ABSTRACT
Syringocystadenocarcinoma papilliferum in situ is extremely rare. A 51-year-old female presented with a solitary yellowish patch on the scalp, accompanied by hair loss and a protruding mass. Histopathological evaluation revealed a large number of sebaceous glands and mild papillomatosis without hair follicles. The tumor contained many cystic spaces filled with amorphous material and a connection to the epidermis. The tumor cells showed papillomatous projections and were multilayered with nuclear atypia but no dermal involvement or lymphovascular invasion. On immunohistochemical analysis, the tumor cells showed immunopositivity for carcinoembryonic antigen, Ki-67, epithelial membrane antigen, and gross cystic disease fluid protein-15. Therefore, the patient was diagnosed with syringocystadenocarcinoma papilliferum in situ originating from a nevus sebaceus. The tumor was removed by wide excision, and no recurrence was observed. Our case report supports the multistep pathogenesis of syringocystadenocarcinoma papilliferum originating from a nevus sebaceus.
ABSTRACT
Syringocystadenocarcinoma papilliferum in situ is extremely rare. A 51-year-old female presented with a solitary yellowish patch on the scalp, accompanied by hair loss and a protruding mass. Histopathological evaluation revealed a large number of sebaceous glands and mild papillomatosis without hair follicles. The tumor contained many cystic spaces filled with amorphous material and a connection to the epidermis. The tumor cells showed papillomatous projections and were multilayered with nuclear atypia but no dermal involvement or lymphovascular invasion. On immunohistochemical analysis, the tumor cells showed immunopositivity for carcinoembryonic antigen, Ki-67, epithelial membrane antigen, and gross cystic disease fluid protein-15. Therefore, the patient was diagnosed with syringocystadenocarcinoma papilliferum in situ originating from a nevus sebaceus. The tumor was removed by wide excision, and no recurrence was observed. Our case report supports the multistep pathogenesis of syringocystadenocarcinoma papilliferum originating from a nevus sebaceus.
ABSTRACT
Reconstruction of defects on the lower third of the nose is always a challenge, as dissection of tissues in this area is not simple due to both a lack of elasticity and the structural complexity of the mid-facial area. When the defect size is less than 1.5 cm on the nose, primary closure or a bilobed flap is widely-used, while a skin graft is required for reconstruction of larger defects. Here we present two cases of a nasalis myocutaneous island pedicle flap with bilevel undermining with a relatively large nasal dorsum defect (>2 cm). The nasalis myocutaneous island pedicle flap with bilevel undermining was performed in order to maximize the movement of skin flaps and minimize the secondary movement of flaps after surgery. The nasal tip showed a slight upward movement immediately after surgery that subsequently moved down to a normal level. This technique can be utilized for reconstruction of the lower part of the nose for defects 2 cm or larger in size by maximizing the movement of the flap within the nasal structure. A major advantage is a higher flap survival rate due to proper arterial supply and the procedure results in relatively reduced secondary motion of the flap after the surgery.
Subject(s)
Elasticity , Nose , Skin , Survival Rate , TransplantsABSTRACT
BACKGROUND: Low-fluence 1,064 nm Q-switched Nd:YAG laser has been widely used for the treatment of melasma. Although new Q-switched Nd:YAG lasers with photoacoustic twin pulse (PTP) mode have been recently developed for high-efficiency, there is limited information available for the new technique. OBJECTIVE: This study was designed to investigate the efficacy and adverse effects after few sessions of repeated low fluence 1,064 nm Q-switched Nd:YAG laser treatment with PTP mode in Asian women with melasma. METHODS: Twenty-two Korean women were treated with a total of five sessions of low-fluence PTP mode Nd:YAG laser treatment (Pastelle®) at 2 weeks interval. Responses to treatments were evaluated by using Melasma Area and Severity Index (MASI) scoring, colorimeter measurement, and the investigators' and patients' overall assessments. Adverse events were recorded at each visit. RESULTS: Investigators' and patients' overall assessment showed that 'significantly improved' was assessed by 13 (59.1%) and 19 of 22 patients (86.4%), respectively. MASI scores were significantly reduced by 20.4%. The lightness, measured by using a colorimeter, was significantly increased by 1.3 point. Notable adverse events were not observed. CONCLUSION: After 5 sessions of laser therapy alone, about 60% of the subjects showed significant improvement. Few sessions of repeated laser toning treatment using the PTP mode is a safe and effective way to treat facial melasma.
Subject(s)
Female , Humans , Asian People , Laser Therapy , Melanosis , TwinsABSTRACT
Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. The main symptoms of scrub typhus are fever, eschar, generalized rash, and swelling of the lymph nodes. Complications include pneumonia, myocarditis, meningitis, hepatitis, acute renal failure, and hearing loss. We report a rare case of Tsutsugamushi disease with acute bilateral hearing loss in a 65-year-old woman. The antibodies against O. tsutsugamushi were detected which led to the diagnosis of scrub typhus. She was treated immediately with oral doxycycline for 9 days and had a rapid and complete recovery. Scrub typhus can be associated with hearing loss, which is present in approximately one-third of the cases, but it is rare in Korea, therefore it is easy to misdiagnose scrub typhus as any other otological abnormalities. When patients present with fever, rash, and sensorineural hearing loss, clinicians should suspect scrub typhus and consider empirical antibiotic therapy.
Subject(s)
Aged , Female , Humans , Acute Kidney Injury , Antibodies , Diagnosis , Doxycycline , Exanthema , Fever , Hearing Loss , Hearing Loss, Bilateral , Hearing Loss, Sensorineural , Hepatitis , Korea , Lymph Nodes , Meningitis , Myocarditis , Orientia tsutsugamushi , Pneumonia , Scrub TyphusABSTRACT
Plexiform fibrohistiocytic tumor (PFHT) is a rare mesenchymal neoplasm of intermediate malignancy and possibly of myofibroblast origin. It is morphologically divided into 3 groups: cellular, fibrous, and mixed. A 4-year-old girl presented with an irregular shaped subcutaneous mass on her left popliteal fossa for 6 months. The biopsy specimen showed multinodular tumor islands extending from dermis to subcutaneous layer, composed of histiocytes and osteoclast-like multinucleated giant cells, and circumscribed by fibrous tissue. Immunohistochemical staining was positive for CD68 in giant cells and histiocyte-like cells within tumor islands and faintly positive for smooth muscle actin around nodules. A cellular variant of PFHT was eventually diagnosed. Although PFHT comprises morphologically normal cells, it has the biological potential for malignant change and distal metastasis. Therefore, PFHT is categorized as a neoplasm of intermediate malignancy, and wide total excision with close follow-up is crucial.
Subject(s)
Child, Preschool , Female , Humans , Actins , Biopsy , Dermis , Giant Cells , Histiocytes , Islands , Muscle, Smooth , Myofibroblasts , Neoplasm MetastasisABSTRACT
Diseases associated with immunoglobulin A (IgA) antibody include linear IgA dermatosis, IgA nephropathy, Celiac disease, Henoch-Schonlein purpura, etc. Although usually idiopathic, IgA antibody is occasionally induced by drugs (e.g., vancomycin, carbamazepine, ceftriaxone, and cyclosporine), malignancies, infections, and other causes. So far, only a few cases of IgA bullous dermatosis coexisting with IgA nephropathy have been reported. A 64-year-old female receiving intravenous ceftriaxone and metronidazole for liver abscess had purpuric macules and papules on her extremities. One week later, she had generalized edema and skin rash with bullae and was diagnosed with concurrent linear IgA dermatosis and IgA nephropathy. After steroid treatment, the skin lesion subsided within two weeks, and kidney function slowly returned to normal. As both diseases occurred after a common possible cause, we predict their pathogeneses are associated.