We report a case of a 42-year-old woman who suffered from recurrent nodular skin lesions on her left foot. Sporotrichoid fungal infection was suspected and two linear nodular skin lesions that had occurred after trauma in a public pool were treated with itraconazole for 4 months. These nodular skin lesions were completely flattened. However, four months after complete flattening, a new lesion developed in the scar of a previous nodule. N. asteroides, which is extremely rare for sporotrichoid cutaneous nocardiosis, was cultured from the relapsed lesion. We treated this case with trimethoprim-sulfamethoxazole for 6 months under an emperical basis and this resulted in complete healing, and sensitivity of N. asteroide to trimethoprim-sulfamethoxazole was confirmed later. There has been no recurrence for 3 years. To our knowledge, our case is the first report in the english literature of primary sporotrichoid cutaneous nocardiosis caused by N. asteroides in terms of anatomic location below the knee and host immunocompetency.
Adult ; Cicatrix ; Female ; Foot ; Humans ; Itraconazole ; Knee ; Nocardia asteroides* ; Nocardia Infections* ; Nocardia* ; Recurrence ; Skin ; Trimethoprim, Sulfamethoxazole Drug Combination

Incidental acantholysis is a rare histologic findings, and reported in basal cell carcinoma, keratoacanthoma, psoriasis, tinea corporis, etc We describe a case of contact dermatitis in a 64-year-old female who suffered from recurrent itchy, erythematous patches on face, neck, and shoulder She presented with recently aggravated itchy skin lesions after using perfume and Tiger balm. Patch test showed strong positive reaction to balsam of Peru, fragrance anix, and Tiger balm. A biopsy specimen showed lichenoid dermatitis and incidental focal acantholysis which was not previously reported in literatures.
Acantholysis* ; Biopsy ; Carcinoma, Basal Cell ; Dermatitis ; Dermatitis, Contact* ; Female ; Humans ; Keratoacanthoma ; Middle Aged ; Neck ; Patch Tests ; Perfume ; Peru ; Psoriasis ; Shoulder ; Skin ; Tigers ; Tinea

Acquired perforating dermatosis (APD) triggers severe itching, and is observed most often in patients with diabetes mellitus (DM) and chronic kidney disease (CKD). Various treatments, such as topical steroids, topical and oral retinoids, allopurinol, and ultraviolet B (UVB) phototherapy, have been used. However, as the precise etiology is unknown, there are a lack of well-established treatment guidelines. We report a peritoneal dialysis patient with a diagnosis of APD who was resistant to topical steroids, phototherapy, allopurinol, and topical retinoids. Severe pruritus persisted, which compromised his ability to lead a normal life. As a final treatment option, we used oral isotretinoin and the patient experienced a dramatic improvement.

BACKGROUND: It is important to distinguish trichoepitheliomas from basal cell carcinomas because, despite the similarity of clinical and histological findings, the treatments and prognoses are different. bcl-2 is a newly characterized protooncogene that has been shown to suppress programmed cell death(apoptosis), which is involved in tumorigenesis, and its expression has been demonstrated within tumor cells in a variety of neoplasms. OBJECTIVE: We tried to evaluate the staining pattern of bcl-2 protooncogene in basal cell carcinomas and trichoepitheliomas. METHODS: We examined cases of basal cell carcinomas and trichoepitheliomas with the immunohistochemical method of labelled streptavidin-biotin complex in paraffin-embedded sections using the antigen retrieval method. RESULTS: 1. The bcl-2 staining pattern in basal cell carcinomas was diffuse throughout the tumor lobules, but multifocal absences of bcl-2 staining were identified in sites of follicular differentiation. Also, inhomogeneous staining patterns were observed around the cystic, glandular structure of several subtypes of basal cell carcinoma. 2. The trichoepitheliomas showed staining of tumor cells limited to the outer layers of the tumor lobules. 3. Normal skin showed staining of basal keratinocytes, rnelanocytes in the epidermis, and eccrine gland secretory cells, basal layer of follicular structures, and dermal hair papilla in the dermis. CONCLUSION: The immunohistcchemical bcl-2 staining is helpful for the differentiation of basal cell carcinomas from trichoepitheliomas particularly in borderline cases and the explanation of different biologic courses for the two diseases. Further investigation of bcl-2 staining in other malignant skin diseases should be undertaken, and its practical adaptation should be more widely used in borderline cases.
Carcinogenesis ; Carcinoma, Basal Cell* ; Dermis ; Eccrine Glands ; Epidermis ; Hair ; Keratinocytes ; Prognosis ; Skin ; Skin Diseases

BACKGROUND: It is important to distinguish trichoepitheliomas from basal cell carcinomas because, despite the similarity of clinical and histological findings, the treatments and prognoses are different. bcl-2 is a newly characterized protooncogene that has been shown to suppress programmed cell death(apoptosis), which is involved in tumorigenesis, and its expression has been demonstrated within tumor cells in a variety of neoplasms. OBJECTIVE: We tried to evaluate the staining pattern of bcl-2 protooncogene in basal cell carcinomas and trichoepitheliomas. METHODS: We examined cases of basal cell carcinomas and trichoepitheliomas with the immunohistochemical method of labelled streptavidin-biotin complex in paraffin-embedded sections using the antigen retrieval method. RESULTS: 1. The bcl-2 staining pattern in basal cell carcinomas was diffuse throughout the tumor lobules, but multifocal absences of bcl-2 staining were identified in sites of follicular differentiation. Also, inhomogeneous staining patterns were observed around the cystic, glandular structure of several subtypes of basal cell carcinoma. 2. The trichoepitheliomas showed staining of tumor cells limited to the outer layers of the tumor lobules. 3. Normal skin showed staining of basal keratinocytes, rnelanocytes in the epidermis, and eccrine gland secretory cells, basal layer of follicular structures, and dermal hair papilla in the dermis. CONCLUSION: The immunohistcchemical bcl-2 staining is helpful for the differentiation of basal cell carcinomas from trichoepitheliomas particularly in borderline cases and the explanation of different biologic courses for the two diseases. Further investigation of bcl-2 staining in other malignant skin diseases should be undertaken, and its practical adaptation should be more widely used in borderline cases.
Carcinogenesis ; Carcinoma, Basal Cell* ; Dermis ; Eccrine Glands ; Epidermis ; Hair ; Keratinocytes ; Prognosis ; Skin ; Skin Diseases

PURPOSE: The purpose of this study was to determine the potential role of three-dimensional conformal radiotherapy (3D-CRT) in the treatment of primary unresectable hepatocellular carcinoma. The preliminary results on the efficacy and the toxicity of 3D-CRT are reported. MATERIALS AND METHODS: Seventeen patients were enrolled in this study, which was conducted prospectively from January 1995 to June 1997. The exclusion criteria included the presence of extrahepatic metastasis, liver cirrhosis of Child-Pugh classification C, tumors occupying more than two thirds of the entire liver, and a performance status of more than 3 on the ECOG scale. Two patients were treated with radiotherapy only while the remaining 15 were treated with combined transcatheter arterial chemoembolization. Radiotherapy was given to the field including the tumor plus a 1.5 cm margin using a 3D-CRT technique. The radiation dose ranged from 36~60 Gy (median; 59.4 Gy). Tumor response was based on a radiological examination such as the CT scan, MR imaging, and hepatic artery angiography at 4~8 weeks following the completion of treatment. The acute and subacute toxicities were monitored. RESULTS: An objective response was observed in 11 out of 17 patients, giving a response rate of 64.7%. The actuarial survival rate at 2 years was 21.2% from the start of radiotherapy (median survival; 19 months). Six patients developed a distant metastasis consisting of a lung metastasis in 5 patients and bone metastasis in one. The complications related to 3D-CRT were gastro-duodenitis (>or= grade 2) in 2 patients. There were no treatment related deaths and radiation induced hepatitis. CONCLUSION: The preliminary results show that 3D-CRT is a reliable and effective treatment modality for primary unresectable hepatocellular carcinoma compared to other conventional modalities. Further studies to evaluate the definitive role of the 3D-CRT technique in the treatment of primary unresectable hepatocellular carcinoma are needed.
Angiography ; Carcinoma, Hepatocellular* ; Classification ; Hepatic Artery ; Hepatitis ; Humans ; Liver ; Liver Cirrhosis ; Lung ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Prospective Studies ; Radiotherapy ; Radiotherapy, Conformal* ; Survival Rate ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Prothrombin induced by Vitamin K Antagonist-II (PIVKA-II) and alpha-fetoprotein (AFP) subtype reacting with Lens Culinaris Agglutinin (AFP-L3) are known as specific tumor markers for HCC. Recently a more sensitive EIA method for PIVKA-II and an automatic analyzer with Liquid Phase Binding Assay method (LBA method) for AFP-L3 have been developed. The aim of this study was to evaluate the feasibility of PIVKA-II and AFP-L3 measured by newly developed methods as complementary tumor markers to AFP in the diagnosis of HCC. METHODS: The serum concentration of AFP, PIVKA-II, and a fraction of AFP-L3 were determined from 188 patients with HCC and 118 patients with various liver diseases including 46 with liver cirrhosis, 10 with chronic hepatitis, 50 with metastatic liver cancers, and 12 with benign tumors of the liver. AFP was measured by EIA, PIVKA-II by sensitive EIA, and AFP-L3 by the LBA method with LiBASys Auto-analyzer. The cutoff values for AFP, PIVKA-II, and AFP-L3 were 400 ng/mL, 40 mAU/mL, and 15%, respectively. RESULTS: The sensitivity and specificity of serum PIVKA-II were 69.2% and 76.5%, respectively. Sixty-two (51.2%) of 121 patients with HCC, in which AFP was less than 400 ng/mL were PIVKA-II positive. The sensitivity and specificity of serum AFP-L3 were 48.8% and 90.8%, respectively. When AFP-L3 was used in combination with PIVKA-II, 31 (46.3%) of the 67 patients with small less than 3 cm HCC were positive for at least one of these markers. CONCLUSION: PIVKA-II measured by sensitive EIA may be useful for the diagnosis of HCC with low AFP level. AFP-L3 and PIVKA-II may improve the detection rate of small HCCs less than 3 cm.
alpha-Fetoproteins ; Carcinoma, Hepatocellular* ; Diagnosis* ; Hepatitis, Chronic ; Humans ; Lens Plant ; Liver ; Liver Cirrhosis ; Liver Diseases ; Liver Neoplasms ; Prothrombin ; Sensitivity and Specificity ; Biomarkers, Tumor ; Vitamin K