We report a case of X-linked recessive ichthyosis with basal cell carcinoma. An 86-year-old man was referred to our department for evaluation of a 1-year history of an ulcer on his left leg. He had suffered from dry skin with scales on his entire body since childhood. Histopathological examination of the lower leg revealed intradermal proliferation of a solid nest of basaloid cells showing unclear palisading in the periphery. Marked hyperkeratosis and hypergranulosis were also seen in the adjacent dermis. Loss of the steroid sulfatase gene was found on chromosome X. Based on these finding, we made a diagnosis of X-linked recessive ichthyosis with basal cell carcinoma. To our knowledge, there has been no report of X-linked recessive ichthyosis with cutaneous malignancy. We discuss the risk of skin cancer in relation to ichthyosis.
We report a case of subcutaneous panniculitis-like T-cell lymphoma with diffuse indurated lesions without erythema. A 27-year-old man was referred to us with a 1-month history of fever, general fatigue and indurated skin lesions. The initial examination revealed indurated skin lesions without erythema and subcutaneous tumors in the right lower abdomen, back and buttocks. Histopathology showed a panniculitis predominantly in lobular pattern, and infiltration of atypical lymphocytes in the subcutaneous tissue. Characteristically, there was rimming of individual fat cells by surrounding atypical lymphocytes. Results of laboratory examinations showed hemophagocytic syndrome (HPS). Based on these findings, we made a diagnosis of subcutaneous panniculitis-like T-cell lymphoma without erythema and subcutaneous tumors with HPS. To our knowledge, there has been no report of SPTCL with diffuse indurated lesions without erythema, tumors, or plaque, all of which are considered to be typical characteristics of SPTCL. Positron emission tomography / computed tomography (PET/CT) showed noticeable thickening of diffuse subcutaneous involvement throughout the body. Hence, PET/CT is a useful for the detection of SPTCL as well as its distribution.
Electron microscopic techniques have been widely used to investigate the pathogenesis of dermatophytosis. In this article, morphological studies by scanning electron microscopy (SEM) and transmission electron microscopy (TEM) concerned with the dermatophyte infection process are literary reviewed and we introduced our morphological study observing the parasitic form of dermatophytes in the lesional cornified layer. Various experimental models have been established to study fungal adhesion and invasion to the skin surface in the early stage of infection by several authors.In these studies, arthroconidial adherence to corneocytes and germination was demonstrated by SEM and TEM. To understand the host-fungus relationship in dermatophytosis, it is also important to identify parasitic forms of fungi and morphological changes of corneocytes in the lesion. The three-dimensional structure of growing or parasitic dermatophytes in the lesional cornified cell layer was observed using the adhesive strip method in tinea cruris and tinea glabrosa. In tinea unguium, however, it is difficult to apply this method because of subungual hyperkeratosis. We introduce the alkaline treatment method for SEM for use in observing fungal elements in a subungual hyperkeratotic lesion and scales in dermatophytosis. With this technique, small pieces of nails or scales were fixed with 2.5% glutaraldehyde, and were treated with low concentrations of alkaline and subjected to the conventional procedure for SEM observation. This method is applicable to various skin lesions, such as tinea unguium, tinea pedis and tinea capitis to investigate the parasitic forms of dermatophytes and the spatial relationship with corneocytes and is useful to understand the infection process of dermatophytosis.
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