Superficial Esophageal Cancer with Deep Submucosal Invasion Misdiagnosed as a Subepithelial Tumor

Endoscopic ultrasonography (EUS) is commonly used to detect the depth of cancer invasion in the preoperative stage. Intrapapillary capillary loop (IPCL) patterns observed in magnification endoscopy with narrow band image are also known to well demonstrate cancer invasion depth. Here, we report a case of superficial esophageal cancer with massive submucosal invasion, which presented as a superficial esophageal cancer confined to the mucosal layer and with a coincidental hypoechoic submucosal tumor under EUS and IPCL evaluation.

Acquired Pure Red Cell Aplasia following Autoimmune Hemolytic Anemia in Systemic Lupus Erythematosus / 대한내과학회지

Pure red cell aplasia (PRCA) is a rare hematological disorder characterized by severe normochromic normocytic anemia and reticulocytopenia due to erythroid progenitor depletion in an otherwise normal bone marrow. Autoimmune hemolytic anemia (AIHA) is caused by autoantibodies directed against red blood cells with normocytic or macrocytic anemia with reticulocytosis. Both diseases can develop in conjunction with various underlying diseases, such as immunological disorders. Although rare, there have been a few cases of AIHA followed by PRCA. Here, we report a patient who developed PRCA following AIHA and was later diagnosed with systemic lupus erythematosus.

Comparative Study of 20% Aluminum Chloride Solution and Botulinum Toxin A Injection in the Treatment of Patients with Primary Palmar Hyperhidrosis / 대한피부과학회지

BACKGROUND: Primary hyperhidrosis carries a substantial psychological and social burden. Early detection and management can significantly improve a patient's quality of life. A large number of therapeutic options are used, such as the application of topical agents, iontophoresis, sympathectomy, and botulinum toxin injection. OBJECTIVE: We aim to comprehensively evaluate the effects of botulinum toxin type A and 20% aluminum chloride on primary palmar hyperhidrosis. METHODS: A total of 55 patients with clinical diagnosis of primary hyperhidrosis were treated by botulinum toxin type A and 20% aluminum chloride solution. To prospectively assess the effects on primary palmar hyperhidrosis, we checked corneometer at baseline, 2 and 4 months later. By regular meetings with patients, including telephone interviews, we analyzed patients' subjective satisfaction scores and complaints during the follow=up periods. RESULTS: During the 2-month period, as compared with that of the control group, the level of corneometer of both groups declined. In the 4-month period, the group treated with 20% aluminum chloride sustained a lower level of corneometer. In the questionnaire, in the 2-month period, the group treated with botulinum toxin resulted in a lower level of overall treatment scores than that of the group treated with 20% aluminum chloride. However, in the 4-month period, the group treated with aluminum chloride showed lower scores. CONCLUSION: Both botulinum toxin type A and aluminum chloride solution were safe and well tolerated, producing high levels of patient satisfaction. However, considering the long-term efficacy of treatment, aluminum chloride may be a more suitable mode of treatment for primary palmar hyperhidrosis.

The Efficacy and Safety of a Combination Cytopurine/Pentadecanoic Glyceride Topical Solution on Androgenetic Alopecia: A Randomized Double-Blind Placebo-Controlled Clinical Trial / 대한피부과학회지

BACKGROUND: Androgenetic alopecia (AGA) is the most common type of hair loss found in both males and females. Oral finasteride and topical minoxidil are the only drugs approved, till now, by the Food and Drug Administration of USA for the treatment of this condition. Unfortunately, these treatment options are not satisfactory. Therefore, it has been necessary to develop new agents for this psychologically frustrating disease. OBJECTIVE: This is a 16-week, double-blinded, placebo-controlled, randomized clinical trial to determine whether a new topical agent, cytopurine/pentadecanoic glyceride topical solution, is effective in showing clinical improvements in patients with AGA. METHODS: A total of 74 men and 21 women (24~55 years old) with AGA were treated either with the new topical solution or a placebo, twice daily. Efficacy was evaluated by daily shed hair count, phototrichogram and patients' subjective and investigators' subjective assessments for clinical improvement. All adverse effects were reported during the study. RESULTS: After 16 weeks of therapy, combination cytopurine/pentadecanoic glyceride topical solution treatment resulted in a significant improvement from the baseline in total hair count and daily shed hair count. But there were no statistically significant differences in anagen hair count, mean hair diameter, patients' subjective and investigators' subjective assessments for clinical improvement and side effects between the cytopurine/pentadecanoic glyceride treated and placebo group. CONCLUSION: We have confirmed the efficacy of combination cytopurine/pentadecanoic glyceride topical solution in treating AGA, by an objective assessment with phototrichogram.

A Case of Unilateral Idiopathic Atrophoderma of Pasini and Pierini

Idiopathic atrophoderma of Pasini and Pierini(IAPP) is an uncommon condition of unknown etiology and typically affects persons in the second and third decades of life. IAPP consists of asymptomatic grey to brown depressed lesions with "cliff drop" borders, which are usually bilateral and located on the trunk. A 40-year-old woman visited our department because of unilateral atrophic lesions on the abdomen, right arm, and posterior aspect of right thigh for 20 years. Laboratory evaluations were normal and histologic examination revealed significantly decreased thickness in dermis. We report an unusual case of idiopathic atrophoderma of Pasini and Pierini presenting unilateral distribution.

Eosinophilia-Myalgia Syndrome not Associated with the Ingestion of Nutritional Supplements

Eosinophilia-myalgia syndrome(EMS) is a systemic illness that occurred as an epidemic by ingestion of over-the counter L-tryptophan preparation in the United States in October 1989. We report a Korean case of EMS not associated with the ingestion of either L-tryptophan or other nutritional supplements such as lysine and niacin.

Effects of Transfection of Keratinocyte Growth Factor Gene derived from Dendritic Epidermal T Cell on Keratinocyte Proliferation and Differentiation / 대한피부과학회지

BACKGROUND: Dendritic epidermal T cell(DETC) resident in the mouse epidermis is gammadelta-T lymphocytes. Most of them express Vgamma5/Vdelta1 T cell receptor. Compared with alphabeta-T lymphocytes, physiologic and/or pathologic role of DETC are not fully understood. Keratinocytes under the conditions such as irradiation, viral and bacterial infection, and exposure to carcinogen may express keratinocyte self-antigen. DETC may have the ability to recognize stressed and malignant keratinocytes. Moreover, specific chemokines released from DETC may contribute to inflammatory response, which maintain skin integrity and homeostasis. OBJECTIVE: The purpose of this study was to investigate the effects of transfection of keratinocyte, growth factor(KGF) gene derived from DETC on the keratinocyte proliferation and differentiation in cell culture. METHODS: RT-PCR using KGF primer to confirm the KGF mRNA in DETC and Keratinocyte MTT assay to evaluate the effect of keratinocyte proliferation and immunohistochemical staining using anti keratin(K)14 mAb, anti K1,10 mAb and anti involucrin mAb as a marker to elucidate the effect of keratinocyte differentiation were done. RESULTS: 1.The KGF specific PCR product was demonstrated in DETC, normal positive control of cultured fibroblast and KGF gene transfected cultured keratinocytes, but it was not observed in normal cultured keratinocytes by RT-PCR using KGF-specific primer. 2.Numbers of keratinocytes in normal control group were (2.5+/-0.5)X10(4), (8.8+/-1.5)X10(4), (8+/-0.5)X10(4), (10.5+/-0.7)X10(4) after 1st, 2nd, 3rd and 4th days, respectively. Numbers of keratinocytes with KGF gene transfected group were (1.5+/-1.0)X10(4), (9.5+/-0.2)X10(4), (9.8+/-0.5)X10(4), (13+/-2.0) X10(4) after 1st, 2nd, 3rd and 4th days, respectively. In comparison to the control, the numbers of keratinocytes were increased in the KGF gene transfected group from the 3rd and 4th day(p<0.05). On the MTT assay, compared with the control, the numbers of keratinocytes were also increased in the KGF gene transfected group at 3rd day(p<0.05). 3.In the immunohistochemical staining with mAb to K1,10 and involucrin, to evaluate the degree of differentiatin of kerationcyte reveals that KGF gene transfected cells with Ca++(0.5mM) were stained weaker than the degree of differentiation of Ca++(0.5mM) treated group. Immunohistochemical staining with mAb to K14 reveals that KGF gene transfected cells with Ca++(0.5mM) were stained stronger than the degree of differentiation of Ca++(0.5mM) treated group. CONCLUSION: The above results strongly suggest that KGF, which produced by activated DETC, have a role in stimulating the proliferation and suppressing the differentiation of keratinocytes in the skin. In conclusion, DETC may involved in the control of proliferating activity of neighboring kerationcytes through KGF communication, which play an important role in the maintenance of epithelial integrity.

Nodular Metastatic Carcinoma from Invasive Lobular Breast Cancer

Among breast cancers, the incidence of invasive lobular carcinoma is rather low, varying in the literature 0.7% to 20% and there have been no reports concerning the frequency of cutaneous metastases from invasive lobular carcinoma. Herein, we describe an interesting case of nodular metastatic lesions from invasive lobular carcinoma.

A Case of Verrucous Carcinoma Occurring in Patient with Diabetes Mellitus and Chronic Renal Failure

Verrucous carcinoma is a slow growing, low grade squamous cell carcinoma, which usually occurs on oropharynx, genitalia and soles. When it occurs on feet, it is known as epithelioma cuniculatum. Epithelioma cuniculatum is characterized by its histologic sinuses and cystic formations in a cuniculate(rabbit burrow-like) pattern. A 59-year-old man was consulted to our department for a well circumscribed, 5 × 5 cm sized, round, hyperkeratotic, verrucous plaque on the right great toe. He suffered from diabetes mellitus for 16 years and was managed by peritoneal dialysis three times a week due to chronic renal failure for last two years. The plaque had gradually increased in size. The biopsy specimen taken from the tumor mass showed chronic ulcerative inflammation with atypical squamous cell proliferation. We herein report a case of verrucous carcinoma occurring in a patient with diabetes melli-t tus and chronic renal failure.

A Case of Pigmented Apocrine Hidrocystoma Occuring on the Vulva

A 7-year-old female was presentd with two black papules and linear pigmentation between papules on the vulva. No other abnormalities were found in her personal and family history. Histopathological examination was consistent with the apocrine hidrocystoma and the pigment in the luminal cells was iron negative and Fontana Masson positive, confirming its melanin nature. We herein report a 7-year-old female patient with pigmented apocrine hidrocystoma occuring on the vulva with the evidence of melanin as the underlying mechanism of the pigmentation.

Keratoacanthoma in Co-existence with Nevus Sebaceus

Nevus sebaceus of Jadassohn has been referred to as a organoid nevus that classically evolves through three stages and may be associated with a range of skin tumors, and of these, syringocystadenoma papilliferum and basal cell carcinoma have been commonly reported to occur. The occurrence of keratoacanthoma is a very rare event in nevus sebaceus. Herein we report on a 23-year-old man with nevus sebaceus of the cheek. He represents a keratoacanthoma arising within nevus sebaceus.

Intralesional Recombinant Alpha-2a Interferon for the Treatment of Patients With Verruca

BACKGROUND: Interferon alpha-2a has already been shown to be effective in clinical use of virus-originated diseases such as hairy cell leukemia, condyloma acuminatum, and AIDS-related Kaposi's sarcoma. The use of recombinant alpha-interferon may allow common warts to be treated relatively atraumatically and with less incidence of recurrence. OBJECTIVE: We tried to determine the safety and effectiveness of intralesional injections of recombinant alpha-2a interferon in the treatment of patients with common warts. METHODS: A single wart on each patient was weekly injected with 0.75 to 1.5×10(5) IU/25mm2 of interferon for 8 weeks, and the response to treatment was followed up-to 6 months. RESULTS: Clearing of the treated wart at the end of treatment occurred in 5(71%) out of 7 patients and the rest showed no improvement. With evaluation for relapses up-to 6 months after treatment, warts relapsed in 2(40%) out of 5 patients. Therefore, 3(43%) out of 7 patients were completely free of warts 6 months after treatment. CONCLUSION: Intralesional recombinant interferon alpha-2a has a limited therapeutic effect, but may be considered as a therapeutic modality of recalcitrant verruca or when it can be anticipated that destructive techniques or blistering agents will not be tolerated.

Leukemid Associated with Acute Basophilic Leukemia / 대한피부과학회지

Cutaneous manifestations in leukemia present an important diagnostic challenge to dermatologists. The skin lesions can be classified as either specific or non specific. Lesions that are the direct result of infiltration and proliferation of leukemic cells in the skin are known as "specific lesions" or "leukemia cutis". Leukemic infiltration of the skin occurs in 3% to 11% of patients with adult leukemia. Non specific lesions(leukemids) occur in approximately 30% of patients with leukemia. Acute basophilic leukemia(ABL) is a rare disorder characterized by many mature and immature basophils in the blood, marrow, and other organs. This type of leukemia has not been included in the French-American-British(FAB) classification. The frequency of specific or non specific skin lesions associated with ABL has not been reported. We report herein a case of leukemid with various skin manifestations associated with ABL.