Evaluation and Utilization of Expanded Criteria Dornor / 대한이식학회지

Kidney transplantation is the best treatment option for end stage renal disease. As a result of disparity between the demand for kidney transplantation and the supply of suitable organs, kidneys from suboptimal donors have been used in kidney transplantation. Since demonstration of better patient survival, using marginal donor kidney rather than remaining on hemodialysis, more expanded criteria for donor kidneys were adopted in kidney transplantation. Several donor scoring systems, including Nyberg's donor scoring system, donor risk score by Schold, delayed graft function nomogram, kidney donor risk index (KDRI), and histological graft variable have been developed for evaluation of the quality of deceased donor kidneys showing an increased risk for graft dysfunction and loss and for improvement of the stratification; 15% highest risk donors by KDRI and grade C (20~29 points) and grade D (30~39 points) by Nyberg's deceased donor scoring system are compatible with the definition of expanded criteria for kidney donors of United Network for Organ Sharing. Utilization of these scoring systems would be very useful in allocation of expanded criteria for donors for improvement of graft and patient survival.

Imprint Cytology of Soft Tissue Myoepithelioma: A Case Study

Soft tissue myoepithelioma is a rare neoplasm composed of myoepithelial cells. Here, we describe the cytologic features of soft tissue myoepithelioma arising on the right forearm in an 18-year-old man. The excised tumor (3.0x1.8x1.5 cm) was well-demarcated, yellow-gray, soft, and myxoid. The cytologic smears showed round to spindle, epithelioid, and plasmacytoid cells in the myxoid background. The nuclei were uniform, round to ovoid, with finely distributed chromatin and eosinophilic or pale cytoplasm. The tumor cells demonstrated immunoreactivity for cytokeratin (AE1/AE3), epithelial membrane antigen, S100 protein, and glial fibrillary acidic protein. Electron microscopy showed intermediate filaments, desmosomes, and basal lamina.

Fine Needle Aspiration Cytology of Hepatic Hydatid Cyst: A Case Study

Hydatid cysts (echinococcosis) are caused by an infestation with larval tapeworms of the genus Echinococcus. The disease is extensively distributed worldwide, and it has been rarely reported in Korea. We describe the cytologic features of a case of hepatic hydatid cyst in a 28-year-old male. Computed tomography revealed a cystic mass in the right lobe of the liver. A right hemihepatectomy was performed. The aspirated fluid from the hepatic cystic mass was clear. The smears showed protoscolices, hooklets, and a laminated membrane.

Preliminary Results of Donor Action in Korea / 대한이식학회지

BACKGROUND: Donor Action (DA) is a well-known program used to evaluate the potential of organ donors and to survey hospital attitudes toward organ donation in a region or nation. DA has not yet been fully implemented in Korea. METHODS: We collected medical information on expired patients from 9 hospitals in Yeoung-nam province. We also passed out Hospital Attitude Survey questionnaires in those same 9 hospitals. We reviewed the medical records of the expired patients in the neurological and neurosurgical critical care units from January 1, 2009 to December 31, 2009. Data was analyzed with a DA system database. RESULTS: A total of 704 patients were enrolled. Altogether, 307 patients (43.6%) were potential donors, and 26 patients (6.5%) were reported to an to organ procurement organization. Among the potential donors, a family approach was taken with 33 patients (10.7%), and family consent was obtained in 26 cases (8.5%). Organ donation was done with 24 patients (7.8%). Among the potential donors, 88.6% of them were not identified as potential donors. Hospital attitude surveys were given to 417 hospital staff members. A positive attitude towards organ donation was shown in 85%. However, only 55.4% of hospital staff agreed on the concept of brain death. CONCLUSIONS: Among the processes of organ donation, identifying a potential donor is a critical step to increase organ donation.

HER2-Positive Breast Carcinomas with Co-amplification or Gain of Chromosome 17 Centromere Locus: Report of Three Cases and an Impact on HER2 Testing

Recently we experienced three cases of human epidermal growth factor receptor 2 (HER2)-amplified invasive breast carcinomas associated with co-amplification or gain of chromosome 17 centromere (CEP17) in silver-enhanced in situ hybridization (SISH) analysis. These cases revealed 2+ or 3+ staining for HER2 immunohistochemistry and >6 HER2 copies per cell on SISH analyses. However, the calculated HER2/CEP17 ratios were low (6 per cell vs HER2/CEP17 ratio>2.2). We recommend reporting raw SISH or fluorescence in situ hybridization data, including number of cells counted, average numbers of HER2 and CEP17 signals, and the calculated HER2/CEP17 ratio to prevent underreporting of HER2 amplification.

Acute Interstitial Nephritis during the First Course of Rifampin Administration in a Renal Transplant Patient / 대한신장학회지

Tuberculosis is recognized as one of the most important complications in an organ transplant recipient. Rifampin has become a standard agent in the treatment of tuberculosis. While rifampin is well tolerated in most patients, adverse effects, including serious forms of toxicity, have been reported. Some of these adverse effects include liver toxicity and various immunologic reactions such as skin rashes, eosinophilia, and interstitial nephritis. We have experienced a case of acute interstitial nephritis during the first course of standard anti-tuberculous therapy in a renal transplant patient. We should not ignore other causes of interstitial nephritis in a renal transplant patient.

Diagnostic Importance of Recognition of Calcareous Corpuscles and Larva Part in the Diagnosis of Sparganosis by Fine Needle Aspiration Cytology: Reports of Three Cases of Mammary Sparganosis

Sparganosis of the breast is an uncommon disease. Cytological granulomatous inflammation is a common feature of sparganosis. The presence of larval fragments is necessary for a definitive diagnosis of sparganosis in a cytological specimen. However, calcareous corpuscles entrapped in necrotic debris can be very diagnostic for sparganosis in endemic areas. We experienced three cases of mammary sparganosis diagnosed by fine needle aspiration cytology before surgical excision. Two cases showed numerous calcareous corpuscles associated with necrotic debris thought to be degenerated parasitic bodies. The remaining case revealed a few degenerative calcareous corpuscles and parasitic bodies. The presence of calcareous corpuscles and/or degenerative parasitic bodies can be an aid in the differential diagnosis between sparganosis and other forms of granulomatous mastitis, particularly in endemic areas of sparganosis.

A Case of Successful Treatment of Cutaneous Aspergillosis with Voriconazole at the Low Cyclosporine Trough Level in a Renal Transplant / 대한이식학회지

Aspergillosis is a serious infectious complication with high mortality in transplant recipients. Voriconazole is a broad spectrum triazole antifungal agent, but it has a drug-drug interaction with immunosuppressants. Herein we report a case of the use of a small dose of cyclosporine (CsA) with coadministration of voriconazole. A 23 year old woman received a kidney transplant from a deceased donor. The initial immunosuppressant was tacrolimus, mycophenolate mofetil, steroids, and basiliximab. Thirty-two days after kidney transplantation, because of hemolytic uremic syndrome, she received Rabbit anti-human thymocyte immunoglobulin and plasmapheresis. Cyclosporine was used instead of tacrolimus. Three months after transplantation, she was admitted to the hospital because of an erythematous nodule on her trunk and a dry cough. Skin biopsy revealed an Aspergillus species and tissue culture showed that it was A. fumigatus. We treated her with itraconazole and subsequently with amphotericin B. Afterwards, her condition got worse. So we changed amphotericin B to voriconazole and a minimum dose of CsA (25 mg bid) at the peril of graft failure. Eventually, she recovered and maintained good graft function. The trough level of CsA ranged from 3.2 to 27.9 ng/mL.

p16INK4a, PTEN, E-cadherin, Bcl-2 and Ki-67 Expression in Prostate Cancer: Its Relationship with the Metastatic Potential and Known Prognostic Factors

BACKGROUND: At present, adequate prognostic markers for prostate cancer progression are still lacking, in spite of intensive investigation. Accordingly, our study examined the relationship between expression of candidate biomarkers and metastasis in prostate cancer patients. Correlation of molecular markers with prostate-specific antigen (PSA) level, Gleason sum score and tumor stage were also evaluated. METHODS: A total of 105 prostate tumor specimens and specimens from 19 cases of nodular hyperplasia were obtained through Yeungnam University Hospital from 2007 to 2008. Immunohistochemical analyses for p16INK4a, phosphatase and tensin homolog (PTEN), E-cadherin, Ki-67 and Bcl-2 were performed. RESULTS: Overexpression of Bcl-2 was significantly related to bone (p = 0.006) and nodal metastases (p = 0.017). Other biomarkers were not related to metastatic potential. There were statistically significant relationships between increased PSA level and loss of expression of PTEN (p = 0.019) and E-cadherin (p = 0.001). High Ki-67 index was significantly correlated with nodal metastasis (p = 0.029) as well as with loss of p16INK4a expression (p = 0.002) and high Gleason score (p = 0.011). CONCLUSIONS: High Gleason score, Bcl-2 overexpression and increased Ki-67 labeling have significant predictive value in assessing the potential for prostate cancer metastasis. In addition, a high Ki-67 index is related to high Gleason score and loss of p16INK4a expression.

Automated Silver-enhanced In Situ Hybridization for Evaluation of HER2 Gene Status in Breast Carcinoma: Comparison with Fluorescence In Situ Hybridization and Immunohistochemistry

BACKGROUND: The human epidermal growth factor receptor 2 (HER2) is amplified in 20-25% of breast cancers. HER2 overexpression or amplification is associated with a worse clinical outcome and it can predict the benefit from anthracycline and anti-HER2 therapies. The HER2 status has usually been assessed by immunohistochemistry (IHC) or fluorescence in situ hybridization (FISH) in clinical samples. A new silver-enhanced in situ hybridization (SISH) technique was recently introduced. Therefore we evaluated the usefulness of SISH for detecting HER2 amplification. METHODS: Tissue microarrays (TMAs) were constructed with 144 invasive breast cancer tissue samples. We performed IHC, FISH and SISH for HER2 on the tissue sections from the TMAs and we interpreted the results according to the American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) guidelines. The concordant rates between the two different tests were calculated. RESULTS: HER2 was overexpressed and amplified in 16.9%, 16.9%, and 18% of the cases by IHC, FISH and SISH, respectively. The concordant rates between IHC and FISH, IHC and SISH, and FISH and SISH were 95.1%, 95.7%, and 97.8%, respectively. CONCLUSIONS: SISH can be an alternative test for evaluating HER2 amplification because the 97.8% concordance with FISH satisfies the ASCO/CAP requirement of > 95% concordance with an alternative validated method.

Study for the Relationship between the Post-Transplant Renal Function and the Donor Score Using Deceased Donor Scoring System / 대한이식학회지

BACKGROUND: Due to the shortage of kidney donation, deceased donor kidney from the expended criteria donor has been used as an alternative. For this, deceased donor scoring system was suggested by Nyberg and his colleagues. We evaluated the Nyberg's scores with 77 patients who received deceased donor kidney. METHODS: We reviewed the records of 77 patients who received deceased-donor kidney transplantation between January, 1, 2003 and Augst, 31, 2008 in Pusan,Paik hospital. Renal function was estimated by Cockroft-Gault equation at 6 month, 1 year, 2 year after transplantation and creatinine reduction ratio on post-transplant day 2 (CRR2). RESULTS: The mean age of deceased donor was 41.1+/-10.4 (male: n=55; female: n=22) and the mean last eGFR before procurement was 72.6+/-4 and HLA mismatching was 3.46+/-1.4. Renal function at 6 months was associated with donor age and last eGFR before procurement. Deceased donor score was ranged from 2 to 26. The number of each grade using the score system by Nyberg et al was 18 in A, 39 in B, 19 in C. The score showed negative correlation with eGFR at 6 months, 1 year and 2 years (P<0.05), but the R-square values were low. There were significant differences between group A+B and C in CRR2 and eGFR at 2 years. CONCLUSIONS: This study showed that donor age is the most important factor in the deceased donor scoring system.

A Case of Mitral-Aortic Intervalvular Pseudoaneurysm with Fistula Complicating Native Aortic Valve Infective Endocarditis

Pseudoaneurysm in the mitral aortic intervalvular fibrosa (MAIVF) is a rare but potentially catastrophic complication of the aortic valve endocarditis, aortic valve surgery or chest trauma. We describe a case of pseudoaneurysm in the MAIVF with fistulous connection to the left atrium in a 55-year-old woman with native aortic valve endocarditis. The diagnosis was confirmed using transesophageal echocardiography and she recovered her health through surgical correction.

Association between Aortic Valve Sclerosis and Risk Factors of Coronary Artery Disease in Patients with Suspected Coronary Artery Disease

BACKGROUND AND OBJECTIVES: Aortic valve sclerosis (AVS) is often considered to be benign and it is also considered to be a manifestation of generalized atherosclerosis that involves the aortic valve. However, it is associated with high cardiovascular morbidity and mortality in a population-based study. This study was performed to evaluate the significance of AVS in patients with suspected coronary artery disease (CAD). SUBJECTS AND METHODS: Patients with AVS (AVS group, n=111) and patients with normal aortic valves (control group, n=99) who underwent coronary angiography (CAG) between May, 2004 and June, 2004 were enrolled in this study. We compared the CAG findings and the CAD risk factors in both groups, and we evaluated the diagnostic value of AVS for predicting CAD. We also performed multivariate logistic regression analysis for the risk factors, including AVS, of CAD. RESULTS: This study showed that AVS is an independent echocardiographic predictor of significant CAD in the patients with suspected CAD (OR=2.55, 95% CI: 1.25 to 5.17, p<0.001). The other independent predictors include the male gender and hypertension. AVS has a relatively high positive predictive value (75.7%) and predictive accuracy (65.2%) for the patients with suspected CAD. CONCLUSION: The recognition of AVS on transthoracic echocardiography should alert the physicians to the possibility of significant underlying CAD and further evaluation is indicated, even though angiographic documentation might not be available.