The glomus tumor is known to assume various pathological forms. It is often accompanied by mucin deposits in the stroma. According to the past reports, glomus tumors with mucin deposits express CD34, whereas those with no mucin don’t. A total of 34 samples (33 patients) diagnosed at Department of Dermatology, Keio University School of Medicine, within the past 27 years were classified using the diagnostic algorithm advocated by Enzinger et al and Andrew et al. Along with clinicopathological analysis, the correlations between myxoid changes and responses to immunohistochemical stains were studied. Myxoid changes were observed in 19/34 samples with H-E stain. These 19 cases expressed CD34 and didn’t express factor-VIII. All 9 cases with abundant mucin deposit in the stroma were of solid type. We speculate that the myxoid changes in glomus tumors occur not as a secondary changes in response to the time course or local environment, but to the differentiation toward fibroblasts.
Recently, histamine-releasing auto-antibodies that react with the high-affinity IgE receptor (FcεRI) or, less often, with IgE have been identified in chronic idiopathic urticaria. Although antihistamines remain the first line and essential treatment for chronic urticaria, immunosuppressive therapies, such as cyclosporine, are useful as an alternative treatments for cases recalcitrant to antihistamines or corticosteroids. A sixty-eight year-old woman consulted our clinic with a three-year history of daily attacks of weals with severe itch on her trunk and extremities. Her symptoms were recalcitrant against antihistamines or 10 mg/day predonisolone. She showed an immediate weal response to an autologous serum skin test, and her serum induced histamine release from basophils derived from a healthy donor. The amount of histamine release from basophils induced by her serum was enhanced by removing cell-surface IgE and abolished by preincubating the serum with soluble FcεRIα, indicating that her serum contains autoantibodies to FcεRIα. Making the diagnosis of autoimmune urticaria, oral cyclosporine 3 mg/kg was added to the preceding medications; this treatment resulted in disappearance of the itch and weal within a few days. The histamine-release activity in her serum also declined in parallel with the severity of clinical symptoms. Cyclosporine may have an inhibitory effect, not only on the degranulation of mast cells, but also on the production of serum autoantibodies with the histamine-releasing activity.
We reported an affirmative treatment for hemothorax in a case of 69-year-old man with hemangiosarcoma of the scalp. The treatment was a combination of contrived radiotherapy and intra-thoracic injection of Docetaxel. X-ray radiation to the whole lung and, in addition, to the chest wall in the tangential direction were effective for halting the pleural effusion of hemangiosarcoma. The administration of intra-thoracic injection of Docetaxel for recurrent hemothorax improved respiratory insufficiency. Our treatments are the first affirmative trials for the pleural effusion of hemangiosarcoma. We suggest that these therapies will be useful for hemothorax caused by hemangiosarcoma.
Mastocytosis includes skin and/or hematologic disorders characterized by hyperproliferation of mast cells. In this report, we described three unrelated cases of cutaneous mastocytosis that carried the same c-kit gene alteration. Case 1 is an 11-month-old boy who has a brownish, pigmented spot emerging from two months after birth on the lower left thigh. Case 2 is a 10-month-old boy who has an eight month history of small brownish spots on his trunk. The number has gradually increased. Case 3 is a 56-year-old male who presents a large number of small brownish spots arising on his trunk in the recent few years before. In all three cases, mastocytosis was diagnosed by the clinical presentation, plane histology, and toluidine blue stain using the lesional skin biopsy. Gene analysis using polymerase chain reaction and direct sequencing identified a heterozygous missense mutation located at the same site in exon 17 ; an A＞T substitution that changes an aspartate (GAC) to a valine (GTC), Asp816Val.
The 308 nm monochromatic excimer light (308 MEL) is a new type of XeCl lamp able to generate non-coherent, monochromatic 308 nm UVB irradiation. Therapy using this lamp has been introduced recently for the treatment of recalcitrant dermatoses in Italy, but there have been as yet no reports in Japan. We investigated narrow-band UVB (NBUVB) therapy, combination therapy using NBUVB plus calcipotriol ointment and 308 MEL therapy on a 25-year-old Japanese female with localized recalcitrant vitiligo vulgaris of left upper arm. Her condition prior to treatment had persisted for 15 years. Our results indicate that the NBUVB therapy and the combination therapy were not effective but 308 MEL therapy can be a valuable targeted therapy for vitiliginous lesions which respond poorly to conventional phototherapy.
The first choice of treatment for the onychomycosis is oral administration of anti-fungal agents. However, there are many onychomycosis patients who are difficult to treat orally for various reasons. It has recently been demonstrated that an electronic dental drill is effective for mechanical removal of mycotic nails. Our aim in this study was to establish the most effective nail grinding method using a set of the latest dental drills. We assessed one hundred and forty-six patients with onychomycosis that were unresponsive to long-term use of anti-fungual liquid or not suitable for the standard regimen of oral medicine. The nail grinding was completed inside a mobile, self-made translucent plastic box to avoid contamination by the powdered nail during treatment. Using the wide-range and medium-sized drills, we obtained satisfactory results in most patients (77/88, 88.6%).The greatest advantages in this system include: i) high stability and safety in nail grinding, ii) accurate removal of the affected sites in individual nails, iii) less comtamination by the powdered mycotic nail during the treatment. These contribute to shortening of the patient’s medical course and considerably improve the morbidity of the disease, as assessed by a questionnaire study. The results suggest that our nail grinding system will prove to be a reliable and useful tool for the treatment of persistant onychomycosis.