A 43-year-old female developed itchy erythema on the bilateral eyelids. She had been treated with the anti-allergic ophthalmic solution Intal® for allergic conjunctivatitis for eight years. Patch tests resulted in a positive reaction to benzalconium chloride, which is used as a preservative in Intal®. All other contents showed negative results.
A case of 31-year-old male with erythrodermic pityriasis rubra pilaris was reported. The patient’s lesions were resistant to several treatments such as systemic steroids, vitamin A and etretinate, however, he spontaneously improved eighteen months after undergoing initial treatment.
The case was a 76-year-old woman, who had been suffered from a epeated appearance of purpura on the lower extremities since a half year before admission. She had been followed as either “anaphylactoid purpura” or “vasculitis allergica cutis,” however, the exact diagnosis remained unclear. After a 20-month follow-up, the patient was diagnosed as having hypergammaglobulinemic purpura based on clinical and histopathologic features as well as laboratory data. The hypergammaglobulinemia was based on Sjögren’s syndrome. Fifteen patients (including our case) with this syndrome accompanied by purpura had been previously reported in Japan. The clinical and histopathological finding of these patients as well as the cause of the purpura were also discussed.
A case of 72-year-old female with systemic cutaneous cryptococcosis was described. The patient had been previously administrated therapy for myelodysplastic syndrome and later developed subcutaneous nodules on her thighs. A chest X-ray showed bilateral pulmonary infiltrates. A histopathologic examination of the skin lesion showed many yeast-like bodies, and Cryptococcus neoformans serotype A was isolated from the cutaneous tissue and sputum. The patient was successfully treated with Amphotericin B. We also briefly reviewed and analyzed ninety-three cases of cutaneous cryptococcosis previously reported in Japan.
Three cases of Trichophyton violaceum infection seen in one family over a 6-year period are reported. Their clinical features were; case 1, a proband, seven-month-old boy with black dot ringworm; case 2, a 59-year-old female with tinea faciei, the grandmother of case 1, and case 3, a 6-month-old boy with tinea faciei and black dot ringworm, the brother of case 1. The lesions recurred repeatedly in each patient over several years, strongly suggesting that the fungus, T. violaceum, a representative of anthropophilic dermatophytes, had remained subclinically on the skin surface of the family members and thus caused the infections. However, all attempts to isolate the fungus from the scalps of healthy family members with a toothbrushing regimen proved unsuccessful.
We recently experienced 18 cases of congenital fistula occurring in the anterior chest region. Most of the cases were accompanied by a secondary infection. This fistula was short and ended in the subcutaneous layer. A histological examination of the excised fistula showed it to be lined by a keratinizing squamous epithelium. Numerous hair follicles and sebaceous glands in varying stages of development were present in the wall. The most difficultdifferential diagnosis was found in subcutaneous dermoid cysts since they lacked a fistula. Therefore, we named this lesion au congenital dermoid fistula of the anterior chest region. A total excision of the fistulous tract is essential for radical management.
We report a case of a 30-year-old man with multiple hemangiomas of the skin distributed in a unilateral pattern. He first noticed a nodule on his right sole at the age of 10 years old. On physical examination, CT scanning and MRI revealed six deep dermal or subcutaneous nodules which were lecated on the right side of his neck, shoulder, finger, chest, back and sole. No hemangioma in any of his internal organs was detected. The histopathological findings of the nodules showed irregularly dilated and variously-sized vascular spaces in the lower dermis. These findings were the same as those of cavernous hemangioma. In addition, smooth muscles and eccrine sweat glands were present close to the dilated vascular spaces. Our case is similar to the one reported by Wilkin in 1980, named unilateral dermatomal cavernous hemangiomatosis. We consider that our case should be included as a case of hemangiomatosis with a benign course such as unilateral dermatomal cavernous hemangiomatosis.
Microvenular hemangioma is a distinctive vascular tumor which generally favors the extremities, particularly the forearms, of young to middle-aged adults according to a report by Hunt et al in 1990. We report a case of an 11-year-old boy, who had a relatively soft purple to red nodule on his left lower extremity. A biopsy specimen revealed an irregular and branching pattern of venules. We discuss our observations along with comments on the differential diagnosis between pyogenic granuloma and Kaposi’s sarcoma.
We report a case of 62-year-old male with clear cell syringoma associated with poorly-controlled diabetes mellitus. The histogenesis of clear cell syringoma is still unknown. Therefore, we performed an immunohistochemical analysis, using monoclonal anti-cytokeratin antibodies, in the formalin-fixed, paraffin-embedded sections obtained from the patient. The results of immunohistochemical staining were as follows: (1) the clear cells in the clear cell syringoma were negative for CAM5.2 which strongly stained the eccrine secretory elements alone; (2) the luminal cells and cuticles in the clear cell syringoma showed a positive reaction to 34βE12 which stained the luminal cells and cuticles of the intraepidermal and dermal eccrine ducts; (3) the clear cells in the clear cell syringoma demonstrated a positive reaction to 34βB4 which was also positive for the outer cells of acrosyringium. Thus, the immunohistochemical analysis using anti-cytokeratin antibodies in tumors originating from the eccrine glands is considered to be useful in revealing the histogenesis and differentiation of these tumors.
A 42-year-old male presented with a six-year duration of violet colored erythema and reticular pigmentations on the trunk. Later these skin lesions spread and worsened, resulting in infiltrated erythema, cutaneous nodules and ulcers. The condition was histologically diagnosed as lymphomatoid granulomatosis (LYG). After hospitalization, pulmonary nodules, which was the main symptom of LYG, appeared and abruptly worsened. The patient eventually died of a multiple invasion of the internal organs, diagnosed as malignant lymphoma. The autopsy revealed an invasion of lymphoma cells into the lymph nodes in the axillary, inguinal, mediastinal and retroperitoneal regions, as well as the heart, spleen, stomach, kidneys and testes. Lung shadows appeared two weeks after hospitalization in this case, but it took 8 years until cutaneous changes appeared. The time span involved in this case was unusual compared with other LYG cases documented thus far. There have been over 200 reported cases of LYG in the world, but only 13 cases in Japan. In Japanese cases, lung changes were present in 12 out of 13 cases (92%), cerebral invasions in 6 cases (46%), cutaneous and renal changes in 4 eases cach (31%), and gastric, splenic and adrenocortical changes in 1 case each (8%). No differences in the symptoms have been noted between Japanese cases and cases from other countries.
We report a case of squamous cell carcinoma considered to have developed in fistules caused by old osteomyelitis. A 62-year-old man presented with multiple ulcers surrounded by hard, brownish skin over his entire buttocks area. He was suffered from a severe injury on the buttocks 40 years earlier when he fell down from a telegraph pole. Since then, he had been paralyzed below the S2 segment and experienced persistent pus discharge from several fistules. The physical examination revealed seven ulcers on the buttocks which were connected to each other by subcutaneous fistules. The largest ulcer measured 3.8×4.3 cm and the sacral bone was exposed in this ulcer. An X-ray demonstrated that the sacral bone below the S2 and the coccygeal bone were absent. After three months of treatment with radiation and chemotherapy, an apparent healing of the skin cancer was observed with a markedly decreased level of the SCC-associated antigen. However, a subsequent operation failed to totally resect the sequestral bones and carcinomatous regions, since almost the whole sacrum and ilium were found to be sequestral and the nerve fibers in the sacral areas had already been invaded by tumors. The patient’s condition gradually deteriorated and he eventually died of respiratory insufficiency and malnutrition twenty-one months after admission.
An 85-year-old female who had a large tumor diagnosed as a Merkel cell carcinoma on her left cheek was reported. Histopathologically a trabecular pattern was barely demonstrated in the periphery of the tumor nest, and membrane coated dense core granules of 80∼110 nm in diameter within the cytoplasm of the tumor cells were observed in the electron micrographs. Since the tumor measured eight centimeters in diameter with regional lymph node metastasis, she was treated with radiation therapy with 12MeV of Linac alone, and thereafter the tumor mass completely disappeared when the total amount of irradiation had been 40 Gy. Although a metastasis to the contralateral cheek skin occurred, no other metastasis to the visceral organs had developed by the time when she died of old age some four years after her first visit to the clinic. During the observation period, squamous cell carcinoma, which might be called a type of double cancer, was also found on the gingiva of her oral cavity.
We describe a 65-year-old female patient with malignant melanoma which developed on a local flap six years after undergoing a resection for malignant melanoma in situ on her right sole. She first noticed a pigmented spot on her right sole in 1984. During the following year, the macule slowly increased in size to a brownish lesion measuring 2.5 cm in diameter, with an irregular shape and variegated shades. The lesion was excised with a 0.5 cm margin after an incisional biopsy. Then in 1991, she noticed a slightly hyperkeratotic well-demarcated nodule with a normal skin color on the right sole which had been covered with a medial plantar flap at time of the previous operation. A histological diagnosis of an excisional biopsy specimen was malignant melanoma, Clark’s level IV. The patient was thus further treated with a wide local excision combined with radical ilio-inguinal lymph node resection and a subtotal integmentomy, chemotherapy (DAV-feron) and immunotherapy (BCG). We discuss the relationship between the malignant melanoma in situ which had been previously resected and the malignant melanoma which developed some six years after the original operation.
Eighty six male and 117 female patients with atopic dermatitis in 1991 were examined. Their ages ranged from 0 to 61 years (mean; 15.53) old. Some clinical features of the patients were peculiar to different age groups: the erythematopapular type was the most common in patients under 4-years-old, while for those over 5-years-old, the lichenified-plaque type was the most common lesion. Prurigo type appeared during childhood, while the facial and erythrodermic type was observed in the adolescent. In patients over 20-years-old, the prurigo and facial type exceeded the lichenified-plaque type. Prurigo nodularis-like nodules and severe facial exanthema were specific for adult patients. Nine patients of 29 with the prurigo type and 6 of 23 with the facial type had changed from the lichenified-plaque type during the time of our observation over the course of several years. In the patients over 16-years-old, the incidence at the first year of life was significantly higher in the prurigo, facial and erythrodermic types. The total IgE levels were also significantly higher in the prurigo, facial and erythrodermic types.
We have studied the host defense mechanisms against the experimental metastasis of B16 melanoma cells using H-2 loss variant cell lines. The NK cells revealed an appreciably higher killing activity toward H-2- cells and prevented pulmonary metastasis of this H-2 loss variant compared to the H-2+ cells. The tumor bearing state using MMC-treated B16 H-2+ and H-2- cells inhibited pulmonary metastasis of the corresponding B16 melanoma cells in NK and T cell-depleted host. In mixed lymphocyte-tumor cell culture (MLTC) experiments, B16 H-2- cells induced non-specific killer cells such as lymphokine-activated killer (LAK) cells, and demonstrated the ability to kill a variety of tumor cells. Furthermore, the effector cells demonstrating broad specificity generated from the spleen cells in H-2--bearing host by incubation for 6 days without IL-2 stimulation. These results thus suggest that the activated killer cells are generated from tumor bearing hosts and play a role against the metastasis of B16 melanoma cells with NK defense system. Considering that developing melanoma cells often have an alteration in the MHC molecule, it is important to better understand the mechanism involved in immunotherapy, particularly against the metastasis of melanoma cells.
Twenty-one cases of sporotrichosis treated at our clinic from December, 1981 to April, 1992 were statistically evaluated. The incidence of sporotrichosis was 0.14% among all outpatients. A higher percentage was noted in patients over 50-years-old, and females were affected more than males. Nine cases (43%) were farmers, while 14 cases (67%) had a history of antecedent injury. The causative organisms could be found in 13 of 18 patients (72%) in paraffinized sections.
The efficacy of the topical application of squaric acid dibutylester (SADBE) was evaluated in nineteen patients with alopecia areata and alopecia totalis. After sensitization with 2% SADBE in acetone, 0.001 to 1.0% of SADBE in acetone was applied to the lesions. Thirteen patients showed excellent responses consisting of a complete regrowth in 11. Among these 11 patients, however, five had a relapse. The treatment time for hair regrowth was 4 to 24 weeks. Six patients had no clinical response after 24 to 56 weeks of therapy. The topical application of SADBE is thus considered to be an effective remedy for alopecia areata and alopecia totalis.
A 26-year-old woman with large cicatricial alopecia on her right temporal area was successfully treated by using a free scalp flap in combination with a tissue expander technique. To form a natural hairline, the frontal side of the cicatricial lesion was reconstructed using a free scalp flap taken from the opposite temporal area. The flap was transplanted with a microsurgical revascularization to the superficial temporal vessels. Then, the rest of the lesion was resected and the defect was covered with the scalp skin expanded by the tissue expander technique.