Unusual Complex Apocrine Tumor Consisting of Syringocystadenoma Papilliferum and Apocrine Hidrocystoma within a Single Lesion: A Case Report

Syringocystadenoma papilliferum (SCAP) and apocrine hidrocystoma (AH) are benign apocrine neoplasms that usually occur separately. SCAP arises predominantly in head and neck, while AH typically develop in periorbital area. We report a case of a 68-year-old male with an asymptomatic erythematous papulonodule that occurred on his back 3 years ago. Histologic examination showed cystic invagination extending from the epidermis into the dermis with some papillary projections. The invaginated portion was lined by epithelial bilayer composed of cuboidal and columnar cells, and decapitation secretion was observed in the inner epithelial layer. In the deep dermis, multiple cystic spaces with variable sizes were observed, and these cysts also presented double layers of the epithelium and decapitation secretion.According to such histologic features, the coexistence of SCAP and AH within a single lesion was demonstrated. The patient was recommended to completely remove the remaining lesion after punch biopsy, but he refused further surgical management. Herein, we report an unusual case of complex apocrine tumor with a rare composition in an atypical site.

A Multicenter, Prospective, Observational Study to Evaluate Ethanol-Induced Symptoms in Patients Receiving Docetaxel Chemotherapy / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#Several previous studies and case reports have reported ethanol-induced symptoms in patients receiving anticancer drugs containing ethanol. Most docetaxel formulations contain ethanol as a solvent. However, there are insufficient data on ethanol-induced symptoms when docetaxel-containing ethanol is administered. The primary purpose of this study was to investigate the frequency and pattern of ethanol-induced symptoms during and after docetaxel administration. The secondary purpose was to explore the risk factors for ethanol-induced symptoms. @*Materials and Methods@#This was a prospective, multicenter, observational study. The participants filled out ethanol-induced symptom questionnaire on the day of chemotherapy and the following day. @*Results@#Data from 451 patients were analyzed. The overall occurrence rate of ethanol-induced symptoms was 44.3% (200/451 patients). The occurrence rate of facial flushing was highest at 19.7% (89/451 patients), followed by nausea in 18.2% (82/451 patients), and dizziness in 17.5% (79/451 patients). Although infrequent, unsteady walking and impaired balance occurred in 4.2% and 3.3% of patients, respectively. Female sex, presence of underlying disease, younger age, docetaxel dose, and docetaxel-containing ethanol amount were significantly associated with the occurrence of ethanol-induced symptoms. @*Conclusion@#The occurrence of ethanol-induced symptoms was not low in patients receiving docetaxel-containing ethanol. Physicians need to pay more attention to the occurrence of ethanol-induced symptoms and prescribe ethanol-free or low-ethanol-containing formulations to high-risk patients.

Approach to Hospitalized Patients with Fever and Skin Eruption: A Retrospective Analysis of Clinical Features / 대한피부과학회지

Background@#Fever and skin eruption are common manifestations in patients; however, assessing them can be challenging because of the wide range of differential diagnosis. @*Objective@#We aimed to obtain tips that could assist in differential diagnoses in patients with fever and skin eruption through the analysis of clinical features. @*Methods@#Medical records of hospitalized patients who had fever and skin eruption were examined from January 2010 to December 2019. @*Results@#The patients of the adverse drug reaction group were older (p=0.024), and they had underlying diseases (p＜0.001), whole body skin eruption (p=0.018), elevated alanine aminotransferase (p=0.027). The autoimmune disease group was associated with longer total fever and skin eruption duration (p=0.049, 0.037), leukocytosis (p=0.015), and neutrophilia (p=0.006). Infectious erythema group was associated with targetoid lesions (p=0.003). @*Conclusion@#Clinicians should examine patients with fever and skin eruption, considering that there may be various causes. This can be assisted by delicate skin exam and laboratory tests.

Awareness and Use of Complementary and Alternative Medicine in Korean Lung Cancer Patients / 결핵및호흡기질환

Background@#Complementary and alternative medicine (CAM) has been used frequently, and its use continues to increase in lung cancer patients, despite insufficient scientific of its efficacy. To investigate this situation, we analyzed the current awareness and use of CAM in Korean lung-cancer patients. Methods: This prospective survey–based study was performed at seven medical centers in South Korea between August and October 2019. The survey assessed general patient characteristics and the awareness and use of CAM. We analyzed differences in the clinical parameters of patients aware and not aware of CAM and of CAM non-users and users. @*Results@#Of the 434 patients included in this study, 68.8% responded that they were aware of CAM and 30.9% said they had experienced it. In univariate analysis, the patients aware of CAM were younger with poor performance status, had advanced-stage lung cancer, received more systemic therapy, and received concurrent chemoradiation therapy (CCRT). By multiple logistic regression, younger age, poor performance status, advanced stage, and prior CCRT were identified as independent risk factors for CAM awareness. There were no significant differences in the general characteristics and cancer-associated clinical parameters of CAM non-users and users. @*Conclusion@#Specific clinical parameters were associated with patients’ awareness of CAM, although there were no significantly different characteristics between CAM users and non-users.

The 2020 revision of the guidelines for the management of myeloproliferative neoplasms

In 2016, the World Health Organization revised the diagnostic criteria for myeloproliferative neoplasms (MPNs) based on the discovery of disease-driving genetic aberrations and extensive analysis of the clinical characteristics of patients with MPNs. Recent studies have suggested that additional somatic mutations have a clinical impact on the prognosis of patients harboring these genetic abnormalities. Treatment strategies have also advanced with the introduction of JAK inhibitors, one of which has been approved for the treatment of patients with myelofibrosis and those with hydroxyurea-resistant or intolerant polycythemia vera. Recently developed drugs aim to elicit hematologic responses, as well as symptomatic and molecular responses, and the response criteria were refined accordingly. Based on these changes, we have revised the guidelines and present the diagnosis, treatment, and risk stratification of MPNs encountered in Korea.

A Case of Hand-Foot-Mouth Disease Caused by Coxsackievirus A6 / 대한피부과학회지

Hand-foot-mouth disease (HFMD) is a viral infection that occurs commonly in children. It is characterized by vesicles with surrounding erythema on the extremities and mouth. Most common pathogens are Coxsackievirus A16 and Enterovirus 71. HFMD caused by Coxsackievirus A6 is uncommon and accompanied by more extensive and atypical eruptions. A 42-year-old man presented with erythematous papules and vesicles on the right hand which occurred 7 days prior to presentation. The rash spread extensively with high fever, chills, headache, and myalgia. He also had whitish ulcer-like lesions on the oral mucosa with swallowing difficulty. One day after hospitalization, he developed arthralgia on his shoulders, pelvis, knees, and fingers. The biopsy specimen showed an intraepidermal blister with reticular degeneration, epidermal necrosis, and neutrophilic infiltration. There were no inclusion cells or giant cells. The serum antibody titer of Coxsackievirus A6 showed a significant increase, at 64 times. He was diagnosed with HFMD caused by Coxsackievirus A6.

Orange-brown Chromonychia with Features of Splinter Hemorrhage on Dermoscopic Findings / 대한피부과학회지

Kawasaki disease is an acute inflammatory syndrome affecting middle-sized arteries. It is diagnosed when a fever lasts longer than 5 days, and four out of the five diagnostic criteria are satisfied. Some skin lesions are not included in the criteria, but are associated with Kawasaki disease. They can be helpful when the patient has an incomplete presentation. Herein, we report a Kawasaki patient who presented with simultaneous orange-brown chromonychia on all 20 nails and black crusted lips.

A Case of Localized Cutaneous Bee Pollen Allergy Showing an Unusual Histopathologic Finding of Subcorneal Eosinophilic Microabscess / 대한피부과학회지

Bee pollen is a mixture made by worker bees and consists of pollen, nectar, and salivary secretions. Due to its abundant nutritional and medicinal effects, people are consuming bee pollen increasingly these days. By the way, some of the elements of bee pollen, such as pollen and fungus, can cause allergic reactions. Anaphylaxis is the most common symptom and other symptoms such as bronchospasm, abdominal pain and urticaria can occur. But localized cutaneous bee pollen allergy has never been reported. A 29-year-old man presented with erythematous vesicular patches on the lower abdomen 3 months ago. The skin biopsy specimen showed a subcorneal pustule filled with eosinophilic microabscess, perivascular eosinophilic infiltration, and epidermal spongiosis. He was diagnosed with skin allergy caused by bee pollen. He stopped ingesting bee pollen and was treated with oral antihistamines and a topical steroid. We report this case because of its unique clinical and histological appearance.

A Clinical Study of the Normal Values and Guideline for Hair Pull Test in Koreans / 대한피부과학회지

Background@#The hair pull test is a quick and easy examination to monitor hair loss. It was recently studied in a large group consisting primarily of Caucasians. Considering the ethnic differences in hair and follicles characteristics, hair pull test results could differ in Asians, including Koreans. @*Objective@#To determine the normal hair pull test value in Koreans and which factors influenced the results. @*Methods@#After the participants (n=102) completed a questionnaire, the experimenter performed the hair pull test on five parts of the scalp including the vertex, right parietal, left parietal, occipital, and frontal areas in two different methods. @*Results@#The normal hair pull test value among the Koreans in this study was less than 1. The results were not affected by tugging (p=0.628) or site (p=0.934). No significant differences in results were observed regardless of time since the last washing (p=0.319) or brushing (p=0.851). However, participants over 50 years of age (p=0.035), those who washed their hair less than once daily (p=0.000), and those who never used a dryer (p=0.037) showed significantly increased values, with normal values of less than 2, while those who washed their hair before sleep showed significantly lower values (p=0.027). @*Conclusion@#The normal hair pull test value in Koreans was less than 1, less than that in Caucasians. Age, number of washings per day, and the use of a dryer affected the hair pull test results. Therefore, care must be taken when interpreting the results.

A Case of Sitagliptin Induced DRESS Syndrome / 대한피부과학회지

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an adverse drug reaction that is difficult to predict. It is characterized by fever, skin rash, and internal organ involvement that usually manifests 2∼6 weeks after use of the culprit drug. The antihyperglycemic agent sitagliptin is commonly used for treating diabetes mellitus, and sitagliptin-induced DRESS syndrome has not been previously reported in Korea. Herein, we report a case of DRESS syndrome after sitagliptin use; these observations may contribute to the timely diagnosis of sitagliptin induced DRESS syndrome and help reduce associated complications or morbidities.

A Case of B Cell Pseudolymphoma in an Infant Showing Disseminated Papular Distribution / 대한피부과학회지

Cutaneous pseudolymphoma is a heterogeneous group of benign reactive T- or B-cell lymphoproliferative diseases of the skin that simulate cutaneous lymphomas histologically and, sometimes, clinically. Thus far, only a few cases of pseudolymphomas showing atypical clinical manifestations have been reported. A 10-month-old boy presented with multiple flesh-colored, yellowish erythematous disseminated papules on the face, abdomen, and arms. The cutaneous lesions morphologically resembled molluscum contagiosum, Langerhans cell histiocytosis, or juvenile xanthogranuloma. Punch biopsy and immunohistochemistry studies were performed, and the lesion was identified as a cutaneous B-cell pseudolymphoma. Most of the lesions were cleared within a month with systemic corticosteroids and oral antihistamine administration. In this report, we present an interesting rare case of infantile cutaneous B-cell pseudolymphoma mimicking many other dermatological diseases in addition to a cutaneous lymphoma.

Validity of Diagnostic Codes for Identification of Psoriasis Patients in Korea

BACKGROUND: Recently, the number of nationwide medical researches on psoriasis using the National Health Insurance Service database has been on the rise. However, identification of psoriasis using diagnostic codes alone can lead to misclassification. Accuracy of the diagnostic codes and their concordance with medical records should be validated first to identify psoriasis patients correctly.OBJECTIVE: To validate the diagnostic codes of psoriasis (International Classification of Diseases, 10th Revision L40) and to find the algorithm for the identification of psoriasis.METHODS: We collected medical records of patients who received their first diagnostic codes of psoriasis during 5 years from five hospitals. Fifteen percent of psoriasis patients were randomly selected from each hospital. We performed a validation by reviewing medical records and compared 5 algorithms to identify the best algorithm.RESULTS: Total of 538 cases were reviewed and classified as psoriasis (n=368), not psoriasis (n=159), and questionable (n=11). The most accurate algorithm was including patients with ≥1 visits with psoriasis as primary diagnostic codes and prescription of vitamin D derivatives. Its positive predictive value was 96.5% (95% confidence interval [CI], 93.9%~98.1%), which was significantly higher than those of the algorithm, including patients with ≥1 visits with psoriasis as primary diagnostic codes or including ≥1 visits with diagnostic codes of psoriasis (primary or additional) (91.0% and 69.8%). Sensitivity was 90.8% (95% CI, 87.2%~93.4%) and specificity was 92.5% (95% CI, 86.9%~95.9%).CONCLUSION: Our study demonstrates a validated algorithm to identify psoriasis, which will be useful for the nationwide population-based study of psoriasis in Korea.

Cutaneous Plasmacytosis Showing a Neuronal Involvement in a 35-Year-Old Female

No abstract available.

First Report of a Patient With Natural Killer-Lymphoblastic Leukemia/Lymphoma in Korea

No abstract available.

Which strategy is better for resectable synchronous liver metastasis from colorectal cancer, simultaneous surgery, or staged surgery? Multicenter retrospective analysis

PURPOSE: The optimal treatment for synchronous liver metastasis (LM) from colorectal cancer (CRC) depends on various factors. The present study was intended to investigate the oncologic outcome according to the time of resection of metastatic lesions. METHODS: Data from patients who underwent treatment with curative intent for primary CRC and synchronous LM between 2004 and 2009 from 9 university hospitals in Korea were collected retrospectively. One hundred forty-three patients underwent simultaneous resection for primary CRC and synchronous LM (simultaneous surgery group), and 65 patients were treated by 2-stage operation (staged surgery group). RESULTS: The mean follow-up length was 41.2 ± 24.6 months. In the extent of resection for hepatic metastasis, major hepatectomy was more frequently performed in staged surgery group (33.8% vs. 8.4%, P < 0.001). The rate of severe complications of Clavien-Dindo classification grade III or more was not significantly different between the 2 groups. The 3-year overall survival (OS) rate was 85.0% in staged surgery group and 69.4% in simultaneous surgery group (P = 0.013), and the 3-year recurrence-free survival (RFS) rate was 46.4% in staged surgery group and 30.2% in simultaneous surgery group (P = 0.143). In subgroup analysis based on the location of primary CRC, the benefit of staged surgery for OS and RFS was clearly shown in rectal cancer (P = 0.021 and P = 0.015). CONCLUSION: Based on our results, staged surgery with or without neoadjuvant chemotherapy should be considered for resectable synchronous LM from CRC, especially in rectal cancer, as a safe and fairly promising option.

Pazopanib for the Treatment of Non-clear Cell Renal Cell Carcinoma: A Single-Arm, Open-Label, Multicenter, Phase II Study / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The optimal treatment strategy for patients with metastatic non-clear cell type renal cell carcinoma (nccRCC) remains unclear. Although several inhibitors of vascular endothelial growth factor have recently shown efficacy against nccRCC, the clinical benefit of pazopanib in nccRCC has not been analyzed. We therefore designed a single-arm, open-label, phase II study to determine the efficacy and safety of pazopanib in patients with nccRCC. MATERIALS AND METHODS: Patients with locally advanced or metastatic nccRCC, exceptfor collecting duct or sarcomatoid type, received 800 mg/day of pazopanib daily until progression of disease or intolerable toxicity. One cyclewas defined as 4 weeks and tumor response was evaluated every two cycles. The primary objective was overall response rate (ORR). RESULTS: A total of 29 eligible patients were enrolled at nine centers in Korea from December 2012 and September 2014. The median age of the patients was 58 years (range, 27 to 76 years) and 21 patients (72%) were male. Regarding histology type, 19 patients had papillary, three had chromophobe, two had unclassified and five had unknown non-clear cell type. Of 28 evaluable patients, eight achieved a confirmed partial response with ORR of 28%. The median progression-free survival was 16.5 months (95% confidence interval, 10.9 to 22.1) and median overall survival was not reached. Sixteen patients (55%) experienced treatment-related toxicity of grade 3 or more, but most adverse events were overcome through dose reduction and delay. CONCLUSION: In this prospective phase II study, pazopanib demonstrated promising activity and tolerable safety profile in patients with metastatic nccRCC.

Korean Treatment Guidelines for Metastatic Prostate Cancer Developed by the Korean Association for Clinical Oncology / 대한내과학회지

The management of advanced prostate cancer has evolved rapidly. Androgen deprivation therapy, via surgical or medical castration, is the first-line therapy for hormone-naïve metastatic prostate cancer. For approximately a decade, docetaxel-based chemotherapy was the only approved agent to show a survival benefit for castration-resistant prostate cancer. However, over the last 5 years, significant advances in the field have led to the approval of several new agents with different mechanisms of action, such as the new androgen pathway inhibitors abiraterone and enzalutamide, a new cytotoxic agent, cabazitaxel, and new bone-seeking agents such as radium-223, which have all been associated with improved quality of life and pain palliation and an increase in survival. However, there has been no Korean treatment guideline for metastatic prostate cancer which is developed based on thorough search for relevant articles, including recently developed agents, and adequate review and assessment of evidences, and thus, a guideline adequate for domestic circumstance is eagerly needed. Experts from the Genitourinary Oncology Committee of the Korea Cancer Study Group developed clinical recommendations for the treatment of metastatic prostate cancer based on 19 key questions. The Korean Association for Clinical Oncology, the Korean Prostate Society, the Korean Urological Oncology Society, and the Korean Society of Pathologists reviewed and endorsed the guidelines. These are the first Korean treatment guidelines developed specifically for metastatic prostate cancer.

Reduced port laparoscopic surgery for colon cancer is safe and feasible in terms of short-term outcomes: comparative study with conventional multiport laparoscopic surgery

PURPOSE: Laparoscopic surgery was previously accepted as an alternative surgical option in treatment for colorectal cancer. Nowadays, single-port laparoscopic surgery (SPLS) is introduced as a method to maximize advantages of minimally invasive surgery. However, SPLS has several limitations compared to conventional multiport laparoscopic surgery (CMLS). To overcome those limitations of SPLS, reduced port laparoscopic surgery (RPLS) was introduced. This study aimed at evaluating the short-term outcomes of RPLS. METHODS: Patients who underwent CMLS and RPLS of colon cancer between August 2011 and December 2013 were included in this study. Short-term clinical and pathological outcome were compared between the 2 groups. RESULTS: Thirty-two patients underwent RPLS and 217 patients underwent CMLS. Shorter operation time, less blood loss, and faster bowel movement were shown in RPLS group in this study. In terms of postoperative pain, numeric rating scale (NRS) of RPLS was lower than that of CMLS. Significant differences were shown in terms of tumor size, harvested lymph node, perineural invasion, and pathological stage. No significant differences were confirmed in terms of other surgical outcomes. CONCLUSION: In this study, RPLS was technically feasible and safe. Especially in terms of postoperative pain, RPLS was comparable to CMLS. RPLS may be a feasible alternative option in selected patients with colon cancer.

Efficacy and Toxicity of Mammalian Target Rapamycin Inhibitors in Patients with Metastatic Renal Cell Carcinoma with Renal Insufficiency: The Korean Cancer Study Group GU 14-08 / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: We evaluated the efficacy and toxicity of mammalian target rapamycin inhibitors in Korean patients with metastatic renal cell carcinoma (mRCC) with chronic renal insufficiency not requiring dialysis. MATERIALS AND METHODS: Korean patients with mRCC and chronic renal insufficiency not requiring dialysis treated with everolimus or temsirolimus between January 2008 and December 2014 were included. Patient characteristics, clinical outcomes, and toxicities were evaluated. Overall survival (OS) and progression-free survival (PFS) durations were evaluated according to the degree of renal impairment. RESULTS: Eighteen patients were considered eligible for the study (median age, 59 years). The median glomerular filtration rate was 51.5 mL/min/1.73 m². The best response was partial response in six patients and stable disease in 11 patients. The median PFS and OS durations were 8 months (95% confidence interval [CI], 0 to 20.4) and 32 months (95% CI, 27.5 to 36.5), respectively. The most common non-hematologic and grade 3/4 adverse events included stomatitis, fatigue, flu-like symptoms, and anorexia as well as elevated creatinine level. CONCLUSION: Mammalian target rapamycin inhibitors were efficacious and did not increase toxicity in Korean patients with mRCC and chronic renal insufficiency not requiring dialysis.

Bone cutting capacity and osseointegration of surface-treated orthodontic mini-implants / 대한치과교정학회지

OBJECTIVE: The objective of the study was to evaluate the practicality and the validity of different surface treatments of self-drilling orthodontic mini-implants (OMIs) by comparing bone cutting capacity and osseointegration. METHODS: Self-drilling OMIs were surface-treated in three ways: Acid etched (Etched), resorbable blasting media (RBM), partially resorbabla balsting media (Hybrid). We compared the bone cutting capacity by measuring insertion depths into artificial bone (polyurethane foam). To compare osseointegration, OMIs were placed in the tibia of 25 rabbits and the removal torque value was measured at 1, 2, 4, and 8 weeks after placement. The specimens were analyzed by optical microscopy, scanning electron microscopy (SEM), and energy dispersive X-ray spectroscopy (EDS). RESULTS: The bone cutting capacity of the etched and hybrid group was lower than the machined (control) group, and was most inhibited in the RBM group (p < 0.05). At 4 weeks, the removal torque in the machined group was significantly decreased (p < 0.05), but was increased in the etched group (p < 0.05). In the hybrid group, the removal torque significantly increased at 2 weeks, and was the highest among all measured values at 8 weeks (p < 0.05). The infiltration of bone-like tissue surface was evaluated by SEM, and calcium and phosphorus were detected via EDS only in the hybrid group. CONCLUSIONS: Partial RBM surface treatment (hybrid type in this study) produced the most stable self-drilling OMIs, without a corresponding reduction in bone cutting capacity.