MALT Lymphoma of Ocular Adnexa: A Case Report

PURPOSE: Lymphoma originated from mucosa associated lymphoid tissue(MALT) is most common in gastrointestinal system, and rarely found in salivary gland, thyroid, bronchus or orbit. We experienced a case of MALT lymphoma which was originated from conjunctiva and involving lower eyelid without metastasis. METHODS: A 40-year-old man suffered palpable mass on right lower eyelid without pain. Orbital computed tomographic and ultrasonographic findings showed a conical mass(1.9x1.2x0.9cm size) inside lower eyelid. The mass was completely excised under local anesthesia and histopathological examination was followed. RESULTS: Microscopic finding showed a multiple follicular colonization. In the follicle, small lymphocytes and plasma cells differentiated to centrocyte-like cell, monocyte B cell, plasma cell were diffusely infiltrated. Immunophenotyping was preformed on fixed section. The majority of the small cells were immunoreactive for the B cell marker CD20. Based on the typical histological findings supported by immunostaining, the mass was defined as MALT lymphoma. After excision, SPECT, abdominal CT was carried out and there were no evidence of extraorbital disease. CONCLUSION: Biopsy and pathological examination should be performed in patients who complain palpable mass on lower eyelid because of possibility of MALT lymphoma. Although MALT lymphoma is rarely metastasized, it is necessary to evaluate the extraorbital involvement using SPECT or other radiologic exams. For detecting extraorbital involvement, periodic follow-up examination is need.

Multiple Cutaneous Leiomyoma Derived from the Mutation in Fumarate Hydratase Gene: A Case Report

PURPOSE: Multiple skin leiomyoma and uterine myoma bearing autosomal dominant traits are benign smooth muscle tumors which originate in skin or female uterus. Skin leiomyoma occurs after gene mutation originating from arrector pili muscle of hair follicle where its clinical manifestations vary significantly from person to person. Our department hereby reports the histological findings and genetic evaluations of this very rare disease. METHODS: A 57-year-old woman presented in our institute with multiple tumors in the left and central parts of her back that started to appear since 19 years ago. The patient was diagnosed as having uterine myoma 15 years ago and underwent hysterectomy. Biopsy has been done on the specimen, and genomic DNA was separated from Fumarate hydratase gene for it to go through PCR amplification. The results of PCR amplification were aligned by sequencer. RESULTS: According to the results of biopsy, tumor cells were spindle-shaped and were aligned in a bundle where there was no dysplasia or mitosis. Moreover, these cells had abundant eosinophilic cytoplasm with elongated nucleus, and benign leiomyoma that showed positive reactions to SMA stain were found. In genetic examination, mutations such as heterozygous single nucleotide substitutions were found in alignments of amplified DNA. CONCLUSION: Multiple skin leiomyoma and uterine myoma are relatively uncommon diseases that are transmitted through autosomally dominant traits from genetic mutations. When a patient's chief complaint lies upon skin-colored or brown masses that occur in multiples appearing in the trunk or extremities with characteristic clinical symptoms and histological findings, and when the patient's family history is acknowledged such as skin or uterine leiomyoma or renal tumor, necessary genetic examination on multiple skin leiomyoma and uterine myoma could be done, and thereby precise diagnosis could also be made.

The Treatment of Pressure Sore Using Hydrogel and Hydrocolloid Dressing

Pressure sores are a common complication of hospitalized patients. However, It is often impossible to correct surgically because the general conditions of these patients are poor. It is known that the hydrogel has a powerful autolytic effect by providing moist environments and facilitates wound healing and hydrocolloid dressing is also known to promotes granulation tissue formation and epithelialization. The patients were treated with hydrogel(Purion gel(R), Coloplast A/S, Denmark) and hydrocolloid dressing (Comfeel Plus Transparent Dressing(R), Coloplast A/S, Denmark) after surgical debridement of pressure sores progressed to stage III(n=2) and IV(n=7). This combination treatment could facilitate to debride the nectrotic tissue and promote granulation tissue formation epithelialization simultaneously. We could achieve complete healing of pressure sores using the combination treatment without requiring surgical correction. In conclusion, hydrogel in combination with hydrocolloid dressing is effective in acheiving complete healing of progressed pressure sores.

Motor Innervation and Nerve Pathway of Glabellar Expression Muscles

We studied the motor innervation and the nerve pathway of glabellar expression muscles and a kind of glabellar skin wrinkles. Electric stimulation and surface tracing of the temporal and zygomatic branches of the facial nerve was performed using an electric nerve stimulator on both sides of 14 healthy volunteers. Micro- dissection of four cadaveric heads were also performed to confirm the results of nerve stimulation test. The corrugator supercilii muscle is innervated by the temporal branch of the facial nerve. The depressor supercilii muscle, the medial head of the orbicularis oculi muscle, and the procerus muscle are innervated by the zygomatic branch. The temporal branch to the corrugator supercilii muscles travels in a curvilinear pattern superior to the upper margin of the eyebrow. The zygomatic branch to the glabellar expression muscles travels in a curvilinear pattern inferior to the inferior orbital rim in the proximal portion and in a cobwebby pattern medial to the medial orbital rim in the distal portion. In cadaveric study, the zygomatic nerve branches off in the inferomedial orbital portion, and its fine branches enter into the procerus muscle, the depressor supercilii muscle, and the orbicularis oculi muscle. The surface pathway of the motor nerve to the glabellar expression muscles is described. We think that the zygomatic and temporal branches both should be blocked simultaneously to improve glabellar skin wrinkles completely.

Neurilemmoma of the Masseteric Nerve in the Masseter Muscle: A Case Report

A case is reported of neurilemmoma of the right masseteric nerve in the masseter muscle. We experienced a 34-years-old male patient who had neurilemmoma in the masseter muscle caused by chronic irritation. Special stain using S-100 immunoperoxidase was useful in establishing the diagnosis in this case. The most important aspect of this case is the anatomical site of the neurilemmoma; this tumor was originated from the masseteric nerve and is the first case reported in the masseter muscle. The patient underwent surgical excision of the tumor and no recurrence occured.