Surgical Pearl: Pinch-punch excisions for scrotal calcinosis.
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Adult↗
Biomedical subjects
Hong-Shang Hong
Publications and source records attributed to Hong-Shang Hong.
A bullous neutrophilic dermatosis in a patient with severe rheumatoid arthritis and monoclonal IgA gammopathy.
A 35-year-old man presented with a 2-month history of itchy grouped vesiculobullae with crusted papules and confluent plaques, distributed symmetrically on the thighs, knees, and elbows. The man had experienced severe disabling seropositive rheumatoid arthritis for 18 years previously. Histologically, subepidermal vesicles were noted, and a dense, diffuse neutrophilic infiltration of the dermis. Direct immunofluorescence studies did not detect IgA deposits. The patient responded well to dapsone (100 mg/d) but not to systemic steroids. This patient's eruption might have been an unusual manifestation of rheumatoid neutrophilic dermatitis.
Adult↗
Distant cutaneous metastases of cholangiocarcinoma: report of two cases of a previously unreported condition.
Cutaneous metastases develop in 2% to 10% of patients with internal malignancies. Here we present two cases of bile duct carcinoma with distant cutaneous metastases, a condition previously unreported. Scalp tumors were the initial presentation in both cases.
Aged↗
Clinical and histopathologic spectrum of cutaneous Rosai-Dorfman disease in Taiwan.
BACKGROUND: Cutaneous Rosai-Dorfman disease (RDD) is a rare entity of unknown origin and is not well documented, especially in Asian populations. OBJECTIVE: The purpose of this study was to evaluate the clinical manifestation, diagnostic histopathology, clinical course, and response to treatment of cutaneous RDD in Taiwan. MATERIALS AND METHODS: This study included 21 patients with cutaneous RDD who presented at our institution from 1995 to 2003. Pathologic examinations with both hematoxylin-eosin and immunohistochemical stains were reviewed, as were associated clinical features and therapeutic methods. RESULTS: None of the 21 patients with cutaneous RDD had nodal lesions. The clinical manifestation was variable, but most commonly involved a central noduloplaque with satellite papules. One patient manifested as an ulcerated nodule, something not reported previously. Multifocal involvement only occurred in 4 patients. Concurrent involvement of uvea or vocal cord occurred in two patients. The most prominent histologic feature was a florid and mixed inflammatory infiltration. The phagocytosis of inflammatory cells into the cytoplasm of histiocytes, a process called "emperipolesis," is a characteristic finding of nodular RDD but usually only focally presented in cutaneous ones. Positivity for S-100 protein helped to confirm the diagnosis. The most effective treatment was surgical excision of solitary lesions. High-dose thalidomide (300 mg/d), but not low-dose, was effective to control the extensive cutaneous diseases in two patients. A total of 3 patients experienced spontaneous remission 1 to 2 years after diagnosis. CONCLUSIONS: Cutaneous RDD appeared more frequently in Asian populations than in reports from Western countries. The incidence of multifocal involvement in this series is much lower than in other literature. Although treatment of disseminated cutaneous RDD is difficult, high-dose thalidomide (300 mg/d), which was effective in two patients in this series, may be helpful.
Adult↗
Cutaneous seeding of hepatocellular carcinoma due to percutaneous ethanol injection and masquerading as a pyogenic granuloma.
BACKGROUND: This investigation reports a 68-year-old man with a history of hepatocellular carcinoma (HCC) diagnosed 2 years previously who developed a single, easy-bleeding, pyogenic granuloma (PG)-like lesion on his right upper abdomen, located in the area of previous therapeutic percutaneous ethanol injection (PEI) for HCC treatment. The lesion developed 3 months after the injection. The tumor was found to be identical to his previous HCC. OBJECTIVE: To describe a case of cutaneous seeding of HCC during PEI presented as a PG-like lesion. To our knowledge, this is the first such case reported in the literature. METHODS: This is a case report and review the literature. RESULTS: Immunostainings for alpha-fetoprotein and hepatocyte monoclonal antibody confirmed the diagnosis. Besides, the patient had no other metastatic lesion. CONCLUSION: This tumor is believed to be caused by cutaneous seeding of HCC during PEI and is simulated clinically as a PG.
Aged↗
A solitary soft fibroma-like polypoid mucinosis: report of an unusual case.
BACKGROUND: Cutaneous mucinosis can be a primary or secondary reaction, as seen in connective tissue diseases, lupus erythematosus, metabolic diseases, paraproteinemias, and even malignant lymphomas. OBJECTIVE: Focal cutaneous mucinosis usually arises as a result of the dysfunction of fibroblasts in a local area. It may arrive from various mechanical stimulations. METHODS: We presented an unusual heretofore unreported case of a polypoid mucinosis. CONCLUSION: The local mucin deposition in this patient was considered as a secondary change from frequent friction by clothes.
Fibroma↗
Intense pulsed light for the treatment of refractory melasma in Asian persons.
BACKGROUND: Patients with dermal or mixed-type melasmas are often refractory to various treatments. Intense pulsed light has been used to treat melanocytic lesions with promising results. OBJECTIVE: The purpose of this study was to clarify the effectiveness of intense pulsed light for refractory melasma in Asian persons. METHODS: Seventeen patients were treated with intense pulsed light, during four sessions at 4-week intervals. The patients were also given 4% hydroquinone cream and broad-spectrum sunscreens to prevent and treat postinflammatory hyperpigmentation. Sixteen patients in the control group were treated with hydroquinone cream and sunscreens. The treatment efficacy was evaluated using reflectance spectrophotometer and patient satisfaction questionnaire. RESULTS: Patients in the intense pulsed light group achieved an average of 39.8% improvement in relative melanin index, compared to 11.6% improvement in the control group (p<0.05) at Week 16. Six (35%) patients in the intense pulsed light group had more than 50% improvement, compared to two (14%) patients in the control group. Two patients in the intense pulsed light group, however, experienced transient postinflammatory hyperpigmentation, and partial repigmentation was noted 24 weeks after the last treatment session. CONCLUSION: Intense pulsed light is a safe and effective treatment for refractory melasma in Asian persons, with minimal side effects. Further treatment sessions are required for maintenance therapy.
Adult↗
Multiple pigmented follicular cysts of the vulva successfully treated with CO2 laser: case report and literature review.
BACKGROUND: A pigmented follicular cyst is an uncommon epithelial cyst, typically occurring as a single asymptomatic pigmented papule or nodule on the head and neck of adult men. To the authors' knowledge, no previous cases of vulvar pigmented follicular cyst have been reported. Although benign, pigmented follicular cyst can affect quality of life when multiple and symptomatic. OBJECTIVE: The objective was to describe the clinicopathologic features of vulvar pigmented follicular cyst and to evaluate the efficacy of CO(2) laser therapy in this region. METHODS: A 62-year-old woman with multiple pigmented follicular cysts affecting the labia majora bilaterally is described. Owing to frequent inflammation and tenderness, continuous-wave CO(2) laser was used to treat the skin lesions under local anesthesia. RESULTS: All cystic nodules were successfully ablated with CO(2) laser. The patient tolerated the procedure well and had a satisfactory cosmetic outcome. CONCLUSION: CO(2) laser is a tolerable and effective therapeutic modality for multiple and symptomatic pigmented follicular cysts of the vulva.
Carbon Dioxide↗
Acute generalized exanthematous pustulosis induced by topical lindane.
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Acute Disease↗
Lupus lymphadenitis simulating Kikuchi's lymphadenitis in patients with systemic lupus erythematosus: a clinicopathological analysis of six cases and review of the literature.
Kikuchi's disease (KD) or Kikuchi's lymphadenitis (KL) is a self-limiting disease mostly affecting the cervical lymph nodes of young individuals. Whether the reported cases of KL associated with systemic lupus erythematosus (SLE) were genuine KL or lupus lymphadenitis (LL) simulating KL in SLE patients is not clear. We analyzed six cases of KD-like lymphadenitis occurring in SLE patients and 12 reported cases to clarify the relationship between KL and SLE. We found that not all cases occurred simultaneously with SLE. Eight cases occurred either before or after SLE. These cases might have true KL independent of SLE with the exception of two cases that occurred after SLE, but the patients still had lupus activity. The 10 cases that coexisted with SLE most likely had LL rather than KL. This was supported by the immunohistochemical finding of sparse cytotoxic T cells in those lymph nodes in contrast to abundant cytotoxic T cells usually seen in a typical KL. We conclude that KL is not related to SLE, and KD-like lymphadenitis coexisting with SLE should be regarded as LL. Pathologists should be aware of the possibility that LL can mimic KL in patients with SLE, especially necrotizing-type KL.
Adolescent↗
Cutaneous metastasis from adenoid cystic carcinoma of the parotid gland.
BACKGROUND: Cutaneous metastasis from adenoid cystic carcinoma of the salivary gland is very rare. OBJECTIVE: To present an unusual case of cutaneous metastasis from adenoid cystic carcinoma of the right parotid gland. METHODS: A 63-year-old woman with multiple subcutaneous nodules on the abdomen and a gradually enlarged mass over the right parotid area was examined. A skin biopsy was taken from one of the abdominal nodules. RESULT: Skin biopsy demonstrated the characteristic histopathologic features of metastatic adenoid cystic carcinoma. A subsequent computerized tomography of the head and neck revealed a huge soft tissue mass involving the right parotid gland. Computerized tomography of the chest revealed extensive nodular pleural thickening, and pleural biopsy also showed typical histopathologic features of metastatic adenoid cystic carcinoma. All of these results are consistent with the diagnosis of an adenoid cystic carcinoma of the right parotid gland with disseminated metastases. CONCLUSION: We report a rare case of cutaneous metastasis from adenoid cystic carcinoma of the right parotid gland. The presentation of cutaneous metastasis is often nonspecific and may mimic benign lesions. Subcutaneous nodules that are rapidly developing or eruptive, are rapidly growing and have stony hardness in nature, have pain or tenderness, and have nonhealing ulceration remind us of the possibility of cutaneous metastases. Dermatologists and dermatologic surgeons should keep the diagnosis of cutaneous metastasis in mind and always perform skin biopsy when encountering these lesions.
Carcinoma, Adenoid Cystic↗
Myxoid liposarcoma confirmed by TLS/FUS-CHOP fusion transcripts.
Described here is the use of detecting TLS/FUS-CHOP fusion transcripts to confirm the diagnosis of a myxoid liposarcoma by nested reverse transcription-polymerase chain reaction assay using archival formalin-fixed, paraffin-embedded tissues of a young man with a benign-looking myxoid tumor on his upper extremity, which is often misdiagnosed clinically or histopathologically as a benign tumor.
Adult↗
Vulvar syringoma: a clinicopathologic and immunohistologic study of 18 patients and results of treatment.
BACKGROUND: Syringoma of the vulva has been rarely reported. No effective treatment modality has been documented. OBJECTIVE: The purpose of this study was to describe the clinicopathologic features of vulvar syringoma, to investigate the hormonal influence on its growth, and to establish an effective treatment modality. METHODS: A total of 18 cases of vulvar syringoma were selected from the surgical pathologic file at Chang Gung Memorial Hospital. In all, 15 formalin-fixed, paraffin-embedded specimens were examined by immunohistochemical staining for estrogen receptor and progesterone receptor. RESULTS: The age of first presentation at our vulvar clinic ranged from 21 to 60 years with a median age of 29.5 years. Of patients, 13 (72%) had vulvar pruritus and 7 noticed aggravation during summer or during menstruation. The most common clinical appearance was multiple flesh-colored or brownish papules on bilateral sides of the vulva (9 of 18). One third of our series was found to have coexisting eyelid syringoma and 4 of them also had a family history of periorbital syringoma. Immunohistochemical stainings for estrogen receptor and progesterone receptor were all negative on the 15 cases studied. Of our patients, 7 with intense pruritus were treated with carbon dioxide laser vaporization. Their lesions resolved and pruritus subsided. CONCLUSION: Vulvar syringoma is not very rare and should be considered in the differential diagnosis of vulvar pruritus. In our study, estrogen receptor and progesterone receptor were not detected in vulvar syringoma. Carbon dioxide laser was an effective therapeutic modality in treating patients with intractable symptoms.
Adult↗
Fatal sodium valproate-induced hypersensitivity syndrome with lichenoid dermatitis and fulminant hepatitis.
Anticonvulsant hypersensitivity syndrome caused by sodium valproate (Depakene) has rarely been reported. Here we describe a patient who presented with nonspecific polymorphous eruptions, fulminant hepatitis, and jaundice. Lichenoid dermatitis was found in the skin biopsy specimen. Toxic hepatitis and microvesicular steatosis were found in the liver biopsy specimen, consistent with valproate hepatotoxicity.
Anticonvulsants↗
Detection of Sporothrix schenckii in clinical samples by a nested PCR assay.
Cutaneous sporotrichosis is a chronic granulomatous fungal infection caused by Sporothrix schenckii with worldwide distribution. Its traditional diagnosis is time-consuming and difficult to differentiate from that of a clinical sporotrichoid lesion caused by various pathogens. In this study, a nested PCR assay for the detection of S. schenckii was evaluated by using a sequence of 18S rRNA gene as a target. For the examination of specificity and sensitivity, five clinical isolates with 1 ATCC 10213 strain of S. schenckii, 10 strains of clinical common fungi, 3 strains of Mycobacterium spp., Staphylococcus aureus, and normal human skin tissue were used. The expected fragment was amplified from six S. schenckii isolates in the first round and nested PCR but not from other microorganisms and human DNA. Their sequences were 100% identical to the S. schenckii 18S rRNA gene sequence deposited in GenBank. A detection limit of 40 fg of S. schenckii DNA extract was determined with ethidium bromide staining. Serial dilution studies demonstrated that the nested PCR could detect a DNA amount of 1 CFU of S. schenckii in tissue samples. We further investigated the nested PCR assay for the detection of S. schenckii from the tail tissues of 5 experimentally infected mice and from the clinical biopsy specimens of 12 patients with sporotrichosis confirmed by culture or histochemical staining. The nested PCR assay was positive in all 5 infected mice and in 11 of the 12 clinical specimens. The high sensitivity and specificity of this nested PCR indicate that the assay can provide rapid diagnosis with sufficient accuracy to be clinically useful for patients with sporotrichosis.
Animals↗
Unusual skin manifestation of cutaneous amyloidosis.
A 76-year-old man with a 20-year history of extensive cutaneous amyloidosis is reported. He had asymptomatic symmetric brownish reticulated pigmented patches with well-demarcated borders on his thighs, lower legs, dorsal feet and both arms. The trunk and popliteal fossae were not affected. A skin biopsy specimen showed abundant amyloid deposits in the papillary dermis and reticular dermis. Despite the extensive cutaneous involvement and large amount of amyloid in the deep dermis, no evidence of systemic amyloidosis could be found. Various manifestations of cutaneous amyloidosis are reviewed. We report this case to remind dermatologists of the protean presentations of cutaneous amyloidosis.
Administration, Topical↗
Efficacy and safety of topically applied tacrolimus ointment in patients with moderate to severe atopic dermatitis.
BACKGROUND: Tacrolimus is a T-cell-selective cytokine inhibitor. The topical formulation was specifically developed for treating inflammatory skin diseases, including atopic dermatitis (AD). The purpose of this study was to evaluate the efficacy and safety of topically applied tacrolimus ointment (Protopic) in treating Taiwanese patients with moderate to severe AD. METHODS: This was an open-labeled, non-comparative, single-center study. Enrolled patients applied Protopic twice daily for up to 4 weeks. Efficacy was evaluated on the basis of the physician's global evaluation of clinical response (PG). Other evaluations included the Eczema Area and Severity Index and the percentage of body surface area; the total score for clinical signs was used for evaluating the efficacy. A safety assessment was based on adverse events reported by patients or observed by the physician. Blood was sampled for the evaluation of tacrolimus levels. RESULTS: In total, 30 patients (16 pediatric and 14 adult patients) with moderate to severe AD were enrolled in this study. At the end of treatment, the PG was 92.3% for the pediatric group and 100% for the adult group. Other efficacy evaluations also showed significant improvement. Two patients had detectable blood tacrolimus concentrations. Skin itching and burning on the application site was a common but temporary side effect. No significant adverse events related to Protopic were observed. CONCLUSION: The results of the study suggest that Protopic ointment may be a safe and effective therapy for treating patients at least 2 years of age with moderate to severe AD.
Administration, Topical↗
Annular pustules in Kawasaki disease: a further case indicating the association with psoriasis?
We report the case of a 4-year-old girl with Kawasaki disease (KD), or mucocutaneous lymph node syndrome, who presented with an annular pustular eruption. Targetlike erythematous and scaly patches were observed after resolution of the pustules. A biopsy of the skin was performed, and results showed spongy pustules not associated with the intraepidermal eccrine duct. Generalized pustular eruption, including pustular psoriatic lesions, has been described in KD. However, to our knowledge, this is the first report of annular pustular eruption mimicking annular pustular psoriasis in KD.
Aspirin↗