BACKGROUND: Vascular lesions can be diagnosed by biopsy, simple x-ray, ultrasound, CT, MRI, venography and MR angiography. These diagnostic tools can identify the detailed structure and abnormalities in the peri-lesional area of vascular lesions. Color Doppler ultrasound (CDU) can demonstrate the hemodynamic features, distribution of veins and arteries, shunts and structures of vascular lesions. Authors have tried to categorize vascular lesions with CDU and also applied this to the selection of treatment methods. MATERIALS AND METHODS: Forty-seven vascular lesions were evaluated by means of CDU. All patients underwent a complete clinical evaluation as well as peak systolic velocity (PSV), peak diastolic velocity (PDV), resistive index (RI) of feeding arteries. In particular, we evaluated the hemodynamic features and structures of vascular lesions. We categorized the vascular lesions and then treated them with systemic steroid, compression, SPTL1 Dye laser, steroid intralesional injection and sclerotherapy. We evaluated the clinical improvement and objective effects of treatments by CDU. RESULTS: There were 37 hemangiomas and 10 vascular malformations. Vascular lesions were classified by the hemodynamic features and structures: category Ia (infantile hemangioma, regressed infantile hemangioma), Ib (RICH), Ic (deep hemangioma, mixed hemangioma), II (arteriovenous malformation), III (venous malformation, verrucous hemangioma). The clinical improvement after treatment was associated with the decrease of PSV and RI values. The clinical improvement above 50% resolution of the lesion showed 70.9% in category Ia, 50% in Ib, 66.6% in Ic, 83.3% in II and 50% in III. CONCLUSIONS: The analysis of hemodynamic feature and structures by CDU can be helpful in the study of vascular lesions. These processes suggest CDU be a useful modality in differential diagnosis of vascular lesions and a more advantageous tool in the decision of treatment policy than the conventional modalities. And it is also useful for the evaluation of treatment effects.
Angiography ; Arteries ; Biopsy ; Diagnosis, Differential ; Hemangioma ; Hemodynamics ; Humans ; Injections, Intralesional ; Lasers, Dye ; Magnetic Resonance Imaging ; Phlebography ; Sclerotherapy ; Ultrasonography* ; Vascular Malformations ; Veins

Multicentric reticulohistiocytosis (MRH) is a rare multisystemic granulomatous disease of unknown cause, characterized by severe debilitating polyarthritis and papular to nodular mucocutaneous lesions. This disease usually manifests as a progressive, destructive polyarthritis with mucocutaneous eruptions consisting of erythematous to brownish-colored papules and nodules. MRH is important, not only because of its disfiguring and disabling manifestations and systemic involvements, but also due to its association with internal malignancy. The histological features of skin and synovial lesions are infiltration of multinucleated giant cells, and histiocytes which contain abundant eosinophilic cytoplasm and have a ground glass appearance. Without the accompanying skin nodules, the patients can be misdiagnosed as having rheumatoid arthritis or psoriatic arthritis, and this inaccurate diagnosis will affect treatment. We report a case of MRH which was misdiagnosed as rheumatoid arthritis.
Arthritis ; Arthritis, Psoriatic ; Arthritis, Rheumatoid* ; Cytoplasm ; Diagnosis ; Eosinophils ; Giant Cells ; Glass ; Histiocytes ; Humans ; Skin

SAPHO syndrome is characterized by sternocostoclavicular osteoarthritis and hyperostosis in the anterior chest wall, and skin changes such as palmoplantar pustulosis and acne. Despite the higher frequency of psoriasis in this syndrome, its inclusion in the psoriatic arthropathy spectrum is not yet clearly established to date. According to a familial series of the SAPHO syndrome, both sacroiliac and sternoclavicular joints could be involved. We report a case of SAPHO Syndrome in a palmoplantar pustulosis patient who had on associated osteoarticular manifestation. A 47-year-old woman had been treated for palmoplantar pustulosis for 15 months. Pain and tenderness then developed abruptly on the chest and neck, and multiple erythematous papules and pustules broke our over the whole body. Laboratory tests were negative for serum RA factor and ANA, and positive for HLA-B27. An X-ray showed a hyperostosis, osteolytic and osteosclerotic lesions in the costo-sterno-clavicular junction. 99mTc isotope scan showed the typical "Bull's head sign" in the anterior chest wall due to increased uptake in the manubrium and both sternoclavicular joints.
Acne Vulgaris ; Acquired Hyperostosis Syndrome* ; Arthritis, Psoriatic ; Female ; Head ; HLA-B27 Antigen ; Humans ; Hyperostosis ; Manubrium ; Middle Aged ; Neck ; Osteoarthritis ; Psoriasis ; Skin ; Sternoclavicular Joint ; Thoracic Wall ; Thorax

PURPOSE: Varicose veins occur commonly in the general population, however the etiology is not well established. Varicosities are frequently associated with a reflux of blood in the leg veins due to valvular incompetence. Our aim was to determine which risk factors are related to reflux in the general population, and thus could be implicated in the etiology of varicose veins. METHOD: One hundred and eighty nine patients were assessed and their clinical records from March 2001 to June 2004 were reviewed. They were all diagnosed as having primary varicose veins of the lower extremities using duplex ultrasonography. We analyzed the sex, age, symptoms, signs, duration, location and CEAP classification. Patients also completed a self-administered questionnaire, asking about their objectives of the visit, cigarette consumption, familial history, previous pregnancies, use of drugs such as oral contraceptives, hormones, and anticoagulant agents, and other associated diseases. We carried out duplex scans to measure the reflux in venous segments in each leg. RESULTS: The mean age was 46.0 years, and there were 3.3 times more females than males. The most common CEAP classification was C2sEpAsPr, followed by C2aEpAsPr and C1sEpAsPr. Venous reflux was significantly associated with females (p=0.0067), duration (p=0.0027), pregnancy (p=0.0034), smoking (p=0.0360), family history of mother (p=0.0082) and brother (p=0.0360), heaviness (p=0.0120) and stasis dermatitis or ulcer (p=0.0219). CONCLUSION: This study identified relatively strong and consistent risk factors of venous reflux that are associated with females, pregnancy, smoking, duration, family history of the mother or brother, heaviness, and stasis dermatitis or ulcers.
Anticoagulants ; Classification ; Contraceptives, Oral ; Dermatitis ; Female ; Humans ; Leg ; Lower Extremity ; Male ; Mothers ; Pregnancy ; Risk Factors* ; Siblings ; Smoke ; Smoking ; Tobacco Products ; Ulcer ; Ultrasonography ; Varicose Veins* ; Veins ; Surveys and Questionnaires

PURPOSE: It is necessary to eliminate the highest point of reflux originating at the saphenofemoral junction (SFJ) and the great saphenous vein (GSV) to treat varicose veins. Minimal invasive alternatives in the treatment of varicose veins due to the SFJ and GSV incompetence have been tried over the years, resulting in various degrees of success depending on the method. Recently, endovenous laser occlusion using a diode laser has been introduced, with initial successful clinical reports. The present study was conducted to evaluate long-term follow-up results of endovenous laser treatment for closing the incompetent GSV at its junction with the femoral vein. METHOD: Forty limbs (thirty one patients) with reflux at the SFJ into the GSV were treated with 810nm or 940nm diode laser energy, administered endovenously through a bare-tipped laser fiber (600micrometer). The parameters were 12~15 W in a continuous mode, with a pulse of laser energy every second. A duplex doppler ultrasound (DDUS) was used to mark the location of the GSV from the knee to the SFJ. Vein access was achieved by using either the stab wound Mueller hook approach or ultrasound-guided needle puncture. Exact placement of the fiber was determined by direct observation of the aiming beam through the skin or ultrasound confirmation. Where necessary, a standard ambulatory phlebectomy was performed to remove remaining varicosities. Clinical and duplex evaluation was carried out at regular intervals (1, 3, 6, 12 months) following the initial treatment. RESULTS: Successful occlusion of the GSV, defined as absence of flow on the DDUS, was noted in 39 of 40 GSV (97.5%) during the last visit. Recanalization of GSV occurred in two limbs, 3 and 6 months after treatment. The GSV junction of 7 limbs had remained closed for 2 years. Side effects were minimal, with 21 limbs showing significant purpura, 6 limbs developing palpable fibrous cord and 4 limbs showing transient hyperpigmentation within less than 2 weeks to one month after treatment. CONCLUSION: Long-term results obtained from treatment of 40 limbs with endovenous laser treatment demonstrate a recurrence rate of less than 6% after 29 months of follow-up. These results are comparable or superior to those available for treatment of GSV reflux, including surgery, US-guided sclerotherapy, and radiofrequency ablation. Endovenous laser treatment appears to offer the benefit of lower rates of complication and the avoidance of general anesthesia.
Anesthesia, General ; Catheter Ablation ; Extremities ; Femoral Vein ; Follow-Up Studies ; Hyperpigmentation ; Knee ; Lasers, Semiconductor ; Needles ; Punctures ; Purpura ; Recurrence ; Saphenous Vein ; Sclerotherapy ; Skin ; Ultrasonography ; Varicose Veins* ; Veins ; Wounds, Stab

Clear cell acanthoma is a rare, benign, epidermal tumor. These tumors usually present as solitary lesions, often localized on the lower legs of middle aged or elderly individuals. Pigmented clear cell acanthoma, a variant of clear cell acanthoma, presents as macroscopically visible brown to black-colored, flat or dome-shaped, sharply-dermacated papules or nodules. Histopathologic findings in these tumors reveal markedly epidermal hyperplasia, with exception of the cells in the basal layer. Also, most of the epithelium showed pallor and slight enlargement. With these pigmented type tumors, dermal melanophages are often noticeable on low-power magnification, plus increased melanocytes with melanin granules in the epidermis. A 41-year-old man presented with a 7-year history of a 1.2x0.8cm sized, black plaque on the right inner thigh. The histologic findings revealed the typical features of pigmented clear cell acanthoma.
Acanthoma* ; Adult ; Aged ; Epidermis ; Epithelium ; Humans ; Hyperplasia ; Leg ; Melanins ; Melanocytes ; Middle Aged ; Pallor ; Thigh

Signet-ring cells are cells in which the nucleus is crescentically compressed with a cellular border, so that the cell looks like a signet-ring. Many cutaneous signet-ring cell neoplasms originate from the stomach, lung and breast, and these appear to be the most common sites of origin. In skin, the appearance of signet-ring cells within a neoplasm can indicate metastatic adenocarcinoma of the stomach, lung and breast. Thus, the primary origin and other metastatic sites should be evaluated. A 44-year-old man presented with a six month history of cutaneous swelling on the left axillary and left supraclavicular area. Histopathologic findings of the axillary lesion showed signet-ring cells in the lymphatics. These clustered cells were PAS-positive, diastase-resistant, and stained with colloidal iron and CEA. During the work-up study to find the primary origin, we discovered advanced gastric cancer and multiple lymph node metastases.
Adenocarcinoma* ; Adult ; Breast ; Colloids ; Edema* ; Humans ; Iron ; Lung ; Lymph Nodes ; Neoplasm Metastasis ; Skin ; Stomach ; Stomach Neoplasms

Calvus, callus, plantar warts and piezogenic papules are well known to cause discomfort and disturbance of gait in ordinary physical and sports activities. Furthermore, calcifying aponeurotic fibroma, whose mass slowly grows on the palms and soles of children and young adults, leads to pain, disturbance of gait, and even to skeletal deformities. A 22-year-old woman noticed an elevated subcutaneous mass on the left plantar surface of her big toe, which was accompanied with pain, tenderness and gait disturbance. The histologic findings showed an ill-circumscribed fibroblastic proliferation with foci of calcification and chondroid differentiation. After total excision of the mass, the patient became free of the above symptoms and the lesion did not recur for 9 months.
Bony Callus ; Child ; Congenital Abnormalities ; Female ; Fibroblasts ; Fibroma* ; Gait* ; Humans ; Sports ; Toes ; Warts ; Young Adult

Spitz nevus is a variant of melanocytic nevus which is histopathologically defined as large spindle and/or epithelioid cells. Angiomatoid Spitz nevus is a rare histologic variant of desmoplastic Spitz nevus characterized by prominent vasculature. We present a case of angiomatoid Spitz nevus, celluar type, that has not been reported before. We provide another example to show the remarkable diversity of Spitz nevus.
Epithelioid Cells ; Nevus, Epithelioid and Spindle Cell ; Nevus, Pigmented

Nicolau syndrome or embolia cutis medicamentosa is an acute necrotic condition of skin that follows intramuscular injection of drugs. A 36-year-old man developed a painful, purpuric and erythematous patch on his left buttock following an intramuscular injection of diclofenac sodium. Histologically, the patch lesion displayed epidermal necrosis, dermal degeneration, and vascular thrombosis. We report a rare case of Nicolau syndrome following intramuscular injection of diclofenac sodium. In our case, the patient was successfully treated by surgical excision with primary closure.
Adult ; Buttocks ; Diclofenac ; Humans ; Injections, Intramuscular ; Necrosis ; Skin ; Thrombosis