Teruo Kurokawa

5-Aminolevulinic acid-mediated photodynamic therapy to superficial malignant skin tumors using Super Lizer.

Photodynamic therapy (PDT) using topically applied 5‐aminolevulinic acid (ALA) has become a generally accepted treatment modality for superficial malignant skin tumors. However, the costly excimer‐dye laser, diode laser and light‐emitting diode (LED) frequently used to administrate PDT are impractical to use in most dermatology clinics. This study evaluated the effectiveness of ALA‐mediated PDT using a Super Lizer (Tokyo Iken, Tokyo, Japan) equipped with band‐pass filters in 38 patients with superficial malignant skin tumors (33 cases of actinic keratosis and five cases of Bowen’s disease). Twenty‐one cases (18 cases of actinic keratosis and three cases of Bowen’s disease) were successfully treated, and the other 17 cases (15 cases of actinic keratosis and two cases of Bowen’s disease) showed partial remission after single or repeated administration of PDT. PDT repeated three times at weekly intervals was more effective against actinic keratosis than randomly repeated procedures. The Super Lizer is easy to handle and move, and is less expensive than other known machinery and is useful for PDT in dermatology, especially under the protocol of three times at weekly intervals for the treatment of actinic keratosis.

Association between the clinical and histopathological classifications of actinic keratosis and the efficacy of topical imiquimod treatment

We investigated the association between the clinical and histopathological classifications of actinic keratosis (AK) and the efficacy of topical imiquimod treatment. Forty patients (55 lesions) with AK were treated with topical 5% imiquimod and the efficacy of imiquimod for AK was evaluated based on the clinical/histopathological changes. The complete remission (CR) rates in patients with the different clinical classifications of AK were 85.4% (erythematous type) and 46.2% (hyperkeratotic type). The CR rates in the different histopathological classifications of AK were 80% (hypertrophic type), 81.8% (atrophic type) and 42.9% (bowenoid type). The results revealed that determining the clinical and histopathological type of AK was important for selecting a therapeutic method. The topical imiquimod treatment could be expected to be more effective for AK clinically classified as the erythematous type, or histopathologically classified as the atrophic or hypertrophic type. However, it would be expected to be less effective for the treatment of AK clinically classified as the hyperkeratotic type or histopathologically classified as the bowenoid type. Our observations suggest that we can predict the efficacy of topical imiquimod therapy in AK by determining its clinical and histopathological type.

Case of generalized eruptive keratoacanthoma with probable Sjögren's syndrome.

elastolyis with acne vulgaris and/or folliculitis makes a great deal of sense. Apart from acne vulgaris, atopic dermatitis was reported as an underlying disorder of perifollicular elastolysis, possibly related to topical corticosteroid-induced folliculitis. On the other hand, our case suggests that other factors may be associated with its pathogenesis because the pseudofolliculitis in Behc et’s disease is a sterile inflammation. Further research is needed to understand the pathogenesis of perifollicular elastolysis.

Immunohistochemical analysis of O 6 -methylguanine-DNA methyltransferase in human melanoma in comparison with skin squamous cell carcinoma

Alkylating agents, often used for chemotherapy in patients with melanoma, can produce O6-alkylguanine (O6AG) which is related to tumor cell killing after treatment with alkylating agents. O6AG is effectively eliminated by O6-methylguanine-DNA methyltransferase (O6MGMT) and its level is correlative to the resistance to alkylating agents. However, little is known about the relationship of O6MGMT to the characteristics of melanoma. This study investigated the expression of O6MGMT in 12 melanomas and compared it with that in 11 skin squamous cell cancers (SCCs) immunohistochemically to evaluate the O6MGMT activity in melanoma and its clinical significance. All of the SCC samples had high O6MGMT expression, while the expression of O6MGMT in melanoma was diverse and 4 out of 12 samples had no or extremely low O6MGMT activity. Out of 6 lesions obtained from metastasis, 4 had a high O6MGMT activity. Two out of 3 cases with a low O6MGMT activity in each primary lesion did not show any evidence of metastasis or local recurrence. The evaluation of O6MGMT activity in melanoma may, therefore, be useful to determine the characteristics of tumor in each melanoma case. In addition, the present study implies the possibility of selective cancer chemotherapy for melanoma in the near future.

Acrodermatitis continua of Hallopeau successfully treated only with infliximab: A case report

A 22‐year‐old man presented with a 2‐month history of rapidly progressing pustular eruptions on the accrual regions of his fingers and toes with local arthralgia and severe nail destruction. A histological examination revealed parakeratosis, hyperkeratosis and elongation of the rete ridges of the epidermis with exocytosis of neutrophils forming spongiform pustules of Kogoj. Based on these findings, we diagnosed this case as acrodermatitis continua of Hallopeau (ACH). ACH, a variant of pustular psoriasis, is often resistant to various topical treatments, and the patient experienced prominent decline in his quality of life. Therefore, we decided to use infliximab in the present case. After the fourth administration of infliximab alone, the patients digital arthralgia and pustular eruptions disappeared completely, and the long‐term administration of infliximab drastically reduced all of the patients symptoms of ACH, including the nail lesions without any adverse events or recurrence. Our findings suggest that ACH shares a disease spectrum with plaque‐type and pustular psoriasis. In addition, biologic agents such as a tumor necrosis factor‐α inhibitor are useful for treating patients with ACH just as those with psoriasis and may even be used alone.

Localized involutional lipoatrophy at the site of an influenza vaccination: A case report.

Dear Editor, Localized involutional lipoatrophy (LIL) is a rare non-inflammatory form of localized lipodystrophy characterized by diminutive fat lobules that contain small adipocytes. Although most LIL cases are idiopathic, the s.c. administration of medicines has been known to occasionally induce this condition. A 31-year-old woman received an influenza vaccination on her upper left arm 10 months prior to her presentation and a concave lesion appeared at the inoculation site 6 months later. She presented with a spotty, concave, light reddish-purple lesion 1.8 cm in diameter on her upper left arm (Fig. 1a,b). Blood samples contained no abnormal findings including antidsDNA and anti-Sm antibody. There were no other abnormal findings in the blood or urine. A histopathological examination revealed unremarkable change in the epidermis and dermis, but the subcutaneous tissue contained irregularly-sized adipocytes and a small number of infiltrating inflammatory cells (Fig. 1c,d). Few normal adipocytes were noted, and small adipocytes and surrounding capillary hyperplasia were prominent (Fig. 1d). Immunohistochemistry verified the scattered infiltration of CD68 cells, which were assumed to be macrophages, among the adipocytes (Fig. 1e). Based on these findings, the patient was diagnosed with LIL. She has been managed by observation alone for 1 year without any change of the lesion. Lipoatrophy is classified based on its clinical features as total, partial or localized. Localized lipoatrophy is further classified as two distinctive subsets, involutional or inflammatory, depending on its histology. In the involutional subtype, the adipocytes are small, the surrounding capillaries are hyperplastic and inflammatory cell infiltration is minimal, while in the inflammatory type, the adipocytes are normal sized, inflammatory cell infiltration is pronounced and no capillary hyperplasia is observed. To our knowledge, there have been 41 reported Japanese cases of LIL from subjects aged 5–67 years (mean, 32), in which the extremities were predominant. Most patients

Generalized milia in an infant with full trisomy 13

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An autopsy case of cholangiocellular carcinoma with metastasis in the skull and pituitary gland through the vertebral venous system.

症例は69歳, 女性. 左顔面の鈍痛, 左眼瞼下垂および下垂体機能低下で発症し. 頭蓋骨, 下垂体に原発不明の癌転移が認められ, 剖検によって胆管細胞癌と判明した症例を報告した. その転移経路は, 肺には肺動脈末梢枝にごく少量の癌塞栓がみられるのみであり, 外椎骨静脈叢に高度の癌塞栓がみられたことから, Batsonの提唱した椎骨静脈系を介するものと考えられた. すなわち, 門脈に侵入した胆管細胞癌が奇静脈に流入し, 椎骨静脈系, 脳底静脈叢および海綿静脈洞を経て下垂体および頭蓋骨に転移したと推測される. 胆管細胞癌が椎骨静脈系を介する経路で頭蓋骨および下垂体に転移することは稀であるが, 肺転移のみられない症例ではこのような可能性を念頭において原発巣を検索する必要がある.

Nodular regenerative hyperplasia of the liver in patient with cholangiocellular carcinoma.

症例, 73歳, 女性. 肝右葉を置換するように高度に増殖した胆管細胞癌症例の左葉に典型的な結節性再生性過形成がみられた. 結節性再生性過形成の発生機序は門脈枝閉塞による肝内血流の不均等がもたらす肝細胞の萎縮とそれに対する代償反応であると一般に考えられているが, 本症例では門脈枝の病変はごく軽度であった. これに対して, 肝静脈枝は胆管細胞癌の侵襲とそれによると考えられる内膜肥厚のために狭窄, 閉塞していた. したがって, 本症例の結節性再生性過形成の発生には, 右葉の癌置換による肝細胞消失に対する代償性の左葉肝細胞の増生と, 左葉肝静脈枝の癌侵襲による狭窄, 閉塞の結果としての肝内血流の不均等が関与していると考えられた.