Takahiro Kiyohara

Pigmented contact cheilitis from dipentaerythritol fatty acid ester.

Pigmented cosmetic dermatitis, which was previously known as melanosis faciei feminae, was first recognized in 1973 (1). Innumerable patients with this pigmentary disorder presented in 1960s and 1970s in Japan (2). After allergen control was performed, the disease became completely preventable and the incidence decreased. However, sporadic cases of this disease continue to be reported in the 1990s and 2000s (3, 4), so it is necessary to recognize the cosmetic allergens that produce hyperpigmentation.

Paraneoplastic pemphigus with widespread mucosal involvement [6]

Mami Wakahara, Takahiro Kiyohara, Masanobu Kumakiri, Takanori Ueda, Kazumori Ishiguro, Tomozo Fujita, Masayuki Amagai and Takashi Hashimoto Department of Dermatology and 1st Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka-cho, Yoshida-gun, Fukui 910-1193 Fujita Memorial Hospital, Fukui, Department of Dermatology, School of Medicine, Keio University, Tokyo and Department of Dermatology, School of Medicine, Kurume University, Fukuoka, Japan. E-mail: kinari@yo.mitene.or.jp Accepted February 21, 2005.

Fasciitis-panniculitis syndrome and advanced gastric adenocarcinoma in association with antibodies to single-stranded DNA.

tol 1968; 80:86–9. 7 Barnes BE. Dermatomyositis and malignancy. A review of the literature. Ann Intern Med 1976; 84:68–76. 8 Grando SA. Autoimmunity to keratinocyte acetylcholine receptors in pemphigus. Dermatology 2000; 201:290–5. 9 Suzuki N, Sugawara M, Sugimoto M et al. Gene expression of human chromosome 8 in mouse cell lines. Biochem Biophys Res Commun 1997; 230:315–19. 10 Beletskaya LV, Gnezditzkaya EV. Reaction of sera of patients with pemphigus vulgaris with antigens of the cementing substance from epithelium of Hassall’s corpuscles of human and animal thymus. Bull Exp Biol Med 1974; 77:678–81.

Spindle cell squamous cell carcinoma not expressing stratified but simple epithelial cytokeratin: efficacy of simple epithelial cytokeratin immunoreactivity.

We present two cases of spindle cell squamous cell carcinoma, which were derived from solar keratosis and burn scar in two elderly Japanese patients, respectively. The tumors involved the whole dermis and subcutis in connection with the overlying epidermis. They were composed mainly of anaplastic spindle cells partially forming storiform patterns. The tumor cells were diffusely positive for vimentin and cytokeratin 8/18 (clone CAM5.2, simple epithelial cytokeratin), but negative for cytokeratin 1/5/10/14 (clone 34βE12, stratified epithelial cytokeratin). Ultrastructural analysis of a patient demonstrated desmosomes and tonofilaments in the tumor cells. Although spindle cell squamous cell carcinoma is usually positive for vimentin, detailed cytokeratin profile is controversial. The present cases revealed immunohistochemistry not expressing stratified but simple epithelial cytokeratin and vimentin. We should be reminded of the efficacy of simple epithelial cytokeratin immunoreactivity in spindle cell squamous cell carcinoma.

Basal cell carcinoma with an epidermal collarette and ductal differentiation on the dorsal foot

Dear Editor, Basal cell carcinomas (BCC) usually develop on the face and neck. Fewer than 30 cases (0.42%) of BCC have been reported on the feet in the English-language published work. Only two cases have been reported on the dorsal feet, while the majority developed on the sole. An 89-year-old man presented with a 2-year history of a tumor on the left dorsal foot. The clinical appearance was a well demarcated, dome-shaped, dark-red to blue-gray nodule measuring 10 mm in diameter (Fig. 1). Dermoscopy demonstrated large blue-gray ovoid nests, multiple blue-gray globules and arborizing vessels. A homogeneous white ring surrounded these structures. Histological examination demonstrated variously shaped islands with cyst formation and lace-like pattern, which was composed of basaloid cells (Fig. 2a). Several ducts within tumor islands were lined by luminar cells as seen in normal eccrine/apocrine ducts and poromas (Fig. 2b). Elongated rete ridges at the periphery of the nodule demonstrated infolding toward the center and partial ductal structures, corresponding to an epidermal collarette (Fig. 2a). Although peripheral palisading was clearly observed, there were no obvious clefts. Immunohistochemical staining was performed using an avidin–biotin technique for carcinoembryonic antigen (CEA), epithelial membrane antigen (EMA), gross cystic disease fluid protein (GCDFP)-15, epithelial cell adhesion molecule as determined by Ber-EP4, and cytokeratins detected by monoclonal

Proliferative Nodule in Small Congenital Melanocytic Naevus After Childhood

© 2012 The Authors. doi: 10.2340/00015555-1186 Journal Compilation

Toxic epidermal necrolysis following allergic contact dermatitis caused by occupational exposure to ultraviolet-cured inks.

Erythema multiforme is a relatively common skin disorder; the most common cause is herpes simplex infection, but topical sensitivities reportedly also provoke this reaction. We report here a case that progressed to toxic epidermal necrolysis due to contact with ultraviolet (UV)-cured inks. The diagnosis was confirmed by patch tests to acrylates in the UV-cured inks, histopathological studies of the lesions, and positive patch test to 1,6-hexanediol diacrylate.

Epidermotropic secondary extramammary Paget's disease of the glans penis from retrograde lymphatic dissemination by transitional cell carcinoma of the bladder.

mented in FHI. Reported changes include hyperpigmentation of the epidermis, and hair follicle and/or eccrine gland hyperplasia. While the mechanisms underlying these changes in our case are unknown, epidermal hyperplasia is a characteristic feature for dermatofibroma, and may be accompanied by follicular and sebaceous hyperplasia. Epithelial–mesenchyme interaction mediated by epidermal growth factor receptor, ectopic hedgehog signaling and/or b-catenin have been implicated in these changes. In the present case, inductive elements released from hamartomatous mesenchymal tissues may have contributed to the proliferation of epidermal and adnexal tissues. Alternatively, FHI may represent a cutaneous organoid hamartoma rather than a hamartoma of only mesenchymal origin, as suggested in a previous report. In a recent study, eccrine changes were frequently seen in FHI; thus, epidermal and adnexal changes may be important components and clues to the histological diagnosis of FHI in superficial partial biopsies. Eishi TAKAHASHI, Hiroo YOKOZEKI, Takahiro SATOH Department of Dermatology, National Defense Medical College, Saitama, and Department of Dermatology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan

Eosinophilic spongiosis in vulvar lichen sclerosus

broma, Schwannoma and traumatic neuroma. A neurofibroma, which may be associated with von Recklinghausen’s disease, lacks a capsule, contains a mucopolysaccharide ground substance and has fewer axons with myelin sheaths. The Schwannomas are usually present in a subcutaneous location, contain Antoni A and B type tissue with Verocay bodies, and lack axons. A traumatic neuroma contains axonal and Schwann cell proliferation with the addition of scarring and inflammatory cells, in contrast to PEN. The present patient’s nodule was confined to the dermis, and the spindle cells were separated by prominent clefts that displayed a Schwann cell immunophenotype. The immunostaining of neurofilaments proved the coexistence of numerous axons. In this case, there was no history of trauma on this lesion, no hyperplasia of collagen fibers, and no inflammatory cells around the lesion, and so we could distinguish this case from traumatic neuromas. Although PEN arising on the hand is uncommon, when a solitary tumor on the hand is seen, it is necessary to consider PEN. ACKNOWLEDGMENT

Ber-EP4 immunoreactivity in infundibulocystic basal cell carcinoma.

1 Pan L, Milligan L, Michaeli J, Cesarman E, Knowles DM. Polymerase chain reaction detection of Kaposi’s sarcoma-associated herpesvirus-optimized protocols and their application to myeloma. J Mol Diagn 2001; 3(1): 32–38. 2 Letang E, Lewis JJ, Bower M et al. Immune reconstitution inflammatory syndrome associated with Kaposi sarcoma: higher incidence and mortality in Africa than in the UK. AIDS 2013; 27: 1603–1613. 3 Speicher DJ, Sehu MM, Johnson NW, Shaw DR. Successful treatment of an HIV-positive patient with unmasking Kaposi’s sarcoma immune reconstitution inflammatory syndrome. J Clin Virol 2013; 57 (3): 282–285. 4 Antonelli LR, Mahnke Y, Hodge JN et al. Elevated frequencies of highly activated CD4+ T cells in HIV+ patients developing immune reconstitution inflammatory syndrome. Blood 2010; 116: 3818–3827. 5 Kahn HJ, Bailey D, Marks A. Monoclonal antibody D2-40, a new marker of lymphatic endothelium, reacts with Kaposi’s sarcoma and a subset of angiosarcomas. Mod Pathol 2002; 15(4): 434–440.