This article shows a case of subungual squamous cell carcinoma that was treated with ray amputation followed by Pollicization. An eighty-year old woman presented a subungual squamous cell carcinoma sized seven centimeters in diameter on her left thumb. The tumor invaded into the middle phalanx. Pollicization was undergone after a ray-amputation of the thumb, and resulted in good function postoperatively. There are several alternatives in thumb reconstruction, like toe-to-thumb transfer, wrap-around flap transfer, local skin flap with bone graft, etc. In old-age patients, microsurgical toe transfers often result in difficulties of micro-anastomosis or donor site complications. Local flap rarely get good sensation. Pollicization can be recommended in old-age patients because of low morbidity of donor site and good functional achievement although it needs reduction of number of fingers.
Basal cell carcinoma (BCC) is popular malignant skin tumor showed by the eyelid. But the eyelid is difficult to reconstruct caused by thin skin and repeatedly open and closed movement. We plan lower lid's BCC is reconstructed by cheek flap, upper lid's and lateral canthal BCC are reconstructed by lateral orbital flap. This results are good functional and cosmetic course. Medial canthal BBC extended upper and lower lid is reconstructed by the combined cheek and median forehead flap. Therefore the eyelid reconstruction with anatomical and functional complication is neccesary to use the combined flap properly.
We report a 76 year-old male patient with skin metastasis of prostatic cancer who was successfully treated with hormon therapy and alive for 3 years and 2 months after the appearance of skin metastases. The patient showed multiple cutaneous nodules on the chest and abdominal region. The histopathology of the nodule revealed moderately differentiated adenocarcinoma. Immunohistochemically prostate specific antigen (PSA) and prostatic acid phosphatase (PAP) were positive. The histopathology of the prostate revealed poorly differentiated adenocarcinoma. Twenty-seven cases of skin metastasis of prostatic cancer have so far been reported in Japan, including our case.
To investigate the affections of arsenic pollution of groundwater on residents in arsenic-contaminated area, we examined the residents in Samta Village located in the southwest of Bangladesh, one of the most severely arsenic-polluted regions, from February 14 to 16 in 1998. Among a total of 135 participants, all except for a 26-year-old man showed some skin abnormalities typical for arsenicism. Twenty three residents (15 men and 8 women) out of them were disclosed to have malignant skin lesion (s) including suspicious one (s) ; furthermore 13 residents (9 men and 4 women) were found to have multiple lesions.
A 61 year-old Japanese female patient visited us with an 8 month history of tumor on the burn scar which she had on the left side of the scalp at age 3. Biopsy specimen obtained from the tumor of the scalp showed the histological features of squamous cell carcinoma. An invasion to the periosteum was histologically observed. Neither metaststic lymph node nor organ was not detected. The patient recieved an excision of the tumor with cervical lymphnode dissection followed by radiation therapy and chemotherapy. Patiet is well alive 11 month after the surgical procedure. It is suggested that the combination therapy is necessary for prognosis of the giant squamous cell corcinoma.
We report a 54-year-old man with squamous cell carcinoma arising from pressuresore scar on the left trochanter which has been occurred 20 years earlier by the sedative therapy for schizophrenia. Comparing with burn scar carcinomas, pressure-sore scar carcinomas are characterized by a shorter latency period and a fulminant clinical course with a very high metastatic rate. It may be due to the additional irritative factor of pressure to the scar, having chronic base disease, poor nutrition and immunity, and easy invasion of tumor cells to bone tissue.
The patient was a woman of 80 years old. She had dialysis for 2 years because of chronic renal failure. She was HCV antibody positive. Two keratoacanthomas appeared in the psoriatic eruption on the dorsum of manus complicated by the basal cell carcinoma in the root of nose. We discussed Psoriasis as the antecedent lesion of keratoacanthomas and the complication of untreated psoriasis and malignant disease.
A 87-year-old man with two different tumors in their appearance on his left cheek was reported. One was a dome-shaped pink tumor which was filled with keratin in the center. The other one was an irregular-surfaced brown tumor. Those were contact intimately with each other. Histopathologically, the former was a keratoacanthoma-like squamous cell carcinoma (SCC) and the latter was a malignant trichilemmoma (MT) in situ. Detail observations of the lateral margins of the tumors and the transition part between the tumors gave the evidences which pre-existent actinic keratosis (AK) was responsible for the both tumors. It was figured out that AK caused not only SCC but also MT.
The patient is a 72-year-old woman who showed poor prognosis of stage II-malignant melanoma arising on her right ring finger following eight operations for recurrent malignant fibrous histiocytoma from the peritoneum. Lymphocytic infiltration, as histological immunoreaction against melanoma, was scarcely seen in the resected tissue. The poor immunoresponse could be a cause of her repidly unfortunate course. Afterward, a radical amputation of the upper extremity, whose indication may be argued, was performed for severe pain owing to nerve infiltration of the recurrent melanoma.
A 65-year-old male had noticed a pruritic eruption on his scrotum about 3 months previously. In spite of initial clinical diagnosis having eczema, topical corticosteroid application was not effective. However, he came to our department after an operation, which was performed due to transverse colonic adenocarcinoma unexpectedly found. Physical examination at that time revealed a flat-elevated, welldemarcated erythema with numerous rice-sized firm papules on his scrotum. Biopsy specimen revealed irregularly-shaped tumor nests or strands both in the epidermis and the dermis. Tumor cells had large, pale cytoplasm with atypical nuclei, and occasionally formed lumina. Immunohistochemical analysis of cytokeratin expression in our case was performed in order to compare with that of primary extramammary Paget's disease. CK20 expression was recognized diffusely in the skin lesion, and focally in the colonic lesion. CK7 expression was also observed focally in the skin lesions. Because primary extramammary Paget's disease showed immunophenotype CK7+/CK20-consistently, immunophenotypes other than CK7+/CK20- in Paget cells suggest underlying regional internal malignancy.
We repoted a case 87-year-old man of signet ring cell carcinoma. He had developed increasing numbers of indurated erythema on the left chest, abdomen, shoulder, and upper arm for about a month. Histologically, aggregated tumor nests were noticed in dermis and subcutaneous tissue. Tumor cells presented signet-ring-cell like appearance which exhibited infiltrating lobular carcinoma like arrangement. Immunohistochemically, the tumor was positive for CA15-3 and negative for estrogen receptor and progesterone receptor. Autopsy showed that there were no primary tumor in viscera. From clinical and historogical findings, we diagnosed this tumor as signet ring cell carcinoma of the breast. This is the first report of signet ring cell carcinoma of the breast of the male in japan.
Since homeobox-containing genes (HOX genes) are a family of transcriptional regulators, which give cells positional information in morphogenesis, cancer metastasis can be explained as a heterotopic expression of HOX genes. In the present study, we investigated expression of a homeobox gene “HOXD3” and a cell adhesion molecule “integrin β3” in human melanomas. Seven cell lines of human melanoma were used as materials. The expressions of HOXD3 and integrin β3 were investigated by RT-PCR and FACS respectively. HOXD3 expressed in 6/7 cell lines and integrin β3 in 6/7. Expression of HOXD3 was highly related to expression of integrin β3 in almost all cell lines. Since it has been reported that melanoma cells use integrin β3 for their invasion and metastasis, HOXD3 can be considered as a factor regulating malignancy.
Histological classification of basal cell epitheliomas (BCE) experienced in our department for recent five years was reported and compared with a reported statistical analysis (Otuka et al., Skin Cancer (Special Issue) 8 : 61-68) . Fifty three histological specimens diagnosed previously as BCE were observed under a light microscope and histologically classified based on those by Lever et al. In contrast to the above mentioned reported analysis showing solid type (51.7%), superficial type (10.1%) and less adenoid type (7.7%), our present study demonstrates differences in significantly more adenoid type (28.5%) than superficial type (10%) . To ascertain if this is true, further analysis is on progress by increasing numbers of cases with BCE.
A 73-year-old man suffered from a mucinous carcinoma of the skin which located on the lower abdomen and underwent a wide excision. Histopathologically, the tumor was divided into numerous compartments which had abundant amounts of mucin and small islets of tumor cells. The immunohistochemical findings, including cytokeratin expression, ruled out mucinous carcinomas originated from other organs. On the right lung, the computed tomogram showed a coin lesion of about 10mm in size which was suspicious as a metastasis and which had no change in size and number during the follow-up period.
A case of extramammary Paget's disease of 62 year-old male is reported. The patient noted an erythematous plaque on his scrotum about five years ago. Although the lesion was diagnosed as a malignant tumor at that time in another hospital, he neglected adequate therapy. By the time he visited our hospital with numbness in the toes and gait disturbance, the lesion had progressed to an infiltrative erythema with tumor on his scrotum, penis and pubis. Furthermore, bilateral inguinal and iliac lymph node metastases and multiple bone metastases were found. Wide excision and inguinal lymphadenectomy were performed and a metastatic lesion in the backbone was also removed as a palliative measure for the symptoms of numbness in the toes and the gait disturbance. Five courses of postoperative chemotherapy with actinomycin D and vincristine led to disappearance of lymph node metastases in the pelvis, prevented recurrence of the tumor and decreased the serum CEA level to almost within normal range. The chemotherapy, however, had to be stopped because of side-effects such as high fever and general fatigue. Hypercalcemia due to bone metastases became marked. He died in 9 months after initiation of the treatment.
We report a case that is strongly suspected as ungual melanoma with spontaneous regression. A 52-year old woman was first seen in February 1997 with a 20-year history of longitudinal melanonychia of the right great toe. In recent two years the brown pigmentation has covered the rest of the nail. Histopathological observation showed melanocytes in the basal cell layer of the nail fold but not of the matrix. The diagnosis of early ungual melanoma was made clinically, so we scheduled for total resection of the nail including the nail matrix and nail bed. But in September 1998, the melanonychia began to disappear at a part of the proximal nail plate. So we decided to follow up her without surgical treatment. The whole body investigation demonstrated no evidence of metastasis. In July 1999, the melanonychia remains at the small part of the distal nail plate and the patient has been kept under periodic observation.
A 63-year-old Japanese woman was referred to us with a 1-month history of a nodule arising within a lesion of medium-sized congenital melanocytic nevus of the left popliteal region. Physical examination showed a black plaque, 13.6×7.7cm, on the site, and at the periphery of which, a reddish black nodule, 1.8×1.4×0.5cm, was detected. Histopathological examination of the nodule revealed nests of atypical melanocytes in the upper dermis. The overlying epidermis was eroded and no proliferation of atypical melanocytes was found in the epidermis. The plaque lesion histologically showed diffuse proliferation of small nevus cells in the reticular dermis. The border between the atypical melanocytes and the nevus cells was somewhat indistinct. The atypical cells were epithelioid or spindle shaped, and mitotic figures were frequently detected. The atypical cells were stained with an antibody to S-100 protein and some of them were also stained with a HMB-45. This case is malignant melanoma arising from a medium-sized congenital melanocytic nevus. The stage was pT4a N2a M1a (Stage IV). She underwent wide local resection along with subtotal integumentectomy and radical lymph node dissection of her left inguinal area. DAV-feron (DTIC, ACNU, VCR, IFN-β) therapy was administered postoperatively. However, soon later, metastases to lung, bones, and brain developed. She died from the disease on July 9, 1999.
We report a patient with malignant melanoma (pT3aN0M0. Stage II ) who died 3 years and 10 months after initial therapy. A 54-year-old Japanese man visited our clinic complaining of a rapidly growing 28×22-mm black tumor on the back. The patient was diagnosed as having malignant melanoma on the basis of clinical and pathological findings, and therefore wide resection and 2 couses of DAV (DTIC, ACNU and VCR) plus IFN-β combination chemotherapy were carried out. Because left axillary lymph node metastases were found 8 months after initial therapy, left axillary lymph node dissection was carried out and 3 couses of CDV (CDDP 125mg, DTIC 800mg and VDS 3mg) therapy were added. Eventually the patient died 3 years and 10 months after initial therapy due to multiple metastases to the liver and skin. Autopsy was not performed.
38-year-old male was visited to our department because of malignant melanoma. He underwent surgical excision of nodule on his left back resion. Wide excision, axillary lymphnode dissection and adjuvant chemotherapy were carried out. A few months later, he noticed several small nodules on his upper abdomen. Histological examination revealed steatocystoma multiplex.