Lesional Expression of Heat Shock Protein 70 in Pemphigus / 대한피부과학회지

BACKGROUND: Heat shock proteins (HSP), especially the HSP 70 family, may play certain roles in the immunophysiology of some skin diseases such as psoriasis, pemphigus, and lichen planus. HSPs generally induce down-regulation of the process of apoptosis that is considered to be one of the acantholysis-producing pathways in pemphigus. OBJECTIVE: We planned to examine possible roles of HSPs 70/105 in the blistering process in pemphigus vulgaris (PV) and pemphigus foliaceus (PF), in connection with the detection results of apoptosis in local tissue specimens. METHODS: Immunohistochemical stainings and Western blot analysis were performed for the detection and semiquantitation of HSPs 70/105 in skin specimens from lesional, nonlesional, and normal control sites. Hoechst 33342 staining was simultaneously carried out to examine features of apoptosis in lesional skin specimens. RESULTS: The findings on expression of HSP were as follows. In PV, the expression of HSP 70 was minimum or negative; however, in PF, the expression was obvious and recognizable in lesional and perilesional normal skin. In contrast, HSP 105 was not detected in all cases of PV and PF. The features of apoptosis were evident at the lesional skin of all cases of pemphigus with acantholytic changes. CONCLUSION: PV and PF had different relative intensities of HSPs in lesional tissue stainings, especially in cases with HSP 70. This suggests that there may be subtle differences in the mechanisms causing acantholysis between PV and PF.

A Case of Adult-onset Henoch-Schonlein Purpura (HSP) Combined with Post-infectious Glomerulonephritis (PIGN) / 대한신장학회지

Henoch-Schonlein purpura (HSP) is a small-vessel vasculitis that are predominantly observed in children, affecting their skin, joints, gut and kidneys. The renal prognosis of HS nephritis is known to be worse in adults than in children. It is defined by tissue deposition of IgA. In most HSP patients, serum complement levels are usually normal. However, some authors reported abnormalities of serum complement levels in children-onset HSP. The authors report here a rare adult-onset case of HSP combined with post-infectious glomerulonephritis, especially hypocomplementemia and subepithelial 'hump'- like electron dense deposits.

Mixed Epithelial and Stromal Tumor of the Kidney: A Case Report

The descriptive term "mixed epithelial and stromal tumor of the kidney" was recently proposed for a group of renal tumors characterized histologically by a mixture of stromal and epithelial proliferation. It is a rare benign neoplasm of the kidney which has been reported under various names such as adult type mesoblastic nephroma or others. We report a case of mixed epithelial and stromal tumor in a 47 yr old female patient presenting as a partly cystic and partly solid renal mass. Microscopically, the tumor exhibited spindle cell component in solid portion and epithelial proliferation around microcystic areas. Immunoreactive profiles and ultrastructural examination suggested myofibroblastic nature of the stromal cells. We believe this case exemplifies a unique adult renal tumor displaying both epithelial and stromal neoplastic component and has a few unusual features worthy of attention.

A Case of Pigmented Epithelioid Cell Nevus / 대한피부과학회지

Pigmented spindle cell nevus was described as a variant of spindle and epithelioid cell nevus (Spitz nevus). However, it hs been classified as a separate disease because of the presence of large pigmented cells confined to the epidermis and papillary dermis. Pigmented epithelioid cell nevus is considered as a counterpart to pigmented spindle cell nevus, because it has similar clinicopathologic features to those of pigmented spindle cell nevus, except for tumor cells being entirely composed of large epithelioid cells. Herein, we report a case of a 31 year-old woman with a deeply-pigmented nodule which was entirely composed of large epithelioid cells, and showed many histologic findings of pigmented epithelioid cell nevus.

Virus Types and Clinical Patterns in Genital Herpes / 대한피부과학회지

BACKGROUND: Genital herpes is a sexually transmitted disease, which affects millions of people worldwide, and is caused by the herpes simplex virus (HSV). Recent data has shown that in a large proportion of genital herpes, there has been a shift from HSV type 2 (HSV-2) to to HSV type 1 (HS V-1) being the main cause. OBJECTIVE: Our objective was to study the types of virus and clinical patterns of patients with genital herpes in Korea METHODS: We investigated the clinical patterns and virus types of 13 patients with genital herpes using indirect immunofluorescence (IIF) after viral culture, and/or nested-multiplex polymerase chain reaction (NM-PCR). RESULTS: Of the 13 patients, HSV-1 was isolated in 2 patients (15.4%), HSV-2 in 7 patients (53.8%), and mixed infection with both HSV-1 and HSV-2 in 4 patients (30.8%). Recurrence of lesions was found to occur when the patient had HSV-2 or a mixed infection, but not the HSV-1 infection. Of 5 patients who underwent IIF and NM-PCR simultaneously, the virus was detected by NM-PCR only, not by IIF after viral culture, in 2 of the patients. CONCLUSION: HSV-1 infection as a cause of genital herpes is increasing, but recurrence is more common in HSV-2 infection. This study demonstrates that HSV-1 and HSV-2 can be detected simutaneously in the same anatomic region of genital herpes, and that NM-PCR is a more sensitive method for the detection and typing of HSV than IIF after viral culture.

A Case of Multicentric Reticulohistiocytosis / 대한피부과학회지

Multicentric reticulohistiocytosis is a rare systemic disorder of unknown ethiology, characterized by development of cutaneous papulonodular lesions, and destructive arthritis. Most patients with this condition have been Caucasian. There have only been a few case reports in Korea. However there appears no racial difference in prevalence. We herein report a case of multicentric reticulohistiocytosis in a 47-year-old female, who presented with papulonodules on both hands and had symptoms of a rapidly progressive arthritis. During a trial with methotrexate, cyclosporin, prednisone and NSAID, the patient dropped out of follow-up treatment at the 2nd month, showing no improvement of the condition.

A Case of Verrucous Cyst / 대한피부과학회지

Verrucous cyst is a rare form of epidermal cyst showing verrucous changes of their stratified squamous epithelial lining, characterized by papillomatosis, acanthosis, and hypergranulosis with large, irregular keratohyaline granules. In addition, vacuolated keratinocytes, parakeratosis, and squamous eddies are often present. Herein, we describe a 45-year-old woman with a verrucous cyst, which occurred on left axilla three months ago, showing the above-mentioned characteristic histologic features. Both the immunohistochemical stain and polymerase chain reaction for the common antigen for human papillomavirus and DNA chip study for the human papillomavirus were negative.

Ischemic Stroke in Children: Analysis of Risk Factors

PURPOSE: This paper evaluate and classified the risk factors that could possibly cause ischemic stroke in children, and investigate whether TOAST classification could be applied to the ischemic stroke in children. METHODS: From March 1995 to February 2002, we retrospectively reviewed the medical record of 87 patients under the age 16 who had been registered to the Ajou Stroke Registry. We evaluated the risk factors of ischemic stroke according to the Ajou Stroke Registry Protocol, and classified the risk factors into 6 main subgroups. In addition, the risk factors were investigated according to the age distribution. TOAST classification had been applied to children with ischemic stroke. RESULTS: There was 64 ischemic stroke(73.6%) and 23 hemorrhagic stroke(26.4%) among the 87 patients. In children with ischemic stroke, there was three major peak age; 13 patients younger than 1 year old(15.3%), 26 patients in age 5 to 8 years old(40.6 %), 22 patients in 9 to 12 years old(34.3%). Vasculopathy(48.6%) was the most common risk factor of the ischemic stroke in this study. Other important risk factors in order of frequency were hypertensive encephalopathy(12.5%), infectious disease(7.8%), metabolic disease(7.8%), and hematologic disease(6.2%). Moyamoya disease was the most common cause of ischemic stroke due to vasculopathy. If we analyze the risk factors according to the age at the presentation of ischemic stroke, 90% of the ischemic stroke due to vasculopathy had been developed after 5 years of age. However, ischemic stroke due to infectious disease had been developed less than 4 years of age. Major stroke was the most common subtype of the ischemic stroke in children, but TIA had been found in 80% of the patients with ischemic stroke due to moyamoya disease. TOAST classification determined the subtype of the ischemic stroke only in 2 children. Risk factors of ischemic stroke in the remained 62 patients were extremely variable, and could not be applicable to the TOAST classification. CONCLUSION: Risk factor of ischemic stroke were found in the 90% of patients. Although risk factors of ischemic stroke were extremely variable in children, cerebral vasculopathy including moyamoya disease was the most common. However, inherited metabolic disorder, coagulopathy, and hypertensive encephalopathy were also relatively common risk factors of ischemic stroke especially in children older than 5 years old. Therefore, we must extensively evaluate all the possible risk factors of ischemic stroke in children. TOAST classification could not be applicable in children because the risk factors of ischemic stroke were extremely variable.