Clinicohistopathologic Findings in Keratoacanthoma and its Immunohi-stochemical Study of Ki-67, p53, bcl-2 and Involucrin Protein Expression / 대한피부과학회지

BACKGROUND: Keratoacanthoma(KA) is common, benign cutaneous tumor that is most likely derived from hair follicle cells, and most often occurs on sun-exposed sites in light-skinned persons of middle age or older. Some authors believed that keratoacanthoma is a variant of squamous cell carcinoma(SCC), which it often resembles clinically and histopathologically. So, the distinction between KA and SCC is still debatable and a matter of speculation. OBJECTIVE: The purpose of this study was to investigate the clinicohistopathologic findings of KA and its expression patterns, compared with SCC, of immunohistochemical staining using Ki-67, p53, bcl-2, and involucrin. METHODS: This clinicohistopathologic study included 20 cases that had confirmed to KA. We performed the immunohistochemical staining with Ki-67, p53, bcl-2 in 14 and with involucrin in 13 KAs. Ki-67, p53, bcl-2, and involucrin staining was also performed in 6 SCCs. RESULTS: All of KAs were solitary lesions. The male to female ratio was 1.2:1. The average age was 63.315.1 years and 11 of 20(55.5%) developed in sixth and seventh decades. The site of predilection were sun-exposed areas(85%) such as face, forearm, neck. Histologically, all of KAs were fully-developed lesions, and 17 of 20(85%) were dome or berry-shaped type II KAs. 17 of 20(85%) KAs showed exo-endophytic growth pattern. Common histologic findings in this study were horn-filled crater formation(80%), epidermal collarette(85%), epidermal proliferation in the perilesional area and the base of crater(100%), lateral extension tendency(80%), individual keratinization(75%), intraepithelial neutrophilic microabscess(65%), and eosinophilic glassy appearance in kertinocytic cytoplasm(95%). In immunohistochemical study using Ki-67, p53, bcl-2, and involucrin, there were no significant differences between KA and SCC except of the distribution pattern of Ki-67 positive cells in tumor. Ten of 14(71.4%) KAs revealed the marginal pattern, whereas no SCCs showed marginal pattern in Ki-67 staining. CONCLUSION: KA is a rapidly growing, cutaneous tumor that most often occurs on sun-exposed sites in sixth and seventh decades. Our results showed that KA is almost similar to SCC immunohistochemically, we suggest that KA is a type of SCC. And also, the characteristic distribution pattern of Ki-67 positve cells is helpful in making differentiation between KAs and SCCs.

A Case of Apocrine Hidrocystoma of the Glans Penis / 대한피부과학회지

Apocrine hidrocystoma is an uncommon benign tumor derived from the secretory segment of apocrine sweat glands and the cyst wall of this tumor consists of columnar to cuboidal cells with a decapitation secretion indicative of apocrine secretion. A 5-year-old boy had a translucent, flesh-colored cystic nodule, 5x2x2mm in size, on the glans penis near the urethral meatus for 4 years. Although apocrine hidrocystoma of the glans penis is very rare, characteristic histopathological features make it easy to diagnose as apocrine hidrocystoma of glans penis, which should be differentiated from the median raphe cyst of the penis.

A case of Stevens-Johnson syndrome after taking herb medicine in a patient with systemic lupus erythematosus / 대한류마티스학회지

Stevens-Johnson syndrome is an acute devastating condition which is related to certain drugs or infections. This syndrome involves multiple organs such as mucocutaneous, respiratory, occular and gastrointestinal systems. Patients who have underlying immunologic diseases are thought to be more susceptible. In lots of case reports and studies, more than 100 drugs have been implicated as causes of Stevens-Johnson syndrome or toxic epidermal necrolysis, but not so much as in Chinese Herb medications. Recently, we have experienced a patient with Stevens-Johnson syndrome after taking herb medicine and diagnosed as SLE during evaluation and treatment. We report this patient with a brief review of literatures.

The Study of Expression of p53 and Apoptosis in Prostatic Cancer / 대한비뇨기과학회지

PURPOSE: Mutation of the p53 gene in one of the most common genetic abnormalities found in solid human tumors. p53 gene is related to the cell cycle and concerned with the control of cellular proliferation or cell death by mediating ?programmed cell death (Apoptosis)?. The objective of this study is to evauate the expression of p53 mutations and apoptosis with metastatic prostatic adenocarcinoma. MATERIALS AND METHODS: We examined 31 paraffin-embedded tissues and compared with the tumor grade, survival estimates. Nuclear expression of p53 could be detected using the monoclonal antibody DO-7 and the expression of apoptosis could be detected using Apotag by in situ hybridization method. The study group was divided by Gleason sum score into low score group (score 2-7, 16cases) and high score group (score 8-10, 15cases). RESULTS: Positive staining for p53 was found in three of sixteen low score group(19%), eight of fifteen high grade group(53%). Diffuse(>20%) staining was considered as positive for p53 expression. Positive expression of p53 showed more frequent in high Gleason score group than low score group(p=0.044). And more expression for p53 was related to more short survival time than negative p53 group(p=0.041). Mean expression for apoptosis in thirty one cases was 32%. In low Gleason score group mean expression for apoptosis was 35% and 28% was found in high Gleason score group. No significant relationship between low and high group in expressing for apoptosis(p=0.2526). No difference was found for survival time between two groups(p=0.96). And no specific relationship was found between the expression of p53 and apoptosis in low and high Gleason score group each other(p=0.275). CONCLUSIONS: p53 mutations play an important role as aggressive biological properties in the metastatic prostate cancer in relation to Gleason grade. Therefore we might use the extent of p53 expression as an usuful prognostic factor in clinical aspects. But the expression of apoptosis cannot reveal any specific features with tumor grade, survival time.

A Case of Dermatitis Artefacta with Widespread Skin Necrosis / 대한피부과학회지

Dermatitis artefacta is an artefactual skin disease caused entirely by the self-destructive behavior. We report, herein, an interesting case of dermatitis artefacta showing recurrent widespread skin necrosis and yellowish color changes of both fingernails in a 28-year-old, unmarried woman. Initially, we examined for an underlying collagen vascular disease, infections, pyoderma gangrenosum, as well as dermatitis artefacta and eventually diagnosed as dermatitis artefacta. We suggest that dermatitis artefacta should be considered in case of recurrent widespread skin necrosis.

A Case of Apocrine Hidrocystoma

Apocrine hidrocystoma is an uncommon benign tumor derived from the secretory segment of apocrine sweat glands and another name for it is apocrine cystadenoma. A 48-year-old female patient had a solitary, translucent red-brownish cystic nodule, 10 × 6 × 7mm in size, on the periorbital area of her left eye. The lesion had enlarged very slowly for 25 years. We excised the lesion and identified it as apocrine hidrocystoma. This is a case of apocrine hidrocystoma with typical clinical and histopathological findings.

Resurfacing of Pitted Facial Acne Scars with a Pulsed Erbium: YAG laser

BACKGROUND: Laser resurfacing has beneficial effects for the treatment of several skin conditions. Recently, the pulsed erbium:YAG laser has been shown to be a highly effective treatment for several kinds of pitted facial scars. OBJECTIVE: The purpose of this study was to assess the efficacy and safety of pulsed erbium:YAG laser skin resurfacing at the setting of low or high energy for pitted acne scars. METHODS: 65 patients with pitted acne scars were included in this study. All patients had skin types III or IV. All patients were instructed to use tretinoin cream 0.05% nightly for 2-4 weeks prior to the laser treatment. The pulsed erbium:YAG laser with a 2 mm handpiece at the setting of 500 mJ/pulse, 3.5-5 W in 45 patients and 1,000 mJ/pulse, 7-10 W in 20 patients was used. Two weeks after laser treatment, topical application of hydroquinone 4%, tretinoin 0.05%, and hydrocortisone 1% cream was recommended for 2-4 weeks. Facial photographs were obtained at baseline and 2 week intervals postoperatively. The results of treatment were evaluated for the changes of skin texture and color at 1 month, 3 months, and 6 months. RESULTS: In 45 cases treated with 500 mJ/pulse energy, pitted acne scars were improved about 46.7 % on average and no erythema and postinflammatory hyperpigmentation was observed after 6 months. In 20 cases treated with 1,000 mJ/pulse energy, pitted acne scars were improved about 64% on average and erythema in two patients and postinflammatory hyperpigmentation in one patient were observed after 6 months. CONCLUSION: The results of laser treatment for pitted facial acne scars at the setting of high energy are better than those of laser treatment at the setting of low energy.

Four Cases of Focal Vitiligo Treated by Suction Blistered Epidermal Graft Using a Suction Device with Intrinsic Heating System / 대한피부과학회지

Suction blistered epidermal graft is a less painful and minimally scarring method that is applicable to various skin diseases, especially vitiligo. The time needed for the suction blister formation is dependent on many factors such as temperature, suction pressure, age, skin site or skin thickness. Among them, the temperature and suction pressure are the most important factors. We report four cases of focal vitiligo treated by suction blistered epidermal graft using the device having the capability of heat itself by intrinsic heating system.

A Case of Nephrogenic Adenoma in Bladder / 대한비뇨기과학회지

Nephrogenic adenoma is an uncommon metaplastic lesion of the lower urinary tract that usually is associated with antecedent inflammation or surgical procedure. The tumor is structural resemblance to renal tubule, low proliferating potential, and shows no malignant transformation, but recurrent rate of this tumor is high. For this reason, periodic follow-up endoscopy is recommended. We report a case of nephrogenic adenoma in 38 years old man with review of the literatur

Effects of Aging on Urethral Function in the Male Rat / 대한비뇨기과학회지

Many symptoms of age related bladder dysfunction may be associated with urethral dysfunction. We compared the contractile responsiveness of urethral strips from young adults (6-9 months) and old (24-27 months) male Fisher 344 rats. Circularly and longitudinally oriented urethral strips from proximal (bladder neck) and distal urethra were obtained and suspended in organ baths containing Tyrodes buffer. Contractile responses to field stimulation (FS), phenylephrine, bethanechol and KC1 were recorded. Results were as followed: 1. Contractile responses of proximal urethral strips from old rats to FS, bethanechol, phenylephrine, KCI were greater than those of young rats. In young rats, general order of responsiveness was FS >KC1 = phenylephrine >bethanechol. In old rats, it became FS >bethanechol >KCI = phenylephrine. 2. Magnitude of the contractile responses for distal urethral strips were significantly lower than for proximal urethra and there were no significant differences of the responses between two age group. 3. For the circularly oriented strips, responses of old rats to FS, bethanechol, phenylephrine and KC1 also were greater than those of young rats. In young rats, general order of responsiveness was FS>KCl =phenylephrine =bethanechol. In old rats, it became FS>bethanechol >KC1 >phenylephrine. 4. For the longitudinally oriented strips, responsiveness to FS and bethanechol was similar between younger and old rats. However, responses to phenylephrine were greater for young rats than for old ones. For both young and old rats, general order of contractile responsiveness was FS>phenylephrine=KCl>bethanechol, In old rats contractile responses of proximal, circular urethral strips to various stimulation were greater than those in young ones. 5. Degree of field stimulated relaxant responses of the urethra precontracted by phenylephrine were similar between two age groups at higher frequencies(16-64 Hz.): whereas higher degrees of relaxation were observed in young rats at lower frequencies(1-8 Hz.). Circularly oriented urethral strips showed better relaxation with FS than did longitudinal ones. Relaxant responses were only partially (50%) blocked by preincubation of L-NAME. These results suggest that as male became older, their urethra responds to various stimulation with obstructive pattern than did the younger ones and also, lesser degree of urethral relaxation may causes obstructive voiding due to poor Opening of bladder outlet. Also it can be said that the ratio of the receptor density of cholinergic and adrenergic nerves varies as one become old.

Effects of Aging on Urethral Function in the Male Rat / 대한비뇨기과학회지

Many symptoms of age related bladder dysfunction may be associated with urethral dysfunction. We compared the contractile responsiveness of urethral strips from young adults (6-9 months) and old (24-27 months) male Fisher 344 rats. Circularly and longitudinally oriented urethral strips from proximal (bladder neck) and distal urethra were obtained and suspended in organ baths containing Tyrodes buffer. Contractile responses to field stimulation (FS), phenylephrine, bethanechol and KC1 were recorded. Results were as followed: 1. Contractile responses of proximal urethral strips from old rats to FS, bethanechol, phenylephrine, KCI were greater than those of young rats. In young rats, general order of responsiveness was FS >KC1 = phenylephrine >bethanechol. In old rats, it became FS >bethanechol >KCI = phenylephrine. 2. Magnitude of the contractile responses for distal urethral strips were significantly lower than for proximal urethra and there were no significant differences of the responses between two age group. 3. For the circularly oriented strips, responses of old rats to FS, bethanechol, phenylephrine and KC1 also were greater than those of young rats. In young rats, general order of responsiveness was FS>KCl =phenylephrine =bethanechol. In old rats, it became FS>bethanechol >KC1 >phenylephrine. 4. For the longitudinally oriented strips, responsiveness to FS and bethanechol was similar between younger and old rats. However, responses to phenylephrine were greater for young rats than for old ones. For both young and old rats, general order of contractile responsiveness was FS>phenylephrine=KCl>bethanechol, In old rats contractile responses of proximal, circular urethral strips to various stimulation were greater than those in young ones. 5. Degree of field stimulated relaxant responses of the urethra precontracted by phenylephrine were similar between two age groups at higher frequencies(16-64 Hz.): whereas higher degrees of relaxation were observed in young rats at lower frequencies(1-8 Hz.). Circularly oriented urethral strips showed better relaxation with FS than did longitudinal ones. Relaxant responses were only partially (50%) blocked by preincubation of L-NAME. These results suggest that as male became older, their urethra responds to various stimulation with obstructive pattern than did the younger ones and also, lesser degree of urethral relaxation may causes obstructive voiding due to poor Opening of bladder outlet. Also it can be said that the ratio of the receptor density of cholinergic and adrenergic nerves varies as one become old.

A Case of Leiomyosarcoma of the Scrotum / 대한비뇨기과학회지

Scrotal leiomyosarcoma arising from dartos layer not involving the testis, epididymis or spermatic cord is very rare tumor. We report a case of scrotal leiomyosarcoma in 29 year old man who present with right scrotal painless growing mass. The lesion had been for 3 months but there was no related symptom such as pain or tenderness. The excised lesion was 3 x 3cm sized ovoid mass with smooth surface and it had no relationship with the testis, epididymis and spermatic cord. Its pathologic finding was compatible with leiomyosarcoma. So additional radical orchiectomy was done.

An analysis of the flow cytometry in transitional cell carcinoma of bladder / 대한비뇨기과학회지

The 32 patients with transitional cell carcinoma of the bladder underwent flow cytometric analysis or nuclei extracted from paraffin-embedded archival material and isolated nuclei were stained with propidium iodide. The results were summarized as follows : 1. Or the 32 blocks, 8 cases showed the diploid pattern and 24 cases showed the aneuploid pattern in DNA histogram. The incidence of aneuploid pattern increased in proportion to rising the grade and stage of the tumor. 2. The flow cytometric results of cell cycle between diploid and aneuploid group were significant different(p<0.05 ) 3. Subsequent progression in clinical status was seen in 1/8 patients in the diploid group and 11/ 24 patients in the aneuploid group. On the basis of the results, it is suggested that the flow cytometric DNA analysis may be correlated with stage, grade and progression of the tumor. But many variable factors are present while results of the flow cytometry are confirmed, that can make it confusing to interpret the results. For more objective and reliable outcomes further investigation will be demeaned.

The significance of random mucosal biopsy in bladder cancer / 대한비뇨기과학회지

Random biopsy of normal-looking mucosa of the bladder at the time of T.U.R.B. in the patients with bladder cancer have been used as a routine assessment of the tumor behavior. To investigate mucosal abnormalities of normal-looking mucosa in bladder cancer. we performed random mucosal biopsies during transurethral resection of the bladder cancer. The following results were obtained. 1. In Group 1 (Solitary, Stalk, Papillary ca). no CIS lesion was found in biopsy specimens. 2. In Group 2 (Solitary. Sessile. Papillary ca) and Group 3 (Solitary. Sessile. Non-papillary ca). some positive results were obtained. On the consideration of above results and the potentiality of implantation. we can raise an issue that the bladder cancer patients with a solitary, papillary shape do not necessarily undergo the mucosal biopsy during T.U.R.B. Instead, close follow up for the patients will be recommended.

The Experience of Indwelling Nylon(#1-0) for the Guidance of Managing Urethral Stricture under the Internal Urethrotomy / 대한비뇨기과학회지

Internal urethrotomy is widely accepted for the treatment of urethral stricture recently. However it is well known the fact that urethral stricture can be recurred after internal urethrotomy. In the presence of severe urethral stricture, internal urethrotomy can not be performed because the operator has difficulty finding his way through the urethra. During the internal urethrotomy or primary realignment of urethral rupture, we inserted the Nylon(#1-0) from the suprapubic into the bladder and then situated into the distal urethra for the guide of right way of re-internal urethrotomy when severe urethral stricture was developed after operation. With above methods, we experienced less difficulties to perform internal urethrotomy. We found the method as simple, easy way to manage of severe urethral stricture under the direct visual urethrotomy.

A Case of Renal Oncocytoma Associated with Angio-invasion / 대한비뇨기과학회지

Renal oncocytoma is an epithelial tumor of the kidney with a particularly good prognosis and is composed entirely of uniform packets of eosinophilic granular cells so-called 'Oncocytic cells' The cytoplasm of the oncocytoma cells is packed with mitochondria and contains few other organelles. At present time 4 cases have been reported in Korean literature without any identifiable angioinvasive lesions. We report a case of renal oncocytoma associated with angioinvasion that was suspected preoperatively and confirmed by pathologic examination including electron microscopy postoperatively. The pathology, diagnosis and treatment of this uncomrnon entity is discussed.

A Case of Submucosal Renal Pelvic Calcification and Ossification / 대한비뇨기과학회지

We report a case of renal pelvic calcification and ossification simulating a renal pelvic stone. histopathological examination of resected kidney revealed submucosal calcification in the pelvic and ossified foci in the perivascular area. This is the first report in the Korean literature and have been reported 1 case in the English literature till now. This is very rare entity unrelated to amyloidosis.

A Case of Spontaneous Rupture of the Kidney / 대한비뇨기과학회지

Spontaneous renal rupture is relatively uncommon entity. In Korean literature, 8 cases have been reported. We experienced 1 case of spontaneous renal rupture secondary to hydronephrosis caused by metastatic adenocarcinoma of undetermined origin invading upper ureter and presented it with a brief review of literature.