Occurence of Cutaneous Marginal Zone B-Cell Lymphoma Post Breast Cancer Chemotherapy: A Case Report.

Primary cutaneous marginal zone B-cell lymphomas (PCMZLs) are classified as low-grade as they run an indolent course. They are histologically characterized through non-epidermotropic nodular or diffuse infiltrates consisting of small or medium heterogeneous atypical lymphoid cells. In the past few years, chemotherapy has increased the survival rate of breast cancer patients. However, the adverse effects of treatment, such as leukemia, have also been shown to emerge gradually. Additionally, cases of occurrence of non-Hodgkin lymphoma (NHL) post chemotherapy have also been reported. A 48-year-old female patient was presented with a violaceous nodule on her left thigh. Around 15 months ago, she completed breast cancer chemotherapy. Eight months later, a skin lesion appeared. Histological findings revealed dense and nodular lymphocyte infiltration. Immunohistochemical staining was positive for CD20 and BCL2. Clinical and histological examination of the lesions confirmed PCMZL. After systemic evaluation, lymphoma was found to be limited to the skin, and thus, she underwent complete excision of the lesion. At the first month follow-up, there was a recurrent lesion on the right wrist, which was excised successfully. However, recurrences occurred again in the calf and forearm in the following five and two months, respectively. These lesions were also confirmed with PCMZL using biopsy. We assume that this case is related to chemotherapy as it was presented and recurred abruptly post chemotherapy. Additionally, there are several reported cases of NHL post breast cancer chemotherapy. However, this is the first case report of PCMZL associated with chemotherapy.

The Study of Relationship between Anatomical Sites and Depth of the Lipoma.

BACKGROUND: Lipomas are the most common benign tumors and surgical removal is the treatment of choice. However, some deep-seated lipomas are technically challenging to surgically excise from a dermatologist's perspective. This study was planned to help predict the depth of lipomas depending on their anatomical site of occurrence. OBJECTIVE: To determine whether there is a relationship between the anatomical site and the depth of lipomas. METHODS: We retrospectively reviewed the medical records of 459 patients with 459 lesions diagnosed as lipoma, surgically treated between June 2006 and June 2019. Histopathologic evaluation was performed to determine the relationship between the depth and the specific subtype of the lipoma. RESULTS: The most common site of occurrence was the trunk (177; 38.6%). Most of the lipomas (388; 84.5%) were located in the subcutaneous fat layer. Some lipomas (71; 15.5%) were found in deeper tissues, such as the intramuscular, intermuscular, and submuscular layers. The forehead and flank had a higher incidence of deep-seated lipomas than other areas. CONCLUSION: Our results revealed that lipomas in the forehead and flank are more likely to occur in deeper layers. In clinical practice, physicians often skip radiologic evaluation before surgery. However, we recommend preoperative radiologic evaluation before surgical excision of lipomas of the forehead and flank.

Sweet's Syndrome Limited on the Palms and Soles: A Case Report.

Sweet's syndrome was first described as a reactive dermatosis characterized by sudden onset of fever, leukocytosis, and erythematous plaques infiltrated with neutrophils. Therefore, Sweet's syndrome is also known as acute febrile neutrophilic dermatosis. However, subsequently, it became clear that fever and neutrophilia in Sweet's syndrome vary depending on the case, and several other characteristics have been described. The lesions in Sweet's syndrome are typically observed not only in the limbs but also in the face, neck, and upper trunk. A 28-year-old female without a specific medical history presented in a hospital following the complaint of painful erythematous patches and pustules on her palms and soles. She had no previous history of palmoplantar pustulosis and other infections or malignancies. A skin biopsy showed diffuse dermal infiltration of neutrophils. Laboratory tests showed increased neutrophil count and erythrocyte sedimentation rate. After systemic corticosteroid administration was initiated, the lesions gradually disappeared. The patient was subsequently diagnosed with Sweet's syndrome according to histology, clinical feature, and response to treatment. However, there have been few reports of Sweet's syndrome confined to the individuals' palms and soles. According to the literatures, although the dorsum of the hand is frequently affected, the palmoplantar involvement as in our case appears to be rare.

Nivolumab-Induced Alopecia Areata: A Case Report and Literature Review.

Nivolumab (anti-PD-1) currently used in many cancers. With the usage of nivolumab increased, many cutaneous side effects were reported including maculopapular rash, lichenoid reactions, vitiligo, bullous disorders, psoriasis exacerbation, and alopecia areata (AA). Here, we report AA after nivolumab for treatment of hepatocellular carcinomas (HCC). A 55-year-old male presented with multiple hairless patch from 1 month ago. He suffered HCC and treated with nivolumab for 6 months after hepatectomy. He treated for hair loss with triamcinolone intra-lesional injection without improvement. We performed skin biopsy on the scalp. Histopathologic findings revealed decreased of hair follicles on the horizontal section with lymphocyte infiltration on the perifollicular area on the vertical section. Clinicopathologic findings were agreed with AA. Considering lack of previous history of AA and hairless patches with 6 months after nivolumab injection, we diagnosed him as nivolumab induced AA. Treatment included topical steroid, and minoxidil. No regrowth of hair was noted after 4 months of follow-up. Nivolimumab induced AA is rare side effect. Pathogenesis of nivolumab induced AA remain unclear. But our case is likely related to nivolumab, known to induce immune related adverse events, and given in the delay of a few months between introduction and the occurrence of the hair loss. Here, we reports nivolmumab induced AA; rare side effect.

Localized Telogen Effluvium Following Hair Transplantation.

Telogen effluvium is categorized in nonscarring alopecia, which shows scalp hair thinning and shedding diffusely resulting from inducing factors such as physiological stressful events and several acute or chronic diseases. It usually appears in female patients following parturition, as well as after febrile disease, major surgery, emotional stress, abrupt diet, chronic illness, or the taking of certain medication pills. Two patients who both recalled an operational history of hair transplantation visited our department with their frontal and both temporal hair loss. Physical examination of the both patients showed localized but diffuse hair loss, especially in the frontal and temporal scalp. Histopathological examination of biopsy specimen taken from their temporal scalp revealed normal follicular density and increased numbers of telogen hair follicles without any inflammatory cell infiltration around follicles. These clinical and histopathological findings were consistent with telogen effluvium. Both of them were reassured and placed on close follow-up without any treatment. From these cases, we demonstrate that localized telogen effluvium could be a cause of hair loss after hair transplantation.

HiComet: a high-throughput comet analysis tool for large-scale DNA damage assessment.

BACKGROUND: DNA damage causes aging, cancer, and other serious diseases. The comet assay can detect multiple types of DNA lesions with high sensitivity, and it has been widely applied. Although comet assay platforms have improved the limited throughput and reproducibility of traditional assays in recent times, analyzing large quantities of comet data often requires a tremendous human effort. To overcome this challenge, we proposed HiComet, a computational tool that can rapidly recognize and characterize a large number of comets, using little user intervention. RESULTS: We tested HiComet with real data from 35 high-throughput comet assay experiments, with over 700 comets in total. The proposed method provided unprecedented levels of performance as an automated comet recognition tool in terms of robustness (measured by precision and recall) and throughput. CONCLUSIONS: HiComet is an automated tool for high-throughput comet-assay analysis and could significantly facilitate characterization of individual comets by accelerating its most rate-limiting step. An online implementation of HiComet is freely available at https://github.com/taehoonlee/HiComet/ .

A Case of Phacomatosis Pigmentokeratotica Associated With Multiple Basal Cell Carcinomas.

Phacomatosis pigmentokeratotica is a recently identified disease characterized by the coexistence of an epidermal nevus with sebaceous differentiation arranged along Blaschko lines and a speckled lentiginous nevus showing a checkerboard pattern, mostly in association with various extracutaneous defects. A 52-year-old man presented with asymptomatic ulcerative plaque on his left side of perioral area. A 2 × 2-cm-sized fleshy colored ulceration on his left perioral area was consistent with basal cell carcinoma with nevus sebaceous. Next to the ulceration, there was a light pinkish to fleshy colored papule on his left cheek that showed syringocystadenoma papilliferum. On his chin area, there was a 2 × 0.3-cm-sized skin colored papule that was consistent with trichilemmoma. Moreover, various sized light brownish macules and dark brownish papules were also located on his left side of the chest wall, back, and arm. Biopsy specimens from macules on the left side of the trunk confirmed the clinical diagnosis of speckled lentiginous nevus and multiple black papules beside that a speckled lentiginous nevus also revealed basal cell carcinomas. Herein, we present a rare case of a patient with phacomatosis pigmentokeratotica who had no extracutaneous abnormalities and who developed basal cell carcinoma, syringocystadenoma papilliferum, and trichilemmoma in nevus sebaceous on the face and speckled lentiginous nevus on the trunk. This syndrome needs adequate follow-up due to the possibility of malignant transformation.

Pretibial Myxedema Presenting as Severe Elephantiasis.

Elephantiasis is a symptom characterized by the thickening of the skin and underlying tissues in the legs. Pretibial myxedema (PTM) is a non-frequent manifestation of autoimmune thyroiditis, particularly Graves' disease. Lesions of myxedema occur most commonly on the pretibial surfaces, also develop at sites of previous injury or scars and other areas. A 49-year-old male presented with severe elephantiasis on the both pretibial areas, dorsum of the feet, ankles and toes. Twenty years previously, he had received radioactive iodine treatment for thyrotoxicosis. Laboratory tests showed that the patient's thyroid function was normal, but the level of thyroid stimulating hormone (TSH) receptor antibodies was very high (>40 IU/L). The biopsy confirmed PTM. Interestingly, the connective tissue was stained with the TSH receptor antibodies in the deep dermis. Elephantiasic PTM is a severe form of the myxedema and there is few reported case. We report a rare case of PTM with appearance of severe elephantiasis.

Syringoid Eccrine Carcinoma of the Thigh.

Syringoid eccrine carcinoma (SEC) is a rare cutaneous malignant tumor thought to be derived from eccrine sweat apparatus. It is usually present in the head, neck and trunk region, and often occurs in the fourth to seventh decades of life. A 94-year-old male patient visited our department with an 80-year history of a lesion showing a 2×2 cm sized well-demarcated round shaped erythematous to pinkish colored nodule with ulcer on his left thigh. Histological findings revealed a tumor consisted mainly of numerous small cords and nests forming luminal or tubular structures and tumor cells showing variable atypia. Some ductal structures showed tadpole appearance. On immunohistochemical staining, epithelial membrane antigen, S-100, cytokeratin 7 and carcinoembryonic antigen were reactive and Ki-67 showed less than 10% positivity. Based on these findings, the final diagnosis was made as SEC. The patient was treated with local wide excision and didn't show any recurrence during the follow-up period of 12 months. Herein, we report a very rare case of SEC which occurred on the left thigh and discuss 10 cases of SEC presented on the extremities, including our case.

Primary Cutaneous Endometriosis of Umbilicus.

Cutaneous endometriosis is defined by the presence of endometrial glands and/or stroma in skin and represents less than 1% of all ectopic endometrium. Cutaneous endometriosis is classified as primary and secondary. Primary cutaneous endometriosis appears without a prior surgical history and secondary cutaneous endometriosis mostly occurs at surgical scar tissue after abdominal operations. The most widely accepted pathogenesis of secondary endometriosis is the iatrogenic implantation of endometrial cells after surgery, such as laparoscopic procedures. However, the pathogenesis of primary endometriosis is still unknown. Umbilical endometriosis is composed only 0.4% to 4.0% of all endometriosis, however, umbilicus is the most common site of primary cutaneous endometriosis. A 38-year-old women presented with solitary 2.5×2.0-cm-sized purple to brown colored painful nodule on the umbilicus since 2 years ago. The patient had no history of surgical procedures. The skin lesion became swollen with spontaneous bleeding during menstruation. The skin lesion was diagnosed as a keloid at private hospital and has been treated with lesional injection of steroid for several times but there was no improvement. Imaging studies showed an enhancing umbilical mass without connection to internal organs. Biopsy specimen showed the several dilated glandular structures in dermis. They were surrounded by endometrial-type stroma and perivascular infiltration of lymphocytes. The patient was diagnosed as primary cutaneous endometriosis and skin lesion was removed by complete wide excision without recurrence. We report an interesting and rare case of primary umbilical endometriosis mistaken for a keloid and review the literatures.

Composite Tumor Associating Trichoblastoma and Seborrheic Keratosis.

Seborrheic keratosis is a common benign epidermal tumor histologically composed of basaloid and squamous cells. It mainly occurs on the face, scalp, and trunk, and presents clinically as a well-circumscribed, brownish to black papule, nodule, or plaque. Trichoblastoma is a relatively rare benign, slow-growing tumor showing differentiation toward the primitive hair follicle. It clinically manifests as a solitary, skin to erythematous colored, well-circumscribed dermal nodule located predominantly on the head and neck with a predilection for the scalp. Histologically, a well-demarcated mass of follicular germinative cells that show various degrees of differentiation, arranged in lobules, sheets, and nests, is located in the dermis or subcutaneous fat layer. We report the case of a 28-year-old female patient with a solitary, 2.0×4.0-cm black plaque with a 0.7-cm skin-colored nodule on the scalp. Histologically, the entire black plaque had prominent hyperkeratosis, acanthosis, and papillomatosis with horn cysts. The central nodule showed well-circumscribed, various-sized dermal tumor lobules without a connection to the overlying epidermis. The lobular aggregation was composed of numerous basaloid epithelial nests and multiple primitive papillary structures with distinct peripheral palisading of nuclei. According to these findings, the scalp lesion was diagnosed as a composite tumor associating trichoblastoma and seborrheic keratosis.

Correction of pincer nail deformities using a modified double Z-plasty.

BACKGROUND: Pincer nail is a deformity characterized by excessive transverse curvature of the nail plate that increases distally for which many conservative and surgical corrective modalities have been recommended. OBJECTIVE: The purpose of this study is to investigate the outcomes and safety of modified double Z-plasty in the management of symptomatic pincer nail. MATERIALS AND METHODS: Modified double Z-plasty has been performed on 20 great toes in 12 patients from January 2008 to December 2013. The mean age of patients was 43 (range: 20-65) years. Three men and 9 women were enrolled. Visual analogue scale (VAS) score for pain, transverse angle, and width indices were investigated at the initial and the last follow-up. The average follow-up period was 2.4 years. RESULTS: All parameters showed significant improvement after surgery. Between the initial and last follow-up, the mean VAS score fell from 7.4 to 0.3, the mean transverse angle improved from 50 to 166°, and the mean width index improved from 65.4% to 97%. In all patients, the deformity was successfully eliminated with no recurrences. No complications were identified. CONCLUSION: Modified double Z-plasty provides a long-standing effective treatment for pincer nail deformity with an excellent esthetic result.

The efficacy and safety of liquid-type botulinum toxin type A for the management of moderate to severe glabellar frown lines.

BACKGROUND: Botulinum toxin type A has been widely used to correct unwanted hyperfunctional facial lines. Most forms of botulinum toxin type A currently used require reconstitution, which is very inconvenient for users. The authors compared the efficacy and safety of a newly developed liquid-type botulinum toxin type A (MT10109L) and onabotulinumtoxinA (Botox) for moderate to severe glabellar lines. METHODS: A double-blind, randomized, active drug-controlled, phase III study with 168 enrolled subjects was performed. The primary efficacy endpoint was the improvement rate at maximum frown at week 4 by the investigators' live assessment. The secondary efficacy endpoint included the improvement rate at maximum frown at week 16 and at rest at weeks 4 and 16 by live assessment, and the improvement rate at maximum frown and at rest based on photographic assessment at week 4. Self-assessment and self-satisfaction with glabellar line improvement were also evaluated. RESULTS: The improvement rate at maximum frown by live assessment was not significantly different between the MT10109L and Botox groups. In addition, the improvement rate of glabellar lines at rest based on the investigators' live assessment and photographic assessment was similar in both treatment groups. However, the improvement rate at maximum frown by live assessment at week 16 was significantly higher in the MT10109L group compared with the Botox group. There were no severe adverse events. CONCLUSIONS: The efficacy and safety of MT10109L were comparable to those of Botox for the management of glabellar frown lines. MT10109L provides greater convenience because it does not require dilution and has long-lasting effects. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Alopecia Neoplastica due to Gastric Adenocarcinoma Metastasis to the Scalp, Presenting as Alopecia: A Case Report and Literature Review.

Alopecia neoplastica is defined as hair loss secondary to a visceral malignancy that has metastasized to the scalp. The scalp is a relatively common site of cutaneous metastasis, usually presenting as a single or multiple firm scalp nodules. Alopecia neoplastica is a well-recognized but rare presentation, and its pathogenesis is incompletely understood. Atrophy of the hair follicles due to tumor invasion of the scalp plays a role in the development of alopecia. Herein, we describe a 33-year-old woman with gastric adenocarcinoma who developed alopecia neoplastica while receiving cancer chemotherapy. Scalp biopsy revealed metastatic adenocarcinoma cells interspersed between collagen bundles and around hair follicles. Immunohistochemical analysis indicated that the tumor cells originated from the primary gastric adenocarcinoma. Therefore, she was diagnosed with alopecia neoplastica due to gastric adenocarcinoma. The findings from this report may be helpful for understanding the mechanism of alopecia neoplastica.