Trichogenic trichoblastoma arising on the supraclavicular fossa with an immunohistochemical study of cytokeratin expression.

We report a 52-year-old female with trichogenic trichoblastoma arising on the supraclavicular fossa. Clinical and histological examinations revealed a thumbnail-sized, elastic, hard, subcutaneous nodule which consisted of keratinous cysts and epithelial cords of basaloid cells with focally follicular differentiation. Based on histological observations, a diagnosis of trichogenic trichoblastoma was made. An immunohistochemical study using a panel of monoclonal antibodies against cytokeratins was performed to investigate the nature and differentiation of this tumour. The most characteristic findings of the immunohistochemistry were CK 8 and 19 expression in the epithelial cords and the outer cells of the cystic structures. These immunoreactivities were similar to those of the outermost layer of the outer root sheath between the lower permanent portion and the upper transient portion, and immunostaining with the other antibodies confirmed this similarity. We can speculate that trichogenic trichoblastoma differentiates mainly toward the outermost layer of the outer root sheath between the lower permanent portion and the upper transient portion, and then into follicular structures.

Vascular involvement in cutaneous sarcoidosis.

Sarcoidosis is a systemic granulomatous disease with systemic vascular involvement, that is, granulomatous angiitis and microangiopathy. To determine if there is vascular involvement in cutaneous sarcoidosis, we examined 42 skin specimens taken from 32 patients with cutaneous lesions of sarcoidosis. Cutaneous sarcoidosis was prevalent in older females with high serum angiotensin-converting enzyme (ACE) levels. Most skin lesions appeared during the following-up of sarcoidosis. Granulomatous angiitis was present in 12 specimens of sarcoid skin lesions (30.8%). Eight of the 12 specimens showed venous involvement in the dermis. There was no correlation between the incidence of granulomatous angiitis and the gross pattern of cutaneous sarcoidosis. Immunohistochemically, thrombomodulin was negative in the vascular endothelium close to the granuloma or a periphlebitis lesion. Electron microscopy revealed endothelial swelling, luminal narrowing, and basal lamina layering of the basement membrane in the capillaries and venules in the dermis. These findings demonstrated that granulomatous angiitis and microangiopathy coexist in cutaneous sarcoidosis.

A case of systemic sclerosis with anticentromere, antitopoisomerase I, and anti-U1RNP antibodies.

We describe a case of systemic sclerosis (SSc) positive for 3 autoantibodies; anticentromere antibody, antitopoisomerase I antibody, and anti-U1RNP antibody, It is known that coexistence of 2 of these 3 antibodies is rare and the coexistence of these 3 antibodies in serum from a patient with SSc has not been reported. In addition, we examined our stock serum samples from 236 cases with SSc or related disorders for the presence of specific antinuclear antibodies and were unable to find a serum sample containing all 3 antibodies.

[Clinical features of male SLE patients--summary of our 22 cases].

We investigated clinical features of our 22 male SLE patients with main respect to 11 articles of ARA criteria for diagnosis of SLE (1982). As for skin lesions, 14 cases (64%) manifested wide spread discoid lupus erythematosus as their first symptoms, however, rather rare lesions could be seen as follows: 3 cases with nodular cutaneous lupus mucinosis, 1 with vesiculobullous LE. As to visceral manifestations, renal involvements could be seen in 11 cases (50%), among which 6 showed nephrotic syndromes. In immunological examinations, 1 case revealed C4A deficiency. The clinical tendency of male SLE cases has not been settled by now, for the disease is uncommon in men. Each of our 22 cases manifested a variety of features respectively, indicating that rather atypical cases as SLE can be more often seen in males than females. In addition, many of our cases showed remarkable changes clinically during their courses, which suggests that we should follow them carefully from now.

[Clinical evaluation of the TMS-19-Q.GC tablet on superficial suppurative disease. A comparative double blind study with midecamycin].

Clinical efficacy and safety of TMS-19-Q.GC tablet (TMS), a new macrolide preparation, were compared with those of midecamycin (MDM) in superficial suppurative skin and soft tissue infections. The study was made by the double-blind controlled trial at the dosage of daily 600 mg in TMS group and 1,200 mg in MDM group. Total 218 cases (106 in TMS, 112 in MDM) were analyzed and the final global improvement rating were 82.1% in TMS and 83.9% in MDM. The clinical effectiveness of TMS was favorable and significantly different from MDM in the aged patients (greater than or equal to 60 years old) and the patients infected with susceptible strains (MIC less than or equal to 3.13) of Staphylococcus aureus. TMS is prepared with a specific formulation to make the absorption easier in the patients with lower acidity of gastric juice, and the favorable effect of TMS is considered to be a contribution of the devise in older patients. Slight adverse reactions were observed at 5.0% (6 cases) in TMS and 2.4% (3 cases) in MDM. In conclusion, TMS at the daily half dose of MDM is as effective as MDM in superficial suppurative skin and soft tissue infections.

Multiple cutaneous neurilemmomas as a skin manifestation of neurilemmomatosis.

Four cases of neurilemmomatosis with multiple cutaneous neurilemmomas are described, including clinical, histologic, and electron microscopic features. Thirteen definite cases and sixteen probable cases of neurilemmomatosis with cutaneous tumors were collected from the Japanese literature. The skin lesions of multiple cutaneous neurilemmomas are nodules, infiltrated pigmented lesions, and plaque-like lesions consisting of papules. From the findings presented here, neurilemmomatosis is a clinical entity clearly distinguished from the neurofibromatosis of von Recklinghausen's disease.