A Case of Vancomycin-Induced Linear IgA Bullous Dermatosis / 대한피부과학회지

Linear IgA bullous dermatosis(LAD) is a subepidermal blistering disease characterized by linear IgA deposits in the basement membrane zone when visualized on direct immunofluorescence microscopy. Intravenous vancomycin has been the drug most implicated, and this disease has been termed vancomycin-induced LAD. Vancomycin-induced LAD tends to spontaneously resolve upon discontinuation of the offending drug. A 70-year-old male patient developed septic knee. Bacterial cultures from this lesion grew methicillin- resistant Staphylococcus aureus. He was treated with vancomycin. Eight days after vancomycin injection, painful bullae appeared on the trunk, feet, and genitalia. A skin biopsy showed a subepidermal blister with an infiltrate composed of neutrophils and eosinophils. Direct immunofluorescence of perilesional skin showed linear IgA deposition at dermo-epidermal junction. The vancomycin was stopped; teicoplanin was substituted. He was treated with dapsone. The use of vancomycin is increasing in Korea and therefore it is important for dermatologist to be aware of the association with LAD.

A Case of Metastatic Leiomyosarcoma on the Scalp / 대한피부과학회지

Leiomyosarcoma are malignant mesenchymal tumors usually found in the uterus, retroperitoneaum, gastrointestinal tract, or deep soft tissue. They do however, rarely occur as primary skin tumors. Metastases from a leimyosarcoma to skin are unusual. We report a case of metastatic leiomyosarcoma on the scalp. A 47-year -old female had hysterectomy following diagnosis of leiomyosarcoma 17 months ago. She presented with an 8 months history of a solitary nontender nodule on the scalp. The histological examination revealed a well demarcated, quite high cellular tumor nodule in the deep dermis . A tumor was usually composed of spindle cells with abundant eosinophilic cytoplasm and elongated, blunt ended nuclei. Some other cells showed pleomorphic nuclei and mitotic figures. Immunohistopathological staining of smooth muscle actin was positive. A diagnosis of metastatic leiomyosarcoma was made on histological and immunohistopathological findings.

The Value of PCR Detection of TCR gamma Gene Rearrangement in the Diagnosis of Early Mycosis Fungoides / 대한피부과학회지

BACKGROUND: The diagnosis and differential diagnosis of mycosis fungoides(MF) is often difficult, clinically and histologically. A variety of inflammatory dermatoses may be seen with similar clinical and histological features. Given the limitation of histologic diagnosis in the early MF, an ancillary method to demonstrate a clonal T cell proliferation would be helpful. Recent attempts to enhance diagnostic sensitivity have involved T-cell receptor(TCR) gene rearrangement studies, using polymerase chain reaction(PCR) technique. OBJECTIVE: The purpose of this study was the value of PCR detection of TCR gamma gene rearrangement in the diagnosis of early MF. MATERIALS AND METHODS: Thirty-two cases of paraffin embedded tissue(PET) from patients of early MF were investigated for the presence of TCR gamma gene rearrangement using a nested PCR technique and analyzed by polyacrylamide gel electrophoresis(PAGE). As a control, PET from patients of 6 psoriasis, 3 lichen planus, 1 neurodermatitis, and 1 allergic contact dermatitis were tested. RESULTS: Monoclonal TCR gamma gene rearrangement was detected in 28 out of 32 (88%) patients with early MF and in none out of 11 patients with inflammatory skin diseases. CONCLUSION: TCR gamma gene rearrangement studies on lesional skin using PCR may be helpful as an adjunct to the histopathologic diagnosis of early MF.

Atypical Eruption Due to Chemotherapeutic Agent

We report a case of atypical eruption due to chemotherapeutic agent in a 60-year-old man who presented with asymptomatic, erythematous, 0.5cm in diameter, confluent, and elevated papules and plaques confined to the face. The patient was previously diagnosed with small cell carcinoma of the lung with liver metastasis. Two months after the diagnosis, a first course of chemotherapy including etoposide was started. Five days after starting the chemotherapy, the patient developed a facial eruption. Histopathologic examination demonstrated increased epidermal mitotic figures, cells in metaphase arrest, basal cell layer hyperpigmentation, prominent dyskeratosis, and squamous atypia. The most distinctive histologic feature was the presence of starburst cells, which are markedly enlarged pale staining keratinocytes containing small basophilic fragments of nuclear debris haphazardly scattered throughout the cytoplasm in a starburst pattern.

Plaque stage of Dermatofibrosarcoma Protuberans / 대한피부과학회지

We report a case of plaque stage of dermatofibrosarcoma protuberans(DFSP). A 36-year-old female visited our clinic with a 10-year history of solitary deep seated palpable erythematous plaque on right anterior chest. There was no history of previous trauma at the site of the lesion. Histopathologic findings are characterized by a flat surface, lower cellularity and slender spindle-shaped neoplastic cells diffusely infiltrated dermis and subcutaneous tissue. The slender neoplastic cells have uniform nuclei with no evidence of cytologic atypia. Especially earlier plaque or nonprotuberans stage of the DFSP could be confused with benign lesions such as dermatofibroma or diffuse neurofibroma. Because plaque areas are strongly positive for CD34, this antibody is very helpful in differentiating other benign tumors.

A Case of Verrucous Hyperplasia with Lymphedema of the Leg Amputation Stump / 대한피부과학회지

Verrucous hyperplasia shows multiple warty like lesion on the amputation stump, but the pathologic findings of viral verrucae has not been discovered. A verrucous plaque on the amputation stump of the right leg was found in 31-year-old man. He had suffered from a traumatic amputation of right leg since 8 years ago. A leg prosthesis had been worn since that time. Histopathologic findings shows hyperkeratosis, acanthosis, papillomatosis, superficial dermal edema and dilated thick-walled venules oriented vertical to the skin surface. Verrucous hyperplasia was diagnosed with lymphedema on the basis of clinical and histological findings.

Combination Chemotherapy with Etoposide, Doxorubicin, Cisplatin (EAP) for Recurred or Metastatic Gastric / 대한암학회지

PURPOSE: We performed this study to evaluate the efficacy and the safety of EAP regimen as a second line therapy for the recurred or metastatic gastric cancer unresponsive to 5-fluorouracil based chemotherapy. MATERIALS AND METHODS: Recurred or metastatic gastric cancer patients unresponsive to 5- fluorouracil based regimen were entered into this trial. They were treated by EAP chemotherpy which consisted of etoposide 40 mg/m2, doxorubicin 15 mg/m2 and cisplatin 25 mg/m2 IV during 3 days each every 3 weeks. RESULTS: From December 1994 to March 1998, Eighteen patients were enrolled in this protdegrees Col. Fourteen patients were evaluable for response. The overall response rate was 28.6% (95% CI: 11.7~56.7%). The median response duration was 21 weeks. The median survival for all enrolled patients was 28 weeks. The major toxicity was myelosuppression. Among total of 69 cycle che motherapy, WHO grade 3 or 4 granuldegrees Cytopenia and thrombdegrees Cytopenia were observed in 71.0% and 27.5%, respectively. CONCLUSION: Second line therapy with EAP regimen was active for gastric cancer. Chemotherapy induced toxicities were moderate to severe.