Breast Cancer to Meningioma: A Rare Case of Tumor-to-Tumor Metastasis

Tumor-to-tumor metastasis (TTM) is defined as the hematogenous metastasis within a primary host tumor from a donor neoplasm. Since there is insufficient evidence regarding the pathophysiology, clinical course, and management of TTM, there are no precise guidelines for its management. A 73-yearold female patient diagnosed with breast cancer was found to have convexity meningioma. Since the size of tumor and peritumoral brain edema increased during follow-up period, the meningioma was treated with surgical resection. Postoperatively, histopathologic examination confirmed metastasis of invasive ductal carcinoma within a secretory meningioma. The final diagnosis was TTM of breast cancer in meningioma. Here, we report a rare case of intra-meningioma metastasis and a review of literature to provide a better understanding of this rare phenomenon.

Association of PTTG1 expression with invasiveness of non-functioning pituitary adenomas

Background@#Pituitary tumor transforming gene 1 (PTTG1), paired-like homeodomain 2 (PITX2), and galectin-3 have been widely studied as predictive biomarkers for various tumors and are involved in tumorigenesis and tumor progression. We evaluated the usefulness of PTTG1, PITX2, and galectin-3 as predictive biomarkers for invasive non-functioning pituitary adenomas (NFPAs) by determining the relationship between the expressions of these three proteins and the invasiveness of the NFPAs. We also investigated whether PTTG1, E-cadherin, and Ki-67, which are known to be related to each other, show a correlation with NFPA features. @*Methods@#A retrospective study was conducted on 87 patients with NPFAs who underwent surgical removal. The NFPAs were classified into three groups based on magnetic resonance imaging findings of suprasellar extension and cavernous sinus invasion. Immunohistochemical staining for PTTG1, PITX2, galectin-3, E-cadherin, and Ki-67 was performed on tissue microarrays. @*Results@#PTTG1 expression showed a statistically significant correlation with the invasiveness of NFPAs, whereas PITX2 and galectin-3 did not have a relationship with the invasiveness of NFPAs. Moreover, there was no association among PTTG1, E-cadherin, and Ki-67 expression. @*Conclusions@#PTTG1 has the potential to serve as a predictive biomarker for invasive NFPA. Furthermore, this study may serve as a reference for the development of PTTG1-targeted therapeutic agents.

Rapid-Growing Intracranial Immature Teratoma Presenting Obstructive Hydrocephalus and Abducens Nerve Palsy: A Case Report and Literature Review

Intracranial immature teratoma is an extremely rare disease with poor prognosis and requires complicated treatment. Owing to the deep midline location of the tumor, total surgical resection of the tumor is challenging. We present our experience with a fast-growing pineal gland immature teratoma in a 4-year-old boy, who presented with obstructive hydrocephalus and abducens nerve palsy, which was treated with total surgical resection of the tumor. In addition, we aimed to determine the appropriate treatment modality for intracranial immature teratomas by reviewing the literature and investigating the prognosis.

Amoebic Encephalitis Caused by Balamuthia mandrillaris

We present the case of a 71-year-old man who was diagnosed with amoebic encephalitis caused by Balamuthia mandrillaris. He had rheumatic arthritis for 30 years and had undergone continuous treatment with immunosuppressants. First, he complained of partial spasm from the left thigh to the left upper limb. Magnetic resonance imaging revealed multifocal enhancing nodules in the cortical and subcortical area of both cerebral hemispheres, which were suggestive of brain metastases. However, the patient developed fever with stuporous mentality and an open biopsy was performed immediately. Microscopically, numerous amoebic trophozoites, measuring 20 to 25 µm in size, with nuclei containing one to four nucleoli and some scattered cysts having a double-layered wall were noted in the background of hemorrhagic necrosis. Based on the microscopic findings, amoebic encephalitis caused by Balamuthia mandrillaris was diagnosed. The patient died on the 10th day after being admitted at the hospital. The diagnosis of amoebic encephalitis in the early stage is difficult for clinicians. Moreover, most cases undergo rapid deterioration, resulting in fatal consequences. In this report, we present the first case of B. mandrillaris amoebic encephalitis with fatal progression in a Korean patient.

Bile Granuloma Mimicking Peritoneal Seeding: A Case Report

Laparoscopic cholecystectomy is a widely used treatment method for most cholelithiasis and is a relatively safe procedure. Foreign body granulomatous reaction to bile or gallstone spillage during laparoscopic cholecystectomy has rarely been reported. We report a case of bile granuloma after laparoscopic cholecystectomy, which mimicked peritoneal seeding. A 59-year-old Korean man presented with right upper quadrant pain. He underwent laparoscopic cholecystectomy for acute cholecystitis with cholelithiasis. Pathologic examination revealed an incidental adenocarcinoma invading the lamina propria with acute cholecystitis and cholelithiasis. After 3 months, follow-up abdominal computed tomography revealed a subhepatic nodule, which showed hypermetabolism on positron emission tomography–computed tomography. Suspecting localized peritoneal seeding, wedge resection of the liver, wedge resection of the transverse colon, and omentectomy were performed. Pathologic examination of the resected specimens revealed multiple bile granulomas. Awareness of bile granuloma mimicking malignancy is noteworthy for patient management to reduce unnecessary procedure during postoperative surveillance.

The Usefulness of Calretinin Immunohistochemistry for Rectal Suction Biopsy to Diagnose Hirschsprung’s Disease / 소아외과

PURPOSE: Hirschsprung’s disease (HD) is a congenital intestinal disorder with absence of ganglion cells in the intestinal muscle and submucosa. Diagnosis is based on histopathological study such as H&E, and acetylcholinesterase (AchE) immunohistochemistry. Calretinin immunohistochemistry was introduced as a new diagnostic method against limitations of other staining. The aim of this study is to investigate the usefulness of calretinin immunohistochemistry for the diagnosis of HD compared to H&E and AchE. METHODS: Ten patients with HD and 22 non-HD patients were included in the study. H&E staining, AchE and calretinin immunohistochemistry were performed in all 32 patients. All slides were evaluated by same single pathologist and the diagnostic value was calculated for each H&E stain, AchE immunohistochemical staining, and calretinin immunohistochemical staining. RESULTS: Calretinin method had sensitivity of 100% and specificity of 100% for diagnosis of HD. Its diagnostic accuracy was 100%. AchE staining showed 100% of specificity and 80% of sensitivity. Diagnostic accuracy of H&E staining was 56.3%. CONCLUSION: We concluded that calretinin immunohistochemistry is a very useful and valuable method to diagnosis HD patient.

Solitary bone and brain metastasis in a patient with papillary thyroid carcinoma mimicking cavernous angioma

No abstract available.

Lymphangioma involving whole mesentery confirmed by core needle biopsy / 영남의대학술지

Lymphangiomas are malformations of the lymphatic system accounting for approximately 5% of all benign tumors in infants and children. Abdominal lymphangiomas are rare, and can arise from either the retroperitoneum, gastrointestinal tract, or the mesentery of the abdominal viscera. Lymphangioma involving the whole mesentery is particularly rare. Most lymphangiomas are detected during infancy or childhood, but intraabdominal lymphangiomas such as mesentery are not found until adulthood. We report here on a patient with uncommon lymphangioma involving the whole mesentery who presented with fever and abdominal pain. This patient is unusual because he was confirmed through core needle biopsy which showed variable sized lymphatic spaces representing a immunoreactive for D2-40 antibody with involvement of the whole mesentery. No cases of mesenteric lymphangioma confirmed preoperatively have been previously reported in Korea.

Short stature and growth hormone deficiency in a girl with encephalocraniocutaneous lipomatosis and Jaffe-Campanacci syndrome: a case report

A 9-year-old Tajikistani girl presented to Keimyung University Dongsan Medical Center for evaluation of a skin lesion on her left eyelid, focal alopecia, unilateral ventricular dilatation, and aortic coarctation. She was diagnosed with encephalocraniocutaneous lipomatosis (ECCL) according to Moog's diagnostic criteria. Café-au-lait spots were found on the left side of her trunk. Multiple nonossifying fibromas were found on her left proximal humerus, left distal femur, both proximal tibias, and left proximal fibula, suggesting Jaffe-Campanacci syndrome (JCS), following imaging of the extremities. Many JCS cases with multiple Café-au-lait macules, multiple nonossifying fibromas may actually have Neurofibromatosis type-1 (NF1). Thus, comprehensive molecular analysis to exclude NF1 mutation was performed using her blood sample. The NF1 mutation was not found. Her height was under the 3rd percentile and her bone age was delayed as compared with her chronological age. Baseline growth hormone (GH) level was below the normal range. Using the insulin stimulation and levo-dihydroxyphenylalanine tests, GH deficiency was confirmed. We present a case of GH deficiency with typical features of ECCL and JCS.

Short stature and growth hormone deficiency in a girl with encephalocraniocutaneous lipomatosis and Jaffe-Campanacci syndrome: a case report

A 9-year-old Tajikistani girl presented to Keimyung University Dongsan Medical Center for evaluation of a skin lesion on her left eyelid, focal alopecia, unilateral ventricular dilatation, and aortic coarctation. She was diagnosed with encephalocraniocutaneous lipomatosis (ECCL) according to Moog's diagnostic criteria. Café-au-lait spots were found on the left side of her trunk. Multiple nonossifying fibromas were found on her left proximal humerus, left distal femur, both proximal tibias, and left proximal fibula, suggesting Jaffe-Campanacci syndrome (JCS), following imaging of the extremities. Many JCS cases with multiple Café-au-lait macules, multiple nonossifying fibromas may actually have Neurofibromatosis type-1 (NF1). Thus, comprehensive molecular analysis to exclude NF1 mutation was performed using her blood sample. The NF1 mutation was not found. Her height was under the 3rd percentile and her bone age was delayed as compared with her chronological age. Baseline growth hormone (GH) level was below the normal range. Using the insulin stimulation and levo-dihydroxyphenylalanine tests, GH deficiency was confirmed. We present a case of GH deficiency with typical features of ECCL and JCS.

Coexistence of Spinal Intramedullary Tuberculoma and Multiple Intracranial Tuberculomas

Spinal intramedullary tuberculoma remains a very rare entity of central nervous system tuberculosis. This is the same with the coexistence of spinal intramedullary and intracranial tuberculomas that remains extremely rare with less than 20 cases reported at present. Authors describe this uncommon case by analyzing a 65-year-old female patient who had past history of kidney transplantation due to stage 5 chronic kidney disease and pulmonary tuberculosis on medication. The patient experiences progressive paraplegia and numbness on both lower extremities. Magnetic resonance imaging demonstrated an intramedullary mass at T9-10 level and multiple intracranial enhancing nodules. Microsurgical resection of spinal intramedullary mass was performed and the lesion was histopathologically confirmed as Mycobacterium tuberculosis. Efficient diagnosis and management of this rare disease are reviewed along with previously reported cases.

Increased Expression of Type I Collagen, MMP-1, and MMP-2 in Platelet-rich Plasma-treated Human Skin Fibroblasts / 대한피부과학회지

BACKGROUND: Platelet-rich plasma (PRP) treatment is a promising tool for dermal tissue regeneration. PRP combined with subcision can synergistically induce dermal tissue regeneration. OBJECTIVE: The purpose of this study was to investigate the effects of PRP on the proliferation and migration of skin fibroblasts, as well as on the type I collagen, matrix metalloproteinase (MMP)-1, and MMP-2 expression in these skin cells. The effect of PRP with subcision on the expression of TGF-beta1 was also investigated in an animal model. METHODS: Human skin fibroblasts were treated with various concentrations of PRP. The proliferation and migration rate of the cells were evaluated by the trypan blue exclusion method and scratch assay, respectively. The expression levels of type I collagen, MMP-1, and MMP-2 were analyzed by western blot or RT-PCR. In addition, the activity levels of MMP-1 and MMP-2 were studied by zymography. Finally, we treated the animal back with PRP, subcision, or PRP with subcision. The specimens were evaluated by H&E, Masson-trichrome, and TGF-beta1 immunohistochemical staining. RESULTS: Data from this study showed that PRP more effectively promoted the migration and proliferation of cells in a dose-dependent manner. The expression levels of type I collagen, MMP-1, and MMP-2 were increased in PRP-treated fibroblasts at the protein and mRNA levels. The in vivo study revealed that the expression of TGF-beta1 was prominently increased by co-treatment with PRP and subcision rather than by treatment with either PRP or subcision alone. CONCLUSION: PRP treatment promoted fibroblast migration and proliferation, and increased the expression of type I collagen, MMP-1, MMP-2, and TGF-beta1. Therefore, PRP co-application with subcision is an effective method for dermal remodeling and can be a good treatment option for depressed acne scars.

Increased Expression of Type I Collagen, MMP-1, and MMP-2 in Platelet-rich Plasma-treated Human Skin Fibroblasts / 대한피부과학회지

BACKGROUND: Platelet-rich plasma (PRP) treatment is a promising tool for dermal tissue regeneration. PRP combined with subcision can synergistically induce dermal tissue regeneration. OBJECTIVE: The purpose of this study was to investigate the effects of PRP on the proliferation and migration of skin fibroblasts, as well as on the type I collagen, matrix metalloproteinase (MMP)-1, and MMP-2 expression in these skin cells. The effect of PRP with subcision on the expression of TGF-beta1 was also investigated in an animal model. METHODS: Human skin fibroblasts were treated with various concentrations of PRP. The proliferation and migration rate of the cells were evaluated by the trypan blue exclusion method and scratch assay, respectively. The expression levels of type I collagen, MMP-1, and MMP-2 were analyzed by western blot or RT-PCR. In addition, the activity levels of MMP-1 and MMP-2 were studied by zymography. Finally, we treated the animal back with PRP, subcision, or PRP with subcision. The specimens were evaluated by H&E, Masson-trichrome, and TGF-beta1 immunohistochemical staining. RESULTS: Data from this study showed that PRP more effectively promoted the migration and proliferation of cells in a dose-dependent manner. The expression levels of type I collagen, MMP-1, and MMP-2 were increased in PRP-treated fibroblasts at the protein and mRNA levels. The in vivo study revealed that the expression of TGF-beta1 was prominently increased by co-treatment with PRP and subcision rather than by treatment with either PRP or subcision alone. CONCLUSION: PRP treatment promoted fibroblast migration and proliferation, and increased the expression of type I collagen, MMP-1, MMP-2, and TGF-beta1. Therefore, PRP co-application with subcision is an effective method for dermal remodeling and can be a good treatment option for depressed acne scars.

Anti-fibrotic Effect of Silibinin in Keloid Fibroblasts and a Bleomycin-induced, Scleroderma-like Animal Model / 대한피부과학회지

BACKGROUND: Silibinin reduces the expression of Type I collagen in normal skin fibroblasts through down-regulation of the TGF-beta/smad pathway. However, it is largely unknown whether silibinin can reduce the expression of Type I collagen in vivo sclerotic animal models, as well as in keloid fibroblasts. OBJECTIVE: The purpose of this study was to investigate the effect of silibinin on the expressions of type I collagen, matrix metalloproteinase-1 (MMP-1), MMP-2, smad2/3, and TGF-b1 receptor in keloid fibroblasts in vitro, and to evaluate the anti-fibrotic effect of silibinin in a bleomycin-induced, scleroderma-like animal model in vivo. METHODS: Keloid and normal skin fibroblasts were treated with silibinin (20~100 mM), and the expressions of type I collagen, MMP-1, MMP-2, and TGF-b1 receptor were analyzed with western blot. The animal model was established by bleomycin treatment (1.0 mg/mL) for 2 weeks in C57/BL9 mice. Then silibinin was injected on one side of the back and the same volume of normal saline was injected on the other side of the back. The specimen was evaluated with H&E, Masson-trichrome, and TGF-beta1 immunohistochemical staining. RESULTS: Expressions of Type I collagen, MMP-1, and MMP-2 decreased, but the expression of TGF-beta1 receptor increased in keloid fibroblasts after silibinin treatment. Thickened dermis with dense extracellular matrix and inflammatory cell infiltration of the bleomycin-induced, scleroderma-like animal model improved after silibinin treatment. Expression of TGF-beta1 decreased after silibinin treatment in the bleomycin-induced, scleroderma-like animal model. CONCLUSION: Silibinin treatment decreased the expression of Type I collagen in keloid fibroblasts in vitro. In addition, silibinin decreased the expression of Type I collagen by inhibiting TGF-beta1 expression in the bleomycin-induced, scleroderma-like animal model. These results indicate that silibinin has the potential to be an effective antifibrotic agent.

Cervicofacial Actinomycosis with Orbit Involvement

Actinomycosis is caused by filamentous Gram positive anaerobic bacteria from the Actinomycetaceae family, and known as a rare cause of the infection at the eyeball. We report magnetic resonance findings of a 60-year-old Korean man with cervicofacial actinomycosis, including cellulitis in the eye and central nervous system actinomycosis. On orbital magnetic resonance imaging, gadolinium-enhanced T1-weight images showed multiple abnormal enhancing lesions in head and neck including right eye, and some include low signal intensities which considered as abscesses. The lesions was diagnosed as actinomycosis by incisional biopsy, and since then was cured by using antibiotics of penicillin family.

Emerging Surgical Strategies of Intractable Frontal Lobe Epilepsy with Cortical Dysplasia in Terms of Extent of Resection

OBJECTIVE: Cortical dysplasia (CD) is one of the common causes of epilepsy surgery. However, surgical outcome still remains poor, especially with frontal lobe epilepsy (FLE), despite the advancement of neuroimaging techniques and expansion of surgical indications. The aim of this study was to focus on surgical strategies in terms of extent of resection to improve surgical outcome in the cases of FLE with CD. METHODS: A total of 11 patients of FLE were selected among 67 patients who were proven pathologically as CD, out of a total of 726 epilepsy surgery series since 1992. This study categorized surgical groups into three according to the extent of resection : 1) focal corticectomy, 2) regional corticectomy, and 3) partial functional lobectomy, based on the preoperative evaluation, in particular, ictal scalp EEG onset and/or intracranial recordings, and the lesions in high-resolution MRI. Surgical outcome was assessed following Engel's classification system. RESULTS: Focal corticectomy was performed in 5 patients and regional corticectomy in another set of 5 patients. Only 1 patient underwent partial functional lobectomy. Types I and II CD were detected with the same frequency (45.45% each) and postoperative outcome was fully satisfactory (91%). CONCLUSION: The strategy of epilepsy surgery is to focus on the different characteristics of each individual, considering the extent of real resection, which is based on the focal ictal onset consistent with neuroimaging, especially in the practical point of view of neurosurgery.

A Primary Malignant Rhabdoid Tumor in Adult Liver

No abstract available.

Effect of Green Tea Extract/Poly-gamma-Glutamic Acid Complex in Obese Type 2 Diabetic Mice

BACKGROUND: The increasing prevalence of type 2 diabetes mellitus (T2DM) is associated with the rapid spread of obesity. Obesity induces insulin resistance, resulting in beta-cell dysfunction and thus T2DM. Green tea extract (GTE) has been known to prevent obesity and T2DM, but this effect is still being debated. Our previous results suggested that circulating green tea gallated catechins (GCs) hinders postprandial blood glucose lowering, regardless of reducing glucose and cholesterol absorption when GCs are present in the intestinal lumen. This study aimed to compare the effect of GTE with that of GTE coadministered with poly-gamma-glutamic acid (gamma-PGA), which is likely to inhibit the intestinal absorption of GCs. METHODS: The db/db mice and age-matched nondiabetic mice were provided with normal chow diet containing GTE (1%), gamma-PGA (0.1%), or GTE+gamma-PGA (1%:0.1%) for 4 weeks. RESULTS: In nondiabetic mice, none of the drugs showed any effects after 4 weeks. In db/db mice, however, weight gain and body fat gain were significantly reduced in the GTE+gamma-PGA group compared to nondrug-treated db/db control mice without the corresponding changes in food intake and appetite. Glucose intolerance was also ameliorated in the GTE+gamma-PGA group. Histopathological analyses showed that GTE+gamma-PGA-treated db/db mice had a significantly reduced incidence of fatty liver and decreased pancreatic islet size. Neither GTE nor gamma-PGA treatment showed any significant results. CONCLUSION: These results suggest that GTE+gamma-PGA treatment than GTE or gamma-PGA alone may be a useful tool for preventing both obesity and obesity-induced T2DM.

Induction of Apoptosis and Autophagy in UVB-Treated HaCaT Cells / 대한피부과학회지

BACKGROUND: UVB irradiation induces apoptosis or/and autophagy through several molecular pathways in keratinocytes. However, the precise molecular mechanism of UVB-induced autophagy is largely unknown in keratinocytes. OBJECTIVE: The purpose of this study was to investigate the molecular mechanisms of UVB-induced apoptosis and autophagy in HaCaT cell lines. METHODS: Cells were irradiated by UVB (Westinghouse FS-40 sunlamps) with various doses (0, 30, 60, 120, 240 mJ/cm2). The expression levels of caspase-3, Bax, Bcl2, Bcl-X(L) and LC3 were confirmed by Western blot analysis in UVB-irradiated HaCaT cell lines. Apoptotic cells were analyzed by PI staining, and autophagy cells were analyzed by immunofluorescent staining. RESULTS: The expression of Bcl-X(L) decreased from UVB 60 mJ/cm2 and Bcl2 decreased from UVB 240 mJ/cm2. The expression of caspase-3 was increased from UVB 120 mJ/cm2. These data showed that UVB-induced apoptosis is mediated by up-regulation of caspase-3 and down-regulation of Bcl2 and Bcl-X(L). Furthermore, the expression of LC3 increased from UVB 120 mJ/cm2. In addition, autophagy formation was observed in few fractions of apoptotic HaCaT cells in immunofluorescent staining; most apoptotic cells did not show autophagy formation. Moreover, autophagy formation inhibitor treatment induced a slight increment of apoptotic cell population under UVB irradiation. CONCLUSION: UVB irradiation induces not only apoptotic cell death but also autophagy formations; these events may create a defense mechanism for the prevention of apoptosis in UVB-treated HaCaT cells.

Deep Sylvian Meningioma in a 43-Year-Old Man: A Case Report

Deep sylvian meningioma is a rare form of meningiomas. So far, only 4 cases including the present one have been reported in South Korea. A 43-year-old man without any previous medical history presented to our hospital with seizure. There was a rim enhancing mass in the right deep sylvian fissure without dural attachment on magnetic resonance images. Surgical resection of the mass revealed the lesion to be a meningioma in this patient.