Nevus sebaceous is known by its association with one or more secondary tumors, but more than three multiple tumors arising from a nevus sebaceous is extremely rare. A 67-year-old female presented with a light brown plaque on the back of her head that contained a dome-shaped black node and an erosive lesion. Histopathological examination showed atypical basaloid cells in the black node. At the periphery of that node, structures resembling follicular germs extruded from interlacing cords in the upper portion and tumor nests with sebocytes were in the lower portion. In the erosive lesion, papillated structures with an apocrine epithelium were observed. In the light brown plaque, enlargement of sebaceous lobules was noted. From those histopathological features, a diagnosis of syringocystadenoma papilliferum, sebaceoma, trichoblastoma and basal cell carcinoma arising from a nevus sebaceous was made. We discuss the rarity of multiple tumors arising from a nevus sebaceous.
References 1 Akiyama M. ABCA12 mutations and autosomal recessive congenital ichthyosis: a review of genotype/phenotype correlations and of pathogenetic concepts. Hum Mutat 2010; 31:1090-6. 2 Shibata A, Ogawa Y, Sugiura K et al. High survival rate of harlequin ichthyosis in Japan. J Am Acad Dermatol 2014; 70:387-8. 3 Thomas AC, Cullup T, Norgett EE et al. ABCA12 is the major harlequin ichthyosis gene. J Invest Dermatol 2006; 126:2408-13. 4 Rajpopat S, Moss C, Mellerio J et al. Harlequin ichthyosis: a review of clinical and molecular findings in 45 cases. Arch Dermatol 2011; 147:681-6. 5 G€ urkan H, Fischer J, Ulusal S et al. A novel mutation in the ABCA12 gene in a Turkish case of harlequin ichthyosis. Clin Dysmorphol 2015; 24:115-17. 6 Koochek A, Choate KA, Milstone LM. Harlequin ichthyosis: neonatal management and identification of a new ABCA12 mutation.
Primary penile melanomas are rare tumors that represent less than 0.1% of all melanomas. We report a case of a 60-year-old Japanese male with a mucosal penile melanoma and describe an increased CD8+ T cell infiltration in brain after dacarbazine (DTIC) administration. After partial penectomy and left inguinal lymphadenectomy, he developed multiple lung, bone, spleen, brain and skin metastases. He was treated with interferon-β, DTIC and nivolumab. However, the metastases were not reduced in size. Immunohistochemistry showed an increase of CD8+ T cell infiltration and programmed death-ligand 1 (PD-L1) expression after the administration of DTIC, but the expression of programmed cell death protein 1 (PD-1) was negative. We speculate that DTIC exerted immunostimulatory effects, but nivolumab was ineffective due to the negative expression of PD-1 and/or an insufficient infiltration of CD8+ T cells. Although this is only one case, this case report could be the first step to discuss the development of effective therapies against melanoma to take advantage of the increased CD8+ T cell infiltration elicited by chemotherapeutic agents. It would be beneficial to pay more attention to the relationship between DTIC and immune checkpoint modulators.
Extraocular sebaceous carcinoma in association with a clonal seborrheic keratosis: Dermoscopic featuresDear Editor, The clinical diagnosis of extraocular sebaceous carcinoma is challenging due to the lack of specific clinical manifestations of this neoplasm. However, previous reports of extraocular sebaceous carcinomas using dermoscopy have been limited. 1 Here, we present a case of an extraocular sebaceous carcinoma in association with a clonal seborrheic keratosis and we describe its dermoscopic features.A 75-year-old woman presented with a tumor in a black plaque on her abdomen. The patient had a history of burn injury on her abdomen 30 years prior. Her burn scar had gradually become black and then developed a tumor with bleeding 3 months earlier.Physical examination revealed a 20 mm 9 12 mm black keratotic plaque with an elevated tumor in the center of her abdomen infraumbilically (Fig. 1a). Dermoscopic examination revealed that this lesion had two components: polymorphous vessels with homogenous yellow backgrounds in the center and blue-gray globules at the periphery (Fig. 1b). The polymorphous vessels were composed of linear irregular vessels, glomerular vessels and hairpin-like vessels (Fig. 1c). At the periphery, similar findings with bluegray structures of various size and shape were observed. Figure 1. (a) A 20 mm 9 12 mm black keratotic plaque with an elevated tumor on the patient's abdomen. (b) Dermoscopic features showing two components: polymorphous vessels with homogenous yellow backgrounds in the center and blue-gray globules at the periphery. The dotted line indicates the section of the histopathological specimen. The two dashed boxes indicate magnified dermoscopic photos shown in (c) and (d). (c) Dermoscopic features of the component of polymorphous vessels with homogenous yellow backgrounds. The dotted line indicates the section of the histopathological specimen. (d) Dermoscopic features of blue-gray globules at the periphery of the lesion. These multiple blue-gray globules were variably sized bluish globular-like structures as described by Longo et al. 2 The dotted line indicates the section of the histopathological specimen. (e) Histopathological examination at low magnification showing tumor nests of the sebaceous carcinoma on the right side and the clonal seborrheic keratosis on the left side. The dashed boxes (right and left) indicate areas shown in (f) and (h), respectively (hematoxylin-eosin [HE], original magnification 940). (f) Tumor nests composed of lobular aggregations (HE, 9100). (g) Tumor nests consisting of atypical neoplastic cells, some of which had vacuolated cytoplasm and scalloped nuclei (HE, 9400). (h) Intraepidermal nests of basaloid or pale cells with extensive pigmentation at the periphery (HE, 9100). (i) Immunohistochemistry with adipophilin (9100).
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