Jun Yajima

Allergic contact dermatitis from curcumin (turmeric)

Discussion Neticonazole, a vinyl imidazole derivative (Fig. 2), is a newly developed antifungal drug in use since 1995. Contact allergy due to neticonazole has not been reported in the literature. Another vinyl imidazole, croconazole, has caused contact sensitivity (I). Cross-sensitization between 2-(2,4-dichlorophenyl)-ethyl imidazoles, e.g. econazole, isoconazole, miconazole, oxiconazole, and sulconazole, is well-known (2-5). Our case cross-reacted to econazole and sulconazole, but not to croconazole, suggesting that the vinyl base may not be related to the antigenic determinant. Non-imidazole drugs (morpholine, benzylamine, or allylamine) should be prescribed in these patients.

A case of renal cancer discovered by multiple skin transition.

A 74-year-old female with skin metastasis of renal cell carcinoma is described.She noticed her cutaneous lesion on her left lower abdomen about three years before visiting our dermatological outpatient clinic. The lesion gradually enlarged and multiple nodule developed on the other parts of the body.The biopsy was taken from the lesion on the right arm. On microscopic findings, the metastasis of renal cell carcinoma was suggested. An examination of whole body was performed and renal cell carcinoma of left kidney was discovered. Systemic and multi-organ involvement were also observed.This case is rare because the patient had a large number of metastatic skin lesions up to 62. In addition, she lived at least 3 years after the metastasis of the skin. It is relatively a long period for the patient with metastatic renal cell carcinoma.

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.