Medicolegal Reconstruction of the Jeju 4.3 massacre / 대한법의학회지

Sixty years after the massacre took place at Jeju, authors carried out a series of exhumations. The exhumation based on anthropological and archaeological method allowed for the interpretation of events occurring during the burial of the body and provided data for crime scene investigation, the evidence.

A case of gastroallergic anisakiasis / 대한내과학회지

Human subjects can be incidentally parasitized by third stage larvae of Anisakis spp. by eating raw or undercooked seafood. Acute gastric anisakiasis is one of the most frequently encountered entities in Korea. Anisakis-related allergic disorder, gastroallergic anisakiasis, has been recently documented. However, it has not been studied in Korea, in spite of the raw fish eating habit. A 33-year-old woman had suffered from stomachache, nausea and vomiting repeatedly after a few hours of eating raw fish. Gastroscopic examination showed normal. Sensitization to Anisakis was demonstrated by skin prick test using crude extracts and excretory-secretory products from the parasites, whereas no sensitization to seafood. Specific IgE in patient's serum and its binding components against Anisakis were detected. We report a case of gastroallergic anisakiasis, diagnosed by repeated typical episode, skin prick test, identification of specific IgE and its binding components in Anisakis.

Allergic Contact Dermatitis with Doxepin Hydrochloride Cream / 대한피부과학회지

Doxepin hydrochloride cream with potent H1 and H2 blocker activity is a tricyclic antidepressant, which is structurally similar to phenothiazines, and also known to be a contact sensitizer and photosensitizer. We report a case of allergic contact dermatitis due to doxepin hydrochloride cream in a 75-year-old-man, who developed facial edema and eczema at the application sites (face, neck and upper trunk) within several hours of application of doxepin hydrochloride cream. Clinicians should be aware of the possibility of allergic contact dermatitis to doxepin cream, if the condition worsens with use of this medication.

Distribution and Recognition of Skin Diseases in Rural Areas / 대한피부과학회지

BACKGROUND: In many epidemiologic reports of distribution of skin diseases, the outpatients of university hospitals have been the target groups of the analysis. But there has been no epidemiologic study of dermatoses in the field of rural area. OBJECTIVE: The purposes of this study were to investigate the distribution of skin diseases in rural areas and to evaluate the rural population's concept of skin disease and the attitude to their skin problems. METHOD: We analysed the results of interview and responses of questionnaires from 481 residents who visited the local public health centers and the free clinics in the rural areas of Kyonggi-Do and Ulsan city. RESULTS: The results of the study are summarized as follows : 1. Of 481 residents, there were 328 females and 153 males. The mean age was 56.6 years old. The residents over 50 years old formed 73.2 percent of total population. 2. The common dermatoses were tinea pedis, onychomycosis, xerosis, seborrheic keratosis, chloasma, pruritus, hand eczema, contact dermatitis, lentigo, seborrheic dermatitis in order of frequency. 3. The cutaneous fungal infection was the most common dermatoses in each study population. 4. To treat skin diseases, 51.2% of the residents visited the drug store initially. 5. The major reason of not taking dermatological care in the rural population was customary habit. 6. The 39.5% of 238 respondents have used self-treatments, and 15.5% of 90 respondents have experienced side effects of self-treatments. 7. On the question about the negative concepts of dermatoses, 61.7% of 462 respondents agreed to the statement that dermatoses look unclean. 8. Half of the 463 respondents thought that dermatologic medicine was harmful. The 50.6% of the 328 respondents had no specific reason, and 34.1% experienced gastrointestinal trouble. 9. The most favorite type of dermatologic medicine was topical agent, which was preferred especially by the group of respondents using nonmedical service including drug store. CONCLUSION: The distribution of the skin diseases in rural areas was similar to other reported results except the high frequency of cutaneous fungal infection. This research could be a basis on the following epidemiologic studies of the skin diseases in rural areas. It is also suggested that the educational program to improve understanding of skin diseases should be performed in the rural areas.

Livedoid Vasculitis: a Clinico-Pathological Study of 19 Patients / 대한피부과학회지

BACKGROUND: Livedoid vasculitis is a distinctive dermatosis characterized by recurrent chronic ulceration and infiltrated purpuric papules on the lower limbs. OBJECTIVE: The purpose of this study was aimed at evaluating the clinical and histopathological features of livedoid vasculitis. METHODS: The hospital charts and histopathologic slides of patients with livedoid vasculitis diagnosed at Asan Medical Center from 1989 to 1999 were reviewed. RESULTS: Twelve male and seven female patients were enrolled in this study(M: F=1.7: 1). The mean age at onset was 30.3 years in men and 25.3 years in women. The mean duration of illness was 3.3 years in male patients and 5.7 years in female patients. All the patients were presented with recurrent chronic ulceration and atrophic scarring. Twelve patients(63.2%) complained of severe pain and tenderness of the lesions and 5 patients(26.3%) complained of itching sensation. In three patients(15.8%), the lesions developed or aggravated in summer. Alcohol intake was aggravating factor in two patients(10.5%) and smoking was in one patient(5.3%). In five patients(26.3%), livedoid vasculitis develops in association with several diseases. Associated diseases were diabetes mellitus in 2 patients(10.5%), antiphospholipids antibody syndrome in 2 patients(10.5%), and protein S deficiency in 1 patient(5.3%). Histopathological examination revealed hyalinized blood vessels, partial to complete obstruction of dermal blood vessels with fibrinoid thrombi, endothelial swelling, and extravasation of RBCs in upper and mid-dermis. Panniculitis-like feature was common finding(73%). In six patients(31%), moderate to severe inflammatory reaction was observed in dermis. Five patients were treated with aspirin, dipyridamole, and pentoxifylline, and among them, only 1 patient(20%) were improved. All the treatment response including pentoxifylline alone, or pentoxifylline plus aspirin, dipyridamole, or corticosteroid was unsatisfactory. In cases of three patients whom were treated with low-dose danazol, all the patients(100%) showed marked improvement. One patient was treated with dapsone with improvement. CONCLUSION: Livedoid vasculitis is a distinct dermatosis with characteristic clinico-pathological features. Low-dose danazol or dapsone may be useful therapeutic options in this intractable disease.

Glomus Tumor:a Clinical and Histopathologic Analysis of 17 Cases

BACKGROUND: Glomus tumor is a benign neoplasm derived from the normal glomus body. This tumor includes the following types; solitary, multiple, proliferating, and acral arteriovenous. Histologically, it was subdivided into solid type, glomangioma, and glomangiomyoma. Its malignant counterpart - glomangiosarcoma - was reported. OBJECTIVES: The purposes of this study were aimed to evaluate the clinical and pathologic presentations of glomus tumor. METHODS: A total of 17 patients who have been diagnosed with glomus tumor by histopathologic examination were reviewed. RESULTS: Male patients were ten and female patients were seven. The age of the onset of glomus tumor varied from birth to 61 years. The location of tumors were as follows: arm (7 cases), finger (6 cases), back (2 cases), leg (1 case), foot (1 case). The digit was the most common site for female patients. Clinical manifestations showed solitary bluish papule (6 cases), subcutaneous nodule (5 cases), nail discoloration (3 cases), nail dystrophy (1 case), bluish plaque (1 case). One patient had no specific lesion but tenderness. The most characteristic symptom was pain in 15 (88.2%) of the 17 patients, and the other two patients had no symptom. Two asymptomatic lesions were located on the forearm and histopathologically showed glomangioma. Histopathologically, 13 (76.5%) of the 17 patients classified as solid type, and 4 (23.5%) the glomangioma variety. CONCLUSION: Glomus tumors were most commonly seen as a painful nodule on the upper extremity and especially female patients showed predilection for subungual location. We speculate that multiple, mild symptomatic lesions might be a tendency to be glomangioma.

A Case of Cutaneous B-Cell Pseudolymphoma / 대한피부과학회지

The differentiation between cutaneous pseudolymphomas and primary cutaneous lymphomas is often very difficult, but it is important because each of them has different therapeutic consequences. We report herein a case of cutaneous B-cell pseudolymphoma probably induced by frequent use of hair dye which mimicked true B-cell lymphoma histologically. Histopathologic examination revealed diffuse, extensive infiltration of atypical B cells on the first biopsy, but 2 years later, a rebiopsy revealed well defined lymphoid follicles in the upper dermis. There was no monoclonality in immunoglobulin gene rearrangement. The skin lesions were resolved after one month with intra-lesional injection of triamcinolone.

A Case of Dermatofibrosarcoma Protuberans with Myxoid Area

Dermatofibrosarcoma protuberans is a rare, slowly growing, locally invasive spindle-cell tumor characterized by a protuberant cutaneous mass with a pronounced tendency to recur and by a prominent storiform histopathologic pattern'-'. We present a case of dermatofibrosarcoma protuberans with myxoid area on the chest of a 57-year-old man. The histopathological study showed a dermal tumor of uniform spindle-shaped cells with storiform pattern. Immunohistochemically, the tumor was stained positively to anti-CD34 antibody and negatively to anti-factor XIIIa antibody.

Two Cases of Cutaneous Metastatic Hepatocellular Carcinoma / 대한피부과학회지

Hepatoma metastasizes to various organs including lung, adrenal gland, regional lymph nodes, portal vein, gallbladder, pancreas, bone, etc. But cutaneous metastasis occurvery rarely. We herein present two cases of cutaneous metastases originated from hepatocellular carcinoma with various clinical features. One patient who had multiple metastases of distant organ had necrotic change on the toe, black hemorrhagic tense bulla on the finger, and hard nodule on the back. The other patient had three subcutaneous nodules on the arm and abdomen. On histopathologic examination, every lesion composed of tumor cells and intervening sinusoids showed characteristics of hepatocellular carcinoma. On immunohistochemical examination, the tumor cells of the first patient were positive for AFP and negative for CEA. Those of the second patient were negative for AFP and CEA.

A Case of Primary Nodular Cutaneous Amyloidosis / 대한피부과학회지

Primary nodular cutaneous amyloidosis is a very rare type of amyloidosis, it must excluded the secondary nodular deposition of systemic amyloidosis. We report herein 47-year-old male with a erythematous waxy nodule on his parietal scalp for one year. Histopathologic examination showed homogenous amorphous eosinophilic deposition in the dermis with nodular fashion. In Congo red, amyloid material stained positively and showed apple-green birefringence with polarized light. On electron microscopic examination, extensive deposit of amyloid with typical 6-10 nm filament was confirmed. He had neither clinical nor laboratory evidence of systemic amyloidosis. We reviewed previously reported nodular amyloidosis in Korea.

Mixed Tumor of the Skin: Clinicopathological Study of Seven Cases

BACKGROUND: Mixed tumor of the skin or chondroid syringoma is a benign neoplasm characterized by histological features of a mixture of epithelial and mesenchymal components. It is a rare and benign appendageal tumor, found mostly on the head and neck, and present as an asymptomatic, firm, subcutaneous nodule. There have only been a few reported cases in Korea. OBJECTIVES: This study was aimed to characterize the clinical and histopathlological features of mixed tumor of the skin. METHODS: We reviewed the clinical data and histologic slides of seven patients who have been diagnosed with mixed tumor of the skin by histopathological examination. RESULTS: There were six male patients and only one female. Age of onset of mixed tumor of the skin varied from 26 to 65 years. A11 patients had the lesion on the head: perioral area (3 cases), nose (2 cases), cheek (1 case), and temple area (1 case). Each tumor was a solitary, asymptomatic, and firm, about 0.5-1.5 cm sized, subcutaneous nodule. Histopathologically, all 7 cases presented apocrine differentiation. Two cases showed follicular differentiation, and 2 cases showed sebaceous differentiation. Every tumor showed myxoid stroma except two with typical chondroid matrix. Adipose metaplasia of the matrix was present in 2 cases. In 3 cases, the so-called hyaline cells were rich in the stroma. CONCLUSION: Mixed tumor of the skin was most commonly seen as an asymptomatic, firm subcutaneous nodule on the head. Tumors showing apocrine differentiation were more common than that of eccrine differentiation, All 7 cases presented apocrine differentiation. Follicular and sebaceous differentiation might occur in apocrine type of mixed tumors of the skin. The stroma of mixed tumor of the skin might be myxoid, chondroid, or adipose.

A Case of Accessory Tragus on Neck / 대한피부과학회지

Accessory tragus is a rare congenital malformation of the external ear. It is usually presented as congenital, firm papules located anterior to tragus commonly. Other less common sites include the cheek and lateral neck anterior to the sternocleidomastoid muscle. Though the possibility of occurrence on the neck, there was no reported case. We present herein a typical case of accessory tragus on the right lateral neck in 24-year-old female.

Clinical and Histopathologic Study on Tufted Angioma / 대한피부과학회지

BACKGROUND: Tufted angioma, a rare vascular disorder found typically in children, usually involves in the trunk and neck with characteristic "cannonball" distributed vascular tuft. OBJECTIVES: The purpose of this study was aimed to characterize the clinical and histopathologic features of tufted angioma. METHODS: Clinical examinations were performed on 7 patients with tufted angioma regarding the age, sex, duration, sites, clinical morphology, associated symptoms and treatments and disease course. Histopathologic studies of 8 specimens obtained from 7 patients were performed with routine hematoxylin and eosin staining and immunohistochemical staining with anti-factor VIII- related antigen antibody. RESULTS: 1. Male-female ratio was 1:0.75 (male patients were 4 and female patients were 3). Onset of the skin lesions ranged from birth to 67 years of age. Over 40 years of age were 4, 2 patients had the skin lesion at birth and 1 patient found the lesion at 67 years of age on the preexisting nevus flammeus. 2. Typical clinical features showing patch with papules were seen in 4 patients, patch only was seen in three patients. 3. 4 patients had the lesion on the proximal extremities, 2 on the trunk, 1 on the finger and one. Mild tenderness was noted in 3 patients, mild hyperhidrosis in 1 and severe tenderness and pain in 1 patient. 4. Histopathologic studies revealed typical vascular tufts with "cannonball" distribution in the dermis. Immunohistochemical staining performed on 2 cases showed weak positivity to factor VIII-related antigen. 5. In 1 patient, because of small size of the skin lesion, a simple excision was possible. Another 2 patients were being treated with dye laser with minimal improvement, 1 patient showed spontaneous complete regression. However in the 2 patients without treatment, the skin lesion was persisted in 1 patient and the other died of underlying malignancy. CONCLUSION: Though there was no statistical significance for the short number of patients, tufted angioma occurred not only in early childhood but also in adulthood with the predilection sites of the proximal extremities and the trunk. Clinical manifestations were erythematous papulo-patch or patch. Histopathologically, typical proliferation of the blood vessel with the array of cannonball was observed. As reported, several treatments have been tried, and there was a case of self-remission.

A Case of Subcutaneous Type Sweet's Syndrome / 대한피부과학회지

We report a case of idiopathic subcutaneous type Sweets syndrome in an otherwise healthy 52-year-old woman. She had suffered from recurrent erythematous tender plaques on the trunk and extremities for 4 years. Histopathological examination revealed heavy infiltration of neutrophils and many cytophagic cells in the subcutaneous fat tissue. We suggest that Sweets syndrome, subcutaneous type, should be included in the differential diagnosis of panniculitis.

Painful Tufted Angioma on the Thumb / 대한피부과학회지

Tufted angioma is a rare slowly progressive vascular disorder found typically in children and young adults, usually involving the trunk and neck. We report a case of painful tufted angioma in a 58-year-old man, who had suffered from a painful reddish patch on the dorsum of the right thumb for 2 years. On histopathologic examination, the numerous round lobules of vascular proliferation showed the typical "cannonball" distribution in the dermis. The unusual location and spontaneous pain are rare manifestations of tufted angioma.

A Case of Congenital Plaquelike Glomus Tumor / 대한피부과학회지

Clinical types of glomus tumors can be divided into the more common solitary type and the rare multiple types. The latters are subdivided into disseminated, regional, and congenital plaquelike type. We report a 25 year old man with a red to blue colored soft nodular plaques on the back. The lesions were soft reddish patches since birth and gradually enlarged. These were gradually changed to blue colored soft nodular plaques with mild tenderness. The histologic findings were compatible with the glomus tumor.

Three Cases of Cutaneous Mesenchymal Hamartoma

Cutaneous mesenchymal hamartoma (CMH) is a very rare disease which most often presents itself at birth and is composed of collagen fibers, immature fibroblasts, fat cells, blood vessels, and mast cells. Until recently, only two cases have been reported. Thus, the clinical and histopathological findings have been unsettled. We describe three cases of cutaneous mesenchymal hamartoma with different clinical findings, discuss its pathogenesis, and suggest that CMH is a distinct disease entity.