The Efficacy and Safety of Cryolipolysis for Subcutaneous Fat Reduction

No abstract available.

Intralymphatic Histiocytosis: A Rare Self-limited Disease / 대한피부과학회지

There have been a small number of recent case reports of patients with erythematous patches around the joints, which histopathologically showed histiocytic aggregations in the dermal vessels. Intralymphatic histiocytosis (ILH) is a rare group of skin diseases that are characterized by the proliferation of histiocytes in a lymphatic vessel lumen, and this is thought to arise as a benign reaction to certain stimuli such as rheumatoid arthritis. The pathogenesis of this intralymphatic proliferation of histiocytes and the reasons they commonly present on the arms are still unknown. We report on a case of ILH with arthritis in a 68-year old female who had no underlying disease, and the ILH presented as irregular erythematous patches on the left antecubital area and these patches demonstrated the distinctive histopathological features of intralymphatic histiocytosis.

A Case of Glycogen Storage Disease with Hypertrophic Cardiomyopathy / 영남의대학술지

Glycogen storage diseases are a heterogeneous group of metabolic disorder affecting multiple organ system: liver, skeletal muscle, heart and brain. Clinical features include: short status, hepatomegaly, hypoglycemia, dyslipidemia and rare involvement of the myocardium except in the case of type III, glycogen storage diseases with hypertrophic cardiomyopathy in adult, which is extremely rare. We treated a case of hypertrophic cardiomyopathy with hepatomegaly that was unknown etiology. The patient was diagnosed as having glycogen storage disease. This 46-year old women was transferred with dyspnea on exertion and abnormal LFTs. She was diagnosed with hypertrophic cardiomyopathy by echocardiography but there was no specific cause for hypertrophic cardiomyopathy. A liver biopsy was performed. The result showed glycogen storage disease possible type III, IV or IX. In conclusion, patients with hypertrophic cardiomyopathy of unknown etiology and abnormal LFTs should be evaluated for glycogen storage disease.

Clinical and Histopathological Study of Cutaneous Melanoma in Korea / 대한피부과학회지

BACKGROUND: Malignant melanoma in Korea has been increasing as in other countries, but there is no nationwide survey of malignant melanoma in Korea. OBJECTIVE: The aim of this study was to document the clinical and histopathological features of cutaneous melanoma in Korea. METHODS: The Dermatopathology Research Group conducted a review of nationwide collection of 109 primary cutaneous melanomas, diagnosed at 23 institutes over a recent 3-year period. Clinical records and pathology slides of the patients were reviewed retrospectively. RESULTS AND CONCLUSION: The peak age was the 7th decade with the mean age of 58.1 years. Korea has a higher rate of acral melanoma and much lower rate of lentigo maligna melanoma. .Major component tumor cell was spindle cell type. Clark level of tumor was III or more and Breslow depth was 2mm or more at the time of the first diagnosis in many cases (62%). Pre-existing melanocytic nevus was present in a few cases (3 cases). All these features suggest that the racial difference between the Korean and the Caucasian is evident. We also suggest that an early detection program is very important to cure this malignant tumor.

Clinical and Histopathological Study of Cutaneous Lymphomas in Korea / 대한피부과학회지

BACKGROUND: The relative frequency and clinicopathologic characteristics of lymphomas vary according to geography and race. Data on the features of cutaneous lymphoma in Korea are limited. OBJECTIVE: The aim of this study was to document the relative occurrence, the clinical and histopathological features of cutaneous lymphomas in Korea. METHODS: The Korean Dermatopathology Research Group conducted a review of nationwide collection of 80 cutaneous lymphomas, diagnosed at 23 institutes over recent 3-year period. Clinical records and pathology slides of the patients were reviewed retrospectively. RESULTS AND CONCLUSION: Korea has a higher rate of T-cell lymphoma and NK/T cell lymphoma and a much lower rate of cutaneous B cell lymphoma. The relative frequency of the major diagnostic group according to WHO classification was as follows: mycosis fungoides/Sezary syndrome, 42.5%; anaplastic large cell lymphoma, 19%; nasal and nasal type NK/T cell lymphoma, 15%; subcutaneous panniculitis-like T cell lymphoma, 11%; peripheral T cell lymphoma, unspecified, 7.5%; follicular lymphoma, 3%; marginal zone lymphoma, 1%; angioimmunoblastic lymphadenopathy, 1%. Compared with Western countries, the rate of nasal and nasal-type NK/T cell lymphoma and subcutaneous panniculitis-like T cell lymphoma were much higher. Therefore, The EORTC classification is not effective in dealing with Korean cases of cutaneous lymphoma. We consider the principles of the WHO classification are applicable to the Korean cases of cutaneous lymphoma.

Clinicopathologic Study of Labial Melanotic Macule

BACKGROUND: Labial pigmented lesions include labial melanotic macule, ephelids, lentigo, venous hemangioma, amalgam tattoo, junctional nevus, Peutz-Jeghers syndrome, Addison's disease, Laugier s disease, and superficial spreading melanoma. OBJECTIVES: The purpose of this study was aimed at investigating the clinical and histopathological characteristics of labial melanotic macule during the past 10 years. METHODS: Clinical information of 49 patients with pigmented lesion of the lips diagnosed in Asan Medical Center from 1989 to 1999 was obtained from the medical records and clinical follow-ups. We re-evaluated all the biopsy specimens obtained from the patients. RESULTS: Twenty-six patients with labial melanotic macule were enrolled in this study. There were 16 women and 10 men. Age at onset varied from 20 to 65 years in women and from 28 to 68 years in men. The duration of the lesion ranged from 4 months to 12 years (mean, 4.5 years). The majority of patients had solitary lesions on the lower lip. Histopathologic examination of biopsy specimens showed increased pigmentation of the basal layer, mild acanthosis without elongation of rete ridges, and scattered melanophages in the dermis. CONCLUSIONS: We suggest that labial pigmented lesions appearing in adults should be biopsied and labial melanotic macule should be diagnosed after the histopathological examination.

Angiolymphoid Hyperplasia with Eosinophilia and Kimura's Disease: a Clinico-Pathologic Study in Korea / 대한피부과학회지

BACKGROUND: There has been considerable controversy about the relationship between angiolymphoid hyperplasia with eosinophilia(ALHE) and Kimura's disease. Recent reports have suggested that they are two different diseases. OBJECTIVE: The purposes of this study was aimed at evaluating the clinical and histopathological characteristics of ALHE and Kimura"s disease and differential points between them. METHODS: The hospital charts and histopathologic slides of 5 patients with ALHE and 2 patients with Kimura's disease diagnosed at Asan Medical Center from 1989 to 2000 were reviewed. We also reviewed the previously published reports of the patients with ALHE and Kimura's disease in Korea. In total, we studied 14 cases of ALHE and 29 of Kimura's disease. RESULTS: 1.Eight male and six female patients(M:F=1.3:1) were enrolled in ALHE group and twenty-four male and five female(M:F=4.8:1) in Kimura's disease. The mean age at diagnosis of ALHE was 25 years in men and 40 years in women. The mean age of Kimura's disease was 30 years in men and 33 years in women. 2.Head and neck were the most frequently involved sites in ALHE(92.9%) and Kimura's disease(89.7%). Especially, among the sites, the ear(57.1%) in ALHE and the mandible(44.8%) in Kimura's disease were the most commonly involved. One patient(7.1%) with ALHE and three(10.3%) with Kimura's disease had the lesions bilaterally. 3.Pruritus was the most common symptom in both the diseases. Lymphadenopathy was present in only one patient with ALHE, whereas 51.7% of patients with Kimura's disease had it. One patient with ALHE had underlying arteriovenous malformation. One case showing pregnancy-associated Kimura's disease was reported. Gastric lymphoma was followed in one case of Kimura's disease. 4.Laboratory investigation showed hypereosinophilia in 41.7% of patients with ALHE(5/12) and 96.4% of Kimura's disease(27/28). Elevated IgE was in 2 cases of ALHE(2/4) and 5 cases of Kimura's disease(5/6). 5.Histopathological examination revealed that angioproliferating lesion comprised of plump epithelioid or histiocytoid endothelial cells and accompanying eosinophils and lymphocytes characterized ALHE. In contrast, Kimura's disease was characterized by deeper lesions showing proliferation of vascular structure with less plump endothelial cells and more fibrotic stroma with many lymphoid follicular structures 6.ALHE was improved with CO2 laser, electrocautery, excision, embolization of underlying arteriovenous malformation and dapsone. However, Kimura's disease tended to recur despite various treatment modalities. CONCLUSIONS: In Korea, Kimura's disease was more common than ALHE. ALHE and Kimura's disease may be different diseases because they showed different clinical and histopathological features.

A Case of Cutaneous Mesenchymal Hamartoma on the face / 대한피부과학회지

Cutaneous mesenchymal hamartoma is a very rare disease which most often presents itself at birth and is composed of collagen fibers, immature fibroblasts, fat cells, blood vessels, and mast cells. We report a case of cutaneous mesenchymal hamartoma on the face.

A Clinico-Pathological Study of Squamous Cell Carcinoma / 대한피부과학회지

BACKGROUND: Squamous cell carcinoma(SCC) may occur anywhere on the skin and on mucous membranes with squamous epithelium. OBJECTIVE: The purpose of this study was to investigate the clinico-pathological characteristics of SCC. METHODS: A total of 62 patients with SCC were enrolled in this study. Six cases with metastatic SCC were included. The hospital charts and histopathological slides of the patients with SCC diagnosed at Asan Medical Center from 1989 to 1999 were reviewed. RESULTS: 1. The male and female ratio was 1.8:1. The mean age at diagnosis was 61.5 years in male patients and 71.8 years in female patients. 2. Most commonly involved sites were the face(41.8%). Upper extremities, trunk, lower extremities, genitalia and scalp were followed in decreasing order. The proximal nail fold was involved in 3 case of primary cutaneous SCC and 1 cases of metastatic SCC. 3. Six cases(9.7%) of metastatic SCC were included. Lung cancer(83.3%) was the most common cause of metastatic SCC in this study. Interestingly, one case presented with SCC of the proximal nail fold revealed metastatic SCC from the lung. 4. The possible causative diseases of primary cutaneous SCC were actinic keratosis(12.5%), burn scar(8.9%), immune suppression(8.9%) owing to kidney transplantation and chemotherapy, arsenical keratosis(7.1%), Bowen's disease(5.4%), trauma(5.4%), osteomyelitis(3.6%), and porokeratosis(1.8%). The causes of 25 cases(44.6%) were undetermined. 5. Histopathological differentiation of the primary cutaneous SCC was performed as follows: 29 cases(51.8%) of well-differentiated, 11 cases(19.6%) of moderately-differentiated, 8 cases(14.3%) of poorly-differentiated, 6 cases(10.7%) of acantholytic, and 2 cases(3.6%) of verrucous SCC. 6. Metastatic rate of primary cutaneous SCC was 16.1%. Metastasis of SCC from osteomyelitis (100%) and burn scar(40%) or trauma(33.3%) and that of poorly differentiated SCC(37.5%) were more common. Regional lymph nodes(55.6%), skin(44.4%), and lung(33.3%) were common metastatic organs.

Livedoid Vasculitis: a Clinico-Pathological Study of 19 Patients / 대한피부과학회지

BACKGROUND: Livedoid vasculitis is a distinctive dermatosis characterized by recurrent chronic ulceration and infiltrated purpuric papules on the lower limbs. OBJECTIVE: The purpose of this study was aimed at evaluating the clinical and histopathological features of livedoid vasculitis. METHODS: The hospital charts and histopathologic slides of patients with livedoid vasculitis diagnosed at Asan Medical Center from 1989 to 1999 were reviewed. RESULTS: Twelve male and seven female patients were enrolled in this study(M: F=1.7: 1). The mean age at onset was 30.3 years in men and 25.3 years in women. The mean duration of illness was 3.3 years in male patients and 5.7 years in female patients. All the patients were presented with recurrent chronic ulceration and atrophic scarring. Twelve patients(63.2%) complained of severe pain and tenderness of the lesions and 5 patients(26.3%) complained of itching sensation. In three patients(15.8%), the lesions developed or aggravated in summer. Alcohol intake was aggravating factor in two patients(10.5%) and smoking was in one patient(5.3%). In five patients(26.3%), livedoid vasculitis develops in association with several diseases. Associated diseases were diabetes mellitus in 2 patients(10.5%), antiphospholipids antibody syndrome in 2 patients(10.5%), and protein S deficiency in 1 patient(5.3%). Histopathological examination revealed hyalinized blood vessels, partial to complete obstruction of dermal blood vessels with fibrinoid thrombi, endothelial swelling, and extravasation of RBCs in upper and mid-dermis. Panniculitis-like feature was common finding(73%). In six patients(31%), moderate to severe inflammatory reaction was observed in dermis. Five patients were treated with aspirin, dipyridamole, and pentoxifylline, and among them, only 1 patient(20%) were improved. All the treatment response including pentoxifylline alone, or pentoxifylline plus aspirin, dipyridamole, or corticosteroid was unsatisfactory. In cases of three patients whom were treated with low-dose danazol, all the patients(100%) showed marked improvement. One patient was treated with dapsone with improvement. CONCLUSION: Livedoid vasculitis is a distinct dermatosis with characteristic clinico-pathological features. Low-dose danazol or dapsone may be useful therapeutic options in this intractable disease.

A Clinico-Pathologic Study of Basal Cell Carcinoma / 대한피부과학회지

BACKGROUND: Basal cell carcinomas(BCC) are seen almost on hair-bearing skin, especially on the face. There have been a few reports about BCC in Korea. OBJECTIVE: The purpose of this study was to investigate the clinico-pathological characteristics of BCC. METHODS: A total of 95 patients with BCC were enrolled in this study. The medical records and histopathological slides of BCC diagnosed at Asan Medical Center from 1989 to 1999 were reviewed. We classified our cases based on the predominant histopathological findings as follows; solid, adenoid, pigmented, superficial multicentric, clear cell, keratotic, morpheic, basosquamous, trichoblastoma-like, fibroepithelioma of Pinkus-like. RESULTS: 1. The male- female ratio was 1.1:1. The mean age at diagnosis was 64.8 years in male patients and 66.9 years in female patients. 2. The clinical diagnoses were BCC(76.8%), melanoma, actinic keratoses, seborrheic keratosis, and so on. 3. The face was the most preferred site, especially nose(41.2%). Solid, adenoid, keratotic, morpheic, and basosquamous types developed exclusively on the face, while superficial multicentric types did not show on the favored sites. 4. Pruritus of the lesion, easy bleeding, and rapid increment of the size were the main complaints. 5. Solid type was the most frequent type(30%). Three cases of BCC arising from organoid nevus were included. In two cases of organoid nevus-origin, fibrofolliculoma of Pinkus-like histopathological findings were noted. 3 cases were recurrent after laser therapy or simple curettage. 6. Ninety two cases were successfully treated with wide excision. One case was treated with radiation therapy, but the lesion persisted. The lesion was widely excised without recurrence. Systemic metastases were absent in our study.

A Clinico-Pathological Study of Cutaneous Sarcoidosis / 대한피부과학회지

BACKGROUND: Sarcoidosis is a chronic granulomatous inflammatory disorder involving many organs including the skin with various clinical manifestations. OBJECTIVE: The purpose of this study was to investigate the clinico-pathological characteristics of sarcoidosis. METHODS: A total of 19 patients with cutaneous sarcoidosis were enrolled in this study. The hospital charts and histopathological slides of the patients with sarcoidosis diagnosed at Asan Medical Center from 1989 to 1999 were reviewed. RESULTS: 1. Three male and sixteen female patients were included(M:F=1:5.3). Age at diagnosis ranged from 4 to 62 years. The mean age was 46 years in male patients and 44.9 years in female patients. 2. Multiple or several(more than 2) skin lesions were common(78.9%). Extremities were the favored sites. Clinically the lesions were presented as subcutaneous nodules, plaques, nodule, macules or papules, patches, psoriasiform, and pitted scar in decreasing order. Cutaneous lesions arising from the scar were present in 3 cases. Six patients(31.6%) complained of systemic symptoms such as fever or weight loss. 3. The systemic involvement was present in 11 cases(57.9%). Lung, hilar lymph nodes, and mediastinal lymph nodes were the most commonly involved organs. 4. Laboratory examinations revealed elevated erythrocyte sedimentation rate(71.4%) and angiotensin converting enzyme(ACE)(90%). In all the patients with elevated level of serum ACE the involvement of intrathorax was present, however one patient with systemic involvement showed normal level of ACE. Serum calcium level was normal in all the patients and the level of CD4/CD8 revealed variable results(1.3 to 3.9). 5. Histopathological evaluation revealed non-caseating epithelioid cell granulomas(100%) with multinucleated giant cells(52.6%) and asteroid body(31.6%). In 11 cases(57.9%), fibrosis was the prominent finding and in two cases(10.5%) partial interstitial necrosis was noted. Histopathologically subcutaneous pattern was predominant in 8 cases(42.1%). The patients with subcutaneous sarcoidosis did not show any specific clinical or laboratory differences from the other types in our study. CONCLUSION: Cutaneous sarcoidosis showed varied clinical and histopathological manifestations and ran various clinical courses. In cutaneous sarcoidosis women were more commonly involved than in systemic sarcoidosis and more elderly patients were involved in cutaneous sarcoidosis. Extensive work-up for systemic involvement may be mandatory when sarcoidosis is presented with cutaneous lesions or the level of serum ACE is elevated in cutaneous sarcoidosis. The level of CD4/CD8 may be a insignificant laboratory index in sarcoidosis. Also, subcutaneous sarcoidosis may not be a marker of the systemic involvement.

Leukemia Cutis: a Clinico-Pathologic Study of 23 Patients / 대한피부과학회지

BACKGROUND: Leukemia cutis is regarded as a dissemination of aggressive systemic leukemia to the skin. The presence of leukemia cutis is usually associated with a grave prognosis. OBJECTIVE: We evaluated the differences in the patienta' age and sex, the clinical appearance and distributions of the skin lesions, histopathological characteristics, interval between diagnosis of systemic leukemia and skin involvement, and prognosis according to the type of leukemias. METHODS: We performed a retrospective study of 23 cases of leukemia cutis. We obtained the clinical characteristics from record reviews and we also reevaluateds biopsy materials of 23 patients diagnosed in Asan Medical Center from 1989 to 1999. RESULTS: 1. The male-female ratio was 1.6 to 1. The mean age at diagnosis was 46.6 years. Leukemia cutis occurred in 4.3% of cases of AML(17/396), 0.4% of ALL(1/276), 9.5% of CML(2/21), and 0% of CLL(0/14) in Asan Medical Center from 1989 to 1999. The patients in this study comprised: 3 patients with myelodysplastic syndrome(MDS), 1 acute lymphocytic leukemia(ALL), 17 acute myelocytic leukemia(AML), and 2 chronic myelocytic leukemia(CML). 2. The clinical appearance of leukemia cutis includes macules, papules, nodules, and erythema nodosum-like lesions. The papular lesions were the most common ones. Trunk and extremities were favored sites. There was no specific difference in the clinical findings of each type of leukemias. 3. Histopathological evaluation revealed perivascular and periadnexal infiltration of leukemic cells in the dermis with grenz zone in more than one third of the specimens. There was no specific difference in the histopathological findings of each type of leukemias. 4. In sixteen of the 23 patients (69.6%) with leukemia cutis, skin lesions developed after the systemic leukemia had been diagnosed. Three of the patients (13%) had skin lesions preceding the diagnosis of systemic leukemia and 4 patients (17%) had concomitant involvement. 5. Eighteen patients (78.3%) died after the diagnosis of leukemia cutis. The mean intervals between diagnosis of leukemia cutis and death was 4.8 months. CONCLUSION: Leukemia cutis is an uncommon manifestation of leukemia cutis that is strongly associated with the presence of extramedullary disease at other sites. Although AML was the most common type in this study, leukemia cutis has developed in CML, AML, ALL, and CLL in decreasing order of frequency in this study. The lesions showed varied morphology and could be difficult to distinguish both clinically and histopathologically from nonspecific dermatoses. The presence of leukemia cutis may be a sign of grave prognosis.

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.

PCR Study for Human Herpesvirus 8 in Korean Patients with Several Cutaneous Diseases / 대한피부과학회지

BACKGROUND: The association of Kaposi's sarcoma-associated human herpesvirus, or human herpesvirus 8 (HHV8) with various skin diseases has been described in many reports. However, only 3 human diseases: Kaposi's sarcoma, primary effusion lymphoma, and multicentric Castleman disease were proved to be associated with HHV8. In addition to Karposi's sarcoma, sarcoidosis and Kikuchi's disease were also described to be associated with HHV8. OBJECTIVE: The purpose of this study was aimed at the association of HHV8 with various skin diseases, such as Kaposi's sarcoma, sarcoidosis, and Kikuchi's disease. METHODS: We performed PCR to examine whether the 233-bp segment of the viral DNA of HHV8 was detected in Korean patients with Kaposi's sarcoma, sarcoidosis, Kikuchi's disease, angiosarcoma, and angiolymphoid hyperplasia with eosinophilia. The medical records and histopathological specimens of patients diagnosed at Asan Medical Center from 1989 to 1999 were reviewed. RESULTS: HHV8 DNA sequences were identified in 9 (69%) of sarcoid tissues from 12 patients with sarcoidosis and in all (100%) of from 8 patients with Kaposi's sarcoma but not in 2 tissues from 2 patients with Kikuchi's disease, in 3 tissues from 2 patients with angiosarcoma and 2 tissues from 2 patients with angiolymphoid hyperplasia with eosinophilia. CONCLUSION: HHV8 may be strongly associated with the pathogenesis of Kaposi's sarcoma and sarcoidosis. However, the association with Kikuchi's disease, angiosarcoma, and angiolymphoid hyperplasia with eosinophilia was denied in this study. Further extensive study will be needed.

Eosinophilic Pustular Folliculitis: a Clinico-Pathologic Study in Korea / 대한피부과학회지

BACKGROUND: Eosinophilic pustular folliculitis (EPF) is a rare chronic disease of unknown cause with pruritic papulopustular lesions and a prominent eosinophilic infiltrate. OBJECTIVE: The purpose of this study was aimed at evaluating the clinical and histopathological features of EPF. METHODS: The hospital charts and histopathologic slides of 8 patients with EPF diagnosed at Asan Medical Center from 1989 to 1998 were reviewed. We also reviewed the previously published reports of 10 patients with EPF in Korea. RESULTS: Nine male and nine female patients were enrolled in this study. The mean age at diagnosis of EPF was 26 years in men and 27 years in women. All the patients complained of mild to severe pruritus. EPF was presented with follicular papules or pustules, except 2 patients, who presented with erythematous plaques free of papules or pustules. All the patients showed the typical histopathological findings of EPF. Laboratory investigation showed hypereosinophilia in 73% of patients (11/15). The levels of blood eosinophils tended to decrease as cutaneous lesions resolved. EPF was improved with dapsone in 12 patients and the rest were treated with topical or systemic steroid or antihistamines. CONCLUSION: EPF may be more common in Korea than can be suspected. Because EPF showed characteristic histopathological findings and EPF responds well to dapsone, the knowledge with this disease may be important to diagnose and treat it.

Expression of Cutaneous Lymphocyte-Associated Antigen in Psoriasis / 대한피부과학회지

BACKGROUND: The evidence that T lymphocytes play a key role in the pathogenesis of psoriasis is compelling. Memory T cells that infiltrate the skin express a unique skin-homing receptor called cutaneous lymphocyte-associated antigen (CLA). CLA is thought to target skin-associated T cells to inflammatory skin sites by interacting with endothelial cell ligand E-selectin. OBJECTIVE: The purpose of this study was to investigate the expression and pathogenetic roles of CLA in psoriasis. METHODS: We performed an immunohistochemical staining on the lesional and nonlesional skin specimens of 13 cases of chronic plaque type psoriasis and 5 skin specimens of normal persons as control group using seven monoclonal antibodies for CLA, CD3, CD4, CD8, CD20, CD45RO, and HLA- DR. Standard streptavidin-biotin peroxidase method using the monoclonal antibodies with AEC was used. RESULTS: CLA was expressed over 75% of mononuclear cells in the psoriatic epidermis and about 50% in the psoriatic dermis. CD3 was expressed in 50-90% of mononuclear cells in psoriatic epidermis and dermis. CD4 was expressed less than 10% in the psoriatic epidermis and 10-50% in the psoriatic dermis. In contrast, CD8 showed the strong reactivity in psoriatic epidermis (50-75%) and dermis (25-75%). CD20, the marker of B cell, was not expressed in the psoriatic epidermis and expressed in less than 25% in the psoriatic dermis. CD45RO, expressed on the memory T cells, was observed in less than 10% in the psoriatic epidermis but more than 75% in the psoriatic dermis. HLA-DR, the marker of activated lymphocytes, was expressed in less than 10% in the psoriatic epidermis and 25-50% in the psoriatic dermis. CONCLUSION: These results suggest that CLA may play a key role in the pathogenesis of psoriasis. In susceptible individuals, inciting factors, such as infection with streptococci, may activate the expression of CLA on T lymphocytes. CLA+ CD4+ T lymphocytes may be extravasated via CLA/E-selecin interaction and activated T lymphocytes could get together in the papillary dermis. Activated skin-homing CD4+ T lymphocytes arouse dormant intraepidermal CD8+ T lymphocytes. These CD8+ T lymphocytes may proliferate and produce cytokines and growth factors that trigger the chain reaction of cellular and molecular events to produce psoriatic plaques.

Kaposi's Sarcoma: a Clinico-Pathological Study of 8 Patients / 대한피부과학회지

BACKGROUND: Kaposi's sarcoma (KS) is a multicentric neoplastic vascular tumor involving the skin or internal organs. KS is an extremely common tumor in tropical Africa and it is also a prime marker of acquired immunodeficiency syndrome (AIDS). Nearly all cases of KS can be classified in four groups: 1) classic, 2) African, endemic, 3) AIDS-associated, 4) iatrogenic immunosuppression- associated KS. OBJECTIVE: The purposes of this study were aimed at evaluating the clinical and biological features of KS. METHODS: The hospital charts and histopathologic slides of patients with KS diagnosed at Asan Medical Center from 1989 to 1999 were reviewed. Immunohistochemical studies for factor VIII, CD31, and CD34 were performed. We also performed PCR-based analysis to determine whether human herpesvirus 8 (HHV8) is present in KS included in this study. RESULTS: 1. Four male and four female patients were included. The mean age at diagnosis of KS was 59.6 years. 2. Our patients could be classified as follows, iatrogenic immunosuppression-associated (7/8) and classic KS (1/8). Iatrogenic immunosuppression-associated group was sub-classified into long-standing steroid use (2/7), chemotheraphy-associated (cancer related, 3/7), and kidney transplantation (KT)-associated group (2/7). Patients with AIDS-associated KS were absent. 3. KS was presented with varied clinical features showing from ill-defined purplish macules to fungating nodules or tumors. Interestingly, two cases were presented with zosteriform or cellulitis-like features. Although upper and especially, lower extremities were favored sites, mucosal involvement such as intraoral and perianal areas was noticed. The cases showing the involvement of systemic organ could not be detected except two cases involving the small intestine. 4. Immunohistochemical studies revealed that spindle cells in stroma were partially positive for CD31 and CD34 and negative for factor VIII. 5. HHV8 sequences were identified in all cases of KS. 6. Four patients (50%) died within 1-2 years after the diagnosis of KS due to underlying diseases. Radiation therapy and interferon-alpha were effective in one case, respectively. Classic KS showed indolent course. Conclusion: KS is a multicentric neoplasm for which the etiopathogenesis is still under discu ssion. We retrospectively studied seven cases with iatrogenic immunosuppression-associated KS and one with classic KS. KS should be considered when the cutaneous lesions newly developed in immunosuppressed patients. HHV8 may contribute to the pathogenesis of KS when other predisposing conditions are present.

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.

Psoriasiform Sarcoidosis

Sarcoidosis is a systemic granulomatous disease of undetermined etiology and pathogenesis that involves the skin and many of the internal organs. It involves any organ of the body; how-ever, the most common sites are the lung, lymph node, skin, and eye. Psoriasiform eruption is a rare morphologic manifestation of sarcoidosis. We report herein a case of 36-year-old man with psoriasiform papules on the elbows, forearms and knees of 5-year duration. Histopathologic examination revealed sarcoid granuloma throughout the dermis. This is the second case of psoriasiform sarcoidosis in Korea.