We report 6 malignant melanomas of the nail apparatus in situ. All cases showed melanonychia striata extended over whole nail with the periungual pigmentation (Hutchinson's sign) clinically. Proliferations of atypical melanocytes were seen limited in epidermis histopathologically. The nail surface profiles by dermatoscope were composed of linear pigmentation, whereas the periungual pigmentation showed diffuse irregularly shaped pigmentation distributed in a disorderly fashion as well as acral lentiginous melanomas in situ. In contrast, both the ungual and the periungual surface profiles of pigmented nevi showed longitudinal linear pigmentation. These distinctive features of surface profiles are very helpful for the differential diagnosis of the longitudinal melanonychia striata with the periungual pigmentation.
A 93-year-old Japanese female had noticed a red colored skin tumor on her right upper eyelid about 7 months before, which gradually increased in size and elevated. Excision of the tumor was done at another institution and revealed Merkel cell carcinoma. At the initial consultation in our department, she had a hard red tumor measuring 25×15×10mm. Surgical resection of the tumor was carried out along clinically 5mm normal skin margin. The skin defect remaining after tumor resection was reconstructed with a switch flap from the lower eyelid. 8 months postoperatively, there has been no sigh of recurrence.
1) In patients with chronic arsenic poisoning at Toroku, the incidence of pulmonary carcinoma and that of urinary tract carcinoma were significantly higher than in the general public. 2) Among carcinomas appearing on the skin, Bowen's disease (covered areas) and solar keratosis were comparatively higher in incidence. 3) The above-stated carcinomas should especially be checked in patients with chronic arsenic poisoning. 4) In cases when Bowen's disease appears preceding internal carcinomas, the period of precedence was longer in woman (13years on the average) than in man (within 5 years or 3 years on the average).
Squamous cell carcinoma (SCC) arising in scar tissues was reviewed in 7 patients treated at National Sapporo Hospital between 1994 and 1999. The mean age at diagnosis was 65.9. There were 5 men and 2 women. The anatomical site of the lesions were lower limb (4), upper limb (2), and head (1) . 4 SCCs arose from scars due to burns, 2 arose from scars related to trauma, and 1 arose from fistules due to chronic osteomyelitis. The mean interval from initial injury to diagnosis was 52 years. At the time of diagnosis 2 patients were in Stage II, and 5 were in Stage III. Death resulted in 4 of the 7 patients. The mean duration from diagnosis to death was 20 months. Immunohistochemically detected p53 protein overexpression seemed correlated with a reduced survival time. A retrospective analysis was performed in patients with scar tissue carcinoma reported in Japan between 1974 and 1998. There were 258 patients, which consisted of 179 men and 79 women. The mean age at diagnosis was 55.3. The anatomical site of the lesions were lower limb (95), head (64), upper limb (48), and trunk (15) . The mean interval from initial injury to diagnosis was 37.2 years. At the time of diagnosis 4 patients were in Stage I, 25 were in Stage II, 29 were in Stage III, and 3 were in Stage IV.
It is difficult to determine the surgical margin of extra-mammary Paget's disease of a concept of “subclinical Paget condition”. For this difficulty, too much wide excision of genital lesion has easily caused the trouble of erection, dysfunction of urination and evacuation. In this paper, 17 cases of extra-mammary Paget's disease, who have received the mapping biopsy before operation in order to determine the margin of this lesion correctly, were reported. Total 16 biopsied skin specimens have been taken at 16 points, which were located on circle 30mm and 60mm away from the margin of erythematous lesion.
We presented 43 cases who had skin metastases from internal cancer experienced for 22 years in our hospital. Among the 43 patients, 25 were males and 18 were females. The mean age was 60.1 years old. The most frequent primary tumors were lung cancer (15 cases) . Face and neck were the most common metastatic lesions. Clinically, nodules type were most frequent and histologically, adenoid type was the comonnest. The average time of the appearance of the skin lesions after detection of the primary tumors was 45.4 months. The average time of death after the appearence of skin metastasis was 10.0 months. It is important that we understand the character of skin metastases from internal cancer for evidence of primary tumors.
Fifty seven cases (male : 34, female : 23) of metastatic skin tumor in our department were statistically investigated about age, location, clinical appearance, primary organs, and histological types. In addition, immunohistochemical examination using antibody against ornithine decarboxylase (ODC) was performed. Ages of cases were from 38 to 88 (mean : 62). Eruptions, which were mainly red nodules or tumors in shape, had been primarily presented on the trunk. Examination of primary organs showed that the ratio of metastasis from gastro-intestine, respiratory tract and lympho-reticular system was each about twenty percent. Histologically, adenocarcinomas were most frequently observed. In elevan cases, metastatic lesions were noticed before primary lesions were found. Duration from confirmation of primary lesions to that of metastatic lesions and duration of survival after skin metastasis were 1 to 63 months (mean :19.9) and 0.5-60 months (mean : 9.9), respectively. Immunohistochemical analysis showed that center of the nests in squamous cell carcinomas reacted with antibody against ODC and the intensity of staining was decreased in the peripheral layer of tumor nests. Our data, such as location, clinical finding and histological types supported previous studies. But, incidence of cases from breast cancer was low compared with that in previous studies. This difference seems to be related to a lower ratio of female cases.
A case of rapidly progressing extramammary Paget's disease is reported. Immunohistochemical and fluorescent in situ hybridization analyses showed erbB-2 protein overexpression in invasive primary tumor and lymph node metastasis, the latter being associated with prominent gene amplification. These results suggest an important role of this oncogene activation in the progression of extramammary Paget's disease.
Surgical specimens from 5 men and 5 women with extramammary Paget's disease were examined for erbB4 and progesterone receptor expressions using immunohistochemical methods. The positive staining was observed only in tumor cells of Case 3, when anti-erbB4 antibody was used. Because Case 3 stayed in the non-invasive stage of extramammary Paget's disease, it seems unlikely that erbB-4 positivity in tumor cells of extramammary Paget's disease may correlate with a poor prognosis. No positive staining was observed when the nine extramammary Paget's disease specimens were stained for progesterone receptor. These results may indicate that extrammary Paget's disease has an essentially different nature from that observed in breast carcinoma.
We presented a case of axillary Paget's disease. The patient was a 75-year-old man who noticed on his left axillary area a round shaped erythema of 2 centimeters in diameter. In 2 months, he had an itch and he consulted us. By punch biopsy, we diagnosed Paget's disease as carcinoma in situ. But, histological examination of excision specimen showed microinvasion of Paget's cells in dermis. In extra-mammary Paget's disease, axillary Paget's disease is rare compared with external genital Paget's disease. About microinvasion in dermis, in axillary Paget's disease it is more frequent than in external genital Paget's disease. In the case of single axillary Paget's disease as well as extermal genital Paget's disease, we have to treat it as cancer.
We have 8 cases of Angiosarcoma during the recent 10years, and 4 cases of them were sixties, the other 4 cases were seventies. Male/Female ratio was 5/3. The most common site of 8 cases was head, and the rare case was left side face. Clinical type : Macular type was 3 cases, Nodular or Ulcertype was 4 cases. Nodular or Macular type was one case. We treated 6 cases by Interleukin-2 (I1-2), and 2 cases of them are alive. The average existence period of 8 cases was 31 months, the longest existence period was 72 months, and the shortest existence period was 3 months. The average existence period of 3 cases treated by Interleukin-2 (I1-2) with electron beam were longer than 2 cases that were not treated in this combination.
Angiosarcoma of the scalp is a relatively rare disorder in Japan, but the number of patients has been increasing gradually recently. We report 4 cases of angiosarcoma treated by our department between 1989 and 1998. 3 men and one women ranged in age from 77 to 82 (mean, 79.2). The lesion was 3×2cm erythema in one case, and erythema with infiltration and bleeding longer than 20 cm in diameter in the other cases of them. The duration between onset and initial visit was under 3 months (mean of 1.5 months). Treatment consisted of a combination of surgery, localized injection of IL-2, intravenous injection of IL-2, intraarterial one-shot injection of IL-2, intraarterial continuous infusion of IL-2, irradiation, LAK, photodynamic therapy. Two of four patients died of angiosarcoma after 7 months and 27 months, the others died of the unrelated disease. The patient with the 3×2cm erythema survived for 27 months, but the mean duration of survival was 16 months. For patients with widespread lesions, we treated to inhibit tumor spread by intraarterial continuous infusion of IL-2, extensive radiation with a wide margin, and tumor resection including the outer layer of the skull and grafting the skin.
A liposarcoma is commonly found in the thigh, the buttocks, and the retroperitoneum, but rarely in the hands and feet. We reported a case of liposarcoma of the sole, that had reccured repeatedly, in 46-year-old male. The initial histological diagnosis was angiosarcoma, and the patient underwent wide resection. One year and 6 months after original surgery, he had local recurrence and lymph node metastasis. Later, reexamination led to the conculusion that the tumor was a round cell liposarcoma. In cases of recurrence, the histologic features of the tumor occasionally change to high-grade malignant type. In view of this possibility, complete surgical excision is very important in the initial treatment of liposarcoma.
We report a case of Woringer-Kolopp disease. A 68-year-old man presented with a polycyclic, infiltrated, erythematous plaque on the right thigh of 7 months duration. The lesion was 15mm in diameter. Histologically, there was a dense infiltrate of atypical mononuclear cells in the epidermis showing a pagetoid appearance. Immunohistochemically, the intraepidermal infiltrates were composed predominantly of CD8+ T cells. Electron microscopy revealed indented nuclei of lymphoid cells. Monoclonal rearrangement of TCR β gene was confirmed by Southern blot analysis. The lesion was totally excised with 5mm margin. There was no evidence of recurrence for 6 months after operation.
We reported a case of cutaneous T cell lymphoma. A 72-year-old woman had a two year-history of small red papules and diffuse erythema without scales on her whole body. Histologically, Pautrier's microabscess was found in the epidermis. She was treated with PUVA, IFN-γ and oral corticosteroid. One year later, her peripheral blood contained an increased number of atypical lymphocytes. INF-α, CHOP therapy and etoposide showed no improvement on her condition. Two years later, she died of the atypical lymphocyte infiltration on her whole body.
This paper presents a case of a 48-year-old female patient with multiple liver metastasis from a rectal malignant melanoma. On first admission her performance status (PS) was 4 and serum lactate dehydrogenase (LDH) was 5205U/l. She received intrahepatic arterial administration of cisplatin (CDDP) 100mg in bolus, and the primary rectal melanoma was surgically resected. After the therapy, LDH decreased to 3193U/l. A totally implantable catheter connected to a subcutaneous access chamber was placed into the hepatic artery. Using this cahteter, we gave her CDDP total 7 times as follows: CDDP 100mg for five times and then 70mg for two times, every 3 or 4 weeks. After the 4th admission her PS became 1 and serum LDH decreased to 403U/l, but mild thrombocytepenia, anemia and general fatigue appeared. After that, serum LDH increased again to 609U/l. Then she received dacarbazine 200mg daily for five tims using the catheter, however, LDH level incresed gradually and her general condision worsened. Chemoembolization to the feeding arteries along with intrahepatic arterial infusion of CDDP were performed, but she died six months later from her first admission. Although the duration of response was limited, the intra hepatic arterial administration of CDDP improved the quality of life of this patient. This therapy may be an alternative for the control of liver metastasis of malignant melanoma.
55-year-old female was visited to our department because of nodules on her right inguinal resion. She underwent surgical excision of malignant melanoma on her right leg before 15 years. Histological examination on her inguinal nodule revealed malignant melanoma. Wide excision and adjuvant chemotherapy were carried out. However 12 months later after the operation, she died of liver metastasis.
Thirty patients who were histologically diagnosed as having Bowen's disease and 3 patients with Bowen's cancer, a total of 33 patients, were clinically examined. They were examined in this department in 5 years from January 1994 through December 1998. The average number of cases per year were 8.8 and the average age was 71.5 years. The ratio of males to females was 2: 3 and the number of female patients were more. A single focus was found in 28 cases and multiple foci were found in 5 cases. the prevalent site of occurrence was the inferior limb and found in 11 cases. The occurrence in exposed regions was rare and found in 6 cases. The size of lesion was 1-1.5cm in diameter in 27 cases. As to the suffering period, about 1 year was found in 14 cases and the largest. Regarding the treatment, excision with 0.5cm margin was performed on 26 cases of Bowen's disease and that with 1.0cm margin on 3 cases of Bowen's cancer. No relapse has been found. In 1 case who underwent excision without taking margin, recurrence occurred after 2 years. HPV was examined in 28 cases using anti-HPV polyclonal antibody, and every case was found negative.
A case of mycosis fungoides, demblee variant, successfully treated by combined therapy with electron beam radiation and rIFN-γ is described. The patient was a 63-year-old male with rapidly progressive reddish tumors on the neck, chest and back. The prognostic index was 2.5, which was a very poor prognosis, using the procedure for calculation of the prognostic index for CTCL by the EORTC group. However, the patient was treated successfully by combined therapy with an electron beam radiation and topical injection of rIFN-γ. Since May of 1996, he has been free of disease.