- Necrobiotic Xanthogranuloma with Paraproteinemia: A case report.
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Yee Jeong Kim, Kwang Gil Lee, Soo Il Chun, Hyung Soon Lee
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Korean J Pathol. 1991;25(6):589-593.
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- Necrobiotic xanthogranuloma(NXG) is a characteristic cutaneous manifestation associated with paraproteinemia. A case of NXG associated with an IgG (lambda) monoclonal gammopathy occurred in a 48-year-old man. Skin lesions were dome-shaped, hard palpable nodules, 2x3 cm to 4x4 cm sized, on both arms and forearms. They were arranged in a linear pattern. Also, hard palpable tumors, 1x2 cm to 2x3 cm in size, were present on the left leg and the dorsum of the left foot. They were violaceous, slightly protruded, and hard on palpation. Histologically, the lesion was characterized by inflammatory xanthogranuloma with broad hands of hyaline necrobiosis. Many foreign body type of bizarre giant cells, Touton type of giant cells and foamy histiocytes were infiltrated into the dermis and subcutaneous fat tissue. Three days after medication with ledercort and immuran, the cutaneous masses decreased in size and became soft.
- A Pathologic Study of Lymphoproliferative Disorders of the Skin.
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Yee Jeong Kim, Kwang Gil Lee, Soo Il Chun, Yun Woong Ko
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Korean J Pathol. 1991;25(6):551-562.
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- Forty eight skin biopsies obtained from 24 patients were reviewed, and clinical, histological and immunohistochemical findings were analyzed. Results obtained are as follows: 1) Skin manifestation was plaque, erythroderma, scale and hyperpigmentation in mycosis fungoides, and subcutaneous nodule, mass and ulcerated patch in cutaneous lymphoma. The skin of lymphomatoid papulosis revealed hemorrhagic ulcerated and erythematous papules which healed spontaneously. 2) Histologically, mycosis fungoides showed epidermotropism in most cases. Pautrier's micro-abscesses were present in one-fourth of the cases. Malignant lymphoma was different in histology from mycosis fungoides. As compared with mycosis fungoides, it showed less frequent epidermotropism, more compact and diffuse infiltration of atypical lymphocytes, more often association with ulcer and necrosis, and more frequent mitotic figures. Lymphomatoid papulosis showed striking hemorrhage and edema of the papillary dermis. 3) Based on the results of immunohistochemical study, mycosis fungoides and lymphomatoid papulosis were considered as a T cell proliferative disorder of the skin. According to these findings, lymphoproliferative disorders of the skin occurred predominantly in the elderly and males. Clinical and histopathologic findings overlapped and were similar each other. It was difficult to make a definite diagnosis in early lesions, and a sequential follow up biopsy was required. It is concluded that strict criteria such as marked atypia and clustering of atypical cells are necessary for a histologic diagnosis of malignant lymphoproliferative disorder of the skin.
- Skin Lesions in Secondary Syphilis.
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Sung Ku Ahn, Kwang Gil Lee, Soo Il Chun, Jung Bock Lee
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Korean J Pathol. 1989;23(2):254-262.
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- We reviewed 37 skin biopsies obtained from 35 patients with secondary syphilis during the period of 9 years from January 1980 to June 1988, which had been diagnosed by dark field examination, serologic tests for syphilis, and identification of spirochetes by immunoperoxidase method (avidin-biotin complex) in the skin biopsies. We investigated the histologic features of the skin lesions in secondary syphilis according to the types and patterns of inflammatory cell infiltration in the dermis, vascular reactions and epidermal changes. We matched these histologic findings with the clinical features of the skin lesions. The results were as follows; 1) The histologic patterns of dermal infiltrate in order of frequency were as follows; junctional pattern in 14 biopsies (38%), lichenoid pattern in 10 biopsies (27%), diffuse pattern in 5 biopsies (14%), patchy pattern in 3 biopsies (8%), normal pattern in 3 biopsies (8%) and undertermined in 2 biopsies (5%). 2) The dermal infiltration of plasma cells was found in 24 biopsies (65%). All the biopsies of diffues and lichenoid patterns, 7 biopsies of junctional and one biopsy of patchy pattern showed plasma cells but none in normal pattern. 3) Eosinophils were observed in the dermis in 11 biopsies (30%). There was no difference in incidence of eosinophils in the dermis among morphologic patterns. However, they were frequently seen in the dermis and epidermis of condyloma lata (4 of 7 biopsies). 4) The vascular changes in the dermis included endothelial cell swelling in 23 biopsies (62%), endothelial cell proliferation in 22 biopsies (60%) and vascular dilatation in 10 biopsies (27%). They were most commonly observed in the lichenoid pattern followed by diffuse and junctional patterns. Three cases showed lymphocytic vasculitis. 5) Epidermal changes were seen in all of the biopsies exocytosis, parakeratosis, hydropic change of basal cells, acanthosis, spongiosis, keratinocyte necrosis and hyperkeratosis in the order of frequency. 6) In relation to the clinical manifestations, junctional pattern (14 biopsies) consisted of 6 papulosquamous lesions, 5 macules and 3 papules. Lichenoid pattern (10 biopsies) consisted of 7 papulosquamous lesions and 3 papules. All the biopsies showing diffuse pattern (5 biopsies) appeared in condyloma lata. Patchy pattern (3 biopsies) consisted of 2 macules and 1 papule. All of the normal pattern (3 biopsies) appeared in macules. In conclusion, with dermal and epidermal changes, the acknowlegement of the 5 basic histologic patterns in secondary syphilis seems to be very helpful for the diagnosis of syphilis.
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