Cutaneous lymphangitic carcinomatosis and acquired ichtyosis associated with prostatic carcinoma

BACKGROUND: Prostatic adenocarcinoma is exceptionally associated with cutaneous lesions. We describe a patient with cutaneous lymphangitis and paraneoplastic ichtyosis related to prostatic cancer. CASE REPORT: A 92 year-old man had been treated for five years for a prostatic carcinoma. An angiomatous lesion developed with in 3 months near the right breast. Physical examination revealed axillary node enlargement, a large skin angiomatous lesion, and ichtyosis. The skin biopsy of the angiomatous skin lesion demonstrated its prostatic origin with carcinomatous metastases in the lymphatic vessels. The ichtyosis was considered as paraneoplastic. DISCUSSION: Cutaneous metastases from prostatic carcinoma are rare. Less than 1 p. 100 of cutaneous metastases are of prostate origin despite the high frequency of this cancer in the general population. The clinical aspects - angiomatous lesion and paraneoplastic ichtyosis - are exceptional.     

Metastatic prostatic carcinoma histologically mimicking malignant melanoma

Prostatic carcinoma rarely metastasizes to the skin. We describe a case in which inguinal metastasis occurred. Histologically, the tumor was composed of pale-staining cells which had pronounced epidermotropism, producing a pagetoid pattern mimicking that seen in malignant melanoma. The diagnosis was confirmed by demonstrating prostatic specific antigen in tumor cells.     

Multiple prostatic abscesses presenting with urethral discharge.

Prostatic abscess has become less common, is now usually related to urinary tract infection, and is a rare cause of urethral discharge. The case is described of a man with prostatic abscesses caused by Staphylococcus aureus possibly related to recent skin abrasions. Transrectal ultrasound was used to make the diagnosis and to facilitate repeated drainage with a successful outcome.     

Cutaneous metastasis of prostatic adenocarcinoma: a cautionary tale

With the exception of skin cancer, prostatic adenocarcinoma represents the most common cancer among men in the United States and the second most common cause of cancer mortality. Mortality is often associated with metastatic disease, which in the case of prostatic adenocarcinoma typically involves bones and only rarely affects the skin. Although clinical history and examination, laboratory tests and routine pathology can suggest the prostate as a source of metastatic disease, immunohistochemistry - specifically, for prostate-specific antigen (PSA) - is often used to help establish the diagnosis. We report a case of cutaneous metastatic prostatic adenocarcinoma presenting in the inguinal region of a 78-year-old man 5 years after his initial diagnosis. The case is unusual in that the clinical appearance mimicked a vascular proliferation and in that the metastatic prostatic adenocarcinoma failed to express PSA. Rather, expression of prostatic acid phosphatase was observed.     

Behaviour of Sarcoptes scabiei in its burrow in hyperkeratotic scabies. A scanning electron microscopic study

The behaviour of Sarcoptes scabiei var. hominis has been studied in the skin of 2 patients with hyperkeratotic scabies. After examination under the scanning electron microscope, the skin specimens can be reprocessed for light microscopic examination. Original aspects and the dynamics of the burrowing parasite are presented, namely its penetration into the epidermis, the elimination of digestive residues and the maturation of the parasite's eggs.     

Paget's disease of the scrotum: a case exhibiting positive prostate-specific antigen staining and associated prostatic adenocarcinoma

A 75-year-old man with carcinoma of the prostate presented with a pruritic, erythematous plaque involving the scrotal skin. Histological examination revealed extramammary Paget's disease. The intraepidermal tumour cells expressed prostate-specific antigen in keeping with a prostatic origin.     

Case of chromoblastomycosis appearing in an Okinawa patient with a medical history of Hansen's disease

Chromoblastomycosis is one of several chronic infectious skin diseases caused by various species of dematiaceous fungi. It is clinically characterized by verrucous skin eruptions and occurs most commonly in tropical and subtropical regions. In Okinawa, a subtropical area, there have been only three reported cases of chromoblastomycosis including the present one. Direct microscopic examination of crust specimens and findings of sclerotic cells in histopathology can confirm the diagnosis, and cultures of crust and/or tissue specimens can identify the causative fungi. We herein report the third case of chromoblastomycosis in Okinawa; it arose in an 87-year-old Japanese woman with a history of Hansen's disease, who lived in a leprosarium in Miyako Island. To identify the causative agent as Fonsecaea pedrosoi, we used the polymerase chain reaction and direct sequencing analysis in addition to the usual methods, which include 20% potassium hydroxide microscopy, histopathological confirmation of sclerotic cells by periodic acid-Schiff stain, culture by Sabouraud's glucose agar, slide culture method, and observation of conidia by scanning electron microscopic examination.     

前列腺内注射结合前列腺穿刺抽脓治疗前列腺脓肿38例临床分析

目的:探讨前列腺脓肿(prostatic abscess,PA)的临床特点,总结治疗体会。方法:对2006年7月～2011年10月治疗的全部38例PA病例按病史、症状、体征、辅助检查及治疗恢复过程进行总结,探讨PA临床特点,总结治疗体会。结果:大部分患者有急性泌尿系感染和糖尿病史,来我院前经口服和输液治疗效果不佳。与单纯前列腺炎相比,PA患者往往出现发热,一部分患者还有高热寒战等中毒症状,尿痛、会阴部腰骶部坠疼,中老年患者往往伴有尿潴留。一部分患者的前列腺液或尿液可检测出脓细胞。38例患者经前列腺穿刺抽脓和前列腺内注射敏感抗生素结合全身用药全部治愈。结论:PA患者症状重、并发症多,单纯口服药物和输液效果不佳,综合治疗,尤其前列腺内注射敏感抗菌药物结合前列腺穿刺抽脓充分引流的方法具有明显效果,创伤少、治愈率高,可避免海底漏和其他并发症的形成。     

The investigation of superficial fungal infections by skin surface biopsy

The skin surface biopsy technique using a cyanoacrylate contact cement was employed for the diagnosis and study of superficial mycoses. The biopsy specimens were used for quick direct examination after treatment with potassium hydroxide and blue-black ink, direct examination after staining with the periodic-acid Schiff method, fungal culture and scanning electron microscopy. Skin surface biopsies were taken from 124 patients for one or more of these purposes. Direct examination and culture of the specimens proved simple, and reliable for diagnostic use in clinical practice. In addition, the morphology of the infective agent could easily be studied in detail in its in vivo arrangement in the intact sheets of horny layer, either in stained preparations or under the scanning electron microscope.     

The effects of bergapten and sunlight on cutaneous pigmentation

The effects of bergapten-containing preparations in sunlight-induced skin pigmentation were evaluated. Oil and lotion vehicles with bergapten/UV-B sunscreen or sunscreen alone were applied to the backs of subjects twice weekly for 4 weeks and the subjects were exposed to gradually increasing doses of midday sunlight. The degree of skin darkening was assessed by clinical examination, reflectometry, and light microscopy of skin biopsy specimens. At 5 weeks, 1 week after the last sunlight exposure, the sites treated with either the bergapten/UV-B sunscreen lotion or the lotion vehicle were significantly darker than the sites treated with the sunscreen lotions without bergapten. Oil preparations produced less clearcut results, possibly because of a less potent sunscreen or because the bergapten did not leave the vehicle and absorb into the epidermis. In type I skin, the bergapten/sunscreen and the oil vehicle alone produced the same amount of tanning; both yielded more tanning than the sunscreen in oil by clinical examination. The findings were not confirmed by reflectometry or by light microscopy. Thus, we conclude that bergapten added to a UV-B sunscreen lotion preparation can increase skin pigmentation over the sunscreen alone when one is exposed to sunlight. The bergapten/UV-B sunscreen combination is a potentially useful product since one can develop a psoralen and UV-A-induced tan while being protected from UV-B-induced sunburn by the UV-B sunscreen incorporated into the formulation.     

Cytodiagnosis of cutaneous basal and squamous cell carcinoma

OBJECTIVE: We performed a prospective study to evaluate the diagnostic accuracy of cytologic examination in basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), in order to assess its clinical value. Study design Samples were taken by the "scraping" technique which involves scraping with a scalpel blade directly over the skin tumor surface, smearing the cells onto several glass slides, and fixing them with "citospray." The specimens were stained with the Papanicolaou stain. Punch biopsies were taken to confirm the clinical and cytologic impression. RESULTS: We collected 45 skin tumors in total, clinically presumed to be either BCC (n = 15) or SCC (n = 30). Imprint cytology demonstrated to be of help in the rapid diagnosis of skin tumors. CONCLUSIONS: Cytologic examination is easy to perform, saves time, provides a rapid diagnosis, and can be considered, under experienced hands, reliable in the confirmation of malignant skin tumors. Cytology does not give much information about tumor patterns or subtypes which can be related to aggressive behavior and can be very important in further therapeutic decisions. Therefore, histopathologic confirmation is mandatory before any therapeutic maneuver.     

Early leprosy with perineural proliferation

A 62-year-old woman, who lived in an area of the United States nonendemic for leprosy, was seen for an enlarging anesthetic lesion that involved the entire left breast. Microscopic examination of skin biopsy specimens taken from the edge of the lesion disclosed chronic perineural inflammation and neural proliferation, with an acid-fast bacillus demonstrable in one nerve. Granulomas, giant cells, epithelioid cells, nerve abscesses, or other characteristics of tuberculoid leprosy were not seen. This woman had a skin lesion of leprosy in an atypical site. It appeared to be indeterminate on pathologic examination and was accompanied by an unusual degree of neural proliferation.     

Studies on the effect of salicylic acid on normal skin

This investigation was prompted by our ignorance of the way in which salicyhc acid aids desquamation. Salicylic acid in aqueous cream or white soft paraffin and in concentrations of 2–12%, was applied to normal skin of twenty-three subjects while the vehicle alone was apphed to the contralateral sites. Biopsies and skin surface biopsies were taken from the test and control sites after 1 week. Histological examination showed that there was less horny layer on the test specimens but that there were no qualitative or quantitative differences in the structure of the viable epidermis. Portions of the biopsies were incubated in the presence of tritiated precursor compounds and subsequent autoradiographic examination showed no difference in the incorporation of thymidine, cytidinc or histidine between test and control preparations. Scanning electron microscopy of skin surface biopsies showed some changes in all specimens—presumably due to hydration—but also showed strking differences between test and control sites and were especially marked with higher concentrations of salicylic acid. It is suggested that salicylic acid causes desquamation by dissolution of intercellular cement material.     

Acrokeratosis paraneoplastica (Bazex' syndrome). Report of a case and review of the literature

Acrokeratosis paraneoplastica (Bazex' syndrome) is a rare but clinically distinctive dermatosis that has been associated in all reported cases, to our knowledge, with either a primary malignant neoplasm of the upper aerodigestive tract or metastatic cancer to the lymph nodes of the neck. Acrokeratosis paraneoplastica was found in a 53-year-old black man with squamous cell carcinoma of the tonsil. A distinctive series of changes was found on histopathologic examination of biopsy specimens taken from his skin lesions, and direct immunofluorescence microscopy of both lesional and nonlesional skin specimens showed immunoglobulin and complement deposition on the epidermal basement membrane. The skin lesions largely resolved following radiation therapy of the neoplasm and of the presumably involved lymph nodes.     

Presence of melanophages in the normal Japanese skin

Human skin samples were obtained from the normal peripheral portion of specimens removed from persons with various cutaneous and systemic diseases. A portion of each specimen was embedded in paraffin and another part in water-soluble embedding medium, and some was frozen in liquid nitrogen for light microscopy and histochemistry. Some specimens were also investigated by electron microscopy. In 31 of 32 specimens, cells containing brown pigment were observed in the superficial dermis. Because both acid phosphatase and Masson-Fontana staining were positive and the 3,4-dihydroxyphenylalanine reaction negative, the cells were considered to be melanophages. Electron microscopic examination revealed that these cells contained melanosome-laden phagosomes. Some fibroblastlike cells were also observed with intracellular single or multiple melanosomes. This study documents the occurrence of melanophages in the normal skin of Japanese subjects.     

Cytoid bodies in cutaneous direct immunofluorescence examination

BACKGROUND: The clinical significance of scattered or grouped cytoid bodies seen on direct immunofluorescence (DIF) examination has not been systematically analyzed in a variety of disorders. METHODS: We prospectively studied skin biopsy specimens obtained from July 2002 to December 2005 for which DIF examination using immunoglobulin (Ig) A, IgG, IgM, C3 and fibrinogen had been performed. Slides with cytoid bodies were further reviewed to assess the number, intensity and location of the cytoid bodies and for other specific findings. These data were compared with both clinical records in the medical charts and pathologic findings from concurrent skin biopsies. RESULTS: Of 1080 DIF examinations performed during the study period, 117 (10.8%) had cytoid bodies. These specimens were from patients with 28 different cutaneous disorders, the most common of which were various forms of lupus erythematosus (29/117, 24.8%) and erythema multiforme (22/117, 18.8%). In 81 (69.2%) of these specimens, interface dermatitis was found histopathologically. CONCLUSION: Cytoid bodies are not infrequent on DIF examination and, in the absence of a clear diagnosis, might point toward several common disorders, particularly those involving interface dermatitis.     

Protooncogene (C-Myc) expression in the infiltrating cells of lesional skin from patients with systemic lupus erythematosus

Polyclonal activation of lymphocytes due to an unknown cause is considered to be one of the most important findings of systemic autoimmune disorders including systemic lupus erythematosus (SLE). In order to confirm the expression of the C-Myc protooncogene in lesional skin, tissue specimens from SLE were examined by the histo in situ hybridization method and a histochemical method using a specific antibody reactive with C-Myc related products. Twenty-two cases of SLE, six cases of DLE, one case of lupus erythematosus profundus, two cases of lichen planus, and five skin specimens from healthy volunteers were selected for the examination. In the SLE group, further comparative examination of diseased skin and normal skin from the same patient, and of diseased skin in an active stage and a stable stage in the same SLE patient with renal involvement, were carried out. In most of the active SLE cases, protooncogene expression had apparently increased as compared with the expression in the groups of inactive and treated SLE, active DLE, active lichen planus, and those with healthy skin. Even in normal-appearing skin from active SLE without other organic failure, the protooncogenes were not expressed very strongly.     

天疱疮及大疱性类天疱疮外观正常皮肤的免疫荧光检查

本文报告9例天疱疮及8例大疱性类天疱疮外观正常皮肤DIF检查结果.“正常”皮肤取自皮损外3cm、5cm及远隔部位,结果均为阳性.同时取自皮损材料对比检查,其反应情况与病期、病情、取材部位及皮损距离等均无明显差异.因此,采取“正常”皮肤作DIF检查对大疱性疾病的诊断是非常有价值的.     

Post-cardiac transplant reactivation of Chagas' disease diagnosed by skin biopsy

Reactivation of Chagas' disease in immuno-compromised hosts may represent a recognizable clinical syndrome that can be diagnosed by examination of skin biopsy specimens of characteristic lesions resembling ordinary bacterial cellulitis. This syndrome appears to result in significant morbidity, which can be avoided with the institution of prophylactic therapy for Chagas' disease. An awareness of this complication of immunosuppression is of paramount importance for the thousands of asymptomatic persons infected with Chagas' disease currently living in the United States and abroad.     

Granular Cell Variant of Dermatofibrosarcoma Protuberans (DFSP)

Adenocarcinoma of the prostate is the most common visceral malignancy in men and has a tendency to metastasize to the axial skeleton, lungs, adrenal, and liver. Cutaneous metastasis is extremely rare and portends resistance to therapy and poor prognosis. We report an unusual case of metastatic prostatic adenocarcinoma to the penile skin. A 77‐year‐old man presented with two‐month history of a subcutaneous nodule on the dorsal aspect of the glans penis in the region of the coronal ridge. The patient was seven years status‐post radical prostatectomy for adenocarcinoma of the prostate, and had previously received both radiation and hormonal therapy for metastatic bone disease. The penile nodule was excised and microscopic examination showed infilteration of the dermis by malignant acini exhibiting a cribriform growth pattern and central comedonecrosis. Immunohistochemical staining revealed that the tumor cells were negative for prostate specific antigen (PSA), thyroid transription factor‐1, cytokeratin 7, and cytokeratin 20, but were strongly and diffusely positive for prostatic acid phosphatase (PAP). Based on these findings, a diagnosis of metastatic prostatic adenocarcinoma was established. In addition to the unusual location on the penis, this case also demonstrates the importance of immunostaining for PAP when metastatic prostatic adenocarcinoma is suspected.