악성 흑색종의 임상 및 병리조직학적 고찰

장경애(Kyoung Ae Jang),최지호(Jee Ho Choi),성경제(Kyung Jeh Sung),문기찬(Kee Chan Moon),고재경(Jai Kyoung Koh),김종혁(Chong Hyeok Kim) 대한피부과학회 2000 大韓皮膚科學會誌 Vol.38 No.11

Background:Cutaneous malignant melanoma represents a tumor arising within the melanocytic systems of the skin. Once considered an uncommon cancer, melanoma is now rising in incidence at a rate faster than any other cancer. Objective:The purpose of this study was to investigate the clinico-pathological characteristics of malignant melanoma. Methods:A total of 61 patients with malignant melanoma were enrolled in this retrospective study. We classified malignant melanoma as follows; ALMM, acral lentigious malignant melanoma, NMM, nodular malignant melanoma, SSMM, superficial spreading malignant melanoma, MM, mucosal melanoma, LMM, lentigo maligna melanoma. We used the staging system of American Joint Committee on Cancer to evaluate the clinical status in our subjects. The hospital charts and histopathological slides of patients with malignant melanoma diagnosed at Asan Medical Center from 1989 to 1999 were reviewed. Immunohistochemical study was performed for S-100 and HMB-45 in 10 cases and for Ki-67 in 5 cases. Results:1. The male to female ratio was 1.3. The mean age at diagnosis was 52.6 years. ALMM was the most common type(52.5%) in this study. ALMM and NMM developed in elderly persons, while SSMM developed in younger persons. Malignant melanomas arising from pre-existing mole were 10 cases(16.4%). 2. In forty two cases(68.9%), malignant lesions were limited to skin, but 19 cases(31.1%) were disseminated to lymph nodes, skin or internal organ at the initial examination. Sole and heel were the favored sites in ALMM. Lower extremities and back were the favored sites in NMM and SSMM. Four patients were initially presented with metastatic symptoms such as dyspnea, abdominal mass, headache, or axillary mass, and cutaneous malignant melanoma eventually were diagnosed as their origin.3. Histopathologically, 6 cases were categorized into amelanotic type and 1 case was into desmoplastic type.4. More than a half cases developed metastases to other organs. Common metastatic sites were lymph nodes, lung, brain, skin, liver, bone, and bladder in decreasing order of frequency. 5. The five-year survival rate was 100% in stage IA, IB, and IIA but 0% in stage IV. Face, chest and lower extremities showed worse prognosis. Men had worse prognosis than women. NMM revealed the lowest 5-year survival rate(30%). Conclusion:Among the prognostic factors such as locations, clinical types, ages, and gender, the stages at the initial presentation was the most important predictable value in our study. Therefore, the early recognition of malignant melanoma is the key to possible cure.(Korean J Dermatol 2000;38(11):1435~1443)

4세 여아에 발생한 유육종증

장경애 ( Kyoung Ae Jang ),최지호 ( Jee Ho Choi ),성경제 ( Kyung Jeh Sung ),문기찬 ( Kee Chan Moon ),고재경 ( Jai Kyoung Koh ),김훈기 ( Hun Ki Kim ) 대한피부과학회 1998 대한피부과학회지 Vol.36 No.2

We report a case of sarcoidosis in a 4-year-old girl. She showed the involvements of the skin and eye, which are the characteristics of sarcoidosis in very young patients, and also showed an unusual finding of hepatosplenomegaly. Because the diagnosis of childhood sarcoidosis is difficult and serious sequelae can develop from sarcoidal uveitis, an early skin biopsy and regular ophthalmologic assessment are essential. (Korean J Dermatol 1998;36(2): 331-334)

단발성 선천성 부정형 세포 조직구종

장경애 ( Kyoung Ae Jang ),정의창 ( Eui Chang Chung ),최지호 ( Jee Ho Choi ),성경제 ( Kyung Jeh Sung ),문기찬 ( Kee Chan Moon ),고재경 ( Jai Kyoung Koh ) 대한피부과학회 1998 대한피부과학회지 Vol.36 No.3

Indeterminate cell proliferations are rarely described in dermatology literature. Indeterminate cells are characterized by positivity for S-100 protein and CD-la, but are distinguished from Langerhans cells by the absence of Birbeck granules. We present a case of congenital indeterminate cell histiocytoma in a 6-day-old male infant. A Skin examination revealed a solitary, erythematous, 6*6cm, superficially crusted, dome shaped papule on his forehead. A Histopathologic examination showed a dense cellular infiltrate in the dermis, below the atrophic epidermis. Frequently, the nucleus demonstrated a single cleft or crease like the shape of a kidney. These cells showed positivity for S-100 protein. Birbeck granules were not found on electron microscopic examination. (Korean J Dermatol 1998;36(3): 498-501)

Verocay body-prominent myxoid intravascular fasciitis

장경애 ( Kyoung Ae Jang ),최지호 ( Jee Ho Choi ),고재경 ( Jai Kyoung Koh ),이민우 ( Min Woo Lee ) 대한피부과학회 1999 초록집 Vol.37 No.20

기저세포암의 임상 및 병리조직학적 연구

장경애(Kyoung Ae Jang),최지호(Jee Ho Choi),문기찬(Kee Chan Moon),고재경(Jai Kyoung Koh),성경제(Kyung Jeh Sung) 대한피부과학회 2000 대한피부과학회지 Vol.38 No.12

Background:Basal cell carcinomas(BCC) are seen almost on hair-bearing skin, especially on the face. There have been a few reports about BCC in Korea. Objective:The purpose of this study was to investigate the clinico-pathological characteristics of BCC. Methods:A total of 95 patients with BCC were enrolled in this study. The medical records and histopathological slides of BCC diagnosed at Asan Medical Center from 1989 to 1999 were reviewed. We classified our cases based on the predominant histopathological findings as follows; solid, adenoid, pigmented, superficial multicentric, clear cell, keratotic, morpheic, basosquamous, trichoblastoma-like, fibroepithelioma of Pinkus-like. Results: 1. The male- female ratio was 1.1:1. The mean age at diagnosis was 64.8 years in male patients and 66.9 years in female patients. 2. The clinical diagnoses were BCC(76.8%), melanoma, actinic keratoses, seborrheic keratosis, and so on. 3. The face was the most preferred site, especially nose(41.2%). Solid, adenoid, keratotic, morpheic, and basosquamous types developed exclusively on the face, while superficial multicentric types did not show on the favored sites. 4. Pruritus of the lesion, easy bleeding, and rapid increment of the size were the main complaints. 5. Solid type was the most frequent type(30%). Three cases of BCC arising from organoid nevus were included. In two cases of organoid nevus-origin, fibrofolliculoma of Pinkus-like histopathological findings were noted. 3 cases were recurrent after laser therapy or simple curettage. 6. Ninety two cases were successfully treated with wide excision. One case was treated with radiation therapy, but the lesion persisted. The lesion was widely excised without recurrence. Systemic metastases were absent in our study. (Korean J Dermatol 2000;38(12):1575~1582)

Multiple Painful Subcutaneous Nodules on the Face and Extremities

장경애 ( Kyoung Ae Jang ),최지호 ( Jee Ho Choi ),성경제 ( Kyung Jeh Sung ),문기찬 ( Kee Chan Moon ),고재경 ( Jai Kyoung Koh ),권영미 ( Young Mi Kwon ),지현숙 ( Hyun Sook Chi ) 대한피부과학회 1998 초록집 Vol.36 No.20

한국에서의 호산구성 농포성 모낭염의 임상 및 병리조직학적 연구

장경애(Kyoung Ae Jang),고광진(Gwang Jin Koh),김성범(Sung Bum Kim),최지호(Jee Ho Choi),성경제(Kyung Jeh Sung),문기찬(Kee Chan Moon),고재경(Jai Kyoung Koh) 대한피부과학회 2000 대한피부과학회지 Vol.38 No.10

Background:Eosinophilic pustular folliculitis (EPF) is a rare chronic disease of unknown cause with pruritic papulopustular lesions and a prominent eosinophilic infiltrate. Objective:The purpose of this study was aimed at evaluating the clinical and histopathological features of EPF.Methods:The hospital charts and histopathologic slides of 8 patients with EPF diagnosed at Asan Medical Center from 1989 to 1998 were reviewed. We also reviewed the previously published reports of 10 patients with EPF in Korea. Results:Nine male and nine female patients were enrolled in this study. The mean age at diagnosis of EPF was 26 years in men and 27 years in women. All the patients complained of mild to severe pruritus. EPF was presented with follicular papules or pustules, except 2 patients, who presented with erythematous plaques free of papules or pustules. All the patients showed the typical histopathological findings of EPF. Laboratory investigation showed hypereosinophilia in 73% of patients (11/15). The levels of blood eosinophils tended to decrease as cutaneous lesions resolved. EPF was improved with dapsone in 12 patients and the rest were treated with topical or systemic steroid or antihistamines.Conclusion:EPF may be more common in Korea than can be suspected. Because EPF showed characteristic histopathological findings and EPF responds well to dapsone, the knowledge with this disease may be important to diagnose and treat it. (Korean J Dermatol 2000;38(10):1287~1293)

건선에서의 피부 림프구 관련 항원 ( Cutaneous Lymphocyte-Associated Antigen ) 의 발현

장경애(Kyoung Ae Jang),최지호(Jee Ho Choi),성경제(Kyung Jeh Sung),문기찬(Kee Chan Moon),고재경(Jai Kyoung Koh) 대한피부과학회 2000 대한피부과학회지 Vol.38 No.10

Background:Arbutin is a glycosylated hydroquinone found at high concentration in certain plants capable of surviving extreme and sustained dehydration. It has been suggested as an inhibitory compound of melanogenesis. Objective:The purpose of this study was to investigate the effect of arbutin on melanogenesis in cultured human melanocytes and to evaluate the effectiveness of arbutin in patients with melasma. Methods:I. In vitro study:we examine the cell number, SRB assay, tyrosinase activity, and melanin contents of cultured human melanocytes in control(absence of arbutin) and experimental groups (presence of 10-5 M, 10-4 M, and 10-3 M arbutin). II. In vivo study:6 patients with melasma applied a 3 % arbutin solution twice daily for 8 weeks. Clinical response to treatment was evaluated by patients' subjective assessment and MASI(Melasma Area and Severity Index) score after 8 weeks of treatment. Results:I. In vitro study 1. The number of melanocytes was decreased in groups treated with 10-5 M, 10-4 M, 10-3 M arbutin for 2 days and 10-4 M, 10-3 M arbutin for 7 days. 2. On SRB assay, the proliferation of melanocytes was decreased in groups treated with 10-5 M, 10-4 M, 10-3 M arbutin for 2 days and for 7 days. 3. Tyrosinase activity was decreased in groups treated with 10-4 M, 10-3 M arbutin for 2 days and 10-5 M, 10-4 M, 10-3 M arbutin for 7 days. 4. The melanin contents were decreased in group treated with 10-3 M arbutin for 7 days. II. In vivo study 1. On patients'subjective assessment, one showed moderate improvement, one showed mild improvement, and the other four showed no change. 2. On MASI score, there was less than 10% improvement in all 6 patients. 3. Side effects were not found in all 6 patients.Conclusion:Although arbutin showed an inhibitory effect on cell proliferation, tyrosinase activity, and melanin synthesis in cultured human melanocytes, there was no significant effect of depigmentation in the patients with melasma. (Korean J Dermatol 2000;38(10):1303~1308)

피부 유육종증의 임상 및 병리조직학적 연구

장경애(Kyoung Ae Jang),최지호(Jee Ho Choi),문기찬(Kee Chan Moon),고재경(Jai Kyoung Koh),강숙경(Sook Kyung Kang),서호석(Ho Seok Suh),성경제(Kyung Jeh Sung) 대한피부과학회 2000 대한피부과학회지 Vol.38 No.12

Background:Sarcoidosis is a chronic granulomatous inflammatory disorder involving many organs including the skin with various clinical manifestations. Objective:The purpose of this study was to investigate the clinico-pathological characteristics of sarcoidosis. Methods:A total of 19 patients with cutaneous sarcoidosis were enrolled in this study. The hospital charts and histopathological slides of the patients with sarcoidosis diagnosed at Asan Medical Center from 1989 to 1999 were reviewed. Results:1. Three male and sixteen female patients were included(M:F=1:5.3). Age at diagnosis ranged from 4 to 62 years. The mean age was 46 years in male patients and 44.9 years in female patients. 2. Multiple or several(more than 2) skin lesions were common(78.9%). Extremities were the favored sites. Clinically the lesions were presented as subcutaneous nodules, plaques, nodule, macules or papules, patches, psoriasiform, and pitted scar in decreasing order. Cutaneous lesions arising from the scar were present in 3 cases. Six patients(31.6%) complained of systemic symptoms such as fever or weight loss. 3. The systemic involvement was present in 11 cases(57.9%). Lung, hilar lymph nodes, and mediastinal lymph nodes were the most commonly involved organs. 4. Laboratory examinations revealed elevated erythrocyte sedimentation rate(71.4%) and angiotensin converting enzyme(ACE)(90%). In all the patients with elevated level of serum ACE the involvement of intrathorax was present, however one patient with systemic involvement showed normal level of ACE. Serum calcium level was normal in all the patients and the level of CD4/CD8 revealed variable results(1.3 to 3.9). 5. Histopathological evaluation revealed non-caseating epithelioid cell granulomas (100%) with multinucleated giant cells(52.6%) and asteroid body(31.6%). In 11 cases(57.9%), fibrosis was the prominent finding and in two cases(10.5%) partial interstitial necrosis was noted. Histopathologically subcutaneous pattern was predominant in 8 cases(42.1%). The patients with subcutaneous sarcoidosis did not show any specific clinical or laboratory differences from the other types in our study. (Korean J Dermatol 2000;38(12):1583~1589) Conclusion:Cutaneous sarcoidosis showed varied clinical and histopathological manifestations and ran various clinical courses. In cutaneous sarcoidosis women were more commonly involved than in systemic sarcoidosis and more elderly patients were involved in cutaneous sarcoidosis. Extensive work-up for systemic involvement may be mandatory when sarcoidosis is presented with cutaneous lesions or the level of serum ACE is elevated in cutaneous sarcoidosis. The level of CD4/CD8 may be a insignificant laboratory index in sarcoidosis. Also, subcutaneous sarcoidosis may not be a marker of the systemic involvement.

악성 흑생종과 병발한 원발암 2 예

강숙경(Sook Kyoung Kang),장경애(Kyoung Ae Jang),최지호(Jee Ho Choi),성경제(Kyung Jeh Sung),문기찬(Kee Chan Moon),고재경(Jai Kyoung Koh) 대한피부과학회 2001 대한피부과학회지 Vol.39 No.7

Survival from malignant melanoma has improved, and as a consequence, the possibility of raised risk of second primary cancers needs to be taken into account in clinical management. We report two cases of second primary cancers in patients with cutaneous malignant melanoma. One is a 61-year-old man suffered from head and neck squamous cell carcinoma with acral lentiginous melanoma, the other is a 65-year-old woman who suffered from malignant lymphoma with superficial spreading melanoma. (Korean J Dermatol 2001;39 (7) 798-802)