Masakazu Asahi

Present state of yusho patients.

“Yusho” is the Japanese term for a notorious mass case of PCB poisoning that occurred in Japan in 1968 as the result of distributing cooking oil, Kanemi Rice Oil, which had been polluted with PCB. At the beginning of the outbreak the hazard was limited to the western part of Japan, particularly Kyushu, where the contaminated Kanemi Rice Oil was intensively marketed. Tracking down the culpable substance and the treatment of the patients were soon undertaken by large-scale collaborative teams from Kyushu University. The history and present status of the catastrophe was stated.

Immunohistochemical analysis of metallothionein expression in malignant melanoma in Japanese patients.

Recently, Zelger et al. found that metallothionein expression in melanoma is a useful prognostic indicator in white patients. In this study, we evaluated metallothionein expression in patients with melanoma as a prognostic indicator.We studied the tumors of 44 patients with cutaneous melanoma seen in our clinic from July 1988 to August 1998. Twenty-five neoplasms were metallothionein-positive, and 19 were metallothionein-negative. Only 9 (37.5%) of 24 cases of level I through III melanoma were positive for metallothionein, but 16 (80%) of 20 level IV and V cases were positive. Eight (40%) of 20 cases of “thin” melanoma (thickness: ⪕1.5 mm) were metallothionein-positive, and 17 (70.8%) of 24 cases of “thick” melanoma (thickness: >1.5 mm) were metallothionein-positive. These results indicate a strong correlation of metallothionein expression with the level of invasion and tumor thickness in melanoma. The survival distribution function curve (Kaplan-Meier) for metallothionein expression showed a much better survival rate in the metallothionein-negative group than in the metallothionein-positive group.

A Laugier-Hunziker syndrome associated with esophageal melanocytosis.

A 62-year-old Japanese woman came to our clinic because of melanotic macules on the lip, palatoglossal arch, lingual margin and palm. Endoscopic examination revealed a melanotic macule on the midesophageal mucosa but no polyposis in the gastrointestinal tract. Histologically, the specimens taken from the labial, esophageal and palmar lesions showed an acanthosis and basal hyperpigmentation in the epithelium. The patient had not taken any medication which could lead to pigmentation. As far as we know, this is the first case report of an esophageal melanocytic macule which occurred in a patient with Laugier-Hunziker syndrome. When confronted with an isolated pigment spot, we emphasize the necessity of systematic examinations for others. Because the pathologic relationship between Laugier-Hunziker syndrome and the esophageal melanocytic lesion is not proven, further studies should clarify this issue.

Sweat gland carcinoma with mucinous and infiltrating duct‐like patterns

We report a rare case of mucinous carcinoma of the skin with mammary infiltrating carcinoma‐like patterns. An 82‐year‐old Japanese male had a gourd‐shaped tumor on his scalp. Histopathologically, the posterior portion of the tumor showed small lobules of cuboidal tumor cells with no atypia floating in mucinous lakes. In the anterior portion, there were solid lobules, cords, and strands of anaplastic tumor cells infiltrating into the surrounding stroma. Enzyme‐ and immunohistochemistry and electron microscopy confirmed the eccrine origin of this tumor. It is suggested that mucinous carcinoma of the skin can occur in association with diverse histological patterns, analogous to mucinous carcinoma of the breast.

A histopathological and ultrastructural study of eccrine porocarcinoma with special reference to its subtypes

Five cases of eccrine porocarcinoma were studied by light and electron microscopy. Histopathologically, these could be classified into two types; the common and the giant cell type. The common type was characterized by almost uniform medium-sized cuboidal tumour cells and a formation of well-developed intracytoplasmic lumina. A broad diversity of histopathological and ultrastructural features was seen in these tumours. The tumours of the giant cell type consisted of mononu-clear polygonal cells and bizarre giant cells. This type was considered to be an undifferentiated form of porocarcinoma.

A combined occurrence of neuroendocrine carcinoma of the skin and a benign appendageal neoplasm

A 76‐year‐old Japanese male presented with a subcutaneous nodule in the dorsal cubital region of the right arm. The center of the nodule showed typical features of neuroendocrine carcinoma of the skin. The peripheral portion showed epithelial islands of squamoid cells with horn cysts suggestive of benign appendageal tumor with pilar differentiation. The coexistence of two skin neoplasms in the same lesion would suggest that both tumors developed from common pluripotential stem cell.

A Case of Toxic Epidermal Necrolysis-Type Drug Eruption Induced by Oral Lysozyme Chloride

We report a case of toxic epidermal necrolysis‐type drug eruption. A 23‐year‐old man took an oral over‐the‐counter preparation for the common cold. A few days later, generalized erythema developed with systemic malaise and pain. A multiple blister formation followed, and Nikolskys sign was noted on each blister. A lymphocyte stimulation test (LST) with the patients peripheral lymphocytes strongly suggested that the eruption was attributable to lysozyme chloride which was included in the preparation taken. Follwing an intravenous drip of betamethasone for two weeks, the eruptions improved favorably.

Medusa head-like granules in squamous cell carcinoma with differentiation toward a hair follicle structure

A case of squamous cell carcinoma (SCC) with regional lymph node metastasis in a 69‐year‐old Japanese man is reported. The tumor was characterized by the proliferation of peripheral basaloid, inner squamoid, and glycogen‐rich cells, the presence of trichilemmal keratinization, and the presence of ladder‐like, membrane‐coating granules. These findings suggested that this tumor differentiates toward a hair‐follicle structure. The most interesting feature of this tumor was the presence of medusa head‐like granules in the cytoplasm of the clear squamoid cells adjacent to the keratinized cells. We have been unable to find any other studies of these granules in squamous cell carcinoma.

Six Cases of Metastatic Malignant Melanoma with Apparently Occult Primary Lesions

We report here six cases of malignant melanoma in which metastatic lesions were detected first. Of these, two cases showed some peculiar features: one exhibited widespread subcutaneous bleeding, probably due to venous rupture, and the other case had a rare primary lesion on the penis. In the Japanese literature, there have been 46 cases of malignant melanoma in which metastatic lesions were detected prior to the initial ones. The preferential site for metastasis was the lymph node (32 cases). The primary lesion was unknown in 35 patients. The outcomes were available for 36 of the 46 patients; 23 died, including 18 who died within two years.

A Case of Cutaneous Infection by Exophiala jeanselmei

A case of cutaneous infection by Exophiala jeanselmei is reported.