Multiple apocrine poromas: a new case report.

Apocrine poromas are rare and distinctive benign adnexal neoplasms featuring tumor cells differentiating toward folliculosebaceous-apocrine units. We report an extremely rare case with multiple apocrine poromas in a single patient. Fifteen tumors were distributed on the head, neck, forearm and axilla of a 74-year-old man. All tumors were mostly composed of poroid cells that surrounded variably sized duct spaces, some of which exhibited decapitation secretion. The poroid cells were continuous with infundibulum-like structures that contained aggregates of mature sebocytes. The patient had no family history of similar tumors and no history of immunosuppressive therapy. This is the first report of multiple apocrine poromas, suggesting that predisposing genetic factors might play a part in the development of the tumors.

[Analysis of causative allergen of the patient with baker's asthma and wheat-dependent exercise-induced anaphylaxis (WDEIA)].

A 47 years-old woman suffering from baker's asthma for several years developed anaphylaxis when she was walking hard after taking wheat. On the provocation test, neither wheat alone nor exercise alone induced any symptoms. The combination of exercise, wheat and aspirin induced urticaria and marked elevation of blood gliadin levels. According to the high titer of omega-5 gliadin specific IgE in her serum and the result of challenge test, we diagnosed wheat-dependent exercise-induced anaphylaxis (WDEIA). By means of western blotting of soluble and insoluble wheat proteins, we detected several bands which were supposed to be beta-, gamma- and omega-5 gliadin by their relative molecular mass. Wheat gliadins might be causative allergen of both baker's asthma and WDEIA in our case.

[The inhibition effect of a synthetic analogue of prostaglandin E1 to the provocation by aspirin in the patients of WDEIA].

BACKGROUND: Exercise or aspirin intake enhances symptoms by increasing blood gliadin levels in patients with wheat-dependent exercise-induced anaphylaxis (WDEIA). Misoprostol, a synthetic analogue of prostaglandin E1 (PGE1) compensates prostagrandins of which synthesis is inhibited by aspirin and protect the gastrointestinal mucosa. We projected to examine the effect of misoprostol in suppression the allergic symptom and elevation of blood gliadin levels in WDEIA induced by aspirin. PATIENTS AND METHODS: Two patients with a history of recurrent anaphylaxis associated with wheat ingestion accompanied with exercise, positive specific IgE and/or skin test were enrolled in the provocation test. On the provocation test of WDEIA, wheat ingestion, exercise, aspirin intake were combined on various ways. During the test, the patients' symptom and serum gliadins levels were monitored. RESULTS: Although wheat with exercise did not induce any symptoms, addition of aspirin induced urticaria and elevation of blood gliadin levels in both cases. In case 1, premedication of misoprostol suppressed the urticaria and elevation of blood gliadin levels which were induced by exercise, wheat and aspirin intake. In case 2, premedication of misoprostol suppressed the urticaria and elevation of blood gliadin levels which were induced by wheat and aspirin intake. CONCLUSION: These findings suggest that a synthetic analogue of PGE1 may suppresses the absorption of the allergen levels and outbreak the allergic symptom induced by aspirin in the patients with WDEIA.

[Sentinel node navigation surgery in melanoma and non-melanoma malignant skin tumor].

Sentinel node biopsy (SNB) has been performed for melanomas by many researchers since Morton's report in 1992. The technique has been well discussed, however, there have been only few reports about the application of SNB for treatment strategy of melanoma patients. Besides, we have not yet enough information of the clinical significance of SNB for non-melanoma malignant skin tumors. In this paper, we report two new findings of SNB for melanoma patients from the results of a multi-institutional study of SNB in 203 cases of melanoma. Firstly, the incidence of metastasis in non-sentinel node (non-SN) is less than 1% if no metastasis in SN; the identification rate of SN was 97.5%, the false negative rate was 0.98%, and correct diagnosis rate was 99.0%. Secondly, the incidence of metastasis in non-SN is less than 36.4% when patients had pSN 1 or pSN 2 metastasis. That means total removal of lymphnode metastasis can be achieved in 63.6% patients with lymphnode metastasis through SNB. Finally, we studied the usefulness of SNB on 71 cases of non-melanoma malignant skin tumors, and found the SN concept was also applicable for squamous cell carcinoma or invasive case of genital Paget's disease (Paget's carcinoma). Especially, we believe SNB for patients with Paget's carcinoma is as useful as for melanoma patients according our results of 25 cases; the identification rate of SN was 97.6%, the false negative rate was 0%, and correct diagnosis rate was 100%. SNB should be applied for patients with Paget's carcinoma as a diagnostic method of lymphnode metastasis and to determine the indication of lymphnode dissection, and its usefulness must be analyzed in the near future.