: April 2015

Trichilemmal carcinoma (TLC) is a cutaneous appendage tumor. In some cases, the histological distinction between TLC and squamous cell carcinoma (SCC) is difficult with hematoxylin & eosin staining. In the present study, in order to establish a simple and reliable method for distinguishing between TLC and SCC, we examined the lectin Ulex europaeus agglutinin‐I (UEA‐I)‐binding patterns of TLC (4 cases), SCC (10 cases), malignant proliferating trichilemmal cyst (MPTC) (3 cases), Bowen's disease (4 cases), Bowen's carcinoma (4 cases), actinic keratosis (4 cases), basal cell carcinoma (8 cases), and eccrine porocarcinoma (1 case). In normal skin samples, UEA‐I was strongly positive in the outer root sheath cells of the hair follicle and weakly positive in the granular layers of the epidermis. UEA‐I stained the tumor cells of TLC clearly and some MPTC and Bowen's disease cells weakly. This result indicates that histochemical staining with UEA‐I is a simple and useful method for distinguishing between TLC and SCC of the skin.
Comparison of the Effects of Intralesional Interferon Alfa‐2a, 2b and the Combination of 2a and 2b in the Treatment of Basal Cell Carcinoma
Authors: Alpsoy Erkan , Yilmaz Ertan , Başaran Erdal , Yazar Şahin
Published: April 2015

Interferons (IFN), especially alfa‐2a and 2b, are potent inhibitors of normal and malignant cell growth and effective choices in the treatment of basal cell carcinoma (BCC).

The aim of the study was to evaluate the effectiveness of the IFN alfa‐2a and 2b, and whether this effect may be increased by their combination.

A total of 45 patients with histopathologically confirmed BCC were divided into three groups, equally. Groups 1, 2 and 3 were treated with intralesional IFN alfa‐2a, 2b, and the combination of 2a and 2b, respectively. Lesions were injected three times weekly in Groups 1 and 2 (total ten injections). IFN alfa‐2a and 2b were injected alternately in Group 3 (5 IFN alfa‐2a and 5 IFN alfa‐2b). Eight weeks after completion of therapy, cytologic specimens were taken, and all cases were evaluated clinically and cytologically.

Ten (66.6%) patients had a complete response (CR) and 5 (33.3%) had a partial response (PR) in Group 1. Patients in Group 2 showed 10 (66.6%) CR, 4 (26.6%) PR, and 1 (6.6%) non response. In Group 3, 11 (73.3%) patients had CR and 4 (26.6%) had PR. Follow‐up periods ranged from 6–24 months, and no recurrences have been observed.

These results suggest that IFN alfa‐2a, 2b, and the combination of 2a and 2b appear to be effective choices for the treatment of BCC; the effectiveness is not increased by their combination.
Accordion‐like Structure of Terminal Hair Follicles of the Human Scalp
Authors: Narisawa Yutaka , Hashimoto Ken , Kohda Hiromu
Published: April 2015

Terminal hair follicles extracted after ethylenediaminetetraacetic acid treatment preserved the basal cell surface of the outer root sheath well enough to examine the outer surface in detail. Light microscopic observations of whole mount specimens revealed several sawtooth‐like structures of follicular epithelium in the lower portion of terminal hair follicle. Vertical sections of the human scalp also showed several invaginations of the outer root sheath of terminal hair follicles in the lower portion, not in association with the arrector pili muscle. Scanning electron microscopy of the same specimens demonstrated accordion‐like structures below the sebaceous gland in the lower half of anagen terminal hair follicles and surrounding the entire circumference of the follicles. Sawtooth‐like structures were unilaterally observed at the level of the middle or lower portion below the sebaceous gland. With transmission electron microscopy, these structures were seen as undulations of basal cells which preserved hemidesmosomes, although the basal lamina had been peeled off during the extraction procedure. Thus, this accordion‐like structure is a genuine structural variation of some human anagen hair follicles and not an artifact.
Successful Treatment of Scleroderma with PUVA Therapy
Authors: Kanekura Takuro , Fukumaru Seita , Matsushita Shigeto , Terasaki Kenjiro , Mizoguchi Shimako , Kanzaki Tamotsu
Published: April 2015

PUVA therapy was carried out on four patients with scleroderma; three of them had cutaneous manifestations of progressive systemic sclerosis and one other exhibited generalized morphea. PUVA therapy was given with daily doses of 0.25 J/cm2 or 0.4 J/cm2 for 3–8 weeks, resulting in total doses between 3.5 J/cm2 and 9.6 J/cm2. All four patients responded well to this treatment; improvements of hand closure, skin sclerosis index, and flexion of fingers or knee joints were obtained. Thus, PUVA appeared to be beneficial for treating scleroderma.
Humoral Hypercalcemia of Malignancy with Elevated Plasma PTHrP, TNFα and IL‐6 in Cutaneous Squamous Cell Carcinoma
Authors: Mori Hiroki , Aoki Kazuhiro , Katayama Ichirou , Nishioka Kiyoshi , Umeda Tadashi
Published: April 2015

A case of humoral hypercalcemia of malignancy in cutaneous squamous cell carcinoma is reported. An 82‐year‐old male underwent surgery for cutaneous squamous cell carcinoma (SCC) of the left hand in 1992. He subsequently developed clouding of consciousness with remarkable hypercalcemia, a high parathyroid hormone related protein (PTHrP) level, and elevated plasma cytokine levels [tumor necrosis factor α (TNFα), interleukin‐6 (IL‐6)]. Diagnosis of humoral hypercalcemia of malignancy (HHM) was made on the basis of these findings. He died of renal insufficiency due to this hypercalcemia in spite of several replacement therapies and chemotherapies. The PTHrP might have derived from the SCC and have been responsible for the HHM in conjunction with IL‐6 and TNFα.
Lymphoepithelioma‐like Carcinoma of the Skin
Authors: Takayasu Susumu , Yoshiyama Masako , Kurata Sotaro , Terashi Hiroto
Published: April 2015

Lymphoepithelioma‐like carcinoma of the skin is a rare tumor with a microscopic resemblance to lymphoepitheliomatous tumors of the nasopharynx. A 62‐year‐old woman exhibited such a tumor on the nose together with regional lymph node metastases. Histologically, irregular islands of atypical epithelial cells unconnected to the overlying epidermis were surrounded by or mixed with numerous lymphocytes in the primary tumor. No squamous or glandular differentiation was present. Metastases to the submandibular lymph nodes appeared as glassy squamous cells that resembled trichilemmal keratinization. Staining of the tumor tissues with S‐100 protein antibody revealed the presence of numerous short dendritic cells in clusters of epidielial cells. Total resection and adjunctive radiotherapy have led to a 6‐year period free of recurrence. This is the second case report of this condition in Japan.
Koebner Phenomenon in an ANCA‐Positive Patient with Pyoderma Gangrenosum
Authors: Papi Massimo , Didona Biagio , Chinni Luca Massimo , Gobello Tommaso , Mazzanti Cinzia , De Pità Ornella , Cavalieri Rino
Published: April 2015

A male with pyoderma gangrenosum is reported. The clinical and histological features were typical. The initial lesions resolved with characteristic cribriform scars. A few days after the complete recovery, he developed several necrotizing focal lesions localized to the scarred areas. A further histological examination revealed a granulation tissue rich in neutrophils and signs of necrotizing vasculitis. We found a high titer of circulating perinuclear antineutrophil antibodies (p‐ANCA), which are a serological marker for various systemic diseases. An immunological circulating factor has been repeatedly suggested to be the “primum movens” of pyoderma gangrenosum. We discuss the unusual clinical presentation interpreted as a Koebner phenomenon and the possible role of immune factors in enhancing circulating‐endothelial cell interactions in relation to the pathogenesis of pyoderma gangrenosum.
Clear Cell Acanthoma Developing in Epidermal Nevus
Authors: Yamasaki Kenshi , Hatamochi Atsushi , Shinkai Hiroshi , Manabe Toshiaki
Published: April 2015

A 33‐year‐old Japanese woman presented with a black papule on a pigmented lesion which had been on her right thigh since her early childhood. A hematoxylin‐eosin‐stained section revealed a sharply demarcated, acanthotic epidermis composed of enlarged clear cells, which stained positively for epithelial membrane antigen and negatively for carcinoembryonic antigen. With antikeratin antibodies, the tumor cells stained for AE1 and AE3, but did not stain for CAM5.2. They contained abundant glycogen. Histologically, we diagnosed the case as a clear cell acanthoma which developed in the pre‐existing epidermal nevus. This is the second such case in the literature.
A Case of Hidroacanthoma Simplex
Authors: Suh Ho Seok , Lee Hwa Jung , Kim Hyun Su , Choi Jee Ho , Sung Kyung Jeh , Moon Kee Chan , Koh Jai Kyoung
Published: April 2015

There are many conditions characterized by nests of cells within the epidermis. One of them, hidroacanthoma simplex, has been regarded as an epidermal tumor differentiating to intraepidermal eccrine duct cell. We report a case of hidroacanthoma simplex with the results of immunohistochemical study. Staining for 35βH11 (reacting with keratin No. 8), 35βE12 (reacting with keratin No. 1, 5, 10, 11), S‐100 protein, and CEA was negative in the tumor cell nests; these monoclonal antibodies stained the nests of eccrine poroma.