Yoshiharu Miki

Subclass Characteristics of IgG Autoantibodies in Bullous Pemphigoid and Pemphigus

Immunoglobulin (Ig) G subclasses in anti‐basement membrane zone (BMZ) autoantibodies found in the sera of bullous pemphigoid (BP) and in anti‐intercellular substance (ICS) autoantibodies of pemphigus were investigated using immunofluorescent (IF) staining. In BP, IgG4, IgG1, and IgG2 were detected in 13, 5 and 6 of 15 patients, respectively; IgG3 was not detected. In pemphigus, IgG4 was detected in all of 10 patients, IgG1 in 7, IgG2 in one, and IgG3 in one patient, respectively. In both BP and pemphigus, the most prominent subclass in intensity of IF staining was IgG4. Although one BP and one PV patient had only IgG4 autoantibodies, C3 deposition was detected.

Cutaneous and pulmonary cancers associated with Bowen's disease

Thirty-one patients with Bowens disease were studied in a restricted district of Namikata and its neighborhood of Ehime, Japan. Nineteen were alive and 12 were dead; the youngest living patient was 52 years of age. Invasive skin cancers were found in 10 patients and internal malignancies in 10, including 7 patients with pulmonary cancers. Palmoplantar keratosis was present in 25 patients and raindrop-type pigment anomalies in 15. Neutron activation analysis of hair showed only slightly higher arsenic values in patients with Bowens disease than those in normal controls, though the differences were statistically significant at p less than 0.05. A possible arsenic exposure 43 years previously was considered responsible for the occurrence of neoplasms, though the arsenic route and amount were not determined. Bowens disease started within 10 years, invasive skin cancers after 20 years, and pulmonary cancers after 30 years following the suspected arsenic exposure.

Malignant skin tumors among dermatology patients in university hospitals of Japan. A statistical survey 1971-1975.

A total of 829 patients with squamous cell carcinoma (SCC), 942 patients with basal cell carcinoma (BCC) and 256 patients with malignant melanoma (MM) was encountered among 1,033,678 new dermatology patients in 44 of 46 university hospitals of Japan between 1971 and 1975. The incidences of skin cancers (SCC and BCC) and of MM among new dermatology patients were 0.171% and 0.025% respectively. The incidences had increased 2 to 2.5 times over those of the previous survey between 1956 and 1960.

Electron spin relaxation of synthetic melanin and melanin-containing human tissues as studied by electron spin echo and electron spin resonance

Electron spin lattice relaxation times (T1) and the phase memory times (Tm) were obtained for the synthetic melanin system from 3-hydroxytyrosine (dopa) by means of electron spin echo spectroscopy at 77 degrees K. Saturation behavior of the ESR spectra of melanins in melanin-containing tissue and of the synthetic melanin was also determined at the same temperature. The spin lattice relaxation time and the spectral diffusion time of the synthetic melanin are very long (4.3 ms and 101 microseconds, respectively, in the solid state), and the ESR signal saturates readily at low microwave powers. On the other hand, ESR spectra of natural melanins from the tissues chosen for this study, as well as those of synthetic melanins which contain Fe3+ of g = 4.3 and Mn2+ of g = 2, are relatively difficult to saturate compared with samples without such metal ions. These results show clearly that a large part of those two metal ions in sites responsible for the ESR spectral components with these particular g values are coordinated to melanin in melanin-containing tissue, and modify the magnetic relaxation behavior of the melanin. Accumulations of these metal ions in melanins are different from system to system, and they increase in the order: hair (black), retina and choroid (brown), malignant melanoma of eye and skin, and lentigo and nevus of skin.

Proliferative Activities in Spitz Nevus Compared with Melanocytic Nevus and Malignant Melanoma Using Expression of Pcna/cyclin and Mitotic Rate

Proliferative activity in Spitz nevus (SN) was determined using proliferating cell nuclear antigen (PCNA) immuno-staining and by assessing the mitotic rate. It was compared with that in compound melanocytic nevus (MN) and in malignant melanoma (MM). The PCNA index (number of positive cells/1.000 tumor cells) in SN was 72.8 ± 45.596 (mean ± SD), which was statistically significantly higher than that in MN (7.2 ± 2.7%) and lower than that in MM (248.5 ± 110%). The PCNA-positive cells in SN and MM were found both in dermal and junctional nests, while those in MN were found almost exclusively in the dermal nests. The mitotic rate in SN was 1.4 ± 0.96%, while it was nothing in MN and 5.4 ± 4.2% in MM. There was a statistically significant correlation between the PCNA index and the mitotic rate at r = 0.8946. p < 0.001. The PCNA index, however, appeared to show the proliferative activity of SN more clearly than did the mitotic rate.

Bloom's syndrome with porokeratosis of Mibeili and multiple cancers of the skin, lung and colon

A 38‐year‐old Japanese male with Blooms syndrome (BS) and porokeratosis of Mibeili (PM) developed multiple carcinomas of the skin and lung. There were multiple, spontaneous chromosomal aberrations and frequent sister chromatid exchanges (SCE). Cutaneous delayed‐type hypersensitivity reactions were defective and serum IgM was decreased. The lung cancer was treated with radiation, which was effective but caused a severe pulmonary atelectasis and esophageal stricture. The patient expired one‐and‐a‐half years later because of pneumonia. Autopsy disclosed an adenocarcinoma of the colon. The concurrent PM was considered responsible for the occurrence of multiple skin cancers.

Cytogenetic studies in a patient with porokeratosis of Mibelli, multiple cancers and a forme fruste of Werner's syndrome

A 49‐year‐old man with extensive porokeratosis of Mibelli (PM) developed a squamous cell carcinoma and several carcinomas‐in‐situ within the lesional skin. The patient also had diabetes mellitus and a short stature with a prematurely aged appearance. The patients father and two siblings also had PM. The patient died from metastatic squamous cell carcinoma, and at autopsy an adenocarcinoma of the descending colon was also found.

ECHOGRAPHIC EVALUATION OF NODULAR LESIONS OF THE SKIN

Echographic differentiation between clinically similar, nodular lesions of the dermis and subcutaneous fat was done in an attempt to open a new field of ultrasonic histopathology.

Distribution of Complement regulators (CD46, CD55 and CD59) in skin appendages, and in benign and malignant skin neoplasms

Summary Immunohistochemical studies were performed to establish the distribution of membrane cofactor protein (MCP; CD46), decay‐accelerating (DAF; CD55) and homologous restriction factor (HRF20; CD59), in normal skin appendages, and in benign and malignant skin neoplasms. At least two of these regulators were detected on normal eccrine glands, apocrine glands and sebaceous glands. They were also found in cellular naevi (CN), seborrhoeic keratoses (SK), basal cell carcinoma (BCC). Bowens disease (BD), squamous cell carcinoma (SCC) and Pagets disease (PD). Although there were slight differences in their distribution, these regulators were found in all the cells examined, indicating that they are essential factors in human skin as well as other organs, and in neoplasms, in preventing autologous complement attack.

Oral fluconazole treatment of fungating candidiasis in the keratitis, ichthyosis and deafness (KID) syndrome.

We report a patient with a congenital ichthyosiform eruption, sensorineural deafness, vascularizing keratitis and pannus formation, and hypotrichosis, who developed recalcitrant fungating candidal plaques on the skin. There was no family history of similar disease, or of consanguinity. The steroid sulphatase level in the keratin was within normal limits, and this finding excluded a diagnosis of X‐linked recessive ichthyosis. Treatment with oral fluconazole for 14 weeks resulted in complete resolution of the fungating lesions, and there has been no evidence of recurrence during a 12‐month follow‐up period.