Herpes Simplex Mastitis in an Adolescent Woman: Clinical and Ultrasound Features

Herpetic mastitis is extremely rare, and its imaging findings remain unclear. We report a case of herpes simplex mastitis in an adolescent woman and describe the clinical and ultrasound features. The patient showed unilateral nipple and areolar skin thickening and axillary lymphadenopathy on B-mode ultrasonography. Doppler ultrasonography revealed multiple linear and branching blood flows in the areolar area. The lesion was verified as herpes simplex mastitis via a skin biopsy. This report shows that the radiologic features of herpes simplex mastitis may be similar to those of Paget’s disease because of localized nipple and areolar skin thickening and increased vascularity.

A Case of Idiopathic Massive Rice Bodies in the Knee Joint without Rheumatoid Arthritis or Tuberculosis and a Literature Review

Rice bodies are materials with an amorphous nucleus and a fibrin layer found floating in the synovial space and bursa. These bodies have often been detected in patients with rheumatoid arthritis, tuberculous arthritis, and bursitis. Although the etiology and pathogenesis of rice bodies are not yet fully understood, it has been hypothesized that they might be caused by chronic inflammation originating from the synovium. However, we report on a case of idiopathic massive rice bodies in the knee joint without evidence of inflammatory articular disease or infection including rheumatoid arthritis, seronegative spondyloarthritides, tuberculosis, or bacterial or fungal infection.

Goblet Cell Carcinoid of the Rectum in a Patient with Neurofibromatosis Type 1

No abstract available.

Human Cutaneous Protothecosis: Report of a Case and Literature Review

The Prototheca species is achlorophyllic algae and rarely causes human infection. Human protothecosis presents clinically as a cutaneous infection, olecranon bursitis, and disseminated systemic disease. We report a case of human cutaneous protothecosis involving the left wrist. A 68-year-old man presented with an ill-defined erythematous lesion with crust at the dorsal aspect of his left wrist. A punch biopsy was performed to reveal the histologic features of granulomatous inflammation with necrosis at the upper dermis, containing Prototheca organisms, of which, the characteristic features were highlighted by special staining. Through a molecular study, the Prototheca zopfii species was identified.

A Case of IgG4 Associated Sclerosing Cholangitis without Clinical Manifestations of Autoimmune Pancreatitis / 대한소화기학회지

IgG4-related systemic diseases are characterized by a diffuse or mass forming inflammatory reaction rich in lymphocytes and IgG4-positive plasma cells (lymphoplasmacytic infiltration), fibrosclerosis of variable organs and obliterative phlebitis. They usually involve various organs including the pancreas, bile duct, gallbladder, salivary gland, retroperitoneum, kidney, lung, and prostate. However, most of them are accompanied by autoimmune pancreatitis, and good response to steroid treatment is one of the hallmarks of this disease. We report a case of an 67-year-old man with IgG4 associated sclerosing cholangitis, who was diagnosed by endoscopic retrograde cholangiopancreatography and successfully treated with steroid therapy.

A Case of Malignant Intraductal Papillary Mucinous Neoplasm of the Pancreas with Duodenal Adenocarcinoma / 대한소화기내시경학회지

Intraductal papillary mucinous neoplasm of the pancreas (IPMN) is a precancerous lesion with a well-described adenocarcinoma sequence. The rate of progression of IPMN appears to be very slow; however, patients with IPMN may be at increased risk for extrapancreatic malignancies. A 55-year-old female was diagnosed with IPMN of the pancreas and a duodenal polyp in 2004. After an approximate 3 year loss to follow-up, she was readmitted for managing abdominal pain and underwent Whipple's operation. Herein, we report a case of a patient with malignant IPMN accompanied by duodenal adenocarcinoma arising from a duodenal polyp.

Telomerase Activity in Urethane-Induced Mouse Lung Tumorigenesis

BACKGROUND: Telomerase activity in precancerous conditions of lung adenocarcinomas has not been well studied. This study is designed to investigate the role of telomerase in premalignant lesions of urethane-induced mouse lung adenocarcinoma. METHODS: We harvested A/J mouse lung tissues at 3, 6, 9, 12, 28, 41, and 48 weeks after intraperitoneal urethane treatment, and classified each lesion in terms of histologic findings. We examined telomerase activity using a modified version of the telomeric repeat amplification protocol assay using both gel-based and enzyme linked immunosorbent assay methods. An immunohistochemical analysis of proliferating cell nuclear antigen (PCNA) was performed. RESULTS: In urethane-induced mouse lung tissues, it was sequentially developed from hyperplasia, adenoma, and eventually to adenocarcinoma. Telomerase activity began to show a positive level in tissues with no histologically visible nodule after urethane administration. It revealed a statistically significant increase in hyperplasia compared to the "control" lung tissue (p<0.05), which was proportionally elevated relative to adenoma and adenocarcinoma. There was a direct correlation between telomerase activity and the PCNA labeling index (p<0.05). CONCLUSIONS: The elevation of telomerase activity in normal-appearing lung lesions is thought to be a possible marker of early detection of pulmonary adenocarcinoma.

Behavioral Changes as the Earliest Clinical Manifestation of Progressive Supranuclear Palsy

BACKGROUND: The clinical and pathological heterogeneity of progressive supranuclear palsy (PSP) is well established. Even with a well-defined clinical phenotype and a thorough laboratory workup, PSP can be misdiagnosed, especially in its early stages. CASE REPORT: A 52-year-old woman, who we initially diagnosed with a behavioral variant of frontotemporal dementia developed parkinsonian features, which then progressed to gait instability and gaze abnormality. CONCLUSIONS: We report herein a pathologically confirmed case of PSP presenting with behavioral changes including agitation and irritability, which eventually led to the cardinal symptoms of progressive supranuclear palsy.

Embolia Cutis Medicamentosa Following Intramuscular Injection of Diclofenac / 대한피부과학회지

Nicolau syndrome or embolia cutis medicamentosa is a rare complication of a still largely unidentified pathogenesis at the site of intramuscular injections of various drugs. It is characterized by development of an acute, severe pain around the injection site followed by a localized erythema, a reticular rash, a hemorrhagic patch and varying degrees of tissue damage. The disease outcomes vary from atrophic ulcers and pigmentation to lower limb paralysis and limb amputation. We describe a 34-year-old woman with the diagnosis of this syndrome after she received an intramuscular diclofenac-beta-dimethyl-aminoethanol injection to the lateral aspect of the right upper buttock. The patient was treated by surgical debridement with concomitant primary closure.

A Case of Ectopic Sebaceous Glands in the Esophagus / 대한소화기내시경학회지

A 42-year-old man without any signs or symptoms of illness underwent esophagogastroduodenoscopy (EGD) for a routine health check up. On esophagogastroduodenoscopy, multiple small and yellowish mucosal plaques were detected in the mid to distal esophagus. These plagues proved to be ectopic sebaceous glands of the esophagus according to the histologic examination. On the immunohistochemical staining with anti-Keratin 14, the basal cells and the heterotopic sebaceous glands were immunoreactive for keratin 14. The histogenesis of this extremely rare lesion is not completely clear. There have been some reports on ectopic esophagus sebaceous glands combined with esophageal cancer or gastric cancer. However, malignant transformation of the ectopic sebaceous gland itself has not yet been reported on. This case was regularly followed up for 12 months, and no interval change or malignant transformation was found both endoscopically and histologically.

A Case of Basaloid Follicular Hamartoma

Basaloid follicular hamartoma (BFH), uncommon rare benign neoplasm connected to the adnexal structures, presents with multiple clinical manifestations that can develop into basal cell carcinoma. BFH may be congenital or acquired, and the congenital form can be further divided into the generalized and unilateral type, and the acquired form may present as localized and solitary lesions. Congenital, generalized BFH is associated with systemic diseases such as alopecia, cystic fibrosis, hypohidrosis, and myasthenia gravis. In contrast, sporadic cases are observed as unilateral or localized lesions. BFH shows thick cords and thin strands of anastomosing basaloid proliferations that arise from hair follicles and are enclosed by loose fibrous stroma. Here, we report a 70-year-old man with an acquired, solitary form of BFH.

An intrathoracic malignant peripheral nerve sheath tumor in a neurofibromatosis type 1 patient / 대한내과학회지

A malignant peripheral nerve sheath tumor (MPNST) is a rare soft tissue tumor defined as any malignant tumor arising from or differentiating toward the cells of the peripheral nerve sheath. It is one of the malignant tumors associated with neurofibromatosis type 1 (von Recklinghausen's disease). They occur most commonly on the lower and upper extremities, trunk, head, and neck, while intrathoracic tumors are very rare. We report an intrathoracic MPNST in a 66-year-old female with neurofibromatosis type 1.

Peripheral Facial Palsy Associated With Ewing's Sarcoma

No abstract available.

A Case of Giant Epidermal Inclusion Cyst

PURPOSE: The epidermal cyst is a very common skin lesion which usually occurs in the hairy regions. They are generally small but rarely reach more than 5 cm in diameter. We present a patient with a giant epidermal cyst on buttock area. METHODS: A 50-year-old man with a slowly enlarging, huge mass in his left buttock was examined. There was no history of trauma in this area. Physical examination revealed a soft, nontender, 15x15cm-sized mass in his left buttock. T1-weighted magnetic resonance images demonstrated a well-circumscribed, multilocular cystic lesion with homogeneous, slightly high signal intensity. On T2-weighted images the lesion had wide areas of high signal intensity. The mass was totally excised. RESULTS: A histopathological finding revealed that the cystic wall was lined with whole layers of stratified squamous epithelium. Keratin layers from the surface of the epithelium were seen to be sloughing into the cystic lumen. Multinucleted giant cells were found outside the cystic wall. CONCLUSION: Herein we report a rare case of giant epidermal cyst occurring on the buttock.

Acute Cytomegalovirus Proctocolitis Presenting with Massive Lower Gastrointestinal Bleeding / 대한소화기내시경학회지

Cytomegalovirus (CMV) colitis usually affects immunosuppressed patients. However, CMV colitis may also affect patients with a debilitation caused by a severe illness or affect patients that have a specific physiological status (old age, pregnancy). Clinically, patients with CMV colitis most commonly present with abdominal pain, diarrhea, and gastrointestinal bleeding. The diagnosis of CMV colitis usually requires a biopsy of mucosal tissue. The characteristic finding on biopsy reveals CMV inclusion bodies. CMV colitis can be successfully treated with ganciclovir. We report two cases of CMV proctocolitis in elderly patients with chronic diseases that presented with massive lower gastrointestinal bleeding due to multiple rectal ulcerations. A pathological examination showed CMV inclusion bodies. CMV colitis should be considered in the differential diagnosis of patients with massive rectal ulcer bleeding when other causes fail to explain the course of the disease.

Acute Cytomegalovirus Proctocolitis Presenting with Massive Lower Gastrointestinal Bleeding / 대한소화기내시경학회지

Cytomegalovirus (CMV) colitis usually affects immunosuppressed patients. However, CMV colitis may also affect patients with a debilitation caused by a severe illness or affect patients that have a specific physiological status (old age, pregnancy). Clinically, patients with CMV colitis most commonly present with abdominal pain, diarrhea, and gastrointestinal bleeding. The diagnosis of CMV colitis usually requires a biopsy of mucosal tissue. The characteristic finding on biopsy reveals CMV inclusion bodies. CMV colitis can be successfully treated with ganciclovir. We report two cases of CMV proctocolitis in elderly patients with chronic diseases that presented with massive lower gastrointestinal bleeding due to multiple rectal ulcerations. A pathological examination showed CMV inclusion bodies. CMV colitis should be considered in the differential diagnosis of patients with massive rectal ulcer bleeding when other causes fail to explain the course of the disease.

Well Differentiated Papillary Mesothelioma of the Ovarian Surface: A Case Report

Well differentiated papillary mesothelioma (WDPM) is an unusual variant of epithelial mesothelioma. Most WDPMs exhibit either benign or indolent behavior. Making the differential diagnosis between this rare tumor and serous papillary carcinoma can be problematic. We report here on a case of a 43-year-old woman with a WDPM of the surface. She presented to our hospital for a routine gynecologic evaluation, and she had no specific symptoms or a history of asbestos exposure. Gynecologic ultrasonography revealed a right ovarian mass that measured 6 x 3.8 x 3 cm in size. No ascites was detected. Right salpingo-oophorectomy was performed; grossly, the tumor was a yellowish firm, multinodular mass. Microscopically, the tumor consisted of numerous papillae that were lined by a single layer of uniform mesothelial cells. Nuclear pleomorphism and mitoses were not found. On immunohistochemical study, the tumor cells were positive for calretinin and cytokeratin, but they were negative for CEA. It is important to differentiate WDPM from serous papillary carcinoma or other malignant tumors to avoid treating them as malignant tumors.

Experimental Production and Implementation of the Pathology Laboratory Teaching Material Using Virtual Microscope / 한국의학교육

PURPOSE: Learning the concepts of pathology can be facilitated by repeated learning situations with illustrative pathology images. Virtual microscopes are digital facsimiles of glass slides that can be viewed on a computer screen. This study was designed to evaluate the possibility of using virtual microscopes as a teaching modality in the pathology laboratory. METHODS: The virtual microscope was produced from high resolution images scanned by an exclusive slide scanner from newly made teaching glass slides. The final teaching material was put up on personal computers in the computer laboratory, classroom, and medical library. RESULTS: This material was easily accessed by exclusive viewers. The students readily adapted to the use of virtual microscopes. The quality of the images in this material was appropriate for viewing. The response from the students displayed highly significant differences between the traditional and virtual microscopes, with the virtual microscope being preferred. CONCLUSION: The virtual microscopes in this study were helpful for medical students studying pathology. The results of this implementation suggest that virtual microscope technology may be extended to other educational venues where traditional microscopes and photomicrographs are currently used.

Subcutaneous Bronchogenic Cyst of the Shoulder: A Case Report

Bronchogenic cyst is an uncommon congenital anomaly that arises from maldevelopment of the primitive foregut, and is usually found in the lung and mediastinum. Cutaneous or subcutaneous bronchogenic cysts are rare, and occur especially in the shoulder region. We report here on a 40-year-old woman with a soft, nontender, cystic mass on the upper posterior aspect of the right acromioclavicular joint; this had been recognized about 20 years before. She underwent incision and drainage of the lesion at a local clinic about 1 year ago, but the wound was not healed. MRI showed an irregular-shaped dark signal intensity lesion that measured 2 x 1.5 cm in the subcutaneous fat layer. Microscopically, the cyst was lined by pseudostratified ciliated columnar epithelium that displayed squamous metaplasia. The cyst wall revealed frequent smooth muscle bundles, occasional seromucous glands and multifocal lymphocytic infiltration. This is the first reported case of subcutaneous bronchogenic cyst of the shoulder in a Korean adult.

DNA Hypermethylation and the Loss of Heterozygosity of Chromosome 16q22 in Hepatocellular Carcinoma

PURPOSE: E-cadherin gene, located on chromosome 16q22, may play crucial roles in the cell adhesion and propensity for more malignant properties of various organs. Although loss of heterozygosity (LOH) and DNA hypermethylation at various chromosomal loci have been reported on many malignant tumors, they have been rarely studied in hepatocarcinogenesis, especially for the E-cadherin gene. Our objectives were to evaluate E-cadherin LOH and hypermethylation in hepatocellular carcinomas (HCC) and to correlate with various clinicopathological facors. METHODS: The LOH analysis was performed by using polymerase chain reaction (PCR) with three polymorphic microsatellite markers (D16S419, D16S3106, D16S498) in 40 surgically resected HCCs and each non-tumorous counterpart. The hypermethylation was studied using methylation specific PCR. RESULTS: LOH and hypermethylation were detected in 35% and 55% of HCC, respectively. Also, LOH and hypermethylation were detected in 0% and 32.5% of non-tumor lesions, respectively. LOH results correlated well with higher tumor histologic grade, tumor size and intrahepatic metastasis or vascular tumor invasion. Hypermethylation results correlated well with presence of cirrhosis. Correlation between LOH and hypermethylation was not recognized, but 45.5% of hypermethylation cases showed LOH detection. CONCLUSION: These results suggest that E-cadherin LOH may be associated with more malignant phenotype and tumor progression. And E-cadherin DNA hypermethylation may participates in the early hepatocarcinogenesis by preceding LOH but not causing LOH.