J. Yu-Yun Lee

Depigmented genital extramammary Paget’s disease: A possible histogenetic link to Toker’s clear cells and clear cell papulosis

Background: The histogenesis of extramammary Paget’s disease (EMPD) is still controversial. Benign pagetoid cells of the nipple first described by Toker and the similar clear cells found in white maculopapules of clear cell papulosis (CCP) have been proposed to be potential precursor cells giving rise to EMPD and primary intraepidermal Paget’s disease in the nipple. The observation of a rare case of depigmented EMPD provided us with a chance to examine further the interesting Toker’s clear cell/CCP hypothesis.

Alopecia syphilitica, a simulator of alopecia areata : histopathology and differential diagnosis

Alopecia syphilitica (AS) may be “moth‐eaten” or diffuse, clinically, and be confused with alopecia areata (AA) or other alopecias. The English language literature contains scant information regarding the histopathology of AS, and the resemblance between AS and AA has not been given adequate recognition. We report the histopathological findings of AS from nine patients with secondary syphilis and acute hair loss. The alopecia was moth‐eaten in four patients and diffuse, but slightly moth‐eaten, in five. Microscopically, the dermoepidermal interface was not involved. The numbers of hair follicles were diminished, with increased numbers of catagens and telogens. Lymphocytic infiltration was present around the hair bulbs and fibrous tracts in eight cases. Plasma cells were present in four biopsies. Other less common findings included lymphocytes in the isthmus, parabulbal lymphoid aggregates, and granulomatous infiltrate in the upper dermis. The findings, save for the follicular changes, resembled those of macular/maculopapular syphilides outside the scalp. With the follicular changes, the overall patterns resembled AA closely. The modified Steiner stain did not reveal spirochetes in any of our cases and failed to differentiate between AS and AA. Comparing the AS cases to 13 cases of AA, we found only a few differentiating features. The presence of peribulbal eosinophils strongly suggests AA. Without peribulbal eosinophils, the presence of plasma cells, abundant lymphocytes in the isthmus, or parabulbal lymphoid aggregates suggests AS.

Primary cutaneous CD30+ anaplastic large cell lymphoma with keratoacanthoma‐like pseudocarcinomatous hyperplasia and marked eosinophilia and neutrophilia

Background:  Pseudocarcinomatous hyperplasia (PCH) and marked tissue neutrophilia have been observed in cutaneous CD30+ anaplastic large cell lymphoma (ALCL) occasionally and may cause misdiagnosis.

Ofuji's disease with follicular mucinosis and its differential diagnosis from alopecia mucinosa.

Objectives:  Ofujis disease (OD) or eosinophilic pustular folliculitis and human immunodeficiency virus‐associated eosinophilic folliculitis (HIV‐EF) both show eosinophil‐rich folliculocentric infiltrates, and it is not clear whether they are distinguishable pathologically. Follicular mucinosis (FM) has been observed in lesions of EF; such cases need to be differentiated from alopecia mucinosa (AM).

Pathogenesis of hair infection and black dots in tinea capitis caused by Trichophyton violaceum: a histopathological study

The majority of tinea capitis in southern Taiwan occur in adult women and are caused by Trichophyton violaceum. We report the histopathological Endings of a series of 10 cases of tinea capitis caused by T. violaceum, the largest such study to date. Our study provides new information regarding the process of hair infection, mechanism of black dot formation, and chronicity of infection caused by this fungus. The cuticle remains intact. The fungi enter the proximal cortex where the cuticle is immature. They then colonize the proximal keratinized cortex and generate septate hyphae which transform gradually into arthrospores as they arc carried upwards by the growing hair. At the infundibular level, the hair cortex is almost completely replaced by spores and swells, impeding further exit of the growing hair and causing the already weakened hair to coil up inside the infundibulum, forming a black dol. In one patient who had infection for more than 20 years, there were changes suggestive of cyclic rein‐lection of the same follicles which might contribute to the chronicity of die infection.

Follicular Mucinosis Occurring after Bone Marrow Transplantation in a Patient with Acute Lymphoblastic Leukemia

Follicular mucinosis (FM) is characterized histologically by mucinous degeneration of the outer root sheath of the hair follicle and sebaceous gland, accompanied by inflammatory infiltrate. It can occur as a primary idiopathic disorder or in association with benign or malignant diseases, most notably mycosis fungoides. In addition, it also can be found incidentally on histology. We describe an unusual case of follicular mucinosis in a 19-year-old man with acute lymphoblastic leukemia (ALL). One month after bone marrow transplantation, he developed cutaneous graft-versus-host disease (GVHD) involving the palms and soles, which was followed 12 days later by the appearance of multiple erythematous follicular papules and plaques on his face, auricles, and postauricular area. Biopsy of follicular plaque revealed changes of follicular mucinosis without evidence of graft-versus-host disease or leukemia cutis. The follicular rash was associated with prominent peripheral eosinophilia. The rash and eosinophilia resolved after 2 and 4 weeks, respectively. In conclusion, we report a case of FM occurring as a transient reaction during the course of cutaneous GVHD following bone marrow transplantation for ALL. Awareness of this condition may avoid undue concern that the rash might represent a manifestation of GVHD, cutaneous relapse of the hematological malignancy, or a drug allergy.

Use of Tissue Meshing Technique to Facilitate Side to Side Closure of Large Defects

background. Primary closure of a large wound usually needs flaps of sophisticated design or skin grafts, both require more skill and wound care. Motley and Holt first reported the use of meshed advancement flap, a relative simple technique to close large defects of the lower leg in five patients. objective. To report the use of tissue meshing technique to close large wounds with significant tension on various sites of the body. methods. Six patients with large benign or malignant neoplasms at various sites of the body were included. Tissue meshing technique was used to facilitate wound closure after elliptical excision of the tumors at office visits. results. The wound defects, ranging from 3.0–3.5 cm in width, were closed with satisfactory cosmetic results, except for the occurrence of transient small hypertrophic scars in one patient. There was no complication of wound dehiscence, ischemia, infection or hematoma. conclusion. Tissue meshing technique is a simple procedure and appears to be a satisfactory alternative to facilitate the closure of large wounds under tension. This technique is suitable for most body sites excluding central face and neck because there may be a stippled appearance in the area of meshing.

Sequential systemic retinoid and photodynamic therapy for multiple keratotic pigmented nodular basal cell carcinomas on the scalp

Dear Editor, Photodynamic therapy (PDT) has become a new cancer treatment based on light activation of a photosensitizer specifically concentrated in tumor tissue and generation of highly reactive oxygen intermediates that destruct tumor in the presence of oxygen. Aminolevulinic acid (ALA)-based PDT is effective in treating superficial skin cancers, including actinic keratosis, superficial basal cell carcinoma (BCC), Bowen’s disease, as well as benign dermatoses, such as warts, acne and port wine stains. PDT is less effective for nodular BCC due to the limitation of light penetration. Moreover, a hyperkeratotic surface, if present, can cause insufficient transdermal drug penetration. We were presented with a case of chronic arsenism with multiple keratotic and pigmented nodular BCC. The tumors were treated successfully with PDT after a 2-month course of oral etretinate 0.5 mg ⁄kg per day. A 68-year-old woman with chronic arsenism and vitiligo first presented to our clinics with two scalp tumors in 1999. Initially, she had three tumors on the scalp, and two of them had been excised elsewhere 5 years before her first visit to our clinics. The third one that was located on left side of the frontal scalp continued to grow despite repeated cryotherapy. A new tumor (the fourth one) appeared later on the right side of the scalp. Examination in our clinics revealed two 2.5-cm pigmented tumors with typical rolling borders and telangiectasia with thick keratotic and crusted surface (Fig. 1a,b) corresponding the fourth and the third tumors, respectively. A biopsy specimen from the right scalp tumor showed changes of nodular BCC consisting of nodules of atypical basaloid cells with pigments and covered by a thick layer of scale-crust on the surface (Fig. 2a,b). The patient

Prurigo Pigmentosa -A Report of Four Cases-

Prurigo pigmentosa (PP) is an uncommon skin disease characterized by a pruritic reticulated erythematous popular eruption that leaves a mottled hyperpigmentation after resolution. To date, only 2 cases were reported from Taiwan. In this report, we describe four cases of PP with typical clinical features and dramatic therapeutic response to minocycline. Histopathologically, characteristic findings of PP, namely vacuolar alteration of basal cells, spongiosis, necrosis of keratinocytes, exocytosis of lymphocytes and a patchy lichenoid or lichenoid predominantly lymphocytic and occasionally eosinophilic infiltration were observed. However, two unusual new findings were noted in 3 cases; one case showed extensive necrosis of keratinocytes as well as reticulate degeneration resulting in intraepidermal vesicles, the other two cases displayed lymphocytic nuclear dust in the epidermis.

Lupus Erythematosus Like Skin Lesions Induced by Tegafur-Uracil - A Case Report -

Tegafhr-Uracil (UFUR) is a second generation anticancer agent. Few skin lesions are associated with UFUR therapy. Skin lesions with features of lupus erythematosus occurred in a 69-year-old man after starting UFUR treatment for 2 weeks for gastric adenocarcinoma. The diagnosis of drug-induced lupus erythematosus was supported by classic histopathologic findings of cutaneous lupus erythematosus, positive antinuclear(speckled and nucleolar pattem), and anti-SSA/Ro and SSB/La antibodies. The skin lesions resolved within 2 weeks after discontinuation of UFUR and treatment with steroids, but recurred on readministration of UFUR. This may be the first reported case of UFUR- induced lupus erythematosus-like skin lesions in Taiwan. UFUR should be considered as a possible cause of lupus erythematosus-like skin lesions during UFUR therapy. (Dermatol Sinica 22: 173-177, 2004)