Seiko Toyozawa

Chemokine receptor CXCR4 is a novel marker for the progression of cutaneous malignant melanomas.

The CXCR4/CXCL12 pathway has recently been reported to be involved in stimulating the metastasis of many different neoplasms, in which CXCR4 activates various phenomena such as chemotaxis, invasion, angiogenesis and proliferation. The purpose of this study was to analyze a possible association between the expression of chemokine receptors CXCR4, CCR6 and CCR7 with the clinicopathological features of cutaneous malignant melanoma, and to assess the usefulness of these chemokine receptors for diagnosis and prognosis. In our study, a percentage of immunoexpression of both CXCR4 and its ligands CXCL12 was associated with high clinical risk. In contrast, the patients with a low immunoexpression of CXCR4 and CXCL12 had low clinical risk. CCR6 and CCR7 immunoexpressions were also correlated with some clinical parameters, but seemed no more useful than CXCR4. These data suggest that the assessment of CXCR4 immunoexpression is a novel tool for predicting tumor aggressiveness in malignant melanomas, and in particular, a high immunoexpression percentage of CXCR4 and CXCL12 might be a sign of a poor prognosis.

Immunohistochemical analysis of CXCR4 expression in fibrohistiocytic tumors.

Functional chemokine receptors are expressed in many malignant tumors. These receptors promote tumor growth and metastasis in response to endogenous chemokines. We analyzed the expression of CXCR4, CCR6 and CCR7 in fibrohistiocytic tumors, including dermatofibrosarcoma protuberance (DFSP), malignant fibrous histiocytoma (MFH), dermatofibroma (DF) using immunohistochemistry. We also investigated the relationship between CXCR4 and CD34, the latter of which is an immunohistochemical marker for DFSP. We observed a higher expression of CXCR4 in DFSP and MFH as compared with DF. Interestingly, a significantly higher expression of CXCR4 was detected in relapsed DFSP than in non-relapsed DFSP, but no significant differences were detected between non-relapsed DFSP and DFSP with CD34 immunostaining. Moreover, MFH had strong immunoreactivity for CXCR4, CCR6 and CCR7. These findings suggest that the assessment of CXCR4 immunoreactivity in fibrohistiocytic tumors is a useful tool for predicting tumor aggressiveness.

Effective treatment of intractable skin ulcers using allogeneic cultured dermal substitutes in patients with systemic lupus erythematosus

Skin ulcers in systemic lupus erythematosus (SLE) patients are non-healing or intractable, because various factors or complications, including vasculitis and immunosuppressants, impair wound healing. In the present study, we applied cultured dermal substitutes (CDSs) to 3 cases of SLE skin ulcers because various systemic or topical therapies were ineffective. CDSs are prepared by culturing human fibroblasts on two-layered spongy matrices of hyaluronic acid and atelo-collagen, and they effectively promote the healing of severe skin defects. After using CDSs in the 3 cases, healthy granulation tissues formed within 6 weeks, and skin grafts were successfully performed. These results indicate that allogeneic CDSs provide new therapeutic alternatives as topical therapies for intractable skin ulcers in SLE.

Successful treatment with trichloroacetic acid peeling for inflammatory linear verrucous epidermal nevus

Figure 1. Histology showing hyperkeratosis of orthotype and parakeratosis (hematoxylin–eosin, original magnification ·100). Dear Editor, Inflammatory linear verrucous epidermal nevus (ILVEN) was originally reported by Altman and Mehregan in 1971. The following criteria seem to be valid: (i) early age of onset; (ii) pruritic erythematous, slightly verrucous scaling papules, which coalesce into linear plaques; (iii) histological features resembling those of psoriasis; and (iv) persistent lesions markedly refractory to treatment. The criterion of ‘‘resistance to therapy’’ is a generally accepted feature of this nevus. Here, we report a patient whose lesions responded effectively to trichloroacetic acid (TCA) peeling treatment. Our patient was a 5-year-old girl. At the age of 1 year, her mother noticed verrucous scaling papules, which coalesced into linear plaques on her right armpit, right pubic region, left breast and left lower leg. These lesions spread gradually, and topical corticosteroids were ineffective. Histological findings from the lesion on the left lower leg showed acanthosis, with elongation of the rete ridges. There were areas with hyperkeratosis of the orthotype, and areas with parakeratosis. The upper dermis showed a mild and predominantly mononuclear infiltrate. Polymorphonuclear leukocytes were sparse, and no exocytosis of these cells into the epidermis was seen (Fig. 1). Initial treatment was topical corticosteroids, vitamin D3 and liquid nitrogen, but they were not effective; therefore, these skin lesions fulfilled the criteria for a diagnosis of ILVEN. After several treatments, we started to treat the lesions with TCA peeling (Fig. 2a). First, we carefully cleaned the skin using 70% ethanol and acetone-soaked gauze to remove any sebum from the application sites. Second, 70% glycolic acid was applied to the site with intensive hyperkeratosis. Next, we applied 60% TCA (w ⁄v) (Wako Pure Chemical Industries, Osaka, Japan) in distilled water to the region using cotton-tipped applicators until white

Clinical and pathological changes in a long-term follow-up case of dermatofibrosarcoma protuberans

Figure 1. (a) Red, hard nodule arising from left upper eyebrow 19 years after initial visit. (b) The tumor continued to grow slowly for another year. Dear Editor, Dermatofibrosarcoma protuberans (DFSP) is a soft tissue neoplasm of intermediate malignancy characterized by a pattern of slow, infiltrative growth and a marked tendency to recur locally after surgical excision. We experienced a case of DFSP who had several recurrences and surgeries in the 20 years after the first surgical excision, and we present his longterm clinical history and pathological changes such as its atypicality and CD34 expression. A 28-year-old man was seen at our hospital due to a subcutaneous tumor in the region of his left eyebrow. He told us that he had received excision therapy on the same lesion 8 years before. On physical examination, he was found to be asymptomatic, and the tumor was a round and hard nodule 1.5 cm in diameter. The wide resection of tumor was performed, and reconstructed by a skin graft. The tumor had histological signs of DFSP in that slender spindle cells were arranged in a district storiform pattern in the dermis. Histological margins were negative for tumor cells. However, the tumor was recurrent under the skin graft after 1 year and the second total resection in our hospital was performed. In spite of total resection, recurrent lesions arose on the right forehead on the outer side of the skin graft after 11 years. A third tumor resection was performed with reconstruction by skin graft. Histological margins were negative for tumor cells. After 16 years from the first surgical excision in our clinic, the tumor appeared again on the left cheek. These lesions were treated by a simple resection (the fourth) following the patient’s wish. Nineteen years after his first visit (47 years of age), the tumor on the left cheek had continued to grow slowly, and a