Secretory Breast Carcinoma: A Case Report with MRI Findings

Secretory carcinoma of the breast is an extremely rare, clinically and histologically distinct variant of invasive ductal carcinoma, with an indolent growth pattern and a more favorable prognosis than that of typical ductal carcinoma. Few studies have described its imaging features. Herein, we report on a secretory breast carcinoma with findings from various imaging modalities, especially including the MRI findings, which appears a well-defined complex cystic mass. Awareness of its imaging features using various modalities will be helpful for the differential diagnosis.

Extensive Squamosu Metaplasia Mimicking Squamous Cell Carcinoma in Fibroadenoma

We report a fibroadenoma with extensive squamous metaplasia in the breast. A 21-year-old woman presented with a mass of the left breast. Breast ultrasonography showed a 1.8x1.7 cm sized, well-circumscribed mass in left subareolar region. The mass was excised. Grossly, the mass was well circumscribed and the cut surfaces were grayish-white in color and elastic in consistency. Microscopically, the breast lesion showed the histological features of fibroadenoma. There were areas of extensive squamous metaplasia seen as isolated clusters or involving duct. But some metaplastic clusters surrounded by fibrous stroma were compressed and distorted and separation of cells into isolated clusters mimicked invasive carcinoma. Co-expression of CK 5/6, high molecular weight CK and p63 in areas of squamous metaplasia and normal myoepithelial cells supported myoepithelial cell origin of metaplastic cells.

A case of atypical polypoid adenomyoma of the uterus in a postmenopausal woman / 부인종양

Atypical polypoid adenomyoma of the uterus is a rare tumor and usually occurs in young women. The most common symptom is abnomal uterine bleeding and the definite diagnosis of the lesions depends on microscopic features. The treatment of this tumor depends on the age of the patient, her desire to retain reproductive function, and the severity of her symptoms. If the patient desires to preserve her reproductive capacity, repeated dilatations and curettages must be done because of the possibility of coexisting endometrial carcinoma. If not, hysterectomy is acceptable. We experienced a rare case of atypical polypoid adenomyoma of the uterus in a postmenopausal woman and report it with brief review of literature.

US and Mammographic Findings of Myofibroblastoma in the Female Breast: A Case Report

Myofibroblastoma is a rare benign mesenchymal tumor of the breast. It presents as a well circumscribed, solitary nodular mass, and it has been reported to mainly occur in male patients. To our knowledge, few reports have described the radiologic appearance of myofibroblastoma in the female breast and there has been no report from Korea. We describe the mammographic, sonographic and histologic findings of a case of myofibroblastoma that presented as a well defined mass mimicking fibroadenoma in a 44-year-old woman.

Chronic Intestinal Pseudoobstruction Associated with Inflammatory Visceral Neuropathy: A Case Report

The pathogenesis of chronic intestinal pseudoobstruction (CIP) presents a broad spectrum of etiologies. Among them, visceral neuropathy and myopathy are two major pathologic conditions. We report here on a very rare case of CIP associated with inflammatory visceral neuropathy involving the terminal ileum, appendix and entire colon in a 64-year-old woman who did not have any detectable neoplasm or family history of this disease. Microscopically, the submucosal and myenteric plexuses showed a severe and diffuse lymphoplasmacytic infiltrate with degenerative changes of the ganglion cells and nerve fibers. The pathogenesis of the inflammatory reaction is unclear for our patient, but we think that this would be a rare example of idiopathic and sporadic visceral neuropathy resulting in chronic intestinal pseudoobstruction.

Astroblastoma: A Case Report

Astroblastoma is one of the very unusual type of tumors, whose histogenesis has not been clarified. It occurs mainly among children or young adults. Astroblastoma is grossly well-demarcated, and shows histologically characteristic perivascular pseudorosettes with frequent vascular hyalinization. Perivascular pseudorosettes in astroblastoma have short and thick cytoplasmic processes and blunt-ended foot plates. A 15-yr-old girl presented with headache and diplopia for one and a half year. A welldemarcated mass, 9.7 cm in diameter, was found in the right frontal lobe in brain MRI, and it was a well-enhanced inhomogenous mass. Cystic changes of various sizes were observed inside the tumor mass as well as in the posterior part of the mass, but no peritumoral edema was found. Histologically, this mass belongs to a typical astroblastoma, and no sign of anaplastic astrocytoma, gemistocytic astrocytoma or glioblastoma was found in any part of the tumor. Immunohistochemically, the tumor cells showed diffuse strong positivity for glial fibrillary acidic protein, S-100 protein, vimentin and neuron specific enolase, and focal positivity for epithelial membrane antigen and CAM 5.2, while showing negativity for synaptophysin, neurofilament protein, pan-cytokeratin and high molecular weight keratin.

Ultrasonographic and Magnetic Resonance Imaging Findings of Transitional Cell Carcinoma Arising at Penile Fossa Navicularis: Case Report

Primary carcinoma of the male urethra are rare. Among the malignant tumors of the male urethra, squamous cell carcinoma is the most common. Transitional cell carcinoma is very rare, particularly in the distal urethra. We experienced a case of distal urethral transitional cell carcinoma, arising at the fossa navicularis of the penis, which we report here with a review of the literature. A 68-year-old male patient presented with bloody discharge from the prepuce for 1 month. Ultrasonography showed a poorly marginating, heterogeneous mass, invading the glans penis and the corpus spongiosum. The mass encircled the glandular urethra of the penis glans, and obstructed the glandular urethra and the fossa navicularis. A Doppler ultrasonogram revealed hypervascularity in this mass. The mass was isointense to the corpus carvernosum on the T1-weighted images and slightly hypointense to the corpus carvernosum on the T2-weighted images. Contrast-enhanced MR imaging showed a poorly enhancing mass in the glans penis. This mass was confirmed as a transitional cell carcinoma by histologic study and a partial penectomy was performed.

A Case of Recurrent MALT Lymphoma in the Lung and Parotid Gland Sequentially after Treatment of Gastric MALT Lymphoma / 대한혈액학회지

The patient was a 64-year old woman who suffered from palpable neck mass. Twelve years ago, she was diagnosed with gastric MALT lymphoma and had undergone a subtotal gastrectomy. And then two years later, she had undergone lobectomy of right middle lobe due to pulmonary MALT lymphoma. This time, biopsy of parotid gland showed MALT lymphoma again. Staging procedures revealed no other organ involvement. This case imply indolent course of MALT lymphoma and possible homing mechanism of MALT lymphoma cells.

Idiopathic Hypertrophic Cranial Pachymeningitis: Case Report

Idiopathic hypertrohpic cranial pachymeningitis is rare, and is essentially a diagnosis of exclusion. A 53-year-old man presented with headache and visual loss in the right eye, first experienced a month earlier. MR images depicted a mass in the right cavernous sinus. At T1-weighted imaging, both the mass and the thickened dura mater present in both fromted lobes were isointense, while at while T2-weighted imaging, the signal intensity of both the mass and the dura mater was low. After the injection of contrast medium, pachymeningeal enhancement was observed. We report the radiologic findings in a case of idiopathic hypertrophic cranial pachymeningitis, confirmed surgically and pathologically.

A Case of Bilateral Testicular Teratoma Found in Infant / 영남의대학술지

Testicular teratoma is characterized that has more than one germ cell layer in various stages of maturation and differentiation. The incidence of mature teratoma varies from 2 to 9% of all germinal testicular tumor. Only 3 cases of bilateral teratoma have been reported in the literature to date. The teratoma can occurs at all ages but is most common between the age of 15-35 year. It is relatively infrequently seen in childhood and infancy. In these age group, teratoma tends to be a benign. Recently, we experienced one case of bilateral testicular teratoma in 4 month-old infancy. We report a case of bilateral testicular teratoma found infancy with review of related literatures.

A Case of Multiple Plexiform Schwannomas / 대한피부과학회지

Plexiform schwannoma is a rare, benign neoplasm arising from the peripheral nerve sheath and usually arises in either the dermis or subcutaneous tissue. This neoplasm occurs most commonly as a slowly growing asymptomatic solitary nodule but may occur as multiple lesions. Multiple plexiform schwannomas could be associated with schwanno matosis as well as neurofibromatosis type 2. We present a 6-year-old boy who had multiple nodules on the occipital area and abdomen with tenderness. On the histopathological examinations, the lesions showed typical features of plexiform schwannoma. After six years, meningiomas were found in his orbital cavity.

Malignant Fibrous Histiocytoma of the Spermatic Cord: A Case Report / 영남의대학술지

Malignant fibrous histiocytoma (MFH) of the spermatic cord represents an uncommon location for the most common soft tissue tumor in adults. MFH of the spermatic cord is extremely rare. No case report has been described in the Korean literature. We report a case of malignant fibrous histiocytoma, myxoid type, arising from left spermatic cord. A 77-year-old male presented with a painless left upper scrotal mass for 5 months. Simple mass excision was performed for a diagnosis. Grossly, the mass closely contacted with the left spermatic cord. Since a myxoid type of malignant fibrous histiocytoma was diagnosed from histopathological findings, left radical orchiectomy with high ligation of the spermatic cord was performed additionally. There were no evidence of local recurrence or metastasis at 6 months after surgery.

A Case of Apocrine Adenocarcinoma associated with Basal Cell Carcinoma / 대한피부과학회지

Apocrine adenocarcinoma is rarely reported in the world and only 4 cases are reported in Korean literature. We encountered a case of apocrine adenocarcinoma associated with basal cell carcinoma in a 76-year-old female. Excisional biopsy showed well demarcated basophilic cell mass in the upper dermis and glandular structure in the lower dermis. Basophilic cell mass consisted with basaloid cells and had peripheral palisading arrangement. Glandular structures characterized by cells with abundant eosinophilic cytoplasm showed decapitation secretion. The cells showed nuclear atypicality, plemorphism and prominent nucleoli. The cytoplasm contained PAS-positive, diastase-resistant granules and stains for lysozyme and GCDFP-15(Gross Cystic Disease Fluid Protein-15) were positive.

A Case of Self-healing Langerhans Cell Histiocytosis / 대한피부과학회지

Langerhans cell histiocytosis is a proliferative disease in which Langerhans cells accumulate in various body sites and cause damage to the affected organs. We report a 7-month-old infant who had only cutaneous lesions and healed spontaneously without treatment. There were rice grain to corn sized erythematous papules and crusted lesions in the chest, abdomen, and back for 2 months. The histologic finding of the lesion showed that the dyscohesive infiltrate, predominantly of histiocytes, were present and extravasated erythrocytes and eosinophils were also found in edematous papillary dermis. Careful examination showed histiocytes with coffee bean or kidney-shaped nucleus which was positive for S-100 protein. The infant had no systemic involvement, and healed spontaneously after 1 month without relapse.

Meningeal Hemangiopericytoma in a Newborn: A Case Report

Several, but not many, cases of congenital meningeal hemangiopericytoma have been described to date. Herein, a case of meningeal hemangiopericytoma in a newborn is described. The patient was a 2-week-old boy with expanded fontanelles and frequent vomiting. A 5 cm sized mass was found in the left temporo-parietal lobe, which was well circumscribed and lobulated. Histologically the tumor was compatible with anaplastic (malignant) hemangiopericytoma, which showed pleomorphic nuclei, frequent mitotic figures and extensive hemorrhagic necrosis. The tumor cells were immunoreactive for vimentin, but negative for CD34, desmin and S-100 protein. Differential diagnosis for meningeal hemangiopericytoma was discussed, and the fact that meningeal hemangiopericytoma might have occurred congenitally was emphasized.

Congenital Glioblastoma Multiforme: A Case Report

Congenital glioblastoma multiforme is relatively rare accounting for 2-9% of all congenital brain tumors. We deseribe a case of congenital glioblastoma multiforme which occurred in the lateral ventricle. T1-weighted images revealed high signal intensity, with areas of internal low signal intensity, while T2-weighted images showed low signal intensity with focal internal high-signal portions. Post-contrast T1-weighted images depicted a lateral ventricular mass which extended to adjacent brain parenchyme and had a serpentine signal void representing internal vessel.

Choroid Plexus Carcinoma: A Report of Two Cases

Choroid plexus carcinoma (CPC), a frankly malignant epithelial neoplasm derived from choroid plexus epithelium, is a rare tumor with a predilection for infants and children. It may be difficult to histologically differentiate it from choroid plexus papilloma, anaplastic ependymoma, medulloblastoma, germ cell tumors, and metastatic carcinoma. We examined two cases of CPC. One is a 12-month-old boy, and the other is a 13-month-old boy. Both patients present lateral ventricular masses with extensive hydrocephalus. Histologically, both tumors show papillary growth in most area, and focal solid growth. The tumor cells show marked nuclear pleomorphism and frequent mitoses on squash and hematoxylin-eosin slides. Immunohistochemically, both tumors are positive for cytokeratin, vimentin, and S-100 protein; but they are negative for glial fibrillary acidic protein, -fetoprotein, and placental alkaline phosphatase. Both tumors show diffuse and strong positivity for p53. The MIB-1 labelling index is 23.6% and 15.82%, respectively. We report two cases of typical CPC, and we briefly discuss differential diagnosis with review of literatures.

Expressions of MIB-1, p53 and CEA in Endocervical Glandular Lesions

BACKGROUND: Endocervical glandular lesions include glandular atypia (GA), endocervical glandular dysplasia (EGD), adenocarcinoma in situ (AIS), and invasive adenocarcinoma (IA). The diagnosis of malignant glandular lesions is occasionally difficult to distinguish from benign mimickers, and the morphologic features of EGD remain unsettled. METHODS: Immunohistochemical stains for MIB-1, p53 and CEA were performed on 81 cases of paraffin-embedded endocervical glandular lesions including 22 IA, 15 AIS, 15 EGD, 13 GA, 8 microglandular hyperplasia (MGH) and 8 tubal metaplasia (TM). RESULTS: The MIB-1 labelling index of IA was 59.68%, 69.53% for AIS, 26.60% for EGD, 16.03% for benign. p53 overexpression was noted in 4 (18%) cases of IA, 3 (20%) of AIS, but none of EGD and benign lesions. It was Interesting to note that one case of MGH showed p53 staining in low intensity. Diffuse strong cytoplasmic CEA positivity was present in all of IA and AIS, whereas seven (47%) of 15 EGD and 12 (41%) of 29 benign lesions showed focal cytoplasmic CEA positivity. There were significant differences in MIB-1 and CEA immunostainings among the adenocarcinoma, EGD, and benign glandular lesions. Adenocarcinoma was closely related to p53 overexpression, although occurring in a low percentage of the cases. CONCLUSION: MIB-1 immunostaining can be useful in differentiating among endocervical adenocarcinoma, endocervical glandular dysplasia and benign glandular lesions. p53 overexpression might be helpful in the diagnosis of adenocarcinoma.

Telomerase mRNA Expression by In Situ Hybridization in Premalignant Lesions and Carcinomas of the Breast

BACKGROUND: Telomerase is a ribonucleoprotein, DNA polymerase that synthesizes telomere repeats onto chromosomal ends and maintains telomere length. Telomerase activity has been detected in a broad range of human malignant neoplasms, but not in normal somatic cells. So, activation of telomerase may represent an essential step in the malignant transformation of cells. However, the expression of telomerase in premalignant lesions remains relatively unexplored. This study was conducted to investigate the reactivation of telomerase in the carcinogenesis of human breast tissue. METHODS: In situ hybridization for the telomerase RNA component (human telomerase mRNA; hTR) was used in a normal breast tissue (n=41), florid ductal hyperplasia (FDH) (n=10), atypical ductal hyperplasia (ADH) (n=3), ductal carcinoma in situ (DCIS) (n=44) and invasive carcinoma (n=33). hTR expression in relation to p53 status and the pathologic parameters in breast cancer was also studied. RESULTS: Expression of hTR was demonstrated in 13 samples (31.7%) of normal breast tissues, 4 (40%) of FDH, 3 (100%) of ADH, 42 (95.5%) of DCIS, and 33 (100%) of invasive carcinoma. The rate of hTR expression of ADH was significantly different from that of FDH (p<0.05), and there were no differences in hTR expression rates among ADH, DCIS and invasive carcinomas. There was no correlation between hTR expression and nuclear grade, tumor size, and p53 status in invasive carcinomas. CONCLUSION: These results suggest that telomerase activation may be an early event and an essential step in the carcinogenesis of human breast tissue, and that telomerase has no correlations with p53 status and prognostic parameters.

Nasal Inverted Papilloma Associated With Squamous Cell Carcinoma: A Report of Two Cases

Nasal inverted papilloma (IP) is a benign neoplasm that may be associated with squamous cell carcinoma (SCC). Several studies have suggested that human papilloma virus 16/18 (HPV 16/18) and p53 are closely related to the pathogenesis of IP with transformation to squamous cell carcinoma (IP-SCC). This study was conducted to investigate the role of HPV 16/18 and p53 in the pathogenesis of IP-SCC using immunohistochemistry. We studied two cases of IP-SCC and 10 cases of IP. None of the IP cases presented positivity for HPV 16/18 or p53 protein. Two cases of IP-SCC showed negative reactions for HPV 16/18. The SCC portion of the IP-SCC showed strong positivity for p53, while the IP portion of the IP-SCC was negative for p53. MIB-1 labeling index (LI) was estimated in the IP cases and the IP-SCC as well. In terms of MIB-1 LI, there was no statistical significance between IP and IP-SCC, and between the IP portion and the SCC portion in the cases of IP-SCC. In conclusion, we believe that alteration of the p53 protein is related to IP with malignant transformation, but further studies are required to investigate the correlation of HPV 16/18 and p53 in the pathogenesis of IP with malignant transformation, and the significance of the MIB-1 LI and p53 as biomarkers in IP.