A Case of Bilateral Macronodular Adrenal Hyperplasia with Cushing's Syndrome Treated by Unilateral Adrenalectomy / 대한내분비학회지

In order to differentiate the causes of Cushing's syndrome; whether it is pituitary or adrenal-dependent, a high dose dexamethasone suppression test is usually performed but this does not always correlated with the imaging diagnosis. We report a case of bilateral macronodular adrenal hyperplasia, which was thought to be independent to adrenocorticotrophin (ACTH) stimulation. At first we thought it was pituitary-dependent Cushing's syndrome, due to its suppression by high dose dexamethasone. However, we found no abnormal findings on the brain sella magnetic resonance image (MRI). A significant finding, however, we found bilateral adrenal masses on the abdominal computed tomography (CT). We performed percutaneous selective adrenal venous sampling (PSAVS), and confirmed hypercortisolism of the left adrenal mass only. Therefore, we decided to remove the left adrenal gland to preserve the residual function of the right adrenal gland. After the left adrenalectomy, the patient became normotensive, and their buffalo hump disappeared, and her 24 hour urinary free cortisol level returned to normal.

A Case of Peutz-Jeghers Syndrome with Intussusception / 대한소화기내시경학회지

Peutz-Jeghers syndrome is a rare autosomal dominant disorder defined by hamartomatous polyps of gastrointestinal tracts and the occurrence of melanin spots on the mucocutaneous surface. This syndrome has important complications such as malignant transformation, gastrointestinal bleeding, and intussusception. About 50% of patients with Peutz-Jeghers syndrome involved Intussusception. A case of Peutz-Jeghers syndrome with intussusception was recently experienced and herein reported.

Expression of Vascular Endothelial Growth Factor in Hepatocellular Carcinomas

BACKGROUND: A tumor must continuously stimulate the growth of new capillary blood vessels for the tumor itself to grow and metastasize. Vascular endothelial growth factor (VEGF) promotes vascular permeability and endothelial cell growth. A hepatocellular carcinoma (HCC) is a typical hypervascular tumor. METHODS: We evaluated the expression of VEGF in 36 cases of HCC by using immunohistochemical staining in order to define its prognostic value. RESULTS: The expression rate of VEGF was 44.4% (16/36) in tumor cells and 0% (0/36) in non- tumorous liver parenchyme. VEGF expression did not correlate with any clinicopathological characteristics. And patients with expression of VEGF in tumor cells had no survival difference in comparison to those without VEGF expression. CONCLUSIONS: These results suggest that the expression of VEGF in HCC cells by itself may not be a significant factor in the prognosis of HCC.

Two Cases with Squamous Cell Carcinoma of the Thyroid Gland / 대한내분비학회지

Primary squamous cell carcinoma of the thyroid is rare, presenting much less than one percent of all primary thyroid malignancies. Most cases have been reported in elderly patients with a history of goiter. It is necessary to differentiate between primary squamous cell carcinoma and secondary involvement from other sites. Secondary involvement of the thyroid may be more amenable to palliation or cure. The treatment of choice in primary squamous cell carcinoma is radical surgery in resectable cases, but the squamous cell carcinoma behaves aggressively and carries a uniformly poor prognosis regardless of the treatment. We had an experience of a primary squamous cell carcinoma of the thyroid in two elderly patients. These patients presented a typical feature of a primary squamous cell carcinoma of the thyroid, which has been rarely reported in Korea.

Biodistribution of Intrasplenically Transplanted Hepatocytes in the Rat

Liver failure still constitutes a major cause of morbidity and death in patients with liver disease. Various potential treatments have been discussed to reduce liver failure-induced deaths. Recently, interest in hepatocyte transplantation(HT) has markedly increased, and HT has been tried for the treatment of liver failure. Both experimental and clinical data indicate that HT may be beneficial both for the support of an acutely devastated liver and for the correction of genetic disorders resulting in states of metabolic deficiency. For this purpose, the location of the HT has been suggested as a critical point. Therefore, we tried to study the biodistribution of hepatocytes in acute and chronic liver failure model in rats at 2 hours and 24 hours after the injection of 125I-labeled hepatocytes into the spleen. A ninety percent partial hepatectomy model and a dimethylnitrosamine-induced liver-cirrhosis model were used as the acute and chronic liver-failure models respectively. An SV-40 T-transfected immotilized cell line named L2A2 was transplanted intrasplenically. The biodistribution of the transplanted hepatocytes was similar in both the acute and the chronic liver-failure groups. In both groups, the biodistribution studies at 2 hours and 24 hours after intrasplenic transplantation demonstrated that the hepatocytes were localized predominantly in the spleen. However, intrasplenic retention of the transplanted hepatocytes progressively decreased with time. We conclude that methods for preventing the progressive loss of intrasplenic transplanted hepatocytes should be investigated.

Relationship of Serum Anti-p53 Antibody with p53 Expression in Liver Tissue of Chronic Diseases / 대한간학회지

BACKGROUND/AIMS: The p53 mutations have been described as the most common genetic alteration during development and progression of malignancy in a wide range of human cancers. Mutant p53 proteins have a prolonged half-life accounting for increased levels of p53 protein frequently detected in tumors. This can induce the production of anti-p53 in the senzn of patients with HCC. We determined the relationship of serum anti-p53 with p53 expression in the liver tissue of chronic liver disease and the correlation of serum anti-p53 with serum alpha- fetoprotein(AFP) in patients with HCC. METHODS: In sera of same patients, we analysed the anti- p53 using ELISA system As controls we tested 50 healthy individuals and 20 patients with chronic hepatitis. Immaiohistochemical study for the presence of mutant p53 was performed on liver tissue from 50 patients with cirrhosis and 30 patients with HCC using monoclonal antibody clone DO-7 and LSAB kit by ABC method. RESULTS: Anti-p53 was positive in 9(30%) of 30 patients with HCC. Among nine patients with positive anti-p53, only two patients had detectable p53 expression in their tumor tissues. Anti-p53 was positive in 5(10%) of 50 patients with liver cirrhosis. The AFP was elevated in 21(70%) of 30 patients with HCC. Among the 9 AFP- negative HCC patients, 4(44.4%) were found to be positive for anti-p53. P53 expression was detectable in 9(30%) of 30 HCCs and 1(3.3%) of RO surrounding non-tumorous cirrhotic tissues. CONCLUSION: Mese findings suggest that anti-p53 was not correlated with the status of p53 expression in liver tissue and serological testing for anti-p53 antibody may be complementary to serum AFP for diagnosing of HCC with normal serum AFP.

A Case of Surgically Treated Insulinoma in Pregnancy / 대한내분비학회지

Insuliin secreting tumor is 70% prevalent disease in female and predoadnant in forth and sixth deeade. The incidence of insulinoma is one case per 250,000 patient-years. Insulinoma in pregnancy was extremely rare, and the prevalence was not reported. The diagnosis of an insulinoma is depend on demonstration of hypoglycemia with high insulin and C-peptide levels. Immunoreactive insulin/plasma glucose ratio0.3 in particular support the diagnosis of an insulinoma. Fetal complication would be developed because of hypoglycemia. In approximately half of the cases reported, surgical exploration was done during pregrancy, the remainder were treated after delivery. Insulinoma poses serious diagnostic and therapeutic problems when she is pregnant. We experienced a case of insulinoma in pregnancy that represented Whipples triad and was treated by surgical intervention.