Hisashi Ohtsuka

Microcystic adnexal carcinoma: review of 51 Japanese patients.

Background: Microcystic adnexal carcinoma (MAC) has been reported to occur predominantly in Caucasians. However, the number of cases in Japanese subjects seems to have recently been increasing. Objective: To review the Japanese cases of MAC. Methods: We collected and analyzed the data of 51 Japanese patients recorded in case reports or abstracts over a number of years. Results: Twenty-five of the cases were reported between 1987 and 1996, and the remaining 26 cases between 1997 and 2000. Forty-three lesions were located on the face, 2 on the scalp, 2 on the chest, 1 on the axilla, 1 on the buttock, 1 on the palm and 1 on the toe. One of the above occurred at the site of previous radiotherapy. Fifteen tumors were initially misdiagnosed histopathologically. Conclusion: Our review shows that MAC also occurs in the Japanese, in whom it may be more common than previously observed.

Reconstruction of a posterior defect of the elbow joint using an extensor carpi radialis longus myocutaneous flap: case report

An extensor carpi radialis longus (ECRL) myocutaneous flap was successfully used for the repair of a posterior defect of the elbow joint in a physically handicapped female with Parkinsonism. This muscle is of value for a one-stage reconstruction of an elbow lesion.

Cryosurgery for hemangiomas of the body surface and oral cavity.

The indications for and limitations of cryosurgery for various types of hemangiomas on the body surface or in the intraoral region are reported based on our clinical experience. In our opinion, cryosurgery is not the method of choice in the management of hemangiomas but is useful under certain conditions, as with a localized cavernous under certain conditions, as with a localized cavernous hemangioma in the facial or intraoral region. It is also valuable for strawberry marks with bleeding or infection and may be acceptable for small port-wine stains; in the treatment of extensive port-wine stains, a resulting hypertrophic scar or depigmentation may present difficulties.

Bilateral vermilion flaps for lower lip repair.

A more natural reconstructive procedure of the lower lip using bilateral vermilion flaps was applied in five patients with excellent results. The vermilion defects were about two-fifths to three-fifths. In three patients, the vermilion defect was repaired using bilateral vermilion flaps alone. In the remaining two patients, a narrow horizontal lip defect was repaired by bilateral vermilion flaps and a subcutaneous V-Y advancement flap of the lower lip. A single vermilion flap or bilateral vermilion flaps are considered to be of great value for vermilion reconstruction because of the inherent elasticity and common anatomic unit. The postoperative scars are not remarkable at all. A long and narrow horizontal lip defect (perhaps within 1.5 cm downward from the vermilion border) may be effectively repaired by the combination of vermilion flap(s) and a V-Y advancement flap without sacrificing any additional healthy tissue.

Modified Limberg flap for lumbosacral meningomyelocele defects

We have recently developed a technique for closing round or wide oval lumbosacral meningomyelocele defects by modifying the Limberg flap. Four cases of repair of lumbosacral meningomyelocele were treated, with good skin closure in 3. The indications for and advantages of our method are discussed.

Nonsense mutations at Arg-1947 in two cases of familial neurofibromatosis type 1 in Japanese

We report two familial cases of NF1 presenting as C to T transitions changing an Arg-1947 codon to a stop codon. In one of the two families, cosegregation of the mutation with NF1 was demonstrated, indicating this mutation causes the disease in this family. As the same mutation at Arg-1947 has been reported previously in three cases of unrelated Caucasians (two are sporadic; the origin of the other is not reported), the codon at Arg-1947 (CGA) in the NF1 gene is considered to be a hotspot common among different ethnic groups and also among familial and sporadic cases.

Merkel Cell Carcinoma and Multiple Bowen's Disease: Incidental Association or Possible Relationship to Inorganic Arsenic Exposure?

An 81‐year‐old Japanese male was referred to our clinic in 1991 with multiple Bowens disease. The associated hyperpigmentation of the trunk and extremities and palmo‐plantar keratotic nodules indicated that he had suffered from chronic arsenic poisoning. Interestingly, he was a native of Namikata in Ehime, Japan, where many residents have suffered from multiple Bowens disease with internal malignancy. Arsenic exposure was strongly suspected. Two years later, Merkel cell carcinoma developed on the dorsum of his right hand, where Bowens disease lesions were absent. Metastasis of this Merkel cell carcinoma led to his eventual death one year later. To our knowledge, this is the first report of Merkel cell carcinoma associated with multiple Bowens disease. Chronic arsenic poisoning may be responsible for the association of these two rare skin neoplasms.

Microcystic Adnexal Carcinoma with Langerhans Cells

A slowly growing, subcutaneous mass in the left eyebrow region of a 54‐year‐old Japanese woman showed numerous small epithelial cell nests surrounded by a dense desmoplastic stroma. The epithelial cell nests showed partially keratinizing cystic structures containing a small amount of glycogen. Immunoperoxidase staining for carcinoembryonic antigen was positive only in the lumina or on the ductal lining surface of tumor cells; staining for S‐100 protein was positive within almost all of the tumor nests. Birbeck granules indicating Langerhans cells were found within some of the cells.

Chondrolipoma of the popliteal fossa and Japanese reports

A rare case of chondrolipoma of the right popliteal fossa in a 24‐year‐old female was reported with review of the Japanese published work. Eleven patients with chondrolipoma including lipoma with cartilaginous metaplasia, including my case, have been reported in Japan. The patients ranged in age from 7–79 years. All cases occurred in adults except for one. Six patients were male and five were female. Two lesions each arose on the tongue, upper back and popliteal fossa, and one each on the buccal submucosa, shoulder, breast, lateral chest and sole. The duration of the lesions ranged from 1 month to 20 years. The lesions ranged 1–10 cm in greatest dimension. The presented tumor was an early one because of the shortest duration and the smallest size in Japan. Recent criteria for a benign mesenchymoma including a chondrolipoma were also described.

A free arterialized venous loop flap.

An arterialized venous loop flap measuring 6 x 16 cm was transferred from the left forearm to the right lower leg for reconstruction of an unstable skin graft on the tibia. The transferred flap became softer and thinner, as intended, after ligation of the afferent artery, which was performed 50 days after the first operation. The operative results were satisfactory.