studies on Malignant Melanoma^

　　　　　　　　　　　　by

Akihiro Kawada and Takashi Nakai**

239

　　Four cases of malignant melanoma, all male and ４２，46, 52 and 58 years of age.

were studied.　The primary tumor occurred in one case in the mandibular region.

in one case　on the neck and in two another cases on the sole. In one case in which

the primary tumor developed on the neck the metastatic tumors were so-called amel-

anotic. In two cas6s, the generalized metastasis in the skin, lymph nodes, gastrointes-

tinal and urogenal tract. liver, meninges and spleen was confirmed by autopsy｡

　　It seems that the malignancy of the tumors has nothing to do with the morpho-

logy of tumor cells. Namely, all cases were malignant no matter whether the tumor

cells were　of　cuboidal　or of　fusiform　type.　As to the histological structures of the

tumors, they were more or less perithelioma-like when the proliferation of cuboidal

tumor cells was prevalent. And there was some resemblance to neurogenous tumors

such as sympathicoblastoma, neurilemoma etc. when the tumors consisted mainly of

fusiform　or　dendritic　cells. This would　be　easily understood so far as the tumor

cells of melanoma i. e. the melanocytes are originated from the neural crest from

which the so-called chromaffine system, Schwann's neurilemma etc. are derived｡

　　In all cases, the tumor cells were usually dopa-positive. although the dopa-positivity

was not at all similar in all cases and in all tumor tissues. The dopa reaction was in.

general by far strongly positive in the primary tumors. especial!ｙin the peripheral

portions of them, while it was often negative in the metastatic lesions and even in the

primary tumors. and here not in all,but in some parts of the tumors｡

　　Argyrophil fibers were found usually in abundance in the melanomatous tissue.

In some cases, however, they were very scanty or even ai)sent in the melanomatous

tissue｡

　　The melanoma was found to be primarily multiple in two cases. In one case each

tumor seemed to have　occurred　from　the　preexisting pigmented nevus.・　In another

case ａ small　tumor　developed　in　the　neighborhood of the larger preexisting tumor.

In both cases the tumors were regarded as primarily multiple also from　ａ　distinctly

vivid so-called junctional activity.

　＊

＊＊

Full-lengthreport: Japanese section pp. 1229～1243

From the Department of Dermatology (Dircetor: Prof. K. Kitamura), Faculty of

Medicine, University of Tokyo, Tokyo.

240

Neurohistologicalstudy and Sensory Examination

　　　　　　　　ofHemangioma Simplex*゜

　　　　　　　　　　　　　　　　　by

　　　　　　　　　　　JunpeiSobukawa゛゛゛゛

　　There have been ａ few outstanding reports about the study of　nerve　endings　in

･hemangioma. The author carried out the neurohistological studies of nerve endings

in hemangioma simplex and obtained the results as follows｡

　　1) Morphological changes of the nerve endings were investigated with Suzuki's

silver method. Retrogressive changes were found chiefly, and very few nerve fibers,

abnormal ramification of the nerves of vessel walls and juvenile fibers were found in

the superficial layer of the corium｡

　　1) The sensory examination of the focus of hemangiomas was performed with

an optical lever esthesio-algesiometer. In this examination, elevation of the sensory

level of touch and pain sensations was found, which means the dull sensation probably

resulting from the retrogressive changes of the nerve endings｡

　　As mentioned above, there are functional and morphological changes of the nerve

endings in hemangioma simplex. In accordance with Ribbert's theory, development of

the blood vessels of the skin may begin earlier than that of the nerve endings in the

embryonal stage, so it is presumed that the morphological changes of the nerve endings

may have resulted from the compression of the nerve　endings by the dilated blood

vessels. The aforementiond findings may somewhat support the theory of nervous

origin, which, however, should　be　ascertained　by the　progress　of　histology　of　the

autonomic ｎｅｒ▽ｅending･

　＊･Full-length report: Japanese section pp. 1244～1256

＊＊　From the Department of Dermatology (Director: Prof. K. Kano), Nagoya University

　　　Schoolof Medicine, Nagoya.　　　　　　　　　　　　　　　　　　，

241

　　　　　　　MultipleIntestinal Polyps and Kgmented Spots of the Oral Mucosa。

　　　　　　　　　　　　　　　　Lipsand Digits (Peutz-Jeghers' Syndrome)゛゜

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　by

　　　　　　　　KenshiroSasada, Hirobumi Mori, Yusho Oota, Zennosuke Kosugi

　　　　　　　　　　　　　　　　　　　　andMasahiko Nagura**

　　　Pigmented　spots on　the　digits, lips and oral mucosa are fairly often encountered

clinically, but　as　the diagnosis of Peutz-Jeghers' syndrome cannot be established by

skin symptom alone. this disease is thought to be ａ rare disease. Most of the reported

cases of this disease had symptoms of intestinal stricture or incarceration, and in most of

the reported cases the polyps were found accidentally during the treatment.

　　　Case 1，ａ female aged ２２，was admitted to our clinic with the chief complaint of

pigmented spots on the lips and digits,under suspicion of this disease. Gastrointestinal

polyps, especially polyps on the gastric mucosa, were discovered on χ-ray examination

of the gastrointestinal tracts and with ａ gastrocamera, and were confirmed on operation.

　　　Case 2，ａ female aged ２７，had the similar pigmented　spots and polyps which were

found during the operation of ileus.:

　　　Case 3，the second son of the case 2，had many lentigo-like pigmented spots on the

digits,lips and　oral　mucosa. Though complication　of gastrointestinal polyposis had

never confirmed, this condition might be suspected as this disease.

　　　Caseｌ had no evidence of hereditary occurrence, but case 2 was thought to　be ａ

hereditary case.　　　　　　　　　　　　　　　　　　　　　　　　　　　　　＜

　　　According to the histopathological and electron-microscopical findings of the skin and

oral mucosa, this　disease　may　be included in the generalized nevus originated from

neural crest as advocated by Kawamura.

　＊　Full-lengthreport: Japanese section pp. 1257～1265

＊＊　From the Department of Dermatology (Director: Prof. K. Kano), Nagoya University

　　　Schoolof Medicine, Nagoya.

242

　　　　　　　　　　　　　　　　　　A study on Axillary･ Odor*

　　　　　　　　　　　　犬　　　　　　　　　　　　　by

　　　　　　　　　　　　　　　　　　　　　Yataro Takami**

　　Ａ study was made on axillary odor of elementary, junior high, and　senior high

school pupils to find the relations of axillary odor to the age. ｓｅχ,heredity, and cerumen.

Further, taking the cases of persons without axillary odor as　control, the　functions　of

liver, adrenal cortex and ｓｅχual glands. perspiration, pH on the skin surface and the

lower fatty acid contained in the secretion of the armpit in the cases of axillary odor

patients were investigated. Also, a histological and histochemical study of the axillary

apocrine glands as　well　as ａ bacteriological observation of the armpit were coducted.

The following are the results thus obtained.

　　1）Ｔｈｅ　frequency　of　axillary odor of elementary, junior high, and senior high

school pupils reached　８.3％　in 2954 cases and it was ａ little higher in female than

male (male : 8.1％in 1655 cases. female: 10％in 1299 cases)･

　　.･Itincreased rapidly at the puberty of both sexes, and the axillary　odor　appeared

at lower age of female than male. The hereditary　relation within the second degree

was found in 96.5％･

　　2）Ｔｈｅ frequency of wet cerumen was 16.7%　in 2954 cases in general. but in

axillary odor patients it was much higher (94.7% of ２６５cases).　No special difference

as to sex and age could be　observed･

　　　3) No remarkable disorder of the functions of　liver. adrenal cortex and sexual

glands could be confirmed in patients with axillary odor.

　　4) The axillary sweating was much larger in quantity in the cases of axillary

odor and generally in proportion to the intensity of axillary odor･and in female than

male. These results were much more clearly perceived by means of Kuno's method

than by Wada-Takagaki's method.

　　5) PH　on the　axillary skin　surface was of weak acid and was slightly more

alkaline in patients with ａχillary odor than in nomal persens. 〔average pH : persons

without axillay　odor　6.26, axillary odor patients　6.75 (30°C, humidity　60;]. This

tendency grew　more remarkable in the cases of stronger odor. and in female than

male. (The result by the pH meter of Beckman's Ｇ type).

　　6) The lower fatty acid contained　in axillary　smears were　analysed by paper

chromatography, and only C2 was found in non-axillary odor smears/while Ｃ２ and Ｃ８

were observed in axillary odor smears. Both Ｃ２and Ｃ８in secretion disappeared entirely

when the armpit was kept under sterilized condition. It may be an evidence that ａ

　＊　FuII-lenghreport: Japanese section pp. 1266～1293

＊＊　From the Department of Dermatology (Director: Prof. Kenzo Iwashita), Kyoto

　　　Prefectural Medical College, Kyoto.

243

bacterial infection plays an important part in axillary odor.

　　7) Histologically, the axil!ary apocrine　glands developed　better　in axillary odor

patients　than in persons without axillary Oder. In the former the glandular acinus

was larger in size and greater in number and ｈａ（!larger glandular cells and numerous

lingulae projecting clearly towards lumina, whicねwere wider and polymorphic･

　　8) Histochemically, the axillary apocrine glands were nearly the same in both.

sexes and had no special relation with the intensity of axillary odor and the following

results were obtained.

　　(i) Iron was negative in normal persons. but it was positive in all cases（16 cases)

of axillary odor in the glandular cells and in one case out of 5 to ３ cases in glandular

cavities.　　Itwas represented more distinctly and　at　ａ　higher　rate by　Berlin　blue

method than by　Turnbull blue method。

　　(ii) Zinc (by dithzon method) was discovered only in glandular cells. Only in one

case of ５０ｆnormal persons zinc reaction was found to be weakly　positive. 5　of　16

cases with axillary　odor　showed　distinctively　positive　reactions. and ４ cases weakly

positive.

　　(iii) Copper (by Okamoto-Utamura' s method) and sulfur (by Shiraki-Ito's method)･

were negative both in patients with axillary odor and normal persons.

　　(iv) Judging from the ｒｅ聊ltｓobtained by methods. such as Best, Me Manus, Me

Mauns and Bensley or Littlie-Greco, carbohydrates without glycogen were intensively

positive both in glandular cells and lumens without any difference between patients with

axillary odor and normal persons･

　　(v) Fat :　From　the results obtained by Daddi, Fischler, Schultz, Okamoto or

Smith-Dietrich method, neutral fats existed in a little more amount in patients with

axillary odor than in persons without axillary odor both in glandular cellsand cavities.

No remarkable difference was found in fatty acid and its salts, cholesterin, cholesterin

fat and lipoid between patients with ａχillaryodor and normal persons･

　　(vi) Acid and Alkaline phosphatase （ｂｙGomori's improved method) in cases glan-

dular cells,were found more actively persons with axillary odor than in normal persons。

　　In cholinesterase activity（bｙ Gomori method) no difference could be perceived

between them.

　　9）No difference　in　bacteriological　findings could be discovered between axillary-

odor patients and normal persons, viz. the　Staphylococcus albus could be cultivated

from　the　shaft of the axillary hairs pulled off and　from　the axillary　skin　surface

after　shaving　in both　cases, whereby Staphylococcus　citreus or gram-negative

bacillus was found in some cases.

　　10）Ｂｏtｈ in axillary odor patients and normal persons, smears absorbed aseptically

in gauzes from aseptic axillary skin surface and axillary apocrine sweat obtained after

48 hours in 37°Ｃ，so far as they were kept under aseptic condition. ０ｎ the contrary。

244

when　thus　obtained　smears　and　apoc!rine sweat were infected with Staphylococcus

albus in ｖlヽtro,the　smears smelled distinctivly from 75 t0 180 minuten after infection,

and the apocrine sweat also did slightl‘ｙfrom 24 t０４８hours after infection in patients

of axillary odor, while in normal persons both of them produced no odor in ａ１１　cases

within the same hour after infection. 。

　　11) Effects of topical application of some antiseptics upon axillary odor (tinctura

jodi, mercurochrome solution. benzalkonium solution, aureomycin vaseline, penicillin

vaseline, Damola ointment （ａ mixture of glycerin. as ａ chief basic medicine, and a

littlequantity of burnt-alum), so-called dextromycin ointment （ａ mixture　of glycerin

and dextromycin), and Ｄ（ａ mixture of　Damola and dextromycin) were studied.

observing the bacteriological findings　of　axillary　skin surface。 It　was　found　that.

whatever medicine was applied, the more perfectly the aseptic condition was kept, the

more remarkably was extinguished the odor｡

　　12) From the examinations mentioned above, it may　well be concluded that ａ

bacteriological infection (mostly with Staphylococcus ａ!bus) plays an indispensable part

in appearnce of ａχillaryodor, though the essential cause of　axillary odor　should of

course　be　investigated　in　functional and　morphological　abnormalities　of　axillary

apocrine glands acquired and congenital.