24歳,男性。初診の5ヵ月前に腹痛と発熱を生じ,胃腸炎と診断されたが,抗生剤内服で軽快した。初診の4ヵ月前に陰嚢の硬結に気がついた。発熱・陰嚢腫大を伴うようになり,切開排膿・抗生剤による治療を行われたが,症状を繰り返したため,当科へ紹介された。左陰茎基部に腫脹と皮下硬結があり,圧迫にて排膿がみられた。陰嚢の瘻孔を壁ごと全切除する目的に全身麻酔下で手術を行ったが,瘻孔は背側(肛門方向)の深部まで続いており,広範囲の死腔と不良肉芽を認めた。腹部CTでは陰茎根部左側から肛門管左側にかけて軟部影がみられた。また,創部培養からは腸内細菌が検出された。病理組織学的に非乾酪性類上皮細胞肉芽腫がみられなかったが,陰嚢の瘻孔が腸管と連続している可能性を考え,消化器内科・外科へ紹介し,クローン病(以下CD)と診断した。CDの皮膚病変は多彩であり,難治性・再発性の瘻孔ではCDに伴う痔瘻の可能性を考慮する必要がある。(著者抄録)

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.2340/actadv.v103.13424

PubMed

担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

BACKGROUND: Bowen disease, one of the common skin cancers, is defined as squamous cell carcinoma in situ, characterized by atypical keratinocytes occupying the full thickness of the epidermis, and predominantly occurs on sun-protected skin. There is no existing data on the impact of tumour and immune cell interactions or cytokeratin expression on the pathology of Bowen disease. OBJECTIVES: We analysed dynamic changes in cytokeratin expression and immune cell composition during the development and progression of Bowen disease. MATERIALS & METHODS: Analysis was performed using immunohistochemistry and electron microscopy for samples from 140 patients with Bowen disease and 20 patients with invasive squamous cell carcinoma. We evaluated cytokeratin expression, the number of infiltrating immune cells and amyloid deposition by immunohistochemistry, and the ultrastructural relationship between tumour cells and immune cells by electron microscopy. RESULTS: The results showed that the expression of CK14 is associated with tumour progression, keratotic status and amyloid deposition and that the expression of CK10 is associated with accumulation of immune cells in Bowen disease. The findings of electron microscopy indicated repeated battles involving immune cells in response to tumour invasion. CONCLUSION: The expression of cytokeratins, hyperkeratosis, inflammatory infiltration and amyloid deposition are useful findings indicating the "stage" in Bowen disease.

DOI： 10.1684/ejd.2023.4497

PubMed

担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）   国際・国内誌：国内誌  

DOI： 10.2302/kjm.2023-0010-ir

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.2340/actadv.v102.2421

PubMed

担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

Cutaneous adnexal malignancies include various types of malignant tumors that show differentiation of cutaneous appendages. They can be classified into sweat gland, hair follicle, and sebaceous gland differentiations. All types of cutaneous adnexal tumors are rare and standard treatment options based on valid evidence have not been established. Although prognosis differs depending on the type of cutaneous adnexal malignancy, surgery is the mainstay of treatment. In surgical treatment, an adequate surgical margin is unclear for wide local excision. Mohs micrographic is a better option than wide local excision in terms of margin control and cosmetic outcome because the face, head, and neck are favorable sites for some cutaneous adnexal malignancies. There has been no randomized trial of radiation therapy and chemotherapy for any cutaneous adnexal malignancies. Radiation therapy should be considered if the tumor cannot be removed surgically. Chemotherapy is one of the options for metastatic cases in some types of cutaneous adnexal malignancies, but evidence of the effectiveness of chemotherapy is lacking. Recent studies have revealed genetic mutations in this field, and target therapy and immunotherapy may be promising treatment options for unresectable cutaneous adnexal malignancies in the future.

DOI： 10.1007/s11864-022-00971-3

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.1111/cod.13991

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.2340/actadv.v101.568

PubMed

担当区分：責任著者   掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.4103/ijd.ijd_1039_20

PubMed

担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.4103/ijd.IJD_15_19

PubMed

担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.1684/ejd.2021.4130

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.1684/ejd.2021.4088

PubMed

症例は74歳女性で、左足底の末端黒子型黒色腫と診断され、2年前に完全切除およびセンチネルリンパ節生検が施行されていた。センチネルリンパ節生検陽性であったが、患者は完全リンパ節郭清を拒否していた。ニボルマブによる1年間の術後補助療法が施行された。術後補助療法終了後4ヵ月で、超音波検査にて鼠径部リンパ節に異常を認めた。リンパ節生検を施行したところ、切除したリンパ節は黒色であり、病理組織学的には転移したメラノーマ細胞で占められていた。また、超音波検査にて正常な外観を呈していた隣接するリンパ節も黒色であり、病理組織学的には転移病巣であることが示された。骨盤内リンパ節にも僅かに腫脹が認められたが、患者が鼠径・骨盤内リンパ節郭清を拒否したため、ペムブロリズマブ投与が行われた。ペムブロリズマブ投与開始1年後に遠隔転移は認められなかった。

担当区分：筆頭著者   国際・国内誌：国内誌  

Recent studies have shown that complete lymph node dissection (CLND) performed immediately did not improve the overall survival in patients with sentinel lymph node (LN)-positive melanoma. According to these results, nodal observation with ultrasonography becomes standard. However, it still has some limitations for detection of metastatic LNs. A 74-year-old woman was diagnosed with acral lentiginous melanoma of her left sole. The sentinel LN was positive for metastasis, but she refused CLND. Sixteen months after operation, ultrasonography showed an abnormal LN in the inguinal region. There was no other abnormal LNs around the LN. We resected the abnormal LN. The resected LN was black in color, and the adjacent LN that showed normal appearance in ultrasonography was also black. A recent study showed only 6.6% sensitivity in preoperative ultrasonographic detection of metastatic melanoma in a LN. We should keep in mind the limitation of ultrasonography for detection of a metastatic LN.

DOI： 10.33160/yam.2021.08.008

PubMed

担当区分：筆頭著者   国際・国内誌：国際誌  

In mycosis fungoides (MF), cutaneous granuloma formation is unusual. Furthermore, MF showing interstitial granuloma, a rare type, after combination therapy with interferon-gamma (IFN-γ) and narrowband UVB (nbUVB) has not been previously reported. A 77-year-old man was referred to our hospital with a 2-month history of erythroderma. Biopsied specimens revealed infiltration of atypical lymphocytes and eosinophils. A diagnosis of an erythrodermic variant of MF was made. He was treated with combination therapy of IFN-γ and nbUVB. After the therapy, papules newly appeared and a histopathological specimen revealed interstitial granuloma. There were several CXCR3-positive cells around the granuloma. We speculated that the combination therapy made T-helper 1 cells migrate to the cutaneous lesion and resulted in the granuloma formation. Furthermore, judging from the disappearance of elastic fibers around the interstitial granuloma, we considered that IFN-γ may induce the infiltration of histiocytes interstitially after damage of elastic fibers caused by nbUVB therapy, and both IFN-γ and nbUVB may thus play an important role in the histogenesis. Not only histopathology but also immunological observations are needed to elucidate the mechanisms underlying the development of different types of granuloma in MF.

DOI： 10.1111/cup.13960

PubMed

担当区分：責任著者   掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

Palisaded neutrophilic granulomatous dermatitis (PNGD) and interstitial granulomatous dermatitis (IGD) are rare granulomatous disorders. Differential diagnosis of PNGD and IGD is often difficult, but both conditions occasionally exist together. We report here the first potential overlapping case of PNGD, IGD, and Immunoglobulin A (IgA) vasculitis associated with incomplete Sjögren's syndrome. An 81-year-old woman who had been followed up for interstitial pneumonia and incomplete Sjögren's syndrome was referred to our clinic. She had multiple erythematous plaques and nodules on her entire body and purpura on her legs. Biopsied specimens showed granuloma formation with neutrophilic infiltration and degenerated collagen fibers in the center. In addition, interstitial granuloma and so-called "floating sign" in the periphery and leukocytoclastic vasculitis were noted. Elastica-van Gieson staining revealed phagocytosis of elastic fibers by multinucleated giant cells around the granulomas. Direct immunofluorescence showed IgM, IgA, and C3 deposition in vascular walls. We made a diagnosis of an overlap syndrome of PNGD, IGD, and IgA vasculitis in a background of incomplete Sjögren's syndrome. No such case has been previously reported. The pathogenesis of the present case may be associated with Sjögren's syndrome.

DOI： 10.1111/1346-8138.15738

PubMed

症例は81歳女性で、4ヵ月間続いている全身のそう痒性紅斑を主訴に当院へ紹介された。間質性肺炎と不完全なシェーグレン症候群(唾液腺造影所見と口唇生検所見が診断基準に合致せず)の病歴があり、3年間にわたり経過観察が続けられていた。診察では全身の紅斑に加え、両肘・両膝に赤色の局面と結節を、下肢に紫斑を認めた。赤色局面の生検では肉芽腫が形成されている様子が示された。その肉芽腫の中心部には好中球浸潤と膠原線維変性がみられ、周辺部には間質性肉芽腫といわゆる「floating sign」が観察された。Elastica van Gieson染色では、肉芽腫周囲に分布する多核巨細胞が弾性線維を貪食している所見が認められた。また小血管の壁にはIgM、IgA、C3が沈着していることも直接蛍光抗体法から明らかにされた。こうした所見から、本症例は不完全なシェーグレン症候群を背景とする、柵状好中球性肉芽腫性皮膚炎(palisaded neutrophilic granulomatous dermatitis)、間質性肉芽腫性皮膚炎、IgA血管炎のオーバーラップ症候群と診断した。

担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

BACKGROUND: Extramammary Paget's disease (EMPD) is a rare skin cancer and sometimes has fatal prognosis. For progressive cases, therapeutic options are limited. In recent years, treatment with an anti-programmed death-1 (PD-1) antibody has improved the prognosis of various malignancies. In addition, correlations between PD-ligand 1 (PD-L1) expression in tumor cells and favorable responses to anti-PD-1 therapy have been reported for several cancers. There have been a few case series of analysis of PD-L1 expression in patients with EMPD. AIMS: The purpose of this study was to investigate the relationship between the EMPD and PD-L1/PD-1 expression in Japanese EMPD patients. MATERIALS AND METHODS: We investigated 39 patients with EMPD by immunohistochemical staining of PD-L1 and PD-1. We counted the number of tumor cells that were positive for PD-L1 and the number of tumor-infiltrating mononuclear cells (TIMCs) that were positive for PD-L1 and PD-1. We also analyzed correlations between the expression of PD-L1 and PD-1 in EMPD and patients' characteristics. RESULTS: We found that none of the Paget's cells expressed PD-L1. All of the specimens contained TIMCs, and some of the TIMCs expressed PD-L1 and PD-1. However, there was no correlation between the expression of PD-L1/PD-1 in TIMCs and patients' characteristics. CONCLUSION: Although tumor cells did not express PD-L1 and the expression of PD-L1/PD-1 in TIMCs did not correlate with patients' characteristics, future clinical studies should be carried out to explore another immune escape pathway in EMPD.

DOI： 10.4103/ijd.IJD_341_18

PubMed

担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

is missing (Quiz).

DOI： 10.2340/00015555-3580

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.1684/ejd.2020.3806

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.1684/ejd.2020.3809

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

The pathogenesis of seborrhoeic dermatitis is controversial and remains unclear. Malassezia is considered to be a commensal fungi and is found not only in the stratum corneum but also in hair follicles. It is an important pathogenic factor in seborrhoeic dermatitis. The aim of this study was to clarify the pathogenesis of seborrhoeic dermatitis, morphologically, through comparison with psoriasis vulgaris. Fifteen cases of seborrhoeic dermatitis, 7 of psoriasis, and 6 of normal skin were examined using routine histopathology, immunohistochemistry, and electron microscopy. Macrophages were found to be diffusely distributed in the upper dermis of seborrhoeic dermatitis and psoriasis. In contrast, a significant increase in the number of dendritic cells in the follicular epithelium and dendritic cell clusters in the perifollicular dermis were found only in seborrhoeic dermatitis. Ultrastructural examination of the clusters demonstrated that dendritic cells interacted with lymphocytes, macrophages, and other dendritic cells. In conclusion, folliculotropic distribution of dendritic cells as well as dendritic cell-immune cell clusters play an important role in the pathogenesis of seborrhoeic dermatitis.

DOI： 10.2340/00015555-3519

PubMed

担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.2340/00015555-3534

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.1684/ejd.2020.3725

PubMed

＜文献概要＞症例のポイント　・皮膚原発肛囲乳房外Paget病を経験した.・大腸内視鏡検査,PET-CTおよび免役組織化学染色で皮膚原発であることを確認した.・異時性に陰嚢部にも乳房外Paget病を発症した.

担当区分：筆頭著者   国際・国内誌：国際誌  

DOI： 10.1111/1346-8138.15192

PubMed

国際・国内誌：国際誌  

DOI： 10.1111/ajd.13140

PubMed

担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

BACKGROUND: A recent clinical trial has shown the efficacy of an anti-programmed death-1 (PD-1) antibody against advanced squamous cell carcinoma (SCC). The expression of PD-ligand 1 (PD-L1) in tumor cells correlates with a favorable response to anti-PD-1 therapy in various malignancies. In recent studies, it has been shown that SCC frequently expresses PD-L1. However, there has been no previous study focusing on the difference in PD-L1 expression between SCC in sun-exposed skin and that in nonsun-exposed areas. AIMS: The purpose of this study was to investigate the relationship between sun-exposure status and PD-L1 expression in patients with SCC. MATERIALS AND METHODS: We investigated 80 patients with SCC (40 patients with SCC in sun-exposed skin and 40 patients with SCC in nonsun-exposed skin) by immunohistochemical staining for PD-L1. Fisher's exact test was used for statistical analyses of the differences between the two groups. RESULTS: Patients with SCC in sun-exposed skin showed a significantly higher expression level of PD-L1 in tumor cells than did patients with SCC in nonsun-exposed skin (P = 0.0133). CONCLUSIONS: We found that the expression level of PD-L1 in patients with SCC in sun-exposed skin was higher than in patients with SCC in nonsun-exposed skin. Practical data are needed for appropriate applications of new therapeutic options for SCC.

DOI： 10.4103/ijd.IJD_187_19

PubMed

国際・国内誌：国際誌  

DOI： 10.1111/all.13935

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.2340/00015555-3170

PubMed

担当区分：筆頭著者   国際・国内誌：国際誌  

DOI： 10.1684/ejd.2019.3544

PubMed

国際・国内誌：国際誌  

DOI： 10.1111/1346-8138.14767

PubMed

国際・国内誌：国際誌  

DOI： 10.1111/ajd.12953

PubMed

担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

OPINION STATEMENT: The symptom prevalence in patients with advanced cancer depends on the type of primary cancer, and the palliative treatment varies according to the nature of the primary cancer. Palliative treatment for unresectable skin cancer has not been fully discussed. Patients with unresectable skin cancer sometimes show the primary lesion in the skin and metastases to the lung, skin, liver, and bone. Pain, anorexia, and dyspnea commonly occur in such patients, and bleeding, exudate, and offensive odor are characteristically observed. For the last three symptoms, surgery and radiation are effective therapeutic options, and cryotherapy, Mohs' chemosurgery, electrochemotherapy, and some topical ointments and dressing materials are also additional options. For pain due to bone metastasis, pharmacotherapy with opioid and/or non-opioid agents is the most basic treatment, and radiation and bisphosphonate therapies are other options. For dyspnea, which is an intractable and uncomfortable symptom, morphine and oxygen play a leading role in treatment. Red blood cell transfusions may be effective for some patients with dyspnea induced by anemia. Nutritional supports and pharmacotherapy are therapeutic options for anorexia. As nutritional supports, enteral nutrition is better than parenteral nutrition. There is some evidence of progestins and corticosteroids having supportive effects for anorexia. Dermatologic oncologists should be skilled with symptom managements to maintain the quality of life in patients with unresectable skin cancer and their families.

DOI： 10.1007/s11864-019-0626-5

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.1111/ced.13636

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.2340/00015555-3043

PubMed