A case of malignant melanoma developed from giant congenital pigmented nevus in a seven year old girl was reported. Since the identification of benign juvenile melanoma, the distinct rarity of true cutaneous malignant melanoma in infants and children has become generally recognized. In giant congenital pigmented nevus, the malignant melanoma as a rule arises deep in the dermis. In this case, the histopathologic finding shows no junctional activity in epidermodermal juction other than ordinary nevocellular nevi, but some nevus cell nests and mild inflammatary cell infiltration in the upper dermis. And in the deep dermis, well marginated but not encapsuIated huge tumor mass, in which variable sized, pleomorphic, several vigorous mitotic figures in predominantly cuboidal cells and bizarre giant cells, which was thought to be developed from giant congenital pigmented nevus. The few recorded cases of fatal cutaneous malignant melanoma in early life are of two types: those arising in giant congenital pigmented nevi and ordinary small nevi, de novo including small nevus. The former account for between 22% and 40% of the total. This case is one of the reported 20 cases in the world.
Child ; Dermis ; Female ; Giant Cells ; Humans ; Infant ; Melanoma* ; Nevus ; Nevus, Pigmented*

The clinical findings in the Vogt-Koyanagi-Harada syndrome ae reviewed and eight cases reported emphasizing the cutaneaus changes. The syndrome consists of symptoms of poliosis, vitiligo, alopecia, meningeal irritation sign, nontraumatic uveitis, and dysacousia. Meningeal or ocular symptons usually appear first, but in some patients thc cutanious changes have been observed beforc the uveitis. The etiology rernains unsettied, but an allergic mechanism or a virus infection is favaveci by most observers. Early diagnosis is important because ocular mobidity can be reduced significantly in some patients if treated in the early stages. During the course of treatment of our patients, corticosteroid is appeared to be the most effective drug for this uncertain etiologic syndrome and this fact may eventually support. the theory nf autoimmue mechanisn. The daily does of corticosteroid is prednisolone 60mg and the duration of administration is from 15 days to 2 months, after that the dose is graclually decreased in relation with the degree of symptoms. The ophthalrnologic symptoms were markedly improved 10 days after the administvation of prednisolonc. The purpose of this report is to emphasize the cutaneous findings in this syndrome, to point out that the cutaneous manifestations may lead to establishing tne diagnosis and on the basis of that, those patients can be received prompt, suitable treatment to avoid the grave ocular morbidity.
Alopecia ; Diagnosis ; Dronabinol ; Early Diagnosis ; Humans ; Prednisolone ; Uveitis ; Uveomeningoencephalitic Syndrome ; Vitiligo

Mycobacteriosis cutis is largely classified to localized forms and exanthematous forms and it is subdivded into five diseases in detail, each. They are 1) primary tuberculous complex, 2) lupus vulgaris, 3) tuberculous verrucosa cutis 4) scrofulo derma, and 5) tuberculosis cutis orificialis in localized ferms and 1) tuberculous miliaris disseminata, 2) lupus miliaris disserninaia faciei, 3) papulonecrotic tuberculid, 4) lichen scrofulosorom and 5) ervthema induratum in exanthematous forms.Rich(1944) insisted on that, the pathogenesis of cutaneous tuberuculosis was essen tially the sarne as that for tuberculosis in general. He said that aII forms of cutaneous tuberculosis were produced by the local action of the bacilus of tuberculosis. In the formerly termed true tuberculosis such as lupus vulgaris, the microorganisrns were found in varing numbers in the lesions, and animal inoculations of tissue were successful, In other forms represented by the tuberculids, the bacillus of tuberculosis was found only in the earilest stages before the true clinical and histological picture had developed, Its short lived existence in this forms was explained by the allergic statc of the tissues and this fact exnlained the failure to find the microorganisms in the lesions, or reproduced the affection by inoculations in animals, in cases sufficiently developed to be recognizable clinically and histologically. The other generally accepted view is that the mycobacteriosis cutis, especially the types in the category of tuberculids are caused by the hematogenous dissemination of tubercle bacilli from a focus, often extrapulmonary in location, into the skin, where they are rapidly destoryed. spiet and Roeckie(1960) agreed with above menitioned plausible theories with the background of their hypothesis, that was the skin was hyperegic, And Miescher(1951) also insisted that, skin had a decreased immunologic resistance. But according to Flegel(1957), if the skin was in a state of hyperegic reaction, the focus from which the dissemination was taking place was also should be in a hyperegic state and vice versa should be right, And moreover, Suizberger(1940) declared that whenever microorganisms or their products were being overcome or neutralized by local lmmunologic reactions, tubercles or tubercles or tuberculoid structures had a tendency to appear. So the theories of different immunologic state between the skin and focus were discarded. After that many authors proposed three factors against a tuberculous etiology of tuberculids. First, inoculation of tissue from lesion into guinea pigs and culturing of such tissue have given no evidence for tuberculosis. Second, active tuberculosis occurs no greater frequency in patients with tuberculids than in the general population. Third, tuberculids does not respond to antituberculous treatment but responds to the adminiatration of corticosteroids. According to Eberhartinger(1963), Schneider and Undeutsch(1965), in erytbema induraturn the primary event is a vasculitis of subcutaneous arteries and veins. And any fat necrosis following vascular damage can develop a tubereuloid appea- rance. Lever(1967) declared with self confidence that it was a relic of the times- when a tuberculoid histology was tantamount to tuberculosis. In this condition we decided to clarify that whether the mycobacteriosis cutis, especially the disease in the category of tuberculids, could be originated from mycobacteria tuberculosis in fact or not. Eleven patients, whose clinical diagnosis were skin tuberculosis or very similar to those diseases such as erythema. nodosum, were biopsied by 5mm puncher after 2% procaine injection on their two of skin lesions, the early one for the culture of tubercle bacilli and the oId one for histopathological study, on the O.P.D. of dermatologic department in Severance Hospital. Those biopsied material of early lesion was digested with proper amount of 4% NaOH and fragmented in tissue grinder about 10 minutes. After that, it was centrifuged in rotating speed of 3,500 r.p.m. for 30minutes, and neutralized by 8% HCl after adding phenol red drop by drop. Again it was centrifuged by same as previous method and its supernatant was discarded. The remnants of precipitin was inoculated on Ogawa's nutrient tuberculous media in incubator at 37C. Finally the acid-fast tubercle bacilli have been grown on the Ogawa's media three months after its first inoculation. The inoculation material was biopsied from the patient of eighteen year-old girl, whose clinical and histopathological diagnosis was erythema induratum. From the result of this study, we got the strong confidence that in spite of many authors powerful countertheories and the extremely poor harvesting of its culture, the erythema induratum can be or in evidently caused from mycobacterium tuberculosis. It may be early days yet to say that erythema induratum is originated fromtubercle bacilli but it is considered to be a truth in Korea, with the result of this study.
Adrenal Cortex Hormones ; Animals ; Arteries ; Bacillus ; Diagnosis ; Erythema ; Erythema Induratum ; Fat Necrosis ; Female ; Guinea Pigs ; Humans ; Incubators ; Korea ; Lichens ; Lupus Vulgaris ; Mycobacterium tuberculosis ; Phenolsulfonphthalein ; Procaine ; Skin* ; Tuberculosis ; Tuberculosis, Cutaneous* ; Vasculitis ; Veins

Epidermal growth factor receptor (EGFR) is an intergral membrane protein. Overexpression or mutation of EGFR may play a role in careinogenesis. Recently, many molecular biologic techniques have been used to study expression of oncogenes. One of them, in situ mRNA hybridization, using paraffin embedded blocks, offers a unique means to allow precise localization within histological preparations, and also overcomes problems relating to translation defects and abnormal translation. In order to confirm the usefulness of epidermal growth factor receptor as a tumor marker, and to compare the expression of EGFR between in situ MRNA hybridization and an immunohistochemical study, in situ MRNA hybridization was performed along with an immunohistochemical study for EGFR in paraffin sections of 84 uterine cervix carcinomas. A positive reaction for EGFR was observed mairdy in the cytoplasm of tumor cells. The vascular muscle layer and uterine muscle tissue around the cancer nest revealed a positive reaction in immunohistochemical stain for EGFR, with a negative reaction for EGFR mRNA. In the cancer nests, the immunohistochemical positive reaction for EGFR was strong in differentiated cells and keratin pearls, but a strong positive reaction for EGFR mRNA was localized in undifferentiated cells. The overall positive of immunostaing for EGFR was 77% for uterine cervix carcinoma; 71 % for carcinoma in situ, 71 % for microinvaseve carcinoma, and 89% for invasive carcinoma. The overall positivity of EGFR from in situ MRNA hybridization was 94% of the uterine cervix carcinoma; 93% for carcinoma in situ, 93% for microinvasive carcinoma, and 96% for invasive carcinoma. From these results, EGFR is a useful tumor marker for uterine cervix carcinoma, and in situ mRNA hybridization has greater sensitivity and specificity than immunohistochemistry.
Sensitivity and Specificity ; Tumor Markers, Biological

Scar sarcoidosis is a rarely encountering variant of cutaneous sarcoidosis and its pathogenesis is still unknown. When inactive scars that have been quiescent for years develop a red or purple hue with induration, we should doubt whether they become infiltrated with sarcoid granuloma or not. We report herein a 45-year-old patient with recurrent scar sarcoid, who shows indurated plaques on the right chin and raised serum level of angiotensin converting enzyme, although there was no evidence of systemic involvement. She was treated with oral doxycycline of moderate doses and skin lesions were cleared after 9 months of treatment.
Chin ; Cicatrix* ; Doxycycline ; Granuloma ; Humans ; Middle Aged ; Peptidyl-Dipeptidase A ; Sarcoidosis* ; Skin

No abstract available.
Glycogen Storage Disease Type II* ; Wolff-Parkinson-White Syndrome*

BACKGROUND: Cystosarcoma phyllodes are relativly rare neoplasms of the breast and have an unpredictable clinical behavior. This study is to determine whether histological features correlate with clinical behavior, and which operation method affect recurrence. METHODS: This study reviewed the histological features and clinical outcomes in 12 patients with phyllode tumors of the breast diagnosed at Chungnam University Hospital from 1989 to 1998. RESULTS: The pathological results revealed benign forms were in 8 cases and malignant forms in 4 casese. As to the nature of the growth, the tumors in 10 cases grew rapidly 10 cases were rapid in nature, but two malignant tumors not. One of the 4 malignant tumors was high grade, the others were borderline. Eight (8) patients were had been treated conservatively (7 cases, wide tumor excision; 1 case, excisional biopsy), and 4 cases patients underwent radical operation (2 cases, modified radical mastectomy; other 2 cases, simple mastectomy). Only one patient with borderline malignancy, who underwent modified radical mastectomy, experienced recurrence. CONCLUSIONS: Tumor growth & histological features do not correlate with recurrence, and wide resection should to be primary treatement and axillary dissection is not worthwhile.
Breast* ; Chungcheongnam-do ; Humans ; Mastectomy, Modified Radical ; Phyllodes Tumor* ; Recurrence

Fine needle aspiration biopsy cytology (FNA) for diagnosis of a variety of breast tum- ors has been proven to be a simple, safe, and cost saving diagnostic methodology with high accuracy. Cytologic specimens from 1,029 fine needle aspirations of the breast during last 3-year period were reviewed and subsequent biopsies from 107 breast lesions were reevaluated for cytohistological correlation. FNA had a sensitivity of 81.6% and a specificity of 98.3%. One out of 107 cases bio- psied revealed a false positive result (0.9%) and the case was due to misinterpretation of apocrine metaplastic cells in necrotic backgound as malignant cells. A false negative rate was 8.4% (9 of 107 cases biopsied). Six of 9 false negative cases were resulted from insufficient aspirates for diagnosis, and remaining three of 9 false negative cases revealed extensive necrosis with no or scanty viable cells on smears. The results indicate that for reducing false positive and false negative rates of FNA, an experienced cytopathologist and a proficient aspirator are of great importance.
Adenoma, Pleomorphic ; Aspirations (Psychology) ; Biopsy ; Biopsy, Fine-Needle ; Breast ; Carcinoma, Adenoid Cystic ; Carcinoma, Mucoepidermoid ; Child* ; Cost Savings ; Diagnosis ; Humans ; Necrosis ; Needles ; Sensitivity and Specificity ; Urinary Tract Infections* ; Urinary Tract* ; Vesico-Ureteral Reflux*

Gastrointestinal cytomegalovirus(CMV) infection in adults is observed as a part of a generalized or localized infection in patients who are immunocompromized. We report a case of CMV infection of the small intestine. The patient is a 34 year-old woman who has complained of palpable purpura in the lower extremities and buttocks, and arthralgia of large joints. The skin biopsy showed fibrinoid necrosis and neutrophils with leukocytoclasis, which findings are compatible with hypersensitivity angiitis. The patient received steroid and cyclophosphamide. During the follow-up period, generalized edema and bloody stool were detected. Resected specimen of small bowel has multiple aphthous ulcer. Microscopically, cytomegalic cells are observed along the endothelial cells and mesenchymal cells. In situ hybridization using DNA probes against CMV revealed positive staining in the cytomegalic inclusions in vascular endothelial and mesenchymal cells.
Adult ; Male ; Female ; Humans ; Biopsy

Onychomycosis is a chronic fungal nail infection which is notoriously difficult to eradicate. In spite of the selection of appropriate oral or topical antifungal medications, treatment failure or recurrences are frequent. Different therapeutic strategies must have been considered to improve the short- and long-term efficacy outcomes. These strategies are followed as: (1) correct diagnosis and classification of onychomycosis, (2) individually tailored treatment regimen, (3) maximizing method of antifungal efficacy, (4) reducing relapse and reinfection.
Antifungal Agents ; Classification ; Diagnosis ; Methods ; Onychomycosis* ; Recurrence ; Treatment Failure ; Treatment Outcome