A case report of hidradenitis suppurativa after subdermal excision for axillary osmidrosis

Hidradenitis suppurativa (HS) is a chronic inflammatory condition with an unclear etiopathogenesis that is considered to be a follicular occlusive disease. We present a case of HS that was suspected to have developed as a complication of subdermal excision. A 19-year-old man who had undergone subdermal excision due to osmidrosis presented 7 months after surgery with a persistent painful mass in his left axilla. Despite medical treatment, incision, and drainage, a painful enlarged abscess recurred in the left axilla and was cured completely by deroofing surgery. However, 15 months after subdermal excision, he revisited the hospital because of a painful mass in the right axilla. The patient’s condition met the diagnostic criteria of HS. After several recurrences, a cure was achieved by radical wide excision. Mechanical stress like that associated with subdermal excision is considered to be a possible etiological factor of HS. In addition, pathological changes at the sebofollicular junction allow rupture and leakage of folliculopilosebaceous units upon exposure to mechanical stress, which may result in the aggressive subcutaneous extension of inflammation. We suggest that HS should be considered in patients with a recurrent abscess after subdermal excision, and recommend surgical treatment as a possible option if conservative treatment is clinically ineffective.

Giant Basal Cell Carcinoma Mimicking Extramammary Paget’s Disease / 대한피부과학회지

No abstract available.

Syringocystadenoma Papilliferum of the Arm / 대한피부과학회지

No abstract available.

Tinea Capitis Caused by Microsporum canis Misdiagnosed as Seborrheic Dermatitis in a 79-Year-Old Woman / 대한의진균학회지

Microspoum canis is a zoophilic dermatophyte that is often transmitted to humans from cats and dogs. It has become one of the most important causative agents in tinea capitis ane kerion celsi. Tinea capitis is uncommon in an adult. Moreover, tinea capitis caused by Microspoum canis is rare in an elderly. The location of the lesion and the clinical course of tinea capitis might have led physicians into misdiagnosis as the seborrheic dermatitis. Therefore, we report this case to emphasize the importance of KOH mount and fungal culture of the skin lesions mimicking seborrheic dermatitis. We report a case of tinea capitis caused by Microspoum canis in a 79-year-old woman. The lesions were manifested by fine scaly erythematous patches on the fronto-vertex scalp for 2 weeks. She was diagnosed as seborrheic dermatitis in local clinic and was treated with topical steroid. However, the lesion was not improved. She kept a cat as a pet. Culture from biopsy specimen on Sabouraud's dextrose agar showed typical cottony colonies of Microspoum canis. The nucleotide sequence of internal transcribed spacer for clinical isolate was identical to that of Arthroderma otae strain ATCC 23828 (GenBank accession number AY213657). She was treated with 200 mg of oral itraconazole daily for 12 weeks. The skin lesions improved after treatment, and recurrence has not been observed.

Tinea Capitis Caused by Trichophyton rubrum in a 81-Year-Old Woman / 대한의진균학회지

Trichophyton(T.) rubrum is an anthropophilic dermatophyte that is found all over the world. It has become one of the most important causative agents in tinea pedis and onychomycosis. But tinea capitis caused by T. rubrum is rare. Tinea capitis is uncommon in an adult. We report a case of tinea capitis caused by T. rubrum in an 81-year-old woman. She presented with localized asymptomatic well-demarcated thick scaly erythematous patches on the fronto-vertex scalp for 6 months. She was diagnosed as seborrheic dermatitis in local clinic and was treated with topical steroid. However, the lesion was not improved and spreading. Culture from scalp lesion of patient was grown on Sabouraud's dextrose agar and showed typical whitish cottony colonies of T. rubrum. She was treated with 200 mg of oral itraconazole daily for 8 weeks. The skin lesions improved 8 weeks after treatment, and recurrence has not been observed.

Tinea Barbae Caused by Trichophyton mentagrophytes / 대한의진균학회지

Tinea barbae is a dermatophyte infection of the bearded areas of the face and neck. The incidence of tinea barbae has decreased as improved sanitation. We report a case of tinea barbae in a 49-year-old-man, who presented with relatively well-defined erythematous patch with pustules on the upper lip. A fungal culture from tissue of the lesions was grown on Sabouraud's dextrose agar and showed typical Trichophyton mentagrophytes. The nucleotide sequence of internal transcribed spacer for clinical isolate was identical to that of Arthroderma vanbreuseghemii IHEM 4411. The patient was treated with oral itraconazole for 3 months. The skin lesions improved 3 months after treatment, and recurrence has not been observed.

A Case of Rapidly Growing Extraocular Sebaceous Carcinoma

Sebaceous carcinoma is a rare malignant tumor differentiated from the adnexal epithelium of sebaceous glands and forms less than 1% of all cutaneous malignancies. We present a case of a 93-year-old woman with a rapidly growing mass on the right cheek. Initial histiopathologic finding was basal cell carcinoma. The mass was widely excised and superficial parotidectomy was performed while preserving the facial nerve branches. The resulting defect was covered with a transposition flap from the ipsilateral posterior auricular area and the donor site was closed primarily. However, histopathologic examination of the excised mass showed a poorly differentiated sebaceous carcinoma with a clear resection margin. The diagnosis of sebaceous carcinoma can be difficult to make at initial presentation. This report describes a rare case of a rapidly growing extraocular sebaceous carcinoma, which resulted in a good treatment outcome, and provides a review of relevant literature.

The Expression of CD10 and CD15 Is Progressively Increased during Colorectal Cancer Development

BACKGROUND: The aim of this study was to examine the expression of CD10 and CD15 in tumor cells, stromal cells and infiltrating inflammatory cells during colorectal carcinoma (CRC) development and to investigate their expression levels between the tumor center and invasive front and compare them to clinicopathological parameters in invasive CRC. METHODS: We performed immunohistochemical staining for CD10, CD15, and E-cadherin in 42 cases of CRC, 49 of tubular adenoma, 15 of hyperplastic polyp, and 17 of non-neoplastic colon. RESULTS: CD10 was expressed in tumor cells (tCD10), stromal cells (sCD10) and infiltrating inflammatory cells (iCD10), and CD15 was expressed in tumor cells (tCD15) and infiltrating inflammatory cells (iCD15). Their expressions were progressively increased during CRC development and the iCD10 expression level was significantly correlated with the iCD15 expression level in invasive CRC. Invasive front revealed a higher expression level of iCD10 and iCD15 than the tumor center. Moreover, the iCD15 expression level of invasive front was significantly correlated with the degree of tumor budding and tCD15 in whole tissue sections was closely associated with tumor depth. CONCLUSIONS: The present study suggests that the expression of CD10 and CD15 is associated with the development and progression of CRC.

Localized Epidermolysis Bullosa Acquisita Limited to the Face / 대한피부과학회지

No abstract available.

A Case of Direct Invasion of the Parotid Gland by Cutaneous Squamous Cell Carcinoma

Cutaneous squamous cell carcinoma is the second-most common skin cancer and represents 20% of all skin cancers. Cutaneous squamous cell carcinoma often spreads to the parotid gland through lymph nodes, but, direct invasion of an adjacent organ may also occur. We present the case of 78-year-old man with ulcerated mass on the right infra-auricular area. The histopathologic finding was squamous cell carcinoma. There was no evidence of distant metastasis, but the mass was found to invade the superficial lobe of the right parotid gland. The mass was widely excised and superficial parotidectomy was performed while preserving the facial nerve. The defect was covered by primary closure. Postoperative radiotherapy was performed. At 20 months after surgery, our patient had no facial palsy, local recurrence, or metastasis. Cutaneous squamous cell carcinoma involving the parotid gland is an aggressive, rapidly advancing lesion, which if not recognized and treated early will result in high morbidity and mortality. Squamous cell carcinoma of the parotid gland has shown that patients who receive adjuvant radiotherapy have a lower recurrence rate and a higher survival rate than patients treated with surgery alone. The role of elective neck dissection remains controversial.

Progressive Increase of Regulatory T Cells and Decrease of CD8+ T Cells and CD8+ T Cells/Regulatory T Cells Ratio during Colorectal Cancer Development

BACKGROUND: We examined the distribution of CD8+ T cells and regulatory T cells (Tregs), measured the CD8+ T cell/Tregs ratio, investigated the relationship between Tregs and cyclooxygenase-2 (COX-2) expression during colorectal cancer (CRC) development. METHODS: We performed immunohistochemical staining for CD8, forkhead box P3, E-cadherin, and COX-2 in 32 cases of invasive CRC, 10 cases of intramucosal CRC, 27 cases of high-grade tubular adenoma, 22 cases of low-grade tubular adenoma, and 32 cases of non-neoplastic conditions. RESULTS: We observed a progressive increase in Tregs, and a decrease in CD8+ T cells and the CD8+ T cells/Tregs ratio during CRC development. The alterations were most severe in high-grade tubular adenoma and CRC. COX-2 expression was positively associated with Tregs infiltration. The degree of T cell infiltration differed among tumor compartment and the ratio in the tumor center was the lowest of all areas. The ratio and number of CD8+ T cells in the tumor center and the invasive front of invasive CRC were associated with gender, differentiation, node metastasis and tumor budding. CONCLUSIONS: Alteration in the distribution of both CD8+T cells and Tregs may contribute to the generation of an immune environment suitable for the development and progression of CRC.

The Expression of Pigment Epithelium-Derived Factor in Bladder Transitional Cell Carcinoma

BACKGROUND: Pigment epithelium-derived factor (PEDF) is an anti-angiogenic factor. The purpose of this study is to examine the involvement of PEDF in the angiogenesis and biological behavior of bladder transitional cell carcinoma (TCC). METHODS: We examined the expression of PEDF in 99 bladder TCCs and ten non-neoplastic tissues, and evaluated microvessel density (MVD). RESULTS: The positive immunoreactivity for PEDF was seen in normal urothelium in 60% (6/10) and TCC in 13% (13/99). The PEDF expression had a significant correlation with MVD, i.e., a low MVD in 42% (5/12), a middle MVD in 11% (8/76) and a high MVD 0% (0/11) of tumors. The PEDF expression was not significantly correlated with the differentiation and invasion of TCC, but the degree of MVD was significantly higher in both high grade TCC and the pT2 tumors. CONCLUSIONS: The degree of PEDF expression is significantly higher in normal bladder urothelium than bladder TCC; it is inversely correlated with the angiogenesis; and it is not related to the differentiation and progression of TCC. It can therefore be concluded that bladder TCC would initially occur if there is a lack of the PEDF expression.

The Expression of Pigment Epithelium-Derived Factor in Bladder Transitional Cell Carcinoma

BACKGROUND: Pigment epithelium-derived factor (PEDF) is an anti-angiogenic factor. The purpose of this study is to examine the involvement of PEDF in the angiogenesis and biological behavior of bladder transitional cell carcinoma (TCC). METHODS: We examined the expression of PEDF in 99 bladder TCCs and ten non-neoplastic tissues, and evaluated microvessel density (MVD). RESULTS: The positive immunoreactivity for PEDF was seen in normal urothelium in 60% (6/10) and TCC in 13% (13/99). The PEDF expression had a significant correlation with MVD, i.e., a low MVD in 42% (5/12), a middle MVD in 11% (8/76) and a high MVD 0% (0/11) of tumors. The PEDF expression was not significantly correlated with the differentiation and invasion of TCC, but the degree of MVD was significantly higher in both high grade TCC and the pT2 tumors. CONCLUSIONS: The degree of PEDF expression is significantly higher in normal bladder urothelium than bladder TCC; it is inversely correlated with the angiogenesis; and it is not related to the differentiation and progression of TCC. It can therefore be concluded that bladder TCC would initially occur if there is a lack of the PEDF expression.

Prostaglandin E2 and Interleukin-1beta Reduce E-cadherin Expression by Enhancing Snail Expression in Gastric Cancer Cells

Inflammation is closely related to the progression of cancer as well as tumorigenesis. Here, we investigated the effect of prostaglandin E2 (PGE2) and interleukin-1beta (IL-1beta) on E-cadherin expression in SNU719 gastric cancer cells. E-cadherin expression decreased as the dose or exposure time of PGE2 and IL-1beta increased, whereas Snail expression increased with dose or time of PGE2 and IL-1beta. E-cadherin expression reduced by PGE2 treatment increased after the transfection of Snail siRNA. Neutralization of IL-1beta using anti-IL-1beta antibody blocked the expression pattern of E-cadherin and Snail occurred by IL-1beta treatment. However, there was no synergic effect of IL-1beta and PGE2 on the expression pattern of E-cadherin and Snail. In conclusion, inflammatory mediators reduced E-cadherin expression by enhancing Snail expression in gastric cancer cells. Inflammation-induced transcriptional regulation of E-cadherin in gastric cancer has implications for targeted chemoprevention and therapy.

CD10 Is Again Expressed at a Certain Stage during the Neoplastic Process of Bladder Transitional Cell Carcinomas / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: CD10, a membrane-bound zinc-dependent metallopeptidase, is normally expressed in many tissues. Accordingly, the derangement of CD10 expression may be related to development or progression in a variety of tumors. The aim of this study is to examine any association between CD10 expression and clinicopathological parameters in bladder transitional cell carcinomas (TCCs) and the relationship between expression of E-cadherin and CD10. MATERIALS AND METHODS: Immunohistochemical staining was performed for CD10 and E-cadherin in tissues of 94 TCCs and 10 non-neoplastic bladder mucosa. RESULTS: Positive immunoreactivity for CD10 was observed in non-neoplastic urothelium at a proportion of 80% and TCCs were observed at a rate of 23%. A positive rate of CD10 expression was observed in 10% of total cases of a low grade tumor and in 35% of those of a high grade tumor. It was also observed in 15% of pTa tumors, 13% of pT1 tumors, and 48% of pT2 tumors. In addition, CD10 expression showed reciprocal correlation with expression of membranous E-cadherin in tumors. CONCLUSION: CD10 is again expressed at a certain stage during the neoplastic process of TCCs and could play some roles intheir carcinogenesis.

A Case Report of Sweet's Syndrome with Parotitis

Sweet's syndrome is characterized by clinical symptoms, physical features, and pathologic findings which include fever, neutrophilia, tender erythematous skin lesions, and a diffuse infiltrate of mature neutrophils. This is a report of our experience of Sweet's syndrome with parotitis. A 57-year-old man initially presented with tender swelling on the right cheek similar to parotitis. His symptoms relapsed despite the use of an oral antibiotic agent for 3 weeks. He additionally presented with erythematous papules and plaques on the periocular area and dorsum of both hands. Histiopathologic findings on punch biopsy of the right dorsum of the hand showed superficial perivenular histiocytic infiltration without vasculitis. We confirmed this as histiocytoid Sweet's syndrome and used systemic corticosteroid. After initiation of treatment with systemic corticosteroids, there was a prompt recovery from both the dermatosis-releated symptoms and skin lesions. Sweet's syndrome should be considered in patients with therapy-refractory parotitis and unclear infiltrated nodules. We present a confusing case who initially appeared to have parotitis but turned out to have histiocytoid Sweet's syndrome.

Anti-p200 Pemphigoid / 대한피부과학회지

Anti-p200 pemphigoid is an autoimmune subepidermal bullous disease characterized by circulating and tissue-bound autoantibodies directed against a 200 kD protein of the human dermis. We report a 78-year-old male who was presented with bullous eruptions on the trunk, extremities, which clinically resemble bullous pemphigoid, epidermolysis bullosa aquisita, linear IgA dermatosis or dermatitis herpetiformis. Oral muscosa of the lower lip was also affected. Histopathological examination of a skin biopsy specimen from the trunk revealed subepidermal blister and infiltration predominantly by neutrophils. Direct immunofluorescence revealed linear deposits of IgG, C3 and IgA at the basement membrane zone. Indirect immunofluorescence using salt-split skin showed that IgG antibodies bound on the dermal side. Immunoblotting with dermal extracts showed that the patient's IgG autoantibodies reacted with a 200 kD protein. The patient showed good response to dapsone.

Anti-p200 Pemphigoid / 대한피부과학회지

Anti-p200 pemphigoid is an autoimmune subepidermal bullous disease characterized by circulating and tissue-bound autoantibodies directed against a 200 kD protein of the human dermis. We report a 78-year-old male who was presented with bullous eruptions on the trunk, extremities, which clinically resemble bullous pemphigoid, epidermolysis bullosa aquisita, linear IgA dermatosis or dermatitis herpetiformis. Oral muscosa of the lower lip was also affected. Histopathological examination of a skin biopsy specimen from the trunk revealed subepidermal blister and infiltration predominantly by neutrophils. Direct immunofluorescence revealed linear deposits of IgG, C3 and IgA at the basement membrane zone. Indirect immunofluorescence using salt-split skin showed that IgG antibodies bound on the dermal side. Immunoblotting with dermal extracts showed that the patient's IgG autoantibodies reacted with a 200 kD protein. The patient showed good response to dapsone.

Sebaceous Carcinoma Arising from the Nevus Sebaceous

No abstract available.

Multiple Merkel Cell Carcinoma in a Vietnam Veteran Exposed to Agent Orange / 대한피부과학회지

Merkel cell carcinoma is a rare aggressive primary skin cancer which mostly occurs in the elderly on sun-exposed skin. It usually presents as a solitary dome-shaped red or purple nodule on the head, neck and extremities. The mortality rate is higher than the rate for malignant melanoma because its local recurrence is common. Agent Orange, an herbicide widely used as a defoliant in the Vietnam War, contains dioxin contaminants and can cause several dermatoses and skin cancers. We report a case of multiple Merkel cell carcinoma in a 65-year-old male with lesions on the head and neck, who had been exposed to Agent Orange during Vietnam War.