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Notes: Some types of skin appendage tumors, particularly ductal eccrine carcinomas (DEC), imitate breast carcinomas histologically, thus causing great diagnostic challenges. We describe a case of DEC presenting as an eczematous, crusted skin lesion on the right nipple-areolar complex in a 67-year-old woman. A skin biopsy done under the clinical impression of Paget's disease of the nipple was initially misinterpreted as infiltrating ductal carcinoma, and a subsequent modified radical mastectomy revealed DEC exclusively confined to the nipple with perinodal tumor metastasis in one of the axillary lymph nodes. This case highlights the diagnostic difficulty caused by the histologic homology between breast carcinomas and skin appendage tumors with ductal differentiation.

Notes: A 22-year-old man had a subcutaneous nodule on the left thigh for 3 months. Physical examination showed an ulcerative nodule on the left thigh (〈link href="#f1"〉Fig. 1). He suffered from a fever for 1 week. Laboratory tests revealed a white blood cell count of 7180/mm3, with 22.4% neutrophils, 68.5% lymphocytes, 8.4% monocytes, 0.3% eosinophils, and 0.4% basophils. Hemoglobin was 9.0 g/dL, hematocrit was 28.1%, and the platelet count was 202 × 109/L. Analysis of serum showed the following abnormal results: aspartate aminotransferase, 102 IU/L (normal, 13–37); alanine aminotransferase, 77 IU/L (normal, 7–43); alkaline phosphatase, 1296 (normal, 70–270); LDH, 1105 (normal, 120–520). Results of other laboratory tests including serum electrolytes, blood and tissue culture, and viral markers for hepatitis were negative or normal. Ultrasonography and computed tomography of abdomen and pelvis showed hepatosplenomegaly with ascites. Whole body bone scan showed an increased long bone activity of the left leg. Bone marrow aspiration was negative for neoplastic cells. Histologic examination from the thigh nodule revealed subcutaneous lymphoid infiltrates with involvement of the deep dermis. Examination at high power magnification showed small, medium, and large-sized, pleomorphic lymphoid cells with hyperchromatic nuclei, nuclear debris, and phagocytic macrophages. Fat necrosis, partial rimming of fat spaces and clustering around blood vessels by pleomorphic lymphoid cells were also seen (〈link href="#f2"〉Fig. 2). The immunohistochemical studies on paraffin sections revealed that most of the infiltrated lymphoid cells positively stained for CD56 (〈link href="#f3"〉Fig. 3), granzyme B, TIA-1, cytoplasmic CD3, and CD45RO, whereas CD4, CD8, CD20, and CD30 showed no immunoreactivity. Clonality of the infiltrate was analyzed by polymerase chain reaction (PCR). Nested PCR was performed using FR3A and VLJH as primers for IgH gene and Vγ – Jγ for T-cell receptor γ chain gene. Polymerase chain reaction analysis showed a distinct band for TCR gene, confirming T-cell monoclonality of infiltrating lymphocytes. EBV-encoded small nuclear RNA was evident in lesional tissue by in situ hybridization. He was treated with two cycles of chemotherapy with CHOP-BV (Cytoxan 735 mg, adriamycin 45 mg, vincristine 1.45 mg, prednisolone 75 mg, bleomycin 15 mg, VP-16 150 mg). He died 5 days after chemotherapy.〈figure xml:id="f1"〉1〈mediaResource alt="image" href="urn:x-wiley:00119059:IJD1577:IJD_1577_f1"/〉An ulcerative nodule on the left thigh〈figure xml:id="f2"〉2〈mediaResource alt="image" href="urn:x-wiley:00119059:IJD1577:IJD_1577_f2"/〉(a) Pleomorphic, small, medium and large-sized lymphocytes with irregular hyperchromatic nuclei, nuclear debris, and phagocytic macrophages in the fat tissue. (b) A vascular involvement of pleomorphic lymphocytes and fat necrosis are seen (hematoxylin and eosin; original magnification × 100)〈figure xml:id="f3"〉3〈mediaResource alt="image" href="urn:x-wiley:00119059:IJD1577:IJD_1577_f3"/〉Positive immunohistochemical staining for CD56 in atypical tumor cells (original magnification × 400)

Notes: Abstract. Doxorubicin is one of the most useful anticancer agents, but its repeated administration can induce irreversible cardiomyopathy as a major complication. The purpose of this study was to investigate doxorubicin toxicity on cardiac sympathetic neurons using iodine-131-metaiodobenzylguanidine (MIBG) and protein gene product (PGP) 9.5 immunohistochemistry, which is a marker of cardiac innervation. Wistar rats were treated with doxorubicin (2 mg/kg, i.v.) once a week for 4 (n=5), 6 (n=6) or 8 (n=7) weeks consecutively. Left ventricular ejection fraction (LVEF), calculated by M-mode echocardiography, was used as an indicator of cardiac function. Plasma noradrenaline (NA) concentration was measured by high-performance liquid chromatography (HPLC). 131I-MIBG uptake of the left ventricular wall (24 ROIs) was measured by autoradiography. 131I-MIBG uptake pattern was compared with histopathological results, the neuronal population on PGP 9.5 immunohistochemistry and the degree of myocyte damage assessed using a visual scoring system on haematoxylin and eosin and Masson’s trichrome staining. LVEF was significantly decreased in the 8-week group (P〈0.05). The serum NA level also showed no statistical difference until 4 weeks and was significantly increased in the 8-week group (P〈0.05). MIBG uptake was decreased in the 6- and 8-week groups (P〈0.05), and was closely correlated with the reduction in the number of nerve fibres on PGP 9.5 stain. Myocyte damage was seen only in the 8-week group. Neuronal population and the 131I-MIBG uptake ratio of subepicardium to subendocardium were significantly increased (P〈0.05) in the 8-week group as compared with the control group. It may be concluded that radioiodinated MIBG is a reliable marker for the detection of cardiac adrenergic neuronal damage in doxorubicin-induced cardiomyopathy; it detects such damage earlier than do other clinical parameters and in this study showed a good correlation with the reduction in the neuronal population on PGP 9.5 stain. The subendocardial layer appeared to be more vulnerable to doxorubicin than the subepicardium.

Notes: Abstract  Objective. To present the MR and angiographic findings of alveolar soft part sarcoma (ASPS). Design and patients. MR examinations (12 tumors of 10 patients) of ASPS performed at multiple hospitals were retrospectively reviewed. The tumors were found in the thigh (n=4), lower leg (n=4), femur (n=2, local metastasis), scalp (n=1) and arm (n=1). The MR signal characteristics including signal intensity, homogeneity and signal void of lesions and bony invasion including direct invasion or local metastasis were evaluated. Angiographic findings (n=4) and post-embolotherapy follow-up MR imaging (n=2) findings were also assessed. Results. Local bony metastasis was found in two cases. Seven tumors showed heterogeneous high signal intensity on T1- and T2-weighted images with good enhancement. One tumor had a very high signal on T1-weighted images. Eight tumors (67%) showed numerous signal voids in or near the tumors. All four angiographic studies showed numerous enlarged vessels, arteriovenous shunts and delayed washout. Two cases mimicked arteriovenous malformations on angiographic studies but MR images demonstrated solid soft tissue components as well as tortuous vessels. Conclusions. High signal on T1-weighted image and numerous signal voids are highly suggestive of ASPS, although they are not universal as has been suggested and arteriovenous malformation should be included in the differential diagnosis. Local bony metastases in ASPS were seen in two cases and should be carefully investigated.