Primary Isolated Bone Marrow Diffuse Large B-cell Lymphoma with Hemolytic Anemia as the First Manifestation / 대한혈액학회지

Primary isolated bone marrow disease as a presenting feature of diffuse large B-cell lymphoma is very rare. We describe the first Korean case of isolated bone marrow diffuse large B-cell lymphoma with hemolytic anemia as the first manifestation. A32-year-old man was admitted to our hospital presenting with fever and hematuria. He had severe anemia and high lactate dehydrogenase activity. His peripheral blood smear and laboratory findings were suggestive of intravascular hemolytic anemia. The bone marrow biopsy revealed involvement with diffuse large B-cell lymphoma. A computed tomographic scan showed splenomegaly, but no lymphadenopathy. Our case shared some clinical features with the Asian variant of intravascular B-cell lymphoma, but there was infrequent involvement of the sinusoids of lymphoma cells and no hemophagocytosis. Our patient was treated with R-CHOP regimen for six cycles and he is in remission after autologous peripheral blood stem cell transplantation.

Fine Needle Aspiration Cytology of Lymph Node : Reactive Hyperplasia vs Malignant Lymphoma / 대한세포병리학회지

No Abstract available.

A case of primary esophageal T-cell malignant lymphoma / 대한내과학회지

Gastrointestinal tract (GIT) lymphomas usually originate from B-lymphocytes but rarely from T-lymphocytes. The stomach is the most common site for extranodal GIT lymphoma but the esophagus is a rare site. In addition, a primary esophageal T-cell lymphoma is an uncommon disorder. We encountered a case of a primary esophageal T-cell lymphoma in a 60-year-old man, who had swallowing difficulties and multiple ulcers in the upper and lower esophageal mucosa on gastroscopy. Immunohistochemical staining for the biopsy material from the multiple esophageal ulcers tested positive for LCA and CD45RO (pan T-cell marker) and negative for cytokeratin and CD20 reactivity, respectively. No other abnormal lesions were observed on a computed tomography scan of the neck, chest, abdomen and pelvis. After six cycles of combination chemotherapy with cyclophosphamide, adriamycin, vincristin, prednisolone, etoposide and gemcitabine, the multiple esophageal ulcers had completely disappeared suggesting a complete clinical response. We report this case with a review of the relevant literature.

A Case of Alpha-Fetoprotein Producing Adenocarcinoma of the Lung / 결핵및호흡기질환

Alpha-fetoprotein(AFP) is a plasma protein produced in the fetal liver, yolk sac and gastrointestinal tract. The plasma level of AFP decreases markedly 1 year after birth. The AFP level is usually increased in hepatocellular carcinoma and yolk sac tumor but is rare in a primary lung cancer. We report a case of primary adenocarcinoma of lung producing high levels of AFP.

A Case of Multiple Metastatic Renal Cell Carcinoma in an Adult Patient Presenting with Ventricular Tachycardia

Cardiac metastases of renal cell carcinomas are rare, and usually clinically silent. A case of a 53-year-old man without a significant medical history, who presented with ventricular tachycardia, which resulted in a cardiac mass of the right ventricle is reported. On chest X-ray, echocardiography, CT scanning, esophagogastroduode-noscopy and MRI, multiple metastatic masses were observed in both lungs, and the kidneys, adrenal, stomach and right ventricle. The kidney mass and the gastric polyp were revealed on biopsy to be a renal cell carcinoma mixed with sarcomatoid and conventional types.

A Case of Low Grade MALT Lymphoma in the Mediastinum with Clinical Appearance of Waldenstr m's Macroglobulinemia / 대한혈액학회지

Low-grade B cell mucosa-associated lymphoid tissue (MALT) lymphoma makes up 8% of non-Hodgkin's lymphomas. It has been characterized by a prolonged clinical course and persistent disease at the site of origin. Most patients with low-grade B cell MALT lymphoma occur in the stomach, orbit, intestine, lung, thyroid, salivary gland, skin, soft tissues, bladder, kidney, and central nervous system. The diagnosis of MALT lymphoma can be established by a characteristic finding of infiltration of small lymphocytes that are monoclonal B cell and CD5 negative. Bone marrow involvement seems uncommom but has been developed. Waldenstr m's macroglobulinemia (WM) is usually defined as bone marrow infiltration of lymphoplasmacytoid lymphocytes with a high level of circulating macroglobulin IgM. Lymphadenopathy and splenomegaly occurs in 20~40% of WM. It is very hard work to do differential diagnosis between disseminated low-grade B cell MALT lymphoma and WM with organ involvement by a bone marrow examination. We reprot one case of low grade mediastinal MALT lymphoma with bone marrow involvement and a high level of serum monoclonal IgM with clinical appearance of WM.

The Effect of CHEP-OB Combination Chemotherapy in Non-Hodgkin's Lymphoma / 대한혈액학회지

BACKGROUND: CHOP (cyclophosphamide, adriamycin, prednisolone, vincristine) regimen is still the standard therapy for non-Hodgkin's lymphoma, but its complete response rate & long-term survival rate are 45~55% and 30%, respectively. New chemotherapy regimen will be required for enhancing response rate and duration of survival. We tried to treat non-Hodgkin's lymphoma with newly developing CHEP-OB (cyclophosphamide, adriamycin, etoposide, prednisolone, vincristine, bleomycin) combination chemotherapy which include etoposide, bleomycin in preexisting CHOP regimen. METHODS: 51 patients with non-Hodgkin's lymphoma who admitted to Busan Paik Hospital Inje University between January 1996 and August 2002 were selected. They were treated with CHEP-OB combination chemotherapy given every 3~4 weeks for total 6 cycles. RESULTS: Objective response was achieved in 82.4% of the patients. Complete response (CR) and partial response (PR) rates were 66.7% and 15.7%, respectively. CR rate was significantly lower in patients with T cell immmunophenotype. Five year overall (OS) and failure-free survival (FFS) rate were 61.9%, 54.7%, respectively. Multivariate analysis showed that sex, stage and attainment of CR were factors independently predictive for OS and that stage and attainment of CR were factors independently predictive for FFS. Major side effect was myelotoxicity. CONCLUSION: CHEP-OB combination chemotherapy might be useful as a treatment strategy in non-Hodgkin's lymphoma considering similar response and survival rate, lower toxicity when it is compared with 3rd generation combination chemotherapy. But more effective chemotherapeutic regimen needs to be explored.

The Biomechanical Responses of Intervertebral Disc due to Degenerative Change in Porcine Lumbar Spine / 대한정형외과연구학회지

PURPOSE: The biomechanical responses of degenerative porcine intervertebral disc were compared with those MATERIALS AND METHODS: Two groups were set; Group A (44.0+/-2.8 months old, female) and Group B (6.2 +/-1.3 months old, female). Histological (H&E stain) observations were carried out to see the degeneration for both groups. Then biomechanical responses were investigated by measuring height changes in disc, intradiscal pressure values and relaxation time for each specimen under axial compressive loads. RESULTS: Degenerative changes were confirmed through H&E staining in Group A. The ratios of the nucleus pulposus area to total area were 14.7+/-4.5% and 29.2+/-6.0% in Group A and B, respectively (p=0.000). The decrease rates in disc height were 12.1+/-3.3% and 21.6+/-7.6%, in Group A and B, respectively under the axial compression of 740 N (p=0.000). No significant difference in intradiscal pressure measured in anterior zone between-groups except at axial load of 740N (p> 0.05). However, significant difference in pressure was found in posterolateral zone when the load was 542 N and higher (542 N: p=0.015, 740 N: p=0.010). The average relaxation time for Group A was significantly longer than that for Group B at 740N, i.e., at maximum load (anterior: p=0.010, posterolateral: p=0.014). CONCLUSION: Different biomechanical responses in degenerative disc were confirmed. They are 1) less flexible, 2) slower in energy relaxation under axial loading, and 3) larger portion of the external load were taken up at posterior part of annulus fibrous, especially in degenerative disc.

Mature Teratoma of the Rectum: A Case Report

Teratoma commonly affects the gonads. Its occurrence in extragonadal sites has also been reported. However, teratoma affecting the gastrointestinal tract is extremely uncommon. Herein, we describe a rare case of rectal teratoma presenting a solid polypoid tumor. A 61-year-old woman with constipation is presented. She had a colonoscopic examination and was noted to have a pedunculated polyp at the rectum, located 15 cm from the anal verge. The 4.2x2.4x2.0 cm polyp arose at the rectal mucosa which had a long stalk and smooth surface. The cut surface showed a solid area with a central yellow area. Microscopically, the polyp was covered with keratinizing stratified squamous epithelium which was abruptly exchanged from the columnar rectal mucosa. Sebaceous glands, sweat glands and hair follicles were mixed in stroma under the surface of the polyp. The central portion of the polyp was composed of mature adipose tissue and collagen fibers. Mature neural elements were noted in the stalk.

A Case of Collecting Duct Carcinoma of the Kidney Detected by Metastasis to Descending Colon / 대한비뇨기과학회지

No abstract available.

Histomorphologic Changes of Small Intestinal Mucosa after Irradiation in Rats

Inadvertent application of ionizing radiation, a valuable tool in diagnostic radiology and radiotherapy, results in injury and death of adjacent normal cells, inducing gene mutations or even producing latent cancers. Captopril, an angiotensin I converting enzyme (ACE) inhibitor, has been reported to prevent the structural and functional changes in variable organs, such as lung and kidney, from radiation injury in different experimental animal models. An experiment was carried out to elucidate the radiation-induced histomorphologic changes of small intestine, especially jejunum, and to determine whether captopril can reduce or prevent the radiation-induced injuries in jejunum. Twenty-six healthy Sprague-Dawley rats were used. Experimental group (n=24) was divided into two large groups: the first one (n=16) was treated with two different single dose (9 Gy, 17 Gy) irradiation only and was sacrificed at 12 hours and at 8 weeks following irradiation; the second one (n=8) received captopril 500 mg/l per oral continuously after same doses of irradiation and was sacrificed at 8 weeks. The control group (n=2) was maintained on a stock diet in a same period of experimental group and sacrificed coincidentally. On light and electron microscopy, the 9 Gy and 17 Gy 12 hours groups revealed frequent apoptosis and necrosis but extremely decreased mitotic figures of the crypt cells. However, the 9 Gy and 17 Gy 8 weeks groups and the combined irradiation with captopril groups showed extremely reduced apoptosis and necrosis with increased mitotic figures. There was good correlation between experimental groups in apoptotic count and mitotic count (p<0.05). In the 9 Gy and 17 Gy 12 hours groups, the mucosal surface was focally or diffusely fragmented and the villi were slightly to moderately distorted. Collagen deposition was very mild and confined to the lower portion of the lamina propria. The 9 Gy and 17 Gy 8 weeks groups showed more severe mucosal surface fragmentation even with foci of erosion, short and distorted villi, and more intense collagen deposition. In contrast, the combined irradiation with captopril groups revealed complete regeneration of the mucosal surface epithelium and absent collagen deposition. These findings suggest that the acute radiation injuries to small intestine occur principally in the mucosal crypt cells. Captopril, the ACE inhibitor, might provide a useful intervention in the radiation injuries of intestinal mucosa.

Soleus Myopathy Induced by Passive Stretch in a Stroke Patient: A case report

We present a 50-year-old woman who sustained spastic left hemiplegia secondary to the right thalamic hemorrhage 6 years ago. She complained of persistent severe left calf pain after serial casting for the treatment of shortened plantar flexors of the left ankle. Two months later, magnetic resonance T1-weighted images showed diffuse high signal intensity involving the whole muscle bulk of the soleus and normal signal intensity of thin atrophied gastrocnemius. Needle electromyography of the soleus revealed myopathic patterns. Histologic findings of the soleus showed necrotic muscle fibers with phagocytosis, endomyseal collagen and fat deposition. We concluded that prolonged passive stretch of spastic plantar flexors of the ankle under serial casting induced soleus myopathy with segmental myonecrosis, and which developed left calf pain. Selective induction of soleus myopathy could be explained by the higher stretch tension produced by ankle dorsiflexion in the soleus compared to the gastrocnemius because of different proximal ends.

Two Cases of Progressive Myoclonus Epilepsy due to Gaucher's Disease, Type 3

Gaucher's disease is an autosomal recessive disorder caused by a deficiency of beta-glucosidase (glucocerebrosidase) which results in an accumulation of glucocerebroside in various organs and tissues. Type 3 (juvenile or subacute neuro-pathic) Gaucher's disease, presented here as progressive myoclonus epilepsy, occurs more rarely than type 1 (adult or nonneuropathic) or type 2 (infantile or neuropathic) Gaucher's disease. Two patients (brother and sister) with type 3 Gaucher's disease had or was expected to develop typical features of progressive myoclonus epilepsy: myoclonus, seizures, dementia, and cerebellar dysfunction. One of them showed Gaucher cells in a liver biopsy specimen and decreased beta-glucosidase activity (14% of normal) in the cultured skin fibroblasts, which confirmed the clinical diagno-sis of type 3 Gaucher's disease.

Thymic Carcinoma: Report of Eight Cases / 대한암학회지

Thymic carcinoma is a rare malignant neoplasm of the thymic epithelium, distinguished from benign or invasive thymoma by the presence of malignant cytology and a greater incidence of local invasion and embolic metastases. The true incidence of this neoplasm is unknown. Nearly three fourth of their patients had symptoms of an anterior mediastinal mass, including cough, chest pain, and superior vena cava syndrome. These patients rarely have myasthenia gravis or other thymoma-associated paraneoplastic syndromes. The treatment of thymic carcinoma remains a controversial matter. We report eight cases of thymic carcinoma treated in our institution from 1990 to 1997.

Crush Cytology Features and Differential Diagnosis of Meningiomas and Schwannomas in Central Nervous System / 대한세포병리학회지

This study was performed in order to evaluate the usefulness of the crush cytologic features and differential diagnosis between meningiomas and schwannomas in the central nervous system. Deeply seated and unusually located meningiomas and schwannomas with equivocal or erroneous frozen section diagnosis can be correctly diagnosed cytologically in crush preparations. Twenty-four meningiomas and nine schwannomas were studied by frozen section and crush preparation technique. These tumors displayed distinctive cytologic features. In meningiomas, the tumor tissue fragments were easy to crush, and the tumor cells were arranged in small clusters, flat sheets, papilla-like, whorling pattern or singly. Individual tumor cells displayed round or oval nuclei with finely granular chromatin pattern and inconspicuous small nucleoli. Occasionally psammoma bodies, nuclear pseudoinclusion or nuclear grooves were found. In schwannomas, tissue fragments were hard in consistency and difficult to crush. The crushed tissue presented as thick, irregular fragments with sharp borders. The cells showed ill-defined cytoplasm and round, oval, cigar-shaped or curved nuclei. It is important to emphasize that the smear pattern under low-power view and cytologic features are helpful in discriminating between these two tumors.

Primitive Neuroectodermal Tumor Associated with Mature Cystic Teratoma of the Ovary: A case report

Malignant transformation of benign cystic teratomas of the ovary is rare, with an incidence rate of 1-3%. The most common malignancy associated with benign cystic teratoma of the ovary is squamous cell carcinoma, which represents 90% of malignant transformations, followed by adenocarcinoma and carcinoid. Primary malignant neuroectodermal tumor in a mature cystic teratoma is extremely rare and microscopically can be subclassified as differentiated, primitive, and anaplatic. We experienced a case of primitive neuroectodermal tumor (PNET) associated with mature cystic teratoma of the ovary in a 11-year-old girl. Grossly, the ovary was a unilocular cyst which contained sebum material and disclosed several large, yellow to gray-tan polypoid excresences attached to the inner cystic wall. Except a large, fish-flesh, soft mass, the other polypoid masses were covered with sebum and contained small pieces of cartilage and tooth, and microscopically represented as mature teratoma. The large, fish-flesh, soft mass disclosed sheets and lobules of closely packed small cells with thin fibrovascular septa, which frequently replacing and encroaching the mature cystic teratoma. The small tumor cells were uniform and made up of round to oval nuclei with coarse chromatin and prominent nucleoli, very similar to those of PNET of the central nervous system.

Fine Needle Aspiration Cytologic Findings of Inflammatory Breast Diseases / 대한세포병리학회지

Fine needle aspiration of the breast is an important diagnostic tool in malignant lesions, but is also useful in differentiation of inflammatory breast diseases mimicking carcinoma clinically and radiologically. Recently. the authors have experienced eight biopsy-proven cases of chronic inflammatory diseases of the breast, which consisted of 4 cases of duct ectasia, 2 cases of fat necrosis, and a case of tuberculous mastitis and granulomatous mastitis respectively, Their cytologic features mainly based on the components and the relative frequency of inflammatory cells were evaluated for differential diagnosis of chronic inflammatory breast diseases. The results are as follows: 1. In cases of duct ectasia, varying amount of neutrophils, mononuclear leukocytes, histiocytes and multinucleated giant cells were intermixed with benign epithelial cell clusters. 2. Abundant fat tissue fragments were diagnostic for fat necrosis. Histiocytes and mononuclear cells were main components but not rich, and neutrophils and giant cells were infrequently observed. 3. Characteristic granulomas composed of epithelioid cells, mononuclear leukocytes and Langhans} type giant cells and lymphocytic infiltrates were conspicuous in tuberculous mastitis, and occasionally neutrophils, necrotic materials and epithelial cell clusters were found. 4. In granulomatous mastitis, epithelioid cell granulomas were also noted but numerous neutrophils and histiocytes were intermingled within or outside the granulomas.

Cytologic Classification of Fibrocystic Disease of the Breast: A Proposal for Use of Cytologic Criteria Grading System / 대한세포병리학회지

Fine needle aspiration biopsy has been proved as a safe, accurate and cost-effective diagnostic modality in palpable breast lesions. Cytologically, fibrocystic disease can be classified into 3 categories as nonproliferative breast disease, proliferative breast disease without atypia, and proliferative breast disease with atypia. This terminology for the needle aspirates is compatible with that of diagnostic histopathology. Cytologic differentiation of nonproliferative disease from proliferative breast disease is important, since the risk of cancer development in cases of atypical hyperplasia is 4-5 times higher than that of general population. Twenty five needle aspirates of fibrocystic disease confirmed by subsequent histopathology were re-evaluated and classified into 3 categories depending on their architectural and nuclear features. In addition. these aspirates were scored according to the cytologic grading system, devised by Masood et al. and based on six cytologic criteria. Concordance rates between cytomorpholgic diagnosis and cytologic diagnosis using the cytologic criteria grading system and histologic diagnosis were 88% and 92%, respectively.

Application of Immunohistochemical Stain for Granulocytic Sarcoma

Granulocytic sarcoma is a rare localized tumor composed of granulocytic precusor cells. Granu-locytic sarcoma occurs in a variety of clinical conditions and it is often misdiagnosed histologically. Differential diagnosis frorh lymphoma or nonhematopoietic malignancies such as undifferentiated carcinoma or sarcoma is difficult in the routing histologic examination. An evaluation of clinical and histopathologic features was done on 4 cases of granulocytic sarcoma which were diagnosed at Pusan Paik Hospital from 1988 to 1992. During the period, 282 cases of myelogenous leukemia were diagnosed. Immunohistochemical reaction for lysozyme, myelopero-xidase, leukocyte common antigen, epthelial membrane antigen and cytokeratin was assessed comparing to lymphoma and undifferentiated carcinoma. The histologic features of the granulocytic sarcoma revealed thin nuclear membrane, fine chromatin pattern and one or two small nucleoli. It also often involved the vascular wall and infiltrated the native structures without destruction. Immunohistochemical stain revealed that all(4 cases) of granulocytic sarcoma showed diffuse and strong positivity for myeloperoxidase, and partial but strong positivity for lysozyme. One case of granulocytic sarcoma was negative and 3 cases revealed focal positive reaction for LCA, and all 4 cases was negative for cytokeratin and EMA. In summary, careful observation under light microscopy with immunohistochemical stain for myeloperoxidase, lysozyme, and LCA is helpful in the differential diagnosis of granulocytic sarcoma from malignant lymphoma and cytokeratin and EMA is useful for differential diagnosis from undifferentiated carcinoma.

Five Cases of Polypectomy using Endoscopic " O " -ring Ligation / 대한소화기내시경학회지

Endoscopic polypectomy was firstly introduced by Tsuneoka in 1969, and till now this method has been widely used for the treatment of benign and malignant polyps with the advent of technical improvement. This method is a very important modality as secondary prevention of malignancy because polyps in gastraintestinal tract are now being considered as precancerous lesion. Polypectomy with snare and electrocautery is mainly used for pedunclated polyps (eg. Yamada Class III, IV), but sessile polyps pose technical difficulty and occasionally cause serious gastrointestinal hemorrhage when resection margin adjacent polyp base. We performed polypectomy with "O"-ring used in endocopic variceal ligation (EVL) to make sessile polyp as semipedunclated form, and also to control bleeding, and then successfully remove it with conventional snare polypectomy. We report these 5 cases with the review of the literature.