A Clinicopathologic Study of Merkel Cell Carcinoma / 대한피부과학회지

BACKGROUND: Merkel cell carcinoma is a rare neuroendocrine tumor that typically presents as indurated nodules in elderly patients. It has an aggressive behavior and thus, such incidence has been increasing. OBJECTIVE: Our purpose was to analyze clinical and histological characteristics of Merkel cell carcinoma, and to obtain a better understanding of this rare malignancy. METHODS: We conducted a clinicopathologic evaluation of 11 patients from our center during 21 year period (1989~2010). We investigated personal and clinical information, including age, sex, time of onset, past history, histologic findings and clinical manifestations. RESULTS: The age of the 11 patients ranged from 48 to 84, and the mean age of onset was 62.3, with a slight female predominance (1:1.7). The most prevalent site was the face then followed by the extremities. Subcutaneous nodular lesion with overlying erythema was the most common finding (72.7%, 8/11). Protruding tumorous lesions were 18.2% (2/11) and palpable lymphadenopathy was 9.1% (1/11), respectively. Histopathologically, pleomorphic atypical cells and granular nuclear dots ("salt and pepper") were observed. Immunohistochemical study showed positivity for pan-cytokeratin (CK), cytokeratin (CK20), CD56, synaptophysin, chromogranin (90%, 81.8%, 100%, 85.7%, 83.3%) and negative result for leukocyte common antigen (LCA, 0/7), and thyroid transcription factor-1 (TTF-1, 0/4), S100 (0/4). CONCLUSION: Merkel cell carcinomas were more frequent in old females and were rare in immunocompromised patients in Korea. Histologic and immunohistochemical features were similar to previous studies, but there was a case of rare type (CK7+/CK20-) of Merkel cell carcinoma. Surgery is a treatment of choice in Merkel cell carcinoma. But radiation or chemotherapy can be used as an adjuvant therapy. Based on this study, characteristics of Merkel cell carcinoma in Korea can be elucidated with more future cases.

Protruding Type of Fibrous Hamartoma of Infancy / 대한피부과학회지

Fibrous hamartoma of infancy (FHI) is a rare benign soft tissue tumor that is composed of an organoid pattern of fibrous tissue and primitive mesenchyme and adipose tissue. The majority of cases of fibrous hamartoma of infancy occur within the first year of life as a single painless subcutaneous nodule. We experienced and report on an uncommon case of protruding fibrous hamartoma of infancy in an 1-year-old girl.

Protruding Type of Fibrous Hamartoma of Infancy / 대한피부과학회지

Fibrous hamartoma of infancy (FHI) is a rare benign soft tissue tumor that is composed of an organoid pattern of fibrous tissue and primitive mesenchyme and adipose tissue. The majority of cases of fibrous hamartoma of infancy occur within the first year of life as a single painless subcutaneous nodule. We experienced and report on an uncommon case of protruding fibrous hamartoma of infancy in an 1-year-old girl.

Exaggeration of Wrinkles after Botulinum Toxin Injection for Forehead Horizontal Lines

There have been no long-term complications or life-threatening adverse effects related to botulinum toxin treatment for any cosmetic indications. Nevertheless, there are well-known, mild side effects of botulinum toxin treatment on the upper face, though most of them are self limited with time. However, excluding brow ptosis, reports about site specific side effects are few and anecdotal. We experienced cases of exaggeration of wrinkles after botulinum toxin injection for forehead horizontal lines, and report them here. In our cases, new appearance of a noticeable glabellar protrusion following botulinum toxin injection on the forehead was observed in 2 patients. Also, a new deep wrinkle on one side of the forehead just above the eyebrow appeared in another 2 patients. The exaggerated wrinkles nearly disappeared without treatment by week 4 in all subjects. These exaggerations of wrinkles may be caused by hyperactivity and overcompensation of untreated muscles. With the increasing availability of diverse botulinum toxin for cosmetic purposes, physicians and patients should be aware of this temporary change after therapeutic injections. We recommend explaining this possible effect prior to injection, for better understanding of treatment for cosmetic indications.

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.

Psoriasis Aggravated by Adalimumab: A Paradoxical Adverse Reaction / 대한피부과학회지

Adalimumab, a recombinant human IgG monoclonal antibody, selectively blocks tumor necrosis factor-alpha (TNF-alpha) and has been successfully used in the treatment of immune-mediated diseases. In particular, its efficacy has been proven in the treatment of rheumatoid arthritis, spondylarthritis, lymphoproliferative diseases and inflammatory bowel disease. Its use has also been studied for the treatment of psoriasis and yet, paradoxically, cases of new onset or exacerbation of psoriasis continue to increase in patients undergoing treatment with anti TNF-alpha agents. A 51-year-old woman had arthritis for a year and was diagnosed with psoriatic arthritis. After she had received adalimumab for psoriatic arthritis five times during one year, erythematous eruptions were found on her entire body. She then stopped adalimumab therapy for two months, although her skin lesions did not resolve. The patient was diagnosed with psoriasis through biopsy and began using cyclosporine, a topical steroid used for treatment of psoriasis.