Large Forefoot Schwannoma: A Case Report / 대한족부족관절학회지

A schwannoma is a benign neurogenic tumor derived from Schwann cells. A rare case of a large painful schwannoma in the foot with metatarsal deformity was presented. Due to suspicion of malignancy, amputation had been recommended previously. We report on a rare case of a large forefoot schwannoma causing pain and paresthesia of the forefoot.

A Randomized Controlled Trial about the Levels of Radiation Exposure Depends on the Use of Collimation C-arm Fluoroscopic-guided Medial Branch Block

BACKGROUND: C-arm fluoroscope has been widely used to promote more effective pain management; however, unwanted radiation exposure for operators is inevitable. We prospectively investigated the differences in radiation exposure related to collimation in Medial Branch Block (MBB). METHODS: This study was a randomized controlled trial of 62 MBBs at L3, 4 and 5. After the patient was laid in the prone position on the operating table, MBB was conducted and only AP projections of the fluoroscope were used. Based on a concealed random number table, MBB was performed with (collimation group) and without (control group) collimation. The data on the patient's age, height, gender, laterality (right/left), radiation absorbed dose (RAD), exposure time, distance from the center of the field to the operator, and effective dose (ED) at the side of the table and at the operator's chest were collected. The brightness of the fluoroscopic image was evaluated with histogram in Photoshop. RESULTS: There were no significant differences in age, height, weight, male to female ratio, laterality, time, distance and brightness of fluoroscopic image. The area of the fluoroscopic image with collimation was 67% of the conventional image. The RAD (29.9 +/- 13.0, P = 0.001) and the ED at the left chest of the operators (0.53 +/- 0.71, P = 0.042) and beside the table (5.69 +/- 4.6, P = 0.025) in collimation group were lower than that of the control group (44.6 +/- 19.0, 0.97 +/- 0.92, and 9.53 +/- 8.16), resepectively. CONCLUSIONS: Collimation reduced radiation exposure and maintained the image quality. Therefore, the proper use of collimation will be beneficial to both patients and operators.

The Prognostic Significance of ErbB1 (EGFR) Expressions in Patients with Curative Resection for Colorectal Cancers

PURPOSE: The ErbB family is associated with cell growth, differentiation, cell survival, apoptosis, cell cycle progression, angiogenesis. In this study, the expressions of ErbB family of colorectal cancer specimen were investigated to determined correlations between the clinicopathologic characteristics and the expression of ErbB family in the curative resection for colorectal cancers, including cancer specific survival. METHODS: Patients who underwent the curative surgery for colorectal cancers from January 1997 to December 2000 at Ansan Medical Center, Korea University College of Medicine were enrolled in this study, and one hundred ninety six of colorectal cancer. The clinical relationship between the expression of ErbB family for colon adenocarcinoma and clinicopathologic characteristic factors including survival were analyzed. RESULTS: There was no clinical relationship of the expression of ErbB family with clinicopatholologic characteristics. However, survival analysis demonstrated that 5 year survival rates (5YSR) of patients with the positive expression of ErbB1 (EGFR) was lower than those of the negative expression of ErbB1 (P<0.05) in colorectal cancer patients. Moreover 5YSR of the positive expression of ErbB1 was lower than that of negative expression of ErbB1 in well differentiation subgroup, node negative subgroup, node positive subgroup, and also stage T3 subgroup (P<0.05). CONCLUSIONS: The positive ErbB1 expression of colorectal cancer was one of poor prognostic factors in patients with colorectal cancer in this study. We need the further study to prove the real relation between target therapy for the positive expression of ErbB1 (EGFR) in colorectal cancer and the improvement of survival rate.

The Evaluation of Neurotoxicity after Intrathecal Restorative Fluid Injection in the Rat

OBJECTIVE: To assess neurotoxicity of intrathecal restorative fluid leakage in the course of the intradiscal restorative fluid injection. METHOD: Twenty male Sprague-Dawley rats, body weight range of 300~350 gm, were divided randomly into four groups. Control group, group A (mixed solution of glucosamine hydrochloride 5%, chondroitin sulfate 5%, and bupivacaine hydrochloride 2%), group B (glucosamine hydrochloride 8%, chondroitin sulfate 2%, and bupivacaine hydrochloride 2%) and group C (glucosamine hydrochloride 16%, chondroitin sulfate 2%, and bupivacaine hydrochloride 2%). The behavioral test for cold allodynia (tail flick test) was conducted 1 day prior to the injection and 7 days postoperatively. Histopathologic evaluation was performed using light microscopy by a neuropathologist. The severity of nerve and cord injury were graded according to injury scoring system. RESULTS: Each group showed no significant difference in sensory function test using tail flick test before and after intrathecal restorative fluid injection. Cold allodynia was not showed statistically significant difference among the group. Histological examination showed statistically significant difference between control group and group B, group C, and between group A and group B, C in both cord and root. CONCLUSION: Intrathecal injection of restorative fluid shows neurotoxic changes in roots and spinal cord in histopathologic studies. Although same ingredients of restorative solution, the different concentration of the ingredients revealed different neurotoxicity.

A Case Report on Cryptococcal Lymphadenitis in an Immunocompetent Adult Patient / 감염과화학요법

Cryptococcus neoformans is an organism that mainly causes opportunistic infection in immunocompromised patients. It can also cause various infections in immunocompetent patients, but cryptococcal lymphadenitis is rare. We have experienced a case of cryptococcal lymphadenitis in an immunocompetent adult patient who presented with cervical lymphadenopathy and fever that did not subside for 3 weeks. Neck and chest CT scan showed multiple lymph node enlargements with central low density and peripheral enhancement on both hilar, mediastinal, and right supraclavicular areas. Cryptococcus lymphadenitis was diagnosed by tissue biopsy, PAS and GMS stain, and culture. This case emphasizes that when an immunocompetent patient presents with lymphadenopathy, cryptococcal lymphadenitis should always be considered in the differential diagnosis.

A Case Report on Cryptococcal Lymphadenitis in an Immunocompetent Adult Patient / 감염과화학요법

Cryptococcus neoformans is an organism that mainly causes opportunistic infection in immunocompromised patients. It can also cause various infections in immunocompetent patients, but cryptococcal lymphadenitis is rare. We have experienced a case of cryptococcal lymphadenitis in an immunocompetent adult patient who presented with cervical lymphadenopathy and fever that did not subside for 3 weeks. Neck and chest CT scan showed multiple lymph node enlargements with central low density and peripheral enhancement on both hilar, mediastinal, and right supraclavicular areas. Cryptococcus lymphadenitis was diagnosed by tissue biopsy, PAS and GMS stain, and culture. This case emphasizes that when an immunocompetent patient presents with lymphadenopathy, cryptococcal lymphadenitis should always be considered in the differential diagnosis.

Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy: Report of an Autopsy Case / 대한법의학회지

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is characterized histologically by massive infilteration of right ventricular wall by fat tissue with surviving strands of cardiomyocytes bordered by or embedded in fibrosis. ARVC has been recognized as a cause of sudden death, especially in the young. We report an autopy case of ARVD/C in a 35-year-old female. She was found dead in her house under apparently natural circumstances. The autopsy revealed a dilated 340-gram heart with a fibrofatty replacement of the right ventricular myocardium. On the review of her past medical history, she had taken medical examination for prolonged general weakness about 1 year prior to death. At that time the echocardiogram revealed dilatation of right ventricular cavity size and moderately decreased left ventricular systolic function, the electrocardiogram revealed R>S at V1 lead and T-wave inversion at V1-V3 leads. To the best of our knowledge, this is the second autopsy case of ARVD/C, reported in the literature of Korea.

Assessment of the Association of Iron Deficiency and Frequencies of Autoantibodies and Abnormal Thyroid Function Tests in Patients with Alopecia Areata / 대한피부과학회지

BACKGROUND: Iron deficiency is known as an aetiological factor in diffuse alopecia and androgen-dependent alopecia, especially in females. In alopecia areata, a few studies have been performed to evaluate the role of iron deficiency, but the results were not conclusive. Alopecia areata is suspected to be an autoimmune disease and increased frequencies of thyroid disease, vitiligo, and autoantibodies have been demonstrated. OBJECTIVE: The purpose of this study is to assess the role of iron deficiency in alopecia areata and to study the frequency of abnormal thyroid function tests and autoantibodies in Korean patients with alopecia areata. METHOD: A total of 40 (32 premenopausal and 8 postmenopausal) female and 33 male patients with patchy alopecia areata were included. Hematologic tests, thyroid function tests and autoantibody tests were performed. RESULTS: About 65% of premenopausal female patients with alopecia areata had low level of serum ferritin below 20 ng/ml. This percentage was increased to 87% with low limit of 40 ng/ml, and to 100% with low limit of 70 ng/ml in premenopausal women, but all postmenopausal patients showed normal ferritin level. About one-fifth of premenopausal female patients had low serum iron level and one-tenth had low hemoglobin level. Serum ferritin level was significantly lower in premenopausal women (21.5+/-12.4 ng/ml) than in postmenopausal women (71.1+/-47.1 ng/ml) (p<0.05). Hematologic test abnormalities were very infrequent in male patients with alopecia areata. Thyroid function tests were normal in most of the patients. Frequency of antinuclear antibody was 30% in female patients with alopecia areata, which was higher than 9% in male patients. Frequencies of antimicrosomal and antithyroglobulin antibodies were rather low and they were similar in female and male patients. CONCLUSION: Our results suggest possible role of ferritin deficiency in premenopausal female patients with alopecia areata. Abnormalities in thyroid function tests or autoantibodies were not a major problem in alopecia areata patients.

A Case of Infantile Acropustulosis Developed after Treatment of Scabies / 대한피부과학회지

Infantile acropustulosis is characterized by recurrent crops of pruritic vesicopustules that are found primarily on the distal extremities of infants. Herein we report a 20-month-old female baby, who had a past history of scabies, with recurrent episodes of 1-2 mm sized, intensely pruritic vesicopustules on both hands and feet. The mite smear for scabietic mites, Gram stain for bacteria, and KOH smear for dermatophytes of lesion were all negative. Tzank test of the vesicle revealed many neutrophils. She was treated with dapsone (2mg/kg/day) and the pruritic vesicles and pustules had disappeared by 48 hours.

Histopathology of Alopecia Areata and Male Androgenetic Alopecia in Horizontal Sections of Scalp Biopsies in Koreans / 대한피부과학회지

BACKGROUND: The advantages of horizontal, over vertical, sectioning of scalp biopsies allow morphometric analysis of follicular structures. OBJECTIVE: In this study, we performed the morphometric analysis of alopecia areata and androgenetic alopecia in Koreans using the horizontal sectioning method. METHODS: Paird, 4-mm punch biopises were taken from the margin of alopecic patch from 21 alopecia areata patients or the frontal lesion of 13 androgenetic alopcia patients, and from clinically normal occipital scalp of all subjects. RESULTS: The general histopathological features were consistent with the known descriptions, but the data on exact follicular counts showed striking differences compared with those from Caucasians. 1. In alopecia areata, numbers of vellus hairs (3.2+/-2.9) and follicular stellae (1.6+/-1.6) was increased significantly (p<0.05) compared with counts from normal occipital scalp (vellus hairs 1.1+/-1.3; follicular stellae 0.5+/-0.8). Anagen/telogen percent ratio was decreased in lesions (64.2%:35.8%) compared with normal occipital scalp (94.0%:5.7%). 2. In androgenetic alopecia, numbers of vellus hairs (4.1+/-3.7) and follicular stellae (4.4+/-3.4) was increased significantly (p<0.05) in the lesion compared with the normal occipital scalp (vellus hairs 1.1+/-1.3; follicular stellae 1.0+/-1.2). Mild decrease of anagen/telogen percent ratio was observed in lesions (86.5%:13.5%) compared with normal occipital scalp (93.5%:6.5%). CONCLUSION: Our results suggest that horizontal sectioning of scalp biopsies is a useful diagnostic method but differences in follicular counts should be considered in interpreting the morphometric data in Koreans.

A Case of Halo Congenital Nevus Undergoing Spontaneous Regression / 대한피부과학회지

Halo congenital nevus is a condition in which halo formation is associated with congenital nevocellular nevus. Both humoral and cell-mediated immunity have been implicated to be involved in halo formation. We described a 8-year-old boy with halo congenital nevus characterized by the unique histologic location of inflammatory cells. He has no personal and familial history of vitiligo, dysplastic nevus, melanoma or autoimmune disease. Histologically, the present case of halo congenital nevus undergoing spontaneous regression showed a marked inflammatory infiltrate with remnants of original nevus cell nests in the upper dermis, whereas no inflammatory infiltrate was present in the deep dermis. Most of inflammatory cells were T-cells.

Effects of Antitumor Agents on Ultrastructure of the Splenic White Pulp of the Mouse Implanted with Ehrlich Carcinoma Cells / 대한해부학회지

This experiment was performed to study the morphological responses of the splenic white pulp, the lymphatic tissue of the spleen, of Ehrlich carcinoma cell-implanted mice to three different anticancer drugs (5-fluorouracil, mitomycin C and AG60). Healthy adult ICR mice weighing 20 g each were divided into normal and experimental groups. In the experimental groups, each of mice was inoculated with 1X10(7) Ehrlich carcinoma cells subcutaneously in the inguinal area. From next day, 0.2 ml of saline solution, 5-fluorouracil (30 mg/kg), mitomycin C (400 microgram/kg) or AG60 (30 mg/kg, Taerim Pharm. Co., Seoul, Korea) were injected subcutaneously every other day, and animals were sacrificed at 14th day following the f irst injection. Pieces of the tissues were taken from the spleen, and prefixed with phosphate buffered 2.5% paraformaldehyde-1.5% glutaraldehyde solution (pH 7.3) followed by post-fixation with phosphate buffered 1% osmium tetroxide solution (pH 7.3). Fixed tissue blocks were dehydrated, and embedded in araldite mixture. Ultrathin sections stained with uranyl acetate and lead citrate were observed with a JEM 100CX-II electron microscope. In the experimental control group (carcinoma cell-inoculated mouse), splenic white pulp did not show pronounced morphological alterations, but myelin figures were frequently observed in the cytoplasm of some lymphocytes and reticular cells than those of normal control mice. In the AG60 treated group, splenic white pulp did not show specific morphological defect, but nuclear bodies and severe invaginations of the nuclear envelope of the lymphocytes and reticular cells were observed occasionally. In the mitomycin C treated group, myelin figures, severe invaginations of the nuclear envelope, nuclear protrusions, nuclear bodies and interchromatin granules were frequently observed in the lymphocytes and reticular cells of the white pulp. In the 5-f luorouracil treated group, myelin f igures, severe invaginations of the nuclear envelope, nuclear protrusions, nuclear bodies and interchromatin granules were observed more frequently in the lymphocytes and reticular cells of the white pulp, as compared with those of mitomycin C treated mice. From the above results, 5-f luorouracil or mitomycin C may suppress the splenic immune function of cancerinoculated mice, since they suppress the process of differentiation and maturation of splenic lymphocyte and reticular cells, and 5-fluorouracil was more harmful on the spleen than mitomycin C. Whereas AG60 does not affect remarkably the process of differentiation and maturation of lymphocytes and reticular cells in the splenic white pulp.

A Case of Cutaneous Metastasis of Distal Common Bile Duct Carcinoma / 대한피부과학회지

Cutaneous metastasis of common bile duct carcinoma is rare. we report a case of cutaneous metastasis of distal common bile duct carcinoma in a 48-year-old female who has asymptomatic multiple erythematous nodules on the occipital area. She had been diagnosed with distal common bile duct carcinoma 2 years ago. Histopathologic examination of the cutaneous lesion showed well to moderately differentiated adenocarcinoma.

A case of Hyperkeratosis of Areola in an Old man / 대한피부과학회지

Hyperkeratosis of the nipple and areola is a rare condition characterized by verrucous thickening and brown pigmentation of the nipple and areola, with variants involving both or alone. The most common type is a nevoid form which occurs more often in women of childbearing age. We report a 62-year-old man with bilateral hyperkeratosis of areola. He has no history of endocrinopathy or exogenous hormonal therapy. Also, he had no other additional hyperkeratotic condition. The present case is a nevoid form by the Levy-Franckel classification and interesting in that it developed in an old man without any underlying disease, just confined to both areolas.

Morphologic Changes and Ha - ras Mutation in DMBA - treated Rat Mammary Tissues / 대한암학회지

PURPOSE: To understand the morphologic and molecular changes in carcinogen-induced breast tissues, DMBA (10-dimethy1-1,2 benzanthracene) was administrated in Sprague- Dawley female rats. MATERIALS AND METHODS: At 50 days of age, all experimental rats were given 20 mg DMBA by gastric intubation. Until the seventh week after DMBA administration, six rats were sacrificed every week, thereafter all tumors found during 20 weeks were removed every week. The morphologic changes were evaluated in routinely processed sections stained with H-E and with anti-smooth muscle actin antibody. Mutation of Ha-ras codons 12 and 61 was examined by ARMS (amplification refractory mutation system) method in frozen tissues. RESULTS: The epithelial cell proliferation of terminal end buds began 2 weeks after DMBA treatment and progressed to the 6th week, resulting in microscopic malignant tumor in one of the 7th weeks rats. The tumors were developed in 43 of 62 rats (69.4%); 8 benign lesions in 4 rats and 72 malignant tumors in 39 rats. Mutations in the 12th and 61th codon of Ha-ras gene were respectively found in 29.7% and 2.7% of preneoplastic breasts, 25% in benign lesions, 2.6% and 31.6% of malignant tumors. CONCLUSION: DMBA treatment in rats induced epithelial proliferation, then benign and malignant tumors through Ha-ras gene mutation, especially in codon 61 leading to cancer.

K-ras and p53 gene mutation in endometrial hyperplasia and adenocarcinoma / 대한산부인과학회잡지

Endometrial adenocarcinoma is the third common malignancy of female genital tract and categorized as estrogen-dependent tumor (type I) or not (type II). Type II endometrial adenocarcinoma more frequently occurs in oriental, which may arise from genetic alterations such as K-ras and p53. To identify whether the K-ras and p53 mutational activation are occurred during endometrial carcinogenesis, we examined point mutations of K-ras codon 12, 13, 61 (PCR-RFLP) and p53 exon 5, 6, 7, 8 (PCR-SSCP) in the 19 samples of endometrial adenocarcinoma. The 9 samples of normal endometrium and 24 samples of endometrial hyperplasia were also examined. K-ras codon 12 mutations were found in one of 3 cases of atypical hyperplasia (33.3%) and three of 19 cases of endometrial adenocarcinoma (15.7%). The correlation with K-ras mutation and endometrial hyperplasia/adenocarcinoma was statistically insignificant(p=0.306). p53 mutation was found in only one case of endometrial adenocarcinoma which concomitantly occurred with K-ras mutation. It could not be determined that K-ras mutation was early or late event during endometrial carcinogenesis due to a few cases of atypical hyperplasia and no K-ras mutation in the benign endometrial hyperplasia. The endometrial adenocarcinoma with K-ras mutation was observed in postmenopausal old age groups, and revealed moderate to severe histologic grade, early clinical stage, and negative lymph node metastasis.

Multiple Well Differentiated Fetal Adenocarcinoma of the Lung: A Case Report / 대한세포병리학회지

Well differentiated fetal adenocarcinoma of the lung is a subtype of pulmonary blastoma. In this report, CT-guided fine needle aspiration smears were performed at the right upper lobe of the lung in a 45 year-old male patient who had the smoking history of one pack per day for 25 years. The smears disclosed round, papillary, and tubular patterns of cell clusters. The individual cells had relatively uniform, small to medium sized nuclei without nucleoli, and showed vesicular or eosinophilic cytoplasm with indistinct cell border. The morules were seen in the central area of papillary clusters. They were composed of two cell types, outer single layered cuboidal cellular lining and central three-dimensional cluster of cells simulating fetal lung. These cytologic features need to be differentiated from usual pulmonary adenocarcinoma, carcinoid, and pulmonary blastoma. On histologic findings, the tumor arised in the bronchial epithelium. And the tumor cells had abundant intracytoplasmic glycogen with neuroendocrine feature on histochemical study. In addition, the multiplicity of this tumor is the unique point comparable to the previous reports.

Fine Needle Aspiration Cytology of Mucoepidermoid Carcinoma of the Salivary Gland / 대한세포병리학회지

PURPOSE: There is no specific treatment guidelines for Henoch-Schonlein (HS) nephritis. Therefore we performed this study to observe the effect of long term steroid therapy combined with azathioprine METHODS: Treatment protocols; 1) Steroid pulse therapy: methylprednisolon 30 mg/kg/dose, maximum 1 gm, intravenously 6 times for alternate day. 2) Oral steroid was given 2 mg/kg/day for 1 month, 1 mg/kg/day for following I month and alternate day oral steroid combined with azathioprine 2 mg/kg/day for 2 years. RESULTS: Time period from HSP to onset of HS nephritis was between 2 weeks to 5 months with mean 7.4+/-7.4 weeks. Clinical remission were seen in 4 cases out of 5 (80%). Mean time period with disappearance of proteinuria and microscopic hematuria were 5+/-2.4 month and 13.3+/-2.9 month respectively. On pathologic findings by ISKDC, 3 cases were grade IIIb, 2 cases were grade IV in first kidney biopsies and showed pathologic improvement in follow up kidney biopsies after 2 years treatment. CONCLUSION: As there no definitive treatment for HS nephritis so far, our study of long term oral steroid therapy with azathioprine was effective in clinical and histologic aspect. Therefore further study in HS nephritis with in a large group will be needed in the future.

Comparative Studies of the Effect on the Cat Brain between Intermittent Brain Retraction and Continuous Brain Retraction

The authors compared the changes of morphology, blood brain barrier alteration, pathology, arterial blood lactate content and cerebrospinal fluid lactate content between an intermittent brain retraction group and a continuous brain retraction group in 56 mongrel cats. The results were as follows ; 1) Microscopically, hemorrhages were punctate in 15 cases among 25 cases in the intermittent retraction group. However, there were multiple or large hemorrhages in 13 cases among the 25 cases in the continuous brain retraction group. 2) All cases of the intermittent retraction group showed 0~25% Evans blue staining of the coronal section crossing the retraction site. However, 8 cases among the 25 cases of the continuous retraction group showed 51~75% Evans blue staining and 4 cases of this group showed 76~100% staining. 3) With photomicroscopy, the authors noted small hemorrhage and cellular swelling in the intermittent retraction group instead of pyknosis, hemorrhagic necrosis, vacuolation in the continuous retraction group. 4) The change of arterial blood lactate content was from 1.22+/-0.24mmol/L at preretraction time to 1.42+/-0.26mmol/L at 90 minutes after release of retractor in the intermittent retraction group(p0.05). In the continuous retraction group, this author noted change in the lactate content from 1.37+/-0.28mmol/L to 2.11+/-0.52mmol/L for the same time as described above(p<0.01). From the above results, the superiority of the intermittent brain retraction was demonstrated as compared with the continuous brain retraction. Also the possible utilization of this experimental method was discussed for other wxperimental studies on ischemia.