BACKGROUND: Mycosis fungoides (MF) is malignant proliferation of T-helper memory lymphocyte, and only a minority of cases present with other phenotypes such as CD3+, CD4-, CD8+ or CD3+, CD8+. Primary cutaneous CD8+ epidermotropic cytotoxic T-cell lymphoma is known to represent aggressive course. OBJECTIVES: The purpose of this study was to define the CD8 expression in mycosis fungoides and clinical characteristics of CD8+ MFs. In addition, we also studied whether the presence of CD8+ tumor-infiltrating lymphocytes (TIL) had any impact on prognosis of the disease. Patients & METHODS: We retrospectively analyzed 9 patients with MFs by chart review and medical records including age, location, disease duration and patients prognostic features. We also observed CD4 and CD8 expression through the immunohistochemical staining on paraffin-embedded tissue. RESULTS: All the patients, including the present study, showed positive response to CD8 immunohistochemical staining. CD8+ TIL was found in upper dermis (100.0%) of all patients. Two patients had lesion with CD4 TIL more strongly stained than with CD8 TIL, 2 patients with CD8 more than CD4, and the rest showed equally stained lesion. There were no significant differences among the location of CD8 TIL, the density of staining, CD4 TIL/ CD8 TIL and disease prognosis. On long-term follow-up, these results described herein showed that patients with CD8+ cutaneous T-cell lymphomas enjoyed good prognosis. CONCLUSIONS: Our results revealed that all MFs showed positive response to CD8 immunohistochemical staining. Our CD4+ and CD8+ MFs showed clinical features similar to those reported CD4+ and CD8- MFs and enjoyed good prognosis rather than aggressive clinical behavior on long-term clinical follw-up.
Dermis ; Follow-Up Studies ; Humans ; Lymphocytes ; Lymphocytes, Tumor-Infiltrating ; Lymphoma, T-Cell ; Lymphoma, T-Cell, Cutaneous ; Medical Records ; Memory ; Mycosis Fungoides* ; Phenotype ; Prognosis ; Retrospective Studies

Pseudoporphyria is a generic term that is used to describe photoaggravated bullous dermatoses associated with multiple iatrogenic causes, including medications and dialysis. The bullous lesions of pseudoporphyria are similar to those of porphyria cutanea tarda, both clinically and histologically, but they occur in the absence of the abnormally high levels of porphyrins which are found in true porphyrias. Treatment entails discontinuation of suspected agents and sun protection, especially against UVA wavelengths. We report a case of pseudoporphyria in a 28-year-old male who had erythematous crusted erosions, vesicles and hyperpigmented macules on his face and both forearms. A biopsy from his Lt. forearm revealed subepidermal bullaes with festooning of dermal papillae, and mild lymphocytic perivascular infiltrations. However laboratory tests for porphyrin were negative in his urine, blood and stool.
Adult ; Biopsy ; Blister ; Dialysis ; Forearm ; Humans ; Male ; Porphyria Cutanea Tarda ; Porphyrias ; Porphyrins ; Skin Diseases, Vesiculobullous ; Solar System

Epidermodysplasia verruciformis(EV) is a rare disease characterized by a unique susceptibility to widespread infection with human papilloma virus. It induces flat papular skin lesions, characterized by large vacuolated cells in the upper epithelial layers. We report a patient of EV in association with non-Hodgkin"s lymphoma(NHL) improved with systemic acitretin treatment. A 69-year-old man presented multiple red flat-topped papules and plaques on his face and upper extremities for 12 years. Past various therapeutic modalities including DPCP sensitization were entirely ineffective. Several years ago, NHL of cervical lymph node was diagnosed. With the treatments with chemotherapy and radiotherapy, he is now in remission state. His skin biopsy specimen showed extensive vacuolation of upper malpighian layer. Bleomycin IL trial showed no response. Only 1 week after oral acitretin administration, his lesions began to exfoliate and became much flatter. Acitretin was effective but not suitable for maintenance therapy.
Acitretin* ; Aged ; Biopsy ; Bleomycin ; Drug Therapy ; Epidermodysplasia Verruciformis* ; Humans ; Lymph Nodes ; Lymphoma, Non-Hodgkin* ; Papilloma ; Radiotherapy ; Rare Diseases ; Skin ; Upper Extremity

Clear cell acanthoma is a relatively uncommon benign disease, which usually presents as solitary lesions, often localized on the lower legs of middle aged or elderly individuals1. Clinically it presents as a flat or dome-shaped, sharply demarcated papule or nodule. Histopathologic findings are composed of clear cells within sharply demarcated area of the epidermis. We report three cases of clear cell acanthoma developed on the nipples and areolar areas of the young women. These cases should be differentiated from various diseases showing clinically benign eczematous feature. In conclusion, clear cell acanthoma could be included in the differential diagnosis of eczema, and it is suggested that biopsies specimen should include the lesion as well as the normal tissue.
Acanthoma* ; Aged ; Biopsy ; Diagnosis, Differential ; Eczema ; Epidermis ; Female ; Humans ; Leg ; Middle Aged ; Nipples*

Verrucous hemangiomas are usually congenital lesions which typically present as warty, bluish, vascular papules, plaques, or nodules mainly on the lower limbs of children. It is a structural variant of capillary or cavernous hemangioma, in which reactive epidermal changes develop secondarily. They show no tendency to spontaneous resolution, and tend to spread and recur after inadequate treatments. It is important, from a prognostic and therapeutic point of view, to make a correct diagnosis between verrucous hemangioma and angiokeratoma circumscriptum, because the former needs a large and deep excision and the latter responds to the common means of physical therapy. We report a case of 37-year-old man with verrucous hemangioma which was developed at his third decade.
Adult* ; Angiokeratoma ; Capillaries ; Child ; Diagnosis ; Hemangioma* ; Hemangioma, Cavernous ; Humans ; Lower Extremity

BACKGROUND/AIMS: Melanoma antigen gene (MAGE)-A which have more than 12 subtypes is a gene family for tumor specific shared antigens, recognized by the cytotoxic T cell. Since these genes are expressed only in tumor cells and silent in normal adult tissues except in the male germ line, they may be used as diagnostic markers in detecting malignancy. During the carcinogenesis of gastrointestinal tract, the hyperplastic epithelium-adenoma-adenocarcinoma sequence is largely accepted and the molecular studies on each step have been issued. However, in the aspect of carcinogenesis in the gastrointestinal tract, MAGE genes have not studied yet. To explore the functional role and clinical significance of MAGE-A genes in the carcinogenesis of the colon, mRNA expression of MAGE-A1 to -A6 in the mucosal tissues obtained from the colonoscopy was investigated and the relationship between their expressions and clinicopathologic parameters was analysed. METHODS: We investigated the expression of MAGE 1~6 in 65 endoscopically biopsied samples of neoplastic and nonneoplastic tissues from the colon, using a MAGE common primer by the reverse transcription-nested polymerase chain reaction and DNA sequencing. RESULTS: Of the 31 colorectal adenocarcinoma specimens examined, MAGE genes were expressed in 11 cases (36%). In contrast, no expression of these genes was observed in any of the 12 samples of tubular adenoma and 12 of non-specific colitis and 5 cases of normal colonic tissues. There was no significant correlation between the expression of the MAGE genes and clinicopathologic factors, such as gender, disease stage, lymph node metastasis and perineural and vascular invasion in colonic carcinoma. CONCLUSIONS: It is postulated that the expression of MAGE genes could reflect the late event of oncogenesis of the colon because no MAGE expression was noticed in chronic inflamamtion and adenomas which might have the important role in the process of malignant transformation.
Adenocarcinoma ; Adenoma ; Adult ; Carcinogenesis* ; Colitis ; Colon* ; Colonic Neoplasms ; Colonoscopy ; Gastrointestinal Tract ; Genes, vif ; Germ Cells ; Humans ; Lymph Nodes ; Male ; Melanoma ; Mucous Membrane ; Neoplasm Metastasis ; Polymerase Chain Reaction ; RNA, Messenger ; Sequence Analysis, DNA

PURPOSE: The aim of the present study was to analyze 7-year cumulative survival rate (CSR, %) of dental implants in the controlled diabetic patients and to evaluate the influence of the position, diameter and length of fixture, bone quality, age, gender and the method of maxillary sinus elevation on the survival rate. METHODS: The data of 342 placed implants in the 104 diabetic patients collected between 1995 and 2007 at the Department of Periodontology in Yonsei University Hospital were analyzed. RESULTS: Seven-year CSR of the 342 dental implants in the 104 controlled diabetic patients was 96.5%. The survival rates of the placed implants according the position have no statistically significant difference. The survival rates according to the length or diameter of the fixtures have no statistically significant difference. The survival rates according to the bone quality were 100% (Type I), 97.1% (Type II), 97.7% (Type III) and 85.7%(Type IV). The difference between the survival rate of Type I, II and III and that of Type IV was statistically significant. The survival rates according to patient gender were 96.8% (male), 95.5% (female). The survival rates according to patient age were 100% (< or = 59), 93.8% (> or = 60). The survival rates according to the method of sinus elevation in the maxillary posterior area were 96.8% (without sinus elevation), 92.9% (lateral approach) and 89.8% (crestal approach). CONCLUSIONS: Dental implants can be used successfully in the controlled diabetic patients. In case of upper posterior region which has poor bone density and older patients, the implant treatment should be more properly planed, executed, and followed-up.
Bone Density ; Dental Implants ; Diabetes Mellitus ; Humans ; Maxillary Sinus ; Retrospective Studies ; Survival Rate

The primary cause of tooth loss after 30 years of age is periodontal disease. Destruction of alveolar bone by periodontal disease is done by bone resorbing activity of osteoclasts. Understanding differentiation and activation mechanism of osteoclasts is essential for controling periodontal disease. The purpose of this study is to identify the possible effects of Vitamin D and cytokines affecting osteoclasts and its precursor cells. Four to six week-old mice were killed and humerus, radius, tibia and femur were removed aseptically and washed two times with Hank's solution containing penicillin-streptomycin and then soft tissue were removed. Bone marrow cells were collected by 22 gauge needle. Cells were cultured in Hank's solution containing 1 mg/ml type II collagenase, 0.05% trypsin, 4mM EDTA. Supernatant solution was removed 5 times after 15 minutes of digestion with above mentioned enzyme solution, and remained bone particles were maintained in alpha-MEM for 15 minutes and 4degrees C temperature. Bone particles were agitated for 1 minute and supernatant solution containing osteoclast precursor cells were filtrated with cell stainer. These separated osteoclast precursor cells were dispensed with 100-mm culture dish by 1x10(7) cells unit and cultured in alpha-MEM containing 20 ng/ml recombinant human M-CSF, 30 ng/ml recombinant human soluble osteoclast differentiation factor and 10% fetal calf serum for 2 and 7 days. Total RNA of osteoclast precursor cells were extracted using RNeasy kit. One microgram of total RNA was reverse transcribed in 42degrees C for 30 minutes using SuperScriptII reverse transcriptase. Expression of transcribed receptors of each hormone and cytokine were traced with 1 microliter of cDNA solution by PCR amplification. Vitamin D receptor was found in cells cultured for 7 days. TNF-alphareceptor was found in cells cultured for 2 days and amount of receptors were increased by 7 days. IL-1 type I receptor was not found in cells cultured 2 and 7 days. But, IL-1 receptor type II was found in cells cultured for 2 days. TGF-alpha,betatype I receptor was found in cells cultured 2 and 7 days, and amount of receptors were increased by 7 days of culture. These results implies Vitamin D and cytokines can affect osteoclasts directly, and affecting period in differentiation cycle of osteoclasts is different by Vitamin D and cytokines.
Animals ; Bone Marrow Cells ; Collagenases ; Cytokines* ; Digestion ; Dihydroergotamine ; DNA, Complementary ; Edetic Acid ; Femur ; Humans ; Humerus ; Interleukin-1 ; Macrophage Colony-Stimulating Factor* ; Mice ; Needles ; Osteoclasts* ; Periodontal Diseases ; Polymerase Chain Reaction ; Radius ; RANK Ligand ; Receptors, Calcitriol ; RNA ; RNA-Directed DNA Polymerase ; Tibia ; Tooth Loss ; Trypsin ; Vitamin D* ; Vitamins*

Dermatophytes generally cause infection of the stratum corneum and superficial layers of skin. They are, therefore, found less frequently in the rete layer and do not ordinarily penetrate deeper than the basal cell layer. Nevertheless, under special circumstances such as the pressure generated during trauma or long term topical steroid application, the fungus elements of some dermatophytes will be forced into the dermis where they instigate a chronic granulomatous reaction. We report a 43-year-old male who presented with multiple erythematous brown colored dome-shaped papules on both periorbital areas, which were clinically similar to lupus miliaris disseminatus faciei (LMDF). Histologic examination revealed follicular and perifollicular infiltration by inflammatory cells, and perifollicular granuloma. Trichophyton species were isolated from the fungus culture of the lesional tissue. The patient was treated with an antifungal agent, resulting in clearance of the skin lesions, and there was no recurrence of skin lesions during a 13-month follow-up period. We suggest that it is important to perform biopsies and cultures on periorbital papules which mimick LMDF, refractory to conventional therapy.
Adult ; Arthrodermataceae ; Biopsy ; Dermis ; Folliculitis* ; Follow-Up Studies ; Fungi ; Granuloma ; Humans ; Male ; Recurrence ; Skin ; Trichophyton

Small cell carcinoma of the gallbladder (GB) is a very rare tumor, found usually in elderly women and associated with cholelithiasis. It carries a grave prognosis, metastasizing early and causing death shortly after diagnosis. We experienced a case of small cell carcinoma of the GB with metastasis to the liver and adjacent lymph nodes in a 67-year-old woman. The patient underwent palliative resection and histologically, the tumor was made up of sheets of uniform small round cells with hyperchromatic nuclei, inconspicuous nucleoli and scant cytoplasm, consistent with small cell carcinoma of the GB.
Aged ; Carcinoma, Small Cell* ; Cholelithiasis ; Cytoplasm ; Diagnosis ; Female ; Gallbladder* ; Humans ; Liver ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis