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조갑진균증에서 병리조직검사의 진단적 가치 및 Periodic Acid-Schiff와 Gomori’s Methenamine Silver 염색의 민감도 비교
백가연 ( Gayun Baek ),구태한 ( Taehan Koo ),이동훈 ( Donghoon Lee ),강현지 ( Hyun Ji Kang ),김민수 ( Min-soo Kim ),김영혜 ( Younghye Kim ),주민숙 ( Mihn-sook Jue ) 대한피부과학회 2021 대한피부과학회지 Vol.59 No.8
Background: A direct potassium hydroxide (KOH) smear is used to diagnose onychomycosis despite its broad sensitivity range. For a more accurate diagnosis, histopathologic examination can be used and consistently show high sensitivity. Objective: We investigated the value of histopathologic examination of the nail plate as a diagnostic tool for onychomycosis. We proposed effective routine diagnostic staining to compare sensitivity between periodic acid-Schiff (PAS) and Gomori’s methenamine silver (GMS) staining. Methods: This retrospective study was conducted from January 1, 2019 to May 31, 2020, and included 97 patients who showed negative results on direct KOH smear but had clinical manifestations that implied onychomycosis. We performed nail plate biopsy and PAS or GMS staining to identify fungal hyphae missed in the direct KOH smear. Sensitivity comparison between PAS and GMS was performed in co-stained samples. Results: Among 97 patients with 102 cases, 55 cases (53.9%) of onychomycosis were confirmed by histopathologic examination. A total of 68 patients (70.1%) had a previous medical history of antifungal agents within previous six months. PAS and GMS staining were concurrently performed in 73 cases, and onychomycosis was confirmed in 41 cases. The sensitivity of PAS was 100% (41/41), while that of GMS was 87.8% (36/41); this difference was not significant. Conclusion: This study suggests that histologic examination of the nail plate is an effective tool to diagnose onychomycosis and can be performed with a direct KOH smear. Two staining methods, PAS and GMS, are recommended for concurrent performance to enhance the identification of fungal hyphae. (Korean J Dermatol 2021;59(8):618∼623)
구태한 ( Taehan Koo ),백가연 ( Gayun Baek ),박은정 ( Eunjung Park ),조민결 ( Mingyul Jo ),박지호 ( Ji-ho Park ),김민수 ( Min Soo Kim ),주민숙 ( Mihn-sook Jue ) 대한피부과학회 2020 大韓皮膚科學會誌 Vol.58 No.7
Fibrofolliculoma is a benign perifollicular connective tissue tumor that usually occurs in the face. Most fibrofolliculoma present as multiple lesions and typically occur with trichodiscomas and acrochordons, constituting the Birt-Hogg-Dube syndrome. Solitary fibrofolliculoma is nonhereditary and unassociated with other cutaneous abnormalities. A 72-year-old man visited our clinic complaining of a solitary umbilicated nodule on the antitragus of the left ear. Skin biopsy from the lesion showed a central dilated follicular infundibulum with anastomosing bands of follicular epithelium extending into the fibrous stroma. The diagnosis of a solitary fibrofolliculoma was made based on the clinical and histopathological findings. No signs of lesion recurrence for 1 year after shave removal were noted. We report a rare case of solitary fibrofolliculoma that occurred on the antitragus of the ear. (Korean J Dermatol 2020;58(7):472∼475)