Yuta Kurashige

Eccrine Porocarcinoma: Clinical and Pathological Report of Eight Cases

Background: Eccrine porocarcinoma (EPC), a slow-growing carcinoma of the sweat gland, is a rare condition documented only in a small number of case series. Due to its rarity, guidelines and specific recommendations are not widely available. Accordingly, many dermatologists encounter difficulty in diagnosing and treating EPC. The aim of this study is to report the clinical and pathological features of EPC in order to contribute to the body of information currently available on the subject. Patients and Methods: From 2003 to 2013, 8 Japanese patients were diagnosed with EPC at the Department of Dermatology in the Hachioji Medical Center of Tokyo Medical University. Patient data, including clinical manifestations, histopathological findings, immunohistochemical results, treatment method, and clinical course were collected and documented. Results: The mean age of the patients (6 males and 2 females) was 72.6 years. The duration of the lesions ranged from 4 months to 5 years (mean: 3.5 years). All of the lesions clinically presented with erosive reddish nodules (mean size: 39.0 mm). Initial CT imaging revealed that 1 case had multiple distant metastases. Surgical resection was performed for all primary lesions and follow-up observations were available in all cases (mean: 10.9 months). One case with distal metastases underwent both radiation therapy and chemotherapy, but nevertheless succumbed to the disease. Conclusion: The EPC cases in our department presented a versatile clinical appearance and characteristic histopathological features.

Three Cases of Sacral Pressure Ulcers Presenting Primary Dermatoporosis on the Forearms

The relatively new term dermatoporosis refers to chronic deficiencies in the skins functions in the elderly population due to aging. This syndrome is marked by chronic cutaneous fragility clinically represented by skin atrophy, senile purpura, stellate pseudoscars, skin laceration, and dissecting hematoma of the skin. In this paper, we report three cases of sacral pressure ulcers presenting primary dermatoporosis on the forearms. Case 1 was a 74-year-old male who presented with a stage IV sacral pressure ulcer. The signs of dermatoporosis appeared on the forearms. Histopathology of the lesions revealed epidermal thinning with loss of rete ridges. Azan and Elastica van Gieson staining demonstrated the degeneration of the dermal collagen fibers and elastic fibers, respectively. In spite of 6 months of treatment, the ulcer failed to heal sufficiently. Case 2 was a 74-year-old male and Case 3 was a 97-year-old female. Both cases presented with a stage II sacral pressure ulcer and dermatoporosis on the forearms. Histopathological examinations and the clinical course of the wound could not be ascertained in Cases 2 and 3. None of the patients had previously used corticosteroids. The presence of a primary dermatoporosis on the forearms in these cases may be associated with the increased risk of pressure ulcer development.

Poroma with sebaceous differentiation: Report of three cases

We herein report three cases of poroma, which showed sebaceous differentiation. The patients were two men and one woman, and the involved sites were the thigh, head and back. In all three cases, histopathological examination revealed anastomosing nests consisting of poroid cells proliferating into the dermis. Tubular structures lined by eosinophilic cuticular cells were scattered in the tumour nests. Furthermore, aggregations of mature sebocytes with vacuolated cytoplasm were also observed forming clusters, or intermingled with the poroma cells. Focal calcification was found within the nests in two cases. Sebaceous component were recognized in the presented three cases among the 62 cases (4.8%) examined in our department within the past 10 years. We also include a review of the 31 reported cases of poroma with sebaceous differentiation. None of them occurred in acral regions, where typical eccrine poromas predominate. The majority of cases were benign. This review indicates that some poromas may show sebaceous differentiation and be of apocrine lineage.

Leukemia cutis originating in the extravasation site of i.v. gabexate mesilate infusion

Leukemia cutis is a localized or disseminated skin infiltration by leukemic cells. A 64‐year‐old man was diagnosed with acute myeloid leukemia (AML) complicated by disseminated intravascular coagulation. During the course of treatment with gabexate mesilate, the substance accidentally leaked from the infusion site in his elbow. One month later, a dark red erythema and induration accompanied by severe pain appeared in the area proximal to the gabexate mesilate injection site. The biopsy specimen demonstrated not only inflammation but infiltration of leukemic cells as well. Immunohistochemical staining for intercellular adhesion molecule‐1 and platelet/endothelial cell adhesion molecule‐1 showed strong expression of endothelial cells and leukemic cells. We speculate that the gabexate mesilate might have played a role in the induction of leukemia cutis via adhesion molecules in our case.

Subungual verrucous carcinoma with bone invasion.

Verrucous carcinoma (VC) is a low-grade, highly differentiated variant of squamous cell carcinoma. Clinically it is characterized by exophytic tumors with a cauliflower-like appearance. On the other hand, VC ultimately penetrates deep into the tissue and sometimes extends into bone, while regional metastasis is rare. Cutaneous VC, though preferentially involving the genitocrural area or the sole of the foot, can arise in any part of the skin surface. Here we report a case of VC occurring in the subungual region of the foot and histopathologically involving an invasion of the underlying bone.

Acute blistering disease presenting IgG autoantibodies against NC16A and COOH-terminal domains of BP180 and laminin-332, with characteristic distribution of eruptions

ejd.2012.1895 Auteur(s) : Yuta Kurashige1 kurasige@tokyo-med.ac.jp, Tokuya Minemura1, Tetsuo Nagatani1, Hiroshi Koga2, Takashi Hashimoto2 1 Department of Dermatology Hachioji Medical Center Tokyo Medical University 1163 Tatemachi, Hachioji-shi, Tokyo 193-0998, Japan 2 Department of Dermatology, Kurume University, Kurume, Japan Bullous pemphigoid (BP) and cicatrical pemphigoid (CP) are autoimmune blistering diseases that produce immunoglobulin (Ig) G autoantibodies against antigens located in the [...]

Primary mucinous carcinoma of the skin arising from an in situ component

ejd.2012.1748 Auteur(s) : Yuta Kurashige1 kurasige@tokyo-med.ac.jp, Takayuki Kariya1, Hirofumi Hirano1, Hiroshi Kawakami1, Tokuya Minemura1, Tetsuo Nagatani1, Hiromi Serizawa2 1 Department of Dermatology, 2 Department of Pathology, Hachioji Medical Center, 1163 Tatemachi Hachioji-shi, Tokyo 193-0998, Japan Primary mucinous carcinoma of the skin (PMCS) is a rare form of malignant neoplasm with characteristic histopathological findings, such as an abundance of mucin pooled on the stroma. However, [...]

Hidradenoma papilliferum of the vulva in association with an anogenital mammary‐like gland

Hidradenoma papilliferum (HP) is a benign adnexal neoplasm which preferentially develops in the anogenital region of women. Although the origin of HP was previously thought to be an apocrine sweat gland, recent studies have suggested that it may derive from the anogenital mammary‐like gland (MLG). In this paper, we present a 43‐year‐old Japanese woman with hidradenoma papilliferum of the vulva. The lesion developed 7 years prior to her visit, and clinically appeared as a skin‐colored cystic nodule. Histopathological examination revealed that the neoplasm was formed by the tubular structures consisting of two types of pleomorphic cells, columnar cells in the luminal layer and cuboidal cells in the basal layer. Further, the surgical specimen contained a wide, divergent, lobular ductal structure located in the vicinity of the neoplastic lesion, which was consistent with MLG.

Two cases of malignant melanoma of the toe developed skin ulcers following local injection of natural beta‐interferon

islands was higher than those for Th cells and CTL from preto post-treatment. These phenomena might account for the ineffective local and systemic control of tumor progression. The increased infiltration of regulatory T cells in the outer layer of the tumor mass may inhibit CTL to infiltrate into the inner layer of the tumor mass and/or avoid antitumor function of CTL. Increased infiltration of NK cells, NKT cells, Th cells and CTL into tumor islands requires that these cells pass through the fibrous or dense collagenous capsule to the inside of the tumor. To achieve this, adequate stimulation of TLR9 in tumorinfiltrating pDC and B cells with CpG-ODN followed by induction of antitumor immune cells is required. The combination therapy in our case elicited only a limited immune response and further treatment options are required for improving the clinical effect through strong induction of antitumor immune cells and alteration of the tumor microenvironment. Akiko OZAWA,* Tomoko NOMIYAMA, Noriaki NAKAI,* Gunther HARTMANN, Hideya TAKENAKA, Saburo KISHIMOTO, Norito KATOH Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Osaka General Hospital of West Japan Railway Company, Osaka, Japan, and Institute of Clinical Chemistry and Pharmacology, University of Bonn, Bonn, Germany *These authors contributed equally to this work.

Herpetiform pemphigus with anti-Dsg 1 and full-length BP180 autoantibodies

ejd.2012.1643 Auteur(s) : Yuta Kurashige1 kurasige@tokyo-med.ac.jp, Yoshihiko Mitsuhashi1, Masuyoshi Saito1, Shunpei Fukuda2, Takashi Hashimoto2, Ryoji Tsuboi1 1 Department of Dermatology, Tokyo Medical University, 6-7-1 Nishishinjuku Shinjuku-ku, Tokyo 160-0023, Japan 2 Department of Dermatology, Kurume University, Kurume, Japan Herpetiform pemphigus (HP) has been considered an unusual clinical variant of pemphigus. HP shows vesicles arranged on the periphery of annular erythemas in a manner similar [...]