Langerhans Cell Histiocytosis Followed by Hodgkin's Lymphoma

A 22-year-old man was referred to our institution due to lower back pain and was diagnosed with Langerhans cell histiocytosis of the thoracic and lumbar spine. The patient achieved complete remission with radiotherapy and chemotherapy. One year later, right cervical lymphadenopathy was observed and Hodgkin's lymphoma was confirmed on biopsy. The patient was treated with chemotherapy and autologous stem cell transplantation, and experienced no further symptoms. Further, no evidence of recurrence was observed on follow-up imaging. This report discusses the association between Langerhans cell histiocytosis and Hodgkin's lymphoma.

Angiosarcomas of the Bilateral Breast and Heart: Which One is the Primary Site?

A 29-year-old pregnant woman with recurrent pericardial effusion and a cardiac tumor, diagnosed as an angiosarcoma, was treated with surgical resection of the tumor followed by radiotherapy. Immediately after completion of radiotherapy, she developed bilateral breast masses, which were also confirmed as angiosarcomas. We thought this might be the first case of bilateral angiosarcoma of the breast metastasizing to heart mimicking a primary cardiac angiosarcoma, although we could not conclude with certainty that angiosarcoma of the heart was not the primary site.

Lymphoepithelial cyst of the pancreas: A case report / 대한내과학회지

Lymphoepithelial cysts of the pancreas, which are lined by squamous epithelium and surrounded by mature lymphoid tissue, represent a rare clinicopathologic entity of cystic lesions of the pancreas and true pancreatic cysts. Here, we report a case of lymphoepithelial cyst of the pancreas and a review of the related Korean literature. A 58-year-old man presented to our hospital with an asymptomatic pancreatic mass and no remarkable medical history except hypertension. Physical examination and laboratory analyses showed no abnormalities. Ultrasonography (US) revealed a cystic lesion with heterogeneous internal echo within the body of the pancreas, and computed tomography (CT) revealed a low-density lesion (2.3*.5 cm) with well-defined margins and lobulating contour. To further characterize the mass, a biopsy was collected via endoscopic ultrasonography (EUS)-guided fine-needle aspiration. Histological examination revealed fibrous tissue and epithelial cells, but was insufficient for a definitive diagnosis. Laparotomy revealed that the mass was composed of keratinizing squamous epithelial cells surrounded by lymphoid tissue, thereby confirming the diagnosis of lymphoepithelial cyst of the pancreas

An epidermoid cyst in an intrapancreatic accessory spleen / 대한내과학회지

Ectopic splenic tissue in the abdominal cavity is common, with a reported incidence of 10% in the general population. Most accessory spleens are located near the splenic hilum. The pancreas is the second most frequent location (16%) of an accessory spleen, while an epidermoid cyst in such an accessory spleen is rare. A 36-year-old man had a cystic lesion detected incidentally in the pancreatic tail on ultrasonography. A distal pancreatectomy and splenectomy were performed. The pathological diagnosis was an epidermoid cyst in an accessory spleen in the pancreas.

A Case of Nephrotic Syndrome after Thymectomy due to Thymoma / 대한신장학회지

Thymoma is often accompanied by different paraneoplastic syndrome, such as myasthenia gravis, pure red-cell aplasia, systemic lupus erythematosus. Association of glomerulonephritis and thymic tumor is very rare, with only about 40 cases reported to date. The authors report here a case of nephrotic syndrome after thymectomy due to thymoma. A 68-year-old man presented with continuous coughing and mediastinal mass. The mass was found to be a thymoma of type AB and was resected completely. One month after removal of the thymoma, nephrotic syndrome appeared. Renal biopsy revealed diffuse foot process effacement, suggesting minimal change disease (MCD), with a focus of intraglomerular coagulation, suggesting thrombotic microangiopathy. There was no evidence of other autoimmune disease or causes of the nephropathy. Treatment with 500 mg methylprednisolone IV for three days followed by oral 60 mg prednisolone daily was started. After six weeks, his nephrotic syndrome was almost improved. To our knowledge, this is the second report of a patient with thymoma and MCD in Korea.

Effect of Dexamethasone on Gene Expression of Surfactant Protein B and Surfactant Protein C / 결핵

BACKGROUND: Surfactant protein B(SP-B) and surfactant protein C(SP-C) are important in accelerating surface spreading of surfactant phospholipid. The glucocorticoids accelerate the morphologic differentiation of epithelial cells into type II cells and increase the rate of phosphatidylcholine synthesis. The hydrophobic surfactant protein has been shown to be upregulated by glucocorticoids in vitro, however, its regulation in vivo is not well established. METHODS: The authors investigated the effects of glucocorticoid on the accumulation of mRNA encoding SP-B and SP-C protein content of the lung. Adult rats were given different doses of subcutaneous dexamethasone and sacrificed at 24 hours and 1 week. SP-B and SP-C mRNA were measured by a filter hybridization method. RESULTS: 1) The accumulation of SP-B mRNA at 24 hours after 0.2 mg/kg dexamethasone treatment was increased by 23.7%. 2) The accumulation of SP-B mRNA at 1 week after 2 mg/kg dexamethasone treatment was significantly increased by 96.6%(P<0.001). 3) The accumulation of SP-C mRNA at 24 hours after 0.2 mg/kg dexamethasone treatment was significantly increased by 42.7%(P<0.01). 4) The accumulation of SP-C mRNA at 1 week after 2 mg/kg dexamethasone treatment was significantly increased by 60.0% (P<0.01). CONCLUSION: The authors concluded that dexamethasone treatment in vivo resulted in increased levels of SP-B mRNA and SP-C mRNA. These results suggested that dexamethasone stimulates the synthesis of hydrophobic proteins associated with surfactant.

Effects of Intracavitary Urokinase Instillation in Complicated Pleural Effusion / 결핵

BACKGROUND: Complicated exudative pleural fluid collections have traditionally been treated by either closed tube thoracostomy drainage or open surgical drainage. Complete drainage is important in order to control pleural sepsis, restore pulmonary function, and entrapment. Recently intracavitary fibrinolytic therapy has been advocated as a method to facillitate drainage of complicated exudative pleural effusion and to allow enzymatic debridemant of the restrictive fibrinous sheets covering the pleural surface. The purpose of this study is to prospectively evaluate the effects of image-guided catheter drainage with high dose urokinase(UK) instillation in the treatment of complicated pleural effusions. PATIENTS: Twenty complicated pleural effusion patients that poorly respond to image-guided drainage were allocated to receive UK. There were 8 pneumonia and 12 tuberculosis. METHODS: Drugs were diluted in 250 mL normal saline and were infused intrapleurally through the chest tube or pig-tail catheter in a daily dose of 250,000 IU of UK. Response was assessed by clinical outcome, fluid drainage, chest radiography, pleural ultrasound and/or computed tomography. RESULTS: The mean UK instillation time was 1.63+/-0.10 The mean volume drained UK instillation was 381.3+/-314.4 mL, and post-UK was 321.6+/-489.5 mL. The follow up duration after UK therapy was mean 212.9+/-194.5 days. We had successful results in 19 cases (95.0%). There were 12 pleural thickenings (60.0%), 2 markedly decreased effusions (10.0%) and 5 cases of no thickening or effusion. In only one patient (5%)with complicated pleural effusion due to tuberculosis, there was recurrence after treatment. CONCLUSIONS: Image-guided drainage with high dose UK instillation (250,000 U/day) in complicated pleural effusion is a safe and more effective method than closed thoracostomy drainage. And this management, in turn, can obviate surgery in most cases.

Study on the Availability of Repeated Flexible Bronchoscopy (RFB) / 결핵

BACKGROUND: Ever since Flexible Fiberoptic Bronchoscopy was introduced into clinical practice, it has played an important role in both diagnosis and therapy of respiratory diseases. Performance of repeated bronchoscopic examinations is not so uncommon. This study was designed prospectively to assess the clinical availability of the Repeated Flexible Bronchoscopy (RFB). METHODS: Pre-established indications were as follows; 1) To confirm diagnosis or the cell type in proven malignancy, 2) For diagnosis or location of hemoptysis, 3) For follow-up or confirming recurrence, 4) For therapeutic purposes. We performed RFB and analysed the data in 156 patients during 28-month period. RESULTS: The frequency of RFB was 23.0%. The indication for diagnosis or cell type of malignancy was 25 cases, in which 2 cases were confirmed by the third bronchoscopic examination and 3 cases by surgical procedures. Localization of bleeding site was confirmed in 53.8%. RFB for small cell lung cancer yielded more information on residual or recurred lesion not apparent even with the CT scan in 30%. Previous cases of bronchostenosis due to endo-bronchial tuberculosis was shown to have worsened in 66.7%. Therapeutic manipulations were done in 126 cases and bronchial suction was most common. Complications showed decreasing tendency with repeated examinations. CONCLUSION: The RFB for diagnosis or cell type of malignancy was useful in that comfirmation of diagnosis was possible in 85.7% of malignancy. More aggressive procedures should be employed including TBLB or TBNA. The RFB showed the possibility of usefulness in the follow-up of patients with small cell lung cancer. For the patients with hemoptysis or endobronchial tuberculosis, the RFB did not showed the significance because its results did not influence the diagnosis, therapy or clinical course.

The Clinical Characteristics of Mycoplasmal Pneumonia in Adults / 결핵

BACKGROUND: The incidence of mycoplasmal pneumonia is predominantly at childhood and early adulthood, but in adults, its incidence is low and its symptoms and physical findings are nonspecific. The definite diagnosis of M. pneumoniae pneumonia can be made by sputum culture, but requires several weeks for positive results, and the early diagnosis must initially be based on the serologic tests and appropriate clinical findings. Thus, we evaluated the clinical aspects of M. pneumoniae pneumonia in the adults patients. METHOD: Among the admitted patients due to pneumonia, the definite diagnosis is anti-M. pneumoniae antibody titer of > 1:40 and a single cold agglutinin titer of > 1:64. The presumptive diagnosis is anti-M. pneumoniae antibody titer of > 1:40 or a single cold agglutinin titer of > 1:64 and the clinical characteristics or chest X-ray findings are compatible with M. pneumoniae pneumonia. We studied the age and sex distribution, seasonal distribution, clinical symptoms, physical findings, serologic test, chest X-ray findings, treatment and its progression. RESULTS: 1) The age distribution was even and the ratio of male to female was 1:1. 2) The monthly distribution was most common in January(16.7%) and the seasonal distribution in autumn and winter(autumn: 30%, winter: 33.3%). 3) The cold agglutinin titers were higher than 1:64 in 12 cases(40%), and reached the peak level around 2 weeks from onset and antimycoplasma antibody titers were higher than 1:160 in 5 cases(16.7%). 4) On the chest X-ray, pulmonary infiltration was noted in 28 cases(93.3%) among 30 cases and right lower lobe involvement was the most common(33.3%) and both lower lobe involvement was noted in 7 cases(23.3%). 5) The mean treatment duration was most common(33.3%) in 1 week to 2 weeks after admission and 26 cases(86.7%) were improved within 4 weeks. 6) On admission, there was fever(> or =38.9degreesC) in 17 cases(56.7%), and the fever subsided in 12 cases(70%) within 3 days after treatment using erythromycin. CONCLUSION: The mycoplasmal pneumonia in adults shows milder clinical patterns than that in childhood and can be completely recovered without complication by early diagnosis and treatment.

Clinical Study of Bronchioloalveolar Cell Carcinoma / 결핵

BACKGROUND: Bronchioloalveolar cell carcinoma today needs further studies as an early diagnosis will drastically improve the chances of cure. METHODS: Twenty-four cases of bronchioloalveolar cell carcinoma for the period of 5 years were studied in terms of incidence, age, sex, underlying diseases, symptoms, radiographic findings, Methods of diagnosis, clinical and pathologic staging, Methods of treatment, and survival retrospectively. RESULTS: No correlation was found between patients' age, sex, and underlying diseases. Most common symptoms were cough(62.5%), chest pain(29.2%), and sputum(29.2%). Of the 24 cases, 13 patients(54.2%) had solitary nodule, 6 patients(25%) had multiple nodules. At the time of diagnosis, 3 patients(12.5%) had the stage I diseases, 3 patients(12.5%) had the stage II diseases, 4 patients(16.7%) had the stage III diseases, 3 patients(12.5%) had the stage IIIb diseases, and 11 patients(45.8%) had the stage IV diseases. 14 cases(58.3%) were found inoperable at the time of admission; they all died within 17 months. In 7 cases with stage I, II, IIIa diseases curative resection were attempted, in 1 case with stage IV disease wedge resection for palliative management was performed, and in 4 cases patients were still alive at the time of Conclusion of this study. CONCLUSION: We conclude that early diagnosis of disease will increase operability and improve chances of survival and that aggressive diagnostic workup for suspicious pulmonary infiltrate is essential as early operation offers the best chances of cure.

A Case of True Precocious Puberty Associated with Pituitary Microadenoma Treated with LHRH Agonist / 대한내분비학회지

Although tubercrlosis is one of the recognized causes of adrenal insufficiency, little is known about adrenal function in patients with active pulmonary tuberculosis. Patients with active pulmonary tuberculosis are at risk from sudden and unexpected death which can occur during the first few weeks of treatment. There are many reports that patients who received rifampicin as a part of their treatment appeared to show impairment in adrenocortical function when compared to a group who received anti-tuberculosis chemotherapy which did not include rifampicin. Adrenocortical function was studied in 15 patients(7 males, 8 females) with active pulmonary tuberculosis, before and 2-weeks after the anti-tuberculosis chemotherapy including rifampicin. At 08: 00 hour a base-line sample of venous blood was taken. One hour after the administration of 0.25mg of Synacthen, a further blood specimen was taken. The base-line and 1-hour specimens were analysed for plasma cortisol and electrolytes.All were initially found to have a normal cortisol response to rapid ACTH stimulation test. Following a 2-week course of anti-tuberculosis chemotherapy including rifampicin there was 1 case(6.6%) of a suboptimal response.Rifampicin, a powerful anti-tuberculosis drug, is a known inducer of the hepatic microsomal enzyme system and has been shown to cause an enhanced clearance of endogenous cortisol. Findings reported in this paper suggest that the adrenocortical function is compromised in some case(6.6%) of tuberculosis patients. It will therefore be necessary to undertake detailed investigations on the effect of treatment with daily and fully intermittent regimens containing rifampicin on the function of this endocrine gland.

Clinical Characteristics of Pulmonary Aspergillosis / 결핵

BACKGROUND: Genus of Aspergilli are ubiquitous saprophytic molds in nature, but its change from a saprophytic fungus to a pathogenic organism has occurred since the use of various antibiotics. The fungus affects the chronically ill and debilitated population. Recently frequency of the fungal infection is increasing in Korea with abuse of antibiotics and glucocorticoids. METHOD: We analyzed medical records of 52 patients with pulmonary aspergillosis seen at Hanyang University Hospital from 1980 to 1994. The results were as follows; RESULTS: 1) Ages ranged between second to eighth decades with majority(50%) in the fourth to fifth decades. The male to female ratio was 1.1:1. 2) Hemoptysis and productive cough, the leading symptoms, occurred in 42.3% and 25% respectively. 3) On chest X-ray fingings, the characteristic 'fungus ball' pattern were observed in 53.8% of the 52 cases. 4) Sputum culture for aspergilli were positive in 21.6% of the cases. We performed foe needle aspiration in 22 patients and the diagnostic yield was 100%. 5) Thirty-six patients had history of treatment with antituberculous drugs under diagnosis of pulmonary tuberculosis for an average of 27.3 months. But sputum analysis for acid-fast bacilli were positive in 5.6%(2cases of 36cases), and postoperative pathologic findings showed that 38.9% (12 cases of 28cases) were combined with tuberculosis. 6) Right upper and left upper lobes were predominantly involved(34.6% and 19.2% respectively) and lobectomies were performed in 21 cases. 7) Underlying diseases were present in 47 cases and 48.9% of them were pulmonary tuberculosis. CONCLUSION: These results showed that pulmonary aspergillosis usually develops in patients with open cavitary pulmonary tuberculosis. And we must consider the possibility of pulmonary aspergillosis in a patient with hemoptysis and cavitary lung lesion.

A Case of Anterior Mediastinal Mass Presenting with SVC Syndrome / 결핵

A 36-year-old man was studied because of signs and symptoms of superior vena naval syndrome. Chest computerized topography showed 10x8x6 cm sized lobulated anterior mediastinal mass, compressing superior vena casa. Fine needle aspiration cytology revealed seminoma. There was no detectable tumor mass in the testes. We report a case of primary mediastinal seminoma presenting with superior vena canal syndrome.

A Case of Chemical Pneumonitis Caused by Acetic acid Fume Inhalation / 결핵

Many organic and nonorganic agents can cause chemical pneumonitis. Chemical pneumonitis induced by inhalation of acetic acid is a rare clinical condition. As acetic acid is a water soluble agent, it causes chemical irritation to respiratory tract and causes variable symptoms. We experienced a case of acute lung injury due to inhalation of acetic acid fume. A 56-year-old male patient was admitted due to dyspnea with vomiting for one day. After he inhaled acetic acid fume in occupational situation, he had chest tightness, chilling sense, and productive cough. Our case was good response to oxygen inhalation, antibiotics, and systemic steroids.

Clinical study of pulmonary paragonimiasis / 결핵

No abstract available.

A case report of unilateral absence of left pulmonary artery / 결핵

No abstract available.

A case with single cavitary nodule in right upper lung / 결핵

No abstract available.