An Adolescent Case of Castleman Disease of the Plasma Cell Type Treated with Radiotherapy / 임상소아혈액종양

Castleman disease (CD) is a disorder with distinct lymphoid hyperplasia of unknown origin, and it is rare in children. There are two major forms of CD: unicentric (localized) and multicentric. Pathologically, it can be categorized into three subtypes: hyaline- vascular, plasma cell, and mixed types. We experienced a 15-year-old boy with histopathologically proven mediastinal CD of the plasma cell type. He was referred to our hospital because of mediastinal widening in a chest x-ray found by chance. Surgery was performed to resect two right paratracheal masses and subtotal excision was done. As complete surgical resection was not possible, the patient subsequently received three-dimensional conformal radiation therapy (total 5,400 cGy in 27 fractions). The size of the mass decreased, and his clinical symptoms regressed without any side effects from radiotherapy. Here we report a case of unicentric plasma cell type CD, treated with radiotherapy due to incomplete surgical resection.

An Adolescent Case of Castleman Disease of the Plasma Cell Type Treated with Radiotherapy / 임상소아혈액종양

Castleman disease (CD) is a disorder with distinct lymphoid hyperplasia of unknown origin, and it is rare in children. There are two major forms of CD: unicentric (localized) and multicentric. Pathologically, it can be categorized into three subtypes: hyaline- vascular, plasma cell, and mixed types. We experienced a 15-year-old boy with histopathologically proven mediastinal CD of the plasma cell type. He was referred to our hospital because of mediastinal widening in a chest x-ray found by chance. Surgery was performed to resect two right paratracheal masses and subtotal excision was done. As complete surgical resection was not possible, the patient subsequently received three-dimensional conformal radiation therapy (total 5,400 cGy in 27 fractions). The size of the mass decreased, and his clinical symptoms regressed without any side effects from radiotherapy. Here we report a case of unicentric plasma cell type CD, treated with radiotherapy due to incomplete surgical resection.

Ultrasonographic Findings of Medullary Thyroid Carcinoma: a Comparison with Papillary Thyroid Carcinoma

OBJECTIVE: This study was designed to evaluate the ultrasonographic (US) findings of medullary thyroid carcinoma (MTC) as compared to findings for papillary thyroid carcinoma (PTC). MATERIALS AND METHODS: The study included 21 cases of MTC that were surgically diagnosed between 2002 and 2007 and 114 cases of PTC that were diagnosed in 2007. Two radiologists reached a consensus in the evaluation of the US findings. The US findings were classified as recommended by the Thyroid Study Group of the Korean Society of Neuroradiology and Head and Neck Radiology (KSNHNR) and each nodule was identified as suspicious malignant, indeterminate or probably benign. The findings of medullary and papillary carcinomas were compared with use of the chi-squared test. RESULTS: The common US findings for MTCs were solid internal content (91%), an ovoid to round shape (57%), marked hypoechogenicity (52%) and calcifications (52%). Among the 21 cases of MTC nodules, 17 (81%) were classified as suspicious malignant nodules. The mean size (longest diameter) of MTC nodules was 19 +/- 13.9 mm and the mean size (longest diameter) of PTC nodules was 11 +/- 7.4 mm; this difference was statistically significant (p < 0.05). An ovoid to round shape was more prevalent for MTC lesions than for PTC lesions (p < 0.05). CONCLUSION: The US criteria for suspicious malignant nodules as recommended by the Thyroid Study Group of the KSNHNR correspond to most MTC cases. The US findings for MTC are not greatly different from PTC except for the prevalence of an ovoid to round shape.

Various Bronchial Fistulas: Pitfalls and Usefulness on CT. A Pictorial Review

The presence and type of bronchial fistulas connected with various organs within the thorax were examined. The types of bronchial fistulas include bronchopleural, bronchoesophageal, adenobronchial, bronchomediastinal, bronchovascular, and other variants. The bronchopleural fistula included a central bronchopleural and peripheral bronchopleural fistula, as well as a bronchoesophageal fistula consisting of congenital and acquired fistula. Generally, an adenobronchial fistula generated by pulmonary tuberculosis or corrosive esophagitis. These conditions may have originated from bronchomediastinal and bronchovascula fistula. The computed tomography results revealed the connection of the bronchial fistula with organs and causative diseases. In addition, applying multiplanar reformatted images provided a the accurate location of bronchial fistula. In this type of clinical atlas, the type of bronchial fistulas and their imagings were introduced.

Carotid Doppler Ultrasound in Patients with Stenosis of the Intracranial Internal Carotid Artery

PURPOSE: To investigate the Doppler ultrasonographic parameters of a carotid ultrasound (CUS) for the stenosis of the intracranial internal carotid artery (IICA). MATERIALS AND METHODS: The authors evaluated 15 patients with normal extracranial ICA, the common carotid artery (CCA), and stenosis of IICA (patient group). The control group consisted of 22 patients with normal findings on a magnetic resonance angiography (control group). All subjects were subjected to a CUS, whereas subjects from the patient group underwent a cerebral angiography. The following parameters were investigated: peak systolic velocity (PSV) and end diastolic velocity (EDV) in ICA, PSV in CCA, resistive index (RI) in ICA, and PSV ratio. Stenosis was measured following an angiography and was graded as follows: normal (0-24%), mild (25-49%), moderate (50-69%), and severe (70-99%). Next, the CUS findings, which reflected the IICA stenosis, were investigated. RESULTS: Of the 74 ICAs, 52 were normal (44 ICAs in the normal group and 8 ICAs in the patient group), 10 had mild stenosis, 8 had moderate stenosis, and severe 4 had severe stenosis. As the stenosis grade increased, PSV and EDV in ICA as well as PSV in CCA, decreased (p value < 0.05); however, the PSV ratio and RI remained unchanged. CONCLUSION: As stenosis of IICA increases, PSV and EDV of ICA and PSV of CCA decreases following a CUS.

A case of chemoresistant placental site trophoblastic tumor in a patient who wants to remain fertile / 부인종양

Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic tumor (GTT) that has different behavior in disease process. The hysterectomy is general for PSTT, but hysterectomy is undesirable for patients who wish to remain fertile. We planned to preserve fertility of a young patient by first administering EMA/CO (Etoposide, methotrexate, actinomycin D/cyclophosphamide, vincristine) chemotherapy and then performing an open uterine surgery to remove residual tumor. The patient who attempted primary chemotherapy for PSTT must be undergone a hysterectomy because this conservative regimen showed sign of chemoresistance. We report a case of chemoresistant PSTT with trial to preserve fertility with a brief review of literatures.

Polyvinyl Alcohol Embolization Adjuvant to Oily Chemoembolization in Advanced Hepatocellular Carcinoma with Arterioportal Shunts

OBJECTIVE: To assess the feasibility and safety of polyvinyl alcohol (PVA) embolization adjuvant to transarterial oily chemoembolization (P-TACE) in advanced hepatocellular carcinoma (HCC) with arterioportal shunts (APS). MATERIALS AND METHODS: Nineteen patients who underwent PVA embolization for APS before a routine chemoembolization (TACE) procedure were retrospectively reviewed. 10 of these 19 patients underwent follow-up TACE or P-TACE after P-TACE (Group A), but nine patients underwent only initial P-TACE because of progression of HCC and/or underlying liver cirrhosis (Group B). Hepatic function tests, APS grades, and portal flow directions were evaluated before and after P-TACE sessions. Complications after procedures and survival days were also evaluated. RESULTS: In group A, APS grade was improved in eight patients and five of six patients with hepatofugal flow showed restored hepatopetal flow postoperatively. No immediate complication was developed in either group. Transient hepatic insufficiency developed in eight (42.1%) of 19 patients after P-TACE, and seven (87.5%) of these eight recovered within two weeks under conservative care. The mean and median survival time all study subjects was 280 days and 162 days. CONCLUSION: P-TACE is feasible and safe in advanced HCC patients with APS.

A case of thoraco-omphalopagus with omphalocele with 3D ultrasonography and MRI / 대한산부인과학회지

One of the most interesting congenital malformations is a conjoined twin. Conjoined twins are a rare occurrence in obstetric practice. More commonly known as Siamese twins, this phenomenon is shrouded in mystery and considered a curiosity by general public. Current technology is providing a basis for earlier diagnosis and a better prognosis. Frequently, the twins are born dead, but there are a few cases in which the twins survive. We present a case of thoraco-omphalophagus with omphalocele in 35 years old woman at 25weeks 5 days gestation by 3-D ultrasonography and MRI.

Clinical Usefulness of Multi-Detector Computed Tomography in Diagnosis of Patients with Microscopic Hematuria / 대한신장학회지

PURPOSE: The number of patients with microscopic hematuria has increased for etiological reasons. The first diagnostic step for microscopic hematuria is usually intravenous pyelography (IVP). Nowadays, multi-detector computerized tomography urography (MDCT urography), which can evaluate the whole urinary tract, has been widely used. The objective of this study was to investigate the clinical usefulness of MDCT urography for diagnosis of microscopic hematuria in comparison with IVP. METHODS: 510 patients were selected randomly and underwent MDCT urography or IVP from October 2004 to September 2006 (MDCT 267 patients, IVP 243 patients). RESULTS: In 267 cases of MDCT urography, normal 158 (59%), simple renal cyst 75 (28%), renal stone 14 (5.3%), ureteral stone 8 (3%), and malignancy 7 (2.6%) (renal cell carcinoma 2, transitional cell carcinoma of ureter 2, bladder cancer 3) were detected. In 243 cases of IVP, normal 221 (91%), simple renal cyst 3 (1.2%), renal stone 4 (1.6%), ureteral stone 7 (2.9%), and malignancy 1 (0.4%) were detected. The detection rates of simple cyst, renal stone and urothelial carcinoma in MDCT urography were higher than those of IVP significantly (p<0.05), but the detection rate of ureteral stone between MDCT urography and IVP was not significantly different. CONCLUSION: MDCT urography is a valuable modality for evaluation of patients with microscopic hematuria. It seems to have a high detection rate in simple renal cyst, renal stone, and urethelial carcinoma, although prospective studies for its efficacy are needed.

An Unexplained case of Recurrent Massive Subchorionic Hematoma in Midpregnancy / 대한산부인과학회지

Placental abnormality is the important predisposing cause of intrauterine growth retardation. Massive subchorionic hematoma is defined as a large size of maternal blood clot that separates the chorionic plate from the villous chorion and can result in serious obstetrical complications. We report a case of massive subchorionic hematoma diagnosed prenatally, and propose an additional peculiar finding detectable on both the ultrasound and magnetic resonance images: a large hematoma in the subchorionic region at 17 weeks gestation. At 18 weeks 2 days gestation, the fetus was miscarried. The clinical and pathological findings were compatible with massive subchorionic hematoma. Recurrent massive subchorionic hematoma without thrombophilic finding was observed at the next pregnancy in 17 weeks 5 days by ultrasound. The patient was managed conservatively and had successful outcome at term. So we report the case with the brief review of literatures.

Radiographic Findings of Tubo-ovarian Abscess / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to identify retrospectively the different computed tomography markers and sonography in a series of surgically and pathologically proven cases of tubo-ovarian abscesses in order to achieve correct preoperative diagnosis of this life-threatening condition. METHODS: A review of the medical and pathological records from the department of obstetrics and gynecology, Catholic University Medical College from January 1993 to January 2003 confirmed 79 patients with the diagnosis of tubo-ovarian abscess. Patient were divided into two groups. From this group 15 patients who underwent CT prior to therapy were identified, and the medical records, pathologic reports and CT of these patients were retrospectively reviewed and correlated. RESULTS: All 79 patients underwent operative surgery and were confirmed tubo-ovarian abscess. CT findings of tubo-ovarian abscess present in our patients were (a) a thick-walled fluid-density mass in an adnexal location, (b) septation or partial septation within the mass, (c) indistinct borders with the uterus and adjacent bowel loops, (d) anterior displacement of the mesosalpinx, indicating a probable adnexal origin, and (e) bilateral or unilateral hydronephrosis with hydroureter. CONCLUSION: Tubo-ovarian abscess must be considered in the differential diagnosis of cystic unilateral or bilateral pelvic masses identified on CT. CT usually plays a secondary role in the diagnosis of tubo-ovarian abscess but can be valuable in difficult cases. Lack of a typical clinical presentation should not dissuade the radiologist from suggesting this diagnosis; indeed, the atypical presentation may be the reason why the patient is being evaluated initially with CT rather than with ultrasound.

Migration of a Slipped Aneurysmal Clip from the Intracranium into the Spinal Canal: Case Report

Very rarely, clips used for the ligation of intracranial aneurysms become detached and subsequently migrate into the spinal canal, causing lumbar pain or radiculopathy by compressing nerve roots or inducing inflammatory processes in their newly established location. However, it is easy to overlook the migration of the clip, because there may be either no noticeable symptoms, or a herniated disk may be mistakenly diagnosed as being the source of the present symptoms. Herein, the authors report a case in which an aneurysmal clip migrated into the spinal cord.

Arachnoid Cyst in Cavernous Sinus: Case Report

Arachnoid cyst of the cavernous sinus is very rare. When present, its anatomic location frequently gives rise to cranial nerve palsy. We report a case of arachnoid cyst of the cavernous sinus in a 38-year-old man with impaired eyeball movement and diplopia.

Diagnosis of Functional Nasolacrimal Duct Obstruction Using Dacryoscintigraphy / 대한핵의학회잡지

PURPOSE: To evaluate the value of dacryoscintigraphy in the assessment of patients with a clinical diagnosis of functional nasolacrimal duct obstruction. MATERIALS AND METHODS: Dacryoscintigraphy was performed in symptomatic 35 lacrimal drainage systems in 18 patients (age range: 37~76, 8 males, 10 females) that were patent on syringing. RESULTS: Abnormalities were detected with dacryoscintigraphy in 75.8% of systems. The positive scintigrams were subdivided into those demonstrating prelacrimal sac delay (31.8%), delay at the lacrimal sac/junction (40.9%), or delay within the duct (27%). CONCLUSION: Dacryoscintigraphy is noninvasive useful technique in the assessment of the functional nasolacrimal duct obstruction and very sensitive at detecting abnormalities in patients with lid laxity caused by senile change and facial nerve palsy.