A histopathologic study of syphilid / 대한피부과학회지

BACKGROUND: The differentiation of syphilids from other skin decreases is frequently difficult due to considerable variations of clinical and histologic pattern. The most common histologic changes in secondary syphilis are swelling & proliferation of endothelial cells and the presence of a perivascular infiltrate containing plasmia cells. But often, these findings are absert or inconspicuous. OBJECTIVE: We examined the histopathologic findings of secondary syphilis in relation to the clinical types of the skin lesion. MEHTODS: 36 biopsy specimens from twenty-nine serologically and clinically confirmed cases of secondary syphilis (15 macules, 8 papules, 2 condylomata latas and 11 papulosquamous lesions) were examined. RESULTS: The histopath,ologic findings of secondary syphilis showed comparative differences according to the clinical types of the skin lesion. The plasms cell infltrates were absent or sparse in 14 csses(39%) and the plasma cell infiltration was significantly correhted with the age of skin lesions(p=0.02197). Vascular changes were seen in 32 cases (89%), but the incidence of endothelial proliferation was less(25%). CONCLUSION: This study demonstrates the histopathologic findirigs of secondary syphilis in accordance to the clinical morphology of the eruption and thus, help to differentiate syphilids from other skin diseases.

Clinical Features of Early Lesions in Pemphigus / 대한피부과학회지

Among 13 patients with pemphigus : 8 of pemphigus vulgaris(PV), 4 of pemphigus foliaceus(PF), l of pemphigus erythematosus(PE), we have examined the sites of early lesions and the clinical appearances of the skin lesions. The most common site of the early lesions in PV was the oral mucosa, however, in PF and PE the face was affected first. The clinical appearances of the early lesions were flaccid bullae, erythematous papules and eczematoid patches. Clinicians should be aware of these clinical features of pemphigus for a more precise diagnosis and better management.

A Case of Livedo Vasculitis / 대한피부과학회지

Livedo vasculitis or vasculitis of atrophie blanche is a clinical entity which can be distinguished from cutaneous vasculitis by distinctive pathology and immunopathologic study. A 18-year-old female with erythematous, telangiectatic, purpuric or hyperpigmented patches, intermingled with white atrophic ivory patches on her legs of 3 years duration was seen in June 3, 1982. The histologic examination of an atrophic patch showed proliferation and occlusion of blood vessels in the upper dermis with patchy atrophy of the epidermis. The immunopatbologic features of an atrophic patch revealed deposits of IgM, Ca and fibrin as a definitive immunofluorescence vessel pattern. This suggests that the livedo va.sculitis or vasculitis of atrophie blanche may he considered one of the immune vasculitides. This patient had received aspirin and persantine for 4 months, and moderate therapeutic effects could be noticed.

A Case of Lymphomatoid Papulosis / 대한피부과학회지

Lymphomatoid papulosis is a strange disease; clinically benign, histologically malignant. Clinically, it may simulate pityriasis lichenoides et varioliformis acuta. The diagnosis is based on the typical histopathological features suggestive of malignant lymphoma, due to the presence of polymorphous lymphoid infiltrate consisting of small lymphocytes intermingled with conspicuous large atypical cells. We experienced a case of lymphomastoid papulosis in 35-year-old woman. Initially, her skin lesions developed as erythematous papules on the extremities, gradually spreading centrifugally with a tendency to involute slowly without treatment, leaving brown wrinkled surface and shallow ulceration. These skin lesions tended to become worse in warm weather and better in cold weather. At first visit, multiple erythematous grouped, ulcerated papules and nodules are seen. 18 months after first visit, most skin lesions are regressed except 5 erythematous pinhead sized papules on right leg in spite of no treatrnent. Labcratory examiniations of CBC, VDRL, urinatlysis, blood chemistry and chest X-ray were all within normal limits. Histopathologically there were hygerkeratosis, mild acanthosis, exocytosis in epidermis, and numerous lymphoid cells were infiltrated especially on perivascular and periappendegeal area, and many atypical cells showing hyperchromatic nuclei, kidney-shaped nuclei and mitotic figures in dermis.

A Case of malignanr Hibernoma / 대한피부과학회지

Malignant hibernoma, also called round cell liposarcoma, is a subtype of liposarcome. It is composed of so-called mulberry cells with scanty stroma. The characteristic mulberry cell has a centrally located nucleus and multivaculoated foamy cytoplasm in which eosinophilic fat droplet granules are contained. The authors experienced a case of malignant hibernoma. The patient, 16-year-old male, had a slowly growing nontender firm solitary subcutaneous mass on the center of chin for about 6 months. He hadn't episode of trauma or exposure to X-ray irradiation on the chin. Histopathological findings of punch biopsied skin specimen revealed compact mulberry cells intermingled with normally matured fat cells in the deep dermis and muscle layer, but there were neither significant infiltrations of lymphocyte nor myxoid changes. The tumor mass was totally removed including surrounding tissues as much as possible. The surgically removed tissue specimen revealed brownish discoloration in the center. Histopathologically, it revealed numerous capillaries and massive extravasated erythrocytes like a hemangiona, just beneath the hibernoma mass. There was no evidence of local recurrence or metastasis during 2.5 years of post-operative observation.

Two Cases of Cutaneous Leishmaniasis / 대한피부과학회지

No abstract available.

A Case of Anetoderma of Jadassohn-Pellizali / 대한피부과학회지

Anetoderma or macular atrophies is a localized laxity of the skin, resulting from defect in the elastie tissue of the dermis. This defect produces a clinical picture consisting of circumscribed area of soft, thin and wrinkled skin, which can be pushed easily into the subcutaneous tissue by the examining finger. When the lesions appear without any preceding recognizable disorder, they considered to be primary macular atrophies. In this group, based on whether an inflammatory reaction has occurred before the appearance of macular atrophy, two types aer generally acknowledged: Anetoderma of Jadassohn-Pellizali has a preceding inflammatory reaction, whereas anetoderma of Schweninger-Buzzi has had no preceding discemible inflammatory changes. The authors observed a case of anetoderma of Jadassohn-Pellizali in a 34 year old male when showed bean to coin sized rovnd or oval, thin, soft and wrinkled macules on the trunk, shoulder and upper extremities. About 3 years ago, erythematous macules developed which extended for several months to reach a size of l.5 to 2.5 cm. Slowly each lesion faded from the cener to outward Ieaving soft and wrinkled macules(Fig.l). Routine physical and laboratory findings were within-normal-limit. Histopathological findings showed scanty and fragmentation of the elastic fiber of the dermis and perivascular non-specific inflammatory cell infiltration. (Fig. 2, 3 & 4) Diagnosis was confirmed by clinical and histopathological findings. Literature was briefly reviewed for the discussion,

A Case of Nevus Lipomatosus Cutaneous Superficialis / 대한피부과학회지

Nevus lipomatosus cutaneous superficialis is a very rare skin disease, which usually is present at birth. The lesion shows groups of asymptomatic soft papules or nodules, which have a smooth or folded surface and are skin colored or yellowish. The area of predilection is the pelvic girdle (especially the buttock and sacrococcygeal areas). Microscopically, nevus lipomatosus cutaneous superficialis reveals groups of etopic fat cell nests within the dermis. Only one case was reported in Korea(1969). The authors observed a case of typical nevus lipomatosus cutaneous superficialis. The patient was 19 year-old male, who ha,ve had asymptomatic soft papules and nodules on the buttock, lower back and scalp since 14 years of his age. Routine laboratory findings were within normal limit. Histopathological findings showed etopic fat cell nests within mid and lower dermis (Fig. 3) Diagnosis was confirmed by clinical and histopathological findings. Litercature was briefly reviewed for the discussion.

A Case of Mixed Tumor / 대한피부과학회지

Mixed tumor can be defined as arising from the skin, often from sweat glands, and as being composed of epithelial elements intermingled with cartilage or myxoid tissue in such a way that epithelial cells appear to be continuous with these otber types of cells without separation by a basement membrane. RecentIy, we had opportunity to observe a patient, 34-year-old woman, who had typical mixed tumor of the skin in the central portion of the chin. The tumor developed as a solitary, firm, rice-sized subcutaneous nodule which had been present for 6 months with little increase in size and without any pain and tendemess. The covering skin was normal except mild erythema. Clinically, the lesion was simiIar to sebaceaus cyst, Under local anesthesia, tbe whole tumor mass was removed surgically for histologic study. The histopathologic finding reveals nests of cuboidal or polygonal cells, tubuloalveolar and ductal structures, and homogeneous, faintly bluish chondroid or foamy appearing matrix. (Photo. 1, 2, 3 & 4)

Two Cases of Juvenile Xanthogranuloma / 대한피부과학회지

Two Cases of Juvenile XanthogranuIoma(JXG) are reported with review of literatures. JXG is a rare disease, and have not yet been reported in this country. Case I: Two months oId healthy female infant has two firm, discrete, brownish yellow waxy nodules on the left postauricular region and the left forearm. The lesion had begun as erythematous pinhead sized papules, and have been enlarged rapidly to pea siez during last three weeks. Case II: Three year old healthy male has firm, discrete, pinhead to pea sized scattered 16 papules and nodules on the trunk and right side of neck. Laboratory findmgs and X-ray studies were normal in both cases and there were no evidence of metabolie disorder or bony abnormality. Histopathologic studies show similar findings in both cases. In hematoxylin-eosin staining, epidermis shows parekeratosis and slight elongation of rete ridges with suprapapillary thinning with focal spongiosis and invasion of inflammatory cells. The entire dermis, from dermal papillae to sbcutis, is replaced by granulomatous lesion composed with histioeytes and a few giant cell reaction, in addition to histiocytic proliferation, considerable amount of eosinophils are infiltrated with some lymphocytes and plasma cells. The dermal collagen fibers are partly degenerated. In the upper most portion, some foamy histiocytes are also seen. In frozen section and Sudan III fat staining, the tissue shows rnild reactivities.

A Case of Klippel-Trenaunay-Weber Syndrome with Congenital Heart Anomaly / 대한피부과학회지

A 17 year old female with Klippel-Trenaunay-Weber Syndrome is presented. Of particular interest was presence of congenital heart anomaly. The nevus flarnmeus invoIved her entire right leg and foot with hypertrophy, elongation and partial ulecration. Elongation of the right leg Iead cornpensatory vertebral scoliosis (Fig.1,2). The cutaneous temperature of affected side was higher than the other side, and. was larger on somatometry and osteometry (Table 1). On auscultation, grade III systolic blowing murmur was heard on left upper sternal border with second heart sound splitting. Electrocardiograrn revealed complete right bundle branch block (Fig. 3). Chest X-ray revealed cardiomegaly, increase 3 hilar shadaws and rnild pulmonary congestion (Fig. 4). Above mentioned signs suggests strongly secundum type of atrial septal defect. Femoral angiography didnt show arteriovenous malformation (Fig. 5). Authors experienced this rare variant of Klippel-Trenaunzy-Weber Syndrome acco- mapanying with congenital heart anamaly, and report this with review of literatures.

One Case of Reactive Perforating Collagenosis / 대한피부과학회지

Authers observed one case of typical reactive perforating collagenosis (RPC) which did not seem to have been described in the Korean literature. A 19 year old male patient complained of a skin eruption involving his face, upper and lower extremities, and trunk in June 1973. The skin eruption appeared at the age of 10 and consisted of discrete papules of which the earliest lesion was a pinhead-sized, skin-colord papule, but it became older, it increased in size and developed a small central area of umbilication containing keratinous material. As new papules continued to develop, the older lesions regressed and disappeared with residual scar. No subjective symptom was obtained except intermittent, mild itching sensation which probably due to a irritation. The Keobner's phenomenon was observed on the dorsum of hands. He has acne vulgaris on the face with many of the individual comedones showing development into RPC. He also had a chronic maxillary sinusitis which was seemed to aggravate the skin eruption. In follow up period (about 5 months), the sinusitis was cured with operation, but the skin eruption was not improved. The family history was negative. Histopathological studies revealed typical RPC, i.e., a cup-shaped epidermal depression of which center was lacked the epidermis was noted, and through it, necrobiotic connective tissue, degenerating inflammatory- cells and collagen bundles are extruded to form a plug. Diagnosis was confirmed by clinical appearance and typical histopathologic features. The patient did not responed to topical application of 0. 1% Retinoic acid solution and Vitamin A and D.

A Case of Lupus Miliaris Disseminatus Faciei / 대한피부과학회지

A case of lupus miliaris desseminatus faciei, 23 year old male was reported. The multiple minute discrete yellowish brown superficial nodules, 2 to 3 mm in diameter, revealed apple-jelly color under diascopy without any subjective symptoms since June, 1971. The lesions affect lower eyelids, forehead, cheeks, malar region, upper lip, chin and nasolabial folds symmetrically. Histopathological findings revealed conglomerated individual tubercles with prominent central caseation necrosis. He was given 600mg of INH and 12 mg of PAS daily per os for 2 months. The eruptions were healed gradually with pitted scars.

Experimental Study on Tissue Mast Cell Change of Ratskin Elicited by Mechanical Irritation Under General and Local Ansthesia / 대한피부과학회지

Normal albino rats weighing 180-200 gm were used for a series of this investigation on change of skin mast cell under general and local anesthesia. At first, left side abdominal skin was prepared by hair cutting with scissors about 3cm square and eight irritations by mean of biting with tip of forceps mosquito were applied along the prepared skin margin. Skin specimens were submitted from central area which surrounded by irritated points and also from intact contra-lateral area in 15, 30, 60 and l20 minutes invervals. Submiitted skin specimens were fixed in 10% formalin solution, then were stained with 1% toluidine blue. The number of mast cell was counted under 450X of microscopic examination. CONCLUSION l. There were two stages in changes of skin tissue mast cell number on normal saline solution injected area and irritated area by mean of biting with tip of forceps without any types of anesthesia. i) Decreasing stage: Number of skin tissue mast cell was decreascd and reached to the lowest level at 30 minutes after each irritation. ii) Increasing stage: Number of skin tissue mast cell was increased to the highest level at 120 minutes after each irritation. 2. General ether anesthesia could not infIuence on the change of mast cell number after mechanical biting irritation. 3, Local anesthesia with 2% procaine hydrochloride solution revealed slightly suppressing effect to increasing number of mast cell at 60 and 120 minutes after mechanical irritation. Hnwever, it was not evidence at 15 and 30 minutes after mechanical irritation. 4. There was no significant change of rnast cell number in the intact contralateraI skin area within 120 minutes under gencral and local anesthesia. 5. The number of degranulated mast cells did not correlated with counted total number of mast cells.

A Case of Morphea / 대한피부과학회지

A case of morphea affecting 22 years old female, who has been suffering from the atrophic, grayishwhite plaques which distributed along the left 8th intercostal nerve area is presented.

Clinical and Histopathological Studies for Vitamin A acid in Psoriasis / 대한피부과학회지

The 10 cases of psoriasis were treated with topical application of 0.3% of Vitamin A acid ointment, once daily, without dressing, and were observed at weekly intervals. Histopathological studies were obtained 5 cases out of former 10 psoriasis patients, before and 3 weeks after treatment. Clinical results(table 1)revealed 6 cases of good result, 4 cases of moderate resuIt in efficacy. In generally, the scales and infiltration were more rapidly responded to the treatment than the erythemas. Histopathological findings after treatment (table 2) were revealed, compare with before treatment, reduced or absence of parakeratosis, regenration of granular cell layer, reduced acanthosis, and decreased inflammatory cell infiltration in the upper derms. Side reaetions, as irritation dermatitis, occurred only on the normaI skin especially periollicular regions, which was cured easily by wet dressing with Burow's solution for a few days. Recurrences were occurred in 3 cases of the treated 10 patients, within 10 days after stop of the therapy.