Toshiyuki Ishizawa

Basal Cell Carcinoma within Vulvar Paget’s Disease

An 85-year-old Japanese woman had noticed erythema on her vulvar region 3 years before. The erythema gradually increased in size and followed erosion and ulceration with pigmentation on the edge of the erythema. A skin biopsy from the pigmented area showed large round cells with ample cytoplasm, which formed nests or glandular structures. In the dermis there was mass formation of basophilic cells and peripheral cells in a palisade arrangement. The tumor cells in the epidermis showed positive immunoreactivity for carcinoembryonic antigen; on the other hand, the dermal tumor was negative. We diagnosed that the tumor in the epidermis was vulvar Paget’s disease, and the dermal tumor was a solid type of basal cell carcinoma. We speculate that the vulvar Paget’s disease preceded and then the basal cell carcinoma developed in the area of Paget’s disease. This is the first report in which basal cell carcinoma in the area of Paget’s disease was documented.

Squamous cell carcinoma arising in chronic perianal pyoderma a case report and review of Japanese literature.

We report a rare case of squamous cell carcinoma developing from fistules of chronic perianal pyoderma in a 49‐year‐old Japanese man. He first noticed an abscess and nodule on his buttocks and perianal area 21 year previously (at the age of 28); the fistules formed later. These fistules were surgically removed, and an artificial anus was constructed 14 years ago (at the age of 35) in our hospital, when a histopathological examination revealed no malignant changes. However, he was recently admitted to our hospital with arterial bleeding from the ulcer of the buttock. On admission, the histological diagnosis of the ulcer was well differentiated squamous cell carcinoma. Wide local excision of the ulcer and scar tissue, including the sacrum, was performed. The defect was covered with a left latissimus dorsi flap and skin graft. He received radiation therapy after the operation. However, he died of cachexia and pneumonia. This case indicated that the CPP would better have been treated with wide excision before the development of SCC. Therefore, we recommend careful follow‐up of patients affected by CPP and repeated biopsies of the lesion, particularly when the condition is severe, longstanding, and extensive. We discussed the term “CPP” and reviewed 22 cases of SCC arising in CPP reported in the Japanese literature.

Chilblain lupus erythematosus of Hutchinson responding to surgical treatment: a report of two patients with anti-Ro/SS-A antibodies

We report two patients with chilblain lupus erythematosus of Hutchinson (CL) who responded to surgical treatment. One of them was a 72‐year‐old woman (case 1), and the other a 62‐year‐old man (case 2). We attempted to treat these patients by excising the lesions and subsequently performing full‐thickness free skin grafting, using skin from the abdominal region. No recurrence was seen in the operated area 7 years (case 1) and 3 years (case 2) after surgery. However, lesions persisted in the areas not operated upon, and in the areas where lesions had not been adequately excised. These results suggest that surgical removal of local factors reduces the rash in these cases. In addition, both patients were serologically positive for the anti‐Ro/SS‐A antibody suggesting that local expression of the Ro/SS‐A antigen may be involved in the pathogenesis of the skin lesions. To our knowledge, full thickness free skin grafting has not been used previously to treat CL‐associated skin lesions, and is promising as a treatment for patients who do not respond to conventional means.

Occurrence and comparison of the expressed keratins in cultured human fibroblasts, endothelial cells and their sarcomas

We investigated keratin (K) expression in cultured fibroblasts, endothelial cells and their sarcomas by using two-dimensional gel electrophoresis and electron microscopy techniques. Although the fibroblast and endothelial cell lines were derived from mesenchyme, we confirmed Ks in both cell lines. The K in two cultured cell lines consisted of K14 and K16, together with vimentin. In addition to the above Ks, K5 and K8/K17 were comprised in each cell line, respectively. On the other hand, the cultured fibrosarcomas contained K8 and K18 in addition to the Ks present in the cultured fibroblasts, except K17. Moreover, cultured angiosarcomas showed the same Ks expression as those of the cultured fibrosarcomas, except vimentin. However, electron microscopy showed that the extremely thin fiber-like substances existed or at least did not form filamentous structures in four cultured cell types.

SISTER JOSEPH'S NODULE : A CASE REPORT AND REVIEW OF THE JAPANESE LITERATURE

We report a case of metastatic carcinoma on the umbilicus, which is known as Sister Josephs nodule. A 65‐year‐old man with the chief complaint of a painful nodule on the umbilicus was refered to our hospital. Histopathological examination revealed moderately differentiated tubular adenocarcinoma in the dermis. Endoscopic examination found gastric cancer of Borrmann type IV. The umbilical lesion represented a metastasis from the gastric cancer. We reviewed 80 cases of metastatic carcinomas to the umbilicus that have been reported in the Japanese literature.

Lipodystrophia centrifugalis abdominalis infantilis.

To describe the clinical features of lipodystrophia centrifugalis abdominalis infantilis (LCAI) with special attention to the erythema which is seen around the depressed lesion.

A patient with subaural arteriovenous malformation complicated by macrotia.

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Case of basal cell cancer in focus of vulva Paget disease.

We report a case of basal cell carcinoma (BCC) in the area of the genital Pagets disease. A 85-year-old woman noticed erythema on her vulvar region 3 years before, and the erythema gradually increased in size and followed erosion and ulcus on the erythema. Histologically, erythema revealed Pagets disease and the ulcus was the solid type of BCC.In the bordered area of Pagets disease and BCC, Paget cells infiltrated into the mass of BCC in the dermis, which were demonstrated with an immunopathological method using anti-CEA antibody.We speculated that the genital Pagets disease and BCC developed isolatedly in the different places nearly, after that, the BCC was surrounded by Pagets disese.