Sung Nam Chang

Generalized multinucleate cell angiohistiocytoma

Multinucleate cell angiohistiocytoma is a rare benign fibrohistiocytic vascular condition that mainly affects middle-aged women. Grouped reddish-brown papules are found in the extremities. We describe a case of multinucleate cell angiohistiocytoma occurring in a 24-year-old man who presented with multiple papules on the trunk and extremities. This is the first report of generalized multinucleate cell angiohistiocytoma.

A Case of Primary Cutaneous Actinomycosis

Primary cutaneous actinomycosis is very uncommon because of the exclusively endogenous habitat of the organism. We report a case of primary cutaneous actinomycosis characterized by histopathological “sulfur granules”. The patient had a well‐defined subcutaneous nodule on the left thigh without any other lesion and was treated with surgical excision and subsequent oral ampicillin for six weeks. There has been no recurrence during a 1‐year period of follow‐up.

Hypereosinophilic syndrome: correlation between clinical severity and cutaneous microthrombi

A 32‐year‐old man, with a 12‐year history of recurrent edema of the upper and lower extremities, was admitted in February 1998 due to edema of the right forearm and tiredness of 1‐month duration. Examination revealed an ill‐defined, itchy, slightly erythematous, indurated patch with excoriation on the right forearm ( Fig. 1 ). There was no history of drug intake, atopy, or asthma. He recalled, however, having experienced cold‐induced Raynauds phenomenon and intermittent arthralgia. In laboratory tests, there was a white cell count of 11.77 × 103/μL with 48% eosinophils (4830/μL). Liver function tests showed elevated serum glutamic pyruvic transaminase (SGPT) and alkaline phosphatase. Rheumatoid factor was positive. Total immunoglobulin E (IgE) concentration was elevated to 4703 U/mL (normal, < 378 U/mL), while other serum immunoglobulins, including IgG, IgA, and IgM, were normal. Bone marrow aspirate and biopsy showed normocellular marrow with an excess of mature eosinophils, but no evidence of blast cells. There was no evidence of parasitic infestation, and allergy skin test was negative. An extensive systemic evaluation showed no other organ involvement. A skin biopsy specimen revealed many eosinophils infiltrating the perivascular, periappendageal, and subcutaneous fat area and also within the vessel walls. Multiple microvascular thrombi with eosinophils were observed in the mid and lower dermis and subcutaneous fat ( Fig. 2 ). The eosinophils showed positive staining with eosinophil cationic protein (ECP) using the monoclonal antibody EG2. On the basis of the above findings, we diagnosed hypereosinophilic syndrome (HES). Treatment with 60 mg prednisolone daily was started and, within 7 days, his edema and itching sensation started to resolve. Follow‐up laboratory and biopsy findings after 1 month returned to normal. The prednisolone dosage was slowly tapered over a 9‐month period and he is currently on a maintenance dose of prednisolone 10 mg alternate day therapy.

Chronic pruritic papular dermatitis in adult men: a variant of prurigo.

Chronic recurrent pruritic papular eruptions in which a specific diagnosis cannot be established becomes a baffling experience to the dermatologist. We have met adult male patients with chronic recurrent pruritic papular eruptions, but their clinicopathological features are not described in English language textbooks. Our purpose was to study the clinical and histological features of this entity and review the various existing taxonomy. We conducted a study of 20 patients over a six year period by taking histories, performing skin biopsies, screening patch tests, and doing immunofluoresence studies. The eruptions occured exclusively in male adults and had a predilection for the trunk and proximal extremities. The lesions were characterized by severely pruritic, nonfollicular, monomorphic, erythematous urticarial papules. There was no evidence of atopic diathesis or history of insect bite. Most patients had normal levels of serum eosinophils and IgE. The predominant histopathologic finding was a presence of perivascular infiltration of mononuclear cells with eosinophils. The patients followed a chronic course of at least six months with waxing and waning; systemic corticosteroids were the only effective treatment. Finally, all other pruritic erythematous papular dermatoses were ruled out. These cases comprise a distinct entity that has previously been mentioned in a few reports. Clear definition of this entity with an appropriate designation is in order to avoid confusion among dermatologists, and we propose the disease name “chronic papular dermatitis in adult men” as a variant of prurigo.

Multiple lentigines syndrome: a comparison of normal skin and lentiginous skin by electron microscopy and immunohistochemical staining.

A 26‐year‐old Korean man exhibited generalized lentigines, a slight prominence of the chin, short stature, and a familial history consistent with the autosomal dominant mode of inheritance. The multiple lentigines appeared at the age of 1 and spread over his entire body including the scalp, palms, and soles by the age of 4. There were several large dark pigmented spots on the trunk, but no other skin abnormalities were found. We performed histologic studies of the normal skin and the lentigo by both electron and light microscopy with immunohistochemical stains. Routine hematoxylin‐eosin staining of the pigmented skin revealed heavily pigmented basal and spinous layers and prominent rete ridges. Fontana‐Masson stain showed enormous black pigmentations on the basal and spinous layers of the pigmented macule. S‐100 protein stain of the pigmented lesion demonstrated an increased number of melanocytes per unit skin area. Ultrastructural studies showed the presence of extensive aggregated melanosomes within the keratinocytes in the epidermis of lentigo, but not the presence of giant melanosomes in either normal skin or lentigines.

A Case of Fibrolipoma

Fibrolipoma is a rare variant of lipomas which shows distinct pathologic findings with both component of mature adipose cells and broad bands of dense fibrous connective tissue. A 52-year-old woman presented with cm sized, indurated, slightly elevated and slightly tender subcutaneous mass which slowly enlarged during the last four to five years accompanied by slight tenderness on the right upper back. The laboratory examination showed non-specific findings. Histopathologic findings revealed a well-defined mass composed of eosinophilic dense connective tissue bands with mature adipose cells scattered throughout the mass. The lesion was totally excised and she showed no evidence of recurrence after 6 months of follow-up.