Shigeo Kawachi

Detection of early lesions of ungual malignant melanoma

Background. The nail area is commonly affected by malignant melanoma. The prognosis of malignant melanoma of the nail is poor, becuase at the time of diagnosis most lesions are in the advanced stage. Correct diagnosis of early lesions could improve the prognosis.

Chronic obesity lymphoedematous mucinosis: three cases of pretibial mucinosis in obese patients with pitting oedema

Pretibial mucin deposition on the shins is known as pretibial myxoedema. We report three patients with pretibial mucinosis without thyroid disease. The patients were characterized clinically by morbid obesity and bilateral lower extremity pitting oedema with gradual and painless onset, and that did not involve the feet and ankles. Vesicles, semitranslucent papules or a woody plaque were found on the shins. Histologically, patients showed characteristic features of epidermal atrophy with effacement of the rete ridge pattern, separation of collagen bundles associated with oedema with stellate to linear fibroblasts, upward‐running increased capillary and small vessels with haemosiderin deposition, and mucin deposition at the superficial papillary dermis and around the vessels. We propose that the present cases of ‘chronic obesity lymphoedematous mucinosis’ belong to the clinical entity of pretibial mucinosis.

Heterophile Hanganutziu-Deicher antigen in ganglioside fractions of human melanoma tissues.

Gangliosides were purified from melanoma tissue extracts obtained from 5 patients. GM3 and GD3 were identified as the major components in ganglioside fractions of the melanoma tissues. Following thin-layer chromatography, enzyme immunostaining with Hanganutziu-Deicher (H-D) antigen-specific chicken antisera demonstrated the presence of NeuGc-neolactotetraosylceramide (H-D5) and NeuGc-lacto-N-norhexa-osylceramide (H-D7) in all 5 melanoma extracts.

Analysis of the Expression of Hanganutziu‐Deicher (HD) Antigen in Human Malignant Melanoma

Hanganutziu‐Deicher (HD) antigen is classified as a heterophile antigen and chemically defined as a ganglioside and/or glycoprotein containing N‐glycolylneuraminic acid (NeuGc). HD antigen is absent from normal tissues in humans and chickens but can be expressed in human malignant neoplasms including melanoma. We analysed HD antigen expression in ganglioside and glycoprotein fractions of human melanoma tissues by means of TLC enzyme‐immunostaining and Western blotting with biotinylated affinity‐purified chicken anti‐NeuGc‐lactosylceramide (anti‐HD3) antibody. No HD‐antigenic gangliosides were detected in 11 specimens of human melanoma. In the glycoprotein fractions, however, a strong HD‐positive band of 58 kD was detected in 3 of 10 specimens and several minor bands (37 kD, 13.5 kD, etc.) were also found in 5 specimens. The positive bands completely disappeared after treatment with neuraminidase. These results suggest that HD antigen is expressed on the carbohydrate chains of glycoproteins but not on those of gangliosides in human melanoma.

A case of an inflammatory variant of epidermolysis bullosa acquisita: Chronic bullous dermatosis associated with nonscarring mucosal blisters and circulating IgG anti-type-VII-collagen antibody

A 42-year-old man showed prominent blistering lesions of the mouth and esophagus in addition to a few bullous lesions of the skin. Direct immunofluorescence microscopy revealed distinct linear deposition of IgG and C3 at the epidermal basement membrane zone where slight deposition of IgA and IgM was also observed. In direct immunoelectron-microscopic examination, antibody was detected in the sublamina densa of the basement membrane zone. Immunoblot analysis with dermal extracts demonstrated that the patient’s serum contained circulating IgG antibodies against the 290-kD protein, which comigrated with type VII collagen. The lesions healed without any scars. The results of these studies corresponded to the laboratory findings in epidermolysis bullosa acquisita (EBA), although the clinical features were distinct from classic EBA.

Immunohistochemical detection of heterophile Hanganutziu-Deicher antigen in human malignant melanoma

SummaryThe Hanganutziu-Deicher (HD) antigen is a heterophile antigen whose immunodominant molecule is N-glycolylneuraminic acid, a sialic acid that cannot be found in normal tissues of either humans or chickens. Using biotinylated chicken anti-HD antibody purified with affinity chromatography, expression of HD antigen was immunohistochemically investigated in formalin-fixed tissues of human malignant melanoma. HD antigen-positive melanoma cells were clearly demonstrated in 7 of 11 lesions of malignant melanoma. No HD antigen-positive cells were found in 8 lesions of melanocytic nevus, and no components of normal human skin including epidermal melanocytes were stained with the antibody. This study is the first that immunohistochemically demonstrates HD antigen in tissue sections of human malignant melanoma. The expression of the HD antigen in transformed human melanocytes may have great immunological significance because the antigen is absent from normal human tissues and is immunogenic in humans.

Histopathological characteristics of malignant melanoma affecting mucous membranes: a unifying concept of histogenesis

Aims: To investigate histopathological characteristics of melanocytic lesions affecting mucous membranes in various anatomical sites. Particular attention was paid to elucidation of morphological characteristics of early phases of mucosal melanoma in order to contribute to effective detection of this highly malignant neoplasm in the curable stages. Methods: A total of 87 melanocytic lesions of mucous membranes were investigated histopathologically. There were 55 malignant melanomas including eight lesions of melanoma in situ, three in the radial growth phase (RGP) and 44 in the vertical growth phase (VGP), and 28 benign melanocytic lesions including four melanotic macules, 19 melanocytic naevi and five blue naevi. In addition, this series also included four equivocal lesions for which diagnoses were not definitely determined. With regard to malignant melanoma, histopathological patterns of in situ phase and RGP were intensely evaluated. Results: Histopathological features of benign melanocytic lesions were essentially the same as those of the corresponding lesions of the skin. In the vast majority of mucosal melanomas, irrespective of anatomical sites, the main histopathological pattern seen in melanoma in situ and in RGP was the lentiginous pattern, which shows proliferation of atypical melanocytes in the lower layer of more or less acanthotic epithelium, though subtle variations of the pattern were detected. No association of melanocytic naevus was detected in any cases of melanoma. Based on these findings, we have proposed a unifying concept of de novo histogenesis of mucosal malignant melanoma. Conclusions: Our concept of histogenesis of mucosal melanoma assists in the identification of this highly malignant neoplasm in the early curable stages.

Acral pseudolymphomatous angiokeratoma of children: a case report with immunohistochemical study of antipodoplanin antigen.

Acral pseudolymphomatous angiokeratoma of children (APACHE) is characterized by multiple angiomatous papules on the hands and feet in children. Here, we report a case of APACHE in a female patient followed up from 13 to 19 years of age with a dark red lesion on the center of the dorsum of the right thigh. Histologically, vacuolar alteration and exocytosis of lymphocytes, and specific dense cellular infiltration beneath the epidermis to the reticular dermis were found. On immunolabeling study, the lesion vessels were found to be positive for both the lymphatic endothelium-specific marker podoplanin and blood vessel-specific marker CD34. These findings suggested that APACHE is a type of vascular malformation.

Solid Facial Edema in a Patient with Rosacea

We report a 53‐year old man with symmetrical nonpitting edema, conjunctivitis, and acneiform eruptions on the face. Histopathological examination showed perifollicular lymphohistiocytic infiltration and telangiectasias in the upper dermis. Loosely aggregated non‐caseating granulomas were scattered through the dermis; some of them were seen in the perifollicular regions. The patient was treated with fleroxacin (100 mg/day, orally) for two weeks with a marked reduction of both solid facial edema and periorbital edema.

Expression of alpha subunit of guanine nucleotide-binding protein Go in Merkel cell carcinoma.

The α subunit of guanine nucleotide‐binding protein Go(Goα), which was initially isolated from bovine brain, interacts with muscarinic cholinergic receptors and regulates neuronal calcium channels. Goα is known to be localized in neural tissues, some endocrine cells, and neuroendocrine tumors. We have immunohistochemically investigated the expression of Goα in 4 cases of Merkel cell carcinoma using the method of microwave treatment. In all cases of Merkel cell carcinoma, Goα was consistently detected on the plasma membrane and cytoplasm of the tumor cells. Nerve fibers in the skin were also positive for Goα, but other epidermal or dermal components such as keratinocytes, melanocytes, fibroblasts, or lymphoid cells were negative. Tumor cells of squamous cell carcinoma, cutaneous lymphoma, sweat gland carcinoma, and malignant melanoma were negative for Go4aL. The present study indicates that Goα may be a useful immunohistochemical marker of Merkel cell carcinoma.