Klebsiella Pneumoniae Associated Extreme Plasmacytosis / 감염과화학요법

Infection-associated plasmacytosis is not uncommon; however, marked plasmacytosis in both peripheral blood and bone marrow that mimicks plasma cell leukemia is a very rare condition. We encountered a case of extreme plasmacytosis associated with Klebsiella pneumoniae sepsis in an aplastic anemia patient. A 42-year-old man presented with high fever of 5 days' duration. Hematological analysis revealed severe neutropenia and thrombocytopenia; his white blood cell count was 900/mm3, with 26% of plasma and plasmacytoid cells in peripheral blood. Bone marrow biopsy and aspiration showed 25% cellularity with marked plasmacytosis (80%), highly suggestive of plasma cell leukemia. On the eighth hospital day, K. pneumoniae was identified in blood and sputum cultures. Fever improved after switching antibiotics, although his hematological condition worsened. His bone marrow cellularity (plasma cell proportion) progressively decreased: the values were 25% (80%), 10% (26%), 10% (11%), and < 10% (< 4%) on the 8th, 30th, 60th, and 90th hospital day, respectively. His plasmacytosis was extremely severe but was confirmed to be reactive with polyclonality. The present case represents the first report of strong suspicion of K. pneumoniae sepsis-associated marked plasmacytosis in an aplastic anemia patient.

Neuroprotective effect of Chunghyuldan (Qing Xue Dan) on hypoxia-reoxygenation induced damage of neuroblastoma 2a cell lines / 中国结合医学杂志

<p><b>OBJECTIVES</b>Chunghyuldan (CHD), a combinatorial drug that has anti-hyperlipidemic and antiinflammatory activities, has been shown to reduce infarct volume in a focal ischemia-reperfusion rat model. To explore the molecular basis of CHD's neuroprotective effect, we examined whether CHD shows a cell-protective activity and has a regulatory effect on Bax and/or B-cell leukemia/lymphoma 2 (Bcl-2) expression in mouse neuroblastoma 2a (N2a) cells subjected to hypoxia-reoxygenation (H/R).</p><p><b>METHODS</b>In order to evaluate the effects of CHD on the cytotoxicity induced from hypoxia or H/R condition, lactate dehydrogenase (LDH) assay was performed. To explore whether the suppression of neural damage when pre-treated with CHD is associated with its anti-apoptotic effect, the CHD effect on the expression of Bcl-2 and Bax was analyzed by Western blotting analysis.</p><p><b>RESULTS</b>Cytotoxicity of N2a cell line was slightly increased in 42 h hypoxia condition and dramatically increased under the H/R condition. CHD treatment markedly decreased the cytotoxicity in both conditions (P<0.01, P<0.05). H/R markedly increased the expression of the pro-apoptotic protein, Bax, but slightly increased the expression of the anti-apoptotic protein, Bcl-2, compared with the normoxia or hypoxia group. CHD significantly decreased Bax expression (P<0.01) and slightly decreased Bcl-2 expression (P>0.05), resulted in a reduction of Bax/Bcl-2 ratio in N2a cells subjected to H/R.</p><p><b>CONCLUSION</b>CHD has neuroprotective effect in N2a cells subjected to H/R, which might be derived at least in part from its ability to decrease the expression of the pro-apoptotic protein, Bax.</p>

A Comparison of Histopathologic Findings in the Nasal Polyp, Maxillary Sinus Mucosa, and Inferior Turbinate Mucosa

BACKGROUND AND OBJECTIVES: The nasal polyp is the most common form of mass lesion in the nose with an unclear etiology and pathogenesis among patients in Asia. Also, the pathological characteristic of nasal polyps in these patients is eosinophil infiltration. These findings, as reported in Asia, are distinct from those of the West. Moreover, the role of eosinophil is recently found to be on the increase even in Asia. So, we investigated the proportion of eosinophil infiltration in the nasal polyp among patients in Korea. MATERIALS AND METHODS: The study group consisted of 35 patients with a mean age of 43 years (ranging from 6 to 72 years). Tissue samples were taken via endoscopic sinus surgeries from the nasal polyp, inflammatory sinus mucosa, and the inferior turbinate. We compared 5 parameters of mucosal histopathology. RESULT: The incidence of a severe eosinophilic infiltration in the nasal polyp was 70%. Nasal polyp and inflammatory sinus mucosa had a larger eosinophil, lymphocyte and polymorphonuclear leukocyte infiltration than a normal nasal mucosa. Also, the nasal polyp and sinus mucosa had a more severe basement membrane thickening and goblet cell hyperplasia. Distinctively, the nasal polyp had a severe eosinophilic infiltration and a more thickened basement membrane. CONCLUSION: The present histopathologic feature of the nasal polyp among Koreans indicates that cases of eosinophilic nasal polyp seems to be on the increase.

Cholesterol Granuloma of the Breast: A Case Report

Cholesterol granuloma is histologically characterized as fibrous granulation tissue containing cholesterol crystals within surrounding giant cells. Cases of cholesterol granuloma of the breast are rare (1). In fact, only eight cases have been previously described, and of these, an ultrasonography was performed in only . Here, we report the ultrasonographic findings of a breast cholesterol granuloma accompanied with with a literature review.

Purely Extradural Spinal Meningioma of the Cervical Spine

Spinal meningiomas located purely in the extradural space are rare, and they may easily be confused with malignant neoplasm. We report an unusual case of a purely extradural spinal meningioma mimcking metestatic neoplasm. A 38-year-old woman had neck pain and left side weakness. MRI scan revealed extradural spinal mass. Preoperative and intraoperative diagnosis was metastatic carcinoma, but permanent diagnosis was extradural meningioma.

Purely Extradural Spinal Meningioma of the Cervical Spine

Spinal meningiomas located purely in the extradural space are rare, and they may easily be confused with malignant neoplasm. We report an unusual case of a purely extradural spinal meningioma mimcking metestatic neoplasm. A 38-year-old woman had neck pain and left side weakness. MRI scan revealed extradural spinal mass. Preoperative and intraoperative diagnosis was metastatic carcinoma, but permanent diagnosis was extradural meningioma.

Medulloblastoma Mimicking an Extraaxial Tumor on Radiological Examination

The extraaxial presentation of medulloblastoma is a rare phenomenon. This article describes the case of 19-year old woman who presented with mild headache and nausea and was diagnosed with medulloblastoma. The tumor arose from the right cerebellar cortex, and it was misdiagnosed meningioma on the basis of radiological examination. We review the literature and discuss the such atypical presentation of medulloblastoma.

Axillary Hibernoma: MRI Characteristics: A Case Report / 대한정형외과학회잡지

Hibernoma is a rare hypervascular benign soft tissue tumor arising from residual fetal brown fat. Awareness of the MR imaging appearances of this lesion may allow at least inclusion of hibernoma in the possible differential diagnosis prior to surgery.

Brachial Artery Transection with Closed Elbow Dislocation: A Case Report / 대한정형외과학회잡지

Vascular injury in the arm associated with trauma usually results from penetrating injury. However, this vascular injury can also be caused by open dislocation of the elbow or closed fracture of the humerus. Although the elbow joint is the third most common site of joint dislocation, closed elbow dislocations without associated fractures rarely have concomitant arterial injury. The authors report a case of complete disruption of the brachial artery associated with closed dislocation of the elbow and massive soft tissue damage. The patient was successfully managed by early diagnosis, prompt reduction of the dislocation, and end to end anastomosis of the brachial artery and fasciotomy.

Clinico-pathologic Profiles and 5-year Survival Rate of 2209 Patients with Invasive Cancer of the Uterine Cervix / 대한산부인과학회잡지

OBJECTIVE: This study was performed to investigate the clinico-pathologic characteristics and to analyze the 5-year survival rate and prognostic factors for invasive cancer of the uterine cervix. METHODS: From May 1982 to October 2000, 2209 patients with invasive cancer of the uterine cervix were diagnosed and treated at Samsung Cheil Hospital. In this retrospective study, we studied the clinico- pathologic characteristics (age, resident area, delivery type, FIGO stage, histologic type, nodal metastasis, lymph-vascular space invasion, endometrial extension), treatment modalities and 5-year survival rate. RESULTS: The mean age was 50.3 years (24-85) and the median age was 50.0 years old. The most common subsets of patients were found in the group of FIGO stage I b (41.9%) and age between 41 and 50 (30.0%). Surgery was the main treatment in stage I a, I b, II a and radiation in stage II b or more. Pelvic and para-aortic nodal metastasis were surgically identified in 1.9% and 0% of stage I a, 18.1% and 4.4% of stage I b, 22.6% and 5.7% of stage II a, 51.4% and 17.1% of stage II b, 14.3% and 0% of stage III/IV. Overall 5-year survival rate was 85.7%; stage I a (93.9%), I b (91.5%), II a (80.7%), II b (68.5%), III/IV (53.7%). The 5-year survival rate according to pelvic lymph node status in surgically confirmed patients were 95.4% in negative patients and 78.1% in positive patients respectively (P=0.0000). 5-year survival rate was significantly different according to age (P=0.0000), FIGO stage (P=0.0000), lymph-vascular space invasion (P=0.0001), endometrial extension (P=0.0199), pelvic (P=0.0000) and para-aortic nodal metastasis (P=0.0000). However, resident area, delivery type, histologic type did not show any significant differences in survival. CONCLUSION: Overall 5-year survival rate of 2209 patients with invasive cancer of the cervix who were diagnosed at Samsung Cheil Hospital from May 1982 to October 2000 was 85.7%. Five-year survival rate was different according to age, FIGO stage, lymph-vascular space invasion, endometrial extension, pelvic and para-aortic nodal metastasis.

Immunohistochemical Expression of p53, p21, and mdm2 Proteins in Human Papillomavirus Positive and Negative Invasive Uterine Cervical Carcinomas

BACKGROUND: In the uterine cervical carcinoma, the inactivation of p53 protein by human papillomavirus(HPV) E6 protein has been reported to play a greater role in carcinogenesis than the mutation of the p53 gene. Therefore, the mutation of the p53 gene is rare. p21 and mdm2 proteins are induced by wild-type p53 protein and are involved in the cell cycle regulatory mechanism. METHODS: Immunohistochemical staining for p53, p21 and mdm2 proteins was performed in 26 HPV-positive and 13 HPV-negative invasive cervical carcinomas together with 5 non-neoplastic cervical tissues. RESULTS: The frequencies of the expression of p53, p21 and mdm2 proteins were 82.1%, 84.6% and 66.7%, respectively. The expression of p53 protein was less frequently demonstrated in HPV-positive cases than HPV-negative cases, which was statistically a negative correlation(p=0.018). The expression of p53 and p21 proteins was statistically significant(p=0.000). CONCLUSIONS: p53, p21 and mdm2 proteins were highly expressed in both HPV-positive and HPV-negative cervical carcinomas. Significantly higher expression of p53 protain in HPV-negative cases necessitate a further study for investigating the role of p53 protein accumulation in carcinogenesis of HPV-negative cervical carcinomas. The relationship between the expression of p53 protein and p21/mdm2 proteins may indicate that p21 and mdm2 proteins also have a role in carcinogenesis, where p53 protein plays a fundamental role.

Churg-Strauss syndrome with perforating ulcers of the colon

We report a case of a 72-year-old woman with Churg-Strauss syndrome, who presented with intestinal perforation. She has had bronchial asthma with peripheral blood eosinophilia for 30 years. Gross findings of a resected colon showed multiple ulcers with perforation. Histologic findings demonstrated transmural inflammation infiltrated with large numbers of eosionophils, neutrophils and lymphoplasma cells, and characteristic extravascular granuloma in the subserosa. There were multifocally-distributed transmural vasculitis showing all stages of activity in medium and small-sized arteries and veins located in the submucosa, and proper muscle and subserosal layers of the colon, some of which revealed granulomatous inflammation. Histologic finding of liver showed chronic viral hepatitis B with mild inflammatory activity and macronodular cirrhosis. Immunohistochemical findings, acid fuschin orange G staining and electromicroscope found no evidence of hepatitis B virus infection contributing to the pathogenesis of this lesion.

Endobronchial Actinomycosis: A report of two cases

Actinomycosis causes a chronic suppurative infection most commonly involving the cervico-facial region, thorax, and the abdomen. Thoracic infection results from an aspiration of contaminated material from mouth or oropharynx. Actinomyces was known to have a predilection for the periphery of the lung and the endobronchial lesion is extremely rare. We report two cases of actinomycosis presenting as an endobronchial mass which arose in 53-year-old and 44-year-old women. The first case presented with cough, sputum, weight loss and had a history of pulmonary tuberculosis 24 years ago. Chest CT revealed a right lobe collapse simulating mass and suggested carcinoma. The second case presented with hemoptysis for 2 years. Chest CT revealed cystic bronchiectasis of both lungs and intracystic soft tissue mass in the anterior segment of the right upper lobe which suggested aspergilloma. The gross features of them were similar to those of aspergilloma. Characteristic sulphur granules consisting of a granular basophilic center surrounded by a radiating zone of eosinophilic, hyaline, club-shaped projection were histologically confirmed in both cases. Granulomas containing P. westermani eggs were present in the second case. Staphylococcus, true fungal organism, nocardia, and streptomyces shoud be distinguished by analysing their morphologic characteristics in the appropriate stains. Actinomycosis should be included in the differential diagnoses of an endobronchial mass.

Fine Needle Aspiration Cytology of Alveolar Soft Part Sarcoma: A Case Report / 대한세포병리학회지

Alveolar soft part sarcoma is a rare soft tissue tumor. Few cases of fine needle aspiration cytology have been reported in the literature. We experienced a case of recurrent alveolar soft part sarcoma of the right thigh diagnosed by fine needle aspiration cytology in a 47-year-old man. Cytologic findings showed single cells and clusters associated with thin walled vasculature in a distinct pseudo-alveolar pattern. The tumor cells exhibited round or ovoid abundant granular cytoplasm and large pleomorphic nuclei with prominent central nucleoli.

Expression of Maspin Protein in Ductal Hyperplasia, Intraductal Carcinoma and Invasive Ductal Carcinoma of the Breast

Maspin is a recently described gene with tumor suppressor activity. The gene product is a 42 kD protein with homology to the serpin family of protease inhibitors and may play a role as an inhibitor of tumor cell invasion. The prior observation that invasive breast cancers and their metastases showed decreased maspin protein expression by immunostaining supports this speculation. However, the role of maspin in breast cancer progression has not been studied in detail. We, therefore, studied maspin protein expression in a series of hyperplasia, atypical ductal hyperplasia, intraductal carcinoma and invasive carcinomas. Immunohistochemical staining (IHC) for maspin was performed on paraffin sections of 136 breast specimens using a commercially available monoclonal antibody. Among the 106 cases studied were 36 moderate/florid ductal hyperplasia, 11 atypical ductal hyperplasia (ADH), 29 intraductal carcinoma (IDC) (4 low grade, 13 intermediate grade, 12 high grade) and 30 invasive ductal carcinomas. Thirty cases of normal breast were also studied as control group. IHC stains were scored using a semiquantitative scoring system. The mean IHC scores for maspin for normal, moderate/florid hyperplasia, atypical ductal hyperplasia, intraductal carcinoma, and invasive carcinoma were 5.51 1.30, 7.36 0.72, 3.82 1.60, 4.48 2.69, 3.97 3.30, respectively. These scores for each category were statistically significant (p<0.05), except between ADH and IDC. Maspin protein expression was increased in most cases of moderate/florid hyperplasia, while maspin expression was more heterogeneous in ADH and IDC. In high grade IDC, maspin protein expression was stronger than low and intermediate grade IDC, and this suggests the possibility of a compensatory cellular response against the forces driving further tumor progression. Two thirds of invasive ductal carcinomas expressed maspin protein weakly and focally. All metastatic carcinomas of lymph nodes were negative for maspin. It is possible that high grade IDC with strong maspin expression may represent a subset less likely to progress to invasive cancer. This speculation merits investigation in clinical outcome studies.

Fibro-osseous Pseudotumor of the Digits: A case report

Fibro-osseous pseudotumor of the digits is a heterotopic ossification closely related to myositis ossificans and occurs in the subcutaneous tissue of the digits. This lesion is considered a reactive fibroblastic proliferation with metaplastic bone formation. We report a case of fibro-osseous pseudotumor of left index finger in a 28-year-old woman. She had had an ovoid smooth subcutaneous mass with tenderness on the left index finger for one month. In gross, the specimen consisted of a relatively circumscribed, rubbery soft mass with grayish white cut surface measuring 2.0 1.7 1.5 cm. Upon microscopic examination the lesion showed irregular multinodular growth with considerably variable cellularity. Because of the focal hypercellularity, cellular atypia, and increased mitotic activity this lesion may be confused with extraskeletal osteosarcoma or parosteal osteosarcoma. This rare lesion is curable by complete local excision.

Cytologic Features of an Angiosarcoma in Pleural Fluid: A Case Report / 대한세포병리학회지

Angiosarcomas are rare tumors, seen most commonly in the skin and soft tissue of head and neck region. But it has been described in numerous body sites including thyroid, breast, liver, spleen, bone, etc.. Their biological behaviors depend on the microscopic grade, site of origin, and multifocality. We report the unique cytological features of an angiosarcoma in pleural fluid. A 61-year-old woman presented with a 6 month history of dyspnea on exertion and chest pain. Chest computerized tomography(CT) revealed multiple subpleural small nodules in the right lung and widespread air space consolidation and pleural effusion in the left lung. CT of liver revealed multiple small low attenuated lesion. The smears obtained from pleural fluid showed hypocellularity with a hemorrhagic background. The tumor cells were highly pleomorphic oval or spindle in shape and presented singly, in loose groups, in knitted syncytial aggregates, and in acinar pattern. Their nuclei had vesicular chromatin with delineated, thick nuclear membranes and occasionally a large eosinophilic, prominent nucleolus. The cytoplasm was plump, thin or projected in spindly fashion. Almost all tumor cells showed variable sized intracytoplasmic vacuoles and their nuclei were sometimes crescentic by a huge vacuole. Occasional binucleated tumor cells and mitotic figures were present. Cellular debris and streaky materials were identified. Needle biopsy specimen from the pleura revealed anastomosing slit-like spaces lined by pleomorphic tumor cells. The tumor cells showed a strong reactivity for CD31 and vimentin and focal weak reactivity for factor VIII-related antigen.

Detection of Mycobacterium tuberculosis DNA in Ethanol-Fixed and Papanicolaou Stained Archival Materials

Granuloma is a chronic inflammatory process associated with non-infectious agents or infectious diseases such as tuberculosis. It is well known that AFB staining, which has been used to determine the etiology of the granulomatous inflammation, lacks both sensitivity and specificity. Due to the slow growth rate of most pathogenic mycobacteria, culturing of organisms can take up to eight weeks. It is not uncommon for specific therapy to be delayed, or for an inappropriate treatment be given to patients without mycobacterial infections or with infections caused by atypical mycobacteria. Determination of the causative agent in Papanicolaou stained cytology specimens gives pathologists even more difficulties when only necrotic material has been aspirated from the center of the granuloma. In recent years, the use of a polymerase chain reaction for the amplification of DNA has appeared promising in terms of speed, efficiency, sensitivity, and specificity. Since a polymerase chain reaction permits the sensitive genetic analysis of small amounts of tissue, it is ideally suited to the genetic analysis of cytologic specimens. A polymerase chain reaction is easily performed on unfixed and unstained cells, however, an analysis of ethanol fixed and Papanicolaou-stained archival smears has also been described. We have recently established a method to detect Mycobacterium tuberculosis organism by a nested polymerase chain reaction with primers in the insertion sequence IS 6110, using cellular digests of ethanol-fixed and Papanicolaou-stained archival specimens aspirated from the lymph nodes, lungs, thyroid, etc. Inhibitors present in Papanicolaou stained material was removed by destaining the slides with 0.5% HCl solution for 10-30 minutes. Eight out of ten cases which have shown the epithelioid granulomas revealed a positive reaction and four out of ten cases which have shown lymphohistiocytic cells in a necrotic background without any evidence of granuloma revealed a positive reaction. This study showed that it was possible to employ a polymerase chain reaction to detect Mycobacterium tuberculosis in Papanicolaou stained archival cytology specimens.

1991 cancer incidence in Seoul, Korea: results of the Implementation Study of the Seoul Cancer Registry

This article presents the results of the Implementation Study of the Seoul Cancer Registry, which started in July, 1991 as a population based cancer registry in Seoul, Korea. The completeness and validity of the registered data were evaluated using Mortality/Incidence ratio (M/I ratio), Histologically Verified Cases (HV%), Primary Site Uncertain (PSU%), and Age Unknown (Age UNK%). Owing to the additional active surveillance, the completeness of the data turned out to be fairly acceptable, except for the aged over 75(Mortality/Incidence ratio was over 100%). Eventhough the Seoul cancer registry(SCR) has further way to go in the completeness especially among elderly persons, the validity of SCR data was also acceptable in terms of HV%, PSU%, and Age UNK%. However, PSU% and Age UNK% might need to be further reduced to be comparable with other well established cancer registries. The age standardized incidence rates(ASR) of all cancers between July 1, 1991 and June 30, 1992 were 232.4/100,000 in males and 147.9/100,000 in females. The top five major sites of cancers in Seoul were the stomach, liver, lung, colo-rectum, and bladder in order in males, and the uterine cervix, stomach, breast, colo-rectum, and liver in females. Those 5 cancer sites comprised 68.9% and 64.7% of the total cancer incidence in males and females, respectively.

Clinical study of germ cell tumor of the ovary / 대한산부인과학회잡지

No abstract available.