Spitz nevus (SN) is predominantly distributed throughout the lower extremities, while an acral location is rare. Since SN occasionally resembles the clinicopathological presentation of malignant melanoma (MM), it pres...Spitz nevus (SN) is predominantly distributed throughout the lower extremities, while an acral location is rare. Since SN occasionally resembles the clinicopathological presentation of malignant melanoma (MM), it presents a diagnostic challenge, especially on glabrous skin. Past reports suggest that several genetic aberrations are associated with specific clinicopathological subtypes of melanocytic tumors. Immunohistochemistry can provide a clue to the presence or absence of a molecular aberration typical of Spitz tumors. We describe a case of a plantar SN with genetic analysis, including anaplastic lymphoma kinase (ALK), ROS proto-oncogene 1 (ROS1), BRAF (V600E) protein, and BRCA1-associated protein-1 (BAP1). However, we were not able to detect a characteristic gene aberration. To the best of our knowledge, no genetic aberrations in plantar SN cases have been reported. A comprehensive understanding of tumor genomics is expected to play an essential role in the classification of melanocytic tumors. Further genetic research on plantar SN is required to establish new criteria for distinguishing between SN and MM.展开更多
Postherpetic neuralgia (PHN) is the most common complication following acute varicella zoster virus infection. PHN is associated with chronic severe pain and is resistant to conservative management treatments. The pur...Postherpetic neuralgia (PHN) is the most common complication following acute varicella zoster virus infection. PHN is associated with chronic severe pain and is resistant to conservative management treatments. The purpose of this study was to evaluate the effect of 0.3-millisecond multi-pulsed 1064-nm Nd:YAG laser treatment on PHN. Five subjects were treated with 2 - 3 sessions at 2-week interval. After the treatments, reduced visual analog scale (VAS) scores were noted in all patients. Treatments showed no adverse or intolerant effects and all patients felt warmth and comfort during the therapy. We first reported treating PHN patients using 0.3-millisecond multi-pulsed 1064-nm laser Nd:YAG. The results showed remarkable improvements in pain. This laser treatment could be an alternative choice for PHN patients with intractable neuralgia.展开更多
Metallothionein (MT) has many functions that are modulated by several factors, including ultraviolet (UV) radiation and cytokines. We thought that these diverse functions of MT might reflect the specific regulatory me...Metallothionein (MT) has many functions that are modulated by several factors, including ultraviolet (UV) radiation and cytokines. We thought that these diverse functions of MT might reflect the specific regulatory mechanisms of its expression. To understand some of the molecular mechanisms underlying MT expression, we examined the effects of several cytokines and UVB on the promoter activity of the MT gene. First, we introduced the MT promoter construct into the HaCaT keratinocytes and treated them with various concentrations of interleukin-1α (IL-1α) and IL-6. The addition of IL-1α and IL-6 led to an increase in the promoter activity of the MT gene. UVB is known to induce MT expression in epidermal keratinocytes, and IL-6 is a possible mediator of MT induction by UV radiation. Therefore, we investigated whether UVB could induce MT promoter activity. Our results showed, interestingly, that UVB radiation has no or little effect on the promoter activity. This suggested a complex molecular regulation of the MT gene.展开更多
Human papillomavirus (HPV) is an important causative agent of cervical carcinoma and some malignant cutaneous tumors. The integration of HPV DNA into the host genome is one of the most important risk factors for malig...Human papillomavirus (HPV) is an important causative agent of cervical carcinoma and some malignant cutaneous tumors. The integration of HPV DNA into the host genome is one of the most important risk factors for malignant transformation. Here, we report the case of a 53-year-old man with multiple, black-brown genital macules and nodules. Histological findings resembled those for Bowen’s disease, and we made a diagnosis of bowenoid papulosis. This condition is generally benign, but invasive squamous cell carcinoma (SCC) arising from bowenoid papulosis has been previously reported. Therefore, we took biopsy specimens from 10 lesions and tested them for the presence of HPV DNA. DNA sequencing identified HPV type 16 (HPV-16) DNA in all samples. Next, we excised 4 different relatively large lesions and performed an amplification of papillomavirus oncogene transcripts (APOT) assay. This assay showed that all samples had only episome-derived viral transcripts, indicating no integration of HPV DNA into the host genome. We have followed this case for 3 years, and no progression to Bowen’s disease or SCC has so far been observed. We conclude that the APOT assay is a feasible method for evaluating the malignant potential of bowenoid papulosis.展开更多
We report a 64-year-old female patient with an insulin allergy. She was treated with a combination of oral antihistamines, topical hydrocortisone cream, and moisturizing agents, which resulted in the improvement of ec...We report a 64-year-old female patient with an insulin allergy. She was treated with a combination of oral antihistamines, topical hydrocortisone cream, and moisturizing agents, which resulted in the improvement of eczema and intense pruritus. To evaluate insulin allergy, intradermal skin tests were performed with several insulin agents for clinical use and 0.9% NaCl. Skin testing with semisynthetic human insulin resulted in local, immediate skin reactions such as itchy erythema and wheals. Furthermore, we analyzed our case and 25 Japanese cases of insulin allergy previously reported in the literature as far as we know. Interestingly, the number of male patients was approximately two times higher than that of female, and the insulin-specific IgE antibody test was positive in 21 patients. We should keep the possibility of human insulin allergy in mind and prepare for it when initiating human insulin therapy.展开更多
A 60-year-old Japanese woman was referred to our hospital for yellow-brown plaques accompanied by ulceration on her left lower leg. Her medical history included neither diabetes mellitus nor minor trauma. A histopatho...A 60-year-old Japanese woman was referred to our hospital for yellow-brown plaques accompanied by ulceration on her left lower leg. Her medical history included neither diabetes mellitus nor minor trauma. A histopathological examination of the plaques showed necrobiotic changes within the dermal collagen surrounded by granulomas that comprised lymphocytes, histiocytes, and giant cells. The lower dermis revealed fibrotic changes that extended into the subcutaneous tissue. The patient’s blood glucose and glycated hemoglobin levels were within the normal ranges. We considered a diagnosis of necrobiosis lipoidica (NL) in the absence of diabetes mellitus. We reviewed 116 cases of NL that were reported in the Japanese medical literature between 1986 and 2014 and found that NL onset was most common in individuals of both sexes ≥ 60 years of age. Previous reports that reviewed NL cases in the Japanese medical literature that were published during the1900s indicated that NL occurs in people ≥ 40 years of age. We suggest that the aging population and increasingly longer life spans have increased the average age of NL onset in Japan. With regard to treatments, there were no effective treatments, but skin grafts were curative. NL treatment is very difficult, especially when ulcers are present;hence, we suggest that further research is needed to determine effective NL treatments.展开更多
While erythema nodosum is a nodular, erythematous eruption predominantly affecting the extensor aspects of the legs, breast abscesses are the result of relatively common bacterial infections, and only 2 studies have r...While erythema nodosum is a nodular, erythematous eruption predominantly affecting the extensor aspects of the legs, breast abscesses are the result of relatively common bacterial infections, and only 2 studies have reported an association between erythema nodosum and breast abscesses. Here, we report the case of a patient with repeated erythema nodosum associated with subareolar abscesses. The patient was a 34-year-old woman with painful erythematous nodules on her right shin, accompanied by an indurated lesion on her right breast 4 days before the onset of the nodules. Therefore, the patient underwent circumareolar incision, and consequently the painful erythematous nodules disappeared. However, after 39 days, the patient developed another tender, painful lesion in her right breast and painful erythematous nodules on her right shin. After another circumareolar incision, the painful erythematous nodules disappeared again. Therefore, we suggested a significant association between erythema nodosum and breast abscess in this patient. The most common underlying causative organism in breast abscess is Staphylococcus aureus;however, erythema nodosum has rarely been proven to be associated with staphylococcal infections. Therefore, the relationship between S. aureus and erythema nodosum is rather controversial. However, the resistance to the usual treatment methods and prolonged clinical course in our case suggest that the pathogenesis of erythema nodosum associated with breast abscesses might be different from that of the common form of erythema nodosum.展开更多
Malignant tumors arising from follicular cysts are rare. Herein, we report of a 62-year-old Japanese woman with a slowly growing tumor, 22 × 20 mm in size, located on her nose for 2 years. Histopathological exami...Malignant tumors arising from follicular cysts are rare. Herein, we report of a 62-year-old Japanese woman with a slowly growing tumor, 22 × 20 mm in size, located on her nose for 2 years. Histopathological examination of the surgically excised tumor showed that the tumor cells were basaloid and formed peripheral palisading patterns. The tumor contained a cystic structure in its center, and the cyst wall was lined with stratified epithelium with or without keratohyalin granules. Based on these findings, a diagnosis of basal cell carcinoma arising from a follicular hybrid cyst was made. To our knowledge, this is the first case of basal cell carcinoma originating from a follicular hybrid cyst. A review of previous reports of basal cell carcinoma from a follicular cyst indicated that the majority of previous cysts were located on the face, and that the lesions had been present for a relatively long time. The present case showed typical clinical findings and followed a regular course. Malignant transformation may be a rare event, but it can occur in a follicular cyst, so cysts and suspected cysts, especially those found on the face and those persisting for relatively long time, should always be subjected to histological examination.展开更多
Spindle cell hemangioma (SCH) is a rare benign vascular tumor and we report 2 cases of SCH who are 50-year-old man and 16-year-old girl. A growing amount of evidence indicates that multifunctional ECM molecule decorin...Spindle cell hemangioma (SCH) is a rare benign vascular tumor and we report 2 cases of SCH who are 50-year-old man and 16-year-old girl. A growing amount of evidence indicates that multifunctional ECM molecule decorin regulate endothelial cell-matrix interactions during angiogenesis. Furthermore, a current publication shows that no detectable decorin expression was found in the stromas of tumor nests in Kaposi’s sarcoma or angiosarcoma groups while the expression was clearly observed in the connective tissue stromas within benign vascular tumors. SCH exhibits spindle cell proliferation and resembles Kaposi’s sarcoma. Therefore, this study examined decorin expression in the tissues of our SCH cases by immunohistochemical analysis. The results demonstrated that immunoreactivity of decorin was clearly detectable in the connective tissue stroma within tumor nests. SCH was first perceived as sarcoma because of spindle cell proliferation, but this proliferation was subsequently found to be reactive. The presence of decorin expression in our cases also indicates that SCH have benign properties. Moreover, this study further increases the reliability of examination of decorin expression for differentiation between benign and malignant vascular tumors.展开更多
Intralymphatic histiocytosis is characterized by dilated vessels containing aggregates of mononuclear histiocytes in their lumina, and the majority of cases have been associated with rheumatoid arthritis (RA). We repo...Intralymphatic histiocytosis is characterized by dilated vessels containing aggregates of mononuclear histiocytes in their lumina, and the majority of cases have been associated with rheumatoid arthritis (RA). We report a case of a 61-year-old woman with RA who presented with livedo-like erythema and red papules around the right elbow and forearm. Histological examinations demonstrated numerous dilated vessels in the dermis partially filled with medium- to large-sized mononuclear cells. Immunohistochemically, most of the intraluminal cells were CD68-positive histiocytes. Endothelial cells were positive for D2-40, a marker for lymphatic endothelial cells. We diagnosed the patient with intralymphatic histiocytosis based on these clinical and histological findings. Interestingly, the skin manifestations exacerbated during the course of the disease when the swelling of the patient’s right elbow joint progressed. Then, the puncture of content fluid of the joint was performed, since then, the symptoms of the skin lesion immediately improved. These observations suggest a possible association between the eruptions of intralymphatic histiocytosis and the involved joint. The results suggest that such skin eruptions may be ameliorated by treating severe arthritis.展开更多
Syphilitic alopecia (SA) is a rare skin manifestation in secondary syphilis and sometimes indistinguishable from other alopecia. SA is of 2 types, symptomatic and essential, and 3 clinical types, moth-eaten or patchy ...Syphilitic alopecia (SA) is a rare skin manifestation in secondary syphilis and sometimes indistinguishable from other alopecia. SA is of 2 types, symptomatic and essential, and 3 clinical types, moth-eaten or patchy pattern, diffuse pattern and a combination of both. SA in our case indicated symptomatic SA with moth-eaten hairloss. A 46-year-old Japanese homosexual man experienced hairloss followed by the pruritic skin rash. Physical examination of the scalp showed diffusely spread papulosquamous erythema and incomplete hairloss around the lesions. The scalp lesions appeared as “moth-eaten alopecia”. Serological examination for syphilis and HIV were positive. Thus, SA complicated with HIV infection was diagnosed. He was treated with a single perioral dose of ampicillin for 4 weeks, then his condition improved rapidly and hair regrowth occurred. HIV-infected persons show a high incidence of syphilis. Therefore, HIV test should be considered for patients with alopecia.展开更多
文摘Spitz nevus (SN) is predominantly distributed throughout the lower extremities, while an acral location is rare. Since SN occasionally resembles the clinicopathological presentation of malignant melanoma (MM), it presents a diagnostic challenge, especially on glabrous skin. Past reports suggest that several genetic aberrations are associated with specific clinicopathological subtypes of melanocytic tumors. Immunohistochemistry can provide a clue to the presence or absence of a molecular aberration typical of Spitz tumors. We describe a case of a plantar SN with genetic analysis, including anaplastic lymphoma kinase (ALK), ROS proto-oncogene 1 (ROS1), BRAF (V600E) protein, and BRCA1-associated protein-1 (BAP1). However, we were not able to detect a characteristic gene aberration. To the best of our knowledge, no genetic aberrations in plantar SN cases have been reported. A comprehensive understanding of tumor genomics is expected to play an essential role in the classification of melanocytic tumors. Further genetic research on plantar SN is required to establish new criteria for distinguishing between SN and MM.
文摘Postherpetic neuralgia (PHN) is the most common complication following acute varicella zoster virus infection. PHN is associated with chronic severe pain and is resistant to conservative management treatments. The purpose of this study was to evaluate the effect of 0.3-millisecond multi-pulsed 1064-nm Nd:YAG laser treatment on PHN. Five subjects were treated with 2 - 3 sessions at 2-week interval. After the treatments, reduced visual analog scale (VAS) scores were noted in all patients. Treatments showed no adverse or intolerant effects and all patients felt warmth and comfort during the therapy. We first reported treating PHN patients using 0.3-millisecond multi-pulsed 1064-nm laser Nd:YAG. The results showed remarkable improvements in pain. This laser treatment could be an alternative choice for PHN patients with intractable neuralgia.
文摘Metallothionein (MT) has many functions that are modulated by several factors, including ultraviolet (UV) radiation and cytokines. We thought that these diverse functions of MT might reflect the specific regulatory mechanisms of its expression. To understand some of the molecular mechanisms underlying MT expression, we examined the effects of several cytokines and UVB on the promoter activity of the MT gene. First, we introduced the MT promoter construct into the HaCaT keratinocytes and treated them with various concentrations of interleukin-1α (IL-1α) and IL-6. The addition of IL-1α and IL-6 led to an increase in the promoter activity of the MT gene. UVB is known to induce MT expression in epidermal keratinocytes, and IL-6 is a possible mediator of MT induction by UV radiation. Therefore, we investigated whether UVB could induce MT promoter activity. Our results showed, interestingly, that UVB radiation has no or little effect on the promoter activity. This suggested a complex molecular regulation of the MT gene.
文摘Human papillomavirus (HPV) is an important causative agent of cervical carcinoma and some malignant cutaneous tumors. The integration of HPV DNA into the host genome is one of the most important risk factors for malignant transformation. Here, we report the case of a 53-year-old man with multiple, black-brown genital macules and nodules. Histological findings resembled those for Bowen’s disease, and we made a diagnosis of bowenoid papulosis. This condition is generally benign, but invasive squamous cell carcinoma (SCC) arising from bowenoid papulosis has been previously reported. Therefore, we took biopsy specimens from 10 lesions and tested them for the presence of HPV DNA. DNA sequencing identified HPV type 16 (HPV-16) DNA in all samples. Next, we excised 4 different relatively large lesions and performed an amplification of papillomavirus oncogene transcripts (APOT) assay. This assay showed that all samples had only episome-derived viral transcripts, indicating no integration of HPV DNA into the host genome. We have followed this case for 3 years, and no progression to Bowen’s disease or SCC has so far been observed. We conclude that the APOT assay is a feasible method for evaluating the malignant potential of bowenoid papulosis.
文摘We report a 64-year-old female patient with an insulin allergy. She was treated with a combination of oral antihistamines, topical hydrocortisone cream, and moisturizing agents, which resulted in the improvement of eczema and intense pruritus. To evaluate insulin allergy, intradermal skin tests were performed with several insulin agents for clinical use and 0.9% NaCl. Skin testing with semisynthetic human insulin resulted in local, immediate skin reactions such as itchy erythema and wheals. Furthermore, we analyzed our case and 25 Japanese cases of insulin allergy previously reported in the literature as far as we know. Interestingly, the number of male patients was approximately two times higher than that of female, and the insulin-specific IgE antibody test was positive in 21 patients. We should keep the possibility of human insulin allergy in mind and prepare for it when initiating human insulin therapy.
文摘A 60-year-old Japanese woman was referred to our hospital for yellow-brown plaques accompanied by ulceration on her left lower leg. Her medical history included neither diabetes mellitus nor minor trauma. A histopathological examination of the plaques showed necrobiotic changes within the dermal collagen surrounded by granulomas that comprised lymphocytes, histiocytes, and giant cells. The lower dermis revealed fibrotic changes that extended into the subcutaneous tissue. The patient’s blood glucose and glycated hemoglobin levels were within the normal ranges. We considered a diagnosis of necrobiosis lipoidica (NL) in the absence of diabetes mellitus. We reviewed 116 cases of NL that were reported in the Japanese medical literature between 1986 and 2014 and found that NL onset was most common in individuals of both sexes ≥ 60 years of age. Previous reports that reviewed NL cases in the Japanese medical literature that were published during the1900s indicated that NL occurs in people ≥ 40 years of age. We suggest that the aging population and increasingly longer life spans have increased the average age of NL onset in Japan. With regard to treatments, there were no effective treatments, but skin grafts were curative. NL treatment is very difficult, especially when ulcers are present;hence, we suggest that further research is needed to determine effective NL treatments.
文摘While erythema nodosum is a nodular, erythematous eruption predominantly affecting the extensor aspects of the legs, breast abscesses are the result of relatively common bacterial infections, and only 2 studies have reported an association between erythema nodosum and breast abscesses. Here, we report the case of a patient with repeated erythema nodosum associated with subareolar abscesses. The patient was a 34-year-old woman with painful erythematous nodules on her right shin, accompanied by an indurated lesion on her right breast 4 days before the onset of the nodules. Therefore, the patient underwent circumareolar incision, and consequently the painful erythematous nodules disappeared. However, after 39 days, the patient developed another tender, painful lesion in her right breast and painful erythematous nodules on her right shin. After another circumareolar incision, the painful erythematous nodules disappeared again. Therefore, we suggested a significant association between erythema nodosum and breast abscess in this patient. The most common underlying causative organism in breast abscess is Staphylococcus aureus;however, erythema nodosum has rarely been proven to be associated with staphylococcal infections. Therefore, the relationship between S. aureus and erythema nodosum is rather controversial. However, the resistance to the usual treatment methods and prolonged clinical course in our case suggest that the pathogenesis of erythema nodosum associated with breast abscesses might be different from that of the common form of erythema nodosum.
文摘Malignant tumors arising from follicular cysts are rare. Herein, we report of a 62-year-old Japanese woman with a slowly growing tumor, 22 × 20 mm in size, located on her nose for 2 years. Histopathological examination of the surgically excised tumor showed that the tumor cells were basaloid and formed peripheral palisading patterns. The tumor contained a cystic structure in its center, and the cyst wall was lined with stratified epithelium with or without keratohyalin granules. Based on these findings, a diagnosis of basal cell carcinoma arising from a follicular hybrid cyst was made. To our knowledge, this is the first case of basal cell carcinoma originating from a follicular hybrid cyst. A review of previous reports of basal cell carcinoma from a follicular cyst indicated that the majority of previous cysts were located on the face, and that the lesions had been present for a relatively long time. The present case showed typical clinical findings and followed a regular course. Malignant transformation may be a rare event, but it can occur in a follicular cyst, so cysts and suspected cysts, especially those found on the face and those persisting for relatively long time, should always be subjected to histological examination.
文摘Spindle cell hemangioma (SCH) is a rare benign vascular tumor and we report 2 cases of SCH who are 50-year-old man and 16-year-old girl. A growing amount of evidence indicates that multifunctional ECM molecule decorin regulate endothelial cell-matrix interactions during angiogenesis. Furthermore, a current publication shows that no detectable decorin expression was found in the stromas of tumor nests in Kaposi’s sarcoma or angiosarcoma groups while the expression was clearly observed in the connective tissue stromas within benign vascular tumors. SCH exhibits spindle cell proliferation and resembles Kaposi’s sarcoma. Therefore, this study examined decorin expression in the tissues of our SCH cases by immunohistochemical analysis. The results demonstrated that immunoreactivity of decorin was clearly detectable in the connective tissue stroma within tumor nests. SCH was first perceived as sarcoma because of spindle cell proliferation, but this proliferation was subsequently found to be reactive. The presence of decorin expression in our cases also indicates that SCH have benign properties. Moreover, this study further increases the reliability of examination of decorin expression for differentiation between benign and malignant vascular tumors.
文摘Intralymphatic histiocytosis is characterized by dilated vessels containing aggregates of mononuclear histiocytes in their lumina, and the majority of cases have been associated with rheumatoid arthritis (RA). We report a case of a 61-year-old woman with RA who presented with livedo-like erythema and red papules around the right elbow and forearm. Histological examinations demonstrated numerous dilated vessels in the dermis partially filled with medium- to large-sized mononuclear cells. Immunohistochemically, most of the intraluminal cells were CD68-positive histiocytes. Endothelial cells were positive for D2-40, a marker for lymphatic endothelial cells. We diagnosed the patient with intralymphatic histiocytosis based on these clinical and histological findings. Interestingly, the skin manifestations exacerbated during the course of the disease when the swelling of the patient’s right elbow joint progressed. Then, the puncture of content fluid of the joint was performed, since then, the symptoms of the skin lesion immediately improved. These observations suggest a possible association between the eruptions of intralymphatic histiocytosis and the involved joint. The results suggest that such skin eruptions may be ameliorated by treating severe arthritis.
文摘Syphilitic alopecia (SA) is a rare skin manifestation in secondary syphilis and sometimes indistinguishable from other alopecia. SA is of 2 types, symptomatic and essential, and 3 clinical types, moth-eaten or patchy pattern, diffuse pattern and a combination of both. SA in our case indicated symptomatic SA with moth-eaten hairloss. A 46-year-old Japanese homosexual man experienced hairloss followed by the pruritic skin rash. Physical examination of the scalp showed diffusely spread papulosquamous erythema and incomplete hairloss around the lesions. The scalp lesions appeared as “moth-eaten alopecia”. Serological examination for syphilis and HIV were positive. Thus, SA complicated with HIV infection was diagnosed. He was treated with a single perioral dose of ampicillin for 4 weeks, then his condition improved rapidly and hair regrowth occurred. HIV-infected persons show a high incidence of syphilis. Therefore, HIV test should be considered for patients with alopecia.
