Extremely Well-Differentiated Papillary Thyroid Carcinoma Resembling Adenomatous Hyperplasia Can Metastasize to the Skull: A Case Report

We describe herein histologic, immunohistochemical, and molecular findings and clinical manifestations of a rare case of an extremely well differentiated papillary thyroid carcinoma (EWD-PTC). Similarly, it is also difficult to diagnose follicular variant papillary thyroid carcinoma (FVPTC), whose diagnosis is still met with controversy. A recently reported entity of well-differentiated tumor of uncertain malignant potential (WDT-UMP) is added to the diagnostic spectrum harboring EWD-PTC and FVPTC. We report this case, because EWD-PTC is different from FVPTC in its papillary architecture, and also from WDT-UMP in its recurrence and metastatic pattern. These morphologically deceptive entities harbored diagnostic difficulties in the past because the diagnosis depended solely on histology. However, they are now diagnosed with more certainty by virtue of immunohistochemical and molecular studies. We experienced a case of EWD-PTC, which had been diagnosed as adenomatous hyperplasia 20 years ago and manifested recurrence with lymph node (LN) metastasis 7 years later. After another 7 years of follow-up, a new thyroid lesion had developed, diagnosed as FVPTC, with LN metastasis of EWD-PTC. One year later, the patient developed metastatic FVPTC in the skull. Immunohistochemically, the EWD-PTC was focally positive for CK19, negative for galectin-3, and focally negative for CD56. Molecular studies revealed BRAF-positivity and K-RAS negativity. The FVPTC in the left thyroid showed both BRAF and K-RAS negativity. In conclusion, EWD-PTC and FVPTC share similar histologic features, but they are different tumors with different molecular biologic and clinical manifestations. A large cohort of EWD-PTC should be included in further study.

Do Helper T Cell Subtypes in Lymphocytic Thyroiditis Play a Role in the Antitumor Effect?

BACKGROUND: Papillary thyroid carcinoma (PTC) is frequently accompanied by lymphocytic thyroiditis (LT). Some reports claim that Hashimoto's thyroiditis (the clinical form of LT) enhances the likelihood of PTC; however, others suggest that LT has antitumor activity. This study was aimed to find out the relationship between the patterns of helper T cell (Th) cytokines in thyroid tissue of PTC with or without LT and the clinicopathological manifestation of PTC. METHODS: Fresh surgical samples of PTC with (13 cases) or without (10 cases) LT were used. The prognostic parameters (tumor size, extra-thyroidal extension of PTC, and lymph node metastasis) were analyzed. The mRNA levels of two subtypes of Th cytokines, Th1 (tumor necrosis factor α [TNF-α], interferon γ [IFN-γ ], and interleukin [IL] 2) and Th2 (IL-4 and IL-10), were analyzed. Because most PTC cases were microcarcinomas and recent cases without clinical follow-up, negative or faint p27 immunoreactivity was used as a surrogate marker for lymph node metastasis. RESULTS: PTC with LT cases showed significantly higher expression of TNF-α (p = .043), IFN-γ (p < .010), IL-4 (p = .015) than those without LT cases. Although the data were not statistically significant, all analyzed cytokines (except for IL-4) were highly expressed in the cases with higher expression of p27 surrogate marker. CONCLUSIONS: These results indicate that mixed Th1 (TNF-α, IFN-γ , and IL-2) and Th2 (IL-10) immunity might play a role in the antitumor effect in terms of lymph node metastasis.

Tubular Adenoma of the Common Bile Duct: Endoscopic Diagnosis and Treatment / 대한소화기내시경학회지

Biliary adenoma of the common bile duct is a rare disease found in biliary tract encounterd in biliary mass lesion, and it is difficult to differentiate from their malignant counterparts. Symptoms and signs of these tumors can mimic choleliathiasis and malignant tumors. Therefore, this tumor is rarely diagnosed preoperatively. In addition, there has been no reported case of a tubular adenoma of the common bile duct in Korea, until recently. We experienced a case of tubular adenoma of the common bile duct, which was diagnosed and partially resected by percutaneous transhepatic cholangioscopy. The patient was a 84-year-old male who showed abnormal liver function test. Abdominal ultrasonography showed a dilated common bile duct, and a soft tissue was observed on endoscopic retrograde cholangiography. This was initially thought as a stone, but it became partially detachable from the common bile duct during an endoscopic retrograde cholangioscopic basket removal. The mass lesion was partially resected by a percutaneous transhepatic cholangioscopic snare. This resected tissue was confirmed as a tubular adenoma.

Intranuclear Cytoplasmic Pseudoinclusions in Pituitary Adenomas

Intranuclear pseudoinclusions are well known in papillary carcinomas of the thyroid gland, hepatocellular carcinomas, meningiomas, paragangliomas, pheochromocytomas, and melanomas. Only two papers on the intranuclear inclusions of adenohypophyseal cells in humans have been reported. This study found that intranuclear cytoplasmic pseudoinclusions occur frequently in pituitary adenoma cases (70.3%, 97 of 138 pituitary adenomas) and are uncommon in normal pituitary tissue (11.1%, 1 of 9 normal pituitary tissues). In addition, the frequency of intranuclear cytoplasmic pseudoinclusions between the functional and non-functional pituitary adenomas was found to be similar. Electron microscopy and immunostaining was used to reveal the entity of the intranuclear inclusion. These intranuclear inclusions are due to cytoplasmic invagination because 1) the inclusions are continuous with the cytoplasm, 2) all cytoplasmic organelles, such as the endoplasmic reticulum, the Golgi apparatus, and the secretory granules are found in the inclusions, 3) immunoreactivity of the intranuclear inclusion is the same as that of the cytoplasm. In conclusion, intranuclear cytoplasmic pseudoinclusions in pituitary adenomas occur frequently (70.3%) and are formed by cytoplasmic invagination. This study suggests that pituitary intranuclear inclusions caused by cytoplasmic invagination be called "intranuclear cytoplasmic pseudoinclusions".

Mucinous cystadenoma coexisting with stromal tumor with minor sex-cord elements of the ovary: a case report

Mucinous neoplasms occur rarely in association with cystic teratoma, Sertoli-Leydig cell tumor, granulosa cell tumor or carcinoid tumor. Several cases of an ovarian stromal tumor with minor sex-cord elements have been reported in the literatures. However, there has been no report about an ovarian mucinous neoplasm coexisting with a stromal tumor with sex-cord elements yet. We report a case of an ovarian neoplasm composed of both mucinous cystadenoma and stromal tumor with minor sex-cord elements in a 58-yr-old female. The ovary including the mass measured 5 cm in size. On section, it revealed an unilocular cyst (4.5 cm in diameter) filled with mucinous fluid. There was a round, yellow, solid nodule, 1.5 cm in diameter within the wall. Microscopically, the cyst was lined by a single layer of endocervical mucinous epithelium and the nodule was composed of spindle cells showing an intersecting and whorled arrangement. There were cell nests showing polygonal shape with abundant cytoplasm among the spindle cells. They showed immunoreactivity for inhibin and did not have any connection with the adjacent mucinous epithelium. Therefore, we interpret the mucinous cystadenoma as having arisen de novo.

Clinical Outcome and Complications of Medpor(R) Orbital Implant

PURPOSE: This study was to observe the clinical outcome and complications of Medpor(R) orbital implant. METHODS: The clinical outcome and complications were studied retrospectively in 64 eyes with Medpor(R) implantation. Evisceration was done in 34 cases, enucleation in 19 cases, and secondary implantation in 11cases. Mean follow up period was 16 months(4~30 months) and mean age of the participants was 34.9(1~79). RESULTS: Implant infection developed in one case, implant exposure developed in four cases and superior sulcus deformity developed in two cases. Motility Coupling Post(MCP) was inserted in 26 eyes. Motility of the prosthesis was good in most cases. CONCLUSIONS: Medpor(R) orbital implant is being widely used currently. Complications or motility of the prosthesis showed no significant difference from those of Hydroxyapatite. But low cost and its handiness in operation makes it a desirable orbit implant.

A Case of Blind Ending Megaureter: Preoperatively suspected of Adnexal Tumor / 대한산부인과학회잡지

A pelvic mass in women may be gynecologic in origin or it may arise from the urinary tract or bowel. Nonovarian or nongynecologic conditions may be confused with uterine or ovarian mass. The rare congenital megaureter should always be kept in mind as a possible cause of a pelvic mass. Congenital megaureter showed various clinicopathological features and frequently associated with ipsilateral or controlateral upper tract anomalies. Early meticulous imaging surgical correction will lead to excellent result. We experienced a rare case of blind ending megaureter which was suspected adnexal tumor in twenty seven-year-old woman. Here we present the case with brief review of literatures.

A Case of Primary Carcinoma of the Fallopian Tube / 대한산부인과학회잡지

Primary carcinoma of the fallopian tube is rare and accounts for less than 1% of all cancers of female genital tract. Presenting symptoms are variable and nonspecific, with preoperative diagnosis rarely entertained. The history and character of fallopian tubal carcinoma is similar to ovarian cancer, so the evaluation and treatment are also essentially the same. This case of primary fallopian tube carcinoma was confirmed postoperatively on the basis of the pathologic examination of resected specimen. We have experienced a case of primary carcinoma of fallopian tube and report with a brief review of the literatures.

Two Cases of Inflammatory Pseudotumor in Respiratory System / 결핵

Inflammatory pseudotumor is a infrequent, benign tumor that affects at all ages and involves the lung, gastrointestinal tract, and salivary gland. They are the most common, isolated, primary lesion of the lung in children, and usually present as circumscribed, peripheral, parenchymal tumors or endobronchial tumors, which may be usually static or increase slowly in size without causing symptoms. Surgical excision is the treatment of choice because of the location and benign nature of this lesion. The prognosis after resection is excellent. Other therapeutic modalities include radiation and steroid therapy. We experienced two cases of inflammatory pseudotumor of the lung parenchyme and endobronchus. We report these cases with a review of literatures.

A Case of Squamous Papilloma in the Middle Ear, External Auditory Canal, and Infratemporal Fossa / 대한이비인후과학회지

Papilloma is a benign neoplasm confined almost exclusively to the sinonasal tract. And rare cases involving middle ear or external auditory canal, usually extended or contaminated from nasal cavity have been reported. We recently experienced a case of squamous papilloma involving middle ear, external auditory canal, and infratemporal fossa without any evidence of involving sinonasal tract. We present a review of literature and discuss the pathophysiology of the papilloma.

Clinical Evaluation of Epiblepharon and Congenital Entropion

We retrospectively reviewed the sex distribution, age at oepration, chief complaints, peroperative and postoperative refractive errors, and corrected visual acuity in 160 previously operated patients to evaluate the clinical manifestations, reractive error, frequency of amblyopia, age at operation, and the postoperative factors affected by the operation of epiblepharon and congenital entropion itself that influence visual acuity and refractive error. The average age at operation was 7.9 years. The chief complaint was ocular discomfort, followed by visual disturbance, photophobia, eyelid rubbing and epiphora. One hundred thirty-three wyws(41.6%) whose preoperative corrected visual acuity was below 0.6 had a mean visual acuity of 0.7. Ninety-five eyes (29.7%) were preoperative myopes above -1.0D, 77 eyes(24%) were hyperopes above +1.0D, and 163 eyes were astigmatic above -1.0D. Twenty-two out of 76 eyes who were followed up for more than one year had a corrected visual acuity of below 0.6. The difference between the older and less than 7 years groups was significantly not significant. Astigmatic changes were not statistically different at any age group. However, the mean significantly visual acuity at postoperative one year was 0.73, which was significantly different from the preoperative value(P=0.006). In conclusion, concurrent postoperative glasses correction and amblyyopia therapy is indicated because the incidence of refractive errors and amblyopia is higher in epiblepharon and congenital entropion.

Relationship among the Expression of Cyclin D1, p21, and p53 Protein, and Prognosis in Non-Small Cell Lung Carcinomas

Recently, cell cycle regulators have been suggested as new prognostic factors of the lung cancer. In this study, we evaluated the expression of cyclin D1, p21, and p53 using the X2-test, with regard to the stage of the patients, histologic type, and histologic differentiation in the 135 cases of non-small cell lung carcinomas (NSCLC). To evaluate the confounding effects among cyclin D1, p21, and p53 on X2-test analysis, we used the Mantel-Haenzel test. The NSCLC in this study included 82 cases of squamous cell carcinoma and 53 cases of adenocarcinoma. Each nuclear staining of cyclin D1, p21, and p53 was observed in 65 cases (48.1%), in 54 cases (40.0%), and in 81 cases (60.0%) of NSCLCs, respectively. Only p53 expression was significantly associated with the stage (stage I, II, IIIa) (p<0.05) and squamous cell carcinoma (p<0.05). On the other hand, cyclin D1 expression was significantly associated with the histologic differentiation. The confounding effects among cyclin D1, p21, and p53 revealed that only p21 expression changed the relationship between p53 and stage. In this regard, further study is needed.

Retroperitoneal multilocular bronchogenic cyst adjacent to adrenal gland

Bronchogenic cysts are generally found in the mediastinum, particularly posterior to the carina, but they rarely occur in such unusual sites as the skin, subcutaneous tissue, pericardium, and even the retroperitoneum. A 30-year-old Korean man underwent surgery to remove a cystic adrenal mass incidentally discovered during routine physical checkup. At surgery, it proved to be a multilocular cyst located in the retroperitoneum adjacent to the left adrenal gland. Microscopically, the cyst was lined by respiratory epithelium over connective tissue with submucous glands, cartilage and smooth muscle, thereby histologically confirming bronchogenic cyst. This is the first reported case of retroperitoneal bronchogenic cyst in an adult without other congenital anomalies in Korea.

Malignant granular cell tumor at the retrotracheal space

We report a case of an extremely rare neoplasm, malignant granular cell tumor (MGCT). The patient was a 21-year-old woman, who was 5 months pregnant. The tumor occurred in the retrotracheal space, extending from the level of the larynx to the thoracic inlet. In addition, there were multiple, variable-sized tumor nodules within both lung fields on chest CT scan. Histologically, tissue biopsied from the periphery of the tumor consisted of solid sheets of large ovoid cells with ample, eosinophilic cytoplasm, eccentric nuclei, and prominent nucleoli. Each cell showed slight atypism of the nuclei. There was a focal necrosis at the periphery of the lesion. These cells stained strongly for S-100 protein, neuron-specific enolase (NSE) and CD68. On electron microscopy, the tumor cells contained autophagic vacuoles. The patient refused further treatment and died 7 months later. The exact cause of death was not known. Until now, the diagnosis of MGCTs has been made only when metastasis and an aggressive clinical course are identified, although some observers advocate that some histologic features such as nuclear pleomorphism, necrosis, and the presence of any mitotic activity are indicative of malignancy. These histologic findings are not easily detectable in every case of MGCT, as in our case. So the diagnosis of a MGCT should be considered in cases with aggressive clinical findings and some histologic features, such as necrosis, nuclear atypism, and mitotic activities, which could suggest the malignant behavior of this neoplasm.

Two Cases of Cushing's Disease Due to Large Pituitary ACTH Secreting Tumor / 대한내분비학회지

Cushing's syndrome that is caused by an adenoma of the corticotrape cells of the anterior pituitay or, rarely, by couticotrope hyperplasia is refered to as Cushing's disease. Cushings disease is usually characterized by chronic, moderate hypersecretion of ACTH and other POMC derived peptide. Most patients have ACTH-secreting anterior pituitary corticotrope microadenomas, but a small minority have a pituitary macroadenoma. We recently experenced two cases of Cushings disease due to pituitary macroadenoma. and report this cases with review of literatures.

A Clinical Cmparison Silicone and Acrysof IOLs

To evaluate and compare the clinical results of implantation of the Silicone and Acrysof IOLs in early postoperative period(to 3 months), we retrospectively analyzed 30 patients who had taken clear cornea incision and been implanted with Silicone IOL in one eye and Acrysof IOL in the other eye. There were no statistically significant difference in postoperative corrected visual acuity, corneal edema and postoperative astigmatic changes between silicone and acrysof IOLs. But, the rates of postoperative capsular fibrosis and contracture of Silicone IOL was higher than those of Acrysof IOL. In conclusion, in the degree and rate of after-cataract, Acrysof IOLs are more useful than silicone IOLs; therefore, more excellent in longterm visual prognosis. Further studies will be needed for the evaluation of clinical safety and efficacy.

A Case of Septic Cavernous Sinus Thrombosis Complicated by Sepsis

Septic cavernous sinus thrombosis usually results from facial infection, paranasal sinusitis, otitis, dental infection, rarely, orbital cellulitis and is a serious sequalae-remained condition which has high mortality rate regardless of treatment. In early phase, it may be difficalt to differentiate orbital cellulitis from that disease because of similar clinical manifestations. We have experienced one case of septic cavernous sinus thrombosis which was caused by paranasal sinusitis and complicated by meninightis and sepsis in 45-year-old male who had taken self-medication for many years due to rheumatoid arthritis. We report this case with review of available literature.