Hidemichi Kubo

Temporal expression of wound healing-related genes in skin burn injury

Determination of the age of burns, as well as of wounds induced mechanically, is essential in forensic practice, particularly in cases of suspected child abuse. Here, we investigated temporal changes in the expression of 13 genes during wound healing after a burn. The expression of cytokines (IL-1β, IL-6, IL-10, TNF-α, and IFN-γ), chemokines (KC, MCP-1), proliferative factors (TGF-β, VEGF), proteases (MMP-2, 9, 13) and type I collagen in murine skin was examined by real-time PCR at 3, 6, 9, and 12 h and 1, 2, 3, 5, 7, and 14 days after a burn. Based on macroscopic and histological appearance, the healing process of a burn consists of 3 phases: inflammatory (from 3 h to 1 day after the burn), proliferative (from 1 to 7 days), and maturation (from 7 to 14 days). Expression of IL-1β, IL-6, TNF-α, IFN-γ and KC increased significantly in a biphasic pattern from 3 or 6 h to 12 h or 1 day and from 3 or 5 days to 7 days. Expression of MCP-1 increased significantly from 6 h to 5 days. Expression of both IL-10 and TGF-β increased significantly from 12 h to 7 days. Expression of VEGF, MMP-2, MMP-13 and type I collagen increased significantly from 3 days to 7 or 14 days. Expression of MMP-9 increased significantly from 6 h to 14 days. Our results suggest that evaluating the expression of a combination of these genes would enable the exact estimation of the age of a burn.

Spontaneous regression of recurrent and metastatic Merkel cell carcinoma

Merkel cell carcinoma (MCC) is a malignant neuroendocrine tumor with a high rate of recurrence and metastasis. Despite its high degree of malignancy, spontaneous regression has been documented. We report an 87‐year‐old woman who presented with recurrent MCC on her left cheek and regional lymph node metastasis. Although she received no treatment due to her poor condition, the recurrent metastatic lesion regressed spontaneously within 2 months.

Evaluation of a newly‐developed immunochromatography strip test for diagnosing dermatophytosis

Background  Traditionally, dermatophytosis, a common disease affecting millions of people world‐wide, has been diagnosed by direct microscopy and fungal culture. The immunochromatography (ICG) strip test was recently developed.

Facial paraffinoma after cosmetic paraffin injection.

Dear Editor, Paraffinoma is characterized by a granulomatous inflammation of the skin due to exogenous paraffin. We encountered a 74-year-old Japanese woman with paraffinoma of the face that developed 40 years after cosmetic paraffin injections. She noticed indurated erythematous lesions with local heat sensation on her bilateral cheeks 2 months prior to visiting our department. Examination of the lesions that had expanded to affect her forehead revealed indurated erythematous plaques on her forehead and bilateral cheeks (Fig. 1). Cheek and forehead biopsy showed dense inflammatory infiltrates involving the entire dermis and epithelioid granulomas without caseation necrosis. Round or ovoid clear vacuoles, varying in size up to approximately 50 μm, were scattered in the dermis (Fig. 2). The results of routine laboratory examinations and her serum angiotensin-converting enzyme level were within normal limits. Acid-fast bacteria staining demonstrated no microbes. Chest X-ray and ophthalmological examinations revealed no abnormal findings. Repeat biopsy for fat stains and electron microscopic (EM) studies showed positive vacuolar fat staining with oil red O and Sudan IV (Fig. 3). There were minute clear deposits in the cytoplasm of macrophages (Fig. 4) that were not stained by osmium acid. Consequently, a diagnosis of paraffinoma was made and she received systemic prednisolone, 20 mg daily. Her skin lesions subsided gradually. Paraffinoma, defined as a granulomatous foreign body reaction, results from the i.d. injection of oily substances containing long-chain acyclic hydrocarbons. It usually manifest as irregular plaque-like indurations of the skin. Macroscopically, excised specimens are white or grayish-white; microscopically, there is granulomatous inflammation with multiple clear vacuoles, resulting in the so-called “Swiss cheese” appearance which was not clearly evident in our case. Because our patient received paraffin injections in the 1960s, we could exclude silicone granuloma. Paraffinoma is characterized by dense inflammatory infiltrates and fewer multinucleated giant cells than are seen in silicone granulomas. In our biopsy specimen, inflammatory infiltrates were dense throughout the dermis and giant cells were absent. In frozen sections, vacuoles were positive for fat stains with Sudan IV and oil red O; on EM study, they were negative for osmic acid.

Forensic diagnosis of ante- and postmortem burn based on aquaporin-3 gene expression in the skin

In order to diagnose death associated with fire, it is essential to show that the person was exposed to heat while still alive. We investigated both AQP1 and AQP3 expression in the skin of an experimental burn model, as well as in forensic autopsy cases, and discuss its role in the differential diagnosis of ante- and postmortem burns. In animal experiments, there was no difference in AQP1 gene expression among four groups (n=4): antemortem burn, postmortem burn, mechanical wound, and control. However, AQP3 expression in the antemortem burn was increased significantly compared with that of the other groups even at 5min after burn. Water content of the skin was decreased significantly by the burn procedure. Consistent with animal experiments, AQP3 gene expression in the skin of antemortem burn cases was increased significantly compared with postmortem burns, mechanical wounds, and controls (n=12 in each group). These observations suggest that dermal AQP3 gene expression was increased to maintain water homeostasis in response to dehydration from burn. Finally, our results suggest that AQP3 gene expression may be useful for forensic molecular diagnosis of antemortem burn.

Metastatic cutaneous squamous cell carcinoma treated successfully with surgery, radiotherapy and S-1/cisplatin chemotherapy

Primary cutaneous squamous cell carcinoma (SCC) is a malignant tumor that arises from keratinizing cells of the epidermis or its appendages. We present a patient with cutaneous SCC on the left instep with metastases to multiple lymph nodes in the para‐aortic, iliac and groin region. We chose a combination of surgery and concurrent chemoradiotherapy. The chemotherapeutic agent S‐1/cisplatin was selected based on results of the histoculture drug response assay. The patient responded dramatically to this multidisciplinary treatment and complete remission was achieved.

Rare case of Langerhans cell sarcoma with cutaneous manifestation arising on the inguinal region.

carcinoma-like features in a nodule. The fact that nodules with solid carcinoma-like histopathological features had appeared from an erythematous plaque leads us to hypothesize that the tumor cells differentiated into two directions of either tubular structures in an erythematous plaque or solid carcinoma-like features in a nodule. In accordance with this hypothesis, immunohistochemical staining shared a positive reaction with EMA in tumor cells of both syringomatous carcinoma and solid carcinoma-like features. The size of this tumor (24 cm 9 15 cm) is quite large compared with previous cases, and the location is relatively rare since most cases of syringomatous carcinoma occur on the face, axillae and scalp. In conclusion, we report a case that supports the concept of syringomatous carcinomas having several different histological expression patterns.

Cryotherapy for Massive Vulvar Lymphatic Leakage Complicated with Lymphangiomas Following Gynecological Cancer Treatment

Vulvar lymphatic leakage is a severe complication associated with gynecological cancer treatments. However, standard treatment strategies have not yet been determined. We encountered a rare case of a 76-year-old multiparous woman suffering from massive lymphatic fluid leakage from the entire vulva, and papules developed and were identified as lymphangiomas. A large amount of straw-colored discharge continued from all vulvar papules, which extended over the mons pubis. Nine years ago, the patient had undergone a radical hysterectomy with concurrent chemoradiation for uterine cervical cancer treatment. Her serum albumin level was 1.9 mg/dl, which was attributed to the loss of a large amount of lymph fluid due to leakage from the vulva. Her quality of life gradually decreased because of general fatigue and the need for frequent diaper exchanges every 2 h. The patient received a less-invasive treatment with cryotherapy using liquid nitrogen. She also received a multimodality treatment consisting of the intravenous administration of albumin, massage of the lower limbs and intensive rehabilitation. Cryotherapy was administered once a week for 3 months. Her discharge almost stopped and vulvar lymphangiomas decreased without any major complications. To the best of our knowledge, this is the first case report of massive lymphatic leakage complicated with vulvar lymphangiomas. Additionally, this case may represent the first successful treatment of vulva lymph leakage by cryotherapy without recurrence. Cryotherapy may have the potential to improve the quality of life as a less-invasive treatment for gynecological cancer survivors without serious complications.

Blastic plasmacytoid dendritic cell neoplasm in a human T-cell lymphotropic virus type I (HTLV-1) carrier: a coincidental association?

ejd.2013.1989 Auteur(s) : Youhei Uchida uchi-y@m2.kufm.kagoshima-u.ac.jp, Kazuhiro Kawai, Hidemichi Kubo, Koichiro Takeda, Mitsuyoshi Shimokawa, Noriko Yoshii, Takuro Kanekura Department of Dermatology, Kagoshima University Medical School 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare aggressive tumor derived from plasmacytoid dendritic cells [1]. Gurgen et al. [2], reported a case of BPDCN in a human T-cell lymphotropic virus type I [...]

Malignant melanoma with nodal involvement in a 17-year-old female

Journal of Cancer Research and Therapeutics July-September 2010 Volume 6 Issue 3 sarcoma, acquired immunodeficiency syndrome (AIDS), tuberculosis, Whipple’s disease and post transplant lymphoproliferative disorder (PTLD), of which non Hodgkin’s lymphoma is the most common cause. Mesenteric lymphomas grow to a large size and cause bulky adenopathy encasing mesenteric vessels without producing clinical symptoms. On CT or ultrasound imaging, the confluent mesenteric nodes resemble two halves of a sandwich and the tubular mesenteric vessels and perivascular fat resemble the sandwich filling. This sign is also seen in PTLD, which should be considered in patients who have undergone transplantation. PTLD is characterized by gastrointestinal involvement and the absence of superficial nodal disease. Other causes of mesenteric adenopathy have typical clinical symptoms and do not produce the large bulky adenopathy that results in the sandwich sign. Mesenteric lymphomas can also show retroperitoneal adenopathy and increased attenuation of the mesentery (misty mesentery).