Primary Extramedullary Plasmacytoma of the Colon: A Case Report

Extramedullary plasmacytoma is a relatively rare tumor, occuring in a wide variety of organs and tissues, and is most frequently seen in the oral cavity and upper respiratory tract. Solitary extramedullary plasmacytoma located in the gastrointestinal tract is rare, especially the in colon. We report a case of solitary extramedullary plasmacytoma in the cecum of a 58-year-old man which simulated a carcinoma both endoscopically and radiologically. But histopathologic evaluation demonstrated a sheet-like proliferation of pure plasma cells with monoclonality for IgM and lamda chain which confirmed the diagnosis of plasmacytoma.

Species Identification of Coagulase Negative Staphylococci by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism of Heat Shock Protein 60 Gene / 대한임상미생물학회지

BACKGROUND: An accurate and rapid method for specise identification of coagulase negative staphylococci(CNS) has been increasingly necessary for the clinical significance and planning the management of patients with staphylococcal infections. Recently, it has been reported that there is a highly conserved area on their 60KDa heat shock protein(HSP60) gene sequences between the interspecies of CNS and it can be amplified by a set of universal degenerate primer. This led us our attention to focus on whether the PCR-based RFLP method using Mse / restriction enzyme could be a useful tool for the species identification of CNS. METHODS: In the present study, we performed PCR-based RFLP analysis using a set of degenerate primers covering HSP60 and Mse / restriction enzyme on the reference strains and 25 clinical isolates(10 of S. epidermidis, 10 of S. haemolyticus, 4 of S. lugdunensis and 1 of S. warneri) which were previously identified by the API-STAPH, Vitek GPI card and/or with conventional biochemical test. RESULT: All the seven reference strains revealed that each strain has a distinct electrophoresed band patterns with combination of different number (up to 8) and size of fragments. And these distinct band patterns showed remarkable concordance with the seven reference strains and 25 clinical isolates. CONCLUSION: These result strongly suggest that the PCR-RFLP method using degenerate primers covering the HSP60 gene and Mse / digestion enzyme offer a convenient and accurate tool for species-specific identification of CNS.

Hemimegalencephaly: A case report

Hemimegalencephaly is an uncommon sporadic congenital malformation of the central nervous system characterized by enlargement of one cerebral hemisphere with cranial asymmetry, hemiparesis, epilepsy, and mental retardation. This report deals with a 12-month-old girl with intractable seizure and developmental delay, who revealed hemispheric asymmetry and enlarged right cerebral hemisphere. MRI scan revealed asymmetric enlargement of right cerebral hemisphere with lissencephaly and multifocal calcification. She underwent right frontal lobectomy and parietal cortical resection, but died of complication of surgery. Histological features included loss of cortical lamination, large atypical neurons, neuronal heterotopia, and astrocytosis with dystrophic calcification. The heterotopic neurons in the white matter were suggestive of aberrant neuronal migration.

Fine Needle Aspiration Cytology of Small Cell Carcinoma of the Parotid Gland: A Case Report / 대한세포병리학회지

Primary small cell carcinoma of the salivary gland is a rare neoplasm that accounts for approximately 1.8% of all primary major salivary gland malignancies. Because of its rarity, it is difficult to diagnose small cell carcinoma of the parotid gland by fine needle aspiration cytology(FNAC). We experienced a case of primary small cell carcinoma of the parotid gland in a 72-year-old woman who presented with two palpable masses of the left infraauricular and ocular regions of two to three month's duration, respectively. Aspirate smears from the left infraauricular area were highly cellular on necrotic and lymphocytic background and showed individually dispersed cells or three-dimensional clusters of small cells. The tumor cells were round to oval with a very high nucleocytoplasmic ratio. Nuclei were about two times the size of lymphocytes and had uniformly dispersed but hyperchromatic to pyknotic chromatin. Nucleoli were occasionally visible but were generally inconspicuous. Numerous mitotic figures were detected. The clusters of these small tumor cells exhibited angular nuclear molding, irregular nuclear outlines, and occasionally rosette like arrangement. The tumor was confirmed by histology and immunohistochemistry.

Multiple Kaposi's Sarcoma in the Renal Transplant Patient: A case report

The Kaposi's sarcoma, which was found in an immunosuppressed patient of renal transplantation, may have been developed by long term use of immunosuppressant agent after the renal transplantation. The case was a 29-year-old woman who was diagnosed as chronic renal failure in 1988, and since then, she had been on CAPD until May, 1997. After the renal transplantation in May 1997, the patient has been prescribed cyclosporin and prednisone as immunosuppressant agent. In June 1997, she showed clinical symptom of Kaposi's sarcoma with multiple papules and nodules in the skin and viscera, such as ureter, urinary bladder, stomach, duodenum and subcutaneous tissue of the chest. Multiple excisional biopsies were carried out in the skin, ureter, urinary bladder, stomach and duodenum. All of excisional biopses indicated nodular stages with extensive proliferation of spindle shaped, somewhat pleomorphic cells which have slit-like vascular spaces, proliferation of small vessels, and extravasation of erythrocytes. These lesions nearly diminished after sytemic chemotherpy, excision and discontinuity of immunosuppressive agents.

Multiple Kaposi's Sarcoma in the Renal Transplant Patient: A case report

The Kaposi's sarcoma, which was found in an immunosuppressed patient of renal transplantation, may have been developed by long term use of immunosuppressant agent after the renal transplantation. The case was a 29-year-old woman who was diagnosed as chronic renal failure in 1988, and since then, she had been on CAPD until May, 1997. After the renal transplantation in May 1997, the patient has been prescribed cyclosporin and prednisone as immunosuppressant agent. In June 1997, she showed clinical symptom of Kaposi's sarcoma with multiple papules and nodules in the skin and viscera, such as ureter, urinary bladder, stomach, duodenum and subcutaneous tissue of the chest. Multiple excisional biopsies were carried out in the skin, ureter, urinary bladder, stomach and duodenum. All of excisional biopses indicated nodular stages with extensive proliferation of spindle shaped, somewhat pleomorphic cells which have slit-like vascular spaces, proliferation of small vessels, and extravasation of erythrocytes. These lesions nearly diminished after sytemic chemotherpy, excision and discontinuity of immunosuppressive agents.

Primitive Neuroectodermal Tumor of the Ovary: A case report

Primitive neuroectodermal tumors (PNET) of the ovary are rare tumors with an exclusive or almost exclusive malignant neuroectodermal composition, and are generally regarded as a monodermal expression of an ovarian teratoma. The tumors are basically identical with the lesions of the same name occuring typically in the central nervous system of children. These tumors consist chiefly of undifferentiated small cells resembling neuroblasts. There are also mature, well- differentiated neuroectodermal cells, such as astrocytes and ependymal cells. We report a case of ovarian PNET with glial and neuroblastic differentiation and focal teratomatous foci of non-neural tissue in a 17-year-old female.

Prevalence of Teicoplanin-resistant Staphylococci and Evaluation of the Disk Diffusion Test for Testing the Susceptibility of Staphylococci to Teicoplanin / 감염

BACKGROUND: Teicoplanin is a glycopeptide antimicrobial agent effective against methicillin-resistant staphylococci. Decreased susceptibility of staphylococci to glycopeptides has been increasing. Teicoplanin diffuses poorly in agar and therefore the correlation between the inhibition zone diameter and the minimal inhibitory concentration(MIC) is rather poor. The purpose of this study was to evaluate the prevalence of teicoplanin-resistant staphylococci and to assess the reliability of inhibition zone diameters for determining the susceptibility of staphylococci to teicoplanin by comparing the results of the agar dilution MICs. METHODS: From June to August 1997, 290 clinical isolates of staphylococci(77 coagulase negative staphylococci(CNS), 213 Staphylococcus aureus) were collected. The antimicrobial susceptibilities to teicoplanin were determined by inhibition zone diameter and the results were compared with the MICs determined by the agar dilution method. RESULTS: Among 77 CNS strains, 75(97.4%) were susceptible and 2(2.6%) were intermediate by agar dilution method and all 213 strains of S. aureus were susceptible to teicoplanin. There was a poor correlation(r=0.50) between the zone diameters of inhibition and agar dilution MICs. In comparison with the results of disk diffusion test and agar dilution MIC, eight (2.8%) out of 290 isolates showed discrepancies (major error rates : 0.3%, minor error rates: 2.4%). CONCLUSIONS: Two(2.6%) out of 77 strains of CNS and none of 213 S. aureus strains revealed decreased susceptibility to teicoplanin. And the inhibition zone diameter was less reliable in determining the susceptibility of staphylococci than MICs. Therefore, the more effective and convenient method is needed.

Histopathology and Mainz Classification of Renal Cell Tumors: A Histogenetic Study and DNA Content Analysis

The Mainz classification for renal cell tumors was introduced in 1986 and it's utility has been reported in several histogenetic and genetic studies of renal cell tumors. We present a study of 127 cases of renal cell tumors with clinicopathologic correlation, DNA content analysis, and histogenesis studied by histochemical and immunohistochemical staining. The 127 renal cell tumors classified by the Mainz classification were 87 clear cell, 17 chromophilic, 13 chromophobe and 3 sarcomatoid renal cell carcinomas, 5 oncocytomas and 2 adenomas. These subtypes showed significant correlation not with age, sex, Robson's stage, DNA ploidy or tumor recurrence but with nuclear grade (p=0.001) and tumor size (p=0.001). Hall's colloidal iron (p=0.002) and carbonic anhydrase II (p=0.013) stains, representing the origin of distal nephron especially of collecting duct, were significantly correlated with specific subtypes of renal cell tumors, especially chromophobe cell renal carcinoma. This study demonstrates that the Mainz classification suggests several morphologically different subtypes and variants of renal cell tumors and that some of them may have originated from the distal nephron, particularly from the collecting duct.

Warty Dyskeratoma with a Cutaneous Horn: Report of a case

The clinical and pathological features of warty dyskeratoma are presented. Warty dyskeratoma is a rarely encountered, solitary, benign cutaneous tumor occurring most often on the head and neck and to our knowledge, no cases associated with cutaneous horn have been published in western literature. We experienced a case of warty dyskeratoma with a cutaneous horn occurring in a 70-year-old male, who had a 1.3 cm-sized and slowly growing nodule on his neck. A brief review of the literature, was made especially in relation to the pathological findings and histogenesis of warty dyskeratoma.

A Case of Wound Infection Caused by Staphylococcus aureus with Decreased Susceptibility to Teicoplanin / 대한임상병리학회지

With increased infection by methicillin-resistant staphylococci, the use of glycopeptides has been increasing. Recently, staphylococci with decreased susceptibility to glycopeptides, especially teicoplanin, are increasingly reported. We isolated a Staphylococcus aureus strain isolated repeatedly from a wound culture, which showed susceptibility to teicoplanin by the disk diffusion method but showed growth on the Mueller-Hinton agar containing 6 g/mL of teicoplanin. This strain was clinically resistant to treatment at 200 mg/day of teicoplanin. By changing the treatment into combining rifampin (600 mg/day) and increasing the dose of teicoplanin (400 mg/day), the S. aureus was not isolated any more.

Pigmented Squamous Cell Carcinoma Arising from Pigmented Actinic Keratosis

Pigmented squamous cell carcinoma is a very rare malignant, pigmented, epidermal tumor. The rarity of pigmented squamous cell carcinomas may reflect in part their misdiagnosis as other pigmented neoplasms, particularly malignant melanoma. To our knowledge, only five cases have been reported in literature. We recently experienced a case of pigmented squamous cell carcinoma arising from pigmented actinic keratosis in a 77 years old female. Physical examination showed a 0.8 0.6 cm, smooth, dark brown pigmented patch with irregular but sharply defined borders located on the upper left chest. The biopsy specimen showed histologic findings of pigmented actinic keratosis with abundant melanin pigments, which became pigmented squamous cell carcinoma. Most of pigments in the squamous cell carcinoma were contained within the melanocytes along with the neoplastic squamous cells.

Fine Needle Aspiration Cytologic Findings of Proliferating Trichilemmal Tumor / 대한세포병리학회지

The cytologic finding of proliferating trichilemmal tumor is not well documented and have difficulties in the cytological analysis of the fine needle aspirates. This rare dermatopathologic entity may be encountered during aspiration biopsy of subcutaneous masses, and is, occasionally, confused with other neoplasm, particulary squamous carcinoma owing to its close cytological resemblance. We report a case of proliferating trichilemmal tumor in the left breast. The patient is a woman and had a lump in the breast for 20 years. Fine needle aspiration revealed a few small clusters of squamoid cells in the background of amorphous and calcified material. After excisional biopsy, the mass was confirmed as proliferating trichilemmal tumor. The main cytologic features discriminating squamous cell carcinoma were bland nature of epithelial cells, absence of atypical dyskeratotic cells, and rich amount of amorphous material.

Fine Needle Aspiration Cytology of Intracystic Papillary Carcinoma of the Breast / 대한세포병리학회지

Intracystic papillary carcinoma(IPC) of the breast is a distinctive and very rare variant of intrductal carcinoma. The cytologic features of IPC have been rarely reported, and there are difficulties in distinguishing between benign and malignant papillary breast lesions. Herein we report a IPC of the breast in a 80 year-old female. Fine needle aspiration cytology revealed monotonous cuboidal epithelial cells in small clusters and individually scattered on bloody background. The tumor cells did not show overt cytologic atypia. With the histologic features of this case and review of the literature, the cytologic differential points are discussed.

Species Identification of Enterococcus by Ribotyping / 감염

BACKGROUND: Emerging drug resistance and increasing incidence of enterococci infection necessitates an accurate species identification. METHOD: We compared the identification of twelve strains of American Type Culture Coliection(ATCC) (E. faecalis, E. avium, E. faecium, E. raffinosus, E. durans, E. casseliflavus, E. hirae, E. flavescens, E. malodoratus, E. gallnarum, E. mundtii, and E. sulfureus) and 73 clinical isolates of enterococci(E. faecalis 8, E. faecium 8, E. avium 13, E. durans 5, and unidentified strains 39) by Vitek Gram-positive Identification card (version R08.1, bio- Merieux Vitek, Hazelwood, Mo., U.S.A.), ribotyping and conventional scheme of Facklam and Sahm. RESULTS: All ATCC strains could be identified on the basis of characteristic 16S-23S rDNA fingerprint patterns by using Eel I and Hind III. Of 39 strains unidentified by Vitek GPI card, 25 strains were identified as E. faecium, 5 strains were E. gallinarum, 5 strains were E. casseliflavus, 3 strains were E. avium and 1 strain was E. hirae. CONCLUSION: By ribotyping with Eel I and Hind m digestion, all twelve ATCC strains and 73 clinical strains were identified and it seems to be a reliable method for identification of Enterococcus species.

Two Cases of Bacteremia Caused by Leuconostoc citreum / 대한임상병리학회지

Two strains of vancomycin-resistant Leuconostoc species were isolated from blood cultures in two compromised patients. The isolates produced gas from Lactobacillus MRS booth, hydrolysed esculin, and produced no ammonia from arginine, thus fulfilling the major criteria as Leucorostoc spp. We recommend that clinical laboratories should perform susceptibility test to vancomycin for clinical isolates (especially from cerebrospinal fluid and blood) which resemble streptococci so as not to confuse Leuconostoc spp. with more commonly isolated pathogens such as streptococci.

Loss of Heterozygosity Affecting the APC and p53 Tumor Suppressor Gene Loci in Colorectal Cancers and Its Prognostic Significance

Development of the human colorectal cancer is associated with several distinct genetic abnormalities involving both dominant-acting oncogenes (K-ras, c-src) and tumor suppressor genes (APC, DCC, p53) which undergo inactivation or loss. In colorectal tumors, the common molecular alteration is localized in the 17p13 and 5q21 loci encoding the p53 and the APC gene, respectively. The identification of these genes may help the understanding of the pathogenesis of colorectal neoplasia. In order to determine whether the frequency of the genetic alterations varies with sex, age, tumor size, or site, including pathologic parameters, such as degree of differentiation, tumor stage, mucin component, lymphoid reaction, tumor invasion pattern, vein and nerve invasion, lymph node metastasis, and other parameters, such as disease-free survival, distant metastasis and patient outcome, the authors analyzed the loss of heterozygosity (LOH) of the APC and the p53 genes in paraffin-embedded specimens of 48 colorectal cancers by use of the polymerase chain reaction and restriction fragment length polymorphism. The results were as follows: the LOH affecting the APC was found in 15 out of 31 (48.4%) heterozygous patients, while the LOH of the p53 locus was observed in 11 out of 26 (42.3%) patients. Among 48 patients, the LOH at both the APC and the p53 loci was observed in five (10.4%) patient. No statistically significant associations were found between the LOH of the APC gene and the proposed parameters. The relationship between the LOH of the p53 and the histologic differentiation, lymphoid reaction was significant (P<0.05), but survival was not correlated. Statistically significant associations were found between overall survival of the colorectal cancer patients and distant metastasis, Astler-Coller stage, lymphoid reaction, invasion pattern, nerve invasion, vein invasion, lymph node metastasis, and disease free survival. The above results suggest that the LOH of the p53 genes could be involved in the progression of colorectal cancers. However, neither the LOH of the APC nor that of the p53 have significant association with survival of the colorectal cancer patients.

Eccrine Spiradenoma: Pathologic Analysis of 9 Cases

The clinicopathology of nine cases of eccrine spiradenoma was examined. The ages of the patients ranged from 32 to 65 years, with an average age of 46 years. There were four males and five females. Eight tumors out of the nine presented on the ventral surface of the upper body. The tumors were solitary in seven cases and multiple in two cases(cases 8 and 9). Six tumors were either painful or tender to palpation. Histologically, two cases(cases 1 and 2) were adenomas with well developed tubular structures, while the remaining seven cases were epitheliomas with poor organization and prominent reticular pattern. All tumors were composed of two distinct cell types. Since four cases showed considerable edema with a lot of cystic change, it was difficult in some areas to differentiate these from other adnexal tumors or vascular tumors. Immunohistochemical staining was performed on paraffin-embedded sections of 5 eccrine spiradenomas. CEA and EMA were expressed in the cytoplasm of tumor cells in all cases. Cytokeratin was expressed in 4 out of 5 cases, and S-100 in 3 out of 5 cases. There has been no evidence of recurrence in 8 cases. In one case(case 9) the tumor recurred locally with carcinomatous transformation- characterized by the presence of solid areas of tumor which was composed of large cells with irregularly shaped nuclei and mitotic figures. There were foci of ductal differentiation, extensive areas of tumor necrosis and invasion into surrounding connective tissue. The carcinomatous portion revealed positive reaction for CEA, EMA, S-100 protein and cytokeratin.

Sarcomatoid Carcinoma with Heterologous Osteosarcomatous Component of the Prostate: A case report

Sarcomatoid carcinoma of prostate has been rarely reported and occasionally difficult to distinguish from a true sarcoma or carcinosarcoma. A case of sarcomatoid carcinoma of the prostate, which has been occured in 61-year-old male patient is presented. The tumor consists of carcinomatous areas with epithelioid cells, sarcomatoid areas with spindle cells and foci of heterologous osteosarcoma component. The phenotypic nature of the tumor was confirmed immunohistochemically by positive reaction for cytokeratin, epithelial membrane antigen, vimentin and prostate specific acid phosphatase in both sarcomatous and carcinomatous components.

Interphase cytogenetics of non-Hodgkin's lymphoma using non-fluorescent in situ hybridization in paraffin embedded tissue

Paraffin-embedded tissue samples from 30 cases of non-Hodgkin's lymphoma(NHL) and 10 of reactive hyperplasia, were processed for interphase cytogenetic chromosomal study. We performed non-fluorescent in situ hybridization(NFISH) using the enzymatic method with digoxigenin-labeled DNA centromeric probes for chromosome 7,12,18 and X, and a painting probe for chromosome 18. Chromosomal aberrations were observed in 27(90%) out of 30 cases of NHL. The most commonly observed numerical aberration was extracopy of X chromosome. There were some characteristic aberrations corresponding to each grade and group of NHL by International Working Formulation: In low grade NHL(9 cases), a third were associated with extracopy of chromosome 12, and disomy X was frequently found in small lymphocytic lymphoma(75%). With intermediate grade(16 cases), tetraploidy(25%), translocation of chromosome 18(25%), and extracopy of chromosome 18(19%) were characteristically associated. These results suggest that interphase NFISH is an easily performable method in retrograde cytogenetic study of archival materials. Some specifically correlated chromosomal aberrations corresponding to the histopathologic grades and groups could provide us more valuable information for determining pathologic diagnosis and assessing the clinical outcome of NHL.