Except for a few anatomic

Except for a few anatomic sites, the sebaceous glands are hair follicle-associated intradermal structures, therefore, extraocular SC (thought to arise from the sebaceous gland) will generally present as a dermal tumor, as expected. It also seems reasonable that cases of extraocular SC with intraepidermal spread (other than pagetoid pattern) into and/or carcinoma in situ change in the overlying epidermis will be unusual or only has such phenomenon in a focal/limited area, let alone the cases with purely intraepidermal growth (called intraepidermal SCs or the thus qualified “SC in situ”). However, the latter do exist, although extremely rarely. On review of the description and figures of the reported extraocular intraepidermal SCs/SC in situ, we note that the intraepidermal growth, as predominant as in our case, basically shows expanding aggregations of tumor ddr1 cost in the lower part of the epidermis. In our case, besides the few small infiltrative tumor nests, those deep blunt extensions from the epidermis (only slightly more than 1 mm in depth) might be considered, by some authors, to be invasive. Nevertheless, this tumor can be regarded as only superficially invasive, and we intend to use a special diagnostic term “intraepidermal SC with superficial dermal invasion” to reflect its actual growth features, progression manner, and distinctive clinicopathological character, which are different from those of usual invasive SCs. Cibull et al did not mention the intraepidermal proliferation in their case, but based on their image of it, we considered the possibility of an initial intraepidermal growth in such an exophytically enlarged nipple tumor. Owing to the scarcity of intraepidermal SC/SC in situ and rare association with usual extraocular SC, some authors think that the intraepidermal SC/SC in situ may not be the precursor of the latter. In clinical practice, however, one should always consider the possibility of an invasive SC whenever the intraepidermal SC/SC in situ is seen. Furthermore, intraepidermal SC/SC in situ will eventually become invasive if untreated; but this kind of SC, to which our case belongs, may own a unique histogenesis different from that of common invasive cases initially growing intradermally. Apart from considering the origination from pluripotent cells in the basal layer of epidermis, as suggested by some authors, we presume another possible derivation from certain sebaceous-committed germinative cells situated in or shortly below the basal layer of the epidermis—i.e., cells in the superficially-located free/non-hair follicle-associated or ectopic sebaceous glands such as those seen on the lip/buccal mucosa, labia minor, prepuce, and the nipple–areola complex; the latter contains free glands either in the Montgomery\'s tubercles or widely covering the surface. Treatment involving entire excision of the lesion of SC with removal of any lymph nodes that are affected is recommended. However, the standard treatment for such a superficially invasive case as ours is not yet proposed due to the small number of cases. The retained expression of MLH-1 and MSH-2, which are lost in most internal malignancy-associated sebaceous neoplasms in MTS, suggests that underlying MTS is unlikely in our patient. The partial reduction rather than complete loss of MSH-2 staining, as seen in many reported cases without MTS, does not indicate increased risk of visceral malignancies.
Acknowledgments
Introduction Herpes zoster is characterized by pain and vesicular eruption on an erythematous base in 1–3 dermatomes. However, varicella zoster virus (VZV) reactivation can produce radicular pain without a rash (zoster sine herpete, ZSH), making the diagnosis more difficult for physicians. In cases in which ZSH is suspected, virological confirmation is needed. The conventional methods that use vesicle samples (e.g., Tzanck smear, punch biopsy, and cell culture) are not available for the diagnosis of ZSH. In addition, serological methods that have been widely used for the diagnosis of herpes zoster are not useful for an early diagnosis, because immunoglobulin (Ig)M and IgA antibodies specific for acute VZV infection are only detected in about 60% of cases. Also, cross-reactions to herpes simplex virus have been reported. Currently, when ZSH is suspected, blood and cerebrospinal fluid (CSF) examination for VZV DNA and anti-VZV IgM and/or IgG antibody are available to confirm the etiological agent. However, CSF examination is too difficult to perform in the outpatient clinic, and VZV DNA has been detected in peripheral blood mononuclear cells (PBMCs) in 16–20% of patients with herpes zoster. In addition, it has been revealed that VZV DNA was not detected in PBMCs from patients with ZSH. As a result, other methods to diagnose ZSH have been attempted. Here, we report a case of ZSH diagnosed by performing polymerase chain reaction (PCR) analysis of skin exudate in a patient who developed thoracic dermatomal distribution pain that had not been reported.