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A case of paraneoplastic pemphigus associated with a malignant thymoma
( Jimyung Seo ),( Jae Won Lee ),( Dongyun Shin ),( Soo Chan Kim ),( Do Young Kim ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1
A 56-year-old female visited our dermatology clinic with a two-month history of persistent painful oral mucositis and erythematous to violaceous papules and plaques without blisters over her trunk and limbs. The patient had been treated with multiple drugs including high-dose oral corticosteroid and ciclosproin under the clinical impression of a generalized lichen planus; however the disease remained inadequately controlled for four months. Paraneoplastic pemphigus (PNP) was considered due to therapy-refractory erosive mucosal lesions, weight loss, and recent hemoptysis. Two biopsies of the skin and oral mucosa revealed interface dermatitis with a thick lichenoid inflammatory infiltrate. Direct immunofluorescence on skin lesion revealed intraepidermal, intercellular IgG staining. Circulating antibodies against desmogleins 1 and 3 were negative in ELISA analysis. Serum indirect immunofluorescence using rat bladder as a substrate was positive for intraepithelial binding. Subsequently computed tomography of the thorax revealed an invasive mediastinal mass and the final diagnosis of PNP associated with malignant thymoma was made. PNP is a debilitating chronic blistering mucocutaneous disease associated with an underlying neoplasm and a poor prognosis. When treatment-recalcitrant erosive mucosal lesions persist, even in patients without known malignancy, PNP should be ruled out.
Mixed Merkel cell carcinoma and squamous cell carcinoma of the skin
( Jimyung Seo ),( Jihee Kim ),( Kyoung Ae Nam ),( Byung Ho Oh ),( Kee Yang Chung ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1
Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous malignancy that has a predilection for locoregional recurrence and distal metastasis. We summarize the cases of two patients with an initial diagnosis of squamous cell carcinoma (SCC), which were subsequently found to have mixed MCC and SCC of the skin after surgical excision. Each tumor located on the lower abdomen and both patients were elderly persons without any known risk factors. Wide local excision and slow Mohs micrographic surgery (slow MMS) with a clear resection margin were performed to complete removal of the tumor, respectively. However, local recurrence with distal lymph node metastasis was observed in one out of the two cases during the follow-up period, which caused the death of the patient. MCC is an aggressive skin cancer. Pathologic lymph node evaluation and adjuvant therapy can be needed if the MCC is large and the lesion is not confined to the dermis. Because early diagnosis and aggressive treatment are important in managing the tumor, physicians should consider that MCC could be included in the differential diagnosis of nodular lesions in SCC.
Cutaneous ulceration after injection of interferon alpha in a melanoma patient
( Jimyung Seo ),( Jihee Kim ),( Kyoung Ae Nam ),( Byung Ho Oh ),( Kee Yang Chung ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1
A 47-year-old male with high-risk cutaneous melanoma diagnosed in 2013 was treated with the high dose interferon-alpha regimen (20 MU/m2) after radical resection of the primary melanoma. Interferon alfa-2b was subcutaneously injected. Three months later, a painful, erythematous, indurated plaque initially developed at the site of injection on his lower abdomen. Results of skin cultures were negative. Examination of a skin biopsy specimen showed epidermal necrosis and acute inflammatory cell infiltrates in the dermis and subcutaneous tissue, consistent with nonspecific ulceration. Ulcer treatment included local wound care measures, surgical debridement, and change of injection site. The ulcer completely healed in two months. This patient represents a rarely reported case of cutaneous ulcer caused by interferon alpha. Increased awareness of the possibility of cutaneous necrosis after interferon therapy is necessary for early diagnosis to prevent continuation of skin ulcers.
Eccrine adenocarcinoma treated by Mohs micrographic surgery
( Jimyung Seo ),( Minseok Lee ),( Shinwon Hwang ),( Jun Young Kim ),( Jihee Kim ),( Kyoung Ae Nam ),( Kee Yang Chung ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1
Primary eccrine adenocarcinoma is a rare malignant cutaneous adnexal tumor most commonly arising in the head and neck. Eccrine adenocarcinoma does not have diagnostic clinical features, and histologic recognition becomes important to consolidate the diagnosis of this tumor. Due to the small number of reported cases in the literature, optimal treatment modality has yet to be established. Earlier, surgical resection with wide local excision was performed for most of the cases. Mohs micrographic surgery (MMS), which becomes popular for treating infiltrative skin cancers, can be suggested as another treatment option for this rare malignant tumor of the skin. We have experienced five patients (M = 4; F = 1) with primary eccrine adenocarcinoma of the skin. Four patients had facial lesions and one had the tumor on the interdigital finger web space. Mean patient age was 50.4 ± 14.6 years (range, 29-70 years). Whole-body positron emission tomography revealed no other visceral neoplasm. Sentinel lymph node biopsy or lymph node dissection was performed if clinically indicated. All five patients were treated by MMS using frozen sections. Local recurrence occurred in one patient who were referred to our clinic and underwent MMS after initial recurrence. The remaining four patients showed no recurrence and metastases of the tumor during the follow-up period.
Rare sarcomas of the skin: a case series
( Jimyung Seo ),( Yeongjoo Oh ),( Jihee Kim ),( Jun Young Kim ),( Zhenlong Zheng ),( Kyoung Ae Nam ),( Kee Yang Chung ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1
All sarcomas of deep soft tissues may also arise in superficial locations and there can be important clinicopathologic differences. Recently, we have experienced some kinds of these rare malignancies occurring in the skin. We report herein the four cases of different sarcomas having a primary cutaneous location: Ewing sarcoma, histiocytic sarcoma, myxofibrosarcoma, and liposarcoma. Extensive metastatic work-up, including a total body computed tomographic and positron emission scan (PET/CT scan), showed the neoplasm to be a primary sarcoma of the skin. All four patients presented with negative sentinel lymph node biopsy specimen and were treated by Mohs micrographic surgery (MMS) using paraffin-embedded sections, i.e. slow Mohs. We hope that our experience will broaden dermatologists’ understanding of these rare sarcomas arising from the skin.
FCP 12 : The role of bone scintigraphy in Behcet`s disease from the view of the dermatologist
( Jimyung Seo ),( Zhenlong Zheng ),( Dongsik Bang ),( Do Young Kim ) 대한피부과학회 2014 대한피부과학회 학술발표대회집 Vol.66 No.2
Background: Behcet’s disease(BD) is a multisystemic inflammatory disease with articular involvement(9%-70% in previous reports). However, non-specific arthralgia is also common in BD patients, and the exact diagnosis of joint involvement is often challenging especially for non- rhuematologists. Objectives: To evaluate the usefulness of 99mTc- methylenediphosphonate(Tc-99m-MDP) bone scintigraphy from the viewpoint of the dermatologist Methods: A total of 211 patients were analyzed. Agreement between bone scintigraphy findings and clinical symptoms was assessed with the Cohen’s kappa statistic. At the same time, 104 patients who showed the accordance between imaging studies and clinical symptoms were re-evaluated by rheumatologists. Results: The total kappa value of 211 cases was 0.604, and the agreement on clinical symptom and scintigraphy image was fair. Individual analysis of the 11 categorized jointsshowed that there were statistically significant correlations in wrist(κ = 0.677), shoulder(κ = 0.661), and foot joints(κ = 0.618). Of the 104 cases referred to the rheumatologist, 95 cases(91.34%) were confirmed as articular involvements of BD. The joint involvement of 9 cases diagnosed as other disorders was noticed in hip, spine and knee joints, all of which were the joints showing low correlation of kappa value. Conclusion: Bone scintigraphy can be a simple and useful option to determine the joint involvement of BD for the dermatologist, especially in certain anatomical sites.
( Jimyung Park ),( Yeon Joo Lee ),( Jinwoo Lee ),( Sung Soo Park ),( Young-jae Cho ),( Sang-min Lee ),( Young Whan Kim ),( Sung Koo Han ),( Chul-gyu Yoo ) 대한내과학회 2018 The Korean Journal of Internal Medicine Vol.33 No.3
Background/Aims: Diffuse alveolar damage (DAD) is the histopathologic hallmark of acute respiratory distress syndrome (ARDS). However, there are several non-DAD conditions mimicking ARDS. The purpose of this study was to investigate the histopathologic heterogeneity of ARDS revealed by surgical lung biopsy and its clinical relevance. Methods: We retrospectively analyzed 84 patients with ARDS who met the criteria of the Berlin definition and underwent surgical lung biopsy between January 2004 and December 2013 in three academic hospitals in Korea. We evaluated their histopathologic findings and compared the clinical outcomes. Additionally, the impact of surgical lung biopsy on therapeutic alterations was examined. Results: The histopathologic findings were highly heterogeneous. Of 84 patients undergoing surgical lung biopsy, DAD was observed in 31 patients (36.9%), while 53 patients (63.1%) did not have DAD. Among the non-DAD patients, diffuse interstitial lung diseases and infections were the most frequent histopathologic findings in 19 and 17 patients, respectively. Although the mortality rate was slightly higher in DAD (71.0%) than in non-DAD (62.3%), the difference was not significant. Overall, the biopsy results led to treatment alterations in 40 patients (47.6%). Patients with non-DAD were more likely to change the treatment than those with DAD (58.5% vs. 29.0%), but there were no significant improvements regarding the mortality rate. Conclusions: The histopathologic findings of ARDS were highly heterogeneous and classic DAD was observed in one third of the patients who underwent surgical lung biopsy. Although therapeutic alterations were more common in patients with non-DAD-ARDS, there were no significant improvements in the mortality rate.
( Jimyung Park ),( Hyung Jun Kim ),( Jee Min Kim ),( Young Sik Park ) 대한결핵 및 호흡기학회 2015 Tuberculosis and Respiratory Diseases Vol.78 No.4
Pulmonary arteriovenous malformations (AVMs) are caused by abnormal vascular communications between the pulmonary arteries and pulmonary veins, which lead to the blood bypassing the normal pulmonary capillary beds. Pulmonary AVMs result in right-to-left shunts, resulting in hypoxemia, cyanosis, and dyspnea. Clinical signs and symptoms vary depending on the size, number, and flow of the AVMs. Transcatheter embolization is the treatment of choice for pulmonary AVMs. However, this method can fail if the AVM is large or has multiple complex feeding arteries. Surgical resection is necessary in those kind of cases. Here, we report the case of a patient with a 6-cm pulmonary AVM with multiple feeding arteries that was successfully treated by repeated coil embolization without surgery.