Kenzo Arakawa

Trigeminal trophic syndrome--a report of three patients.

Three Japanese patients with trigeminal trophic syndrome, a rare dermatosis in Japan, were reported. Cutaneous lesions were a long‐standing ulcer and destruction of the right ala nasi in case 1, a persistent deep ulceration on the forehead after a small trauma in case 2, and development of small, discrete ulcers on the right forehead during the treatment of a postherpetic neuralgia in case 3. A protective device was very effective in one patient.

Prominent Telangiectasia Associated with Marked Bleeding in CREST Syndrome

A 64‐year‐old woman with CREST syndrome developed prominent telangiectases mimicking hereditary hemorrhagic telangiectasia (HHT) of Osler‐Rendu‐Weber. We have been following her since she first came to us with discrete telangiectatic mats and Raynauds phenomenon 11 years ago. Telangiectatic lesions have been seen on her larynx and esophagus in addition to commonly affected sites. She has experienced spontaneous epistaxis and marked bleeding from the lesions on her lips, oral mucous membrane, and soles.

Giant neuroendocrine (Merkel cell) carcinoma of the skin.

An 82-year-old woman had a dark red to purple tumor on the left buttock that had gradually enlarged during the last 5 years. Although routine histologic examination was not sufficient for diagnosis, neuroendocrine carcinoma was diagnosed by immunohistochemical and ultrastructural studies. Immunohistochemical-positive reactions to neurofilament, cytokeratin, neuron-specific enolase, and epithelial membrane antigen were noted. Electron microscopically, membrane-bound, dense core granules that yielded a positive uranaffin reaction and intermediate filaments in the perinuclear area were observed in the cytoplasm of most tumor cells. Desmosome-like structure between them was also found. Approximately 6 months after local excision, metastatic lesions developed in the regional lymph nodes and liver.

AN EXPERIMENTAL MODEL OF XANTHOMA BY INTRADERMAL DEXTRAN SULFATE INJECTION

Large molecular weight sodium dextran sulfate (SDS) injection into the dermis of both normolipemic rabbits and hypercholesterolemic rabbits induced infiltration of histiocytes and foam cells. Sudan III staining showed that the histiocytes and foam cells of hypercholesterolemic rabbits accumulated lipids similarly to xanthoma foam cells. The accumulated lipids increased as the injection was repeated at the same site. However, the lipid accumulation was minimal in the histiocytes of normolipemic rabbits. As determined by quantitative analysis of lipid composition in the lesions of hypercholesterolemic rabbits, cholesterol esters remarkably increased concomitantly with injection frequency. Free cholesterol accumulation was less pronounced than cholesterol ester. In normolipemic rabbit dermis, accumulation of free cholesterol was insignificant and cholesterol esters did not accumulate progressively with repeated SDS injections. Apparently the foam cells of hypercholesterolemic rabbits actively incorporated serum low density lipoproteins (LDL) and cholesterol was esterified in the foam cells. On the other hand, LDL were minimally incorporated into histiocytes in the normolipemic state. The intradermal SDS injection is a beneficial experimental model for further investigations on the mechanisms of lipid accumulation and the intracytoplasmic lipid metabolism of xanthoma foam cells.

Linear Epidermal Nevus with Acantholytic Dyskeratosis in an Infant

A 7‐month‐old boy came to us with flat papules and small erosions on the extensor aspect of his left forearm and a linear arrangement of verrucous papules on the dorsum of his left hand. Histological examination revealed hyperkeratosis, parakeratosis, irregular acanthosis, and marked acantholysis from suprabasal through upper epidermis. This is the first reported case of linear epidermal nevus with acantholytic dyskeratosis in Japan.

Acid Cholesterol Esterase Activity in the Foam Cells Isolated from Rabbit Experimental Xanthoma Tissues

Acid cholesterol esterase (ACE) activity was assayed in the 10,000×g pellet from infiltrating cells isolated from experimental rabbit xanthoma tissues. Skin specimens were obtained from sites of intradermal dextran sulfate injections on a normolipemic rabbit (NLR) and a diet‐induced hypercholesterolemic rabbit (HCR). Most infiltrating cells were histiocytes or foam cells. Histiocytes from the NLR did not accumulate cholesteryl esters after the injections. Accumulation of cholesteryl esters in the xanthoma tissues of the HCR increased after repeating the injections at the same site. The ACE activity was greater in the cholesteryl ester‐accumulated foam cells than in histiocytes. The enzyme activity in the foam cells decreased during the developmental course of cholesteryl ester accumulation. These findings indicate that lysosomal ACE is activated and hydrolyzes the internalized cholesteryl esters of serum lipoprotein origin in the histiocytes which are transforming into foam cells. However, the enzyme activity decreases when too much of the cholesteryl esters has accumulated in the foam cells.

A case of squamous cell carcinoma under nail plate with invasive lesion of the distal phalanx.

We reported a case of squamous cell carcinoma of the nail bed in a 52-year-old man. He had a well demarcated, erythematous plaque, 1.2×1.6cm in diameter, on the nail bed of his right middle finger. The X-ray examination of the right finger showed osteolysis in the distal phalanx. The histopathological examination of the tumor revealed a well differentiated squamous cell carcinoma. He was treated by surgical excision and chemotherapy.