A Case of Trichilemmal Carcinoma Showing a Feature of Cutaneous Horn

Trichilemmal carcinoma is a rare malignant neoplasm of the hair follicle, which is derived from or differentiates towards cells of the outer root sheath. We report a case of trichilemmal carcinoma in an 83-year-old female patient. She presented with a tender dome-shaped crusted papule showing a feature of cutaneous horn on the forehead, which was first detected 6 months before. nstopathologically, lobular patterned tumor cells with peripheral palisade of basaloid cells, nuclear atypia, and clear or pale, PAS-positive, diastase-sensitive cytoplasm were observed beneath the marked hyperkeratosis. After the diagnosis, total excision was done. The patient has been free of recurrence or metastasis till now.

Epidemiologic Study of Burn Patients / 대한피부과학회지

BACKGROUND: A burn injury is not only a life-threatening problem for the injured patient but may have serious physical, psychological and financial effects on the individual, the patient's family and society. Despite the high frequency of factors predisposing to burns, preventive measures are few, with a virtual absence of educational campaigns for the population. Thus, the epidemiologic data of patients would be of benefit for the region. OBJECTIVE: The purposes of this study were to understand burn injuries and to plan effective postburn management. METHODS: We reviewed and analyzed the records of 593 cases of burn patients who were admitted to the department of general surgery in Hangang Sacred Heart Hospital from May 1999 to April 2000. RESULTS: Males were more affected than females ; 69.1% were males and 30.9% were females. The 31-45 age group had the highest rate of burns (36.5%). The most common burn type was by flame burn injury (59.9%), followed by scalding burn injury (24.0%). In 49.6% of the cases, the extent of the burned surface was under 20%. The number of deaths in this study was 39 patients (6.6% of total burn patients). The most frequent cause of death was sepsis (51.2%), followed by ARDS (20.6%), and burn shock (17.9%). When 51-60% of the surface area was burned, the mortality was 16.7%, when over 61% of the surface area was burned, the mortality was 41.4%. CONCLUSION: It is evident that the best approach to rectifying the harm caused by burn injury is prevention.

A Case of Malingant Eccrine Poroma / 대한피부과학회지

Malinant eccrine poroma is a rare malignant tumor that arises from the intraepithelial ductal portion of the eccrine sweat gland, that may develop either spontaneously or from a preexisting benign eccrine poroma. It usually affects elderly patients in both sexes and is usually found on the lower extremities and the head. We described 71-year-old female with a malignant eccrine poroma in the scalp developing from benign eccrine poroma, which has been present for 5 years. The local recurrence and regional metastatic rate are both approximately 20%. Distant metastasis occurs in 12% of cases. In our case the tumor demonstrated without local invasion and distant metastasis, and was successfully removed by surgery.

Two Cases of Cutaneous Metastases Originating from Esophageal Carcinoma / 대한피부과학회지

We report two cases of cutaneous metastases originating from esophageal carcinoma. Case 1, about 0.5cm sized brownish round keratotic papule was detected 1 month ago on the left fifth finger tip in a 70-year-old man. Case 2, about 1.5 x 1.2cm sized ivory oval flat topped elevated nodule was detected 1 month ago on the lower lip in a 60-year-old man. Histologic examination of case 1 showed that dilated lymphatics contained tumor nests, some of which showed central necrosis. Case 2 showed tumor cell infiltration from upper dermis to mid dermis. Regardless of chemotherapy, both patients died after two and three months from the appearance of cutaneous lesions respectively.

A Case of Pseudoxanthoma Elasticum Clinically Mimicking Cutis Laxa / 대한피부과학회지

Pseudoxanthoma elasticum is a rare, heritable, systemic disease of connective tissue characterized by degeneration of elastic fiber and mainly affects the skin, eye and blood vessels. We report a case of pseudoxanthoma elasticum mimicking cutis laxa. She had a generalized laxity of the skin for about 30 years. There were similar skin lesions in her sister. No other systemic involvement was found. Histopathologic examination revealed clumping, fragmentation and calcification of elastic fibers in the dermis.

A Case of Intradermal Nevus on the Lower Lip / 대한피부과학회지

We report a case of intradermal nevus in a 52-year-old female patient, who presented with asymptomatic, solitary papule, which had been on the site for years as a macule on the center of the lower lip, which is a rare site for intradermal nevus. The skin biopsy revealed the upper dermis containing nests and cords of nevus cell without junctional activity. The skin lesion was totally removed by surgical excision on biopsy.

A Case of Milia en Plaque Occurring on the Bilateral Retroauricular Area and Occipital Scalp / 대한피부과학회지

Milia en plaque(MEP) is an unusual eruption characterized by multiple milia-like lesions within an erythematous edematous plaque in the retroauricular area. The histopathological findings are consistent with milia. We report a case of MEP occurring on the bilateral retroauricular area and occipital scalp. To our knowledge, a case which has developed on the scalp has not been reported previously. The absence of a known etiologic factor in contrast to the previously published causes suggests that the present case belongs to the group of primary milia.

A Case of Intravenous Pyogenic Granuloma of the Palm

Intravenous pyogenic granuloma (IVPG) is a form of pyogenic granuloma (PG) in which the capillary proliferation is confined entirely within the lumen of a vein. It occurs typically in the neck and upper extremities. Histologically, this benign lesion is similar to PG of other localizations and is characterized by a lobular proliferation of capillaries growing in a sparsely cellular, edematous collagenous stroma. We report a case of IVPG developing in the palm, an unusual site of occurrence.

A Case of Sweet's Syndrome Associated with Myelodysplastic Syndrome / 대한피부과학회지

We report a case of Sweet's syndrome associated with myelodysplastic syndrome in a 48-year-old male patient who presented with high fever, general weakness and tender, erythematous, painful vesiculopapules and plaques with crust on the face, extremities and perianal area. Skin biopsy revealed dense infiltration of neutrophilis in the upper and mid-dermis. Peripheral blood smear showed normocytic normochromic anemic feature with thrombocytopenia. Bone marrow biopsy revealed dyspoiesis of marrow cells, consistent with myelodysplastic syndrome. He was treated with methylprednisolone 50mg/day and general symptoms improved immediately with drop of fever and skin lesions began to improve within 2 days.

A Case of Solitary Malignant Peripheral Nerve Sheath Tumor on a Finger / 대한피부과학회지

The malignant peripheral nerve sheath tumor is a rare neoplasm arising from the neural sheath of peripheral nerve sheath, accounting for less than 5% of all soft tissue malignancy. Most tumors occur in patients with neurofibromatosis and solitary malignant peripheral nerve sheath tumor without neurofibromatosis is rare. A review of the literature revealed that there were relatively few documeted cases of these tumors involving digits, although there were several cases of these tumors involving the major peripheral nerve trunk. We report a case of solitary malignant peripheral nerve sheath tumor on a finger, which neither originated from the major peripheral nerve nor was associated with neurofibromatosis. A 46-year-old woman showed a solitary, child palm-sized, eroded fungating tumor on her right third finger tip. Immunohistochemical studies for S-100, neuron-specific enolase, vimentin and electron microscopy were used in the diagnosis, confirming the neural origin of this tumor.

Three Cases of Clear Cell Basal Cell Carcinoma / 대한피부과학회지

Clear cell basal cell carcinoma (clear cell BCC) is a rare variant of BCC, which is characterized by variable proliferation of clear cells within the mass. We herein report three cases of clear cell BCC. Three old Korean men presented lesions as a solitary nodule on their face. Histologic examination showed multiple dermal tumor lobules composed of basophilic cells, clear cells and peripheral palisading with surrounding retraction spaces. The clear cells showed either a clear cytoplasm or eosinophilic granular cytoplasm, and contained glycogen. There were no recurrences after surgical excision.

Comparison of the Concentrations of 8-MOP in both Plasma and Suction Blister Fluid after Oral Ingestion

BACKGROUND: The value of plasma concentration of 8-Methoxypsoralen(8-MOP) in the supervision of photochemotherapy has been recognized. However, plasma levels of 8-MOP were not proportionate to the degree of PUVA induced erythema and couldn't alone predict the degree of PUVA induced erythemal reaction. We made a speculation that the degree of PUVA induced erythema might correlate better with skin tissue levels of 8-MOP than plasma levels. Suction blister fluid(SBF) has been known to represent tissue fluid in the skin. So we per-formed a study of comparison of 8-MOP concentrations in both plasma and SBF. OBJECTIVE: Our purpose was to evaluate the correlation of the concentrations of 8-MOP in plasma and SBF 2 hours after oral administration of 0.6 mg/kg of 8-MOP. METHODS: Twenty six patients, aged between 16 and 50 years, undergoing suction blister surgery for vitiligo treatment, participated in this open study. Single oral doses of 0.6 mg/kg of body weight of 8-MOP were taken. Blood samples(5ml) and SBF(2ml) were collected at 2 hours after the drug administration, and 8-MOP concentration in plasma and SBF were quantitated by reverse phase high-performance liquid chromatography (HPLC). RESULTS: 8-MOP concentrations in plasma and SBF ranged from 18 to 545 ng/ml and 8 to 179 ng/ml, respectively. On the analysis of linear regression, a close-relation could not be observed between two SBF levels; measured and predicted values which were calculated from measured plasma and SBF concentrations (r²=0.583, P < 0.001). CONCLUSION: The correlation of plasma and SBF concentrations of 8-MOP is weak. So, SBF levels of psoralen are recommended for the study of PUVA erythemal reactions.

A Case of Tuberculosis Verrucosa Cutis / 대한피부과학회지

We report a case of tuberculosis verrucosa cutis in a 35-year-old male patient who presented itchy verrucous plaque over both buttocks. Skin biopsy revealed hyperkeratosis, parakeratosis, and irregular acanthosis in the epidremis, and inflammatory infiltration and noncaseating tuberculoid granulomas in the dermis. Several AFB-positive bacilli were detected. He was treated with isoniazid, rifampicin, ethambutol, and pyrazinamide for 4 months till now and the verrucous skin lesions have been markedly improved.

Two Cases of Steatocystoma Multiplex Localized on the Face / 대한피부과학회지

Steatocystoma multiplex is a hamartomatous malformation of the pilosebaceous duct junction. It is not common and inherited in an autosomal dominant pattern. But numerous non-hereditary cases have been reported. It is characterized by asymptomatic numerous, skin-colored to yellowish cystic papules and nodules principally located on the anterior chest, epigastrium, axillae, groin, and proximal part of the extremities. We experienced two cases of steatocystoma multiplex localized on the face. The face is an unusual site in steatocystoma multiplex. One case is that of 33-year-old male with a family history, the other case is that of 66-year-old female. We report these two cases with the review of the previous literature.

Two Cases of Xanthogranuloma in Adults / 대한피부과학회지

Recently, we have experienced two cases of xanthogranuloma in adults presenting either a solitary papule or multiple papules. Laboratory findings including blood lipid substances such as cholesterol and triglyceride were within normal limits. In both cases, we could not find any other extracutaneous manifestations. Granulomatous infiltrates containing foam cells, foreign body giant cells and Touton giant cells as well as histiocytes and lymphocytes were revealed by histopathologic findings.

A Study on the CD34 Expression of Cutaneous Benign and Malignant Vascular Tumors / 대한피부과학회지

BACKGROUND: CD34 is a 115 kD glycoprotein which is expressed on hematopoietic progenitor cells. It is also known as an immunohistochemical marker of endothelial cells. OBJECTIVE: This study was designed to investigate the patterns of CD34 expression on: (1) cutaneous benign and malignant vascular tumors and (2) on the mature and immature vessels of pyogenic grauloma and capillary hemangioma. METHOD: We performed immunoperoxidase staining using a monoclonal anti-CD34 antibody (QBEND/10) on formalin fixed, paraffin-embedded sections of 23 benign and malignant cutaneous vascular tumors. RESULTS: The results are summerized as follows: 1. In 3 cases of nevus flammeus and 6 cases of carvernous hemangioma, vascular endothelial cells of all hemangiomas showed CD34 expressions. In 5 cases of angiokeratoma, endothelial cells of hemangioma, did not express CD34. 2. In all 5 cases of pyogenic granulomas and one case of capillary hemangioma, endothelial cells of mature vessels, endothelial cells near the well-formed lumina and endothelial cells showing intracellular lumina showed strong positivity for CD34, wbile endothelial cells far from the lumina and endothelial cells without lumina formation mostly showed negative staining for CD34. 3. One cese of Kaposis sarcoma showed focall positivity for CD34 both in endothelial cells of the small, well-formed vessels and spindle cells. Two cases of angiosarcoma showed CD34 expression only in endothelial cells of well-formed, normal appearing vessels, whereas atypical endothelial cells of tumor vessels and spindle cells were negative for CD34. CONCLUSION: CD34 could be a marker for endothelium in mature, well-differentiated vascular structures and may serve as a marker of lumen formation or differentiation of endothelial cells.

Effect of Cryosurgery on Hypertrophic Scars / Keloids / 대한피부과학회지

BACKGROUND: A variety of therapeutic regimens has been used in the treatment of hypertrophic scars/keloids with onsatisfactory final results. Application of cryosurgery could be beneficial sinee it was reported to produce less scarring and recurrence after treatment compared with other methods. Objective This study was undertaken to evaluate the effect of the cryosurgery through objective, quantitative measurement of hypertrophic scar/keloid thickness and to assess the influence of the cryosurgery on fibroblasts. The latter was achieved through fibroblast cultures established from hypertrophic scars/keloids. METHODS: Eight patients, ageA 17 to 47 years old, with hypertrophic scars/keloids were treated with liquid nitrogen using the cantact method. One freeze-thaw cycle of 10-30 seconds per lesion was employed, and if needed, treatment was repeated every 20 to 40 days. The thicknesses of the lesions were measured objective,ly with ultrasound in five patients, before and after cryosurgery and were compared with controlled scars in other areas. In three patients, we cultured fibroblasts from the treated and the untreated lesions and exmuned the rate of fibroblast proliferation and collagen production. RESULTS: In all five patients, thicknesses of the hypertrophic scars/keloids decreased compared to those of controlled areas after treatment. Five of 6 hypertrophic scar cell lines demonsbated decreased fibroblast proliferation rates in comparison to control fibroblast lines. Collagen produced by the fibroblasts was variable. CONCLUSION: Cyosurgery was effective and safe in the treatment of hypertrophic scars/keloids.

A Case of Generalized Pustular Psoriasis / 대한피부과학회지

We present a case of generalized pustular psoriasis in a 47-year-old female who was treated with cyclosporine and methotrexate. She developed generalized pustular eruptions after irregular therapy of steroid and etretinate for severe psoriasis. Treatment with cyclosporine and a steroid supplement produced much improvement, but during the tapering of cyclosporine there was aggravation with pusutules and fever. She was placed on methotrexate therapy. The pustules and erythema began to remit, and eventual clearing of the skin lesions was achieved in 4 months after introduction of methotrexate.

Two Cases of Cutaneous Cryptoccosis Mimicking Cellulitis / 대한의진균학회지

Crytococcus neofomans is an encapsulated budding yeast with well-defined ecological biotopes and the second most common nose of the fungal infection in immunocompromised patients. It is 18re for a cryptoccosis infection to be localized only to the skin. We report two cases of cryptococcosis mimicking cellulitis. The frist case was suspected as primary cutaneous cyptococcosis in the 57-year-old female SIE patient who had been treated with prednisolone 60 mg/day for 1 month. Erythematous swollen patch developed on the left thigh and subsided spontaneously without relation to the course of 519 after 2 weeks of onset. The second case developed in the 45-year-old female patient with adrenal cancer. Erythematous patches developed on the medial sides of both thighs. The lesions were resistant to the combination therapy of amphotericin B 0-7 mg/kg/day and 5-fluorocytosine 100 mg/kg/day and the patient died after 1 month of treatment.

A Case of a Tumor of the Follicular Infundibulum-like Change in Nevus Sebaceus / 대한피부과학회지

Cribier and Grosshans(1995) reported two cases of tumor of the follicular infundibulum(TFI) arising in nevus sebaceus for the first time. In 1961 Mehregan and Butler described a new benign adnexal neoplasm, which they called tumor of the follicular infundi4ulurn." Since then few observations have been published. The majority of the lesions are solitary. They appeared in adults, predominantly in wornen, on the face, arm, and neck. Histopathologically, the unique feature is a benign hyperplastic lesion that extends from the follicular infundibuluni. as an epithelial plate either with underlying elastic fiber network in TFI or without underlying elastic fiber network in TFI like change. A 52-year-old man has haf a solitary, well-defined, hairless, verrucous plaque on his right supra auricular area for about 10 years. It has seerned to increase gradually in size over the last year. The histologic findings shwed a plate-like growth of epithelial cells in the upper dermis extending parallel to the epidermis with multiple connections at the lower margin of the epidermis. The peripheral cell layer of ttie tumor plate showed palisading, and centrally located cells were pale staining. Many hair follicl s, mature sebaceous glands, ectopic apocrine glands, and inflammatory cell infiltrations were present in the dermis. However, there was no elastic fiber network beneath the epithelial cell plate. We believe our case is the first to be reported in Korea as TFI-like change in nevus sebaceus.