Merkel Cell Polyomavirus Is Frequently Detected in Korean Patients with Merkel Cell Carcinoma

BACKGROUND: Merkel cell carcinoma (MCC) is an increasingly common neuroendocrine cancer of the skin. Merkel cell polyomavirus (MCPyV) is one of the causative agents of MCC. The prevalence of MCPyV in primary MCC and sun-exposed non-MCC tumors has been known to have different results depending on where it was investigated. OBJECTIVE: This study assesses the prevalence of MCPyV from primary MCC and sun-exposed non-MCC tumors in Korea. METHODS: A molecular pathology study was performed on 7 tissue specimens of MCC, 1 tissue specimen of metastatic small cell carcinoma of the lung, and 32 tissue specimens of non-MCC tumors occurring from sun-exposed areas [8 basal cell carcinomas (BCCs), 8 squamous cell carcinomas (SCCs), 8 actinic keratoses (AKs), and 8 seborrheic keratoses (SKs)]. All specimens were analyzed to determine the presence of MCPyV-DNA using both polymerase chain reaction (PCR) and real-time quantitative PCR. Immunohistochemistry with monoclonal antibody of MCPyV large T antigen (CM2B4) was also conducted. RESULTS: Using both PCR, MCPyV sequences were detected in six of seven MCC tissue specimens (85.7%). Five (71%) of seven MCC tumors were immunoreactive for CM2B4. All five immunoreactive cases were positive for MCPyV. However, there was no association of MCPyV with BCC, SCC, AK, and SK. CONCLUSION: Our results implicate that MCPyV may contribute to the pathogenesis of primary MCC, not of non-MCC skin tumors in Korea, and the persons with MCPyV infection are unusual in Korea compared to other areas.

Metastatic Carcinoma Manifesting as Clubbed Finger in a Patient with Lung Cancer / 대한피부과학회지

Metastatic carcinoma on the hand occurs in 0.1% of all metastasis and the diagnosis is difficult since it frequently mimics other conditions such as infection, osteomyelitis, gout, and pseudoclubbing. A 70-year-old woman with lung carcinoma was consulted for the evaluation of a painful swelling patch on the tip of her right 2nd finger. She was initially treated with antibiotics due to the misdiagnosis of the condition as an infection. Her pain persisted for a month. The skin biopsy revealed a metastatic adenocarcinoma with papillary growth pattern. We report a rare and an interesting metastatic carcinoma manifesting as clubbed finger.

A Case of Sparganosis in a Patient with Rectal Cancer / 대한피부과학회지

Human sparganosis is a rare parasitic disease that is caused by cestode larvae (spargana) of the genus Spirometra, which commonly invades subcutaneous tissue or intermuscular fascia, but seldom invades the dermis. Although the most common feature is a subcutaneous nodule, which is usually soft, fixed, or sometimes migratory, the mass may be complicated by abscess formation or subcutaneous hemorrhage. In a patient with metastatic cancer, chemotherapy may cause immunodeficiency, and sparganosis reported infrequently, as an opportunistic infection. We experienced a case of sparganosis in a patient with metastatic rectal cancer. A 61-year-old man had a reddish plaque with a hemorrhage vesicle on abdomen for 3 months. He had intricate past histories of eating raw snakes, fried frogs, freshwater fishes, raw meats and fresh water. He had suffered from rectal cancer for 2 years and received chemotherapy. We obtained the parasite from the lesion and diagnosed this case as sparganosis by histologic diagnosis.

Disseminated Mycobacterium abscessus Infection in Healthy Adult / 대한피부과학회지

Mycobacterium (M.) abscessus have been known to cause cutaneous and soft-tissue infections in immunocompetent individuals as a result of skin injury. We report a case of disseminated M. abscessus infection transmitted by intramuscular injections to control pain in the right shoulder in of a 48-year-old female. She presented with multiple erythematous cutaneous draining nodules and ulcers on her right upper back. Although she was a healthy woman, painful cutaneous nodules were newly developed on her anterior chest and left inguinal area without any apparent causes. M. absessus was identified via mycobacterial culture on both the primary lesions and other sites.

Reconstruction of Nasal Defects after Skin Cancer Excision by Paramedian Forehead Flap / 대한피부과학회지

BACKGROUND: Repairing large nasal defects in the nose gives us technical challenge. Despite the commonly available surgical techniques, paramedian forehead flap (PFF), an arterial flap, should be considered in repairing some of the large nasal defects. OBJECTIVE: The aim of this study was to evaluate the effectiveness and cosmetic consequences of PFF for the reconstruction of large nasal defects after skin cancer excision. METHODS: Between 2008 and 2011, 8 patients were treated with PFF for reconstruction of large nasal defects after Mohs surgery or wide excision. We reviewed surgical techniques, complications, and final results. Post-operative results were assessed with serial clinical photographs, physicians' objective records and patients' subjective records. RESULTS: The size of surgical defects was ranged from 2.0 to 3.0 cm in their greatest diameter, involving at least 2 cosmetic subunits after tumor excision. Frequent involved sites were nasal tip and nasal dorsum. There were no significant complications, except transient bleeding and oozing. The cosmetic outcomes were considered as good or excellent in most of patients. CONCLUSION: PFF is regarded as the recommended technique for the repair of large nasal defects, involving several cosmetic subunits, providing excellent cosmetic results with few complications.

Reconstruction of Nasal Defects after Skin Cancer Excision by Paramedian Forehead Flap / 대한피부과학회지

BACKGROUND: Repairing large nasal defects in the nose gives us technical challenge. Despite the commonly available surgical techniques, paramedian forehead flap (PFF), an arterial flap, should be considered in repairing some of the large nasal defects. OBJECTIVE: The aim of this study was to evaluate the effectiveness and cosmetic consequences of PFF for the reconstruction of large nasal defects after skin cancer excision. METHODS: Between 2008 and 2011, 8 patients were treated with PFF for reconstruction of large nasal defects after Mohs surgery or wide excision. We reviewed surgical techniques, complications, and final results. Post-operative results were assessed with serial clinical photographs, physicians' objective records and patients' subjective records. RESULTS: The size of surgical defects was ranged from 2.0 to 3.0 cm in their greatest diameter, involving at least 2 cosmetic subunits after tumor excision. Frequent involved sites were nasal tip and nasal dorsum. There were no significant complications, except transient bleeding and oozing. The cosmetic outcomes were considered as good or excellent in most of patients. CONCLUSION: PFF is regarded as the recommended technique for the repair of large nasal defects, involving several cosmetic subunits, providing excellent cosmetic results with few complications.

Glue Sniffing Presenting with Severe Hypokalemia and Metabolic Acidosis: A Case Report

Toluene is an aromatic hydrocarbon found in glues, cements, and solvents. Chronic or acute exposure is known to cause acid-base and electrolyte disorders and to be toxic to both the nervous system and the hematopoietic system. The three major clinical presentations involve neuropsychiatric, gastrointestinal, and muscular disorders, whereas toluene intoxication is difficult to diagnose without a history of substance abuse, such as glue sniffing. We report the case of a 27-year-old women who presented with the three major clinical manifestations associated with profound hypokalemia (K+=1 mEq/L) and metabolic acidosis (pH=7.17) after prolonged glue sniffing. To make an early diagnosis, the emergency physician should consider toluene intoxication in patients presenting with altered mental status, hypokalemic muscular paralysis, and a history of glue sniffing.