Hiroshi Takasu

Malignant chondroid syringoma with bone invasion: A case report and review of the literature

We describe a 27-year-old Japanese female with a recurrent nodule on the left big toe and local bone invasion. Histopathologically, the tumor consisted of nests of atypical cells with few mitotic cells, which partly formed gland-like structures. Areas of myxoid degeneration, positive for Alcian blue staining and that did not stain after they were digested with hyaluronidase, were prominent in the matrix among tumor cells. Positive staining was noted in tumor cells for cytokeratin (AE1+AE3), S-100 protein, neuron specific enolase (NSE), and glial fibrillary acidic protein (GFAP). These findings, especially positive GFAP staining were characteristic and very helpful for the diagnosis of the rare tumor-malignant chondroid syringoma. Based on the previous reports, 39% of cases were found to have metastatic lesions and 22% died of this malignant tumor. There have been no reports reporting effectiveness of chemotherapy and radiotherapy, and an early wide excision with a broad margin may be the most reliable treatment to date.

Prognostic significance of the hair follicle stem cell marker nestin in patients with malignant melanoma

Nestin is an intermediate filament protein, and serves as a hair follicle stem cell and neural stem cell marker. Recent studies have suggested that nestin expression is also important for tumorigenesis. Previous reports from our laboratory have revealed that nestin is a marker of HMB-45-negative melanoma cells in dermal invasive lesions of nodular malignant melanoma. The present study examines nestin expression in malignant melanoma and investigates the relationship between nestin expression and prognosis in patients. We immunohistochemically stained 78 formalin-fixed and paraffin-embedded malignant melanomas for nestin, HMB-45 and S100 reactivity. We found that nestin, HMB-45 and S100 protein were detected in 56.5%, 88.4% and 100% of malignant melanomas, respectively. The 5-year survival rate of stage I and II nestin-positive cases was significantly decreased compared to the nestin-negative cases (p < 0.05). In addition, the 5-year survival rate exceeded 80% in nestin-negative malignant melanomas at all stages of tumor development. We conclude that nestin expression may be a predictor of poor prognosis in patients with malignant melanoma.

Aggressive digital papillary adenocarcinoma on the palm with pulmonary metastases

A 41‐year‐old Japanese male had aggressive digital papillary adenocarcinoma with pulmonary metastases. He had an asymptomatic, solitary, dome‐shaped, skin‐colored firm nodule on his left palm for half year. The tumor consisted of multiple lobules of anaplastic epithelial cells with central necrosis. The neoplastic cells were immunohistochemically positive for cytokeratin and S‐100 protein. Two years after the lesion was removed, pulmonary nodular lesions were found on chest X‐ray. On histopathological examination, the pulmonary biopsy specimens showed lobular proliferation of acantholytic tumor cells and some ductal structures associated with papillary projections. Five years after the initial removal of the lesion, the patient was referred to our hospital because of a recurrent skin nodule on his left palm. The recurrent skin tumor was found to have lobular proliferation of anaplastic cells. On immunohistochemistry, the pulmonary metastasis and the palmar skin nodules were identical. The tumor was diagnosed as an aggressive digital papillary adenocarcinoma. This report is a rare case of aggressive digital papillary adenocarcinoma that was diagnosed based on the histopathology of the pulmonary metastases, which showed ductal structures associated with papillary projections.

The Analysis of mRNA Expression of Cytokines from Skin Lesions in Churg-Strauss Syndrome

We report our recent clinical experience with a patient suffering from Churg‐Strauss syndrome and the results of our investigation into the mRNA expression of cytokines in the patients lesions as well as in the frozen sections from a previous patient. In both cases, blood IgG was at a high level.

A case of solitary indeterminate cell histiocytosis

Introduction Indeterminate cell histiocytosis (ICH), a disorder of cells of the histiocytic family, has been infrequently reported in the literature (1). Although ICH usually presents as numerous papules or nodules, there have been a few reports of solitary lesions (2, 3). Levisohn et al. (2) reported an ICH patient presenting with a single regressing nodule composed of indeterminate cells. We describe herein an additional case of solitary ICH that showed spontaneous regression.

Nestin is expressed in HMB-45 negative melanoma cells in dermal parts of nodular melanoma

Nestin, a marker of neural stem cells, is expressed in the stem cells of the mouse hair follicle. The nestin‐expressing hair follicle stem cells can differentiate into neurons, glia, keratocytes, smooth muscle cells and melanocytes in vitro. These pluripotent nestin‐expressing stem cells are keratin 15 (K15)‐negative, suggesting that they are in a relatively undifferentiated state. Recent studies suggest that the epithelial stem cells are important in tumorigenesis, and nestin expression is thought to be important in tumorigenesis. In the present study, we examined the expression of the hair follicle and neural stem cell marker nestin, as well as S‐100 and HMB‐45, in melanoma. Nestin immunoreactivity was observed in the HMB‐45‐negative melanoma cells in all five cases of amelanotic nodular melanomas. Moreover, nestin immunoreactivity was observed in the dermal parts in seven of 10 cases of melanotic nodular melanomas. Especially, nestin immunoreactivity was observed in the HMB‐45‐negative melanoma cells in the dermal parts of all 10 cases of HMB‐45‐negative amelanotic and melanotic nodular melanomas. On the other hand, nestin expression was negative in 10 of 12 cases of superficial spreading melanoma. These results suggest that nestin is an important marker of HMB‐45‐negative melanoma cells in the dermal parts of patients with nodular melanoma.

Detection of human papillomavirus type 16 in Bowen's carcinoma of the toe.

Background  Human papillomavirus (HPV) is known to cause cervical cancer. Because it has been detected in lesions of Bowenoid papulosis, Bowen’s disease, and Bowen’s carcinoma, HPV infection has been implicated in the pathogenesis of these diseases.

Folliculotropic mycosis fungoides successfully treated with narrow band UVB

Auteur(s) : Tomonori Taniguchi, Yasuyuki Amoh, Kensei Katsuoka, Hiroshi Takasu Department of Dermatology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa, 228-8555, Japan A 56-year-old Japanese female was referred to our hospital with a 2-month history of indurated, erythematous plaques on her trunk and lower extremities. Initially, she had noticed a red plaque on the lateral aspect of her lower leg with other lesions gradually appearing over the period of 1 month [...]

A case of cutaneous sarcoid vasculitis with livedo and review of the literature

and CD68 was positive for granuloma cells. The histopathological features were considered to be those of CSV. The abovementioned clinical and histopathological findings and laboratory results led to the diagnosis of CSV with granulomatous vasculitis. The livedo and BHL disappeared without any treatment approximately 2 months after onset. She was treated as steroid ophthalmic solution for uveitis, and her visual acuity improved. These diseases did not show recurrence until now. Livedo is caused by impaired perfusion and hypoxia in the skin; therefore, it may occur in the setting of vessel wall injury or intravascular obstruction that interrupts the circulation. Livedo occurs in peripheral atherosclerosis, autoimmune and collagen diseases, thrombosis, and in cholesterol embolization syndrome [7], but rarely in sarcoidosis [8, 9]. Cutaneous manifestations of sarcoidosis include lupus pernio, infiltrated plaques, maculopapular eruptions, subcutaneous nodules, infiltration of old scars, and erythema To the Editor,

A case of symmetrical drug‐related intertriginous and flexural exanthema induced by acetaminophen

Dear Editor, A 53-year-old man was treated with radiation therapy for prostate cancer. After radiation therapy, acute prostatitis developed. Cefcapene pivoxil and acetaminophen were administrated. One day after commencement of the two drugs, he noticed a sharply defined, symmetrical erythema on both legs, axillae, and buttocks without systemic symptoms (Fig. 1a,b). No mucosal lesions were seen. Laboratory tests revealed mild leukocytosis (9600/lL) and an increased level of C-reactive protein (8.84 mg/dL). The skin biopsy specimen from the cutaneous lesions on the buttocks showed small subcorneal neutrophilic pustules, numerous lymphocytes, and some eosinophilic infiltrates around upper dermal small vessels (Fig. 1c). After discontinuing cefcapene pivoxil and acetaminophen, oral prednisolone at 20 mg daily was administrated, and the erythema disappeared without pigmentation. Patch tests were negative. The lymphocyte transformation test for acetaminophen was positive at 140 cpm and the stimulation index (S.I.) was 218% (control was 64 cpm and the normal limit of S.I. is <180%). Oral provocation testing with acetaminophen resulted in an identical flexural rash on the right leg that appeared a few hours after provocation. A diagnosis of SDRIFE induced by acetaminophen was made based on the above findings. The baboon syndrome is a particular form of systemic contact dermatitis caused by systemic exposure to mercury, nickel, or other agents. Drug-related baboon syndrome is also known as SDRIFE. The proposed criteria are: (i) exposure to a systemically administered drug (classical contact allergens have to be excluded); (ii) sharply demarcated erythema of the gluteal/perianal area and/or V-shaped erythema affecting the inguinal/perigenital area; (iii) involvement of at least one other intertriginous/flexural fold; (iv) symmetry of eruption; and (v) absence of systemic symptoms and signs. Although our patient met all of these criteria, he did not have the characteristic inguinal erythema. The common histopathological finding is a superficial perivascular infiltrate of lymphocytes, sometimes with neutrophils and eosinophils. Other findings include epidermal spongiosis, subcorneal pustules, and vacuolar change in the basal layer. SDRIFE is primarily a clinical diagnosis, and laboratory investigations and histopathological features are not strictly required for the diagnosis. The differential diagnosis of SDRIFE is fixed drug eruption and acute generalized exanthematous pustulosis (AGEP). Fixed drug eruption presents with a small number of violaceous plaques that leave postinflammatory hyperpigmentation. AGEP is characterized by numerous non-follicular pustules on erythematous and edema(a)