Necrobiotic Xanthogranuloma Coexists with Diffuse Normolipidemic Plane Xanthoma and Multiple Myeloma

( Joon Goon Kim ),( Hye Ri Kim ),( Moon Hyung You ),( Dong Hoon Shin ),( Jong Soo Choi ),( Young Kyung Bae ) 대한피부과학회 2020 Annals of Dermatology Vol.32 No.1

Necrobiotic xanthogranuloma (NXG), is a rare multisystem disease that manifests as cutaneous inflammatory lesions, and is commonly associated with lymphoproliferative disease. Diffuse normolipemic plane xanthoma (NX), is also a rare, acquired disease that is often associated with systemic diseases such as lymphoproliferative disease. Both of these diseases have been reported to be associated with monoclonal gammopathy (MG). However, there are few cases in which these diseases co-exist. A 78-year-old female, who had a known case of NX on the neck and axillary area, presented with an asymptomatic erythematous plaque on her left supraclavicular area. Histopathological examination showed lymphoid aggregates, necrobiotic areas, and granulomatous inflammation in the dermis. Numerous foreignbody and Touton type giant cells were noticed. Serum protein immunoelectrophoresis showed an IgG kappa type MG. Lipid profile of the patient was normal. Bone marrow examination showed plasma cell myeloma. Based on these histologic and laboratory results, we diagnosed this lesion as NXG coexisting with NX and multiple myeloma. She was started on treatment with bortezomib and melphalan for multiple myeloma, and high-dose systemic corticosteroid and triamcinolone intralesional injection for the skin lesion. After 3 months of treatment, the NXG skin lesion and MG improved. (Ann Dermatol 32(1) 53∼56, 2020)

P169 Clinical use of PCR-REBA for diagnosis of onychomycosis

( Joon Goon Kim ),( Moon Hyung You ),( Yeon Woong Kim ),( Byeong Su Kim ),( Dong Hoon Shin ),( Jong Soo Choi ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

<div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div> Background: To identify the causative organism in onychomycosis, we conventionally have used fungal cultures and PCR with ITS sequencing. However, fungal culture is low sensitivity and PCR with ITS sequencing cannot be performed in cases of mixed infection or contamination. PCR-based reverse blot hybridization assay (PCR-REBA) is available and easily used in general hospitals to identify the causative organism. Objectives: To compare diagnostic efficacy of fungal culture and PCR-REBA in onychomycosis. Methods: 31 nail samples from 31 patients diagnosed with onychomycosis by direct microscopic examination. And we performed fungal culture and PCR-REBA Results: 1. The sensitivity of conventional fungal culture and PCR-REBA were 41.9% and 100% 2. In PCR-REBA, 27 Trichophyton (T.) rubrum, 4 T. mentagrophytes, 2 T. sp., 1 Microsporum gypseum and 1 panfungal DNA sequence were identified. 3. In fungal culture, 14 samples were identified. 8 T. rubrum, 3 Rhodotorula mucilaginosa, 1 Penicillium cvjetkovicii, 1 Lachnum soppittii, and 1 Non-dermatophytic mold were identified. 4. 17 samples showed positive for PCR-REBA but negative for fungal culture. 5. 14 samples were positive in both PCR-REBA and fungal culture, but only 9 were in concordance with each other. Among 5 discordance samples, PCR-REBA shows 5 as T. sp., fungal culture shows 3 as molds and 2 as yeasts. Conclusion: Using PCR-REBA is considered to be useful in identification of the causative organism in mixed infection like onychomycosis.

기능성 소화불량증에서 Helicobacter pylori 감염이 위근위부 운동기능에 미치는 영향

김영호,박정미,손희정,최준영,김재준,최규완,백승운,고광철,이풍렬,이종철,김병태,심상군,김창섭 대한소화기학회 1999 대한소화기학회지 Vol.34 No.2

Background/Aims: Little is known about the effect of Helicobacter pylori (HP) infection on proximal gastric motor function in functional dyspepsia (FD). We evaluated total gastric emptying, initial proximal gastric distribution of meal (IPGD), proximal gastric emptying, basal tone, compliance and postprandial accommodation in the patients with FD relating to HP status. Methods: Of 25 subjects, 18 were HP positive and 7 were HP negative by the result of 13C urea breath test. A solid-phase scintigraphic gastric emptying and gastric barostat were performed. Results: In both HP-positive and HP-negative patients, sex, age, symptom score and body mass index were not different. Total gastric half-emptying time (101±13.9 min vs. 107±25.9 min), retention rate at 30 min (80.4±1.2% vs. 81.6±3.2%) and at 120 min (47.3±4.1% vs. 49.9±7.7%) were similar between the two groups. IPGD (69.4±4.1% vs. 64.6±11.1%) and proximal half-emptying time (37.9±5.2 min vs. 48.4±13.2 min) were not different between the two groups. basal tone (60.8±3.4 ml vs. 65.0±7.0 ml), compliance (49.2±2.4 ml/mmHg vs. 37.6±5.7 ml/mmHg), and accommodation (207±46% vs. 137±75%) were not different between the two groups. Conclusions: There was no association between HP infection and proximal gastric motor function in FD.

P124 Vitamin D status of inpatients referred to the department of dermatology

( Joon Goon Kim ),( Moon Hyung You ),( Yeon Woong Kim ),( Byeong Su Kim ),( Dong Hoon Shin ),( Jong Soo Choi ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

<div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div> Background: Numerous studies have reported the positive association between vitamin D insufficiency and various cutaneous disorders such as atopic dermatitis, psoriasis, urticaria and skin cancer. Vitamin D insufficiency could be associated with increasing dermatologic referral. Objectives: This study aims to examine vitamin D levels of the inpatients referred to the Department of Dermatology, and compared to the general population. Methods: 185 inpatients who were referred to the Department of Dermatology were categorized by the referred department and 9 disease categories and serum 25-hydroxyvitamin D levels were analyzed. Average vitamin D levels of referred inpatients were compared to average vitamin level from the Korean national health and nutrition examination survey (KNHANES) Results: Serum 25-hydroxyvitamin D levels were significantly low in referred female inpatients (13.9±8.3) and male inpatients (13.7±8.3) compared with females (18.2±7.1) and males (21.2±7.5) from the KNHANES (p<0.001). But vitamin D level didn’t show correlation with the departments, (p=0.41) disease categories (p=0.92). Vitamin D level was the lowest in drug eruption, erythema & urticaria category and followed by nevi & tumors, disorder of the skin appendages in ascending order. Conclusion: Serum vitamin D levels were lower in referred inpatients than those in general population. No correlation between the level of vitamin D and the departments from which the inpatients were referred or disease categories.

A case of primary cutaneous anaplastic large cell lymphoma on the palm

( Yeon Woong Kim ),( Joon Goon Kim ),( Byeong Su Kim ),( Jin Hwa Choi ),( Dong Hoon Shin ),( Jong Soo Choi ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Primary cutaneous anaplastic large cell lymphoma(ALCL) is a rare primary cutaneous lymphoma and it is predominantly composed of large lymphoid cells that express the CD30 antigen. It is described as CD30 positive lymphoproliferative disorder in company with lymphomatoid papulosis. Primary cutaneous ALCL usually occurs over the middle age. The lesion of ALCL is usually single and bigger than that of lymphomatoid papulosis, and has frequent ulceration. ALCL is usually located on the trunk, extremities but rarely on the palm. There has been 1 reported case of ALCL on the palm. A 25-year-old female presented with a plaque on the left palm for 20 days. The plaque was walnut sized and purple to gray colored with erosion on the center. The lesion has become thick in color with mild itching sensation. The results of laboratory test were within normal limits. Histopathologic examination showed infiltration of large atypical cells in dermis. The large tumor cells showed positivity for CD3, CD4, CD30 and negativity for CD8, CD20, epithelial membrane antigen, anaplastic lymphoma kinase. PET-CT showed no hypermetabolic lesion except the left palm. Therefore we diagnosed primary cutaneous ALCL. The patient was treated with methotrexate intralesional injection(25mg/ml, 0.45cc) and the lesion has regressed. After 6weeks of injection, a walnut sized purple to gray colored thick plaque turned to a pea sized yellowish thin crust.

A case of leukemia cutis in a patient with suspicious leukemic transformation from primary myelofibrosis

( Yeon Woong Kim ),( Joon Goon Kim ),( Byeong Su Kim ),( Jin Hwa Choi ),( Dong Hoon Shin ),( Jong Soo Choi ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Leukemia cutis is defined as cutaneous infiltration of malignant hematopoietic cells. The clinical features of leukemia cutis are variable and the lesions may be localized or disseminated. Primary myelofirbrosis(PMF) is one of the chronic myeloproliferative disorders, which are characterized by clonal proliferation of myeloid cells. PMF should be distinguished from the other chronic myeloproliferative neoplasms: chronic myeloid leukemia(CML), myelodysplastic syndrome(MDS). In Korean dermatologic literature, there are no cases of leukemia cutis with primary myelofibrosis. Instead, there are 16 cases of leukemia cutis with CML and 5 cases of leukemia cutis with MDS. A 53-year-old male presented with a month history of several normal skin colored to erythematous papules on trunk and abdomen. The number of lesions had increased but he had no subjective symptom. He was diagnosed as PMF 3 years ago. For last 5 months, he has suffered from inguinal lymph node enlargement, myalgia, and abdominal discomfort. Laboratory test showed leukocytosis in peripheral blood(blast cells: 10%). Histopathologic examination showed perivascular infiltration of immature myeloid cells in dermis. The infiltrative cells showed positivity for myeloperoxidase. We diagnosed as leukemia cutis with suspicious leukemic transformation from primary myelofibrosis.

Isolation rates of fungi from soil near playground and barber shop in daegu

( Byeong Su Kim ),( Yeon Woong Kim ),( Joon Goon Kim ),( Dong Hoon Shin ),( Jong Soo Choi ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2

Background: Soil is one of the major habitat of fungi. Keratinophilic fungi (KPF) are an important group of fungi that live in soil and some of them are potential pathogens for humans and animals. Objectives: The aim of this study is to isolate and identify KPF near playgrounds and barber shops. Methods: We visited 20 playgrounds and 10 barber shops in Daegu, Korea from July to August 2015. We examined isolation rates of fungi from 185 soil samples with hair baiting technique. By the distance away from the playgrounds and barber shops, soil samples were divided into 3 groups consist of near, 10 m, and 100m. Results: Of the 185 soil samples examined, 74 (40%) yielded KPF. Isolation rates of KPF from the soil were observed in 60% of near, 56% of 10 m, and 2% of 100 m, respectively. In particular, of the 125 samples around playgrounds, isolation rates were 44% (20/45) of near, 35% (14/40) of 10 m, and 0% (0/40) of 100 m. Of the 60 samples around barber shops, isolation rates were 95% (19/20) of near, 85% (17/20) of 10 m, and 5%(1/20) of 100 m. Conclusion: In this study, isolation rates of KPF were higher in the soil closer to the playgrounds and barber shops. Especially near barber shops, where the soil is rich in keratinous material like hairs, we found KPF in almost soil samples. We should be aware of these results and pay attention to eliminate hairs or keratins in soils.

A case of infantile perianal pyramidal protrusion

( Yeon Woong Kim ),( Joon Goon Kim ),( Byeong Su Kim ),( Jin Hwa Choi ),( Dong Hoon Shin ),( Jong Soo Choi ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Infantile perianal pyramidal protrusion(IPPP) is a benign mass which is characterized by solitary pyramidal protrusion and typical localization on the perineal or perianal area. In 1996, Kayashima et al first used this name. IPPP has been divided into three categories based on the history and clinical findings at presentation: constitutional IPPP, functional IPPP, and IPPP associated with lichen sclerosus et atrophicus. Two cases of IPPP have been reported in Korean dermatologic literature. A 2-year-old girl presented with a month history of a smooth linguiform protrusion on anterior to the anus. She had suffered from painful defecation but had no history of constipation. There was no remarkable medical history and family history. We performed shave biopsy and CO2 laser ablation. Histopathologic examination showed epidermal hyperplasia, dermal edema, and hemorrhage with inflammatory cell infiltration in dermis. In general, IPPP shows a benign clinical course. IPPP can be misdiagnosed as sexual abuse, anogenital warts or hemorrhoid due to its location on the perineal area. Therefore physician’s awareness of IPPP is important in its differential diagnosis from other disease.

A case of meningothelial hamartoma

( Yeon Woong Kim ),( Joon Goon Kim ),( Byeong Su Kim ),( Jin Hwa Choi ),( Dong Hoon Shin ),( Jong Soo Choi ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Meningothelial hamartoma is an uncommon developmental anomaly and characterized by ectopic meningothelial elements in the dermis or subcutaneous tissue. In the past, it has been described as a variant of primary meningocele. But recently, it is considered to belong to another disease category. Most lesions usually arise since birth on the midline of occiput. Five cases of meningothelial hamartoma have been reported in Korean dermatologic literature. A 16-year-old male presented with a nodule on the scalp since birth. A 1.5cm sized hairless nodule was on vertex. The nodule has been slowly growing and sometimes there was tenderness. There was no remarkable medical history and family history. Histopathologic examination showed thin-walled pseudovascular spaces lined by spindle shaped meningothelial cells. These meningothelial cells were positive for epithelial membrane antigen. Brain MRI showed neither visible underlying skull and brain parenchymal change nor connection with meninges.

Immunohistochemical staining of Wilms` tumor protein 1 in malignant melanomas and melanocytic nevi

( Yeon Woong Kim ),( Joon Goon Kim ),( Byeong Su Kim ),( Dong Hoon Shin ),( Jong Soo Choi ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2

Background: Malignant melanomas represent pigmented skin lesions and should be distinguished from melanocytic nevi. However, differential diagnosis of malignant melanomas and melanocytic nevi is often challenging. Wilms’ tumor protein 1 (WT1) is a specific immunomarker of Wilms’ tumor, and recently, several studies revealed that various malignant tumors have WT1 expression. Objectives: The purpose of this study is to evaluate the usefulness of WT1 staining for differentiating malignant melanoma from benign melanocytic nevi. Methods: We selected 50 cases of melanocytic nevi (19 cases of intradermal nevi, 19 cases of compound nevi, 12 cases of junctional nevi) and 35 cases of malignant melanoma from clinicopathologically proven cases reviewed by the Department of Dermatology at our medical center. WT1 staining was performed, and labeling index (LI) of WT1 expressions was measured. Results: LIs of melanocytic nevi and malignant melanomas were 19.2% and 54%, respectively. The best WT1 cut-off point to distinguish melanomas from benign melanocytic nevi was 27.2%.; the sensitivity and specificity were 68.6% and 74%, respectively. When WT1 cut-off point of 75% was used, the specificity was 100%. Conclusion: WT1 staining is a potential diagnostic tool for differentiating malignant melanomas from benign melanocytic nevi.