ABSTRACT
We described here a patient who had two lung masses. Although the two masses had the same histology and a similar good response to initial chemotherapy with gemcitabine and carboplatin, the response to pemetrexed as a second-line treatment was different after re-growth of the tumors. These two lung masses could have originated from different clones or they could have progressed through different paths of molecular pathogenesis after metastasis, which would lead to different tumor characteristics, including their chemosensitivity. Regardless of their pathogenetic mechanisms, it seems important to recognize that tumors with the same histology that develop in one patient can have different responses to drugs.
Subject(s)
Aged , Female , Humans , Antimetabolites, Antineoplastic/therapeutic use , Antineoplastic Agents/therapeutic use , Carboplatin/therapeutic use , Carcinoma, Squamous Cell/drug therapy , Deoxycytidine/analogs & derivatives , Drug Resistance, Neoplasm , Glutamates/therapeutic use , Guanine/analogs & derivatives , Lung Neoplasms/drug therapy , Neoplasms, Second Primary/drug therapyABSTRACT
A large intrathoracic meningocele, a saccular protrusion of the meninges through a dilated intervertebral foramen or a bony defect of the vertebral column, was diagnosed in a 41-year-old female patient showing clinical features of neurofibromatosis-1 (NF-1), including cafe-au-lait spots, cutaneous neurofibromas, and axillary frecklings and Lisch nodules on the iris. Her daughter and son also had similar manifestations of NF-1. Regular follow-up with periodic imaging was recommended without surgical treatment because there were no signs or symptoms. Meningocele should be differentiated from posterior mediastinal tumors such as neurofibroma, neuroblastoma, and ganglioneuroma because NF-1 has a high risk of tumor formation. We report on this case with a brief review of the literature.
Subject(s)
Adult , Female , Humans , Diagnosis, Differential , Incidental Findings , Meningocele/complications , Neurofibromatosis 1/complications , PedigreeABSTRACT
Although a paradoxical response of tuberculosis to antituberculous therapy is not a rare phenomenon, it can be a clinical challenge to differentiate a paradoxical response from treatment failure. A 25-year-old woman was admitted for miliary lung nodules and multiple intracranial nodules. Antituberculous treatment was started with a preliminary diagnosis of tuberculosis based on the history and clinical findings. After one month, the miliary lung nodules improved while the intracranial nodules increased in size and number. Based on a stereotactic biopsy, it was confirmed that the intracranial lesions were tuberculomas. Although the therapeutic regimen was not changed, the symptoms eventually were ameliorated and the intracranial nodules improved two months later.
Subject(s)
Adult , Female , Humans , Biopsy , Lung , Treatment Failure , Tuberculoma , Tuberculoma, Intracranial , TuberculosisABSTRACT
Pulmonary alveolar proteinosis is a rare disorder that is characterized by the abundant accumulation of surfactant-derived material within the alveolar spaces and distal bronchioles. Although the findings of homogenous ground-glass opacities overlaid by thickened septa, which form a "crazy paving" pattern on high-resolution computed tomography, can assist in making a diagnosis, a lung biopsy is usually required. This disorder has a variable clinical course, from spontaneous resolution to respiratory failure and death. While a whole lung lavage has been the standard treatment since the early 1960s, GM-CSF therapy has been attempted based on the recently suggested pathogenetic mechanism. We report a case of pulmonary alveolar proteinosis that resolved spontaneously after an open lung biopsy.
Subject(s)
Biopsy , Bronchioles , Bronchoalveolar Lavage , Diagnosis , Granulocyte-Macrophage Colony-Stimulating Factor , Lung , Pulmonary Alveolar Proteinosis , Respiratory InsufficiencyABSTRACT
Dermatofibroma with granular cells is composed mainly of spindle shaped cells mixed with in-conspicuous foamy cells that contain granular cytoplasm. We present a case of dermatofibroma with granular cells in a 36-year-old male who visited our clinic to evaluate a slow-growing nodule on the medial side of the left lawer leg. He have had the nodule for five years and sometimes felt an itching sensation. Biopsy of the nodule identified a dermal nodular tumor showing cellular spindle cell proliferation admixed with peripheral foamy histiocytes. With the immunohistochemical staining, the granular cell was positive for alpha-1-antitrypsin and CD68, and negative for S-100. A few electron-dense granules were seen in the cytoplasm on the electronmicroscopic study. These results suggested that the granular cells originated from histiocytes.
Subject(s)
Adult , Humans , Male , Biopsy , Cell Proliferation , Cytoplasm , Histiocytes , Histiocytoma, Benign Fibrous , Leg , Pruritus , SensationABSTRACT
We report a case of fixed-type sporotrichosis in a 12-month-old infant, who presented with a well-defined scaly erythematous patch on the right lateral nasal root area of approximately 2.5 months duration. Hiopsy revealed pseudoepitheliomatous hyperplasia with chronic granulomatous inflammation in dermis and PAS-positive fungal spores in the stroma. Sporothrix schenckii was identified with fungal culture of biopsy specimen. The lesion was responded to treatment. with itraconazole(3mg/kg) for 12 weeks, without relapse at 5-month follow-up.
Subject(s)
Humans , Infant , Biopsy , Dermis , Follow-Up Studies , Hyperplasia , Inflammation , Itraconazole , Recurrence , Spores, Fungal , Sporothrix , SporotrichosisABSTRACT
Terrys nail(TN) might be causally associated with cirrhosis or other disorders, but his criteria have been proved to be inadequate reflection of systcmic disorders. Modified criteria of Holzberg and Walker were introduced in TN examination in 1984. Using these criteria, fingernails were studied in 444 medical inpatients with chronic systemic diseases at Taegu Catholic Hospital from March 1991 to March 1992. There were 136(30.6%) patients with TN and 308(69.4%) patients without TN, respectively. Ninety-three patients with TN showed a signifiart association with cirrosis(49/86, 57%, p<0.01 by the x-test), congestive heart failure 18/35, 515, p<0.05), and diabetes mellitus(25/51, 49%, p<0.05), and otherwise not;ignificantly associated with chronic renal failure(19%), and cancer(18%). Male and female patients with TN were affected about equally. Age distribution in The patients with TN showed 35(25.8%) the age group from twenty to fortynine and 101(74.2%) in the age group from fifty and above with a mean age of 57.3+14.0, whereas the patients without TN had 178(57.8%), and 130(42.2%), with 47.4+16.9, respectively. The greater part was distributed in the older group(p<0.001 by student t-test), suggestive of an increased risk in older group. The average number of nails affected per patient was tending to be higher in frequency close to the thumb, with an equal frequency in six. Thirty-nine patients(28.7%) had all nails affected. The distal band with was 0.5 to 3.0mm averaging 1.0+0.5mm with no difference, in sex. The distal band was pink in 43(31.6%) of the 136 patients with TN, brown in 62(45.6%) and intermediate in color in 13(22,8%). The results of routine laboratory test such as hemogram, eiythrocyte sedimenation rate, liver enzyme, triglyceride, protein, albumin, blood urea nitrogen and creatinine were statistically insignificant between the patients with and without TN.
Subject(s)
Female , Humans , Male , Age Distribution , Blood Urea Nitrogen , Chronic Disease , Creatinine , Fibrosis , Heart Failure , Inpatients , Liver , Nails , Thumb , TriglyceridesABSTRACT
A healthy 12-year-old girl had noted over 2 years a gradual-growing painless nodule on the area below the right axilla. The lesion measuring approxima:;ely 1.2 x 1.2 x 0.4cm in size, had a reddish-blue colored ulcerative papule raised on its cente with mucous discharge to compression. Histopathelogically, a circumscribed solid tumor located in the deep dermis, revealed the predominnntly epidermoid features of polyhedral cells, with the mucous cells within and at the peripiiery of the tumor. The mucous cells exhibited diastase-resistant PAS -positive, alcian-blue reactive at pH 2.5 and mucicarmine-positive reactions. Results of irnmunoperoxidase staining for cytokeratin and carcinoernbryonic antigen were focally cytoplasmic-positive, while negative for S-100 protein and epithlial membrane antigen. She has remained free of disease one year following excision.
Subject(s)
Child , Female , Humans , Acrospiroma , Axilla , Dermis , Hydrogen-Ion Concentration , Keratins , Membranes , S100 Proteins , UlcerABSTRACT
The occurrence of a lipoma-like condition associated with trauma would tend to be regarded as a subset of or a separate entity from ordinary lipoma. We report herein a case of traumatic Lpoma occuring on the dorsum of the left hand. The patient was a 46-year-old male, who had struck his left hand against a window about two months previously and noted casually an asymptomatic, firm, dermal lesion at the site of injury. On gross examination, the enucleated nodule was a smooth-surfaced, yellow fatty mass measuring 0.3 × 0.5 × 0.3cm which looked like a kernel of corn. Microscopic examination revealed encapsulated mature fat consistent with lipoma.
Subject(s)
Humans , Male , Middle Aged , Hand , Lipoma , Zea maysABSTRACT
We report herein a case of clear cell hidradenoma in a 65-year-old man, who had a 8-month history of a asymptomatic, smooth-surfaced, round, blue tumor mass with cystic grape-like nature on the left upper chest, measuring 2.0 x 2.0 x 1.5cm in size. A histopathological examination revealed tubular and cystic structures within the intradermal tumor composed of predominant fusiform cells and clear cells, and some transitional cells. The patient remained free of recurrence for a period of one-year follow-up after the excision.