Increased Expression of Dickkopf-1 in Acral Lentiginous Melanoma / 대한피부과학회지

BACKGROUND: Dickkopf-1 (DKK-1), an inhibitor of the Wnt signaling pathway, is known as an inhibitor of melanocyte proliferation. In recent studies, the expression of DKK-1 gene is reduced in melanoma and they lose their preventive role during development or progression of melanoma. There are no available data regarding the changes in DKK-1 gene expression in acral lentiginous melanoma (ALM), which is common in Asians. OBJECTIVE: To analyze changes in DKK-1 expression in the development or progression of ALM in Koreans. METHODS: Immunohistochemical staining using DKK-1 antibody of 13 invasive ALM, six ALM in situ, nine acral nevi, and four benign non-related palmoplantar specimens as controls were evaluated by the semi-quantitative grading scale, which is divided into three distinctive grades according to the degree of cytoplasmic staining of DKK-1. RESULTS: Among the invasive ALM specimens, seven of 13 (53.8%) were graded as strongly positive (2+), and only one case (7.7%) was negative. In cases of ALM in situ, two specimens (33.3%) stained positive (1+) and the remaining four specimens (66.6%) were not stained. All specimens from both acral nevus and benign palmoplantar lesions, which were used as the control group, were also negative. CONCLUSION: In contrast with recent reports, DKK-1 expression showed a positive correlation with ALM progression or invasiveness. The role of DKK-1 as a potential predictor of ALM progression warrants further study.

Intravascular Cytotoxic T-Cell Lymphoma in a Young Immunocompetent Woman

Intravascular lymphoma (IVL) is a rare disorder characterized by the presence of large neoplastic lymphoid cells restricted to the lumens of small vessels with a predilection for the skin and the central nervous system. While the vast majority of cases involving IVL are of B-cell lineage, the disease rarely affects the T-cell, the histiocytes, and the natural killer cells. We report a case of intravascular T-cell lymphoma (IVTL) associated with Epstein-Barr virus (EBV). A 23-year-old healthy woman presented with tender indurated erythematous patches with overlying telangiectasia on her right breast, abdomen, both the upper and the lower extremities and the back for 3 months. The pathology revealed an infiltration of dermal and subcutaneous vessels by large and atypical lymphoid cells with immunohistochemical features of the T-cell lineage with a cytotoxic phenotype (CD3+, CD8+, granzyme B+, TIA-1+, CD4-, CD5-, CD20-, CD56-). Interestingly, the DNA extracted from the skin biopsies demonstrated evidence of a monoclonal immunoglobulin heavy chain gene rearrangement, but no T-cell receptor gene rearrangement was found. In situ hybridization study for EBV-encoded RNA was positive. She was diagnosed with an EBV-associated IVTL. The patient's skin lesions were refractory to the combination of chemotherapy and autologous stem cell transplant, and she expired. The findings in the present case may highlight the unique clinicopathologic aspects of EBV-associated cytotoxic IVTL that occurred in a young, immunocompetent woman.

The Clinical Significance of Tumor-Infiltrating Lymphocytes and Microscopic Satellites in Acral Melanoma in a Korean Population

BACKGROUND: There are various histological prognostic parameters of cutaneous malignant melanoma, including tumor thickness and ulceration. Tumor-infiltrating lymphocytes (TIL) are among these parameters and can be further classified into three categories: 'absent', 'non-brisk' and 'brisk'. Brisk TIL usually indicates better clinical prognosis. Microscopic satellite (Ms) is defined as a nest of tumor cells that is greater than 0.05 mm in diameter and definitely separated from the main tumor. Even though the incidence of Ms varies according to Breslow thickness, the presence of Ms generally indicates poor prognosis. OBJECTIVE: Clinical significance of both TIL and Ms has been extensively studied in western populations but much less so in Asian countries, including Korea, where acral melanoma is the most common subtype. METHODS: We reviewed 90 patients with acral melanoma diagnosed at Kyungpook National University Hospital in Korea. Tissue specimens were examined using hematoxylin-eosin and HMB45 immunohistochemical staining. They were also evaluated by the presence and categorization of TIL (absent, non-brisk and brisk) and the presence of Ms. We further evaluated their impact on survival events (recurrence, distant metastasis and death). RESULTS: The number of survival events by TIL type was 22 in the absent category (22/64, 34.4%), 3 in the non-brisk category (3/25, 12.0%) and 0 in the brisk category. For Ms, survival events were present in 7 patients in Ms-present group (7/11, 63.6%) and 21 patients in Ms-absent group (21/79, 26.6%). CONCLUSION: We suggest the possibility of TIL and Ms as prognostic indicators for acral melanoma in Korean population.

Incidental Isolation of Trichophyton rubrum from Five Inpatients' Urine / 대한의진균학회지

Trichophyton (T.) rubrum is the dermatophyte most frequently isolated from humans. It has the ability to form molecular attachments to keratin, resulting in dermatophytic infections on the keratinized tissues, including the stratum corneum of the skin. Uncommon dermatophytic infection, such as granulomatous disease or extensive and severe diseases, can be also developed. However, reports about the isolation of T. rubrum from urine are not expected in the literature. We report incidental isolation of T. rubrum from inpatients' urine.

Congenital Malalignment of the Fourth Toenail with Congenital Curved Nail of the Contralateral Fourth Toe

No abstract available.

Classic Type of Kaposi's Sarcoma Showing Spontaneous Regression / 대한피부과학회지

Self-regression of Kaposi's sarcoma is rare with the exception of the iatrogenic immunosuppressive type. No cases of classic type Kaposi's sarcoma showing spontaneous regression have been reported in the Korean dermatologic literature. We report a case of classic type of Kaposi's sarcoma in a 69-year-old man which followed a clinical course of spontaneous regression. He presented with multiple asymptomatic beefy red papules and nodules scattered on both cheeks and upper extremities during a state of increase in the number of skin lesions at the initial visit. He had no history of immunosuppressive treatment and the laboratory findings were unremarkable. An anti-HIV antibody test was negative. A histopathologic examination revealed typical findings of Kaposi's sarcoma and positive staining with CD31 and D2-40. HHV-8 DNA was detected in a biopsy specimen. Without any specific treatment, the skin lesions healed without leaving any complications after 15 months, and did not show any evidence of recurrence during the ensuing 5 years.

Antiproliferative Effect of Lovastatin on Vascular Smooth Muscle Cell

BACKGROUND AND OBJECTIVES: This study was performed to investigate the antiproliferative effect of lovastatin on vascular smooth muscle cell, especially to determine whether lovastatin induces apoptosis in vascular smooth muscle cell and the products of mevalonate pathway can reverse the antiproliferative effect of lovastatin. METHODS AND MATERIALS: Lovastatin only and lovastatin with one of the products of mevalonate pathway such as isopentenyl adenine, farnesol, mevalonate, cholesterol were added respectively in cultured rat vascular smooth muscle cells stimulated with 10% fetal calf serum. DNA synthesis was measured by tritiated-thymidine incorporation. Cell number was determined by hemocytometric counting. Cells were Giemsa-stained to evaluate morphological changes of apoptosis. Extracted DNA from the cells treated with lovastatin was assessed by gel electrophoresis. RESULTS: 1)Lovastatin inhibited DNA synthesis and cell proliferation in a dose-dependent manner. 2)The inhibitory effects of lovastatin could be reversed almost completely by mevalonate, partially by farnesol. 3)Lovastatin-treated vascular smooth muscle cells showed typical morphological changes of apoptosis. 4)A distinct ladder of DNA bands was visualized by gel electrophoresis of the DNA from the cells treated with lovastatin. CONCLUSION: Mevalonate metabolism is essential for vascular smooth muscle cell proliferation. The antiproliferative effect of lovastatin may result from the induction of apoptosis in vascular smooth muscle cells.