Usefulness of endoscopic resection using the band ligation method for rectal neuroendocrine tumors

BACKGROUND/AIMS: Rectal neuroendocrine tumors (NETs) are among the most common of gastrointestinal NETs. Due to recent advances in endoscopy, various methods of complete endoscopic resection have been introduced for small (≤10 mm) rectal NETs. However, there is a debate about the optimal treatment for rectal NETs. In our study, we aimed to evaluate the efficacy and feasibility of endoscopic resection using pneumoband and elastic band (ER-BL) for rectal NETs smaller than 10 mm in diameter. METHODS: A total of 55 patients who were diagnosed with rectal NET from January 2004 to December 2011 at Gil Medical Center were analyzed retrospectively. Sixteen patients underwent ER-BL. For comparison, 39 patients underwent conventional endoscopic mucosal resection (EMR). RESULTS: There was a markedly lower deep margin positive rate for ER-BL than for conventional EMR (6% [1/16] vs. 46% [18/39], P=0.029). Four patients who underwent conventional EMR experienced perforation or bleeding. However, they recovered within a few days. On the other hand, patients whounderwent endoscopic resection using a pneumoband did not experience any complications. In multivariate analysis, ER-BL (P=0.021) was independently associated with complete resection. CONCLUSIONS: ER-BL is an effective endoscopic treatment with regards to deep margin resection for rectal NET smaller than 10 mm.

The Risk Factors Influencing between the Early and Late Recurrence in Systemic Recurrent Breast Cancer / 한국유방암학회지

PURPOSE: Patients with recurrent breast cancer usually die of their disease, even after radical surgery and adjuvant therapies which could reduce the odds of dying. Many studies analyzed and compared patients who died of recurrent disease with those that died without recurrent disease. However, less attention has been paid to evaluating factors associated with the timing of recurrence. Thus, the objective of this study is to investigate the correlation between various factors and the timing of recurrence. METHODS: We retrospectively reviewed the data of 95 recurrent breast cancer patients who underwent curative surgery to determine the prognostic factors such as menopausal status, operation method, stage, nodal status, histologic grade, nuclear grade, extensive intraductal carcinoma component, hormone receptor, p53, c-erbB-2, Ki-67, and molecular subtype. We had attempted to compare the recurrent patients within 2 years after operation and adjuvant chemotherapies as the early recurrence with those over 2 years as the late recurrence. RESULTS: Histologic grade (p=0.005), nuclear grade (p<0.001), p53 (p=0.022), and Ki-67 (p<0.001) were significant different factors that influenced the systemic recurrence between early recurrence and late recurrence. In stage I/II, histologic grade (p=0.001), nuclear grade (p<0.001), and Ki-67 (p=0.005) were significant factors that influenced the systemic early recurrence. In stage III, nuclear grade (p=0.024), and Ki-67 (p=0.001) were significant factors that influenced the systemic early recurrence. But subtypes (p=0.189, p=0.132, p=0.593, p=0.083) are not associated with the timing of recur rence. CONCLUSION: In systemic recurrent breast cancer patients, the risk factors such as histologic grade, nuclear grade, p53 and Ki-67 are also associated with the timing of recurrence. We sug gest that these patients should be proper treated and be closely followed up.

Langerhans Cell Histiocytosis in the Thyroid and Draining Lymph Nodes: A Case Report

A 53-year-old woman was presented with several 0.3-0.6 cm-sized nodules within the right lobe of the thyroid. Histologic sections of the thyroid demonstrated multiple papillary microcarcinomas in the background of lymphocytic thyroiditis, with a small focus of Langerhans cell histiocytosis (LCH). Small LCH nodules were also found in the draining cervical lymph nodes. Although the association of LCH with papillary thyroid carcinoma in the thyroid has been reported, their co-existence with LCH in the draining lymph nodes is very rare.

Solitary Fibrous Tumor of the Conjunctiva with Heretofore Undescribed Pathologic Findings

A 37-year-old female presented with a conjunctival mass discovered 3 years prior. An excisional biopsy revealed a patternless proliferation of round and spindle-shaped cells with an eosinophilic fibrillary cytoplasm and vesicular nuclei with occasional inclusions. Psammoma bodies were arranged around the dilated irregularly-shaped vessels. Differential diagnoses included conjunctival solitary fibrous tumor (SFT), nevus, glomangioma, ectopic meningioma, and mesectodermal leiomyoma. The tumor cells were immunoreactive for CD34, CD99, bcl-2 and vimentin, and were negative for smooth muscle actin, desmin, glial fibrillary acidic protein, S-100 protein, epithelial membrane antigen, and human melanoma black-45. Ultrastructurally, the tumor cells had rough endoplasmic reticulum, free ribosomes, and scattered mitochondria without basal lamina or cellular junctions, which are features of fibroblasts. A diagnosis of SFT was rendered based on the light microscopic, immunohistochemical, and electron microscopic findings. We report here on the second case of a SFT arising in the conjunctiva, which clinically and histologically mimics conjunctival nevus, glomangioma, ectopic meningioma, and a hybrid neurogenic-myogenic tumor such as mesectodermal leiomyoma.

Marginal Zone B-cell Lymphoma of MALT in Small Intestine Associated with Amyloidosis: A Rare Association

A 62-yr-old man presented with a 5-yr history of intermittent abdominal distention and pain. These symptoms persisted for several months and subsided without treatment. A diagnosis of suspected small bowel lymphoma was made based on plain radiograph and computerized tomogram findings, and he was referred to our institution for further evaluation. Segmental resection of the small intestine was performed and the diagnosis of marginal zone B-cell lymphoma associated with amyloidosis was made. This is the first case of marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) in the small intestine associated with amyloidosis in Korea.

Pathologic Findings of Surgically Resected Nontuberculous Mycobacterial Pulmonary Infection

BACKGROUND: Surgical resection of the involved lung for nontuberculous mycobacteria (NTM) has become an important curative therapy. However, there is limited information on the histopathological features of NTM pulmonary disease in Korean patients with NTM infection. METHODS: We evaluated 51 specimens from 49 patients who were treated at our referral center from 2002 to 2009. RESULTS: Almost all the cases showed bronchiectasis with lymphocytic infiltration. Variable features of granulomatous inflammation were found; well-defined granulomas in the parenchyma (68.6%), pneumonia-like granulomatous lesions (49.0%) and granulomatous inflammation in the bronchial wall (41.2%) were identified. The microscopic findings of cavitary lesions (37.3%) showed that these lesions were composed of granulomas and necrosis. CONCLUSIONS: The differentiation of tuberculosis from NTM could not be accurately made based solely on the histological features. However, the airway centered tendency of NTM reflected an airborn etiology, and this could be correlated with the classification according to the radiological findings. In addition, coexisting constitutional lung diseases, and especially bronchiectasis, were suspected to be predisposing conditions for NTM organisms to colonize and progress to true NTM pulmonary disease.

Adnexal Clear Cell Carcinoma with Comedonecrosis: A Case Report

Adnexal clear cell carcinoma with comedonecrosis (ACCCC) is a very rare malignancy of the skin with an aggressive clinical course and a predilection for the scalp. This is the first reported case of ACCCC in Korea. A 79-year-old male presented with left abdominal masses that proved to be two subcutaneous nodules. The tumors histologically consisted of epithelial nests that showed a distinctive zonal arrangement. The centrally located clear cell areas with comedonecroses were merged with the peripheral squamoid cells, often exhibiting retraction artifacts and an infiltrating border. Nuclear pleomorphism and frequent mitoses were prominent. The clear cells were immunopositive for carcinoembryonic antigen and epithelial membrane antigen. We report here on a case of ACCCC involving the abdominal skin, and this tumor should be distinguished from the more indolent squamous cell and tricholemmal carcinomas.

Primary Lung Adenocarcinoma Metastasis to the Vagina: A Case Report

Lung cancer is a malignant tumor that is often fatal. Vaginal metastasis of pulmonary adenocarcinoma is very rare. To the best of our knowledge, this is the second such report worldwide and the first one from Korea. A 67-year-old woman presented with cough, excessive sputum and dyspnea that she had sufferd with for the past one year and she had a palpable lesion in the vagina. Chest CT showed diffuse bronchial wall thickening involving the left main bronchus, the left upper lobar bronchus and the lingular divisional bronchus of the left upper lobe. There were multiple, various sized nodules in both lungs, of which the largest one measured about 1.0 cm in diameter. Both lung and vaginal biopsies were performed and the masses were diagnosed as adenocarcinoma. Immunohistochemically, the tumor cells were positive for cytokeratin 7 and TTF-1, but they were negative for cytokeratin 20. We present this case of primary lung adenocarcinoma metastasis to the vagina.

Gliosarcoma with Components of Anaplastic Oligodendroglioma and Unclassifiable Spindle Cells: A Case Report

Gliosarcoma is a distinct disease entity that is characterized by a biphasic tissue pattern with alternating areas displaying glial and mesenchymal differentiation. The tumor in our case was a rare morphologic variant of gliosarcoma with components of anaplastic oligodendroglioma and unclassifiable spindle cells. Spindle cells showed CD34 and S-100 protein immunoreactivity, which was possibly related to peripheral nerve sheath differentiation. This unique feature has not been described previously and so this case expands the spectrum of possible divergent mesenchymal differentiation, and it lends support to pluripotential stem cells being the origin of this tumor.

Granular Cell Tumors of the Abdominal Wall

Granular cell tumors (GCT) are found in virtually any body site, including the tongue, skin, subcutaneous tissue, breast, rectum and vulva. However, they are rarely seen in the abdominal wall. We report here on a rare case of GCT in the rectus muscle of the abdominal wall. A 44-year-old woman presented with a non-tender, hard mass in the right lower abdominal wall. Upon microscopic examination, the tumor was found to comprise of large polygonal cells with an abundant eosinophilic granular cytoplasm and round to oval nuclei. Upon immunohistochemical staining, the large cells showed S-100 and CD68 positive granular aggregates in the cytoplasm. Many lysosomes of variable size were observed in the cytoplasm.

Granular Cell Tumors of the Abdominal Wall

Granular cell tumors (GCT) are found in virtually any body site, including the tongue, skin, subcutaneous tissue, breast, rectum and vulva. However, they are rarely seen in the abdominal wall. We report here on a rare case of GCT in the rectus muscle of the abdominal wall. A 44-year-old woman presented with a non-tender, hard mass in the right lower abdominal wall. Upon microscopic examination, the tumor was found to comprise of large polygonal cells with an abundant eosinophilic granular cytoplasm and round to oval nuclei. Upon immunohistochemical staining, the large cells showed S-100 and CD68 positive granular aggregates in the cytoplasm. Many lysosomes of variable size were observed in the cytoplasm.

The Clinicopathological Characteristics of Gastrointestinal Neuroendocrine Tumors; An Analysis of 65 Cases

Background : This study was designed to investigate gastrointestinal neuroendocrine tumors with an emphasis on their clinicopathological characteristics. Methods : Sixty-five cases were reviewed and classified as typical carcinoid (TC), atypical carcinoid (AC), large cell neuroendocrine carcinoma (LCNEC) and small cell carcinoma (SmCC). We performed immunohistochemistry to characterize the expression of the immunoreactivity for synaptophysin, chromogranin, gastrin, somatostatin, thyroid transcription factor-1, p53 and Ki-67. Results : Most commonly, the tumors were located in the rectum (54%), followed by the stomach (23%) and colon (9%). Histologically, the tumors were classified as 49 TCs, 4 ACs, 6 LCNECs and 6 SmCCs. Most tumors were stained positive for synaptophysin and/or chromogranin. Four LCNECs and one SmCC were p53-positive. The carcinoids revealed a low level ( or =30% of the cells showed reactivity for Ki-67 in the majority of LCNECs and SmCCs. Six patients with metastatic carcinoids were older than those patients without metastasis (64 vs 48 years, respectively, p=0.004). Furthermore, the size of tumors was larger for the patients with metastatic carcinoids than for the patients with nonmetastatic carcinoids (2.3 vs 0.5 cm, respectively, p=0.005). Conclusion : Old age, large tumor size and muscle invasion are associated with high grade neuroendocrine tumor and lymph node metastasis for those patients with carcinoids.

Comparison of Sporadic Sclerotic Fibroma and Solitary Fibrous Tumor in the Oral Cavity

Sporadic sclerotic fibroma (SF) and solitary fibrous tumor (SFT) arising in the oral cavity are very rare. In this report, we describe two cases of oral pathology, one involving SF and the other involving SFT. Both cases presented with well- circumscribed, firm nodules with similar gross findings. However, the histologic findings of the SF and SFT showed rather distinct features. The SF was composed of hyalinized sclerotic collagen bundles arranged in a whorled pattern, whereas the SFT was formed by spindles cells arranged in hypo- and hypercellular areas. The immunohistochemical findings were similar in both cases; there was positivity for vimentin, CD34, and CD99, but bcl-2 positivity was only seen in the SFT. Although their histopathologies are similar, SF and SFT should be considered in the differential diagnosis of soft tissue tumors in the oral cavity.

Juvenile Xanthogranuloma of the Nasal Cavity: A Case Report and Review of the Literature

Juvenile xanthogranuloma (JXG) is a benign and self-limiting non-Langerhans-cell histiocytosis that generally occurs during infancy and childhood. It develops frequently in the head and neck but is very rare in the nasal cavity. To date, only five cases of JXG in the nasal cavity have been reported. Here, we report the second case of JXG in the nasal cavity in Korea. A 19-year-old male patient presented with a protruding 1.1 cm mass in the left nasal vestibule. Histologically, a dense dermal infiltrate of histiocytes with Touton giant cells was observed. Immunohistochemically, the histiocytes tested positive for CD68 and the S-100 protein but negative for CD1a. This shows that a S-100-positive histiocytic lesion dose not exclude a diagnosis of JXG.