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Fumi MIYAGAWA, Takaya FUKUMOTO, Hiroshi IIOKA, Kohei OGAWA, Yasunori E ...
2014 Volume 28 Issue 3 Pages
259-263
Published: 2014
Released on J-STAGE: May 01, 2014
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Although CD99 was originally described as a specific and diagnostically useful marker for Ewing sarcoma/primitive neuroectodermal tumor (PNET), the list of tumors known to express CD99 has expanded recently and includes leukemia, lymphoma, synovial sarcoma, and ependymoma. We describe a case of CD99+ primary cutaneous anaplastic large cell lymphoma (C-ALCL) presenting as a subcutaneous tumor on the forearm. Because histopathologically, the tumor was composed of small round cells that were positive for CD99, peripheral PNET was suspected and the patient was referred to our department. Immunohistochemistry allowed for a diagnosis of C-ALCL. A definitive diagnosis of small round cell tumors such as PNET, Ewing sarcoma and lymphoma may be problematic in some cases. With CD99 expression, a diagnosis of pPNET may be incorrectly made in our case. Immunohistochemistry and an understanding of histopathologic features of small round cell tumors are important for a differential diagnosis.[
Skin Cancer (Japan) 2013 ; 28 : 259-263]
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Kazunori URBE, Yumiko KAKU, Fumitaka OHNO, Naoko WADA, Kayo HARADA, Yo ...
2014 Volume 28 Issue 3 Pages
264-267
Published: 2014
Released on J-STAGE: May 01, 2014
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A 22-year-old woman presented with a nodule within a giant congenital nevus on her back. A hisitopathological examination revealed the smooth transition of the pre-existing lesion and the nodule, the absence of strong atypical nuclei, the atypical mitotic figures and the absence of necrosis. Immunohistochemical stains showed only 7% labeling index with Ki-67. Based on observation, a diagnosis of proliferative nodule arising within a giant congenital pigmented nevus was made. One year and six months passed after the resection, but neither recurrence nor metastasis has occurred.[
Skin Cancer (Japan) 2013 ; 28 : 264-267]
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Koichi NAKAGAWA, Aya OKABAYASHI, Mari TAGUCHI, Tomoko OSHIMO, Nami SHI ...
2014 Volume 28 Issue 3 Pages
268-273
Published: 2014
Released on J-STAGE: May 01, 2014
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We report two cases of familial malignant melanoma. Case 1 : a 34-year-old Japanese male was referred to our hospital with a 15×18 mm irregularly pigmented macule on his chest and multiple moles on almost his entire body. His father died owing to liver metastasis of a malignant melanoma on the bulbar conjunctiva. The lesion on his breast was excised, and the result of the histopathological examination of the specimen was a malignant melanoma. Moreover, the mole on his back showed dysplastic nevus. Case2 : a 63-year-old female presented with a black nodule on her lower abdomen. Her elder sister underwent an operation on a malignant melanoma of the leg 30 years ago. Although we excised the tumor from her abdomen, the pathological diagnosis was also a malignant melanoma. Cases 1 and 2 were both diagnosed as familial malignant melanomas from the above findings. In addition, a germline mutation in neither the
CDKN2A nor the
CDK4 gene was identified in genomic DNA prepared from the peripheral blood of case 1, suggesting the involvement of other gene abnormalities in his malignant melanoma pathogenesis.[
Skin Cancer (Japan) 2013 ; 28 : 268-273]
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Megumi HIRABAYASHI, Toshihiko HOASHI, Hiroko NAKAJIMA, Takeshi IOZUMI
2014 Volume 28 Issue 3 Pages
274-278
Published: 2014
Released on J-STAGE: May 01, 2014
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A 72-year-old man was referred to us with a black macule of a couple of years' duration on the left sole. It was hyperkeratotic on the surface, accompanied by two black dots in the vicinity. Two hard masses were palpated in the left groin. The macule was resected along with the juxtaposed spots, followed by ipsilateral inguinal lymphadenectomy. Postoperatively, pathology revealed the patient had plantar malignant melanoma with satellite lesions and inguinal metastases (positive in 5/19 nodes resected). The deep margin was not secure near the cutting edge of plantar aponeurosis and we proceeded to resect only the upper layers of the flexor hallucis longus tendon in a peeling fashion with the intention of toe salvage. Notably, two well-demarcated depigmented lesions were observed after adjuvant DAV-feron therapy. As of 20 months after the first surgery there has been no manifestation of local or regional recurrence, which convinces us that the second surgery was valid and sufficed the survival.[
Skin Cancer (Japan) 2013 ; 28 : 274-278]
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Yuka YAMAGUCHI, Takahiro KIYOHARA, Shiro IINO, Masami YOSHIDA
2014 Volume 28 Issue 3 Pages
279-282
Published: 2014
Released on J-STAGE: May 01, 2014
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A 57-year-old man presented with an irregularly shaped, black macule measuring 5 mm on the inside border of his left plantar arch area. Histological examination revealed irregular hypertrophy and atrophy of the involved epidermis. A slight inflammatory infiltration and a few melanophages distributed irregularly around the superficial dermal plexus. There were slightly atypical single melanocytes which irregularly ascended up to the mid-epidermis from the basal layer. A few well-defined nests could be seen in the lower rete ridges. Although a definite diagnosis could not be obtained through the H.E. findings alone, Fontana-Masson staining preferred acral nevus to melanoma. It demonstrated regularly distributed, relatively wide, melanin columns in the cornified layer above the limiting ridges. Since the macule in present case was situated on a site-specific sole and was furthermore located on the transition between hairy and glabrous areas, it possessed the histological characteristics of pseudomelanoma. We should recognize that acral nevus could mimic melanoma histologically, and that Fontana-Masson staining is very useful in the differential diagnosis between them.[
Skin Cancer (Japan) 2013 ; 28 : 279-282]
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Akina OGAWA, Kentaro MIZUTANI, Yoshinari MATSUMOTO, Youichi AKITA, Dai ...
2014 Volume 28 Issue 3 Pages
283-286
Published: 2014
Released on J-STAGE: May 01, 2014
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Quadruple extramammary Paget's disease (EMPD) is very rare. Herein we report a case of quadruple EMPD in a Japanese male. A 68-year-old Japanese male presented with a 4-year history of erythema of the umbilical lesion. After a biopsy, he was suspected as having EMPD, and was referred our hospital. Physical examination revealed erythematous lesions on his axillae and genital area, as well as on the umbilicus. Biopsy specimens from the 4 lesions exhibited tumor cells with large pleomorphic nuclei and abundant cytoplasm, which had proliferated in the intra-epidermis. Enhanced computed tomography did not reveal any signs of lymph node or visceral metastasis. Under general anesthesia, the lesions were resected with a 1 cm-margin. Histological examination revealed tumor cells with large pleomorphic nuclei and abundant cytoplasm, and were positive for PAS staining. These cells had proliferated in focal, adenomatous, or were solitary in the intra-epidermis. Immunohistological analysis showed the tumor cells to be positive for CK7 and negative for CK20. From these observations, a confirmed diagnosis of quadruple EMPD was made.[
Skin Cancer (Japan) 2013 ; 28 : 283-286]
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Hazuki KAGEYAMA, Keiko SAKAMOTO, Shioto SUZUKI, Keigo GOTO, Ayano SUZU ...
2014 Volume 28 Issue 3 Pages
287-291
Published: 2014
Released on J-STAGE: May 01, 2014
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We describe a 43-year-old woman with pigmented mammary Paget's disease (PMPD) on the left nipple. Two years before our initial examination, she noticed a black lesion on her left nipple which gradually increased in size. Dermoscopic examination revealed the presence of irregular blotches, blue-white structures, irregular streaks showing the features of malignant melanoma (MM). Histopathologic findings included numerous pagetoid cells with clear and abundant cytoplasm in the epidermis, upper dermis, and inner side of mammary ducts. Immunohistochemical study showed that those cells were positive for CEA and CK-7 and negative for HMB-45 and melon-A. Although there have been scarce reports on the dermoscopic characteristics of MPMD, it seems that PMPD and MM have similarities with each other. We further documented the resemblance between the two diseases by exhibiting dermoscopic and immunohistochemical findings.[
Skin Cancer (Japan) 2013 ; 28 : 287-291]
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Yoshie HASEGAWA, Kenji YOKOTA, Michihiro KONO, Masaki SAWADA, Takaaki ...
2014 Volume 28 Issue 3 Pages
292-296
Published: 2014
Released on J-STAGE: May 01, 2014
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A 75-year-old man had had a mass on his right buttock for about 10 years. The mass developed slowly, and he visited a private clinic of a plastic surgeon. According to the clinical record, a 9×8 cm infected mass on the right buttock was incised, drained and also biopsied. The biopsy specimen of the mass showed the existence of squamous cell carcinoma, and he was referred to our hospital. Physical examination revealed that there was a 6×4 cm mass on his right buttock. Image inspection results suggested swelling of the right inguinal lymph node. We performed a wide excision of the tumor. Histopathological examination of the resected tumor showed a cystic structure and highly differentiated squamous cell carcinoma connected to the cyst wall. The tumor had infiltrated into the subcutaneous tissue. Metastasis was found in one lymph node.[
Skin Cancer (Japan) 2013 ; 28 : 292-296]
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Tetsuo SHUKUWA, Hiroshi ISHIKAWA, Yukiko TOKAI, Shigeto MAEDA
2014 Volume 28 Issue 3 Pages
297-301
Published: 2014
Released on J-STAGE: May 01, 2014
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A 75-year old woman noted a subcutaneous nodule on the left axilla in December, 2007. On February 29, 2012, physical examination revealed a subcutaneous nodule, 12×7mm in size, with a pedunculated tumor, 3×2mm, on the left axilla. Excisional biopsy was performed on March 6, 2012. Histologically, the neoplasm consisted of nests with atypical epithelial cells and glands with abundant eosinophilic cytoplasm that showed decapitation secretion. Normal mammary glands or ducts were not found. Immunohistochemistry showed that tumor cells were positive for EMA, CK7 and GCDFP-15, but negative for CEA, S-100, ER, PR or HER-2. This tumor was diagnosed as primary cutaneous apocrine carcinoma. A wide excision with left axillar lymph node dissection was performed on April 6, 2012. There has been no evidence of recurrence or metastasis for fifteen months, after the last surgery.[
Skin Cancer (Japan) 2013 ; 28 : 297-301]
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Takuya INOUE, Noriyuki MISAGO, Hiromi KIMURA, Reiko SHIRAI, Naomi YONE ...
2014 Volume 28 Issue 3 Pages
302-305
Published: 2014
Released on J-STAGE: May 01, 2014
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A 51-year-old woman with neurofibromatosis type 1 presented with a left foot mass that had progressively enlarged for two years. The mass was a 3.5-cm well-circumscribed superficial tumor, and we resected the tumor based on a diagnosis of neurofibroma. A histopathological examination demonstrated atypical spindle cells proliferating in the dermis to the subcutis. These findings led to a diagnosis of malignant peripheral nerve sheath tumor (MPNST). After an additional wide excision, no recurrence or metastasis was evident for 2 years. Most MPNSTs arise in association with major nerve trunks, and superficial MPNST is rare. We herein report a cutaneous MPNST located in the dermis to the subcutis.[
Skin Cancer (Japan) 2013 ; 28 : 302-305]
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Yutaka INABA, Naoya MIKITA, Fukumi FURUKAWA, Yasushi NAKAMURA, Yuki YA ...
2014 Volume 28 Issue 3 Pages
306-309
Published: 2014
Released on J-STAGE: May 01, 2014
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A 50-year-old man suffering from neurofibromatosis type 1 noticed a subcutaneous tumor (30×30 mm) on his right lower back in 1999. We carefully observed this tumor and identified it as a neurofibroma. But he had not come to our hospital since 2009. The tumor grew gradually and caused redness and swelling in June 2012. When he came to our hospital in July 2012, the size of the tumor was 20×16 cm. MRI of the tumor revealed a polycystic subcutaneous tumor, approximately 12×12 cm, on his right lower back. We diagnosed intratumoral bleeding of malignant peripheral nerve sheath tumor (MPNST) because his tumor enlarged rapidly and his anemia worsened. An immediate excision of the tumor was performed after embolization therapy. The tumor was histologically diagnosed as an MPNST. As the surgical margin was pathologically negative without distant metastasis, no chemotherapy or radiotherapy were performed after the surgical treatment. He has been free from recurrence or metastasis for at least nine months.[
Skin Cancer (Japan) 2013 ; 28 : 306-309]
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Aya ARAKAWA, Hiroshi YATSUSIRO, Yoshinori HASEGAWA, Takahiro KIYOHARA
2014 Volume 28 Issue 3 Pages
310-314
Published: 2014
Released on J-STAGE: May 01, 2014
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An 88-year-old woman presented with a 40×40 mm-sized, light brown nodule with a central ulcer on her lower abdomen. She had noticed the nodule two weeks before the first visit. Dermoscopic examination showed fissures and ridges with many comedo-like openings on the periphery of the nodule. Histopathology demonstrated reticulated seborrheic keratosis (SK), accompanied by solid basal cell carcinoma (BCC) in the center. BCC cells invaded reticulated epithelial strands of SK between them. Immunohistochemistry revealed positive reactivity of only BCC cells for Ber-EP4. Although the pathogenesis of malignant transformation is controversial, solid BCC was supposed to arise from reticulated SK in the present case.[
Skin Cancer (Japan) 2013 ; 28 : 310-314]
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Naotaka DOI, Naoya MIKITA, Osamu MASUO, Arisa UMESAKI, Yasushi NAKAMUR ...
2014 Volume 28 Issue 3 Pages
315-319
Published: 2014
Released on J-STAGE: May 01, 2014
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We present an 87-year-old male patient who developed a malignant fibrous histiocytoma of the frontal bone with epidural invasion. The subcutaneous tumor was observed in the right forehead from which excision was carried out in another hospital. The tumor recurred one month after the operation, and we excised it including the frontal bone and dura mater. Pathological examination revealed dense proliferation of small hyperchromatic cells and large, bizarre and multinucleated cells, which showed positive stain, vimentin, CD68, and HHF35. This case was diagnosed as malignant fibrous histiocytoma. After three months had passed since the surgical treatment, local recurrence was found. Then we treated the tumor with pazopanib, which is a potent and selective multi-targeted receptor tyrosine kinase inhibitor of VEGFR-1, VEGFR-2, VEGFR-3, PDGFR-
α/
β, and c-kit. Tumor regression was observed.[
Skin Cancer (Japan) 2013 ; 28 : 315-319]
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Takashi MIZUNO, Tomohiko TANEGASHIMA, Aki SUZUKI, Sayaka KUZE
2014 Volume 28 Issue 3 Pages
320-324
Published: 2014
Released on J-STAGE: May 01, 2014
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We report a 63-year-old Japanese woman who presented with an 11×9 mm dark-red nodule on the right upper part of her abdomen. The lesion had been growing for two months. Histlogical examination showed that the tumor was well circumscribed and centered almost in the dermis. Grenz zone, epithelial collarette and solar elastosis in the surrounding area were not found. The tumor consisted mainly of atypical spindle cells, showing a storiform pattern. Histiocyte-like round cells and bizarre giant cells were also recognized. Immunohistochemical findings confirmed that tumor cells were partially positive for
α-SMA and lysozyme. Tumor cells did not stain for actin, myosin, desmin, or S-100. MIB1 was positive for 20% of the tumor cells. We diagnosed this case as malignant fibrous histiocytoma based upon these findings. A wide excision was performed. No recurrence has been evidenced 5 months postoperatively.[
Skin Cancer (Japan) 2013 ; 28 : 320-324]
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Izumi NISHIOKA, Hitoshi TSUCHIHASHI, Keiko OKUMA, Kyoko SATO, Toshio H ...
2014 Volume 28 Issue 3 Pages
325-328
Published: 2014
Released on J-STAGE: May 01, 2014
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A 65-year-old woman presented with a several-year history of a slight red colored palpable indurated tumor on the right trunk. Skin biopsy examination revealed that the tumor cells had plump spindle-shaped cytoplasm, and the cells were arranged in fascicle or epithelioid nests with collagenous stroma. The inflammatory part showed a cellular infiltration that consisted of plasma cells and lymphocytes. The spindle cells were immune-reactive for smooth muscle actin and CD68, but they were negative for CD34, ALK and IgG4. According to these findings, the lesion was diagnosed as an inflammatory myofibroblastic tumor (IMT). IMT occurs in various organs and among them, the lung is the most frequently affected organ. Cutaneous IMT is very rare and to the best of our knowledge, only 18 cases of cutaneous IMT have been reported.[
Skin Cancer (Japan) 2013 ; 28 : 325-328]
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Asami TOZAWA, Hiroki NAKAOKA, Hideki MORI
2014 Volume 28 Issue 3 Pages
329-335
Published: 2014
Released on J-STAGE: May 01, 2014
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A 39-year-old woman presented with a colored lump on her left knee that was causing pressure pain. The lump had first appeared 3 months earlier, and spontaneous pain that developed 2 weeks before admission led her to seek medical attention. On examination, there was a slightly raised, red, indurated area that measured 15 mm in diameter. This was diagnosed as an epithelioid hemangioendothelioma (EHE) after biopsy. The lesion was excised with a 20-mm margin and an all-layer dermoplasty was performed. Lymph node enlargement developed in the groin 2.5 months later, and computed tomography (CT) showed enlarged lymph nodes near the external iliac artery. A lymph node biopsy led to a diagnosis of metastasis. She was given five cycles of chemotherapy with adriamycin and ifosfamide. The patient remains in remission with no metastasis 47 months later. EHE in the skin is reported only rarely.[
Skin Cancer (Japan) 2013 ; 28 : 329-335]
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Hiroshi MIIDA, Kazushi SAWAMURA
2014 Volume 28 Issue 3 Pages
344-348
Published: 2014
Released on J-STAGE: May 01, 2014
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A 42-year-old woman was referred to the department of psychiatry in our hospital for poorly controlled schizophrenia, abdominal distension and fever. She had suffered from schizophrenia since the age of 19 years. She had diffuse dermatitis with a little erosion on the posterior surface of the lower limbs and decubitus on the sacral and right calcaneal region, too. Furthermore, she also presented with a fist-sized black tumor on the orifice of the vagina with no complaint about it. Computed tomography and magnetic resonance imaging (MRI) showed that the giant tumor measuring 17.8×11.0×9.5 cm in MRI occupied through the intra-vaginal cavity with rectus flattened and shifted the uterus in an anterosuperior direction. And they showed a lot of ascites and large ovaries suggesting metastasis. The biopsy specimen showed the proliferation of atypical melanocyte, both S-100 and HMB-45 positive. The mechanism underlying giant malignant melanomas remains to be determined, although they are rare tumors. The present case suggests that the poorly controlled schizophrenia might have deterred her from visiting medical institutions, and that the tumor could have grown excessively without diagnosis and treatment.[
Skin Cancer (Japan) 2013 ; 28 : 344-348]
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