Shin Koseki

An immunohistochemical study of lysozyme, CD-15 (Leu M1), and gross cystic disease fluid protein-15 in various skin tumors : assessment of the specificity and sensitivity of markers of apocrine differentiation

We investigated immunohistochemically the localization of lysozyme and Leu M1 in normal skin, 76 cases of benign sweat gland tumors, 28 cases of malignant sweat gland tumors, 23 cases of extramammary Pagets disease, 7 cases of sebaceous carcinoma, 6 cases of malignant trichilemmoma, 10 cases of squamous cell carcinoma, and 10 cases of basal cell carcinoma and compared the results with those for gross cystic disease fluid protein (GCDFP)-15 to assess the sensitivity and specificity of our assay conditions for apocrine differentiation. Normal apocrine glands were stained with all three antibodies, while eccrine glands were positive only for GCDFP-15, and other portions of normal skin were not stained with any of the antibodies used. In neoplastic tissue thought to be from apocrine tumors, antibodies raised against lysozyme and GCDFP-15 had a greater specificity (100%) for apocrine differentiation, while Leu M1 had a greater sensitivity (88%). Tissues that were stained with two or three of these antibodies appeared to exhibit apocrine differentiation. In the tumors examined, the specificity for apocrine differentiation was 100% and the sensitivity for such differentiation was 92% by these criteria. According to these criteria, some cases of syringocystadenoma papilliferum, primary mucinous carcinoma of the skin, and extramammary Pagets disease with underlying adenocarcinoma showed apocrine differentiation.

An immunohistochemical study of E-cadherin expression in human squamous cell carcinoma of the skin: relationship between decreased expression of E-cadherin in the primary lesion and regional lymph node metastasis.

E‐cadherin is a Ca2+‐dependent, intercellular adhesion molecule that is specifically expressed in epithelial tissues and is essential for maintaining intercellular connections. It has been reported that E‐cadherin expression of tumor cells is often decreased in some types of metastasizing carcinomas as compared with those without metastasis.

A case of ductal sweat gland carcinoma connected to syringocystadenoma papilliferum arising in nevus sebaceus

We report a case of a tumor arising in the preauricular region in a 50‐year‐old woman. The histopathological findings revealed it to be a ductal sweat gland carcinoma connected to a syringocystadenoma papilliferum (SCAP) arising in a nevus sebaceus. Mucinous stroma, considered to be deposition of hyaluronic acid, was also observed in the ductal carcinoma portion. The immunohistochemical and ultrastructural findings in the ductal carcinoma were compared with those in the SCAP. The proliferating cell nuclear antigen labeling index of the cells in the ductal carcinoma was higher than that of those in the SCAP. Both the ductal sweat gland carcinoma and SCAP showed findings compatible with the ductal segment of a sweat gland.

A CASE OF TRIPLE EXTRAMAMMARY PAGET'S DISEASE

We report a 74‐year‐old Japanese man with triple extramammary Pagets disease; the genital and both of the axillar regions were simultaneously involved. Literature review revealed that 27 cases of triple extramammary Pagets disease have been reported in Japan, but there are no reports of triple extramammary Pagets disease from countries other than Japan, although 2 cases of double extramammary Pagets disease are reported. In all 28 cases, including our case, the genital lesion preceded the axillary lesions. All cases except one were male and only the exceptional female case was reported to have an the invasive tumor in the dermis. We speculate that extramammary Pagets disease may appear multi‐centrically.

Malignant transformation of benign hidroacanthoma simplex

A case of malignant hidroacanthoma simplex of the anterior aspect of the right ankle in a 75-year-old man is reported. A specimen obtained in 1987 showed the features of benign hidroacanthoma simplex, whereas that taken in 1991 revealed malignant transformation. We performed immunohistochemical studies on these two specimens, and they suggest this tumor derives from the outer cells of intraepidermal ducts. The proliferating cell nuclear antigen labelling index and argyrophil nucleolar organizer regions of these two specimens were also compared and correlated with malignant transformation.

Squamous cell carcinoma arising in chronic perianal pyoderma a case report and review of Japanese literature.

We report a rare case of squamous cell carcinoma developing from fistules of chronic perianal pyoderma in a 49‐year‐old Japanese man. He first noticed an abscess and nodule on his buttocks and perianal area 21 year previously (at the age of 28); the fistules formed later. These fistules were surgically removed, and an artificial anus was constructed 14 years ago (at the age of 35) in our hospital, when a histopathological examination revealed no malignant changes. However, he was recently admitted to our hospital with arterial bleeding from the ulcer of the buttock. On admission, the histological diagnosis of the ulcer was well differentiated squamous cell carcinoma. Wide local excision of the ulcer and scar tissue, including the sacrum, was performed. The defect was covered with a left latissimus dorsi flap and skin graft. He received radiation therapy after the operation. However, he died of cachexia and pneumonia. This case indicated that the CPP would better have been treated with wide excision before the development of SCC. Therefore, we recommend careful follow‐up of patients affected by CPP and repeated biopsies of the lesion, particularly when the condition is severe, longstanding, and extensive. We discussed the term “CPP” and reviewed 22 cases of SCC arising in CPP reported in the Japanese literature.

A patient with rhabdomyosarcoma and clear cell sarcoma of the skin

We describe a patient with rhabdomyosarcoma of the posterior cervical region and clear cell sarcoma on the occipital scalp. These two tumors later metastasized to distant skin. We differentiated these tumors by histopathologic, histochemical, immunohistochemical, and ultrastructural findings. Cells of the posterior cervical tumor showed differentiation toward striated muscle, whereas those of the occipital tumor showed findings compatible with melanocytic differentiation.

E-cadherin Expression in Skin Tumors Using an AMeX Immunohistostaining Method

The AMeX (acetone‐methylbenzoate‐xylene) method results in good preservation of tissue and morphological details, almost equivalent to that of routinely processed formalin‐fixed and paraffin‐embedded tissue specimens, and of antigenicity equivalent to that of fresh frozen tissue specimens. It has been reported that the expression of the cell‐cell adhesion molecule E‐cadherin is often decreased in some types of carcinomas. A decrease in E‐cadherin expression is associated with the invasive or metastatic potential of tumor cells. We immunohistochemically examined the expression of E‐cadherin with anti‐E‐cadherin monoclonal antibody in various skin tumors (25 basal cell carcinomas, 11 squamous cell carcinomas, 9 keratoacanthomas, and 11 Bowens disease) using the AMeX method and found that this method preserved antigenicity well without pretreatment. E‐cadherin expression was decreased in 18.2% of squamous cell carcinomas and 33.3% of keratoacanthomas. On the other hand, it was preserved in almost all Bowens disease and basal cell carcinomas. From the results of our study, we suggest that Bowens disease and basal cell carcinoma do not have much metastatic potential due to retention of high levels of E‐cadherin expression. We hope to apply the AMeX method to other immunohistochemical examinations because this is a very useful staining method.

DERMATOMYOSITIS ACCOMPANIED BY PROSTATIC CANCER AND ELEVATED SERUM CA 19.9

In January 1992, a 74-year-old man visited our clinic with the complaints of erythematous lesions on the scalp and neck, facial edema, myalgia of the extremities, and dysphagia present for over 1 month. Dermatologic examination at that time revealed diffuse edema of the face, severe edema with purple-red erythema of the periorbital region, poikiloderma on the scalp, diffuse edematous erythema on tbe upper extremities and knee, and diffuse erythema with scaling at the base of all fingernails and knuckles. The patient also complained of spontaneous pain and tenderness of the muscles of the proximal extremities. Slight fever was noted. The laboratory findings revealed mild anemia and elevated serum levels as follows: glutamate oxaloacetic transferase (GOT) 450 lU/L (normal range: 9-30 lU/L); glutamate pyruric transferase (GPT) 104 lU/L (4-30 lU/L); lactate debydrogenase (LDH) 1232 lU/L (202-357 lU/L); creatine phosphokinase (CPK) 6867 lU/L (30-180 lU/L); C-reactive protein (CRP) 2.1 mg/dL (0.2 mg/dU; blood urea nitrogen (BUN) 31 mg/dL (8-20 mg/dL); aldolase 39.7 lU/L (1.7-5.7 lU/L); antinuciear antibody x 320 with homogeneous and speckled pattern; myoglobin 1876.9 ng/mL (50 ng/mL); carcinoembryonic antigen (CEA) 10.3 ng/mL (2.5 ng/mL); CA 19.9 337.0 U/mL (> 37 U/mL). Histopathologic examination of a biopsy specimen obtained from the left triceps muscle revealed absence of striation with interruption of muscle fibers and mononuclear cell infiltration. Most of the otber laboratory data were normal. Based on these clinical and laboratory findings, the patient was diagnosed as baving dermatomyositis (DM), and administration of prednisoione (60 mg iv daily) was begun. After several days of prednisoione administration, tbe erythematous lesions on the face and the myalgia were decreased and the fever subsided, but the dysphagia persisted. The high CPK, LDH, GOT, and GPT also decreased gradually. Examination for internal malignancy at this time revealed chronic pancreatitis with dilation of the pancreatic duct, but no other pathologic change was found in the lung, urinary tract, or upper respiratory tract. Three weeks after the start of therapy, an increase of muscle pain and progression of dysphagia were observed

Assessment of Cellular Proliferation of Sebaceous Neoplasms by AgNOR Counts and Immunohistochemical Demonstrations of PCNA and Ki-67

We assessed cellular proliferation of sebaceous neoplasms by AgNOR counts and the immunohistochemical demonstration of proliferating cell nuclear antigen (PCNA) and Ki‐67, using formalin‐fixed and paraffin‐embedded tissue specimens. We used three categories of sebaceous neoplasms: four cases of sebaceoma, three cases of basal cell carcinoma with sebaceous differentiation (BCSD), and seven cases of sebaceous carcinoma (SC). Significant differences were noted between SC and non‐SC tumors (sebaceoma and BCSD) in AgNOR counts and semi‐quantitative grading of PCNA and Ki‐67 labelling indices (P<0.01). When a cut‐off value of 6 was chosen, the AgNOR value discriminated SC from non‐SC tumors with high specificity and sensitivity. When a cut‐off value of 25% was chosen, PCNA and Ki‐67 labelling indices also discriminated between these tumors. Significant differences were not observed between sebaceoma and BCSD with PCNA and Ki‐67 labelling indices. AgNOR counts of BCSD were a little higher than those of sebaceoma, but the number of cases was too small to perform statistical assessment. We consider AgNOR counts and semi‐quantitative grading of PCNA and Ki‐67 labelling indices to be useful in differentiating SC from BCSD and sebaceoma.