Ultrasound-guided foam sclerotherapy for treating incompetent great saphenous veins--results of 5 years of analysis and morphologic evolvement study.

BACKGROUND: Varicose veins of the lower leg is a common disease and is associated with long-term morbidity. It has been treated using high ligation with stripping and endovenous laser surgery of the great saphenous vein (GSV). OBJECTIVES: To investigate the clinical outcomes of GSV insufficiency after ultrasound-guided foam sclerotherapy (UGFS) using 3% sodium tetradecyl sulfate (STS). METHODS: Between 2005 and 2009, patients with symptomatic varicose veins secondary to GSV insufficiency were enrolled; 3% STS foam was injected into the GSV under ultrasound visualization. Ultrasound examinations and clinical follow-up were performed at 3- to 6-month intervals. Follow-up visits continued through April 2011. RESULTS: Two hundred 88 limbs of 233 patients were enrolled. The mean follow-up interval was 37.8 months. Occlusion was achieved for 89.6% of the incompetent veins in two sessions of UGFS. The mean number of therapy sessions per leg was 1.53. The internal diameters of the treated veins reduced to 66.9% 3 months and 32.7% at 12 months. CONCLUSIONS: UGFS is effective in sealing incompetent GSV segments. It is a minimally invasive procedure and can be redone several times in cases of recurrence. UGFS is simpler and less painful than stripping surgery and endovenous laser treatment.

Extramammary Paget's disease of the unilateral axilla: a review of seven cases in a 20-year experience.

BACKGROUND: Extramammary Paget's disease (EMPD) is an uncommon malignancy that occurs on apocrine-rich skin. EMPD of the axillary region is extremely rare and is not well documented. Objectives The aim of the study is to review our experience with axillary EMPD with regard to initial examination, treatment, and long-term outcome. METHODS: A retrospective study of inpatient files with the diagnosis of axillary EMPD was made. The data were collected regarding patient demographics, symptoms, surgical treatments, and time to recurrence. Follow-up information was obtained as well. RESULTS: Seven patients with a median age of 67.6 years were diagnosed with axillary EMPD during a 20-year period from 1989 to 2008. The male-female ratio was 1 : 1.3. All patients had a unilateral axillary occurrence, with three in the left and four in the right side. Patients typically presented with a chronic erythematous to brownish plaque with or without pruritus. All patients were treated with wide excision with margins up to 2-3 cm. There were no recurrences after surgery during the follow-up period. CONCLUSIONS: Extramammary Paget's disease of the axillary region is a rare finding even in a large medical center. The disease process is generally a prolonged one without remarkable symptoms. The prognosis of axillary EMPD is relatively good, and long-term follow-up is recommended.

Sebaceous carcinoma of the eyelids: thirty cases from Japan.

Sebaceous carcinoma of the eyelids is rare in Western countries but not uncommon in Asian countries. Diagnosis is difficult both clinically and histologically. Thirty cases of sebaceous carcinoma of the eyelids treated at Tokyo Medical University Hospital were reviewed to elicit characteristic features of pathological findings. The tumor cells were infiltrating in a lobular pattern that consisted mainly of large atypical germinative cells. Sebocytes seen in the lobules had conspicuous nucleolus associated with perinucleolar halo. In 17 cases (57%) there was foamy histiocyte infiltration in and around the tumor nests. Sebaceous duct differentiation, namely holocrine secretion indicating a specific type of coagulation necrosis maintaining a cellular framework or maintaining a bubbly cytoplasm associated with nuclear debris in the periphery, was seen in 24 cases (80%). Although unequivocal squamous differentiation was limited to only 11 carcinomas, scattered individual necrosis with nuclear debris in the background of germinative cells appeared in 29 cases (96.7%). Expression of epithelial membrane antigen, perilipin and adipophilin were detected in all cases. In conclusion, to detect sebaceous differentiation in sebaceous carcinoma, it would be helpful to focus on holocrine secretion, squamous differentiation and foamy macrophage infiltration, and to utilize immunohistochemistry involving anti-perilipin and anti-adipophilin stain.

Cheilitis granulomatosa associated with allergic contact dermatitis to betel quid.

Cheilitis granulomatosa (CG) is a rare disorder of unknown origin, which is characterized clinically by painless, recurrent or persistent swelling of 1 or both lips. Betel quids, composed of betel nuts (seeds of the Areca catechu), slake lime, and Piper betel leaf/or Piper betel inflorescence, are widely used in Asia and strongly associated with oral mucosal disease. It has also been found to be a cause of contact leukomelanosis because of its ingredients of various chemicals. We describe a case of CG induced by betel quid chewing.

Subungual melanoma: histological examination of 50 cases from early stage to bone invasion.

Subungual melanoma is a rare form of malignant melanoma. It is extremely difficult to differentiate it histologically from benign melanonychia striata or melanocytic nevus, especially in the early stage. We divided 50 cases of subungual melanoma into four groups according to clinical progress, and examined their histological findings in each respective stage. In the early stage (19 cases), atypical melanocytes were polygonal showing slight nuclear atypia with no mitoses at all. In six out of 19 cases (31.6%), the atypical melanocytes proliferated more in the hyponychium than in the nail matrix, and only very few in the nail bed. Periungual pigmentation (Hutchinson's sign) appeared from the early stage in almost all cases. With stage progression (middle stage, 13 cases; progressive stage, 13 cases; and bone invasive stage, five cases) the number of atypical melanocytes and their degree of nuclear atypia increased, and the ascent of atypical melanocytes and pagetoid spread became conspicuous. Mitoses became apparent only from the progressive stage. From these observations, we would like to propose three new pathological clues of early stage subungual melanoma: (i) "skip lesion", proliferation of the tumor cells are more prominent in the hyponychium than in the nail bed or nail matrix; (ii) histological confirmation of Hutchinson's sign; and (iii) epithelial thickening and/or compact arrangement of the elongated basal cells.

Ten cases of sebaceous carcinoma arising in nevus sebaceus.

Although nevus sebaceus is known to develop various types of secondary neoplasms, it rarely causes carcinoma and only 14 cases of secondary sebaceous carcinoma have been reported. In this study, 10 cases of sebaceous carcinoma arising in nevus sebaceus were collected. The clinicopathological features and results of immunohistochemical examinations with adipophilin, perilipin and p53 were summarized. Sebaceous carcinoma arising in nevus sebaceous predominantly occurred on the scalp (8/10) of elderly women (mean age, 67.7 years). No case was associated with Muir-Torre syndrome. We found several pathological features of sebaceous carcinoma; that is, made up mainly of germinative cells, moderate nuclear atypia without pleomorphism and many mitoses (4-28/10 high-power field). Adipophilin and perilipin antibodies highlighted lipid drops in the cytoplasm of the malignant cells in all cases. Overexpression of p53 was seen in all cases. In two cases there were coexisting benign-looking sebaceous lesions at the periphery of the main cancer nodule, and in these lesions p53 showed low positivity compared with the clearly malignant area. There was co-occurrence of another neoplasm in three cases with trichoblastoma, sebaceoma and syringocystadenoma papilliferum, respectively. All cases were treated by excision of the malignant lesion, with or without inclusion of the nevus sebaceus. In a follow-up period of 1-7 years, there was no case of recurrence, lymph node metastases or distant metastases. With these specific pathological and immunohistochemical findings using adipophilin, perilipin and p53, we have to consider the possibility that there is a tendency to underdiagnose secondary sebaceous carcinomas in nevus sebaceus. These clinicopathological features of sebaceous carcinomas developing in the nevus sebaceus seem to indicate different biological entities from de novo sebaceous carcinoma.

Treatment of a tufted angioma with intense pulsed light.

Tufted angioma is a rare cutaneous angiomatous proliferation named because of its characteristic histologic pattern of grouped dermal capillary tufts. Lesions usually begin in infancy or early childhood but rarely are congenital. Clinical manifestations are dull red coalescent papules and plaques, most commonly located on the neck, shoulders, and upper back, and can sometimes be tender. Although transformation to malignancy has not been described, tufted angiomas do not tend to regress. Effective treatments reported in the literature are scarce. We report an adult case of tufted angioma, with unusual presentation as annular plaques, which was alleviated after treatment with intense pulsed light in terms of both cosmetics and discomfort.

Malignant cutaneous tumors of the scalp: a study of demographic characteristics and histologic distributions of 398 Taiwanese patients.

BACKGROUND: The scalp is a unique anatomic region, in which pilosebaceous follicles are concentrated. OBJECTIVE: We sought to investigate demographic characteristics and histologic distributions of malignant scalp tumors. METHODS: Primary and metastatic scalp malignancies diagnosed histopathologically between 1983 and 2003 were reviewed. Age at diagnosis, sex, and histologic types were analyzed. RESULTS: A total of 398 Taiwanese patients (200 males, 198 females) were selected. Age at diagnosis ranged from 3 to 103 years. Most malignant scalp tumors (69.8%) occurred in those 50 years or older. Basal (41.2%) and squamous (16.6%) cell carcinomas were the most common histologic types. Surprisingly, metastatic tumors (12.8%) came in third, in which lung cancers were the most frequent primary tumor in both male and female patients. LIMITATIONS: In our series, the case number of metastatic scalp malignancies was underestimated because not all patients with metastatic scalp tumors received a scalp skin biopsy. CONCLUSION: Because a wide spectrum of primary and metastatic malignancies can occur on the scalp, scalp inspection should be included in general screening for either skin or internal cancers.