A Case of High-Grade B Cell Lymphoma, Not Otherwise Specified Originating From Interior Turbinate / 대한이비인후과학회지

High-grade B cell lymphoma not otherwise specified (HGBL, NOS) is a new diagnostic category of non-Hodgkin lymphoma (NHL) based on World Health Organization statement in 2016. Up to 40% of NHLs are located in the extra-nodal area, commonly involving the gastrointestinal tract, head and neck region, bone and skin. The diagnosis of NHL originating from the inferior turbinate (IT) is rare, and there have been no reported cases yet of HGBL, NOS in IT. In this study, we report on a 43-year-old female who had a nasal polyp in IT and was diagnosed with HGBL, NOS after surgery. Endoscopic polypectomy under general anesthesia was performed. A histopathological report confirmed the resected specimen as HGBL, NOS, with a clear resection margin. Nasal obstruction was improved immediately after surgery and the patient was followed up for 10 months without any recurrence or complications.

Poroid hidradenoma of the scalp

Poroid hidradenoma has both features of hidradenoma and poroma. The histological hidradenoma framework consisting of solid and cystic components, and the presence of poroid and cuticular cells resembling a poroid neoplasm. Despite transforming into malignant neoplasm only in < 1% of cases, its histological characteristics may resemble those of malignant neoplasms. Although the risk of malignant transformation is very low, surgical excision is recommended to prevent growth and/or recurrence. To date, very few cases of poroid hidradenoma have been reported in the literature. Herein, we present a case of poroid hidradenoma on the scalp of a 74-year-old woman.

Poroid hidradenoma of the scalp

Poroid hidradenoma has both features of hidradenoma and poroma. The histological hidradenoma framework consisting of solid and cystic components, and the presence of poroid and cuticular cells resembling a poroid neoplasm. Despite transforming into malignant neoplasm only in < 1% of cases, its histological characteristics may resemble those of malignant neoplasms. Although the risk of malignant transformation is very low, surgical excision is recommended to prevent growth and/or recurrence. To date, very few cases of poroid hidradenoma have been reported in the literature. Herein, we present a case of poroid hidradenoma on the scalp of a 74-year-old woman.

Synchronous Cancers of Hepatic Angiosarcoma and Gallbladder Adenocarcinoma, Mimicking Gallbladder Cancer with Hepatic Invasion: a Case Report

Synchronous primary cancers in the liver and gallbladder have been rarely reported.We report a case of synchronous cancers of hepatic angiosarcoma and gallbladder adenocarcinoma, mimicking gallbladder cancer with hepatic invasion. Additionally, the clinical implications, the radiologic features, and the diagnostic difficulties are further discussed.

Solitary sclerotic fibroma on the thigh

Sclerotic fibroma is a rare fibrous tumor of the skin associated with Cowden’s disease. In 1989, Rapini described sclerotic fibroma without Cowden’s disease as solitary sclerotic fibroma of the skin. It is a solid, well-circumscribed, slow-growing nodular tumor and it looks similar to a keloid scar. Consequently, it is extremely difficult to make a differential diagnosis of solitary sclerotic fibroma with keloid scar based on clinical findings only. The authors report a case of solitary sclerotic fibroma arising at the left lateral thigh of a 25-year-old man.

Spinal Epidural En Plaque Meningioma Misdiagnosed as Lymphoma: A Case Report

Spinal meningiomas in the epidural location are rare, accounting only 2.5% to 3.5% of all spinal meningiomas. The diagnosis of spinal epidural meningiomas, solely based on imaging findings, can be difficult. They are easily mistaken for metastatic tumors or lymphomas, especially, meningiomas of the enplaque type. Misdiagnosis of meningiomas can affect the extent of surgery and patients' outcome; hence, a careful diagnosis is needed. We report a case of pathologically confirmed epidural enplaque meningioma in the cervical spine with neural foraminal extension. Additionally, its clinical implications, radiologic features, and diagnostic difficulties are discussed.

Hepatic Pseudolymphoma Mimicking a Hypervascular Tumor: A Case Report

Hepatic pseudolymphoma is a rare benign liver mass that is characterized by proliferation of non-neoplastic lymphocytes extranodally. To the best of our knowledge, only 46 cases have been reported in the English literature. We described the case of a 75-year-old woman with hepatic pseudolymphoma mimicking a hypervascular tumor. After the histological confirmation of the rectal neuroendocrine tumor, CT scan revealed a 1.0 cm-sized, poorly-defined and low-density nodule in the liver. On MRI, the hepatic nodule showed an arterial enhancement and a low-signal intensity on the hepatobiliary phase. On diffusion-weighted imaging, the hepatic nodule showed a high signal intensity on a high b-value. On fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT, it revealed a high standardized uptake value nodule. The US showed the hypoechoic nodule and the US-guided biopsy confirmed the hepatic pseudolymphoma.

Myxoid Solitary Fibrous Tumor on the Scalp

Myxoid solitary fibrous tumor (SFT) is very rare soft tissue neoplasm. It is microscopically composed of spindle cells which is individually separated by delicate band of collagen fibers. And this tumor cells are immunohisto-chemistrically highlighted by CD34. Myxoid SFT has indolent clinical course and a good prognosis, so it is important to make a diagnosis because of its morphological similarities to myxoid spindle cell neoplasms that have different prognoses and treatment. We report the case of a 20-year-old female with a myxoid SFT found in the left temporo-parietal scalp. This case report appears to be the first reported scalp occurrence of this rare tumor.

Signet-ring cell carcinoma of the appendix: a case report with an emphasis on sonographic findings

In this report, we present a rare case of primary signet-ring cell carcinoma of the appendix in a 51-year-old woman with right lower quadrant pain. Since non-specific concentric appendiceal wall thickening was found in a radiologic evaluation, it was misdiagnosed as non-tumorous appendicitis. An in-depth examination of the correlation between sonographic and histopathologic findings demonstrated that a single markedly thickened hypoechoic layer was well correlated with the diffuse infiltration of tumor cells in both the submucosal and muscle layers. If this sonographic finding is observed in certain clinical settings, such as potential ovarian and peritoneal metastasis, submucosal infiltrative tumors, including signet-ring cell carcinoma, should be considered in the differential diagnosis.

Neurolymphomatosis Involving Antebrachial Cutaneous Nerve / 대한정형외과학회잡지

The term neurolymphomatosis has included infiltration of the peripheral nervous system by lymphoma. In generally, direct invasion of the peripheral nervous system is rare. The difficulty in treatment of neurolymphomatosis is due to unclassified characteristic symptoms and diagnosis. We performed excision of mass on the antebrachial cutaneous nerve with no specific symptoms. After diagnosis of diffuse large B cell lymphoma, further treatment and observation were followed. However, recurrence of the lymphoma was found in the ipsilateral forearm ulnar nerve, therefore we described a case of neurolymphomatosis with a brief review of the literature.

Bedside Sonographic Characteristics of Early and Late Appendicitis

PURPOSE: Studies on the relationship between appendiceal inflammation and bedside ultrasonographic findings are lacking. The purpose of this study was to determine statistically significant parameters to diagnose appendicitis earlier by comparing ultrasonographic findings and clinical features between early and late appendicitis. METHODS: A registry of right lower quadrant (RLQ) pain ultrasound from December 2011 to December 2012 was reviewed. Among these cohorts, patients pathologically proven to have appendicitis were selected and divided into two groups: an early appendicitis group, patients who complained of a diffuse abdominal pain, and a late appendicitis group, patients who complained of a localized right lower quadrant pain. The two groups were compared according to gender, age, bedside ultrasonographic findings, inflammatory markers, clinical features, and postoperative pathological findings. RESULTS: A total of 102 patients were enrolled in this study. Among them, 42 patients (41.2%) were in the early appendicitis group and 60(58.8%) were in the late appendicitis group. Appendiceal diameter and noncompressibility did not differ between the groups. However, periappendiceal fat infiltration and fluid were less prevalent in the early group (p=0.031 vs. p=0.022, respectively). CONCLUSION: Appendiceal diameter and non-compressibility were the only bedside ultrasound findings found in early appendicitis patients. Emergency physicians can detect early appendicitis and prevent complications before the migration of abdominal pain to the RLQ by bedside ultrasonography.

Bedside Sonographic Characteristics of Early and Late Appendicitis

PURPOSE: Studies on the relationship between appendiceal inflammation and bedside ultrasonographic findings are lacking. The purpose of this study was to determine statistically significant parameters to diagnose appendicitis earlier by comparing ultrasonographic findings and clinical features between early and late appendicitis. METHODS: A registry of right lower quadrant (RLQ) pain ultrasound from December 2011 to December 2012 was reviewed. Among these cohorts, patients pathologically proven to have appendicitis were selected and divided into two groups: an early appendicitis group, patients who complained of a diffuse abdominal pain, and a late appendicitis group, patients who complained of a localized right lower quadrant pain. The two groups were compared according to gender, age, bedside ultrasonographic findings, inflammatory markers, clinical features, and postoperative pathological findings. RESULTS: A total of 102 patients were enrolled in this study. Among them, 42 patients (41.2%) were in the early appendicitis group and 60(58.8%) were in the late appendicitis group. Appendiceal diameter and noncompressibility did not differ between the groups. However, periappendiceal fat infiltration and fluid were less prevalent in the early group (p=0.031 vs. p=0.022, respectively). CONCLUSION: Appendiceal diameter and non-compressibility were the only bedside ultrasound findings found in early appendicitis patients. Emergency physicians can detect early appendicitis and prevent complications before the migration of abdominal pain to the RLQ by bedside ultrasonography.

A Case of Castleman's Disease Mimicking a Hepatocellular Carcinoma: A Case Report and Review of Literature / 대한소화기학회지

Castleman's disease is a rare disease characterized by lymph node hyperplasia. Although Castleman's disease can occur wherever lymphoid tissue is found, it rarely appears in the abdominal cavity, and is especially rare adjacent to the liver. Here, we report a rare case of Castleman's disease in the portal area that mimicked a hepatocellular carcinoma (HCC) in a chronic hepatitis B patient. A 40 year-old woman with chronic hepatitis B presented with right upper quadrant discomfort. Computed tomography and magnetic resonance imaging results showed a 2.2 cm-sized, exophytic hypervascular mass in the portal area. HCC was suspected. However, histologic examination revealed Castleman's disease. We suggest that Castleman's disease should be included as a rare differential diagnosis of a hypervascular mass in the portal area, even in patients with chronic hepatitis B.

A Case of Idiopathic Recurrent Duodenojejunitis / 대한소화기학회지

There are various etiologies of duodenojejunitis such as Henoch-Schonlein purpura (H-S purpura), vasculitis, Crohn's disease, celiac sprue, ischemia, lymphoma, Zollinger-Ellison syndrome, bacteria or parasite infection, radiation, drug induced jejunitis, eosinophilic jejunitis, and toxins. A 31-year-old man presented with left upper quadrant pain. He did not have febrile sense, hematochezia, melena, diarrhea, arthralgia and hematuria. He had neither drug history nor traveling history. Esophagogastroduodenoscopy showed diffuse mucosal erythema and segmental hemorrhagic erosions on the distal area to the descending portion of the duodenum and proximal jejunum, which were commonly observed in the gastrointestinal involvement of H-S purpura. However, he showed no skin lesions, joint and urologic problems until the discharge. Autoimmune markers such as antinuclear antibody and antineutrophil cytoplasmic antibody were negative. Celiac and mesenteric angiogram showed no vascular abnormality. After the administration of oral prednisolone 40 mg daily for therapeutic trial, abdominal pain and endoscopic lesions were improved. He experienced relapses of same episode without skin lesions 16 times during follow-up of 8 years, which were also treated with prednisolone. The abdominal computed tomography during the follow-up also showed no significant finding. We report a case of primary recurrent duodenojejunitis similar to the gastrointestinal involvement of H-S purpura without purpura.

A Case of Ciliated Hepatic Foregut Cyst Discovered by Chance in Elderly Patient with Cholecystitis and Cholangitis

Ciliated hepatic foregut cyst (CHFC) is a rare disease that originates from the tracheobronchial tree of the foregut. Most patients with CHFC, which is believed to be a non-malignant neoplasm, are clinically asymptomatic. However, there have been some case reports that identify it as changing to malignant in the last decade of the condition. Surgical excision is, therefore, preferred to observation as the treatment of CHFC. However, surgical excision of CHFC in asymptomatic elderly patients is controversial. We experienced a rare case of a 73-year-old female patient who was accidentally diagnosed with CHFC while being diagnosed for cholecystitis and cholangitis. The patient simultaneously underwent laparoscopic cholecystectomy and resection of CHFC, which was finally diagnosed as benign. We report asymptomatic CHFC in elderly patient, focusing our discussion on whether surgical excision of CHFC is necessary for asymptomatic elderly patients. According to a review of case reports, surgical excision of CHFC is not necessary for asymptomatic elderly patients.

A Case of Multiple Organ Failure Complicating Hepatitis A Virus Superinfection in a Chronic Hepatitis B Patient / 대한내과학회지

Hepatitis A virus is a major cause of viral hepatitis worldwide. The prevalence of hepatitis A in young adults has recently been increasing in Korea. Hepatitis A infection rarely complicates fulminant hepatitis, acute pancreatitis, and acute renal failure. We experienced a case of multiple organ failure involving fulminant hepatitis, acute pancreatitis, and acute renal failure complicating a hepatitis A superinfection in a chronic hepatitis B patient. The patient was a 38 year old man who presented with febrile sense and myalgia. He was initially alert, but became confused and developed acute renal failure and acute pancreatitis. He received continuous renal replacement therapy and conservative treatment and completely recovered from the multiple organ failure. It is important to consider a variety of potential complications in hepatitis A patients, especially in those with underlying chronic liver disease.

A case of mammary-like glands carcinoma of the vulva / 대한내과학회지

Mammary-like glands are poorly recognized structures of normal vulvar skin. Here, we report the first case of primary mammary-like gland adenocarcinoma of the vulva in Korea and discuss the differential diagnosis and treatment of this rare tumor. A 62-year-old woman presented with an itching sensation and palpable mass of the vulva. Abdominal computed tomography showed multiple variable-sized nodules with peripheral rim enhancement in the liver. The pathology of the vulva and liver lesions was consistent with invasive ductal carcinoma of the breast, with positive staining for estrogen receptors, progesterone receptors, HER-2, and GCDFP-15. Ultrasonography and magnetic resonance imaging of the breast were normal. Given the histological findings in conjunction with the absence of a breast lesion, a diagnosis of primary mammary-like gland adenocarcinoma of the vulva was made. She died of pneumonia 7 weeks after the diagnosis.

Expression of p53 and bcl-2 in Gastric Adenocarcinoma Affects the Prognosis and Survival Rate

PURPOSE: p53 and bcl-2 are important markers of apoptosis. The expression of p53 and bcl-2 in gastric adenocarcinoma was examined in relation to prognosis and survival rate. MATERIALS AND METHODS: The clinicopathologic data from 238 patients who underwent gastrectomies for gastric adenocarcinoma between December 1999 and July 2007 were reviewed. Immunohistochemical staining of gastric adenocarcinoma tissues embedded in paraffin blocks was performed using an Envision kit (DAKO, Glostrup, Denmark). Statistical comparisons were made between age, gender, tumor invasion, lymph node metastasis, TNM stage, Lauren's classification, cell differentiation, and the relationship with p53 and bcl-2. RESULTS: The expression of p53 was related to cell differentiation (P=0.028) and UICC TNM stage (P<0.001). The expression of bcl-2 was related to UICC TNM stage (P=0.005). The co-expression of p53 and bcl-2 was related to UICC TNM stage (P=0.002). The co-expression group exhibited a greater reduction in the survival rate (P=0.001). CONCLUSION: The expression of p53 and bcl-2 nuclear proteins has significant relationships with other conventional prognostic factors and the survival rate. Bcl-2 will be characterized through analysis of a greater number of patients and comparison with survival data over a longer period of time.

A case of allopurinol-induced granulomatous hepatitis with ductopenia and cholestasis / 대한간학회지

Allopurinol-induced hypersensitivity syndrome is characterized by an idiosyncratic reaction involving multiple-organs, which usually begins 2 to 6 weeks after starting allopurinol. In rare cases, the adverse reactions to allopurinol are accompanied by a variety of liver injury, such as reactive hepatitis, granulomatous hepatitis, vanishing bile duct syndrome, or fulminant hepatic failure. Here we report a case with granulomatous hepatitis and ductopenia. A 69-year-old man with chronic renal failure, hyperuricemia, and previously normal liver function presented with jaundice, skin rash, and fever 2 weeks after taking allopurinol (200 mg/day). In histopathology, a liver biopsy specimen showed mild spotty necrosis of hepatocytes, marked cholestasis in parenchyma, and some granulomas in the portal area. There were vacuolar degeneration in the interlobular bile ducts and ductopenia in the portal tracts. Pathologic criteria strongly suggested the presence of allopurinol-induced granulomatous hepatitis with ductopenia and cholestasis. The patient fully recovered following the early administration of systemic corticosteroid therapy.

Comparative Study of the Clinicopathologic Characteristics between Gastrointestinal Stromal Tumors Arising from the Stomach and Small Bowel

PURPOSE: The purpose of this study is to compare the clinicopathological characteristics of stomach and small bowel gastrointestinal stromal tumors and to determine the risk factors and treatment guidelines. MATERIALS AND METHODS: Among 38 patients who were diagnosed with a gastrointestinal stromal tumor from August 1998 to May 2006, 29 patients at the Pundang Jesaeng General Hospital, Daejin Medical Center were evaluated. The clinicopathological characteristics of gastrointestinal stromal tumors arising from stomach and small bowel were compared. Immunohistochemical staining for CD117, CD34, smooth muscle actin, desmin, and S-100 protein was performed and classified according to NIH criteria. Prognosis between groups was analyzed according to NIH criteria. RESULTS: There was no significant difference in the clinicopathological characteristics and prognosis between gastrointestinal stromal tumors arising from the stomach and small bowel. Recurrence of the disease occurred in four (13.8%) patients. Classification of gastrointestinal stromal tumors according to NIH criteria was predictive of recurrence (P=0.030). CONCLUSION: NIH criteria were predictive of recurrence, but the location of the primary site was not predictive of recurrence. A further study involving multi center data and a long-term follow-up will be needed for formulating diagnostic and therapeutic guidelines.