tsuruta kyoko

A 42-year-old male noticed a subcutaneous small nodule in the abdomen 7 years ago. On the initial consultation in our department, a red, elastic-hard, cauliflower-like giant tumor measuring 17×16×9 cm was detected in the abdomen. The tumor surface was destroyed and hemorrhagic. Resection and mesh skin grafting were performed at an area horizontally 5 cm from the tumor peduncle margin. Since the border between the deep tumor area and rectus abdominis was partially unclear on magnetic resonance imaging, the anterior sheath of the rectus abdominis was also resected. In the totally extirpated specimen, CD34-negative, spindle tumor cells comprised approximately 70% of the tumor, showing a herringbone pattern, while CD34-positive, spindle tumor cells comprised the remaining 30%, showing a storiform pattern. COL1A1-PDGFB fusion gene was detected in the tumor tissue, and a diagnosis of dermatofibrosarcoma protuberans with fibrosarcomatous change was made. There has been no relapse or metastasis during the 1-year-and-2-month postoperative follow-up.[Skin Cancer (Japan) 2012 ; 27 : 339-344]

Tako-no-Suidashi ointment (TSO) is an old Japanese over-the-counter drug, used for the drainage of infectious pustular disease, such as furuncles, carbuncles and infectious atheroma, although whether it works well or not is unknown. The ingredients of the TSO compound commonly include rapeseed oil, gum rosin, wood rosin, Japanese wax, paraffin, petrolatum, copper sulfate, Peru balsam, acetic acid, salicylic acid and trace amounts of Guinea green B. We report a case of contact dermatitis in a 38-year-old Japanese woman caused by TSO. The patient presented to our hospital with pruritic erythema on her left cheek. In order to remove a subcutaneous tumor, she had applied TSO4 days prior to presentation. Clinical examination showed a well-demarcated exudative erythematous macule with yellowish crusts and scales on her left cheek. Patch testing showed a positive reaction to TSO (++), gum rosin (++) and wood rosin (++) at 72 h. As TSO includes highly allergenic material, caution should be made in applying this topical therapy.

A 40-year-old female patient presented with a history of first noticing eruptions on her back approximately 5 weeks before her initial visit to our hospital. Noticing that the eruptions were spreading, she first visited a nearby hospital. At her first visit to our hospital, she gave a history of having had similar eruptions on the arms approximately 5 years earlier. Although she had undergone workup and treatment, the cause of that eruption remained unknown. On examination, she still had depressed lesions from the earlier episode. She was referred to our hospital for treatment in June 2007. At presentation, she was found to have subcutaneous induration and swelling extending across the right side and center of her back, and tenderness and erythema with infiltration in the lower limbs. The results of laboratory examinations revealed significantly increased serum LDH and ferritin levels, as well as elevation of the serum transaminase (GOT and GPT) levels. Histopathological examination of biopsy specimens revealed a lobular panniculitis with prominent lymphocytic infiltration, and a bean-bag appearance of the cells. Immunostaining revealed that the lymphocytes were CD4 (-), CDS (+), CD30 (-), CD56 (-), CD6S (+) and EBV (-), and based on the findings, the patient was diagnosed as having subcutaneous panniculitis-like T-cell lymphoma. She was initiated on treatment with prednisolone at the dose of 30 mg/day, which resulted in complete disappearance of the erythema on the lower limbs, gradual resolution of the subcutaneous induration on the back, and reduction of the swelling. On two occasions, when the dose of prednisolone was tapered to 10 mg/day, the serum levels of LDH and ferritin began to increase again and symptoms and signs, such as general malaise, subcutaneous induration and erythema reappeared. Five months have passed since her first visit to our hospital, and although she is still under treatment with 13 mg/day of prednisolone, no other cutaneous lesions have appeared and examinations have revealed no abnormalities in the general condition.