Masayuki Nishimura

Extramammary Paget's disease: comparative histopathologic studies of intraductal carcinoma of the breast and apocrine adenocarcinoma.

We examined 32 cases (38 lesions) of extramammary Pagets disease (EMPD) in relation to comparative studies on intraductal carcinoma of the breast (ductal carcinoma in situ, DCIS) and apocrine adenocarcinoma (AAC). Lesions included scrotum (18 lesions), vulva (8), axilla (6), groin (3), penis (2) and chest wall (1), and the distribution was compatible with that of apocrine or supernumerary mammary glands. Histologically, extra‐mammary Pagets and DCIS cells exhibited a large amount of a pale‐stained cytoplasm. The cytoplasm of AAC cells frequently contained granules, was eosinophilic and differed from that of Pagets or DCIS cells. Immunohistochemical studies revealed positive reactions for polyclonal and monoclonal antibodies to carcinoembryonic antigen in all EMPD and most DCIS, but not in AAC. Recent studies have shown that extramammary Pagets cells exhibit characteristics of glandular epithelial cells and that most cases of EMPD are not accompanied by an underlying carcinoma. The results obtained in this study, coupled with data on the frequency of the supernumerary breasts, lead to the speculation that extramammary Pagets cells originate from ectopic mammary glands or from pluripotential germinative cells in the epidermis, capable of differentiating toward the mammary glands.

Balanitis of Zoon

A patient with an eruption of clinical and histologic features typical of plasma cell orificial mucositis of the glans penis is reported. Immunohistologically, IgE and IgG are found to be major immunoglobulin classes in the plasma cellular infiltrate. Although specific allergen has not been identified yet, the present findings suggest that this condition is not‘a nonspecific inflammatory response but is related to immediate hypersensitivity.

Malignant hidroacanthoma simplex

A case of malignant hidroacanthoma simplex is described. Histological examination revealed that the malignant cells had arisen from a tumor cell nest of benign hidroacanthoma simplex and invaded the dermis. Two years and 7 months after the excision of the original thigh lesion, a groin lymph node metastasis was discovered. The metastatic tumor cells in the lymph node were histologically similar to the carcinoma cells in the original thigh lesion and had enzymatic and ultrastructural features resembling eccrine sweat duct.

Necrobiotic xanthogranuloma in a human T-lymphotropic virus type 1 carrier

A 67-year-old man who had necrobiotic xanthogranuloma associated with paraproteinemia is described. He was a human T-lymphotropic virus type 1 (HTLV-1) carrier who had a high titer of circulating anti-HTLV-1 antibodies and neurologic abnormalities that suggested HTLV-1-associated myelopathy. The patients necrobiotic xanthogranuloma and neurologic symptoms improved after he received four 5-day courses of melphalan, 2 mg/day, and prednisolone, 20 mg/day, at 4-week intervals.

Nature of so-called metaplasia of the apocrine epithelium: macrophages attack apocrine epithelium

Immunohistochemical and electron-microscopic studies were performed on the lesion termed “metaplasia of the apocrine epithelium,” which was seen in association with an apocrine adenocarcinoma. The cells of this so-called “metaplasia” lacked cytokeratin, which was present in the apocrine epithelium. Surprisingly, the lesion ultrastructurally consisted mainly of terminally differentiated macrophages, the cytoplasms of which were filled with numerous phagosomes and lipid droplets. The cells lacked a desmosomal connection at their borders and some had Langerhans granule-like structures in the cytoplasm. The luminal wall was often infiltrated with macrophages and lymphocytes, and, in some portions, was replaced by macrophages with a large cytoplasm filled with numerous phagosomes. The immunohistochemical and ultrastructural findings indicate that the lesion is not composed of cells of the apocrine epithelial origin, but of macrophages that have ingested apocrine epithelium.

Mucha-Habermann disease resolves after tonsillectomy.

Pytiriasis lichenoides et varioriformis acuta (Mucha-tlabermann disease) is an uncommon cutaneous disorder characterized by generalized erythematous or tan. scaly papules and maeules occurring over the trunk and flexual surfaces of the extremities. The etiology still remains to be elucidated and a reliable therapeutic modality, especially for pediatric patients, has not been established. Recently, we saw a pediatric case of Mueha-Habermann disease that resolved after tonsilleetomy.

Chalazion Coexisting with Dacryolithiasis

A 41‐year‐old woman presented with a painless hard subcutaneous nodule in the right upper eyelid. The lesion was diagnosed clinically as pilomatricoma and removed surgically. Histological examination disclosed a granulomatous lesion composed mainly of mononuclear cells with a foamy appearance and multinucleated giant cells with some admixture of granulocytes, plasma cells, and lymphoid cells. Lipid droplets and dilated ductal structures containing an eosinophilic fibrillar substance were observed in and around the granulomatous lesion. In addition, an intraductal dacryolith was seen near the granulomatous lesion. We finally diagnosed this case as chalazion; the coexisting dacryolithiasis was considered to be involved in the pathogenesis of chalazion.