Cutaneous Histiocytic Sarcoma With Cellular Cannibalism.

Cutaneous histiocytic sarcoma (HS) is a rare malignant tumor. An 82-year-old woman presented with a 4 × 2-cm irregular-shaped red nodule on the left posterior scalp. A biopsy specimen revealed sheets of pleomorphic atypical cells in the dermis and subcutis. A diagnosis of HS was made based on the results of a panel of immunohistochemical stains that revealed positivity of leukocyte common antigen, CD4, CD163, and HLA-DR. At the time of resection, the tumor grew rapidly to 12 × 6.5 × 5 cm in size in 2 months. The resected tumor comprised round, oval, plasmacytoid, and spindled cells. Signet-ring cell type tumor cells were also observed. The histiocytic nature of HS was confirmed owing to the presence of cellular cannibalism, emperipolesis, Langhans giant cell-like cells, Touton giant cell-like cells, foreign-body giant cell-like cells, and hemosiderin laden cells. In some foci, a storiform pattern and fascicular pattern were occasionally observed. Local recurrence occurred shortly after resection. Subsequent radiation therapy showed insufficient effectiveness. It is challenging to make a diagnosis of HS without performing immunohistochemical studies; however, a variety of histiocytic features confirmed in hematoxylin and eosin-stained sections may suggest HS.

A retrospective observational study on biological drug treatment in a daily practice serving patients with psoriasis in Japan.

BACKGROUND: In Japan, more than five years have passed since emergence of the first three biologics, infliximab, adalimumab, and ustekinumab, became available in daily practice; however, no data for drug survival was reported from Japan. OBJECTIVE: To study the long-term drug survival of infliximab, adalimumab, and ustekinumab used for Japanese psoriatic patients. METHODS: We retrieved data on all patients treated with biological agents and calculated the long-term drug survival for infliximab, adalimumab, and ustekinumab using our psoriasis registry (Kurume Psoriasis Registry: KURUPR) consisted of 343 patients by the end of March 2017. We analyzed 103 treatment courses of 83 patients with all types of psoriasis, as well as 79 treatment courses of 62 patients with psoriasis vulgaris using the Kaplan-Meier method. RESULTS: Drug survival was higher for ustekinumab than infliximab and adalimumab in both settings, although there were no statistical differences. CONCLUSIONS: Previous studies of long-term drug survival in patients with psoriasis vulgaris showed significantly higher drug survival for ustekinumab than infliximab, and adalimumab. Our data showed similar tendency. Besides randomized clinical trials, drug survival data is useful because it reflects real-world management.

Angiotropic syringomatous carcinoma.

Syringomatous carcinoma (SC) is a slow-growing malignant skin tumor that usually affects the face or scalp. An 83-year-old female developed SC on the sole, a rare location. Histopathologically, numerous ducts with few keratinizing cysts were seen in the upper dermis, and cords, strands and nests with sclerotic stroma were seen in the deep dermis and subcutis. In addition to the perineural and intraneural invasion of the tumor, the tumor cells had also invaded the vessel walls. There was no intravasation of tumor cells or interruption of the endothelium. Because melanoma with vascular wall invasion without intravasation of melanoma cells or interruption of the endothelium has been called angiotropic melanoma, we termed the present tumor angiotropic SC. Tumor cells showed wide local invasion.