Biomedical subjects

N Misago

Publications and source records attributed to N Misago.

32 records · Page 2Linked to original sources

PubMed1996

Necrotizing fasciitis due to group A streptococci: a clinicopathological study of six patients.

The recent worldwide appearance of invasive group A streptococcal infections has again called attention to streptococcal necrotizing fasciitis. However, in contrast to polymicrobial necrotizing fasciitis, the streptococcal form has not been thoroughly studied clinically. The objective of the study was to elucidate the characteristic features of recent cases of necrotizing fasciitis due exclusively to pure group A streptococci. We encountered six patients with these criteria at a single hospital in Japan during the last 12 years. A clinicopathological analysis was performed in these six patients. In three patients, the clinical signs and the laboratory findings were characteristic of systemic toxicity. In this group, the clinical presentation was a pale or blue-gray lesion associated with severe intravascular coagulation histologically involving the vessels in the lesion. In the three patients without signs of systemic toxicity, a swollen, erythematous skin lesion persisted for as long as one week; histologically, the intravascular coagulation within these lesions was mild. In clinicopathological terms, the entity in these six patients could be clearly classified as either fulminant or subacute. In the fulminant type, immediate surgical debridement of necrotic fascia is required; in the subacute type, incision and drainage alone are sufficient.

Adult↗

PubMed1996

Intradermal dermoid cyst associated with occult spinal dysraphism.

A 2-year-old boy with congenital lumbosacral skin lesions is described. He presented with associated occult spina bifida and a sagittal cleft of the vertebral body deep in the skin lesions. The skin lesions presented as a combination of a lipoma, telangiectasia, mild hypertrichosis, and a dermoid cyst. Magnetic resonance imaging (MRI) revealed that the lipoma extended to the spina bifida region, but that it did not connect to the dura. MRI also demonstrated no other spinal lesions requiring surgical treatment. The intradermal location of the dermoid cyst observed in our patient was unusual. We discuss the location of dermoid cysts in the lumbosacral region associated with spinal dysraphism.

Dermoid Cyst↗

PubMed1996

Malignant peripheral nerve sheath tumor of the skin: a superficial form of this tumor.

A case of malignant peripheral nerve sheath tumor (MPNST) of the skin, which is a superficial form of this type of tumor, is described. Although our patient did not present the usual diagnostic criteria for MPNST, the clinicopathologic findings for both the initial and recurrent tumors were compatible with those of the ordinary type of this tumor and not with those of neurotropic melanoma or cellular schwannoma. The recurrent tumor presented progression compared to the low grade malignancy in the original tumor. Perhaps because of the superficial location of the tumor our patient showed an unexpected favorable outcome in spite of repeated recurrences. Reports indicate that, of the superficial forms, the ordinary type is still less frequently encountered than the epithelioid type. We also discuss the differentiation between MPNST of the skin and neurotropic melanoma.

Female↗

PubMed1996

Primary cutaneous T-cell lymphoma with an angiocentric growth pattern: association with Epstein-Barr virus.

We report a case of primary cutaneous T-cell lymphoma with an angiocentric growth pattern. The lesions had been confined for about 2.5 years to the skin, but there had been a gradual progression of the disease both clinically and histologically. We assessed the neoplastic clonality and the presence of Epstein-Barr (EB) virus genome in this case using immunohistochemistry, Southern blot analysis and RNA in situ hybridization. Clonal proliferation of a CD4+ alpha beta T-cell phenotype was demonstrated. In addition, the clonal population harboured the EB virus genome, which suggested that the virus was involved in the pathogenesis of the disease. The patient has remained in remission for 10 months, and has received treatment with cyclophosphamide and prednisone.

Adult↗

PubMed1995

Erythematous papules in a patient with cardiac myxoma: a case report and review of the literature.

A 35-year-old woman was followed up by a physician for one and a half years as a case of transient ischemic attach (TIA) due to thrombosis. She had a few erythematous papules on the dorsal side of her right forearm and on the right side of her neck. From the history of TIA and the transient erythematous papules, we suggested the possibility of cardiac myxoma. Echocardiogram demonstrated a large mass in her left atrium. An immediate operation was carried out, and the cardiac myxoma was excised surgically. Histological examination of the erythematous papule revealed myxoma emboli.

Adult↗

PubMed1995

Necrotizing fasciitis in association with hyperimmunoglobulin E syndrome.

A case of necrotizing fasciitis in association with hyperimmunoglobulin E (HIE) syndrome is reported. The patient was a 17-year-old Japanese boy with a clinical history of recurrent skin and pulmonary infections and eczematoid dermatitis, markedly elevated serum levels of IgE, and coarse facies. He had a gangrenous swelling on the lower abdominal wall, and his general condition was poor with high fever. The involved site was accompanied by subcutaneous gas; the culture of the pus of the lesion grew anaerobes without mixed growth of Staphylococcus aureus. Exhaustive debridement of necrotic fascia, which extended much farther than the gangrenous area, and administration of antibiotics had a curative effect on the gangrenous soft tissue infection. To the best of the authors' knowledge, this is the first published case of necrotizing fasciitis in association with HIE syndrome.

Adolescent↗

PubMed1995

A single lesion demonstrating features of eccrine poroma and poroid hidradenoma.

A case of a single poroma lesion with the features of eccrine poroma and poroid hidradenoma is reported. The patient was a 61-year-old woman with a soft nodule, light brown in color, located on the posterior aspect of the right knee and containing a pigmented papular lesion in its center. The histological features of the papular lesion and the nodule were consistent with those of eccrine poroma and poroid hidradenoma, respectively. The eccrine poroma portion consisted mostly of poroid cells. The number of cuticular cells was slightly greater than that of poroid cells in the poroid hidradenoma portion. The cuticular cells in this portion as well as the poroid cells in both portions were immunohistochemically positive for epithelial membrane antigen. The findings in this case suggest that there is a close relationship between eccrine poroma and poroid hidradenoma and support the view that poroid hidradenoma is a type of poroma.

Acrospiroma↗

PubMed1994

Association of nevus sebaceus with an unusual type of "combined nevus".

A case of nevus sebaceus with development of a basal cell epithelioma is described. This case of nevus sebaceus was characterized by an association with extensive nevoid growths of melanocytes in the same lesion. The nevoid growths of melanocytes showed features of an unusual "combined nevus", representing a combination of speckled lentiginous nevus with blue nevi. We discuss the relationship between nevus sebaceus and nevoid growths of melanocytes.

Adult↗

PubMed1993

Trichilemmal carcinoma occurring in a lesion of solar keratosis.

A case of trichilemmal carcinoma occurring in a lesion of solar keratosis was reported. A 92-year-old woman had an erythematous plaque on her face that contained a reddish nodule. Histological examination of the nodule revealed typical features of trichilemmal carcinoma accompanied by those of solar keratosis in the marginal zone. The histological features of the erythematous plaque corresponded with those of solar keratosis. However, in situ the carcinoma developed in the epithelium of a hair follicle as well as in the interfollicular epidermis in the lesion of solar keratosis. We considered it likely that bowenoid malignant transformation occurred in both interadnexal and adnexal epithelium because of actinic damage, and a trichilemmal carcinoma arose. The paper also discussed the histogenesis of trichilemmal carcinoma.

Aged↗

PubMed1993

A combination of speckled lentiginous nevus with patch-type blue nevus.

A peculiar case of "nevus on nevus" was reported. A 67-year-old man had had a pigmented lesion in the left hypochondrial area since birth. The clinicopathologic findings of the pigmented lesion revealed a combination of speckled lentiginous nevus and patch-type blue nevus. This case of "nevus on nevus" is not described under the term of combined nevus as is current in the literature; it was considered to be a subtype of the type II atypical blue nevus described by Kawamura.

Aged↗

PubMed1993

Occurrence of paroxysmal synchronous EEG discharges in subcortical arteriosclerotic encephalopathy (Binswanger's disease).

A 72-year-old patient with von Recklinghausen's disease showed akinetic mutism within 6 months of the onset of dementia. The findings of diffuse cerebral atrophy on CT and periodic synchronous discharges (PSDs) in EEG suggested Creutzfeldt-Jakob disease. However, autopsy findings of diffuse softening of the subcortical white matter and marked arteriosclerotic changes of the subcortical arterioles with sparing of the cortex in the cerebrum confirmed a diagnosis of Binswanger's disease. Binswanger's disease should be included in the differential diagnosis of dementia showing PSDs in EEG.

Aged↗

PubMed1992

A unique case of extramammary Paget's disease. Derivation from eccrine porocarcinoma?

A unique case of extramammary Paget's disease is reported that may have derived from eccrine porocarcinoma. A palm-sized erythematous plaque on the patient's pubis spread to the lower abdominal wall. The center of the lesion contained a reddish tumor. Histologic findings of the erythematous plaque showed features of extra-mammary Paget's disease. Those of the reddish tumor, however, corresponded most closely to eccrine porocarcinoma, though we could not entirely rule out that the changes corresponded to larger nests of less differentiated Paget cells. The two distinct neoplastic areas showed continuity both clinically and histologically; our case differed from epidermotropic eccrine porocarcinoma in several clinicopathologic respects. Our case suggests the possibility that extramammary Paget's disease could arise from preexisting porocarcinoma.

Adenoma, Sweat Gland↗

PubMed1991

Unilateral dysplastic nevi associated with malignant melanoma.

A case of dysplastic nevi associated with malignant melanoma was reported. The case was characterized by unilateral distribution of dysplastic nevi. Multiple dysplastic nevi were observed only dorsally on the patient's left upper quadrant. To the best of our knowledge, the report of this form of dysplastic nevi is the first in Japan. In addition, dysplastic nevus cell nests were present in histologic contiguity with intraepidermal proliferation of melanoma in the radial growth phase. Histological evidence suggested that the melanoma in our case had probably been derived from the context of dysplastic nevus.

Adult↗

PubMed1990

[Treatment of adult T-cell leukemia with intravenous administration of IFN-gamma-immunohistochemical studies of infiltrating cells in cutaneous lesions].

Three cases of adult T-cell leukemia (ATL) with cutaneous lesions of disseminated papules or nodules were treated with recombinant human interferon-gamma (IFN-gamma) by intravenous administration. Clinical stage of each case was different, i.e., 1) preleukemic state of ATL (pre-ATL), 2) chronic-type ATL, and 3) crisis-type ATL. We evaluated clinical efficacy of IFN-gamma, and performed immunohistochemical analysis of biopsy specimens derived from cutaneous lesions of the patients both before and during treatment. The case of pre-ATL achieved a complete remission of cutaneous lesions for 18 months. The other cases also obtained clinical responses with a shorter duration, but relapsed while they are still on IFN-gamma therapy. The cutaneous lesions reduced in size during the therapy associated with a decrease in the ratio of Leu3a + 3b (CD4)+ cells in all three cases. After the therapy, Leu7 (HNK-1)+ cells increased in all cases, and LeuM5 (CD11)+ cells did in two. These results suggested that IFN-gamma enhanced tumor immunity although its clinical effect was less clear. Only in the cutaneous lesions of pre-ATL case an increased number of LeuM5+ cells, probably monocyte-macrophage series in host defence, were seen before the therapy. And IFN-gamma was useful for this case after all.

Female↗