Takashi Takaiwa

Calcinosis Cutis in Juvenile Dermatomyositis Responsive to Aluminum Hydroxide Treatment

Calcinosis cutis is a frequent complication of juvenile dermatomyositis; however, its treatment remains unsatisfactory. We report a case of calcinosis cutis in juvenile dermatomyositis which was successfully treated with oral aluminum hydroxide. Almost complete clearing of calcinosis was observed after 8 months of therapy. There were no adverse effects from therapy. Aluminum hydroxide is worth trying in treating calcinosis cutis.

Trichosporon cutaneum (Trichosporon asahii) infection mimicking hand eczema in a patient with leukemia

Trichosporon Cutaneum is a yeast-like fungus that causes white piedra and onychomycosis. Recently, it has also been recognized as an opportunistic pathogen in immunocompromised hosts. We describe a 64-year-old woman who developed a superficial Trichosporon infection mimicking hand eczema during chemotherapy for her chronic myelocytic leukemia. To our knowledge, no cases of superficial infection like this one have previously been reported. This case suggests that careful examination is required in diagnosing Trichosporon infection in immunocompromised hosts, because the infection can be invasive or unusual in appearance.

Cutaneous mucinosis associated with SLE--a case provoked by PUVA.

A patient with SLE which was complicated by a characteristic cutaneous mucinosis is reported. The skin lesions were composed of intradermal soft nodules, purple‐red plaques, and alopecia of the scalp. Acid mucopolysaccharides accumulated in each lesion. PUVA provoked an infiltrated skin lesion in which acid mucopolysacchraides were deposited in the dermis. Deposition of immunoglobulins and complements were also observed at the dermo‐epidermal junction and on the vascular walls. Some immunological processes which may stimulate the synthesis of acid mucopolysaccharides in the dermis were suggested.

Eccrine gland cancer forming extensive ulcer in thigh.

A 74-year-old female presented in January 1995 with indurated plaques and ulcerson her left thigh. These lesions had first appeared as nodules at the age of about 60 years and had slowly spread and ulcerated. The patient had never received anytreatment for the skin lesions because of her antipathy to doctors.Physical examination revealed numerous indurated erythematous plaques withsuperficial ulcers and nodules on the left thigh and edematous swelling of the entireleft leg. Several indurated erythematous plaques and nodules were also seen on theleft lower leg, perineum and right inguinal resion. A chest X-ray showed pulmonarymetastatic lesions and atelectasis of the left lung field. CT scan disclosed swelling ofthe celiac lymph nodes but no tumor originated from internal organs. Serum CA-125 level was elevated in all the course of the disease. We supposed that the neoplasm onthe patients left thigh originated from the skin. She died of multiple organ failure in March 1995.Histologically, the many tumor cell nests were seen. in the dermis. Some of themshowed restiform-like pattern. Vacuoles were also seen in the tumor cell. Electronmicroscopical examination revealed tonofilaments in tumor cells, cell membraneswith complex interdigitating microvilli-like processes, desmosomes and intracellulartubules. These findings suggest that the neoplastic cells differenciated to eccrinesweat gland, and especially resemble eccrine porocarcinoma.

A case of axilla apocrine cancer.

A 52-year-old woman was admitted to our hospital in February 1991 with an intracutaneous tumor on the left axilla which was noticed as a small mass at the age of 20 and began to enlarge for the last 4 months.On admission, the tumor was firm, approximately 2.4cm in diameter, purplish red and showed radial folds on the surface.Histologically, the tumor was located in the dermis and subcutaneous tissue. The overlying epidermis was papillomatous. Numerous degenerated elastic fibers were seen in the upper and middle dermis.The tumor cells with eosinophilic cytoplasm tended to form tubular structures. Tubular luminal cells often showed decapitation secretion in the central part of the tumor.In the peripheral portion, the cells were atypical in part and showed invasive proliferation to the adjascent, along with vascular and nerve tissues. Transitional form of cells were seen between cetral and peripheral part of the tumor. A few apocrine glands were found in the stroma.Immunohistochemical studies revealed that all tumor cells were positive for EMA and keratin, negative for S-100 protein but CEA was pratially reactive in the periph-eral portion. Electron-microscopic study revealed apocrine and merocrine secretion.Widespread radical excision was performed and lymph node metastasis was found. There was no recurrence or metastasis at follow-up 16 months later.The tumor was diagnosed as apocrine carcinoma arising from axillary apocrine apparatus, however a possible diagnosis of carcinoma derived from accessory mamma remained to be ascertained.

OBSERVATIONS AND IDENTIFICATION OF BROWN PIGMENT GRANULES FOUND IN THE CHROMATED SKIN A HISTOCHEMICAL STUDY

A histochemical study of the presence of catecholamine‐containing cells (chromaffin cells) in human skin which had been treated by chromate‐bichromate solution according to Hillarp and Hökfelt then counter‐stained with various methods, was carried out.