Papillary Histiocytic and Mesothelial Hyperplasia of the Ovary Related to a Huge Uterus: A Case Report

Nodular histiocytic/mesothelial hyperplasia (NHMH) is a very rare condition. It is generally thought to be associated with repeated mechanical or chemical stimulation. This study reported NHMH with papillary growth pattern in the ovary following high-intensity focused ultrasound (HIFU) treatment for uterine leiomyoma and adenomyosis. A 48-year-old female, who had a history of undergoing HIFU treatment 7 times for adenomyosis and leiomyoma of the uterus 6 months ago, was referred to the hospital. After the hysterectomy and right salpingo-oophorectomy, the patient was confirmedly diagnosed with nodular histiocytic and mesothelial hyperplasia with the papillary growth pattern of the right ovary. This benign reactive inflammatory lesion of the mesothelium mimicking malignancy must be kept in mind to avoid unnecessary treatment.

Pelvic Actinomycosis Mimicking Malignancy of the Uterus: a Case Report

Pelvic actinomycosis is an uncommon infectious disease. It induces a chronic, suppurative illness characterized by an infiltrative and granulomatous response and, thus, the clinical and radiologic findings may mimic other inflammatory and neoplastic conditions. A 56-year-old female with a long-standing intrauterine device was diagnosed with pelvic actinomycosis manifesting as a large uterine mass with locally infiltrative spread into surrounding tissue that mimicked uterine malignancy. Actinomyces israelii infection was confirmed with a surgical specimen, and the patient was treated with antibiotic medication. Pelvic actinomycosis must be included in the differential diagnoses of patients with an infiltrative pelvic mass extending across tissue planes or in patients with findings of multiple microabscesses, particularly in a patient with an intrauterine device, even the lesion primarily involves the uterus.

Concurrent Medullary Thyroid Carcinoma and Primary Thyroid Lymphoma (Diffuse Large B Cell Lymphoma): the First Case Report

Cases of simultaneously occurring medullary thyroid carcinoma (MTC) and lymphoma are extremely rare. An 84-year-old woman visited the hospital due to dyspnea, resulting from rapidly aggravated enlarged neck mass. Ultrasonography revealed two lesions in the thyroid and they were diagnosed as concurrent medullary thyroid carcinoma and diffuse large B cell lymphoma after total thyroidectomy. A few cases simultaneously diagnosed with MTC and systemic lymphoma have been reported. However, the coexistence of MTC and primary thyroid lymphoma is extremely rare.

Evaluation of the VE1 Antibody in Thyroid Cytology Using Ex Vivo Papillary Thyroid Carcinoma Specimens

BACKGROUND: Recently, VE1, a monoclonal antibody against the BRAFV600E mutant protein, has been investigated in terms of its detection of the BRAFV600E mutation. Although VE1 immunostaining and molecular methods used to assess papillary thyroid carcinoma in surgical specimens are in good agreement, evaluation of VE1 in thyroid cytology samples is rarely performed, and its diagnostic value in cytology has not been well established. In present study, we explored VE1 immunoexpression in cytology samples from ex vivo papillary thyroid carcinoma specimens in order to minimize limitations of low cellularity and sampling/targeting errors originated from thyroid fineneedle aspiration and compared our results with those obtained using the corresponding papillary thyroid carcinoma tissues. METHODS: The VE1 antibody was evaluated in 21 cases of thyroid cytology obtained directly from ex vivo thyroid specimens. VE1 immunostaining was performed using liquid-based cytology, and the results were compared with those obtained using the corresponding tissues. RESULTS: Of 21 cases, 19 classic papillary thyroid carcinomas had BRAFV600E mutations, whereas two follicular variants expressed wild-type BRAF. VE1 immunoexpression varied according to specimen type. In detection of the BRAFV600E mutation, VE1 immunostaining of the surgical specimen exhibited 100% sensitivity and 100% specificity, whereas VE1 immunostaining of the cytology specimen exhibited only 94.7% sensitivity and 0% specificity. CONCLUSIONS: Our data suggest that VE1 immunostaining of a cytology specimen is less specific than that of a surgical specimen for detection of the BRAFV600E mutation, and that VE1 immunostaining of a cytology specimen should be further evaluated and optimized for clinical use.

Esophageal Cancer in Esophageal Diverticula Associated with Achalasia

The simultaneous occurrence of achalasia and esophageal diverticula is rare. Here, we report the case of a 68-year-old man with multiple esophageal diverticula associated with achalasia who was later diagnosed with early esophageal cancer. He initially presented with dysphagia and dyspepsia, and injection of botulinum toxin to the lower esophageal sphincter relieved his symptoms. Five years later, however, the patient presented with worsening of symptoms, and esophagogastroduodenoscopy (EGD) was performed. The endoscopic findings showed multifocal lugol-voiding lesions identified as moderate dysplasia. We decided to use photodynamic therapy to treat the multifocal dysplastic lesions. At follow-up EGD 2 months after photodynamic therapy, more lugol-voiding lesions representing a squamous cell carcinoma in situ were found. The patient ultimately underwent surgery for the treatment of recurrent esophageal multifocal neoplasia. After a follow-up period of 3 years, the patient showed a good outcome without symptoms. To manage premalignant lesions such as achalasia with esophageal diverticula, clinicians should be cautious, but have an aggressive approach regarding endoscopic surveillance.

Perianal Paget's Disease

The incidence of extramammary Paget's disease (EMPD) is very low. An 84-year-old Korean man was treated with topical and oral medications at a local dermatologic clinic for a year, but the symptoms did not improve. He visited Severance Hospital and underwent a perianal skin biopsy and was finally diagnosed with EMPD. The authors performed a wide local excision according to a 1-cm margin around the lesion. For the skin and the soft tissue defects, bilateral inferior gluteal artery perforator flap transpositions were performed. The size of the lesion was 14 cm2 x 9 cm2, and the lateral and the basal margins were all disease free.

Primary omental yolk sac tumor

Extra-ovarian yolk sac tumor arising in the omentum is extremely rare. As yolk sac tumor originated from the omentum has been rarely reported, its clinical information is very limited. The authors encountered a case of yolk sac tumor originated from the omentum, and reported the case herein. A 32-year-old woman was presented with developed low abdominal distension for a month. Magnetic resonance imaging findings were suggestive of ovarian malignancy with ascites and peritoneal seeding nodules. Explorative laparotomy was performed and then the findings from frozen biopsy of omentum were suggestive of poorly differentiated tumor though whether it was primary or metastatic was uncertain. Thus, staging laparotomy were performed. Histopathology confirmed that the tumor was a yolk sac tumor of omentum origin. Then, 6 cycles of postoperative adjuvant chemotherapy at intervals of 3 weeks were performed using bleomycin, etoposide, and cisplatin regimen. Four-year outpatient follow-up thereafter showed no relapse.

Renal Histologic Parameters Influencing Postoperative Renal Function in Renal Cell Carcinoma Patients

BACKGROUND: Pre-existing non-neoplastic renal diseases or lesions may influence patient renal function after tumor removal. However, its description is often neglected or omitted in pathologic reports. To determine the incidence and clinical significance of non-neoplastic lesions, we retrospectively examined renal tissues obtained during 85 radical nephrectomies for renal cell carcinoma. METHODS: One paraffin-embedded tissue block from each case containing a sufficient amount of non-tumorous renal parenchyma was cut and processed with hematoxylin and eosin and periodic acid-Schiff methods. Non-neoplastic lesions of each histological compartment were semi-quantitatively and quantitatively evaluated. RESULTS: Among the various histologic lesions found, tubular atrophy, arterial intimal thickening, and glomerulosclerosis were the most common (94.1%, 91.8%, and 88.2%, respectively). Glomerulosclerosis correlated with estimated glomerular filtration rate at the time of surgery, as well as at 1- and 5-years post-surgery (p=.0071), but tubulointerstitial fibrosis or arterial fibrous intimal thickening did not. Post-hoc analysis revealed that glomerulosclerosis of more than 20% predicted post-operative renal function. However, its significance disappeared when gender and age were considered. CONCLUSIONS: In conclusion, non-neoplastic lesions, especially with regard to glomerulosclerosis percentage, should be described in pathology reports to provide additional information on renal function decline.

Clinical Remission of Renal Amyloidosis after Autologous Peripheral Blood Stem Cell Transplantation / 이화의대지

Primary amyloidosis has unfavorable prognosis, particularly with organ involvement. Here, we report a case of clinical remission of renal amyloidosis after autologous hematopoietic cell transplantation. A 51-year-old female patient visited our hospital due to generalized edema. Initial evaluation showed hyperlipidemia, hypoalbuminemia, and heavy proteinuria, which were consistent with nephrotic syndrome. However, IgM lamda type monoclonal gammopathy was detected in serum and urine electrophoresis studies. Renal biopsy showed Congo red-positive amyloid deposition in mesangial area, glomerular capillary walls, and arterioles and amyloid fibers were confirmed by electron microscopy. Immunohistochemial study of the biopsy tissue demonstrated systemic light-chain amyloidosis (AL amyloidosis). Multiple myeloma was not evident on bone marrow examination. She received autologous hematopoietic cell transplantation after high dose melphalan treatment. Complete remissions were achieved after the treatment, respectively. Our findings suggest the potential role of autologous peripheral blood stem cell transplantation in treatment of AL amyloidosis.

Clinical Remission of Renal Amyloidosis after Autologous Peripheral Blood Stem Cell Transplantation / 이화의대지

Primary amyloidosis has unfavorable prognosis, particularly with organ involvement. Here, we report a case of clinical remission of renal amyloidosis after autologous hematopoietic cell transplantation. A 51-year-old female patient visited our hospital due to generalized edema. Initial evaluation showed hyperlipidemia, hypoalbuminemia, and heavy proteinuria, which were consistent with nephrotic syndrome. However, IgM lamda type monoclonal gammopathy was detected in serum and urine electrophoresis studies. Renal biopsy showed Congo red-positive amyloid deposition in mesangial area, glomerular capillary walls, and arterioles and amyloid fibers were confirmed by electron microscopy. Immunohistochemial study of the biopsy tissue demonstrated systemic light-chain amyloidosis (AL amyloidosis). Multiple myeloma was not evident on bone marrow examination. She received autologous hematopoietic cell transplantation after high dose melphalan treatment. Complete remissions were achieved after the treatment, respectively. Our findings suggest the potential role of autologous peripheral blood stem cell transplantation in treatment of AL amyloidosis.

Gastritis Cystica Polyposa Treated with Endoscopic Submucosal Dissection / 대한소화기학회지

No abstract available.

Urinary Decoy Cell Grading and Its Clinical Implications

BACKGROUND: Examination of urine for decoy cells (DCs) is a useful screening test for polyomavirus (PV) activation. We explored the significance of the amount of DCs in persistent shedding, PV nephropathy and acute rejection. METHODS: A case-controlled study was performed in 88 renal allograft patients who had DCs detected at least once in four or more urine samples. RESULTS: Fifty one patients were classified into the high-grade shedding group (HG) and 37 patients into the low-grade shedding group (LG) according to DC shedding (> or =10 or or =10 DCs/10 HPF is associated with sustained shedding, polymerase chain reaction positivity and PV nephropathy, but not a predictor of acute rejection.

Urinary Decoy Cell Grading and Its Clinical Implications

BACKGROUND: Examination of urine for decoy cells (DCs) is a useful screening test for polyomavirus (PV) activation. We explored the significance of the amount of DCs in persistent shedding, PV nephropathy and acute rejection. METHODS: A case-controlled study was performed in 88 renal allograft patients who had DCs detected at least once in four or more urine samples. RESULTS: Fifty one patients were classified into the high-grade shedding group (HG) and 37 patients into the low-grade shedding group (LG) according to DC shedding (> or =10 or or =10 DCs/10 HPF is associated with sustained shedding, polymerase chain reaction positivity and PV nephropathy, but not a predictor of acute rejection.

Facial dysmorphisms associated with holoprosencephaly / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to determine and classify holoprosencephlay with the associated facial abnormalities. METHODS: This was a retrospective study in which were reviewed the sonographic findings in correlation with the clinical and pathologic data of fetuses or neonates identified with holoprosencephaly at the Department of Obstetrics and Gynecology of the Catholic University in the period 1995-2007. RESULTS: Twelve cases with a Holoprosencephaly were found. Mean gestational age at diagnosis and delivery was 28 weeks of pregnancy (range from 14 to 41 weeks). Modes of delivery were 8 cases of preterm spontaneous delivery, 2 cases of missed abortion, 1 case of normal fullterm spontaneous delivery, and 1 case of full term cesarean delivery. Associated facial anomalies were present in 9/12 cases (75%) which involved with cyclopia, proboscis, cleft lip and palate, ethomocephaly and otocephaly. Among those anomalies, abnormal karyotypes were 3/6 cases (50%). CONCLUSIONS: When a midline brain anomaly is detected by antenatal sonography, accurate sonographic analysis of midline facial defect may allow more definitive diagnosis of holoprosencephaly, and the outcome of affected fetuses often have other major structural abnormalities and nearly always fatal.

Study of Pulsed Dye Laser Followed by Intralesional Bleomycin Treatment Compared to Lone Intralesional Bleomycin Treatment for Recalcitrant Periungual Warts / 대한피부과학회지

BACKGROUND: Viral warts affect 7~10% of the population and are a major burden on time and resources for all dermatology departments. There are currently various treatment modalities available, including cryotherapy, laser therapy, immune therapy, and topical keratolytics. However, some warts have proven to be resistant to these multiple therapies. Bleomycin has shown to be effective on these warts, but its injection can be difficult because of risk of local complications. OBJECTIVE: We compared the cure rate, efficacy, tolerability, side effects, and practicality of pulsed dye laser immediately followed by intralesional bleomycin treatment compared to treatment by intralesional bleomycin alone. METHODS: This study is a randomized controlled trial. Twenty-four patients, all with recalcitrant viral periungual warts of at least 2 years duration, were recruited. Twelve patients were treated with pulsed dye laser followed by intralesional bleomycin injection, and the other 12 patients were treated with intralesional bleomycin injection alone. RESULTS: All warts were cleared in all patients. There was no significant difference in the mean treatment number and the mean number of nail changes between the two groups. However, there was a significant decrease in the VAS score and the size of hemorrhagic blistering, involving the surrounding normal skin, in the combined pulsed dye laser and intralesional bleomycin group. In addition, the combined therapy enabled physicians to inject bleomycin more easily and safely. CONCLUSION: The combined method of pulsed dye laser and intralesional bleomycin appears to be a safe, effective and well tolerated treatment for recalcitrant periungual warts.

A Case of Spiradenoma in A Linear Arrangement / 대한피부과학회지

As a rule, spiradenoma occurs as a solitary intradermal nodule measuring 1 to 2cm in diameter. Occasionally, there are several nodules, and rarely, there are numerous small nodules in a zosteriform pattern or large nodules, up to 5 cm, in a linear arrangement. A 51-year-old man presented with a 4-year history of multiple, small, tender nodules which showed a linear distribution along the right subclavian area. The diagnosis of spiradenoma was made by clinical and histopathological findings and all the subcutaneous nodules were completely excised by a surgical method. We, herein, report a rare case of multiple linear spiradenoma.

A Case of Pigmented Spindle Cell Nevus / 대한피부과학회지

Pigmented spindle cell nevus (PSCN) is often interpreted as a Spitz nevus or misdiagnosed as a malignant melanoma. Some authors consider PSCN as a pigmented variant of Spitz nevus, but many dermatologists classify it as a separate disease. We report a case of pigmented spindle cell nevus which occurred in a 4-year-old boy. The lesion was a well-demarcated, 3x3mm sized, black macule on the dorswn part of the 4th finger, left hand. The histopathologic findings of the excisional biopsy specimen revealed the proliferation of uniform, spindle shaped, pigmented melanocytes at the dermoepidermal junction and sharply defined lateral margins. The pathologic features were consistent with PSCN.

A Case of Ecthyma Gangrenosum Associated with Liver Abscess and Renal Abscess / 대한피부과학회지

Ecthyma gangrenosum is usually seen in the immunocompromised patients or in the patients with underlying malignancy. Ecthyma gangrenosum is a rapidly progressing skin infection characterized by edema, hemorrhage, bullae and necrosis. We experienced the case of a 13-month-old male who had ecthyma gangrenosum associated with liver absess and renal abscess. The patient initially presented with skin lesions of multiple well defined central necrotic black colored large erythematous bullae. The multiple liver abscess with hepatomegaly and multifocal pyelonephritis with focal renal abscess revealed by abdominal ultrasonogram and computed tomogram. In the bacterial cultures of skin, urine and liver aspiration fluid, Pseudomonas aeruginosa was grown. The patient had no immune deficiency disease. We report this case with a review of related literatures.

A Study on Histopathology and NBT dye Reduction Test in Patients with Pustular Eruptions of Palms And soles / 대한피부과학회지

First rnany years there has been a great dea,l of disagreement about the classification and histology of recalcitrant pustular eruptions of the palms and soles and the rela.tion of this condition to psoriasis. It ia the purpose of this investigation to describe histological changes in fresh pustules from patients witb pustular eruptions of the palms and soles and compare these changes between patients with clinically preceding or co-existing psoriasis (4cases) and without clinically preceding or co-existing psoriasis (7cases). Nine biopsies of pustules were exarnined and the results were compared between two groups. Histopathological findings were otherwise uniform and typical intradermal well-delineated pustules. No significant differences were found bet.ween th two groups. In view of the uniforrn histology, the unknown etiology, and uncertain clinicaI classification, the authors prefer the clearly descreptive term pustulosis palrnaris et plantaris(PPP). Recent;ly the phagocytic ability of neutrophilic leukocytes was reported to be impaired in patients suffering from pustular eruptions of the palms and soles. In our study this ability was performed with the aid of the NBT. dye reduction test before and after administration of Descresept (aristolochic acid). The aim of the present study was to observe the effect of Descresept on NBT test in relation to the clinical acitivity of PPP. The results were as follows: l. In 6 of 11 patients, clinical improvement was accompanied with increasing NBT' scores. 2. In 2 of 11 patients, clinical aggravation was noted in spite of Descresept adrninistration. In these 2 cases, increase in dosage of Descresept made clinical improvement again with increasing NBT scores. 3. In 3 of the 11 patients, there was noted clinical improvement, but NBT scores were slightly decreased.

Therapeutic Trial of Dinitrochlorobenzene ( DNCB ) Sensitization in Patients with Warts / 대한피부과학회지

Warts are benign turnors caused by oncogenic human papovavirus which has been clearly identified on electronmicroscopy, although repeated atternpts at culture have not been successful. Various therapeutic modalities have been tried for the treatment of warts, however thete is no saisfactory method and the clinical course as well as the prognosis is always variable. Recently several authors have reported successful therapeutic results in the treatment of warts by DNCB sensitization method based on the findings that warts are often regressing spontaneously and that the spontaneous regression seems to depend on host's ability to mount an immune response against the wert virus. The present study was undertaken to evaluate the DNCB sensitization method for possible routine use in the treatment of warts. Fifteen cases including five verruca vulgaris and ten verruca plana juvenilis patients were sensitized with 1000ug of DNCB in acetone solution on either side of their inner forearms. Seven or ten days after sensitization, several warts, which were unintentionally selected, were challenged with 0.05 to 0.1ml of weaker DNCB solution(50ug-25ug/0.1ml)at weekly interval. Four patients with verruca vulgaris and three patients with verruca plana juvenilis did not return after 1 to 4 times of challenge, however six out of these 7 patients showed a slight decrease in size and number of the warts. One patient with verruca plana juvenilis developed marked irritative and delayed cutaneous hypersensitivity reaction to the 3 times of challenge, so that this patient was excluded from further study. The remaining 7 patients consisted of I verruca vulgaris and 6 verruca plana juvenilis patients showed complete disappearance of all warts including those which were never challenged, after 1 to 13 times of DNCB challenge application. The authors reviewed the possible therapeutic mechanism of DNCB sensitization in the wart patients, the possible advantage and disadvantage of this method and concluded that this method can be cautiously used in seleted patients with warts whose response to the conventional treatment methods are poor.