ABSTRACT
Proliferating trichilemmal tumor (PTT) is an uncommon neoplasm originated from the outer root sheath of a hair follicle. Malignant transformation occurs occasionally in proliferating trichilemmal tumors, which can be manifested by sudden rapid growths. Histologically, the malignant proliferating trichilemmal tumors (MPTTs) have shown severe nuclear atypia, marked cellular pleomorphism with atypical mitoses, dyskeratotic cells and infiltrating margins. Squamous cell carcinoma (SCC) should be differentiated with MPTT which indicates characteristic trichilemmal keratinization. Large tumor is considered as a risk factor of metastasis in SCC, but the relationship between tumor size and metastasis in the MPTT is not yet clarified. In this report, two patients have large erythematous nodules with focal ulceration and necrosis on their scalps and were diagnosed as MPTT. Despite the large sizes of the tumors, there were no evidences of metastases. Herein, we report 2 cases of the large MPTT which are presented without metastasis.
Subject(s)
Humans , Carcinoma, Squamous Cell , Hair Follicle , Mitosis , Necrosis , Neoplasm Metastasis , Risk Factors , Scalp , UlcerABSTRACT
BACKGROUND: Acquired bilateral nevus of Ota-like macules (ABNOM) is a dermal pigmented lesion common in individuals of Oriental origin. The Q-switched Nd:YAG laser (QSNYL) has been used successfully to treat a variety of benign, dermal, pigmented lesions, including nevus of Ota lesions. The similarity between ABNOM and nevus of Ota suggested that QSNYL may also be effective in the former. OBJECTIVE: To determine the efficacy and side-effect profiles of QSNYL treatment of ABNOM in Korean patients. METHODS: Of 42 Korean patients with ABNOM, 29 were treated with QSNYL (1,064 nm, 3 mm spot size, fluence 8~9.5 J/cm2), for up to 10 sessions each. Clinical photographs were taken before and after treatment. Lesion clearance was graded and complications such as hyperpigmentation, scarring, hypopigmentation, and erythema were assessed. RESULTS: Of the 29 treated patients, 19 (66%) showed excellent or good results. Of the patients who were treated more than 3 times, 76% showed good to excellent results. Two patients experienced post-laser hyperpigmentation (PLH), which persisted for more than one month, but no patient experienced persistent erythema or hypertrophic scarring. CONCLUSION: QSNYL is safe and effective in the treatment of ABNOM in Korean patients. Short-interval repetitive treatment is especially useful in improving therapeutic results and reducing PLH.
Subject(s)
Humans , Cicatrix , Cicatrix, Hypertrophic , Erythema , Hyperpigmentation , Hypopigmentation , Laser Therapy , Nevus , Nevus of OtaABSTRACT
Papulonodular mucinosis (PNM) is a rare variant of lupus erythematosus (LE) eruptions, and PNM is characterized histologically by diffuse dermal mucin without any typical epidermal inflammatory changes. We herein describe a case of papular mucinosis that was characterized by several erythematous papules on the lower back of a 32-year-old man with systemic LE. It is interesting that he didn't display any other skin manifestations of LE such as malar rash, discoid rash and photosensitivity during the previous 2 years. He achieved remission of his PNM without recurrence after 5 months treatment with topical steroids, in addition to receiving systemic antimalarials and steroids.
Subject(s)
Adult , Humans , Antimalarials , Exanthema , Lupus Erythematosus, Systemic , Mucinoses , Mucins , Recurrence , Scleromyxedema , Skin Manifestations , SteroidsABSTRACT
Calcifying aponeurotic fibroma is an unusual, but well-characterized soft tissue tumor that typically involves the extremities. The age at presentation ranges from birth to 64 years of age. However, the majority of cases are seen in children with a median age of 12 years. Histologically, this tumor shows a poorly circumscribed, fibrotic mass extending into fat with areas of dense hyalinization, fibrosis and scattered calcification. Due to its infiltrative growth, calcifying aponeurotic fibroma has a high rate of local recurrence after surgical treatment. We recently encountered a 53-year-old Korean man with a solitary, hyperkeratotic, subcutaneous nodule on the sole of his foot. After histopathologic examination, the lesion was diagnosed as calcifying aponeurotic fibroma. During the follow-up period for 3 months, there was no increase in size of the lesion.
Subject(s)
Adult , Child , Humans , Middle Aged , Extremities , Fibroma , Fibrosis , Follow-Up Studies , Foot , Hyalin , Parturition , RecurrenceABSTRACT
Extraskeletal Ewing's sarcoma has been recognized as being histologically indistinguishable from Ewing's sarcoma of bone. Histopathologically, Ewing's sarcoma consists of solid sheets of small round cells with vesicular nuclei and scant cytoplasm, and the cells are arranged in irregular masses separated by strands of fibrous tissue. Extraskeletal Ewing's sarcoma may arise virtually anywhere, but it is most common in the deep soft tissues of the extremities. We report here on a 27-year-old woman with cutaneous extraskeletal Ewing's sarcoma. She presented with a subcutaneous tumor of the right upper arm, and this was without osseous involvement. The patient underwent wide local excision and she received chemotherapy with vincristine, cyclophosphamide, etoposide and ifosfamide. There has been no evidence of recurrence or metastasis during 16 months of follow up.
Subject(s)
Adult , Female , Humans , Arm , Cyclophosphamide , Cytoplasm , Etoposide , Extremities , Follow-Up Studies , Ifosfamide , Neoplasm Metastasis , Recurrence , Sarcoma, Ewing , Skin , VincristineABSTRACT
BACKGROUND: Epidermal growth factor receptor (EGFR) inhibitors are associated with cutaneous adverse events, including papulopustular eruption, xerosis, paronychia, hair abnormality and mucositis. In particular, acneiform eruptions might serve as the visible markers of anti-tumor activity and the therapeutic efficacy of EGFR inhibitors. OBJECTIVE: Our aims are to investigate the common cutaneous adverse events induced by cetuximab, which is one of the EGFR inhibitors approved by the US Food and Drug Administration, and to analyze whether the presence and severity of papulopustular eruptions have a correlation with the tumor response. METHODS: We retrospectively reviewed the medical records and clinical photographs of 114 Korean patients who had been treated with cetuximab at Asan Medical Center from September 2004 to March 2007. Results: Papulopustular eruptions occurred in 100 patients (87.7%) and this usually happened 10 days after starting chemotherapy. There was a tendency that the better the tumor responded to the chemotherapeutic agents including cetuximab, the more severe were the papulopustular eruptions. The papulopustular eruptions prominently improved after the treatment with topical agents such as benzoyl peroxide, metronidazole, clindamycin and retinoid, and with systemic agents such as minocycline and tetracycline, and there was no adverse event induced by this treatment for papulopustular eruptions. Xerosis appeared in 67 patients (58.8%), and there was a tendency that the more severe papulopustular eruptions were, the more frequently xerosis occurred. Paronychia occurred in 8 patients (7.0%). CONCLUSION: Although the cutaneous adverse events are burdensome to the patients, they might serve as visible markers of the anti-tumor activity and therapeutic efficacy of cetuximab and they can be easily and safely controlled with many topical and systemic agents. Therefore, it is important for dermatologists to properly treat these cutaneous adverse events and to reassure the patient to continue with the cetuximab treatment.
Subject(s)
Humans , Acneiform Eruptions , Antibodies, Monoclonal, Humanized , Benzoyl Peroxide , Clindamycin , Drug Therapy, Combination , Hair , Medical Records , Metronidazole , Minocycline , Mucositis , Paronychia , ErbB Receptors , Retrospective Studies , Tetracycline , United States Food and Drug Administration , CetuximabABSTRACT
Although injectable soft-tissue augmentation materials are extremely well-tolerated, undesirable effects sometimes occur. Whereas minor adverse events such as erythema, edema or bruising are generally reversible, the formation of foreign body granuloma, atypical mycobacterial infections or tissue necrosis may cause serious irreversible damages and disfigurement. We present here the case of a 50-year-old woman with an indurated painful nodule and patch on the right cheek, and this occurred after an unlicensed nonspecialist injected filler of unknown ingredients. The histopathologic findings showed granulomatous inflammation composed of lymphocytes, histiocytes and multinucleated giant cells with a Swiss cheese appearance. Although any acid-fast bacilli were not observed on Ziehl-Neelsen staining, the mycobacterial culture demonstrated an ivory-colored wet colony that was identified as M. chelonae by polymerase chain reaction-restriction fragment length polymorphism. The patient was treated with 1 g of clarithromycin for seven weeks, and the lesion improved considerably.
Subject(s)
Female , Humans , Middle Aged , Cheek , Cheese , Clarithromycin , Edema , Erythema , Foreign Bodies , Giant Cells , Granuloma, Foreign-Body , Histiocytes , Inflammation , Lymphocytes , Mycobacterium , Mycobacterium chelonae , NecrosisABSTRACT
Trichodiscoma are hamartomas of the dermal portion of the hair disc, and these are found as asymptomatic flesh- colored papules 1~3 mm in diameter, and they are usually located on the face, trunk and thigh. Histopathologically, this is characterized by non-encapsulated fibrovascular lesion with a myxoid stroma surrounded by folliculo- sebaceous units. Birt-Hogg-Dube syndrome, which develops multiple trichodiscomas with fibrofolliculomas and skin tags, has been described. The case of solitary trichodischoma is rare. We recently encountered a 29-year-old woman with a solitary, dome-shaped papule on the right thigh. After histopathologic examination, the lesion was diagnosed as trichodiscoma.
Subject(s)
Adult , Female , Humans , Birt-Hogg-Dube Syndrome , Hair , Hamartoma , Skin , ThighABSTRACT
BACKGROUND: Lichen sclerosus et atrophicus (LS et A) is an uncommon chronic lymphocyte-mediated dermatosis that causes substantial discomfort and morbidity, most commonly in adult women. It occurs predominantly in the anogenital area, and extragenital lesions also occur. OBJECTIVE: The aim of this study is to compare clinical and histopathologic features of genital and extragenital LS et A. METHODS: We retrospectively reviewed the medical records and 31 biopsy specimens of 29 patients who had been diagnosed with LS et A between January 2001 to June 2007 in Asan Medical Center. RESULTS AND CONCLUSION: The male to female ratio of genital LS et A and extragenital LS et A was 1:20, 1:3 respectively. Mean age at onset of genital LS et A and extragenital LS et A was 47.8 and 36.9 respectively. The color of the lesions was mostly white, irrespective of the involved area. Genital LS et A lesions were mostly located on labium majora or minora. Extragenital LS et A lesions were mostly located on the trunk, head and neck. The predominant symptom for genital LS et A was pruritus, whereas extragenital LS et A was mostly asymptomatic. The main treatment regime of LS et A was topical corticosteroid. The combination therapy with topical corticosteroid and pimecrolimus/tacrolimus resulted in symptomatic relief as well as improvement of skin lesions, without significant side effect. Histopathologically all LS et A cases showed vacuolar alteration, papillary dermal hyalinization, and dermal lymphohistiocytic infiltration. Hypergranulosis, exocytosis, red blood cell extravasation, lichenoid inflammatory cell infiltration were more frequently observed in genital LS et A (p<0.05). Follicular plugging, epidermal atrophy and loss of rete ridges were more frequently observed in extragenital LS et A (p<0.05).
Subject(s)
Adult , Female , Humans , Male , Atrophy , Biopsy , Erythrocytes , Exocytosis , Head , Hyalin , Lichen Sclerosus et Atrophicus , Lichens , Medical Records , Neck , Pruritus , Retrospective Studies , Skin , Skin DiseasesABSTRACT
Proliferative fasciitis is a rare, rapidly growing, pseudosarcomatous nodule of subcutaneous tissue. It commonly occurs on the extremities. Lesions on the head and neck are exceedingly rare. Histopathologically, it is characterized by several large basophilic ganglion-like cells deposited in a myxoid stroma with spindled cells. Herein, we report a case of a 54-year-old man who noticed a nodule on his right cheek about six months before examination. At first, its size abruptly increased, and then remained without any change in size. Microscopically, many basophilic ganglion-like cells and spindled cells were deposited in a myxoid stroma. Immunohistochemically, ganglion-like cells and spindled cells were strongly positive for vimentin and weakly positive for smooth muscle actin and CD68. Although it was not radically excised, the lesion has not been found for 3 months.
Subject(s)
Humans , Middle Aged , Actins , Basophils , Cheek , Extremities , Fasciitis , Head , Muscle, Smooth , Neck , Subcutaneous Tissue , VimentinABSTRACT
Stucco keratosis is a clinically distinct variant of seborrheic keratosis, which presents exclusively on the lower legs as white-gray keratotic warty papules. When the lesion is removed, a peripheral collarette of scale remains without bleeding. We report a case of stucco keratosis on the dorsum of the feet and ankles of a 79-year old man. Pathologic findings showed characteristic epidermal hyperplasia of the "church spire" pattern with basket-weave hyperkeratosis. He was treated with topical urea and lactic acid for 2 months and showed improvement.
Subject(s)
Animals , Ankle , Foot , Hemorrhage , Hyperplasia , Keratosis , Keratosis, Seborrheic , Lactic Acid , Leg , UreaABSTRACT
Mucoepidermoid carcinoma is the most common primary salivary gland malignancy. About 60% of mucoepidermoid carcinomas occur in the major salivary glands and 35% in the minor glands, in which the palate and buccal mucosa are the most frequent sites. Histologically, tumor cells, composed of intermediate, mucous, epidermoid, and clear cells in widely varying proportions, form numerous sheets, islands, duct-like structures and cysts. Many foci of mucin production are prominent. Herein, we report a case of a 37-year-old man who presented a nodule on left buccal mucosa. After the diagnosis, he was referred to a dental surgeon, by whom the tumor was radically excised. But, tumor cells were observed at one of the resection margins. As a result, he received radiation therapies (6 weeks, 60 Gy). He is now undergoing regular follow ups without any signs of recurrence.
Subject(s)
Adult , Humans , Carcinoma, Mucoepidermoid , Follow-Up Studies , Islands , Mouth Mucosa , Mucins , Palate , Recurrence , Salivary Glands , Salivary Glands, MinorABSTRACT
Childhood granulomatous periorificial dermatitis is a granulomatous disease that's characterized by monomorphous, small papular eruptions around the mouth, nose and eyes. The condition is benign and self-limiting and it is not associated with systemic involvement. We recently encountered a 7-year-old Korean boy with multiple, discrete, monomorphic, papular eruptions of 4-week duration on the perioral, periocular and perinasal areas. Histopathological examination revealed an upper dermal and perifollicular granulomatous infiltrate. He was treated with oral erythromycin and the condition resolved without leaving any scar.
Subject(s)
Child , Humans , Cicatrix , Dermatitis , Erythromycin , Eye , Mouth , NoseABSTRACT
Spindle cell lipoma is a benign tumor composed of ropey collagen, myxoid stroma, CD34-positive spindled cells, and mature fat. The variable proportion of these elements among different cases of the neoplasm makes diagnosis difficult. Furthermore, numerous variants have been reported, including pseudoangiomatous spindle cell lipoma, angiomatous spindle cell lipoma, fibrous spindle cell lipoma, and low-fat or fat-free spindle cell lipoma. Here we report a case of low-fat, fibrous spindle cell lipoma in which fat is noted to be present in <5% of the tumor, whereas fibrous collagenous stroma is predominant.
Subject(s)
Collagen , LipomaABSTRACT
Chondrosarcoma is the second most commonly encountered primary malignancy of bone, accounting for as much as 20% of such tumors. It most frequently involves the large limb bones (femur, tibia, and humerus), the scapula, and the ribs. Metastases are relatively rare and tend to occur late in the course of the disease. The lungs are the most common site of metastases. Metastatic chondrosarcoma to the skin is extremely rare, with only 10 cases described in the English literature. We herein report a case of disseminated cutaneous metastases from chondrosarcoma, presented as multiple papules and nodules on the trunk, scalp, and upper extremities.