ABSTRACT
Spindle cell lipoma is a rare benign neoplasm that features a mixture of evenly aligned spindle cells, mature adipocytes, and ropey collagen. Most cases of spindle cell lipoma are found in the subcutaneous tissue, and intradermal spindle cell lipoma is rarely reported. We present a case of intradermal spindle cell lipoma in a 46-year-old female who presented with a 0.7-cm flesh-colored and dome-shaped nodule on the right temple that had developed 6 years ago. This mass was excised, and upon histopathologic examination, an unencapsulated lesion was located in the dermis, which consisted of bland spindle cells, scanty mature adipocytes, rare lipoblasts, and ropey collagen bundles with prominent basophilic myxoid stroma. Immunohistochemical staining showed diffuse positivity for CD34, negativity for the S-100 protein, and loss of retinoblastoma protein expression. Based on these features, intradermal low-fat spindle cell lipoma was diagnosed. No evidence of local recurrence was observed 4 months after excision. Intradermal low-fat spindle cell lipomas are extremely rare and can easily be mistaken for tumors that have similar clinical and histopathological findings. Herein, we report a globally rare case of an intradermal low-fat spindle cell lipoma.
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Superficial CD34-positive fibroblastic tumor (SCPFT) is a recently described disease entity characterized by marked nuclear pleomorphism, low mitotic count, and diffuse CD34 positivity. It is a rare, distinctive, low-grade fibroblastic neoplasm. To date, only 44 cases have been reported in the English-language literature. Herein, we report two cases of SCPFT involving a 48-year-old male and a 22-year-old male with superficial tumors on the right and left thighs, respectively. Excision was performed in both cases. Histologically, both tumors showed spindle-to-epithelioid cells arranged in fascicular or sheet-like patterns. Most cells displayed granular or eosinophilic glassy cytoplasm, marked nuclear pleomorphism, and a low mitotic rate. On immunohistochemical staining, tumor cells were diffusely positive for CD34 and negative for S100 protein, smooth muscle actin, and desmin. After wide excision, neither patient experienced recurrence or metastasis after 16 months and 11 months of clinical follow-up, respectively. To the best of our knowledge, these are the first two cases of SCPFT reported in Korea. We believe these case reports would contribute to the clinicopathological understanding of SCPFT and assist clinicians in differentiating this tumor from other superficial soft tissue neoplasms.
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Background@#Inverted follicular keratosis (IFK) is a benign tumor that occurs mainly as a single lesion in the head and neck. Histologically, the tumor lobules show endophytic or exophytic growth and are characterized by squamous eddies. IFK should be differentiated from seborrheic keratosis, verruca vulgaris, and squamous cell carcinoma (SCC).In particular, differentiating from well-differentiated SCC can be difficult when downward growth is observed along with some mitotic figures and inflammatory cell infiltration. @*Objective@#To evaluate and compare the clinical and histopathological characteristics of IFK and well-differentiated SCC. @*Methods@#We retrospectively reviewed the clinicopathological records of 21 patients diagnosed with IFK and 21 randomly assigned patients diagnosed with well-differentiated SCC between 2000 and 2022 at the Dermatology Department of the Yeungnam University Medical Center. @*Results@#IFK occurs frequently on the head and neck of middle aged and older adults, and its average size is less than 1 cm. Acantholysis was observed in varying degrees in IFK; however, well-differentiated SCC was mostly absent (17 cases) or mild (three cases) showing a statistically significant difference. Squamous eddies were observed in 21 cases of IFK and eight of well-differentiated SCC. The average number of dyskeratotic cells and mitotic counts did not differ significantly between IFK and well-differentiated SCC. @*Conclusion@#We suggested some evidence for the irritant origin of IFK. We also compared the clinicohistological findings of IFK with those of well-differentiated SCC and concluded that excluding atypical cells, abnormal mitotic figures, and irregular invasive borders is important for differential diagnosis.
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Background@#Nodular hidradenoma is a relatively common benign cutaneous neoplasm, which usually presents as solitary intradermal nodule. In Korea, an extensive study on tumors with eccrine differentiation was performed in 2006; however, the study considered all eccrine tumors and detailed analysis of its differentiation was not performed. In addition, although most skin pathology textbooks classify it as a tumor showing eccrine differentiation, its differentiation remains controversial. @*Objective@#This study investigated clinicopathological features of nodular hidradenoma in Koreans at a tertiary referral center. @*Methods@#We retrospectively investigated 22 patients who presented with nodular hidradenoma at Yeungnam University Hospital between 2000 and 2021. Diagnosis was confirmed by histopathological examination in all the patients. @*Results@#About half of the lesions were located on the head and neck area (45.5%), followed by the trunk (31.8%). Histopathological examination revealed that tumor cells in most of the cases consisted of cuboidal and clear cells; however, in some cases there were several specific modified cells such as clear cells (9.1%), squamoid cells (4.5%), and poroid cells (22.7%). Considering the morphological characteristic of tubular structures, most cases (90.9%) showed apocrine differentiation, and only 2 cases (9.1%) showed eccrine differentiation. @*Conclusion@#Considering the characteristics of cells and tubular structures constituting tumors, it is reasonable to consider nodular hidradenoma as a tumor with apocrine differentiation rather than with eccrine differentiation, which had previously been the predominant classification. Furthermore, there still is no distinct marker for determining whether cells differentiate into eccrine or apocrine tissues and further studies are therefore needed.
ABSTRACT
Piloleiomyoma originates from the arrector pili muscles. Multiple piloleiomyoma lesions may occur, especially on the trunk and extremities. However, multiple lesions throughout the body are rare. We present a case of generalized cutaneous piloleiomyomatosis in a 72-year-old man who had numerous lesions throughout his body. Clinically, the patient presented with fixed and non-tender reddish to brownish papules and nodules mainly on the back and extensors of extremities. Punch biopsy was performed, and the specimen was stained with hematoxylin and eosin, revealing interweaving fascicles of cigar-like spindle cells on the upper dermis. On immunohistochemical staining, tumor cells were positive for smooth muscle actin. Based on these features, we diagnosed the patient with generalized cutaneous piloleiomyomatosis.
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Syphilis is a highly contagious sexually transmitted disease, and early diagnosis and prompt treatment significantly affect the prognosis. Syphilis usually presents with genital lesions in the early stages; therefore, extragenital syphilitic lesions can easily be misdiagnosed. A 20-year-old man presented with a 1-month history of a worsening hyperkeratotic black crusted ulcerative plaque on the right 4 th finger, with distorted periungual structures.Histopathological examination showed epidermal hyperplasia, mild endothelial swelling, and numerous plasma cells in the dermis. Excessive dermal infiltration of plasma cells suggested primary syphilis, which necessitated additional serological tests; the patient showed positive results on Venereal Disease Research Laboratory and Treponema pallidum hemagglutination testing. The lesion significantly improved after an intramuscular injection of 2.4 million units of benzathine penicillin G. We report a rare case of primary syphilis involving the finger in a patient with clinical features of ulcerative paronychia.
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Purpose@#For patients with time-critical acute coronary syndrome, reporting electrocardiogram (ECG) findings is the most importantcomponent of the treatment process. We aimed to develop and validate an automated Fast Healthcare InteroperabilityResources (FHIR)-based 12-lead ECG mobile alert system for use in an emergency department (ED). @*Materials and Methods@#An automated FHIR-based 12-lead ECG alert system was developed in the ED of an academic tertiarycare hospital. The system was aimed at generating an alert for patients with suspected acute coronary syndrome based on interpretationby the legacy device. The alert is transmitted to physicians both via a mobile application and the patient’s electronic medicalrecord (EMR). The automated FHIR-based 12-lead ECG alert system processing interval was defined as the time from ED arrivaland 12-lead ECG capture to the time when the FHIR-based notification was transmitted. @*Results@#During the study period, 3812 emergency visits and 1581 12-lead ECGs were recorded. The FHIR system generated 155alerts for 116 patients. The alerted patients were significantly older [mean (standard deviation): 68.1 (12.4) years vs. 59.6 (16.8)years, p<0.001], and the cardiac-related symptom rate was higher (34.5% vs. 19%, p<0.001). Among the 155 alerts, 146 (94%) weretransmitted successfully within 5 minutes. The median interval from 12-lead ECG capture to FHIR notification was 2.7 min [interquartilerange (IQR) 2.2–3.1 min] for the group with cardiac-related symptoms and 3.0 min (IQR 2.5–3.4 min) for the group withnon-cardiac-related symptoms. @*Conclusion@#An automated FHIR-based 12-lead ECG mobile alert system was successfully implemented in an ED.
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Background@#Lichen planus-like keratosis (LPLK), also known as benign lichenoid keratosis, usually presents as a single, brown to red, scaly, flat-topped plaque. Several large-scale studies have reported LPLK in Caucasians; however, no study has reported LPLK in Koreans. @*Objective@#To investigate the clinicopathological features of LPLK in Koreans. @*Methods@#We retrospectively investigated 60 patients with LPLK at Yeungnam University Hospital between 2001 and 2019. Diagnosis of LPLK was confirmed by histopathological examination in all patients. @*Results@#Most patients (96.6%) had a single lesion. The most common location was the face (63.3%), followed by the trunk (16.7%), and upper extremities (11.7%). Mean patient age was 62.7 years, and the female:male ratio was 1.3:1. The initial clinical impression involved seborrheic keratosis in 56.7% of cases and LPLK in only 16.7% of cases. Solar elastosis (58.3%) and red blood cell extravasation (55%) were also commonly observed in this study population. Histopathological findings revealed focal parakeratosis (35%), dermal eosinophils (30%), and plasma cells (10%). @*Conclusion@#LPLK may commonly be misdiagnosed, because it is often clinically indistinguishable from seborrheic keratosis and other epithelial neoplasms. Skin biopsy findings and clinicopathological correlation are therefore necessary for differential diagnosis. Several histopathological features, such as parakeratosis as well as dermal eosinophil and plasma cell infiltration, can distinguish LPLK from lichen planus.
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Subject(s)
Aged , Female , Humans , Bone Marrow Examination , Bortezomib , Dermis , Giant Cells , Immunoelectrophoresis , Immunoglobulin G , Inflammation , Injections, Intralesional , Melphalan , Multiple Myeloma , Neck , Necrobiotic Xanthogranuloma , Paraproteinemias , Skin , Triamcinolone , XanthomatosisABSTRACT
BACKGROUND@#Sporotrichosis is a common deep mycosis caused by the Sporothrix schenckii complex. Until 2016, no molecular studies had been conducted on these fungi, and all the included strains were reported as S. schenckii. However, investigations conducted in northeast China, Japan, and India revealed that S. globosa was the most prevalent Sporothrix species, whereas S. schenckii sensu stricto was reported very rarely.@*OBJECTIVE@#To investigate the accurate prevalent causative species of sporotrichosis among strains reported as S. schenckii in Korea.@*METHODS@#We isolated strains of Sporothrix spp. Prevalent in Korea from fungus collection centers or private collections and reviewed the available literature on molecular studies of strains from this region. We found five S. schenckii (1998-2016) and three S. globosa (2016-2018) strains. Ribosomal DNA internal transcribed spacer (ITS) sequences of these strains were compared with those of the S. schenckii complex strains.@*RESULTS@#The ribosomal ITS sequences of the eight strains were 100% identical with that of S. globose. No S. schenckii sensu stricto was found. In addition, a study on the molecular analysis of Korean S. schenckii published by Ishizaki et al. (2004) demonstrated that the eight strains were of the mitochondrial subtype group B (S. globosa). Thus, all the 16 strains examined within the Korean S. schenckii complex were determined to be S. globosa.@*CONCLUSION@#In summary, S. globosa is the causative species within the tested Korean sporotrichosis cases reported between 1998 and 2018. Based on our analyses, S. globosa, and not S. schenckii, may be the predominant species in Korea.
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Fibrous hamartoma of infancy (FHI) is a rare entity with a benign nature. The typical clinical features are a single, slowly growing, painless mass on the trunk that appears within the first 2 years of life. We report a 13-month-old boy who presented with a plaque on the lower back since 4 months of age. The plaque had gradually become larger and firm, and hyperhidrosis and hypertrichosis were noticed. No visible connection between the spinal cord and the lesion was found in radiologic studies, indicating a disease other than spinal dysraphism. Histopathological findings showed well-defined fibrous trabeculae, mature adipose tissue, and primitive mesenchymal cells, all consistent with FHI. This is the first case of FHI presenting with hyperhidrosis and hypertrichosis reported in Korea.
Subject(s)
Humans , Infant , Male , Adipose Tissue , Hamartoma , Hyperhidrosis , Hypertrichosis , Korea , Spinal Cord , Spinal DysraphismABSTRACT
BACKGROUND@#The prevalence of onychomycosis is increasing due to the recent increase of the elderly population and immunosuppressed individuals. Clinical studies on onychomycosis have been reported several times in Korea. However, the public awareness of onychomycosis has not received considerable attention, and there have been no Korean studies focused on it.@*OBJECTIVE@#To evaluate public awareness and experience of onychomycosis in Korean.@*METHODS@#A total of 621 participants were given questions developed for this survey. Sociodemographic characteristics, public awareness, general knowledge and experience about onychomycosis, and diagnostic and treatment behavior were surveyed.@*RESULTS@#According to this survey, 99.5% of respondents have heard of onychomycosis, 79.4% of respondents experienced onychomycosis suspicious symptoms, and 52.8% of them responded that onychomycosis can be completely cured only by cleansing the hands and feet. The rate of self-diagnosis was 64.1% among the respondents who experienced symptoms. Only 23.9% of the respondents who were diagnosed with onychomycosis visited the hospital for the first time. Of the respondents, 54.6% who were treated at the hospital discontinued their treatments before complete cure mainly because of long treatment period.@*CONCLUSION@#Participants were well aware of onychomycosis, but the rate of self-diagnosis was high. They generally agreed to the importance of hospital treatment, but the number of patients visiting hospital was low. Moreover, people frequently discontinue their hospital treatment despite insufficient treatment duration. Patient's behaviors need to be changed, and the roles of dermatologists are important in the diagnosis, treatment, and education of the patients.
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BACKGROUND@#There have been several therapeutic guidelines for onychomycosis in different countries and advances in its diagnosis and treatment. Optimal treatment decision-making is affected by healthcare systems and cultural backgrounds of countries.@*OBJECTIVE@#The executive committee for onychomycosis guideline of the Korean Society for Medical Mycology aims to provide up-to-date practical guidelines for onychomycosis management in Koreans.@*METHODS@#The committee thoroughly reviewed relevant literature and previous guidelines. The structured algorithmic guideline was developed by experts' consensus.@*RESULTS@#The optimal treatments can be selected alone or in combination based on the nail and patient variables. Three major classes of treatment are available: standard (topical or oral antifungals), additional (nail removal), and alternative treatments (laser). Both topical and oral antifungals alone are appropriate for mild onychomycosis, while oral antifungals are primarily recommended for moderate-to-severe cases if not contraindicated. Combined topical and oral antifungals are recommended to increase the efficacy in moderate-to-severe cases. Additional infected nail removal is also considered for moderate-to-severe onychomycosis, which is unresponsive to standard medical treatment alone. Laser therapy can be an alternative without significant side effects when standard medical treatments cannot be applied regardless of onychomycosis severity. After treatment course completion, periodic therapeutic response monitoring and onychomycosis preventive measures should be rendered to reduce recurrence.@*CONCLUSION@#The Korean consensus guideline provides evidence-based recommendations to promote good outcomes of onychomycosis. The proposed algorithm is simple and easy to comprehend, allowing clinicians to facilitate optimal treatment decision-making for onychomycosis in clinical practice.
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BACKGROUND@#Superficial dermatomycoses are fungal infections of the skin, hair, or nails and are most commonly caused by dermatophytes. Superficial dermatomycoses are very common diseases in the field of dermatology; however, their prevalence and clinical characteristics vary with geographical areas and populations. Moreover, pathogenic species change constantly over time.@*OBJECTIVE@#This multicenter study aimed to investigate the epidemiologic and clinical findings of tinea corporis, tinea faciale, and tinea capitis in Korea during 2016-2017. In addition, we sought to identify the pathogenic organism causing these three different types of fungal infections.@*METHODS@#Total 453 patients from the dermatology clinics of 13 tertiary hospitals in Korea were enrolled in this study. Information regarding demographic characteristics, comorbidities, occupation, family history of superficial dermatomycoses, suspected routes of infection, and treatment was collected. Fungal cultures and molecular analyses were performed for patients with tinea corporis, tinea faciale, and tinea capitis.@*RESULTS@#Of the 453 patients, 275 were men and 178 were women. With respect to past history, 214 patients (53.4%) had at least one comorbidity. Tinea corporis (27.3%) was the most common form of superficial dermatomycosis, followed by tinea pedis (23.2%) and tinea unguium (16.6%). Overall, the fungal culture positivity was 77.8% (126/162). Trichophyton rubrum was the most common causative organism for tinea corporis (66.7%, 68/80) and tinea faciale (43.8%, 14/23), while Microsporum canis was the most common causative organism for tinea capitis (36.7%, 11/23).@*CONCLUSION@#Trichophyton rubrum was consistently the most common causative organism of superficial dermatomycoses, except for tinea capitis in Korea.
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Typically, sporotrichosis follows an environmental transmission route via traumatic inoculation of contaminated plant or soil matter. Although familial occurrences of sporotrichosis are rare, human-to-human transmission is even rarer. Herein, we report two cases, a father and son, with sporotrichosis caused by Sporothrix (S.) globosa. A 33-year-old male who otherwise appeared healthy presented with a tender, erythematous, ulcerative crusted plaque on the left ala nasi and upper lip. A skin biopsy and mycological study revealed fixed cutaneous sporotrichosis. The patient irregularly received oral itraconazole with a relapsing course. Approximately a year later, his 3-year-old son developed a single plaque on the left leg. When the father carried his son on his shoulder, there was direct contact between the two lesions. Fungal culture results from the father and son's lesions confirmed S. globosa with ribosomal DNA ITS sequencing. In both patients, oral terbinafine exhibited better results than oral itraconazole. These cases are an excellent example of human-to-human transmission of sporotrichosis.
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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
BACKGROUND: PCR-based reverse blot hybridization assay (PCR-REBA) has high sensitivity and specificity, can be performed directly on nail samples, is relatively cheaper than other molecular biologic methods, and is useful for diagnosing onychomycosis. OBJECTIVE: This study aims to compare the diagnostic efficacy of fungal culture and REBA Fungus-ID® which is a commercial PCR-REBA-based kit used for onychomycosis diagnosis. METHODS: Fifty nail samples were collected from 50 patients diagnosed with onychomycosis via direct microscopic examination using KOH preparation, and subjected to fungal culture and REBA Fungus-ID® test. RESULTS: The sensitivity of conventional fungal culture and REBA Fungus-ID® was 56% and 100%, respectively. In REBA Fungus-ID®, 43 of 50 samples were found to be infected with Trichophyton rubrum. Four of the remaining 7 samples were identified as infected with Trichophyton spp., one with Trichophyton mentagrophytes, and two revealed a panfungal DNA sequence. In fungal culture, 28 of 50 samples showed growth, of which 18 samples were identified as T. rubrum, 3 as Rhodotorula mucilaginosa, 3 as Cladosporium spp., 1 as Cyphellophora europaea, 1 as Penicillium cvjetkovicii, 1 as Lachnum soppittii, and 1 as non-dermatophytic mold. REBA Fungus-ID® and fungal culture were identical in 20 cases (40%). The non-dermatophytic fungi identified in fungal culture were considered contaminants. CONCLUSION: Nail specimens can be used directly for REBA Fungus-ID®, which has a high sensitivity for onychomycosis diagnosis. Therefore, it can be considered useful for diagnosis and identification of the causative organism in mixed infections like onychomycosis.