In Vitro Effects of 1,25-Dihydroxyvitamin D3 on the Production of Interleukin-1alpha by Ultraviolet B Irradiation in Cultured Human Keratinocyte Cell Line HaCaT Cells / 대한피부과학회지

BACKGROUND: Keratinocyte-derived interleukin-1(IL-1)alpha is one of the key cytokines in initiation of cutaneous inflammation. Release of IL-1alpha from human keratinocytes may be induced by proinflammatory stimuli including ultraviolet B(UVB) irradiation, and subsequently, keratinocyte-derived IL-1alpha may exert numerous paracrine and autocrine effects. 1,25-dihydroxyvitamin D3(1,25(OH)2D3) is involved in the regulation of keratinocyte proliferation and differentiation and is also recognized to have immunoregulatory properties such as an antiinflammatory effect. OBJECTIVE: The purpose of this study was to investigate the in vitro effects of 1,25-(OH)2D3 on the production of IL-1alpha by UVB irradiation in cultured human keratinocyte cell line HaCaT cells. RESULTS: are summerized as follows; 1. The vialility of cultured HaCaT cells measured by MTS assay at 24 hours after UVB irradiation was significantly reduced at the doses of above 100 mJ/cm2 of UVB(p<0.05). 2. The secretion of IL-1alpha by HaCaT cells was significantly increased at the doses of above 30 mJ/cm2 of UVB(p<0.05). UVB irradiation could not influence on the secretion of IL-1beta by HaCaT cells. 3. At the concentrations of 10-8M and 10-6M of 1,25(OH)2D3, the production of IL-1alpha by HaCaT cells(48 hours after 100 mJ/cm2 UVB irradiation) was significantly inhibited in both culture supernatants and cell lysates(p<0.05). CONCLUSION: UVB irradiation increased the production of IL-1alpha by HaCaT cells and this stimulatory effect on the production of IL-1alpha induced by UVB irradiation was suppressed by 1,25-(OH)2D3. Calcipotriol(MC-903) had similar suppressive effect on the production of IL-1alpha induced by UVB irradiation in HaCaT cells to that of 1,25(OH)2D3.

Kaposi's Sarcoma: a Clinico-Pathological Study of 8 Patients / 대한피부과학회지

BACKGROUND: Kaposi's sarcoma (KS) is a multicentric neoplastic vascular tumor involving the skin or internal organs. KS is an extremely common tumor in tropical Africa and it is also a prime marker of acquired immunodeficiency syndrome (AIDS). Nearly all cases of KS can be classified in four groups: 1) classic, 2) African, endemic, 3) AIDS-associated, 4) iatrogenic immunosuppression- associated KS. OBJECTIVE: The purposes of this study were aimed at evaluating the clinical and biological features of KS. METHODS: The hospital charts and histopathologic slides of patients with KS diagnosed at Asan Medical Center from 1989 to 1999 were reviewed. Immunohistochemical studies for factor VIII, CD31, and CD34 were performed. We also performed PCR-based analysis to determine whether human herpesvirus 8 (HHV8) is present in KS included in this study. RESULTS: 1. Four male and four female patients were included. The mean age at diagnosis of KS was 59.6 years. 2. Our patients could be classified as follows, iatrogenic immunosuppression-associated (7/8) and classic KS (1/8). Iatrogenic immunosuppression-associated group was sub-classified into long-standing steroid use (2/7), chemotheraphy-associated (cancer related, 3/7), and kidney transplantation (KT)-associated group (2/7). Patients with AIDS-associated KS were absent. 3. KS was presented with varied clinical features showing from ill-defined purplish macules to fungating nodules or tumors. Interestingly, two cases were presented with zosteriform or cellulitis-like features. Although upper and especially, lower extremities were favored sites, mucosal involvement such as intraoral and perianal areas was noticed. The cases showing the involvement of systemic organ could not be detected except two cases involving the small intestine. 4. Immunohistochemical studies revealed that spindle cells in stroma were partially positive for CD31 and CD34 and negative for factor VIII. 5. HHV8 sequences were identified in all cases of KS. 6. Four patients (50%) died within 1-2 years after the diagnosis of KS due to underlying diseases. Radiation therapy and interferon-alpha were effective in one case, respectively. Classic KS showed indolent course. Conclusion: KS is a multicentric neoplasm for which the etiopathogenesis is still under discu ssion. We retrospectively studied seven cases with iatrogenic immunosuppression-associated KS and one with classic KS. KS should be considered when the cutaneous lesions newly developed in immunosuppressed patients. HHV8 may contribute to the pathogenesis of KS when other predisposing conditions are present.

Leukemia Cutis: a Clinico-Pathologic Study of 23 Patients / 대한피부과학회지

BACKGROUND: Leukemia cutis is regarded as a dissemination of aggressive systemic leukemia to the skin. The presence of leukemia cutis is usually associated with a grave prognosis. OBJECTIVE: We evaluated the differences in the patienta' age and sex, the clinical appearance and distributions of the skin lesions, histopathological characteristics, interval between diagnosis of systemic leukemia and skin involvement, and prognosis according to the type of leukemias. METHODS: We performed a retrospective study of 23 cases of leukemia cutis. We obtained the clinical characteristics from record reviews and we also reevaluateds biopsy materials of 23 patients diagnosed in Asan Medical Center from 1989 to 1999. RESULTS: 1. The male-female ratio was 1.6 to 1. The mean age at diagnosis was 46.6 years. Leukemia cutis occurred in 4.3% of cases of AML(17/396), 0.4% of ALL(1/276), 9.5% of CML(2/21), and 0% of CLL(0/14) in Asan Medical Center from 1989 to 1999. The patients in this study comprised: 3 patients with myelodysplastic syndrome(MDS), 1 acute lymphocytic leukemia(ALL), 17 acute myelocytic leukemia(AML), and 2 chronic myelocytic leukemia(CML). 2. The clinical appearance of leukemia cutis includes macules, papules, nodules, and erythema nodosum-like lesions. The papular lesions were the most common ones. Trunk and extremities were favored sites. There was no specific difference in the clinical findings of each type of leukemias. 3. Histopathological evaluation revealed perivascular and periadnexal infiltration of leukemic cells in the dermis with grenz zone in more than one third of the specimens. There was no specific difference in the histopathological findings of each type of leukemias. 4. In sixteen of the 23 patients (69.6%) with leukemia cutis, skin lesions developed after the systemic leukemia had been diagnosed. Three of the patients (13%) had skin lesions preceding the diagnosis of systemic leukemia and 4 patients (17%) had concomitant involvement. 5. Eighteen patients (78.3%) died after the diagnosis of leukemia cutis. The mean intervals between diagnosis of leukemia cutis and death was 4.8 months. CONCLUSION: Leukemia cutis is an uncommon manifestation of leukemia cutis that is strongly associated with the presence of extramedullary disease at other sites. Although AML was the most common type in this study, leukemia cutis has developed in CML, AML, ALL, and CLL in decreasing order of frequency in this study. The lesions showed varied morphology and could be difficult to distinguish both clinically and histopathologically from nonspecific dermatoses. The presence of leukemia cutis may be a sign of grave prognosis.

The Removal of Eyebrow Tattoos by the Q-switched Alexandrite Laser / 대한피부과학회지

BACKGROUND: Women sometimes have eyebrows tattooed for cosmetic purpose. But until recently, the removal of tattoos has been difficult. Several laser techniques have been proposed for the removal of tattoos. The lasers that have been used most successfully are the Q-switched systems because of their ability to target tattoo pigment selectively with minimal risk of adverse tissue response. OBJECTIVE: The objective of this study was to determine the clinical effectiveness of the newest Q-switched system, the alexandrite laser, in removing both eyebrow tattoos and to observe side effects such as scarring or permanent pigmentary changes. METHODS: Forty seven patients with both eyebrows tattooed were treated with the Q-switched alexandrite laser (755 nm, 100 ns) at eight week intervals and clinically evaluated.

Subcutaneous Panniculitic Angiocentric T/NK-Cell Lymphoma / 대한피부과학회지

Nasal-type T/NK cell lymphoma shows frequent extra-nodal involvement including skin with poor prognosis. Subcutaneous panniculitic T-cell lymphoma which is characterized by subcutaneous nodules, systemic signs and symptoms, and a hemophagocytic syndromes was also identified and must be differentiated with primary cutaneous nasal-type T/NK cell lymphoma. We report a case of subcutaneous angiocentric T/NK cell lymphoma in a 77-year-old man who had multiple deep ulcers on the extremities. Strong CD56 positivity and EBV RNA by in situ hybridization were demonstrated in the angiocentric infiltrates of the subcutis. The skin lesions were resistant to combination chemotherapy and pancreatic involvement of lymphoma developed. One year after onset of the skin lesions, he had a rapid downhill course.

Primary Cutaneous CD30(Ki-1)-Positive Pleomorphic Large Cell Lymphoma in a Patient with Generalized Lichen Myxedematosus

A case of primary cutaneous CD30(Ki-1)-positive pleomorphic large cell lymphoma in a 51-year-old woman with generalized lichen myxedematosus is presented. Histopathological findings of the biopsy specimens from the lichenoid papules of the left forearm and the dorsum of the right hand were compatible with papular mucinosis. The mucinous material in the papillary dermis stained with alcian blue at pH 2.5 and was susceptible to hyaturonidase, but serum protein electrophoresis showed no abnormal bands and an abnormal paraprotein was not detected in our patient. Histopathological examination of a solitary, firm, purplish nodule on the right popliteal area showed diffuse and extensive infiltration in the reticular dermis composed of large, atypical, often hyperchromatic, sometimes multinucleated and markedly pleomorphic cells. The majority of the large atypical cells were CD30(Ki-1) positive. The TCR gene re-arrangement analysis demonstrated the presence of a monoclonal rearrangement of the y-TCR gene in the skin biopsy specimen of our patient. The organ-system survey revealed no evidence of internal organ involvement. We concluded that this was primary cutaneous CD30(Ki-1)-positive pleomorphic large cell lymphoma developing in a patient with generalized lichen myxedematosus.

Angiocentric T - cell Lymphoma: Clinical and Histopathologic Features of Four Patients / 대한피부과학회지

BACKGROUND: Angiocentric T-cell lymphoma(AL) is a rare subtype of cutaneous T-cell lymphoma and recently many cases have been reported from Taiwan and Japan. But little is known about the clinical and histopathologic features of AL and few data are available in Korea. OBJECTIVE: Our purpose was to characterize the clinical and histopathologic features of the specific cutaneous manifestauons of AL and to investigate the association with Epstein-Barr virus (EBV). METHODS: Clinical records and histopathologic evaluation of skin biopsy specimens from four patients with AL were reviewed. We also performed immunohistochemical staining using monoclonal antibodies against, surface markers of lymphocytes and in situ hybridization for EBV-encoded RNA(EBER) in lesional skin. RESULTS: 1. The most common clinical finding in our patients was indurated plaque predominantly on the trunk. 2. The common histopathologic finding in skin biopsy specimens from all four patients was angiocentric, angioinvasive, and angiodestructive infiltrate containing atypical lymphocytes. 3. In three of four patients, EBER was demonstrated in lesional skin by in situ hybridization. CONCLUSION: AL is an unique clinicopathologic entity showing strong association with EBV in Korea.

Angiocentric T - cell Lymphoma of the Skin / 대한피부과학회지

BACKGROUND: Angiocentric T-cell lymphomas are rare T-cell malignancies which involve extranodal sites, such as the skin, nasal cavity, soft tissue and gastrointestinal tract. They have been reported with significant frequency in Asia. OBJECTIVES: The main objective of this study is to characterize the clinical, pathological, and immunohistochemical featnres of cutaneous angiocentric T-cell lymphoma. Another objective is to search for the Epstein-Barr virus (EBV) in the tissues of cutaneous angiocentiric T cell lymphoma. METHODS: Clinical records, laboratory data, and histopathologic sections of 12 patients with cutaneous angiocentric T-cell lymphoma were reviewed. Paraffin tumor tissues were immunophenotyped. In situ hybridizaion studies were performed to detect the EBV genomes. RESULTS: The ages of the 12 patients ranged from 34 to 64 years(mean 45.8 years). The cutaneous lesions were nodules or plaqes, and were with ulcerated or had intact skin. Eight patients had evidence of extracutaneous involvement, usually involving lymph nodes, liver, and spleen. Eleven patients showed the abnormal laboratory findings including anemia, leukopenia, and elevated level of LDH. The disease pursued an aggressive course and was not uncommonly resistant to treatment. Histologically, the lymphomatous infiltrate occurred predominantly in the subcutaneous layer with involvement of the dermis. The pattern was mainly perivascular and periadnexal. A prominent feature was invasion of small or medium vesselsby lymphoma cells. The infiltrating lymphrcytes expressed CD45RO in all cases; variable expression of CD3 and CD56 was detected in piaffin sections. Among the 11 cases where in situ hybridization was performed, EBV genome could be detected in 9 cases. CONCLUSION: Angiocentric T-cell lymphoma of the skin is an aggressive lymphoma distinct from classic cutaneous T-cell lymphoma. However, further studies are needed to regard them as a homogeneous entity of T-cell lymphoma involving the skin.

Esptein-Barr Virus Associated Cutaneous Angiocetric Immunoproliferative Lesion Showing Histologic Features of Classical Lymphomatoid Granulomatosis

We describe a patient with cutaneous angiocentric immunoproliferative lesion (AIL) associated with the Epstein-Barr virus (EBV). An organ system survey revealed no evidence of internal involvement. A skin biopsy specimen .showed infiltrating cells involving mainly deeper dermis and subcutaneous tissue. An examination of the reticular dermis revealed polymorphous angiocentric and angioinvasive infiltrate containing some atypical lymphocytes and histiocytes. EBV encoded RNA (EBER) was demonstrated in lesional skin by the in situ hybridization technique. On the basis of these findings, we conclude that our case may represent a form of AIL associated with EBV showing histologic features of classical lymphomatoid granulomatosis.

A Solitary Granular Cell Tumor on the Palm / 대한피부과학회지

Granular cell tumors were originally described in 1926 by Abrikossoff as myoblastic myomas. They usually occur as solitary tumors but can be multiple in about 10% of cases. They have a predilection for the skin, subcutaneous tissue and tongue, but also occur in many other organs. We report a case of solitary granular cell tumor on the palm. This is a very unusual location of this disease which merits consideration.

A Clinical Observation of Primary Epithelial Skin Cancers / 대한피부과학회지

BACKGROUND: The incidence of primary epithelial skin cancers is rising steadily, but little is khown of the clinical features of primary epithelial skin cancers, and limited data are available in Korea. OBJECTIVE: Our purpose was to analyze the clinical characteristics of primary epithelial skin cancers. METHODS: A retrospective analysis was conducted of 106 cases of primary epithelial skin cancers observed between 1989 and 1995. RESULTS: 1. Basal cell curcinoma(BCC), 41 cases, was the most common skin cancer. The numbers of cases of squamosis cell carcinoma(SCC) and Bowens disease(BD) were 33 and 24, respectively. There were 3 cases of mixed type(BCC + SCC), 2 cases of Pagers disease and 3 cases of extramammary Pgets disease. 2. The average age at ciragnosis and the mean duration of disease were as follows . BCC(65.5 years old 4.34 years), SCC(70.2 years old-1.63 years), BD(59.3 years old-2.85 years) 3. The face was the most common anatomic site for BCC(93%) and SCC(70%), but the trunk was the most common site for BD. 4. The most common c inical type of BCC was the noduloulcerative type(65% ) and the solid type was t.he most frequert histologic type of BCC. 5. In histologic grading of SCC, grade I and II lesions occupied in 88% of total cases. The numbers of special variants of SCC were as follows aenoid(4), spindle cell(1), verrucous(2) CONCLUSIONS : 1. The average age of patient with primary epithelial skin cancers was older thar: in earlier reports in Korea, and was closer to the recent, reports in western count.ries. 2. The number of cases of BD was much higher than that reported previously. This emphasizeci the importance of tissue examination for the pigmented lesions of the skin, especially on the trunk and extremities.