A case of primary malignant fibrous histiocytoma of the lung / 대한내과학회지

Malignant fibrous histiocytoma(MFH) is a high grade soft tissue sarcoma, commonly occur in the retroperitoneum, extremities, head and neck in the patient with old ages. But it is very uncommon that MFH primarily occurs in the lung, and uncommon in young ages. We experienced a young male patient with primary MFH of the lung. The patient had huge masses on both lungs which were diagnosed as MFH by thoracoscopy-guided wedge resection of mass, so we could not perform operative management. And we tried 6 cycles of chemotherapy using ifosfamide, doxorubicin, dacarbazine. After chemotherapy, masses still remained in spite of decreasing sizes.

Telomerase Activity in Primary Lung Cancers / 결핵

BACKGROUND: Telomerase enzyme activity is not detected in most normal cells, a phonomenon believed to be associated with limitations on cellular proliferation. Since this activity is detected in nearly all human tumor, including lung cancers, it has been suggested that telomerase activation may be coupled to acquisition of malignant phenotype. In this study, we determined whether telomerase activity was associated with tumor pathologic stage. METHODS: Primary tumor specimens obtained by bronchoscopic biopsies from 33 patients were analyzed. Telomerase activity was measured by means of a modified Telomeric Repeat Amplication Protocol(TRAP) assay. RESULTS: Telomerase activity was detected in 23 of the 27 non small cell lung cancer and 5 of 6 small cell lung cancer. A few primary tumors did not appear to have detectable telomerase activity. Positive associations were found between the telomerase-positive rate and tumor stage(p<0.05). CONCLUSION: High telomerase activity is detected frequently in primary lung cancers that exhibit high tumor cell proliferation rates and advanced pathologic stage.

The Significance of IL-10, IL-12, IFN-gamma and ADA in Tuberculous Pleural Fluid / 결핵

BACKGROUND: Cell mediated immune response mediated by interaction between CD4+ T lymphocytes and macrophagies is thought to play an important role in tuberculous pleurisy. This interaction is dependent on the interplay of various cytokines. The immunologic response of tuberculous pleurisy is thought to depend on the balance between helper T cell(Th1) cytokine Interleukin-12, Interferon gamma and Th2 cytokine IL-4, IL-10. To understand immunologic mechanism in tuberculous pleurisy and evaluate diagnostic value of these cytokines, the concentrations of Th1 cytokine IL-12, IFN-gamma and Th2 cytokine IL-10 were measured in tuberculous pleurisy and malignant pleural effusion group. MATERIAL AND METHODS: The concentrations of IL-b, IL-12 and IFN-gamma were measured by ELISA method in pleural fluids and serums of 20 patients with tuberculous pleurisy and 20 patients with malignant pleural effusion. ADA activities were measured by spetrophotomery in pleural fluids of both groups. RESULTS: In tuberculous pleurisy, the mean concentrations of IL-b, IL-12 and IFN-gamma of pleural fluids showed 121.3+/-83.7 pg/mL, 571.4+/-472.7 pg/mL and 420.4+/-285.9 pg/mL. These were significantly higher than that of serum, 21.2+/-60.9 pg/mL, 194.5 pg/mL, 30.1+/-18.3 pg/mL respectively(p<0.0l). In malignant pleural effusion, the mean concentrations of IL-10, IL-12 and IFN-gamma of pleural fluids showed 88.4+/-40.4 pg/mL, 306.5+/-271.1 pg/mL and 30.5+/-54.8 pg/mL respectively. Compared with that of serum (43.4+/-67.2 pg/mL, 206.8+/-160.6 pg/mL, 14.6+/-3.3 pg/mL), only IL-10 was significantly higher (p <0.001), but IL-12, IFN-gamma were not significant. In tuberculous pleural effusion compared with malignant pleural effusion, the concentration of IL-12, IFN-gamma, ADA were significantly higher (p value 0.046, <0.001, <0.001), but IL-10 was not significant. For differetial diagnosis of tuberculous pleurisy from malignant pleural effusion, using cut-off value of IL-12, IFN-gamma ADA as 300 pg/mL, 100 pg/mL, 45 U/L, the sensitivity/specificity were 60%/70%, 90%/87.5%, 85%/90% respetively. CONCLUSION: In tuberculous pleurisy, IL-10, JL-12 and IFN-gamma were selectively concentrated highley in pleural space than serum. Compared with malignant pleural effusion, IL-12 and IFN-gamma were significantly higher, but IL-10 were not in tuberculous pleural effusion. The results suggest that Th1 pathway contributes to immune resistant mechanism in tuberculous pleurisy. IFN-gamma and ADA revealed useful methods of differential diagnosis in tuberculous pleurisy from malignant pleural effusion.

Analysis of rpoB Gene in Rifampin-Resistant M. Tuberculosis by Direct Sequencing and Line Probe Assay / 결핵

BACKGROUND: The emergence of multidrug-resistant strains of Mycobacterium tuberculosis presents a significant challange to the treatment and control of tuberculosis, and there is an urgent need to understand the mechanisms by which strains acquire multidrug resistance. Recent advances in molecular methods for the detection of M. tuberculosis genetic targets have approached the sensitivity of culture Furthermore the prospect of determining resistance in mycobacteria at the nucleic acid level particulary to first-line drugs like rifampin, isoniazid has provided a glimps of the next generation of sensitivity test for M. tuberculosis. Previous studies in RMP resistant M. tuberculosis have shown that mutation in beta subunit of RNA polymerase is main mechanism of resistance. METHOD: In this study, rpoB gene for the ~3 subunit of RNA polymerase from M. tuberculosis of 42 cultured samples (32 were RMP resistant and 10 were sensitive cases) were isolated and characterised the mutations. Direct sequencing data were compared with the results of INNO-LiPA Line Probe Assay (LiPA, Innogenetics, Belgium), commercial RMP resistance detecting kit using reverse hybridization method. RESULTS: All of the RMP resistant samples were revealed the presence of mutation by LiPA. In 22 samples (68.8%) out of 32 RMP resistant cases, the mutation types were confirmed by the positive signal at one of 4 mutation bands in the strip. The most frequent type was R5 (S53 IL) which were 17 cases (77.3%). Results of direct sequencing were identified the exact characteristics of 8 mutations which were not comfirmed by LiPA. S522W type point mutation and 9 base pair deletion at codon 513-515 were new identified mutations for the first time. CONCLUSION: Mutations in rpoB gene is the main mechanism of RMP resistance in M. tuberculosis and LiPA is a very useful diagnostic tool for the early diagnosis of RMP resistance in M. tuberculosis.