Hiko Hyakusoku

Sentinel node biopsy in a patient with malignant melanoma of the under back.

In patients with malignant melanoma, the site for lymph node dessection is now determined by the primary site of the tumor according to the standard of UICC. However, sometimes it is difficult to predict accurate lymph node drainage because the tumor occupies two or three lymph node areas, which Sappey called “Watershed” areas, such as the midline of the trunk. We applied the technique of sentinel node biopsy (SNB) using patent blue dye for the patient with malignant melanoma of the under back. It was possible to detect the lymph node drainage flowing not only to the groin area but also to the axillar area. We consider that SNB is one of the effective methods to determine the lymph node drainage of the tumor in so-called “Watershed” areas. [Skin Cancer (Japan) 2002; 17: 31-37]

Example of Bowen disease from porokeratosis.

We reported on one case of Bowens disease believed to have arisen from porokeratosis. It is known that malignant tumors develop from the porokeratosis eruption, so the course of the disease has to be monitored over a period of time. Further, acutive histological examination should be carried out with this disease when the following are recognized in the area of the eruption, erythema, roughening of the surface, warts, erosion, ulcers, or the adherence of a crust.

A case of head apocrine adenocarcinoma.

A case of apocrine adenocarcinoma arising in the scalp is reported. A 69-year-old male presented with an ulcerated nodular reddish firm mass in his scalp and two subcutaneous nodules in the left side of his neck. The biopsy suggested a metastatic adenocarcinoma, but a whole body CT, Ga scintigram and other examinations revealed no evidence of malignant tumor in other organs. Therefore we diagnosed it as sweat gland carcinoma and the wide resection and total neck dissection were done. The histopathology of the resected tumor showed adenocarcinoma with varying degrees of differentiation, composed of cords and nests which occasionally formed branching lumina. Atypical epithelial cells had abundant eosinophilic cytoplasm and only rarely showed projections from the apical cytoplasm consistent with decapitation secretion. Some tumor cells and luminal eosinophilic material were PAS positive, diastase-resistant, and were also alcian blue and CEA positive. By electron microscopy, the epithelial cells showed enlarge and rounded mitochondria and electron dense secretory granules, but no tonofilaments in the cytoplasm. Microvilli were seen along the luminal membrane. Infrequently apical membranes protruded in the lumen and showed typical dividing membrane. In addition, myoepithelial cells were seen along the basal epithelial membranes that led us to the final diagnosis of apocrine adenocar-cinoma.It is difficult to make a diagnosis of carcinoma of sweat glands, especially in poorly differentiated cases, because of the histological similarity to metastatic adenocarcinoma in the skin. Apocrine adenocarcinoma that usually occurs in axilla or wherever apocrine glands normally exist and has high risk of regional lymph nodes metastasis is an uncommon neoplasm. Our case of apocrine adenocarcinoma of the scalp is the 4th reported case in Japan. Immuno-histochemical stainings are likely to be overused to make a diagnosis of sweat gland carcinoma. We should be reminded that some basic histological features such as decapitation secretion or myoepithelial cells which are elongated cells surrounding tumor nests and positive for smoothmuscle actin are still very contributory to define these tumors.Mishima and Morioka suggest sweat gland tumors can be classified according to their anatomical origin and malignancy that provide us relatively clear-cut concept of these tumors. Using Mishima and Morioka system, we classify this tumor as an apocrine spirocarinoma because of the presence of decapitation secretion and myoepithelial cells, and the absence of tonofilaments.

Reconstruction of face by vein flap.Application of vein flap in reconstruction after extraction of face skin malignant tumor.

静脈皮弁 (arterialized venous flap) による皮膚悪性腫瘍摘出後の顔面再建例2例を経験した。本皮弁を遊離皮弁として顔面に移植することで, 従来の局所皮弁法に比べて顔面瘢痕を最小限にできるとともに, 顔面以外の部位を採取部とする有茎皮弁法, 遊離皮弁法に比べ採取部の主要動脈を温存しつつ, 手技的に容易にthin flapの移植が可能であることを症例を供覧し報告した。