A case of lumbosacral infantile hemangioma with spinal anomaly

( Chihyeon Sohng ),( Jun Hong Park ),( Dong Hyuk Eun ),( Jun Young Kim ),( Yong Hyun Jang ),( Weon Ju Lee ),( Seok-jong Lee ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Infantile hemangioma can accompany complications such as ulcers, obstructions, visual impairment, disfigurement and various associated malformations. It is important to note that infantile hemangioma, developed on midline lumbosacral area, can be accompanied with diverse organ anomalies previously reported as LUMBAR, PELVIS, SACRAL syndrome in literature. A 2-month-old girl presented with hemangiomas with skin dimple on lower mid back and left ankle since birth. MRI showed dermal sinus tract between intraspinal and dermal vascular tumor with spina bifida occulta on T11-12 spine level. The patient was treated with oral propranolol and clinical improvement was observed. Consultation about further work up and management for the intraspinal hemangioma and associated anomalies is on processing with a department of neurosurgery. Midline lumbosacral infantile hemangiomas with concomitant skin defects are strongly suggestive of spinal anomalies. In those cases, appropriate screening image studies, such as ultrasound or MRI, and referral to neurosurgical specialist should be undergone, and it can prevent irreversible neurologic damages from either spinal hemangioma or spinal anomaly. Herein, we report an educational case to highlight necessity of an appropriate diagnostic imaging work up for lumbosacral hemangiomas with suspicious of spinal anomaly.

Low but continuous occurrence of microsporum gypseum infection in 198 cases, from 1979 to 2016

( Chihyeon Sohng ),( Jun Hong Park ),( Jun Young Kim ),( Yong Hyun Jang ),( Seok-jong Lee ),( Do Won Kim ),( Yong Jun Bang ),( Jae Bok Jun ),( Weon Ju Lee ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.2

Background: Microsporum (M.) gypseum was isolated from South Korea in 1966, but the incidence of M. gypseum infection is very low. Objectives: The study aimed at contributing additional data pertaining to M. gypseum to the literature, thereby providing useful information on its clinical and mycological characteristics. Methods: We retrospectively analyzed the data of 198 patients infected with M. gypseum from 1979 to 2016. M. gypseum was identified through mycological examination using a 15% potassium hydroxide preparation and potato corn meal tween 80 agar culture media. Results: The incidence of M. gypseum infection shows a slightly decreasing tendency. Out of 198 cases, there were 94 men (47%) and 104 women (53%). The overall mean age was 29.8 years (males, 25.0 years; females, 34.2 years). M. gypseum infection occurred most frequently in August (16%) and September (16%). The most common clinical type of M. gypseum infection was tinea corporis (38%). Conclusion: M. gypseum infections showed very low incidence, but persistently occurred with a slightly decreasing tendency until recent years. We should be mindful of the characteristics of M. gypseum.

A Calculating Method for Nail Growth Using CO₂ Laser Drilling and Dermoscopy

( Chihyeon Sohng ),( Jun Young Kim ) 대한피부과학회 2021 Annals of Dermatology Vol.33 No.5

The impact of hutchinson's nail sign on T-stage in subungual melanoma

( Chihyeon Sohng ),( Jun Hong Park ),( Man Hoon Han ),( Yong Hyun Jang ),( Weon Ju Lee ),( Seok-jong Lee ),( Jun Young Kim ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Hutchinson's nail sign (HS) is an important clinical clue to diagnose subungual melanoma (SUM). However, there are rare studies about other clinical importance of HS in SUM. Objectives: This study is to investigate the relationship between HS and clinicopathological features of SUM. Methods: A retrospective study was conducted with 61 SUM patients from 2006 to 2017. We reviewed medical records and photographs of the patients. Results: HS was seen in 46 (75.4%) of 61 SUM. The patients with HS showed ulceration more frequently (45.7%) and received sentinel lymph node biopsy (SLNB) more often (58.7%) than those without HS (13.3%, 26.7%). This tendency was also shown when HS exists on lateral nail folds (66.7% vs. 30.6% for ulceration, 83.3% vs. 42.9% for SLNB). The patients with HS on proximal nail fold or hyponychium showed nail changes more commonly (87.5%, 90.3%) than those without HS on those sites (62.1%, 60.0%). The patients with HS on 3 or 4 nail folds around the nail showed more frequent ulceration (66.7% vs. 30.6%), thicker Breslow thickness (2.52±3.03 mm vs. 1.46±2.80 mm), higher T-stage (≥2b, 66.7% vs. 30.6%) and higher stage (≥IIA, 66.7% vs. 30.6%) than those with HS on less than 3 nail folds around the nail. Conclusion: HS correlated with some clinicopathological features of SUM. Especially, when the HS exists on 3 or 4 nail folds around the nail, we should consider that T-stage of SUM might be higher than expected.

Clinical usefulness of infrared thermal imaging as a non-invasive screening test for diagnosis of vascular malformations

( Chihyeon Sohng ),( Jun Hong Park ),( Won Kee Lee ),( Jun Young Kim ),( Yong Hyun Jang ),( Weon Ju Lee ),( Seok-jong Lee ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Infrared thermal imaging (ITI), aka thermography, has been used widely in medicine, but been studied rarely its clinical application in vascular malformations (VMs). Objectives: This study investigated validity and usefulness of ITI as a new screening test to differentiate between capillary malformation (CM) and arteriovenous malformation (AVM). Methods: This study included 50 patients with VMs who conducted ITI between 2011 and 2018. They were divided into two groups; CM and AVM, and those with Parkes-Weber syndrome (PWS) were also included in AVM group. Temperature difference (ΔT) between lesional and contralateral non-lesional area was compared using ITI to calculate the maximum ΔT (ΔTmax). The receiver operating characteristic (ROC) curve was then plotted to determine optimal cutoff value of ΔTmax. Results: Of the total 50 patients, 34 were finally diagnosed with CM, and 16 AVM (12 pure AVM, and 4 PWS). AVM group had significantly higher ΔTmax (2.57±1.23°C) than CM group (0.69±0.50°C).The area under the curve of ΔTmax for diagnosis of AVM versus CM was 0.938. The sensitivity and specificity were showed 87.5% and 94.1% (LR+, 14.87; LR-, 0.13) in cutoff value of ΔTmax 1.39°C, and 81.3% and 97.1% (LR+, 27.62; LR-, 0.19) in cutoff value of ΔTmax 1.42°C. Conclusion: The value of ΔTmax measured by ITI was useful to distinguish AVM from CM, so ITI can be employed as a new non-invasive differential screening test for uncertain VMs.

Three cases of arteriovenous malformation misdiagnosed and erroneously treated as portwine stain

( Chihyeon Sohng ),( Jun Hong Park ),( Dong Hyuk Eun ),( Jun Young Kim ),( Yong Hyun Jang ),( Weon Ju Lee ),( Seok-jong Lee ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

The clinical presentation of arteriovenous malformation (AVM) can be diverse such as red macule and bluish mass in initial developmental stage (stage 1~2). So it may mimic Portwine stain (PWS) and correct differential diagnosis is very important because of different treatment strategy. The patient 1, 3-year-old female, has presented with reticulated pinkish red patches with mild hypertrophy of right foot dorsum and sole since birth. The patient 2, 21-year-old female, has presented with erythematous patch with black papules on left lateral neck since birth and newly appeared dusky reddish black macules. The patient 3 was 26-year-old female, presented with purplish slightly thickened patches studded with walnut-sized nodule on left lateral face, neck and parietal scalp. All three patients were primarily diagnosed as PWS and treated with laser therapy several times at dermatologist’s clinics and hospitals. Unfortunately their lesions had no improvements and even underwent aggravation. The patients' final diagnosis was confirmed as AVM by doppler ultrasound with or without CT angiography, finally in KNUH vascular anomalies clinic. The AVM of early stage is often challenging to differentiate from PWS, however, it is important for dermatologists to try earlier correct diagnostic procedures and consequently its appropriate management. We, herein, report three cases of AVM misdiagnosed and erroneously treated as PWS.

Steatocystoma multiplex appeared as large multiple cysts

( Chihyeon Sohng ),( Jun Hong Park ),( Dong Hyuk Eun ),( Jun Young Kim ),( Yong Hyun Jang ),( Seok-jong Lee ),( Weon Ju Lee ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Steatocystoma multiplex (SM) is a rare genetic disorder with an autosomal dominant pattern of inheritance. A number of literatures have been reporting the SM pedigree with missense mutation in the keratin 17 (KRT17) gene. SM is characterized by multiple asymptomatic matchhead-sized cysts with yellowish creamy fluid on axillae, chest and arms. A 50-year-old woman presented with numerous asymptomatic small bean to child palm-sized cysts on whole body for more than 40 years. Her father and son also had similar history of multiple small cysts. She was undergone surgery in a pinching-out technique with small incisions and forceps. In histopathological study, the cysts were lined by stratified squamous epithelium without granular layer and had adjacent sebaceous lobules. The result of immunohistochemical examination with cytokeratin 17 antibody was positive on the cystic walls and sebaceous glands. After the histopathological confirmation, we carried out mutation analysis of KRT17 gene using direct sequencing and found new point mutation in the exon 1 of KRT 17 gene (c. 425G>T). This patient was treated with surgical procedure and got a good cosmetic result. We here report a case of huge steatocystoma multiplex with new point mutation in the exon 1 of KRT 17 gene.

A case of deeply-invading spindle cell squamous cell carcinoma confirmed by expression of cytokeratin and smooth muscle actin

( Chihyeon Sohng ),( Eun Hye Lee ),( Yong Hyun Jang ),( Weon Ju Lee ),( Seok-jong Lee ),( Jun Young Kim ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Cutaneous spindle cell squamous cell carcinoma (SpSCC) is a rare variant of SCC showing spindle cell differentiation and often deep invasion into the subcutis or fascia. An 83-year-old female presented with 2.7x2.0 cm sized skin colored nodule with central ulceration on right preauricular cheek for 4 months. A punch biopsy was performed and histopathological examination revealed features of actinic keratosis in epidermis and pandermal proliferation of atypical spindle cells with epidermal connection. Immunohistochemical stains showed that the tumor cells are positive for mesenchymal markers such as vimentin and smooth muscle actin which may need differential diagnosis with other spindle cell neoplasms. However, cytokeratin was also diffusely positive on tumor cells and she was finally diagnosed with SpSCC. Subsequent USG examination for head and neck lymph node showed normal results. Wide excision with an inferior margin of superficial muscular aponeurotic system and a reconstruction of the defect with full-thickness skin graft were performed. But an invasion of tumor cells into inferior margin was noted and adjuvant radiotherapy is on processing. Because this unusual tumor showed high risk factors of SCC such as size>2 cm, depth>4mm and fascial invasion, aggressive treatment and careful follow-up will be needed. But whether cutaneous SpSCC has poorer prognosis than conventional SCC is controversial.

A case of basal cell carcinoma developed from an epidermal cyst

( Chihyeon Sohng ),( Jun Hong Park ),( Jun Young Kim ),( Yong Hyun Jang ),( Weon Ju Lee ),( Seok-jong Lee ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Basal cell carcinoma (BCC) is a tumor arising from pluripotent stem cells in epidermal basal layer or pilosebaceous structures, but it rarely has been introduced to be associated with epidermal cyst (EC). Here in, we report an unusual case of BCC arising from EC. A 36-year-old man presented to our department and he stated that a skin-colored small warty papule was developed on his left medial cheek about 4 years ago. It had been partially excised by laser ablation in local medical center and was diagnosed with BCC. But, at the time of visiting, there were no further clinical clues to suspect BCC and only a bean-sized subcutaneous mass with an overlying depressed scar and minute pore was observed. Surgical removal was performed and, as expected, only a cystic mass was observed during exploration. Pathologic exam revealed a symmetric and well demarcated dermal cyst containing keratinous material. The cyst wall, surprisingly, was lined by basaloid tumor cells with peripheral palisading pattern and focal nodular and micronodular aggregation of tumor nests. The tumor was diagnosed with BCC occurring in EC and additional wide excision revealed no residual tumor. Both BCC and EC can originate from infundibular portion of hair follicle, and it may explain the association of them. But it is hard to be clinically recognized as a malignant tumor, so we emphasize the importance of histologic examination for the correct diagnosis of common cysts.

척수 기형과 피부굴이 동반된 요골부 유아혈관종(SACRAL 증후군) 1례

송치현 ( Chihyeon Sohng ),김준영 ( Jun Young Kim ),이석종 ( Seok-jong Lee ) 대한피부과학회 2019 大韓皮膚科學會誌 Vol.57 No.4

Infantile hemangioma (IH) usually presents solely as a cutaneous manifestation, and rarely accompanies diverse anomalies such as spinal dysraphism. A 2-month-old girl presented with IH on her lumbar skin as a coin-sized red plaque with adjacent depressed skin and a child-palm-sized red plaque on her left ankle since birth. Considering the coexistence of IH and depressed skin on the midline in her lumbosacral area, magnetic resonance imaging of her spine was performed, which showed intraspinal/dermal vascular tumors with spina bifida occulta at the 12th thoracic vertebrae level. Furthermore, no neurologic deficits were observed. She has been taking oral propranolol with topical timolol to prevent neural complications and the lesions clinically improved. However, additional surgery for the intraspinal lesions was considered due to urination/defecation abnormalities since she was 13 months of age. In cases of midline IH, particularly with additional skin lesions, appropriate imaging studies to identify accompanying anomalies should be performed, and referrals to neurosurgical specialists should be considered. (Korean J Dermatol 2019;57(4):197∼200)