Susumu Takayasu

A case of squamous cell carcinoma of the scrotum associated with invasion of surrounding dermal lymphatic vessels and regional lymph node metastasis.

A-75-year-old man developed a rapidly growing tumor followed by swelling of regional lymph nodes, on the left side of his scrotum. Histopathological examination of the tumor revealed a deep invasion of atypical squamous cells associated with embolism of dermal lymphatic vessels by tumor cells, as far as 4cm apart from the tumor. Wide local excision of the tumor including total scrotal skin and bilateral ilioinguinal lymph node dissection was performed. Subsequently five courses of chemotherapy with cisplatin and fluorouracil and radiotherapy were added. In spite of these treatments, he had a recurrence located on the posterior border of the grafted skin of scrotum one year after the operation. [Skin Cancer (Japan) 2001; 16: 47-50]

A Case of Recurrent Dermatofibrosarcoma Protuberans Invading the Cerebral Parenchyma.

A 22-year-old Japanese man visited our hospital with a large tumor on his occipital region. He first noted a nodule on his scalp when he was 14-years-old in 1986. Although the tumor was excised in 1987, he noticed recurrence one year later. Since then, surgical excision of recurrent tumors had been performed six times. In 1994, he complained of frequent headaches, walking disturbance and visual disorder. Physical examination revealed several large nodules located on the anterior border of the previously grafted skin. Magnetic resonance imaging showed the scalp mass invading the cerebral parenchyma. The recurrent tumors were further resected five times. In spite of the radiotherapy and chemotherapy, the tumor progressively disseminated into spinal cord, and he died of respiratory failure in January, 2000. [Skin Cancer (Japan) 2001; 16: 77-82]

A case of squamous cell carcinoma with nerve invasion occurred in calcaneal burn scar.

Malignant skin tumors rarely show perineural spread or neural invasion. The incidence was reported to be 2.4-4.9% for squamous cell carcinoma of the skin. We report a case of squamous cell carcinoma arising on the burn scar of the right heel of a 31-year-old woman with perineural and endoneural invasion.Despite appropriate treatments including wide local excision, resection of medial calcaneal nerve and radioand chemotherapy, the tumor recurred near the site of the perineural invasion after 10 months. Her right leg was amputated above the knee.

2 cases of malignant lymphoma with cerebrospinal invasion.

Two cases of malignant lymphoma with skin and secondary central nervous system (CNS) involvement were reported.Case 1: A 69-year-old male presented with the skin, paranasal cavity, laryngeal and intrathoracic involvement by B cell lympboma (diffuse medium cell type). He also complained of paraesthesia on the left leg. Although these lesions almost disappeared after VEPA therapy, the patient complained of clounding of conciousness and poor memory two months later. Examination revealed leptomeningeal involvement and epidural spinal cord compression. Lumbar puncture disclosed numerous atypical cells which were positive for CD20. The patient died of pneumonia after few months, although these atypical cells in the spinal fluid disappeared after intrathecal chemo-therapy.Case 2: A 61-year-old male developed cutaneous T cell lymphoma (diffuse medium cell type) without any other symptoms. The skin lesions disappeared after VEPA therapy. He suddenly developed clouding of conciousness and poor memory after one year of remission. CT scans showed an intracerebral mass. In spite of whole brain irradiation and both systemic and intrathecal chemotherapy, the tumor did not decrease in size and the patient died of pneumonia after 1.5 years.In the literature, CNS involvement developed 5-10% of adult malignant lymphoma. The risk factors for secondary CNS involvement were considered to be stage IV diseases, B symptoms, diffuse large cell or mixed cell type, involvement of the testis, peripheral blood, nasal/paranasal sinuses and bone marrow. Thus, the case 1 might have been given a prophylactic treatment, since he had several signs described above.

A case of basal cell epithelioma of the anus.

69歳男性の肛門部基底細胞上皮腫の1例を報告した。肛門部7°～11°の方向に45mm×25mm, 高さ10mmの黒色腫瘤があり, 一部線状に肛門管へ浸潤し, 歯状線直上まで存在していた。生検にて基底細胞上皮腫の診断を得, 辺縁5mm離し, 脂肪織と外肛門括約筋を一部含めて切除後, V-Y advancement subcutaneous flapにて創を一期的に閉鎖した。術後排便良好。鑑別診断として, cloacogenic zone (移行帯) 由来の類基底細胞癌があげられる。

Statistical studies on basal cell epitherioma at the Medical College of Oita Hospital, Oita prefecture.

我々は, Aggressive BCE (Basal Cell Epitheliolna) を (1) 臨床的に再発例, (2) 組織学的に筋層, 軟骨あるいは骨へ達する例のうちいずれかを満たすものと定義づけし, 大分医大皮膚科における59例のBCEをAggressive BCE (14例) とNon-Aggressive BCE (45例) の2群に分け組織学的に比較検討した。その結果, Aggressive BCEではirregular spiky pattern, micronodular nest, peripheral palisading irregularityが組織学的特徴として認められた。炎症細胞浸潤の程度, 潰瘍形成は二つのグループの間に差を認めなかった。これらの結果にもとづき, 当科ではAggressive BCEに対して通常のBCEに対する切除範囲では不十分と考え, SCCに準じた皮膚広範囲切除を行っている。