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The Ixodidae family of hard ticks has cement-producing and non-cement-producing species. Involved skins of four patients bitten by cement-producing ticks and two by non-cement-producing ticks were histopathologically examined. Those of the latter two patients were also studied immunohistochemically to characterize the infiltrating inflammatory cells. In patients with cement-producing ticks, the cement substance was observed as external cement or outer zone of internal cement, respectively. Coagulative necrosis was present in the epidermis in one patient and from the epidermis to the dermis in another patient. Epidermal cells were damaged in the remaining two patients. Despite these severe tissue damages, the cutaneous inflammatory reaction in all four patients was very mild. In contrast, the patients bitten by non-cement-producing ticks had severe cutaneous inflammatory reaction. In addition to caseous necrosis-like change in the entrance site of the inserted mouthparts, extensive interstitial lymphohistiocytic infiltrate was present diffusely from the dermis to the subcutaneous tissue. In one of the patients coagulative necrosis was present from the dermis to the subcutaneous tissue. Immunohistochemically, the infiltrating lymphocytes were T-cell dominant and mixed moderately with B-cells. Pathogenetically, the cutaneous inflammatory reaction is only mild in the skins involved by the cement-producing ticks, perhaps because inflammatory reaction in the host skin is suppressed by antiinflammatory and immunosuppressive substances contained in tick's saliva in order to prevent position of their mouthparts fixed to the host skin from rejection of the host until finishing their engorgement. In contrast, the cutaneous inflammatory reaction induced by the non-cement-producing ticks is severe, possibly because these ticks have no antiinflammatory and immunosuppressive substances in their saliva, and because their saliva is much more injurious than that of the cement-producing ticks.

SUMMARY The elimination of elastic fibres through the regenerated epidermis of human skin was studied using histochemical, immunofluorescent and electron microscopic techniques. No abnormality was detected in the elastic fibres which were being eliminated, but they were in direct contact with the cytomembranes of some lymphocytes and were captured by histiocytes. It seemed that these elastic fibres were recognized as a foreign substance and provoked inflammation. Lymphocytes and histiocytes may play an important role in the transepithelial elimination of elastic fibres.

74歳の男性。2001年7月頃に右側背部の腫瘤に気づいた。その後徐々に増大するため近医を受診，当科を紹介された。臨床的に扁平隆起性の淡紅褐色斑でその中に紅褐色の小結節が認められた。結節部のみ生検を行いSmith-Coburn型のporomaと診断。その後全切除術施行。全体像は脂漏性角化症のclonal typeであり，その中にSmith-Coburn型のporomaを合併していた。脂漏性角化症に汗腺系腫瘍を合併することは非常に稀だと考えられる。

Skin of DA/Slc rat fetuses removed on the fetal days 11 to 20 and on delivery day (21 days post-fertilization) was used. In the immunohistochemistry, the anti-neurofilament 69 kDa (NF68)-positive fibers appeared in the subepidermal dermis on the fetal day 12. The subepidermal and intraepidermal NF68-positive fibers reached to a maximum number on the fetal day 14. They disappeared completely on the fetal day 16. After the fetal day 19, a small number of the subepidermal and intraepidermal NF68-positive fibers were seen again. As for anti-nerve growth factor (NGF), intermediate cells, spinous cells and granular cells of the epidermis showed strongly positive stain. In the electron microscopy, there were bundles of immature axons which were packed by abundant microtubules and neurofilaments during the entire fetal period. On the fetal days 16 and 17, a considerable number of axons showed severe degenerative changes. From these findings, the subepidermal and intraepidermal nerve fibers in the fetal rat skin increased temporarily to a maximum number, and soon after they disappeared completely, followed by another period of re-appearance until delivery day. Such a dynamic change of the number of the cutaneous nerve fibers was not synchronous with expression of NGF of the epidermal cells.

71歳, 男性。四肢に浸潤を触れる丘疹状の紫斑が出現。少し遅れて下腿浮腫, 蛋白尿も出現した。病理組織像では真皮上層を中心に壊死性血管炎の所見がみられ, 一部では真皮下層にまで同じような血管病変がみられた。また真皮下層の一部の血管病変でIgAの沈着が認められた。一方, 本例はネフローゼ症候群を合併したため, 内臓悪性腫瘍の有無について全身検索を行ったところ, 腎細胞癌が発見された。高齢者のアナフィラクトイド紫斑が内臓悪性腫瘍のデルマドロームであることを示唆する症例と思われた。

松江赤十字病院皮膚科において過去8年間 (1993年4月～2000年10月) にマムシ咬傷47例を経験した。受診患者数は年間平均約6例で, 男性26例, 女性21例と男性にやや多く, 年齢別では60歳代に多かった。時刻別発生数では夕方前から日没にかけて集中していた。季節・天候別発生数は7月から9月の晴れとくもりの日に多かった。受診時間は受傷後30～40分の間が最も多く, 全体の約8割が60分以内に受診していた。受傷状況は田畑での農作業中が多く, そのため受傷部位は手指, 次いで足関節より末梢の順であった。治療はセファランチン・抗毒素併用例39例, 抗毒素単独例4例, セファランチン単独例4例であった。セファランチン・抗毒素併用例の重症度分類別による入院日数の検討では, 入院日数はstage Iに比べstage III, stage IVで有意に長かった。併用例の臨床症状 (発赤・腫脹) の程度による重症度分類と検査値による重症度分類との間には有意な相関性が認められ (相関係数R=0.62), 腫脹が進行している時は同時に組織破壊も進行していると考えられた。抗毒素皮内テスト陽性例9例のうち3例はセファランチン単独投与のみにて治癒し, 6例は除感作による抗毒素投与を行い治癒した。受傷後24時間以降に抗毒素を投与した例は2例で, いずれも抗毒素投与が有効であった。マムシ咬傷の重症度は腫脹及び検査値を含めて評価が可能であり, 重症化する例では経過が長い場合でも抗毒素の投与を考慮する必要があると考えられた。

This study aimed to identify gender differences in the impact of performance status (PS) 1, that is, of physically mild impairment, on psychological distress and coping in ambulatory cancer patients. The subjects were 260 male and 242 female cancer outpatients who participated in a structured interview and completed the Profile of Mood States and the Mental Adjustment to Cancer scale. Multivariate analyses controlling for confounding biomedical and psychosocial variables revealed a significant impact of PS 1 on helplessness/hopelessness and a trend toward an impact on fighting spirit in women alone, whereas a trend was observed in regard to psychological distress in both genders. The results of this study suggest that PS 1 may be a risk factor for negative ways of coping in female, but not male, cancer outpatients.

This study was undertaken to visualize the subepidermal nerve networks immunohistochemically. Specimens were obtained from the normal skin of the back, abdomen and nose of seven adult male Hartley guinea pigs, and immersed in 1 M NaCl solution. Dermal sheets were obtained by separating the dermis and epidermis, followed by fixation in Zamboni's fixative. The dermal sheets were sectioned parallel to the separated surface. Using the immunoperoxidase technique and immunofluorescence, the sections were immunostained with primary antibodies to S 100 protein (S100), protein gene product 9.5 (PGP 9.5), neuron-specific enolase (NSE), substance P (SP) and calcitonin gene-related peptide (CGRP). In double-labeled immunofluorescence of PGP 9.5 and SP or CGRP, the sections were viewed under a confocal laser scanning microscope. In skin of the back and abdomen, networks of S100-, PGP 9.5- and NSE-positive fibers were observed, some of which showed a multicentric arrangement. The outermost structures were formed by the thickest fibers which were 5-10 micro m thick, the outer networks consisted of fibers 3-6 micro m thick, and the inner networks consisted of fibers 1-3 micro m thick. From these networks, single fibers approximately 0.5 micro m thick branched out and terminated in free endings. The SP- and the CGRP-positive substances appeared as granules on the PGP 9.5-positive fibers. These results confirm that the dermis has a three-layered sensory nerve plexus, i.e. deep, superficial and subepidermal. In the skin of the nose, however, nerve networks were made up of only thick fibers which were probably situated in the subpapillary dermis.

Background: Acral pseudolymphomatous angiokeratoma of children (APACHE) is a disorder characterized clinically by red nodules and histopathologically by a massive subepidermal lymphohistiocytic infiltrate. Although it was initially thought to be a vascular nevus, it has never been regarded as a pseudolymphoma. Case report: We report a 7-year-old-girl with small red nodules on the dorsum of the right foot and a 73-year-old man with asymptomatic brown-red nodules on the lower extremities. Results: Histopathologic examination revealed a massive lymphohistiocytic infiltrate with plasma cells, some eosinophils, or a multinucleated giant cell immediately beneath the epidermis. Thick-walled vessels were observed in the infiltrate. These characteristics are identical to those of acral pseudolymphomatous angiokeratoma of children. The infiltrate was composed mainly of equal numbers of CD4+ or CD8+ T cells and equal numbers of B cells stained for κ or λ light chains. PCR amplification of rearranged immunoglobulin heavy chain genes or T-cell receptor γ genes showed no evidence of clonality, suggesting that these infiltrates were polyclonal both for B and T cells. Conclusions: Our data support the idea that this disorder represents a reactive process. The modified term ‘papular angiolymphoid hyperplasia’ would define this disorder more appropriately.

We report here a case of an 89-year-old man with bilateral axillary apocrine adenocarcinoma. He first noticed the nodule on his left axilla in March 2000. We excised the nodule in November 2000. Histopathologically, the tumor was composed of nests with atypical epithelial cells and glands with abundant eosinophilic cytoplasm that exhibited decapitation secretion. Immunohistochemically, the tumor cells were positive for GCDFP-15; thus, we diagnosed this tumor as apocrine adenocarcinoma. In September 2001, he noticed a similar nodule on his right axilla and it was excised again. The histopathological feature of this tumor was almost the same as the tumor on his left axilla. [Skin Cancer (Japan) 2002; 17: 259-263]

帯状疱疹後神経痛が経験的に温めることで改善することをヒントに,体質的に冷えを伴う帯状疱疹後神経痛の患者に漢方の代表的温剤である桂枝,附子を含む方剤で治療した。方剤としては煎剤で桂枝加附子湯加減,エキス剤で八味地黄丸を使用した。今回対象とした症例は帯状疱疹の皮疹が消失ないし潰瘍が上皮化したのちに疼痛を生じた8例で,高齢者,女性が多く,全例手足の冷感を強く訴えた。また東洋医学的診察では脈診で全例が沈,細,弱であり腎虚証を呈していた。今回行った温剤による漢方治療は,冷感との関連がつよい帯状疱疹に伴う疼痛に対して有効な治療法の一つと考えた。

We describe a unique patient with mosquito-bite hypersensitivity who had extremely high titres of Epstein-Barr virus antibodies. For many years he developed intractable ulcers on the sites of mosquito-bite. Epstein-Barr virus infection was detected in almost all inflammatory cells in the ulcers and in the peripheral blood lymphocytes by using in situ hybridization to Epstein-Barr virus-encoded small ribonucleic acids and by polymerase chain reaction to Epstein-Barr virus DNA. The inflammatory cells in the ulcers were positive for T-cell marker. Our results suggest that the Epstein-Barr virus infection in T cells may participate in the pathogenesis of exaggerated mosquito hypersensitivity and in delayed healing of ulcers on the sites of mosquito-bite.

In Tottori Prefecture, we gathered the data of all patients known to have been infected with tsutsugamushi disease (TD) over a span of 49 years, from 1950 to 1998. The total number of patients reported so far has been 19, 16 of which occurred after 1988. Recently, it has been observed that the incidence tended to increase. Of the 13 laboratory confirmed patients, 7 came from Saji Village and Chizu Town, in the Yazu district, a place whereby, a body of water known as the Sendai River partly passes through, and is located in the eastern region of Tottori Prefecture. The remaining 6 came from Nichinan Town in the Hino district, a locality whereby the Hino River partly passes through; in the western part of the same prefecture. Both are mountainous areas, where corniferous trees such as Japanese cedars and pines grow. These results indicate that the occurrence or prevalence of TD in Tottori Prefecture was restricted only to particular places. Seasonal occurrence was during April and May in Nichinan, while October and November in Yazu, particularly in Saji, with one exceptional case in Chizu in which TD occurred during spring. It is likely that the causative chigger mite is the Leptotrombidium pallidum (L. pallidum). The causative agent in Yazu was the Gilliam strain only of Orientia tsutsugamushi (O. tsutsugamushi), while in the latter, it was the Karp, Kato or some unknown strains with antigen(s) common to the Gilliam, Karp and Kato strains. The seasonal difference in the occurrence among the three places may be caused by the difference in temperature because the average autumn/spring temperature difference in the 2 districts was 2-3 degrees C lower in Nichinan than in the Saji-Chizu areas. As a result, the activity of larval chigger mites may be temporarily halted or stopped by the relatively lower temperature in Nichinan during autumn.

Gene therapy directed to the skin requires efficient transfer of the desired gene into cutaneous cells. In this study, we examined several chemical substances present in various ointments by enhancement of virus infectivity. The recombinant adenovirus vector, Ax-CALacZ, was used to infect dermal fibroblasts with some chemicals both in vitro and in vivo, and the expression of the LacZ gene was determined by X-Gal reaction. As the result, it was shown that PEG 6000 had the highest ability to enhance the exogenous gene expression in cultured fibroblasts with little toxicity. In vivo, it was also demonstrated that fibroblasts in mouse skin were efficiently gene transfer by adenovirus vector and 20% PEG 6000-treatment. These results suggest that this chemical treatment appears to be a simple, safe, convenient, and effective method for facilitating virus-mediated gene therapy in the skin.

A 47-year-old woman, suffering from von Recklinghausen's disease, visited us because the tumor grew rapidly on her right neck. Except for numerous pigmented spots and cutaneous neurofibromas, there was a 18×10cm tumor on the area from right lateral neck to the right supraclavicular fossa, in addition to an indurated tumor measuring approximately 5cm in diameter on the right breast. According to the operative findings of an emergency operation for the lesion on the right neck, it was suspected of malignant tumor.Histopathologic diagnosis from department of clinical pathology was malignant peripheral nerve sheath tumor complicated with von Recklinghausen's disease. However, since the lesion had intralesional small nests and scattered large clear cells, it was suspected of undifferentiated cancer. Immunohistochemistry for myoglobin, desmin, NSE, S-100, EMA etc. could not show definite result. On the other hand, a biopsy specimen from her right breast was histopathologically diagnosed as breast cancer. Based upon all the above-mentioned histopathologic findings of both lesions of the right neck and the right breast, the lesion of the right neck was finally diagnosed as metastatic lesion of the breast cancer.

Although pruritus is the cardinal symptom of atopic dermatitis, its mechanism is not well understood. Free nerve endings in the skin are involved in pruritus as itching receptors. We studied the cutaneous nerve fibres in lichenified lesions of 16 patients with adult atopic dermatitis. On immunohistochemistry, fibres immunoreactive for neurofilament, neuron-specific enolase, and protein gene product 9.5 were observed in the papillary dermis and dermoepidermal junctions as well as in the epidermis. In these areas, no fibres stained positively for substance P, neuropeptide Y, vasoactive intestinal peptide, beta endorphin, somatostatin or serotonin. On electron microscopy, the ultrastructure of subepidermal and intraepidermal free nerve endings appeared to be essentially normal. However, the distribution density of the cutaneous nerve fibres was much higher than in normal controls, and the diameter of these fibres was much larger, because of the large number of axons in each nerve fibre. Degranulation of mast cells was not seen. These findings suggest that pruritus in lichenified atopic skin is probably not caused by damage to the cutaneous free nerve endings. In such lesions, the number of the cutaneous free nerve endings is greatly increased, but they may have a normal function.

We examined cell loss (apoptosis) and proliferation in a histopathological spectrum of epidermal squamous cell neoplasia, including 11 cases of solar keratosis (SK), 18 Bowen's diseases (BD) and 19 invasive squamous cell carcinomas (SCC). Apoptotic and proliferative cells were determined by terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-digoxigenin nick end labeling (TUNEL) and by the detection of nuclear antigen Ki-67, respectively. Few apoptotic cells were observed in normal epidermis, while TUNEL index (TI; percentage of TUNEL-positive cells) was highest for SCCs, followed by BDs and SKs, in the order given. Although the mean Ki-67 index did not differ between SCCs and BDs, both disease types showed a significantly higher index than the SKs. Of SCCs, both TI and Ki-67 index values were significantly higher in poorly than in well differentiated carcinomas. TI was significantly higher in SCCs without P53 immunohistochemical expression than in SCCs with P53 expression, while TI and Ki-67 indices did not correlate with P53 expression in the SKs and BDs. These results suggest that apoptosis reflects not only cell loss, but also proliferative activity in the epidermal neoplastic lesions.

手掌の黄色線条を主訴に受診した49歳の女性。高脂血症を疑い精査した結果, コレステロール, 中性脂肪が共に高く, 電気泳動法でbroad βリポ蛋白が認められ, アポE蛋白の表現型がE2/2であったことからIII型高脂血症に黄色腫を合併した症例と診断した。黄色腫は手掌線条黄色腫のほかに肘頭, 膝蓋, 臀部, 足背部, アキレス腱部に結節性黄色腫を認めた。両側卵巣摘出後に高脂血症, 黄色腫の臨床症状が発現したことから本症例の発症に血漿エストロゲン濃度の低下が関与していることが疑われた。食餌療法, 高脂血症用剤, エストロゲン補充療法により高脂血症は改善し, 黄色腫も消退した。

We report a 79-year-old woman with primary cutaneous plasmacytoma in whom polymerase chain reaction (PCR) was used to demonstrate the monoclonality of the tumour. Four years after presentation, further skin lesions occurred and PCR again showed evidence of monoclonality despite the histology being non-specific. The reported frequency of multiple primary cutaneous plasmacytoma is increasing, and the mortality rate of patients with multiple lesions is three times that of those with a solitary lesion. PCR may be a useful technique for assessing such patients at presentation.

Sunburn cells appear in the epidermis after UVB irradiation and are histologically suggested to be keratinocytes undergoing apoptosis. We here show a known biochemical process of apoptosis, genomic DNA fragmentation, in rat skin. UVB irradiation induced sunburn cells in the epidermis of rat skin at a lower dosage and the cleavage of genome DNA to nucleosomal size units at dosages of more than 0.3 J/cm 2 . The fragmented DNA observed could be driven from the epidermis though the involvement of DNA in dermal cells cannot be neglected. PUVA treatment also induced sunburn cells and the fragmentation of genome DNA. The extent of DNA fragmentation by UVB irradiation was enhanced depending on the dosage and peaked at 12–24 h after the irradiation. The induction of the DNA fragmentation observed in this study indicates the presence of a common pathway related to the DNA damage-induced apoptosis in the skin, and might become a useful marker in the course of in vivo studies on the physiological role of apoptotic process in the skin.

Pilonidal sinusの1例を報告した。症例は24歳の男性。中学生の頃, 長時間の坐位を契機に尾骨部に有痛性の硬結を生じ時折排膿した。近医にて主に抗生剤で加療されるも難治であり病変は上方の仙骨部まで拡大した。初診時には仙骨部に有痛性の結節と尾骨部に毛髪を内包する瘻孔が認められ, 皮下にはこれらを結ぶように硬結, 浸潤を触れた。Pilonidal sinusの診断にて広範囲な病変の切除を施行し, 術中尾骨部瘻孔と仙骨部の結節が連続していることを確認した。病理組織学的検討では瘻孔は重層扁平上皮よりなる壁をもち, 尾骨部から皮下を上行し仙骨部結節に達していたが, 上皮性瘻孔壁はこの結節部分で消失していた。瘻孔内には毛髪が内包され一部は瘻孔先端で皮下組織へ排出され, また一部は上皮成分を貫通し多数の炎症性細胞浸潤がみられた。これらの所見は本症の後天説を裏付けるものであった。

A 39-year-old female presented with a rapidly enlarging and easily bleeding tumor on her right thigh. On physical examination, there was a 3×2.5cm, parallelogramatic, black and dark red tumor on the lateral portion of the right thigh. The tumor was radically excised with regional lymph nodes dissection, followed by receiving chemotherapy with DAV etc. Up to the present time, she has remained disease-free. Gross pathologically, the lesion consisted of a nodule and a flat-elevated part. Histopatho-logically, the nodule had central and bilateral portions. The former consisted of A-type-like cells similar to A-type of nevus cell nevus and B-type cells of the nevus cell nevus. There was gradual transition between them. The bilateral portions composed of highly atypical tumor cells showed expansive growth. The flat-elevated part consisted of A-type-like cells and spindle-shaped cells in the epidermis and the papillary dermis. Tumor cells of the regional lymph node metastasis had almost the same characteristics as those of A-type like cells. The tumor cells in local recurrence were mainly spindle-shaped.Immunohistochemistry showed common reactivity between A-type-like cells and tumor cells in the flat-elevated part, but the tumor cells in bilateral portion of the nodule had the characteristics different from those of A-type-like cells. These findings suggest that in this patient malignant melanoma arose from nevocytic cells in the dermis.

Primary cutaneous meningioma (PCM) is a rare tumor whose pathogenesis is quite obscure. We reported PCMs occurring on almost the same occipital region of two siblings studied by histology, immunohistochemistry, and electron microscopy. Both lesions were attached to duras, but extracranial. One lesion was histologically diagnosed as meningothelial meningioma; its tumor cells showed electron microscopically interdigitating cytoplasmic processes with junctional complexes. The other was interpreted as fibroblastic meningioma; its tumor cells were arranged linearly in a stepping-stone arrangement and had small dense bodies in the cytoplasm. The tumor cells stained positively with anti-vimentin antibody. Both lesions had adenomatous hyperplasia of the eccrine glands. Although the histologic and electron microscopic features of these two lesions slightly differed from each other, their pathogenesis was essentially considered to be acoelic or rudimentary meningocele.

We studied three cases of genital lichen sclerosus et atrophicus (LSA) using histological, immunohistochemical and ultrastructural techniques to elucidate the characteristics of the collagen fibres, the elastic fibres and the interfilamentous matrix in the upper dermal homogeneous zone. In the early stages of LSA, the homogeneous zone caused elaunin fibres to push downwards and partially disappear, the collagen fibres were presumably phagocytosed by fibroblasts, and there were peculiar cells containing numerous vacuoles in the cytoplasm. In the advanced stages of LSA, the homogeneous zones showed newly formed collagen fibres and amorphous, dispersed, medium electron-dense substances that were probably composed of elastin or elastin-like substances and microfilaments originating from the collagen fibres. Immunohistochemically, there were numerous anti-aortic alpha-elastin-positive substances, but there was no positivity for anti-amyloid P component. These findings suggest that in advanced LSA a hybrid substance (elastocollagenous mass) between collagen fibres and elastic fibres may be formed in the homogeneous zone.

Although solar keratosis (SK) is commonly classified histologically into five types i.e., hypertrophic, atrophic, acantholytic, bowenoid and pigmented types, we added another type, spongiotic clefting type, which has spongiotic suprabasal cleft. Squamous cell carcinoma (SCC) derived from SK has been reported to have such histologic types as de novo, acantholytic and bowenoid SCCKs and small celled carcinoma. Of 109 cases of SK studied, hypertrophic type was 56.9%, atrophic type 5.5%, acantholytic type 4.6%, bowenoid type 17.4% and spongiotic clefting type 15.6%, respectively. Of 17 cases of SCC from SK, de novo type was 23.5%, acantholytic type 47.0%, bowenoid type 5.9%, and small celled carcinoma 23.5%, respectively. Acantholytic type of SCC having the highest rate of occurrence, possibly, derives from acantholytic type of SK. Thus, it is supposed that tumor cells of acantholytic type of SK have higher tumor invading rate. Using PCNA and AgNORs as index of cell proliferating rate, we examined all types of SK. However we could not have any significant difference among them.

68歳女性。2年前より前額部の両外側に紫褐色の色素斑が対称性に出現し, 徐々に拡大した。眼球結膜, 口腔粘膜に同様の色素斑はなし。病理組織学的に表皮基底細胞の軽度メラニン顆粒の増加, 真皮中∼下層にかけてメラニン顆粒を多量に含む類円形ないし紡錘形の色素細胞が多数みられた。免疫組織化学的にこの色素細胞はS100蛋白陽性, α1-antichymotrypsin, lysozyme陰性でメラノサイトと同定した。電顕的には真皮メラノサイトのメラノソームはよく成熟した第IV期のもので, 表皮メラノサイトのそれと比して大型でtranslucent bodyが多数みられ, 形態学的にかなり異なるものであった。このことは, 病因として表皮の変性などによる表皮メラノサイトの真皮への滴落説は否定的で, いわゆる真皮メラノサイトの活性化説を支持する結果であった。

The lamina densa of normal human epidermis was exposed by treatment with 1 M sodium chloride and was examined by high-power scanning electron microscopy before and after trypsinization. Localization of type IV collagen in the lamina densa was also studied by transmission and scanning immunoelectron microscopy. Before trypsinization, the surface of the lamina densa consisted of microridges and microvalleys. The microridges varied in height and were connected with each other. They were arranged in a concentric fashion around the tips of the dermal microprojections. At a higher magnification, the surface of the lamina densa was composed of densely packed cobblestone-like structures approximately 7-15 nm in size, between which were interspaces 4-11 nm wide. These structures expressed type IV collagen. After trypsinization, the lamina densa was found to be composed of microfilaments approximately 10 nm thick showing beaded appearances. These microfilaments exhibited the same cobblestone-like structures as the lamina densa surface. Observation of the torn lamina densa demonstrated anchoring fibrils and oxytalan fibers that were attached to the lamina densa itself. Another kind of filament about 7 nm thick linked the anchoring fibrils and the oxytalan fibers. Beneath the lamina densa was a network of fibers about 40-50 nm thick, which was composed of collagen fibers and possibly also elaunin fibers. In conclusion, this study revealed the detailed surface ultrastructure of the epidermal lamina densa and its underlying filamentous elements.

We report a Japanese boy with centrifugal lipodystrophy. The initial lesion developed on the forehead as an area of erythema which showed centrifugal spread and central fading to leave a residual depression. Three years later, similar erythematous lesions appeared on the cheeks, and he developed a cadaverous appearance. A central depression on the upper trunk was surrounded by an erythematous border and there was right cervical lymphadenopathy. Histological examination revealed inflammatory changes in the subcutaneous fat. Although this patient showed the characteristics of both centrifugal and progressive lipodystrophy (partial lipodystrophy), we consider that he has centrifugal lipodystrophy of the face because of the overall features of the lesions.

The three-dimensional ultrastructure of molluscum contagiosum virus (MCV) in human skin was visualized using scanning-electron microscopy with the osmium-dimethyl sulphoxide-osmium method. There were spherical, ellipsoidal, brick-shaped, miniature and incomplete forms of MCV. In all the forms the surface had densely distributed small protrusions and all had the same ultrastructure. All the forms had one or two long cord-like substances that appeared to be linked together, but became short, vestigial or absent on the surface of the mature virus. The cord-like substances were connected to the core of the MCV. In the matrix between the viruses, the cord-like substances formed an intricate fine network.

A lesion of lichen nitidus in a 53-year-old man was examined by histology and electron microscopy. The histology showed typical features. The electron microscopy revealed primary changes in hydropic degeneration of basal cells which possibly indicated severe edema between the basal keratinocytes and in the subepidermal area. The basal keratinocytes themselves were not particularly altered, except for clustered micro-vacuolar structures in a small portion of the peripheral cytoplasm. In one of the eight blocks observed, the cytoplasmic process of a mast cell was found between the basal keratinocytes, indicating that mast cells may possibly infiltrate the epidermis in lichen nitidus. Scattered mast cells in the dermis were also noted. Thus primary pathologic changes of lichen nitidus may be induced by severe edema, which was accompanied by inflammatory cells including mast cells, in the region of the dermal-epidermal junction.

A 17-year-old boy had a keratinous cyst on the sole. The keratinous cyst and its overlying epidermis had solitarily scattered keratinocytes, which contained a peculiar intracytoplasmic inclusion body above the lower spinous layer. Immunohistochemistry and electron microscopy revealed that the nuclei of these cells had virions of papillomavirus. These virions appeared above the spinous layer. The inclusion bodies were highly eosinophilic masses in the viable layer, and slightly basophilic, fine granules in the cornified layer. Their number at any time was usually one. Their histologic and ultrastructural features and their N-(7-dimethylamino-4-methylcoumarinyl)-maleimide staining property were different from those of keratohyalin and from those of amyloid or hyaline body. Also the keratinous cyst was associated with colloid bodies, showing the lamellated figure in the subepithelial area.

A 40-year-old woman who had used nylon towels in the bath for about 10 years noticed hyperpigmentation on the prominent regions over the bones of the trunk and extremities. She also developed lichenoid papules with itching on her back. Histologically, both the pigmented and the papular lesions had amyloid deposits beneath the epidermis. In this case it is presumed that the papular lesions with amyloid (lichen amyloidosus) developed initially from friction melanosis which became macular pigmented lesion (macular amyloidosis). The etiologic factor of these sequential pathologic changes is considered to be repeated scrubbing with nylon towels.

A seventeen-month-old female had a pigmented nodule on her left lower leg. The excised lesion was histologically diagnosed as a Spitz nevus, composed mainly of spindle-shaped melanocytes containing large amounts of melanin pigment. When nodular regrowth was seen at the operative site, the recurrent lesion was radically excised as nodular melanoma. However the histological characteristics of the second excised specimen were essentially the same as those in the initially excised one except for the existence of the newly formed collagen fibers, which may suggest an involuting stage in the central portion of the lesion.

10歳男子の左下腿に生じた悪性黒色腫を報告した。病変は左膝蓋下部の紅色腫瘤で, 病理組織検査の結果, amelanotic typeの結節型悪性黒色腫と診断した。広範囲腫瘍切除術, 左浅鼠径リンパ節廓清術を施行し, リンパ節の1個に転移を認めた。術後, DAV化学療法5クール, ベスタチン1日30mg内服にて加療し現在までのところ再発をみていない。思春期以前に発症する悪性黒色腫の頻度は低く, 前駆症として巨大色素性母斑などが知られているが, 自験例は前駆症を有さず, また, amelanotic typeであり, まれな症例と思われた。

We present a patient with microcystic adnexal carcinoma. The lesion was an indurated plaque on the skin of the right upper lip of a 58-year-old woman which was slowly growing during 27 years. Carcinoembryonic antigen was immunoreactive in the luminal contents of the tumor ducts and in the cytoplasm of cells surrounding ducts. S-100 protein was positive in the cytoplasm of a few cells at the lower dermis. These observations suggested that this tumor was related to sweat glands. Furthermore, electron microscopy revealed that tumor cells had features of eccrine ductal cells. These observations confirm that this tumor appeared at least capable of eccrine duct differentiation.

1980年1月から1989年12月までの10年間に, 鳥取大学皮膚科に受診したPaget病15例について, 乳房Paget病2例と, 乳房外Paget病13例に分けて検討した。治療は全例に手術が施行された。乳房外Paget病のうち4例に所属リンパ節転移がみられ, 全て臨床的に腫瘤を形成していた。そのうち2例が腫瘍死の転帰をとった。

表在性BCEとボーエン病の各1例に対してrIL-2局注を行った。投与終了時の組織所見でいずれも好酸球を含む炎症性細胞浸潤と腫瘍細胞が正常表皮細胞様に分化した像が見出された。BCE例の免疫組織化学所見ではOKT 8陽性suppressor/cytotoxic T細胞が多く認められた。IL-2の上皮性腫瘍に対する作用機序として, 表皮細胞調節に関与し, 癌の再分化を誘導する可能性が示唆され, 興味深い所見と考え報告した。

76歳の女性。口腔粘膜全体に粗大網状の黒褐色色素斑, 舌に灰褐色色素斑, 全手指足趾に爪甲色素線条と指尖から指腹にかけての淡褐色斑が認められた。口唇粘膜の病理組織学的所見では粘膜上皮内のpigment blockade melanocyteと基底細胞層のメラニン色素の増加が認められたが, 基底層メラノサイト数の増加は認められなかった。自験例ではPeutz-Jeghers症候群やAddison病を示唆する所見はなく, その特徴的な皮膚症状からLaugier-Hunziker症候群と診断した。

We report an autopsy case of Epstein-Barr virus (EBV)-infected malignant lymphoma in a young male who had hypersensitivity to mosquito bites. The autopsy revealed multiple confluent lymphoma lesions in the lungs, and on the right leg irregular-shaped skin ulcers were seen. The left pleural effusion also contained a large number of lymphoma cells. The lymphoma cells were determined as T/NK-cell type cells by immunohistochemistry. EBV DNA was detected most intensively in the lungs and EBV-encoded small RNAs-positive lymphoma cells were also observed in the lungs at a high frequency. EBV latent membrane protein-1 expression and a high Ki-67 labeling indices were noted in the lymphoma cells of the lung lesions. These findings indicate that the development of the malignant lymphoma was associated with the proliferation of EBV-infected lymphoma cells, and the cells that infiltrated the whole the body, especially the lungs, caused the patient's death.

A total of 272 men and 252 women with cancer participated in a study of the impact of being married and the presence of spousal support on psychological distress and coping with cancer. All participants underwent a structured interview and completed the Profile of Mood States and the Mental Adjustment to Cancer scale. Multivariate analysis controlling for potentially confounding biomedical and psychosocial variables revealed that unmarried men had significantly higher levels of psychological distress and lower levels of fighting spirit than married men, and that men with spousal support showed higher levels of fighting spirit than men without spousal support. However, no such difference was observed between unmarried and married women or between women with and without spousal support. These findings suggest that being married may play an important role in reducing psychological distress and enhancing fighting spirit of men with cancer, and that being unmarried may be a risk factor for psychological distress and lower fighting spirit for men with cancer.

We describe serpiginous erythema with alopecia developing on the scalp of a 10-year-old boy during follow-up of centrifugal lipodystrophy. Because the clinical and histopathologic features of these lesions were identical to those of centrifugal lipodystrophy, we conclude that involvement of a hairy region by this disorder could cause alopecia and that the hair loss might be an indirect effect of interstitial inflammatory infiltrates around the hair follicles and in the subcutaneous fat.

A case study was undertaken to determine whether or not the same dermal histiocytes could phagocytose both melanin and hemosiderin simultaneously. A biopsy specimen was taken from a pigmented lesion of the lower leg of a 57-year-old woman with stasis dermatitis. The specimen was processed for histology, conventional transmission electron microscopy and electron-probe X-ray microanalysis. Histologically, numerous histiocytes with their cytoplasm packed with either Prussian blue-positive granules or Fontana-Masson-positive granules were distributed almost equally in the dermis. Electron microscopically, the dermis had many histiocytes with their cytoplasm containing solitary or compound electron-dense substances. The electron-dense substances were classified into three types according to their degree of electron density. By electron-probe X-ray microanalysis, these electron-dense substances were classified into iron-containing and non-iron-containing substances. Both substances were seen in the cytoplasm of the same histiocytes and even in the same compound electron-dense substance. The former were siderosomes and the latter were probably melanosomes. These results show that the same dermal histiocytes probably phagocytose non-selectively both hemosiderin and melanin granules.

疼痛持続1ヵ月以上の帯状疱疹後神経痛の患者10名(男性4名, 女性6名, 年齢32歳∼82歳)に, 0.025%カプサイシン軟膏を1日2回疼痛部に外用し, 6例に有効性を認めた。なお4例に塗布後の灼熱感を認めた。カプサイシンの作用機序として, 神経細胞や神経末端における痛みの神経伝達物質であるサブスタンスPの放出を促し, 蓄積を抑制すると考えられている。カプサイシン軟膏は難治である帯状疱疹後神経痛に対する新しい治療剤のひとつと思われた。