Abstract: Background: Consumption of the epidermis (hereafter, consumption), namely thinning of the epidermis with attenuation of basal and suprabasal layers and loss of rete ridges adjacent to collections of melanocytes, has been used to differentiate invasive melanoma from Spitz nevi. Evaluation of 213 invasive melanomas, including only two cases of acral lentiginous melanoma (ALM), showed that the frequency of consumption increases with increasing tumor thickness. Methods: We evaluated consumption in 52 acral melanomas relative to age, gender, Breslow depth, tumor thickness (based on the 2010 American Joint Commission on Cancer guidelines), Clark level, mitoses, ulceration, vertical-growth phase, regression, tumor-infiltrating lymphocytes and anatomical site. Results: Consumption was more frequent in ALM with increasing Breslow depth (p = 0.01), and in the presence of ulceration (p = 0.0078); in all cases with ulcer, consumption was found adjacent to the ulceration. There was no statistically significant difference in consumption in nail melanomas in comparison to melanomas of acral skin other than the nail. Conclusions: These results support the hypothesis that epidermal thinning in consumption represents an early phase of ulceration. No statistically significant difference in consumption was found between nail melanomas and melanomas of acral skin other than the nail, probably because of similar tumor thickness in both groups. Ohata C, Nakai C, Kasugai T, Katayama I. Consumption of the epidermis in acral lentiginous melanoma.
Abstract: Hybrid schwannoma/perineurioma represents a recently characterized dermal or subdermal tumor showing schwannian cytomorphology and a perineurioma-like architecture composed of an admixture of both cell types. We report two additional cases of hybrid schwannoma/ perineurioma, one of which occurred after irradiation. Patient 1 was that of a 33-year-old man presented with a 2.8-cm dermal tumor on his left lower leg. Patient 2 was that of an 89-year-old woman with a history of uterine carcinoma treated by surgery and radiation therapy at the age of 35. She presented with a 1.2 × 1.0 cm dermal tumor on her left mons pubis with multiple coincidental basal-cell carcinomas around it. Both tumors were microscopically well circumscribed but unencapsulated and situated in the dermis and adipose tissue and showed a vague storiform and lamellar pattern. Cytologically, both tumors contained two-cell populations, i.e. spindled cells with plump nuclei, which were positive for S-100 protein and negative for epithelial membrane antigen (EMA), claudin-1 and CD34, as well as cells with very slender nuclei and elongated cytoplasmic processes, which were negative for S-100 protein yet expressed EMA, claudin-1 and CD34. Claudin-1 was a better marker to highlight cells with very slender nuclei than EMA. Both tumors lacked expression of neurofilament.
Abstract: Famciclovir is a guanine analog antiviral drug used commonly for herpes zoster. Efficacy of famciclovir treatment has been reported to be comparable to valacyclovir treatment. Both of these medications reduce the time to complete cessation of zoster-associated pain including post-herpetic neuralgia, as compared to acyclovir. We conducted a multicenter, randomized, open clinical trial in order to evaluate the extent of pain relief afforded by these two antiviral drugs during the acute disease phase of herpes zoster. The study group comprised 86 immunocompetent adult patients suffering from herpes zoster, who were treated with either famciclovir or valacyclovir for 7 days. Of these, 55 patients enrolled in this study within 72 h of the onset of the rash and 31 patients after 72 h of the onset. There was a significant reduction in acute herpes zoster pain with famciclovir on day 7 and at 2-3 weeks in both of these patient groups, while with valacyclovir, there was not significant reduction in pain on day 7. Of patients aged 50 years or older, there was a significantly earlier reduction in pain with famciclovir than with valacyclovir. In addition, a significant reduction in the number of patients with pain was observed as early as days 3-4 with famciclovir treatment as compared with valacyclovir treatment. We conclude that famciclovir was superior to valacyclovir in the relief of acute pain of herpes zoster. Accordingly, famciclovir is recommended for herpes zoster patients with moderate symptoms and a visual analog scale score of under 50 mm.
Abstract: Localized pemphigus foliaceus (PF) clinically presents as red plaques with scale and crust due to acantholysis of the epidermis. The follicular infundibulum shows acantholysis, but usually with epidermal acantholysis or at least erosion. Localized PF exclusively involving the follicular infundibulum, which shows a peau d'orange appearance, has never been reported. We describe a patient with a red plaque and peau d'orange appearance on the cheek for 20 years. Dyskeratotic acantholysis in the follicular infundibulum was overlooked when the first biopsy specimen was obtained, and a disseminated lesion developed soon after, which led to the diagnosis. Although a peau d'orange appearance is a rare clinical manifestation of PF, PF should be considered as the differential diagnosis on the basis of this appearance, especially when the lesion persists on the face for long periods.
Abstract: Sex hormones are known to be associated with increases of melanocytes and melanin production in human skin. However, the expression of estrogen receptor (ERalpha) in melanocytic lesions has been controversial. In 1996, a new subset of estrogen receptor was cloned, and named estrogen receptor beta (ERbeta). We used immunohistochemical staining to characterize the expression of ERalpha and ERbeta in normal skin and in melanocytic lesions. Normal sebaceous glands and hair follicles were positive for ERalpha and ERbeta. Other adnexal structures and constituents in the skin were positive for ERbeta, but not for ERalpha. Melanocytic nevi and malignant melanomas were negative for ERalpha, but both were positive for ERbeta. The ubiquitous expression of ERbeta may play a fundamental role in various normal skin cells and melanocytic tumors.
Abstract: The common mesenchymal elements of apocrine mixed tumor of the skin are mucin and chondroid tissue. An apocrine mixed tumor of the skin with extensive adipose content is reported. A 56-year-old Japanese man presented with a subcutaneous mass in the glabella region that was 1 cm in diameter and had developed within the preceding 5 years. Light microscopic examination showed a well-circumscribed and encapsulated subcutaneous tumor composed of tubular structures with apocrine secretion and mucin as well as extensive adipose tissue. This case, in light of another recently reported case, indicates that adipose tissue can be the major mesenchymal element in apocrine mixed tumor of the skin.
Abstract: Normal skin is composed in part of cells that express CD34. These include periadnexal spindle cells, vascular endothelial cells, and interstitial dendritic cells. We report on a tumor composed mainly of CD34-reactive spindle cells. A 66-year-old Japanese woman presented with a skin-colored, dome-shaped, cutaneous papule on her left palm that was 7 mm in diameter and had developed within the preceding 3 months. Light microscopic examination showed a well-circumscribed polypoid tumor consisting of spindle-shaped cells and thin collagen fibers arranged loosely in a fascicular pattern within a myxoid matrix. Immunohistochemically, most of the tumor cells stained strongly for CD34, but did not stain with antibodies to S-100 protein, smooth muscle actin, desmin, neuron-specific enolase, epithelial membrane antigen, or factor XIIIa. Staining for vimentin and CD68 was positive. We believe this lesion to be a CD34-reactive myxoid dermal dendrocytoma of a type that has not been described previously.
Abstract: A ripple pattern seen in sebaceoma derives from many wavy lines having been formed by elongated nuclei of immature sebocytes, the nuclei opposite one another being arranged in a palisade. The appearance of a ripple pattern is reminiscent of that in Verocay bodies in which elongated nuclei of Schwann cells are organized in a palisade and are separated from one another by the cytoplasm of the cells. In the case of sebaceoma, the elongated nuclei are separated from one another by stroma mostly.
In sum, so-called rippled-pattern trichoblastoma is one of many histopathologic manifestations of sebaceoma, a benign neoplasm with sebaceous differentiation and the only true sebaceous adenoma. When at scanning or higher magnification a "ripple pattern" is seen in a neoplasm of epithelial cells, the diagnosis is sebaceoma if the silhouette signals benignancy. It would not be surprising were a ripple pattern to be encountered one day in a well differentiated sebaceous carcinoma.
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Abstract: A 54-year-old Japanese female developed granuloma annulare twice in herpes zoster scars. Soon after the second event, she developed ulcerative colitis, which was well controlled by sulfonamides and corticosteroid suppository. She had no history of diabetes mellitus. There was no recurrence of granuloma annulare by June of 1999. Granuloma annulare might have contributed to the complications of ulcerative colitis, although this had not been noticed before.
