Jeong Nan Kang

Acute Generalized Exanthematous Pustulosis Induced by Parvovirus B19 Infection

Received June 20, 2012, Revised April 26, 2013, Accepted for publication May 29, 2013 Corresponding author: Jong Keun Seo, Department of Dermatology, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 614-735, Korea. Tel: 82-51-890-6135, Fax: 82-51-897-6391, E-mail: derma09@hanmail.net This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Fig. 1. Multiple nonfollicular pustules with surround erythema on the trunk. Fig. 2. Histopathologic findings shows subcorneal pustules in the epidermis, perivascular and interstitial inflammatory cells infiltration in the dermis. The inflammatory cells are comprised of lymphohistiocytes, neutrophils and a few eosinophils (H&E, ×40). Acute Generalized Exanthematous Pustulosis Induced by Parvovirus B19 Infection

Analysis of Dermatologic Consultations in a Neonatal Intensive Care Unit Over a 7‐year Period: Retrospective Review of 60 Cases

The need for dermatology consultations for neonatal intensive care unit (NICU) patients is increasing, but no study has systemically examined the skin diseases of patients in NICUs. The aim of this study was to analyze dermatology consultations in the NICU of a tertiary medical center in Korea and determine the effect of the dermatology consultation on the clinical course and management of the patients after the consultation.

Aquagenic Urticaria Diagnosed by the Water Provocation Test and the Results of Histopathologic Examination

An 18-year-old male visited our department complaining of recurrent episodes of an itchy rash after hand washing, showering/bathing, drinking water, and getting rain-soaked. He was diagnosed with aquagenic urticaria after a water provocation test and histopathologic examination. Five months of antihistamine treatment successfully prevented further wheal formation. Aquagenic urticaria is a very unusual form of physical urticaria caused by contact with water. It manifests as pruritic small wheals surrounded by erythema within 30 minutes of exposure. The condition can be diagnosed by a water provocation test. Systemic antihistamines are the first-line treatment, with anticholinergics, phototherapy, or barrier cream used alternatively or additionally. Four cases of aquagenic urticaria have been reported in Korea, but no histopathologic evaluation was reported in the English or Korean literature. Herein, we provide both a case report of aquagenic urticaria diagnosed by the water provocation test and histopathologic examination results for this patient.

A Giant, Deep, Benign Fibrous Histiocytoma with a Palisading Pattern.

Dear Editor: A 42-year-old male patient presented to our clinic with a skin-colored mass that had been present for 2 years; his medical and family histories were otherwise unremarkable. Physical examination revealed a soft, movable, skin-colored mass on his upper left back, with a brown, bean-sized pedunculated nodule on the overlying skin (Fig. 1A). Excisional biopsy was performed. The tumor, which was well demarcated and localized in the subcutaneous layer, measured 5.4×5.1×2.1 cm (Fig. 1B). The histopathological examination indicated that the lesion was an encapsulated mass, located in subcutaneous tissue with a central cavity. The tumor was well-circumscribed by a fibrous capsule, and no honeycomb pattern was observed in the marginal area. In the tumor periphery, large blood vessels with a dilated, branching appearance were observed (Fig. 2A). The tumor cells were arranged in a palisading and partially storiform pattern, with focal myxoid change (Fig. 2B). Under high magnification, the tumor cells were spindle shaped with elongated nuclei and an ill-defined cytoplasm; individual cells were infiltrating between collagen bundles and arranged in a palisading pattern, similar to Verocay bodies (Fig. 2C). Cellular atypia and mitotic bodies were not detected. Immunohistochemical analysis revealed that the cells were strongly positive for CD34 (Fig. 2D); focally positive for factor XIIIa; and negative for S-100 (Fig. 2E), desmin, actin, and CD68. A diagnosis of giant, deep, benign fibrous histiocytoma (BFH), with a palisading pattern, was rendered, with no evidence of recurrence at 15 months after excision. Fig. 1 (A) A skin-colored mass on the back (arrows) with a coincident overlying skin tag (inset: close-up view). (B) The excised 5×5×2 cm well-encapsulated erythematous oval mass. Fig. 2 (A) Scanning view of the histopathological examination of the lesion showing an encapsulated mass located from the lower dermis through the subcutaneous tissue with a central cavity. The tumor was well circumscribed by a fibrous capsule, and no honeycomb ... BFH, which is characterized by several histological subtypes, is among the most-common soft tissue skin tumors. Since Fletchers1 description in 1990 of 21 cases of deep BFH (DBFH), several more cases have been reported1,2,3. DBFH, which accounts for <1%~2% of all BFH cases, is larger and arises lower in the subcutis1, and confers an increased risk of local recurrence and distant metastasis3. Similar to BFH, giant fibrous histiocytoma (>5 cm), which represents a rare variant of fibrous histiocytoma, is benign, and no local recurrence after surgical excision has been reported to date4. Palisading BFH is a rare variant of BFH, first described by Schwob and Santa Cruz5 in 1986. On histopathological examination, palisading BFH resembles a schwannoma; the lack of neural cells and S-100 negativity could facilitate the differential diagnosis5. Although several cases of palisading BFH have been reported2,5, only one case of palisading DBFH has been documented2. In our patient, the tumor cells were strongly positive for CD34; therefore, it is difficult to exclude dermatofibrosarcoma protuberance. However, Gleason and Fletcher3 reported that 40% of DBFH cases are positive for CD34. The histopathological findings of a well-circumscribed capsule, low cell density, and a lack of atypical cells and mitotic bodies also suggest a benign nature; therefore, the final diagnosis was an uncommon case of giant DBFH.