Pancreatic Endocrine Tumors: A Report on a Patient Treated with Sorafenib

A 31-yr-old man with abdominal pain was diagnosed with a pancreatic endocrine tumor and multiple hepatic metastases. Despite optimal treatment with interferon alpha, a somatostatin analog, local therapy with high-intensity focused ultrasound ablation for multiple hepatic metastases, and multiple lines of chemotherapy with etoposide/cisplatin combination chemotherapy and gemcitabine monotherapy, the tumor progressed. As few chemotherapeutic options were available for him, sorafenib (800 mg/day, daily) was administered as a salvage regimen. Sorafenib was continued despite two episodes of grade 3 skin toxicity; it delayed tumor progression compared to the previous immunotherapy and chemotherapy. Serial computed tomography scans showed that the primary and metastatic tumors were stable. Thirteen months after beginning targeted therapy, and up to the time of this report, the patient is well without disease progression. We suggest that sorafenib is effective against pancreatic endocrine tumors.

Modified FOLFIRI as Second-Line Chemotherapy after Failure of Modified FOLFOX-4 in Advanced Gastric Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to evaluate efficacy and toxicity of irinotecan, leucovorin and 5-fluorouracil (FOLFIRI) as second-line treatment after failure of oxaliplatin, leucovorin and 5-fluorouracil (FOLFOX) for advanced gastric cancer. MATERIALS AND METHODS: Patients who received modified FOLFOX-4 as first-line treatment and then received sequential modified FOLFIRI for disease progression were included in this study. The modified FOLFIRI regimen consisted of irinotecan 150 mg/m2 in a 90-minute intravenous infusion on day 1, leucovorin (LV) 20 mg/m2 and 5-fluorouracil (5-FU) 400 mg/m2 as a bolus followed by 600 mg/m2 as a 22-hour infusion on days 1 and 2 with the same dose of 5-FU/LV of modified FOLFOX-4 every 2 weeks. RESULTS: A total of 32 patients received 126 courses of FOLFIRI chemotherapy. No complete response was achieved. Three patients (9.4%; 95% confidence interval [CI], 0 to 20.1%) achieved partial response, whereas 11 (34.4%; 95% CI, 17.0 to 51.8%) patients showed stable disease. Disease control rate (complete response, partial responses and stable diseases) was 43.8% (95% CI, 25.6 to 61.9%) and median follow up duration was 11.3 months (range, 2.23 to 37.9 months). Median time to progression was 2 months (95% CI, 1.49 to 2.51 months), and median overall survival from the start of FOLFIRI was 5.84 months (95% CI, 4.34 to 7.34 months). Toxicities were tolerable. CONCLUSION: Modified FOLFIRI as second-line chemotherapy after failure of the modified FOLFOX-4 in advanced gastric cancer was tolerable but showed a lower response rate. Further study about retrying 5-FU/LV with irinotecan after failure of the 5-FU/LV combined regimen is necessary in advanced gastric cancer.

Modified FOLFIRI as Second-Line Chemotherapy after Failure of Modified FOLFOX-4 in Advanced Gastric Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to evaluate efficacy and toxicity of irinotecan, leucovorin and 5-fluorouracil (FOLFIRI) as second-line treatment after failure of oxaliplatin, leucovorin and 5-fluorouracil (FOLFOX) for advanced gastric cancer. MATERIALS AND METHODS: Patients who received modified FOLFOX-4 as first-line treatment and then received sequential modified FOLFIRI for disease progression were included in this study. The modified FOLFIRI regimen consisted of irinotecan 150 mg/m2 in a 90-minute intravenous infusion on day 1, leucovorin (LV) 20 mg/m2 and 5-fluorouracil (5-FU) 400 mg/m2 as a bolus followed by 600 mg/m2 as a 22-hour infusion on days 1 and 2 with the same dose of 5-FU/LV of modified FOLFOX-4 every 2 weeks. RESULTS: A total of 32 patients received 126 courses of FOLFIRI chemotherapy. No complete response was achieved. Three patients (9.4%; 95% confidence interval [CI], 0 to 20.1%) achieved partial response, whereas 11 (34.4%; 95% CI, 17.0 to 51.8%) patients showed stable disease. Disease control rate (complete response, partial responses and stable diseases) was 43.8% (95% CI, 25.6 to 61.9%) and median follow up duration was 11.3 months (range, 2.23 to 37.9 months). Median time to progression was 2 months (95% CI, 1.49 to 2.51 months), and median overall survival from the start of FOLFIRI was 5.84 months (95% CI, 4.34 to 7.34 months). Toxicities were tolerable. CONCLUSION: Modified FOLFIRI as second-line chemotherapy after failure of the modified FOLFOX-4 in advanced gastric cancer was tolerable but showed a lower response rate. Further study about retrying 5-FU/LV with irinotecan after failure of the 5-FU/LV combined regimen is necessary in advanced gastric cancer.

Angiolymphoid Hyperplasia with Eosinophilia That Was Possibly Induced by Vaccination in a Child

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare benign vasoproliferative disease of an unknown cause involving the skin or subcutaneous tissue of the head and neck, and particularly around the ear. It predominantly affects Caucasian adults during the third and fourth decades and it very rarely occurs in children. We experienced a case of ALHE in a 2-year-old Korean boy who had a firm, pruritic, skin-colored, subcutaneous nodule on his right upper arm. The histopathological findings were compatible with ALHE and they showed prominent vascular changes with epitheloid or histiocytoid endothelial cells surrounded by inflammatory cells, including a large proportion of eosinophils. This unusual distribution of the lesion and the young age of the patient may be associated with vaccination.

Effect of Octreotide on Patients with Malignant Bowel Obstruction / 한국호스피스완화의료학회지

PURPOSE: Malignant bowel obstruction causes gastrointestinal symptoms and leads to diminished quality of life in patients with advanced cancer. Several studies have shown the efficacy of octreotide for the relief of malignant bowel obstruction-related symptoms. The aim of this study is to assess the efficacy and safety of octreotide in patients with malignant bowel obstruction. METHODS: We retrospectively reviewed medical records of twenty nine patients who had suffered from malignant bowel obstruction without clinical improvement of conservative care and subsequently, received octreotide treatment. Initial dosage of octreotide was 0.1 mg/day, and dose was escalated depending on the clinical effect. For each patient, we assessed visual analogue scale (VAS) of pain, number of vomiting episode, and amount of nasogastric tube drainage. RESULTS: Median dosage of octreotide was 0.2 mg/day (range 0.1~0.6), and median duration from initial medication to death was 20 days (range 2~103). VAS before and after octreotide treatment were 5.6+/-1.24, and 2.7+/-0.96, respectively. The numbers of vomiting episode before and after octreotide treatment were 3.6/day+/-2.5, and 0.4/day+/-0.8, respectively. The mean amounts of nasogastric tube drainage before and after octreotide treatment were 975+/-1,083 cc/day and 115+/-196 cc/day, respectively. Statistically significant reduction in VAS, the number of vomiting episode and the amount of nasogastric tube drainage were observed after octreotide treatment (P<0.05). CONCLUSION: Administration of octreotide in patients with malignant bowel obstruction, which is uncontrolled by other medication, was effective and safe. In such clinical situations, physicians should consider to add of octreotide for symptomatic control.

A Global Gene Expression Analysis of the Peripheral Blood Mononuclear Cells Reveals the Gene Expression Signature in Psoriasis

BACKGROUND: Psoriasis is a chronic inflammatory skin disease that affects approximately 1~3% of the general population. OBJECTIVE: We performed cDNA microarray analysis with using the dendrimer labelling method to investigate the gene expression profile in the peripheral blood mononuclear cells (PBMCs) of psoriatic patients. METHODS: The peripheral blood mononuclear cells of 5 patients with psoriasis and 8 control subjects were used in the gene expression analyses of psoriasis. RESULTS: We identified 212 differentially expressed genes that showed at least a two-fold induction and/or reduction in psoriatic patients. Among those, 63 genes, including CD44, CD56 and IL7R, were induced, while 139 genes, including the sphingosine kinase 1 and p16-INK genes, were reduced in the psoriatic patients. CONCLUSION: We can speculate that these genes may have a role for the pathogenesis of psoriasis via their affecting different cellular functions. Our results suggest a possible mechanism by which activated immune cells migrate from the blood to the skin in psoriatic patients, and we provide novel putative targets for developing drugs to treat psoriasis

A Case of Pneumatosis Cystoides Intestinalis in an Allogenic Stem Cell Transplant Recipient Who had Bronchiolitis Obliterans and Pulmonary Infection by Mycobacterium abscessus

Hematopoietic stem cell transplantation (HSCT) can cause various complications involving lung, liver, intestine and other organs. Chemotherapy, radiation therapy, and graft-versus-host disease (GVHD) may injure the cells in the intestinal mucosa of HSCT recipients. Pneumatosis cystoides intestinalis (PI) is a condition that presence of air in the bowel wall is demonstrated by radiologic or pathologic tests. It is one of the infrequent complications after HSCT and is associated with several medical and surgical conditions. However its pathogenesis and definite etiologic factors are still unknown. Here, we present a case of PI in a HSCT recipient, who was diagnosed of bronchiolitis obliterance accompanied with chronic GVHD and pulmonary disease caused by Mycobacterium abscessus.

A Case of Pneumatosis Cystoides Intestinalis in an Allogenic Stem Cell Transplant Recipient Who had Bronchiolitis Obliterans and Pulmonary Infection by Mycobacterium abscessus

Hematopoietic stem cell transplantation (HSCT) can cause various complications involving lung, liver, intestine and other organs. Chemotherapy, radiation therapy, and graft-versus-host disease (GVHD) may injure the cells in the intestinal mucosa of HSCT recipients. Pneumatosis cystoides intestinalis (PI) is a condition that presence of air in the bowel wall is demonstrated by radiologic or pathologic tests. It is one of the infrequent complications after HSCT and is associated with several medical and surgical conditions. However its pathogenesis and definite etiologic factors are still unknown. Here, we present a case of PI in a HSCT recipient, who was diagnosed of bronchiolitis obliterance accompanied with chronic GVHD and pulmonary disease caused by Mycobacterium abscessus.

A case of adrenocortical adenoma clinically mimicking pheochromocytoma / 대한내과학회지

The coexpression of cortical and medullary features in a single adrenal cortical cell has been recognized, leading to terms such as cortico-medullary cells. Here, we reported a case of adrenocortical adenoma consisting of cortico-medullary cells that clinically mimicked pheochromocytoma. A 52-year-old woman was admitted to our hospital complaining of an 8-month history of paroxysmal palpitation with refractory hypertension. A 24-hour urine study revealed increased norepinephrine and metanephrine levels. Computed tomography of the abdomen revealed a 1.0x0.9-cm mass in the left adrenal gland. The patient subsequently underwent unilateral laparoscopic adrenalectomy for a presumptive pheochromocytoma. Light microscopic findings of the left adrenal mass indicated an adrenocortical adenoma, but electron microscopy identified lipid vacuoles and smooth endoplasmic reticulum, along with dense core neurosecretory granules, so-called cortico-medullary cells. This is the first report of the detection of cortico-medullary cells in adrenocortical adenoma presenting as pheochromocytoma in Korea.

A Case of Erythema Nodosum-like Eruptions as a Manifestationof Azathioprine Hypersensitivity / 대한피부과학회지

Azathioprine is an immunosuppressant that has been widely used in the prevention of organ post-transplantation rejection, rheumatoid arthritis, inflammatory bowel disease and myasthenia gravis. The adverse effects reported with this drug have been classified as early events that include fever, hypotension, vasculitis and erythema nodosum-like eruptions or as late events that include bone marrow depression, nausea and vomiting. Although erythema nodosum-like eruptions could be useful for recognition of azathioprine hypersensitivity, this eruption has not yet been reported in Korean dermatological literature. We report, herein, a 68-year-old female with myasthenia gravis, who presented with tender, erythema nodosum-like eruptions on both upper and lower extremities 14 days after the first administration of azathioprine. Her symptoms improved 2 days after discontinuation of azathioprine and healed with no scarring change.

A Case of Acral Erythema Induced by Etoposide / 대한피부과학회지

Etoposide is a semi-synthetic podophyllotoxin that binds to microtubular proteins to inhibit cell division. It has been used extensively in the treatment of both solid and hematologic malignancies. Chemotherapy-induced acral erythema is a distinctive syndrome of painful, symmetric, well-defined swelling and erythema of the palms and soles seen in patients receiving high-dose chemotherapy. It occurs most commonly with fluorouracil, doxorubicin, and especially cytosine arabinoside. Although etoposide, mercaptopurine and methotrexate have also been implicated. Here we report a case of acral erythema induced by etoposide in a 15-year-old child with neuroblastoma.

Assessment of the Quality of Life in Vitiligo Patients / 대한피부과학회지

BACKGROUND: Although vitiligo does not cause direct physical impairment or life-threatening conditions, it can produce significant psychosocial problems. Nevertheless, its effect on the psychosocial well-being of patients has been neglected. OBJECTIVE: This study compared quality of life (QOL) in patients with vitiligo and in healthy controls, and assessed the impact of vitiligo on the patients' QOL using Skindex-29. METHODS: This study recruited 105 vitiligo patients and 105 healthy controls, and the QOL scores of the groups were compared using Skindex-29. Statistical analyses were performed to examine the relationship between QOL and clinical characteristics. RESULTS: The total Skindex-29, emotion, and function scores, but not the symptom scores, were significantly higher in the vitiligo group than in the healthy controls. QOL, including symptom, function, and emotion scores, was significantly impaired in women, the elderly, married patients, and patients with a longer duration of disease, greater area of vitiligo, and lesions appearing on the exposed sites. But, symptom scores generally did not differ significantly. All aspects of QOL were impaired in patients with a previous treatment history, longer duration of treatment, and relatively low levels of satisfaction with treatment. CONCLUSION: Vitiligo can impair a patient's QOL. Therefore, it is important for the dermatologist to recognize and manage psychological problems to improve the QOL of vitiligo patients.

The Clinical and Radiology Characteristics of Diabetic or Non-diabetic Tuberculosis Patients: a Retrospective Study / 결핵및호흡기질환

BACKGROUND: Patients with diabetes mellitus are highly sensitive to infections, including tuberculosis, and the longer the duration of DM, the greater is the prevalance of tuberculosis. We studied the difference of the clinical manifestations, radiologic findings, resistance and others factors of patients with diabetic and non-diabetic pulmonary tuberculosis. METHODS: The patients we enrolled in this study were newly diagnosed with pulmonary tuberculosis from January 2003 to December 2005. RESULTS: 159 patients were enrolled in this study. There were 30 pulmonary tuberculosis patients with diabetic mellitus (DMTB) and 129 pulmonary tuberculosis patients without diabetic mellitus (non-DMTB). There was no difference in the basic characteristics and clinical manifestation between both the groups. For the chest X-ray findings, the moderately advanced tuberculosis patients were the most common (43.3% in the DMTB group and 49.6% in the non-DMTB group). There was no relation between the severity of tuberculosis activity on chest x-ray and the presence of diabetes. The prevalence of cavitory lesions in the DMTB group was significantly higher than that in the non-DMTB group, but the prevalence of atelectasis was higher in the non-DMTB group (p<0.05). There was no difference in the incidence of lower lung involvement, the number of involved lobes, the number of treatment days and the radiological sequelae in both groups. CONCLUSION: The DMTB patients had a higher incidence of cavitory lesions and a higher incidence of atelectasis than the non-DMTB patients.

A Case of Chronic Expanding Hematoma with Initial Presentation as Massive Hemotpysis through Bronchopleural Fistula in the Thorax / 결핵및호흡기질환

Chronic expanding hematoma of the thorax is a specific subtype of the chronic empyema. It presents as a slowly expanding intrathoracic mass which result in dyspnea or recurrent hemoptysis. The symptoms develop months or years after tuberculous pleurisy, trauma or surgery. Usually, it shows three common findings: a giant mass lesion in the thorax, some surrounding calcifications, the absence of signs or symptoms of infection. We report a case of chronic expanding hematoma of the thorax, initially presenting as massive hemoptysis through bronchopleural fistula which resulted in radiologic findings of new air-fluid level within the previous pleural lesion filled with unknown materials.

The Clinical Significance of Symmetry in the Distribution of Vitiligo Lesions / 대한피부과학회지

BACKGROUND: Vitiligo is an acquired disease that causes depigmented patches of various sizes. The most widely used method of classification is by the distribution, which is categorized into four types: localized, segmental, universal, and generalized vitiligo. In addition, vitiligo can be divided into segmental and non-segmental, according to its relation to dermatomes. However, few studies have compared the clinical features and prognosis with the symmetry of the vitiligo lesions. OBJECTIVE: We examined 690 vitiligo patients to investigate the clinical significance of symmetry in the distribution of vitiligo lesions. METHODS: The clinical characteristics, distribution, and lesion sizes were investigated in 690 patients who were diagnosed with vitilgo at the Dermatology Department of Chungnam National University Hospital from January 1991 to August 2006. RESULTS: Of the 690 vitiligo patients, 369 (53.3%) had symmetric vitiligo lesions and 321 (46.5%) had asymmetric lesions. Patients with symmetric lesions had an older age of onset, longer duration of disease, wider distribution area, and greater tendency of the lesions to enlarge with time. CONCLUSION: Our clinical classification method, based on the the symmetry of the vitiligo lesions, may help physicians to predict the course and prognosis of the disease. Therefore, the dissemination of new vitiligo lesions in symmetric vitiligo patients should be observed closely.

Cutaneous Plasmacytosis Improved by PUVA Therapy / 대한피부과학회지

Cutaneous plasmacytosis is a rare disorder characterized by multiple red-brown plaques, mainly on the trunk, which histologically show a marked hyperplasia of mature plasma cells with no mitotic figures or cellular atypia. It is sometimes accompanied by extracutaneous symptoms like lymphadenopathy or interstitial pneumonia, but without plasma cell infiltration. Although many treatments such as corticosteroid lesional injection, cyclophosphamide, melphalan, systemic PUVA, and local tacrolimus application have been introduced for cutaneous plasmacytosis, there is no reported post-treatment data on cutaneous plasmacytosis in Korea. We report a case of a Korean male patient who was diagnosed with cutaneous plasmacytosis which was improved by PUVA therapy.

Three Cases of Allopurinol-induced DRESS Syndrome / 대한피부과학회지

Allopurinol (4-hydroxypyrazolo-[3,4-d]pyrimidine) is an effective and widely used xanthine oxidase inhibitor administered in the treatment of hyperuricemic states such as gout. Allopurinol-induced DRESS (Drug rash with eosinophilia and systemic symptoms) syndrome is characterized by hematologic abnormalities, especially eosinophilia and mononucleosis-like atypical lymphocytosis, skin rash, fever, lymph node enlargement and single or multiple organ involvement, which starts within 8 weeks after the initiation of therapy. We report three cases of allopurinol-induced DRESS syndrome who developed erythematous skin eruption six weeks, nine weeks and seven weeks, respectively, after allopurinol therapy. The clinical, laboratory and histologic findings of these patients were compatible with allopurinol-induced DRESS syndrome.

Neutrophilic Eccrine Hidradenitis Probably Induced by Intravenous Administration of Placental Extracts / 대한피부과학회지

Neutrophilic eccrine hidradenitis (NEH) is a rare, self-limited, neutrophilic dermatosis characterized histologically by a neutrophilic infiltration around the eccrine coils and necrosis of the eccrine glands. It occurs most commonly in patients undergoing chemotherapy for acute myelogenous leukemia and other malignant disease, but, other associations, such as infections, drugs or even in generally healthy individuals. We report a case of 45-year-old Korean woman with numerous erythematous papules on her trunk after treatment with intravenous administration of placental extracts. The hisopathological findings were compatible with neutrophilic eccrine hidradenitis.