Biomedical subjects
Publications and source records attributed to H Tagami.
An elderly male patient with primary myelofibrosis developed many papules on the trunk and later numerous subcutaneous nodules on the face. Histologically these lesions showed the features of extra-medullary haematopoiesis consisting of all the three components, i.e. myeloid, erythroid and megakaryocytic elements, findings never reported in the skin.
Purpura pigmentosa chronica comprises a group of vascular disorders of unknown etiology. In biopsied specimens obtained from 8 patients, we observed vascular changes such as fibrinoid degeneration and occlusive damage occasioned by a hyalinized substance as well as swollen endothelia in 3. However, in all biopsied specimens, direct immunofluorescence studies demonstrated depositions of C3 or C1q with or without immunoglobulins, and of fibrin in papillary vessels. These findings suggest the possibility that immunological processes are involved in producing the histopathologic features of this disorder.
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A case of systemic scleroderma with peculiar morphaea-like lesions is reported. The patient at first started with typical acrosclerosis, some parts of which later became softened and apparently resumed the appearance of normal skin, so that morphaea-like cutaneous plaques which remained hard, were soft. These changes were surrounded by erythema resembling the 'lilac ring' as noted in characteristic active lesions of morphaea.
An aged man with a large scaly plaque over the left buttock was successfully treated by local heat therapy using an electric bed-warmer with a surface temperature of 46 degrees C. Clinically, the lesion involuted completely after two months of treatment. This was concomitantly confirmed by histopathological and mycological studies of biopsy specimens obtained from the lesion at an interval of several weeks. The isolated fungus strain of Fonsecaea pedrosol could grow at 37 degrees C on Sabouraud's dextrose agar, but was totally eradicated 24 hours after the culture was incubated at 46 degrees C. We consider that local heat therapy carried out under strict supervision is a quite effective treatment for chromomycosis. Moreover, it can be performed safely and without much discomfort to patients, and can yield satisfactory results in a relatively short time.
A bizzare erythematosquamous, partially verrucose, crustly or eroded eruption developed in a 6-year-old boy one week after his first measles vaccination. The eruption regressed completely after a two-year clinical course. Histologically, the epidermis showed unique columnar eosinophilic degeneration. There was a dense, mononuclear cell infiltration in the upper part of the dermis. To our knowledge these clinical and histologic features have not been reported in the literature, although they resemble, in some aspects, Kyrle's disease, Mucha-Haberman's disease, or lichen planus verrucosus. Regarding the pathomechanisms underlying the development of this unique epidermal change, a postulate was made that it represented a special form of toxic epidermal reaction, probably resulting from autoagressive lymphoid cell response to epidermal cells. Furthermore, relationship of measles vaccination to this special response is suggested.
Two elderly women with seborrheic keratoses on the abdomen are reported on because of the peculiar histologic appearance characterized by prominent acantholysis. Although the basic histologic architecture was a papillomatous acanthoma corresponding to that of seborrheic keratosis, the upper portion of the lesions showed extensive acantholytic changes and dyskeratotic cells. Differentiation from seborrheic keratosis with focal acantholytic dyskeratosis, warty dyskeratoma, keratosis senilis and acantholytic squamous cell carcinoma could be made on the basis of clinical as well as histological features. Although the histogenesis is uncertain, it seems logical to propose that this is a rare variant of irritated seborrheic keratosis.
A severe, extensive, erosive stomatitis developed in a 33-year-old Japanese man who had had intraperitoneal giant lymph node hyperplasia (Castleman's tumor) of the hyaline-vascular type. Histologically, there was a dense lymphoid cell infiltration in the dermis with invasion of the mucosal epithelium. It was hypothesized that an autoaggressive attack of lymphoid cells against the epithelium of the oral mucosa played a role in the pathogenesis of this erosive stomatitis and it was suggested that there might be a correlation between the occurrence of stomatitis and the presence of Castleman's tumor.
Seven patients are described, who had generalized toxic erythema with sterile pustules. Study of serial sections of the pustules confirmed a specific localization to hair follicle or epidermal sweat duct. Five patients had a past history of medications, exposure to an organic solvent, or infections.
Previous studies on the chemotactic properties of soluble substances from psoriatic scales demonstrated the presence of complement-derived chemotactic factors (anaphylatoxins) that seem to play a crucial role in the production of typical psoriasiform tissue changes. The crude extract from the stratum corneum of lesions of pustulosis palmaris et plantaris (PPP) was also noted to contain highly chemotactic components for polymorphonuclear leukocytes (PMN's) as compared with a crude callus extract in the present study. The leukotactic factors contained in the major chemotactic fractions isolated by Sephadex G-75 chromatography revealed in vitro characteristics and in vivo biological activities very similar to those of the leukotactic factor derived from psoriasis scale reported in earlier work, i.e. complement cleavage products (C3a and C5a). On the basis of these findings we have reason to believe that pustule formation in PPP occurs through a mechanism that has a strong resemblance to that in pustular psoriasis. We hypothesize further that similar mechanism may be operative in other dermatoses in which the formation of sterile subcorneal pustules is a characteristic feature.
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A study was made on the in vitro characteristics and in vivo biological activities of a leukotactic factor derived from psoriatic scale (PLF). Sephadex G-75 chromatography showed that PLF eluted in the region of the 12,500 dalton protein marker. It resisted heating, lyophilization, acidity (pH 3) and alkalinity (pH 11), but was destroyed by trypsin digestion. The substance attracted polymorphonuclear leukocytes (PMNs) in vitro; this ability was inhibited by antiserum to C3a and was partially reduced by antiserum to C5. Although PLF showed strong chemotactic activity for PMNs, its activity for mononuclear cells was only mild. Intradermal injection of PLF into man or guinea-pig produced an erythematous response with dense tissue neutrophilia, the time course of which was similar to that of the Arthus response. PLF also provoked increased vascular permeability in guinea-pig skin. Moreover, repeated intradermal injection of PLF to the same site in guinea-pigs led to moderate acanthosis of the overlying epidermis. These observations strongly suggest that transepidermal migration of leukocytes in psoriatic lesions is provoked by PLF, whose activity appears to reflect that of complement cleavage products, particularly C3a, presumably produced by complement activation in the subcorneal region of the epidermis. Furthermore, it is postulated that PLF may be a factor which plays a crucial role in the production of typical psoriasiform tissue changes.
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A case of chronic dental draining sinus on the dorsum of the nose is reported. The skin lesion, clinically simulating basal cell epithelioma, healed promptly after extraction and eradication of the periapical abscess of the right upper canine. The importance of considering this condition is emphasized in cases of chronic facial granulomatous or ulcerative lesions.
Based on clinical and histological studies in 25 patients, we have confirmed that plane warts show a characteristic phenomenon of spontaneous regression totally distinct from that described in common warts. This regression developed during various treatments in nine cases, and in 16 cases, it occurred spontaneously. In all the patients, there was a sudden and systemic onset of inflammation in every flat wart. Within two to six weeks, all the warts completely involuted. Histologically, there were variable degrees of epidermal changes depending on the stage of inflammation. However, a mononuclear cell infiltration with epidermal invasion was demonstrated in every biopsy specimen. This evidence further supports the earlier concept that this regressive phenomenon of plane warts is mediated by cellular immunity. It represents a natural experimental model of rejection of tumors induced by papovavirus in humans.
The regressing process of plane warts can be divided into two phases: initial changes of wart virus-infected cells that later result in degeneration of warts, and recovery phase in which degenerating warts are rejected from the level of the basal layer followed by regeneration of normal epidermal cells from the surrounding epidermis. Electron microscopic observations of recovery phase of wart regression showed (1) the epidermal lesion was clearly divided into degenerating wart possessing altered viruses and regerating epidermis; (2) melanocytes were demonstrated in degenerating warts; and (3) a new granular layer was evident beneath regressing wart in late recovery. Throughout the recovery process, infiltration of lymphocytes and macrophages was observed only in regenerating epidermis.
Trichophytin contact sensitivity was investigated in patients with dermatophytosis by patch testing with highly concentrated purified trichophytin on partially stripped skin. The lack of primary irritant reactions was confirmed on the skin of children. Positive patch tests were noted in 113 of 178 patients (63.5%). However, there was a great difference in the incidence of trichophytin contact sensitivity between cases with different clinical types. The highest frequency of positive patch tests was obtained in patients with the vesiculobullous type of tinea pedis (83.3%). In contrast, a very low incidence was noted in patients with tinea corporis (37%) and the squamous hyperkeratotic type of tinea pedis (36%). Causative organisms and the age and sex of the patients did not show a relationship with the reactivity. A diminished incidence of positive reactions was noted in atopic individuals and in patients seen in winter. Patients who had persistent or recurrent infections for a long period of time, especially those having inflammatory lesions, had a higher frequency of positive patch tests.
In an attempt to elucidate the mechanisms underlying the production of transepidermal migration of leukocytes toward the stratum corneum in psoriatic lesions, the chemotactic properties of soluble substances in psoriasis scales were examined by a modified Boyden's chamber. All crude extracts of horny tissues studied, i.e. callus, scales of exfoliative dermatitis and of psoriasis vulgaris, showed chemotactic activity for human peripheral blood leukocytes. But only the chemotactic activity of the psoriasis scale extract was highly potent. This was greatly reduced after dialysis. Fresh serum was not required to manifest the chemotactic activity. By Sephadex G-200 chromatography, the scale extracts from psoriasis vulgaris and pustular psoriasis had potent activity eluted near the cytochrome C marker. The same fractions of other horny tissue extracts, bacterial filtrate prepared from cultured psoriasis scale fragments, and serum did not show such potent activity. On the basis of analysis by gel filtration and recent findings of immunopathological studies, a postulate was made that a complement derived chemotactic factor, possibly a C5 cleavage product, developed as a result of antigen-antibody reaction in the stratum corneum of psoriatic lesions.