Abstract. Sex steroids have been postulated to influence pathophysiology of human skin through various skin appendages. The presence of sex steroid receptors has been also reported in adnexal tumors but its details still remained unknown. Therefore, in this study, we immunolocalized sex steroid receptor protein (estrogen receptor (ER)a, ERb, progesterone receptor (PR)A, PRB and androgen receptor (AR)) in 23 cases of non-pathological skin (male: 10, female: 13) and in 50 cases of skin adnexal tumors (male 24, female 26; 38 benign and 12 malignant). ERa immunoreactivity was detected exclusively in basal cells of sebaceous glands of non-pathological skin. AR and PRB immunoreactivity was detected in both differentiated and basal cells of sebaceous gland. AR and ERb immunoreactivity was also detected in sebaceous and eccrine sweat glands but not in outer root sheath of hair follicles. In sebaceous gland neoplasms, the number of ERa positive cases was significantly lower in skin appendage neoplasms than non-pathological skin. ERb immunoreactivity was not detected in any of sebaceous gland neoplasms examined. There were no significant differences in PRA, PRB and AR immunoreactivity between non-pathological sebaceous gland and its neoplasm. In sweat gland neoplasms, the number of AR positive cases was significantly lower in benign neoplasms than their non-pathological counterpart. Therefore sex steroids are considered to play important roles in regulation of non-pathological skin appendage function and pathogenesis and/or development of its neoplasm. In addition, the status of the great majority of sex steroid hormone receptors was maintained throughout the process of neoplastic transformation of skin appendages, except for AR and ERa in sweat and sebaceous gland neoplasms.

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IMPORTANCE Dermatofibrosarcoma protuberans (DFSP) is a rare skin cancer that develops in the deep dermis to subcutaneous adipose tissues. A COL1A1-PDGFB gene fusion, leading to the constitutive expression of PDGFB, is the tumorigenic mechanism in most DFSP cases. OBJECTIVES To evaluate the specificity of PDGFB expression as a diagnostic marker of DFSP and to determine whether other pathomechanisms (ie, gene fusions) exist in patients with DFSP without the COL1A1-PDGFB fusion gene.

Immunohistochemistry is widely used for pathological diagnosis of breast lesions. Other than hormone receptors and HER2/neu analysis for primary breast carcinomas, several markers may be useful for differential diagnoses, although in limited situations. To decide the malignant potential of intraductal proliferative lesions, analysis for the staining pattern of cytokeratins may be a good reference. Most ductal carcinoma in situ cases are diffusely positive for luminal cell markers (CK8, CK18, CK19), but negative for basal cell markers (CK5/6 and CK14). However, usual ductal hyperplasia may show the mosaic staining patterns for any of these markers, which may indicate a heterogeneous cell population in benign lesions. Myoepithelial markers (alpha-SMA, myosin, calponin, p63, CD10) are almost consistently positive for benign papillomas but they do not completely distinguish intraductal papillary carcinomas. Preservation of myoepithelial layer is the diagnostic key when looking at benign sclerosing lesions, including carcinoma with pseudoinvasive structures. E-cadherin is mostly positive for ductal carcinomas but negative for lobular carcinomas. Some of the lobular carcinomas are positive for 34betaE12, but they are consistently negative for CK5/6. Comparison with histopathological findings of hematoxylin and eosin is essential to make proper diagnosis in the individual case.

Aim:We evaluated the diagnostic efficacy of transpapillary intraductal ultrasonography before biliary drainage (IDUS-BD) and transpapillary biopsy (TPB) for the assessment of the longitudinal extent of bile duct cancer. Methods: Between November 1999 and January 2005, we performed IDUS-BD and TPB preoperatively in 27 patients with carcinoma of the extrahepatic bile duct. Following IDUS-BD, TPB was performed under fluoroscopic guidance immediately after endoscopic sphincterotomy. The diagnostic efficacy of IDUS-BD and TPB for the longitudinal extent of the cancer and the complications which accompanied the procedure were evaluated. Results: The overall success rate of sampling and the diagnostic accuracy of bile duct cancer by TPB were 85.3% (192/225) and 85% (23/27), respectively. The sensitivity, specificity and accuracy of the assessment of the longitudinal extent of cancer on the hepatic and duodenal sides by IDUS-BD were 82%, 70%, 78% and 85%, 43%, 70%, respectively. Those by a combination of IDUS-BD and TPB were 88%, 80%, 85% and 77%, 86%, 80%, respectively. Overestimation of the longitudinal extent of BD cancer by IDUS-BD was mainly due to inflammation and obscure images, especially resulting from collapse of the bile duct on the duodenal side of the tumor, and was corrected by TPB in four of five patients. No serious complications occurred following the combination of IDUS-BD and TPB. Conclusions: TPB is useful for preoperative histological diagnosis of bile duct cancer. The combination of IDUS-BD and TPB is practical for evaluation of its longitudinal extent; basically, IDUS-BD is sufficient on the hepatic side of the tumor, but concomitant TPB is recommended on the duodenal side.

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Dermoscopic observation of acquired digital fibrokeratoma developed on the dorsum of the fourth left toeDear Editor, A 53-year-old man noticed a solitary, asymptomatic nodule on the dorsum of the fourth left toe, 3 years before his first visit to our hospital. He was otherwise healthy and did not have any symptoms of tuberous sclerosis, including facial angiofibroma, hypomelanotic macule, forehead and scalp plaques, and shagreen patches. His family had no history of similar skin tumors. He did not report any trauma or incidents before the tumor appeared. As the tumor enlarged gradually, he repeatedly

A case of malignant hemangioendothelioma of the stomach is reported. The patient was a 21-year-old female who developed bloody stool. Pathological studies on the stomach revealed a gastric submucosal tumor. This tumor was growing on the outside of the stomach wall and formed a large abdominal mass. Evidence of metastases was detected in the liver, omentum and parietovisceral peritoneum. Biopsies were taken of the gastric mucosa and the metastatic lesions of the liver and omentum, and histological studies on these specimens led to the diagnosis of malignant hemangioendothelioma. A laparoscopic examination yielded very interesting findings: the presence of small red tumors on the omentum and the parietovisceral peritoneum. The usefulness of laparoscopic examination in the diagnosis of malignant hemangioendothelioma of the stomach is stressed.