Clinical and Histopathologic Study of Seborrheic Keratosis / 대한피부과학회지

BACKGROUND: Although seborrheic keratosis is one of the most common epidermal tumors, there are only rare studies on the clinicohistopathologic features of seborrheic keratosis in Korea. The majority of cases of typical seborrheic keratosis can be clinically differentiated with ease from other dermatoses such as melanocytic nevi, lentigo, basal cell carcinoma and melanoma. However, its differential diagnosis can sometimes be difficult. OBJECTIVE: This study was designed to investigate the clincohistopathologic characteristics of seborrheic keratosis, the frequency of biopsy and the accuracy of making the clinical diagnosis, as well as to analyze the cases where there is a mismatch between the clinical diagnosis and the histological diagnosis. METHODS: We conducted a retrospective study and we searched for patients who were clinically diagnosed as having seborrheic keratosis between January 2000 and December 2008. The search found 1,248 patients and the patients were divided into two groups: a non-biopsy group (n=891) and a biopsy group (n=357). The clinical features, including age, gender, the anatomic site of lesion and the treatment method, were investigated in each group. In addition, the frequency of biopsy, the accuracy of the clinical diagnosis and the histopathological features were studied in the biopsy group. RESULTS: Between the two groups, we found that the clinical features, including the proportions between the involved body sites, such as trunk/face, and the treatment methods were different. However, these differences might be partly attributed to the clinical decisions such as the frequency of performing biopsy for making the differential diagnosis of skin malignancy. In both groups, the most frequent age period was in the seventh decade and the most common anatomical site was the face. Only one-third of patients who were clinically diagnosed as having seborrheic keratosis received biopsy for histopathologic confirmation and the lesions were mostly located on the face. The clinical diagnosis matched the histological diagnosis in 282/357 (79.0%) patients. In 75 patients who revealed a mismatch between the clinical and histological diagnosis, the skin lesion most frequently involved the face (57.3%) and the most common final diagnosis was basal cell carcinoma (13.3%). The frequency of a mismatch for the sun-exposed lesion was significantly higher than that of the non-sun exposed lesion (p=0.035). CONCLUSION: We present the clinical and histopathological features of seborrheic keratosis. If the lesion is presented with an atypical appearance or it located on a sun-exposed area and so it requires a differential diagnosis from other premalignant diseases or cutaneous malignancies, then we should perform a biopsy to make the differential diagnosis.

Utilidad del estudio histopatológico de especímenes de apendicectomía y colecistectomía / Usefulness of histopathologic study of appendectomy and cholecystectomy specimens

Introducción: trabajos recientes indican que en algunos especímenes quirúrgicos se puede omitir el estudio microscópico. El objetivo del presente estudio fue evaluar la utilidad del estudio histopatológicorutinario de apéndices cecales y vesículas biliares y determinar su impacto en el tratamiento posteriordel paciente. Métodos: revisamos todos los informes anatomopatológicos de apendicectomías y colecistectomías en nuestro laboratorio entre enero de 2008 y julio de 2009. Determinamos la frecuencia de diagnósticosinesperados y su impacto en el tratamiento del paciente. Resultados: de 2.175 especímenes de apendicectomía, 40 (1,8%) tuvieron diagnósticos inesperados,la mayoría de ellos infestación por parásitos (23 casos). Aparte de estos, hubo solo dos casos conimpacto en el tratamiento: uno de tuberculosis y otro de cistadenoma mucinoso limítrofe (borderline);. Entre 1.039 colecistectomías en 14 (1,3%) hubo hallazgos inesperados: 2 carcinomas in situ y 12 carcinomas invasores; 8 de los casos con implicaciones para el tratamiento no fueron sospechados por los cirujanos, y de estos, solo 4 no se evidenciaron macroscópicamente. Conclusiones: es muy infrecuente encontrar en el estudio histopatológico de estos especímenes lesiones inesperadas importantes para el tratamiento de los pacientes; sin embargo, estos casos indican la necesidad del estudio microscópico. El estudio rutinario de estos especímenes es costoso y nuestros resultados permiten plantear que se haga el estudio histológico solo en casos seleccionados.

Introduction: Recent evidence shows that microscopic examination of some surgical specimens is not necessary. The aim of this work was to assess the usefulness of routine histopathologicalexamination of appendectomy and cholecystectomy specimens, and its impact on the management of patients. Methods: We reviewed all pathological reports on appendectomy and cholecystectomy specimens studied in our laboratory between January 2008 and July 2009.The frequency of unexpected pathological diagnoses and their impact on management of patients were evaluated. Results: Out of 2.175 appendectomy specimens, 40 (1.8%) revealed unexpected pathological findings, mostly parasitic infestations (23 cases). Apart from parasites, there were only 2 cases with impact on management: one of tuberculosis and another of a mucinous borderline cystadenoma. Unexpected pathological gallbladder findings were present in 14 (1.3%) of 1.039 cholecystectomy specimens: 2 were of in situ carcinoma and 12 of invasive carcinoma; 8 cases with treatment implications had notbeen suspected by the surgeons, and 4 of them were notevident in the macroscopic examination. Conclusions: Incidental histological findings that are relevant to the management of patients are rare but, nevertheless, they indicate that microscopic examination is necessary. Since routine studies are expensive, a more selective approach to histological studies could be proposed.

A Clinical and Histopathologic Study of Lichen Nitidus / 대한피부과학회지

BACKGROUND: Lichen nitidus is a rare condition of unknown cause, characterized by minute, flesh-colored, shiny papules occurring on the abdomen, chest, extremities, and genitalia. There have been few studies worldwide about the clinical and histopathologic manifestations of lichen nitidus. OBJECTIVE: The purposes of this study were aimed to evaluate the clinical and pathologic presentations of lichen nitidus. METHODS: The medical records and histopathological slides of 31 patients with lichen nitidus diagnosed at Korea University Medical Center from April 1983 to March 2002 were reviewed. RESULTS: Onset age of skin lesions ranged from 1 year to 34 years and 17 cases(63%) were developed in the patients younger than 9 years old. The ratio of male to female was 2.1: 1 and the mean duration of the eruption was 2.8years. Twenty four cases(77%) had multifocal lesions, four cases(13%) had generalized lesions, and three cases(10%) had unifocal lesions. The predilection sites were trunk(27.8%), upper extremities(24.1%), lower extremities(19%), face and neck(13.9%), penis(10.1%), and hands(5.1%) in decreasing order. Mild pruritus was noted in 8 cases(26%), and Koebner phenomenon in 9 cases(29%). Atopic dermatitis was noted in 3 cases(10%), lichen planus in 1 case, urticaria in 1 case, and verruca plana in 1 case. None had a positive family history. The papules were closely grouped but remained discrete except in areas exhibiting the Koebner phenomenon. The color of papules was skin-colored(74%), reddish-brown(13%), and mixed(13%). The frequent histopathologic findings were liquefaction degeneration of the basal layer(100%), edema of the dermis within the areas of the infiltrate(100%), clawlike rete ridges(96.8%), epidermal atrophy(87.1%), perivascular inflammatory cell infiltrate(87.1%), and absent or thinned granular layer(77.4%). We divided lichen nitidus into three stages, early stage, developed stage and late stage, according to the predominant cell types of the inflammatory infiltrates in the dermal papilla. There was a tendency of increasing number of infiltrated dermal papillae as the lesion progressed to late stage. It was interpreted as the lesions tend to be grouped clinically. CONCLUSION: In our study, we were able to obtain the clinical and histopathological features of lichen nitidus which help to understand lichen nitidus.

A Clinical and Histopathologic Study of 20 cases of Lichen striatus / 대한피부과학회지

BACKGROUND: Lichen striatus(LS) is an uncommon dermatosis that generally affects children. LS can usually be identified by clinical history and histology of typical lesions. However, the clinical manifestations and the histologic features are diverse. OBJECTIVE: The aim of this study is to investigate clinical and histopathologic features of LS in Koreans. METHODS: Total 20 patients were included in this study. Data complied were sex, age, duration, distribution, symptoms, course and some histopathologic findings including hyperkeratosis, acanthosis, dyskeratosis, basal degeneration, perivascular lymphocytic infiltration, lichenoid infiltration and eccrine sweat gland inflammation. Seventeen cases were studied further by immunohistochemistry for interleukin(IL)-1beta to understand the biological basis of the disease. RESULTS AND CONCLUSIONS: 1. It was observed predominantly in females as the sex ratio of 1: 2.3. The mean age was 5.5 years and the mean duration was 17.7 months. 2. Most of patients were asymptomatic, but only five patients complained of mild itching. 3. It occured most frequently in the lower(11 cases), upper extremities(6 cases), axilla(1 case), anterior chest(1 case) and multiple location(1 case). Twelve cases were consisted of erythematous papules, and the rest appeared hypopigmented macules. 4. The lesions of 9 of 10 patients were almostly cleared in one year. Five of 9 were consisted of erythematous papules and four hypopigmented macules. One who had no change was consisted of hypopigmented macules. Therefore, there was no significant difference of prognosis between two groups. 5. Histologic examination revealed hyperkeratosis(65%), acanthosis(70%), parakeratosis(50%), exocytosis(95%), spongiosis(55%), dyskeratosis(70%), basal degeneration(90%) in epidermis, and colloid body(35%), lichenoid infiltration(65%), perivascular lymphocytic infiltration(95%) and eccrine sweat gland inflammation(50%) in dermis. 6. There was no significant difference between the papular group and the macular group, except parakeratosis and spongiosis, which were increased in the papular group as compared with the macular group. 7. IL-1beta was expressed diffusely in keratinocytes, endothelial cells, hair follicles and eccrine sweat glands. IL-1beta immunoreactivity was expressed in the entire epidermis in 15 of 17 cases. Most of the eccrine sweat glands showed intense immunolabeling in 12 of 17 cases. In contrast, only 2 cases of lichen planus were positive for epidermis and only 1 case for eccrine sweat gland. Therefore, we think that it is helpful for discriminating two diseases immunohistochemically.

Severance of Optic Nerve Following Traffic Accident and Its Electron Microscopic Findings

The optic nerve do not easily sever because of its anatomic status in the orbit. The purpose of this study is to investigate electron microscopic findings in the proximal portion of the severed optic nerve which remained in the orbit for about 4.5 months. Thirty seven-year-old woman showed the protruded eyeball and deep skin laceration following traffic accident. Computerized tomography and MRI demonstrated the complete severance in her left optic nerve. Her eyeball containing the proximal portion of the severed optic nerve was enucleated at about 4.5 months after traffic accident. Eletron microscopic findings showed several macrophages, fibroblast, and dense collagen fibers, which mean the fibrosis histopathologically. The fibrosis was the main pathologic outcome in the proximal portion of the severed optic nerve. We suggest that the process of the fibrosis could result from the incorporation of the fibroblast within the meninges around the optic nerve and the proliferation of the fibroblast within fibrovascular septa of the pia mater which extend into the optic nerve.

Clinicohistopathologic Analysis of 28 Cases of Trichotillomania / 대한피부과학회지

BACKGROUND: The patients of trichotillomania seem to have received much attention based on patients behavioral psychological aspects, but most of the patients are met in dermatological clinics. Dermatological observation of the lesion dose not seem to not sufficient. OBJECTIVE: The purpose of this study is to exarnine clinical and histopathological characteristics of the lesion of trichotillomania. METHODS: We have observed 28 cases of the trichotillornania and exarnined their cutaneous lesions and histopathological featwres. Histopathological examination with vertical serial sections was done in 21 cases. Because hai folllicles are independent of each other and a usual 5 thickness vertical sect,ion shows only very limited numbers of the hair follicles, authors accomplished sectioning of the biopsied scalp tisue to have 300 serial sections cut and 60 representative sections observed to allow the fullest qiiantitative and qualitative examinations of the follicular pathology of the lesion. RESULTS: The important featuies are as follows. 25 cases(89.2%) were under 18 years old with a slight male predorninance(M:F=1.3:1). Only in 2 cases, psychiatric consultation was made. The degree of involvement was vari ble from less than 5%(6 cases) of the scalp up to 100% involvement of the scalp(3 cases). Thr rnean duration of illness was 12.5 months. The involved hair follicles showed one of the following five roots of hairs they are new hairs with tapered ends, broken short hairs, vellus or intermediate hairs, comedone-like hair bodies or empty follicle orifices. Microscopical observation of thr epilat,ed hairs was done in 16 cases, of which in 13 cases there were no telogen roots of terminal hairs, The histopathological results were as follows : 1. Catagen follicles were increased in 20 cases(95.2%). The actual number of catagen follicles was 1386(37.5%) out of a tota 3695 follicles observed in the total examined slides. 2. Trichornalacia were seen ir 11 cases(52.4%). The actual number of hairs with trichomalacia was 195(10.5%) out of a total 1005 hair canals observed. 3. Pigment clumps of the follicular infundibula were seen in 9 cases(42.9%). The actual number of the pigment-laden infundibula was 148(17.9%) out of a total 826 infundibula observed. 4. Destruction of the hair canal wall were seen in 4 cases(19.0% ). The actual number of destructed hair canal wall was 190(10.2%) out of a total 1863 hair canals observed. Hernorrhage around the follicles was not seen. CONCLUSION: The involved areas of trichotillomania were varied in size up to the whole scalp and showed four different type of hairs. Histopathologically catagen follicles increased in almost all cases with 37.5% of all follicles examined. Trichomalacia, pigmented clumps, and the destruction of hair canals were seen by less frequently.

Efficacy of Methylprednisolone in Aconite Induced Myelo-optic Neuropathy in the Rabbit

Studies in animals indicate that aconitine or aconite has toxic effects in the visual system of a rabbit model. Such a toxic effects causes myelo-optic neuropathy in the visually evoked cortical potential(VECP) and histopathologic studies. Whether the administration of intravenous high-dose of methyprednisolone(MP) in the myelo-optic neuropathy caused by aconitine(1.5ml/kg, equivalent to 0.7mg/kg of aconitine) is experimentally effective remains uncertain. The group treated with MP(daily 30mg/kg X 2 for 3 days followed by 15mg/kg for 3 days) in addition to aconite was compared with the aconite alone group and the normal control group. In the MP treated group, increased recovery of onset latency, peak latency, and amplitude in VECP in comparision with the aconite alone group was recorded at 2 weeks (p<0.05). The MP treated group in comparision with the normal control group showed a significant delay in onset latency at 1 month and 2 months(p<0.05). But, the amplitude in both the MP treated group and the aconite alone group increased at 2 months and did not show a significant difference in comparision with the normal group(p<0.05). In histopathologic study, pathologic findings of myelin sheath in the MP treated group were less severe than in the aconite alone group generally. The true benefit of high-dose MP was at least clear within 2 weeks. The authors conclude that treatment with intravenous high-dose MP immediate after aconite injection may have some beneficial effects in recovery of neurologic function although such a treatment do not have the definite recovery in aconite induced myelo-optic neuropathy.

Epidermal nevus: a clinical and histopathological study / 대한피부과학회지

We reviewed 48 skin bicpsies obtained from 48 patients with epidermal nevus during a 10 year period from January 1981 to December 1990. The results are summarized as follows : 1) Of our 48 patients, 23 were male and 25 were female, and male to female ratio was 1 to 1.1. 2) The average of the patients was 19.8 years at the time of diagnois. 3) Lesions were present at birth in 45.7 percent of patients, and most of the remainder de veloped in childhood. The mean age of onset was 7.7 years. 4) The clinical varieties of the nevi in 48 patients were classified according to caicegories of nevus verrucosus, including systematized epidermal nevus, nevu, unius lateris, ichthyosis hystrix, epidermal nevus syndrome and inflammatory linear veirucous epidermal nevus. The most common type was nevus verrucosus(88.6%). 5) A large variety of histopathologic changes can be seen in epidermal nevi. The most common histopathologic .ype was nonspecific(31.3%), follows by common(12.5%), epidermolytic hyperkertosis(12.5%), and acanthosis nigricans(10.4%). 6) The most commonly affected area was head and neck(48.5%) followed by trunk(28.6%), upper limb(11.4%) and lower limb(2.9%).

Clinical and Histopathologic Study of Tsutsugamushi disease / 대한피부과학회지

The clinical and histopathologic study of 26 cases with tsutsugamushi disease seen at the Department of Derrnatology, Kosin Medical Center, Pusan, Korea from October 1986 to December 1988 was performed. The results were summarized as follows : 1. Age distribution was from 12 to 73 years and male to female ratio was 1: 1.2 (1P, males 14 females). 2. The disease occurred from September to December in a year. The peak incidence was in October (61.5%). 3. Major clinical manifestations were as follows : Chill, fever and headache (100 %), maculopapular eruption (90.2%), eschar (88.5%) and myalgia (84.6%). 4. Eschars were distributed on the abdomen (34.8%), chest (30.4%), leg (7.4%) and ot.her sites. 5. Histopathologic findings of the erythernatous macules in 24 patients showed epiderrnal changes including exocytosis of rnononuclear cells (66.7%), liquefaction degeneration of basal cells (54.2%), spongiosis (33.3%) and epidermal cell necrosis (29.2%). Dermal changes revealed vascular dilatation and perivascular infiltration of rnononuclear cells (100%), extravasated RBC (50%), and edema of papillary dermis (45.8%). Epidermal changes around the eschar were liquefaction degeneration of basal cells (52.2%), spongiosis (43.5%) and exocytosis of mononuclear cells (30.4%). Dermal changes included vascular dilatation and perivascular mononuclear cell infiltration (100%), vessel wall necrosis (73.9%), ederna of papillary dermis (65.2%) and endothelial cell swelling (65.2%).

Histopathologic Study of the Regional Lymph Nodes Reactivity in Gastric Carcinomas

This study represents the immune reaction pattern of gastric carcinoma, based on the morphologic characteristics of regional lymph nodes in the cases of stomach carcinomas. The materials were obtained from the resected specimens from 100 carcinoma patients. We chose Tsakraklides' method in classification of the structure of lymph node, which are as follows: lymphocyte predominance, germinal center predominance, unstimulated and lymphocyte depletion. The incidence was as follows: lymphocyte predominance 45, germinal center predominance 32, unstimulated 21 and lymphocyte depletion 2. In the lymph nodes of peptic ulcer, lymphocyte predominance pattern was most common. The reactivity of lymph nodes is suppressed proportionally to the severity of cancers, thus the advanced case of cancer exhibited lymphocyte depletion pattern which suggests exhaustion of immune reaction. The lymphocyte predominance pattern was frequent in superficial type and expanding type of gastric carcinoma. The cancer metastasis of lymph node in lymphocyte predominance was smaller than the other type of lymph nodes, while metastasis increased progressively higher with the orders as following: lymphocyte predominance, germinal center predominance, unstimulated and lymphocyte depletion.

Clinicohistopathologic Study of 121 Patients with Subcutaneous Lipomas / 대한피부과학회지

We reviewed the clinico-histopathologic aspects. of 121 patients diagnosed as subcutaneons lipamas in 1981~1986, Additionally, the size of lipoma cells was statistica,lly compared with normal controls. The results were obtained as follows: The majority of patients visited the surgical department, specially general surgcry, whereas only 7 visited dermatology. The ratio of solitary to multiple type was 10:1. Females predominated in the patients with solitary type, outnumbering males in multiple type. While solitary type consisted of 98 patients (89.1%) with SL, 10 with FL and 3 with AL, multiple type had 7 with SL and 4 with AL. There were prominent incidences in the 5th and 6th decades followed by a slow decline. Faur of all 6 AL patients were multiple type. Males were affected in all but one. All AL patients showed non-infiltrating. The torso was mostly involved in 60.4% In 7 of all 17 AL lesions, the upper extremity was predorninantly involved. Sixty sevenr of the 136 masses were less than,3cm in diameter. In AL lesions, 76.5% was less than 3cm and likely to be smaller than other 2 types. The presumed time of onset was most common in 1~3 years The size of liporna cells was found to be slightly larger in only SL specimens than in controls(63.65+432pm and 56.32+6.50um respectively; p<0.0l).

A Clinical and Histopathologic Study on Skin Tuberculosis / 대한피부과학회지

A clinical and histopathologic study was done on 48 cases of cutaneous tuberculosis among 43, 209 out-patients in Dermatologic department of Korea t.Jniversity Hospital during the period of 15 years and 9 mont4s from January, 1969 to September, 1984. These 48 cases were consistent with skin tuberculosis in histologic and clinicalI finc1ings, The result were summarized as follows: ]. The incidence of skin tuberculosis was 0 I 1 g among 43, 209 cases of outpatients. 2. Localized type of skin tuberculosis was 3. 2 times more frequent than disseminated type. Frequent skin tuberculosis was lupus vulgaris (57 3%), erythema induratum (12, 5%), tuberculosis verrucosa cutis(8.3%) and lupus milaris disseminatus faciei (8. 3%). 4, The ratio between male and fenmle was 1: l. 1. 5 The ages of onset were variable according to the types of skin tuberculosis. but 45 8% of all cases developed in the age group between 10 and 29 years. Seasonal incidences of skin tuberculosis were 52. 1% in spring, 85%, in winter, 18. 8% in summer, 4, 2%, in autumn. 7 In histopathologic findings, there were tubercle or tubrculoid structures in all cases and typical tubercle structures were observed in 18.8% The ratio of accordance between the histopathologic diagnosis and clinicopa thologic diagnosis was 81.3%.