Purpose: The clinical implications of tumor-infiltrating T cell subsets and their spatial distribution in biliary tract cancer (BTC) patients treated with gemcitabine plus cisplatin were investigated. Materials and Methods: A total of 52 BTC patients treated with palliative gemcitabine plus cisplatin were included. Multiplexed immunohistochemistry was performed on tumor tissues, and immune infiltrates were separately analyzed for the stroma, tumor margin, and tumor core. Results: The density of CD8+ T cells, FoxP3- CD4+ helper T cells, and FoxP3+ CD4+ regulatory T cells was significantly higher in the tumor margin than in the stroma and tumor core. The density of LAG3- or TIM3-expressing CD8+ T cell and FoxP3- CD4+ helper T cell infiltrates was also higher in the tumor margin. In extrahepatic cholangiocarcinoma, there was a higher density of T cell subsets in the tumor core and regulatory T cells in all regions. A high density of FoxP3- CD4+ helper T cells in the tumor margin showed a trend toward better progression-free survival (PFS) (p=0.092) and significantly better overall survival (OS) (p=0.012). In multivariate analyses, a high density of FoxP3- CD4+ helper T cells in the tumor margin was independently associated with favorable PFS and OS. Conclusion The tumor margin is the major site for the active infiltration of T cell subsets with higher levels of LAG3 and TIM3 expression in BTC. The density of tumor margin-infiltrating FoxP3- CD4+ helper T cells may be associated with clinical outcomes in BTC patients treated with gemcitabine plus cisplatin.

Recent studies suggest that liver cirrhosis is reversible after administering oral nucleos(t)ide analogue therapy to patients with hepatitis B virus (HBV) infection. However, few studies have addressed whether esophageal varices can regress after such therapy. We report a case of complete regression of esophageal varices during entecavir therapy in patients with HBV-related liver cirrhosis, suggesting that complications of liver cirrhosis such as esophageal varices can regress after the long-term suppression of HBV replication.
Abdomen/diagnostic imaging ; Antiviral Agents/*therapeutic use ; DNA, Viral/blood ; Esophageal and Gastric Varices/complications/prevention & control ; Guanine/*analogs & derivatives/therapeutic use ; Hepatitis B virus/genetics ; Hepatitis B, Chronic/complications/*drug therapy/virology ; Humans ; Liver Cirrhosis/*diagnosis/etiology ; Male ; Middle Aged ; Polymerase Chain Reaction ; Ultrasonography

Sparganosis is a kind of parasitic skin disease caused by sparganum, the plerocercoid larvae of the taper worm of the genus Spirometra. Sparganosis usually manifests as migrating or fixed subcutaneous nodules; therefore, it should be differentiated from lipoma, cysts, and cutaneous malignancies. Although the final diagnosis of sparganosis in humans depends on the identification of the worm in an infected tissue, suspicion for the presence of the parasite and careful history taking are important before making the diagnosis. However, it might be difficult for a clinician to suspect the existence of sparganosis because the incidence of this disease is extremely low. Therefore, an effective method for differentiating sparganosis from other skin disorders is needed. We suggest that ultrasonography could be an answer to this problem, on the basis of our experience of a case of cutaneous sparganosis in a 65-year-old woman showing very characteristic ultrasonographic findings.
Aged ; Diagnosis* ; Female ; Humans ; Incidence ; Lipoma ; Parasites ; Skin ; Skin Diseases, Parasitic ; Sparganosis* ; Sparganum ; Spirometra ; Ultrasonography*

No abstract available.
Syphilis, Cutaneous*

BACKGROUND: Various kinds of alopecia can show small round or oval hairless patch. Dermoscopy could be a simple, useful tool for making a correct diagnosis. OBJECTIVE: The aim of this study is to investigate clinical usefulness of dermoscopy for diseases with small round or oval hairless patch on the scalp. METHODS: Dermoscopic examination was performed for 148 patients with small round or oval hairless patch using DermLite(R) II pro. The type and its patient number of alopecia investigated in the study were as below: alopecia areata (n=81), trichotillomania (n=24), tinea captis (n=13), traction alopecia (n=12), lichen planopilaris (n=8), discoid lupus erythematosus (n=7), congenital triangular alopecia (n=2) and pseudopelade of Brocq (n=1). The significance of dermoscopic findings for each disease were evaluated. RESULTS: Characteristic dermoscopic findings of alopecia areata were tapering hairs and yellow dots. Those of trichotillomania and traction alopecia were broken hairs. Dermoscopic findings of tinea capitis included bent hairs, perifollicular white macules and greasy scales. Discoid lupus erythematosus and lichen planopilaris were characterized by dermoscopic findings of lack of follicular ostia. Furthermore, keratin plugs were frequently seen in discoid lupus erythematosus whereas perifollicular hyperkeratosis and erythema were frequently seen in lichen planopilaris. CONCLUSION: Dermoscopic examination for small round or oval hairless patch showed characteristic findings for each disease. Based on these results, we propose dermoscopic algorithm for small round or oval hairless patch on the scalp.
Alopecia ; Alopecia Areata ; Dermoscopy ; Diagnosis ; Erythema ; Hair ; Humans ; Lichens ; Lupus Erythematosus, Discoid ; Scalp* ; Tinea ; Tinea Capitis ; Traction ; Trichotillomania ; Weights and Measures

No abstract available.
Eosinophilia ; Eosinophils ; Folliculitis ; Skin Diseases, Vesiculobullous ; Tacrolimus

Livedo racemosa (LR) is characterized by a striking violaceous netlike patterning of the skin similar to the livedo reticularis, from which it differs by its localization (more generalized), and shape (irregular, broken circular segments). LR is probably caused by patchy impairment of cutaneous arteriolar circulation, resulting in venous dilatation and stasis of blood. LR is always associated with a pathological condition, including hematologic/hypercoagulable disease, vasculitis, connective tissue diseases, neoplasm, lymphoma, infection, cerebrovascular disease, adverse response to a drug, and etc. Hence, clinical, pathological and laboratory examinations are important for excluding these underlying diseases. To date, there have been few reports of LR secondary to posttransplant lymphoproliferative disease (PTLD) in dermatologic literatures. Herein, we report a case of LR associated with Epstein-Barr virus-induced PTLD of cervical lymph node in a 19-year-old female, who had generalized reticular erythematous to violaceous patch on the entire body after allogenic peripheral blood stem cell transplantation.
Connective Tissue Diseases ; Dilatation ; Female ; Herpesvirus 4, Human ; Humans ; Livedo Reticularis ; Lymph Nodes ; Lymphoma ; Lymphoproliferative Disorders ; Peripheral Blood Stem Cell Transplantation ; Skin ; Strikes, Employee ; Vasculitis

A 56-year-old man with chronic hepatitis C was treated with pegylated interferon alfa-2a in combination with ribavirin. However, psoriatic lesions appeared and worsened dramatically during therapy. Because of the extensive skin eruptions, he stopped therapy for chronic hepatitis C and subsequently started narrow-band ultraviolet B phototherapy and topical calcipotriol/betamethasone dipropionate ointment. After this, the psoriasis improved in a slow but comprehensive manner. Our case suggests that physicians should keep in mind the possibility of psoriasis as a side effect of interferon treatment for chronic hepatitis C.
Hepatitis C ; Hepatitis C, Chronic* ; Hepatitis, Chronic* ; Humans ; Interferon-alpha ; Interferons* ; Middle Aged ; Phototherapy ; Polyethylene Glycols ; Psoriasis* ; Recombinant Proteins ; Ribavirin* ; Skin

Disseminated and recurrent infundibulo-folliculitis is an infrequent entity of unknown etiology that was first described in 1968, by Hitch and Lund. Most patient reports have been on young black male adults. It is rarely reported in Asian, and there has been only 1 case reported in the Korean medical literature in the year 1984. The syndrome has been characterized as tiny uniform, skin-colored papules similar to 'goose-bumps' of skin. These papules predominantly involve the trunk and proximal extremities, and are usually accompanied by mild pruritus. In this report, we presented a 33-year-old man with a 10-year history of generalized skin-colored, follicular papules on the chest and back with intermittent pruritus. The clinical initial differential diagnosis included keratosis pilaris, lichen spinulosus, lichen nitidus, folliculitis, and disseminated and recurrent infundibulo-folliculitis. A histopathologic examination showed predominant mononuclear cell infiltration around the infundibular portion of hair follicles, follicular spongiosis and lack of hyperkeratosis. Herein, we reported a rare case of disseminated and recurrent infundibulo-folliculitis with typical clinical and histopathological findings in a 33-year-old Korean man.
Abnormalities, Multiple ; Adult ; Asian Continental Ancestry Group ; Darier Disease ; Diagnosis, Differential ; Extremities ; Eyebrows ; Folliculitis ; Hair Follicle ; Humans ; Keratosis ; Lichen Nitidus ; Lichens ; Male ; Pruritus ; Skin ; Thorax

BACKGROUND: There is as yet no effective and safe treatment for vitiligo. One percent pimecrolimus cream, a topical calcineurin inhibitor, has been tried for the treatment of vitiligo, with its therapeutic efficacy having mostly been reported in non-segmental vitiligo. However, questions about the therapeutic efficacy of 1% pimecrolimus cream have remained unanswered regarding segmental vitiligo. OBJECTIVE: The aim of this study was to study the therapeutic efficacy and safety of 1% pimecrolimus cream for segmental childhood vitiligo. METHODS: Nine childhood patients with segmental vitiligo were treated with 1% pimecrolimus cream twice daily for three months, after which good responders were scheduled to continue with the 1% pimecrolimus cream monotherapy. The efficacy and safety of this treatment were determined by the levels of repigmentation, initial response time and the presence of adverse events including burning, dryness, stinging and itching. RESULTS: Four of nine patients achieved mild to moderate responses after three months of treatment and thus continued with treatment. Among these four patients, three achieved an excellent response and one patient achieved a moderate response, with a mean treatment duration of 7.3 months. Transient local burning sensation was the most common adverse event. In comparison with the patients with poor response, those patients with good response showed a shorter disease duration (8.5+/-10.5 mo vs. 13.4+/-10.1 mo), more frequent facial involvement (4/4 patients vs. 3/5 patients) and earlier initial response after treatment (1.0+/-0.0 mo vs. 2.0+/-1.0 mo). CONCLUSION: This study suggests that 1% pimecrolimus cream is an effective and well-tolerated treatment for segmental childhood vitiligo.
Bites and Stings ; Burns ; Calcineurin ; Humans ; Pilot Projects ; Reaction Time ; Sensation ; Tacrolimus ; Vitiligo