A Case of Atypical Adult-onset Still's Disease That Presented with Unique Histopathologic Findings / 대한피부과학회지

Adult-onset Still's disease (AOSD) is an uncommon disorder characterized by fever, polyarthralgia, elevated white blood cell count, and maculopapular rash, the histologic features of which have not been well known. A 54-year-old woman presented with fever, arthritis, and persistent pruritic lichenified rash. These cutaneous lesions showed unique histological features such as dyskeratosis with a peculiar, distinctive distribution in the upper epidermis and cornified layers with hyperkeratosis. In addition, dermal mucin deposition was increased, with inflammation and minimal fibroblast proliferation. The patient was diagnosed with AOSD according to the diagnostic criteria of Yamaguchi. Herein, we present an atypical form of AOSD showing distinctive clinical and pathological manifestations.

Cutaneous Metastasis from Pancreatic Cancer Simultaneously Developed on the Scalp and Chest / 대한피부과학회지

No abstract available.

Spitz Nevus on the Perianal Area of a Child: An Unusual Location

No abstract available.

A Case of Poroid Hidradenoma / 대한피부과학회지

Poroid hidradenoma is a benign tumor that is classified as a poroid neoplasm, and is so called because of its morphology, which is intermediate between the cytological features of a poroid neoplasm (poroid and cuticular cells) and the architectural features of a hidradenoma (solid and cystic areas, and tumor cells restricted to the dermis). As these tumors are cystic and superficially located, fine needle aspiration cytology has been useful, but the diagnosis relies on the histological examination. A 79-year-old woman presented with a solitary walnut-sized, soft, tender, reddish-to-bluish nodular lesion that had been enlarging steadily over a period of two years. Histopathologic examination of the cutaneous lesion showed a well-demarcated tumor composed of poroid and cuticular cells in the dermis not connected to the overlying epidermis, consistent with poroid hidradenoma. Herein, we present a rare case of poroid hidradenoma arising in an unusual location.

A Case of Vulvar Syringoma in a 9-year Old Child / 대한피부과학회지

No abstract available.

Clinical Evaluation of Dermatologic Consultations in Psychiatric Inpatients / 대한피부과학회지

BACKGROUND: The need for dermatological consultations for hospitalized patients has gradually increased and there are a number of dermatoses caused by underlying psychological conditions. However, the data regarding the analyses of these consultations for psychiatric inpatients are limited. OBJECTIVE: To analyze the demographics and the type of dermatoses among inpatients with primary psychiatric diseases. METHODS: We retrospectively reviewed 581 consultation reports for inpatients referred by the Department of Psychiatry between January 1, 2009 and December 31, 2014. RESULTS: The proportion of the consulted patients from the Department of Psychiatry was 25.9% (331 consulted inpatients/1279 psychiatric inpatients). The most common age group was the 40~49 year-old group (19.3%) and the male to female ratio was 1:1.14. There were no remarkable findings regarding the annual or seasonal distribution. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), the most common underlying psychiatric disorders were mood disorders (41.0%), followed by schizophrenia and other psychotic disorders (25.0%), and substance-related disorders (12.1%). The most frequent skin disorders were eczematous dermatoses (34.6%) and infectious dermatoses (32.2%); dermatomycosis (20.8%) was especially common. The most common reasons for consultation were new-onset dermatologic problems (68.5%), followed by persistence or aggravation of pre-existing dermatologic disorders (28.7%). CONCLUSION: This study reports the dermatologic characteristics of psychiatric inpatients. We conclude that dermatologists and psychiatrists need to be concerned about the education and continuous management of various skin diseases in psychiatric patients.

Leser-Trelat Sign Associated with Malignant Melanoma / 대한피부과학회지

Leser-Trelat sign is a rare paraneoplastic dermatosis that is characterized by the eruptive and rapid development of multiple seborrheic keratosis that coincides with an internal malignancy. Eruptive seborrheic keratosis can be pruritic and appear in a "Christmas-tree pattern." This sign occurs in association with a number of cancers, such as adenocarcinoma of the gastrointestinal tract and various lymphoproliferative disorders. However, Leser-Trelat sign associated with a malignant melanoma is very rare. A 58-year-old male patient presented with an asymptomatic black mass on the penile orifice and patch on the glans penis. He complained of gross hematuria. At the same time, he developed asymptomatic multiple brown papules and plaques on the back. The histopathologic findings of the glans and back lesions were consistent with malignant melanoma and seborrheic keratosis, respectively. Here, we describe a rare case of Leser-Trelat sign associated with malignant melanoma.

Infantile Erythema Annulare Centrifugum / 대한피부과학회지

Erythema annulare centrifugum is an inflammatory skin disorder of unknown etiology characterized by erythematous urticarial papules that enlarge in a centrifugal pattern to form annular appearance. These lesions are usually asymptomatic. Erythema annulare centrifugum generally tends to be a chronic condition. It develops most frequently in adults between 30 and 50 years of life, and only a few infantile cases have been reported in the English literature. Herein, we present an additional case of infantile erythema annulare centrifugum with a review of the literature.

Cutaneous Crohn's Disease on the Groin / 대한피부과학회지

Crohn's disease is a systemic inflammatory and granulomatous disease, mainly involving the gastrointestinal tract with extraintestinal manifestations such as the skin, liver and bone. Cutaneous manifestations of Crohn's disease are relatively common; however, the groin is an unusual site for cutaneous Crohn's disease. A 36-year-old male presented with mild pruritic nodules on the left groin for 2 months. Nine years ago, he was diagnosed with intestinal Crohn's disease by endoscopic biopsy. Histopathologic examination of the cutaneous lesion showed non-caseating granulomatous reactions composed of multinucleated giant cells with lymphohistiocytic infiltration in the dermis. Staining for periodic acid-Schiff and acid-fast bacilli was negative. From these findings, we diagnosed these lesions as cutaneous Crohn's disease. The lesions were markedly improved with three rounds of intralesional steroid injection.

Interspinous Implantation for Degenerative Lumbar Spine: Clinical and Radiological Outcome at 3-yr Follow Up

OBJECTIVE: Interspinous devices for dynamic stabilization of lumbar spine are undergoing development and clinical trials. A few short-term outcomes of interspinous devices have been reported but little has been mentioned about longterm outcomes. We reviewed 19 cases of interspinous implantation (Coflex Paradigm spine, Germany) to evaluate clinical long-term outcome and radiologic features. METHODS: From January 2003 to March 2004, 19 patients (13 female and 6 male) who underwent interspinous implantation were included and follow-up data on clinical and radiologic outcomes were obtained at last clinic visit (mean follow-up: 38 months). Clinical outcomes were assessed by Visual analogue scale (VAS) score and Odom..s criteria. RESULTS: Preoperative VAS score for low back pain and leg pain was improved from 4.9+/-2.4 and 7.5+/-2.4 to 2.6+/-1.2 and 3.0+/-1.8 respectively at postoperative last clinic visit (p<0.01). Using Odom..s criteria, 7 and 9 patients showed excellent (36.8%) and good (47.3%) results for low back pain and 7 and 11 showed excellent (36.8%) and good (57.9%) results for leg pain. Anterior and posterior disc height were decreased significantly on postoperative follow-up radiologic data due to discectomy at the level of instrumentation (p<0.01). There were no complications such as infection or device failure. CONCLUSIONS: In this long-term follow-up study, clinical outcome was good but disc degeneration after discectomy at instumented level resulting in decrease of disc height was observed.

The Transforming Growth Factor-beta1 Expression in Normal Laryngeal Mucosa, Laryngeal Dysplasia and Laryngeal Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Transforming growth factor-beta1 (TGF-beta1) is a multifunctional regulator of cellular differentiation, motility and growth. Loss of sensitivity to the growth inhibitory effects by TGF-beta1 plays important roles in neoplastic progression. So expression of TGF-beta1 has been described in several tumors, but little is known about the role of TGF-beta1 in neoplastic progression of human larynx. The aim of this study was to investigate the role of TGF-beta1 in the neoplastic progression of human larynx. MATERIALS AND METHODS: We evaluated the expression of TGF-beta1 using immunohistochemical study in 6 cases of normal laryngeal mucosa, 6 cases of laryngeal dysplasia, 20 cases of laryngeal carcinoma. RESULTS: The results were as follows: 1) Normal laryngeal mucosa has no expression of TGF-beta1. 2) The expression of TGF-beta was 16.7% in laryngeal dysplasia, 50.0% in laryngeal carcinoma. CONCLUSION: The TGF-beta1 expression rate was correlated to the progression of laryngeal lesions when compared to normal laryngeal mucosa, laryngeal dysplasia and laryngeal carcinoma.

Expression of bFGF and CD-31 in Laryngeal Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tumor angiogenesis is an essential process required for growth and metastasis of cancer. Basic fibroblast growth factor (bFGF) is one of angiogenetic factors, and platelet endothelial cell adhesion molecule (CD-31) is the commonly used marker to identify the vessel. It is unclear that the degree of angiogenesis and expression of bFGF are related to the growth and metastasis in laryngeal squamous cell carcinoma. We examined the expression of bFGF and degree of angiogenesis in laryngeal squamous cell carcinoma and compared them to normal larynx. Relationship between bFGF and angiogenesis to growth and nodal metastasis in laryngeal squamous cell carcinoma was also evaluated. MATERIAL AND METHODS: Immunohistochemical study for bFGF and CD-31 were performed to detect the angiogenetic factor and degree of angiogenesis in 24 squamous cell carcinoma of larynx and 6 normal laryngeal tissue. Relationship of bFGF expression and degree of angiogenesis in laryngeal squamous cell carcinoma were compared to that in normal larynx. We evaluated relationship of expression of bFGF and degree of angiogenesis to primary stage and nodal stage in laryngeal squamous cell carcinoma. RESULTS: These expression of bFGF and degree of angiogenesis in laryngeal squamous cell carcinoma were significantly higher than in the normal control (p<0.05). The degree of angiogensis were significantly correlated with bFGF expression (p<0.05): the bFGF expression and degree of angiogenesis were not correlated to the nodal stage, but to the primary stage in laryngeal squamous cell carcinoma (p<0.05). CONCLUSION: These results indicate that bFGF and angiogenesis may play an important role in the growth of larygeal squamous cell carcinoma.

A Case of Multicentric Duodenal Carcinoid / 대한소화기내시경학회지

Carcinoid tumors are the most common endocrine tumors of gastrointestinal tract. Argentaffin cells are the origin of carcinoids. These cells belong to the amino precursor uptake and decarboxylation (APUD) system. These cells give the tumor its most distinguishing feature: the ability to produce biogenic amines and polypeptide hormones that, in turn, give rise to the dramatic carcinoid syndrome. We treated a case of multi-centric carcinoid tumor of the duodenum in a 63-year-old male patient. He was admitted to the hospital because of epigastric pain. On the gastrofiberscopic examination, 1.0 x1.5 cm and 0.7 x0.8 cm sized two polyps (Yamada type II, I) were noticed on the duodenal bulb. The biopsy specimen showed carcinoid tumors of different histologic types. The level of 24-hour urine 5-HIAA of this case was normal. He was treated with subtotal gastrectomy with Billroth-II anastomosis. We report this case with literature review.

A case of plasma cell type castleman's disease that transformed into a malignant lymphoma / 대한내과학회지

Castleman's disease is a benign disorder characterized by hypervascular lymphoid hyperplasia. The etiology of the disease is still unknown. Although it may occur at the various sites such as peritoneum, retroperitoneum, pelvic lymph node, muscle and lung, it occurs most commonly at the mediastinum. Even though specific pathophysiologic relations are still not clearly determined between two different histologic types -hyaline vascular type and plasma cell type-, there were several previous reports dealing with the plasma cell type transformed or progressed into different types of malignancies such as malignant lymphoma, Kaposi's sarcoma and Hodgkin's disease. We experienced a case of plasma cell type Castleman's disease that transformed into a malignant lymphoma and report this case with review of literatures.

A Case of Relapsing Polychondritis Developed in Both Auricles / 대한이비인후과학회지

Relapsing polychondritis is a rare disease of unknown etiology. The disease is an immune disorder probably caused by autoimmunity. The characteristics are episodic with progressive inflammation of the cartilages of the body, most often of the ears, nose, costochondral junctions, joints, airway and cardiovascular system. Authors have recently experienced a case of relapsing polychondritis in a 28 year old man who had recurrent chondritis of both auricles. He did not have other involvement. The pathologic finding to the diagnosis was presented. We report this case with a review of the literature.

A Study on the Expression of p53 and the Detection of Human Papilloma Virusin the Sinonasal Inverted Papilloma Associated with Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There have been some reports suggesting that the malignant and benign clinical courses are separable on the basis of HPV subtypes in the sinonasal inverted papilloma. The E6 protein of high risk HPV subtype including types 16 and 18 is known to be associated with p53. The viral E6 protein-p53 complex is responsible for the functional loss of p53 which then becomes immunohistochemically negative. The aim of this study was to determine the prevalence and types of HPV in this neoplasm and evaluate the relationship between expressions of the oncogenes and HPV. MATERIALS AND METHOD: The material was composed of 11 cases of inverted papilloma and 7 cases which were associated with carcinoma. Immunohistochemical staining for p53 was performed. A molecular study of the E6 gene of HPV DNA types 6, 11, 16 and 18 was also performed with separate nest-PCR on squamous cell lesions stainned p53 and papillomatous lesions by use of microdissection technique with paraffin embedded materials. RESULTS: The carcinomatous and dysplastic areas were diffusely positive for p53 in all cases associated with carcinoma, whereas the control group was negative for p53. HPV types 6 and 11, generally known as the lower risk types were presented in the 80% of all cancers and papilloma lesions. A HPV DNA type 18 was solely positive in 2 cases on the p53 overexpressed lesion, associated with carcinoma. CONCLUSION: p53 and HPV may be involved in the pathogenesis of malignant transformation in the inverted papilloma. Therefore, it can be disproved that the HPV subtypes are directly related to either benign or malignant clinical course. However, functional loss of the wild type p53 gene is deeply associated with malignant transformation. In addition to the classical E6 of HPV 16,18-p53, another mechanism could be involved in the functional inactivation of p53.

Monothermal Caloric Test: Comparison of Dizziness Sensation and Nystagmus Parameters according to Age Groups / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: here have been some studies on the influence of age on the results of vestibular function tests with conflicting results. In influence of age on the results of caloric test, we investigated the sensation of dizziness during caloric test by drawing a correlation between the direction of rotatory sensation and the direction of nystagmus. MATERIALS AND METHODS: We performed monothermal caloric test on 44 healthy adults and divided them into six age groups ranging from 16 and 67. RESULTS: During the test with eyes-closed, 80.23% of patients reported a sensation of self-rotation. Of those, 55.81% expressed the direction of rotation to be the same as that of the fast component of nystagmus, whereas 24.42% expressed the direction to be the same as that of the slow component of nystagmus. During caloric test with eyes-open in light, 59.30% reported a sensation that their surroundings rotated around them. Of those, 43.02% expressed the direction of rotatory sensation to be the same as that of the fast component of nystagmus, whereas 16.28% expressed the direction to be the same as that of the slow component of nystagmus. During caloric test with eyes-closed, most of the subjects felt themselves rotating, whereas most of the subjects felt the outside world were rotating in tests with eyes-open in the light. CONCLUSION: Nystagmus parameters (latency, duration, SPEV at eyes-open and at eyes-closed, visual suppression) did not result in significant differences among different age groups: therefore, we conclude that age doesn't influence the results of caloric tests.

Expression of Phospholipase C-beta1 and Phospholipase C-gamma1 on Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A histological finding that is the most characteristic of cholesteatoma is the proliferation of the squamous cell. Signal transduction through phospholipase C(PLC) participates in the regulation of epidermal cell growth and differentiation. EGF, PDGF, and TGF-alpha bind to their receptors and thereby induce tyrosine phosphorylation of the phospholipase C-gamma1 (PLC-gamma1). PLC-gamma1 is a substrate for several receptor tyrosine kinases and its catalytic activity is increased by tyrosine phosphorylation. Tyrosine kinase phosphorylation of PLC-gamma1 stimulates PLC activation and cell proliferation. The G-protein has been shown to specifically activate PLC-beta1. However, the signal transduction pathway and the significance of PLC in cholesteatoma is unknown. This study attempted to provide some evidence that PLC plays a role in cholesteatoma by investigating the distribution and quantity of PLC-beta1 and PLC-gamma1 in the posterior auricular skin and cholestsatoma. MATERIALS AND METHODS: Western blotting and immunohistochemical study were performed for 20 cholesteatoma specimens obtained from patients who underwent operation. RESULTS: Western blot analyses revealed that PLC-beta1 protein and PLC-gamma1 protein were detectable in cholesteatoma and that these proteins were in higher levels compared with the control. In the imm-unohistochemical study, PLC-gamma1 was detected in the horny cell layer of posterior auricular skin but not in the suprabasal layer and the horny cell layer of cholesteatoma. PLC-beta1 was detected in the primary basal layer and a minor reaction was also noted in the spinous layer of posterior auricular skin. However, there were detactable reactions in both the basal and the suprabasal layers of cholesteatoma. CONCLUSION: The results of this study suggest that there are signal transduction pathways through PLC, over-expression of PLC, the different signaling mechanism by PLC in the basal and the suprabasal layer of cholesteatoma.

A Case of Membranous Nephropathy Improved by Removal of Early Gastric Cancer / 대한신장학회잡지

The nephrotic syndrome in association with extrarenal malignancy is not an uncommon event. The membranous nephropathy is most frequently associated with various carcinomas of the lung, breast, stomach and colon. Though the exact causal relationship has not been determined completely, deposition of the immune complexes composed of antitumor antibody and tumor antigens in the subepithelium is most favorably accepted. We experienced a patient with previously diagnosed membranous nephropathy and subsequently demonstrated early gastric cancer during patient follow-up. After surgical resection proteinuria improved significantly. All physicians are strongly recommended to examine thoroughly and search carefully for possibility of concomitant occult malignancy when an aged patient, especially over 40 years old, is diagnosed as a nephrotic syndrome.

The Effect of Substance P on Nasal Mucosal Hypersensitivity through Sensory Nerve Axonal Reflex

The mucus secretion of airway glands is known to be controlled by the various autonomic neurotransmitters such as noradrenalin and acetylcholine. However, a recent study suggests that non-adrenergic, non-cholinergic (NANC) nerves may contribute to the secretory activity of glands. Substance P (SP) has been proposed as a neurotransmitter of the NANC nervous system. SP is present within nerve fibers innervating the airway mucosa and is known to be released from sensory nerves via an axonal reflex. SP activity is controlled by neutral endopeptidase (NEP) which degrades SP. In this study, we evaluated the effects of NEP inhibitor (thiorphan) and substance P on nasal mucosa and histamine on the nasal mucosa in healthy males. In the thiorphan-substance P experimental group, the nasal volume decreased after nebulization of substance P in proportion to the concentration of histamine. In the thiorphan-substance P experimental group, the frequency of sneezing increased in proportion to the concentration of histamine, but there was no increased frequency of sneezing from thiorphan, SP and normal saline. The results of this study suggest that axonal reflexes can play a role in the pathogenesis of nasal mucosal hypersensitivity and neurogenic inflammation.