A Case of Extramammary Paget's Disease on the Scalp

We treated a case of extramammary Paget's disease that affected the scalp of a 45-year-old female. It is extremely rare that the disease arises in areas other than the anogenital region and the axillae. The lesion was a round erythematous oozing crusted hairless patch. Histopathologically, many pagetoid cells were found within the epidermis and dermis. The cytoplasms of these cells stained with alcian blue at pH 2.5, CEA, EMA and low-molecular-weight-cytokeratin. The patient underwent a wide local excision. We used a mapping technique to reveal the distribution of microscopically involved lesions.

Expression of CD31, CD34, and Factor VIII-related Antigen in Vascular and Spindle Cell Tumors of the Skin

BACKGROUND: The immunohistochemical detection of endothelial differentiation in skin tumors has been hindered by the relative paucity of reliable markers that are applicable to rou- tinely-processed specimens, which are both specific and sensitive as well. OBJECTIVE: This study was designed to evaluate the utility of CD31 and CD34, newly introduced vascular markers, in the immunohistochemical differentiation of vascular neoplasms from other mesenchymal tumors and to compare their sensitivity and specificity with factor VII-related antigen (FVIIIRA). METHODS: Paraffin-embedded specimens of 26 cases of benign and malignant vascular tumors and 25 cases of non-vascular mesenchymal neoplasms of the skin and subcutis were investigated for CD31, CD34, and FVIIIRA expression using immunohistochemical methods. RESULTS: CD31-immunoreactivity was observed in all of the 26 vascular lesions. CD34 and FVlllRA were labelled in 23 cases and 16 cases of vascular tumors, respectively. All of the 25 non-vascular mesenchymal tumors were negative for CD31 and FVIIIRA. In contrast, positive reactivity for CD34 was seen in 14 cases, among which dermatofibrosarcoma protuberans(2/2), neurofibroma(8/8), neuriilemmoma(2/2), and leiomyoma(2/3) were included. CONCLUSION: Our results indicate that CD31 is a more sensitive and specific vascular marker than CD34 and FVIIIRA. A small panel composed of these three antibodies will constitute a comprehensive and reliable method for identifying tumors of vascular origin.

Four Cases of Acquired Reactive Perforating Collagenosis / 대한피부과학회지

Reactive perforating collagenosis(RPC) is one of the range of essential perforating disorders and is characterized by the transepithelial elimination of altered collagen. Two types have been recognized: the childhood(inherited) form and the adult(acquired) form. The acquired form is non-familial and is associated with various systemic disorders such as diabetes mellitus or nephropathy. We report four cases of acquired RPC. All have diabetic nephropathy and three have liver disease.

A Case of Actinic Reticuloid / 대한피부과학회지

Actinic reticuloid is a rare, chronic photosensitivity dermatosis with clinical and histologic femtures resembling a cutaneous T cell lymphoma. Phototesting in these patients typically reveals extreme sensitivity to UVB, to UVA, and sometimes to visible light. has site of lymphomatoid histologic appearance, actinic reticuloid is now regarded as a histologic arant of chronic actinic dermatitis, which is the spectriam of several photosensitivity dermatosis, delet to its benign course and transition to or from other photosensitivity dermatosis. We present a case of actinic veticuloid in 58-year-old male, who has severely edematous infiltrated lichenified erytherratous patches on sun-exposed skin, lynptmatoid histologic features with selective T cell infiltrat,ion, and selective photosensitivity to UV.

Alopecia Associated with Underlying Congenital Melanocytic Nevus

A localized area of alopecia of the scalp can be a challenge in diagnosis. We report two patients with alopecia which was found to be associated with underlying congenital melanocytic nevus. Congenital melanocytic nevus should be taken into consideration in the differential diagnosis of alopecic plaques of the scalp.

A Case of Malignant Melanoma of Soft Parts with Unusual Histopathologic Findings

We report a case of malignant melanoma of soft parts presented with a hard mass on the dorsum of the left second toe. Malignant melanoma of soft parts has also been known as clear cell sarcoma of tendons and aponeuroses, which indicates the histologic feature of clear cell predominance and the origin of tumor cells, tendinous or aponeurotic structures. Although our case presented with many characteristic clinicopathologic features of malignant melanoma of soft parts, diagnosing this case as malignant melanoma of soft parts was made with great difficulty because of a rather unusual finding that the major cell component of neoplasm was spindle shaped cells in stead of clear cells. Cases featuring this distinctive histopathologic finding have not been reported individually to our knowledge, but described briefly in the literature. We think this case deserves special attention because of its close resemblance to various sarcomas.

p53 Protein and Proliferating Cell Nuclear Antigen Expression in Epidermal Keratinocytic Neoplasms / 대한피부과학회지

BACKGROUND: Although actinic keratosis and Bowens disease ar considered as carcinoma in situ, most of them are biologically benign and dont progress to invasive squamous cell carcinoma. It is little known why they take the benign courses and which factors are involved in the tumorigenesis. Keratoacanthoma, self-regresi;ing benign tumor, may be sometimes or fused morphologically with well-differentiated squamous cell carcinoma. So it is necessary to find a useful marker to help us distinguish them. OBJECTIVES: We performed this study to gain a better understani ling of biologic behaviour and tumerigenesis of epidermal keiatinocytic neoplasms. METHODS: We investigated the expression of p53 protein and priliferating cell nuclear antigen (PCNA) by an immunohistochemical method on the formalin-fixed, araffinembedded tissue specimens of epidermal keratinocytic neoplasms. RESULTS: Fourteen out of 20 cases of squamous cell carcinoma(70.0%), 14 out of 22 cases of actinic keratosis(63.6%), and 13 out of 20 cases of Bowens disease(65.0%) showed p53 protein expression, but keratoacanthoma was negative. All the tumors studied sho ved significantly increased numbers of PCNA-positive eells when compared with normal epidermis and characteristic distribution pattern. of PCNA-positive cells. Most cases of actinic keratosis exhibited the basal dysplastic pattern, but Bo wenoid variants showed diffuse dysplastic pattern. Karatoacanthoma revealed the marginal pattern and Bowens disease showed the diffuse dysplastic pattern. Well-differentiated squamous cell carcinoria showed the basal dysplastic pattern, while poorly differentiated squamous cell carcinoma revealed d ffuse dysplastic pattern. CONCLUSION: Our results suggest that p53 mutation is a common and early genetic change in the epidermal tumorigenesis and may be used as a good marker for malignan transformation, but it does not seem to correlate with the biollagic behavior or prognosis of epidermal neoplasms. PCNA, which is considered as a proliferation-relaited marker, was expressed with chavaceristic distribution patterns according to the type of tumors, but the frequency of PCNA expression is unlikely to reflct the malignant potential of epidermal neoplasms.

p53 Protein and Proliferating Cell Nuclear Antigen Expression in Epidermal Keratinocytic Neoplasms / 대한피부과학회지

BACKGROUND: Although actinic keratosis and Bowens disease ar considered as carcinoma in situ, most of them are biologically benign and dont progress to invasive squamous cell carcinoma. It is little known why they take the benign courses and which factors are involved in the tumorigenesis. Keratoacanthoma, self-regresi;ing benign tumor, may be sometimes or fused morphologically with well-differentiated squamous cell carcinoma. So it is necessary to find a useful marker to help us distinguish them. OBJECTIVES: We performed this study to gain a better understani ling of biologic behaviour and tumerigenesis of epidermal keiatinocytic neoplasms. METHODS: We investigated the expression of p53 protein and priliferating cell nuclear antigen (PCNA) by an immunohistochemical method on the formalin-fixed, araffinembedded tissue specimens of epidermal keratinocytic neoplasms. RESULTS: Fourteen out of 20 cases of squamous cell carcinoma(70.0%), 14 out of 22 cases of actinic keratosis(63.6%), and 13 out of 20 cases of Bowens disease(65.0%) showed p53 protein expression, but keratoacanthoma was negative. All the tumors studied sho ved significantly increased numbers of PCNA-positive eells when compared with normal epidermis and characteristic distribution pattern. of PCNA-positive cells. Most cases of actinic keratosis exhibited the basal dysplastic pattern, but Bo wenoid variants showed diffuse dysplastic pattern. Karatoacanthoma revealed the marginal pattern and Bowens disease showed the diffuse dysplastic pattern. Well-differentiated squamous cell carcinoria showed the basal dysplastic pattern, while poorly differentiated squamous cell carcinoma revealed d ffuse dysplastic pattern. CONCLUSION: Our results suggest that p53 mutation is a common and early genetic change in the epidermal tumorigenesis and may be used as a good marker for malignan transformation, but it does not seem to correlate with the biollagic behavior or prognosis of epidermal neoplasms. PCNA, which is considered as a proliferation-relaited marker, was expressed with chavaceristic distribution patterns according to the type of tumors, but the frequency of PCNA expression is unlikely to reflct the malignant potential of epidermal neoplasms.

A histopathologic study of congential melanocytic nevi / 대한피부과학회지

BACKGROUND: since congenital nevi may not always be identified clirically, it remains a challange for histologists to separate an acquired from a congehital nevus. The camparative histologic feature of congenital and acquired lesions have been described by several authors. OBJECTIVE: In an attempt to establish reliable microscopic recognition of congenital nevi, the histologic features of 52 congenital melanocytic nevi were studied. MATERIAL AND METHODS: By reviewing HMB slides, histologic paterns were observed depending on the extent of nevus cell infiltration. An immunohistochemical study wi h anti S-100 protein and HMB-45 antibody was also performed. RESULTS: Diffuse infiltratien of upper and lower dermis with nevu. cells was observed in 21 cases (40.0%). Nevus cell infiltration of appendages and neurovascular structures was observed in 29 cases (55.8%). Indian filing of dermal nevus cells was observed in 33 casesl(64.7%). Epidermis showed elongation of rete ridges in 36 ca.es(69.2%). Immunohistochemical staining with HMB 45 showed a positive raction in 9 cases out of 51 having dermal nevus cells, and epidemal melanocytes showed positive reaction in 20 cases. CONCLUSION: Congenital melanocytie nevi can be classified by histolcgic appearance into several patterns. Nevus cells had a trend to infiltrate into the deeper dermis as the clinieal size increrased. Nevus cell infiltration of appendages and neurovascular structure was a common finding in congenital melanocytic nevi.

A Case of Nodular Amyloidosis

A 65-year-old female patient visited our clinic complaining of multiple skin lesions since one year ago. There were yellowish to brownish colored, bean to walnut-sized nodules on both lower extremities. Dylon stain with polarizing microscopy, immunohistochemical stain to amyloid P and immunoglobuhn-kappa chain showed positive reactivities but keratin stain was negative. According to histopathologic and immunohistochemical findings, she was diagnosed as nodular amyloidosis.