ABSTRACT
BACKGROUND: Malignant melanomas represent pigmented skin lesions and should be distinguished from melanocytic nevi. However, differential diagnosis of malignant melanomas and melanocytic nevi is often challenging. Wilms' tumor 1 (WT1) protein is a specific immunomarker of Wilms' tumor, and several studies revealed that various malignant tumors have WT1 expression. OBJECTIVE: The purpose of this study was to evaluate the usefulness of WT1 staining for differentiating malignant melanoma from melanocytic nevi. METHODS: We selected 50 cases of melanocytic nevi (12 cases of junctional nevi, 19 of compound nevi, and 19 of intradermal nevi) and 35 cases of malignant melanoma (7 cases of malignant melanoma in situ and 28 cases of invasive melanomas) from clinicopathologically proven cases in the Department of Dermatology of Yeungnam University Medical Center. Immunohistochemistry analysis of WT1 was performed, and the labeling index of WT1 expressions was measured. RESULTS: The mean labeling indices of junctional nevi, compound nevi, intradermal nevi, malignant melanoma in situ, and invasive melanomas were 1.9%±2.8%, 23.6±21.2%, 25.7±23.5%, 5.7±5.2%, and 66.1±32.0%, respectively. The labeling index of malignant melanoma in situ was higher than that of junctional nevi. The labeling index of invasive melanoma was higher than those of compound nevus and intradermal nevus. When the WT1 cut-off point to distinguish melanomas from melanocytic nevi was 27.2%, the sensitivity and specificity were 68.6% and 74%, respectively. When a WT1 cut-off point of 75% was used, the sensitivity and specificity were 40% and 100%, respectively. The mean labeling indices of stages I, II, III, and IV malignant melanoma were 29.5%±30.4%, 68.8%±33.9%, 79.5%±6.4%, and 77.7%±18.8%, respectively, and those of Tis, T1, T2, T3, and T4 were 5.7%± 4.8%, 8.0%±0%, 69.5%±18.5%, 61.9%±28.6%, and 78.6%±30.0%, respectively. CONCLUSION: WT1 staining could be a potential diagnostic tool for differentiating malignant melanomas from melanocytic nevi because the WT1 labeling indices of melanomas were significantly higher than those of melanocytic nevi. WT1 staining may be helpful in predicting the depth and prognosis of malignant melanomas.
Subject(s)
Academic Medical Centers , Dermatology , Diagnosis, Differential , Immunohistochemistry , Melanoma , Nevus , Nevus, Intradermal , Nevus, Pigmented , Prognosis , Sensitivity and Specificity , Skin , Wilms TumorABSTRACT
Primary cutaneous anaplastic large cell lymphoma (PCALCL) is a rare primary cutaneous lymphoma that is predominantly composed of large lymphoid cells that express the CD30 antigen. The skin lesion of PCALCL is usually single, ulcerative, and located on the trunk or extremities and rarely the palm. A 25-year-old woman presented with a plaque on the left palm for 20 days. The plaque was walnut-sized and purple to gray colored with erosion in the center. Histopathologic examination showed infiltration of large atypical cells in the dermis. The large tumor cells showed positivity for CD3, CD4, and CD30 and negativity for CD8, CD20, epithelial membrane antigen, and anaplastic lymphoma kinase. PET-CT showed no other hypermetabolic lesion except that on the left palm, and we finally arrived at a diagnosis of PCALCL. The patient was treated with an intralesional injection of methotrexate (25 mg/mL, 0.45 cc). After 3 months of treatment, the walnut-sized plaque had disappeared and a peripheral hyperpigmented patch remained.
Subject(s)
Adult , Female , Humans , Ki-1 Antigen , Dermis , Diagnosis , Extremities , Injections, Intralesional , Lymphocytes , Lymphoma , Lymphoma, Large-Cell, Anaplastic , Lymphoma, Primary Cutaneous Anaplastic Large Cell , Methotrexate , Mucin-1 , Phosphotransferases , Skin , UlcerABSTRACT
Sporotrichosis is a chronic cutaneous fungal infection caused by Sporothrix (S.) schenckii complex. Fixed cutaneous sporotrichosis is one of the three subtype of sprotrichosis and accounts for 20% of total sporotrichosis cases. However, the incidence of total sporotrichosis cases is decreasing recently due to improvement of personal hygiene and industrialization. A 60-year-old woman presented to the hospital with multiple erythematous papules and ulcers on left cheek for 5 months. Histopathologic examination revealed chronic granulomatous inflammation and immunohistochemical staining was positive for GMS and PAS stain. The fungal culture on Sabouraud dextrose agar showed grayish dark brown colonies and the sequences of ribosomal DNA internal transcribed spacer region of clinical sample was 100% similarity with S. globosa. The patient was treated with oral itraconazole 200 mg daily and topical ketoconazole cream for 3 months. At that time after this treatment, skin lesion was almost cured and recurrence is not observed to date.
Subject(s)
Female , Humans , Middle Aged , Agar , Cheek , DNA, Ribosomal , Glucose , Hygiene , Incidence , Inflammation , Itraconazole , Ketoconazole , Recurrence , Skin , Sporothrix , Sporotrichosis , UlcerABSTRACT
Primary myelofibrosis (PMF) is a chronic myeloproliferative disorder that is characterized by clonal proliferation of myeloid cells in the bone marrow. PMF should be distinguished from other chronic myeloproliferative neoplasms. Leukemia cutis is defined as cutaneous infiltration of malignant hematopoietic cells. The clinical features of leukemia cutis are variable, and the lesions may be localized or disseminated. A 53-year-old male individual presented with a month's history of several erythematous papules on the trunk. The number of lesions had increased, but he had no subjective symptom. He was diagnosed with PMF 3 years ago. For the last 5 months, he has suffered from inguinal lymph node enlargement, myalgia, and abdominal discomfort. Laboratory test showed leukocytosis in the peripheral blood (blast cells: 18%). Histopathologic examination of skin lesions showed perivascular infiltration of immature myeloid cells in the dermis. The infiltrative cells showed positivity for myeloperoxidase. We diagnosed the condition as leukemia cutis from primary myelofibrosis.
Subject(s)
Humans , Male , Middle Aged , Bone Marrow , Dermis , Leukemia , Leukocytosis , Lymph Nodes , Myalgia , Myeloid Cells , Myeloproliferative Disorders , Peroxidase , Primary Myelofibrosis , SkinABSTRACT
BACKGROUND: Dermatofibrosarcoma protuberance (DFSP) must be differentiated from dermatofibroma (DF). However, especially in cases of superficial biopsy and cellular dermatofibroma, this is difficult by using histopathology alone since both are composed of neoplastic spindle cells. Although a panel of immunostains is useful, the expressions of conventional markers often overlap. A previous study showed that novel D2-40 immunostain may be useful for differentiating between DF and DFSP. OBJECTIVE: To evaluate the usefulness of D2-40 immunohistochemical staining for differentiating DFSP from DF and compare the results with other commonly used immunostains (CD34 and factor XIIIa). METHODS: Twenty-eight cases of DF and 15 cases of DFSP were selected from clinicopathologically proven cases reviewed by the Department of Dermatology at our medical center and Daegu Catholic University Medical Center. D2-40, CD34, and factor XIIIa immunohistochemical staining was performed. The immunopositivity was measured throughout the entire lesion. RESULTS: Seventeen cases (60.7%) of DF and no cases of DFSP showed immunoreactivity to D2-40 in the spindle cells. Three (10.7%) cases of DF and 13 (86.7%) cases of DFSP showed immunoreactivity to CD34 in the spindle cells. Twenty-five (89.3%) cases of DF and four (26.7%) cases of DFSP showed immunoreactivity to factor XIIIa in the spindle cells. A total of 60.7% of cases of DF were positive on D2-40 staining, 89.3% were negative on CD34 staining, and 89.3% were positive on factor XIIIa staining. All cases (100%) of DFSP were negative by D2-40 staining, 86.7% were positive by CD34 staining, and 73.3% were negative by factor XIIIa staining. CONCLUSION: D2-40 immunostaining may be useful for distinguishing between DF and DFSP since the immunoreactivity of DF was significantly higher than that of DFSP (p=0.001). However, the results of our study were not as useful as those of a previous study. Therefore, further studies are needed to address this issue.
Subject(s)
Academic Medical Centers , Biopsy , Dermatofibrosarcoma , Dermatology , Factor XIIIa , Histiocytoma, Benign FibrousABSTRACT
Kaposi's sarcoma is an angioproliferative neoplasm that is derived from endothelial cells of blood and lymphatic vessels. Although the etiology is not yet clearly revealed, human herpes virus (HHV)-8 is believed to play an important role in the occurrence of Kaposi's sarcoma. A 57-year-old man presented with hyperpigmented patches on the right lower leg for 2 months. The patient received a kidney transplantation 19 years ago and has taken immunosuppressants since then. He had undergone a percutaneous coronary intervention twice, and his right lower leg was swollen for a year. We performed a skin biopsy on the right lower leg. Histopathological examination showed neovascularization and vascular dilatation in the dermis with perivascular proliferation of spindle cells. Immunohistochemistry revealed positive findings for CD31 and CD34. An HHV-8 test using polymerase chain reaction (PCR) showed positive findings. We report an interesting case of Kaposi's sarcoma presenting as hyperpigmented patches with percutaneous coronary intervention-induced lymphedema in an immunosuppressed patient.
Subject(s)
Humans , Middle Aged , Biopsy , Dermis , Dilatation , Endothelial Cells , Herpesvirus 8, Human , Immunohistochemistry , Immunosuppressive Agents , Kidney Transplantation , Leg , Lymphatic Vessels , Lymphedema , Percutaneous Coronary Intervention , Polymerase Chain Reaction , Sarcoma, Kaposi , SkinABSTRACT
Clear cell acanthoma (CCA) is an asymptomatic benign lesion of unknown origin that typically appears as a brownish, dome-shaped papule on the leg. It has an unusual clinical feature in that it appears as chronic eczema, Bowen disease, or Paget disease on the areola. Its histopathologic findings are well-demarcated psoriasiform acanthosis with pale keratinocytes (clear cells) that are rich in intracellular glycogen, which stain positively with Periodic acid-Shiff. We report herein on a young female patient with CCA on the areolar areas.
Subject(s)
Female , Humans , Acanthoma , Bowen's Disease , Eczema , Glycogen , Keratinocytes , Leg , NipplesABSTRACT
A 2-year-old girl presented with a month history of a tender, erythematous pyramidal protrusion on the perineum, anterior to the anus. She had suffered painful defecation due to the protrusion, but had no history of constipation. The family history was negative, and physical examination showed no evidence of associated anal fissuring or skin atrophy. Histological examination revealed epidermal hyperplasia, dermal edema, and hemorrhage with inflammatory cell infiltration. The patient was treated with a CO2 laser to relieve painful defecation. Infantile perianal pyramidal protrusion (IPPP) is characterized by a solitary protrusion observed in the perineal and perianal area. Since IPPP is predominantly observed in female children in the perineal area, it can be misdiagnosed as sexual abuse, anogenital warts, or hemorrhoids. The disease is generally benign and may resolve spontaneously, with the exception of the lichen sclerosus-associated type. Physicians should be aware of IPPP to make an accurate diagnosis.
Subject(s)
Child , Child, Preschool , Female , Humans , Anal Canal , Atrophy , Constipation , Defecation , Diagnosis , Edema , Hemorrhage , Hemorrhoids , Hyperplasia , Lasers, Gas , Lichens , Perineum , Physical Examination , Sex Offenses , Skin , WartsABSTRACT
Meningothelial hamartomas represent a collection of meningothelial elements in ectopic skin lesions. They present as a tan-gray, red, flesh-colored papule or nodule with alopecia on the scalp. Histologically, there are numerous thin-walled pseudovascular spaces lined by meningothelial cells with psammoma bodies and collagen bodies. The meningothelial cells are immunopositive for vimentin and epithelial membrane antigen (EMA). We report two cases of meningothelial hamartomas. A 16-year-old boy had a skin-colored nodule with alopecia on the midline of the occipital area. Histopathologic examination showed meningothelial cells in collagen fibers, and these cells formed pseudovascular spaces. Immunohistochemical staining was positive for EMA. Brain MRI showed no abnormality in skull or brain parenchyma. Our other patient was a 1-month-old girl who had a depressed alopecic plaque on the central line of the occipital area. Skin biopsy showed a pseudovascular space consisting of meningothelial cells, which were positive for EMA. There was no gross abnormality of the skull or brain parenchyma.
Subject(s)
Adolescent , Female , Humans , Infant, Newborn , Male , Alopecia , Biopsy , Brain , Collagen , Hamartoma , Magnetic Resonance Imaging , Meningioma , Meningocele , Mucin-1 , Scalp , Skin , Skull , VimentinABSTRACT
Patients with lymphomatoid papulosis have an increased risk (approx. 5% to 20%) of developing a malignant lymphoma such as mycosis fungoides, anaplastic large cell lymphoma (ALCL) and Hodgkin's disease before, during, or after lymphomatoid papulosis occurs. However, it is very rare that lymphomatoid papulosis occurs after ALCL, especially in childhood. An 11-year-old boy who had been diagnosed with ALCL 3 years prior and treated with chemotherapy and peripheral blood stem cell transplantation developed multiple scaly papules on his trunk and both extremities. Histopathologic and immunohistochemical examination of the scaly papules revealed lymphomatoid papulosis. The patient was cured with narrow band UVB treatment and there has been no relapse in lesions 10 years later. We report a case of lymphomatoid papulosis following allogenic stem cell transplantation for ALCL.
Subject(s)
Child , Humans , Male , Drug Therapy , Extremities , Hodgkin Disease , Lymphoma , Lymphoma, Large-Cell, Anaplastic , Lymphomatoid Papulosis , Mycosis Fungoides , Peripheral Blood Stem Cell Transplantation , Recurrence , Stem Cell TransplantationABSTRACT
BACKGROUND: Traditionally, mating types of dermatophytes had been identified by mating experiments. It took a long time and there were many limitations. Recently, we can figure out the fungal mating types using molecular mating type analysis by detecting mating type (MAT) genes. The mating type (+) specific gene of the high-mobility-group (HMG) DNA binding domain and the mating type (-) specific gene of alpha-box were found in Arthroderma simii and A. vanbreuseghemii. OBJECTIVE: We applied this molecular mating type analysis to strains of Trichophyton interdigitale, T. rubrum, Microsporum canis in Korea and compared these results with previous reports. METHODS: Thirty-four strains of T. interdigitale (12 granular types, 9 powdery types, 8 purple-red types, 5 cottony types), 5 strains of T. rubrum, and 5 strains of M. canis were examined. We analyzed ribosomal RNA internal transcribed space 1, 4 sequencing of T. interdigitale subtypes and investigated the mating type of dermatophytes using alpha-box gene and HMG gene primers. RESULTS: Among 12 strains of granular type of T. interdigitale, 9 strains were type (-) and other 3 strains were type (+). All of them were zoophilic. All strains of powdery, purple-red and cottony types of T. interdigitale were type (+) and anthropophilic. In T. rubrum and M. canis, all strains were type (-). These results were matched with previously reported studies. CONCLUSION: The molecular mating type analysis of dermatophytes was quicker method than conventional mating experiments. Moreover, MAT genes are highly conserved even in apparently asexual fungi. The results were well matched with previous reports with traditional mating tests.