Tufted Angioma:Clinicopathologic Surveys and the Response to Intralesional Steroid

BACKGROUND: Tufted angioma is an uncommon slowly progressive vascular tumor found typically in infants and young children with characteristic histologic findings, so called "cannonball" appearance. OBJECTIVE: The purpose of this study was aimed to investigate the clinical and histopathological characteristics of tufted angioma and the response to intralesional steroid. METHODS: Clinical information of 10 patients with tufted angioma diagnosed in Severance hospital and Pundang CHA hospital from 1983 to 1999 was obtained from the medical records and clinical follow-ups. We re-evaluated 10 biopsy specimens obtained from them with routine H&E staining. RESULTS: Five male and five female patients were included. In 9 patients the lesion appeared before 2 months of age. Four had a lesion at birth. The thigh was the most common site. The clinical symptoms were diverse, but characteristically tenderness was present in most cases. In all the patients the lesions had a tendency to spread progressively. Microscopically, numerous, distinct, variably sized, tightly packed capillary and endothelial cellular lobules were scattered in the dermis. There were characteristic semilunar spaces adjacent to the capillary tufts. Six patients received intralesional triamcinolone. This treatment was found to be effective in 5 patients who experienced remarkable improvement. The improved cases had similar histologic findings which were composed of cellular mass more than lumen formation. We classified our specimens into two categories, one with more cellular mass and the other with more lumen formation in relative proportion. The former was different from the latter in that it had more solid appearance and more definite margin. And we realized that it was useful to divide into these two categories since its response to treatment could be different. CONCLUSIONS: Tufted angioma is a relatively uncommon disease with characteristic histopathologic findings. It seems not to regress spontaneously. So early treatment is required to pre-vent further spreading up to the extent. We treated 6 patients with intralesional injection of triamcinolone and 5 patients experienced marked improvement which had more cellular mass more than lumen formation histopathologically.

A Case of Generalized Hypertrichosis After Treatment with Topical Minoxidil / 대한피부과학회지

There are few reports about generalized hypertrichosis after treatment with topical minoxidil , even though there are numerous reports about generalized hypertrichosis after treatment with oral minoxidil. We experienced a rare case of generalized hypertrichosis after treatment with 3% topical minoxidil in a 5-year-old boy. He visited our hospital for generalized hypertrichosis on face, trunk, arm after treatment with 3% topical minoxidil for 2 months due to alopecia areata. The laboratory examination including CBC, SMA and the level of corticotropin releasing hormone, luteinizing hormone, follicular stimulating hormone, cortisol, estradiol, testosterone were within normal limits. Two months after discontinuation of treatment with 3% topical minoxidil, the hair started to shed and six months after discontinuation of topical minoxidil, he showed almost complete resolution.

Proliferating Nodules Within a Congenital Melanocytic Nevus: Proper criteriae for surgical removal in infantile periods

Congenital melanocytic nevus(CMN) constitute a well-known risk factor in the development of malignant melanoma, but melanoma developing in newborn and infants are extremely rare. We describe a case of proliferating nodules within CMN at the age of 13 months. Like our case it is difficult to manage the proliferating lesions within CMN in infants. So we carefully suggest the indications of preventive excision when proliferating lesions occur within CMN as follows; 1) preventive excision is postponed until the age of two when the proliferating lesions are slowly growing, 2) surgical excision is needed when the lesions are rapidly growing exceeding 1 cm in size even though it is before the age of two.

A Case of Aneurysmal Fibrous Histiocytoma / 대한피부과학회지

Aneurysmal fibrous histiocytoma(AFH) is a histologic variant of dermatofibroma. The importance of the recognition of AFH as a variant of dermatofibroma lies in the differential diagnosis because the histologic appearance of AFH is very similar to dermatofibrosarcoma protuberans and other vascular malignancies, such as Kaposi's sarcoma and angiosarcoma. A 32-year-old man was seen for a nodular mass on the right popliteal fossa of 4 years' duration. The excisional biopsy specimen showed a relatively well circumscribed tumor mass in the dermis. In addition to compact storiform proliferation of spindle cells, there were multiple, irregular, blood-filled, aneurysmal tissue spaces that were devoid of lining of endothelial cells. Also, deposition of hemosiderin was prominent, particularly in the periphery of the aneurysmal spaces. Immunohistochemical stain for CD34 were negative to most tumor cells. After excisional therapy, there was no evidence of recurrence during the period of ten months' follow-up.

A Case of Verruciform Xanthoma Associated with Epidermal Atypia / 대한피부과학회지

Verruciform xanthoma is a rare benign lesion characterized by verrucous epidermal hyperplasia with aggregates of foam cells in dermal papillae. The pathogenesis is still unknown. Although most verruciform xanthoma tend to occur as isolated lesions, several have been associated with other conditions including squamous cell carcinoma and epidermal atypia. We describe a case of verruciform xanthoma associated with epidermal atypia.

A Case of Branchial cleft fistula / 대한피부과학회지

Congenital branchial anomalies are developmental defects resulting from incomplete obliteration of branchial clefts, arches and pouches, and usually found as cysts, fistulas and sinuses. The sinus or fistula is usually noted during infancy and young childhood due to recurrent infection. We have experienced a case of branchial cleft fistula in a 12-year-old male. It was a skin colored, nontender nodule which had mucus secreting from a small opening pore. We performed complete surgical removal and histopathologically the lumen was lined by pseudostratified columnar cells and the stroma was composed of aggregates of lymphocytes with many germinal centers. So we finally diagnosed it as branchial cleft fistula of second type branchial anomaly.

A Case of Lipoma with Membranous Fat Necrosis / 대한피부과학회지

Membranous fat necrosis is a variant of fat necrosis characterized by the presence of membranocystic foci which is lined by eosinophilic, homogeneous and crenulated membrane that has pseudopapillary projections. Membranous fat necrosis may be idiopathic or has been associated with many local and systemic diseases. The pathogenesis of membranous fat necrosis is uncertain but trauma may be suspected in our case. We describe a case of lipoma with membranous fat necrosis.

A Case of Targetoid Hemosiderotic Hemangioma / 대한피부과학회지

We describe a 23-year-old man showing typically clinical and histological features of targetoid hemosiderotic hemangioma. About 35 cases of this newly-described entity have been reported since the first description by Santa Cruz and Aronherg in 1988. It is important to distinguish these tumors from patch stage Kaposi's sarcoma, retiform hemangioendothelioma and progressive lymphangioma.

Giant Angioleiomyoma of the Hand / 대한피부과학회지

Angioleiomyoma is a benign solitary tumor that arises from the medial layer of the vein walls. We encountered a 21-year-old man who was presented with a non-tender, slowly growing, 3 cm x 5 cm-sized mass on the thenar eminence of his left hand. Histopathological examination showed the tumor to be a giant vascular leiomyoma. It is extremely rare for an angioleiomyoma to reach this size as well as occurring on the palm and this is the first report of such a case in Korea.

A Case of Giant Sebaceous Gland Hyperplasia / 대한피부과학회지

Sebaceous hyperplasia is not a rare disorder and commonly develops on the face over the age of forty. The typical clinical manifestations are 2 ~ 3mm sized, single or multiple, soft protuberant yellowish nodules with central umbilication and histology shows a group of mature sebaceous lobules and central sebaceous ducts. We report an exceptionally "giant" size of sebaceous gland hyperplasia which lead us to such clinical impressions as an acrochordon, intradermal nevus, and verruca vulgaris. Histologically, the lesion showed a greatly enlarged sebaceous gland composed of numerous lobules grouped around a wide sebaceous duct. Besides the extraordinarily large size of the nodule, the benign proliferating pattern led us to a diagnosis of giant sebaceous hyperplasia.

A Case of Erosive Adenomatosis of the Nipple / 대한피부과학회지

We present a case of erosive adenomatosis of the nipple in a 22-year-old woman. The clinical features of erosive adenomatosis of the nipple are similar to Paget's disease in that it has erythematous erosions with oozing and fissured crusts on one nipple. However, histologic findings are characteristic, consisting of dilated tubular structures that are lined by a peripheral layer of cuboidal cells and a luminal layer of columnar cells showing secretary properties into the lumen. The clinical course is benign, so simple mastectomy is enough for treatment.

A case of loiasis

The prevalence of Loa loa infections in non-endemic areas such as Korea is very low, even though it is quite common in the endemic regions of West and Central Africa. We describe a patient who presented with temporary localized edema (classical Calabar swellings) after travelling to Cameroon and in whom the diagnosis of loiasis was made by ELISA. This is the second reported case of loiasis in Korea. As international travel is becoming more frequent, Loa loa infection should be considered in the differential diagnosis for patients with eosinophilia and Calabar swellings in Korea.

Sweet's Syndrome Associated with Acute Erythema Nodosum

A 44-year-old man had Sweet's syndrome (acute febrile neutrophilic dermatosis), accompanied by erythematous tender subcutaneous nodules resembling erythema nodosum(EN). The EN-like lesions histologically showed a septal panniculitis with predominantly neutrophilic in-filtrates. The association of Sweet's syndrome with EN seems to be uncommon and only a few cases have been reported until the present. We describe a patient with Sweet's syndrome associated with acute EN.

Prurigo Pigmentosa:A Report of 5 Cases with a Review of the Korean Literature

Prurigo pigmentosa(PP) is a rare dermatosis with an unknown cause characterized by intensely pruritic papules that resolve with reticulate pigmentation. It is a disease entitity commonly reported in Japan but seemingly rare in other parts of the world. We report 5 cases that clinically and histopathologically fulfilled the characterisitics of PP and were treated with dapsone resulting in significant clinical improvement.

Clinical and Histopathological Observations of Actinic Keratoses in Korea / 대한피부과학회지

BACKGROUND: Although actinic keratoses is the most common precancerous cutaneous lesion, there has been no clinical and histopathological study about actinic keratoses in Korea. OBJECTIVE: Our purpose was to carry out a clinical and histopathological study about actinic keratoses in Korea. METHODS: 158 patients, diagnosed with actinic keratoses from 1987 to 1995 in Korea, were analyzed clinically and histopathologically. RESULTS: 1. The ratio of males to females was 1:2.4 and the most frequent age groups were the 6th(29.1%) and 7th decade(33.5%). 2. The duration of the lesions was more than 1 year in most cases. 3. The most commonly involved sites were the face, in which the cheek, nose and forehead were the most common sites. 4. Clinically, the size of the lesions was less than 1cm in many cases(66.8%). The color was erythematous in 57.9%, brownish in 26.7%, and dark brownish in 15.3%. Crust and scale were noted in 28.7% and 25.2%, respectively. In 4% of patients, cutaneous horn also was noted. 5. Squamous cell carcinoma was associated with actinic keratoses in 5.7%, basal cell carcinoma in 3.2%, and keratoacanthoma in 1.3%. 6. Histopathologically, hypertrophic types of actinic keratoses were noted in 25.0%, atrophic types in 21.3%, hypertrophic and atrophic types in 18.1%, bowenoid types in 17.6%, acantholytic types in 13.3%, and pigmented types in 4.7%. 7. The most commonly used methods of treatment for actinic keratoses were cryotherapy, surgical excision, 5 FU ointment, and electrodesiccation with good effect. CONCLUSION: Actinic keratoses in Koreans was present on the face most commonly over 50 years of age. It showed a more frequent incidence in females than males. The clinical course of the lesions was chronic and the association with other cutaneous malignancies was noted to be less than 6%. The various histopathological types were noted, including hypertrophic, atrophic, hypertrophic and atrophic, bowenoid, acantholytic, and pigmented. The most commonly used methods of treatment. for actinic keratoses were cryotherapy, surgical excision, 5-FU ointment, and electrodesiccation.

A Case of Guttate Morphea with Secondary Cutaneous Mucinosis / 대한피부과학회지

The cutaneous mucinose are a group of connective disorders characterized by the deposition of mucin in the dermis. Thc disease may be a primary (metabolic) or secondary (catabolic). Secondary mucinosis is common in lupus erythematosus and dermatomyositis but rare in morphea. We report a case of guttate morphea with secondary cutaneous mucinosis.

A Case of Fibrolipoma

Fibrolipoma is an uncommon variant of lipomas which shows a distinct pathologic findings with both component of mature adipose cells and broad bands of dense fibrous connective tissue. A 30-year-old woman developed an 5×7cm sized, indurated, ill-defined, subcutaneous mass on the right axilla. Microscopically, the tumor contained broad bands of dense connective tissue with mature adipose tissue scattered throughout the mass, but it did not show encapsulation. The lesion was excised and she showed no evidence of recurrence after 6 months of follow-up.

Two Cases of Sebaceous Epithelioma / 대한피부과학회지

Sebaceous epithelioma is a rare skin appendage tumor with sebaceous differentiation. It may occur as a primary lesion or may arise within a nevus sebaceus. We present two cases of sebaceous epithelioma developed on the scalp in a 55-year old woman and on the forehead in a 75-year old wornan. Histopathologically the tumors are composed of irregularly shaped cell masses. The majority of cells are undifferentiated basaloid cells, but some cells show differentiation toward sebaceous cells.

A Clinical Study of Localized Scleroderma / 대한피부과학회지

BACKGROUND: There has been an increase in incidence of localized scleroderma. However observations on the clinical aspects ot localized scleroderma have been scarce in Korea. OBJECTIVE: The purpose of this study was to elucidate the clinical observations and associated diseases of localized scleroderma METHODS: During a 10-year-period from Jan. 1984 to Dec. 1993, 61 patients were evaluated in regard to age incidence, sex ratio, clinical type, location and distribution of plaque and linear type, and associated conditions. RESULTS: l. Age distribution from 4 to 61 years with mean of 27.6 years. Most patients were between 11 to 30 years of age. 2. Sex distribution of male 14 female 47 with 3: 1 ratio in favor of female. 3. No difference in right and left involvement. 4. Plaque and linear forms were predominant. 5. The plaque form was distributed evenly while the linear form involved mainly the head and neck. The linear form and generalized form appeared most frequently in developement of associated conditions. 6. ANA test results were positive in 14 patients and most of them were of the speckled pattern. 7. Of the 41 patients who were treated with d-penicillamine, 26 patients showed improvement of their lesions.

A Case of Progressive Acquired Lymphangioma / 대한피부과학회지

Acquired progressive lymphangioma is a benign lymphatic proliferation characterized clinically by gradually enlarging erythematous patches and histopathologically by dermal vascular channels with "dissection of collagen" appearance. A 30-year-old woman presented a 6x4cm sized, erythematous patch on the right thigh, which had been gradually enlarging for 10 years since she had had a burn injury on the same site. Histopathologic findints of the lesion showed vascutar channels forming a network in the dermis with a "dissection of collagen" appearance. The cells lining the channels were stained with antibodies against muscle actin, factor VIII-related antigen, Ulex europaeus agglutinin I, CD34, and CD31. We made a diagnosis of acquired progressive lymphangioma and have been observing the course of the disease without specific treatment.