A Case of Hidroacanthoma Simplex / 대한피부과학회지

Hidroacanthoma simplex is a rare skin tumor which most often develops on the lower extremity of an elderly person. Clinically, the lesion appears as a well-demarcated brownish flat or verrucous plaque, resembling seborrheic keratosis or Bowen's disease. Histologically, it is characterized by intraepidermal nests of basaloid cells within an acanthotic epidermis. there is some controversy over the histogenesis of hidroacanthoma simplex, many consider it an epidermal tumor differentiation into intraepidermal eccrine duct cells. We report a case of hidroacanthoma simplex presented a small verrucous papule on the left foot with the results of an immunohistochemical study.

A Case of Desmoplastic Melanoma / 대한피부과학회지

Desmoplastic melanoma is a rare variant of the spindle cell melanoma that first was recognized and described in 1971 as an invasive fibrosarcoma-like tumor that exhibits an abundant collagenous stroma. These tumors usually arise in sun-damaged skin of the head and neck in older persons, in association with lentigo maligna or de novo. The clinical presentation is often not characteristic, and they may clinically simulate other tumors of the skin. Hence they are often diagnosed late. Histologically, desmoplastic melanoma appears as a nodule of fibrous tissue containing hyperchromatic pleomorphic spindle cells that either are scattered singly, lie in fascicles, or aggregate in nests, and collagenous tissue replacing the reticular dermis. Immunohistochemistry is usually quite helpful as the tumors are almost always immunoreactive with S-100 protein and negative for HMB-45. We report a case of desmoplastic melanoma in a 67-year old male who had a walnut sized tumor upon large indurated plaque on the left thigh. A biopsy specimen of the tumor showed that fascicles of spindle cells are interspersed throughout collagenous tissue and most tumor cells are immunoreactive with S-100 protein. To our knowledge, this is the first case report in Korea.

In Vitro Effects of 1,25-Dihydroxyvitamin D3 on the Production of Interleukin-1alpha by Ultraviolet B Irradiation in Cultured Human Keratinocyte Cell Line HaCaT Cells / 대한피부과학회지

BACKGROUND: Keratinocyte-derived interleukin-1(IL-1)alpha is one of the key cytokines in initiation of cutaneous inflammation. Release of IL-1alpha from human keratinocytes may be induced by proinflammatory stimuli including ultraviolet B(UVB) irradiation, and subsequently, keratinocyte-derived IL-1alpha may exert numerous paracrine and autocrine effects. 1,25-dihydroxyvitamin D3(1,25(OH)2D3) is involved in the regulation of keratinocyte proliferation and differentiation and is also recognized to have immunoregulatory properties such as an antiinflammatory effect. OBJECTIVE: The purpose of this study was to investigate the in vitro effects of 1,25-(OH)2D3 on the production of IL-1alpha by UVB irradiation in cultured human keratinocyte cell line HaCaT cells. RESULTS: are summerized as follows; 1. The vialility of cultured HaCaT cells measured by MTS assay at 24 hours after UVB irradiation was significantly reduced at the doses of above 100 mJ/cm2 of UVB(p<0.05). 2. The secretion of IL-1alpha by HaCaT cells was significantly increased at the doses of above 30 mJ/cm2 of UVB(p<0.05). UVB irradiation could not influence on the secretion of IL-1beta by HaCaT cells. 3. At the concentrations of 10-8M and 10-6M of 1,25(OH)2D3, the production of IL-1alpha by HaCaT cells(48 hours after 100 mJ/cm2 UVB irradiation) was significantly inhibited in both culture supernatants and cell lysates(p<0.05). CONCLUSION: UVB irradiation increased the production of IL-1alpha by HaCaT cells and this stimulatory effect on the production of IL-1alpha induced by UVB irradiation was suppressed by 1,25-(OH)2D3. Calcipotriol(MC-903) had similar suppressive effect on the production of IL-1alpha induced by UVB irradiation in HaCaT cells to that of 1,25(OH)2D3.

17 Cases of Atypical Molluscum Contagiosa / 대한피부과학회지

BACKGROUND: Molluscum contagiosum is a commom benign viral disease of the skin characterized by discrete, 2-5 mm, flesh colored, slightly umbilicated, dome-shaped papules with frequent grouping. But atypical presentation of site, number and size is recently not rare, it may give rise to difficulty in diagnosis. OBJECTIVE: The purpose of this study was to investigate the clinical and histopathological characteristics of various atypical molluscum contagiosa. METHODS: We reviewed medical records, clinical photographs, and histopathologic findings in biopsy specimens of 17 patients with molluscum contagiosa diagnosed at Korea Veterans Hospital from January 1990 to June 2001. The ratio of male to female patients was 3:1, and the mean age at diagnosis was 30 years(range: 3-67). RESULTS: 1. Most commonly involved sites were trunk(80%), extremities(30%), and perianal(12%). 2. The duration of the lesion is 15 days to 3 years. 3. The size of lesion is 2 mm to 50 mm. 4. The number of lesions is one to over a hundred. 5. The clinical features were multiple papules without umbilication(9 cases, 53%) and giant tumor(2 case), pyogenic granuloma-like lesion(2 cases), solitary papule with flat surface(2 cases). 6. The combined disease are atopic dermatitis(1 case), epidermal cyst(1 case), and liver cirrhosis(1 case), diabetes mellitus(1 cases). CONCLUSION: This study shows various atypical molluscum contagiosa in immunocompetent patients. Histopathological examination in atypical molluscum contagiosa is necessary for the proper diagnosis and treatment.

A Case of Papillary Eccrine Adenoma / 대한피부과학회지

The papillary eccrine adenoma is a rare benign sweat gland neoplasm, first described by Rulon and Helwig in 1977. It is usually present as a solitary dermal nodule on the distal extremities. Histological examination revealed a well circumscribed, non capsulated dermal nodule consisting of multiple ducts with various size. These ducts were composed of double layered epithelial cells mostly and intraluminal papillation with eosinophilic luminal materials was seen. We report a case of papillary eccrine adenoma in 52-year-old male who presented single nodule on the right midback, uncommon area.

Myxoid Myofibromatosis-type Perivascular Myoma Showing Prominent Verocay Body-like Formation

Differential diagnoses showing Verocay body-like formation include schwannoma, palisading myofibroblastoma, palisading cutaneous fibrous histiocytoma, dermatofibroma with myofibroblastic differentiation, leiomyoma, palisaded encapsulated neuroma, and neuroma. A 60-year-old Korean man presented with a 10-year-history of an asymptomatic nodule on the right forearm. Histopathological examination revealed well-circumscribed multi-micronodules with prominent Verocay body-like formation consisted of spindle cells and extensive infiltrate of mutinous materials. The spindle cells were negative for S-100 protein and desmin, but positive for vimentin and a-smooth muscle actin by immunohistochemical staining. The micronodules were lined by CD34 and factor VIII positive endothelial cells. The mutinous materials were stained with alcian blue at pH 2.5, but not at pH 0.5. We diagnose it as myxoid myofibromatosis-type perivascular myoma showing Verocay body-like formation.

A Case of Dermatofibrosarcoma Protuberans with Myxoid Area

Dermatofibrosarcoma protuberans is a rare, slowly growing, locally invasive spindle-cell tumor characterized by a protuberant cutaneous mass with a pronounced tendency to recur and by a prominent storiform histopathologic pattern'-'. We present a case of dermatofibrosarcoma protuberans with myxoid area on the chest of a 57-year-old man. The histopathological study showed a dermal tumor of uniform spindle-shaped cells with storiform pattern. Immunohistochemically, the tumor was stained positively to anti-CD34 antibody and negatively to anti-factor XIIIa antibody.

The Clinical Study of Zinc Deficiency Presented as a Skin Manifestation of Acrodermatitis Enteropathica / 대한피부과학회지

BACKGROUND: Zinc is an essential trace and has a close relation with skin metabolism and zinc deficiency is associated with acrodermatitis enteropathica, inflammatory bowel disease, chemotherapy, intravenous hyperalimentation, chronic diarrhea and other malabsoption state. OBJECTIVE: The purpose of this study was to analyze the clinical characteristics of zinc deficiency presented as a skin manifestation of acrodermatitis enteropathica. METHODS: In a retrospective study including 45 patients, we reviewed the clinical features of zinc deficiency presented as a skin manifestation of acrodermatitis enteropathica. RESULTS: The ratio of male-to-female patients was 1.14:1 and the onset of the disease occured in childhood in 14 cases, and adulthood in 31 cases. The associated diseases were bowel diseases(13 cases), chemotherapy(11 cases), and postgastrectomy state(5 cases), only acrodermatitis enteropathica without associated disease(4 cases), and the other associated diseases were anorexia nervosa, malnutrition in old age, chronic pancreatitis and alcoholic liver disease, etc. The most common skin manifestation was erythematous scaly patches with erosion(77.8%) and vesicles, bullae, pustules and acneiform eruptions also developed. The perianal area was the most common anatomic site and the skin lesions were associated with diarrhea(35.6%), candida infection(20.0%), and severe hair loss(2.2%). In laboratory findings, low serum zinc levels were present in 26 patients among the 36 patients and a lower limit of the normal range of serum zinc was present in 8 patients among the 10 patients with normal zinc levels. Decreased serum albumin and protein level(48.9%), anemia (26.7%), and decreased alkaline phosphatase(6.7%) were observed. CONCLUSION: We should pay special attention to the prevention of zinc deficiency in bowel disease, chemotherapy, chronic diarrhea and other malabsoption state. To prevent zinc deficiency, detailed skin examination was necessary and zinc should be added to maintenance therapy during chronic malnutrition and malabsorption state.

A Case of Tinea Incognito on the Face due to Trichophyton mentagrophytes / 대한피부과학회지

Recently, we have encountered an increasing number of patients who have obtained topical steroids to self-treat various dermatosis. Tinea incognito has been used to describe a dermatophyte infection modified by corticosteroid treatment. Lesions are often atypical appearing and the diagnosis can be delayed or missed. We report a case of tinea incognito with ill-defined erythematous patch and nodules on the right upper eyelid and taken intermittently application with corticosteroid ointment over a period of l year. Mycologic studies including KOH mount and fungus culture were positive for hyphae and colonies of Trichophyton mentagrophytes. The lesion was treated with of itraconazole and cured 3 weeks later.

Pseudo-Kaposi Sarcoma:Differential Diagnosis from Kaposi Sarcoma

BACKGROUND: Pseudo-Kaposi sarcoma mimicks Kaposi sarcoma, both clinically and histopathologically. These conditions are due to congenital (Stewart-Bluefarb syndrome) or acquired (Mali) vascular malformations. OBJECTIVES: The purposes of this study were aimed at evaluating the clinical and histopathological characteristics of pseudo-Kaposi sarcoma and finding differential diagnostic tools from Kaposi sarcoma. METHODS: Clinical information of 7 patients with pseudo-Kaposi sarcoma diagnosed in Asan Medical Center from 1989 to 1999 was obtained from the medical records and clinical follow-ups. We re-evaluated 10 biopsy specimens obtained from them and immunohistochemical studies for cutaneous lymphocyte antigen (CLA), CD34, vimentin, and factor VIII were performed with the standard streptavidin-biotin method using paraffin-embedded tissue specimens of 7 pseudo-Kaposi sarcomas and 3 Kaposi sarcomas. In addition, we examined whether human herpesvirus 8 (HHV8) was detected in 3 patients by polymerase chain reaction (PCR). RESULTS: Six male and one female patients were included. Mean age was 36.3 years. Three patients were classified into Mali type and the other four patients were into Stewart-Bludfarb type. Histopathological examinations revealed capillary proliferation in the upper dermis, perivascular infiltrate of inflammatory cells, extravasated red blood cells, and fibrosis of dermis. Anti-factor VIII and CD34 stained endothelial cells only. CLA was expressed in lymphocytic infiltrate in the epidermis and dermis of pseudo-Kaposi sarcoma, whereas it was negative in Kaposi sarcoma. PCR for HHV 8 showed negative results. CONCLUSIONS: Pseudo-Kaposi sarcoma is an uncommon entity with characteristic clinical and histopathological features. Differential diagnosis between Pseudo-Kaopsi sarcoma and Kaposi sarcoma is important. We suggest that detection of HHV 8 by PCR and imunohistochemical study for CLA may be effective tools in the differential diagnosis between them.

The Effects of Adenosine on Enhanced ICAM-1 Expression by IFN-gamma in Cultured Human Keratinocyte Cell Line HaCaT Cells / 대한피부과학회지

BACKGROUND: Intercellular adhesion molecule(ICAM)-1 mediates cell to cell adhesion by acting as a receptor for leukocyte surface antigen. Increased ICAM-1 expression was observed in chronic inflammatory skin diseases, such as psoriasis, atopic dermatitis and allergic contact dermatitis. Adenosine is an endogenous antiinflammatory agent released by cells under metabolically unfavorable conditions, recently the studies about antiinflammatory effects of adenosine in various tissues were increased, but there are few studies about the effect of adenosine on epidermal keratinocytes. OBJECTIVE: We investigated the effects of adenosine on ICAM-1 expression in cultured human keratinocyte cell line HaCaT cells. METHODS: Our study analyses the ICAM-1 expression in HaCaT cells by various stimulants and the effects of adenosine, adenosine receptor agonist&antagonist and an inhibitor of cellular adenosine uptake on ICAM-1 expression of cells stimulated by IFN-gamma through the cell-ELISA (enzyme-linked immunosorbent assay)&FACS (fluorescence-activated cell sorter) analysis. RESULTS: The results are summerized as follows: 1. ICAM-1 expression was significantly increased by IFN-gamma(500U/ml), IFN-gamma&TNF-alpha(10-8M) and IFN-gamma&LPS(10-8M)(p<0.05), but not by TNF-alpha, LPS and TNF-alpha & LPS. 2. Incubation of HaCaT cells with IFN-gamma(1-2000U/ml) for 48 hours induced dose-dependent expression of ICAM-1 at above 500U/ml of IFN-gamma. 3. Adenosine had no effect on ICAM-1 expression of unstimulated cells. 4. Adenosine(esp. 10-4M) significantly inhibited ICAM-1 expression of cells stimulated by IFN-gamma(p<0.01). 5. Adenosine(10-4M) significantly inhibited ICAM-1 expression of cells stimulated by IFN-gamma(p<0.01), IFN-gamma & TNF-alpha(p<0.05) and IFN-gamma&LPS. 6. The inhibition of ICAM-1 expression was not observed when cells were preincubated with an adenosine A1 receptor agonist(R-PIA) or an adenosine A2 receptor agonist (NECA). 7. The inhibition of ICAM-1 expression of adenosine was not affected by pretreatment state with an adenosine A1 & A2 receptor antagonist(theophylline)(p<0.01). 8. The inhibition of ICAM-1 expression of adenosine was not observed by pretreatment state with an inhibitor of adenosine cellular uptake (dipyridamole). CONCLUSION: High concentration of adenosine inhibits enhanced ICAM-1 expression on HaCaT cells by stimulated with IFN-gamma and these inhibitory effects of adenosine are mediated through other adenosine receptors excect adenosine A1 and A2 receptors. And we suggest that there may be an unknown intracellular mechanism about inhibition of ICAM-1 expression via intracellular-uptaken adenosine.

The Study of Clinical and Histopathological Features of Granuloma Annulare / 대한피부과학회지

BACKGROUND: Granuloma annulare(GA) is a benign skin disorder of unknown etiology. Even though some cases were reported in Korean journals, systematic reviews of clinical and histopathologic features of granuloma annulare were not done. OBJECTIVE: The purpose of this study was to analyze the clinical and histological characteristics of granuloma annulare. METHODS: In a retrospective study including 38 patients and 44 skin biopsy specimens, we reviewed the clinical and histological features of granuloma annulare. RESULTS: The results were as follows: 1. The ratio of female-to-male patients was 4.4:1 and in the majority of cases(68.4%), the onset of GA occured in the first three decades of life and the mean age of onset was 22.7 years. In the majority of cases(65.8%), the duration was less than 6 months and the mean duration was 22 months. 2. The clinical types were localized type(52.6%), subcutaneous type(26.3%), and generalized type(21.1%). 3. The lower extremities(42.9%), especially the knee joint was the most common anatomic site. 4. Ten patients(26.3%) have systemic diseases including diabetes mellitus(10.5%), thyroid disease, SLE, anemia, osteoarthritis, atopic dermatitis, and asthma. 5. Nine patients(23.7%) have precipitating factors including seasonal variation, insect bite, stress, and irritation of shoes and 15 patients(39.5%) have associated symptomes including an itching sensation and pain or tenderness. 6. The histological findings were as follows: The histologic types were dermal granuloma(50%) and subcutaneous type(50%). The dermal granulomatous lesions consist of interstitial type(11 cases, 25.0%), palisading type(8 cases, 18.2%), perforating type(2 cases, 4.5%), and epithelioid tubercle type(1 case, 2.3%). Mucin deposition was detected in the 88.6%, eosinophils in 31.8%, and neutrophils in 13.6 %. CONCLUSION: Granuloma annulare has various clinical and histological variants, and some cases are associated with systemic diseases. And we need to have an interest because recently granuloma annulares developed in immunocompromised patients, such as AIDS and bone marrow transplants.

A Case of Solitary Congenital Calcified Nodule of the Ear / 대한피부과학회지

We report a case of solitary congenital calcified nodule of the ear in a 1-year-old female. The lesion was a 2 X 2mm-sized, elevated, slightly erythematous and whitish-centered nodule located since birth on the superior helical rim of her left ear. Histopathological findings fram the totally excised lesion showed calcium deposits as amorphous, basophilic masses in the upper dermis and focal discharge of calcium by means of transepidermal elimination. Surrounding the calcium deposits, lymphohistiocytic infiltrations were present.

Three Cases of Secondary Membranous Lipodystrophy / 대한피부과학회지

Membranous lipodystrophy is a peculiar type of fat necrosis, present in patients with various types of skin diseases. It is charaeterized by the presence of microcysts and macrocysts lined by amorphous eosinophilic material with a crenelated arabesque appearance and microgranules in the subcutis with massive fat necrosis. The eosinophilic lining and microgranules stain positively with periodic acid-Schiff, are resistant to diastase, and also stain with Sudan black B. We report three cases of subcutanous membranous lipodystrophy in patients with erythema induratum, posttraumatic panniculitis and morphea with typical clinical and histopathologic findings.

Lupus Erythematosus Profundus:Clinical and Histopathological Study

BACKGROUND: Lupus erythematosus profundus (LEP) is an unusual clinical variant of lupus erythematosus (LE). It is unclear which part LEP occupied in the disease spectrum of LE. OBJECTIVE: Clinical and histopathological studies were performed on 19 patients with LEP in order to further define the clinical patterns, know the various serological findings, and review the histopathological features. METHODS: A retrospective review was carried out of the clinical records and histopathological specimens of 19 patients with LEP. RESULTS: The most common clinical features were indurated nodules or plaques on the cheek. There was a 37% positivity in the ANA test. Histopathogically epidermal changes as well as subcutaneous involvements were common. There were no cases of newly developed SLE during the follow up period of 41 months. CONCLUSION: Most patients with LEP have a relatively benign disease course, although a few develop systemic abnormalities and have abnormal laboratory findings.

Two Cases of Plexiform Neurilemmoma / 대한피부과학회지

Plexiform neurilemmoma is a relatively rare, benign peripheral nerve sheath tumor, whieh usually arises in either the dermis or subcutaneous tissue. These tumors may occur singly or as multiple lesions (plexiform neurilemmomatosis), We report an unusual case of plexiform neurilemmomatosis associated with cafe au lait spots reminiscent of neurofibromatosis clinically and another case of plexiform neurilemmoma on the finger. A Biopsy revealed the characteristic palisaded arrangement of spindle cells within well circumscribed elongated nodules, The skin lesions were completely excised without recurrence thereafter.

A Case of Eosinophilic Panniculitis Associated With Superior Sagittal Sinus Thrombosis

Eosinophilic panniculitis is characterized by a prominent infiltration of numerous eosinophils in subcutaneous fat, and has been identified in patients with a variety of associated clinical conditions. A case of eosinophilic panniculitis in a 20-year-old woman with a history of atopic dermatitis is reported. She later developed superior sagittal sinus thrombosis, and we stress the importance of systemic evaluations in patients with eosinophilic panniculitis.

A Case of Sweet's Syndrome Treated with Potassium Iodide / 대한피부과학회지

Sweet's syndrome(acute neutrophilic dermatosis) is characterized by raised, painful red plaques with pseudoblistering and pustules on the face, neck, chest, and extremities accompanied by fever, polymorphonuclear neutrophilic leukocytosis, and elevated ESR. We report a case successfully treated with potassium iodide in which showed tender indurated erythematous papules, nodules, plaques, and several overlying vesicles with fever and general malaise. These lesions had frequently recurred in spite of oral corticosteroid administration for 5 months at a local clinic. The cutaneous eruptions subsided 7 days after administration of a saturated potassium iodide solution and have not recurred to date.

A Case of Reticulohistiocytoma

Reticulohistiocytoma, a rare form of non-Langerhans cell histiocytoses, usually presents it-self as a single cutaneous nodule mainly on the head and neck of young men without associated arthritis. We describe an 18-year-old male patient with a red dome-shaped nodule of 2 months' duration on the scalp. Histologic examination of the excised mass revealed numerous large, mononucleated or multinucleated histiocytes with abundant eosinophilic, finely granular cytoplasm having a ground-glass appearance. Immunohistochemical staining was positive for vimentin, lysozyme, and factor XIIIa, supporting a dermal dendrocyte lineage. Ultrastructurally, large mononuclear or multinucleated cells exhibiting numerous peripheral villi contained pleomorphic cytoplasmic inclusions, fatty droplets and dense bodies. Our clinicopathologic findings support the concept that reticulohistiocytoma is a variant of adult xanthogranuloma.

A Case of Male Breast Carcinoma Manifested as a Subcutaneous Nodule on the Chest / 대한피부과학회지

Breast carcinoma in men is very rare but a potentially serious neoplasm. We report herein a case of male breast carcinoma presented with a mobile asymptomatic nodule on the chest in a 73-year-old man. Histopathologic diagnosis was invasive ductal carcinoma of a male breast.