Solid and Papillary Epithelial Neoplasm of the Pancreas in a Child: A case Report

Solid and papillary epithelial neoplasm (SPEN) of the pancreas is a rare tumor with low malignant potentiality that usually occurs in young females. Preoperative evaluation, especially radiologic tests, including ultrasonography and CT scan, is helpful in the diagnosis. These studies demonstrate a well-demarcated large mass with solid and cystic portions, frequently in the tail or body of the pancreas. Complete resection is usually curative, however local invasion and/or metastasis may occur. The authors report a case of a solid and papillary epithelial neoplasm of the pancreatic body in a 14-year old child at St. Benedict Hospital and review the literature.

A Case of R122H Mutation of Cationic Trypsinogen Gene in a Pediatric Patient with Hereditary Pancreatitis Complicated by Pseudocyst and Hemosuccus Pancreaticus / 대한소화기학회지

Hereditary pancreatitis is a rare autosomal dominant inherited disease with 80% penetration rate. The disease is characterized by recurrent episodes of pancreatitis often beginning in childhood, positive family history with at least two other affected members and no known precipitating factors. Most forms of hereditary pancreatitis are caused by one of two commoner mutations, R122H in exon 3 and N29I in exon 2 of the cationic trypsinogen (CT) (PRSS1) gene, located on chromosome 7. These genetic defects are speculated to cause excessive trypsin activity or to prevent inactivation of prematurely activated trypsin, resulting in pancreatitis. We performed mutation analysis of a Korean family with two members having clinically suspicious hereditary pancreatitis. We analyzed the CT gene in DNA samples extracted from peripheral blood of five family members. First of all, polymerase chain reaction and restriction enzyme digestion were performed in exon 3 of the CT gene. And then DNA products were purified and sequenced. We found out that three members of the family, the mother and two daughters, had a R122H mutation of the CT gene. We report the first family of hereditary pancreatitis associated with the CT gene mutation, an arginine to histidine amino acid substitution at residue 122, in Korea.

Elastofibroma

An elastofibroma, which is a rare soft tissue tumor, was excised from the left subscapular region of a 82-year-old woman. An elastofibroma is a slow-growing, pseudotumoral lesion of the soft tissues of the chest wall with peculiar radiological (CT, MR) and ultrasonographic images, and histological patterns. All cases need to undergo a biopsy in order to rule out a sarcoma. An elastofibroma is a benign tumor. If left untreated, it can grow to a considerable size and become symptomatic. Therefore it needs to be closely observed and its nature confirmed by a biopsy. This condition is rarely encountered in Korea. However, more patients could be diagnosed if more careful attention to elastofibroma is paid.

Thiosulfate sulfurtransferase and UDP-glucuronosyltransferase activities in cholestatic rat liver induced by common bile duct ligation

We have investigated the effect of cholestasis on the hepatic thiosulfate sulfurtransferase (rhodanese) and UDP-glucuronosyltransferase (UDP-GT) activities in rats. Rhodanese activities in the liver cytosol, mitochondria and microsomal fractions as well as in the rat serum, and UDP-GT activity in the microsome have been investigated for a period of 42 days after common bile duct (CBD) ligation. The cytosolic rhodanese activity showed a significant decrease between the first through the 42nd day, and the mitochondrial activity showed a significant decrease between the 7th through the 42nd day after CBD ligation compared to the activities from the sham operated control, respectively. In the case of microsomal preparation, both rhodanese and UDP-GT also showed significant decrease in their activities after the ligation for the former enzyme between the 14th and the 42nd days, and for the latter enzyme between the third and 42nd days, respectively. On the other hand, the serum rhodanese activity increased markedly soon after the ligation, exhibiting the peak activity after 1 day of CBD ligation with about 4.6-fold increment. The activity subsequently decreased gradually reaching to the control level at the 42nd day post-ligation. Enzyme kinetic parameters of hepatic rhodanese and UDP-GT were analyzed using sodium thiosulfate and p-nitrophenol as substrates, respectively, with the preparations from the 28th day post-ligation. The results indicated that although the K-m values of these enzymes were about the same as the sham-operated control, the V-max values of the both enzymes decreased significantly. These results, therefore, suggest that the biosynthesis of rhodanese and UDP-GT have been reduced in response to cholestasis, and that the elevation of rhodanese activity in the serum is most likely due to leakage from the liver subsequent to CBD ligation.

Automatic coding method of the ACR code

The authors devdeloped a computer program for automatic coding of ACR (American College of Radiology) code. The automatic coding of the ACR code is essential for computerization of the data in the department of radiology. This program was written in FoxBASE language and has been used for automatic coding of diagnosis in the Deparment of Radiology, Wallace Memorial Baptist Hospital since May 1992. The ACR dictionary files consisted of 11 files, one for the organ code and the others for the pathology code. The organ code was obtained by typing organ name or code number itself among the upper and lower level codes of the selected one that were simultaneously displayed on the screen. According to the first number of the selected organ code. the corresponding pathology code file was chosen augomatically. By the similar fashion of organ code selection, the proper pathologic dode was obtained. An example of obtained ACR code is "131.3661". This procedure was reproducible regardless of the number of fields of data. Bacause this program was written in "User's Defined Function" from, decoding of the stored ACR code was achieved by this same program and incoporation of this program into another data processing program was possible. This program had merits of simple operation, accurate and detail coding, and easy adjustment for another program. Therefore, this program can be used for automation of routine work in the department of radiology.

Focal hepatic lesions:Differential diagnosis with MRI

Differentiation between benign and malignant hepatic lesions was attempted according to the shape of the lesion, internal architecture and characteristics of signal intensity on MR images. MR images. We retrospectively analyzed 20 cases of hemangiomas, 12 cases of hepatomas and 5 cases of cysts which were diagnosed by clinical, radiological and surgical methods (33 patients). On T1-weighted, proton weighted, and T2-weighted images, most hemangiomas (70%) and cysts (100%) had smooth margin and were round or oval in shape, while hepatocellular carcinomas had irregular (67%) or lobulated (33%) borders. Ninety percent of hemangiomas and 100% of cysts had homogeneous signal intensity, but 67% of hepatocellular carcinomas were inhomogeneous. Signal intensities of hepatocellular carcinomas were more variable. However, hemangionmas were isointense or hyperintense on proton weighted images, and markedly hyperintense on T2-weighted images . In conclusion, inhomogenous, irregular border, and variable signal intensity lesions had high likelihood of malignancy, while homogenous and markedly hyperintense lesions were more likely benign.

Focal hepatic lesions:Differential diagnosis with MRI

Differentiation between benign and malignant hepatic lesions was attempted according to the shape of the lesion, internal architecture and characteristics of signal intensity on MR images. MR images. We retrospectively analyzed 20 cases of hemangiomas, 12 cases of hepatomas and 5 cases of cysts which were diagnosed by clinical, radiological and surgical methods (33 patients). On T1-weighted, proton weighted, and T2-weighted images, most hemangiomas (70%) and cysts (100%) had smooth margin and were round or oval in shape, while hepatocellular carcinomas had irregular (67%) or lobulated (33%) borders. Ninety percent of hemangiomas and 100% of cysts had homogeneous signal intensity, but 67% of hepatocellular carcinomas were inhomogeneous. Signal intensities of hepatocellular carcinomas were more variable. However, hemangionmas were isointense or hyperintense on proton weighted images, and markedly hyperintense on T2-weighted images . In conclusion, inhomogenous, irregular border, and variable signal intensity lesions had high likelihood of malignancy, while homogenous and markedly hyperintense lesions were more likely benign.

MR study of normal nasal cycle

Magnetic resonance images frequently demonstrate asymmetrical mucosal volume in the nasal area of asymptomatic patients. To further evaluate this phenomenon, sequential MR examinations of the nasal cavity and paranasal sinuses were performed three to four times during a 3 to 8 hours period in ten normal volunteers. The study demonstrated that the mucosal volume changes alternated from side to side during this period in eight volunteers. Changes were also observed within the ethmoid sinuses, nasal septum and nasolacrimal ducts. Awareness of MR findings of nasal cycle may reduce the likehood of inflammatory disease being confused with normal physiologic changes, and also may provide another method in the study of this physiologic phenomenon.

MR imaging of lumbar disc disease: correlation with CT and myelography

No abstract available.