A case of coexistence of extramammary Paget`s disease and condyloma acuminatum

( Byoung Yong Koh ),( Eun Sun Kwon ),( Kyung Geun Lee ),( Ki Bum Myung ),( Seung Hyun Cheong ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Extramammary Paget’s disease (EMPD) is a rare cutaneous neoplastic condition, which usually affect apocrine gland-bearing skin. The most frequently affected site is vulva, followed by perineal, perianal, scrotal and penile skin regions of older individuals. Condyloma acuminatum (CA) is a human papilloma virus (HPV) associated benign neoplasm, involving mostly anogenital area. To our knowledge, there have been a few reports about simultaneous occurrence of EMPD and other epidermal proliferative diseases so far. A 84-year-old man presented with over 10-year history of erythematous crusted oozing patch on penile shaft and scrotal area and multiple verrucous surfaced papules on right side of scrotal area. Skin biopsy specimens were taken from the two other sites respectively. Microscopic finding from erythematous patch showed Paget cells containing large pleomorphic nuclei with abundant pale cytoplasm in the basal layer of the epidermis. Immunohistochemically, cytokeratin 7 expressions were confined to the cytoplasm of the Paget’s cells. Histological finding from verrucous papule showed focal parakeratosis, marked acanthosis, and slight papilomatosis. On closer examination, koilocytes with irregular nuclei and vacuolated cytoplasm were conspicuous in the epidermis. We report a rare case of coexistence of extramammary Paget’s disease and condyloma acuminatum on scrotal area.

A case of systematized nevus sebaceus

( Byoung Yong Koh ),( Eun Sun Kwon ),( Kyung Geun Lee ),( Ki Bum Myung ),( Seung Hyun Cheong ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Nevus sebaceous is a common benign and harmatomatous lesions presenting as verrucous, hairless, and yellow-orange plaque from birth or within the first years of life. Rarely, congenital nevus sebaceous is associated with other abnormalities. In this case, involvement tends to be linear or wide distribution. Most of such cases are classified as sebaceous nevus syndrome which presents with a triad of nevus sebaceous, seizures, and mental retardation. In addition, opthalmological, skeletal, and other symptoms may appear. A male weighing 3, 580g was born at 38 weeks gestational age after a normal pregnancy. He was referred to the dermatologic department on the first day of life. He presented with yellow-orange, verrucous, and hairless plaques on both sides of the temporal areas, face, neck, upper and lower extremities, and trunk. Skin biopsy specimens were taken from the scalp and right lower leg. Histologically, both specimens showed sebaceous gland hyperplasia, absence of mature hair follicle, infundibular cystic structures, and apocrine glands. To check up possible co-morbidities, brain magnetic resonance imaging, transthoracic echocardiography, abdomen ultrasonography, and routine laboratory investigations were done and those showed nonspecific findings. During 10 days of hospitalization, he did not show seizure and he is now on closed observation. We herein report a very rare case of systemitized nevus sebaceous presenting at birth.

[P057] A case of atypical fibroxanthoma

( Byoung Yong Koh ),( Won Choi ),( Kyoung Geun Lee ),( Ki Bum Myung ),( Seung Hyun Cheong ),( Hyung Jin Hahn ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Atypical fibroxanthoma is uncommon, pleomorphic, and spindle cell cutaneous neoplasm. Clinically, it presents commonly as a solitary red or pink papule or nodule on the head or neck. Exposure to ultraviolet light most likely contributes to the development of it. A 74-year old man presented with about 1.0 x 1.0 cm sized, skin-colored, and intracutaneous nodule on the left elbow with the onset of several years. Skin excisional biopsy was perfomed. Histologically, it revealed well-circumscribed and nonencapsulated highly cellular dermal tumor consisting of proliferation of bizarre spindle cells, epitheloid cells, and multinucleated giants cells. The spindle cells showed pleomorphic and hyperchromatic nucleus and frequent atypical mitoses. CD68 and CD10 stains were positive in spindle cells but CD34, desmin, smooth muscle actin, and S-100 protain were negative. Herein we report a rare case of atypical fibroxanthoma.

Two cases of generalized herpes simplex infection

( Byoung Yong Koh ),( Eun Sun Kwon ),( Kyung Geun Lee ),( Ki Bum Myung ),( Seung Hyun Cheong ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Herpes simplex virus (HSV) is a common human pathogen, causing orofacial and genital infections. Generalized HSV infections have been described in pregnant women, neonates, and with a patient with immunosuppression. These infections usually are a reactivation of a previous HSV infection, characterized by lager size of lesions, deeper ulceration, satellite lesions, longer healing time, and atypical locations. These atypical skin lesions can resemble autoimmune blistering disorders such as bullous pemphigoid. A 73-year old man and a 84-year woman were on ICU care with ventilator for management of pneumonia. Both patients presented with acute onset of multiple tense blisters on erythematous bases on trunk. Histologically, specimens of both patients showed intraepidermal blister, ballooned acantholytic keratinocytes with intranuclear eosinophlic inclusion bodies, and multinucleated keratinocytes. Immunohistochemical stain for HSV-1 antibody was positive for the man. Direct immunofluorescence (DIF) showed no evidence of autoimmune blistering disorders. Herein, we report two cases of atypical manifestation of HSV infection, generalized HSV infection in immucompromised patient on ICU care.

Verrucous carcinoma clinically simulating giant fibroepithelial polyp

( Byoung Yong Koh ),( Eun Sun Kwon ),( Seung Hyun Cheong ),( Ki Bum Myung ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Verrucous carcinoma is rare variant of well-differentiated, low grade squamous cell carcinoma. It shows slow-growth, low metastatic potential but local aggressiveness. It is divided into oral, anogenital, plantar and other cutaneous types. In cases of anogenital lesions, exophytic aspect is more pronounced and tumors often appear to arise from pre-existing condyloma acuminatum. A 91-year-old female patient presented with over 20 years of history of pedunculated mass measuring 3.5 x 3.0 x 1.5cm with a cauliflower-like appearance like giant fibroepithelial polyp on right labium majora. Histologic finding showed endo-exophytic growth pattern, hyperkeratosis, acanthosis. The exophytic projections showed blunt border and pushed-down appearance with well-differentiated squamous epithelial cells, forming keratin-filled cysts. Inflammatory cells infiltrated the surrounding stroma. On the basis of clinical and microscopic finding, the patient was diagnosed with verrucous carcinoma. Herein, we report a peculiar case verrucous carcinoma clinically simulating giant fibroepithelial polyp on anogenital area.

[P275] A case of atypical mycobacterial infection

( Byoung Yong Koh ),( Won Choi ),( Kyoung Geun Lee ),( Ki Bum Myung ),( Seung Hyun Cheong ),( Hyung Jin Hahn ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Atypical mycobacteria are abundant in soil and water. These skin infections may be acquired by direct inoculation into the skin or by hematogenous spread from a visceral focus. The clinical and pathological manifestations of the infections were variables. The skin lesions were often resembling panniculitis showing multiple subcutaneous nodules. A 77-year-old man presented with erythematous, infiltrated, and tendered nodules on scalp, forehead, both eyebrows, neck, and trunk. Duration of the lesions was over a month. He had a medical history of peripheral neuritis on taking oral corticosteroid and gabapentin. Two specimens were taken from the forehead and neck. Histologically, the specimen from nodular lesion on the forehead showed inflammatory infiltrates of lymphohistiocytes and large and voluminous macrophages. The specimen form nodular lesion on the neck revealed lymphohistiocytic infiltration and spindle cell transformation of macrophages forming a histoid-like lesions in the dermis. AFB stain was positive for numerous acid-fast bacilli in the dermis. Mycobacterial culture was done and it showed no growth for mycobacterium. He was successfully treated with oral clarithromycin 500mg twice a day for over four months. Here, we report a case of atypical mycobacterial infection.

Angiosarcoma, Xeroderma pigmentosum

( Byoung Yong Koh ),( Eun Sun Kwon ),( Seung Hyun Cheong ),( Ki Bum Myung ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Cutaneous amyloidosis is manifested as primary cutaneous amyloidosis without systemic involvement or as cutaneous form of primary systemic amyloidosis. Primary cutaneous amyloidosis is subdivided into macular, lichen and nodular type. Primary cutaneous nodular amyloidosis is the rarest form. In this form, the amyloid deposits are distributed entire dermis and derived from the immunoglobulin light chains from monoclonal expansion of localized plasma cells. Clinically, it shows solitary or multiple firm, waxy nodules or plaques on legs, face, trunk and genitalia in decreasing order. A 63-year-old woman presented with 7-year history of flesh colored waxy papules and plaques on left calf. She had no remarkable past medical history. Histologically, amorphous and pale eosinophilic amyloid deposits were infiltrated in the entire dermis. On closer examination, focal plasma cells infiltration around amyloid deposits was identified. Congo red staining was positive and exhibited characteristic apple-green birefringence under polarized light microscope. Additional study including blood chemistry, urinalysis and serum protein electrophoresis showed no systemic involvement. We report a case of primary cutaneous nodular amyloidosis, the rarest form of primary cutaneous amyloidosis.

[P348] A case of eccrine porocarcinoma

( Byoung Yong Koh ),( Won Choi ),( Kyoung Geun Lee ),( Ki Bum Myung ),( Seung Hyun Cheong ),( Hyung Jin Hahn ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Eccrine porocarcinoma is a rare malignant cutaneous appendageal neoplasm that originates from the intraepidermal eccrine sweat duct. It usually occurs on the pre-existing lesion of benign eccrine poroma. It has propensity to affect the elderly and females. A 57-year old man presented with about 2.0 x 2.0 cm sized verrucous and keratotic nodule with central crateriform ulceration on the left first web space. Histopathological examination revealed cribriform and infiltrating intraepidermal aggregations composed of polygonal or cuboidal malignant cells invading into the dermis. The cells demonstrated conspicuous nuclear atypia with occasional mitosis. Ductal structures are present within the tumor nests. Immunoreactivity for EMA showed positivity within the tumor cells. He was referred to the department of plastic surgery and underwent wide excision and coverage by full thickness skin graft. We report a case of eccrine porocarcinoma

Seborrheic keratosis like lichen planus-like keratosis

( Byoung Yong Koh ),( Eun Sun Kwon ),( Seung Hyun Cheong ),( Ki Bum Myung ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Lichen planus-like keratosis consists of non-pruritic solitary papule or slightly indurated plaque with smooth or verrucous surface. It has brown to erythematous color and occurs predominantly on sun-exposed trunk and upper extremities of adult between the 5th and the 7th decades. A 51-year-old woman presented with about 1 cm x 1 cm sized solitary slightly indurated and pigmented plaque on left forearm with onset of early adulthood. At first visit, our impression was seborrheic keratosis, because it showed sharply demarked brownish plaque with verrucus surface. For definitive diagnosis, skin punch biopsy was done and the epidermis showed focal parakeratosis, hyper granulosis and a few necrotic keratinocytes. Lichenoid infiltrate of lymphocytes obscured the dermoepidermal junction. Small number of plasma cells and solar elastosis were found in the upper dermis. Clinically, lichen planus-like keratosis is confused with seborrheic keratosis. For differential diagnosis, histologic study is necessary. Characteristic histologic features of lichen planus-like keratosis are focal parakeratosis, necrotic keratinocyte and lichenoid infiltration. Although clinical feature of her skin lesion was confused with seborrheic keratosis, histologic findings were consistent with lichen planus-like keratosis. We report a case of seborrheic keratosis like lichen planus-like which is clinically apt to be misdiagnosed with seborrheic keratosis.

광노화 병변의 유병률 조사 및 단일성과 다발성 광선각화증 환자들의 특성 비교: 환자 61명에 대한 후향적 연구

고병용 ( Byoung Yong Koh ),명기범 ( Ki Bum Myung ),한형진 ( Hyung Jin Hahn ),정승현 ( Seung Hyun Cheong ) 대한피부과학회 2017 大韓皮膚科學會誌 Vol.55 No.9

Background: Photoaged skin is characterized by actinic skin lesions such as wrinkling, elastosis, and premalignant and malignant lesions. Actinic keratosis (AK) is one of the most common precancerous lesions, and multiple actinic keratosis lesions are one of the risk factors for skin cancer. Few studies have investigated the prevalences of actinic skin lesions and compared the characteristics of the lesions and the patients with sinle and multiple AK lesions. Objective: The aim of this study was to evaluate the prevalences of actinic skin lesions and to compare characteristics between single and multiple lesions in Korean patients with AK. Methods: We retrospectively reviewed the medical records and biopsy specimens of 61 patients. Results: Frequencies of deep wrinkle, solar elastosis, cutis rhomboidalis nuchae, and senile purpura were higher in the multiple lesions group. The ratio of males to females was 1:3.43 and the mean age was 79 years in the multiple lesions group, both of which were higher than those in the single lesion group (1:1.14, 72 years). The mean duration was longer in the multiple lesions group. Sun protective behavior was more frequent in the single lesion group, and the occupation of farmer was more common in the multiple lesions group. There was no statistically significant clinicopathological difference between the two groups. Conclusion: This study may improve our understanding of the characteristics of actinic keratosis with both single and multiple lesions. (Korean J Dermatol 2017;55(9):580∼587)