Ultrasonographic and Pathologic Findings of Dermatofibrosarcoma Protuberans of the Breast: A Case Report

Dermatofibrosarcoma protuberans (DFSP) is a rare, malignant soft tissue tumor. It arises from the dermis, however, a few lesions are known to infiltrate into deeper layers. It commonly occurs on the trunk and extremities, but rarely involves the breast. We report a case of a 43-year-old woman who had histologically proven DFSP of the breast, with emphasis on ultrasonographic findings and pathological features. In our case, the ultrasonographic features of DFSP revealed an ovalshaped hypoechoic mass in the dermis of left breast with surrounded by increased levels of echogenic subcutaneous fat. This ultrasonographic finding correlated with pathologic features of infiltration of tumor cells into the subcutaneous fat. No previous study reported this feature of DFSP associated with the breast.

A Case of Mycobacterium gordonae Pulmonary Disease in a Patient with Ulcerative Colitis Treated with Infliximab / 대한내과학회지

Tumor necrosis factor-alpha (TNF-alpha) is a key component of the host defense against mycobacterial infection. Mycobacterium gordonae (M. gordonae) is one of the least virulent mycobacteria, and is generally considered non-pathogenic if detected from a clinical specimen. Here, we report a rare case of pulmonary M. gordonae infection in a patient with ulcerative colitis who had been treated with infliximab, a TNF-alpha antagonist. M. gordonae infection was treated successfully with clarithromycin, rifampin, and ethambutol. We believe this to be the first report of M. gordonae pulmonary disease associated with TNF-alpha antagonist treatment.

Missed Spermatic Cord Torsion in an Old Man

The fate of testicular salvage in spermatic cord torsion depends on the duration of ischemia and the degree of torsion. Even though spermatic cord torsion (SCT) can occur at any age, it is rarely reported in older patients. If the physician does not pay close attention to this unusual situation, the lack of suspicion for SCT may result in a missed or delayed diagnosis. We report a very uncommon case of missed SCT occurring in a 63-year-old man.

Epithelial-Myoepithelial Carcinoma of External Auditory Canal Evolving from Pleomorphic Adenoma

A 45-year-old female patient visited the clinic due to ear fullness. A 8 mm sized mass was found in the external auditory canal. It was surgically removed and the pathology exam confirmed epithelial-myoepithelial carcinoma (EMC). EMC is glandular epithelial neoplasm of the salivary gland. EMC originating from the external auditory canal is very rare, and only 1 case has been reported so far in the literature. The difference between our case and the one previously published was that the tumor was previously proven as a benign tumor (i.e. pleomorphic adenoma) 5 years ago. Therefore, this is the first case in the literature showing the evolvement of pleomorphic adenoma of the external auditory canal into EMC.

Epithelial-Myoepithelial Carcinoma of External Auditory Canal Evolving from Pleomorphic Adenoma

A 45-year-old female patient visited the clinic due to ear fullness. A 8 mm sized mass was found in the external auditory canal. It was surgically removed and the pathology exam confirmed epithelial-myoepithelial carcinoma (EMC). EMC is glandular epithelial neoplasm of the salivary gland. EMC originating from the external auditory canal is very rare, and only 1 case has been reported so far in the literature. The difference between our case and the one previously published was that the tumor was previously proven as a benign tumor (i.e. pleomorphic adenoma) 5 years ago. Therefore, this is the first case in the literature showing the evolvement of pleomorphic adenoma of the external auditory canal into EMC.

Auricular Tophi Presenting as a Unilateral Auricular Mass Lesion

Tophus due to gout is most commonly found in the toes and ankles, but can also be found in the auricle. Although small nodules on the helix are sometimes found in gout patients, a large mass lesion on the back side of the auricle is rare. We report a patient who visited the otology clinic due to an auricular mass lesion, which was diagnosed as a large auricular tophus. A 17-year-old male patient who suffered from gout complained of a right side auricular mass. A 3 cm sized solid mass lesion was detected on the back side of the right canvum conchal cartilage. The mass was soft, non-tender, and well-circumscribed. The lesion was first found 1-2 years earlier. The size of the lesion had been slowly increasing, but had recently stopped growing. The mass was surgically removed for pathologic confirmation and cosmetic reasons. Specimens were composed of 2 irregularly shaped pieces of soft-gray tan and yellowish tissue. The upper larger tophus was attached to the cartilage and the lower smaller tophus was embedded inside the auricular cartilage. Pathologic findings suggested tophus with amorphous deposits and subepithelial tissue.

A Case of Sparganosis in the Leg

The life-span of the sparganum in humans is not exactly known, but it may survive longer than 5 years in some patients. We experienced a case infected with a sparganum that is presumed to have lived for 20 years in a patient's leg. The patient was a 60-year-old woman, and she was admitted to a hospital due to ankle pain that was aggravated on dorsiflexion. She had noticed a mass on her knee some 20 years ago, but she received no medical management for it. The mass moved into the ankle joint 3 months before the current admission, and then the aforementioned symptoms appeared. A living sparganum was recovered by surgery, and the calcified tract near the knee was proved to be the pathway along which the larva had passed.

Association of the myeloperoxidase-463G->A polymorphism with development of atrophy in Helicobacter pylori-infected gastritis / 대한내과학회지

BACKGROUND: Helicobacter pylori (H. pylori) infection is characterized by extensive infiltration of neutrophils and induces atrophic gastritis, however, the host factors governing the development of atrophy have not been defined. Myeloperoxidase (MPO) in neutrophils amplifies the oxidative potential, thus MPO is suspected to play a role in H. pylori-induced gastric atrophy. Therefore, we explored the association of host MPO genetic polymorphism with atrophic gastritis upon H. pylori infection. METHODS: Biopsy specimens taken from the gastric mucosa were examined histologically in 127 patients. The PCR-RFLP assay was used to characterize MPO genotypes. RESULTS: The distributions of MPO genotypes were MPO (G/G) 81.9% and MPO (G/A) 18.1%. None of MPO (A/A) genotype was observed in 127 patients studied. The degree of active inflammation increased with the increase in H. pylori colonization. A strong positive correlation between the levels of neutrophil infiltration and gastric atrophy was found only in MPO (G/G) but not in MPO (G/A) genotype. CONCLUSION: MPO G/G genotype may be a critical determinant in the pathogenesis of atrophic gastritis subsequent to H. pylori infection.

The Correlation of TUNEL Apoptotic Index with Clinicoradiologicopathologic Scores in Interstitial Lung Disease / 결핵

BACKGROUND: Interstitial lung disease has various manifestations that are differentiated by their pathology, progress and treatment However, all manifestations eventually progresses to pulmonary fibrosis. Recent studies have shown that apoptosis of pulmonary epithelial cells might be related to pulmonary fibrosis. The correlation of the apoptotic index with the clinical manifestations, pathological findings, HRCT findings and the response to treatment were examined. METHOD: Twenty subjects (14 men, 16 women), who had been diagnosed with interstitial lung disease through an open lung biopsy, were enrolled in this study. The subtypes were one AIP, two NIP, eight BOOP, and seven UIP cases. The apoptotic index was scaled from 0-2 depending on the fraction of positive staining cells by TUNEL method. The clinical severity was assessed by a modification of a previously developed CRP scoring system. The pathologic scores were based on 4 components: fibrosis, cellularity, desquamation, and granulation. In the HRCT study, each lobe was scored by the radiologists on a scale for both fibrosis and ground-glass attenuation. The treatment response was assessed by an increase in more than 10% of the CRP score, and comparing the results 3 months before and after treatment. RESULTS: The apoptotic index showed no correlation with the CRP and HRCT scoring system. The apoptotic index correlated with the pathologic elements including fibrosis, cellularity and the desquamation score (p<0.05). Of the 16 patients who received corticosteroid therapy, 9 patients (56.3%) responded to therapy. There was no correlation between the response to corticosteroid and the apoptotic index. In the case of patients with acute and subacute ILD, the apoptotic index showed a correlation with the cellularity, desquamation, and the total histological score (p<0.05). In the case of patients with chronic ILD, the apoptotic index correlated with the fibrosis and cellularity score (p<0.05). CONCLUSION: Apoptosis of the pulmonary epithelial cells is implicated in the pathogenesis of interstitial lung disease particularly on a pathological basis.

A Case of Mediastinal Angiomyolipoma

Angiomyolipoma is a common tumor of the kidney but has rarely been found in the mediastinum. We report a case of angiomyolipoma of the posterior mediastinum in a 62-year-old woman. She experienced exertional dyspnea and intermittent cough at admission. Computed tomography indicated a tumor located at the left paravertebral and upper posterior mediastinum and MRI imaging demonstrated a mass with low signal intensity in T1-weighted image at T4-5 level. Thoracotomy was done for surgical removal of the tumor and histologic examination revealed a mesenchymal tumor composed of mature fat, capillaries and smooth muscle fibers. The tumor was immunohistochemically positive for CD34 and factor-VIII (for vascular component) smooth muscle actin (for smooth muscle component) and S-100 protein (for fat component). There have been four case reports about mediastinal angiomyolipoma, namely three Japanese cases and one French case. It is suggested that angiomyolipoma could be considered for the differential diagnosis of mediastinal tumors.

Thyroid Hemiagenesis and Ectopic Thymus at Thyroid Bed, and Papillary Cancer in Opposite Thyroid Lobe with Hyperthyroidism

Thyroid hemiagenesis is a development failure of one of the thyroid lobes, predominantly in females with a left lobe. The associated disease in the remaining thyroid lobe include benign adenoma, multinodular goiter, hyperthyroidism, chronic thyroiditis, and carcinoma etc. We report a very rare case of thyroid hemiagesesis with hyperthyroidism, thyroid cancer, and ectopic thymus. A 43-year-old female presented with hyperthyoidism and thyroid nodule. Thyroid scan with 99mTcO4 revealed cold nodule in left lobe with absent right lobe. The patient underwent thyroid exploration. Because nodule in the remaining thyroid lobe proved to be a thyroid cancer on frozen biopsy, total thyroidectomy was performed. There was a thyroid-like tissue at the right side (scan 'absent' side) and removed. Pathology confirmed that the removed tissue from right side was thymus. There has been no report in world literatures of such case; in one patient, thyroid hemiagenesis, hyperthyroidism, thyroid carcinoma, and ectopic thymus coexists. We report the case and review the literature on thyroid hemiagenesis and ectopic thymus.

Short Rib Syndrome Beemer-Langer Type with Polydactyly: A Case Report / 대한주산의학회잡지

A female fetus with short rib(polydactyly) syndrome, Beemer-Langer type was terminated at 28 week's gestation because of abnormalities visualized on sonography. We present the clinical, radiological and autopsy findings of this case with a brief review of the literatures.

A Comparative Study on Transcatheter Renal Arterial Embolization (TRAE) in Rabbits with Absolute Ethanol and Gelfoam Particles

PURPOSE: To evaluate the therapeutic effectiveness of absolute ethanol and gelfoam particles and the degree of vascular recanalization after gelfoam embolization. MATERIALS AND METHODS: Transcatheter renal arterial embolization(TRAE) was performal in 16 rabbits ; Eight were embolized with absolute ethanol, and eight with gelfoam particles. Of this total, three died less than one week after embolization. Pre- and post embolization angiographies at five minutes, one week, two weeks(gelfoam group only) and 5-6 weeks after embolization were performed. Six rabbits were sacrificed at one week, and seven at 5-6 weeks after embolization. Pathologic examination was performed. RESULTS: The ethanol group(n=6) showed complete occlusion of the main renal artery on follow-up angiography at one week and 5-6 weeks after embolization. The pathologic finding was complete total necrosis of embolized kidneys. The gelfoam group(n=7) showed partial recanalization of renal arteries in follow upangiography at one week, two weeks and 5-6 weeks after embolization. The pathologic finding was partial lysis ofgelfoam particles within intrarenal arteries. CONCLUSION: Absolute ethanol can be used as a permanent embolicagent and gelfoam as a temporary such agent in various clinical applications. Gelfoam, however, did not show complete recanalization on angiography and pathology at six weeks after embolization.

Cerebellar Botryomycosis: Case Report

A 60 year old male patient with a medical history of pulmonary tuberculosis presented with severe headaches and general weakness. Radiological studies revealed mass lesions both in the right using and the right cerebellar hemisphere. Clinically metastatic brain tumor and tuberculoma were highly suspected. The cerebella mass was totally excised and an unusual pathologic result was reported as botryomycosis. According to literatures reviewed, botryomycosis is a chronic bacterial infectious lesion resembling actinomycosis and mycotic abscess and it has been frequently reported in the skin, subcutaneous lesions and other visceral organs, but the cases of brain involvement were extremely rare. This article is a case report of a cerebellar botryomycosis. The pathologic characteristics and the differential diagnosis of botryomycosis are discussed.

Secretory Meningioma: A case report

Secretory meningioma is now a distinctive subtype of mostly meningotheliomatous type of meningioma, which was first defined by Alguacil-Garcia et al. It shows characteristic light-microscopic, ultrastructural, and immunohistochemical features of epithelial and secretory differentiation of meningothelial cells with accumulation of secretory material in the from of hyaline inclusions. A 38-year-old female presented with headache for about 5 months. Magnetic resonance imaging revealed a round multilobated mass, measuring 4x4x3 cm, in the right inferior frontal lobe near the skull base, with surrounding brain edema. Histologically, the tumor basically showed a pattern of meningotheliomatous meningioma but tended to deposit eosinophilic homogeneous material both in the intracellular and extracellular spaces. The shape was globular intracellularly and of variable shape and often conglomerated extracellularly. Histochemical stains revealed the material not of psammomatous but of pseudopsammomatous proteinaceous nature. On electron microscopy, there was no intracellular lumen with secretion but granular electron-dense material of variable size accumulated in the degenerated endoplasmic reticulums, suggestive of proteinaceous secretion.

Neuroendocrine Differentiation in Adrenal Cortical Tumor of Chidhood: A case report

Although neuroendocrine differentiation is a characteristic feature of tumors of the adrenal medulla, cortical tumors may also rarely be differentiated into medullary element. Recently we experienced such a case of adrenal cortical tumor having features of both cortical and medullary tumor. The patient was an 11-year-old girl who was incidentally found to have a left adrenal mass. Laboratory results showed elevated serum cortisol, aldosterone, renin, and epinephrine with high excretion of urinary metanephrine. Urine vanillyl mandelic acid and 17-ketosteroid remained within normal limits. Histologic featuresof a 6 cm round yellowish tumor were ambiguous to decide the orgin of this neoplasm. Cortical element predominated in the tumor with minor areas of pheochromocytomatous feature. Immunohistochemically, the tumor cells were positive for vimentin, neuron specific enolase, and epithelial membrane antigen. Ultrastructural examination revealed scattered membrane bound dense core granules in the tumor cells of medullary differentiation, measuring 150~500 nm in average diameter. Cortical tumor element showed corresponding ultrastructural features. These results indicate that this is a case of adrenal cortical tumor with features of neuroendocrine differentiation.

The Enhancing Effect of Ethanol on the Development of Glutatione S-Transferase Placental Form-Positive Foci Induced by Diethylnitrosamine in F344 Rat

The effects of ethyl alcohol and pig serum administration on the development of preneoplastic hepatic enzyme-altered foci were examined in an in vivo mid-term assay system. Rats were initially given a single dose (200 mg/Kg) intraperitoneal injection of diethylnitrosamine (DEN). Two weeks later, treatment was started with 10% ethanol + 10% sucrose solution, 10% sucrose solution, or tap water as drinking water for 6 weeks with or without intraperitoneal injection of porcine serum twice a week. All rats were subjected to a two-thirds partial hepatectomy at week 3. The modification potentials were evaluated by comparing the number and area per cm2 of glutathione S-transferase placental form-positive (GST-P+) foci in the liver of each group. As a result, ethanol significantly enhanced the development of GST-P+ foci. Unfortunately, the porcine serum injection produced no hepatic fibrosis and no significant alteration in GST-P+ foci.