Clinicopathologic Features and Ki-67 Expression in LargeCell Acanthoma / 대한피부과학회지

BACKGROUND: 1970, Pinkus described large cell acanthoma(LCA) as a benign epidermal neoplasm which clinically resembles a actinic keratosis or seborrheic keratosis. However, the entity of this disease is still unclear.OBJECTIVE: The purpose of this study was to find out if LCA is a distinctive entity by investigating its clinical features, histopathologic features and Ki-67 expression. METHODS: 20 LCA samples including normal tissue were analyzed after investigating their clinicopathologic features and immunohistochemical analysis of Ki-67 expression which was performed on the formalin-fixed, praffin-embedded tissue section. The assessment of immunohistochemical staining was based on the growth fraction(GF), defined as the number of Ki-67 positive cells divided by the total number of tumor cells counted, and was expressed in a percentage. RESULTS: 1. LCA was usually presented as a well demarcated, brown or light brown, 5 to 30 mm, round, flat to hyperkeratotic scaly patch and plaque. It predominantly affected female (5.6 females:1 males) aging from 37 to 76 years of age(mean 51 year-old). The duration of LCA ranged from 6 months to 30 years. In eleven cases, the lesion was located on the face and in nine cases, on the extremities. Eight cases showed a solitary lesion and twelve cases showed multiple lesions. Transformation to malignancy was not found.2. Histopathologic study showed sharply circumscribed epidermal neoplasms characterized by large (approximately twice the normal size) uniform keratinocytes with proportionally large nuclei and an increase of melanin in the basal layer. In many cases, hypergranulosis(18 cases) and hyperkeratosis(17 cases) were observed. Occasionally, acanthosis(10 cases), papillomatosis(9 cases) and epidermal atrophy(7 cases) were also observed. However, keratinocyte necrosis was not observed. Moderate solar elastosis and moderate lymphocytic infiltration was observed in the upper part of the dermis in all cases. Mild and moderate melanin incontinence was observed in 14 cases and 1 case respectively. Appendage involvement(follicular infundibulum and acrosyringium) was observed in all cases.3. The Ki-67 expression of LCA tissue(4.87 +/- 3.10%) was significantly higher than the adjacent normal skin(2.50 +/- 1.89%, p=0.01). CONCLUSION: Our study of the clinical and histopathologic features and the expression of Ki-67 strongly suggests that LCA is a distinctive entity.

A Case of Plasma Cell Balanitis Controlled by Fusidic Acid Cream / 대한피부과학회지

In 1952, Zoon described eight cases of benign circumscribed chronic balanitis characterized by an extensive infiltration of plasma cells with no evidence of dysplasia of the overlying epidermis. Plasma cell balanitis can often be confused clinically with other conditions, such as erythroplasia of Queyrat, fixed drug eruptions, secondary syphilis, candidiasis and Reiters disease. We report a case of plasma cell balanitis in a 65-year-old man. He complained of a single, red, shiny and smooth patch involving the glans penis and adjacent prepuce. This patch was unresponsive to systemic and topical steroid treatment. Laboratory studies were negative or within the normal range. Histopathological findings showed a band-like mainly plasmacytic inflammatory infiltrate of the upper dermis. This patient was treated once daily with 2% fusidic acid cream topically for 5 weeks. The lesions resolved and no recurrence was observed during 2 years of follow-up.

A Case of Gloves and Socks Syndrome / 대한피부과학회지

Clinical characteristics of papular-purpuric gloves and socks syndrome consist of a purpuric erythema affecting the hands and feet in a gloves and stocking distribution. It is sometimes associated with fever and oral lesions. The disease is self-limiting and resolves within 1 to 2 weeks. Serological studies have shown that there is an association with parvovirus B19 infection in most patients affected by this syndrome. We report a case of gloves and socks syndrome in a 21-year-old female. She had a 4-day history of papular-purpuric eruptions of the hands and feet in a gloves-and-socks distribution. She also complained of fever(up to 39C) during the first 2 or 3 days of clinical onset. The oral mucosa was normal and there were no palpable lymph nodes. Laboratory and histopathological findings were non-specific. However, human parvovirus B19 DNA was detected in the serum by a polymerase chain reaction. Systemic manifestations were transient and disappeared within a few days, whereas the skin lesions resolved gradually over a period of 2 weeks.