Extranodal Marginal Zone B-Cell Lymphoma of Mucosa-Associated Tissue Type Involving the Dura / Journal of the Korean Cancer Association, 대한암학회지

Primary central nervous system marginal zone B-cell lymphoma (MZBCL) is very rare, with only a few reported cases worldwide. It has an indolent disease course with high cure potential. We experienced a rare case of dural MZBCL of mucosa-associated lymphoid tissue (MALT) in a 69-year-old man who presented with headache. A magnetic resonance imaging scan of brain showed a 1.9×3.6-cm-sized extra-axial mass with a broad based dural attachment to the anterosuperior aspect of the falx cerebri, radiographically consistent with meningioma. Surgical resection yielded a MZBCL of the MALT type. Histopathology revealed a lymphoplasmacytic infiltration of the dura, and immunohistochemical study showed a B-cell phenotype with CD20, bcl-2, MUM-1, Ki-67 positive. He was treated with chemotherapy after complete surgical resection and remained free of disease at 30 months after chemotherapy. MALT lymphoma must be considered in the differential diagnosis in patients presenting radiographically with meningioma.

Extranodal Marginal Zone B-Cell Lymphoma of Mucosa-Associated Tissue Type Involving the Dura / Journal of the Korean Cancer Association, 대한암학회지

Primary central nervous system marginal zone B-cell lymphoma (MZBCL) is very rare, with only a few reported cases worldwide. It has an indolent disease course with high cure potential. We experienced a rare case of dural MZBCL of mucosa-associated lymphoid tissue (MALT) in a 69-year-old man who presented with headache. A magnetic resonance imaging scan of brain showed a 1.9×3.6-cm-sized extra-axial mass with a broad based dural attachment to the anterosuperior aspect of the falx cerebri, radiographically consistent with meningioma. Surgical resection yielded a MZBCL of the MALT type. Histopathology revealed a lymphoplasmacytic infiltration of the dura, and immunohistochemical study showed a B-cell phenotype with CD20, bcl-2, MUM-1, Ki-67 positive. He was treated with chemotherapy after complete surgical resection and remained free of disease at 30 months after chemotherapy. MALT lymphoma must be considered in the differential diagnosis in patients presenting radiographically with meningioma.

A First Case of Solid Pseudopapillary Tumor of the Pancreas in an Old Man in South Korea / 대한내과학회지

Solid pseudopapillary tumor (SPT) of the pancreas is a rare tumor that typically affects young women without causing significant clinical symptoms. No case of SPT in an old man has been reported in South Korea, and such cases are very rare worldwide. We report a 70-year-old man with SPT of the pancreas with multiple organ metastasis. Although surgical resection is the treatment of choice for SPT, we decided not to treat, considering his age and the disease severity.

Therapeutic efficacy of metronidazole for patients with Clostridium difficile-associated diarrhea / 대한내과학회지

BACKGROUDN: The rate of treatment failure with metronidazole for C. difficile-associated diarrhea (CDAD) has been recently increasing in Western countries. A retrospective study was performed to evaluate the clinical outcome of metronidazole treatment and determine the risk factors for treatment failure for patients with CDAD in Korea. METHODS: From January 2000 to May 2005, patients who had shown a positive result for C. difficile toxin A assay in feces were considered for the study. Patients who had diarrhea and one or more symptoms of fever, abdominal pain or leukocytosis after 48 hours of hospitalization were included. The medical records of the patients and laboratory data were reviewed. RESULTS: A total of 476 patients (mean age, 56.7 years old) were enrolled in the study. Of these, 382 patients (80.3%) were treated with metronidazole as an initial regimen for CDAD; 316 patients (82.7%) received successful treatment within 14 days, 29 patients (6.3%) had persistent symptoms and signs of colitis and 37 patients (9.7%) had a recurrence of symptoms and signs within 4 weeks after completion of treatment. There were no significant differences in the rates of treatment success for each 5-year period (p>0.05). Among 66 patients who failed to respond to an initial course of metronidazole, 48 patients underwent prolonged or additional courses of metronidazole treatment. Of these, 34 patients (70.8%) were successfully treated. By multivariate analysis, severe diarrhea (p=0.02), prior use of fluroquinolones (p=0.02) and enteral tube feeding (p=0.02) were the risk factors for treatment failure of CDAD with metronidazole. CONCLUSIONS: Contrary to a recent survey in Western countries, metronidazole is still useful as a primary regimen for the treatment of patients with CDAD in our institution. In CDAD patients with tube feeding, severe diarrhea or the prior use of quinolones, precautions for treatment failure should be taken.

A case of hepatocellular carcinoma with ovarian metastasis / 대한내과학회지

Primary hepatocellular carcinoma with metastasis to the ovary is a rare malady. To the best of our knowledge, approximately eight cases in the English literature and two cases in the Korean literature have been reported. We report here a case of hepatocellular carcinoma with metastasis to the ovary in a 40-year-old woman who presented with a month long history of lower abdominal discomfort and a palpable mass. She had been diagnosed with hepatocellular carcinoma (HCC) four years prior and subsequently underwent a several courses of transarterial chemoembolization and radio-frequency ablation. The patient had then been seen regularly and was generally well until 4 month ago, when the alpha fetoprotein (AFP) level began to rise to 425 ng/mL. After that time she had been seen and examined every month, however, the AFP level rose to 2,150 ng/mL without evidence of recurrence on the computed tomography (CT) scan of liver, the heapatic artery angiography, PET and so on. On admission, a pelvis MRI revealed mainly solid masses of both ovaries and multiple peritoneal and omental nodules. Transvaginal core biopsy was performed and the histologic examination of the specimen revealed metastatic hepatocellular carcinoma. We report here on one case of ovarian metastasis from hepatocellular carcinoma together with a brief review of the literature.

A case of the primary malignant melanoma arising from uterine endometrium / 대한내과학회지

Malignant melanoma arising in the uterine endometrium is extremely rare. Only 12 cases of malignant melanoma of the uterine endometrium have been previously reported to date. All of them were metastatic cases. The most common presenting symptom was abnormal uterine bleeding. We report a case of primary malignant melanoma arising from the uterine endometrium. A 63-year-old multigravid woman presented with uterine bleeding. The pathologic review of an endometrial curettage specimen suggested an undifferentiated malignant tumor. A total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection were performed. Final pathologic examination revealed malignant melanoma. Immunohistochemical studies demonstrated reactivity of tumor cells for HMB-45 and S-100 protein. She had no previous history of malignancy. Whole body PET scan was performed in an effort to find the primary site of malignant melanoma and showed no demonstrable abnormal FDG uptake suggesting malignancy elsewhere. This case is the first report of primary malignant melanoma involving uterine endometrium in Korea.

Regional Citrate Anticoagulation in Continuous Venovenous Hemodiafiltration: Report of Two Cases / 대한신장학회잡지

Continuous renal replacement therapy (CRRT) has been used increasingly for the management of renal failure in hemodynamically unstable and critically ill patients. CRRT requires anticoagulation, usually with heparin, to prevent clotting in the extracorporeal circuit. Systemic heparinization is associated with a high rate of bleeding when used during CRRT in critically ill patients. We applied regional citrate anticoagulation for CRRT to two critically ill patients with high bleeding risk using calcium containing commercial solutions. We conclude that regional citrate anticoagulation with commercial calcium containing solution can be used alternative to heparin for CRRT in patients with high bleeding risk.