Yasuhide Takahashi

A case of infantile digital fibromatosis showing spontaneous regression

A case of infantile digital fibromatosis (IDF) in a 3‐year‐old girl is reported. Two tumours were present on the left fourth toe and one over the lateral aspect of the left heel. Histological examination revealed that the tumour cells contained intracytoplasmic inclusion bodies, characteristic for this condition. The tumours showed spontaneous regression without therapy.

AgNOR (Nucleolar Organizer Regions) Staining in Malignant Melanoma

Nucleolar organizer regions (NORs) are loops of ribosomal DNA seen in nuclei, which are demonstrable as black dots (AgNOR) in tissue sections by silver (Ag) colloid staining. The number of such AgNORs is correlated with cellular activity and is an indicator of the degree of malignancy. In this study, 76 melanocytic lesions were analyzed by AgNOR staining, and the clinical and histopathological characteristics of malignant melanoma and melanocytic nevi were considered. Although the AgNOR counts for melanocytic nevi were significantly different from those in malignant melanoma, an obvious overlap between them was detected. The number of AgNORs in melanocytic nevi per cell was usually 1 or 2. On the other hand, the number of AgNORs per malignant melanoma cell was variable. Morphologically, malignant melanoma cells often showed dispersal of AgNORs throughout the nucleus as well as multiple nucleoli containing clustered AgNORs, whereas melanocytic nevus cells tended to have a regular nucleolus with tightly clustered AgNORs. The correlation between AgNOR count and pathological staging was uncertain, but a slight correlation between AgNOR count and thickness of the primary lesion was obtained. However, the AgNOR count in malignant melanoma was not a prognostic factor for the disease. Therefore, the AgNOR method is difficult to use for differential diagnosis between benign pigmented lesions and malignant melanoma. Nonetheless, an AgNOR count of more than two per cell favors a diagnosis of malignant melanoma.

Treatment of cutaneous T-cell lymphomas (CTCL) with extracorporeal photochemotherapy--preliminary report.

Since August of 1988, we have treated seven CTCL patients with extracorporeal photochemotherapy, including two with tumor‐stage mycosis fungoides (MF) showing mucinous degeneration, two with plaque‐stage MF, and two with erythrodermatous MF. One was withdrawn just after the first trial. For each patient, the phenotypes of peripheral blood lymphocytes were analyzed by flow cytometry in terms of the percentages of OKT11, OKT3, OKT4, Leu9, OKT8, B1, Tac, OKT9, OKIal, Leu7, Leu3a/4B4, and Leu3a/2H4 cells. These parameters were compared with the clinical responses according to skin score. The two patients with tumors died, but the five patients without tumors did not. Three of the 6 patients responded to the treatment. Side effects that are often associated with standard chemotherapy, such as bone marrow suppression, gastrointestinal symptoms and hair loss, were not observed. One cardiovascular event (1 patient) occurred. No significant changes in T‐cell subsets were seen during the course of therapy. These preliminary data suggest that extracorporeal photochemotherapy may be effective for CTCL other than tumor‐stage MF.

Three cases of sporotrichosis with numerous fungal elements.

Three cases of sporotrichosis with numerous fungal elements were reported. Clinically these cases showed nodules to plaques with ulceration. Histologically, they showed unusual features, including histiocytic granuloma in the upper to middle dermis which contained few neutrophils but were surrounded by lymphocytes and epithelioid cells. There was no formation of an abscess. Fungal elements were found in abundance in the histiocytic granuloma, mainly in the form of oval or round spores of varying sizes, some of them produced germ tubes. No asteroid bodies were found. The spores stained positively with HE and PAS, and, in case 1, with anti‐Sporothrix schenckii antiserum. All three cases had been treated with topical corticosteroid ointment. In one case, after the topical corticosteroid treatment was stopped, the histological pattern returned to the usual features seen in sporotrichosis, and fungal elements decreased significantly. This unusual histological pattern was also observed in a specimen from a healthy control infected with Sporothrix schenckii and treated with steroid ointment. These histological and fungal patterns may be possibly induced by the local immunodeficiency following topical steroid treatment.

4 cases of malignant melanoma for 18 years.

In our clinic, we encountered 4 patients (3 men and one woman, 42-76 years old) with malignant melanoma during an 18-year period from 1975 to 1992. Acral lentiginous melanoma was observed in 3 patients, and nodular melanoma in one. Wide surgical excision was done in all cases, and right inguinal lymphadenectomy was added in one patient (case 1, pT4N1M0. Stage III) . One patient (case 1) died 3 years and 2 months after the first visit due to metastasis to the lung. Another patient (case 2, pT3aN0M0. Stage II) died 5 years and 1 month after surgery due to pneumonia without metastasis or recurrence. One patient (case 3, PT3aN0M0. Stage II) is still alive without metastasis or recurrence 1 year and 10 months after surgery. In the remaining patient (case 4, pT3aN0M0. Stage II), left axillar metastasis was found 8 months after surgery, despite DAV and IFN-& combination therapy. Although chemotherapy was not done in cases 1, 2 and 3, IFN-& therapy was added in case 3.

Statistical observation of epithelium malignant tumors.Statistical observation of epithelium malignant tumors in the Yokohama City Univ. medical school dermatology.

横浜市立大学皮膚科における最近10年間の上皮系悪性腫瘍について統計的観察を行った。上皮系皮膚悪性腫瘍は合計403例 (光線角化症, 放射線角化症, 砒素角化症を除くと314例) で, 外来新患総数の約0.6% (同じく0.5%) であった。最近10年間に増減傾向はないが, 当科における前回10年間の統計と比較すると基底細胞上皮腫, 光線角化症, Paget病, 付属器系悪性腫瘍の増加がみられた。性別では, 有棘細胞癌, Paget病, 毛包脂腺系腫瘍は男性に多かった。年齢では有棘細胞癌, Paget病, 転移性皮膚腫瘍は60～70歳代, 基底細胞上皮腫, Bowen病は50～70歳代, 光線角化症は60～80歳代に多かった。有棘細胞癌では前回の10年間に比べ高齢化傾向がみられた。発生部位は有棘細胞癌, 基底細胞上皮腫, 光線角化症は顔面, Bowen病は下肢・体幹に多くみられた。死亡例は有棘細胞癌7例, Paget病2例, 皮膚付属器系悪性腫瘍2例, 転移性皮膚腫瘍8例であった。

The effect of extracorporeal photochemotherapy for mycosis fungoides.

1988年8月以来2名の腫瘤期, 2名の局面期病変, 2名の紅皮症型菌状息肉症 (MF) の合計6名の患者に対してExtracorporeal photochemotherapyを施行し, その効果と末梢血液所見の変化とを検討した。腫瘤期の2名は治療に反応せず増悪が認められた。残りの4名は生存しているが, 7クール以上の治療を行った3名は50%以上の皮疹の改善が認められた。重篤な副作用は認められなかった。赤血球数, 白血球数, 血小板数, 末梢血液中のリンパ球サブセットに関しては治療開始前後で有意差は認められなかった。また, 有効症例および無効症例で治療前のリンパ球サブセットを比較すると, 無効例ではCD3陽性リンパ球, CD4陽性リンパ球が有意に低下しており, CD4陽性CD45RA陽性リンパ球およびCD4/CD8比にも低下が認められた。このことより, extracorporeal photochemotherapyは腫瘤期を除く菌状息肉症でCD4陽性T細胞,CD4陽性CD45RA陽性リンパ球の減少の認められない症例に有効であると言えた。