We reported a 53-year-old woman with a 28-year history of many atrophic, skin-covered, pendulous, bulky tumors located on her face, chest, bilateral axillae, arms, groin, and upper limbs. She has leukocytosis (59,200/μl), peripheral eosinophilia (90%), and a high titer of IgE (215,523 U/ml). The biopsy specimens showed a massive infiltration of low grade malignant lymphocytes and histiocytes with multinucleated giant cells in the dermis and into the subcutaneous tissue. Most of the infiltrating lymphoid cells were CD3+, CD4+. A monoclonal rearrangement of the TCR-β gene was detected in the skin lesion by Southern blot analysis. The diagnosis of granulomatous slack skin (GSS) with hypereosinophilia was established. Prednisolone (5 mg/day) was effective for lesional control. Forty-eight cases of GSS have been reported to date, and hypereosinophilia has been demonstrated in 4 patients, including our case, who showed the most hypereosinophilia. The association of GSS with preexistng lymphoproliferative disorders such as MF and GMF was about 71% (5 of 7 cases), and that with subsequent lymphoproliferative disorders such as HD and NHD was about 80% (11 of 14 cases).
The term “primary dermal melanoma” has been used to describe a solitary melanoma lesion confined to the dermal and/or subcutaneous tissue in primary unknown melanoma cases. There are no significant histopathological differences between primary dermal melanoma and cutaneous metastasis of melanoma. The most important distinction to be made is with metastatic melanoma, because the prognoses for stage IV melanoma and primary dermal melanoma are vastly different. In some reports, the five-year survival rate was reported to be over 80%. We report 2 cases of primary dermal melanoma. Both cases, at first, were diagnosed as cutaneous metastasis of melanoma histopathologically. However we could not detect any primary lesion. One case is disease-free over 4 years after the operation. The other case only recently underwent surgery, so it is too early to be definitely diagnosed as primary dermal melanoma.
A 67-year-old woman had undergone hemodialysis for two years because of diabetic renal failure. She had noticed some subcutaneous nodules on her inguinal regions six months previously, and the number of nodules had increased. On the first consultation, acid-fast bacilli were observed in the pus from the absess, and PCR and cultivation of the bacilli in egg-based medium showed Mycobacterium tuberculosis. The histopathological findings from the one of the nodules revealed caseous necrosis, inflammatory infiltration with lymphocytes, and a few Langhansʼs giant cells surrounding the necrosis. No tuberculous granuloma was observed. Triple anti-tuberculosis chemotherapy (RFP 300 mg/day, INH 300 mg/day, EB 500 mg/every other day) produced a complete remission. Skin biopsies were perfomed periodically 3 times after the treatment. Two months after therapy, a lot of Langhansʼs giant cells were observed. but the tuberculous granuloma was poorly formed. Four months and 7 months later, much tuberculous granuloma was observed, As the number of scrofuloderma cases is increasing in the elderly, we consider that it is important to test for not only common bacteria but also mycobacteria in the subcutaneous abcesses found on immuno-suppressive patients.
We present five cases of unique bullous dermatosis with in vivo IgG deposition both in intercellular spaces and along dermoepidermal junctions in immunofluorecence studies. Cases 1 and 5 had mucosal involvement. Cases 2 and 3 had annular erythema. Case 4 had butterfly rash-like erythema on the cheeks. Histology showed both intraepidermal and subepidermal bullae in Case 1, subepidermal bulla in Cases 2 and 3, and intraepidermal bullae in Cases 4 and 5. In ELISA, anti-Dsg3 antibody and anti-BP180 antibody was positive in Case 1, anti-Dsg1 antibody, anti-Dsg3 antibody, and anti-BP180 antibody, were positive in Case 2, anti-Dsg1 antibody was positive in Case 4, and anti-Dsg3 antibody was positive in Case 5. We diagnosed Case 1 as a combination of pemphigus vulgaris and bullous pemphigoid, Cases 2 and 3 as bullous pemphigoid, Case 4 as pemphigus folliaceus, and Case 5 as pemphigus vulgaris. In conclusion, this unique autoimmune bullous dermatosis is a heterogenous entity, because the clinical features and immunological analyses showed various results. The main IgG subclass in these bullous dermatoses was IgG1.